Becoming Men

I came across this great article about some of our Founding Fathers on a website designed to encourage young people to do hard things for God - The Rebelution.  Here is a summary paragraph in the article:

"...As an old saying goes, “As a twig is bent, so grows the tree.”  This understanding is what our founding fathers had in common. It was the secret to their greatness. They put into practice the principle of Lamentations 3:27, “It is good for a man that he bear the yoke in his youth.”  As young adults they adopted the determination and high ideals that went on to characterize their entire lives. Their history-making adult years were directly connected to their focused years as young adults.

It is no coincidence that the same Samuel Adams who organized the Boston Tea Party at age 51 wrote his master’s thesis in defense of the people’s liberties at age 21.  It is no coincidence that David Farragut, who became the U.S. Navy’s first Admiral at age 65, was given command of his first ship at age 12.  It is no coincidence that Alexander Hamilton, who became our nation’s first Secretary of the Treasury at age 34, was a clerk in a counting house at age 13.  Likewise, it is no coincidence that, as the primary author of the Federalist Papers at age 32, Hamilton had already been publishing political pamphlets since he was 19.  And, of course, it is no surprise that the same George Washington who became the Commander-in-Chief of the Revolutionary Army at age 43, was appointed Commander-in-Chief of the Virginia Militia 20 years earlier.

The Body Fat Setpoint, Part IV: Changing the Setpoint

Prevention is Easier than Cure

Experiments in animals have confirmed what common sense suggests: it's easier to prevent health problems than to reverse them. Still, many health conditions can be improved, and in some cases reversed, through lifestyle interventions. It's important to have realistic expectations and to be kind to oneself. Cultivating a drill sergeant mentality will not improve quality of life, and isn't likely to be sustainable.

Fat Loss: a New Approach

If there's one thing that's consistent in the medical literature, it's that telling people to eat fewer calories does not help them lose weight in the long term. Gary Taubes has written about this at length in his book Good Calories, Bad Calories, and in his upcoming book on body fat. Many people who use this strategy see transient fat loss, followed by fat regain and a feeling of defeat. There's a simple reason for it: the body doesn't want to lose weight. It's extremely difficult to fight the fat mass setpoint, and the body will use every tool it has to maintain its preferred level of fat: hunger, reduced body temperature, higher muscle efficiency (i.e., less energy is expended for the same movement), lethargy, lowered immune function, et cetera.

Therefore, what we need for sustainable fat loss is not starvation; we need a treatment that lowers the fat mass setpoint. There are several criteria that this treatment will have to meet to qualify:

1. It must cause fat loss
2. It must not involve deliberate calorie restriction
3. It must maintain fat loss over a long period of time
4. It must not be harmful to overall health
   

I also prefer strategies that make sense from the perspective of human evolution.

Strategies: Diet Pattern

The most obvious treatment that fits all of my criteria is low-carbohydrate dieting. Overweight people eating low-carbohydrate diets generally lose fat and spontaneously reduce their calorie intake. In fact, in several diet studies, investigators compared an all-you-can-eat low-carbohydrate diet with a calorie-restricted low-fat diet. The low-carbohydrate dieters generally reduced their calorie intake and body fat to a similar or greater degree than the low-fat dieters, despite the fact that they ate all the calories they wanted (1). This suggest that their fat mass setpoint had changed. At this point, I think moderate carbohydrate restriction may be preferable to strict carbohydrate restriction for some people, due to the increasing number of reports I've read of people doing poorly in the long run on extremely low-carbohydrate diets (2).

Another strategy that appears effective is the "paleolithic" diet. In Dr. Staffan Lindeberg's 2007 diet study, overweight volunteers with heart disease lost fat and reduced their calorie intake to a remarkable degree while eating a diet consistent with our hunter-gatherer heritage (3). This result is consistent with another diet trial of the paleolithic diet in diabetics (4). In post hoc analysis, Dr. Lindeberg's group showed that the reduction in weight was apparently independent of changes in carbohydrate intake*. This suggests that the paleolithic diet has health benefits that are independent of carbohydrate intake.

Strategies: Gastrointestinal Health

Since the gastrointestinal (GI) tract is so intimately involved in body fat metabolism and overall health (see the former post), the next strategy is to improve GI health. There are a number of ways to do this, but they all center around four things:

1. Don't eat food that encourages the growth of harmful bacteria
2. Eat food that encourages the growth of good bacteria
3. Don't eat food that impairs gut barrier function
4. Eat food that promotes gut barrier health

The first one is pretty easy: avoid refined sugar, refined carbohydrate in general, and lactose if you're lactose intolerant. For the second and fourth points, make sure to eat fermentable fiber. In one trial, oligofructose supplements led to sustained fat loss, without any other changes in diet (5). This is consistent with experiments in rodents showing improvements in gut bacteria profile, gut barrier health, glucose tolerance and body fat mass with oligofructose supplementation (6, 7, 8).

Oligofructose is similar to inulin, a fiber that occurs naturally in a wide variety of plants. Good sources are jerusalem artichokes, jicama, artichokes, onions, leeks, burdock and chicory root. Certain non-industrial cultures had a high intake of inulin. There are some caveats to inulin, however: inulin and oligofructose can cause gas, and can also exacerbate gastroesophageal reflux disorder (9). So don't eat a big plate of jerusalem artichokes before that important date.

The colon is packed with symbiotic bacteria, and is the site of most intestinal fermentation. The small intestine contains fewer bacteria, but gut barrier function there is critical as well. The small intestine is where the GI doctor will take a biopsy to look for celiac disease. Celiac disease is a degeneration of the small intestinal lining due to an autoimmune reaction caused by gluten (in wheat, barley and rye). This brings us to one of the most important elements of maintaining gut barrier health: avoiding food sensitivities. Gluten and casein (in dairy protein) are the two most common offenders. Gluten sensitivity is widespread and typically undiagnosed (10).

Eating raw fermented foods such as sauerkraut, kimchi, yogurt and half-sour pickles also helps maintain the integrity of the upper GI tract. I doubt these have any effect on the colon, given the huge number of bacteria already present. Other important factors in gut barrier health are keeping the ratio of omega-6 to omega-3 fats in balance, eating nutrient-dense food, and avoiding the questionable chemical additives in processed food. If triglycerides are important for leptin sensitivity, then avoiding sugar and ensuring a regular source of omega-3 should aid weight loss as well.

Strategies: Micronutrients

As I discussed in the last post, micronutrient deficiency probably plays a role in obesity, both in ways that we understand and ways that we (or I) don't. Eating a diet that has a high nutrient density and ensuring a good vitamin D status will help any sustainable fat loss strategy. The easiest way to do this is to eliminate industrially processed foods such as white flour, sugar and seed oils. These constitute more than 50% of calories for the average Westerner.

After that, you can further increase your diet's nutrient density by learning to properly prepare grains and legumes to maximize their nutritional value and digestibility (11, 12; or by avoiding grains and legumes altogether if you wish), selecting organic and/or pasture-raised foods if possible, and eating seafood including seaweed. One of the problems with extremely low-carbohydrate diets is that they may be low in water-soluble micronutrients, although this isn't necessarily the case.

