Wednesday, August 31, 2011


Arts for Health at MMU and
Greater Manchester Arts Health Network
An Un-Conference event

four separate sessions
on 20th October 2011

focusing on arts and culture for public mental health and wellbeing

Dorothy Rowe on Depression and Imagination

Mark O’Neill on Cultural Participation for Public Mental Health
Professor Lynn Froggett on Transformative Arts Practice

Phil Burgess and Langley Brown on Changing Mindsets - the realities of arts health engagement

at Manchester Metropolitan University, Manchester

Within an overarching public mental health context, these four separate sessions will involve active participation to expand and develop arts and health practice and foster dialogue across the arts , health and voluntary sectors.

Each free session is aiming to engage different audiences from across the North West with a primary focus on arts and health in Greater Manchester. We do not anticipate delegates will attend more than one or two of the four sessions. If you do wish to attend more than one session you must register separately for each, following the relevant booking links. Places will be confirmed at the end of September.

Full details and booking can be found at:

Please note that Clive Parkinson and Anne Crabtree are not dealing with enquiries for this event. If you have any booking queries please contact Events Northern Ltd on 01772 336639 or
...and something to get you in the mood (for those of you who missed it last week)


Monday, August 29, 2011

Men who are skinny-fat: There are quite a few of them

The graph below (from Wikipedia) plots body fat percentage (BF) against body mass index (BMI) for men. The data is a bit old: 1994. The top-left quadrant refers to men with BF greater than 25 percent and BMI lower than 25. A man with a BF greater than 25 has crossed into obese territory, even though a BMI lower than 25 would suggest that he is not even overweight. These folks are what we could call skinny-fat men.

The data is from the National Health and Nutrition Examination Survey (NHANES), so it is from the USA only. Interesting that even though this data is from 1994, we already could find quite a few men with more than 25 percent BF and a BMI of around 20. One example of this would be a man who is 5’11’’, weighing 145 lbs, and who would be technically obese!

About 8 percent of the entire sample of men used as a basis for the plot fell into the area defined by the top-left quadrant – the skinny-fat men. (That quadrant is one in which the BMI measure is quite deceiving; another is the bottom-right quadrant.) Most of us would be tempted to conclude that all of these men were sick or on the path to becoming so. But we do not know this for sure. On the standard American diet, I think it is a reasonably good guess that these skinny-fat men would not fare very well.

What is most interesting for me regarding this data, which definitely has some measurement error built in (e.g., zero BF), is that it suggests that the percentage of skinny-fat men in the general population is surprisingly high. (And this seems to be the case for women as well.) Almost too high to characterize being skinny-fat as a disease per se, much less a genetic disease. Genetic diseases tend to be rarer.

In populations under significant natural selection pressure, which does not include modern humans living in developed countries, genetic diseases tend to be wiped out by evolution. (The unfortunate reality is that modern medicine helps these diseases spread, although quite slowly.)  Moreover, the prevalence of diabetes in the population was not as high as 8 percent in 1994, and is not that high today either; although it tends to be concentrated in some areas and cluster with obesity as defined based on both BF and BMI.

And again, who knows, maybe these folks (the skinny-fat men) were not even the least healthy in the whole sample, as one may be tempted to conclude.

Maybe being skinny-fat is a trait, passed on across generations, not a disease. Maybe such a trait was useful at some point in the not so distant past to some of our ancestors, but leads to degenerative diseases in the context of a typical Western diet. Long-living Asians with low BMI tend to gravitate more toward the skinny-fat quadrant than many of their non-Asian counterparts. That is, long-living Asians generally tend have higher BF percentage at the same BMI (see a discussion about the Okinawans on this post).

Evolution is a deceptively simple process, which can lead to very odd results.

This “trait-not-disease” idea may sound like semantics, but it has major implications. It would mean that many of the folks who are currently seen as diseased or disease-prone, are in fact simply “different”. At a point in time in our past, under a unique set of circumstances, they might have been the ones who would have survived. The ones who would have been perceived as healthier than average.

Friday, August 26, 2011

Riots...Consumer Culture...Violence and RSPH Awards

Bonjour à tous nos amis en France et bienvenue!
Amidst the bleakness of this social landscape, squinting all the while in the glare of a culture that radiates ultraviolet consumerism and infrared celebrity.

