Friday, July 29, 2011

Guest Commentary: It’s Always Sunny in Philadelphia



Alexis Skoufalos, EdD
Associate Dean for Continuing Professional Education
Jefferson School of Population Health

Thursday, July 21st was sunny and stiflingly hot – one of the most brutal summer days we’ve experienced in Philadelphia in many years. And yet, over 150 of JSPH’s colleagues came together on the Jefferson campus to share with us their thoughts about important issues in population health.

In an odd way, it was a birthday party of sorts. July marks JSPH’s birthday month – it was only 3 years ago that we toasted the beginning of our journey to create a new school dedicated to educating leaders that would help us improve the quality of health and health care in America.

In that time, we’ve developed new academic programs, published two books, convened multiple conferences, conducted cutting-edge research, added stellar new leaders, faculty and staff to our team, and encouraged some of our most valued colleagues as they moved on to new endeavors.

In 3 short years, we have assembled a diverse and talented team with a passion for making meaningful change. The challenges we face have only become more complex in the last few years, and the stakes have never been higher.

While we have much to celebrate, there is so much more to do. And we can’t do it alone; we need to hear from you about the type information you need, the challenges you face that we can help address, and the programs we should focus on in the future.

We are committed to making a world of difference in health care. Let us know how we can help you by contacting any one of the leaders listed below.

JSPH Program Contacts:

Caroline Golab, PhD
Associate Dean, Academic and Student Affairs
(215) 503-8468
caroline.golab@jefferson.edu

Joseph D. Jackson, PhD
Program Director, Applied Health Economics and Outcomes Research
(215) 955-4755
joseph.jackson@jefferson.edu

Kathryn M. Kash, PhD
Program Director, Chronic Care Management
(215) 955-9549
kathryn.kash@jefferson.edu

Mark Legnini, DrPH
Director, Center for Value in Healthcare
(215) 955-0427
mark.legnini@jefferson.edu

David B. Nash, MD, MBA
Dean, Jefferson School of Population Health
(215) 955-6969
david.nash@jefferson.edu

James Pelegano, MD, MS
Program Director, Healthcare Quality and Safety
(215) 955-3888
james.pelagano@jefferson.edu

Rob Simmons, DrPH, MPH, MCHES, CPH
Program Director, Public Health
(215) 955-7312
rob.simmons@jefferson.edu

Alexis Skoufalos, EdD
Associate Dean for Continuing Professional Education
(215) 955-2822
alexis.skoufalos@jefferson.edu

Wednesday, July 27, 2011



It’s difficult to write anything meaningful following such a terrible event in Norway. So, a succinct blog this week, with no glib photographs.


ANOTHER BLACK DOG
Sane is celebrating its 25th anniversary this month and, to mark the occasion, it will be continuing the fight to beat the taboos surrounding mental illness by producing larger-than-life-size sculptures of dogs that its founder and chief executive, Marjorie Wallace, hopes will be sponsored by companies, schools and individuals and put in prominent positions up and down the country. Details at:
http://www.guardian.co.uk/society/2011/jul/24/mental-health-black-dog-sculpture-campaign
http://www.sane.org.uk/what_we_do/black_dog/

Regular readers of this blog will know that DADAA are supporting the Black Dog Day Drop, and more details can be found at:
http://blackdogdaydrop.blogspot.com


MEASURING WHAT MATTERS
National Statistician's Reflections on the National Debate on Measuring National Well-being

I had the pleasure of sitting on a panel that was part of the Office for National Statistics debate at Bolton University this year, and so was excited to get first sight of the reflections on this national debate. Whilst there is no explicit sign of creativity, culture and the arts in this narrative as yet, it is important we stay connected with this ongoing process in the development of what the coalition government will see as a methodologies for measuring well-being (and understanding it).

Available in Welsh and English at:
http://www.statistics.gov.uk/cci/article.asp?ID=2718


PUBLIC COLLECTIONS FOR PUBLIC HEALTH: MUSEUMS, HEALTH AND WELL-BEING
A workshop
Wednesday 21 September 2011, 2pm-5pm Manchester Art Gallery

Much museum practice in the field of health and wellbeing has been to run projects with clinical health partners. The workshop will discuss how this work can be extended. We believe that the health promoting resources of museums can be made available to a broader but still targeted population through working with colleagues from public health and other fields.

