Category: health

Dangerous Noise and “Doctors Hurt You”

Seth Roberts18 Comments

I have a friend with life-altering hyperacusis, a hearing problem where ordinary sounds can cause pain. It started after she worked in a noisy workplace for three years.

“People are always told about things they should do for good health: eat right, exercise, wear sunscreen, don’t smoke,” said my friend. “But they are almost never warned about loud noise, and if they are, it’s only about hearing loss far off in the future.” Her healthcare philosophy is doctors hurt you, which she finds so self-evident that she can barely explain why she believes it.

Her husband has hyperacusis, too, even worse than hers. His came from too many rock concerts. He sought medical treatment for a disorder that even Google has barely heard of, and now takes a staggering amount of pain medicine. His philosophy, at least historically, has been doctors help you. She has done her best to keep him away from doctors, but there is no doubt that, through a combination of bad advice and bad treatment, doctors have made his health much worse. (The pain medicines do reduce pain — but much of his pain was caused by doctors.) Judging by his and her experience, doctors hurt you is more accurate.

I am writing this in the loudest Starbucks I have ever been in, in New York City. (I have been in hundreds of Starbucks.) Three employees have told me they cannot control the volume of the music. Even with my Bose noise-cancelling headphones, it is too loud. I must find somewhere else. A friend who used to work at Starbucks disputes their claim that they cannot control the volume. She says the content of the music is set by corporate but the volume is controllable at individual stores. A customer at the loud Starbucks told me he thought the employees made the music so loud to drive customers away.

Exhibit 1 in the argument that doctors hurt you is tonsillectomies, probably the most common operation ever. Your tonsils are part of your immune system — removing them makes as much sense as removing part of your brain. Tonsillectomies remained common long after it was clear that tonsils were part of the immune system. Perhaps doctors didn’t understand high school biology? Or they didn’t care? Either answer suggests that doctors should be avoided.

 

 

Magnesium and Rectum Healing

Seth Roberts6 Comments

After I posted a link to an article about magnesium deficiency (“50 studies suggest that magnesium deficiency is killing us”), a reader who wishes to be anonymous looked into it.

After reading your post about magnesium oil, I read up on it, and thought I’d try it. I didn’t notice any difference, but I have a report. In my reading, I came across stories of people who sprayed the oil on wounds.

I have a recurring minor irritation that, when it occurs, usually takes weeks to heal. Passing a large stool can cause small tears in the rectum, so small they don’t even bleed but nonetheless can be felt. If another stool, even a regular-sized one, passes before the tears heal, they are painfully re-opened, though not re-opened fully. The pain is not severe but is, frankly, a pain in the ***. In my case it usually takes weeks for the tears to completely heal.

I was a couple weeks into this cycle when my bottle of magnesium oil arrived. I had read that it promotes healing and some people spray it on wounds. So I sprayed it on my irritated area once a day for three days, and on the third day when I passed a stool there was no pain! Never before had it healed so quickly, and I’ve had this problem at least once a year for over ten years.

I’m impressed. This resembles a theory making an unlikely prediction that turns out to be true. Other examples of magnesium benefits are here and here. Maybe magnesium will improve my sleep. That should be easy to test.

Organic Pollutants Associated With Diabetes

Seth Roberts4 Comments

Everyone knows that diabetes is associated with obesity, probably because obesity causes diabetes. However, thin people also become diabetic. A clue to why is provided by the correlation between diabetes and what are called “persistent organic pollutants” (POPs). POPs are man-made organic compounds, usually pesticides, such as polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans.

A 2006 study using NHANES (National Health and Nutrition Examination Survey 1999–2002) data found very strong associations between levels of these chemicals and diabetes. For example, a risk ratio of 30. These associations persisted even when the data was stratified in all sorts of ways. The scariest result came from people who had BMI < 25. Looking only at such people, those above the 90th percentile for amount of POPs had 16 times the risk of diabetes as those below the 25th percentile. Here is something associated with thin people getting diabetes.

Does the association exist because POPs cause diabetes? You might argue that POP exposure is correlated with poverty (poor people are more exposed), poor people exercise less than rich people, and lack of exercise causes diabetes. However, Agent Orange exposure among soldiers is associated with diabetes. That is unlikely to be due to confounding with poverty or lack of exercise.