Hello again and welcome back. The year continues to progress with startling changes across society. There's been lots in the press about where we should apportion blame following the 'riots', but very little that links greed and consumerism. I was suprised to read article by Russell Brand that does make this connection and  links the unfolding unrest to banking.

m a n i f e s t o
The first manifestation of our ideas and passion will be published this September and just thinking about how our arts and health agenda is increasingly being affected by politics and affecting politics, its worth reminding ourselves of the way the arts question society. Syrian cartoonist Ali Ferzat, has this week, been seriously assaulted for his provocative work. Like Ai Weiwei and many that have come before them, artists give voice to this experience of being human. Like Augusto Boal, many have been imprisoned for enabling debate, some have lost their lives.

Ali Ferzat
Who Cares? Big congratualations to all those involved in the Who Cares? programme that has won the RSPH Arts and Health Practice and Research awards.

Wednesday, August 24, 2011

Guest Commentary: A Fellow's Reflections on the 10th Annual Quality Colloquium

Zoe Clancy, PharmD

Fellow, Health Economics & Outcomes Research

Jefferson School of Population Health

In the words of Paul Wallace, MD, co-chair of the Harvard Tenth Quality Colloquium, “The test if you learned something is if you can go back home and talk about it.” This past week I attended the Tenth Quality Colloquium and I would like to think that I learned a lot. This is the first professional conference I have attended as a Health Economics and Outcomes Research Fellow at the School of Population Health and it was a rewarding experience.

Attending this conference has really highlighted a lot of topics and issues that I am learning about through the fellowship. The sessions I attended on health informatics, value-based purchasing, and quality improvement in the patient experience were led by leaders in their fields. Many topics about the culture of safety were discussed, such as accountable care organizations, meaningful use, and electronic health records.

The session devoted to Using Data to Improve Health Care Quality, Safety and Efficacy was interesting to me as a fellow in an outcomes research program. One of the main ideas I learned from the session was that data banks and the amount of information may be growing, but Health Informatics is still only a tool to access that data. Automating healthcare is important, but it is not enough. Training of personnel in informatics is needed in order to use data collection to its full potential.

In the Value-Based Purchasing seminar I became more familiar with Meaningful Use and other quality incentive programs. I was first exposed to these concepts by working with the JUP Quality Improvement team here at Jefferson, and after attending the session I look forward to applying what I learned to future JUP projects.

I noticed that pharmacists were mentioned frequently during the colloquium. It was brought up numerous times that pharmacists, being the medication experts, can play a crucial and valuable role in patient safety by becoming involved in medication safety. As a pharmacist, I am inspired by all that I heard, and am energized to utilize those principles in my fellowship.

I look forward to the opportunity to attend more conferences and sessions like the Tenth Quality Colloquium in the future.

Monday, August 22, 2011

"Soul" Food Mondays || Put A Period on Your Past

Let go.  Put a period on your past.  Below is a video all about it, by a favorite youtuber.

Refined carbohydrate-rich foods, palatability, glycemic load, and the Paleo movement

A great deal of discussion has been going on recently revolving around the so-called “carbohydrate hypothesis of obesity”. I will use the acronym CHO to refer to this hypothesis. This acronym is often used to refer to carbohydrates in nutrition research; I hope this will not cause confusion.

The CHO could be summarized as this: a person consumes foods with “easily digestible” carbohydrates, those carbohydrates raise insulin levels abnormally, the abnormally high insulin levels drive too much fat into body fat cells and keep it there, this causes hunger as not enough fat is released from fat cells for use as energy, this hunger drives the consumption of more foods with “easily digestible” carbohydrates, and so on.

It is posited as a feedback-loop process that causes serious problems over a period of years. The term “easily digestible” is within quotes for emphasis. If it is taken to mean “refined”, which is still a bit vague, there is a good amount of epidemiological evidence in support of the CHO. If it is taken to mean simply “easily digestible”, as in potatoes and rice (which is technically a refined food, but a rather benign one), there is a lot of evidence against it. Even from an unbiased (hopefully) look at county-level data in the China Study.

Another hypothesis that has been around for a long time and that has been revived recently, which we could call the “palatability hypothesis”, is a competing hypothesis. It is an interesting and intriguing hypothesis, at least at first glance. There seems to be some truth to this hypothesis. The idea here is that we have not evolved mechanisms to deal with highly palatable foods, and thus end up overeating them.  Therefore we should go in the opposite direction, and place emphasis on foods that are not very palatable to reach our optimal weight. You might think that to test this hypothesis it would be enough to find out if this diet works: “Eat something … if it tastes good, spit it out!”

