More Thoughts on Macronutrient Trends

I had a brief positive exchange with Gary Taubes about the NuSI post.  He reminded me that there's an artifact (measurement error) in the USDA data on fat consumption in the year 2000 when they changed assessment methods.  Here are the USDA data on macronutrient consumption since 1970, corrected for loss (28.8%) but not corrected for the artifact:

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Nutrition Science Initiative (NuSI)

Some of you may have heard of an ambitious new nutrition research foundation called the Nutrition Science Initiative (NuSI).  In this post, I'll explain what it is, why it matters, and how I feel about it-- from the perspective of an obesity researcher. 

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Calories and Carbohydrate: a Natural Experiment

In the lab, we work hard to design experiments that help us understand the natural world.  But sometimes, nature sets up experiments for us, and all we have to do is collect the data.  These are called "natural experiments", and they have led to profound insights in every field of science.  For example, Alzheimer's disease is usually not considered a genetic disorder.  However, researchers have identified rare cases where AD is inherited in a simple genetic manner.  By identifying the genes involved, and what they do, we were able to increase our understanding of the molecular mechanisms of the disease.

The natural experiment I'll be discussing today began in 1989 with the onset of a major economic crisis in Cuba. This coincided with the loss of the Soviet Union as a trading partner, resulting in a massive economic collapse over the next six years, which gradually recovered by 2000. 

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A Late Summer Harvest

It's been a good year for gardening in Seattle, at least in my garden.  Thanks to great new tools* and Steve Solomon's recipe for homemade fertilizer, my house has been swimming in home-grown vegetables all summer.  I'm fortunate that a friend lets me garden a 300 square foot plot behind her house.  Here's a photo of part of today's harvest; various kale/collards, zucchini, tomatoes and the last of the pole beans:

Perfect for the Eocene diet.  

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Does Calorie Restriction Extend Lifespan in Mammals?

Until about two years ago, the story went something like this: calorie restriction extends lifespan in yeast, worms, flies, and rodents.  Lifespan extension by calorie restriction appears to be biologically universal, therefore it's probably only a matter of time until it's demonstrated in humans as well.  More than 20 years ago, independent teams of researchers set out to demonstrate the phenomenon in macaque monkeys, a primate model closer to humans than any lifespan model previously tested.

Recent findings have caused me to seriously question this narrative.  One of the first challenges was the finding that genetically wild mice (as opposed to inbred laboratory strains) do not live longer when their calorie intake is restricted, despite showing hormonal changes associated with longevity in other strains, although the restricted animals do develop less cancer (1).  One of the biggest blows came in 2009, when researchers published the results of a study that analyzed the effect of calorie restriction on lifespan in 41 different strains of mice, both male and female (2).  They found that calorie restriction extends lifespan in a subset of strains, but actually shortens lifespan in an even larger subset.  Below is a graph of the effect of calorie restriction on lifespan in the 41 strains.  Positive numbers indicate that calorie restriction extended life, while negative numbers indicate that it shortened life:

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SOCIAL MEDIA AND THE MEDICAL PROFESSION

I am a Luddite when it comes to social media, the web-based interactive media such as Facebook and other more professionally oriented ones like Linkedin.  I do have a Facebook page but I rarely use it. I have a blog where I post my poetry http://stephenleeder.blogspot.com.au/but no one ever visits and another blog where I post extended versions of articles like this
http://steve-leeder-better-health.blogspot.com/. And yes, I have Tweeted 30 times!  Basically, I stick to email.

But my youngest son (19) belongs to a generation for whom social media are a principal social communication channel. Recent medical graduates know all about it and how to use it wisely and well. It serves to link doctor to doctor and to some extent patient to doctor.

Social media according toWikipedia includes “web- and mobile-based technologies that are used to turn communication into interactive dialogue among organisations, communities and individuals”.

Today, news travels like lightning via Twitter and Facebook.  "A common thread," says Wikipedia, "running through all definitions of social media is a blending of technology and social interaction for the [rapid] co-creation of value."

