Thursday, December 30, 2010

Healthy Hair Tips for 2011

{Image Source}
Are you looking to achieve healthy hair in 2011?  Start with these suggestions:

1. Eat Healthily
Healthy hair starts from within.  If you are not getting sufficient nutrients from your meals, invest in a good multivitamin.  (For more info: hair foods, multivitamins.)

2. Drink sufficient water
Water helps to move nutrients throughout the body.  (For more info: water.)

3. Design a hair care regimen
Start with a basic routine (wash, condition, detangle, and moisturize) and build upon it as necessary (e.g., cowash, prepoo, etc.).  Example regimen, Featured regimens.

4. Find your staple hair products & tools
Clean out your shelves. Keep products and tools that work on your hair.  Donate those that do not.  Learn your hair and what ingredients it likes and doesn't like.  (For more info: moisture.)

5. Protective style more often
Protective styling helps to retain length and maintain healthy strands.  (For more info: Length retention.)

Twist Series: Growth Questions

Hey ladies!  I'm in the process of writing about "Growth & Length Retention" in the Twist Series.  Feel free to add questions in the comment section that I can address in the post.


How much protein does one need to be in nitrogen balance?

The figure below, from Brooks et al. (2005), shows a graph relating nitrogen balance and protein intake. A nitrogen balance of zero is a state in which body protein mass is stable; that is, it is neither increasing nor decreasing. The graph was taken from this classic study by Meredith et al. The participants in the study were endurance exercisers. As you can see, age is not much of a factor for nitrogen balance in this group.

Nitrogen balance is greater than zero (i.e., an anabolic state) for the vast majority of the participants at 1.2 g of protein per kg of body weight per day. To convert lbs to kg, divide by 2.2. A person weighing 100 lbs (45 kg) would need 55 g/d of protein; a person weighing 155 lbs (70 kg) would need 84 g/d; someone weighing 200 lbs (91 kg) would need 109 g/d.

The above numbers are overestimations of the amounts needed by people not doing endurance exercise, because endurance exercise tends to lead to muscle loss more than rest or moderate strength training. One way to understand this is compensatory adaptation; the body adapts to endurance exercise by shedding off muscle, as muscle is more of a hindrance than an asset for this type of exercise.

Total calorie intake has a dramatic effect on protein requirements. The above numbers assume that a person is getting just enough calories from other sources to meet daily caloric needs. If a person is in caloric deficit, protein requirements go up. If in caloric surplus, protein requirements go down. Other factors that increase protein requirements are stress and wasting diseases (e.g., cancer).

But what if you want to gain muscle?

Wilson & Wilson (2006) conducted an extensive review of the literature on protein intake and nitrogen balance. That review suggests that a protein intake beyond 25 percent of what is necessary to achieve a nitrogen balance of zero would have no effect on muscle gain. That would be 69 g/d for a person weighing 100 lbs (45 kg); 105 g/d for a person weighing 155 lbs (70 kg); and 136 g/d for someone weighing 200 lbs (91 kg). For the reasons explained above, these are also overestimations.

What if you go well beyond these numbers?

The excess protein will be used primarily as fuel; that is, it will be oxidized. In fact, a large proportion of all the protein consumed on a daily basis is used as fuel, and does not become muscle. This happens even if you are a gifted bodybuilder that can add 1 lb of protein to muscle tissue per month. So excess protein can make you gain body fat, but not by protein becoming body fat.

Dietary protein does not normally become body fat, but will typically be used in place of dietary fat as fuel. This will allow dietary fat to be stored. Dietary protein also leads to an insulin response, which causes less body fat to be released. In this sense, protein has a fat-sparing effect, preventing it from being used to supply the energy needs of the body. As long as it is available, dietary protein will be favored over dietary or body fat as a fuel source.

Having said that, if you were to overeat anything, the best choice would be protein, in the absence of any disease that would be aggravated by this. Why? Protein contributes fewer calories per gram than carbohydrates; many fewer when compared with dietary fat. Unlike carbohydrates or fat, protein almost never becomes body fat under normal circumstances. Dietary fat is very easily converted to body fat; and carbohydrates become body fat when glycogen stores are full. Finally, protein seems to be the most satiating of all macronutrients, perhaps because natural protein-rich foods are also very nutrient-dense.

It is not very easy to eat a lot of protein without getting also a lot of fat if you get your protein from natural foods; as opposed to things like refined seed/grain products or protein supplements. Exceptions are organ meats and seafood, which generally tend to be quite lean and protein-rich.


Brooks, G.A., Fahey, T.D., & Baldwin, K.M. (2005). Exercise physiology: Human bioenergetics and its applications. Boston, MA: McGraw-Hill.

Wilson, J., & Wilson, G.J. (2006). Contemporary issues in protein requirements and consumption for resistance trained athletes. Journal of the International Society of Sports Nutrition, 3(1), 7-27.

Tuesday, December 28, 2010

How much dietary protein can you store in muscle? About 15 g/d if you are a gifted bodybuilder

Let us say you are one of the gifted few who are able to put on 1 lb of pure muscle per month, or 12 lbs per year, by combining strength training with a reasonable protein intake. Let us go even further and assume that the 1 lb of muscle that we are talking about is due to muscle protein gain, not glycogen or water. This is very uncommon; one has to really be genetically gifted to achieve that.

And you do that by eating a measly 80 g of protein per day. That is little more than 0.5 g of protein per lb of body weight if you weigh 155 lbs; or 0.4 per lb if you weigh 200 lbs. At the end of the year you are much more muscular. People even think that you’ve been taking steroids; but that just came naturally. The figure below shows what happened with the 80 g of protein you consumed every day. About 15 g became muscle (that is 1 lb divided by 30) … and 65 g “disappeared”!

Is that an amazing feat? Yes, it is an amazing feat of waste, if you think that the primary role of protein is to build muscle. More than 80 percent of the protein consumed was used for something else, notably to keep your metabolic engine running.

A significant proportion of dietary protein also goes into the synthesis of albumin, to which free fatty acids bind in the blood. (Albumin is necessary for the proper use of fat as fuel.) Dietary protein is also used in the synthesis of various body tissues and hormones.

Dietary protein does not normally become body fat, but can be used in place of fat as fuel and thus allow more dietary fat to be stored. It leads to an insulin response, which causes less body fat to be released. In this sense, dietary protein has a fat-sparing effect, preventing it from being used to supply the energy needs of the body.

Nevertheless, the fat-sparing effect of protein is lower than that of another "macronutrient" – alcohol. That is, alcohol takes precedence over carbohydrates for use as fuel. However, protein takes precedence over carbohydrates. Neither alcohol nor protein typically becomes body fat. Carbohydrates can become body fat, but only when glycogen stores are full.

What does this mean?

As it turns out, a reasonably high protein intake seems to be quite healthy, and there is nothing wrong with the body using protein to feed its metabolism.

Having said that, one does not need enormous amounts of protein to keep or even build muscle if one is getting enough calories from other sources.

In my next post I’ll talk a little bit more about that.

