Emotions for Engineers

Book Review - Paleo Comfort Foods: Homestyle Cooking for a Gluten-Free Kitchen

2012-01-14T12:23:00.000-08:00

This is my first book review on e4e.

Full disclaimer: I received the book as a gift from the authors. They offered a copy to volunteers at the recent Ancestral Health Symposium. I have no financial or other interest in the success of the book unless you click the link to Amazon at the bottom of the post.

If you do want to order this (or any) book, I encourage you to go to Latest in Paleo target="_BLANK" scroll down a little and launch your Amazon search session with the keywords "Paleo Comfort Foods" from there. He does a really good service to the paleo community and we might as well give him a buck instead of Amazon.

I have no conflict of interest, but there is a possible bias. They were very kind to offer this book for free, with no strings attached, but with encouragement to review the book on Amazon and or Barnes and Noble. so I am well-disposed to the book in the first place.

Paleo Comfort Foods: Homestyle Cooking for a Gluten-Free Kitchen

One of the challenges with following a low carb, paleo, or any unusual diet is the social aspect of it. There are always recipe books available, but in the end, the food is just... different. This book "Paleo Comfort Foods" gives us a way around that. The recipes yield highly palatable food that look normal. They do this by substituting ingredients like almond or coconut flour for normal flour found in standard recipe books.

This book is excellent. The food recommendations are aligned pretty well with the e4e recommendations. It has a lot of foods that look like standard comfort foods. Your Aunt Mildred from Dubuque would recognize most of the dishes. However, what she wouldn't know is that those mashed potatoes are really cauliflower, and that the breading on the chicken is almond flour. If you want to follow a paleo diet (stay away from grains, added sugars, and processed seed oils) yet still wish to function in a world of people who do not follow that way of eating, this book provides a perfect bridge.

It is an impressive book. The photos are beautiful. The cover has a photo of fried chicken, mixed vegetables and what looks like mashed potatoes and gravy. But looks can be deceiving. The mashed potatoes are cauliflower, the fried chicken has an almond flour coating and was fried in coconut oil.

It is not a low carb cookbook per se, but rather is good real food, with carbohydrates coming mainly from vegetables, fruit, and root vegetables, such as sweet potatoes.

Recipes:
The book is in six sections
1. starters and snacks: examples - spicy salmon salad or dip, devilish eggs, maryland crab cakes, bacon-wrapped dates
2. sauces and staples: chimichurri, not peanut sauce, paleo mayonaisse, cave ketchup, turkey gravy
3. soups and salads: creamy caesar salad, gingered butternut squash salad, chicken tomatillo stew
4. on the side: mashed cauliflower; creamed spinach; scattered, smothered and chunked sweet hash, sweet potato spears, dirty cauliflower "rice"
5. main dishes: green eggs and turkey, ham and egg cups, chicken breasts with mushroom sauce, chicken enchiladas, fried chicken, cedar-plank chipotle salmon
6. desserts: banana nut bread, strawberry shortcakes, jules' banana pudding, sweet potato pie, luscoius lemon squares

Also Robb Wolf does the foreword, there is a section on foods to keep around the house, and a section on essential kitchen tools.

Bottom Line: We have tried a half dozen recipes from this book. All have been great. (One suggestion though--if you make the decadent chocolate cake with a kick, dial back a little on the pepper). I heartily recommend this book.

A few final words:
Kurt Harris of the Archevore blog might disapprove of this book as being akin to smoking candy cigarettes. That is by creating food in the form of unhealthy foods we encourage people around us to eat those unhealthy foods. From a purist standpoint, I see where he's coming from. But sometimes, we just don't want to have to explain our choices to people.

Ancestral Health Symposium Notes

2011-08-08T08:44:00.000-07:00

I have just attended an amazing event--the Ancestral Health Symposium. It was an incredible few days. I want to tell you all about it, but have no idea where to start, so I'll just wade in.

What Is It?

A two day conference held on the UCLA Campus on August 5 and 6. The conference featured many presentations about the "Paleo" diet and exercise (all the talks will be put online over the next few months). In some of my posts on diet, I have mentioned this philosophy, so I'll start with some of the basics.

Ancestral Framework

There is not at present a standards committee that declares what is and isn't paleo. I think of it more as a framework for thinking about what is healthy for us. The idea is that, fundamentally, humans are the product of millions and millions of years of evolution. We have both very primitive and very sophisticated chemical signaling systems in our body. Our bodies evolved through many different environments and circumstances.

In the last few hundred years, and especially in the last 30 or so years, we seem to be falling apart as a species. Worldwide, obesity and diabetes are skyrocketing. A key hypothesis behind this ancestral health movement is that the foods introduced into our collective diet, since the dawn of agriculture, and especially in the past few hundred years is literally killing us. It is becoming increasingly evident that although we are living longer, we are doing so with lower health than ever before.

Much of the press and publicity for this approach to health have focused on caveman re-enactment and Fred Flintstone slabs of beef. That is simply not the point of the Ancestral Health movement. In any event

Ancestral Diet

Defining the paleo diet is easiest to do by exclusion:
1. Eliminate refined sugar, limit highly concentrated natural natural sugars
2. Eliminate grains in general
3. Eliminate oils from seeds, e.g. canola, cottonseed, and corn oil

Within the paleo community, some say you should go further and
4. Eliminate legumes i.e. beans
5. Eliminate dairy and dairy products

What remains then is animal products (muscle, organs, and fat from animals including fish, fowl, beef, pork), vegetables (both starchy and green leafy), fruit (whole fruit, not juice), nuts.

Because so many foods have changed so much in the last 10,000 years, (the advent of agriculture), we can really only guess at the specific nutrients in paleo-man's diet. There is a general consensus in the community that it is best if the animals that you eat, eat their natural diets, e.g. grass fed beef, wild-caught fish. The community also seems to believe that omega-6 oils are more prone to oxidation than other oils, so fish oil supplementation or reduction of the omega-6 oils in the diet are important. Let's not forget the importance of sunshine.

The community tends towards some degree of variability to mimic ancient patterns e.g. there were not strawberries year round in our distant past, so eating seasonally may have value; periodic fasts without food whether for 16 hours or a few days are probably something we can handle without undue problems and that might even have benefits.

In its current incarnation the paleo community has rallied around a self-experimentation paradigm. It's not "anything goes", but rather within the above guidelines, try different approaches and see what works for you.

I will put out some more details on diet and some revisions to the E4E recommendations in the near future.

Ancestral Exercise

There is much less consensus around and focus on what constitutes true paleo exercise and how to gain benefits related to that. I would say that in general, there is less emphasis on "chronic cardio" and more emphasis on periodic intensity in exercise, as well as natural movement (running, jumping, climbing).

Interesting Talks

The conference was announced about a year ago and when tickets went on sale, I started to try to arrange my schedule, etc. I waited a little too long, so by the time I tried to buy a ticket, the conference was sold out. However, they needed volunteers, so I was able to participate as a volunteer. I was present but working for many of the talks and had down time as well to focus on them.

Here is a list of the talks that I really liked and that people seemed to be buzzing about:
Denise Minger - How to Argue with a Vegetarian
Nora Gedgaudis - lots of amazing stuff on mind-body integration
Tom Naughton - entertaining talk on bad science
Erwan LeCorre - moving naturally
Melissa McEwen - clues from the colon (humans are unique)
Emily Deans and Jamie Scott - the rainforest in your gut
Dr. BG and Tim Gerstmar - curing autism through diet
Pedro Bastos - Dairy
Robert Lustig - Fructose and Leptin
Mat Lalonde - heavy chemistry talk, but the real message was that paleo needs to go beyond caveman and have really good science
Andreas Eenfeldt - Sweden's experience with lower carb as their national paradigm
Richard Nikoley - representing the blogosphere, how he has used self-experimentation to lose 70 pounds and become a better animal

All the talks will go on the internet. They will first be uploaded in raw form, but later with some editing and polish. I have little information beyond these talks. I was either not in on the buzz, they were rehashing old material, or possibly were not well received.

In the meantime, here are some other bloggers' takes on the event.
http://ethicaleats.blogspot.com/2011/08/woodstock-of-evolutionary-medicine-part.html
http://naturallyengineered.com/blog/?p=4725
http://livinlavidalowcarb.com/blog/must-hear-podcast-interviews-after-attending-the-2011-ancestral-health-symposium/11446
http://jackkruse.com/my-very-fresh-initial-thoughts-of-ahs-2011/
http://www.mattmetzgar.com/matt_metzgar/2011/08/back-from-ahs.html
http://whole9life.com/2011/08/whole9-goes-to-the-ahs/
http://blog.cholesterol-and-health.com/2011/08/reflections-on-ancestral-health.html
http://www.wildnessandwonder.com/2011/08/initial-thoughts-from-the-ancestral-health-symposium/
http://perfecthealthdiet.com/?p=4244
http://evolutionarypsychiatry.blogspot.com/2011/08/ahs-people-post.html?spref=tw

E4E Experience

I met and spoke with a lot of people while there. I was extremely gratified and thrilled at how many were familiar with this blog. I have no illusions about its place in the blogosphere, but there were a few conversations of note.

J. Stanton of gnolls.org, author of The Gnoll Credo, saw my name tag and told me that he had sent someone to my gout post and that a month later the man was free of gout. The person had made a number of changes, but my gout post was a reference for him.

Another person I met was Krista Scott-Dixon, whose work I have perused for years. She has long been a proponent of women lifting actual weights (not the pink ones). Her dork to diva series is really good and she has put out lots of good information through the years. She is also editor-in-chief of Spezzatino. I introduced myself to her, she told me that she knew about E4E and in fact had used one of my posts (I think this one) with one of her clients. I was totally thrilled that someone who I have followed through he years was familiar with my stuff.

Finally, I shared a house for the three nights with a really cool group of people from the Bay Area including a few fellow bloggers, so check out An Omnivore's Decision and Primal Girl in a Modern World. Thanks to Tess for doing all the work to get the house lined up.

I will also thank US Wellness Meats for saving my (figurative) bacon from the fast food in the student union at UCLA. The beef sticks and jerky made me tingle in the best possible way.

I feel really energized after hearing the E4E feedback from people, listening to the amazing talks, and all the geeky discussions. Over the coming months, as the edited lectures become available, I plan to highlight some of the key ones.

Stay tuned.

My Voice on the Internets - Jimmy Moore Low Carb Conversations

2011-07-22T08:30:00.000-07:00

Jimmie Moore and Mindy Noxon Iannotti spoke with Kim Bosold and me a few weeks ago on Jimmy's newest podcast endeavor "Low Carb Conversations." Hear the discussion at this link.

Here is my most recent post extolling my dietary perspective.

My take on a recent JAMA letter Proposing real food.

Here is my take on Gout.

Some of my relationship posts get a lot of hits too.
Feelings are Facts
The Nature of Love 1
The Nature of Love 2
Emotional Needs In a Relationship
More on Needs In a Relationship

Please be sure to subscribe either through email or RSS.

I hope you enjoy!

Coming Into the Light

2011-06-12T09:32:00.000-07:00

I have given it a lot of thought. When I started Emotions For Engineers (e4e), I decided to keep it as anonymous as I reasonably could. I am not a saint, and my life is not perfect. I was concerned about a couple of scenarios. First, that I would say something here that would have a negative impact on my work, or alternatively, that people would assume that I was writing autobiographically when I wasn't. That, and frankly, it's a little embarrassing to me personally just how late in life it was before I began to understand so many thing about relationships, health, love.

In the first case it could affect my ability to earn a living, in the second, I was concerned how people might treat my wife or other members of my family.

I am still concerned about those things. But I am going to come clean anyway.

Angelo Coppola, who has a blog and a podcast called Latest in Paleo in his March 28, 2011 podcast (at 14:35) mentioned the e4e blog post about the JAMA recommendations, and I realized that I want personal recognition for what I do here. Even more than the recognition though, I think that having a person associated with the writing will make it more effective. This is not a moneymaker for me (although I have made about $15 from Amazon).

