UX Maturity Models – A Collection

For at least ten years now I have been collecting User Experience (UX) and Customer Experience (CX) Maturity Models.  I keep hoping to find the perfect one to help executives understand what we do, and what good looks like.  Oftentimes my conversations are about how to maximize funding for UX services.  Other times the goal may be to help an executive understand just how much further we have to go before we’re really getting the benefits of engaging a UX professional.

Over the years, I’ve been frustrated that so many of the models I’ve read seem best suited to help UX teams think about their own evolution and growth.  Either the complexity or the language make them by UX and for UX.  Very few of them seem accessible enough for an executive audience, and particularly ones who may not be familiar with UX.   Maturity Models from the CX field seem to be more accessible and executive-ready, which in and of itself is a lesson for UXers.

In the end, I ended up writing one that seems to be effective with the executives stakeholders and customers I work with ever day.  It meets the very specific needs that I have with my audience(s), but I’d love to know what others think.

Before I share it, I thought it might be worthwhile to review some of the others I’ve collected over the years, what I liked about them, and a brief statement about why they didn’t work for what I was trying to accomplish.

Design Maturity Stages

Design Maturity.png

This was originally published in Ambidextrous magazine’s ‘Nearly Winter 2006’ issue, in an essay entitled Investing in design: To build business buy-in, designers need to buy in to business, by Rosa Wu and Jess McCullin.  I like it for many reasons, and in fact the shift from style to problem solving / framing echoes some of what is coming out of DMI-influenced organizations in Europe in the past few years.  Interestingly, many of the more recent models put the least mature state on the bottom, but that’s not the case here.  Although I was thrilled to find it at the time, I am not sure these dimensions would be easy to use in an executive conversation.

Jonathan Earthy’s Usability Maturity Scale

Earthy Usability Maturity.pngI like the simplicity of this one.  I have found it valuable when thinking about the maturity of my own team, or helping a client think about their own internal capability building.  It describes the behaviors present at each stage, but it’s missing some of the depth present in the next few models – notably some idea of how to move through the various levels, and how to have those conversations outside the UX team.

Jakob Neilsen’s Corporate Usability Maturity

Nielsen's Usability Maturity Model.jpg

Neilsen’s model makes a lot of important points about the maturity of UX services, and also of the organization as a whole.  I think it is a great reference for practitioners, but, ironically, it is just way too complicated for any group except perhaps a UX leadership team.  You can read about the different dimensions on the Norman Neilsen Group (NNG) website – Stages 1-4 and Stages 5-8.

One of the things that is useful and unique to this model (but a tough reality check) is the number of years that it takes to progress; Neilsen says it can take years to move through the stages – as long as 20 years to get to the final stages of maturity.  He says a company can “remain hostile to usability for decades” and that oftentimes it’s only a crisis that creates the impetus for change.

Forrester’s Experience-Based Differentiation

Forrester - CX Matters.png

Forrester (an analyst group) has been writing more about Customer Experience (CX) in the past few years, and more recently they have been writing about User Experience (UX) as well.  I have some concerns with how they describe the relationship between the two, which I wrote about in this blog entitled UX is not a subset of CX.

This blog post describes the Forrester levels depicted above in more detail.

Early in my career at ZS, I helped the Chief Technology Officer establish a business case for and build a T2 Technical Support team.  The goal was to improve the experience of both clients and internal teams receiving support for our software, while at the same time relieving engineers of the support responsibilities that were distracting from their core work.  We used a Lean approach, which (as I’ve written about before) has a lot in common with UX; we started with customer touchpoints and worked backwards from there to address the most relevant processes first.

As part of building the business case for our approach, I created my own, simplified version of the Forrester model, which I think could just as easily be used for UX:

Forrester.png

What I like about the Forrester model is that the title and stages are described in terms that are easy to understand, and less complicated than Neilsen’s.  While it is not prescriptive in terms of how to move between stages, it does provide some good detail about the key activities in each stage.

The Journey to a Customer-Centric Business, by Infosys

infosys-stages-of-maturity

In an article entitled The Journey to a Customer-Centric Business, Infosys describes the stages of customer-centric maturity, as summarized above.  I like this one because the levels (and the behaviors at each stage) are simple and clear to a business audience.  I think the leap from ‘Heard’ to ‘Understood’ is pretty huge, though, and would be a challenging one for any organization to make.  Finally, I think the tie to Net Promoter Score (NPS) in the final stage is useful (because of it’s familiarity to business executives) but also limiting, as there are many cases in the Enterprise UX space where NPS doesn’t make sense.

Indicators of UX Maturity, by Macadamian

Macadamian.png

I have used this scale with a few clients who are thinking about building their own UX capability.  It has the simplicity of the Forrester framework, and keeps the main action areas relatively simple but specific.   My main reservation with this one is that it doesn’t impart the clarity and urgency about why you want or need the organization to move between stages.  You can read more about their model here, if you’re interested.

Design Management Institute (DMI)’s Design Maturity Matrix

DMI - Level 1 & 2.pngDMI - Level 3.png

A few years ago I took a course from DMI, and this was provided as part of the course materials.  I agree with the general framing, and the focus on process is also good.  I think this could be a very useful tool for discussion within a UX leadership team.  But it is not crisp, clear, or simple enough for an executive audience.  That means someone still needs to do a translation or repackaging to communicate these ideas up and/or out.

Danish Design Centre (DDC)’s Design Ladder

Design Ladder.jpg

In the past few years there has been some interesting writing coming out of the UX community in Europe.  This simple framework described in this DDC article is one of my favorites, and in fact strongly influenced the one that I’ve written and will share in my next post.

Maturity Models on UX Matters

uxmaturity-diagram-yvetrov-3-strategic

Yury Vetrov has written a five-part series about UX maturity and Maturity Models on UX Matters.  He makes a number of good points that should benefit teams trying to figure out where and how to go next.  This feels more like a framework for operational maturity than it does a UX-specific one.  And, the five part series would definitely need to be distilled before it could inform an executive conversation.

Seductive Interaction Design

Seductive Interaction Design.png

I’ve seen a number of different models like this, which build on Maslow’s Hierarchy of Needs.  I have not read Stephen P. Anderson’s book (entitled Seductive Interaction Design: Creating Playful, Fun, and Effective User Experiences).  The graphic above from Sara Soueidan‘s website is supposed to be a ‘product maturity continuum’, but to me it really only makes sense for UX professionals and the internal teams they work with, such as product management and front-end development.  I might use something like this to help a client make a decision whether the goals for their website or application are aspirational enough.  Generally, I feel like this includes consumable ideas, but it is mostly targeted at UX professionals talking within their community.

Artefact’s Design Maturity Survey

I just recently discovered the work of Artefact.  They have developed a survey instrument to help companies assess their design maturity along five dimensions – empathy, mastery, character, performance, and impact.  I am planning to take the survey this quarter, and if I learn anything perhaps I’ll post again.  I am hoping their survey might help me reflect on the team I’m building, and perhaps help me engage in new ways with clients to whom we are providing UX consulting services.

In closing

These different frameworks have informed my own thinking about who my audience is, what I am trying to impart to them.  It’s clear to me that my audience is executives who are not necessarily deeply knowledgeable about the field of User Experience, or the value it can bring to business when engaged effectively.  In my next post I will share my attempt at a maturity model – this one targeted at buyers of UX services, or executives who need to understand enough to champion the strategic growth of UX in their own organizations.

I’m a People Nerd

In January I was interviewed by dScout for their People Nerd blog series.  dScout is a mobile research platform that spun off from innovation consultancy Gravity Tank, which was recently acquired by SalesForce.  The interview is called The how and why of building UX for SAP and ZS: Natalie Hanson on anthropology getting a seat at the table.  It went live yesterday.

Here is a teaser …

Natalie Hanson has had anthropology on the brain since at least the third grade. She’s followed her curiosities in the decades since, from her Ph.D. in anthropology to building out the UX teams for both SAP and ZS Associates. She sat with dscout recently to discuss launching UX teams before UX was a thing, the contrast between UX for consulting and engineering, and mainstream perspectives on anthropology and design.

I still have Hashimotos

Just over three years ago, I was diagnosed with an autoimmune condition called Hashimoto’s Disease.  I was in pretty bad shape at the time.  I knew my mental acuity was deteriorating rapidly, I was perpetually exhausted, and I gained weight no matter what I did about food and exercise.  It was finally with a referral from my ob-gyn to an endocrinologist that I received a diagnosis.  However, beyond prescribing a few pills, the endo did very little to help me on my healing path.