Everyone has these chemicals in their body, but almost no one knows how much. I don’t know if I’m in the 10th percentile or the 90th percentile. If I’m in the 90th percentile, what can I do about it? A good place for self-measurement and tracking.

David Grimes Responds to Comments

Seth Roberts4 Comments

In recent posts (here, here, and here), I’ve described the ideas of David Grimes, a British doctor, about the cause of heart disease. Grimes recently responded to comments on the last post:

First, to develop the latitude theme, that distance from the equator determines risk of heart disease, cancers, multiple sclerosis and others. Four visual pieces of evidence for you.

Sunshine_Average_1971-2000_1 (1)

The sunshine map of the UK: We see what would also be the map of multiple sclerosis and CHD in the UK — both diseases most common in the west of scotland and least common in the south-east of England. Similar pattern of average life expectancy.

Look at cancer incidence in North America for another latitude effect.

Then there is breast and colon cancer in Europe:

But the [most] important observation of the sun being protective against cardiovascular disease comes from the USA. A latitude effect is present but weak. However a longitude effect is powerful. It works out as an altitude effect — the higher the altitude of residence the lower the risk of death from cardio-vascular disease (coronary heart disease + stroke). It is interesting to note the mirror image of the land profile from east to west and the CVD death profile. This can be explained most simply and most plausibly by the higher UV exposure at higher altitudes.

This is a powerful supplement to the latitude observations in Europe. The [north-south] length of Europe is worth remembering: the north of Scotland is the same latitude as Hudson Bay. In the north of England I live further north than anywhere in China. This means big sun exposure effects.

The size of the disease differences is impressive — e.g., a factor of 2. I think these sunshine correlations are due either to a protective effect of Vitamin D or a protective effect of sleep (more sunshine = better sleep). There’s no doubt that sleep quality depends on the amplitude of a circadian rhythm (greater amplitude = better sleep), which in turn depends on the amplitude of the sunlight intensity rhythm, the day-night difference.

Heart Disease Epidemic and Latitude Effect: Reconciliation

Seth Roberts9 Comments

For the last half century, heart disease has been the most common cause of death in rich countries — more common than cancer, for example. I recently discussed the observation of David Grimes, a British gastroenterologist, that heart disease has followed an infectious-disease epidemic-like pattern: sharp rise, sharp fall. From 1920 to 1970, heart disease in England increased by a factor of maybe 100; from a very low level to 500 deaths per 100,000 people per year. From 1970 to 2010, it has decreased by a factor of 10. This pattern cannot be explained by any popular idea about heart disease. For example, dietary or exercise or activity changes cannot explain it. They haven’t changed the right way (way up, way down) at the right time (peaking in 1970). In spite of this ignorance, I have never heard a health expert express doubt about what causes heart disease. This fits with what I learned when I studied myself. What I learned had little correlation with what experts said.

Before the epidemic paper, Grimes wrote a book about heart disease. It stressed the importance of latitude: heart disease is more common at more extreme latitudes. For example, it is more common in Scotland than the south of England. The same correlation can be seen in many data sets and with other diseases, including influenza, variant Creuztfeldt-Jacob disease, multiple sclerosis, Crohn’s disease and other digestive diseases. More extreme latitudes get less sun. Grimes took the importance of latitude to suggest the importance of Vitamin D. Better sleep with more sun is another possible explanation.

The amount of sunlight has changed very little over the last hundred years so it cannot explain the epidemic-like rise and fall of heart disease. I asked Grimes how he reconciled the two sets of findings. He replied:

It took twenty years for me to realize the importance of the sun. I always felt that diet was grossly exaggerated and that victim-blaming was politically and medically convenient – disease was due to the sufferers and it was really up to them to correct their delinquent life-styles. I was brought up and work in the north-west of England, close to Manchester. The population has the shortest life-expectancy in England, Scotland and Northern Ireland even worse. It must be a climate effect. And so on to sunlight. So many parallels from a variety of diseases.

When I wrote my book I was aware of the unexplained decline of CHD deaths and I suggested that the UK Clean Air Act of 1953 might have been the turning point, the effect being after 1970. Cleaning of the air did increase sun exposure but the decline of CHD deaths since 1970 has been so great that there must be more to it than clean air and more sun. At that time I was unaware of the rise of CHD deaths after 1924 and so I was unaware of the obvious epidemic. I now realize that CHD must have been due to an environmental factor, probably biological, and unidentified micro-organism. This is the cause, but the sun, through immune-enhancement, controls the distribution, geographical, social and ethnic. The same applies to many cancers, multiple sclerosis, Crohn’s disease (my main area of clinical activity), and several others. I think this reconciles the sun and a biological epidemic.