Also, my wife tells me it's good for transparency and to show vulnerability. Plus, I was tired of trying to be careful about this, although I am confident that anyone with reasonable skill in the art of google-fu could figure out who I am.

So, my name is Tony Kenck. I live in Oakland, CA, and work for Chevron as a Manager of Strategic Planning. I am married to my second wife, my first marriage having ended in divorce after two children. I have a BSc in Geophysical Engineering from Colorado School of Mines, and I have an MBA from the University of St. Thomas in Houston.

I was born in 1957 and have no religious affiliation. My wife and I each have two children from previous marriages. Hers have lived with us. All are either in college or out on their own now.

I also have a personal blog where I write about various subjects including politics, business planning, portfolio analysis, or whatever strikes my fancy.

And by the way, you may have noticed a dearth of postings lately. We were in the process of empty nesting and moving out of our family-sized San Ramon home to a small condo in Oakland. Over the last six months we have been busy selling, buying, moving, disposing, storing, borrowing, negotiating, buying, and planning. Thanks for your patience and understanding. More posts to come.

Government in Our Kitchens

2010-11-20T10:06:00.000-08:00

This recent article about Sarah Palin serving cookies to kids to protest government incursions into our food choices caught my eye. (Disclaimer: I am not a Sarah Palin fan, but this article is not much about her anyway.)

I agree with her sentiment, government should not be involved in our food choices. There are some unfortunate realities to deal with however.

They are already in our food choices. The USDA has pushed US Agriculture on the American public for over 100 years. Remember that their mission has historically been to promote American agriculture. It was NOT to ensure the health of Americans by better food choices. There is damage to undo. Recently they added the following words to their strategic plan "... improving nutrition and health by providing food assistance and nutrition education and promotion..."
Various food programs exist, e.g. school lunches, and follow the unfortunate guidelines laid out by the food pyramid.
Government does have a clearly legitimate role in feeding our armed forces.
The food industry, left to its own devices, has repeatedly shown preference to profits over food safety. This applies to other industries as well.

On the first two issues, it is no secret that I believe that the grain-based food pyramid has directly led to the epidemic of metabolic syndrome including increased diabetes and heart disease. The USDA has an institutional mandate to promote the agricultural industry in the US. They do not have a mandate to improve the health of US citizens.

I believe that the employees of the USDA are good people and that most have convinced themselves that they are also acting in the best interests of the health of the American people. It's the only way to deal with the cognitive dissonance created by the actual results of their recommendations. Face it. We eat more carbs, less fat, the mix of fats changed to more polyunsaturated and less saturated fats, we exercise more as a society. We followed their advice.

And we're dying.

The third issue is important in that, we need to feed our warriors. I wish we were feeding them well, I don't know the facts around the food in the armed forces. I'm not going to look into it now because it's not relevant to the point I am trying to make.

The fourth one is tricky. I am a libertarian at heart, but industries have shown repeatedly that left to their own devices, they poison the environment, do not look out for worker safety, and do not follow safe practices in their products. There are plenty of examples and counterexamples, but corners get cut in the pursuit of profits time and again. I think over the long term, companies that protect its workers and the environment will win. In the short term though, they seem to have no problem killing people.

I am not saying that government gets it all right. They assuredly do not. But contrary to the fantasies of Ayn Rand, government may be the only force large enough and with enough stroke to counter destructive industrial practices in the short term. It could be done better, e.g. I believe that the recent classification of carbon dioxide as a pollutant exceeds their authority and common sense. But overall, I am glad that OSHA and EPA exist. I believe that the net impact is positive.

Back To Sarah and the USDA

So Sarah brought cookies to the kids. This is just as wrong as the food pyramid. At least local governments are trying to undo some of the damage caused by the food pyramid by banning sweetened wheat. We can argue about whether they should have a role in it, but at least, finally, the message is good. Sweet wheat is bad for you. Maybe, just maybe, they can begin to undo some of the damage wrought by the USDA.

Note to Sarah: Next time you do this, please have a barbecue with bacon wrapped grass-fed filets, sweet potatoes (no marshmallows), and whole raw milk.

It will send the right message on both the government meddling and on healthy dietary choices. And by the way, it would probably be the best meal the kids have had in their lives.

And USDA, please fix the pyramid. It has been proven dangerous because people comply. Consider something like this food pyramid from Castle Grok.

Addendum: I stumbled across some information on miltary food (MREs), which is what the soldiers eat in the field.

They are 51% carbs, 13% protein, 36% fat, and 1200 Calories. The idea is that they eat 3 of these per day.

For more on Cognitive Dissonance check out:

For more on diet science and health check out:
Good Calories, Bad Calories

Communication: Owning Your Feelings and The Public Eye

2010-11-01T00:24:00.000-07:00

In my Feelings are Facts post, I talked about how to communicate feelings. You say, "I feel frightened when you yell." It puts a simple fact on the table that nobody can dispute or find fault with.

Now, I find myself in a position to modify a part of that. It is absolutely the right thing to say still, but you need to make sure that your audience is at a point where they can hear the truth.

There were two incidents recently where this played out.

Juan Williams of NPR

Juan Williams was employed as a commentator by both National Public Radio (NPR) and Fox News. Being interviewed on The O'Reilly Factor on Fox News, he said, "If I see people who are in Muslim garb and I think, you know, they are identifying themselves first and foremost as Muslims, I get worried. I get nervous." A clip of the interview is here.

This was part of a larger conversation where Williams was in fact speaking against demonizing an entire religion because of the actions of a relative few. He was actually pointing out that his feelings were not rational and not a basis for any kind of policy.

Regardless, his statement was decried as bigoted and he was promptly fired by NPR. (Don't cry for him though, Fox offered him a $2 million contract).

E4E Take on Williams

So was it bigoted? If he had said "Muslims are evil," then I would agree he was being bigoted and not speaking factually. Demonstrably there are non-evil Muslims. His words however were clean.

He used the word "get" in place of "feel," but I think it's the same. He may be pre-judging the part about their identification, but he simply said that he is nervous around these people who dress differently. He didn't speak badly of them, he owned his feelings.

Bottom Line is that NPR was out to get him and just waiting for him to slip. It's too bad because it closes off an avenue for public rational discourse. This goes beyond political correctness.

Maura Kelly of Marie Claire

Kelly wrote an article about overweight people on TV. Much of the article was fine, she said that our country's obsession with physical perfection is unhealthy, and at the same time, it's probably not good to be glorifying obesity. So far so good.

Then she dropped the bomb.

"So anyway, yes, I think I'd be grossed out if I had to watch two characters with rolls and rolls of fat kissing each other ... because I'd be grossed out if I had to watch them doing anything. To be brutally honest, even in real life, I find it aesthetically displeasing to watch a very, very fat person simply walk across a room — just like I'd find it distressing if I saw a very drunk person stumbling across a bar or a heroine addict slumping in a chair.

"Now, don't go getting the wrong impression: I have a few friends who could be called plump. I'm not some size-ist jerk. And I also know how tough it can be for truly heavy people to psych themselves up for the long process of slimming down. (For instance, the overweight maintenance guy at my gym has talked to me a little bit about how it seems worthless for him to even try working out, because he's been heavy for as long as he can remember.)

"But ... I think obesity is something that most people have a ton of control over. It's something they can change, if only they put their minds to it."

She received megabytes of hate mail and issued an apology.

E4E take on Kelly
First of all, she is young (30s), beautiful, single, thin, never had kids, and by her own admission, has never been in love. So, I think it is safe to say that she is a self-absorbed person who can't relate to people who have families.

She expressed feelings adequately. In her first paragraph she said she'd "...be grossed out..." and "...find it aesthetically displeasing...", and "...find it distressing..." So she is expressing feelings of displeasure, distress, and disgust. So from a communication standpoint, what she said is defensible.

What she lacks completely is empathy. I'm sure she works hard to maintain her weight and has time to go to the gym and not have responsibilities for others in her life. She lives and works in the fashion world bubble and, based on her writing, seems to have no idea of what real life is.

Her weight loss message sounds fine. She goes on to say, "...eat more fresh and unprocessed foods, read labels and avoid foods with any kind of processed sweetener in them whether it's cane sugar or high fructose corn syrup, increase the amount of fiber you're getting, get some kind of exercise for 30 minutes at least five times a week, and do everything you can to stand up more — even while using your computer — and walk more."

You can't argue with that (although it needs more specifics to actually be useful), but it is what millions of people try to do and fail at.

--on soapbox-- It's not because of an epidemic of sloth and gluttony. Rather, it is because so many people's metabolisms have been perturbed by the standard American diet, which has been promoted by the USDA (food pyramid), doctors and congress. People living according to those guidelines are becoming diabetic and succumbing to the symptoms of the metabolic syndrome in increasing numbers. It's good for the grain and pharmaceutical industries though. When obese people try to get help they get the old calories in - calories out pep talk. Yes, most people can overcome obesity, but at a societal level, there is a tremendous amount of education that needs to be done in order to effect significant change. It starts with knowledge.--off soapbox=--

Bottom Line on Kelly is that although her words are fine, she is horribly insensitive to people who have been misled by our culture, our scientists, and our leaders. She owned her feelings, then went on to blame the victims. She chastises them by her false opinion about how easy it is to change. She also has her own body image issues an they spilled over into her writing. Please check out the Single Dad Laughing blog for a more sympathetic perspective of Ms. Kelly.

Overall

I am not defending either of these two people's opinions or feelings. I do not feel scared of Muslims, and I do not feel the same repulsion of large people. But, they owned their own feelings. Being public figures associated with the media, they both should have known better. The emotional intelligence of the American people is not very high, and Williams was probably on the bubble anyway with NPR.

I have no problem with political correctness in the way that I think about it. It boils down to speaking the truth objectively. People who complained were unprepared to hear the truth from these two folks. They wanted or expected them to be perfect, bland people devoid of human emotions, and if they had them to not share those emotions.

We all have to be careful with our words. They matter in many ways. Both of the journalists have a great opportunity to learn that simply saying something right does not mean that it is the right thing to say.

JAMA: Dietary Guidelines in the 21st Century - a Time for Food

2010-08-20T22:08:00.000-07:00

The Journal of the American Medical Association (JAMA) has a commentary in the August 11 edition entitled: "Dietary Guidelines in the 21st Century - a Time for Food" by Darius Mozaffarian, MD, DrPH and David S. Ludwig, MD, PhD.

The purpose of this post is to summarize and review the article and to talk about whether it is consistent with the e4e dietary recommendations. Special thanks to Ashley at itsofinterest.com for providing me with a copy of the article.

Commentary Overview

The second part of the title is a great start. A time for food. The article itself is in three parts, I will summarize the parts below.

Section 1 - Introduction
In the introduction in the commentary, they talk about how the last 200 years have been characterized by the discovery of finer and finer detail of the nutrients and nutrient deficiencies that led to widespread disease. This has led to a reductionist perspective in our food choices.

Section 2 - Dietary Guidelines in the Age of Chronic Disease

This reductionist view led to guidelines in the 70s and 80s around minimum and maximum intakes of nutrients. Although appealing, the RDAs have not worked, perhaps simply because of the complexity involved in translating these recommendations into real dietary choices. I will copy the last paragraph of this section directly with some highlights of my own. It is an amazing admission.

"Nutritional science has advanced rapidly, and the evi-
dence now demonstrates the major limitations of nutrient-
based metrics for prevention of chronic disease. The propor-
tion of total energy from fat appears largely unrelated to risk
of cardiovascular disease, cancer, diabetes, or obesity. Satu-
rated fat—targeted by nearly all nutrition-related profes-
sional organizations and governmental agencies—has little re-
lation to heart disease within most prevailing dietary patterns.
Typical recommendations to consume at least half of total
energy as carbohydrate, a nutrient for which humans have no
absolute requirement, conflate foods with widely divergent
physiologic effects (eg, brown rice, white bread, apples). Foods
are grouped based on protein content (chicken, fish, beans,
nuts) despite demonstrably different health effects. With few
exceptions (eg, omega-3 fats, trans fat, salt), individual com-
pounds in isolation have small effects on chronic diseases.8
Thus, little of the information found on food labels’ “nutri-
tion facts” panels provides useful guidance for selecting
healthier foods to prevent chronic disease."

