Acne Gone Thanks to Self-Experimentation

A year ago I told students at my friend’s Mohamed Ibrahim‘s school that a student of Allen Neuringer’s had gone on a camping trip and found that her acne went away. At first she thought it was the sunshine; but then, by self-experimentation, she discovered that the crucial change was that she had stopped using soap to wash her face.

Now Mohamed writes:

I told my classes about your friend who went camping without her face products only to discover that the face products were contributing to her acne, and that from that point on she only washed her face with water. It turns out that two of my students wash their faces with water! And their skin looks great! I started “washing” my face with water about a month ago, and [now] my face is acne free and soft as a pair of brand new UGG boots. [He had had acne for years.] The only additional thing I do is wipe my face with a napkin throughout the day to remove any excess oil.

So one cause of acne is using soap to wash your face.

Acne really matters. And it’s common. It now turns out that it has a pathetically easy solution, in at least some cases. Dermatologists don’t know this. Apparently hardly anyone knows it. Somehow the entire healthcare establishment, to whom we entrust our health in many ways, missed this. Dennis Mangan’s discovery that niacin can cure restless-leg syndrome is another example of a pathetically easy solution missed by experts. Likewise, the Shangri-La Diet is very different than anything an obesity expert has ever proposed.

What else has been missed?

More Imagine a med student in a dermatology class. The student raises his hand and asks a question. “I read in a blog that acne goes away if you stop using soap. What do you think about that?” What would the instructor say — after telling the student not to believe everything he reads on the Web?

Fermented Food in Africa

Michael Bowerman writes from Kenya:

First, I’ve made a point of eating yogurt daily and have had no stomach problems in a month of eating here. May be coincidence as I haven’t eaten at risker spots, but most others I know here have had some problem during their stay. I did drink one yogurt which tasted foul, and realised it was past expiration. I wonder if my perception that it was foul was culturally indoctrinated, or a useful rejection of spoiled food. What is the relationship between fermentation and true spoilage?

Second, reading Nelson Mandela’s autobiography he talks about a traditional drink of his tribe, the Xhosa, called amasi – feremented milk. He writes about how much he loves the taste during an anecdote where fermenting the milk on his window ledge while staying at a safehouse in a white neighbourhood draws the attention of passing Africans who are wondering why “their” milk is in the window. I wonder if he would have liked my “spoiled(?)” yogurt? I haven’t looked for commercial versions yet, but will.

Third, a Sudanese friend told me that the Sudanese have a drink made from cow’s blood, urine, and fermented milk. The only part I was incredulous about was the urine but it seems cow and camel urine have been drank by other cultures — there is a urine-based soft-drink being released in India called Gau Jai. I found this site which documents the extensive fermentation in Sudanese culture — meat, milk, urine — including “…mish, which is made by prolonged fermentation to the extent that maggots thrive in it. The product is consumed whole, with the maggots included. These two products are closely related to Egyptian mish (1).”

Scott Adams Accidentally Does the Shangri-La Diet

From his blog:

Recently I lost my sense of smell thanks to, I assume, some allergy meds I’ve been snorting. . . .My wife, Shelly, kept asking versions of the question “Do you smell that? It’s awful!” But I never smelled that. . . I think I also gave up something in the food tasting department thanks to my lack of a functional sniffer, but I’m okay with that too. I’ve dropped about eight pounds in the last two months because lately I’m not attracted to the taste of food, just its utility.

Thanks to David Cramer

More In related news, a popular cold remedy causes anosmia. Thanks to Marian Lizzi.

Homemade Yogurt: What I’ve Learned

Years ago I made yogurt using a recipe from Saul Sternberg. I still use the same ingredients — the basic point is to add about 1/2 cup powdered milk per quart of regular milk at the start — but I implement the temperature changes differently. Since I became interested in fermented foods, I’ve made yogurt a dozen times. Here’s what I’ve learned.

1. Makes a great condiment. I blogged about this. Store-bought yogurt, even the plain stuff, is too runny — not thick enough — nor sour enough to make this clear. The addition of powdered milk makes the yogurt thick enough to easily eat with anything, including meat. It improves the flavor of just about anything, especially if the yogurt is really sour. This might be the most important lesson since it means you can eat it at every meal and it makes cooking easier. I use spices much less now. The yogurt supplies complexity.

2. You can incubate it for days. I want it as strong as possible — not only because more sour (food writers euphemistically say tart) is better but also because the longer it ferments the more bacteria there will be. After a while it stops getting more sour and I stop. I routinely let it incubate one or two days, much longer than any recipe I’ve seen.

3. Preheating helps. Most recipes say you should heat the milk before you add the cultures. Some say this kills “bad” bacteria, which could compete with the bacteria you add. According to Harold McGee, the preheating denatures the milk proteins, which helps them trap liquid (whey). I did a little experiment in which I didn’t preheat some of the batches. Without preheating, the yogurt was much less solid. Supporting McGee.

4. Strauss yogurt better than Pavel yogurt. (Two popular Bay Area brands.) When I make a new batch I start it with store-bought yogurt; that works better than using what I have left. Side-by-side tasting showed that Strauss yogurt is more sour than Pavel yogurt. I made yogurt using each as the starter; the Strauss-started yogurt was clearly more sour than the Pavel-started yogurt.

5. Slow cooker works great. It is very easy to do the preheating via a crockpot (also called a slow cooker). I put it on high and wait 3-4 hours. This heats the milk to about 185 degrees F. Then I cool it down, add the cultures, and put the whole crockpot in the oven (set very low) to keep it warm for a few days. No spillage. I use a food thermometer to track the temperature. I got the idea from the Shangri-La Diet Forums.

