Health

Good Work, Denninger

Posted on by Amir

His latest post–about medical costs and the inability of government to spend at the current levels of growth on a sustained basis–is spot-on. Aside from the pure government spending side of this, there are other monster issues that need to be addressed, particularly (a) the government-medical-financial complex and (b) the impact of price controls in other countries (i.e. England, Canada) on our prices.

Still, the last time I saw a Denninger video clip, I swore he had to have lost some serious weight. At the end of his latest post is a before/after picture which confirmed what I thought. Very impressive.

His fitness advice is very sound. While some people are otherwise only marginally able to control their weight, most Americans don’t have that problem: it’s purely a matter of lifestyle and reasonable fitness is attainable.

Getting a good handle on food intake–especially portion control and calorie quality while ensuring that enough protein is consumed–is important. There is plenty of room for variety in this: from Atkins on one hand to pure vegan on the other. Get with your doc first, and find out which diets are more optimal for your condition. (From some studies I’ve seen, Type 2 diabetes sufferers may benefit from Atkins whereas heart patients with major blockage might benefit from the vegetarian path recommended by Dr. Caldwell Esselstyn. But I am neither a doc nor a nutritionist, so what I am saying here is not to be taken as Gospel advice.)

As for activity, unless you are severely handicapped or otherwise have a major medical condition that precludes you, you can exercise. As Denninger points out, there are lots of options out there, even for a variety of disabilities.

For most of you, fitness is a choice.

Discuss

Posted on by Amir

There is enough here to offend just about everyone.

I’m seeing a few things here:

(1) Docs are inadequately trained in the area of nutrition. This is not a new fact.
(2) Docs largely have no idea how to address this issue in their patients. It’s easy enough to deal with matters such as cancer, asthma, and other medical conditions that are not often tied to behavior. But confronting obesity–which, with some exception, is a condition that is tied to behavior–usually means confronting lifestyle. No one likes to be told they are responsible for their condition.
(3) Many docs are harder on women than men, even though obesity stats are pretty much even between the sexes.
(4) Many women will be offended, no matter how the doc tries to address the (almost literal) 900 pound elephant in the room.

Campbell, Government, Big Food, Big Medicine, and Nutrition

Posted on by Amir

In The China Study, T. Colin Campbell provides substantial insight as to the conflicts between science, government, the medical establishment, and the food industry in the fight over what constitutes proper nutrition. While he does a wonderful job articulating the mess we currently have, what he fails to understand is that this is exactly why we need to get government out of the business of recommending nutritional guidelines.

Right now, we have a system in which Big Food and Big Medicine–two establishments that wield the big money–pretty much dominate the ear of Big Government.

Big Food–which includes the meat and dairy industry, the fast food industry and related restaurant chains, as well as food companies that make products from meat and dairy–has a vested interest in protecting the status quo. They have hired guns in science and academia who wield a large degree of influence over government agencies, lawmakers, and their staffs.

Big Medicine–which includes physicians, insurance companies, medical services, and Big Pharma–is a similar opponent. While the medical world is increasingly aiming in the direction of prevention of disease, they place the emphasis on prevention that involves the work of medical professionals. Heart scans, angioplasties, bypass surgeries, radiological procedures, colonoscopies, pills, and injections–those are things that bring in the bucks for Big Medicine.

If you go vegan, you may reduce your chances of a heart attack to zero, but it makes no money for your cardiologist or your primary care doc. You’ll also hit many players in the Big Food industry in the pocketbook.

Unfortunately, Campbell seems to think that getting government on the side of the vegans is the answer to all of this. In fact, the better answer is to get government completely out of the business of nutritional guidelines and recommendations.

Ultimately, it’s not the government’s place to control what doctors learn, what doctors discuss with their patients, what citizens wish to eat, or what products Big Pharma and Big Food market to us.

Fact is, in the Internet, we have the best free market of information ever known to the world. And nutrition is not rocket science.