All I can say is WOW.
To sum up:
Fat ingestion, in general, is fine.
Saturated Fat is not bad.
Carbohydrate food sources are not necessary and are not created equal.
Protein food sources are not created equal.
Individual compounds in isolation are largely unimportant.
Food labels suck.

The only thing that I wildly disagree with in this paragraph is that they included salt as a compound as an exception to the compounds in isolation comment. Salt is nowhere close to the villain that people make it out to be.

Section 3 - The Need for a New Approach

This is the longest section, and I would have roken it into at least two parts, but I digress.

They start this section by citing associations between food classes and disease from a paper called "Dietary Patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women", by Heideman, Schulze, Franco, et al.

They go on to say that the effects of foods "likely reflect complex, synergistic contributions from
and interactions among food structure, preparation meth-
ods, fatty acid profile, carbohydrate quality (eg, glycemic
index, fiber content), protein type, micronutrients, and phytochemicals." So far so good.

Then they say that "Healthy eating patterns share many character-
istics, emphasizing whole or minimally processed foods and
vegetable oils, with few highly processed foods or sugary
beverages. Such diets are also naturally lower in salt, trans
fat, saturated fat, refined carbohydrates, and added sugars;
are higher in unsaturated fats, fiber, antioxidants, miner-
als, and phytochemicals; and are more satiating." This is mostly ok, but they are somewhat contradicting their earlier statement that saturated fat is ok. They're still missing the boat on salt, and unsaturated fats are a mixed bag. Unsaturated fat is not by itself good or bad. The devil is in the details.

They continue by saying that the nutrient based approach to diet has fostered products that replace fat with refined carbohydrate, "providing an aura of healthiness but without
actual health benefits." A national obesity prevention program categorizes whole-milk yogurt and cheese with french fries and donuts as foods together (eat only occasionally). Puts sauteed vegetables and canned tuna in the same category as pretzels and processed cheese spread (eat sometimes). Puts trimmed beef and vegetables and fat free mayonnaise as foods to eat almost anytime. They fortify processed food parts with vitamins and call them healthy.

Recently, there has been movement towards recommending food rather than simply nutrients. Nutrients are still important, we should not simply throw away the last several decades. Although this is a promising direction, they believe that much research work still remains to be done.

They finish with the following:

"The relatively recent focus on nutrients parallels an increas-
ing discrepancy between theory and practice: the greater the
focus on nutrients, the less healthful foods have become. As
national and international organizations update dietary guide-
lines, nutrient targets should largely be replaced by food-based
targets. Such change would facilitate translation to the pub-
lic, correspond with scientific advances in chronic disease pre-
vention, mitigate industry manipulation, and remedy wide-
spread misperceptions about what constitutes healthful diets.

"Although this approach may seem radical, it actually rep-
resents a return to more traditional, time-tested ways of eat-
ing. Healthier food-based dietary patterns have existed for
generations among some populations. Modern nutritional
science now provides substantial evidence for how foods and
food-based patterns affect health, guiding the design of more
effective approaches for the prevention of chronic disease."

e4e Take On This

Wow. This is great. It is generally consistent with the e4e recommendations in, "Eat Food, Light on Carbs, Mindfully." I talk about some general targets for macronutrients, depending on goals, but interestingly once you go light on carbs and stick to the fringes of your grocery store (food), it's hard to go too far wrong.

Regarding my comments on salt, please read the article "The (Political) Science of Salt" by Gary Taubes.

The 2010 food pyramid looks like it will be more of the same old stuff. This commentary represents a significant step towards dietary sanity in a mainstream medical journal. Is sanity finally winning?

Sex Addicts? - Tiger Woods? Spitzer? Sanford? Moffat? The SEC?

2010-08-01T05:11:00.000-07:00

I'll start with some discussion of sex addiction or sexaholism. Addiction, in general, is a continuum. It is difficult and arbitrary to draw a line between addiction, obsession, kinky, or just plain love.

Sex addiction is tricky. If one is a sex addict, simply going cold turkey is not a good long-term solution. Sex, like food, is a part of the human condition and a good thing by itself. It's only when sex or food take on a purpose and control one's life that they become addictions.

Addictions aren't good because ultimately, "Mental health is commitment to reality at any cost." The following folks did not exhibit that. They put up tremendous stakes, ranging from presidential ambitions to the health of their wives, to vast sums of money. They convinced themselves that they could get away with it. So basically they had unlimited downside. The upside, you decide...

Tiger On The Road

Tiger is the latest in a string of high-profile Americans who have been identified as sex addicts (or possible ones). Mark Sanford and Elliot Spitzer are a couple other recent examples.

Tiger did everything that sex addicts do. He risked everything in his private life to spend a night or two with women who were very much out of his league. He had unprotected sex, thereby endangering his wife's health as well as his own. He risked hundreds of millions of dollars.

Here's a cynical view on it.

What makes an addict or, more specifically, a sex addict? And what distinguishes a sex addict from a "player"?

Infidelity News

SF Examiner

Tiger, in his public apology, used a lot of the right words that one who is receiving treatment for sex addiction would use. Many criticized him for his scripted speech, but I think it was a great first step.

e4e Verdict: Tiger is a sex addict. Risking and losing tens of millions of dollars, his reputation, family, and health to have sex with women well below his status. His only gain here was sex on the road.

The Curious Case of Eliot Spitzer

Another prominent sex scandal had to do with Eliot Spitzer, governor of New York. His case is different in a few ways than Tiger's. First, he wasn't having sex with random people while on the road. He chose to use prostitutes. And not just prostitutes, but very expensive ones.

The prostitutes that he was using charged several thousand per night, and reputedly provided a "girlfriend experience." It is more than just having sex with someone, but actually going on a date. Conversing, a meal, perhaps a show followed by making out, and sex is the modus operandi.

Spitzer had the high rank and a lot to lose by his actions, so that certainly fits the mold. I wonder if his case is a little different. He is essence was going out with actresses, women who knew how to be a blank slate, and as Sasha Grey says in The Girlfriend Experience, "Sometimes clients think they want the real you, but, at the end of the day, they want what they want you to be. They want you to be something else... If they wanted the real you, they wouldn't be paying you." and "You really have to adapt and become something that they want." So they come across as a young, beautiful, intelligent girl who is truly interested in him as a person--perhaps what his wife was like when they were courting.

He feels that spark again that has been gone for so long--the first stage of falling in love. Deep down, presumably, he knows that it is a facade, an image of a real relationship with a real person, but he pays the big bucks to get that feeling again. From a political standpoint, he doesn't have to get divorced and he doesn't have to deal with a real relationship. I am guessing that he saw this as a lower risk way to have an affair. It's all upside...

Until you get caught. Affairs are not illegal and would perhaps be less damaging to a political career. That's why I think that he is towards the middle of the sex and love addiction spectrum. His motives were more about the thrill of a new relationship rather than simply notches in the bedpost, but he took big risks in his personal life. I am assuming that his sex was protected. If not, that would put him further towards the addict side.

Here are some other views on Spitzer.

Often times these high-end prostitutes do not even have sex with their clients.

This article from Slate has the following quote:

"The last time I met him, I gave him a bath," she told me. "I told him he was the most sensitive man I'd ever met. I never tell him he's a piece of shit; I make him feel like superman." (This was not about Spitzer).

e4e Verdict: More love addict than sex addict. Definite problems by risking his career and marriage for thrills. If he had marital problems he should have dealt with those directly. I'm not justifying his actions. I suspect he was lonely and not receiving emotional props at home.

Mark Sanford and His Argentine Girlfriend

In contrast to Spitzer, Mark Sanford, governor of South Carolina was apparently having an actual girlfriend experience. He, in essence, threw out his marriage and possibly his political career for an Argentine woman, who was not a prostitute.

e4e Verdict: I don't think he's a sex addict, just a male who is in the first stage of love, where his hormones are completely dominating his common sense.

Robert Moffat of IBM

Although less well-known than some of the others, Moffat was a high level executive at IBM who got mixed up with an attractive analyst/former beauty queen who fed information from him to a hedge fund operator. He lost something on the order of $65MM. His wife of over 30 years had her MS flare up. Moffat apparently did not benefit financially from the arrangement, but that is not required to convict him. The only need to demonstrate that he obtained a benefit of some kind. Receiving sexual favors is considered a benefit.

Moffat is quoted in the article as saying, "Everyone wants to make this about sex. Danielle had an extensive network of business people. And she added clarity about what was going on in the business world...I know in my heart what this relationship was about: clarity in the business environment." The author reveals his skepticism by saying, "He may even believe that."

e4e Verdict: He is delusional. He was getting exciting sexual favors in exchange for information, and rationalized it away by his lack of financial benefit and by convincing hinself that he was getting "clarity in the business environment." Moffat is not mentally healthy. He is probably a sex or love addict of some kind. There was not enough information in the article to make a clear call. He did some really foolish things though, had no upside and lots of downside.

There is an excellent article in Fortune on this if you want more details.

The SEC?

What does the SEC have to do with this? In this article from the Atlantic Monthly, the author asks the question, "Did porn cause the financial crisis?".

e4e Verdict: not addicts, but the regulators were fiddling with themselves excessively during work hours, as the financial system was burning. I wouldn't be surprised if some of those involved are sex addicts. Maybe they're just immature.

Some additional reading and resources:

Helen Fisher on Why We Love and Cheat in Ted Talks

Willard Harley from Marriage Builders on how infidelity can sometimes be misinterpreted as sex addiction

Scientific American article on Why Men Buy Sex
Covers all the bases.

Hormones and Hunger--Which is the chicken; which is the egg?

2010-07-20T23:01:00.000-07:00

Recently, a person close to me revealed that he had been using anabolic steroids for almost a year in an attempt to increase his weightlifting. This caused quite an uproar in his family for a number of reasons (it was done surreptitiously, school studies doing poorly, misalignment in prioritization, etc.). That's not what I want to talk about though.

I want to talk about the calories in v calories out concept.

So first a little about steroids:

from Wikipedia:
Body composition and strength improvements
A review spanning more than three decades of experimental studies in men found that body weight may increase by 2–5 kg as a result of short term (10 weeks) [anabolic steroid] use, which may be attributed mainly to an increase of lean mass. Animal studies also found that fat mass was reduced, but most studies in humans failed to elucidate significant fat mass decrements. The effects on lean body mass have been shown to be dose dependent. Both muscle hypertrophy and the formation of new muscle fibers have been observed. The hydration of lean mass remains unaffected by AAS use, although small increments of blood volume cannot be ruled out.

During the year that he was on steroids, he gained about 50 pounds. There was a lot of muscle as well as fat. He was continually ravenously hungry. In that time, he ate "everything that didn't eat him first" according to his mother. Grocery bills in his home went up by about $500 per month.

So the question is did he gain weight because he was eating more, or did he eat more because he was gaining weight? I believe the main influence was the latter. I believe that he was forcing food in as well, so perhaps to some extent that forcing increased his fat mass, but his ravenous hunger was coming from someplace. It was the change in his hormonal environment caused by the steroids.

So obviously, this is not directly applicable to you or me, but the question I put to you is "how different is this really from the normal obese person?" Changes in hormones caused by stress, exercise, sleep, or lack thereof, the foods we eat, the bad stuff we eat that we call foods and the music we listen to, all change our mix of hormones. So what causes the obese to eat more than they consume? Are they eating because they're getting fat or getting fat because they are eating? Understanding the arrow of causality is fundamental to fixing obesity.

Our national assumption that overeating causes obesity has failed miserably (after all calories in minus calories out is the first law of thermodynamics). It's time to take an engineering approach and understand the real root cause, not just the simple-minded math/physics.

Very Quick Post on Free Will

2010-07-04T01:25:00.000-07:00

I have been looking for a way to describe a seeming contradiction in my thinking about free will or our lack thereof. That is the whole chicken and egg thing around if one has no free will, how can they possibly ever effect change in their own life. Ultimately, it comes down to rewriting our electro-chemical programs by changing the people we associate with, the food we eat, the exercise we do, the sleep we get, etc.

