Month: March 2012

Does Kerrygold Butter Improve HDL and LDL?

Seth Roberts5 Comments

More: Greg used Kerrygold butter in the results given below. I now see that he omitted data from other butters that did not agree with his conclusions. This makes his results considerably more doubtful and his whole post (in which Kerrygold butter is called “butter”) misleading. I have changed the title of this post to reflect this.

A New York lawyer named Greg reports remarkably clear evidence about the effect of butter on blood lipid levels: It improved them. For a few years he measured his HDL and LDL regularly with a home cholesterol device. For unrelated reasons, he started eating more butter. He ate a half stick (about 60 g)/day, like me. Here’s what happened.

The first five measurements are from lab tests. The rest are from his home machine.

I asked Greg for details.

I’m 36. I bought the cholesterol meter last July after my doctor said he couldn’t figure out why my numbers were a bit high. We both agreed it was not something to worry too much about and that there was no point charging my insurance company for a VAP test every 6 months. We both also agreed that going on a statin was a bad idea. I picked up the meter out of curiosity. I had previously been monitoring my blood sugar (since 2009) and found it to be very interesting, so I thought I could have some fun with the numbers. The result is all the more surprising because I did not expect it. I was tracking my numbers around the time of the experiment [with butter] to make sure they did not go the wrong way like everyone says they should.

The machine is a CardioChek PA [about $600], which is designed for use in doctors offices, not for the consumer market. The device is “CLIA-waived”, which means that the FDA considers it so simple that the user does not need any special training in clinical chemistry (home glucometers fall into the same category). The machine gives significantly different numbers for different people, suggesting it is measuring something real and not spitting out random numbers.

I asked what the reaction to this data has been.

Most people I’ve spoken to have been receptive to the idea [that butter improves blood lipids], but I got no sense that they would be willing to try it for themselves. Most people I know seem to be quite willing to accept the fact that the old stories about cholesterol are not true. In contrast, one conservative cardiologist said I must have “unique genetics”.

Fermented Foods Improve Irritable Bowel Syndrome

Seth Roberts5 Comments

It’s hard to get scurvy. If you eat anything resembling an ordinary diet you won’t get it. The existence of scurvy, produced by extreme conditions, led to the discovery of Vitamin C. From the case of scurvy and Vitamin C we learned — well, most people learned — that some diseases are clues to what we need to eat to be healthy.

There is no lab test for irritable bowel syndrome (IBS). It is diagnosed if you have “abdominal pain or discomfort in association with frequent diarrhea or constipation,” says Wikipedia, and a dozen other things (colon cancer, lactose intolerance, celiac disease and so on) can be ruled out. It is common. In the United States, one study found that 14% of those surveyed had it. Surveys in other countries produce even higher values — the United States is not a hotspot. “It is one of the most common diseases diagnosed by doctors,” says an NIH webpage.

What is it telling us? According to the NIH webpage, “medications are an important part of relieving symptoms.” Those medications include anti-depressants. If you treat the problem with drugs, you completely ignore the possibility that a digestive problem is due to eating the wrong food. You might think that would be obvious — but no. Of course, people with IBS are less interested in taking medicine so they often believe they are “intolerant” to various foods. But they have a hard time figuring out what those foods are, and their problems persist. The Wikipedia section about causes is a monument either to the ignorance of medical school professors or Wikipedia contributors:

The cause of IBS is unknown, but several hypotheses have been proposed. The risk of developing IBS increases sixfold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression.Publications suggesting the role of brain-gut “axis” appeared in the 1990s, such as the study “Brain-gut response to stress and cholinergic stimulation in IBS” published in the Journal of Clinical Gastroenterology in 1993. A 1997 study published in Gut magazine suggested that IBS was associated with a “derailing of the brain-gut axis.” Psychological factors may be important in the etiology of IBS.

That’s all. Nothing about eating the wrong food. And people wonder what to do about the cost of health care! My suggestion: get rid of everyone (especially medical school professors) too blind or biased to consider that a digestive problem may caused by the wrong food.

Fortunately not everyone is rushing to treat IBS sufferers with drugs. In an obscure journal called Molecular Medical Reports, an open-access article recently appeared about diet and IBS (“Diet and effects of diet management on quality of life and symptoms in patients with irritable bowel syndrome”). The authors are from Norway, which makes the sanity more understandable. The article looks at the effect of dietary advice on IBS symptoms. It compares three groups of patients (IBS patients given dietary advice, IBS patients not given dietary advice, and people without IBS). Patients with IBS eat quite differently than everyone else (for example, they eat less dairy, thinking they might be lactose intolerant), but they are still bad off.