But it is not so simple. To test this palatability hypothesis one could try to measure the palatability of foods, and see if it is correlated with consumption. The problem is that the formulations I have seen of the palatability hypothesis treat the palatability construct as static, when in fact it is dynamic – very dynamic. The perception of the reward associated with a specific food changes depending on a number of factors.

For example, we cannot assign a palatability score to a food without considering the particular state in which the individual who eats the food is. That state is defined by a number of factors, including physiological and psychological ones, which vary a lot across individuals and even across different points in time for the same individual. For someone who is hungry after a 20 h fast, for instance, the perceived reward associated with a food will go up significantly compared to the same person in the fed state.

Regarding the CHO, it seems very clear that refined carbohydrate-rich foods in general, particularly the highly modified ones, disrupt normal biological mechanisms that regulate hunger. Perceived food reward, or palatability, is a function of hunger. Abnormal glucose and insulin responses appear to be at the core of this phenomenon. There are undoubtedly many other factors at play as well. But, as you can see, there is a major overlap between the CHO and the palatability hypothesis. Refined carbohydrate-rich foods generally have higher palatability than natural foods in general. Humans are good engineers.

One meme that seems to be forming recently on the Internetz is that the CHO is incompatible with data from healthy isolated groups that consume a lot of carbohydrates, which are sometimes presented as alternative models of life in the Paleolithic. But in fact among influential proponents of the CHO are the intellectual founders of the Paleolithic dieting movement. Including folks who studied native diets high in carbohydrates, and found their users to be very healthy (e.g., the Kitavans). One thing that these intellectual founders did though was to clearly frame the CHO in terms of refined carbohydrate-rich foods.

Natural carbohydrate-rich foods are clearly distinguished from refined ones based on one key attribute; not the only one, but a very important one nonetheless. That attribute is their glycemic load (GL). I am using the term “natural” here as roughly synonymous with “unrefined” or “whole”. Although they are often confused, the GL is not the same as the glycemic index (GI). The GI is a measure of the effect of carbohydrate intake on blood sugar levels. Glucose is the reference; it has a GI of 100.

The GL provides a better way of predicting total blood sugar response, in terms of “area under the curve”, based on both the type and quantity of carbohydrate in a specific food. Area under the curve is ultimately what really matters; a pointed but brief spike may not have much of a metabolic effect. Insulin response is highly correlated with blood sugar response in terms of area under the curve. The GL is calculated through the following formula:

GL = (GI x the amount of available carbohydrate in grams) / 100

The GL of a food is also dynamic, but its range of variation is small enough in normoglycemic individuals so that it can be treated as a relatively static number. (Still, the reference are normoglycemic individuals.) One of the main differences between refined and natural carbohydrate-rich foods is the much higher GL of industrial carbohydrate-rich foods, and this is not affected by slight variations in GL and GI depending on an individual’s state. The table below illustrates this difference.

Looking back at the environment of our evolutionary adaptation (EEA), which was not static either, this situation becomes analogous to that of vitamin D deficiency today. A few minutes of sun exposure stimulate the production of 10,000 IU of vitamin D, whereas food fortification in the standard American diet normally provides less than 500 IU. The difference is large. So is the difference in GL of natural and refined carbohydrate-rich foods.

And what are the immediate consequences of that difference in GL values? They are abnormally elevated blood sugar and insulin levels after meals containing refined carbohydrate-rich foods. (Incidentally, the GL  happens to be relatively low for the rice preparations consumed by Asian populations who seem to do well on rice-based diets.)  Abnormal levels of other hormones, in a chronic fashion, come later, after many years consuming those foods. These hormones include adiponectin, leptin, and tumor necrosis factor. The authors of the article from which the table above was taken note that:

Within the past 20 y, substantial evidence has accumulated showing that long term consumption of high glycemic load carbohydrates can adversely affect metabolism and health. Specifically, chronic hyperglycemia and hyperinsulinemia induced by high glycemic load carbohydrates may elicit a number of hormonal and physiologic changes that promote insulin resistance. Chronic hyperinsulinemia represents the primary metabolic defect in the metabolic syndrome.