I think it comes down to something to nudge you in a different direction, then that nudge becomes a cascade of positive (or negative) results.

Nicholas Nassim Taleb who wrote The Black Swan and Fooled by Randomness (the better of the two IMHO), tweeted something that I think says it well.

"Unless we manipulate our surroundings, we have as little control over what & whom we think about as we do over the muscles of our hearts."

So it's not simply deciding to do something differently, we have to change our environment, i.e. do something in order to set up the conditions to make a change.

I would add that external forces can change the surroundings as well. Think of the woman who tells her husband that his breathing is broken at night.

OK. That's it. Happy Independence Day weekend for those in the US, Belarus, Argentina, Algeria, Burundi, Malawi, São Tomé and Príncipe, Solomon Islands, and Venezuela.

Snoring, Sleep Apnea, and Happy Father's Day

2010-06-20T07:55:00.000-07:00

Men have their struggles and so do women. The guys have historically had it better in the job market, while women live longer. Trade offs are everywhere. One place where men do get the short end of the stick is with snoring and sleep apnea.

I snore and have sleep apnea. It has caused a number of problems in my life. Here's my story, but first some definitions:
Snoring - making excessive noise while asleep during breathing. It can emanate from the nose or throat and is caused by partial obstruction in the air passages.
Sleep apnea or obstructive sleep apnea - obstruction during inhalation while sleeping. The word is from the Greek roots a: wihout, and pnea: air (same root as pneumatic and pneumonia).

I have a history of snoring dating back about 12 - 15 years. I probably snored some before that, but more sporadically. Over the years, my snoring got worse and worse. I slept on my side, face, changed position, etc. All those measures helped--for a while.

I began to sleep really hot. I would wake up and my sheets or nightshirts and pillow would be drenched in sweat. I became a serious head sweater. I did not link it to any underlying problem. It was just some weird sweating thing I did.

Finally, my wife had enough of the snoring and I went to see an otolarygologist. He told me I had three things going against me: I'm male, I'm not young anymore, and I could stand to lose a few pounds. I also got a sleep study. That is where they hook up sensors that measure heart rate, respiration, and other functions. They told me I had mild sporadic sleep apnea. Since there was nothing I could do about maleness or age, I embarked on a weight loss approach by reducing fat, exercising, etc.

I really tried, but just could not lose the weight. In fact I gained. Somewhere around his time we moved to California. My weight continued to climb, my blood pressure increased, I would feel a need to doze in the afternoons, and driving lfor more than an hour or so could be a real problem for me because I would get very sleepy. I had a persistent headache. Not bad, but it would not go away.

I got another sleep test, but this time the apnea was worse. The doctor strongly recommended that I use a CPAP (Continuous Positive Airway Pressure) machine.

It changed my life. The headaches went away immediately. I woke up with a dry pillow. I had less drowsiness problems during the day. Unfortunately, the noise from the machine and air leaking, etc bothered my wife almost as much as the snoring, so the noise has continued to be a problem in our lives. We do not sleep together as much as either of us would like. I am still working on my weight and have made good progress. I have found that when I get my weight below 200 lbs, snoring and apnea are hardly a problem.

I have gotten several consultations and found that in my case, because of the configuration of my tongue and throat, I would need fairly major surgery to fix it. There is a fairly low percentage of success, and if it fails, the CPAP machine would no longer be effective. So my best choice is to continue with the CPAP and lose weight in order to get it out of the bedroom.

Why Care?
I think of snoring as pre-apnea. If you snore you may not have sleep apena, but if you have sleep apena you probably snore. Snoring by itself is not a health risk. Only when it continues to sleep apnea does it cause severe health problems.

The sleep apnea cycle looks something like this:
1. You begin to fall asleep
2. Your throat muscles relax, closing the airway in the throat
3. Breathing stops
4. You wake up because you are suffocating

This causes hormonal changes (including excessive cortisol) and bad sleep patterns. Which lead to all sorts of problems.

Some common symptoms of sleep apnea include:

Restless sleep
Excessive sweating at night
Loud, heavy snoring often interrupted by silence and gasps
Drowsiness or lack of energy, caused by the lack of sleep
Headaches in the morning
Irritability, forgetfulness, mood or behavior changes
Anxiety or depression
Sore throat in the morning

It is believed that sleep apnea leads to other problems including:

Causes bodily changes that lead to Hypertension or high blood pressure
Heart related conditions such as coronary artery disease, myocardial infarction and stroke
Psychiatric problems such as depression
Impotence and lack of interest in sex
Cognitive dysfunction or memory loss

E4E Recommendations:

If you have any of the symptoms or if people tell you that you snore or hold your breath while sleeping, get a sleep study done.
Limit alcohol. It can have a relaxing effect on those throat muscles.
Do not sleep on your back.
Get a CPAP as a first line treatment. Breaking the cycle of bad sleep can help you ultimately make the lifestyle changes required to go off the machine eventually.
Focus on eating well to get your weight under control.
Consider other treatments for apnea. There are dental appliances that reposition your jaw at night, and a wide range of surgeries from minimally invasive to major jaw reconstructions. These surgeries can also work for simple snoring, but you have to question whether the cure is more dangerous than the condition at that point. Also, when snoring is caused by nasal obstructions (e.g. deviated septum), it can sometimes be fixed with surgery.
Since this is mainly a male disorder, I want to encourage partners of men with sleep disorders to encourage them to do the above. It could be the best Father's Day present they'll ever get.
Also for partners of snorers, if the noise is a problem with or without treatment, try earplugs or a white noise machine. Sleeping together is a good form of physical intimacy.

Happy Father's Day
Take care.

Additional links:

A fantastic site from UCSF Sleep Surgery Center with full information and treatment alternatives. The focus is on surgery, but the overview page is excellent.

An online test from UCSF
An online test you can take.

BaconCamp SF 2010

2010-05-08T18:50:00.000-07:00

We went to BaconCamp SF2010 today in the Mission District of San Francisco.

My wife talked about the food that we had prepared, then she introduced me to talk about the special sauce.

I started like this. "Not long ago, I called mayonnaise "white death." Like so many others in this country, I was brainwashed to believe that fat, especially "artery clogging saturated fat was unhealthy." It could only lead to an early grave."

You see we had made some homemade mayonnaise, but instead of using normal cooking oil, we used rendered bacon fat to make it. It is delectable. Baconnaise is the new black.

Here is the handout we prepared for the group at BaconCamp.

BET (Bacon Endive Tomato): - Organic red endive, organic cherry tomatoes, baconnaise, crumbled bacon

Baby artichokes: Steamed organic baby artichokes, baconnaise crumbled bacon

http://whatscookingamerica.net/History/SauceHistory.htm

“There are five foundation sauces or basic sauces, called in French grandes sauces or sayces meres. Two of them have a record of two hundred years behind them; they are the "bechamelle" and the "mayonnaise." They have lasted so long, not only because they are very good, but also because they are so adaptable and provide a fine basis for a considerable number of other sauces.”

Baconnaise Recipe

Adapted from Serious Eats and the book Fat by Jennifer McLagan

http://dinersjournal.blogs.nytimes.com/2008/08/25/introducing-a-recipe-contest-with-prizes/ basic recipe from Fat

http://www.seriouseats.com/recipes/2009/10/baconnaise-meat-mayos-mayonnaise-recipe.html basic recipe from Serious Eats

http://www.seriouseats.com/2009/10/the-food-lab-meatonnaise-mayonnaises-mayos-bacon-lamb-duck-beef-fats-science.html info about the science

Ingredients

3/4 cup rendered bacon fat, melted , slightly warm, but not hot (don’t cook the eggs!)

3/4 cup canola oil  or other lightly flavored, less-saturated oil (e.g. avocado)

2 egg yolks

 1 tablespoon Dijon mustard 

1 tablespoon water, plus more to correct consistency

about 1 tbsp  lemon juice (more or less to taste)

 salt and pepper to taste

 4 strips crisp bacon, crumbled

Procedure

1. Combine bacon fat and canola oil in 2-cup liquid measuring cup. Whisk to combine.

2. Add egg yolks, Dijon mustard, mayonnaise, and water to bowl of food processor. Run processor for 5 seconds to combine. Scrape down sides of processor bowl with rubber spatula. With processor running, slowly drizzle fat into bowl in a thin, steady stream (added over about 2 minutes), stopping and scraping down sides as necessary. Add lemon juice, salt, and pepper to taste, and adjust consistency with water until thick, smooth, and creamy, but not mouth-coatingly waxy. Stir in crumbled bacon bits, if using. Store in refrigerator in airtight container for up to two weeks.

For our contributions at BaconCamp SF 2010, we used Farmers Hickory Brand Natural Applewood Smoked Center Cut Bacon (CostCo), cage-free eggs, juice from a Meyer Lemon, and canola oil.

Healthwise
Look at the ingredients: a simple emulsion of egg yolk, bacon fat, canola oil, lemon juice, and water. By far, the worst ingredient in there is canola oil, and a lot of folks believe that it is actually good for you. I have moved to the belief that if the food is something that we, as a species, could have eaten 15,000 years ago, it's probably ok. Food that has been around for less time than that carries more risk. So pork, lemon, and eggs are good, whereas canola in my mind is a question mark.

So, we aren't going to eat the stuff by the tablespoon, but it is delicious as a condiment. Try it on a baconburger or BLT.

Results
The judges at BaconCamp overall liked the BET, but I think one of them got a piece of endive from which the baconnaise had fallen out. The baby artichoke was blander. We would have been much better off if we had really heaped on the baconnaise. One judge dinged it because he could "taste the artichoke."

All in all fun. We will be back next year.

By the way, we met a guy, Tom, from the Wooly Pigs Company. He sold us a package of jowl bacon from their Mangalitsa herd. It was like a drug deal--cash for a package. They have been in business a few years. I can't wait to try it. I won't blog a review, but watch my tweets.

White Death

By the way, I got the name white death from a comic strip from the 80s called Arnold. It was a favorite of mine. Arnold was a sick little dude.

Perhaps he was talking about Hellman's mayonnaise
Soybean oil, whole eggs, vinegar, water, egg yolks, salt, sugar, lemon juice, natural flavors, calcium disodium EDTA (used to protect quality)

Short Term Personal Healing vs. Long Term Public Health

2010-04-21T11:37:00.000-07:00

The Rise of the Superbugs has been in the news lately.

Dave at Spark of Reason tweeted an article about disinfectants promoting the growth of superbugs.

The New York Times had an op-ed piece on antibiotics in the the food supply (Cows on Drugs).

Nicholas Kristof at the NY Times did a good article about this. The Rise of the Superbugs the view expressed in that column is that the large scale use of antibiotics that we feed to cattle is the leading cause of the evolution of the antibiotic resistant bacteria.

The articles are about microevolution in action, and more broadly about the tragedy of the commons.

In simple terms, it works like this. If you clean something with a disinfectant, there is a chance that some of the bacteria and germs will survive. The ones that survive are, in principle, those best adapted to repel the disinfectant. Their offspring will then be more fit, meaning that we would need stronger or different disinfectants to kill them, etc. The Kristof article goes further, and in fact, the microbes become more immune to antibiotics as well.

This is one of the reasons that when you get antibiotics from your doctor they tell you to finish the prescription. If you take a few pills and it kills only some of the microbes--enough to make you feel better--the remaining microbes will be those most immune to the drug.

It's escalation at a microscopic level. The more people that use disinfectants and clean the beejeezus out of themselves, the more likely that strong bugs will proliferate. So for all of us, keeping ourselves clean with soap and other anti-bacterial agents is, at some level a disservice to society. Just sayin'.

Many workplaces have taken to putting out alcohol based hand cleansers to help prevent the spread of colds and flu. Is there an unintended consequence waiting to happen. I would recommend vitamin D, over using sanitizers.

There is also an idea that our children are more prone to disease and autoimmune issues because of the relatively sterile environments in which we live today (hygiene hypothesis). There is even a type of therapy called helminthic therapy in which you are infected with hookworms, which has the effect of reducing allery symptoms.

