Link-o-rama - March 10, 2017

"Someone in Kansas Created a Protected Bike Lane Using Toilet Plungers—and It's Amazing"

"The true paleo diet is eating whatever’s out there in the environment." Based on DNA in dental plaque, it looks like Neanderthals ate whatever they could get their hands on, not just organic, grass-fed beef and free-range chicken. Huh.

Florence Williams on the Outside Podcast talking about her new book "The Nature Fix," which I'm reading right. this. minute.

The bacterium Akkermansia muciniphila appears to protect against obesity and diabetes in mice. Google is already crawling with ways to buy it, natch. *shakes head*

What's with all the arrows?

You’re back! I guess the random link dumps and talk about what a tightrope we're all on health-wise didn't scare you off. Where to start today's post, then? Let’s start with the name. Why “Double Arrow Metabolism?”

I grew up on a farm in south central Kansas. Our farm raised cattle, at least until I was 13-14 years old or so. According to WikiPedia, branding, in the form of burning a pattern into animals’ hair and skin, has been performed since at least ancient Egyptian times to identify cattle. The Wild West of the 1970s and '80s hadn't changed the practice. Our farm’s brand was the double arrow, two vertical arrows arranged in parallel, each with an arrowhead on each end. You can see it splattered all over this site:

Everything in Kansas leans to the right.

Now, this may be simple coincidence, but as you may recall from post #2, I’m an endocrinologist, a hormone and metabolism specialist. And if there’s a medical specialty that loves arrows, it’s endocrinology:

There was a time when I could draw this from memory. Then I decided that God gave us Google images for a reason. Now that space is taken up by happier memories.

Wow! Converting cholesterol to hormones takes a lot of arrows. And chicken wire. Maybe now you can see how, when my world shifted from the windy, sun-drenched agrarian plains of southern Kansas to the fluorescent, air-conditioned, mint-scented hallways of medical academia, sometimes my studies reminded me of home. And not to get sentimental, but that two-headed arrow has always looked like it wanted to move. It reminds me of freedom of movement back and forth between phases or choices. Or, in my case, over the last couple of years, movement away from those fluorescent-lit hallways back to the outdoors and back in contact with people, not just patients.

So: Double Arrow Metabolism.

It’s not particularly catchy. It doesn’t follow the craze of single-word names out there (Spruce) or baby noises (Hulu) or left-out vowels (Scribd, Flickr) or any of the other internet weirdness. It hasn't been tested for SEO or "optimized" (I hate that word) through Google Ad Words. It hasn't been A/B tested.

But it’s honest. And since I’m looking to connect with people and not necessarily just to optimize search engine results, I like the homage to my past. Plus, metabolism is a cheap way to sound smart without using a word people can’t pronounce (if I'm looking to throw out unpronounceable words, I think I've covered that with the diagram above).

I promise that I’ll get back to discussing the path toward medical, financial, and health independence soon. But first a couple of observations: you shouldn't let the process of getting yourself healthier intimidate you. Just as not every new business name has to follow the naming conventions of Silicon Valley, not every healthy person has to be an athletic coastal hipster foodie or a lycra-covered sex kitten. I mean, if that’s what you are, then great. Magazines apparently can’t shoot enough pictures of you:

Backstreet's back, alright!

But you can just as easily be a middle-aged, slightly frumpy guy like me who decided to paddle himself out of the vortex we talked about in post #1. And you can be as happy as that guy is at how it feels to have your feet planted on dry land.

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Link dump - March 8, 2017

Fewer and fewer Americans report trying to lose weight. We may be settling into our role as the one of the fattest countries on earth (we're coming for you, Tonga...). I can't help but think this is because of the many, many, many shitty options that people have had pushed on them that didn't work. Now they've given up. *sigh*

The search for the perfect artificial sweetener continues: 

"Let us pause here to acknowledge the sugar-frosted codependent embrace of Big Food and the American consumer. You could rightly fault consumers for their insistence on an oxymoronic product. But who has been indulging their fantasies for decades now, promising sweet, satisfying taste and no calories? Big Food, of course. Now customers are upping the stakes—and it’s not at all clear that companies can pass the test."

In what seems like a just reversal of a law that had the unintended consequence of highlighting the law of unintended consequences, after 60 years, street hockey will once again be legal in Hamilton, Ontario, under the following conditions:

• The roadway has a speed limit of 40 km/h or less and is a local road.
• Play happens in a place that is "safe and suitable."
• People play no earlier than 9 a.m. and no later than 8 p.m.
• No one plays during periods of limited visibility from fog, snow or rain.
• Play is stopped for any vehicles. ("Car!")

