Health Kismet
The Problems With Health Science

There’s a decent video by a British doctor on the various problems with the health science industry. His talking is a bit scattered, but for the most part his opinions are interesting, and IMO correct.

If you don’t feel like watching, here are the take home points:

1). News that says “new study suggests x might cause y” should not be trusted. See my post about the problems with interpreting medical research results for more information.

2). The drug industry usually games studies to get things approved.

3). The placebo effect is powerful, but too much emphasis is placed on it in the clinical approval process.

4). Very few important medical decisions are made with appropriate information. Often they’re made with really crappy information.

He ends on a dour note, saying he doesn’t see an easy way to solve any of these problems at the moment, and ends with a vague call to action for an industry wide emphasis on transparency to bring more errors in the medical industry under public scrutiny.

Let me add a few thoughts.

1). I think the human intuition to break everything into discrete categories gets us in trouble with interpreting research results. Research is sort of like a garden with different plants always blooming and dieing, and the overall picture evolves like a kaleidoscope. To zero in on any particular correlation from one study is to commit sins of omission.

2). Experts tend to lament the ignorance of the poor common-folk in their particular field, and yearn for the day when everyone will be well informed about what it is they’re experts in, thus solving the dilemmas in their field. You see this attitude everywhere, and I think it’s a chimera. To really create a solution for something, it needs to work with ignorant people, because that’s not going to change. At least not quickly enough to allow someone’s pet plans to come to fruition.

3). On a similar note, it’s best not to focus on how to ensure people have as much information as possible, but instead focus on how to mitigate the bad consequences of someone making an un-informed decision.

Attitudes Towards Alternative Medicine

There was an interesting article in the LA Times that describes how more doctors are using alternative medicine……..on themselves.

While doctors are schooled in traditional Western medicine, a growing number like Michelfelder are turning to complementary and alternative medicine to stay healthy, then integrating the techniques into their medical practices.

A study published in the online version of Health Services Research in August found that 76 percent of health care workers and 83 percent of doctors and nurses used CAM (Complimentary Alternative Medicine), compared with 63 percent of the general population.

However, despite their personal acceptance of yoga, acupuncture, etc, as healing mechanisms, they’re slow to recommend it to their patients:

Doctors who work in hospital integrative medicine departments or use CAM methods in their own practices say their referrals from other physicians have been steadily increasing, though many physicians are still reluctant to suggest it. But doctors agree that patients themselves are the ones who have pushed much of the change in health care.

I don’t want to risk sounding anti-scientific, but I think most people enjoy the insulation that comes from deferring their health decisions to people with badges, and place too much emphasis on the perceived “rigor” of professional medicine. 

Doctors themselves might contribute to this problem by narrowly believing in what they were taught in medical school and adopting paternalistic attitudes towards their patients.

Myths About the Vegetarian Diet

The following is an excerpt from an article I wrote about misconceptions people have about a vegetarian diet:

The best reason to avoid going vegetarian is because you just really love to eat meat. If so, that’s fine. Eat it. But too many people suffer from kooky notions that cutting animals out of your diet will lead to deleterious effects on your health that simply aren’t there.

If you don’t want to read the whole thing (though I recommend you do), here are the five myths:

  1. You won’t get enough protein
  2. Your diet will be lacking in vital nutrients
  3. Your food bill will go up
  4. You’ll have to give up sacred flavor sensations
  5. A vegetarian diet impairs your physical performance.

None of the above are true. And that’s in addition to the more talked about benefits of going meat-free (treatment of animals, better health outcomes, etc). 

While I think the treatment of animals has a middling future, I’m optimistic overall about the prevalence of vegetarianism. 

According to this survey, about 10% of the population identifies as vegetarian in some respect, and here’s a good article about the slowly moving vegetarian tide in America.

Overall, vegetarian diets lead to better health outcomes than non-vegetarian ones (see here, and here), and typically don’t suffer from many drawbacks. However, the differences between vegetarian and non-vegetarian health outcomes get much smaller when you only study health conscious people (see also here). But vegetarians still have a lower prevalence of diseases of abundance, which follow meat consumption more closely than plant consumption.

The Omega6/Omega3 FA Ratio Is A Myth
Omega6

There’s an excellent report from Food Insight about the legitimacy of health claims made about the Omega6/Omega 3 fatty acid ratio. You have to download the PDF at the link.

There are a lot of graphs/statistics, but it’s excellent if you can slog through it. Highly recommended.

Lots of pundits attribute great importance to the ratio, claiming that it’s the basis of many other health problems.

According to the latter report, all those claims are a crock.

Most clinical studies suggest Omega 6 consumption in moderate quantities is good for you, and focusing on the Omega6/3 ratio has the following problems:

1). It says nothing about the absolute intake of either….which is also very important.

2). It doesn’t differentiate between the different types of N-6 and N-3….there are more than one of each.

3). It doesn’t clarify whether it’s a reduction of N-3 fatty acid consumption or  an increase in N-6 consumption that causes the problems.