Social media are cheap to use.  Anyone can publish on them unlike on the commercial media.  And they are immediate: whereas it may take weeks to get an idea into print, with social media communication is now. You can edit an article easily on social media whereas reprinting to correct an error is a nightmare. 

Are the social media likely to be professionally useful?  My guess is that they will prove to be so.  A group of general practitioners could use social media to discuss how best to manage a group of patients in a local nursing home. But they might get their fingers burnt unless the social medium they were using was fenced off, like a gated village, for their use alone. 

Australian Doctorhas established docs4docs for that purpose.  Take a look at http://just4docs.com.au/index.php/forums/topic/26/medicare-localsand see as an example a series of depressing conversational comments on Medicare Locals

If you are going to use social media for professional purposes please be careful.  A list of questions to ask yourself before you get too deeply into social media were provided in a paper published in the Medical Journal of Australia last year by a working group drawn from the AMA Council of Doctors in Training, NZMA Doctors-in-Training Council, AMSA, and the New Zealand Medical Students’ Association (NZMSA).

A guide from which the MJA paper was drawn can be found at http://ama.com.au/socialmedia.  Here are the questions.

Have you ever Googled yourself? Do you feel comfortable with the results that are shown?

Have you ever:

• Posted information about a patient or person from your workplace on Facebook?

• Added patients as friends on Facebook or MySpace?

• Added people from your workplace as friends?

• Made a public comment online that could be considered offensive?

• Become a member or fan of any group that might be considered racist, sexist, or otherwise derogatory?

• Put up photos or videos of yourself online that you wouldn’t want your patients, employers or people from your workplace to see?

• Felt that friends have posted information online that may result in negative consequences for them? Did you let them know?

• Checked your privacy settings?

So there you have it!  Good luck but take care!

Madonna's "MDNA Show Manifesto" Defends Using Guns on Tour: Do You Agree?

As we speak, Madonna is en route to my city- Philadelphia, to launch the North American leg of her "MDNA World Tour".  In advance of her arrival, she has released a statement to the local Metro defending one of the most controversial parts of her tour...the use of fake firearms in concert.  Here is a portion of that statement:

"It's true there is a lot of violence in the beginning of the show and sometimes the use of fake guns - but they are used as metaphors.  I do not condone violence or the use of guns.  Rather they are symbols of wanting to appear strong and wanting to find a way to stop feelings  that I find hurtful or damaging.   In my case its wanting to stop the lies and hypocrisy of the church,  the intolerance of many narrow minded cultures and societies I have experienced throughout my life and in some cases  the pain I have felt from having my heart broken".

Gun violence is (unfortunately) not a new problem.  However, the topic is quite timely due to increased U.S. media coverage following several mass shootings in the past few weeks- Aurora, CO, Oak Creek, WI, and New York, NY.  The issue of gun violence has reached crisis levels in Philadelphia where Madonna will be performing.  A new open source journalism project called http://guncrisis.org/ "contends that there is an epidemic of homicide by gunfire in Philadelphia and similar cities".  They are seeking solutions.

The solutions being sought by GunCrisis: Philadelphia and others involve taking a public health approach to gun violence.  The recent high profile shootings have produced several well-written pieces about gun violence and what we need to do next:

•  Prompt policy discussions about easy access to ammunition, high-capacity magazines, and assault weapons.
• Use our public health skills to conduct further research into the causes of firearm injuries.
• Examine gun violence as a social disease- one that stems from a society "saturated with guns".

Tell me what you think:

Do you believe that the gun "saturation" goes beyond those in our homes to include those used for entertainment?  E.g., Guns in movies or video games; Madonna's concert props

Is Madonna successful? Does using guns as a metaphorical image help her reach her goals and battle against hypocrisy and intolerance?

In addition to those listed above, what other strategies should we incorporate into a public health approach against gun violence?