Having robot minions control the lights for them may be turning kids into a bunch of lazy, entitled monsters.

No one can get you to take your medicines but you. Three reminder devices to take your medications were no better than no notification or device in a randomized controlled trial. 

Go. To. Bed. People who get out of bed in the morning tend to eat better and earlier in the day than night owls. Original paper here.

"We found that night owls had postponed timing of food intake, and less favorable eating patterns with higher intakes of sucrose, fat and saturated fat in the evening hours than early birds," said Maukonen, a doctoral candidate in the department of public health solutions. 

Things you can control right now

There are a lot of things you can't control: the weather, the stock market, your neighbor's loud music. But many, many things are under your control, as pointed out by Lori Deschene. And how well you do at seizing control makes a huge difference in your health and happiness:

Right now, you can control:

1. How many times you smile today.

7. When you pull out your wallet for luxuries.

11. How often you notice and appreciate small acts of kindness.

17. The type of food you eat.

21. How much exercise you get.

22. How many times you swear in traffic. [I'd amend this to say that you can control how often you're in traffic at all. If you're swearing at traffic, chances are you are the traffic.]

27. The attention you give to your loved ones when you see them.

28. How much you enjoy the things you have right now.

41. Whether you formulate a new plan or act on your existing one. [this is my favorite]

44. Whether you smoke or drink. [unless you’re an alcoholic, in which case you are in control of whether or not you seek help from a qualified practitioner]

50. How much rest you get at night.

40 minutes

Who is the maniac posting here the last few days? 

What the hell is Double Arrow Metabolism? Doctors always think they know everything. And I don't like the looks of this guy. He was probably born skinny, and here he is trying to judge the rest of us for driving cars, smoking, eating processed foods, spending our money on whatever we want, and spending our free time on social media. Sure, maybe you can be healthy if you've got a good set of genes and luck into a doctor who's not a quack. But it's a roll of the dice. Life is hard, and this guy acts like we can all just "choose" to be healthy. Some of us have obligations! Kids at home, a mortgage to pay. So we get a little stressed out and watch some TV and maybe have a beer or two. Live a little for a change. So what? 

Yet some people live happily and healthily into their 90s, while the overall life expectancy is going down. Is it all just genetics, or is there something we can do to live longer and happier? Let's examine the thin grey line between being healthy and happy and being sick and depressed.

How thin is the line? How about 40 minutes a day?

Let's say you are holding your own, health-wise. On the Double Arrow Metabolism Wellness Index, you're a solid two or three. Then you decide that lying on your side for thirty minutes in bed each night flipping through your Facebook feed is more important to you than moving through space like you were designed to do. All the light from the screen blasting into your retinas throws off your sleep cycle, so you wake up in the middle of every night for ten minutes and raid the fridge to the tune of 200 highly-processed calories.

Then, since you couldn't sleep the night before, you wake up twenty minutes late and decide that you don't have time to make a sensible, non-cake-based breakfast at home.

Let's assume that you commute less than five miles to work, as a solid plurality of
Americans do. You're in a hurry and instead of biking, walking, or busing to work, you swing your fancy gas-powered wheelchair through McDonald’s on your way there and spend $5 on a meal that should have cost you less than $2. Let's be generous and say that this breakfast was no better and no worse than what you would've had at home (a generous assumption indeed). Say this routine (self-inflicted bad sleep, sedentary commuting, breakfast of processed crap, repeat) becomes a habit.

So that 40 minutes a day: 30 minutes of Gay French King scrolling Twitter or Facebook, then 10 minutes of late-night insomnia binging, all at the sacrifice of a more meaningful breakfast and commute, leads to this: 1400 extra highly-processed calories a week in food intake, 1148 fewer calories per week burned by missing your average 19.2 minute one-way cycling commute, $21 a week spent on food you didn't need and shouldn't have bought, and, at the current Federal rate of $0.52 per mile, $30 a week from gas-powered wheelchair driving. And, for the sake of being fair, let's say your fancy gas-powered wheelchair is a sensible car and not a gas-guzzling adult Tonka Toy:

Goodbye, one year's salary. I'll miss you.

If that's what you drive, these numbers would be far, far worse.

End result? One year later, if you started out at 150 lbs, you're now almost 60 pounds heavier. The extra $1440 you spent on your habit in that year, had you just put it in an indexed fund, would now be worth $1541.

