Author: Seth Roberts

Food versus Nutrients

Seth Roberts4 Comments

A few years ago, I learned that persons who apply to the Chez Panisse Foundation for funding are warned by staffers not to use the word nutrition in their applications — Alice Waters hates that word. A more nuanced version of this attitude was expressed in Michael Pollan’s In Defense of Food. Supposedly we should eat food (= choose our food using food names and categories) rather than nutrients (= choose our food according to nutrient content). Here is Marian Nestle, the prolific and influential NYU professor, on the subject:

Q: How do nutritionists feel about Michael Pollan’s idea in “In Defense of Food” that we should be eating food, not nutrients?

A: I can’t speak for all nutritionists, but my guess is that we are all jealous of how well he writes. But look around you. Except for people in hospitals who are fed intravenously, I don’t know anyone who eats nutrients. Everybody I know eats food.

When I give lectures in Australia or India, as I did last year, I see people eating food – all kinds of food. In Australia, I went to a Chinese restaurant one night and sampled kung pao kangaroo. In India, I ate dosas every chance I got. I never gave the nutrient content of those foods a single thought.

“Everybody I know” indeed. Our understanding of vitamins comes from nutrition research that, contra Waters, Pollan and Nestle, focused on nutrients rather than food. This research has been enormously beneficial, mainly among the poor and institutionalized. From a review article about Vitamin A:

By 1992, most large-scale mortality prevention trials and at least 3 measles treatment trials [in poor countries] were completed. A meeting convened at the Rockefeller retreat in Bellagio reached consensus that vitamin A deficiency increased overall mortality, particularly from measles; improving vitamin A status would reduce overall mortality; and treating children already ill with measles with high-dose vitamin A was an effective means of reducing their risk of complications and death. This “Bellagio Brief,”published widely, helped draw attention to the importance of vitamin A. . . . National programs of varying effectiveness have been launched in over 70 countries and vitamin A “coverage” is now one of the core health indicators published annually in the State of the World’s Children. By UNICEF’s estimate, over one-half a billion vitamin A capsules are distributed every year, preventing 350,000 childhood deaths annually. . . . The World Bank lists vitamin A supplementation as one of the most cost-effective of all medical interventions.

This isn’t esoteric knowledge.

Science in Action: Why Did I Sleep So Well? (part 14)

Seth Roberts10 Comments

Two more people have gotten results similar to mine. From a comment on an earlier post:

I’ve been doing these exercises – standing on one leg – and it’s helped my sleep immensely. About a year ago, I went through a pretty traumatic experience that disrupted my sleep patterns. The end result was that I couldn’t sleep for longer than 3 or 4 hours at night without waking up. For several months, the lack of sleep was like living in a nightmare, and prescription drugs just made the problem worse. I finally decided to go off medication all together and change my attitude, which worked wonders – I could get back to sleep after I woke up – but I’d still only sleep in 4 hour chunks.

About a month ago, I began doing these exercises, and now I’m sleeping 6 to 7 hours at a time. It’s amazing; and on the days I don’t do them, I don’t sleep well at all.

It’s amazing how easy they are to do – if I find myself standing in line, meeting friends for a happy hour, or even watching tv, I’ll do them.

Last night I told a friend to do them while he was at a happy hour, and this morning, he said he slept “like a log.”

As Pale Fire says:

If on some nameless island Captain Schmidt
Sees a new animal and captures it,
And if, a little later, Captain Smith
Brings back a skin, that island is no myth.

I have started to measure my sleep with a SleepTracker so I will have another way to measure the effects, in addition to (a) how rested I feel when I awake and (b) how long I sleep.

More The SleepTracker — my second, the first didn’t work — worked correctly for the first three nights but failed on the fourth.

Park(ing) Day in Berkeley

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Park(ing) Day was today. The first Park(ing) Day was in 2005. You celebrate it by turning a parking place into a park — as in the verb to park. In North Berkeley, around lunchtime, I came across a dozen Landscape Architecture grad students sitting around a long table full of food that filled up two parking places on Shattuck Avenue (a busy street). My big question was where the tables came from — that seemed like the hard part. From Wurster Hall (where the Landscape Architecture Department is). They invited me to join them and the whole thing was so interesting I couldn’t resist.

The food was very good. One person brought tomatoes, broccoli, cucumbers, and purslane picked that morning from his garden. Someone else brought homemade salsa.

You might think you could lay claim to a parking spot by putting money in the meter. Not in Berkeley. A parking cop came by and wondered what was going on. Someone had reported “a picnic,” the cop said. The cop left. Twenty minutes later he returned. Apparently there had been discussion about how to handle this. The ruling was you need a permit. Parking places are for cars, said the cop. Feeding the meters wasn’t enough. The cop gave the students 15 minutes to leave. At that point I left.

Do Genes Matter for Health?