Strategies: Miscellaneous

In general, exercise isn't necessarily helpful for fat loss. However, there is one type of exercise that clearly is: high-intensity intermittent training (HIIT). It's basically a fancy name for sprints. They can be done on a track, on a stationary bicycle, using weight training circuits, or any other way that allows sufficient intensity. The key is to achieve maximal exertion for several brief periods, separated by rest. This type of exercise is not about burning calories through exertion: it's about increasing hormone sensitivity using an intense, brief stressor (hormesis). Even a ridiculously short period of time spent training HIIT each week can result in significant fat loss, despite no change in diet or calorie intake (13).

Anecdotally, many people have had success using intermittent fasting (IF) for fat loss. There's some evidence in the scientific literature that IF and related approaches may be helpful (14). There are different approaches to IF, but a common and effective method is to do two complete 24-hour fasts per week. It's important to note that IF isn't about restricting calories, it's about resetting the fat mass setpoint. After a fast, allow yourself to eat quality food until you're no longer hungry.

Insufficient sleep has been strongly and repeatedly linked to obesity. Whether it's a cause or consequence of obesity I can't say for sure, but in any case it's important for health to sleep until you feel rested. If your sleep quality is poor due to psychological stress, meditating before bedtime may help. I find that meditation has a remarkable effect on my sleep quality. Due to the poor development of oral and nasal structures in industrial nations, many people do not breathe effectively and may suffer from conditions such as sleep apnea that reduce sleep quality. Overweight also contributes to these problems.

I'm sure there are other useful strategies, but that's all I have for now. If you have something to add, please put it in the comments.


* Since reducing carbohydrate intake wasn't part of the intervention, this result is observational.

3 Strikes and You're Out, IPCC

Here's the third story of a "scientific" conclusion made in the IPCC that has now been revealed to be based on something less than pure science:

"A STARTLING report by the United Nations climate watchdog that global warming might wipe out 40% of the Amazon rainforest was based on an unsubstantiated claim by green campaigners who had little scientific expertise.... The source for its claim was a report from WWF, an environmental pressure group, which was authored by two green activists. They had based their “research” on a study published in Nature, the science journal, which did not assess rainfall but in fact looked at the impact on the forest of human activity such as logging and burning."

Beauty and Brains on Fox News

I wanted to watch the Miss America Pageant tonight, but not for the obvious reason. Most years I could care less. But this year is special - Rush Limbaugh is a judge. So, I tuned in to see how he looked/came across on TV in such a mainstream venue. This is all actually just an intro to the clip below from Jon Stewart, which I saw quite a while ago and thought was very funny/sad. Stewart is actually mocking Fox Newscaster Gretchen Carlson for "dumbing down" herself for the news. Carlson is actually a former Miss America, which brings this all together.

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Gretchen Carlson Dumbs Down
www.thedailyshow.com
Daily Show Full Episodes Political Humor Health Care Crisis

I don't really watch this show on Fox and Stewart is pretty fair to point out the ridiculousness of it all.

weekend cooking

I love doing food prep on Saturday. This is the day I take my car to my exercise class (instead of biking), then stop at the grocery store and buy tons of food. Today I spent $200. $200! Well, for two people for one week for delicious organic produce, it's not so bad. Actually that's not the whole bill. During the week I buy a bag of spinach and a few boxes of berries every day. Today I made 8 smoothies (4 batches of 2) for housemate, and 7 green sludge smoothies for myself. I froze them all. Then I made a pot of beans and froze them into five 2-cup containers for Mon-Fri. Today's beans were fabulous. I cooked a leek and a couple of parsnips separately, then blended them and added to the beans. This added creaminess and a nice flavor. And as usual, I cooked the beans with lots of fresh veggie juice. Yum. I bought the parsnips because they are one of the few local veggies we have left in Wisconsin this time of year. They are good. The first time I tried them I didn't like them but now I do.

Now I'm set for the week. My brekky will be green sludge and a small box of berries. Lunch will be beans, veggies, & seeds. What's nice about this is the veggies can vary every day: steamed, lightly steamed or raw broccoli, cauliflower & carrots; raw bok choy (this is good raw!); kale or collards; brussels sprouts; etc. This takes about 15 minutes to prepare including prep and using a pressure cooker. And dinner will be my favorite spinach salad right now. This salad takes 2 minutes to prepare. So I'll have easy meals with lots of greens for a busy week. That seems to be my groove right now.

Oh, the only problem today is I ate too much. There was some leftover from each smoothie and the beans were just too tasty. Next time I will have to try to eat less of everything else because I love eating the leftover smoothies while I make them.

The Real Side of Foreign Aid

Here's an account of one effort to distribute food to the needy in Haiti.  The idealism in us says if we send money or other contributions, the rest of the work will be easy.  But conditions on the ground, as this case shows, sometimes can make that impossible.  There really is no ONE to blame, but a thousand factors why people in need can't get help that is available.  That's why it is called a disaster.  The article is insightful and should demonstrate why good plans and good intentions don't always solve all the problems.

Quotes from a Criminal Mind

I have seen a few episodes of the TV show Criminal Minds recently. Each episode starts and ends with a quote. Here is a website that is transcribing them. Here are a few that I found particularly profound:

A belief is not merely an idea the mind possesses. It is an idea that possesses the mind. ~ Robert Oxton Bolton

Although the world is full of suffering, it is also full of overcoming it. ~ Helen Keller

We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. ~ Plato

Nothing is so common as the wish to be remarkable. ~ [attributed to] Shakespeare

Murder is unique in that it abolishes the party it injures, so that society must take the place of the victim, and on his behalf demand atonement or grant forgiveness. ~ W.H. Auden

Out of suffering have emerged the strongest souls. The most massive characters are seared with scars. ~ Khalil Gibran

Of all the preposterous assumptions of humanity, nothing exceeds the criticisms made of the habits of the poor by the well-housed, well-warmed, and well-fed. ~ Herman Melville

There is a sacredness in tears. They are not the mark of weakness, but of power. They are messengers of overwhelming grief and of unspeakable love. ~ Washington Irving

Prager University

I have really enjoyed Dennis Prager when I have had the chance to listen to him. Unfortunately, he's not on where I now live. But I did find this website where he posts 5 minute video "lectures" in his Prager "U". Check these out and check back regularly. You will enjoy. Here's one to tease you: The Most Important Verse in the Bible.

Obama Inherited Budget Deficits from... HIMSELF

I don't know why someone [DOESN'T] point this out every time Obama makes this claim. Congress passes the budget, not the President. And Obama voted for the 3 budgets from the last few years of Bush's time in office. Each budget since the Dems took control of Congress in '06 increased Federal spending well beyond what Bush had asked for. So, in all actuality, Senator Obama [along with all the other members of the Democrat-controlled Congress] gave President Obama these massive budget deficits. Per the post at Hotair:

"Obama repeatedly insisted that he inherited massive budgetary problems from George Bush, but the Con Law professor may want to retake his high-school civics class. Congress passes budgets, not the President, and the last three budgets came from Democrats. In three years, they increased annual federal spending by $900 billion, while the admittedly profligate and irresponsible Republican Congresses under George Bush increased annual federal spending by $800 billion — in six years. And during the last three years before taking office as President, Obama served in the Senate that passed those bills, and he voted for every Democratic budget put in front of him."