Thursday, December 23, 2010

38 g of sardines or 2 fish oil softgels? Let us look at the numbers

The bar chart below shows the fat content of 1 sardine (38 g) canned in tomato sauce, and 2 fish oil softgels of the Nature Made brand. (The sardine is about 1/3 of the content of a typical can, and the data is from The two softgels are listed as the “serving size” on the Nature Made bottle.) Both the sardine and softgels have some vegetable oil added; presumably to increase their vitamin E content and form a more stable oil mix. This chart is a good reminder that looking at actual numbers can be quite instructive sometimes. Even though the chart focuses on fat content, it is worth noting that the 38 g sardine also contains 8 g of high quality protein.

If your goal with the fish oil is to “neutralize” the omega-6 fat content of your diet, which is most people’s main goal, you should consider this. A rough measure of the omega-6 neutralization “power” of a food portion is, by definition, its omega-3 minus omega-6 content. For the 1 canned sardine, this difference is 596 mg; for the 2 fish oil softgels, 440 mg. The reason is that the two softgels have more omega-6 than the sardine.

In case you are wondering, the canning process does not seem to have much of an effect on the nutrient composition of the sardine. There is some research suggesting that adding vegetable oil (e.g., soy) helps preserve the omega-3 content during the canning process. There is also research suggesting that not much is lost even without any vegetable oil being added.

Fish oil softgels, when taken in moderation (e.g., two of the type discussed in this post, per day), are probably okay as “neutralizers” of omega-6 fats in the diet, and sources of a minimum amount of omega-3 fats for those who do not like seafood. For those who can consume 1 canned sardine per day, which is only 1/3 of a typical can of sardines, the sardine is not only a more effective source of omega-3, but also a good source of protein and many other nutrients.

As far as balancing dietary omega-6 fats is concerned, you are much better off reducing your consumption of foods rich in omega-6 fats in the first place. Apparently nothing beats avoiding industrial seed oils in that respect. It is also advisable to eat certain types of nuts with high omega-6 content, like walnuts, in moderation.

Both omega-6 and omega-3 fats are essential; they must be part of one’s diet. The actual minimum required amounts are fairly small, probably much lower than the officially recommended amounts. Chances are they would be met by anyone on a balanced diet of whole foods. Too much of either type of fat in synthetic or industrialized form can cause problems. A couple of instructive posts on this topic are this post by Chris Masterjohn, and this one by Chris Kresser.

Even if you don’t like canned sardines, it is not much harder to gulp down 38 g of sardines than it is to gulp down 2 fish oil softgels. You can get the fish oil for $12 per bottle with 300 softgels; or 8 cents per serving. You can get a can of sardines for 50 cents; which gives 16.6 cents per serving. The sardine is twice as expensive, but carries a lot more nutritional value.

You can also buy wild caught sardines, like I do. I also eat canned sardines. Wild caught sardines cost about $2 per lb, and are among the least expensive fish variety. They are not difficult to prepare; see this post for a recipe.

I don’t know how many sardines go into the industrial process of making 2 fish oil softgels, but I suspect that it is more than one. So it is also probably more ecologically sound to eat the sardine.

Wednesday, December 22, 2010

Guest Commentary: Promoting Healthy Aging for Dual Eligibles

Laura Kimberly, MSW, MBE
Director of Special Projects
Jefferson School of Population Health

As we enter the final days of 2010, it seems like an opportune moment to look ahead at milestones we anticipate in 2011, and we have a major demographic milestone coming down the pike – the first wave of baby boomers in the United States will turn 65 in 2011. This means that, in 2011, the first baby boomers will become eligible for Medicare. Today, the number of adults age 65 and older accounts for about 13 percent of the population in the United States. With the influx of the boomer generation, this proportion is expected to increase to nearly 20 percent by 2030. Given the current structure for financing health and long-term care services for older adults, the anticipated growth in the aging population will have serious budgetary implications for our government-sponsored Medicare and Medicaid programs, which are already contending with significant fiscal pressure.

Older adults with multiple chronic conditions present a particular challenge. While they make up only 20 percent of Medicare beneficiaries, they account for about 80 percent of Medicare expenditures. Medicare, financed and administered by the federal government, covers acute care and other health care services, while Medicaid picks up the long-term care (LTC) tab, and older adults must pay privately for LTC if they do not meet the means-tested criteria for Medicaid. Nearly 70 percent of adults over age 65 will need LTC services at some point, and currently Medicaid pays for 40 percent of all LTC spending ($177.6 billion).

Within the Medicare population, nine million older adults are enrolled in both Medicare and Medicaid (and known as “dual eligibles”), representing 21 percent of all Medicare beneficiaries. Half of dual eligibles are in fair or poor health, which is more than twice the rate of other Medicare beneficiaries, and they suffer from a great number of multiple complex, chronic conditions. One of the greatest challenges in maintaining the health of this population is the lack of coordination between Medicare and Medicaid. Due to the absence of incentives for Medicare and Medicaid to work together, health and long-term care services for dual eligible adults, many of whom have multiple complex chronic conditions, are fragmented and poorly organized at best.

Models such as the Program of All-Inclusive Care for the Elderly (PACE) and demonstration programs including the Medicare Advantage Special Needs Plans have sought to address this issue by streamlining the organization, financing and delivery of services for community dwelling dual eligibles (i.e. the PACE program provides and manages medical, social and rehabilitative services by combining Medicare and Medicaid funding streams). However, more data is needed to spell out the impact of these models on quality, cost and effective service delivery, and it is not clear that these small-scale models provide sufficient incentive for Medicare and Medicaid to work together on a broader scale.

When asked, the vast majority of older adults indicate that they would prefer to stay in their own homes and communities for as long as possible. So how do we enable older adults to remain healthy and active, living in the setting of their choosing? By increasing the focus on health and wellness, including preventive care, and by better coordinating care upstream, we can help reduce downstream adverse outcomes such as ED visits, hospitalizations, and, ultimately, nursing home stays. This calls for a more integrated, rational approach to the financing and delivery of health and long term care services for older adults.

More research is needed to generate policy recommendations that address the lack of coordination between Medicare and Medicaid and propose effective solutions. At JSPH, we have recently convened the Healthy Aging Research Team (HART), a research interest group for faculty and staff eager to explore and address the challenges and opportunities associated with our aging population in the context of population health. To learn more about our group, please click here.

Monday, December 20, 2010

Nuts by numbers: Should you eat them, and how much?

Nuts are generally seen as good sources of protein and magnesium. The latter plays a number of roles in the human body, and is considered critical for bone health. Nuts are also believed to be good sources of vitamin E. While there is a lot of debate about vitamin E’s role in health, it is considered by many to be a powerful antioxidant. Other than in nuts, vitamin E is not easily found in foods other than seeds and seed oils.

Some of the foods that we call nuts are actually seeds; others are legumes. For simplification, in this post I am calling nuts those foods that are generally protected by shells (some harder than others). This protective layer is what makes most people call them nuts.

Let us see how different nuts stack up against each other in terms of key nutrients. The quantities listed below are per 1 oz (28 g), and are based on data from All are raw. Roasting tends to reduce the vitamin content of nuts, often by half, and has little effect on the mineral content. Protein and fat content are also reduced, but not as much as the vitamin content.

These two figures show the protein, fat, and carbohydrate content of nuts (on the left); and the omega-6 and omega-3 fat content (on the right).

When we talk about nuts, walnuts are frequently presented in a very positive light. The reason normally given is that walnuts have a high omega-3 content; the plant form of omega-3, alpha-linolenic acid (ALA). That is true. But look at the large amount of omega-6 in walnuts. The difference between the omega-6 and omega-3 content in walnuts is about 8 g! And this is in only 1 oz of walnuts. That is 8 g of possibly pro-inflammatory omega-6 fats to be “neutralized”. It would take many fish oil softgels to achieve that.

