"Popular Media Helps Establish the Public Health Agenda" That's What I Said.

"Popular media helps establish the public health agenda". I just read this line in a new article from the March 2010 edition of Preventing Chronic Disease...I thought- that's what I've been talking about. I knew public health and pop culture went hand in hand!
This particular research project was inspired by the CDC/Alzheimer's Association Initiative: National Public Health Action Plan to Promote and Protect Brain Health. The authors conducted a content analysis of the four most circulated Women's magazines (Good Housekeeping, Ladies Home Journal, Women's Day, Family Circle) and Men's magazines (Men's Health, GQ, Men's Journal, Esquire). They conducted a content analysis to see how the magazines described the three strategies correlated with healthy cognitive function (physical activity, healthy diet, and social involvement).
I will say that I was slightly disappointed that there was almost no discussion of the differences in how these issues are presented in Women's vs. Men's magazines. It is always interesting to see how public health issues are marketed differently based on gender. For example, I was fascinated in graduate school to see how cigarettes and smoking have been presented over the years. For example, Virginia Slims cigarettes were advertised in Women's Magazines with slogans like "You've come a long way baby". The products were visibly thin and the slogans focused on being free and empowered.
This content analysis was also interesting however, in that it identified what strategies were being talked about. They found that both types of magazines were focusing on prevention vs. treatment (yay!) Women's articles tended to be longer and were were likely to include contact information (for websites/researchers). It seems the magazines have done their research that women are more likely to seek help for a health issue. They also found that most articles focused on healthy diet, while increasing social involvement was almost never discussed. The authors do not speculate as to why social involvement was not presented. I find that interesting (and a shame) since social support/connection is also a protective factor for other health issues (e.g., suicide).
I think this type of research has great implications for other public health work. How often are pop media channels evaluated for the content/accuracy of their public health messages? How can the evaluation of those channels/messages inform the public health agenda? My message to MPH students: "Study that qualitative analysis textbook!" We're going to be needing researchers that can analyze the content of commercials, magazines, social networking sites...it sounds like a fun job!

If you'd like to check out the article I cited above:
Friedman et al. Cognitive Health Messages in Popular Women's and Men's Magazines, 2006-2007. Prev Chronic Dis. 2010: 7(2).

Corn Oil and Cancer?

The benefits of corn oil keep rolling in. In a new study by Stephen Freedland's group at Duke, feeding mice a diet rich in butter and lard didn't promote the growth of transplanted human prostate cancer cells any more than a low-fat diet (1).

Why do we care? Because other studies, including one from the same investigators, show that corn oil and other industrial seed oils strongly promote prostate cancer cell growth and increase mortality in similar models (2, 3).

From the discussion section:

Current results combined with our prior results suggest that lowering the fat content of a primarily saturated fat diet offers little survival benefit in an intact or castrated LAPC-4 xenograft model. In contrast to the findings when omega-6 fats are used, these results raise the possibility that fat type may be as important as fat amount or perhaps even more important.

There's a large body of evidence implicating excess omega-6 fat in a number of cancer models. Reducing omega-6 to below 4% of calories has a dramatic effect on cancer incidence and progression*. In fact, there have even been several experiments showing that butter and other animal fats promote cancer growth to a lesser degree than margarine and omega-6-rich seed oils. I discussed that here.


* The average American eats 7-8% omega-6 by calories. This means it will be difficult to see a relationship between omega-6 intake and cancer (or heart disease, or most things) in observational studies in the US or other industrial nations, because we virtually all eat more than 4% of calories as omega-6. Until the 20th century, omega-6 intake was below 4%, and usually closer to 2%, in some traditional societies. That's where it remains in contemporary traditional societies unaffected by industrial food habits, such as Kitava.

Magnesium and Insulin Sensitivity

From a paper based on US NHANES nutrition and health survey data (1):

During 1999–2000, the diet of a large proportion of the U.S. population did not contain adequate magnesium... Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.... Because magnesium intake is low among many people in the United States and inadequate magnesium status is associated with increased risk of acute and chronic conditions, an urgent need exists to perform a current survey to assess the physiologic status of magnesium in the U.S. population.

Magnesium is an essential mineral that many people apparently don't get enough of. One of the many things it's necessary for in mammals is proper insulin sensitivity and glucose control. A loss of glucose control due to insulin resistance can eventually lead to diabetes and all its complications.