New York Times article recognizes the Institute for Healthcare Improvement

Since 1991, the Institute for Healthcare Improvement (IHI) under the leadership of Don Berwick, MD, MPP, has been leading quality and safety improvement across the world. The IHI Open School for Health Professions provides an interdisciplinary learning environment for health professions students where they engage in conversations about the quality and safety of health care systems. Today, more than 20,000 students are engaged in 41 states and 24 countries. These efforts and the need to move from discussions about patient safety to curricular changes gained national attention this week as an article topic in the January 26^th edition of the New York Times. To read more, please follow the link to the Open School blog, below.

http://tjuopenschool.blogspot.com/

favorite spinach salad

Ingredients:

1 bag (5 oz) spinach

1 box fresh blackberries and some frozen berries OR 1 bag of frozen berries, any kind

2-3 Tbsp seeds (hemp, chia, sunflower)

2 Tbsp D'angou Pear or other flavored vinegar

optional: 1/2-1 cup beans or edamame or sweet peas (I almost never include this because the salad is plenty filling)

Put the spinach in the bowl. Add everything else. Note: I usually don't add beans because I have them at lunch, which is my biggest meal of the day. This is usually my dinner. Here's a version with a bag of blueberries:

Note: I've been trying out the different Fuhrman flavored vinegars. My favorites by far are D'Angou pear and spicy pecan. Blueberry and orange are okay but not nearly as good.

easy cabbage salad

This is similar to my other cabbage salad but with fewer ingredients. Take your pick!

Ingredients:

1 cup shredded cabbage

1 cup shredded apple

1 cup shredded carrots

optional: 1 cup shredded beets (housemate doesn't like beets)

1/3 cup raisins, or to taste

Combine. It's better after it sits for an hour or two.

Simple eating

This week, I am doing easy and quick meals, and it all tastes great.

For brekky, before exercising, I've been enjoying green sludge. Then afterwards, just some fruit, usually a small box of strawberries and a small box of blueberries. Note: I eat dinner early, and I have a hard time going all the way until 11 am to eat brekky, so that's why I have part of it before exercising. Then I don't have to eat as big of a dinner either.

Yesterday for lunch I made this quick and easy meal:

a bunch of kale, ripped into pieces by hand, 1/2 onion coarsely chopped, 1 can tomatoes. I cooked this in the pressure cooker for 3 minutes; then added a can of no-salt garbanzo beans. For housemate, I cooked a potato at the same time (on one side of the pressure cooker). I took more kale for my dish, and put the potatoes in hers. Mine is on the left, hers on the right:

Also, easy cabbage salad.

Today I had kale-fennel soup that I had frozen (the recipe makes a huge batch so I froze into serving-size containers). I had that over chopped baby bok choy--yum! And I finished off the cabbage salad.

Dinner this week has been: my favorite spinach salad.

I finished off lunch and dinner with a big carrot. I love carrots, especially the ones we get here in Wisconsin for most of the year.

Daily Blended salad

I'm not a big smoothie fan because I prefer chewing my food and tasting the flavors of each bite separately. But if it's really true as Dr. Fuhrman says, that you absorb 5-10 times more nutrients from blending, then it seems worth it to blend up some salad greens once a day. And I like this one because it's not very sweet. I'd rather save the sweet fruits for other dishes. This is refreshing in a slightly sweet, bitter, and tart kind of way. The lemon is a key ingredient because it neutralizes the bitter taste of the greens. I really like this smoothie, but I don't recommend it for first-timers. For those, I recommend house-mate's smoothie or the spinach-mango smoothie.

Ingredients:

One 5-oz bag baby romaine or baby greens salad mix

2 oranges or 1 grapefruit (remove seeds or buy seedless like navels)

2 Tbsp lemon juice

1 Tbsp flaxseed

daily supplements (gentle care, osteo-sun, and DHA)

Combine in a high-speed blender.

Nutritional info: 226 calories, protein 6 g (10%), carbs 46 g (73%), fat 4 g (18%)

I usually make 7 smoothies on Saturday morning and freeze them in 16 oz water bottles. Here's the assembly line before production starts:

Housemate's spinach berry smoothie

This is the easiest and best tasting housemate smoothie with spinach in it (the spinach-mango is as good but too green-looking for housemate). This makes two 16-oz smoothies.

Ingredients:

1 bag frozen sweet cherries

1 bag frozen berries (blueberry, strawberry, raspberry, or mixed)

1 bag (5 oz) spinach

1-2 Tbsp date syrup or date sugar or 1-2 dates (or more or less, to taste)

1/2 cup grape or cherry juice; or 1 cup grapes
1 banana (optional)
fresh figs (in season)

2-4 Tbsp seeds (flax, sunflower, hemp, chia) or walnuts

vitamins and vitamin D

DHA supplement

Blend the supplements, seeds, juice, dates, and spinach until smooth. Add the berries and water and blend again until smooth.

Here's the juice I used last time:

Best of all, it doesn't look green, due to the cherries. Housemate does not want green-looking smoothies. (foil over the glass and straw works too):

I often make 6-8 of these on weekends, cover with aluminum foil, freeze, and then take one out every night to thaw in the fridge for brekky. Here's the production line for the big batch:

STATE of the UNION

The President clearly wants to "get moving" on reform of the health care system but tonight was not the night for any details. This is a fight that he will not back away from but he is calling a sort of time out if you will, a chance for tempers to cool and to re-examine the fundamentals. From his perspective those fundamentals include covering the uninsured, protecting Medicare, ending insurance company "abuses" and not raising the deficit any further. To me, we are back to square one---no discussion about improving the value of our investment , no attempt to focus on wellness and prevention, no talk of comparative effectiveness research so that we are making decisions based on good science and no mention of expanding primary care. Our School of Population Health cannot take a "time out"---in fact, we are pushing ahead each and every day. We will get many of our key courses on line by September 2010 and go from a regional school to a global one. We will launch the first of its kind Masters Degree in Chronic Care Management so that our graduates will be ready to tackle the Accountable Care Organization of the future. We will educate leaders to reduce the fourth leading cause of death in the nation---medical error!! We are MOVING now, we will not wait, we will "get the job done". I hope our elected leaders will follow us soon. Thanks and tell me what you think about reform too. DAVID NASH

Pet Hippo

I have heard of the song about getting a hippo for Christmas, but this one is for real.  This is one glimpse of what heaven will be like, when the animals are not afraid/ or a threat to us anymore.