Walnuts should be eaten in moderation. Most studies looking at the health effects of nuts, including walnuts, show positive results in short-term interventions. But they usually involve moderate consumption, often of 1 oz per day. Eat several ounces of walnuts every day, and you are entering industrial see oil territory in terms of omega-6 fats consumption. Maybe other nutrients in walnuts have protective effects, but still, this looks like dangerous territory; “diseases of civilization” territory.

A side note. Focusing too much on the omega-6 to omega-3 ratio of individual foods can be quite misleading. The reason is that a food with a very small amount of omega-6 (e.g., 50 mg) but close to zero omega-3 will have a very high ratio. (Any number divided by zero yields infinity.) Yet, that food will contribute little omega-6 to a person’s diet. It is the ratio at the end of the day that matters, when all foods that have been eaten are considered.

The figures below show the magnesium content of nuts (on the left); and the vitamin E content (on the right).

Let us say that you are looking for the best combination of protein, magnesium, and vitamin E. And you also want to limit your intake of omega-6 fats, which is a very wise thing to do. Then what is the best choice? It looks like it is almonds. And even they should be eaten in small amounts, as 1 oz has more than 3 g of omega-6 fats.

Macadamia nuts don’t have much omega-6; their fats are mostly monounsaturated, which are very good. Their protein to fat ratio is very low, and they don’t have much magnesium or vitamin E. Coconuts (i.e., their meat) have mostly medium-chain saturated fats, which are also very good. Coconuts have little protein, magnesium, and vitamin E. If you want to increase your intake of healthy fats, both macadamia nuts and coconuts are good choices, with macadamia nuts providing about 3 times more fat.

There are many other dietary sources of magnesium around. In fact, magnesium is found in many foods. Examples are, in approximate descending order of content: salmon, spinach, sardine, cod, halibut, banana, white potato, sweet potato, beef, chicken, pork, liver, and cabbage. This is by no means a comprehensive list.

As for vitamin E, it likes to hide in seeds. While it may be a powerful antioxidant, I wonder whether Mother Nature really had it “in mind” as she tinkered with our DNA for the last few million years.

Friday, December 17, 2010

Scottish Mental Health Arts and Film Festival 2011


Our annual open film submission gives filmmakers the opportunity to share their work and ideas with audiences across Scotland and internationally. The festival is committed to finding and celebrating the work of filmmakers who explore mental health in film. In its broadest sense ‘mental health’ is a term which touches most aspects of our lives; from our relationships to how we respond to the world around us. We’re looking for films which show that mental health is something we all have, and something we all need to prioritise from time to time.

Previous winning submissions have looked at topics such as moving home, ageing, grief, loss, endurance, support, friendship, equality, sport, music, childhood as well as films about specific diagnoses or conditions.

Entry is free. The closing date for entries is Friday 6th May 2011. Please visit the website for more information. Email for submission guidelines and entry form.

The fifth annual Scottish Mental Health Arts and Film Festival will take place across Scotland throughout October 2011. 

Measuring the Value of Culture: a report to the Department for Culture Media and Sport 
Dr. Dave O’Brien

The cultural sector faces the conundrum of proving its value in a way that can be understood by decision-makers. Arts and cultural organisations face a ‘cooler climate’ than the one that prevailed during the early 2000s. As a result it will not be enough for arts and culture to resort to claiming to be a unique or special case compared with other government sectors. Since the 1980s the value of the cultural sector has been demonstrated through the lens of ‘impact’, whether economic or social. However in recent years there has been recognition, both within central government and in parts of the publically funded cultural sector, of the need to more clearly articulate the value of culture using methods which fit in with central government’s decision-making. Thus the cultural sector will need to use the tools and concepts of economics to fully state their benefits in the prevailing language of policy appraisal and evaluation.

Full report can be found at:  

S C E N A R I O S in Arts and Health
Following on from the ongoing M A N I F E S T O events and building on an emerging, shared vision, MMU will be hosting a free event on the 23rd September 2011 to explore where the arts/health agenda is in relation to the ongoing financial downturn; government changes and cuts; and societal shift, to explore our future practice over a generation. Places will be strictly limited to this event and you can register your interest at (this does not guarantee a place). 

Thursday, December 16, 2010

Maknig to mayn tipos? Myabe ur teh boz

Undoubtedly one of the big differences between life today and in our Paleolithic past is the level of stress that modern humans face on a daily basis. Much stress happens at work, which is very different from what our Paleolithic ancestors would call work. Modern office work, in particular, would probably be seen as a form of slavery by our Paleolithic ancestors.

Some recent research suggests that organizational power distance is a big factor in work-related stress. Power distance is essentially the degree to which bosses and subordinates accept wide differences in organizational power between them (Hofstede, 2001).


I have been studying the topic of information overload for a while. It is a fascinating topic. People who experience it have the impression that they have more information to process than they can handle. They also experience significant stress as a result of it, and both the quality of their work and their productivity goes down.

Recently some colleagues and I conducted a study that included employees from companies in New Zealand, Spain, and the USA (Kock, Del Aguila-Obra & Padilla-Meléndez, 2009). These are countries whose organizations typically display significant differences in power distance. We found something unexpected. Information overload was much more strongly associated with power distance than with the actual amount of information employees had to process on a daily basis.

While looking for explanations to this paradoxical finding, I recalled an interview I gave way back in 2001 to the Philadelphia Inquirer, commenting on research by Dr. David A. Owens. His research uncovered an interesting phenomenon. The higher up in the organizational pecking order one was, the less the person was concerned about typos on emails to subordinates.

There is also some cool research by Carlson & Davis (1998) suggesting that bosses tend to pick the communication media that are the most convenient for them, and don’t care much about convenience for the subordinates. One example would be calling a subordinate on the phone to assign a task, and then demanding a detailed follow-up report by email.

As a side note, writing a reasonably sized email takes a lot longer than conveying the same ideas over the phone or face-to-face (Kock, 2005). To be more precise, it takes about 10 times longer when the word count is over 250 and the ideas being conveyed are somewhat complex. For very short messages, a written medium like email is fairly convenient, and the amount of time to convey ideas may be even shorter than by using the phone or doing it face-to-face.

So a picture started to emerge. Bosses choose the communication media that are convenient for them when dealing with subordinates. If the media are written, they don’t care about typos at all. The subordinates use the media that are imposed on them, and if the media are written they certainly don’t want something with typos coming from them to reach their bosses. It would make them look bad.

The final result is this. Subordinates experience significant information overload, particularly in high power distance organizations. They also experience significant stress. Work quality and productivity goes down, and they get even more stressed. They get fat, or sickly thin. Their health deteriorates. Eventually they get fired, which doesn’t help a bit.

What should you do, if you are not the boss? Here are some suggestions:

- Try to tactfully avoid letting communication media being imposed on you all the time by your boss (and others). Explicitly state, in a polite way, the media that would be most convenient for you in various circusmtances, both as a receiver and sender. Generally, media that support oral speech are better for discussing complex ideas. Written media are better for short exchanges. Want an evolutionary reason for that? As you wish: Kock (2004).