He has written three related ebooks: Vitamin D: Evolution and Action, Vitamin D: What It Can Do For Your Baby, and You Will Not Die of a Heart Attack.

Sunlight and Heart Disease

Seth Roberts7 Comments

Vitamin D and Cholesterol: The Importance of the Sun (2009) by David Grimes, a British doctor, contains more than a hundred graphs and tables. Most of the book is about heart disease. Grimes argues that a great deal of heart disease is due to too little Vitamin D, usually due to too little sunlight. I recently blogged about other work by Dr. Grimes — about the rise and fall of heart disease.

Part of the book is about problems with the cholesterol hypothesis (high cholesterol causes heart disease). One study found that in men aged 56-65, there was no relationship between death rate and cholesterol level over the next thirty years, during which almost all of them died (Figure 29.2). There is a positive correlation between death rate and cholesterol level for younger men (aged 31-39). The same pattern is seen with women, except that women 60 years or older show the “wrong” correlation: women in the lowest quartile of cholesterol level have by far the highest death rate (Figure 29.5). A female friend of mine in England, who is almost 60, was recently told by her doctor that her cholesterol is dangerously high.

The book was inspired by Grimes’ discovery of a correlation between latitude and heart disease: People who lived further north had more heart disease. This association is clear in the UK, for example (Figure 32.4). Controlling for latitude, he found a correlation between hours of sunshine and heart disease rate (Table 32.3): Towns with more sunshine had less heart disease. No doubt you’ve heard that dietary fat causes heart disease. In the famous Seven Countries study, there was indeed a strong correlation between percent calories from fat and heart disease death rate (Figure 30.2). You haven’t heard that in the same study there was a strong correlation between latitude and dietary fat intake (Figure 30.8): People in the north ate more fat than people in the south. The fat-heart disease correlation in that study could easily be due to a connection between latitude and heart disease. The correlation between latitude and heart disease, on the other hand, persists when diet is controlled for.

Grimes convinced me that the latitude/sunshine correlation with heart disease reflects something important. It is large, appears in many different contexts, and has resisted explanation via confounds. Maybe sunshine reduces heart disease by increasing Vitamin D, as Grimes argues, or maybe by improving sleep — the more sunshine you get, the deeper (= better) your sleep. Sleep is enormously important in fighting off infection, and a variety of data suggest that heart disease has a microbial aspect. As long-time readers of this blog know, I take Vitamin D3 at a fixed time (8 am) every morning, thereby improving my Vitamin D status and improving my sleep.

Grimes and his book illustrate my insider/outsider rule: To make progress, you need to be close enough to the subject (enough of an insider) to have a good understanding but far enough away (enough of an outsider) to be able to speak the truth. As a doctor, Grimes is close to the study of disease etiology. However, he’s a gastroenterologist, not a cardiologist or epidemiologist. This allows him to say whatever he wants about the cause of heart disease. He won’t be punished for heretical ideas.

 

The Rise and Fall of Heart Disease

Seth Roberts11 Comments

Heart disease was once the number one killer in rich countries. Maybe it still is. Huge amounts of time and money have gone into trying to reduce it — statins, risk factor measurement (e.g., cholesterol measurement), telling people to “eat healthy” and exercise more, and so on. Unfortunately for the poor souls who follow the advice (e.g., take statins), the advice givers, such as doctors, never make clear how little they know about what causes heart disease. Maybe they don’t realize how little they know.

I encountered an ignorant-without-knowing-it expert after a talk I gave about the effect of butter on brain function. I found that butter improved my brain function (measured by arithmetic speed). I had been eating lots of butter for more than a year. A cardiologist in the audience said I was killing myself. He thought butter caused heart disease. I said that I had experimental data that butter was good for me. Easy to interpret. The notion that butter is bad has come from epidemiological (non-experimental) data, which is hard to interpret. The cardiologist said that the epidemiology has not been misleading. One sign of our correct understanding, he said, is that heart disease has declined. I said there were many possible reasons for the decline.