    If you have heart disease, a vegan diet may save your life.
    If you have naturally high cholesterol, an Atkins or South Beach diet is tantamount to pouring gasoline on a fire.
    If you have a high diabetes risk, getting your weight down will go far toward preventing Type 2 Diabetes. If you have Type 2 Diabetes, getting your weight down–and keeping it down–may eliminate your diabetes.

Do we need government to tell us any of those things? Of course not. We don’t know the “causation”, but let’s not kid ourselves: if you’re at risk, the actionable intelligence is there, and it’s on you to decide what to do with it.

People can choose to make their own decisions about nutrition. Dr. Esselstyn found that patients–once they realized the control they had over their disease via diet–were very willing to make the changes they needed to make.

The medical establishment needs to start deciding which team they are on: the side of the patients or the side of their pocketbook. Docs need not advise all patients to go vegan, but if I’m a cardiologist and I have a patient who has heart disease, you can bet that I’m going to be telling him that going vegan may save his life. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient with diabetes (Type 1 or 2), you can bet that I’m going to be telling him that going vegan and getting weight control will cut the amount of insulin needed (for Type 1) and possibly even eliminate the (Type 2) diabetes altogether. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient that is showing some signs of Alzheimer’s or related dementia, you can bet that I’m going to be telling him that he has nothing to lose by going vegan. (While we have not determined the efficacy of this approach with respect to dementia, it’s not like other therapies are working worth a rat’s posterior.)

If I’m a neurologist and I have a patient with MS, you can bet that I’m going to be telling him that going vegan may improve his overall quality of life by mitigating his complications. The science is unmistakable here.

You can also bet that if I have a patient that has found weight control to be elusive, I’ll be telling him that going vegan may succeed where other attempts have failed. The science may not be perfect here, but the pointers are strong enough.

You can also bet that if I have a patient that is in otherwise good health, but who eats a “standard” diet, and he asks me about proper nutrition, I’ll be telling him that at least cutting back the proportion of animal based products–and replacing that with plant-based products–will provide a foundation for long-term health.

On a different take, the patient is going to need to start taking responsibility for knowing what is best and what is not. This information is not restricted from you; it is readily available and is but a mouseclick or two away. You need not spend thousands of dollars on specialists to learn what is available at your library, or via the Internet. I don’t need government to do this for me.

Moreover, by getting the government out of the business of making nutritional recommendations, we will make the landscape more of a true free market. As more people cut back on animal-based products, Big Food will invest more capital in developing plant-based products that are healthier and taste good.

We may also see a driving down of health care costs without costly legislation. Fewer heart procedures, fewer chemo treatments, fewer surgeries…all of that means less strain on insurance costs. It also makes medical pricing for routine services more competitive. Traditional physicians (MDs) may see more competition from osteopaths (DOs) and even chiropractors and nutritionists over basic prevention of disease.

The critics will complain–with some merit–that we will see a lot of quacks emerge. At the same time, we have plenty of quacks now. They exist in the medical establishment, government, and all levels of industry. In the current setup, they are protected by government.

By getting government out of the business of nutrition, we might see a badly-needed shakeup in this area.

Re-Assessing Nutrition, Part 2 (“Correlation does not equal causation” only goes so far)

Posted on by Amir

At times, nutrition can seem like economics: get 3 nutritionists in a room, and you’re going to get 6 different opinions.

Anyone with an opinion can cite one or more studies that give them credibility. If you want to eat a high-fat/high protein diet, there are studies that appear to support you. If you want a low-fat/high-carb diet, there are plenty of studies that appear to support you. If you want something in between, there are studies that appear to support you.

The problem is that when we assess the question–“what is the best dietary regimen”–we often don’t qualify it appropriately. The proper question is, “What is the best dietary regimen for my given activity level and health situation?”

We also have to qualify it–as economists do–by indicating ceteris paribus (all things being equal). This is because some people have food allergies, others have metabolic issues, others have Type 1 Diabetes, and so forth. Dietary needs can vary. This is perhaps the main factor that makes the field of nutrition a difficult one.