Seth Roberts6 Comments

How much disease do genes cause? Sure, they cause some rare diseases that affect very few people but what about major health problems, such as depression, that affect everyone? The notion that genes make a big difference to human health — that some people are healthy and others sick because of genetic differences — was much of the rationale for funding the human genome sequencing project, which cost billions. The founders of the company 23andme (23 = 23 human chromosomes) often say genes matter, most recently in The New Yorker:

“It’s very useful if you know that you’re at increased risk for deep-vein thrombosis and you’re on a plane,” she continued. “You might want to stay vigilant about moving around.” Instead of finding out the hard way that their children are allergic to peanuts, parents may someday be able to test their DNA. Even small inherited traits, Avey added, can serve as health clues: “There is some correlation between your ability to metabolize caffeine and your risk for a heart attack.”

There is something breathtaking in the fact that someone who believes you can learn about allergies by studying DNA is taken seriously in The New Yorker.

Some rare non-hype on this issue has recently come from Dr. David Goldstein:

But David B. Goldstein of Duke University, a leading young population geneticist known partly for his research into the genetic roots of Jewish ancestry, says the effort to nail down the genetics of most common diseases is not working. “There is absolutely no question,” he said, “that for the whole hope of personalized medicine [where people with different genes are treated differently], the news has been just about as bleak as it could be.”

The researchers have been unable to find genes that make much difference.

If they had found such genes, I would have been stunned. My self-experimentation has led me to believe that our environments are far from ideal — in non-obvious ways. I believe that people don’t get sick because of their genes, or gene-by-environment interactions, they get sick because of their environments, which lack something essential or include something bad. Animal experiments have given us a decent understanding of nutrition; maybe we know half or more than half of the basic requirements. When it comes to subjects that don’t lend themselves to animal experiments, little is known — about what causes depression, for example. My self-experimentation took over where animal experiments left off; it provided a way to do experiments that generate ideas. (Which is crucial for knowledge advancement, as opposed to career advancement.) I have been able to find one big self-experimental effect after another (most recently, about omega-3s and sleep) related to common health problems only because (a) so little was known and (b) I accidentally picked up an effective tool (self-experimentation) that no one else had used this way (to find new experimental effects).

More More from the other side of the debate: 1. Elderly genetics. 2. Google co-founder has Parkinson’s gene. It is hard to find support for my side of the debate in print. It isn’t easy to notice when you don’t get sick (because of advances in the study of nutrition, for example) so it isn’t easy to notice how study of the environment has paid off in concrete ways. I’m in an unusual position: I can easily notice how my life has improved via self-experimentation.

Even more Dean Ornish agrees with me. Thanks to Carl Willat.

Treadmill Desks

Seth Roberts11 Comments

As far as I know, I was the first person to have a treadmill desk. I wanted to be able to stand more easily. I had found that if I stand a lot I sleep better. I reasoned it might be easier to stand a long time if you are walking than if you are standing still.

Treadmill desks are now becoming mildly popular, the New York Times reports. I had nothing to do with this. They were popularized by James Levine, a Mayo Clinic endocrinologist, who believes that calorie burning is a good way to lose weight. I used my treadmill desk for a few years. There were two big problems: 1. The noise bothered my neighbors. The Times article says these desks tend to be placed in common areas, where that would be less of a problem. 2. It was tiring. After one or two years I mainly stood on it and rarely walked on it. Finally I replaced it with a standing-height desk.

The article describes non-weight-loss benefits: Walking makes it easier to concentrate.

“I thought it was ridiculous until I tried it,” said Ms. Krivosha, 49, a partner in the law firm of Maslon Edelman Borman & Brand.

Ms. Krivosha said it is tempting to become distracted during conference calls, but when she is exercising, she listens more intently.

“Walking just takes care of the A.D.D. part,” she said.

Allen Neuringer, a professor of mine at Reed College, found that movement helped him learn. I think an urge to be active builds up during inactivity just as thirst builds up when we don’t drink. Being able to be active while you work gets rid of that distraction — and no doubt is healthier in other ways than sitting all day. I would like to be able to use a computer while I am free to move around the room (or larger spaces) and move my arms, not just walk forward with my hands on the keyboard. I’d like to be able to write this blog post while strolling through my neighborhood, for example.

Thanks to Marian Lizzi.

Red State Blue State Rich State Poor State

Seth Roberts3 Comments

To explain why Andrew Gelman et al.’s Red State Blue State Rich State Poor State is such an important book I have to tell two stories.

A few years ago a student did a senior thesis with me that consisted of measuring PMS symptoms day by day in several women. After she collected her data she went to the Psychology Department’s statistics consultant (a psychology grad student) to get help with the analysis. The most important thing to do with your data is graph it, I told the student. The statistics consultant didn’t know how to do this! There was little demand for it. Almost all the data analyses done in the Psychology Department were standard ANOVAs and t tests. If you look at statistics textbooks aimed at psychologists, you’ll see why: They say little or nothing about the importance of graphing your data. Gelman et al.’s book is full of informative graphs and will encourage any reader to plot their data. There are few examples of this sort of thing. That’s the obvious contribution. Because graphing data is so important and neglected, that’s a big contribution right there.

