30 December 2009

Interpreting Science Writing

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."

25 October 2009

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

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."

02 September 2009

The Causes of Gout

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 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.

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 to 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.

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.

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

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
5. - The initial stages of ketosis can inhibit excretion of uric acid from competition in the kidneys with the ketones. Once the body is adapted to using ketones for fuel (6-12 weeks), this is no longer a problem for most.

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

1. The standard medical recommendations--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 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 painkillers and/or allopurinol for treatment of chronic gout. Gout is really painful and this will help get you through any acute crisis.

Once allopurinol was instituted as a cure for gout, little research was 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 forms 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
Loren Cordain Paleo Diet Newsletter (The Insider) Vol 2 No 4 I have a pdf of the full article
Chris Kresser on Gout
Petro Dobromylskyj from Hyperlipid had two posts on gout here (1) and here (2). He puts the blame on excess fructose.
Very interesting article by Ed Yong (Not Exactly Rocket Science) on the evolutionary aspect of gout and the enzyme that breaks down uric acid in many animals.
Exercise and Gout from Journal of Biological Chemistry JBC
Taubes on Gout
Mark Sisson of Mark's Daily Apple totally agrees with me
Dr. Lustig from UCSF video about fructose
BBC article on Gout and sweet drinks
Gout website with some folk or popular remedies
Nice Google Answers site on gout.
Ketosis and Gout post from August 2018 by Amy Berger "... 10% of cases of hyperuricemia are caused by overproduction of uric acid; the other 90% result from impaired excretion."
Addendum: March 2, 2010
A paper with the purine content of many foods. Biological and Pharmaceutical Bulletin
A 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.

References regarding Neutral Effect of Dietary Purines and Protein from
Cordain Paleo Newsletter, Vol 2, No. 4
"Further, the recommendation to reduce high purine foods such as fish, shellfish, meats, poultry and organ meats may be of dubious therapeutic value (11) because clinical trials of low purine diets only marginally reduce (1-2 mg/ dl) blood uric acid concentrations (15-17). Although high protein, meat based diets contain high amounts of purines and would be expected to promote gout symptoms, protein ingestion actually decreases blood uric acid levels by increasing uric acid excretion (18). This seemingly paradoxical effect occurs because the kidney increases its excretion of uric acid when faced with elevated dietary purines (19).
"So, let’s put 2 and 2 together. If high protein, meat-based diets actually increase uric acid excretion, and 90 % of all gout patients have the disease because they are underexcretors, it makes little sense to implicate meat and high protein diets as a fundamental cause of gout. What we really need to look for are dietary factors which can simultaneously increase uric acid synthesis in the liver and suppress its secretion by the kidneys – Bingo!"
18. Matzkies F, Berg G, Madl H. The uricosuric action of protein in man. Adv Exp Med Biol 1980;122A:227-31.
19. Loffler W. Grobner W, Medina R, Zollner N. Influence of dietary purines on pool size, turnover, and excretion of uric acid during balance conditions. Isotope studies using 15N-uric acid. Res Exp Med (Berl). 1982(2):113-123.

22 August 2009

Ask Amy, Curious Husband, and Love

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, Ph
ysical 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 w
as 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?

03 August 2009

Emotions For Engineers on Twitter

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.

30 July 2009

Addiction Visually

Everybody learns things differently. Some from pictures, some from 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.

08 July 2009

Some Sample Correlations

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

30 June 2009

Mindful vs. Mindless Eating

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

20 June 2009

Dear E4E. A Letter to Myself

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.

10 May 2009

Diet and Health Some Media Links

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.


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.

29 April 2009

Is Vitamin D a Silver Bullet?

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.
  1. 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.
  2. 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.
  3. 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.
  4. 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

Can Vitamin D Help Prevent Swine Flu?

31 March 2009

Live in the Now

It is good to have an end to journey toward; but it is the journey that matters, in the end." --Ernest Hemingway

I have been living in the now recently (mostly at work) and as such, have had little time to focus on e4e this month.

The good news is that my job has been a big focus. That's also the bad news.

So this will be simply a short reminder to know what you want as your destination in life or in your tasks, but to live in the present as well. Sometimes your focus is drawn very much to one narrow aspect of your life. You can do that for a short time, but it is not sustainable for most people. Your loved ones want you to be a part of their lives. Take time out from the workday world. Find the correct balance between urgent and important, long and short term, physical and mental/spiritual.