Who are the authors of this article? They are Loren Cordain, S. Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A. Watkins, James H O’Keefe, and Janette Brand-Miller. The paper is titled “Origins and evolution of the Western diet: Health implications for the 21st century”. A full-text PDF is available here. For most of these authors, this article is their most widely cited publication so far, and it is piling up citations as I write. This means that not only members of the general public have been reading it, but that professional researchers have been reading it as well, and citing it in their own research publications.

In summary, the CHO and the palatability hypothesis overlap, and the overlap is not trivial. But the palatability hypothesis is more difficult to test. As Karl Popper noted, a good hypothesis is a testable hypothesis. Eating natural foods will make an enormous difference for the better in your health if you are coming from the standard American diet, and you can justify this statement based on the CHO, the palatability hypothesis, or even a few others – e.g., a nutrient density hypothesis, which would be closer to Weston Price's views. Even if you eat only plant-based natural foods, which I cannot fully recommend based on data I’ve reviewed on this blog, you will be better off.

Thursday, August 18, 2011

A Forum to Discuss ...

Hi Readers,

Feel free to join the new Healthy Hair and Body forum here.  (Or click the "Forum" link above.)  It is your place to discuss healthy hair, body, and soul.  Ask questions.  Share knowledge.  Support one another's journeys.  And more.


3in6: Encore in January!

By popular demand, the 3in6 challenge will be back ... but in January 2012!  It'll be a great way to begin the new year.  For the time being, I wish you all the best in continuing on your own for the rest of the year!

Migraines and Drinking Water?

"Dehydration ... results in less blood and oxygen flow to the brain and dilated blood vessels."  Hence, the migraine.  For the complete article, read here.

Wednesday, August 17, 2011

The 10th Annual Quality Colloquium at Harvard

For four days this week the leaders in the quality and safety movement from all over the nation converged on the campus of Harvard University for the 10th Annual Quality Colloquium co sponsored by the Jefferson School of Population Health. In the first morning of the program, three key leaders, including the CEO of the IHI in Boston, the National Patient Safety Foundation, and the AHRQ, set the tone for the rest of the week by challenging the audience to get further engaged in the movement.These leaders reminded us all that medical error remains the fourth leading cause of death in the US and more must be done to protect our patients from harm. The research presentations covered a wide range of topics including the latest research on safety improvement in both the hospital and the office setting. Others presented an update on the role of hospital governance in quality and called for a renewed commitment on the part of board members to this agenda. In the pre conference workshop, nearly 100 persons spent a day in a special "boot camp", with myself and my colleage Dr Ed Walker from the University of Washington in Seattle. Together, we gave a day long overview of the field and we too challenged the attendees to return to their home institutions with a renewed sense of energy and new tools to tackle the epidemic of harmful errors. Our team is already hard at work planning the August 2012 session!! I sure hope that you will think about joining us next summer. DAVID NASH

Monday, August 15, 2011

Youtube: Genetically Modified Food ...

In this videoDearNaptural85 discusses "eating well and organic living".  As part of her discussion, she shares her thoughts on a book entitled "The Unhealthy Truth".  Here's a short description of the author's journey:

"O'Brien turns to accredited research conducted in Europe that confirms the toxicity of America’s food supply, and traces the relationship between Big Food and Big Money that has ensured that the United States is one of the only developed countries in the world to allow hidden toxins in our food--toxins that can be blamed for the alarming recent increases in allergies, ADHD, cancer, and asthma among our children. Featuring recipes and an action plan for weaning your family off dangerous chemicals one step at a time, The Unhealthy Truth is a must-read for every parent--and for every concerned citizen--in America today."

To purchase the book:
The Unhealthy Truth: One Mother's Shocking Investigation into the Dangers of America's Food Supply-- and What Every Family Can Do to Protect Itself

Healthy Hair Features: RECAP

In case you've missed them, here are healthy-haired women who have been featured on the blog:

Natural: NowIamnappy
Natural: MissAlinaRose
Natural: Chime
Texlaxed: MsKibibi
Natural: Janet
Youtube Natural: Afrostory
Youtube Natural: Rusticbeauty
Natural: Redecouverte
Natural: Lina
Natural: Copa
Relaxed: Caroline
Natural: Gisele

*If you're interested in being featured, use the "Contact Me" button above.

Book review: Sugar Nation

Jeff O’Connell is the Editor-in-Chief for, a former executive writer for Men’s Health, and former Editor-in-Chief of Muscle & Fitness. He is also the author of a few bestselling books on fitness.