- Discuss the ideas in this post with your boss; assuming that the person cares. Perhaps there is something that can be done to reduce power distance, for example. Making the work environment more democratic seems to help in some cases.

- And ... dot’n wrory soo mach aobut tipos ... which could be extrapolated to: don’t sweat the small stuff. Most bosses really care about results, and will gladly take an email with some typos telling them that a new customer signed a contract. They will not be as happy with an email telling them the opposite, no matter how well written it is.

Otherwise, your organizational demise may come sooner than you think.


Carlson, P.J., & Davis, G.B. (1998). An investigation of media selection among directors and managers: From "self" to "other" orientation. MIS Quarterly, 22(3), 335-362.

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks, CA: Sage.

Kock, N. (2004). The psychobiological model: Towards a new theory of computer-mediated communication based on Darwinian evolution. Organization Science, 15(3), 327-348.

Kock, N. (2005). Business process improvement through e-collaboration: Knowledge sharing through the use of virtual groups. Hershey, PA: Idea Group Publishing.

Kock, N., Del Aguila-Obra, A.R., & Padilla-Meléndez, A. (2009). The information overload paradox: A structural equation modeling analysis of data from New Zealand, Spain and the U.S.A. Journal of Global Information Management, 17(3), 1-17.

Wednesday, December 15, 2010

Guest Commentary: Advocating for Antibiotic Preservation

Tamar Klaiman, PhD, MPH
Assistant Professor
Jefferson School of Population Health

On December 2, 2010, I attended a seminar presented by the Women’s Health & Environment Network (WHEN) funded by the Pew Charitable Trusts titled “Food, Antibiotics, and Public Health: A Call to Action” held at Thomas Jefferson University. The program incorporated a short film and speakers including Meredith Montalto from the Pew Charitable Trusts, Dianne Moore and Teresa Mendez-Quigley from WHEN. The focus of the seminar was the increasingly routine use of antibiotics in the food chain, particularly among farm animals in industrial farming, and its potential impact on antibiotic resistance.

Large industrial farms use antibiotics prophylactically to reduce disease among food animals living in unsanitary conditions. The impact of such routine antibiotic use is that bacterial strains that cause illnesses, from ear infections to tuberculosis, are becoming resistant to medications.

Learning this reiterated the importance of buying locally grown food from family farms as found in farmer’s markets throughout the country. While there is no guarantee that local food is produced without the routine use of antibiotics, the hope is that small, sustainable farms may not require the use of such drugs because they may implement more humane and safe farming practices such as allowing cows to graze, rotating crops, and letting chickens roam outside of their coops.

The most important message I came away with from this seminar is the need to contact legislators about the importance of antibiotic preservation. Currently, there is a bill entitled “Preservation of Antibiotics for Medical Treatment Act” (PAMTA) (H.R. 1549/S. 619), which would require the Food and Drug Administration (FDA) to re-review the approvals it previously issued for animal feed uses of the seven classes of antibiotics that are important to human medicine. Any drugs found to be unsafe from a resistance point of view will have their approvals rescinded.

This bill has support from numerous health organizations such as the American Public Health Association, American Medical Association, and the Union of Concerned Scientists; however, the lame duck Congress may not vote on the bill, requiring the writing of an entirely new bill in the next Congressional session.

If you are interested in learning more about this bill, or signing on to support it, please click here.

Monday, December 13, 2010

Twist Series: Washing & Matting

  • How do you wash your hair when it's twisted?
I use diluted shampoo, do one lather only, and focus on massaging the scalp.  I try not to manipulate the roots and strands much.  This helps to minimize matting.  (When I feel like it, which is rare, I will put my twists into 6-8 plaits prior to washing.)  More details below ...

After every wash, I airdry my twists in two big frenchbraids.  This helps to minimize frizzing.

  • Hi! Thank you so much for the twist series. I'm making a twist regimen of my own and it helps to see yours. I have a question-- When you say "twist for 3 weeks and 1-2 washes", do you mean 1-2 washes after the inital wash (the same day you twist your hair)? I want to avoid matting.
Yes, I do.  After the initial wash/twist day, I usually wait 2 weeks then do my first wash.  On week three,  I do my second wash.  (When I'm able to, I wait the full three weeks then do my first wash.)
  • weekly, i washed my hair in braids (10-15) and detangled every two weeks. most of the time it was fine, but sometimes i found that the base of the plait was matted. i could feel it -- straight + whatever that was + straight.  how do you avoid matting at the base of your twists/plaits?
For my hair, it really comes down to a) how I wash and b) how often I wash.

a) How I wash: The method of washing is more important than how often you wash.  Avoid manipulating the roots much.  I purposely use the shampoo that I use because it lifts the oils/dirt without me having to do much work.  I don't massage the scalp haphazardly while washing.  I kind of do a pinch method ... pinch the base of each twist with my thumb and index finger.  I also focus on cleansing the visible scalp between sections.  (Let me know if this makes sense; otherwise, I'll try to post a photo the next time.)

b) How often I wash: I keep washes to a minimum - about 1-2 washes during a twist session.

"Soul" Food Mondays || Love Is Patient ...

Spread the love this season.  Love is good for the soul!

1 Corinthians 13 (NLT)

1 If I could speak all the languages of earth and of angels, but didn’t love others, I would only be a noisy gong or a clanging cymbal. ...  3 If I gave everything I have to the poor and even sacrificed my body, I could boast about it;[a] but if I didn’t love others, I would have gained nothing.

4 Love is patient and kind. Love is not jealous or boastful or proud 5 or rude. It does not demand its own way. It is not irritable, and it keeps no record of being wronged. 6 It does not rejoice about injustice but rejoices whenever the truth wins out. 7 Love never gives up, never loses faith, is always hopeful, and endures through every circumstance.

What is a reasonable vitamin D level?

The figure and table below are from Vieth (1999); one of the most widely cited articles on vitamin D. The figure shows the gradual increase in blood concentrations of 25-Hydroxyvitamin, or 25(OH)D, following the start of daily vitamin D3 supplementation of 10,000 IU/day. The table shows the average levels for people living and/or working in sun-rich environments; vitamin D3 is produced by the skin based on sun exposure.

25(OH)D is also referred to as calcidiol. It is a pre-hormone that is produced by the liver based on vitamin D3. To convert from nmol/L to ng/mL, divide by 2.496. The figure suggests that levels start to plateau at around 1 month after the beginning of supplementation, reaching a point of saturation after 2-3 months. Without supplementation or sunlight exposure, levels should go down at a comparable rate. The maximum average level shown on the table is 163 nmol/L (65 ng/mL), and refers to a sample of lifeguards.

From the figure we can infer that people on average will plateau at approximately 130 nmol/L, after months of 10,000 IU/d supplementation. That is 52 ng/mL. Assuming a normal distribution with a standard deviation of about 20 percent of the range of average levels, we can expect about 68 percent of the population to be in the 42 to 63 ng/mL range.

This might be the range most of us should expect to be in at an intake of 10,000 IU/d. This is the equivalent to the body’s own natural production through sun exposure.

Approximately 32 percent of the population can be expected to be outside this range. A person who is two standard deviations (SDs) above the mean (i.e., average) would be at around 73 ng/mL. Three SDs above the mean would be 83 ng/mL. Two SDs below the mean would be 31 ng/mL.