Given that a third of Americans are obese, the common question is, “What is the best dietary regimen for getting off these #$%! pounds???”

If you have heart ailments, a better question may be, “What is the best dietary regimen for keeping my ticker tocking?”

If you are an athlete, the question might be, “What dietary regimen puts me in the best position to get my best performance?”

For me, the proper question is, “What is the best dietary regimen that minimizes my risks of cancer, heart disease, and dementia?”

In the world of sports–especially those that require high endurance–the science is indicative of high complex carbs/low-moderate protein/low-moderate fat. In the endurance world, vegans are not uncommon. While weightlifters and bodybuilders are still steeped in protein-mania–and science appears to support that approach in those sports that are dependent on strength–the rest of the sports world is not as big on steak and eggs as was the case 30 years ago.

But what if you are not a full-time athlete? What if you don’t run marathons? What if you’re only getting a couple hours of cardio per week? What if you just want to stay healthy, keep the excess pounds off, keep autoimmune diseases in check (i.e. arthritis) and mitigate your risk of cancer?

What if you’re like me: you want to do all those things, but still do the occasional 100-mile bike ride, or half-marathon, or half-Ironman?

It’s fair to ask what the science says about all of this.

Enter two excellent reads–Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD and The China Study, by T. Colin Campbell.

Esselstyn did his own 20-year study while he was a surgeon at the Cleveland Clinic. He took a set of patients with advanced heart disease–many of them had already had bypass surgery and/or angoplasty–and put them on a strict vegan diet. He monitored the results over a 20 year period. The results were breathtaking: those patients overwhelmingly were able to avoid further cardiac incidents, and in many cases the heart disease was even reversed.

The skeptics, however, can look at Esselstyn’s work and punch holes in it: (a) there was no “control” group, (b) it’s only one isolated study, (c) perhaps Esselstyn was personally biased.

Even then, the results are what they are. It’s a Cleveland Clinic study. Esselstyn’s credentials are impeccable. Any bias-centered criticism of Esselstyn would have to be balanced against his record of intellectual integrity as a physician.

Verdicts:

(a) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who have heart disease and wish to avoid future surgeries and/or premature death.
(b) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who wish to mitigate their risks of heart disease and complications thereof.

And that’s what we’re all about here: ACTIONABLE INTELLIGENCE.

And that brings me to Campbell and The China Study (TCS).

In TCS, Campbell makes a more comprehensive case for a vegan nutritional regimen. He begins by highlighting his scientific work, analyzing carcinogens (aflatoxin), and nutritional approaches in various undeveloped nations. It was in the course of studying the dynamics of aflatoxin that Campbell stumbled into the dilemmas between plant versus animal proteins. His first two chapters are foundational in this respect.

As Campbell made his case for the vegan approach–highlighting links between animal-based diets and a myriad of ailments–the skeptic in me often screamed, “Correlation does not equal causation!” Everyone with a bare-bones-basic knowledge of statistics knows that.

Unfortunately, while that statement is indeed true, it only goes so far. And every physician worth a penny knows that.

Want an example? Type 2 Diabetes.

While we have a plethora of scientific evidence correlating obesity with Type 2 Diabetes, we still have not verified conclusively that obesity causes Type 2 Diabetes. At the same time, (a) every good physician in America will tell diabetes patients to get their weight down and keep it down; and (b) when a Type 2 Diabetic drops the pounds, the diabetes usually goes away.

Correlation does not equal causation, but–if the correlation is strong enough, that constitutes ACTIONABLE INTELLIGENCE.

If dropping the pounds eliminates the diabetes, does it really matter–for your own health–if causation has not been established?

If you have the choice between eating a vegan diet or enduring painful, costly, and debilitating heart surgery, does it matter if causation has not been established?

Now some of Campbell’s proposals are controversial. For example, we have not determined that a vegan diet will keep you from getting Alzheimer’s, or Rheumatoid Arthritis, or Multiple Sclerosis.