Finding that balance is life's journey.

27 February 2009

Show-Off Bias?

My friends at Overcoming Bias have an interesting post about a new kind of bias. It's called Show-Off bias. The poster, Kip, defines it as follows: self-identified smart people are biased towards complex or counter-intuitive answers to problems.

A corollary, supplied by one of the commenters is, "self-identified smart people often sacrifice clarity and precision for style. instead of making ideas easy to comprehend they present them in the most impressive, stylized way possible."

This seems like one I will be on the lookout for. In fact, it makes me wonder if all the looking into low-carb diets and the physiological processes behind them is a show-off bias desire to run counter to the FDA food pyramid or the conventional wisdom of low-fat.

I guess I would be much more concerned if it weren't working so well for me. (The first half of the graph was my attempt at lower fat and lots of exercise. The second half was lower carb--going off of grains essentially--while maintaining the exercise).

Of course, confirmation bias may be leading me to continue to believe that it is a more healthy diet. I will do more posts on cognitive biases. It is a rich and important field, especially for people who work with their brains.

15 January 2009

Open Letter to Oprah Winfrey

I have been thinking about the nature of this blog and have a few thoughts on the direction. First, I don't want it to be simply a tip blog. I want to capture principles that can be applied to life, which keeps it all at a higher level. The other thing is, I don't want it to be a news digest blog. I want the content to be more or less timeless. Not something based on today's news or gossip.

Having said that, I will now go against those principles and publish a letter I sent to Oprah Winfrey about her diet. OK, I believe the principles are timeless, but it is a little newsier than I am interested in.

I also said I would go lighter on diet articles, but here I am with another diet article. I have developed a bit of an obsession around diet. Starting next month, Feb 2009, I will be going back to more general topics. Thanks for staying with me.

Letter to Oprah

I sent a letter to Oprah through her website. That site limited me to 2000 characters and I had much more to say. So following is the original note that I wrote that has much more detail. Any bets on whether she'll leave a comment here?

Dear Oprah,

I have been reading about your weight loss efforts. I am sure you have received thousands of letters of advice and encouragement. I would like to add one more voice to the din.

First, I want to say that I admire you and your accomplishments. You have found ways to connect with large numbers of people in ways that are meaningful to them. You have been a source of inspiration and information for millions.

But this weight loss thing...

I know you have received lots of advice from leading nutritionists and trainers, but they all have the simple calories-in minus calories-out approach.

While that is mathematically correct and in accordance with the laws of physics, it misses a key point; starving oneself is not a sustainable lifestyle. Your body needs energy to live. It can obtain that energy from outside through food, or it can literally eat itself by burning its own fat, muscle, and carbohydrates.

To lose weight, you limit the amount of food coming in from the outside so that the body uses itself for energy. You have only about 400 grams of carbohydrate stored in your body, so that is not a significant source of weight loss. You do NOT want to lose muscle, so you therefore want your body to be using its fat stores.

You achieve this state by setting your body up hormonally to burn fat.

Something for you to think about. Many people believe that binge eating or unhealthy eating is a symptom of poor mental health and represents a failure. People start on diet and exercise programs, then when they fail, blame themselves for being weak or "emotional eating." That is not the reality.

Think about it. People who kick themselves for emotional eating are often already on a diet and overweight. They feel hungry all the time and struggle to find the energy and time to exercise. Then something happens. Maybe their kid gets sick or their spouse loses a job. Suddenly, the stress level ramps up. Well you may not be able to control the course of sickness or your spouse's job search, but you can reduce the hunger and exercise stress. In a way then, going off a diet may be a very HEALTHY response, not a sick one. In times of stress, your body needs sustenance. Not providing it can lead to your own ill-health.

Gary Taubes has written Good Calories, Bad Calories. Many people mistake it for a diet book. Others mistake it for a scientific treatise. It is neither. It is a documentation of how poor science has led to misconceptions about healthy diets. He also lays out an alternative hypothesis about diet.

The key in all this is to eat foods that allow your body to use its own fat as fuel. An important key to this is the hormone, insulin. Insulin is, in essence a storage hormone. It takes nutrients out of your blood and stores them in muscle and fat cells. Fat and sugar are stored as fat, while proteins are either put into muscle or converted to glucose in the liver for use as a fuel. Insulin also prevents fat from leaving fat cells. This is really important so I'll say it again. The presence of insulin prevents fat from leaving fat cells.