Free but you need to book a place with k.athey@manchester.org.uk 0161 235 8825  We will confirm whether you have a place.
For further information contact m.trustram@manchester.org.uk 0161 235 8849

Monday, July 25, 2011

Laser surgery for myopia early in life may create reading problems after 40

Shortsightedness, or myopia, seems to be endemic in urban populations. The National Institutes of Health suggests that myopia cannot be prevented, and that neither reading nor watching television causes myopia. I find that doubtful, as reading is a rather unnatural activity, and there is evidence that myopia is significantly associated with amount of reading at early ages.

(Source: WebMD.com)

Trying to avoid reading early in life would not be a highly recommended Paleolithic-mimicking choice, except for those who later decide to live among hunter-gatherers. (In spite of our romantic views of hunter-gatherer life, it is very rare to see an urbanite do this outside the context of anthropological studies.) Education requires a lot of reading, and without education in urban environments one is likely to end up suffering from other diseases of civilization. Diabetes, for example, is strongly and inversely associated with education level in urban environments.

Also, keeping up with friends on Facebook, without which life as we know it now could go on, requires a lot of reading and writing.

A different theory, often associated with Cordain, is that myopia is due to consumption of industrial carbohydrate-rich foods. Interestingly, according to Cordain and colleagues, myopia is typically accompanied by higher stature, a finding that is supported by empirical evidence. The idea here is that industrial carbohydrate-rich foods promote abnormal growth patterns during developmental stages, which arguably include abnormal growth of the human eye and its various structures.

Avoiding industrial carbohydrate-rich foods during developmental stages is feasible, but currently very difficult given public health policies that strongly promote the consumption of some of those foods, during development stages, as healthy choices (e.g., cereals). In part as a result of those policies, and also due to budget constraints (those foods tend to be generally cheap), industrial carbohydrate-rich foods are frequently served as meals in schools.

Okay, now to the main topic of this post. Let us say a person has myopia, should he or she fix it surgically?

As one ages, the ability to read at a short-distance (as in reading from books, or from a computer screen) goes down, because the ability to focus on short-distance objects becomes impaired. This phenomenon is called presbyopia, and is also associated with excessive reading. Therefore it could be called a disease of civilization as well. Most college professors at the level of Associate Professor and higher I know (that is, older folks, like me) have developed it, sometimes as early as in their late 30s.

In the general population, normally presbyopia sets in between 40 and 50 years of age, requiring the use of "reading glasses" afterwards … except for those with myopia. This is sometimes called the “myopia payoff of presbyopia”. People with myopia are often able to read well, without the help of glasses, after presbyopia sets in. The reason is that myopia essentially opposes presbyopia at short distances.

Someone with myopia will still have it after presbyopia sets in, and thus will have difficulty seeing at long distances, but will frequently be able to read well at short distances.

So, if you undergo eye laser surgery (the most common type) to correct myopia early in life, you may create reading problems after 40.

P.S.: A friend of mine who has been studying this tells me that eye problems in general are caused by avoidance of indirect sunlight. I am planning on looking into this more deeply in the future.

Wednesday, July 20, 2011

Potter v Murdoch; the Numinous; Networking Event; Arts and Mental Health diary date; BBC Radio 4 and Open Public Services

ONE FROM THE GRAVE TO MR MURDOCH
Some of you may have heard me give a full version of my paper on the Big Society: Arts, Health and Well-being at the nalgao conference last year. In my presentation, I gave an account of the interview between the terminally-ill playwright Dennis Potter and Melvyn Bragg. I share this clip with you in light of the controversy over News Corp and the phone hacking ‘scandal’ (does it really surprise you?)and to remind us that Potter’s ideas are as relevant now as they were then.


