20 November 2010

Government in Our Kitchens

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.

  1. 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..."
  2. Various food programs exist, e.g. school lunches, and follow the unfortunate guidelines laid out by the food pyramid.
  3. Government does have a clearly legitimate role in feeding our armed forces.
  4. 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

01 November 2010

Communication: Owning Your Feelings and The Public Eye

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.


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.

20 August 2010

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

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 broken 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 methods, fatty acid profile, carbohydrate quality (e.g, glycemic index, fiber content), protein type, micronutrients, and phytochemicals." So far so good.

Then they say that "Healthy eating patterns share many characteristics, 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, minerals, 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?

01 August 2010

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

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.

20 July 2010

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

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.

04 July 2010

Very Quick Post on Free Will

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.

20 June 2010

Snoring, Sleep Apnea, and Happy Father's Day

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 a 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: without, 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 an 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 otolaryngologist. 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 for 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 fewer 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 apnea, but if you have sleep apnea 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:
  1. 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.
  2. Limit alcohol. It can have a relaxing effect on those throat muscles.
  3. Do not sleep on your back.
  4. 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.
  5. Focus on eating well to get your weight under control.
  6. 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.
  7. 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.
  8. 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.

08 May 2010

BaconCamp SF 2010

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

“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

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

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.

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.

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)

21 April 2010

Short Term Personal Healing vs. Long Term Public Health

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.

23 January 2010

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

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.