My father was a doctor. Some years ago, I asked him about antibiotics and strengthening the enemy. His response was that if a patient came to him with a disease that could be treated by antibiotics, he would not hesitate to prescribe them. His focus was on treating the person, and for him a worse case scenario was something like, person comes in, he doesn't prescribe, and that person dies.

In my own mind, I have arrived to the conclusion, after reading the articles above that fundamentally, my father's view is a good perspective.

Judicious treatment of large numbers of symptomatic people with antibiotics, may result in some cases of creating stronger bugs, but the benefit to individual humans can't be ignored. However, blanket antibiotic treatment, as happens in the meat and dairy industry, is not good for anyone.

E4E Recommendations:
1. Keep adequate vitamin D levels in your body. It strengthens your body's ability to repel the invaders.
2. Consider organic and grass fed meat raised without the use of antibiotics. Corn is not a normal diet for cattle, and they tend to get sicker on that diet, thus the antibiotics. If you're worried about some of the recent press around beef and global warming, Spark of Reason has something to say about it.
3. I won't recommend hookworm (helminthic) therapy, don't worry. It is intriguing though.
4. If you are sick, and your doctor recommends antibiotics, take them, get yourself well. Consume the entire bottle, don't stop partway through the course.
5. You should still wash your hands with soap after using the toilet and before cooking. There are nasty bugs that can live in the digestive tract and nether regions.
6. Consider going soapless. I don't do it myself, but personally know one person who has done it, and Richard over at Free The Animal has also done it. Wash yourself, but use cloths, brushes, and water to get clean, not soap.

Thanks for reading. I hope you follow my tweets on twitter as well. My tweet handle is ee4ee.

Eat Food, Light on Carbs, Mindfully - E4E Nutrition Recommendations Revisited

2010-01-23T15:13:00.000-08:00

In 2008, I published a series of nutrition posts.

The final entry was a set of dietary recommendations.

Since then diet and health has continued as ~~a full blown obsession~~ a special interest, I have read and studied a lot and and done a little self-experimentation. I have evolved my thinking to believe that something resembling caveman or paleo diets is the most healthful way to eat. Eat natural foods (don't shy away from meat), stay away from processed sugars, grains, and seed oils (which are relatively new in the human diet).

As I look back, I realize that I have a few modifications on the original post.

First, the original post recommended 1 gram of protein per pound of bodyweight. Although that amount won't hurt anyone, it is probably more than many people need. If you are a. engaged in intense physical activity or b. trying to seriously lose weight, that amount is probably ok. If you are not a serious athete and not trying to lose weight, most people can knock that back a bit. The US RDA is 0.8 g/kg of body weight (.36 g/ lb). I think that, as a minimum, most people should be in the 0.5 - 0.75 range. Protein has a lot of benefits including being the best food type for promoting satiety. (Aug 20, 2010 Edit: Some of my recent reading indicates that rather than bodyweight, lean body mass is a better benchmark. So a person who weighs 200 lbs and is 20% body fat should use 160 [200-(200*.2)] as the reference weight for protein consumption. This is still consistent with the above recommendations for most, but people with very high body fat may need to dial protein back a little).

Second, I recommended 50-100g of carbohydrates. I still think that's ok, even though many people can tolerate more than that without ill effects. Previously I said that healthy whole grains were ok. I'm retracting that now.

The carbohydrates you eat should come largely from vegetables. Not from sugar; not from grains.

Many people can tolerate grains (wheat, rice, etc.). But, I am hearing more and more about people who have coeliac (pronounced see-lee-ack) disease or an intolerance to gluten, a composite protein found in many grains. It also contains phytic acid, which, despite some potential therapeutic uses, also has myriad bad effects on teeth and mineral absorption. Bottom line is that grain provides nothing that is not easily found in other foods, and has lots of potential downsides. If you must eat grains, consider the advice given at Food Renegade (sprout, ferment, or soak). Stephan Guyenet at Whole Health Source has a number of informative articles about grains and phytic acid.

Compounds found in vegetables and many fruits are healthful (as opposed to the relatively empty calories of grains). Fruits may be over-sugary, so stick mainly with vegetables as the source of your carbohydrates. If you exercise intensely or are a competitive athlete, you may need to refill muscle glycogen. You can use starchy vegetables like potatoes or other tubers to do that, with little danger of ill-effects. If you must eat sugar, do so within about an hour of intense exercise (preferably after). Then your body will simply store it as muscle glycogen. That is pretty good advice for carbs in general as well.

Sugar, like grains, has little upside (besides the taste). Neither of these are required to sustain life, and there is lots of potential downside. One of the main issues with sugar is the fructose in it (see this video for an interesting perspective on fructose). This leaves vegetables as the best source of additional carbohydrates.

As a final note on sugar, fruit juice is not much different from a can of Coke. A 12 oz glass of orange juice has about the same sugar, and all you get extra is a little vitamin C and folate. That glass of sunshine is not what it's cracked up to be.

Third, I want to put a little more emphasis on the fats and oils in the diet. I said that you should stay away from trans fats, and that's still good. In general, oils made from grains (canola, corn) or soybeans requite a lot of processing to be edible. These unsaturated oils tend to oxidize easily and can lead to inflammation. I would lean more towards oils that require minimal processing. Do not be afraid of saturated fats like those found in dairy, coconut oil, and animal fats. A recent meta-analysis study shows that there is no evidence that saturated fats increase the risk of heart disease.

There is also the possibility that omega 6 to omega 3 ratio in our diet is causing problems across our population. Vegetable oils tend to be higher in omega 6. The best sources of omega 3 are fatty fish or fish oil and grass fed and finished beef. This is another reason to stay away from vegetable oils.

Fourth, I said to stick to the basics until you are on the right track. To clarify that a little bit, the basics include getting your macronutrient amounts about right (Protein: (20 - 40%), Carbohydrate: (10 - 20%), Fat: (40 - 70%)). Minimize sugar and grain consumption. Cut back, in general, on vegetable oils. The more processing required to be edible, the more you should stay away from them. Use butter instead of margarine; lard instead of crisco (crystallized cottonseed oil). Do NOT stress over meal frequency. If you don't feel hungry, (more than just a grumbling belly), there's no pressing urgency to eat.

The basic concept is to establish a metabolism similar to what ancestral humans had pre-agriculture. This is not to say that you should do caveman food re-enactment, just that you want to eat foods that have the same overall effect on your metabolism.

One other thing, you don't have to be perfect about all this. Don't kick yourself if you blow one meal (or day). Sometimes, it is just a good thing to live a little. Don't ruin your health by eating something to which you are allergic, but if one night you have a scoop of ice cream, or you have some pasta with your daughter at her team's pasta feed, it's ok. Food events can be very personal bonding events, and it's ok. In fact, some of the diet folks, especially Lyle McDonald, incorporate carbohydrate refeeds to help normalize leptin, which then helps to suppress appetite. So once in a while, ease up a little, call it a carb refeed, forgive yourself, and move on.

Just doing the above will make a huge difference to many people. Going beyond that, some things to consider in my view of order of importance:

1. Take a vitamin D supplement, especially if you have darker skin, live in high latitudes, or get little unprotected sun exposure.
2. Consider pasture-fed meat and dairy products. The fat in those tends to be higher in omega-3 fatty acids and lower in omega-6. A corollary to this is to consider cutting out milk products altogether. Many people are sensitive to dairy and some do not think it is appropriate for humans. Here is Mark Sisson's take.
2a. If you do not implement 2, take a few fish oil capsules to supplement omega 3 fatty acids.
3. Consider consuming more organic produce in general. Less pesticides, chemicals, and other gunk.
4. Consider a vitamin K2 supplement or increasing foods with K2.
5. I do not encourage a vegetarian or vegan diet. It is obviously fine for some people, but many will have trouble meeting the protein requirements without lots of soy, and the oil content may be a problem. This is probably offset in many cases by overall reduced calories. Lierre Keith, a former vegetarian, recently wrote The Vegetarian Myth. I have not yet read it, but have seen a number of interesting and excellent reviews.

Some of my favorite sources:
Whole Health Source - refined grains, sugar, industrial seed oils are bad
Lyle McDonald - Nothing is good or bad per se. Food can help achieve specific goals.
Protein Power - More protein, less carbs. Drs. Michael and Mary Dan Eades. Also Sous Vide Supreme.
Summer Tomato - Foodie blog by a San Francisco Neuroscientist
The Paleo Diet, Loren Cordain - Paleo/caveman - No dairy, limited saturated fat ok
PaNu - Paleolithic nutrition. Establish an "Evolutionary Metabolic Milieu (EM2) not about food reenactment. Dairy ok.
Spark of Reason - Dave posts good info with sound logic. Give us more...
Free the Animal - Richard is a self-experimenter and paleo nutrition enthusiast. Lots of good info.
Zeroing In On Health - espouses zero carb lifestyle
Nephropal - Good science and understanding of hormones and biochemistry. Great information with a paleo bias. Here are their dietary recommendations.
Fat Head Blog and Movie - I highly recommend the movie. The blog has interesting and funny perspectives on many diet topics.
and of course, Good Calories, Bad Calories by Gary Taubes - I am not sure he gets everything right, but most of it is really good.

Interpreting Science Writing

2009-12-30T00:06:00.000-08:00

Note to readers: This column is coming out much later than I had intended. I apologize for that. I think I may have blown my resolution from earlier this year to put out one post per month. I really struggled with this one. As I wrote, the article kept getting longer and more detailed. There is no shortage of bad science coverage out there. I was stalled and my wife helped me break out of it (thanks). Ultimately, I probably should treat this as an overview post, then put in detailed posts in the future on some of the individual points.

So please let me know in the comments if you are interested in reading more detail about any of the points made in this post. --e4e

Writing about science writing is like writing about vocabulary or word usage. There is a really good chance that you will find inconsistencies in some of your own practices. Shame and ridicule have never stopped me though, so here goes.

Sensational headlines call to us to stop eating saturated fat. Or to stay out of the sun. Do more cardio (or less). How can we make sense of this hodge-podge?

First, research has a well-defined and specific structure and process. The researcher states a null hypothesis, e.g. saturated fat does not cause heart disease. Then they determine a protocol for testing that hypothesis. Run the research and analyze the results. In standard scientific method, the results do not prove the hypothesis--they either reject it or fail to reject it. This is similar to a court case, where a defendant is found guilty or not guilty. A "Not guilty" verdict does not prove innocence, only that there was not sufficient evidence to prove guilt.

Repeating studies and testing variations of the hypothesis are an important part of this as well. For example, if the researchers use palmitic acid (a saturated fat) in the original protocol, someone else might try a similar experiment with lauric acid (another saturated fat) to see if the result is generalizable to another saturated fat. Or perhaps they would try a similar test with fewer refined carbohydrates in the diet to test a suspected interaction.

In the final analysis, only when a hypothesis has been tested multiple times with valid well-designed studies, along with reasonable variations, and has been peer-reviewed, can we begin to say that the hypothesis or its evolved state is very likely. This is even more true in human studies, where numerous factors can confound results.

Sadly, in the current state of our society and even perhaps in research communities, we take as given, hypotheses that are much less well-founded. A typical flow is more like this. A researcher analyzes a data set and looks for relationships in the data. If he or she finds one, he builds a hypothesis that rationalizes what he thinks he sees in the full data set, or even worse, a filtered or smoothed one. So far, it's not too bad. If he then takes his analysis and designs a good intervention study he may be on to something.

Unfortunately, too often, a science writer gets wind of his hypothesis (the researchers are not innocent in this), and publishes a sensational story before the real work begins.

As always, you are your own n = 1. Read carefully, learn voraciously, and caveat emptor.

Following are some considerations to think about when reaing and interpreting science writing.

1. Many, or perhaps most, mainstream science writers are much stronger at writing than science. They do not have the ability, inclination, or motivation to discriminate between important and unimportant results. Question mainstream media (MSM) reports of science. Gary Taubes is seen by many as one of the better science writers around. Who are some others?