And ten years later, if you really fell into a rut, that 40 minutes would have cost you $10,791! Your weight would eventually level out--we all hit our genetic max for obesity at some point--but you'd almost certainly have complications, like diabetes, heart disease, or sleep apnea.

And all this assumes you didn't even take on any credit card debt to pay for this, and assumes that the bad sleep you were getting didn't make your metabolic issues worse, and doesn't even take into account the $1184/year that your new diagnosis of diabetes cost you.

40 minutes a day to stay out of this swirling vortex. 40 minutes.

Link dump - March 3, 2017

People who cook real food and eat it at the table like human beings instead of eating processed garbage in front of a screen like drooling automatons have a lower risk of obesity. Good to know.

Wichita roads are friendlier to cyclists. I've experienced this myself, and I've meant to write a letter to the Eagle thanking the city and its drivers for not killing me, but now it's taken care of. *washes hands*

Obese people who "self stigmatize" may be at higher metabolic risk. This is an interesting hypothesis. Intuitively, I believe it; there's so much undeserved self-hatred out there among people who weigh more than they want to. But the sample size of this paper makes me suspicious. It has the smell of p-value hunting.

Aggressive treatment of subclinical hypothyroidism with levothyroxine in pregnancy probably doesn't result in smarter kids. This is disappointing.

Taxing sugared drinks makes people drink less insect bait. Go figure.

Have a good weekend

What the hell is water?

There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, "Morning, boys. How's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, "What the hell is water?"

-David Foster Wallace

I don't know exactly what the late, great DFW meant by this. Tragically, he's not around to tell us. But what I think he meant is that the most important realities are often the ones that are the hardest to detect. And to continue to borrow DFW's analogy, most of us paddle forward as best we can without ever feeling the flow of water against us, pushing us back, keeping us from reaching our potential. That rush of water consists of a lot of things, but most of them are visible if you look closely.

I’m a physician, as you might have deduced by the initials after my name. And physicians by training are supposed to notice the things that others don't. But most of us don't, and I've been more guilty of this than anyone in the past. See, I'm an endocrinologist. That’s a specialist in metabolic and hormonal disorders (think disorders of the pituitary, thyroid, and adrenal glands; and osteoporosis and diabetes and whatnot). You’d think that an endocrinologist is a person particularly well-trained to help patients escape the vortex of fancy motorized wheelchairs, faux-food, time-sucking devices, and all the other things pulling us under.

But that’s not at all what I was trained to do. In fact, I found during my career as an academic endocrinologist that instead of getting people safely to shore, I was often quickening or deepening the vortex that my patients were swimming in. In 15-minute office visits, I’d prescribe drugs that cost thousands of dollars and have trite, brief (in case the 15-minute visit didn’t give it away) conversations about what they could do with their weight, or their fatigue, or their sadness. The visits cost me 15 minutes, that is. They cost my patients a lot more. A lot more.

I was doing my best, obsessing over the things I could measure or manipulate, like blood sugars, cholesterol, blood pressure, and weight. All those are important. Don’t let anything you read here convince you otherwise. But I was swimming in the vortex myself. I simply paddled forward in the water I was trained to swim in, comfortably moving myself from today into tomorrow, spending the loads of money I made on things that didn’t make me happy and working extra hours to pay them off. I drove like a maniac between two clinics and four hospitals, often putting almost 100 miles a day on my car. The vortex deepened. The extra hours ate into time that I should have spent doing things I loved, like chasing my kids or riding my bike, so I weighed thirty pounds more than I wanted to. The water sped up. And then my blood sugars--one of those things I prided myself on controlling--started going up. And then I started getting really unhappy and resentful at work. I was swimming as hard as I could, but spiraling. What I couldn’t detect was that I and my patients needed to become people again.

What’s that? My patients weren’t people? What am I, a veterinarian?

P. henrylawsoni can out-wrestle A. woodhousii any day of the week.

What I mean is, that once a person crosses that gauzy threshold from the waiting room to the exam room, he experiences a transition from personhood to patienthood. And patients are bad swimmers. Let me illustrate. Most of us, whether we’ve thought about it or not, exist somewhere on this spectrum:

1. I feel great. I’m as healthy as I can be, and I’m intentionally doing things daily to improve my health.

2. I’m healthy, but mostly by accident.

3. I’m not sick, but I don’t feel good. I’m always stressed out.

4. I have one or two health problems that I manage pretty well, but I’m broke.

5. I have a few health problems that I struggle to manage, I’m broke, and I’m working a second job to pay medical expenses.