Magnesium status is associated with insulin sensitivity (2, 3), and a low magnesium intake predicts the development of type II diabetes in most studies (4, 5) but not all (6). Magnesium supplements largely prevent diabetes in a rat model* (7). Interestingly, excess blood glucose and insulin themselves seem to reduce magnesium status, possibly creating a vicious cycle.

In a 1993 trial, a low-magnesium diet reduced insulin sensitivity in healthy volunteers by 25% in just four weeks (8). It also increased urinary thromboxane concentration, a potential concern for cardiovascular health**.

At least three trials have shown that magnesium supplementation increases insulin sensitivity in insulin-resistant diabetics and non-diabetics (9, 10, 11). In some cases, the results were remarkable. In type II diabetics, 16 weeks of magnesium supplementation improved fasting glucose, calculated insulin sensitivity and HbA1c*** (12). HbA1c dropped by 22 percent.

In insulin resistant volunteers with low blood magnesium, magnesium supplementation for four months reduced estimated insulin resistance by 43 percent and decreased fasting insulin by 32 percent (13). This suggests to me that magnesium deficiency was probably one of the main reasons they were insulin resistant in the first place. But the study had another very interesting finding: magnesium improved the subjects' blood lipid profile remarkably. Total cholesterol decreased, LDL decreased, HDL increased and triglycerides decreased by a whopping 39 percent. The same thing had been reported in the medical literature decades earlier when doctors used magnesium injections to treat heart disease, and also in animals treated with magnesium. Magnesium supplementation also suppresses atherosclerosis (thickening and hardening of the arteries) in animal models, a fact that I may discuss in more detail at some point (14, 15).

In the previous study, participants were given 2.5 g magnesium chloride (MgCl2) per day. That's a bit more than the USDA recommended daily allowance (MgCl2 is mostly chloride by weight), in addition to what they were already getting from their diet. Most of a person's magnesium is in their bones, so correcting a deficiency by eating a nutritious diet may take a while.

Speaking of nutritious diets, how does one get magnesium? Good sources include halibut, leafy greens, chocolate and nuts. Bone broths may also be a source of magnesium. Whole grains and beans are also fairly good sources, while refined grains lack most of the magnesium in the whole grain. Organic foods, particularly artisanally produced foods from a farmer's market, are richer in magnesium because they grow on better soil and often use older varieties that are more nutritious.

The problem with seeds such as grains, beans and nuts is that they also contain phytic acid which prevents the absorption of magnesium and other minerals (16). Healthy non-industrial societies that relied on grains took great care in their preparation: they soaked them, often fermented them, and also frequently removed a portion of the bran before cooking (17). These steps all served to reduce the level of phytic acid and other anti-nutrients. I've posted a method for effectively reducing the amount of phytic acid in brown rice (18). Beans should ideally be soaked for 24 hours before cooking, preferably in warm water.

Industrial agriculture has systematically depleted our soil of many minerals, due to high-yield crop varieties and the fact that synthetic fertilizers only replace a few minerals. The mineral content of foods in the US, including magnesium, has dropped sharply in the last 50 years. The reason we need to use fertilizers in the first place is that we've broken the natural nutrient cycle in which minerals always return to the soil in the same place they were removed. In 21st century America, minerals are removed from the soil, pass through our toilets, and end up in the landfill or in waste water. This will continue until we find an acceptable way to return human feces and urine to agricultural soil, as many cultures do to this day****.

I believe that an adequate magnesium intake is critical for proper insulin sensitivity and overall health.


* Zucker rats that lack leptin signaling

** Thromboxane A2 is an omega-6 derived eicosanoid that potently constricts blood vessels and promotes blood clotting. It's interesting that magnesium has such a strong effect on it. It indicates that fatty acid balance is not the only major influence on eicosanoid production.

*** Glycated hemoglobin. A measure of the average blood glucose level over the past few weeks.

**** Anyone interested in further reading on this should look up The Humanure Handbook

Lindeberg on Obesity

I'm currently reading Dr. Staffan Lindeberg's magnum opus Food and Western Disease, recently published in English for the first time. Dr. Lindeberg is one of the world's leading experts on the health and diet of non-industrial cultures, particularly in Papua New Guinea. The book contains 2,034 references. It's also full of quotable statements. Here's what he has to say about obesity:

Middle-age spread is a normal phenomenon - assuming you live in the West. Few people are able to maintain their [youthful] waistline after age 50. The usual explanation - too little exercise and too much food - does not fully take into account the situation among traditional populations. Such people are usually not as physically active as you may think, and they usually eat large quantities of food.