On the NUMINOUS
Sveiki atvykę - mūsų skaitytojams Lietuvoje (Thanks to S)

A few months ago I heard the term numinous used in relation to nature and the arts; in particular as a way of describing that feeling we sometimes get when we’re moved by something that blows our minds, or in some way fills us full of awe. This sensation, which I’d suggest doesn’t happen often, when it does, is like really seeing something remarkable for the first time. It could be the beauty of a landscape that’s transformed by the right conditions (think: a giant silver ball of a moon; a cornfield gently swaying on the warmest of breezes; all the wonderful insect sounds of a mid-summers starry night, and the cool hand of someone you love in yours)1…or equally, that feeling of sheer exhilaration when you are immersed deeply in the climactic moment of a book, a film or a play when, oblivious to all others, a tear of pure tragedy or joy escapes your normally retentive eyes: symphonic bliss!



Sadly, this feeling escapes me all too often, and surrounded as I am by the trappings of consumerist superficiality, I frequently miss this temporal euphoria or sometimes, transient fear.2

In an engaging film of an un-moderated 2-hour discussion, Richard Dawkins and others debate, amongst other things, the possibility of differentiating the numinous from the supernatural and reclaiming it from its religious roots. This thing we feel, the sublime moment that exposes us to our sense of being, is typically seen as a gift from God. The twentieth century theologian Rudolf Otto divided the numinous into two parts: mysterium tremendum, which is the tendency to invoke fear and trembling; and mysterium fascinans, the tendency to attract, fascinate and compel.

Contemporary definitions define the numinous in relationship to a supernatural presence; the sublime; spiritual; sacred and transcendent. But if we are to understand the numinous in relation to the individual, isn’t it useful to separate the supernatural from the numinous? Is religion the only way of making sense of these rare and heightened moments?


Might it be that this experience is simply part of our neurology? –and if it is a heady mix of the social and the chemical, does removal of the supernatural diminish the meaning? I’m sure those of you who have dabbled in the illicit intoxicating world of Lysergic Acid Diethylamide may have an understanding of the chemically induced version of the numinous, as will those of you who have for other reasons, a fluctuation in your chemical balance. I think here, of our sometime giants of the arts world, who have been affected by precarious health and yet, have illuminated much of our thinking.


I’ve had the opportunity to share this notion of the numinous on my travels over the last few months, and responses to it have been varied, from dead-eyed incomprehension to complete recognition. For me, it’s useful for us to develop the ways in which we understand the reach of the arts and its occasional profound impact. Too often, the arts can be bland and prescriptive, offering mild distractions from our day-to-day reality, but once in a while, I’ll hear a story of an event, or moment that has had an overwhelming effect on an individual or group.

Last week, in what could have been a dull steering group meeting, a consultant in pediatric intensive care recounted the way in which the arts had rescued a young man from the darkest of suicidal thoughts, brought on by serious, life limiting disease. Through a moment of deep creative engagement, this young man had, had a lifeline thrown to him that had nothing to do with his illness; that transcended his frustration and fear, and illuminated the possibilities of life beyond the confines of sickness.


Did this young man have a numinous experience? – I have no doubt at all that he did. Do we have the evidence of this experience and its impact? – Of course not: that is the nature of our work. He wasn’t wired up to an EEG, ECG or a CT Scanner. Neither bloods, nor saliva were taken to scrutinize for raised levels of serotonin. And although a part of me would be thrilled to see those affirming areas of the brain sparkle and shine at moments of pure bliss, it would be an unnecessary health burden and entirely counter-intuitive.

Our semantics and the way we discuss the impact of the arts on health and wider society, means we should constantly explore what it is we believe and understand about our practice and its reach. By distinguishing the numinous from the supernatural, and articulating impact without making claims for miracles, we enrich our arts/health agenda.

1. Cheesy I know, but it is real and you do get the point?
2. Being driven by a friend across a desert the size of the UK in Central Australia, I woke from a slumber to whiteness as far as the eye could see. This vast, impossibly bright sand-scape was only punctuated by startling pillars of sand which rose high into the distant sky. I later learnt that these were part of a sand-storm heading in our direction. The experience was terrifying and exhilarating and the humbling product of the natural elements.


NETWORKING EVENT on THURSDAY 28th JULY
Due to circumstances beyond my control, the networking evening planned for next Thursday evening had been cancelled. Sorry for this, and normal service will be resumed as soon as possible!