There are other factors that may affect levels. For example, being overweight tends to reduce them. Excess cortisol production, from stress, may also reduce them.

Supplementing beyond 10,000 IU/d to reach levels much higher than those in the range of 42 to 63 ng/mL may not be optimal. Interestingly, one cannot overdose through sun exposure, and the idea that people do not produce vitamin D3 after 40 years of age is a myth.

One would be taking in about 14,000 IU/d of vitamin D3 by combining sun exposure with a supplemental dose of 4,000 IU/d. Clear signs of toxicity may not occur until one reaches 50,000 IU/d. Still, one may develop other complications, such as kidney stones, at levels significantly above 10,000 IU/d.

See this post by Chris Masterjohn, which makes a different argument, but with somewhat similar conclusions. Chris points out that there is a point of saturation above which the liver is unable to properly hydroxylate vitamin D3 to produce 25(OH)D.

How likely it is that a person will develop complications like kidney stones at levels above 10,000 IU/d, and what the danger threshold level could be, are hard to guess. Kidney stone incidence is a sensitive measure of possible problems; but it is, by itself, an unreliable measure. The reason is that it is caused by factors that are correlated with high levels of vitamin D, where those levels may not be the problem.

There is some evidence that kidney stones are associated with living in sunny regions. This is not, in my view, due to high levels of vitamin D3 production from sunlight. Kidney stones are also associated with chronic dehydration, and populations living in sunny regions may be at a higher than average risk of chronic dehydration. This is particularly true for sunny regions that are also very hot and/or dry.


Vieth, R. (1999). Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. American Journal of Clinical Nutrition, 69(5), 842-856.

Saturday, December 11, 2010

Strength training: A note about Scooby and comments by Anon

Let me start this post with a note about Scooby, who is a massive bodybuilder who has a great website with tips on how to exercise at home without getting injured. Scooby is probably as massive a bodybuilder as anyone can get naturally, and very lean. He says he is a natural bodybuilder, and I am inclined to believe him. His dietary advice is “old school” and would drive many of the readers of this blog crazy – e.g., plenty of grains, and six meals a day. But it obviously works for him. (As far as muscle gain is concerned, a lot of different approaches work. For some people, almost any reasonable approach will work; especially if they are young men with high testosterone levels.)

The text below is all from an anonymous commenter’s notes on this post discussing the theory of supercompensation. Many thanks to this person for the detailed and thoughtful comment, which is a good follow-up on the note above about Scooby. In fact I thought that the comment might have been from Scooby; but I don’t think so. My additions are within “[ ]”. While the comment is there under the previous post for everyone to see, I thought that it deserved a separate post.


I love this subject [i.e., strength training]. No shortages of opinions backed by research with the one disconcerting detail that they don't agree.

First one opening general statement. If there was one right way we'd all know it by now and we'd all be doing it. People's bodies are different and what motivates them is different. (Motivation matters as a variable.)

My view on one set vs. three is based on understanding what you're measuring and what you're after in a training result.

Most studies look at one rep max strength gains as the metric but three sets [of repetitions] improves strength/endurance. People need strength/endurance more typically than they need maximal strength in their daily living. The question here becomes what is your goal?

The next thing I look at in training is neural adaptation. Not from the point of view of simple muscle strength gain but from the point of view of coordinated muscle function, again, something that is transferable to real life. When you exercise the brain is always learning what it is you are asking it to do. What you need to ask yourself is how well does this exercise correlate with a real life requirements.

[This topic needs a separate post, but one can reasonably argue that your brain works a lot harder during a one-hour strength training session than during a one-hour session in which you are solving a difficult mathematical problem.]

To this end single legged squats are vastly superior to double legged squats. They invoke balance and provoke the activation of not only the primary movers but the stabilization muscles as well. The brain is acquiring a functional skill in activating all these muscles in proper harmony and improving balance.

I also like walking lunges at the climbing wall in the gym (when not in use, of course) as the instability of the soft foam at the base of the wall gives an excellent boost to the basic skill by ramping up the important balance/stabilization component (vestibular/stabilization muscles). The stabilization muscles protect joints (inner unit vs. outer unit).

The balance and single leg components also increase core activation naturally. (See single legged squat and quadratus lumborum for instance.) [For more on the quadratus lumborum muscle, see here.]

Both [of] these exercises can be done with dumbbells for increased strength[;] and though leg exercises strictly speaking, they ramp up the core/full body aspect with weights in hand.

I do multiple sets, am 59 years old and am stronger now than I have ever been (I have hit personal bests in just the last month) and have been exercising for decades. I vary my rep ranges between six and fifteen (but not limited to just those two extremes). My total exercise volume is between two and three hours a week.

Because I have been at this a long time I have learned to read my broad cycles. I push during the peak periods and back off during the valleys. I also adjust to good days and bad days within the broader cycle.

It is complex but natural movements with high neural skill components and complete muscle activation patterns that have moved me into peak condition while keeping me from injury.

I do not exercise to failure but stay in good form for all reps. I avoid full range of motion because it is a distortion of natural movement. Full range of motion with high loads in particular tends to damage joints.

Natural, functional strength is more complex than the simple study designs typically seen in the literature.

Hopefully these things that I have learned through many years of experimentation will be of interest to you, Ned, and your readers, and will foster some experimentation of your own.


Thursday, December 9, 2010

M A N I F E S T O for Arts and Health update...

Dear friends...the first manifesto event was a great success and more sessions are planned for the new year. As a taster and keep you interested, the first group that met in October worked wonders and some of their thoughts and aspirations are here for you to see...but there, is more, much more to follow between now and June.

Networking Evening Events 2011

I’m pleased to announce that the North West Arts and Health Network evenings are continuing through 2011 and the dates below are confirmed, but are of course, subject to change and all updates will be made on the BLOG and Arts for Health main website  
  • January 27th

  • March 24th

  • May 26th

  • July 28th

  • September 29th

  • November 24th

All sessions will be held at Manchester Met between 6:00pm and 8:00pm in a room that will be confirmed in the week prior to the event.
On the January 27th, Bits and Bats evening, I’m going to share some short archive films from the early days of the NHS in the late 1940’s. It’s all good fun and interesting given today’s climate of change. If you have any interesting archival footage that you’d like to share that relates to our Arts/Health agenda, please get in touch.

I’m still very keen for members of the network to influence these sessions and encourage you to send in ideas for themes for the evenings.

...a stimulus

I wonder what are the works of art that inspired you towards this arts/health agenda? Or, do certain works impact on your thinking. I gave a paper recently that explores the relationship between the pharmaceutical industry; the happiness industry and the arts. I had to edit such a lot out of it, and this includes a poem by Philip Larkin called, This Be The Verse, which links very much into my thoughts around the pathologising of depression and dissatisfaction with our lot. I'll leave you to work out any subtleties.

This Be The Verse
They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the thoughts they had
And add some extra, just for you.

But they were fucked up in their turn
By fools in old-style hats and coats,
Who half the time were soppy-stern
And half at one another’s throats.

Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don’t have any kids yourself.

Tuesday, December 7, 2010

Reader's Question: Low Comb Routine

  • Hello! I am currently experimenting with detangling my hair less often. I read that you do a low comb routine. Can you do a post on your detangling routine? How often you detangle? What you use to detangle (conditioners, combs, brushes, etc) What you do between combing sessions (finger comb, etc)?