Science AGAIN not a Science

If you can't figure out why "Deniers" exist, this one article would explain my position.  Unintended consequences are very common, especially when politics or ideology trump true science.  At the end of the day, our ecosystem is very complex.  I don't understand why I get this, but many in the "science" fields don't comprehend this until they stumble upon "unexpected" results - the fact that something is unexpected proves to me science didn't get them to their recommendations in the first place.  Doesn't the basic scientific method say that a hypothesis is tested and results can be repeated?  If so, there should be no unexpected results to social experiments/environmental policy/etc.  Case in point, remember that hole in the ozone layer that was going to destroy the world:

The Leeds team found that beneath the Antarctic ozone hole, high-speed winds whip up large amounts of sea spray, which contains millions of salt particles.

This spray then forms clouds, and the increased spray over the last two decades has made these clouds brighter and more reflective – helping to keep global warming in check.

Prof Carslaw described the phenomenon as an "unexpected and complex climate feedback".

He highlighted that atmospheric impacts on the climate were "inordinately complicated" and it was not unusual for unexpected consequences to be revealed.

So why didn't people know about the sea spray 20 years ago?  Why was this not studied or observed before now?  No one wondered about the clouds in the whole process?  This is what makes me say slow down on public/social policy when attempting to determine how, OR IF, to fix to planet.  Is anyone looking to see if the planet will "fix" itself before we legislate ourselves back to the dark ages?

Scientist Admits Politics Valued over Science

Here is another in a recent flurry of articles detailing the role ideology has played in the Global Warming Alarmism, as opposed to true science.  In particular,

"The scientist behind the bogus claim in a Nobel Prize-winning UN report that Himalayan glaciers will have melted by 2035 last night admitted it was included purely to put political pressure on world leaders.  Dr Murari Lal also said he was well aware the statement, in the 2007 report by the Intergovernmental Panel on Climate Change (IPCC), did not rest on peer-reviewed scientific research."

As for the stringent scientific scrutiny that this data goes through to reach "scientific consensus" and, thus included in the IPCC reports that effect international policy,

"Dr Lal said: ‘We knew the WWF report with the 2035 date was “grey literature” [material not published in a peer-reviewed journal]. But it was never picked up by any of the authors in our working group, nor by any of the more than 500 external reviewers, by the governments to which it was sent, or by the final IPCC review editors.’  In fact, the 2035 melting date seems to have been plucked from thin air."

How is this possible?  And although the article does report that some people questioned this, the decision-makers ignored these concerns, so much so that:

"...Hayley Fowler of Newcastle University, suggested that their draft did not mention that Himalayan glaciers in the Karakoram range are growing rapidly, citing a paper published in the influential journal Nature.  In their response, the IPCC authors said, bizarrely, that they were ‘unable to get hold of the suggested references’, but would ‘consider’ this in their final version. They failed to do so."

How is it that they could not get a copy of Nature journal!  Again, a political ideology valued above the science.  And the Alarmists wonder why we are skeptics.

5-day cleanse

I'm doing Dr. Fuhrman's 5-day cleanse from his September 2003 Newsletter. His "cleanse" is not what most people think a cleanse is. It is a bunch of healthy meals heavy on the leafy greens, with veggies and fruit and some seeds thrown in. As Dr. Fuhrman says, "The most important thing to understand about detoxification is that it is an ongoing bodily process. It isn't something that you can buy in a package. The healthier you are, the easier it is for your body to keep its tissues clean. In order to maintain excellent health and true internal cleanliness, you must avoid all harmful, irritating substances (such as salt, pepper, and hot spices) and eat a diet rich in phytochemicals and antioxidants. Fresh fruits and vegetables contain the most powerful healing agents. They nourish your body and help maximize its normal functions. The only way to effectively detoxify is to live and eat healthfully, and allow your body to do its thing at full throttle...Let's see how you feel after five days of eating Nature's most powerful healing foods."

The recipes are:

Fruit plate: orange, blue

berries, strawberries, optional lettuce

Blended salad: baby greens, orange, lemon juice

Healthy slaw: raw cabbage, beets, carrots, apples, and raisins

Spinach salad: raw spinach, red onion, various seeds, blackberries, pear vinegar

The Green Machine: tons of kale, bok choy, broccoli rab or other greens, tomatoes, garlic, mushrooms, onion

Apple-stuff peppers: red pepper, apple, cinnamon and nutmeg.

I probably shouldn't give more detailed recipes since they are probably proprietary. But this gives you an idea. He splits these into 3 meals, which I find humorous because it took me 3 days to get through all the recipes. The ones I started repeating every day were the spinach salad and the blended salad. I really like them. They are simple and good. I think I could eat those every day for a long time! I'm really surprised I like the blended salad. I only made the green machine once. It was good, just a lot of food. I made the apple-stuff pepper twice and split it with housemate. It wasn't spectacular, and yet I enjoyed it.

I just finished day 4 of the cleanse and feel good and back to my healthy self. Here are pictures of the meals:

Fruit plate:

Green sludge, I mean, blended salad:

Green Machine:

Apple-stuffed bell pepper (shared with house-mate):

cabbage salad:

spinach salad, probably my favorite meal:

The Body Fat Setpoint, Part III: Dietary Causes of Obesity

What Caused the Setpoint to Change?

We have two criteria to narrow our search for the cause of modern fat gain:

1. It has to be new to the human environment
   
2. It has to cause leptin resistance or otherwise disturb the setpoint
   

Although I believe that exercise is part of a healthy lifestyle, it probably can't explain the increase in fat mass in modern nations. I've written about that here and here. There are various other possible explanations, such as industrial pollutants, a lack of sleep and psychological stress, which may play a role. But I feel that diet is likely to be the primary cause. When you're drinking 20 oz Cokes, bisphenol-A contamination is the least of your worries.

In the last post, I described two mechanisms that may contribute to elevating the body fat set point by causing leptin resistance: inflammation in the hypothalamus, and impaired leptin transport into the brain due to elevated triglycerides. After more reading and discussing it with my mentor, I've decided that the triglyceride hypothesis is on shaky ground*. Nevertheless, it is consistent with certain observations:

• Fibrate drugs that lower triglycerides can lower fat mass in rodents and humans
  
• Low-carbohydrate diets are effective for fat loss and lower triglycerides
• Fructose can cause leptin resistance in rodents and it elevates triglycerides (1)
• Fish oil reduces triglycerides. Some but not all studies have shown that fish oil aids fat loss (2)
  

Inflammation in the hypothalamus, with accompanying resistance to leptin signaling, has been reported in a number of animal studies of diet-induced obesity. I feel it's likely to occur in humans as well, although the dietary causes are probably different for humans. The hypothalamus is the primary site where leptin acts to regulate fat mass (3). Importantly, preventing inflammation in the brain prevents leptin resistance and obesity in diet-induced obese mice (3.1). The hypothalamus is likely to be the most important site of action. Research is underway on this.

The Role of Digestive Health

What causes inflammation in the hypothalamus? One of the most interesting hypotheses is that increased intestinal permeability allows inflammatory substances to cross into the circulation from the gut, irritating a number of tissues including the hypothalamus.