The other contribution is even more important, but more subtle. Recently I was chatting with a statistics professor whose applied area is finance. What do you think of behavioral economics? she asked. I said I didn’t like it. “It’s too obvious.” (More precisely, it’s too confirmatory.) For example, the conclusion that people are loss-averse — fine, I’m sure they are, but it’s too clear to be a great discovery. She mentioned prospect theory. Tversky and Kahneman’s work has had a big effect on economists — which certainly indicates it wasn’t obvious. Yes, it has been very influential, I said. I’m not saying their conclusions were completely obvious — just too obvious. Tversky and Kahneman were/are very smart men who had certain ideas about how the world worked. They did experiments that showed they were right. There’s value in such stuff, of course, but I prefer research that shows what I or the researcher never thought of.

Red State Blue State is an example. Andrew and his colleagues didn’t begin the research behind the book intending to show what turned out to be the main point (that the red state/blue state difference is due to an interaction — the effect of wealth on tendency to vote Republican varies from state to state). I suspect they got the idea simply by making good graphs, which is an important way to get new ideas. (Neglect of graphics and neglect of idea generation go together.) Red State Blue State could be used in any class on scientific method to illustrate the incredibly important point that you can get new ideas from your data. There aren’t many possible examples.

If I were teaching scientific method, I’d assign a few chapters of Red State Blue State and then have a class discussion about how to explain the results. Not just the state-by-wealth interaction but also the fact (revealed by a scatterplot) that the United States is far more religious than other rich countries — an outlier. Then I’d say: The graphs in the book made you think new thoughts. Your own graphs can do that.

New Way to Lose Weight: Don’t Eat Till Your Blood Sugar is Low Enough

Seth Roberts10 Comments

Tim Lundeen‘s sister Miriam wrote this:

Tim and I have been having conversations about health, diet and blood sugars for several years and I figured I was insulin-resistant with mild blood sugar dysregulation, but never was more than interested. About two months ago after a move cross-country with the accompanying stresses, I became more acutely concerned about my metabolic damage and was in a place where I could pay attention and do something about it. At Tim’s recommendation, I read Dr.Bernstein’s Diabetes Solution and Jenny Ruhl’s Blood Sugar 101 and started monitoring my blood sugar with a glucometer. Initially, my morning readings were usually 91-94. Not too bad but not the 83-85 that is “normal” [i.e., optimal]. I started waiting till I was hungry or when I would normally eat and then take my blood sugar again. If it was 85 or below I would eat a normal meal with an awareness of the carb content and eat smaller portions of these foods. Then I would monitor my postprandial (post-meal) blood sugars about every hour and see when and how high my spike was. If it was too high (over 140 for sure, and in the 130′s probably) I would adjust the amount of carbs downward. If my blood sugar was over 86 and I wasn’t famished I would distract myself with some engaging activity and check my sugar again when I noticed I was hungry. If I became really famished but my sugar was still not under 86, I would have a no-to-low carb snack like almonds, walnuts, left-over meat or a salad. Then I’d wait till I was hungry again. After a few weeks of doing this my morning sugar was consistently 81-85. If I ate off-plan and had an occasional 94, that was fine by me. I was happy about my blood sugars, but the pleasant surprise came when I had a physical exam at my doctor’s. I had lost 20 pounds without even noticing! [She is 5 feet 5 inches tall. After losing 20 pounds her weight was 155.] I was amazed since I had tried to diet a number of times over the last 10 years and my weight just kept creeping up. This has been the most fun and healthy weight loss program I could imagine. I am hoping my carbohydrate metaboliism will eventually recover and I will again be able to eat more carbs without weight gain and metabolic damage.

I am doing something similar for a few days, too soon to tell the results. About six months ago, to help write a chapter in my self-experimentation book about diabetes, I got a glucometer and started testing myself regularly. I was displeased to find that my morning readings were about 91, like Muriel’s, and further displeased to find that eating less carbs didn’t help.

Blood sugar testing isn’t cheap, but it’s easy and painless. The glucometer I use is Abbott’s Freestyle Lite (which is free). It’s painless if you get the blood from your arm. The test strips cost about 60 cents each.

The Case of the Missing Evidence

Seth Roberts38 Comments

The most telling detail in Robin Hanson’s lecture about doctors was about a nurse assigned to measure hand-washing rates among surgeons at her hospital. After she measured the hand-washing rates, she — as ordered — correlated them with death rates. It turned out that the surgeon who washed his hands the least had the highest death rate. For reporting this — as she was ordered to — the nurse was fired. Robin learned this story from his wife, who was a friend of the ex-nurse.