ARTS, MENTAL HEALTH and WELL-BEING EVENT 
Thursday 20th October,
Manchester Metropolitan University, Oxford Road


This event is being planned between the Greater Manchester Arts and Health Network and Arts for Health at MMU and isn’t a day of passive listening day, but one of moving this agenda on through learning and action.
Confirmed speaker/facilitators include:

Psychologist, Dorothy Rowe on Depression and Imagination
Mark O’Neill (Glasgow Life) on Cultural attendance and Public Mental  Health

We are currently discussing Artists input and Early Years input for the event, and will provide details shortly.
Please put this date in your diary, but remember putting this in your diary doesn’t guarantee you a place.



SIDE EFFECTS, BBC RADIO 4, SUNDAY 24th JULY
Written and Presented by CHRISTIE DICKASON
An Episode of Something Understood
At 6:05 am and 11:30 pm 
(And for a week thereafter on BBC R4 'Listen Again' at any time!)
An intriguing exploration of the unexpected interactions of art and illness

OPEN PUBLIC SERVICES 
White Paper published
The Government published its much anticipated Open Public Services White Paper this week which presses for radical changes to public services. New measures will see public services markets open up, users given more control, and the encouragement of innovation to drive better services for all, which will encourage a wider range of providers of many public services.

The paper has classified the delivery of public services into three categories: individual services, neighbourhood services and commissioned services, with power devolved to those levels, accordingly. Some of the main headlines so far include: proposals allowing communities to bid to run services, a legally enforceable “right to choose” services and proposals allowing for providers of some services to make profits for delivering results. The paper is extensive and covers a plethora of services across the country and, of course, forms part of the Government’s wider Big Society agenda.


In November the Government will set out how departments will put the principles into practice to open up public services over the parliament, including proposals for legislation. From April 2012 departments will publish regular progress reports on the steps taken to open public services.

There will be a listening period between July and September 2011. To add your voice click here. To read BBC coverage of the main proposals please click here
(Source: NCA News via Arts Development Ezine Issue 8)


‘To be shaken out of the ruts of ordinary perception, to be shown for a few timeless hours the outer and inner world, not as they appear to an animal obsessed with survival or to a human being obsessed with words and notions, but as they are apprehended, directly and unconditionally, by the Mind at Large – this is an experience of inestimable value to everyone…’
Aldous Huxley, The Doors of Perception, 1954

Monday, July 18, 2011

Dietary protein does not become body fat if you are on a low carbohydrate diet

By definition LC is about dietary carbohydrate restriction. If you are reducing carbohydrates, your proportional intake of protein or fat, or both, will go up. While I don’t think there is anything wrong with a high fat diet, it seems to me that the true advantage of LC may be in how protein is allocated, which seems to contribute to a better body composition.

LC with more animal protein and less fat makes particularly good sense to me. Eating a variety of unprocessed animal foods, as opposed to only muscle meat from grain-fed cattle, will get you that. In simple terms, LC with more protein, achieved in a natural way with unprocessed foods, means more of the following in one's diet: lean meats, seafood and vegetables. Possibly with lean meats and seafood making up more than half of one’s protein intake. Generally speaking, large predatory fish species (e.g., various shark species, including dogfish) are better avoided to reduce exposure to toxic metals.

Organ meats such as beef liver are also high in protein and low in fat, but should be consumed in moderation due to the risk of hypervitaminosis; particularly hypervitaminosis A. Our ancestors ate the animal whole, and organ mass makes up about 10-20 percent of total mass in ruminants. Eating organ meats once a week places you approximately within that range.

In LC liver glycogen is regularly depleted, so the amino acids resulting from the digestion of protein will be primarily used to replenish liver glycogen, to replenish the albumin pool, for oxidation, and various other processes (e.g., tissue repair, hormone production). If you do some moderate weight training, some of those amino acids will be used for muscle growth.

In this sense, the true “metabolic advantage” of LC, so to speak, comes from protein and not fat. “Calories in” still counts, but you get better allocation of nutrients. Moreover, in LC, the calorie value of protein goes down a bit, because your body is using it as a “jack of all trades”, and thus in a less efficient way. This renders protein the least calorie-dense macronutrient, yielding fewer calories per gram than carbohydrates; and significantly fewer calories per gram when compared with dietary fat and alcohol.