Overweight has been extremely rare among hunter-gatherers and other traditional cultures [18 references]. This simple fact has been quickly apparent to all foreign visitors...

The Kitava study measured height, weight, waist circumference, subcutaneous fat thickness at the back of the upper arm (triceps skinfold) and upper arm circumference on 272 persons ages 4-86 years. Overweight and obesity were absent and average [body mass index] was low across all age groups. ...no one was larger around their waist than around their hips.

...The circumference of the upper arm [mostly indicating muscle mass] was only negligibly smaller on Kitava [compared with Sweden], which indicates that there was no malnutrition. It is obvious from our investigations that lack of food is an unknown concept, and that the surplus of fruits and vegetables regularly rots or is eaten by dogs.

The Population of Kitava occupies a unique position in the world in terms of the negligible effect that the Western lifestyle has had on the island.

The only obese Kitavans Dr. Lindeberg observed were two people who had spent several years off the island living a modern, urban lifestyle, and were back on Kitava for a visit.

I'd recommend this book to anyone who has a scholarly interest in health and nutrition, and somewhat of a background in science and medicine. It's extremely well referenced, which makes it much more valuable.

The Commercials for The Heart Truth Campaign: Can We Stop "Raising Awareness" and Change the Environment Instead?

If you are a hard core Olympics watcher like I am, then you have probably been inundated with these Diet Coke commercials. They are so pretty...they have red hearts on the can...they are getting a lot of exposure during Primetime TV...and the goal is...WAIT- I have no idea what the goal is!
According to the commercial, the campaign is aiming to "raise awareness of heart health". Does this mean people should know that their heart could be healthy or unhealthy? Does this commercial give us all we need to create "awareness", or should we be directed to their website for more information? Are people supposed to do something to improve or change their current heart health status after watching?

This is the perfect example of a public health campaign that drives me crazy because it wastes valuable resources on unclear, unmeasurable, and ineffective goals.

For more information, I visited their website. Here I learned that: The Heart Truth is a national awareness campaign, sponsored by the National Heart, Lung, and Blood Institute, being embraced by millions who share the goal of better heart health for all women. The campaign not only warns women about heart disease, but it equips them to take action against risk factors.

Okay- so it sounds like the goal is to achieve better heart health for women. So that will require some actual change to achieve (e.g., increase healthy behaviors like exercise, improve treatment for heart disease, etc). However, the commercial (and most of the website) does not include a "Call to Action". A Call to Action is a clear indication of the action that you would like people to take after viewing your health communication materials. In order for people to make/change their current actions, you must do a lot more than "raise their awareness" of the problem. Awareness raising is simply an increase in knowledge. In addition to knowledge, actions/behaviors are influenced by several layers of factors. For example:

• Individual (e.g., does one feel like they are at risk for heart disease? They may not even think these commercials are applicable to them. Do they have a genetic risk?)
• Interpersonal (e.g., does their family support their wanting to make changes to reduce heart disease? Do family members provide child care so that women can exercise and attend doctors appointments?)
• **Environment ( This layer is so important! But is most frequently ignored by campaigns that are wanting to "raise awareness" among individuals. E.g., what if your neighborhood does not have grocery stores that sell affordable healthy food? What if your neighborhood isn't safe for exercise such as walking/bike riding? What if there is no affordable healthcare within the scope of the public transportation that you rely on for transit?)
• **Society/Policy (What if you do not have health insurance to cover the doctors and/or nutritionist visits that are outlined in the "Action Steps" on the campaign website?)

As you can see from the list above, I would argue that the most daunting barriers to heart health for women fall in the 3rd and 4th categories. However, we continually see campaigns focusing on changing individual knowledge about diseases. Has that ever worked in the past?! Was it enough to tell people that cigarettes were unhealthy? No- we had to look at the environment and policy issues. We had to increase the prices/tax on cigarettes and create smoke-free work places, etc. The same has been seen in alcohol prevention.

So this week when you are watching speed skating in Primetime and this adorable soda can with a heart comes on the screen...picture me rolling my eyes as I sit on the couch. Please- let's spend valuable resources on reducing the barriers that actually impede health. Let's think bigger!

Confirmed: Alexander McQueen Died by Suicide. When will Entertainment Reporters Catch on to Recommendations for Safe Reporting on Suicide?