Dr. Remy Burcelin and his group have spearheaded this research. They've shown that high-fat diets cause obesity in mice, and that they also increase the level of an inflammatory substance called lipopolysaccharide (LPS) in the blood. LPS is produced by gram-negative bacteria in the gut and is one of the main factors that activates the immune system during an infection. Antibiotics that kill gram-negative bacteria in the gut prevent the negative consequences of high-fat feeding in mice.

Burcelin's group showed that infusing LPS into mice on a low-fat chow diet causes them to become obese and insulin resistant just like high-fat fed mice (4). Furthermore, adding 10% of the soluble fiber oligofructose to the high-fat diet prevented the increase in intestinal permeability and also largely prevented the body fat gain and insulin resistance from high-fat feeding (5). Oligofructose is food for friendly gut bacteria and ends up being converted to butyrate and other short-chain fatty acids in the colon. This results in lower intestinal permeability to toxins such as LPS. This is particularly interesting because oligofructose supplements cause fat loss in humans (6).

A recent study showed that blood LPS levels are correlated with body fat, elevated cholesterol and triglycerides, and insulin resistance in humans (7). However, a separate study didn't come to the same conclusion (8). The discrepancy may be due to the fact that LPS isn't the only inflammatory substance to cross the gut lining-- other substances may also be involved. Anything in the blood that shouldn't be there is potentially inflammatory.

Overall, I think gut dysfunction probably plays a major role in obesity and other modern metabolic problems. Insufficient dietary fiber, micronutrient deficiencies, excessive gut irritating substances such as gluten, abnormal bacterial growth due to refined carbohydrates (particularly sugar), and omega-6:3 imbalance may all contribute to abnormal gut bacteria and increased gut permeability.

The Role of Fatty Acids and Micronutrients

Any time a disease involves inflammation, the first thing that comes to my mind is the balance between omega-6 and omega-3 fats. The modern Western diet is heavily weighted toward omega-6, which are the precursors to some very inflammatory substances (as well as a few that are anti-inflammatory). These substances are essential for health in the correct amounts, but they need to be balanced with omega-3 to prevent excessive and uncontrolled inflammatory responses. Animal models have repeatedly shown that omega-3 deficiency contributes to the fat gain and insulin resistance they develop when fed high-fat diets (9, 10, 11).

As a matter of fact, most of the papers claiming "saturated fat causes this or that in rodents" are actually studying omega-3 deficiency. The "saturated fats" that are typically used in high-fat rodent diets are refined fats from conventionally raised animals, which are very low in omega-3. If you add a bit of omega-3 to these diets, suddenly they don't cause the same metabolic problems, and are generally superior to refined seed oils, even in rodents (12, 13).

I believe that micronutrient deficiency also plays a role. Inadequate vitamin and mineral status can contribute to inflammation and weight gain. Obese people typically show deficiencies in several vitamins and minerals. The problem is that we don't know whether the deficiencies caused the obesity or vice versa. Refined carbohydrates and refined oils are the worst offenders because they're almost completely devoid of micronutrients.

Vitamin D in particular plays an important role in immune responses (including inflammation), and also appears to influence body fat mass. Vitamin D status is associated with body fat and insulin sensitivity in humans (14, 15, 16). More convincingly, genetic differences in the vitamin D receptor gene are also associated with body fat mass (17, 18), and vitamin D intake predicts future fat gain (19).

Exiting the Niche

I believe that we have strayed too far from our species' ecological niche, and our health is suffering. One manifestation of that is body fat gain. Many factors probably contribute, but I believe that diet is the most important. A diet heavy in nutrient-poor refined carbohydrates and industrial omega-6 oils, high in gut irritating substances such as gluten and sugar, and a lack of direct sunlight, have caused us to lose the robust digestion and good micronutrient status that characterized our distant ancestors. I believe that one consequence has been the dysregulation of the system that maintains the fat mass "setpoint". This has resulted in an increase in body fat in 20th century affluent nations, and other cultures eating our industrial food products.

In the next post, I'll discuss my thoughts on how to reset the body fat setpoint.


* The ratio of leptin in the serum to leptin in the brain is diminished in obesity, but given that serum leptin is very high in the obese, the absolute level of leptin in the brain is typically not lower than a lean person. Leptin is transported into the brain by a transport mechanism that saturates when serum leptin is not that much higher than the normal level for a lean person. Therefore, the fact that the ratio of serum to brain leptin is higher in the obese does not necessarily reflect a defect in transport, but rather the fact that the mechanism that transports leptin is already at full capacity.

World Poverty is Falling

Here is an interesting study that shows how world poverty rates are calculated, but also demonstrates that those who live on less than $1 /day have decreased around the world:

"World poverty is falling. Between 1970 and 2006, the global poverty rate has been cut by nearly three quarters. The percentage of the world population living on less than $1 a day (in PPP-adjusted 2000 dollars) went from 26.8% in 1970 to 5.4% in 2006"

I'm not sure what to title this--a diversion of sorts

I’ve been reading a book about Nonviolent Communication for reasons that have nothing to do with my health. On the plane ride home from my last trip, I was reading Chapter 9, “Connecting Compassionately with Ourselves." A big part of compassionate communication and conflict resolution is learning to empathize with the other party. The author says it’s a lot harder to empathize with others if you don’t empathize with yourself. “When we are internally violent toward ourselves, it is difficult to be genuinely compassionate toward others.” I thought, yeah, that’s reasonable. The first section after the introduction was titled “Evaulating Ourselves When we’ve been less than perfect.” Well, that was timely, given my recent dietary indiscretions. So I practiced his suggestions on this topic, and it was very interesting (to me).

Here was the first thing that struck me. He says, “In our language there is a word with enormous power to create shame and guilt.” It is the word “should”. Here is a concept I never thought of: “Think for a moment of all the people you’ve heard say, ‘I really should give up smoking’, or ‘I really have to exercise more.’ They keep saying what they ‘must’ do and they keep resisting doing it, because human beings were not meant to be slaves. We were not meant to succumb to the dictates of should and have to, whether they come from outside or inside ourselves. And if we do yield and submit to these demands, our actions arise from an energy that is devoid of life-giving joy.” Wo, really? That’s interesting! “Our challenge then, when we are doing something that is not enriching life, is to evaluate ourselves moment by moment in a way that inspires change both (1) in the direction of where we would like to go, and (2) out of respect and compassion for ourselves, rather than out of self-hatred, guilt or shame.” Okay, so time to evaluate myself.

“…if we find ourselves reacting reproachfully to something we did, we can quickly stop and ask ourselves, ‘what unmet need of mine is being expressed through this moralistic judgment?’” Okay, I read through this section a few times, and it took me a while to figure this out. I had to come back to it after finishing the rest of the exercise and I finally came up with something. I am not really judgmental about anything I did this week except when I overate the dates. Overeating is what makes me feel shame, because it shows a lack of control, and gluttony. I feel flawed when I do that. The question is, “what unmet need of mine is being expressed through this moralistic judgment?” So we’re talking about my judgment of myself. I finally concluded that it is that I have conditional love for myself rather than unconditional. I love myself as long as I behave. Not so much otherwise. So that was interesting. For the other things I did this week, going off plan, I feel some regret but I don’t feel shame or guilt. I know I messed up but I don’t blame myself too much. Hey, I’m human, and unhealthy food is addictive and ubiquitous. Moving on to the next step, that’s where we discuss this further.