It is obvious that Jeff is someone who can write, and this comes across very clearly in his new book, Sugar Nation.

Now, with a title like this, Sugar Nation, I was expecting a book discussing trends of sugar consumption in the USA, and the related trends in various degenerative diseases. So when I started reading the book I was slightly put off by what seemed to be a book about a very personal journey, written in the first person by the author.

Yet, after reading it for a while I was hooked, and literally could not put the book down. Jeff has managed to write something of a page-turner, combining a harrowing personal account with carefully researched scientific information, about a relatively rare form of type 2 diabetes.

Jeff has a genetic propensity to insulin resistance, just like his father did. What makes Jeff’s case a little unusual is that Jeff is thin, and apparently has difficulty gaining weight. The most common type of diabetes is type 2, and most of those who develop type 2 diabetes do so via the metabolic syndrome. Typically this involves becoming obese or overweight before getting diagnosed as a diabetic.

In fact, in a thin person who is insulin resistant it seems that body fat cells become resistant to the normal actions of insulin much sooner than in the obese. This essentially means that they start rejecting fat. This is a problem, because fat should either be stored in fat cells (adipocytes) or used for energy; as opposed to being deposited in other tissues or remaining in circulation. Apparently this makes it even more difficult for them to control glucose levels once insulin resistance sets in; there is no “cushion”, so to speak.

Still, Jeff appears to believe that his case was that of a skinny-fat person, where body fat percentage is a lot higher than expected based on a low body mass index, and where excess visceral fat is a main culprit. In fact, Jeff seems to think that most cases of thin folks who developed type 2 diabetes are like this, as they follow the metabolic syndrome progression pattern. Fasting triglycerides go up and HDL cholesterol goes down, among other things, but in a skinny-fat body.

Somewhat predictably, what Jeff found out is that, in his case, adopting a low carbohydrate diet made an enormous difference. In fact, it made the difference between having a fairly normal life versus constantly suffering through hypoglycemic episodes. And, at the stage in which Jeff caught the problem, he did not have to avoid all natural carbohydrate-rich foods, not even things like apples. (He had to control portions though.) It is the refined carbohydrate-rich foods that were the problem for him.

I must say that I disagree with a few of the statements in the book. For example, the author seems to believe that excess saturated fat and salt may be quite unhealthy. I think that foods rich in refined carbohydrates and sugars are much more of a problem; cut them out and often excess saturated fat and salt either cease to be a problem, or become healthy. Jeff doesn’t seem to think that excess omega-6 fats can also cause diabetes; I believe the opposite to be true, via a pro-inflammatory path.

Still, this is a great book on so many levels. Jeff meticulously records his experience dealing with doctors, most of whom seem to be clueless as to what to do to prevent the damage that is caused by abnormally high glucose levels. This happens even though diabetes is those doctors’ main area of expertise. He talks about himself with complete abandon, and manages to mix that up with quite a lot of relevant research on diabetes. He gives us an insider’s view of the professional bodybuilding culture, including its use of insulin injections. His description of the Amish is very interesting and somewhat surprising.

For these reasons and a few others, I think this is a great book, and highly recommend it!

Wednesday, August 10, 2011

Guest Commentary: Collaborative Care's Crucial Role in Population Health

Amanda Solis, MS

Project Director

Jefferson School of Population Health

A focus on population health requires a creative and collaborative approach to care.

The traditional perspective in healthcare has been fairly physician-focused. As we seek to fulfill the mandate to become more patient-centered in our outlook, it is important to leverage the important roles of pharmacists, physical therapists, nurses, nurse practitioners and physician assistants, health coaches and nutritionists.

To illustrate my point, here is one example of the role a collaborative care team can play in the management of chronic disease that specifically highlights the community pharmacist. Beginning in 2006, the American Pharmacists Association (APhA) launched a program named the “Diabetes Ten City Challenge.” Originally born from the Asheville Project, also conducted by the APhA Foundation and funded by GlaxoSmithKline, this program was aimed at implementing a patient self-management program for diabetes using community-based pharmacies as the base of operations.

The Diabetes Ten City Challenge (DTCC) consisted of 3 main objectives:

1. To implement an employer-funded, collaborative health management program using community-based pharmacist coaching, evidence-based diabetes care guidelines, and self-management strategies designed to keep patients with diabetes healthy and productive.