The fashion world suffered a great loss last week. For those of you who also drool over Sandra Bullock's SAG award dress...or Sarah Jessica Parker's ensemble for the London Premiere of 'Sex and the City', you must be familiar with the designs of Alexander McQueen. The British fashion designer died by suicide last Thursday.
As I read multiple accounts of his death via various sources of entertainment news, I am continually struck by the irresponsible reporting of a celebrity suicide. In 2001, Reporting on Suicide: Recommendations for the Media, a report by the Centers for Disease Control and Prevention, National Institute of Mental Health, Office of the Surgeon General, Substance Abuse and Mental Health Services Administration, American Foundation for Suicide Prevention, American Association of Suicidology, and Annenberg Public Policy Center was released. Research indicates that the way suicide is reported in the media can contribute to additional suicides and suicide attempts. Conversely, stories about suicide can inform readers and viewers about the likely causes of suicide, its warning signs, trends in suicide rates, and recent treatment advances. The above recommendations have been developed to assist reporters and editors in safe reporting on suicide. In 2005, these recommendations were even summarized to be a quick "At a Glance" reference for reporters.
I'm highlighting what I see as a typical entertainment news story on Alexander's death and how this and stories that first surfaced late last week basically do the opposite of what is recommended for safe reporting.

What NOT to Do:

• Avoid detailed descriptions of the suicide, including specifics of the method and location. This article provides a description of the location and method of the suicide.
  
• Avoid romanticizing someone who has died by suicide. Avoid featuring tributes by friends or relatives. Avoid glamorizing the suicide of a celebrity. Many articles have simply included tributes by fellow celebrities, such as Lady GaGa, Madonna, and Sarah Jessica Parker.
• Avoid oversimplifying the causes of suicides, murder-suicides, or suicide pacts, and avoid presenting them as inexplicable or unavoidable. Although many articles have highlighted that Alexander was a survivor of his best friend's suicide three years ago (which can be a risk factor for suicide) and that he lost his mother just a week before his own death...we don't know the myriad of risk factors that could a played a role in this tragedy. Suicide is a complex system of risk and protective factors, that cannot be explored in a two paragraph article.

What TO Do:

• Always include a referral phone number and information about local crisis intervention services. I did not see this in any articles that I read.
• Emphasize recent treatment advances for depression and other mental illness. Include stories of people whose treatment was life-saving or who overcame despair without attempting suicide. Again- Nada.
• Interview a mental health professional who is knowledgeable about suicide and the role of treatment or screening for mental disorders as a preventive strategy. Um- Nope.

But not to be discouraged! Many newspapers and news reporting organizations have begun to ask for training on this issue (SPRC is a resource). However, I would argue that the entertainment news organizations are the last to follow. Are national and statewide suicide prevention organizations reaching out to places like E! News? Access Hollywood? People Magazine? I would bet that these news organizations have a much higher readership than many local/national newspapers. Advocates, are you listening? Contact these organizations! There is a desperate need to improve the safety of reporting on celebrity suicide.

Resources:
Are you feeling desperate, alone or hopeless? Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. Your call will be routed to the nearest crisis center to you.

• Call for yourself or someone you care about
• Free and confidential
• A network of more than 140 crisis centers nationwide
• Available 24/7

Kevin Smith 'Too Fat' to Fly Southwest? Discrimination or Legitimate Enforcement of a Public Safety Policy?

Via Twitter and/or popular media, I am sure many of you have seen the story regarding Kevin Smith and Southwest Airlines. Kevin Smith, a New Jersey native like myself, is well known for comedies such as the 90s favorite- Clerks. This past weekend, Kevin was removed from an Oakland to Burbank, CA flight because he did not fit comfortably into the passenger seat. Kevin has since published multiple tweets documenting the humiliating experience of being kicked off that flight. He argues that Southwest Airlines was wrong in their actions- that he posed no flight/safety risks.
I would argue that even though Kevin Smith is a celebrity (so he can make a louder rebuttal to a larger audience when he feels he is wronged), Southwest Airlines was correctly enforcing a clear and specific public health/safety policy. (A policy that is certainly not unique to this airline- almost all major airlines have a similar policy with similar definitions/actions). The Southwest Travel Policy website clearly lays out FAQs for "Customers of Size" (this term varies a bit airline to airline). The policy clearly defines what it means by Customers of Size (i.e., the armrest is the definitive gauge- if the customer is unable to lower both). It also clearly defines the action that can be taken proactively by customers in this category- they can buy a second seat (this will ensure their comfort and reduce any embarrassment having to deal with this at the airport or on the flight). In an upgrade over many other airlines' policies, customers are offered a refund for the second seat if that flight does not oversell. The website indicates that 98% of extra seat purchases qualify for a refund.
The article highlighted above states that "Smith originally purchased two tickets- as he's been known to do when traveling Southwest, but when he decided to fly standby on an earlier flight, only one seat remained." Since Smith originally purchased two tickets, I would argue that he was very familiar with (1) the Southwest policy on customers of size and (2) his inclusion in that category. Therefore, his cry of discrimination is unfounded and somewhat slanderous. The purpose of these policies is not to embarrass individuals, but instead to protect the health and safety of all individuals on the flight. All customers must have ample opportunity to access plane facilities as well as emergency exits if necessary. Having clear and specific written policies should protect Southwest and their actions...and Kevin Smith should probably lay off his Twitter attack.