At the time of my diagnosis in October 2014, I was sleeping ten hours a day, and then taking 3-4 hour naps every weekend.  I was too tired to exercise, and I continued to gain weight in spite of making a number of dietary changes (including eliminating gluten, dairy, and soy).  I also tried a low carb diet to no avail.  I was depressed, but it was largely because of my health issues.  I felt like my life was slipping away from me, and what scared me the most was that I was missing so much time with my young children (who were 4 and 6 at the time).  I knew I needed to focus on healing.

With the little bit of energy I gained from the thyroid medicine and some additional dietary changes, I began reading everything I could get my hands on about Hashis and the constellation of conditions that typically accompany it.  What terrified me the most was that people in patient support communities said I should expect it to take 18-24 months until I was able to truly understand and manage my illness.  Although I am more than three years in, I remember my near hysteria at the time.  I had felt so terrible for so long, and waiting another two years seemed unbearable.

Towards the end of my first year, I chronicled my findings and my progress in a blog post entitled I have Hashimotos.  I had made a number of changes and discoveries, and that blog post was the first substantive one I had written on this blog in years.  The intent of this post is to continue that trajectory by sharing with you what I’ve learned and experienced in the past two years, and what I think may come next.  Briefly, I would say I have learned to manage the condition, but I know now that my life will never be the same.  And it’s hard not to resent that sometimes.

As an example, just last week I developed – seemingly out of nowhere – a painfully dry, itchy, red rash all over my face.  I felt it getting progressively worse over the course of my work day.  I still I have no idea why it happened.  Did I develop an intolerance to the soap I have been using for the past two months?  Is it my new shampoo?  Might it be a reaction to environmental toxins in our brand new office space?  Was it something I ate?  Suddenly, anything I’d done and everything around me was suspect.  These occurrences result in ongoing, low-grade anxiety because there is rarely a definitive reason why a “flare” occurs.  My weakened immune system responds to all kinds of thinks that I could have never imagined or predicted in the past.  These miserable, soul-crushing, unplanned, and often unexplainable symptoms remind me on a regul9crrl89kiar basis that life will never, ever be the same.

Part of the reason I’ve struggled to write this post is that I do want to share a positive outlook with those who might read this.  But it has not been easy.  Nonetheless, I think it’s more important to raise awareness than to pretend it’s all going to be ok. Hopefully my experiences will help you advance your own healing, and also avoid some of the pitfalls I encountered since my diagnosis.

In case you were not aware, a blue butterfly is used as a community symbol for those of us with Hashis.  January was Thyroid Awareness Month; please continue to spread the word about this serious and often undiagnosed condition.

Overview

Over the past two years I have read, listened, and watched to countless resources about autoimmunity and Hashimotos, and so I do wonder whether what I have to say that will be new and useful to others with this condition.  My original post has been viewed over 600 times, and hopefully helped a few people along the way.  The feedback that I received (in the comments, on Facebook, and in many private emails) following the first post is that people seemed to value reading my story.

If you want a medical perspective on Hashimoto’s, I like Dr. Isabella Wentz’s approach, which is accessible, comprehensive, and systematic.  I would recommend starting with her book Root Cause, and (if you have the financial means), her online course Hacking Hashimotos.  She has also recently released a nine-part online movie called The Thyroid Secret.  At the beginning, I also learned a lot from Dr. Sarah Ballantyne‘s books, which are eye-opening but very dense (she is a medical researcher).  Many people also recommend the work of Dr. Datis Kharrazian.  I also found his work very insightful, but I honestly didn’t have the mental clarity to read and understand it all until just a few months ago.

I think their approaches make great sense, but my PhD is not in a medical field.  My current personal health research folder in Evernote has nearly a thousand entries now, but I’ll spare you that!  Instead, I am going to focus on sharing my own experiences and some lab results here, supplemented by what I’ve read.  In this post I will to address some of the general areas I’ve learned about but didn’t understand well at first such as genetics, other hormonesenvironmental toxins, and co-infections.  Then for the remainder of this post, I’ll focus on the things that I’ve learned along the way as I’ve tried to address the three symptoms that I have struggled with the most – mental clarity, energy, and weight loss.

General

Before I begin in earnest, one thing I wanted to mention is that I have tried many different thyroid medications over the past year.  My endocrinologist had originally put me on Tirosint (a T4-only medication with minimal contaminants).  At my request she tested for T3 and Reverse T3 (RT3), and following that she added Cytomel (T3).  I found that as my morning Cytomel wore off, I had a precipitous drop-off in energy, which I really hated.   Later, when I started working with a functional medicine practitioner (two years ago now), I switched to WP Thyroid, which seemed to work fine.

But after many months and small changes on a number of other fronts, I still felt that I was operating at about 75% of the energy I used to have.  I began pushing harder for that next level of health and well being.  During that time, it became clear (from a routine thyroid panel) that I was not converting the T4 to T3.  So, this Spring I switched to a T3-only medication.

The thing I don’t like about T3 is that all forms that I have tried have a very short half life (six-ish hours), so you have to take it more than once a day, and plan your meals around it.  It requires that you take it on an empty stomach – no food for two hours before and 45 minutes afterwards.  It’s not the end of the world, but it does serve as a perpetual reminder that you’re sick and managing a disease.  This is in contrast to T4, which you can take just once a day in the morning, and then go about your day like everyone else.

Now I’d like to share with you a bit about my learnings and experiences as it regards genetics, hormonesenvironmental toxins, and co-infections and how those may affect people with Hashimoto’s.

Genetics

As I described in my first blog post, I was lucky to find a Functional Medicine Practitioner (FMP) who was opening up her private practice right around the time I was diagnosed. She asked me to bring my 23 and me data and some related reports (such as Genetic Genie and NutraHacker) with me to my first appointment.

Some of you will be familiar with medical research that has shown that certain genetic markers indicate women who are prone to a deadly version of breast cancer.  Having the gene has led some women to choose a double mastectomy, knowing that a breast cancer diagnosis would otherwise be inevitable.

While autoimmune conditions don’t induce the same kind of fear in people as cancer does, the same principles nonetheless hold true.  Your genome mapping and subsequent analysis can help a knowledge physician understand what combination of mutations may have contributed to your autoimmune condition.  For example, I had a test run to evaluate my gut microflora.  One of the things that I learned in that test was that my pancreas function is less than 20% of what it should be.  In reading Dr. Datis Kharrazian’s book entitled Why Do I Still Have Thyroid Symptoms when My Lab Tests Are Normal?, I learned that it’s very common for people with Hashis to develop an autoimmune condition against the pancreas.  This can be tested by looking for GAD antibodies.  At my request, my physician ordered Cyrex Array 6, which is the Diabetes Autoimmune Reactivity Screen.  The results were normal (no antibodies against the pancreas), which was disappointing and relief all at once.  But when we went back to my 23andme results and the subsequent NutraHacker analysis, my doctor realized that my genetic markers pointed to low pancreas function. So, it is possible that we could have delved more deeply into those reports, made adjustments, and perhaps avoided the $500-600 cost of the Cyrex test.  

I also have a number of serious problems with detoxification.  You may have read about MTHFR, which is shorthand for a series of genetic markers related to detox.  Dr. Ben Lynch is an expert in this area.  In addition to a couple of MTHFR mutations, I have others which compound the problem.  The combination has signficantly reduced my ability to detox, which in turn has resulted in lead and mercury poisoning, elevated levels of barium, and problems with the hormones our bodies produce and eliminate naturally.  More on that below.

Hormones

Hashimotos affects women with much higher frequency than men.  Based on current medical research, this seems to be due at least in part to female hormones (estrogen), and disruption caused by estrogen-like substances in our environment.  In addition to checking my thyroid hormone levels regularly, I have also had sex hormones levels checked a few times.  When we first checked, my estradiol levels were elevated, which is to say my body was able to produce estrogen, but not to remove it from my system.  This leads to estrogen dominance, which can be a trigger for Hashimotos.  Sadly, in the year prior to my diagnosis (while my health was deteriorating rapidly), I was prescribed birth control pills in an attempt to regulate my hormones.  The pills I was prescribed had two different forms of estrogen, which likely contributed to (or accelerated) my getting Hashimotos.

The health and function of the adrenals are also tightly coupled with thyroid health.  Although the exact reasons are not yet known, it’s clear that “if your stress is out of control, your body will steal valuable resources to make stress hormones (including cortisol) instead of healthy thyroid and sex hormones”.  You can learn more from this article on the Hypothyroid Mom website.  I have had my cortisol levels checked a few times, but I have not made much progress.  It is hard to reduce stress when you’re worried about your health all the time!  In addition to the impact on thyroid hormone production, adrenal problems can lead to significant sleep disruption.  Sleep deprivation is no fun, and can of course lead to other problems.  More on that in the Energy section, later.