2. To implement the patient self-management training and assessment credential that equips patients with the knowledge, skills, and performance monitoring priorities needed to actively participate in managing their diabetes.

3. To assess participant satisfaction with overall diabetes care and pharmacist care provided in the program.

Patients in the DTCC program worked with a community pharmacist to develop their knowledge, skills, and performance related to self-management of diabetes. This unique approach established the community pharmacist as a patient coach and leader of the care team. Community pharmacists are in a prime position to serve this role, since they have so much regular contact with patients

DTCC program outcomes included statistically significant improvements in A1C, LDL cholesterol, and systolic and diastolic blood pressure measures. Patients also reported higher rates of influenza vaccinations, and being current in terms of eye and foot examinations.

In addition to improved clinical outcomes, average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Full results and more information can be found here

The DTCC illustrates an important opportunity to shift the model of care, improve health outcomes, and lower cost. As we face a reduction in primary care physicians and an increase in the number of patients with chronic conditions, we need to work toward implementing creative and collaborative solutions to meet the needs of our citizens.

Monday, August 8, 2011

3in6: Wrap Up!

{February photo}
See "3in6 Challenge" details here.

Hey, ladies!  The challenge has come to an end.  Six months of healthy hair care and eating to retain 2-3 inches of new growth.  I did alright.  I haven't reached waistlength (yet), but I retained 2-2.5 inches of growth.  (Photos will come when I get my friend to help me.  :Smiles:)  I plan to continue doing this challenge (offline) for the rest of 2011.  I hope you all gained something from this group support.

How did my challengers wrap up the 3in6?

REVIEW #11: Karma Organic Nail Polish

NOTE:  I am not paid to review this product.  This product was purchased via my own pocket and curiosity.

Ingredients: unknown. 

Number of trials: 3 to 4


The nail polish was true to the colors presented online and coated well with just 1-2 applications.  I was fairly impressed.  With the help of the 2-in-1 base coat, it lasted up to week, which is good in my book.  The only negative I really have is that the polish is expensive.

PROS: many color choices, true to colors, coats well, no toluene, no formaldehyde, no DBP 
CONS: expensive for a little bottle

RATING: Overall, I give the Karma Organic Nail Polish 3 out of 5 stars.  I'll explore other "natural" polishes, like Zora, before committing to Karma.

May be purchased at Karma Organic.

Potassium deficiency in low carbohydrate dieting: High protein and fat alternatives that do not involve supplementation

It is often pointed out, at least anecdotally, that potassium deficiency is common among low carbohydrate dieters. Potassium deficiency can lead to a number of unpleasant symptoms and health problems. This micronutrient is present in small quantities in meat and seafood; main sources are plant foods.

A while ago this has gotten me thinking and asking myself: what about isolated hunter-gatherers that seem to have thrived consuming mostly carnivorous diets with little potassium, such as various Native American tribes?

Another thought came to mind, which is that animal protein seems to be associated with increased bone mineralization, even when calcium intake is low. That seems to be due to animal protein being associated with increased absorption of calcium and other minerals that make up bone tissue.

Maybe animal protein intake is also associated with increased potassium absorption. If this is true, what could be the possible mechanism?

As it turns out, there is one possible and somewhat surprising connection, insulin seems to promote cell uptake of potassium. This is an argument made many years ago by Clausen and Kohn, and further discussed more recently by Benziane and Chibalin. See also this recent commentary by Clausen.

Protein is the only macronutrient that normally causes transient insulin elevation without any glucose response. And the insulin response to protein is nowhere near that associated with refined carbohydrate-rich foods. It is much lower, analogous to the response to natural carbohydrate-rich foods.

A very low carbohydrate diet with more animal protein, and less fat, would induce insulin responses after meals, possibly helping with the absorption of potassium, even if potassium intake were rather limited. Primarily carnivorous diets, like those of some traditional Native American groups, would fit the bill.

Also, a low carbohydrate diet with emphasis on fat, but that was not so low in carbohydrates from certain sources, would probably achieve the same effect. This latter sounds like Kwaśniewski’s Optimal Diet, where people are encouraged to eat a lot more fat than protein, but also a small amount of carbohydrates (e.g., 50-100 g/d) from things like potatoes.