The Death of an Olympic Luger: Human Error, a Dangerous Track, or Both?

Like many of you, I have been excited for weeks waiting for the start of the 2010 Vancouver Winter Olympic Games. I've had a love for the games ever since I recorded the Calgary Olympics in 1988 and watched them over and over again (you could not beat the drama of the "Battle of the Brians").
So I shared in the horror and sadness yesterday when I heard that Nodar Kumaritashvili, a 21-year old luger from the Republic of Georgia, was killed during a training run on the luge track. As someone who works in the injury prevention world, I thought- "How could this happen?" "Why wasn't Nodar safe on that track?"
At 7:30pm last night, NBC began their Opening Ceremony coverage with an examination of this accident. As they spoke with athletes and analysts, an interesting trend emerged. Former lugers, such as Duncan Kennedy said that they weren't worried about the top athletes on the track. They don't worry about those ranked one through twelve. They are worried about number thirteen and beyond. Interesting- what types of safeguards are in place (or should be in place) for less experienced lugers?
We heard a consistent message this morning on Yahoo Sports, which reports that after a probe Friday night, "International Luge Federation and Vancouver Olympic officials said their investigation showed that the crash was the result of human error and that “there was no indication that the accident was caused by deficiencies in the track.” It sounds like Nodar came late out of the turn and wasn't experienced enough to compensate at those high speeds.
While it seems reasonable to think that accidents happen because of individual behavior (inexperience, incompetence, etc), in public health we take a broader view and look at issues on multiple levels. Could something be deficient in the environment (e.g., the luge track, safety precautions around the walls, available safety equipment for athletes); policies and procedures (e.g., are more inexperienced lugers provided with additional support/practice/safeguards); tracking systems (e.g., are there statistically more accidents/falls on this track versus others throughout the world?).
As you can imagine from a field that trains you to examine the broader context and understand that complex systems usually influence outcomes (not just one level like individual behavior), I will be holding my breath throughout the luge, skeleton, and bobsled competitions....because I don't buy that inexperience was the only cause of this accident.
As I read reports stating that there has been concern about the speed and safety of this track since it opened in 2007 and that training days have been "crash filled" (including crashes among more experienced athletes)- I believe that a complex system of failures led to the numerous crashes (including a Romanian woman being knocked unconscious) and the tragedy for the Georgia team. I'd like to see the "investigation" last more than a few hours the night before an event. I'd like to see the officials examine multiple levels of the system, as I've outlined above. The "top 12" are not the only lugers that qualified for the event...shouldn't the track be safe for all the athletes?

The Inspiration for Pop Health

Welcome! For quite some time now, I have been wanting to find a way to combine two of my greatest interests. Public Health- the area where I have formal training and experience...and Pop Culture- which I shamelessly love and enjoying analyzing. Last year, one of my Professors from Graduate School directed a project which conducted a content analysis of the media coverage of the Rhianna and Chris Brown "incident". I went to a talk she gave on the results and thought "That would be my dream job...a way to combine my love of public health and tabloids and E! News"!
I've also been inspired by several "bloggers" in my personal and professional life to jump in and give this a try. As a teaching assistant, I collaborated on a class project that used a blog called "Challenging Dogma" to display final papers and generate conversation about their central themes/arguments. A great friend and colleague blogs weekly for Psychology Today with a column called "Promoting Hope, Preventing Suicide". I've really enjoyed being a reader of that blog and forwarding on articles/stories that I think she may be interested in. So now I'm trying it myself with my own stories. Enjoy!

Saturated Fat and Insulin Sensitivity

Insulin sensitivity is a measure of the tissue response to insulin. Typically, it refers to insulin's ability to cause tissues to absorb glucose from the blood. A loss of insulin sensitivity, also called insulin resistance, is a core part of the metabolic disorder that affects many people in industrial nations.