A 2012 paper called “An epidemic of coronary heart disease” by David Grimes, a British doctor, could hardly make clearer how little we know about the cause of heart disease. Grimes points out that before 1920 heart disease was almost non-existent, that it rose sharply from 1930 to 1970 and since 1970 has declined sharply, at roughly the same rate that it rose. Both the rise and the fall are mysteries, says Grimes, in agreement with what I told the cardiologist. The rise and fall contradict all popular explanations. Heart disease cannot be due to obesity or wealth — both increased substantially at the same time heart disease fell sharply. Nor was the decline due to government intervention:

The decline of CHD deaths in the UK was further described in a UK Government report of 2004, Winning the War on Heart Disease. In this report, the government predictably but undeservedly assumed responsibility for the decline. Clearly, the NHS [National Health Service] in the UK could not have had an international effect [the decline is international].

“There [has been] no obvious effect of statin therapy or other medical intervention,” Grimes continues. Yet statins continue to be prescribed in very high amounts and very great expense. The NNT (number of people you need to treat to save one life) is often in the thousands, he noted.

Those who complain about the high cost of health care fatally fail to grasp this enormous ignorance — about many things, not just heart disease — and its consequences. Reducing the cost of health care (reducing the cost of statins, for example) would improve health if cost were the only thing deeply wrong with our health care system. It isn’t.

How Much Benefit from the Human Genome Project?

Seth Roberts3 Comments

Ten years ago researchers finished the first sequencing of an entire human genome. To mark the anniversary, Eric Green, the director of the National Human Genome Research Institute at the National Institutes of Health, spoke to an unnamed reporter at the New York Times. Here is the final question of the interview:

What about the naysayers who [say], “Where are the cures for diseases that we were promised?”

I became director of this institute three and a half years ago, and I remember when I first started going around and giving talks. Routinely I would hear: “You are seven years into this. Where are the wins? Where are the successes?”

I don’t hear that as much anymore. I think what’s happening, and it has happened in the last three years in particular, is just the sheer aggregate number of the success stories. The drumbeat of these successes is finally winning people over.

We are understanding cancer and rare genetic diseases. There are incredible stories now where we are able to draw blood from a pregnant woman and analyze the DNA of her unborn child.

Increasingly, we have more informed ways of prescribing medicine because we first do a genetic test. We can use microbial DNA to trace disease outbreaks in a matter of hours.

These are just game changers. It’s a wide field of accomplishment, and there is a logical story to be told.

There you have it. The head of the Human Genome Project, a very big deal, says in an oblique way that the project has had little practical benefit so far. Note the present tense: “We are understanding cancer”. Nothing about decreasing cancer. In a short discussion of benefits, he mentions microbial DNA. In a short discussion of benefits, he says, “We are able to draw blood from a pregnant woman and analyze the DNA of her unborn child.” Genetic tests of fetuses are not new. I think he means that the number of rare genetic diseases that can be detected has increased (by how much?). Well, yes, not surprising. It is an increase of something that was already happening and helps only a tiny number of people. Not a “game-changer”.

Cuban Data Refute Mainstream Health Beliefs

Seth Roberts30 Comments

A new BMJ paper looks at Cuban health before and after the economic crisis of 1991-1995, when the Cuban economy nose-dived. There wasn’t enough gasoline for cars. so bike riding greatly increased. In addition, people ate less. What effect did these changes (more exercise, less eating) have on health?

You know what is supposed to happen: Better health. Walter Willett, the Harvard epidemiologist, wrote a commentary about the study that concluded “The current findings add powerful evidence that a reduction in overweight and obesity would have major population-wide [health] benefits.” In other words, Willett said that what happened supports conventional beliefs.

But it didn’t. In several ways, what happened contradicts conventional beliefs.

1. A popular belief is that exercise causes weight loss. However, the percentage of “physically active individuals” doubled from 1985 to 2010 (from about 30% to 60%). In spite of this, the prevalence of obesity considerably increased (from about 13% to 18%) at the same time. Apparently exercise is considerably less important than something else. I have never heard a public health advocate say this.

2. A graph showing rates of heart disease, cancer, and stroke (the three main killers) over the period showed no change in rates of cancer and stroke. In spite of big changes in both exercise and obesity. The rate of heart disease stayed constant during the period when obesity went down. It steadily dropped during the period of time when obesity went up. Apparently the factors that control obesity and the factors that control heart disease are quite different (contradicting the usual view that exercise reduces both).