6. Whole milk better than low-fat milk. Whole tasted better.

Harold McGee’s recommendations.

Homemade Kombucha: What I’ve Learned (part 2)

I’ve been making it in 2-quart jars. Doing little experiments, I’ve figured out that

1. 4 tea bags is better than 6. I’ve been using Tetley’s low-cost black tea. Each teabag supposedly has 33% more tea than usual. In Wild Fermentation, Sandor Katz suggests 4 teabags for 2 quarts.

2. 3/4 cup of sugar is better than 1/2 cup of sugar. The Wild Fermentation recipe says 1/2 cup of sugar for 2 quarts.

Part 1.

Relief for Ankylosing Spondylitis

Ankylosing spondylitis is a kind of arthritis with puzzling symptoms all over the body. Its main symptom is back vertebrae fusing together; ankloysis is stiffening or fusion of a joint. To read Wikipedia you’d think it can only be treated with dangerous drugs that don’t work very well.

I recently learned from someone with the condition that it got much better after he cut out all refined carbohydrates, especially sugar, an idea he got from Dr. Bruce West. He describes his regimen as “avoid processed foods [= food with lots of additives], such as fast foods, and especially refined carbohydrates, such as high fructose corn syrup.” After he started this, he felt better in three days. He can eat fruit, but not bread or soft drinks or desserts. He’s never tried eating more fermented foods; he barely knew what they were.

Is the idea spreading? I asked. No, he said. Curious, in this day of forums and patient-centered websites.

More A reader noted that the same advice is given here.

The Fall of GM

There is nothing new about large industry leaders, such as General Motors, going bankrupt; in The Innovator’s Dilemma, Clayton Christensen gives many examples and an explanation: complacency, also called smugness. We’re doing well, why shouldn’t we continue to do things our way? They fail to innovate enough and less-complacent companies overtake them, often driving them out of business. Complacency is human nature, true, but it’s the oldest mistake in the economic world. (I’ve studied a similar effect in rats and pigeons.) In the 1950s, complacency was surely why the big American car companies rejected the advice of quality expert Edward Deming. In less-complacent Japan, however, his ideas were embraced. This doomed the US car industry. Much later, Ford was the first American car company to take Deming seriously, which may be why Ford is now doing better than GM or Chrysler.

The further away you are I suspect the more clearly you see complacency for what it is — a failure to grasp basic economics (innovate or die):

“Chinese financial assets [in America[ are very safe,” [Treasury Secretary Tim] Geithner said. His response drew laughter from the [Peking University] audience.

The American Health Paradox: What Causes It? (continued)

Atul Gawande might be the best medical writer ever. He is the best medical writer at The New Yorker, at least, and the best one I’ve ever read. He consistently writes clearly, thoughtfully, and originally about the big issues in medicine. That is why his recent article about health care costs (my comment here) and his graduation speech at the Univesity of Chicago are so telling. And not in a good way, I’m afraid.

The graduation speech starts off with an excellent story:

The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.

So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.

Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.

Bill Gates, Jeffrey Sachs, are you listening? Gawande goes on to say that to improve medicine, there needs to be the same sort of study of “positive deviants”. Here is his first example:

I recently heard from one such positive deviant. He is a physician here in Chicago. He’d invested in an imaging center with his colleagues. But they found they were losing money. They had a meeting about what to do just a few weeks ago. The answer, they realized, was to order more imaging for their patients—to push the indications where they could. When he realized what he was being drawn to do by the structure he was in, he pulled out. He lost money. He angered his partners. But it was the right thing to do.

No kidding. The contrast between mothers who figure out creative iconoclastic new ways to feed children on tiny amounts of money and a doctor who merely refuses to be a scumbag could hardly be greater. But Gawande uses the same term (“positive deviant”) for both! This is the depth to which a writer and thinker of Gawande’s stature has to descend, given the straitjacket of how he thinks about medicine. Gawande thinks that doctors will improve medicine. He’s wrong. Just as farmers didn’t invent tractors — nor any of the big improvements in farming — neither will doctors be responsible for any big improvements in American health. The big improvements will come from outside. I’m sure they will involve both (a) advances in prevention and (b) patients taking charge of their care.

When these innovations happen, where will doctors be? Helping spread them or defending the status quo? That’s what Gawande should be writing about. One big advance in patients taking charge was home blood glucose testing. It came from an engineer named Richard Bernstein. Best thing for diabetics since the discovery of insulin. Doctors opposed it. When I invented the Shangri-La Diet, and lost 30 pounds, my doctor didn’t ask how I lost all that weight. Not one question. Like all doctors, he had many fat patients; the notion that I, a mere patient, could know something that would help his other patients didn’t cross his mind. When I was a grad student I did acne experiments on myself that revealed that antibiotics (hugely prescribed for acne) didn’t work. My dermatologist appeared irritated that I had figured this out. That’s a little glimpse of how doctors may react to outside innovation involving patients taking charge. Of course doctors, like dentists, cannot do good prevention research.

If Gawande took the first story he told to heart, he might realize it is saying that the improvements to health care won’t come from doctors, just as the improvements to the health of those village children didn’t come from experts. As I said earlier, doing my best to channel Jane Jacobs, a reasonable health care policy would empower those who benefit from change. That’s what the village nutrition program did. It empowered mothers who were innovating.