Still, given that medical treatments for those diseases have not shown much promise, if eating less meat and jacking up the veggie intake might mitigate that risk–assuming it is a risk that you feel passionate about–then Campbell has given you ACTIONABLE INTELLIGENCE.

Correlation isn’t causation, but it is useful in forming testable hypotheses. At the very least, Campbell provides a nice basis for a myriad of such hypotheses.

Another aspect of TCS that is refreshing is the way Campbell provides insight into how the government has influenced nutrition education in ways that are harmful to Americans. While Campbell strikes me as a left-of-center type, his analysis is without respect for political parties and is more centered on the fascistic, incestuous relationship between lobbyists for the food industry, government agencies, and lawmakers. Campbell also provides a stark picture of how government influences nutrition: from the Department of Agriculture to the Department of Education, and how the food lobby has fought to stack the advisory panels with their own hired guns.

One does not have to be a vegan to appreciate the fact that the government’s recommended daily allowances are too fat-heavy and do not include enough fruits, whole grains, and vegetables. And Campbell provides an honest assessment as to why those recommendations are what they are.

At the end of the day, Campbell is no hack. He’s an honest scientist who has gone where the evidence took him. That evidence has led to many correlations, some of which have statistical significance.

We don’t have causation established, but we have the same smoking guns that appear to be showing up whenever a malady gets studied. You can decide, “Correlation does not equal causation, so I don’t care.” And that is your business. Or you can decide that you have enough inherent risk that this intel is worth acting on. That is also your business.

I would argue that it is not the government’s place to tell you what you must do, but it is on you to decide for yourself if Campbell and Esselstyn are on the money.

Maybe there’s a risk that is important to you; perhaps not. Does everyone need to go vegan? Not by a long shot. Is a total vegan approach required to mitigate the risks highlighted by Campbell? No (although Esselstyn insists on it himself.) Do we need government telling us to go vegan? No.

But if mitigating your risks of cancer, heart disease, stroke, autoimmune disorders, Type 2 Diabetes, and perhaps dementia is important, then it’s worth a look.

My only gripe with TCS: Campbell provides no vegan recipes. He does a wonderful job extolling the virtues of the vegan approach, but does a crappy job of providing a portrait of how appealing and enjoyable it can be. (Esselstyn, however, devotes a large part of his book to providing recipes.)

Campbell, however, has started a larger discussion: to what extent ought government be involved in the promotion of nutrition?

I’ll try to tackle that one next week.

Marriage May be Bad for Physical Health

Posted on by Amir

This has not been the case for myself or for MrsLarijani.

In all seriousness, here’s my observation on the matter. I know couples who were fit until they got married, and then–after the fact–made their fitness less of a priority. Maybe after she had a couple kids, she was not getting out much, not getting to the gym, not going out of walks, and perhaps slacked a little in the food discipline. The husband often did the same: became a homebody, didn’t get that hour of cardio in as he used to, and things got away from him.

Those, however, who continue to at least make their fitness an important priority–even after having kids–still manage to remain fit. They may not get to the gym like they did when they were single, but they still exercise. They may not count every calorie or fat gram or carb as they did when they were single, but they remain sensible with their food discipline. For them, weight gain is light, if at all. A couple with whom Cubbie and I are good friends has managed to do just fine, even with hectic work life, homeschooling, and two kids.

MrsLarijani and I get out to the gym often. I don’t exercise to the same degree that I did during my single days, but my fitness hasn’t suffered. MrsLarijani is in better shape today than she was a year ago: she’s dropped some body fat, added some muscle, and even finished her first half-marathon.

That said, it would be interesting if the Marriage Mandate crowd shows some intellectual honesty in conceding that there is credible research showing that marriage is no panacea.

Anakin and others have done a good job showing that married men are not necessarily happier than single men. Now the evidence is out there showing that marriage is no guarantor of physical health either.