3. There is no simple connection between diabetes and obesity. During the economic crisis, when the prevalence of obesity went down by half (from 15% to 7%) and exercise greatly increased, the prevalence of diabetes slightly increased . Only after the crisis did the usual correlation (more obesity, more diabetes) emerge.

4. The only lifestyle factor to have its conventional effect: smoking. When you stop smoking, you gain weight is the usual belief (which I also believe). The data definitely support this connection. A huge reduction in the fraction of people who smoke (from 30% to 10%) did not reduce cancer but did coincide with a great increase in obesity.

5. Cubans are doing something right, as shown by the considerable decrease in heart disease and diabetes deaths. Apparently they are also more health-conscious, as shown by much higher rates of exercise and much lower rates of smoking. (Assuming that cigarettes did not become too expensive.) They are getting fatter, too, but apparently that is less damaging than we are told.

Willett and the authors of the study look at subsets of the data and use theories about “time-lag” to draw reassuring conclusions. In fact, large portions of the data are not easily explained by conventional ideas, as I’ve shown. You can look at the data many ways, but to me the study makes two main points. 1. During a period when everyone was forced to do what doctors recommend (exercise more, eat less), health did not improve. 2. During a period (post-crisis) when obesity got steadily worse, health improved (heart disease rates went down, cancer stayed the same, diabetes mortality went down). Cuba is too poor for the improvement to be due to better high-tech modern medicine. Taken together, these findings suggest we should be more skeptical of what we are told by doctors and health experts such as Willett.

Is Red Meat Dangerous?

Seth Roberts7 Comments

A recent paper from the Cleveland Clinic reports more than a dozen studies that add up, say the authors, to the conclusion that red meat and other meats cause heart disease at least partly by increasing trimethylamine-N-oxide (TMAO), which is made from carnitine by intestinal bacteria. Meat, especially red meat, is high in carnitine.

The results were reported all over the world, including the New York Times. There are several reasons to question the conclusion:

1. The association between meat and heart disease is weak. An epidemiological paper from the Harvard Nurses Study found estimated reductions in heart disease on the order of 10-20% when a “healthy” food was substituted for meat. Conclusions about causality (eating Food X causes Disease Y) based on the Harvard Nurses Study have predicted wrongly over and over when tested in experiments, so even this weak association is questionable. A 2010 meta-analysis found no association between red meat consumption and heart disease. The absence of any correlation is surprising because red meat is widely believed to be unhealthy. People who eat more red meat would presumably do more other “unhealthy” things. (Perhaps the error rate of the underlying epidemiology is high. Errors push associations toward zero.)

2. Within the Cleveland paper, the associations between carnitine and TMAO and heart disease are weak. For example, people with the greatest sign of heart disease (“triple” angiographic evidence of heart disease) had only slightly more carnitine in their blood (about 15% more) than people with the least sign of heart disease. (Maybe it is peak levels of carnitine rather than average levels that matter.)

3. A 1996 epidemiological study (via Chris Kresser) that looked at the correlates of various “healthy” habits among people especially interested in health (e.g., they shop at health food stores) found no detectable effect of being a vegetarian. For example, vegetarians had the same all-cause mortality as non-vegetarians. Other factors were associated with reduced mortality, including eating wholemeal bread daily and eating fruit daily. This study looked at a large number of people (about 11,000) for a long time (17 years), so I consider the lack of difference (vegetarians versus non-vegetarians) strong evidence against the idea that modest amounts of meat are harmful. (And I am going to start eating wholemeal bread in small amounts.)

I don’t dismiss the paper. Among people who eat more than modest amounts of meat, there may be something to it. Now and then epidemiology turns up a powerful risk factor — something associated with a risk increase by a factor of 4 or more (people at a high level of the risk factor get the disease at least four times more often than people at a low level of the factor). History shows that such correlations are likely to tell us something about causality. With weaker correlations (such as the correlation between red meat and heart disease), it is much more a guessing game.

To me, the important clue about heart disease is that it is very low in both Japan and France, much lower than in countries with high rates of heart disease. The two countries that have little in common besides the fact that in both people eat a lot more fermented food than in most places. In France, they drink wine, eat stinky cheese and yogurt. In Japan, they eat miso, pickles, and natto. Maybe fermented food protects against heart disease.