It is commonly asserted in journal articles and on the internet that saturated fat reduces insulin sensitivity. The idea is that saturated fat reduces the body's ability to handle glucose effectively, placing people on the road to diabetes, obesity and heart disease. Perhaps this particular claim deserves a closer look.

The Evidence

I found a review article from 2008 that addressed this question (1). I like this review because it only includes high-quality trials that used reliable methods of determining insulin sensitivity*.

On to the meat of it. There were 5 studies in which non-diabetic people were fed diets rich in saturated fat, and compared with a group eating a diet rich in monounsaturated (like olive oil) or polyunsaturated (like corn oil) fat. They ranged in duration from one week to 3 months. Four of the five studies found that fat quality did not affect insulin sensitivity, including one of the 3-month studies.

The fifth study, which is the one that's most commonly cited, requires some discussion. This was the KANWU study (2). Over the course of three months, investigators fed 163 volunteers a diet rich in either saturated fat or monounsaturated fat.

The SAFA diet included butter and a table margarine containing a relatively high proportion of SAFAs. The MUFA diet included a spread and a margarine containing high proportions of oleic acid derived from high-oleic sunflower oil and negligible amounts of trans fatty acids and n-3 fatty acids and olive oil.

Yummy. After three months of these diets, there was no significant difference in insulin sensitivity between the saturated fat group and the monounsaturated fat group. Yes, you read that right. Even the study that's commonly cited as evidence that saturated fat causes insulin resistance found no significant difference between the diets. I'll be generous and acknowledge that the small difference was almost statistically significant (p = 0.053).

What the authors focused on is the fact that insulin sensitivity declined slightly but significantly on the saturated fat diet compared with the pre-diet baseline. That's why this study is cited as evidence that saturated fat impairs insulin sensitivity. But those of you with a science background may be able to spot the problem here. You need a control group for comparison, to take into account normal fluctuations caused by such things as the season, eating a new diet provided by the investigators, and having a doctor poking at you. That control group was the group eating monounsaturated fat. The comparison between diet groups was the comparison that matters most, and it wasn't quite significant.  I think the most you can say about this study is that it provides weak evidence that saturated fat decreases insulin sensitivity.

So we have five studies through 2008, which overall offer little support the idea that saturated fat reduces insulin sensitivity in non-diabetics. Since the review paper was published, I know of one subsequent study that asked the same question (3). Susan J. van Dijk and colleagues fed volunteers with abdominal overweight a diet rich in either saturated fat or monounsaturated fat. I e-mailed the senior author and she said the saturated fat diet was "mostly butter".  After 8 weeks, insulin sensitivity was virtually identical between the two groups. This study appeared well controlled and used the gold standard method for assessing insulin sensitivity, called the euglycemic-hyperinsulinemic clamp technique***.

The evidence from controlled trials is rather consistent that saturated fat has no major effect on insulin sensitivity in humans, at least on time scales of a few months.

UPDATE: other trials have added to this finding.  The large European LIPIGENE randomized controlled diet trial found that substantial differences in SFA intake had no effect on insulin sensitivity over 12 weeks in people with the metabolic syndrome (3b).


* For the nerds: euglycemic-hyperinsulinemic clamp (the gold standard), insulin suppression test, or intravenous glucose tolerance test with Minimal Model. They didn't include studies that reported HOMA as their only measure, because it's not very accurate.

*** They did find that markers of inflammation in fat tissue were higher after the saturated fat diet.

Thank You

I'd like to extend my sincere thanks to everyone who has supported me through donations this year. The money has allowed me to buy materials that I wouldn't otherwise have been able to afford, and I feel it has enriched the blog for everyone. Here are some of the books I've bought using donations. Some were quite expensive:

Food and western disease: health and nutrition from an evolutionary perspective. Staffan Lindeberg (just released!!)

Nutrition and disease. Edward Mellanby

Migration and health in a small society: the case of Tokelau. Edited by Albert F. Wessen

The saccharine disease. T. L. Cleave

Culture, ecology and dental anthropology. John R. Lukacs

Vitamin K in health and disease. John W. Suttie

Craniofacial development. Geoffrey H. Sperber

Western diseases: their emergence and prevention. Hugh C. Trowell and Denis P. Burkitt

The ultimate omega-3 diet. Evelyn Tribole

Our changing fare. John Yudkin and colleagues


Donations have also paid for many, many photocopies at the medical library. I'd also like to thank everyone who participates in the community by leaving comments, or by linking to my posts. I appreciate your encouragement, and also the learning opportunities.