Dietary fat is easily stored as body fat after digestion. In LC, it is difficult for the body to store amino acids as body fat. The only path would be conversion to glucose and uptake by body fat cells, but in LC the liver will typically be starving and want all the extra glucose for itself, so that it can feed its ultimate master – the brain. The liver glycogen depletion induced by LC creates a hormonal mix that places the body in fat release mode, making it difficult for fat cells to take up glucose via the GLUT4 transporter protein.

Excess amino acids are oxidized for energy. This may be why many people feel a slight surge of energy after a high-protein meal. (A related effect is associated with alcohol consumption, which is often masked by the relaxing effect also associated with alcohol consumption.) Amino acid oxidation is not associated with cancer. Neither is fat oxidation. But glucose oxidation is; this is known as the Warburg effect.

A high-protein LC approach will not work very well for athletes who deplete major amounts of muscle glycogen as part of their daily training regimens. These folks will invariably need more carbohydrates to keep their performance levels up. Ultimately this is a numbers game. The protein-to-glucose conversion rate is about 2-to-1. If an athlete depletes 300 g of muscle glycogen per day, he or she will need about 600 g of protein to replenish that based only on protein. This is too high an intake of protein by any standard.

A recreational exerciser who depletes 60 g of glycogen 3 times per week can easily replenish that muscle glycogen with dietary protein. Someone who exercises with weights for 40 minutes 3 times per week will deplete about that much glycogen each time. Contrary to popular belief, muscle glycogen is only minimally replenished postprandially (i.e., after meals) based on dietary sources. Liver glycogen replenishment is prioritized postprandially. Muscle glycogen is replenished over several days, primarily based on liver glycogen. It is one fast-filling tank replenishing another slow-filling one.

Recreational exercisers who are normoglycemic and who do LC intermittently tend to increase the size of their liver glycogen tank over time, via compensatory adaptation, and also use more fat (and ketones, which are byproducts of fat metabolism) as sources of energy. Somewhat paradoxically, these folks benefit from regular high carbohydrate intake days (e.g., once a week, or on exercise days), since their liver glycogen tanks will typically store more glycogen. If they keep their liver and muscle glycogen tanks half empty all the time, compensatory adaptation suggests that both their liver and muscle glycogen tanks will over time become smaller, and that their muscles will store more fat.

One way or another, with the exception of those with major liver insulin resistance, dietary protein does not become body fat if you are on a LC diet.

Saturday, July 16, 2011

More on Accountable Care Organizations



The Jefferson School of Population Health just finished hosting a special two day invitation only advisory board on the current status of Health Reform. We had one dozen experts from all around the nation convene on our campus for a two day discussion of the details and an update on implementation challenges. It was sobering indeed!! At this juncture, I believe that most organizations are NOT culturally ready for the hard work of true accountability.The heart of a real ACO, whether with Medicare or commercial patients, is the realization that clinicians will have to self evaluate, measure what they do everyday, and be willing to engage in the gut bustingly difficult work of improvement. The "shared savings" may in fact be minimal, especially in the early stages. It will take a commitment to practicing based on the evidence and a willingness to benchmark performance against regional and national leaders. A tall order for any organization and in my view, most are not at all ready for this cultural paradigm shift. Who will make it---organizations with a hierarchical doctor culure, accustomed to profiling and willing to police members within their own ranks. The Ochsners, Geisingers and Mayos of the world will be able to make it work, very few others have the skill sets necessary at this juncture. Stay tuned for more posts from our amazing advisory board and for publications that will come from our deliberations together. DAVID NASH

Friday, July 15, 2011

Networking, New Opportunities, the News of the World and Dance



Mi hoffwn ddweud diolch yn fawr iawn wrth bawb yn Rhuthun a Chaerdydd roeddent oll mor groesawus. Mae'r gwaith 'da chi'n ei wneud yn anhygoel ac rwyf yn gobeithio y gallwn weithio gyda'n gilydd yn y dyfodol. Os y gallaf eich cefnogi mewn unrhyw fodd, yn enwedig i alluogi rhwydweithio rhwng pobl o'r un feddwl, yna cysylltwch a mi...Clive


ENGAGE
Over the last couple of years, I’ve had the pleasure of working with a range of people involved in museums and galleries and who see the potential reach of their work on well-being. Renaissance North West and the Museum of Modern Art in New York are two such organisations that are leading the way and I’d urge any of you not aware of their work to have a look.