Marriage is a very good thing–MrsLarijani and I are very happy in that–but we were not unhappy as singles. We were not looking to marriage as something that was going to fix everything that was wrong with us.

For the Christian, marriage can be a vehicle for sanctification. The same can be said, however, for singleness. To ask, “How can I be holy without marriage?” is to fail to understand either sanctification or holiness. Neither are dependent on your marital status, although marriage can be a vehicle for those.

Even in sexual matters, marriage is no panacea. I will say this much: marriage, done rightly, makes that battle easier. It will not, however, eliminate all threats of sexual immorality. A married man will find women–otherwise attractive ones–interested in him who would not have given him the time of day when he was single.

For women, the dynamics are a little different, but the threat is the same. It’s no big deal if you’re doing marriage rightly, but if you’re not doing marriage rightly, it’s not hard to see how one can get drawn to those to whom one is forbidden. Don’t believe me? Read Anna Karenina and let’s talk.

I’ve seen pastors walk away from their wives AND CHILDREN–and churches–for other women. I’ve seen pastor’s wives abandon their husbands for other men. Trust me on this: Total Depravity is exactly that. Given the right stimulus and opportunity, anyone is capable of anything.

Marriage doesn’t roll back your depravity. It can make some of the battles easier. It can provide the accountability that you need to face some matters that you might have overlooked as a single. What you–and your spouse–do with that framework is a different matter.

But make no mistake: marriage, in and of itself, is not some magical institution that is going to transform you into a better person.

School Nutrition: Bipartisan Fascism

Posted on by Amir

That Republicans also voted for this terrible piece of legislation only comes to show that both parties are just different sets of whores who tell us that their pimps are less-abusive than the other party’s pimps.

If you want your kid to be healthy, then be a grownup and take that responsibility yourself:

(a) make sure they have good breakfasts in the morning.
(b) Pack their lunch for them.
(c) eat sensibly for dinner.
(d) ensure that they are active and minimize their time in front of the boob tube.
(e) practice good diet and exercise yourself.
(f) educate your kids regarding good nutrition. Do not deprive them of desserts, but encourage their enjoyment in moderation. Educate them regarding soft drinks: don’t avoid them, but keep them in check.
(g) stay the hell away from diet soft drinks.
(h) pay particular attention to portion sizes. Stay away from “large” orders of fried things.

It isn’t that hard. Families did this for decades–without government–and childhood lardassity was hardly the epidemic that it is today.

Is Mohler Right?

Posted on by Amir

Or is he just meddling when he attacks our cultural love affair with yoga? When I started having some degenerative disk issues with my back, the PA at the medical practice recommended yoga.

I know some folks at work who practice it. They insist there is nothing wrong with it, but I never felt that way about any form of meditation that involves emptying the mind. (After all, that’s the persistent state of a liberal: an empty mind.)

There are some who–no doubt–will insist that one can practice the yoga exercises sans the meditation. While that may be possible in theory, I’ve yet to see it in practice. Having done my fair share of studies of New Age spirituality, I am leery of it myself, as it is very difficult to separate the physical exercises from the meditative dimension that makes yoga unique. What do you call yoga without the meditation? It’s glorified calisthenics. (Oh, and the folks I know who do that, are quite overweight. If you want a fitness routine, you need to join Recon’s Fitness Institute, where my cat will work you over with his 1,000-yard stare. I’m just saying…)

There are also others who will cry foul, “Amir, what about martial arts???” On that front, it depends.

Pilgrim is a longtime practitioner of a variety of martial arts. He also used to be a VERY practicing Pagan. He swears by the premise that one can differentiate a fighting art from the meditative exercise. I’d say he’s credible. One can excel in the former without participating in the latter. Even then, one must be wary of the instructors who are teaching it. If they are teaching you techniques and principles for handling different types of attacks and attackers, that’s one thing. If they are teaching transcendental (or other Eastern) meditative exercises, then you’re flirting with heretical practices.