6. I have been hospitalized one or more times in the last year for chronic health problems, and I can’t work.

7. I’m in a nursing home or assisted living because I can’t take care of myself anymore.

8. I am dying.

The thing about this spectrum is that the strategy for moving up on it depends on where you start, and it’s never a straight line. If you’re one of the unfortunates at #7 or #8 that our system most definitely calls patients, my thoughts are with you. If you are at #5 or #6, your strategy for moving up may involve a lot of pharmaceutical help. I have opinions, at least metabolically speaking, on what that help might look like. But if you’re at #4 or above, and you’re working on getting to #1, the path to get there may meander through the local pharmacy for a bit, but most of the path is outside in the sunshine and fresh air. The path most definitely does not intersect with your couch.

So by reading this blog, if you’ll bear with me, you’re going to learn to feel the water around you, and you're going to get the skills to map out your own path out of the evil vortex. I intend to be completely honest and transparent about what I know and what I’m not so sure about. There’ll be philosophical stuff, like what a good partner in health ought to offer. There may even be diversions into seemingly unrelated topics, like pop culture, the weather, or my favorite, cycling. If I haven’t scared you off yet, come back for the next post.

Freedom from the vortex

Maybe you’re sick. Not throwing up or coughing up blood or having a fever, at least not most of the time, but you’re on a few medications, probably for diabetes or blood pressure issues or cholesterol, and your doctor picks on you to change your diet or be more active whenever you see her. Your medications cost a couple hundred dollars per month, and every second or third time you visit the doctor she adds another one, or replaces an old, cheap medication with a newer, more expensive one.

And maybe you weigh a few pounds (or many pounds) more than you want to. You’ve tried a few diets, mostly Atkins-type stuff, or low-fat, or calorie counting, and you’ve lost weight a few times, but each time the weight eventually came back.

Maybe you’re tired all the time. You feel bad when you get up in the morning, you are fatigued and achy all day, and you don’t sleep well at night. Your doctor thinks you might be depressed, and you’ve tried a couple medications for it, but they don’t seem to help.

And maybe you worry about money. You spend a lot of it on medications, and you go through the drive-through a few times a month even though you promise yourself that you won’t, and you end up working longer hours than you want to because you need to make sure the bills get paid.

Maybe you worry about the environment. You worry that our habits are putting your kids’ futures at risk, and you worry about it, but you aren’t sure what to do. A couple of times you’ve clicked the button to buy carbon offsets when you flew somewhere, but mostly you just try to ignore the problem.

And maybe it hasn’t occurred to you that these are all different manifestations of the same problem. You read that right. There is a very good chance that your diabetes is just another manifestation of the same set of problems as your weight and your fatigue and your money issues and even climate change.

We’re gonna talk about how. This blog is about your health, but not in the way that you’re used to talking about it with your doctor. It's not about the “blood pressure, blood sugar, cholesterol,” kind of health that makes you feel like a gadget someone is tinkering with. It’s more about the “What do I look forward to when I get out of bed in the morning?” kind of health. Or the “What can I do today to make sure I’m happier tomorrow than I was yesterday?” kind of health. Health as freedom: freedom from false choices, freedom from medications (not all of them, but some of them), freedom from the, *ahem*, Bravo Sierra that passes for medical advice from celebrities and celebrity doctors. I’m talking to you, Dr. Oz.

You’re not going to see click-baity posts on this blog about some new supplement or cellulite-destroying cream. You’re going to see posts on how you can take control of your life back. I’m not talking about a life jacket to protect you from the evil, swirling vortex of drug companies, subsidized faux-food, and carbon-spewing cars and factories. I’m talking about the freedom of learning how to swim your way out of that vortex altogether, put your feet on dry land, and walk away. All those people wrapped in spandex and padding away on a commercial gym’s treadmill under creepy fluorescent lights: do you think they’re free? They sure don’t look like it to me. You, with dry feet, having sprung once and for all from the vortex and now walking one foot in front of the other toward a happier, healthier life: that’s what freedom looks like.

I intend to be your guide along this path to medical freedom. I want to teach you a new way to think about your health; a way that allows you to make decisions that are your own and that will get you out of the vortex. You know the last time you had a bad cold, and you felt guilty for taking all the healthy days you had before that for granted, and you wondered when you would finally feel normal again? Remember how you said to yourself that you’d never take a healthy day for granted again? Once you claw your way out of the vortex, you won’t. And it will be because you MADE that next healthy day. You will have made it yourself, with your own hands and feet and decisions. If you believe me, I’ll see you at the next post.