2. Correlation does not imply causation, however, lack of correlation does imply lack of causation - If you are reading about an epidemiological (observational) study it proves nothing. Epidemiology is the study of factors affecting the health and illness of populations. Not long ago they tracked thousands of people over 10 years based on what they reported eating, then said that eating more red meat was "linked to early death." That's fine as far as it goes, but then the reporting (and the "scientists") took the next step and said that therefore, eating meat causes cancer. That's not science.

In a similar vein, beware the expression, "...is a risk factor for...", e.g. "Obesity is a risk factor for diabetes." When I read that I interpret causality, as in obesity causes diabetes. The truth of the matter is more like, "people who have diabetes tend also to be obese, both conditions are related to a insulin-resistant metabolic defect."

The epidemiological studies can point you in the direction of something to test further, i.e. they can generate a hypothesis, but it can not establish causality. A great comment by "seyont" from Dr. Eades' blog. "An observational study is sort of a triple-blind study. The researchers do not know what experiment was performed, on whom it was performed, or even if it was performed. They grab a bunch of people and dream up an experiment which could plausibly have produced the correlations they see."

3. Mouse studies are similar. They can point you in a direction for further study, but are not conclusive. I'm sure you get that mice are not people (although some people are rats). Here's an example and an alternate hypothesis.

4. Look out for the word "adjusted." There are always confounding factors in studies that researchers want to adjust for. It is impossible to adjust accurately and there is always slop in it. If there is an adjustment factor applied there is doubt in the conclusions. This is especially an issue when the size of the adjustments (the noise) is of a similar order of magnitude to the quantity being measured (the signal). It doesn't mean the conclusions are wrong necessarily, but the basis of the adjustments has to be really strong for the conclusions to be valid.

5. Watch out for weasel words like "probably," "potentially," and "may." It doesn't mean that the conclusions are necessarily wrong, but often those words are inserted to make the sensational headlines true. Brad Pilon of Eat Stop Eat fame talks about an article with plenty of weasel words here.

6. Details are important and usually not covered in a 1,000 word article.

7. Randomized double-blind placebo controlled intervention studies are the gold-standard for nutrition research. Unfortunately they can be extremely expensive, especially for long term effects.

8. Follow the money - Look to see who paid for the research. If the results fit their commercial or social agenda, doubt the conclusions. There is a very strong bias in research publications that results that do not support the sponsors agenda do not get published or get spun. This article hammers the statin people for treating their agenda as science.

9. Focus on what you care about. Many studies support a very narrow agenda. For example, the American dermatologists association says to always protect your skin from the sun with sun screen. Their agenda is to prevent skin cancer. However, lack of sun can cause lack of vitamin D, which is associated with (causality?) higher incidence of other cancers, flu, and colds.

10. Question results that are not consistent with how mankind has lived for two million years. Using sun exposure as an example again, our bodies are finely tuned to an ancient lifestyle. It seems crazy in that framework to think that exposure to "normal" amounts of sun would be overall detrimental to health. Your mileage may vary if you are very fair for example, but keep things in perspective.

11. Beware statistical significance. Statistical significance is a term that tells how sure you are that a difference or relationship exists. If a relationship between to variables is found to be "statistically significant", it means that it is unlikely that the observed relationship is random. The relationship may be small or meaningless, but they are highly likely (generally 95%) to be linked.

12. Paradoxes aren't paradoxes. They are information that disproves the hypothesis of some preconceived notion or prejudice. Perhaps the most famous paradox is the "French Paradox." the French eat more saturated fat, yet have better heart health than Americans. Lots of hypotheses have been generated to explain this (more smoking, more red wine, etc). Yeah, that's it, that's the ticket. Drinking and smoking actually protect you from heart disease. Oh, but not too much. That will kill you. Dave at Spark of Reason wrote this article on paradoxes. Tom Naughton of Fat Head fame had this to say.

Let's apply Occam's Razor. There is a much simpler conclusion--the original hypothesis is wrong: saturated fat does not cause heart disease. From Dave at Spark of Reason: "A true paradox would indicate inconsistency in the rules and assumptions used to build the system."

13. Many intervention studies do not test the reported factor, but rather something entirely different. As an example, if you want to test the impact of a low carbohydrate diet on lipid profiles, there should be control of the actual ingestion of carbohydrates. However, some studies are actually designed to test compliance to that type of diet as well as the impact. It then becomes difficult to draw conclusions about the physical effect of the diet.

14. Statements of certainty, e.g. "the science is settled" or "it is universally accepted that..." can be used to bully people into alignment. It takes a gutsy and very confident person to argue against the "consensus." This doesn't mean that the predominant view is wrong, just raises a red flag to the possibility that people are trying to cut off additional inquiry.

15. It is possible that most published research is wrong. Bayesian analysis of false positives and negatives, combined with human nature and biases conspire to place a scary-high likelihood that any given research results are incorrect. Here's the original paper for anyone interested.

16. Look at the logic. If the author is simply focusing on the qualifications (or lack thereof) of someone. It may indicate that the substance is weak.

Some Examples of Analysis of Science Writing

1. This article, "A High Fat Diet During Pregnancy Can Lead To Severe Liver Disease in Offspring," as skewered here by Chris Masterjohn is an excellent example of several of the points above. First, the article talks about the mother or the woman or the child in several places, the headline talks about high fat, while the researchers talk about high saturated fat. Incredibly, they fail to mention that the "woman and mother" in question is a mouse. Oh and by the way, that low fat control diet was higher in saturated fat as a percentage than the high fat diet.

From Masterjohn:
"...less than seven percent of the calories from the 'unhealthy saturated-fat-enriched diet' actually came from saturated fat.

"The "unhealthy saturated fat-enriched diet" actually contained 44 percent of its fat as polyunsaturated fatty acids (PUFA) and almost twenty percent of its total calories as PUFA. This is in great excess of the PUFA consumption seen even in the Standard American Diet (SAD), loaded in processed PUFA-rich vegetable oils."

2. Design of experiments, Hypothesis Testing and Bayesian Inference are critical aspects of understanding the validity of ideas. It seems that many researchers are not skilled in the application of those aspects, especially in nutrition and exercise. We're left then with unskilled reporters and broscience.

One of the more famous occurred some years ago when an epidemiological studies demonstrated a correlation between hormone replacement therapy (HRT) in women and better cancer rates. For years after that millions of women were put on HRT, post-menopause. Only recently did they actually perform a placebo-controlled study and find that (oops), HRT actually increases breast cancer and heart attack and can lead to early dementia. It can also have some positive effects such as decrease in hip fracture and colorectal cancer. It seems that in the early epidemiological studies, the women on HRT tended to be more health conscious in general. This then masked the negative impact of the HRT.

But, here are some of the details in this. Even with the good study, the timing of starting the HRT made a difference, and it showed age variation in the impacts. Also, it could be that it was an indictment of the specific hormones used in the study and not HRT in general.

3. Another significant epidemiological study that is looking worse every day is the Ancel Key's Seven Nations Study. This may be of the most devastatingly believed studies in the history of the world. In a nutshell, Keys plotted cardiovascular disease against animal fat consumption in seven countries and found a very high correlation. However, he omitted 14 countries with data that did not support his hypothesis. This in turn led directly to higher sugar and carbohydrate intake and to reduced fat consumption. Some believe that this is one of the main causes of the obesity and cardiovascular disease epidemic in the world today.

4. Read Gary Taubes' article on epidemiology or better yet, buy Good Calories, Bad Calories

5. Here's another Taubes interview on Good and Bad Science

6. Michael Eades on epidemiological research

7. Staggeringly good 4-part example (1), (2), (3), (4) of analyzing a study and generating an alternate hypothesis from Whole Health Source

8. Interesting perspective on good science from OvercomingBias

A quote from one of the commenters, daublin

"There is a lot of confusion in both the cited article and in this article about what science is. For sure, it’s not the “scientific method”. That doesn’t mean science doesn’t happen, but that it’s being misdescribed. Here’s what science means, in the tradition descending from the Enlightenment. Science is study with the following properties:

"1. It’s about objective claims. There is no place in science for claims that different observers will, by definition, never agree on.

"2. It’s about falsifiable claims. There is no place in science for claims that could never possibly be decisively proven false.

"3. The evidence must be repeatable by other scientists. In particular, experiments must be communicated in enough detail that other scientists can repeat the experiment so as to verify the result.

"4. It follows Occam’s Razor. Simple theories are better than complex ones."

Which Vitamin D Test to Get? 25-hydroxy-vitamin D!

2009-10-25T14:43:00.000-07:00

Swine flu and seasonal flu are in the air. We're close to panic season now. At work, more than 1500 people showed up in one day to get flu shots. They had to turn people away.

Some of my family members recently had flu-like symptoms for several days, then recovered. A family doctor said it was in all likelihood the swine flu. I didn't get (some really minor feverishness, followed by a nap and all was ok).

There is evidence that sufficient blood levels of Vitamin D is protective against colds, flu, and even cancer. Read about Vitamin D here. Also Grassroots Health is an excellent resource.

When I went to my doctor in the spring, he ordered a vitamin D test, but it was not the "right" one, so I had him change it.

For the record, you should get a 25-hydroxy-vitamin d test, and the results should be 50–80 nanograms per milliliter (ng/mL) or 125–200 nanomoles per liter (nM/l) year-round.

If you are below that range, consider supplementation with Vitamin D3 (cholecalciferol), not D2 (ergocalciferol). It makes a difference, although there is some controversy. Some claim that oil based caplets offer more reliable absorption than dry pills.

Many people like the Carlson Gelcaps.

I use Costco myself.

An excellent overall resource to learn about Vitamin D is the Vitamin D Council.

If you have trouble with your doctor, you can get a mail-order vitamin d test.

While you're at it, you might consider Vitamin K2 levels as well...

What Blood Test Should I Have?
from an article by John Cannell

"The only blood test that can determine vitamin D adequacy is a 25-hydroxy-vitamin D. Whenever I say "vitamin D level," I'm talking about a 25-hydroxy-vitamin D. Ask your doctor to order a 25-hydroxy-vitamin D blood test. Unfortunately, many doctors order an "activated vitamin D" level, thinking it better to measure the most active form of vitamin D. It is not. Activated vitamin D, also known as 1,25-di-hydroxy-vitamin D or calcitriol, should never be obtained to determine vitamin D sufficiency. Calcitriol is often elevated in vitamin D deficiency. You cannot tell anything about your vitamin D nutrition by measuring a calcitriol level. If your doctor insists on ordering a calcitriol level to determine your vitamin D nutrition, find another doctor."

"(Although 1,25 dihydroxy-vitamin D (calcitriol) should never be used to diagnose vitamin D deficiency, calcitriol is important in evaluating one cause of high blood calcium, called vitamin D hypersensitivity. High blood calcium rarely occurs due to vitamin D toxicity, but calcium is elevated in people who have vitamin D hypersensitivity, although their vitamin D level will be normal or even low. Primary hyperparathyroidism is a common cause of vitamin D hypersensitivity, as is sarcoidosis and other granulomatous diseases. It can occasionally occur in cancer; about 20% of patients with non-Hodgkin's lymphoma have vitamin D hypersensitivity. Any competent endocrinologist can treat vitamin D hypersensitivity.)"

"However, serious problems exist with the technology used by some laboratories to measure vitamin D levels. Different labs will report different results when given the exact same specimen of blood. Furthermore, the same lab often reports significantly different numbers when sent the same specimen of blood at different times. In general, low numbers are more reliable than high numbers because interfering substances can easily give falsely elevated results. Prominent scientists have issued urgent calls for standardization. ...

"If you take ergocalciferol, or "vegetarian" vitamin D, be warned. Ergocalciferol is not vitamin D, but a vitamin D-like patent drug whose patent has expired. It does not normally occur in the human body and is probably a weak agonist at the receptor site, meaning it may actually partially block vitamin D actions. Ergocalciferol is the villain in most of the reported cases of toxicity in the world's literature. All bets are off in terms of measuring blood levels if you take ergocalciferol. Some of the labs can pick it up, and some can't. Don't take ergocalciferol; it is not vitamin D."