This week I’ve been working with colleagues in Engage Cymru at the Ruthin Craft Centre and National Museum and Gallery in Cardiff on their excellent engage programme. As well as being inspired by the people and projects, I’m increasingly aware of the pockets of excellence that take place in diverse communities, that if I hadn’t had the good fortune to learn about on these occasions, I’d never know about.

And it seems when I meet these inspiring people/projects, they all feel that they are somehow, small-fry; not part of the bigger picture…and the truly exciting thing for me (with some bloated egos tossed to one side for a moment), is that these pockets of excellence are not only happening in Wales and England*, but all over the world. I’ve seen tiny projects in Australia as well as the big ones and recently heard visionary stories of work in South Africa and truly ground breaking work in communities in the USA.

I recently heard Mike White describe this movement as 'a small scale global phenomenon’, to which I am deeply indebted. This sums us up, doesn’t it?

The conversations I’ve had inevitably come round to training, finances and more often than not networking.

I for one, am really keen that our networking opportunities aren’t hampered by bureaucracy: language: egos or imaginary boundaries. Technology increasingly means that we can communicate with each other regardless of distance, and with our idiosyncratic google translator (to some extent), regardless of language differences too. So, do you want to network and explore some of these issues further and like me, do you think we can do this without being hung up on obstacles. Get in touch, make suggestions and lets explore what is possible.

*I don’t really need to tell you how much groundbreaking work’s happening in Scotland and Ireland do I?…just look at the Bealtaine Festival for a starter, or perhaps if your child is poorly the Royal Aberdeen Children’s Hospital might be conducive to a speedy recovery…or the Maggies Centre’s…the list in these two countries is endless.

ARTS AT THE HEART
For the latest copy of Arts Development UK magazine (formerly nalgao) go to:
http://artsdevelopmentuk.org/resources/magazine


MEDICAL NOTES
The Royal Northern College of Music are looking for an experienced evaluator for our Youth Music funded Medical Notes project at Royal Manchester Children’s Hospital. Please find all details in the attached brief. Deadline for the submission of expression of interest is Monday 1 August 2011 at 10am. Interviews will be held in the week commencing 5 September.
http://www.rncm.ac.uk/component/content/article/73/100.html


CHESHIRE DANCE
CALL for 10 Facilitators with teaching and training experience for PAID contracts

There are 10 exciting facilitator roles in this project, apply if you have:
  • Experience in facilitating specific community groups with different specialism’s
  • Experience creating work for and engaging with community groups
  • 3 – 5 years of professional practice
10 facilitator contracts are available ranging from £2,500 - £4,500 (20 – 40 days, dependent on skills, experience / funding) Shadowing opportunities will also be available with this work.

Please e-mail info@cheshiredance.org or call 01606 861770 for an application pack and return this to us by 5pm Thursday 18th August 2011

Interviews will be on 24th and 25th August 2011. http://www.cheshiredance.org/ 

Whilst we're all keen to have a go at the Murdoch empire, don't we need to examine our own appetite for the salacious and popularist, fed by consumerism and the 'free market'? This new article by Christopher Hitchens examines our hypocrisy.

It took another dog to eat Murdoch’s dog
“It is Sunday afternoon, preferably before the war. The wife is already asleep in the armchair, and the children have been sent out for a nice long walk. You put your feet up on the sofa, settle your spectacles on your nose, and open the News of the World. In these blissful circumstances, what is it that you want to read about? Naturally, about a murder.” – George Orwell, Decline of the English Murder
...thanks Sally!!!
These '...characters, are consciously “slumming” it by picking up a newspaper that was intended for the less-literate elements of the proletariat. But for decades, in fact since well back into the mid-Victorian epoch, Britain’s News of the World was the winning formula for the depiction of crime and squalor and vice. The brilliance of the formula lay in its venerable hypocrisy; actually in two distinct kinds of venerable hypocrisy...'

ON THE TRAIL OF THE BLACK DOG...




...but just where is it?