Environmental Toxins

I mentioned above, there are all kinds of chemicals in our environment (and even phytoestrogens in food like soy) that are causing health problems for many people.

It’s becoming increasingly clear that BPA (which is present in plastic water bottles, the lining of canned foods, and more) is associated with a multitude of health issues.  One of the very first articles I wrote on this blog nearly ten years ago was about the risks of BPA. I had become aware of it when selecting bottles for my newborn son.  Here is a recent medical journal article on the connections to hypothyroidism, if you’re interested.

I have written a whole separate post called It’s not just Flint about my personal health challenges with and research on environmental toxins.  If this is something you’re dealing with or concerned about, please have a look.  But in short, doctors are ill-informed to diagnose and treat these things.  The more you know about your options, the better position you’ll be in to advocate for your own health.

In addition to all the tests described in my earlier post, my doctor also recommended running Cyrex Array 11, the Chemical Immune Reactivity Screen.  Through that I learned I have a sensitivity to Benzene, which is a petroleum derivative found in cleaning products and more.

cyrex-10-2016

My doctor said I should avoid walking on roads where there is a significant amount of automobile traffic (not a problem since I usually walk before sunrise).  A few weeks ago I waited 30-40 minutes on the airport sidewalk for a hotel shuttle.  By the time I got to the hotel, my throat was swollen, I had a headache, and it hurt to swallow.  So, the consequences are real and immediate.

My doctor also suggested that when I am traveling I should wear a face mask that filters for chemical exposure.  Her concern is that on the airplane while people are boarding, there are a lot of fumes coming into the plane.  All that sounds very dramatic, but I am often fatigued after my business trips, and I have to wonder if less exposure to airline and car exhaust would help.  Unfortunately in this case, my vanity (more on that below) is working against me.  I just can’t bring myself to buy and use a big bulky mask like that on my frequent business trips.

One of the million scary things about our new administration is that is has been very difficult to find the information I needed to understand and combat what I’m dealing with.  The REINS Act and the gag order on the EPA and USDA and other agencies can only mean a growing emphasis on corporate interests, and increasing risks to consumers from exposure to unregulated chemicals.

Co-infections

One area that I’ve wanted to explore further is co-infections.  Of particular note is the growing interest and momentum around the Epstein-Barr Virus (EBV).  While I never had mono, my antibodies to EBV are high:

ebv-results

It’s interesting that my test results show evidence of a past infection.  But the reality is that many, many people are exposed to the virus, and not all of them end up with an auto-immune condition.  So what is the connection?

Some time ago, I read a summary of medical research on the Hashimotos’s Healing website (which is unfortunately no longer active).  The author explained the various kinds of  Herpes virus, the progression of EBV, and the many things the virus can disrupt.

Of particular interest to me was that “foods and supplements … can feed and encourage the herpes virus .. [t]he most common are foods that are low in lysine and high in arginine”.  This includes orange juice, coconut, and chocolate.  And also that “[h]ighly acidic foods and those laden with chemicals can also exacerbate viral infections and lead to outbreaks”.  I began to suspect that my food choices were affecting my health in ways that I had not even imagined possible.

There is a growing body of research that suggests that there is an intricate connection between EBV and the onset of autoimmune conditions such as Hashimoto’s.  Here is a recent article from a medical journal.  However, since so many people are exposed to the virus from a very young age, it’s still not clear to medical researchers what the underlying reasons or triggers are for those who end up chronically ill.

Although I’m not generally a fan of USA Today, there was an interesting, four minute video posted about Dr. Henry H. Balfour Jr, who is seeking to develop a vaccine for mono.  One doesn’t exist, although the virus was identified in 1964.  The news story centers around a woman who has faced years of strange illnesses, which for many years seemed disconnected.  His vaccine has enabled her to feel consistently well for the first time in years.

What really knocked me back is that the EBV antibody levels she describes are lower than mine (above), which leads me to wonder whether the vaccine is something I should pursue in the future.  It is something I’m planning to discuss with my physician at my next appointment, though I’m not sure I’m ready to subject myself to a clinical trial given how much I’ve already been through on the health front!

I have also met others with Hashis whose root cause was mold exposure.  Apparently it has many symptoms in common with Hashis and other auto-immune conditions.  Although I don’t have an auto-immune response to mold (I had that tested too), our previous house was built in 1924 and flooded multiple times while we lived there, including twice with sewer water.  So I wouldn’t be surprised if mold or fungus contributed to my ill health as well.  They are on my list of things to test this year.

So, this seems like a good time to move on to my three big symptom areas, and share some of my learning and experiences along the dimensions of mental clarity, energy, and weight loss, which (besides lead and mercury!) have been my main focus in the past two years.

Mental Clarity

If I reflect back on where I was at the point of my diagnosis, this aspect of my life and health has definitely changed the most.  I work in management consulting, which is a very fast-paced and demanding environment.  At my level, I’m expected to be interacting with clients, managing my team, staying on top of industry trends, and innovating.  No pressure!

What I was most distressed about a few years ago was that I was struggling to do more than react to everything coming at me.  I was hardly blogging at all – I occasionally posted about the kids on my mommy blog.  I was not reading professionally, and certainly not writing much of anything new except what was required for work.

But the combination of health-related changes I made over the few years really started to turn the tide, and I find myself with more mental clarity than I have had in years.  It’s hard to say exactly what changed – I wish there had been one magical change that I could share with all of you! It was definitely a product of doing many things consistently, including regular sleep, exercise, supplements (especially the ones related to detox), and ongoing adjustments to my food.

Last year I did more writing and public speaking (including academic guest lectures and one conference) than I have in years.  I also attended two professional conferences, which I hadn’t done in nearly ten years.  Even just looking at the number of blog posts I’ve written here is a huge indication of how far I’ve come.  This year I have a couple of speaking engagements lined up, more blogging planned, a journal article, and I may even co-author a book.  So we’ll see how all that goes!  I have been seeking out those opportunities, and I feel much more confident in my ability to take things on than I have in many, many years.

Which is not to say things are perfect.  My partner pointed out to me that while I’m cooking on the weekends, I often leave multiple cabinet doors open (and fail to notice). Earlier this year I bought a sweet little set of four succulents for my office.  I was so proud of myself for remembering to water them on a regular basis.  I brought home all my office plants in December, because we were moving to a new work location.  At some point I finally realized that they were fake.  I had watered them diligently for months, not realizing.  So needless to say, I do still think I have a ways to go to be fully clear and present again!

Energy

Lack of energy was my major frustration when I started treatment with my FMP.  I had always been a highly energetic person.  I saw the same in my maternal grandmother (who died in her mid-90s) and my mother (who is still active in many ways, including regular doubles tennis games) in her mid-70s.  I feel like steady energy is THE foundation for everything else.  If you don’t have energy, how do you advocate for your own health, or even find the reserves to make the hard changes that this disease requires?  For me, I felt there were three big areas I needed to focus on to improve my energy – sleep, thyroid flares, and exercise. And, I also feel like hormones (not just thyroid hormones) play a really big role, but I will confess I don’t yet have that sorted out to my satisfaction, so I won’t write much about that here.

Sleep

Before my diagnosis I was sleeping ten hours a night, and taking 3-4 hour naps in the  middle of the day on the weekend.  It was not much of a life, and (although I was exhausted and didn’t really have a choice) I was unhappy because I knew I was missing precious time with my young kids.

As I started to feel better, I was thrilled that I didn’t need as much sleep anymore.  It was especially great to have the weekend time back.  I desperately wanted to feel ‘normal’ again, and stay up late reading or watching a movie after the kids went to bed.  And every once in a while, circumstances dictated that stay up late to complete something for work.  But when the incremental improvements in my health stopped, I had to make a conscious decision to change my behaviors and make sleep a priority.

Any article you may read about improving sleep quality recommends similar things – consistent waking and sleeping times, a calming bedtime routine, and no screen time in the hour or two before bedtime.  And of course, avoiding foods with sugar and caffeine in them.  What I learned about myself was that if I stay up after 9 pm, I can stay up for hours – but I pay the price in the subsequent days.  So I made a decision that I was going to prioritize my health and get to bed at a decent time.  My kids crawl into bed at 8 pm and read until 8:30.  While they are reading, I get ready for bed, and I usually turn out my lights by 9 pm.  The hardest parts of that are (1) not getting back on my computer or phone, and (2) knowing that there are a million other things I’d love to be doing besides sleep.  But once I let those things go, I appreciate not only a decent night’s sleep, but the pleasure of waking up rested and ready to face the next day.  And, by the way, I have lots of nights where I don’t sleep well, or I am up multiple times.  But on the whole these days, I have more good nights than bad, and that foundation helps me get through the days that aren’t so good.