The Causes of Gout

2009-09-02T18:16:00.000-07:00

In a previous post I mentioned that a bout of gout had been my wakeup call for getting my diet right. That wakeup call led to a much deeper understanding of metabolism and the biochemistry of the body.

I recently had a minor recurrence of gout and it followed a similar pattern to what happened in 2007, so I did more research on it.

The Pattern

I noticed in mid-2007, that the day after a really hard workout, usually a leg workout, my feet hurt--not badly though. It almost felt as if I had a bone a little out of joint or something. I attributed it to something about the way I was doing my calf raises. When I had the bad gout in November of 2007, it was after a leg workout, and as it got worse, I thought it was related to an infection on my foot. Finally, it just went away on its own and my podiatrist told me it was probably gout.

I have had a few very minor cases since then, each time it went away after a day or two, So last week, after a leg workout, my foot hurt. It was just a little bit, and I thought that it was related to a splinter or something I had in the ball of my foot (my feet are a mess). But then it got worse, and I realized that it was the onset of gout. Again, it was following exercise.

Findings
First, it is generally accepted that gout is caused by the formation of crystals of uric acid in the joints. It usually expresses itself in the foot. The crystals form often when the blood concentration of uric acid reaches a high level.

For a long time, the standard cure was lay off organ meats and red wine, because those contain purines (of which uric acid is a by-product). The problem is that I was not eating organ meat, and I wasn't drinking that much red wine. So the standard advice was useless for me.

So I have found a number of interesting things about the accumulation of uric acid in the blood.

Under normal conditions, uric acid is pulled out of the blood and excreted in urine. However, there are some situations that can cause an imbalance and lead to higher levels of uric acid. According to Cordain, the problem in 90% of gout cases is that people underexcrete uric acid, not overgenerate it.

Production
1. +Uric acid production - fructose and alcohol both increase uric acid production in the liver.

Excretion
1. - Lactic acid, as can be generated by strenuous exercise , fructose (e.g. from high fructose corn syrup (HFCS)), or alcohol consumption, reduces the excretion of uric acid.
2. - Insulin in the bloodstream, as from high glycemic foods
3. - Dehydration/lack of proper hydration can inhibit excretion of uric acid
4. - Fasting or a starvation diet inhibits uric acid excretion

Neutral Effect
1. +/-High purine foods (organ meat, seafood, protein) increase uric acid production and stimulate excretion. Net effect is very low.

Conclusions:
1. The standard medical advice, stop eating purine containing foods and drinking red wine, are not well supported by research. Purine foods have only a minor impact on uric acid and red wine is part of the larger alcohol problem.
2. Sucrose and HFCS have a triple whammy effect on uric acid levels. They increase production, and inhibit excretion through both lactic acid and insulin pathways.
3. Alcohol is only a double whammy (increase production and lactic acid).
4. Strenuous exercise can inhibit excretion of uric acid via the lactic acid pathway.
5. Lack of sufficient water and nutrients can inhibit excretion of uric acid.

E4E Recommendations
If you find yourself with excruciating pain in your feet, see a doctor. He can make the gout diagnosis. He will likely give you a list of foods to avoid and a prescription for pain killers and/or allopurinol for treatment of chronic gout. Gout is really painful and this will help get you through any acute crisis.

Since allopurinol was instituted as a cure for gout, little research has been done on prevention through other means. Allopurinol works well for many people. However, in my view, behavioral, interventions are always better than chemical (if they work of course).

So longer term, reduce consumption of fructose, especially in the form of sucrose (table sugar) and HFCS, and reduce alcohol consumption. If you feel gout symptoms coming on, reduce exercise intensity, make sure you are well hydrated, and eat at maintenance calories.

Some References
Cordain on Gout
Petro Dobromylskyj from Hyperlipid had two posts on gout here (1) and here (2). He puts the blame on excess fructose.
Taubes on Gout
Dr. Lustig from UCSF video about fructose
BBC article on Gout and sweet drinks
Gout website with some folk or popular remedies

Addendum: March 2, 2010
A new paper came out called Lack of association between dietary fructose and hyperuricemia risk in adults.

It used a large database called NHANES to search for an association between dietary fructose and hyperuricemia. It found that there is no statistical association between even high "normal" fructose intake and hyperuricemia. Alcohol was positively correlated, fiber was negatively correlated with hyperuricemia. This does not mean you get a free ride on fructose--large amounts do cause hyperuricemia--just that you should not overdo it. Alcohol and fructose are metabolized similarly, but there was no mention in the article about whether the effects may compound.

Ask Amy, Curious Husband, and Love

2009-08-22T23:28:00.000-07:00

One of my guilty pleasures is reading advice columnists. Most of the time they tell people who are not facing reality, what they already know. Amy Dickinson is one of the better ones. She replaced Ann Landers in 2003. I usually read her stuff through ether the Chicago Tribune or Washington Post.

She recently had a letter from a guy whose wife had an affair some years earlier.

The gist of it is that he caught her, they have rebuilt their relationship, etc. But something bugged him. She had done things for her lover, sexually, that she would not and still does not do with her husband. Amy's response was that he should romance his wife, without any explicit quid pro quo implied, get them out of their various ruts (bills kids, or whatever), and maybe the wife would come around. She ended by saying, " This could prompt both of you to begin a welcome new phase of your marriage."

In my opinion, this is weak. I'll explain why in a minute.

There was a follow-up letter from a woman's perspective.

It said in part
"An affair is an illicit and temporary relationship in which the participants can be different people than they are in their daily lives: This includes trying different things and being more comfortable doing them. I can tell you my husband would be shocked if I behaved with him the way I behaved with my lover. But I enjoyed every minute, and I am glad I got to be so free for a brief time.--Been There
To Which Amy Responded:
DEAR BEEN THERE: It is a shame that you don't feel free to be yourself and try new things in your own marriage. If you learned nothing else from your affair, surely you could take this lesson back home."

I think this was a better answer from Amy. unless "Been There's" husband is unadventurous, he might actually welcome the variety. But if he is unadventurous, perhaps Been There was fine with her response. She apparently has some needs that are not being fulfilled by her husband, and she should ask for them from him.

E4E Take On This

First I want to review a few things.
Definition of Love: Remember that love has two phases. In the first one, love is a feeling. Your hormones and enzymes go into overdrive and turn into an overpowering sense of love that prompts acts of selflessness. The recipient receives these acts as indicative of love.

In the second phase of love, the overpowering feeling is gone. Your hormones are back to normal. Sure you feel fondness, loyalty, call it love if you want. But it's different. M. Scott Peck in the The Road Less Traveled says that this is inevitable. The idealistic side of me doesn't want to believe that, but...

The second phase of love, is not the overpowering feeling. Rather, it's a mature conscious commitment to acts of love for your spouse. It's not about feeling; it's about doing. It is your choice.

You may also recall the posts I wrote on Emotional Needs in a Relationship. It lays out the needs in a few ways, but I personally like the one put together by Steve Harley of MarriageBuilders. There is a list of 10 needs, and in his experience, the normal breakdown by sex is shown below.
Men: Sexual Fulfillment, Recreational companionship, Domestic support, Physical attraction, and Admiration
Women: Conversation, Affection, Financial support, Honesty and Openness, Family commitment

So this is the framework in which to evaluate this question to Amy. So first, about the affair. Amy had it at least partly right when talking about the hum drum bill-paying stuff. It's just not exciting. Wife probably was in phase 2 of love and was wondering why she didn't love her dear hubby (DH) anymore. She just wasn't feeling, it. ...then along comes Prince Charming (Prince). She felt this overpowering surge of phase 1 love, with its flood of hormones. Prince, who was more experienced and aggressive than (DH), suggests she pole dance (or whatever) for him and she gets caught up in the spirit and does it for him--presumably the first time she has done that.

So far, so good. I don't know anything about the marriage, what DH's role was in the disintegration of it, etc, but this seems like a pretty common set of circumstances. After that is where Amy loses it. She says he should just be nice to her, then maybe she will come around.

Let's recap graphically.

Now consider a similar scenario.
Hubbie goes out and has an affair with his secretary. He buys her flowers every week and gifts, while at the same time complaining at home about not having enough money (he was never much of a gift-giver anyway). Now that the affair is over, he still won't buy his wife gifts.

Here's how it looks graphically,

The wife writes a letter to Amy who says, "Here's what you should do. Give him staggering, mind-blowing sex as if he were your forbidden lover. Do anything he asks for (and some things he doesn't) with no stated "quid pro quo," but just because you want to treat him differently. This could prompt both of you to begin a welcome new phase of your marriage."

It's pretty much an idiotic answer. The positive is that it focuses on what the wronged person can do to help set things right and is ok as far as it goes. DH should be giving his wife what she needs.

However, Amy is suggesting that DH grovel to the person who violated her marital vows, in hopes that she will actually fulfill her vows by satisfying his emotional needs. Again, I do not know what stuff he did over the years to set up the conditions precedent in which the wife cheated, but by not giving him the full measure of her abilities as a lover, which he apparently desires, she is withholding love.

Wife should give DH what he needs. She is fully capable of pole dancing, yet she refuses to do it for the one man in the world for whom she absolutely should. I can't imagine an act more disrespectful of her husband or her marriage, unless she were to pole dance again for someone else.

She is in a marriage in which she is content (she's probably fond of DH and what sahe gets from him), but unwilling to love him in return. How long will he take that treatment?

Edit: Nov 1, 2009 - I have been thinking about this a bit and want to restate the issue that the woman in the drama has. Above I said, "...she refuses to do it for the one man in the world..." In line with the idea that we have limited free will, I think a better characterization of the issue is that when she met Prince and her hormones were screaming, it pushed her to be able to do things that she would otherwise be ashamed to do. When she was back with poor DH her hormones were back to normal and her shame overrode her hormones and her husband's needs.

Shame can be a healthy emotion, it prevents us from doing things that would truly shake up society. That is not likely the case here. Her pole-dancing would remain only between her and DH, so to be charitable, I will assume that she is not consciously withholding her skills from DH, but rather feels terribly ashamed about it. I think the answer is the same. She should get past it and become able to love her husband.

Another (perhaps offensive) View

Finally, another blog picked up on this letter and absolutely raked Amy (and the husband) across the coals. Before I give you the link on this one though, I have a few disclaimers. It is a very male oriented blog that usually gets way nasty in its opinions about women. It endorses very dominant (alpha as opposed to beta) male behavior. I do not condone or endorse either the opinions or the way they are voiced. It is an interesting perspective, which if communicated differently, in some cases has some merit. You are likely to be offended by many of the viewpoints there. In any case, it seems to have a lot of people enthusiastic as evidenced by hundreds of comments on every blog post.

The column that I am linking to explains a rationale for making the husband in the first letter the beta of the month for July. He is candidate number 2.

In a nutshell, he says that Confused Husband is a candidate for beta of the month for not a.) insisting that she give him what she gave her lover or b.) sending her packing.

What Am I Missing?

Does my analysis make sense? Is the analogy good?

Assuming DH still wants the "treatment," is there any good excuse for the wife not to give it?

Emotions For Engineers on Twitter

2009-08-03T22:21:00.000-07:00

I find tons of interesting things on the internet. I save the website fully intending to write a blog post about it, then never do.

Sometimes, the author has already done such a good job that there is little to add. Other times, there is not an Emotions for Engineers angle to put on it, so it sits in my drafts folder.

From now on, when I find something interesting, I will post it first on Twitter and then maybe I'll write about it or maybe not. But at least those of you who follow this blog will have a chance to see it.

To follow my tweets go to this link and press the follow button.

Addiction Visually

2009-07-30T13:19:00.001-07:00

Everybody learns things differently. Some from pictures, some form reading, some from hearing things.

This video struck me as a pretty visually amazing portrayal of addiction. The guy is the addiction, the girl is the addict.

By the way, speaking of learning things, I inadvertently posted this from YouTube. Oops.

I won't count this as a "real" post for purposes of my monthly goal of one per month.

Enjoy.