Monday, July 11, 2011

Fasting for 24 hours and ending up with a bigger waist!? This may be a sign that you are losing abdominal fat

This is such a common phenomenon that you’d expect to see it discussed more often – people fasting for a non-negligible number of hours and ending up with a bigger waist. However, it is very difficult to find anything published on it. (Lyle McDonald discussed a related phenomenon on this post on whooshes and squishy fat.) I am not talking about only a perceived bigger waist; I am talking about measurably bigger. This frequently happens with folks who were obese, lost a lot of body fat, and are trying to get rid of the stubborn lower abdominal fat.

(Source [ironically]: Gograins.com.au)

Fasting and ending up with a bigger waist; how is that possible?

Contrary to popular belief, this is very unlikely to be due to the body turning muscle protein into glucose, and then converting that glucose into fat for storage in fat cells around the waist. When you are fasting, one factor strongly opposes that transformation. The body is in net body fat release mode, due in part to low circulating insulin, and thus body fat cells are essentially rejecting glucose. Blood glucose levels are maintained, to feed the brain, but uptake by adipocytes via GLUT4 isn’t happening.

So where does the bigger waist come from?

When people fast they typically drink water, quite often lots of it. A reasonable explanation for the bigger waist is that body fat cells store water in place of fat, as fat becomes energy. Since water is denser than fat, the stronger gravitational pull will lead to a larger bulge around the lower abdominal area, increasing waist circumference at the point it is widest. The amount of fat mass, however, is going down due to fasting.

In the obese, body fat cells generally become insulin resistant, even though many people believe the opposite to be true. This leads to the creation of new body fat cells (hyperplasia) to store the extra fat. If body fat loss is maintained over time, I’d expect the body to get rid of those fat cells that were created through hyperplasia during the obese period. The literature, however, seems to suggest that the number of body fat cells is set before adulthood, and does not change afterwards. I am skeptical, as the body seems to be very good at  getting rid of cells and tissues that are not used.

The loss of those extra body fat cells may bring the number of adipocytes to pre-obesity levels, but for many people quite some time is needed for that to happen. Often in the order of months; maintaining reasonably low body fat levels.

So don’t despair if you end up with a bigger waist around noon after skipping breakfast, or before dinner after fasting the whole day. That may be a good sign; a sign that you are actually losing abdominal fat.

Friday, July 8, 2011

Nothing but our thanks...

I have been overwhelmed by people’s responses to the Head to Head session last week at MMU. THANK YOU. In short, the event was superb, with 6 dynamic and exciting speakers sharing work of beauty, diversity and that challenged us. I want to say a big thanks to the speakers:

Mike White
Margret Meagher
David Doyle
Kate Wells
Ann O'Connor
Peter Wright

A great contribution from you all and I hope to share some of your presentations with participants from the event.

I have had a request from Peter Wright, who gave his card to someone at the event, only it had some notes on the back that he'd like! If you're the lucky owner of that card, could you get in touch with me directly?

As part of the Critical Mass events happening across the North of England, we also concluded the first stage of the m a n i f e s t o events and in between now and October, the meat is being put on the flesh. An especially big thanks to Ali Clough and Jay Haigh at the Looking Well in Bentham for launching this next phase so wonderfully last week.

Monday, July 4, 2011

Liver and meatballs separated by a wall of sweet potatoes

A commenter wrote here some time ago that she liked to eat rice because rice can be easily used to separate food items on a plate. One can just as easily use sweet potatoes to do that; preparing the sweet potatoes in much less time than the rice. This post explains how, with a simple recipe.

- Cut up half of a sweet potato as shown on the first photo below, adding coconut oil or butter to prevent the pieces from sticking to a microwave-safe saucepan.
- Microwave the sweet potato pieces in high heat for about 5 minutes.
- Use the sweet potatoes to separate food items as in the second photo below, showing beef liver and meatballs with their respective sauces.
- Cover the dish with a wet paper towel to prevent spilling, and microwave it for as long as needed to heat up the meats. In this case, 2 minutes in high heat was enough. That will further cook the sweet potato, but not to the point of burning it.




The above assumes that the beef liver and meatballs are leftovers that had been cooked before. In this example, we have about ½ lb of meat and ½ of a sweet potato. As far as plant foods are concerned, sweet potatoes are at the very high end of the nutrition density scale. This is a very nutritious and satiating meal (for me) with over 55 g of protein, as well as a great mix of macro- and micro-nutrients.