Great question!  I have a two-part answer that depends on hair length:

(I actually started this routine at APL, but it works for shorter lengths as well.)  When my hair was this length, I comb detangled every 1-3 months.  I would soak my hair in LustraSilk Cholesterol mixed with olive oil for about an hour.  Then I would comb through each section of hair with a wide-tooth comb followed up by a medium-tooth comb.  After I completed each section, I would twist/braid it up, rinse out the conditioner, and proceed to style my hair as usual. Every 1-2 weeks (between comb detangling sessions), I redid my twists and used that opportunity to finger detangle on dry hair.  

I currently detangle about once every 3-4 weeks.  I soak my hair in LeKair Cholesterol mixed with olive oil for about 20-30 minutes.  (As my hair has gotten longer, the ends require just a little bit of protein to remain strong, hence my switch to LeKair.)  Then I run through the ends with a wide-tooth comb followed by a paddle brush from from roots to the ends.  (I use a paddle brush instead of a medium-tooth comb for ease and speed.)  At this length, I no longer finger detangle since my twist styles last from one comb detangling session to the next.

EDITED - MBL and BEYOND: I no longer use a paddle brush.  I only use a wide tooth comb.

I hope this helps!

Monday, December 6, 2010

Pressure-cooked meat: Top sirloin

Pressure cooking relies on physics to take advantage of the high temperatures of liquids and vapors in a sealed container. The sealed container is the pressure-cooking pan. Since the sealed container does not allow liquids or vapors to escape, the pressure inside the container increases as heat is applied to the pan. This also significantly increases the temperature of the liquids and vapors inside the container, which speeds up cooking.

Pressure cooking is essentially a version of high-heat steaming. The food inside the cooker tends to be very evenly cooked. Pressure cooking is also considered to be one of the most effective cooking methods for killing food-born pathogens. Since high pressure reduces cooking time, pressure cooking is usually employed in industrial food processing.

When cooking meat, the amount of pressure used tends to affect amino-acid digestibility; more pressure decreases digestibility. High pressures in the cooker cause high temperatures. The content of some vitamins in meat and plant foods is also affected; they go down as pressure goes up. Home pressure cookers are usually set at 15 pounds per square inch (psi). Significant losses in amino-acid digestibility occur only at pressures of 30 psi or higher.

My wife and I have been pressure-cooking for quite some time. Below is a simple recipe, for top sirloin.

- Prepare some dry seasoning powder by mixing sea salt, garlic power, chili powder, and a small amount of cayenne pepper.
- Season the top sirloin pieces at least 2 hours prior to placing them in the pressure cooking pan.
- Place the top sirloin pieces in the pressure cooking pan, and add water, almost to the point of covering them.
- Cook on very low fire, after the right amount of pressure is achieved, for 1 hour. The point at which the right amount of pressure is obtained is signaled by the valve at the top of the pan making a whistle-like noise.

As with slow cooking in an open pan, the water around the cuts should slowly turn into a fatty and delicious sauce, which you can pour on the meat when serving, to add flavor. The photos below show the seasoned top sirloin pieces, the (old) pressure-cooking pan we use, and some cooked pieces ready to be eaten together with some boiled yam.

A 100 g portion will have about 30 g of protein. (That is a bit less than 4 oz, cooked.) The amount of fat will depend on how trimmed the cuts are. Like most beef cuts, the fat will be primarily saturated and monounsatured, with approximately equal amounts of each. It will provide good amounts of the following vitamins and minerals: iron, magnesium, niacin, phosphorus, potassium, zinc, selenium, vitamin B6, and vitamin B12.

Friday, December 3, 2010

Hair Playlist for the Holidays!

Currently playing: 4 weeks of flat twists into twist-hawk

Sounds like: Willow Smith (whip my hair)

Chorus: Bi-weekly washes, moisturize as needed

Twist Series: How to Flat Twist

More answers coming soon.  Keep the questions coming....

This is my new favorite way to spice up regular twists ... flat twisting!

This is a great tutorial for beginners:

Another great tutorial, and with a style you can imitate: Tutorial #2

Thursday, December 2, 2010

Guest Commentary: SOPHE's Take on Healthy People 2020

Rob Simmons, DrPH, MPH, CHES, CPH
Director, Master of Public Health (MPH) Program
Jefferson School of Population Health

The Society for Public Health Education (SOPHE) annual meeting was held in Denver recently, with the theme “Healthy People 2020, A Look Back, A Look Forward.”

The goal of the meeting was to review progress on the US preventive health agenda since the 1979 inception of the Healthy People national plan for prevention and the creation of the Office of Disease Prevention and Health Promotion (ODPHP) within the Dept. of Health and Human Services (HHS). The meeting also examined changes proposed in the fourth iteration of the initiative, Healthy People 2020, which will be released in early December.

Healthy People 2020 will be quite different from the previous national prevention plans. It will be web-based and directly linked to a range of national digital databases, allowing professionals and the public to search for any health topic and obtain information on related topics in other health areas. Fourteen new health focus areas have been added to the 28 in Healthy People 2010, and over 100 new objectives with data sources have been delineated. Content areas include life stages, dementia, genomics, global health, healthcare infections, preparedness, quality of life, lesbian/gay/bisexual/transgender (LGBT) health, and social determinants of health.

Healthy People 2020 will be a branded “movement” with new communication mechanisms to reach those outside of the healthcare sector as the goals, objectives and actions are integrated into the context of our lives, where we live, learn, work and play.

I was asked to facilitate a town hall meeting about the national prevention and health promotion strategy featured in the Patient Protection and Accountable Care Act (PPACA) and linked to Healthy People 2020. Representatives from HHS and the Centers for Disease Control and Prevention (CDC) provided an overview of the National Prevention Council, which includes representatives from 17 federal departments, 12 federal agencies, and a 25-member community advisory board. he federal representatives were very receptive to commentary received from the group of public health educators at the meeting, and from those who participated online.

I left the SOPHE conference with new inspiration. I can’t wait to share my enthusiasm with colleagues and students when Healthy People 2020 and the National Prevention and Health Promotion Strategy are released early in 2011.

How lean should one be?

Loss of muscle mass is associated with aging. It is also associated with the metabolic syndrome, together with excessive body fat gain. It is safe to assume that having low muscle and high fat mass, at the same time, is undesirable.

The extreme opposite of that, achievable though natural means, would be to have as much muscle as possible and as low body fat as possible. People who achieve that extreme often look a bit like “buff skeletons”.

This post assumes that increasing muscle mass through strength training and proper nutrition is healthy. It looks into body fat levels, specifically how low body fat would have to be for health to be maximized.

I am happy to acknowledge that quite often I am working on other things and then become interested in a topic that is brought up by Richard Nikoley, and discussed by his readers (I am one of them). This post is a good example of that.

Obesity and the diseases of civilization

Obesity is strongly associated with the diseases of civilization, of which the prototypical example is perhaps type 2 diabetes. So much so that sometimes the impression one gets is that without first becoming obese, one cannot develop any of the diseases of civilization.

But this is not really true. For example, diabetes type 1 is also one of the diseases of civilization, and it often strikes thin people. Diabetes type 1 results from the destruction of the beta cells in the pancreas by a person’s own immune system. The beta cells in the pancreas produce insulin, which regulates blood glucose levels.