Kwaśniewski’s suggestions may sound counterintuitive sometimes. But, as it turns out, potatoes are good sources of potassium. One potato may not be a lot, but that potato will also increase insulin levels, bringing potassium intake up at the cell level.

Thursday, August 4, 2011

Away for a couple of weeks...

Away on leave for a couple of weeks, I thought I'd leave a few thoughts from artists manifestos that might just have some relevance to our own time...

Aphorisms on Futurism 
Die in the Past
Live in the Future.
WHAT can you know of expansion, who limit yourselves to compromise?
Mina Loy (1914)

Vorticist Manifesto 
Beyond Action and Reaction we would establish ourselves.
The nearest thing in England to a great traditional French artist is a great revolutionary English one.
Wyndham Lewis and others (1914)

What is Architecture? 
Painters and sculptors, become craftsmen again, smash the frame of salon art that is around your pictures, go into the buildings, bless them with fairy tales of colour, chisel ideas into the bare walls - and build in imagination...
Walter Gropius (1919)

First German Dada Manifesto 
Art in it's execution and direction is dependent on the time in which it lives, and artists are creatures of their epoch. The highest art will be that which in it's conscious content presents the thousandfold problems of the day, the art which has been visibly shattered by the explosions of last week, which is forever trying to collect it's limbs after yesterday's crash. The best and most extraordinary artists will be those who every hour snatch the tatters of their bodies out of the frenzied cataract of life, who, with bleeding hands and hearts, hold fast to the intelligence of their time.
Richard Huelsenbeck (1918)

Draft Manifesto 
Mankind is passing through the most profound crisis in it's history. An old world is dying, a new one is being born. Capitalist civilisation, which has dominated the economic, political and cultural life of continents, is in the process of decay...
John Reed Club of New York (1932)

Tentative ideas for a manifesto after 1 and 1/3 years at art school
There must be intercommunication. The genuine participating audience has been lost. Lack of audience reaction has been made a virtue. There must be a communal basis even if only from the artists themselves. Fragmentation and the perverted cult of individuality at all cost is a force which has rendered the artist impotent...The audience must become participators, the creators. The artist must abrogate his mystery.
Derek Jarman (1964)

The Foundation and Manifesto of Futurism 
Standing tall on the roof of the world, yet again, we hurl our defiance at the stars.

F.T. Marinetti (1909)

Thanks to Alex Danchev's excellent 100 Artists' Manifesto

Wednesday, August 3, 2011

Foods & Etc. that Boost Brain Power

Gotta love that omega-3, algae, social interaction, and ...

For more, read the full article.

Tuesday, August 2, 2011

The work to improve medication safety

For more than twenty years, I have been a member of our hospital's P and T Committee---an important committee whose job, among other things, is to maintain and update the formulary AND to monitor and improve the safety of medication at all times. I have chaired a subcommittee on Medication Safety for more than a decade. Each year around this time, we issue a summary of our progress in this struggle. I would like to hit the highlights of the current summary. In this past year the team reviewed quarterly medication event and adverse drug reaction reports and made many recommendations to address key safety issues. We benchmarked our own data against national data from hospitals just like us who are members of the University Healthsystem Consortium in Chicago. In other words, we put our dirty laundry out to dry and explicitly compared our progress to a national peer group--not an easy job!! We invited national experts from the ISMP, the Institute for Safe Medication Practice ,to come inside our tent and to make specific recommendations as to how we might improve our internal control processes. We tackled some specific clinical challenges in caring for patients with a wide range of diseases including diabetes, heart disease,many types of cancers, and others. In each clinical condition, we carefully tracked medication safety from quarter to quarter and year to year. We empowered multidisciplinary teams to "tell us like it really is" and we listened closely to their reports. In a word, we spent a year of tough self evaluation---asking difficult questions and sometimes getting answers that we did not like. However, we never lost sight of the real goal---to do no harm and to improve every day. The staff involved here are the unsung day to day real heroes of hospital care. What are you doing to improve the safety of medication where you work?? DAVID NASH

Monday, August 1, 2011

There is no doubt that abnormally elevated insulin is associated with body fat accumulation

For as long as diets existed there have been influential proponents, or believers, who at some point had what they thought were epiphanies. From that point forward, they disavowed the diets that they formally endorsed. Low carbohydrate dieting seems to be in this situation now. Among other things, it has been recently “discovered” that the idea that insulin drives fat into body fat cells is “wrong”.