People purporting the benefits of the ratio are (at best) making an attribution error. The ratio is a symptom of other nutrition habits (like an out of whack meat/plants ratio) that have degenerating effects.

As a general rule, be suspicious of “single variable” eating strategies. Whether it be an ingredient (gluten, fat, lactose, etc) or measurement (n6/n3 ratio, pH, etc). 

Your body is complicated, making claims about the importance of a single factor probably false.

Like Einstein said….."Everything should be made as simple as possible, but not simpler."

More Evidence That Fast Food Is Expensive, Not Cheap

From the Institute of Food Technology:

A new national study of eating out and income shows that fast-food dining becomes more common as earnings increase from low to middle incomes, weakening the popular notion that fast food should be blamed for higher rates of obesity among the poor.

There was a good op-ed written in the New York Times here talking about the fallacy of fast food being cheap. 

I also added additional critiques of that notion when I pointed out research data on fast-food consumption, and later on when it was reported people were buying more fresh produce as a way to save money.

If you want to save money on your food bill, the easiest solution is to start buying bulk produce and get a rice cooker or crock pot. Your grocery bill will be cut in half, and you’ll probably start to lose weight as well.

Licorice Root Has At Least 7 Cancer Preventing Compounds
Licorice
Berries, broccoli, and (lately) chia seeds grab most of the attention for potent green superfoods, but the more I read about licorice root, the more I’m amazed at its nutritional potency.

In particular, it has a remarkable effect on tumorous cell growth.

The most famous compound in licorice root is called Glycyrrhizic Acid, which became famous after a study published in Nature in 1979 found that it singlehandedly reversed virus activity without affecting normal cell replication

The results in that study proved not to be flukey. They were replicated several times. (Here’s an example, and here’s another one). 

I just finished reading a paper that dissected licorice root and found 7 different chemopreventive compounds in the plant, and possibly more.

Studies here, here, and here, show cancerous cell lines being inhibited when treated with licorice root extract. There’s a lot more, but I won’t link to them to avoid redundancy.

Licorice has a long history of chinese medicinal use. Modern science has a hit-and-miss track record with verifying ancient folk tales. (For instance, a lot of the performance enhancing effects of Ginseng haven’t showed up in lab results too much), but in this case, it looks like lab practices are a lagging indicator.

Disease Fighting Nutrition

Reading through some papers, there were some interesting notes on new wrinkles in nutrition and disease prevention.

Apparently, in pop science, phenolic compounds are overtaking anti-oxidants as the super-nutrient of choice:

 Many epidemiological studies have indicated that consumption of some plant-derived foodstuffs with high phenolic content is associated with the prevention of some diseases and that these compounds may have similar properties to antioxidants, antimutagenic agents, antithrombotic agents, anti-inflammatory agents, anti-HIV-1, and anticancer agents.

More evidence is also being accumulated that suggests obesity, cancer, and under consuming the above nutrients through your diet are more highly correlated than previously thought. 

Hormones found in fat tissue, like adiponectin and leptin might be highly tumourigenic in high quantities.

But of course, potential cancer treatments look less and less heterogeneous by the day. Here’s from another review:

Most research studies provide us with data on the average person. But who is the average person anyway? The central tenet of personalized cancer prevention is that average is overrated.

When things go right, everything looks the same. But when things go wrong, nuanced differences between individuals always come into higher definition, making solutions more difficult to conceive than if you just studied healthy people.

When Assholes Finish First

A new article in Big Think speculates that the best CEO’s are highly narcissistic:

A new study on the habits of highly effective CEOs suggests that narcissistic personalities do better at bringing their companies into line with the latest innovations.

Why? Because leadership and narcissism go together.

It stands to reason that narcissistic personalities may indulge their own vision of the world more which may result in bold and forward thinking. Confidence matters a lot, after all.

In his newest book Thinking Fast and Slow, Daniel Kahneman makes repeated references to the disproportional effect over-confident people have in our lives.

If most people have muddling opinions of their own abilities, they’ll shirk away from having to make important decisions because they’re afraid they’ll mess things up. To some degree this is healthy. However, in that situation the over-confident (or ignorant) will have an easier path to the top than their abilities will merit. The unsuspecting peasants assume the narcissist must have remarkable qualities to warrant such confidence, and the narcissist takes the approval of the helpless peasants as proof of his remarkable abilities.

My guess is that positions of power are strongly self-selecting for delusional people. (And yes, that probably includes your favorite talking head.) It might also explain why men are over-represented in positions of power. Women are smart enough to recognize their limitations, and men have more extreme personality traits, which will heavily skew the distribution in favor of men for positions that require extreme qualities.

Happiness and Longevity: Learning from Centenarians
Secrets-of-the-centenarians-photo-slideshow

Living a long and happy life is a goal most of us aspire to. 

Most calls to action for exercising, eating healthy, becoming a better you, etc, usually evoke a conservative ethos that demand discipline, commitment, and a willingness to “embrace the pain” that healthy living demands.