Still, obesity is undeniably a major risk factor for the diseases of civilization. It seems reasonable to want to move away from it. But how much? How lean should one be to be as healthy as possible? Given the ubiquity of U-curve relationships among health variables, there should be a limit below which health starts deteriorating.

Is the level of body fat of the gentleman on the photo below (from: low enough? His name is Fedor; more on him below. I tend to admire people who excel in narrow fields, be they intellectual or sport-related, even if I do not do anything remotely similar in my spare time. I admire Fedor.

Let us look at some research and anecdotal evidence to see if we can answer the question above.

The buff skeleton look is often perceived as somewhat unattractive

Being in the minority is not being wrong, but should make one think. Like Richard Nikoley’s, my own perception of the physique of men and women is that, the leaner they are, the better; as long as they also have a reasonable amount of muscle. That is, in my mind, the look of a stage-ready competitive natural bodybuilder is close to the healthiest look possible.

The majority’s opinion, however, seems different, at least anecdotally. The majority of women that I hear or read voicing their opinions on this matter seem to find the “buff skeleton” look somewhat unattractive, compared with a more average fit or athletic look. The same seems to be true for perceptions of males about females.

A little side note. From an evolutionary perspective, perceptions of ancestral women about men must have been much more important than perceptions of ancestral men about women. The reason is that the ancestral women were the ones applying sexual selection pressures in our ancestral past.

For the sake of discussion, let us define the buff skeleton look as one of a reasonably muscular person with a very low body fat percentage; pretty much only essential fat. That would be 10-13 percent for women, and 5-8 percent for men.

The average fit look would be 21-24 percent for women, and 14-17 percent for men. Somewhere in between, would be what we could call the athletic look, namely 14-20 percent for women, and 6-13 percent for men. These levels are exactly the ones posted on this Wikipedia article on body fat percentages, at the time of writing.

From an evolutionary perspective, attractiveness to members of the opposite sex should be correlated with health. Unless we are talking about a costly trait used in sexual selection by our ancestors; something analogous to the male peacock’s train.

But costly traits are usually ornamental, and are often perceived as attractive even in exaggerated forms. What prevents male peacock trains from becoming the size of a mountain is that they also impair survival. Otherwise they would keep growing. The peahens find them sexy.

Being ripped is not always associated with better athletic performance

Then there is the argument that if you carried some extra fat around the waist, then you would not be able to fight, hunt etc. as effectively as you could if you were living 500,000 years ago. Evolution does not “like” that, so it is an unnatural and maladaptive state achieved by modern humans.

Well, certainly the sport of mixed martial arts (MMA) is not the best point of comparison for Paleolithic life, but it is not such a bad model either. Look at this photo of Fedor Emelianenko (on the left, clearly not so lean) next to Andrei Arlovski (fairly lean). Fedor is also the one on the photo at the beginning of this post.

Fedor weighed about 220 lbs at 6’; Arlovski 250 lbs at 6’4’’. In fact, Arlovski is one of the leanest and most muscular MMA heavyweights, and also one of the most highly ranked. Now look at Fedor in action (see this YouTube video), including what happened when Fedor fought Arlovski, at around the 4:28 mark. Fedor won by knockout.

Both Fedor and Arlovski are heavyweights; which means that they do not have to “make weight”. That is, they do not have to lose weight to abide by the regulations of their weight category. Since both are professional MMA fighters, among the very best in the world, the weight at which they compete is generally the weight that is associated with their best performance.

Fedor was practically unbeaten until recently, even though he faced a very high level of competition. Before Fedor there was another professional fighter that many thought was from Russia, and who ruled the MMA heavyweight scene for a while. His name is Igor Vovchanchyn, and he is from the Ukraine. At 5’8’’ and 230 lbs in his prime, he was a bit chubby. This YouTube video shows him in action; and it is brutal.

A BMI of about 25 seems to be the healthiest for long-term survival

Then we have this post by Stargazey, a blogger who likes science. Toward the end the post she discusses a study suggesting that a body mass index (BMI) of about 25 seems to be the healthiest for long-term survival. That BMI is between normal weight and overweight. The study suggests that both being underweight or obese is unhealthy, in terms of long-term survival.

The BMI is calculated as an individual’s body weight divided by the square of the individual’s height. A limitation of its use here is that the BMI is a more reliable proxy for body fat percentage for women than for men, and can be particularly misleading when applied to muscular men.

The traditional Okinawans are not super lean

The traditional Okinawans (here is a good YouTube video) are the longest living people in the world. Yet, they are not super lean, not even close. They are not obese either. The traditional Okinawans are those who kept to their traditional diet and lifestyle, which seems to be less and less common these days.

There are better videos on the web that could be used to illustrate this point. Some even showing shirtless traditional karate instructors and students from Okinawa, which I had seen before but could not find again. Nearly all of those karate instructors and students were a bit chubby, but not obese. By the way, karate was invented in Okinawa.

The fact that the traditional Okinawans are not ripped does not mean that the level of fat that is healthy for them is also healthy for someone with a different genetic makeup. It is important to remember that the traditional Okinawans share a common ancestry.

What does this all mean?

Some speculation below, but before that let me tell this: as counterintuitive as it may sound, excessive abdominal fat may be associated with higher insulin sensitivity in some cases. This post discusses a study in which the members of a treatment group were more insulin sensitive than the members of a control group, even though the former were much fatter; particularly in terms of abdominal fat.

It is possible that the buff skeleton look is often perceived as somewhat unattractive because of cultural reasons, and that it is associated with the healthiest state for humans. However, it seems a bit unlikely that this applies as a general rule to everybody.

Another possibility, which appears to be more reasonable, is that the buff skeleton look is healthy for some, and not for others. After all, body fat percentage, like fat distribution, seems to be strongly influenced by our genes. We can adapt in ways that go against genetic pressures, but that may be costly in some cases.

There is a great deal of genetic variation in the human species, and much of it may be due to relatively recent evolutionary pressures.

Life is not that simple!


Buss, D.M. (1995). The evolution of desire: Strategies of human mating. New York, NY: Basic Books.

Cartwright, J. (2000). Evolution and human behavior: Darwinian perspectives on human nature. Cambridge, MA: The MIT Press.

Miller, G.F. (2000). The mating mind: How sexual choice shaped the evolution of human nature. New York, NY: Doubleday.

Zahavi, A. & Zahavi, A. (1997). The Handicap Principle: A missing piece of Darwin’s puzzle. Oxford, England: Oxford University Press.

Guest Commentary: Reflections from the APHA 138th Annual Meeting “Social Justice: A Public Health Imperative”

Rob Simmons, DrPH, MPH, CHES, CPH
Director, Master of Public Health (MPH) Program
Jefferson School of Population Health

The American Public Health Association (APHA) annual meeting was held a couple of weeks ago with the theme of 'Social Justice: A Public Health Imperative.' A pall hung over the large amphitheater as APHA celebrated its annual meeting. Reeling from the national midterm elections and fear that the priority and resources in federal revenues for public health prevention and health promotion gained over the previous 18 months would be lost with the new Congress in January, the conference theme of “social justice” seemed most appropriate for the over 10,000 public health professionals and students who gathered in Denver.

The opening speeches by public health dignitaries resounded in their vigor to rally participants to work hard to support public health and conduct and report on research evidence showing that prevention and an investment of federal resources for the public health infrastructure will improve the nation’s health and save millions in reduced health care costs.