Based on some of the comments I have been receiving lately, apparently a few readers think that I am one of those “enlightened”. If you are interested in what I have been eating, for quite some time now, just click on the link at the top of this blog that refers to my transformation. It is essentially high in all macronutrients on days that I exercise, and low in carbohydrates and calories on days that I don’t. It is a cyclic approach that works for me; calorie surpluses on some days and calorie deficits on other days.

But let me set the record straight regarding what I think: there is no doubt that insulin is associated with body fat accumulation. I was told that an influential health blogger (whom I respect a lot) denied this recently, going to the extreme of saying that no professional metabolism or endocrinology researcher believes in it, but I couldn’t find any evidence of that statement. It is not hard at all to find professional metabolism and endocrinology researchers who have asserted that insulin is associated with body fat accumulation, based on very reliable evidence. Actually, this is Biochemistry 101.

What I think is truly unclear is whether insulin spikes associated with carbohydrate-rich foods in general are the cause of obesity. This idea is, indeed, probably wrong given the evidence we have from various human populations whose members consume plenty of non-industrialized carbohydrate-rich foods. On a related note, I particularly disagree with the notion that the pancreas gets tired over time due to having to secrete insulin in bursts, which seems to also be one of the foundations on which many low carbohydrate diet varieties rest.

As with almost everything related to health, the role of insulin in body fat gain is complex, and part of that complexity is due to the nonlinear relationship between body fat gain and postprandial insulin release. Industrial carbohydrate-rich foods have a much higher glycemic load than natural carbohydrate-rich foods, even though their glycemic index may be the same in some cases. In other words, the quantity of easily digestible carbohydrates per gram is much higher in industrial carbohydrate-rich foods.

In normoglycemic folks, this leads to an abnormally elevated insulin response, among other hormonal responses. For example, circulating growth hormone, which promotes body fat loss, is inversely correlated with circulating insulin. Insulin drives fat, typically from dietary sources of fat, into adipocytes. That fat may also come from excess carbohydrates, packaged into VLDL particles.

Under normal circumstances, that would be fine, since our body is designed to store fat and release it as needed. But the abnormal insulin response elicited by industrial carbohydrate-rich foods, together with other hormonal responses, leads to a little more body fat accumulation, and for longer, than it should. And I’m talking here about people without any metabolic damage. Saturated and monounsaturated fats are healthy when eaten, but when they are stored as excess body fat, they become pro-inflammatory.

Body fat is like an organ, secreting many hormones into the bloodstream, several of which are pro-inflammatory. One of those pro-inflammatory hormones, which I believe is closely linked with many diseases of civilization, is tumor necrosis factor. (The acronym is now TNF. Apparently the “-alpha” after its name and acronym has been dropped recently.) Dietary fat, particularly saturated fat, seems to be anti-inflammatory. In other words, body fat accumulation is the problem. You only need 30 g/d of excess body fat accumulation to gain around 24 lbs of fat per year. Over three years, that will add up to over 70 lbs of body fat.

In my view, ultimately it is excess inflammation (which is, in essence, a vascular response) that is at the source of most of the diseases of civilization.

That is where the nonlinearity comes in. Insulin is healthy up to a point. Beyond that, it starts causing health problems, over time. And one of the main mechanisms by which it does so is via excessive body fat accumulation, with different damage threshold levels for different people. Insulin may decrease appetite as it goes up, but it increases it if goes down too much. If it goes up abnormally, typically it will go down too much. As it reaches a trough it induces hypoglycemia, even if mildly.

Take a look at the graph below, from this post showing the glucose variations in normoglycemic individuals. There is a lot of variation among different individuals, but it is clear that the magnitude of the hypoglycemic dips is inversely correlated with the magnitude of the glucose spikes. That inverse correlation is due primarily to the effect of insulin. Under normal circumstances, a decrease in circulating insulin would promote an increase in free fatty acids in circulation, which would normally have a suppressing effect on hunger in the hours after a meal. But industrial carbohydrate-rich foods lead to increases and decreases in glucose and insulin that are too steep, causing the opposite effect.

You may ask: why do you keep talking about industrial carbohydrate-rich foods? Why not talk about industrial protein- or fat-rich foods as well? The reason is that the food industry has not been very successful at producing industrial protein- or fat-rich foods that are palatable without adding a lot of carbohydrate to them.

More often than not they need enough carbohydrate added in the form of sugar to become truly addictive.