The main point of the article is that the dietary advice was helpful. IBS patients given the advice two years before the study were better off than IBS patients not given the advice, although even those given the advice were considerably worse than normal. Looking at the difference between the diets of the two IBS groups, the better-off group ate a lot more probiotic dairy:

The guided IBS patients reported a consumption of sour milk products containing probiotics almost twice as often as the unguided IBS patients and one and a half times that of the controls. The products used were supplemented with Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5 and Bifidobacterium Bb-12. Patients with IBS were found to have fewer Lactobacillus spp. and Bifdobacterium spp. in their intestinal flora than healthy individuals (44). These bacteria have been shown to bind to epithelial cells and inhibit pathogen binding, and to enhance barrier function (46). Furthermore, these bacteria do not produce gas on fermenting carbohydrates, an effect which would be amplified as they also inhibit Clostridia spp. (46). A number of studies have shown an improvement in flatulence and abdominal distension with a reduction in the composite IBS symptom score, following probiotic intake (45,46) [emphasis added]

It is highly unlikely that we need to eat sour milk products containing probiotics to be healthy — such products are new in evolutionary history. But it is entirely possible that we need to eat plenty of microbe-laden (e.g., fermented) food to be healthy, as I have said countless times on this blog. The big improvement in IBS symptoms produced by probiotics supports my belief that we need to eat plenty of fermented foods to be healthy. (The Wikipedia entry about IBS mentions probiotics and yogurt, but not fermented foods.) Maybe IBS, like scurvy, is a clue to something really important.

Thanks to Melissa McEwen.

 

Assorted Links

Seth Roberts3 Comments
  • All about kefir
  • Fraud and waste at a New York hospital. From the comments you can see that the problems have lasted decades. If someone is always sick, year after year, it means there is something about their sickness (about health in general, actually) we do not understand. Likewise, the decades-long persistence of huge problems at this hospital suggests there is something fundamental about regulation (and perhaps health care) we do not understand.
  • This paper about how well blood uric acid level predicts mortality, which appeared in 2004, did not get nearly the attention it deserves. I was shocked by its existence — American medical school professors are almost incapable of good research. Well, it’s from Finland.
  • David Healy’s new blog.

Thanks to Bruce Charlton, Jazi Zilber, Melissa McEwen and Alex Chernavsky.

Nick Winter’s Big Success with Percentile Feedback

Seth Roberts7 Comments

I have posted several times about using what I call percentile feedback to boost productivity. Percentile feedback means comparing your current performance to your previous performance using a percentile. If the current performance is in the middle of your previous performances, the percentile is 50, for example. Percentile feedback is easy to understand (scores above 50 are better than average) and is sensitive to small improvements — so even small improvements are rewarded. My implementation had three other helpful features: 1. It adjusted for the time I woke up to make different days more comparable. 2. It measured efficiency (time working/time available) to further improve comparability across days. 3. It was graphical. I made a graph of efficiency throughout the current day versus previous days. It greatly increased how much I worked every day.

I love it and wish I had it for everything I measure. Unlike so many feedback systems, it is realistic and encouraging. I found it worked extremely well — to my surprise, actually. It’s not so surprising I would think of it because it vaguely resembles an animal-learning procedure. (Animal learning is my area of expertise within psychology.)

Nick Winter, one of the developers of Skritter (which I use), recently started to use it. He gave a much-too-short QS talk about it in Pittsburgh a month ago. I asked him about his experience. He is as enthusiastic as I am. He wrote:

The percentile feedback has been a huge success–I’m getting way more done than I ever did, and I’m much better at prioritizing toward my main project. Seeing the graph going in real time has been much better at making me aware of what I need to do to hit high targets each day. I will do a full writeup on this, and on my self experiments, when I finish this iOS app and stop focusing so much on work. The short teaser goes something like this:
Phase 0: just tracking normal work at end of day in a Google Doc, average 2 hours a day on iOS development
Phase 1: tracking normal work and iOS dev separately in the Google Doc, average 4 hours a day on iOS development
Phase 2: using Beeminder to have better graphing and goal incentive for iOS dev, average 5 hours a day
Phase 3: first three weeks of using percentile feedback, average 6.4 hours a day
Phase 4: second three weeks of using percentile feedback, deciding to really push it based on the positive feedback from my metrics (more productivity, more happiness), average 9.4 hours a day
So now I’m getting close to averaging 70 hours of focused iOS dev a week and it feels great. In a normal work place, “time spent working” != “productivity”, but for me they’re very similar as long as my energy is good, which it almost always is now.
The surprising insight is that changing the way that I measured my work performance–from spreadsheet, to better spreadsheet, to graph, to better graph–has had such a huge impact. I have been working on maximizing work productivity for four years, ever since starting the startup, but in the last six months I’ve become radically more effective. I love the percentile feedback graph design!

You can see his implementation on his homepage.

The Future of Email: What I Want

Seth Roberts9 Comments

In this essay, which I learned about from Alex Tabarrok, Paul Graham complains about email. Too easy for someone to send him email. Also slow. He thinks of email as a todo list. Here’s what he wants:

More restrictions on what someone can put on my todo list. And when someone can put something on my todo list, I want them to tell me more about what they want from me. Do they want me to do something beyond just reading some text? How important is it? (There obviously has to be some mechanism to prevent people from saying everything is important.) When does it have to be done?

Here’s what I want: A price per email. A service that charges people for each email they send me (e.g., $1/email). I get most of the price, the company providing the service gets a small percentage (1%?). With two additional features: 1. The initial charge is just for me to look at it. Then, after I read the email, there is a mechanism that allows me to easily charge more to do what they ask, such as give them Shangri-La Diet advice. 2. I can easily put people on a list that allows them to send me email for free.