If you realize that sleep is important to you too, but you’re not sure where to begin, you may want to look into Dr. Sarah Ballantyne’s program called Go to Bed: 14 Steps to Healthier Sleep.

Flares

One of the huge a-ha moments for me last few years has been how much food affects my energy levels.  After receiving results of my first round of food sensitivity tests a few years ago, I immediately eliminated all the offending foods, and I felt so SO much better.  I felt even better yet again after finishing the elimination stage of the Auto-immune Protocol (AIP).  I have successfully re-introduced some foods, and I (as I mentioned in last year’s blog post) I found Eileen Laird’s ebook on reintroductions to be the most thorough, clear, systematic, and helpful resource to help me through that.

Unfortunately, in my case, feeling consistently healthy has been elusive.  After my initial success with AIP, I developed new intolerances.  I was making bone broth regularly, along with the three-herb beef burgers in Angie Alt’s The Autoimmune Paleo Cookbook: An Allergen-Free Approach to Managing Chronic Illness.  I was batch cooking on the weekends the way Angie taught in the SAD to AIP in Six Weeks course that I took from her.  I was also making bacon and eggs on the weekends for myself and the kids.  But I kept experiencing waves of horrible fatigue, and I knew something was still not right.  After trying a bunch of other things, 6-7 months after my initial test, my FMP ordered a second round of food sensitivity testing through Genova Labs.  My initial tests were through ALCAT,  which I personally preferred (more foods tested, easier to read and understand the results), but Genova testing was covered by my insurance.  Through the test results I learned that I had overcome many of the foods I was allergic to before.  That was a sign that my gut was healing, which was great news.  And it was a real pleasure to have more variety in my diet again.  But I also learned that I had developed sensitivities to carrots (in my bone broth) and sage (in the burgers).  I realized that there were generic (undefined) ‘spices’ in the bacon that I was sensitive to, and egg whites had become an issue, in spite of a successful reintroduction earlier.

More recently, I have been having weird intermittent fatigue and joint pain.  If auto-immune conditions are not addressed, they often lead to other ones.  Since I have both Rheumatoid Arthritis (RA) and Polymyalgia Rheumatica (PMR) in my family, it’s hard not to get worried when my joints or muscles ache!

I am not eating anything processed at all, and my food is so restricted now (more on that shortly) that there are not many foods left that could be affecting me.  I have been soaking and roasting my own nuts, including brasil nuts, hazelnut, macadamia, pine nuts and almonds.  I have been rotating them in my diet, but I suspect one of them is causing issues for me now.  Maybe the pine nuts, since they are actually a seed.  Anyways, I eliminated all but the almonds again and I seem to be doing better, so now I need to test each type of nut again in turn and figure out which one is the culprit.

My point in all this is that flares occur for a wide range of reasons (stress, fatigue, exposure to toxins).  But sometimes our everyday choices unintentionally set us back and we have to re-evaluate the basics.  I suspect that will be the case for the rest of my life, unfortunately.

Exercise

Well the good news is, I have been exercising more in the past few years that I had in the 7-10 years prior.  My exercise routine has varied a lot over the past year.  I was feeling great before Christmas over a year ago, and I got into a regular routine where I was going to the gym 3-4 times a week.  The more I exercised, the better I felt.  I am not sure why I stopped working out so consistently early in the year – maybe a couple of flares, or work travel, or something else.

In early April last year we made an offer on a new house, and in the ensuing mayhem I stopped exercising completely (except for carrying boxes).  I worked long days getting us settled into our new house; moving furniture and boxes up and down three flights of stairs was a great workout.  I went to bed late and woke up each day with lots of energy.  But I definitely didn’t feel as good in the sedentary months following.

walking

I walked consistently over many weeks, rarely missing a day.

In mid-Summer last year, I received lab results that showed the early warning signs of insulin resistance (pre-diabetes, basically), which requires vigilance on food and exercise.  I read many articles which explained the basics of insulin resistance, and confirmed the necessity of regular exercise.  I read many recommendations about what an appropriate routine might look like, though some felt too ambitious for me.  I also read a compelling article written by a man who had reversed his insulin resistance over several years (ugh!) by making incremental changes.  I found what I learned discouraging and elucidating all at once.

At that point I had been on the auto-immune paleo diet for more than 18 months, so I knew there was not much to be done in terms of changing my diet.  But terror of a pre-diabetes diagnosis got me exercising again.

70k-steps

Over the Summer and into the Fall, I consistently walked more than 70K steps a week.  I also found that I needed less sleep to feel good.

I started slowly at first because I was out of shape, but I was fortunate that my baseline health was so much better than it had been in years prior.  By the early Fall I was walking the recommended 10K steps a day, 70K steps a week (see one example at right).  I was consistent over a number of months (as in the graph at right, above).  The Pokemon Go craze helped keep me moving!  If I couldn’t get out of bed in the morning, I found ways to walk at lunch, even if it meant talking to members of my global team while I huffed and puffed along.

The more I exercised, the better I felt.  I was more positive, high energy, and clear-headed.  It was definitely more fun for me to be outside every day than it was to get to the gym, especially on beautiful late summer days.  So it’s probably not surprising that as the weather turned colder (and work got busier) it was harder to stick with a daily routine.

I didn’t lose a single pound during that time, by the way, which was completely exasperating.  More on that below.  However, as frustrating as it was, my experience was consistent with what I had read both in the popular press and in medical journals, which is that regular exercise can improve insulin resistance and BMI without resulting in weight loss.

I had also read in multiple places that High Intensity Interval Training (HIIT) is a good way to reset the body’s metabolism.  I took one HIIT class at my gym, and also met with a trainer once.  The workouts were great, and made me realize the huge gap between the exercise I get from walking and true intense exercise.  But I was struggling with the balance between exercise and rest, and I found it almost impossible to push myself to that degree without an instructor.

In fact, the Wikipedia article referenced above says HIIT requires “‘an extremely high level of subject motivation’ and question whether the general population could safely or practically tolerate the extreme nature of the exercise regimen”.  In spite of all my progress, I was slow to recover from the few sessions I had done, and I was nervous that pushing myself so hard would result in a flare.  However, as I continue to heal, it is clear I am going to need to engage in more rigorous exercise if I want to lose weight.

Weight Loss

The challenge with a blog post like this is striking the right balance between being informative, and TMI – too much (personal) information.  This section is definitely going to toe that line.

It’s embarrassing to admit that of all the Hashi’s related issues I’ve struggled with, the inability to lose weight may be the thing that affects my self-esteem the most.  Stacy Robbins (author of You’re Not Crazy and You’re Not Alone) wrote an essay called It’s a Beautiful Thing, in which she talks about how deeply her sense of self-worth was tied up in her appearance, and her efforts to make peace with her Hashis-induced weight gain.  My maternal grandmother, my mother, and my younger sister have all worked as professional models.  Looking beautiful (both in terms of physical appearance and in terms of how we dress) has always been important in my family.  Those deep beliefs are incredibly difficult to overcome.

weight-gain

No matter what I did, I continued to gain weight.

And so, I will confess (with some embarrassment) that I first started seeking help for my health issues when I was unable to lose weight.  Not because I was tired all the time (which my doctors told me was normal for a working mom), not because my mental acuity was going screaming downhill.  I had changed my diet in as many ways as I could imagine – Weight Watchers, gluten and dairy free, low carb (all of which I’ve chronicled here) – without success.  In fact, it wasn’t just that I wasn’t able to lose, but I was gaining slowly and steadily, and there seemed to be nothing I could do to stop it.  You can see a graph (from my FitBit data) at right.  I was 163 ten weeks after my first pregnancy, but I haven’t been able to get close to that again in the past ten years.   The big dips you see occurred when I switched thyroid medicines.

However, once I started working with an FMP and she identified serious issues like lead poisoning, I realized I was being ridiculous to obsess about my weight when I was dealing with much more serious issues.  I worked very hard to stop freaking out about what I was seeing on the scale, and focus on the underlying reasons why.  I learned that excess estrogen leads to weight gain, and that the body also stores lead in fat cells.  I learned that losing weight too fast could result in the lead moving from fat cells in my abdomen into the fat cells in my brain.  That was sobering enough for me to stop obsessing about my weight.  At least briefly.

Autoimmune Protocol (AIP)

In my first blog post on Hashi’s I think I mentioned that I was exposed to gluten on a business trip.  I was unwell for two months, and when I finally started to feel better, I had lost all the progress I made on reintroductions.  After that I became much more cautious about my food choices.  I don’t go out to eat; I travel with everything I need or I stop at a local grocery store for ingredients I need.  Even for work events, I bring my own food.  Although it felt awkward at first, I’ve gotten used to it now.