On to forgiveness: “When I behaved in the way I which I now regret, what need of mine was I trying to meet?” I wanted to be in community with others while eating (and I did have several nice conversations with other patrons). I wanted to enjoy what they were enjoying. I wanted to experience an opportunity to eat in a couple of restaurants like we don’t have at home—vegan and raw, so a feeling of not wanting to pass up this opportunity. I wanted to see the effect it would have on my body (curiosity) and confirm that I prefer my own way of eating. I wanted to be “normal” for a few meals. I thought “what harm will this do? It’s part of the life plan.” Now, what need was I trying to meet when I ate too many dates? An addictive need I guess. I felt pleasure eating them and wanted to continue feeling pleasure. And excitement. The sugar hit to the brain. This is an innate drive to seek pleasure. What need was I trying to meet when I went to the restaurant a second time? A desire to get as much in as possible before the door is shut again on me and this becomes forbidden. My choices were “an attempt to serve life” (to feel good momentarily) even though it felt short of my true needs.

So what is the solution? I prefer long-term happiness to short-term pleasure; that is, I prefer my longer term needs for health and wellness and happiness to be satisfied, rather than my short-term pleasure goals. And I really like the concept of not being a slave to the word “should”. I gave up caffeine, alcohol, and salt as a choice, when I was ready. I knew it was a recommendation of Dr. Fuhrman to avoid them, but I thought I could still be healthy and partake in all of these things at a low level. Over time, though, I preferred not to ingest them anymore because I didn’t like how they felt in my body. I think I have to recognize that my desire to eat healthy is a choice. I prefer to have the freedom of choice, rather than the requirements of “should”. This would remove this problem of forbidden foods becoming more desirable. So I am eating healthy because I want to. There are no forbidden foods, even when I pretend there are. I can say, I won’t eat another cookie, and then I can get into my car, drive to the co-op, and buy and eat a vegan cookie. So it really is a choice, and naming something forbidden does make me resist. So, there are no forbidden foods, and I will make a choice at every meal about what I want to eat.

I’ll see how this works and get back to you.

My latest trip

Yea, I’m back from my trip. Yea yea yea! I’ve been gone since Jan. 3. That was too long. First I was in DC for a week. I posted about that already. Then I was in Berkeley, CA for the rest of the time. Well, veganbarbie indulged herself in this vegan mecca. On the healthy side, I asked for a fridge in my hotel room; no problem, got it in 10 minutes. There were 3 great grocery stores within a couple of miles of my hotel. I discovered the best one last, but they were all great. I got wonderful fresh California produce. Yum! I ate well. Usually a salad with lettuce greens, kale or bok choy, raw veggies (zucchini, beets, broccoli, asparagus, tomatoes, bell pepper, not all at once!), frozen berries (cherries yum! Strawberries, blueberries), edamame, and my seed mixture (sunflower, hemp, and ground flax). It was luscious. I usually had fruit for brekky, and then this salad for lunch and dinner. I got many remarks about the salad, and after a while, people started saying “that looks good.” Here's a picture:

Going from mostly healthy to least, here were my other food adventures:

I met up with a couple of "nutritarians" (from the Fuhrman member forums) for dinner at one of their homes. That was a blast! We cooked up chili, kale with orange sesame sauce, and an apple crisp for dessert (already made by the host—yum!). And Anne gave me some fresh dates (dried, but fresh compared to what I get in Wisconsin), which I ate a little too many of during the rest of the week, oops.

I also went to a raw vegan restaurant (Cafe Gratitude) a couple of times. The entrees were healthy. The first time I had a tamale with butternut squash as its filling (not raw), and black beans and cole slaw on the side. The second time I had a very yummy salad and nutty-mushroom soup. About the only thing wrong with these is they had some salt. I indulged in the desserts too. I won’t say what they were because I think I should only talk about healthy foods on this blog to spare readers of developing cravings for slightly unhealthy food. These were raw vegan desserts, made with nuts and dates, but they also probably had quite a bit of agave nectar in them. They were good, and didn’t make me feel crappy the next day, maybe because there were no refined grains?

I also went to a banquet at a fancy Chinese restaurant. I thought maybe I would go off-plan for the rare opportunity to indulge in some delicious dumplings, but it was a meat and seafood restaurant. Vegetarian food wasn’t their specialty. I ate some uninteresting tofu. I was there for 3 hours watching everyone else eat, so I also ate some salty yet bland noodles that were on the table with all the meat and seafood. I was disappointed that I went off-plan and didn’t even enjoy it. I think this led me down the slippery slope of thinking if I’m going to go off plan, I should go to the Herbivore Restaurant, a vegan restaurant a few blocks from my hotel.

So finally, I did go to this Herbivore restaurant on the last 2 days of the trip, thinking, this is my chance to eat at an all-vegan restaurant, and it was fun to have this menu full of vegan entrees and desserts. Dare I confess I went there twice? Yes, I did. I had dinner and dessert both times. Sorry to confess this to all the people who think I’m a great example! After going there once, I wanted to go again and try another entrée out. It’s a slippery slope!

The scientist in me monitored my reactions to the food. I was fine until I went to the vegan restaurant at the end of the trip and ate the refined grains, chocolate, sugar, oil and salt. After those meals, I was hyper-active and couldn’t sleep. And I got puffy from the salt. I still feel nauseas 2 days later. That feeling is reminiscent of my SAD (Standard American Diet) days. I think I was always slightly nauseaus when I ate that way all the time. (was it the refined grains? I don't know for sure). That’s probably why I didn’t use to overeat even though I was overweight from the unhealthy food. Another thing I noticed is that the SAD food does not convert to much poop. All that stuff probably just gets converted to fat. Not much comes out. I thought that was kind of humorous. Fortunately I wasn’t on the diet long enough to get constipated.

So I wasn’t perfect on this trip. Let’s see, Dr. Fuhrman says you can let 10% of your calories be unhealthy. I calculated I’ll have to eat healthy for about a month to make up for this. I’d just as soon eat healthy for six months! I am done with wanting a splurge, I hope for a long time. I am so happy to be eating my fruits and veggies today. This healthy stuff has become my comfort food, thank goodness.

I have a lot of trips planned this year, so I guess I just have to do a lot of grocery shopping while traveling. Right now, that sounds just fine!

Krauss's New Article on Saturated Fat Intervention Trials

Dr. Ronald Krauss's group just published another article in the American Journal of Clinical Nutrition, this time on the intervention trials examining the effectiveness of reducing saturated fat and/or replacing it with other nutrients, particularly carbohydrate or polyunsaturated seed oils. I don't agree with everything in this article. For example, they cite the Finnish Mental Hospital trial. They openly acknowledge some contradictory data, although they left out the Sydney diet-heart study and the Rose et al. corn oil study, both of which showed greatly increased mortality from replacing animal fats with polyunsaturated seed oils. Nevertheless, they get it right in the end:

Particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.