Some Sample Correlations

2009-07-08T12:37:00.000-07:00

We all know that correlation is not causation. Causation arrows are not always clear, and sometimes two factors that correlate to each other are actually caused by a third factor.

My favorite example of correlation not proving causation is that it is not appropriate to say that firemen cause fires because every time there's a fire there are firemen there.

Correlation is expressed as a decimal between -1 and 1.
1 is a perfect positive correlation. An increase in one variable yields a proportionate increase in another one.
-1 is a perfect negative correlation. An increase in one variable yields a proportionate decrease in another one.
0 is no correlation. A change in one variable has no relation to changes in another one.

Tom Naughton, who made the movie Fat Head writes a blog. A recent one discussed a large study called the NIH-AARP Diet and Health Study. A number of correlations between diet and health outcomes were observed with varying levels of correlation. He discusses the significance of the study and correlations and there are some really good comments after the post.

He talks about some of the correlations found in the study, and I realized that I didn't have a really good sense of what these correlations look like, so I generated some.

Here are the correlations assuming underlying uniform distributions between two variables. Note that even a 0.6 correlation has a lot of variability.

Here are the correlations assuming underlying normal distributions between the two variables. These points are more centrally grouped because of the nature of the underlying distributions.

A fun allegory on correlation and causation

Correlation is not causation

Mindful vs. Mindless Eating

2009-06-30T19:00:00.000-07:00

This post will catch me up on my one per month promise. You may have noticed that the post I did last month didn't count because it was just a bunch of links.

Fitness Black Book blog did a nice post about mindless eating and some of the studies that have demonstrated how external cues indirectly cause people to eat more.

You may recall that I posted about mindful eating some time ago.

I will reiterate part of what I said then:

"Fourth, eat only when you are hungry. People eat for reasons besides sustenance. Sometimes there is an emotional attachment to eating in which food is used to medicate one’s psyche. This is a type of addiction. Other times people eat because it just tastes sooooo good or they simply don’t want to waste food. If you find yourself using food for emotional support or overeating at special events, try to find a way to stop that."

I was traveling last week, visiting some friends. I found myself eating and drinking because it-was-time-to-eat-and-we-were-at-a-nice-restaurant-with-good-wine. I wasn't hungry. I ate and drank a lot anyway. I gained a nice layer of subcutaneous fat over muscles that had previously been visible. Not just from one meal, but from a whole week of similar temptations and behaviors.

This is especially a problem at restaurants. They give big portions because they can charge more for them. Then perhaps you eat all of it because it's a hassle to take it home or you don't want to bother. Buffet restaurants are impossible for many people. Holiday celebrations can also be a time of overeating. Don't succumb to the pressure to eat everything, but listen to your hunger and and take your time eating. Hunger is driven by a number of factors including empty stomach, and cells not receiving sufficient nutrients. You can get past the empty stomach part, but if your cells are not receiving enough fuel to do their jobs, it will eventually override your "willpower."

So in thinking about all this, I had a realization. Most people are in a pattern of eating at certain times in the day. We wake up and eat breakfast, then around noon have lunch, then finally at 7 in the evening we have dinner. It is important socially to have meals with other people and especially family. We get our three square meals on a set schedule. But in doing so, we lose the sense of our natural rhythms. We eat when we're not hungry, and we eat what is put in front of us. When that happens, we find ourselves complaining about problems with portion control.

What To Do Then

The solutions are obvious but there are two prerequisites: a body that is hormonally able to burn its own fat as fuel (low insulin environment) and mindfulness about eating when you do not feel hungry. Eat very lightly so you can fulfill the social needs without blowing your diet, or if you foresee a big meal coming up, skip the one before it or after it to compensate.

The other thing to think about is to consider your bad week as a break from your diet. This is actually a good thing as pointed out by Lyle McDonald.

Link to the book Mindless Eating by Brian Wansink

Dear E4E. A Letter to Myself

2009-06-20T09:02:00.000-07:00

Dear E4E,

My 20 year old son who lives across the country with his mother, seems to want to have nothing to do with me. I have called him, texted him, and left messages on his facebook page. I get no response from him.

Recently, he left his job (released for being late). Now he contacts me and wants to visit. Yay.

Except, when I try to contact him to set dates, he doesn't respond. It's really odd. For the life of me, I can't think of anything I've done to anger him or drive him away. I feel hurt and sad about this.

What the heck is going on?

Signed, Baffled Engineer

Dear Baffled,

Regardless of whether you slighted him, the answer is the same--continue to reach out. Hold out a hand of unconditional, non-judging love.

Yes, you feel hurt and maybe want to punish. Perhaps you think it's terribly undignified or weak to reach out unrequitedly. Forget that.

But he gave you the cold shoulder and maybe you didn't deserve it. It doesn't matter. But you're a dude. You learned a long time ago not to take crap from anyone. To return disrespect with greater disrespect.

That's OK in battle, but this is not battle. It's not a power or blame game. This is family. Families are not a democracy, they're more like a benevolent dictatorship, or even communism (from each according to his abilities, to each according to his needs).

You are the parent; you are the adult. That is your role in this scenario. Unless a family member is actively hurting the family, your job is to strive to maintain cohesiveness.

Now try to look at it from your son's perspective. He's 20 years old, he was out earning lots of money and feeling pretty independent. He probably lost sight of the importance of family; maybe he didn't really understand the importance of maintaining contact. Perhaps you could have done a better job over the years of keeping touch with him. (Remember Cat's in the Cradle by Harry Chapin?)

Perhaps, he didn't think that he was meeting your expectations (good grades, go to college, etc.) and was feeling ashamed about that. Perhaps he had a secret that he thought would disappoint you in some way. Again, it really doesn't matter.

Remember, it's not your job to judge him or try to change him. Regardless of his emotional age or maturity, he is an adult now. Accept him as he is and do what you can to help him succeed in his life. Be proactive in keeping communications open. Hope that he will come around.

Good luck.
E4E

Diet and Health Some Media Links

2009-05-10T13:25:00.000-07:00

There have been a number of good movies, books, and youtube clips lately that support some of the ideas around a more healthy way of eating and living.

I put some links below.

By the way, I'm not counting this post as one of my monthly posts. It's just too easy.

Paleo Eating

Paleo Exercise

Fathead: The Movie

Excellent introduction, with some humor, on many of the subjects that Taubes writes about in Good Calories, Bad Calories (link below).

Good Calories, Bad Calories
I am rereading sections of this book and after a year and a half of studying and reading about health, diet, and exercise, I find myself more impressed than ever at the quality of this book. It's not an easy read, but if it ever can break free from the being labeled in the category of diet books, could actually make a difference in the world.
Paperback

Hardcover

My Big Fat Diet
Described as "Supersize Me meets Northern Exposure in My Big, Fat Diet when the Namgis First Nation of Alert Bay gives up sugar and junk food, returning to a traditional style of eating for a year to fight obesity and diabetes."

I haven't seen it, but I have heard good things about it.

Is Vitamin D a Silver Bullet?

2009-04-29T20:50:00.000-07:00

I am not a big believer in "silver bullets." But that belief system may be changing for me.

If you're not aware, much of the blogosphere, especially low-carb. primal, and/or paleo blogs have been abuzz about the importance of Vitamin D in preventing sickness and disease.

So, it turns out that Vitamin D is not technically a vitamin. It is a steroid hormone or prohormone. Your body is theoretically capable of creating all it needs in your skin from sunlight (specifically UVB rays), but in wintertime, far from the equator there is not enough sunlight. It is a likely driver of skin color--the reason that those who live near the equator have darker skin than those closer to the poles. It is why so many people get sick in the winter, yet are healthy all summer, and a likely reason that latitude is a good correlation with cancer incidence.

I have a multitude of links below, but I would like to share my experience from the past few months. I have been supplementing my vitamins with Costco Vitamin D3 tablets. Each tablet is 1000 i.u. These are dry tablets and I want to note that I have seen some recommendations to take oil-based gel caps for more reliable absorption.

In a typical winter, I get 2 - 4 colds, each one lasting a good week, requiring tons of Nyquil, Dayquil, Mucinex, etc to help get me through. Typically, I would feel some scratchiness in the back of my throat. That would progress to stuffy nose, and soon after down to my lungs.

This winter has been different though. I was typically taking about 4000 i.u. per day. When I felt the scratchy throat (two or three times this year), I'd double it for a few days. About a week ago, my daughter was visiting me on spring break. I was a little lax with my Vitamin D--probably missed a day or two. I felt the throat scratchiness and for some reason attributed it to allergies, so I didn't increase D.

The scratchy throat on Wednesday had progressed by Friday to bronchitis. I felt like death warmed over. My doctor told me that it would get worse before it got better. When I went home after the doctor, I took 10,000 i.u. of my Vitamin D as well as some mucinex, (which I had already been taking).

By the next day, I felt 100% better (I took another 6,000 i.u. of Vitamin D) and by Sunday morning I felt almost well.

I can't recall ever recovering from a cold this quickly. The usual caveats apply. I am an n of 1, and there may be a placebo effect, but I am amazed at how I have felt this winter.

A recent study states that the evidence for Vitamin D is strong enough that it should become a recommendation for cancer prevention and treatment. PubMed, sponsored by the United States National Institutes of Health has hundreds of papers linking latitude and cancer, latitude and flu, seasonality and disease. The thread running through it all is, the less sunlight, the more disease.

Melanoma rates are increasing despite record amounts of sunscreen being used. It turns out that sunscreens filter UVB rays well, but in the past have not done a good job of filtering UVA. UVB causes sunburn and is the driver of Vitamin D synthesis in the body. UVA rays are a big driver of melanoma (the most deadly skin cancer) and other skin disorders. Part of the increase in skin cancer may be due to the false security and comfort from sunscreen, leading people to be in the sun more. I believe that another part is likely due to the dampening effect on Vitamin D production. Could that be creating higher risks for other cancers as well?

It is apparently unusual to get a Vitamin D overdose from the sun. From the Wikipedia article on Vitamin D. "Exposure to sunlight for extended periods of time does not normally cause vitamin D toxicity. This is because within about 20 minutes of ultraviolet exposure in light skinned individuals (3–6 times longer for pigmented skin) the concentration of vitamin D precursors produced in the skin reach an equilibrium, and any further vitamin D that is produced is degraded. Maximum endogenous production with full body exposure to sunlight is 250 µg (10,000 IU) per day."

Here is an excellent article from 2000 from the Medical College of Wisconsin. Here is an older article (the recommendations do not align well with the explanatory text, but the explanatory text is good). Here is an MSNBC article warning that "sunscreen has not been conclusively shown to protect against melanoma..." Richard at FreeTheAnimal did this sunscreen post.

So here's the e4e recommendation.

Get your Vitamin D levels (25(OH) D, Serum 25 Hydroxyvitamin D) tested. If your doctor won't order the test, try Grassroots Health. Edit: I did a future post on which vitamin D test to get.
If your levels are below 40-60 ng/ml, take a Vitamin D3 supplement. People with darker skin and those who do not spend much time outdoors are more likely to have low levels of Vitamin D.
If you don't get the test, but find yourself having lots of colds and upper respiratory tract issues, take a vitamin D3 supplement try 4,000 i.u. for a few months and see if your health improves. This is especially important in the winter months. There appears to be little danger of Vitamin D toxicity.
Do not fear the sun, but treat it with respect. Try not to burn, cover up, develop a tan when the sun is less intense during the day. Some unprotected sun is ok, but don't overdo it.

The Vitamin D Council

Is Vitamin D Deficiency during pregnancy is a cause of Autism

Dr. Michael Holick Presentation

Can Vitamin D Help Prevent Swine Flu?

Vitamin D Anecdotes

Vitamin D Toxicity Is Rare

Heartscan Blog Vitamin D Writing

How About Vitamin K2?

Cool story about Vitamin D and flu

Some conditions are worsened by more Vitamin D

Free The Animal blog's Supplements Links

Animal Pharm Blog Vitamin D posts

Pubmed. An incredible resource for research abstracts.

Heartscan Blog - Vitamin D for the pharmaceutically challenged

Whole Health Source - a good resource

Dr. Briffa has information about Vitamin D and heart disease