In my first blog post about Hashi’s, I wrote about beginning the Autoimmune Protocol (AIP).  It is supposed to be an elimination diet, with gradual reintroductions.  I did do some reintroductions late last year, but (as I mentioned earlier), after being exposed to gluten, most of my progress was unravelled.  This year I did manage a few reintroductions, including mustard seed (homemade salad dressing – yay!) and some types of nuts, which have provided me with health snack options.  But I have yet to revisit some of the basics such as eggs and fresh legumes.

But the reality is, things got worse before they got better.  I mentioned earlier that I had another round of food sensitivity tests.  I had developed all kinds of new intolerances, and had to eliminate additional foods from my diet.  It was one of the very lowest points in this process since my diagnosis three years ago.

While it may sound harsh, I have been consistently doing AIP and traveling regularly for work, and I have little sympathy for people who occasionally cheat and feel like hell later.  I have been on an increasingly restricted diet over the past two years, and I am still not where I’d like to be.  But through all the issues snd self-experiments I’ve described above, I have ultimately come to accept that my food issues are really hard.  But food is also one of the major factors influencing my health, and I have almost complete control over it, so I stick with it.

Rotation Diet

After gluten exposure and increased sensitivities a few years ago, I introduced a rotation diet, which I read was really important for people in a downward spiral with food allergies.  I learned that people facing the most serious toxicity issues found themselves on increasingly restricted diets, and that – in spite of the significant challenges – it was possible to heal in this way.  Simply put, it becomes critical to rotate foods in a four day cycle, so you are not eating the same food family more than once in four days.  This reduces the risk of additional intolerances developing.  Here are the best resources I found on this topic:

  • The first article I read was an eye opener.  It was on the Super Allergy Girl website, and written by a mom named Lindy Lundy who had multiple children with major food allergies and sensitivities.  This was in the days before IgG testing even existed, and she describes her efforts at adjusting her children’s diet until she was able to get their various symptoms under control.  It was humbling to realize how much she had to do on her own, compared to what is available to us today.  In this excerpt of her book, Lisa explains the basics of the rotation diet.  And in additional excerpts, she also provides invaluable charts of foods and food families, and provides links to additional online resources.  I would have not known where to begin without the information she provided.
  • Author and blogger Kathryn Chastain Treat was being treated at the Environmental Health Center in Dallas to deal with the severe health issues she faced following severe exposure to mold at work.  As part of that process, she chronicled her rotation diet.  Although it was intense, it was also a sobering reminder that my health issues paled in comparison to hers.  Kathryn describes rotating foods faithfully for five or six years.
  • Another invaluable source of guidance for me was a blog post on Planet Thrive.  I found Julie Genser’s blog post detailed and incredibly useful to help me understand foods and food families, and how to get past my own list of allergies into a rotation diet.

One of the strategies I learned was that it was important – if you have significant restrictions in certain food families – to plan your meals very carefully.  For example, four days of meals times three meals a day is 12 different foods in a family.  Even for meat or fish, I don’t have that many foods that I eat.  So, the solution (for meat, for example), would be to eat beef for all three meals on Monday, turkey for all three meals on Tuesday, and so on.  Or, do beef for breakfast and lunch on Monday, and something very different (like fish) for dinner.  Needless to say, this way of eating means your whole life is centered around food and food planning.

As onerous as it sounds, the idea of developing further allergies (and having my diet restricted even further) was incredibley stressful to me.  So, I started with this four-day food diary that I found online.  I apologize that I can’t remember from where I downloaded it, but it was an inspiration.   For the first week or two, I hand-wrote my food in every day.  But I felt so, so restricted and deprived (and almost panicked) about being able to stick with it.  And I realized that I needed to look at the problem differently.  If I was going to do this, I had to have a more expansive mindset, and start with a list of every possible thing I could eat.

So using all the information I learned online, I created my own worksheet.  Similar to Julie’s approach on Planet Thrive, I created columns for all the food families. In each column I listed all the foods I could eat, and at the bottom, I made a list of all the foods in that family that I could not eat.  I used that sheet (a new one every four days) to make my grocery list and plan my meals.  By marking off what I had eaten at each meal, I was able to keep track of what to pack for breakfast and lunch each day.  When I looked at in this way, it seemed imminently possible:

food-sensitivities-snap.pngIn case it will be of help, I’ve also attached the spreadsheet I made for myself (depicted above) at that time.  I’ve provided Microsoft Word and PDF versions.

I did the rotation diet consistently for a number (4-6?) months, and I can tell you unequivocally that it makes AIP look easy.  But as I started to feel better (measured in months, not years!), I gradually relaxed this way of eating.  It has nonetheless left me very aware of how hard it is to establish sufficient variety in our diets, and the risks we create for our health if we get stuck in a rut with what we eat.

Insulin Resistance

At the beginning of the summer, I was finally feeling well enough to raise my frustrations about my weight again with my doctor.  She recommended that I start by eliminating all fruit (fructose).  I cut out my occasional morning orange juice, fruit smoothies, bananas, berries, melon, and even the dried cranberries and blueberries I was putting on my salad.  I was allowing myself one glass of champagne a month, and I eliminated that too.

A month passed and nothing changed.

I wasn’t surprised, but I was very disappointed.  And, worried about what it might mean.  I had a doctor’s appointment at least once a month, and now I asked at every appointment.  I emailed my doctor the articles that I was reading about Hashimoto’s and weight loss, and made clear it was my top priority for every appointment.  I am sure I was driving her nuts, but I had had it!  Finally, lab tests revealed that I was developing insulin resistance (which, as I mentioned earlier) is a precursor to diabetes.

Based on my lab results (as well as the lack of progress from eliminating fructose), my doctor recommended I make further, significant changes in what I was eating.  I was to eliminate all carbohydrates.  I had successfully reintroduced rice, which I had to stop.  I also eliminated sweet potatoes, and all the root vegetables I was eating including parsnips, parsley and celery root, rutabaga, and turnips.  Not being completely sure of what was considered too many carbs, I also eliminated all squashes, including spaghetti squash, acorn and butternut, as well as zucchini.

My doctor also asked me to fast 16 hours at a time.  That is not as bad as it sounds.  It meant that after dinner at six o’clock, I was not to eat again until 10 or 11 the next morning.  The change was extremely challenging at first; I was hungry all the time for the first ten days or so.  In retrospect, I think delaying my breakfast was much harder than eliminating the carbs.

At the same time, my doctor encouraged me to add more fats into my diet.  With my food choices being so restricted, it was hard.  But I ate avocado more regularly, and increased the amount and variety of nuts I was eating.  I also resumed making bone broth (still without carrots), which I drank for breakfast each day, supplemented with a tablespoon coconut oil.  I read Dr. Mark Hyman’s book Eat Fat, Get Thin: Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health, and I also watched Robert Lustig’s YouTube video entitled Sugar: The Bitter Truth, which has been viewed nearly 7 million times.  I have not yet read his book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease, which has been recommended to me, and appears to touch on many of the same issues.

weight-lossThis wave of changes was just a few months ago, and it was pretty radical.  I had eliminated a ton of food cravings and blood sugar ups-and-downs when I eliminated gluten in 2013, and again after starting AIP.  I also thought I understood portion control from having done Weight Watchers and counting carbs.  But this was another level of change entirely.

My food choices were unbelievably constrained, but surprisingly, after the initial adjustment, I didn’t find myself to be hungry. In fact, I found myself to be less and less so.  And (even though I had to make sure I was eating the right kinds of foods), there were less choices, and it somehow felt way less complicated.  And, food was somehow less important.  That is consistent with patient experience Dr. Mark Hyman’s book

What was most exciting was that I lost two pounds each week for the first three weeks.  It wasn’t a lot, but after gaining weight consistently for several years, I was over the moon!  I knew finally that weight loss was possible, even if it was to be slow.  After the inital loss I plateaued again, but every few weeks since then I have lost a little bit.  I think the bumps up are flares, which for me usually result in a few pounds of weight gain (along with fatigue).  This gentle downward slope has given me the patience to stick with these pretty radical changes, and to see if I can finally address the real reason I sought treatment so many years ago.

Eat Your Greens

spinachI often get questions about my food, especially when I’m traveling with or meeting work colleagues.  I tell them that I don’t eat gluten (or any grains), dairy, or soy, and that I have other restrictions as well.  People look at me with amazement, and ask me what there is left to eat.  The question seems funny to me now, because the answer is simply meat, fish, and vegetables.  And people’s faces change – “Oh, well that’s not so bad!”  But because as a country we eat so many processed and prepared foods, it is actually harder than it should be to eat in such a simple way when I am away from home.