This is really cool. Krauss is channeling Weston Price. If this keeps up, I may have no reason to blog anymore!

News to report, and more travel logs

It's been an eventful 7 days in Berkeley, CA, with 3 more to go. First of all, last week I found out I passed my final exam, and I am now a certified Nutritional Education Trainer! (They changed the name, used to be Nutritional Excellence Trainer).

The other news is that I started up a Madison Area Nutritarian meetup group. Our first meeting will be Feb. 13, assuming I can find people to sign up. We'll have a potluck.

oops, I have no more time to post. I'll post the travel logs later. I have to report that this Nutritional Education Trainer did indulge in some raw vegan desserts. She did resist the vegan donuts though. And the raw vegan chocolate, which she was tempted by only out of curiosity (what does it taste like?). gotta run...

The Body Fat Setpoint, Part II: Mechanisms of Fat Gain

The Timeline of Fat Gain

Modern humans are unusual mammals in that fat mass varies greatly between individuals. Some animals carry a large amount of fat for a specific purpose, such as hibernation or migration. But all individuals of the same sex and social position will carry approximately the same amount of fat at any given time of year. Likewise, in hunter-gatherer societies worldwide, there isn't much variation in body weight-- nearly everyone is lean. Not necessarily lean like Usain Bolt, but not overweight.

Although overweight and obesity occurred forty years ago in the U.S. and U.K., they were much less common than today, particularly in children. Here are data from the U.S. Centers for Disease Control NHANES surveys (from this post):

Together, this shows that a) leanness is the most natural condition for the human body, and b) something about our changing environment, not our genes, has caused our body fat to grow.

Fat Mass is Regulated by a Feedback Circuit Between Fat Tissue and the Brain

In the last post, I described how the body regulates fat mass, attempting to keep it within a narrow window or "setpoint". Body fat produces a hormone called leptin, which signals to the brain and other organs to decrease appetite, increase the metabolic rate and increase physical activity. More fat means more leptin, which then causes the extra fat to be burned. The little glitch is that some people become resistant to leptin, so that their brain doesn't hear the fat tissue screaming that it's already full. Leptin resistance nearly always accompanies obesity, because it's a precondition of significant fat gain. If a person weren't leptin resistant, he wouldn't have the ability to gain more than a few pounds of fat without heroic overeating (which is very very unpleasant when your brain is telling you to stop). Animal models of leptin resistance develop something that resembles human metabolic syndrome (abdominal obesity, blood lipid abnormalities, insulin resistance, high blood pressure).

The Role of the Hypothalamus

The hypothalamus is on the underside of the brain connected to the pituitary gland. It's the main site of leptin action in the brain, and it controls the majority of leptin's effects on appetite, energy expenditure and insulin sensitivity. Most of the known gene variations that are associated with overweight in humans influence the function of the hypothalamus in some way (1). Not surprisingly, leptin resistance in the hypothalamus has been proposed as a cause of obesity. It's been shown in rats and mice that hypothalamic leptin resistance occurs in diet-induced obesity, and it's almost certainly the case in humans as well. What's causing leptin resistance in the hypothalamus?

There are three leading explanations at this point that are not mutually exclusive. One is cellular stress in the endoplasmic reticulum, a structure inside the cell that's used for protein synthesis and folding. I've read the most recent paper on this in detail, and I found it unconvincing (2). I'm open to the idea, but it needs more rigorous support.

A second explanation is inflammation in the hypothalamus. Inflammation inhibits leptin and insulin signaling in a variety of cell types. At least two studies have shown that diet-induced obesity in rodents leads to inflammation in the hypothalamus (3, 4)*. If leptin is getting to the hypothalamus, but the hypothalamus is insensitive to it, it will require more leptin to get the same signal, and fat mass will creep up until it reaches a higher setpoint.

The other possibility is that leptin simply isn't reaching the hypothalamus. The brain is a unique organ. It's enclosed by the blood-brain barrier (BBB), which greatly restricts what can enter and leave it. Both insulin and leptin are actively transported across the BBB. It's been known for a decade that obesity in rodents is associated with a lower rate of leptin transport across the BBB (5, 6).

What causes a decrease in leptin transport across the BBB? Triglycerides are a major factor. These are circulating fats going from the liver and the digestive tract to other tissues. They're one of the blood lipid measurements the doctor makes when he draws your blood. Several studies in rodents have shown that high triglycerides cause a reduction in leptin transport across the BBB, and reducing triglycerides allows greater leptin transport and fat loss (7, 8). In support of this theory, the triglyceride-reducing drug gemfibrozil also causes weight loss in humans (9)**. Guess what else reduces triglycerides and causes weight loss? Low-carbohydrate diets, and avoiding sugar and refined carbohydrates in particular.

In the next post, I'll get more specific about what factors could be causing hypothalamic inflammation and/or reduced leptin transport across the BBB. I'll also discuss some ideas on how to reduce leptin resistance sustainably through diet and exercise.


* This is accomplished by feeding them sad little pellets that look like greasy chalk. They're made up mostly of lard, soybean oil, casein, maltodextrin or cornstarch, sugar, vitamins and minerals (this is a link to the the most commonly used diet for inducing obesity in rodents). Food doesn't get any more refined than this stuff, and adding just about anything to it, from fiber to fruit extracts, makes it less damaging.

** Fibrates are PPAR agonists, so the weight loss could also be due to something besides the reduction in triglycerides.

Guest Commentary: US Health Care Reform from a UK Perspective

Louisa Baxter, MD, MSc, MRCP
Harkness Fellow
Jefferson School of Population Health

When I landed at Philadelphia Airport in September after my 6-hour flight from Heathrow in London, I had half expected to be grilled by US Customs about my involvement in death panels and then turned back and sent home in disgrace. After 7 years spent in clinical practice in the UK, the home of “socialized” medicine, I had jumped at the opportunity to come to Jefferson School of Population Health to do some research and watch the tremendous theatre that is the US health care reform debate unfold across the country.

It has been an incredible 3 months; I have met clinicians from (nearly) every state, patients, hospital and health plan executives, researchers and policy makers. I have read commentaries in the New York Times, watched CNN and CSPAN, listened to Glenn Beck and Senator “You lie!” Joe Wilson and marveled at the heterogeneity of opinions around health care and its reform. As with all countries, it is clear that in the US the health care system faces significant challenges; the growing number of un- or underinsured, rising prices, the medical arms race, unwarranted variation in care and the lack of evidence base for many interventions, to name just a few.