So, in general terms, carbohydrates, especially sugars and highly processed flours induce your body to release insulin. This in turn traps the fat cells in your body. When you run out of fuel in your system from the previous meal, an obvious choice to refuel your body's cells immediately is to eat more carbs. This sets up a vicious circle. you feel hungry so you eat carbs for a pick-me-up. Insulin cleans out your blood stream, you feel hungry again. Your body never has a chance to burn those fat cells.

This is the deal with the lower carb diets. They shut down the insulin response to food and let the fat come out of your tissues to be used for fuel. When the fat can flow freely you tend not to feel hunger because your body's cells are fueled.

You have to be careful not to overdo it a diet though. Research indicates that your body can burn about 31 calories of its own fat per pound of body fat per day. So you can maintain a caloric deficit of about 31 calories per pound of body fat without cutting into muscle. As an example, a 200 pound person at 35% body fat is therefore carrying about 70 lb. of fat. 70 lb. times 31 calories per pound is 2,170 calories of potential fat loss per day. If you diet harder than that you will cut into muscle. As you lose fat, your maximum daily loss will also decrease. This is one of the reasons that a rate of weight (fat) loss is difficult to maintain.

My Story

The things I have written above come from a fair amount of research and my own experience in weight loss. In 2007, I weighed 240 lb. (I'm 5'10 and was 50 years old). I had tried losing weight in the past, typically by cutting back on fats, cutting back on calories, and exercising like a maniac. I could lose 15 lb. or so, before beginning to feel weak, lose muscle, and feel hungry all the time. Inevitably, I would then fall off the wagon and gain it back.

At Thanksgiving of 2007, I got gout in my left foot. I started to research that, and for some reason stumbled across Gary Taubes lecture at Berkeley. That lecture (http://webcast.berkeley.edu/event_details.php?webcastid=21216) changed my life.

I dialed back pasta and bread (I had already cut out sweet sodas) and the weight simply disappeared over the next four months. I lost about 30 pounds with almost no effort. I am now working on the next phase of my weight loss where I will lose another 15 lb. I will be using a very similar approach with a few modifications. Specifically, I will be doing a periodic (weekly or so) carbo load to induce leptin secretion. This follows some of the ideas that Lyle McDonald has laid out at his website (http://www.bodyrecomposition.com).

So I urge you to consider a lower carb diet in your fat loss efforts. In the long run, it is more sustainable, it seems likely that it is a more healthful way of life than low-fat,

I have written about diet and other issues at my blog. I invite you to check out Emotions for Engineers at http://www.emotionsforengineers.com.

Best regards,

The following is the letter as submitted to O.

I admire you and your accomplishments. You have found ways to connect with people in meaningful ways. You have been a source of inspiration and information for millions. But this weight loss thing.

Simple calories in minus calories out misses a key point; starving oneself is not a sustainable lifestyle. Your body needs energy to live. When it doesn't get it, it sends hunger signals. We obtain energy from outside through food, or it can literally eat itself by burning its own fat, muscle, and carbohydrates. You want your body to be burning fat. You achieve this state by setting your body up hormonally.

People who kick themselves for emotional eating are often already on a diet They feel hungry and struggle to find the energy and time to exercise. Then maybe their kid gets sick. Stress increases. You can't control the sickness, but you can reduce the stress from hunger. Going off a diet may be a very HEALTHY response, not a sick one. In times of stress, your body needs sustenance.

Gary Taubes lays out another diet hypothesis diet in "Good Calories, Bad Calories." The key is to eat foods that allow your body to use its own fat as fuel by limiting insulin release. It takes nutrients out of the blood and stores them as fat. It prevents fat from leaving fat cells and can cause you to feel hunger.

Carbs induce insulin. This is why lower carb diets work. By limiting the insulin response, your body uses its fat as a fuel without hunger.

Dietary fat has been vilified by the government and press. It is not bad for you. In fact, when your body burns its own fat, you are burning the equivalent of a high fat diet.

I urge you to consider a lower carb diet in your fat loss efforts. In the long run, it is more sustainable and it seems likely that it is a more healthful way of life than low-fat.

I have written about diet and other issues at my blog. I invite you to read at a more detailed version at http://www.emotionsforengineers.com.

Regards, Tony