One of the most inspiring things that I have read or watched in the past few years was a TEDx talk by Dr. Terry Wahls, which has been watched 2.6 million times.  Some time ago, Dr. Wahls had been consumed by progressive Multiple Sclerosis (MS).  In spite of access to the country’s most advanced medical care, she was unable to slow the progression of her disease.  She was in a motorized wheelchair, rapidly losing her remaining mobility.

She began doing her own research, and as a result, she made radical changes to her diet and supplements. One of the things I remember the most from her talk is that she was eating multiple platefuls of leafy greens every day.  She had learned that her body was severely depleted of the B vitamins, and she had determined that it was easier for her to absorb the nutrients she needed through food than through supplementation.

I would recommend watching the video if you can – she is one amazing lady!  Some people with chronic disease prefer the Wahls Protocol to AIP, perhaps because she is such an inspiration, and she has personally shown it works.

b-vitamins

My B vitamins remain critically low, in spite of regular supplementation over the past few years.

Her presentation really resonated for me because, in spite of regular supplementation, there are some key vitamin and mineral levels that I have not been able to improve – notably magnesium and the B vitamins – in spite of trying a variety of brands and means of ingestion (pills, liquid, powder).  Among other things, the B vitamins are used to convert food into energy.  These low levels could help to explain many of the symptoms I’ve been combatting over the past ten years.

As a result of making these and other changes, Dr. Wahls was able to reverse her MS, and she began to walk (and eventually run) again. She is a wonderful inspiration, and a good reminder about the centrality of food in the healing of chronic illness.   And, in all my reading and following of patient sites, I have never heard of someone being allergic to leafy greens.  So eat as many as you can stand!  In my case, I typically buy kale, spinach, and arugula, and I eat that (or a similar) mix of dark greens twice a day, along with meat or fish, and some nuts.

In Closing

In the years since my diagnosis, I have been increasingly open about what I’m dealing with, in the hopes it will help others.  I have met an extraordinary number of women and a few men who are dealing with some or all (or more!) of the miserable symptoms I’ve dealt with.  What worries me the most is that all of those women are on Synthroid, they have never even had a complete thyroid panel, and absolutely none of them have been told that they are dealing with an underlying autoimmune condition that needs to be addressed before they can truly feel well again.  By the way, there also seem to be plenty of women that take Synthroid and feel just fine – they can’t understand why it’s such a struggle for me to get my health and my life back on track.

It really bothers me that so many women are being failed by the medical establishment that they’ve put blind trust in, and I can only hope that by continuing to speak up, I will help more people find their way to wellness.

It’s been a long journey for me to get to this point, but I just couldn’t tolerate the alternative.  Maybe because I was lucky to have felt so healthy and energetic when I was younger.  In the past few years, we’ve made enormous changes in our household, for reasons small and large.  We filter our water, we buy almost everything organic, we use toothpaste with no fluoride, and we no longer use dryer sheets (both have been linked to chronic health issues).  And although we were not unhealthy before, our diet has changed radically.  The changes we’ve undertaken are pretty radical on the whole – they are not for the faint of heart.  Making and sticking with all these changes would certainly not been possible for me without the support of a loving (and also chronically ill) spouse and my patient family.

In spite of how difficult it’s been, I feel lucky to be doing as well as I am today.

And it’s a good thing I have more energy than I used to, because it’s taken a lot of stamina to actually get all of this written down!  But if it helps at least a few people, it will have been worth it.  If nothing else, I hope it will help you advocate for yourself and whatever it takes to achieve your own healing and long term wellness.

Last time I wrote about Hashimoto’s, I didn’t finish writing my blog post until May.  At the time it was a huge achievement.  This year, getting my post finished in February (only four days late!) is a tremendous improvement.  I wish you such exponential progress in your healing as well.  🙂

Happy (belated) Thyroid Awareness Month!

It’s not just Flint

Every day I read more news about toxins in our environment, and the growing body of research that makes the connection between these (largely unregulated) chemicals and a variety of insidious health conditions.  I feel like Americans generally don’t understand the seriousness of the situation, and how much corporations affect our environment and ultimately our health.  I do have some hope that the press about Flint Michigan will help, but that is far from the worst of it.

If we just look at lead as one well-known contaminant, we begin to see how very difficult the situation is.  The reality is that – in spite of the fact that the US government collects data on lead poisoning – many states don’t report lead levels in water at all:

lead-poisoning-map.png

Given the publicity related to the lead poisoning in Flint, maybe consumers will start to pay more attention and start to demand this information.  But, according to the comments in this post, there are 160K water systems in the US, regulated by a wide variety of local agencies.  And the most recent version of the Safe Drinking Water Act has a loophole that avoids any EPA accountability for issues in drinking water that result from fracking.

In the meantime, you may recall the movie called Erin Brockovich starring Julia Roberts, which came out in 2000.  The movie tells the story of how Erin and her husband fought and won a huge lawsuit regarding the presence of Chromium-6 in the water of a local community.   Apparently it causes cancer even at very low levels of contamination, and it is now in the drinking water water of an estimated 200 million Americans in all fifty states.  But corporations and our own government agencies resist meaningful regulation because changing work practices (and of course the clean-up) are onerous and expensive.  If that sounds discouraging, keep in mind that today, the legislation that does exist regarding C-6 is the “only enforceable drinking water standard at either the state or federal level”.  That just goes to show you how far we have to go with lead, which is more widely recognized as an issue of late.  But it’s only the latest in a long line of unregulated industrial chemicals taking a toll on our health.  Erin Brockovich continues her efforts to fight for the safety of Americans against these toxic substances.  If you’re interested in learning more, you can follow the newsfeed on her website or on Facebook.

Part of the reason that I’ve been so interested in these issues is that in the summer of 2015 (six months after my Hashimoto’s Disease diagnosis) I had received lab test results from Doctor’s Data that revealed I had lead and mercury poisoning:

dd-05-2015.png

As you can imagine, I was pretty panic-stricken about it.  In hindsight, it seems likely that the mercury was from amalgam fillings that were not properly removed.  I had them removed shortly after my second son was born, which was also the earliest onset of my Hashi’s symptoms.

Humans do store lead in our bones, and for women, those reserves begins to release as women approach menopause.  My my doctor was very concerned about my levels being so high before the onset of menopause, so she recommended a number of concurrent treatments, including regular DMSA (a chelation agent) and a product called Zeolite (which I would not recommend, more on that in a minute).  I am now also taking something called PectaClear, which is a fruit pectin that apparently helps to absorb and remove heavy metals from the digestive system.  But as I started chelating, my lead levels continued to rise, along with those of other chemicals:

dd-02-2016.png

One hypothesis from my doctor was that the test results were skewed because she had given me more chelation agent before the second test (due to weight gain).  That seemed like a pretty lame explanation and, frankly, unconvincing.  I was also losing my hair in fistfuls, likely due to the fact that chelation was also drawing the iron out of my system.  I was exhausted and balding – not a good place.  So my whole family and I started researching like crazy.  We learned the following things along the way:

  • We had our house water tested by Schneider Laboratories and it was fine.  We did learn that drinking water can be contaminated at any time, though, so that wasn’t particularly reassuring.
  • Many ceramic pans have lead in them.  Our newest pans were, in fact, ceramic.  We had no way of verifying whether they had lead in them or not, so out they went.  If you want to cook with ceramic (it’s a great way to avoid the carcinogenic toxins in non-stick pans), I would recommend the Greenpan line by Sur La Table, which claims to be free of lead and other toxins.
  • I was taking a small mountain of daily vitamins and supplements at the time of my testing (I still am!), and I learned through my research how little regulation of supplements exists in the United States.  It’s horrifying, actually.  You may have seen news articles in the past year about recalls of vitamins from Walmart, Target, and many other companies.  More recently, there have been recalls of tumeric and other spices which have unacceptable levels of lead in them.  You can follow the latest recalls on the FDA website – Recalls of Foods & Dietary Supplements.   What I learned from this Chemistry Central Journal article about heavy metals and supplements is that some supplements such as Magnesium and Manganese occur in”natural geochemical association with essential metals” such as lead.  So unless you buy your supplements from suppliers that truly check lead levels, these supplements may further raise your toxic load.  A Functional Medicine Practitioner (FMP) can recommend suitable brands; most of what I am prescribed comes from Pure Encapsulations or Douglas Labs.
  • In an effort to avoid fluoride (which has also been associated with Hashis), I tried a number of different alternative toothpastes.  Removing the fluoride really helped with my sensitive gum tissue and teeth.  Of all the brands I tried, the two that I liked the most were called Desert Essence Natural Tea Tree Oil and Neem Toothpaste and Redmond Earthpaste.  But if you read the fine print on the Redmond Earthpaste, it says that is contains trace amounts  of lead – enough so that they are required by law to document it on the packaging.  So out went the new toothpaste.
  • One of the many suggestions I came across on patient discussion boards was to use Himalayan salt, because it supposedly has a lot of essential elements in it, including Magnesium.  However, around this time, I read an article that suggested that Himalayan salt could cause lead poisoning.  Later, a rebuttal from the CEO of Original Himalayan Crystal Salt® appeared on the same site.  He claims their product offers many important trace minerals, and that they do thorough testing.  But of course (even if their claims prove true) most consumers can’t distinguish their brands from the many others on the market.  So out went our Himalayan salt as well.
  • The icing on the cake for me was learning that Zeolite (which was recommended as a gentle chelation agent by my FMP), has been shown to have extremely high levels of lead in it.  Now, the author of the website who posted the study appears certifiably nuts.  But he does run a high-end laboratory.  And, timing-wise, the significant jump in my lead levels appears to be correlated with my use of zeolite.  Needless to say, I stopped using it immediately.  But all of this gets back once again to the lack of regulation in the U.S. around dietary supplements, and the hazards of being a guinea pig on the bleeding edge of functional medicine.