Since Google already has Google Checkout, it might be relatively easy for them to add this to gmail.

Assorted Links

Seth Roberts1 Comment

Thanks to Tom George and Mark Griffith.

Assorted Links

Seth Roberts1 Comment

Sleep and Mood Strongly Linked

Seth Roberts13 Comments

I recently came across a 2005 survey, done in Texas, that found people with poor sleep were far more likely to be depressed or anxious than people with better sleep. Huge risk ratios:

People with insomnia . . . were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety [than persons without insomnia.]

Other studies have found similar results. For example, a 1979 survey interviewed the same people twice, one year apart. People who had insomnia both times were 40 times more likely to be newly diagnosed with major depression during the intervening year than those who did not have insomnia at either time.

A simple thing to say about the sleep/mood correlation is that it supports my theory of depression, which says depression is often due to malfunction of two circadian oscillators (one controlled by light, the other by faces). If they are working properly (in sync, with large amplitude) you sleep well and are in a good mood when you are awake. If they are not working properly (e.g., not in sync) then you do not sleep well and are in a bad mood at least part of the time while you are awake. What is called depression (e.g., not wanting to do anything) is actually a good thing in the middle of the night. Not wanting to do anything — being still — is necessary to fall asleep.

A sad and more complicated thing about this correlation is that it is ignored. It is not explained by any theory of depression popular among psychotherapists, such as cognitive-behavioral therapy, not to mention a dozen other explanations of depression (psychoanalytic, etc.) that psychotherapists favor. Nor is it explained by any pharmacological theory of depression. In other words, if you seek treatment for depression within our healthcare system the treatment you will receive will derive from a theory that cannot explain this result. Yet the correlation is so strong it must be telling us something important.

You can read endlessly about the high cost of health care. What if the high cost is not the core problem? What if it is only a symptom of something less obvious? What if health care costs a lot because we have a poor understanding of health and disease (as the failure of popular theories of depression to explain the sleep/mood correlation suggests)? What if we have a poor understanding of health and disease because health research is too concerned with allowing healthcare providers to make money?

Another Unintentionally Revealing Response From the American Medical Association

Seth Roberts5 Comments

A few weeks ago I blogged about the lame response of the American Medical Association to HealthTap, a website that solicits doctors’ answers to medical questions. Their criticism was so weak it amounted to praise.

More recently, the AMA was asked about its position on doctor rating websites. Here’s what happened:

Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.” This, however, is almost exactly the same statement it provided to its own publication, American Medical News, in 2008, when it was attributed to Dr. Nancy H. Nielsen, the president-elect of the A.M.A. at the time.

Such plagiarism is more consistent with what Jane Jacobs in Systems of Survival called guardian values (where honesty is unimportant) than commercial values (where honesty is very important). When you grasp that doctors follow guardian values rather than commercial ones their behavior becomes far more predictable — and plainly in need of control by outsiders. That doctors are allowed to charge for their services resembles allowing policemen to write as many parking tickets as they like and pocket the fines.

Thanks to Bryan Castañeda.

The Hunger Games

Seth Roberts11 Comments

I recently read The Hunger Games and liked it a lot. I finished it in a few hours — couldn’t stop reading. In contrast, I read a few pages of the first Harry Potter and stopped. When I was ten years old, I read The Hobbit, The Fellowship of the Ring (the first book of The Lord of the Rings trilogy), and stopped halfway through the second book. I never went back and have not seen the movies. I have never read a book by Stephen King, John Grisham, Robert Patterson, Anne Rice, Stephanie Meyer, and so on. None of them appealed to me. The Hunger Games is different than other books that have sold huge numbers of copies. When it came out, Stephen King reviewed it in Entertainment Weekly and gave it it a B. The second book in the trilogy, reviewed by someone else, got a C.

Sentence by sentence, even scene by scene, The Hunger Games is mediocre. It is not quotable. There is no vivid writing. The characters are barely interesting. It is not Jonathan Franzen, much less Vladimir Nabokov. But it does a wonderful job of supplying the four basic elements of a good story: a hero, a villain, making you care about the hero, and putting the hero in jeopardy.

Beneath the surface, also, is something I rarely find in novels: the author feels strongly about her subject matter. Collins, the author of The Hunger Games, has said she is writing for teenagers about war. Her father, who was in the Army, cared deeply about this and taught his children about it. “A family trip to a castle, which [the 13-year-old Collins] imagined would be “fairy-tale magical,” turned into a lesson on fortresses [given by her father],” says an article about Collins. Did Vladimir Nabokov know this much about child molesters (Lolita)? No, it was a literary device. Did Tolstoy or Flaubert have the events of Anna Karenina or Madame Bovary drilled into them in childhood? Unlikely. Both novels are built on basic novelistic subjects (actually, the same subject — infidelity). Somehow Collins’s deep connection comes through. I have no idea if you can write a good book simply because you love something. But you can definitely write a good book if you hate something: The Devil Wears Prada.