I was very impressed by Robin’s lecture, which was both accessible and profound, and it was one reason that during my next encounter with a doctor I was more skeptical than most patients. As I blogged earlier:

I have a tiny hernia that I cannot detect but one day my primary-care doctor did. He referred me to Dr. [Eileen] Consorti, a general surgeon [in Berkeley]. She said I should have surgery for it. Why? I asked. Because it could get worse, she said. Eventually I asked: Why do you think it’s better to have surgery than not? Surgery is dangerous. (Not to mention expensive and time-consuming.) She said there were clinical trials that showed this. Just use google, you’ll find them, she said. I tried to find them. I looked and looked but failed to find any relevant evidence. My mom, who does medical searching for a living, was unable to find any completed clinical trials. One was in progress (which implied the answer to my question wasn’t known). I spoke to Dr. Consorti again. I can’t find any studies, I said, nor can my mom. Okay, we’ll find some and copy them for you, she said, you can come by the office and pick them up. She sounded completely sure the studies existed. I waited. Nothing from Dr. Consorti’s office. After a few weeks, I phoned her office and left a message. No reply. I waited a month, phoned again, and left another message. No reply.

Yesterday Dr. Consorti finally got back to me, by posting a comment:

Seth, While I am in the process of finding papers in the literature to satisfy your scientific curiosity on why this hernia should or should not be fixed I am additionally trying to care for around 30 new patients referred to me for their new cancer diagnosis in the last 3 months. This may or may not explain why I have not been motivated to answer your call regarding your ambivalence about fixing your hernia. Yes, it is small and runs the risk of incarceration at some time. I will call you once I clear my desk and do my own literature search. Thanks for the update. Eileen Consorti

Fair enough. She’s busy. And I am glad to have her reply and her view of the situation. On the other hand, I am pretty sure the studies she was so sure existed — that justified the surgery — don’t exist. To call my curiosity about whether the proposed surgery would do more good than harm “scientific” has a bit of truth: No doubt scientists understand better than others that you can test claims such as “you need this surgery”. But it isn’t “scientific” in the least to worry that a medical procedure will do more harm than good. Everyone, not just scientists, worries about that. Surgery is scary. Let’s set aside the death rate, which is low but non-zero. How many brain cells are killed by general anesthesia? Dr. Consorti doesn’t know, nor do I. The number is plausibly more than zero. I suspect a power-law distribution: Most instances of general anesthesia kill a small number, a small fraction kill a large number.

I pointed Robin to Dr. Consorti’s response. He replied:

I wonder if she even realizes that she in fact doesn’t know why you should get surgery.

What I know and Dr. Consorti, very reasonably, doesn’t know, is that my mom was a librarian at the UCSF medical library and has done a vast amount of medical-literature searching. If she can’t find any relevant studies, it is very likely they don’t exist. And my mom did find a study in progress, which, to repeat myself, shows that my question about cost versus benefit is a good one. Others had the same question and launched a study to answer it. Robin’s lecture helped me ask it. Thanks, Robin.

More. Robin’s version of the fired-nurse story is here. Thanks to Charles Williams.

I Love This

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In late July, JemSparkles posted this to the SLD forums:

Ok so I have tried many diets. Here’s the list Jenny Craig (10 lbs lost but gained back), Atkins (3 months of phase 1 and nothing lost), Curves (1 year and 10 lbs lost), Herbal Magic, a multitude of diet pills, the Zone, and then simply working out non stop. The weight doesn’t want to come off. So here I am with the last attempt that sounds crazy enough to work! I bought the book and this is day two. I am going to start tracking my data and see if I get any results.

Here’s to hoping!!!

Ok so I weighed myself for the first time this morning and my starting weight will be 260lbs.

Two weeks later she posted this:

Ok so I haven’t seen the fast results that some have seen but I am seeing results which is what matters. And compared to any diet this has been super easy to keep up with.

Today she posted this:

254!!! Yes I am finally down a total of 6 pounds and starting to feel much better. I have been working really hard on this and am not giving up. This diet has been the most effective I have been on to date.

We now return to our regularly-scheduled blogging.

If Your Comment Doesn’t Appear

Seth Roberts1 Comment

I just found two perfectly good comments in the spam pile, which contains thousands of items. If you post a comment on this blog and it doesn’t appear right away it means either

–it’s being held for approval by me;

or

–it’s been classified as spam, in which case I don’t see it. Comments classified as spam usually have one or more links. If your comment has two or more links, it has a good chance of being considered spam.

If you have commented successfully before your comment should appear right away. If it doesn’t, please let me know. You can send your comment to me and I will post it or de-spam it.

If you haven’t commented before and your comment doesn’t appear within a day, please let me know and I will post it or de-spam it.