After making all of these changes, my doctor and agreed to wait six months before testing heavy metals again.  I was so, so crazy stressed about this topic that I knew I had to put my energy elsewhere for awhile.  During that time, my sister sent me a very interesting paper from the Canadian Medical Association Journal entitled Lead and mercury exposures: interpretation and action, which I’ve attached as a PDF for you here.  My biggest takeaways after reading this article were:

  • Most physicians who are willing to engage on this topic have no idea what they are doing in testing for metals, interpreting the results, or treating patients appropriately.
  • There are safety tests that can be conducted, but most labs do not use the most robust means possible – only the minimum that is required by law.  The manufacturers whose supplements I was taking had nothing posted on their websites, and were unwilling to explain their safety testing procedures in writing to me.  I had to call each one and ask them to explain their testing methods.  I did not call Pure Encapsulations or Douglas Labs, but of the others I called, I did not find one that met the testing standards and safety levels recommended by the CMAJ article linked above.
  • Another huge realization was that I had only ever done a heavy metals test following provocation with a chelation agent.  I had no baseline measurement – a huge mistake.  I was now 18 months into treatment without knowing where I had started.  Needless to say I was pissed as hell about that.

When I went back to see my doctor, I asked a lot of questions, but didn’t get many satisfactory replies.  I did, however, get a new heavy metals test without a chelation agent, and I received these results:

dd-12-2016.png

How about that?  I have no idea where the elevated Barium levels came from, in spite of reading up on it on the NIH website.  One of the main reasons people get Barium poisoning is from peanut butter, which I don’t eat.  But note how different the lead and and mercury levels are.  Sadly, without a baseline, it’s hard to really know what this means.  Either my earlier levels were related to one of the many things I changed (pans, supplements, salt, toothpaste, zeolite).  Or it was never that high to begin with, and the chelation agent was simply drawing out what is being stored in bones, fat tissue, or elsewhere.

What my doctor was able to tell me is that my current levels are likely as a result to past exposure (e.g. fillings, lead-based paint).  Knowing that, I am still attempting detox, but at a more relaxed pace.  I hope that this blog post will help raise your awareness of the importance of environmental regulations, and help you make better decisions as a consumer about what you buy for your kitchen, your personal hygiene, and more.

And now – after 18 months of tremendous anxiety on this topic – I know I am no longer dying of heavy metal poisoning, so I am actively turning my attention to other aspects of my health.  More on that in a subsequent post, hopefully before Thyroid Awareness Month is over!

Origins of anthrodesign

Anthrodesign is an active online community of about 3000 practicing social scientists and interested colleagues from other disciplines.  The focus of our dialogue is on the use of ethnographic methods in non-academic contexts.  I created the listserv in 2002, and many of the reasons for its founding are the same reasons it continues to be so successful today.  Over the years I’ve received inquiries about why I formed anthrodesign, what problems I intended to solve, and what I think about it today.   As anthrodesign approaches it’s fifteen-year anniversary, this blog post is intended to answer those questions and more.  I believe sharing some of our history may help shape our trajectory, and at the same time inform others who might be interested in establishing their own vibrant and long-lasting community of like-minded practitioners.

Background

In 2002, I was two years away from finishing my dissertation.  I had taken an extra year preparing for my comprehensive exams, because much of the material I needed to write my literature review hadn’t been covered in my earlier coursework.  Working alone, I was struggling to find materials and to explain their relevance to my subject matter, an ethnography of a high-tech corporation.  In parallel, I was beginning to think about what life might be like after my PhD was complete.  I had been working full time since the start of my doctoral program, and had enjoyed teaching a couple of undergraduate courses.  But after the fast pace of the software industry, I was clear that campus life was probably not a good fit for me.  And I was lonely.  I loved what I was studying, and I desperately wanted to talk to others who were learning and doing and struggling as I was.

In an effort to build a support system and define my next steps, I began to reach out to anthropologists who were researching or working in the business context – I spoke with Marietta Baba, Susan Squires (who was leading the NAPA Mentor program at the time), Patricia Sachs, Gitte Jordan, and others.  Though those connections, I met many more anthropologists – many of them also working alone – who were doing the work I wanted to be doing.  I was inspired, energized, and much more clearly focused on my next steps as I expanded my social network.  Today, I am a successful User Experience (UX) professional in part because of what I learned from those many individuals who took the time to engage with me as my goals and plans emerged.

In 2002, I organized a panel for the American Anthropology Association (AAA) annual meeting entitled Anthropology and Innovation in the High Tech Sector.  I was still writing my dissertation, and I’m not sure I had anything meaningful to say at the time!  But I did organize the panel and bring together interesting participants from Pitney Bowes and Microsoft. I learned a lot, and those conversations continued after the meetings.  It’s possible that all the excitement and momentum drew us into a meal together afterwards – that definitely became a tradition in subsequent years.  It was such a pleasure to engage in conversation with anthropologists whose work resembled my own.

Following the AAA meetings, the dialogue continued by email in the weeks following, and our numbers swelled from our panel participants to 24 people exchanging email.  At that time I knew we needed another format, and in August 2002 the anthrodesign listserv was formed.

In 2004, I brought together many of the same people from Pitney Bowes, Microsoft, and also Intel.  The Society for Applied Anthropology (SfAA) panel was entitled Across the Wall: Ethnographers and Technologists at Work Together.  The panelists were colleagues who had been working side-by-side on these problems for a number of years.  We were assigned a little shoebox of a room, but the topic garnered attention; the room was packed, and we had people standing in the hallway outside to hear what we had to say.

I’ve been contacted many times about anthrodesign, what my inspiration was for founding it, what I think contributed to its longevity.  It’s easy to say in hindsight, of course!  But since I have spent significant time working on social media strategy in my career, hopefully that knowledge – combined with my fourteen-plus years of moderating anthrodesign – will provide some valuable perspective.

In the beginning

For me there were three main reasons for forming anthrodesign (1) it felt like the right moment both personally and for the discipline (2) I wanted to combat the isolation that I and many other practicing anthropologists were feeling, and (3) I was looking for ways to accelerate knowledge sharing.  Ultimately, I wanted to foster a cross-disciplinary dialogue about our work.

The right moment

An important aspect of building a community is meeting people where they are.  About ten years ago, I had a UX executive tell me that one of his teenage research respondents had described email as the way I would “send thank you notes to friends of my parents”.  Email is the hand-written thank-you note of my generation.  The listserv is essentially a centralized email capability, which does put us at risk for being irrelevant as communication preferences change.  Over the years I tried Facebook (not for everyone for a variety of reasons), Twitter (good for quick exchanges but not real dialogue), LinkedIn (great for networking, but not good for people that need to ensure the privacy of their employer or client as they ask questions).  We also have a website with a (largely neglected) blog.  Most recently, we’ve established a Slack community (like group chat, or a closed Twitter community) together with EPIC and Ethnography Matters.  Today, that seems to work well, and it has forced me to stay current.  But in all seriousness, different working styles and younger generations engage in different ways, and if we truly want to foster a dialogue, we need to enable people to connect in the ways that works best for them. And what the best way is changes as technologies (and the people they serve) evolve.  Today the Slack community is growing significantly faster than the original list, and bringing together new members who might have not otherwise found their way to us.