Howard Koh, Assistant Secretary for the U.S. Department of Health and Human Services (HHS), provided much of that evidence and encouraged participants to continue their passionate involvement in the process. Cornell West, of the Center for African American Studies and Department of Religion at Princeton University, delivered an incredible sermon summarizing our history of social injustices and necessary actions at all levels of society to achieve equal opportunity for all. These talks set the stage for three days of meetings to plan to do just that.

Some of the significant trends among the many sessions I attended included:

• A growing interest in the creation of health literacy policy and program initiatives in the healthcare and community health environments

• The burgeoning movement in undergraduate public health education, the creation of undergraduate public health majors and minors and infusion of a public health framework in undergraduate liberal arts education

• Increasing interest in global health education, service and research and its implications for our work in the School of Population Health

Finally, I had the pleasure of attending presentations on important public health issues made by two current Jefferson MPH students and two recent MPH alumni. They certainly made us proud.

Sunday, November 28, 2010

HealthCorrelator for Excel 1.0 (HCE): Call for beta testers

This call is closed. Beta testing has been successfully completed. HealthCorrelator for Excel (HCE) is now publicly available for download and use on a free trial basis. For those users who decide to buy it after trying, licenses are available for individuals and organizations.

To download a free trial version – as well as get the User Manual, view demo YouTube videos, and download and try sample datasets – visit the web site.

Tuesday, November 23, 2010

Guest Commentary: NBCH - Health Reform or Business As Usual?

Robert Lieberthal, BA
Jefferson School of Population Health

Recently, I attended National Business Coalition on Health's 15th annual conference. The NBCH is a national organization consisting of local business groups on health around the country. The local groups are made up of mostly mid to large sized employers who are big purchasers of healthcare and who want to get more value from their healthcare dollars.

The main impression that I got from the assembled employers and local business groups is that they are staying the course. Their main motivations for implementing population health programs – rising medical costs and the desire for a healthier work force – haven't gone away.

Major changes in the Patient Protection and Affordable Care Act (PPACA), such as first-dollar coverage for preventive services and the excise tax for high cost health plans, will only push employers more toward wellness programs and preventive medicine in the hopes of complying with current law and avoiding the consequences of having a high cost population.

Employers recognize that the PPACA didn't fundamentally change the health insurance system for large employers, and they are betting that future changes won't fundamentally affect their benefit structure, either. It was a good reminder that the huge shift on the provider side isn't mirrored by big changes for private payers.

Monday, November 22, 2010

Human traits are distributed along bell curves: You need to know yourself, and HCE can help

Most human traits (e.g., body fat percentage, blood pressure, propensity toward depression) are influenced by our genes; some more than others. The vast majority of traits are also influenced by environmental factors, the “nurture” part of the “nature-nurture” equation. Very few traits are “innate”, such as blood type.

This means that manipulating environmental factors, such as diet and lifestyle, can strongly influence how the traits are finally expressed in humans. But each individual tends to respond differently to diet and lifestyle changes, because each individual is unique in terms of his or her combination of “nature” and “nurture”. Even identical twins are different in that respect.

When plotted, traits that are influenced by our genes are distributed along a bell-shaped curve. For example, a trait like body fat percentage, when measured in a population of 1000 individuals, will yield a distribution of values that will look like a bell-shaped distribution. This type of distribution is also known in statistics as a “normal” distribution.

Why is that?

The additive effect of genes and the bell curve

The reason is purely mathematical. A measurable trait, like body fat percentage, is usually influenced by several genes. (Sometimes individual genes have a very marked effect, as in genes that “switch on or off” other genes.) Those genes appear at random in a population, and their various combinations spread in response to selection pressures. Selection pressures usually cause a narrowing of the bell-shaped curve distributions of traits in populations.

The genes interact with environmental influences, which also have a certain degree of randomness. The result is a massive combined randomness. It is this massive randomness that leads to the bell-curve distribution. The bell curve itself is not random at all, which is a fascinating aspect of this phenomenon. From “chaos” comes “order”. A bell curve is a well-defined curve that is associated with a function, the probability density function.

The underlying mathematical reason for the bell shape is the central limit theorem. The genes are combined in different individuals as combinations of alleles, where each allele is a variation (or mutation) of a gene. An allele set, for genes in different locations of the human DNA, forms a particular allele combination, called a genotype. The alleles combine their effects, usually in an additive fashion, to influence a trait.

Here is a simple illustration. Let us say one generates 1000 random variables, each storing 10 random values going from 0 to 1. Then the values stored in each of the 1000 random variables are added. This mimics the additive effect of 10 genes with random allele combinations. The result are numbers ranging from 1 to 10, in a population of 1000 individuals; each number is analogous to an allele combination. The resulting histogram, which plots the frequency of each allele combination (or genotype) in the population, is shown on the figure bellow. Each allele configuration will “push for” a particular trait range, making the trait distribution also have the same bell-shaped form.

The bell curve, research studies, and what they mean for you

Studies of the effects of diet and exercise on health variables usually report their results in terms of average responses in a group of participants. Frequently two groups are used, one control and one treatment. For example, in a diet-related study the control group may follow the Standard American Diet, and the treatment group may follow a low carbohydrate diet.

However, you are not the average person; the average person is an abstraction. Research on bell curve distributions tells us that there is about a 68 percentage chance that you will fall within a 1 standard deviation from the average, to the left or the right of the “middle” of the bell curve. Still, even a 0.5 standard deviation above the average is not the average. And, there is approximately a 32 percent chance that you will not be within the larger -1 to 1 standard deviation range. If this is the case, the average results reported may be close to irrelevant for you.

Average results reported in studies are a good starting point for people who are similar to the studies’ participants. But you need to generate your own data, with the goal of “knowing yourself through numbers” by progressively analyzing it. This is akin to building a “numeric diary”. It is not exactly an “N=1” experiment, as some like to say, because you can generate multiple data points (e.g., N=200) on how your body alone responds to diet and lifestyle changes over time.

HealthCorrelator for Excel (HCE)

I think I have finally been able to develop a software tool that can help people do that. I have been using it myself for years, initially as a prototype. You can see the results of my transformation on this post. The challenge for me was to generate a tool that was simple enough to use, and yet powerful enough to give people good insights on what is going on with their body.

The software tool is called HealthCorrelator for Excel (HCE). It runs on Excel, and generates coefficients of association (correlations, which range from -1 to 1) among variables and graphs at the click of a button.

This 5-minute YouTube video shows how the software works in general, and this 10-minute video goes into more detail on how the software can be used to manage a specific health variable. These two videos build on a very small sample dataset, and their focus is on HDL cholesterol management. Nevertheless, the software can be used in the management of just about any health-related variable – e.g., blood glucose, triglycerides, muscle strength, muscle mass, depression episodes etc.

You have to enter data about yourself, and then the software will generate coefficients of association and graphs at the click of a button. As you can see from the videos above, it is very simple. The interpretation of the results is straightforward in most cases, and a bit more complicated in a smaller number of cases. Some results will probably surprise users, and their doctors.

For example, a user who is a patient may be able to show to a doctor that, in the user’s specific case, a diet change influences a particular variable (e.g., triglycerides) much more strongly than a prescription drug or a supplement. More posts will be coming in the future on this blog about these and other related issues.