From afar, it is easy to mock the debates as simply a circus fuelled by the special interests of big business and I fear that this is what many countries watching the US at the present time may do. But as an outsider to your system who has been given privileged access to the discussion, what has impressed me is the remarkable depth of feeling around the debate. It is clear, that hidden beneath very complicated policy wonkish jargon and the arguments at town hall meetings, that this is a discussion about what values and priorities should be at the very heart of your health system. It is something to be proud of, that so many voices can come together (relatively peacefully) to enter into the dialogue.

I have also been impressed by the kindness and openness of so many people both in Philadelphia and across the whole US. From everyone in the School at Jefferson, who have helped me through the maze of paperwork necessary to come over here, shown me the best delis to buy lunch and opened their homes to me, to passersby who have shown me how to post mail, how to ride the SEPTA and patiently given me directions, I am often surprised by the care that people take that of me as a guest in your country. If the death panels didn’t need me, it would be an incentive to stay.

New Saturated Fat Review Article by Dr. Ronald Krauss

I never thought I'd see the day when one of the most prominent lipid researchers in the world did an honest review of the observational studies evaluating the link between saturated fat and cardiovascular disease. Dr. Ronald Krauss's group has published a review article titled "Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease". As anyone with two eyes and access to the medical literature would conclude (including myself), they found no association whatsoever between saturated fat intake and heart disease or stroke:

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.

Bravo, Dr. Krauss. That was a brave move.

Thanks to Peter for pointing out this article.

Health Care Reform: Implications of Pending Legislation

At yesterday’s monthly health policy forum, we had the pleasure of hearing Dr. Valerie Arkoosh discuss the health care reform battle currently underway in Congress. From her professional perch as President of the National Physicians Alliance in Washington, DC, Dr. Arkoosh has witnessed the wrangling up close. Her detailed yet straightforward side-by-side comparison of the House and Senate bills was illuminating and highlighted several key elements with the potential to affect academic medical institutions, either positively or adversely. Some of the issues she mentioned included: changes to Disproportionate Share payments for Hospitals (DSH), allowing for Medicaid reimbursement at Medicare levels for primary care, payment bundling, provision of resources for education and training of health care providers, and malpractice reform, to name just a few.

What do you think about the House Bill versus the Senate Bill? How can we help move the dialogue in Washington beyond a discussion of health insurance to a more comprehensive conversation about health care reform?

David Nash, MD, MBA
Dean, Jefferson School of Population Health

AMSA Quality Institute

In the past three days, nearly two dozen medical students and premeds descended on the Jefferson School of Population Health for the Second Annual AMSA Quality and Safety Institute. AMSA is the American Medical Student Association, an important national membership organization that seeks to create a group of future physician leaders for our country. Recognizing the growing importance of quality and safety in the curriculum, these students spent a weekend learning about the cultural barriers to quality, the tools to measure quality and the ins and outs of moving ahead with key campus projects at their home institutions. The faculty came from JSPH, Christiana Care, Drexel U College of Medicine, The NBME, New York Hospital Cornell Medical Center, and RWJ Medical School. The students participated in lectures, workshops, two dinner programs as they built their leadership portfolios. Quality and Safety are NOT ELECTIVES and these students will go forth to put this critical information into the standard med school curriculum. They are armed and dangerous!!---most current faculty know little about this entire field. It is time to recognize how important these issues are to training the doctor of tomorrow. WHAT is your school doing to tackle this challenge?? Should every medical school participate is such an Institute?? What more can AMSA do to institutionalize this approach to learning?? DAVID NASH DEAN JSPH

Paleo is Going Mainstream

There was an article on the modern "Paleolithic" lifestyle in the New York Times today. I thought it was a pretty fair treatment of the subject, although it did paint it as more macho and carnivorous than it needs to be. It features three attractive NY cave people. It appeared in the styles section here. Paleo is going mainstream. We can expect media health authorities to start getting defensive about it any minute now.

Eating while traveling

I’m traveling for 3 weeks this month (house-mate is home so no burglar opportunities). My first trip worked out well--assuming I make it home tonight. There was an organic grocery store 0.6 miles from the hotel, and I requested and got a refrigerator for my room. In addition to the fresh produce from the store, I brought several cans of beans and Fuhrman soups. So I was set!

My typical breakfast was a big salad topped with lots of berries (fresh or frozen ) ,½ can beans, and 1 Tbsp ground seeds. Super yummy.

Lunch was a big salad topped with chopped apple, banana, the rest of the can of beans, ½ bag frozen cherries, and 1 Tbsp ground seeds. The cherries made it fabulous.

Dinner was a big salad topped with a can of soup, chopped small tomato, bell pepper, some lime juice (forgot my flavored vinegars so bought some limes) and 1 Tbsp ground seeds. This was good but was my least favorite meal.

This turned out to be too much food. I didn’t really get hungry between meals. Next week I will probably can the canned soups, though I’ll bring a couple for backup. I think I’ll have berries and sweet peas on my dinner salad instead of the soup. I love berries and sweet peas.

Since this was a business meeting I socialized a lot with my colleagues at the bar and restaurants. I’m getting a reputation for being a weed/grass/salad eater. I brought my meals to the restaurants or just said I’d meet people later at the bar. I ran into a little trouble at one restaurant. As usual, I bribed the server by telling him: I am allergic, brought my own food, and will tip him as if I’d purchased an entree. That has never failed to work. But the maitre de saw me eating out of my plastic bowl and he got upset. I asked him if he wanted me to leave and he said, “Can you just put your food on a plate?” So I said yes and he left me alone. The next time I was more discreet and it worked fine. So lesson learned there—use a restaurant plate instead of my plastic bowl.

You might ask, why don’t you just try to eat the restaurant food? I’ve tried this in the past and either I end up compromising on the healthy choices or eating a very low calorie salad, leaving me hungry. Since I’m traveling three weeks this month, compromising is not an option for me. Compromising for 3 weeks is just eating unhealthy. So I just do this, people think I’m a little weird, but in fact, it really is no big deal once people get used to it. And if it does bother some people, I don’t really care.

My roommate at the meeting also tries to eat healthy so she also likes to go grocery shopping and fix her own breakfast and lunch in the hotel room. She has an interesting view. She says society is waging war on us (both the food industry and the “health care” industry which makes a lot of money treating symptoms of disease but not curing them) and leaving us with no healthy eating options. So we are fighting back by eating healthy.

I’m still adjusting to not drinking at these meetings. I only stopped this last year, and my friends are used to my getting drunk with them. So it’s an adjustment for both of us. It’s not quite as interesting to hang out with friends to the bar as it was when I drank with them. There seem to be three stages of being a bystander to this. The first is when they just start drinking. I think this is most pleasurable, as I recall. It’s time to relax and be with your friends, it feels good going down, and good when it hits your brain. This is the part where I’m a little jealous because I’m just sitting there feeling normal while they are feeling extra good. In the second stage, they are getting a little dumb and the conversation gets a little boring, reverting to the usual topics. In the third stage, they are getting drunk and letting loose so the conversation starts getting interesting again. When I drank, I used to prefer the first stage. Now I prefer the third, admittedly at their expense. Maybe I should just show up later when they are drunk. It’s nice knowing I won’t have a hangover in the morning.