Last year, the CEO of Ford announced that had put his whole leadership team through IDEO’s design thinking training, and he was talking about the importance of ethnographic methods.  That was not happening 15 years ago, in spite of the fact that anthropologists have been working in the automotive industry (at Ford, GM, Chrysler, and others) for years.  So, what has changed?  At least for me, in the high-tech industry, the dot-com crash was a turning point; we had to get past valuing technology for technology’s sake, and become clearer both about the business and human value that our solutions would create.  Suddenly, there was room to consider people in the context of technology, and anthropologists who were interested in engaging with such problems.  There has also been a growing interest and curiosity about design in the business and popular press, as evidenced by a growing number of articles in Harvard Business Review, Business Week, Fast Company, Wired, and more.  I am not sure – if I attempted to found anthrodesign again today – whether there would be the same interest and urgency as there was at the time.  In other fields where market research is more central to decision-making, I’m not sure it would have worked either.  It was the right topic, at the right place, and the right time.

Combat isolation through virtual community

One of the unexpected things about anthrodesign is that it’s founded around the ethnographic method, which is used in a variety of fields, including practicing anthropology and design research.  That has been both a blessing and a challenge.  It’s been a blessing because it’s opened up the conversation beyond anthropology (more on that later), and enabled us to have a dialogue around the many diverse literatures that inform our work.  And, it’s a challenge because the community is so interesting and wonderful, it’s often a temptation to ask the group about things that have nothing at all to do with ethnographic methods.  It has also meant that there is no one obvious place to go advertise the group.  In fact, it’s been a conscious decision on my part to keep the group closed (e.g. I have to add each member myself), and to avoid sweeping invitations.  The User Experience group on LinkedIn, for example, has over 100K members.  It’s a wonderful resource, but in my experience, it doesn’t foster the same sense of community and dialogue that a smaller group does.  Most joiners find out about anthrodesign by word of mouth from a current member, from a book on ethnography in business (more on that below), from a blog, or from a Google search.  The aspiration has never been to be large, but rather to be of high quality, so this approach to publicizing the group has made good sense.

Over the years, I’ve had the opportunity to engage with many members of the list, whether through brief email exchanges, or meet ups at relevant conferences.  Having a chance to connect over a meal with other like-minded anthropologists has been a personal highlight for me.  Many, many of us are working as lone practitioners or lone anthropologists in a multidisciplinary team.  Under those conditions, it becomes so important to have others to talk to – whether it’s to corroborate whether we’re crazy (likely not), to discuss how to handle objections to our work or our recommendations in a specific situation, or to track down an obscure article that we need for a paper we’re writing.  Although I derive pleasure from being part of such a vibrant community, those individual connections are what make the administrative effort worthwhile for me.  And in fact, I think good communities do help build relationships, or at least provide fertile ground for those relationships to form when / if they are needed.  I see the evidence of that now in the data available about our Slack community.  While it appears very active, in fact about fifty percent of the communication is happening through direct messages, rather than in a public channel.  The dialogue doesn’t have to be fully public to foster a sense of community!

Accelerate knowledge creation and sharing

There was some writing on participatory design (notably Participatory Design: Principles and Practices from 1993, now out of print) that emerged in large measure from Europe.  During the writing of my dissertation, that work that inspired me to look more closely at design methods.  I was looking to other fields because at the inception of anthrodesign, there had been very little written about the use of ethnographic methods in the business setting.  The American Anthropological Association has a small special interest group called NAPA (National Association of Practicing Anthropologists), which was a welcoming organization.  And, while I enjoyed attending the Society for Applied Anthropology meetings, it took some time for me to understand that my work was really practicing, and not applied.  NAPA Bulletins provided insights about anthropologists studying business contexts, but showcased very little or nothing about anthropologists who were truly embedded in their work contexts, and providing anthropological / ethnographic insights for (rather than about) their places of work.

However, in the years since, there has been a wealth of material written about the topic.  Many of those books were written or edited by members of the anthrodesign community, including:

In the years since the list was formed, there have also been a number of books published by European authors about anthropology and design:

I am sure there are others that I’ve missed – please let me know which ones in the comments.

In addition, beginning in 2005, the Ethnographic Praxis in Industry Conference (EPIC) emerged, and the resulting intimate event was much larger and more generative than any post-conference dinner could be.  The double-blind peer reviewed proceedings (now available online) continue to provide insight and perspective into how the field has evolved.

As I was preparing this blog post, EPIC founders Tracey Lovejoy and ken anderson shared their thoughts with me about how EPIC emerged from the strong foundation of community that had been established with anthrodesign.  Ken stated that the “vibrancy and growth of the list … demonstrated that there was at least a virtual community of interest, one willing to actively engage with each other” and Tracey said that being part of the early anthrodesign dinner events at anthropology meetings (AAA, SfAA) helped her to see the value of having a safe place to engage in dialogue with others doing similar work.  Together, they felt that it made sense to bring people together in real life to continue the conversation and create a shared body of knowledge.  Today, EPIC has ~3000 registered members across many disciplines and geographies, with a total of 5000 people subscribed for email communications.  The community has produced and curated eleven years of conference content in a growing number of formats, from formal papers, to Pecha Kucha presentations, and most recently to a business school style Case Study format.  This body of knowledge will help to ensure that the next generation of social scientists and designers can learn from the past and continue to advance the field.

The promise of cross-disciplinary collaboration

Today we have nearly 3000 members globally on the listserv, with another 600 or so (some overlapping) on Slack.  At the inception (at least the first 100 members), almost all of us were social scientists.  Nonetheless, the need to collaborate effectively in interdisciplinary teams remains central to our work.

One of the many challenges for applied anthropologists is learning how to collaborate with people trained in other disciplines.  How do engineers think?  What do they value?  What / do they see as the value proposition of the work that I do?  One of the most insightful and funny moments in that 2004 SfAA panel has stuck with me all these years.  Jill Lawrence (from Pitney Bowes, now at Crown Equipment) was present with one of the engineers she was working with at the time.  They had agreed to take classes so that they could better understand the other person’s perspective.  Her a-ha moment came while taking a programming class; Jill said “Now I know why he wants me to answer questions with a yes or a no”.  She learned that for an engineer, there is no way to program for “it depends”, which includes all the subtlety and complexity of human behavior.  Much of this comes with experience, of course – by working with the same team, or similar types of colleagues over time, we learn about what works and what doesn’t.  Our ability to be effective results in part from using participant observation techniques in our own places of work!  But in a consulting role, we are thrust time and time again into situations with new collaborators, where familiar ways of working may not apply.

My hope with anthrodesign was to foster a dialogue between social scientists and designers, specifically.  I could see that designers were trained with many skills that were complementary to anthropology education.  For example, design school is practical and applied; the student portfolio is built by systematically addressing a series of business problems with a business stakeholder, an end-user, or a consumer in mind, and often with a fixed or pre-defined set of materials.  My training allowed me to think about how technology transforms the way people work, the power dynamics in play, the discourse within a system.  I didn’t receive formal education about how to make those ways of thinking useful in the business context, but I was fortunate to learn that in my day job at a software company.

Knowing that collaboration with both designers and engineers would be critical to my success, I wanted to engage in a conversation about how we could do that together.  How can we work together more effectively, what can we learn from each other, how can we deliver better outcomes if we work together?  I had some ideas at the outset, and I hoped that we could advance our thinking as a group through our discussions.  But in reality, the designers on anthrodesign are usually lurkers.  They are happy to learn, and to post the occasional question.  Perhaps because the group’s name begins with ‘anthro’, or because ethnographic methods have historically been the anthropologists’ method, the designers remain largely silent.  And that, I suppose, is my biggest regret.  In spite of all the wonderful outcomes of the group, the social scientists were so eager to engage with one another that we have not actively engaged with the design community as much as I might like.  Perhaps I should have looked for a co-facilitator that could have nurtured those voices and perspectives earlier on, or perhaps my ambitions for the group were unrealistic.  I value the EPIC proceedings because they establish the canon for our shared ideas.  However, it does privilege those (like anthropologists) who are accustomed to imparting their wisdom in words.  I hope that the EPIC Pecha Kucha and other formats will continue to make room for alternative voices in the community.  How to do that within the existing anthrodesign community – and whether such change is possible fifteen years in – is still an open question for me.

In closing

I hope this piece provided some interesting perspective on the anthrodesign community, why it was formed and how it has evolved, as well as my perspective on where we are today.  I would love to discuss this further with any who are interested, whether that’s to learn about relevant literature that I’ve missed, recommendations about how to better engage our design colleagues, or other ideas this sparks for you.  Please feel free to post in the comments here, or join the discussion and comment via the listserv or Slack.