However, most research suggests these approaches peter out after a few months, followed by adverse consequences. For example, extreme dieting is usually quickly followed by overeating that causes people to regain their old weight and then some. This ends up being true about 2/3 the time. Furthermore, your body forms “set points” that it wants to stay at, and rapid weight loss or weight gain is usually followed by hormonal changes that make you eat more or less to get back to your original weight. 

When you read studies about centenarians (people who live to be 100), you get the impression they didn’t get there by reading diet magazines and years of willful neglect. Instead, most of them “relaxed” their way into graceful aging.

There are a lot of reasons why people live to be a long time. Low calorie diets help. The immune systems of centenarians also undergo different changes in old age than people that don’t live as long. Men seem to do it less often than women, and for different reasons. But all centenarians seem to be pretty happy and laid back.

Centenarians are not immune to the rigors of old age. A recent study in Aging Research found that the prevalence of lifestyle diseases among the super old is not significantly different from those in their 70’s and 80’s. However, one of their defining traits is they have “low-anxiety” responses to unexpected circumstances, and a higher perception of their health than other old people.

The best source of information on longevity is Japan. They have a well established history of centenarians, and their census system is very meticulous, making reliable epidemiological research possible. The prevalence of centenarians in Japan has increased 100 fold in the last 4 decades.

Japanese_centenarians

In Japan the highest prevalence of centenarians is in the Okinawan region, and their lifestyle habits are revealing. They eat about 1,000 calories a day from mostly vegetable sources, live a communal lifestyle, and most people have very well defined lifestyle habits. Daily walks, gardening, and well-defined social norms are ways of life. 

Okinawans

In Okinawan villages, the concepts of Yuimaru and Moai are central tenets of social life.

Yuimaru is an Okinawan concept of shared work that requires everyone to help everyone else with their everyday tasks.

Moai are regular meetings held within villages among people with shared interests. The idea being shared commitment makes the responsibilities of everyday life more enjoyable and helps enforce social bonds.

So, maybe living into old age can be summed up in six words: eat plants, keep friends, don’t worry.

References:

Jinmyoung Cho, Peter Martin, Jennifer Margrett, Maurice MacDonald, and Leonard W. Poon, “The Relationship between Physical Health and Psychological Well-Being among Oldest-Old Adults,” Journal of Aging Research, vol. 2011, Article ID 605041, 8 pages, 2011. doi:10.4061/2011/605041

Laura Tafaro, Maria Teresa Tombolillo, Nina Brükner, Giovanni Troisi, Paolo Cicconetti, Massimo Motta, Elisabeth Cardillo, Ettore Bennati, Vincenzo Marigliano, Stress in centenarians, Archives of Gerontology and Geriatrics, Volume 48, Issue 3, May-June 2009, Pages 353-355, ISSN 0167-4943, 10.1016/j.archger.2008.03.001.

Hideki Tanaka, Shuichiro Shirakawa, Sleep health, lifestyle and mental health in the Japanese elderly: Ensuring sleep to promote a healthy brain and mind, Journal of Psychosomatic Research, Volume 56, Issue 5, May 2004, Pages 465-477

"Healthy Agriculture, Healthy Nutrition, Healthy People", World Council on Genetics, Nutrition, and Fitness for Health. Pgs 114-117, Karger Publishers, 2011.

Christy F. Telch, W. Stewart Agras, The effects of a very low calorie diet on binge eating, Behavior Therapy, Volume 24, Issue 2, Spring 1993, Pages 177-193, ISSN 0005-7894, 10.1016/S0005-7894(05)80262-X.

The Wisdom of Going Gluten Free

There’s a new article in the NY times about the euphoria around going gluten-free:

Alcocer was excited, too, as usual. The Cornell University graduate was once a captain in the Air Force, where he worked on decoys to confuse enemy missiles and became a Global Positioning System expert who negotiated international treaties on behalf of American interests — heady, scientific stuff. But this job, he said, is just as important as his former military duties. He’s in charge of selling products to a large and once-unknown consumer population: gluten-free America.

“We’ve got food everywhere,” Alcocer said from atop his chair at the expo. “It’s coming out of everywhere. You can’t slow it down. We won’t slow it down.” He paused and smiled. “It’s like I’m selling cars up here,” he chuckled. “How do I get you into a Nature Valley bar today?”

Uh-huh.

When I read stories like this, I feel like Gandalf from the Lord of the Rings: This too shall pass.

If you have Celiac’s disease or some other allergic reaction to gluten, then avoid it. Otherwise, it makes no difference if you have gluten in your diet or not.

The venerable Jonas Luster said it best on Quora:

There is no wisdom in going gluten free. To some, a small, very small, number of people in this world, gluten triggers intolerances and can lead to a diminished quality of life if consumed. Those people, many of which are as appalled as I am by “normals” who think “gluten free” is the new “organic”, are forced to live a life consisting of a restricted diet. They’re not happy. They’d kill to have a normal gut, one that didn’t rebel at the presence of gluten.

As far as diet fads go, gluten-free is pretty bad. Worse than Atkins.

As a proxy for health, the term “gluten-free” means less than organic, fresh, raw, or vegan.