Links for Monday, October 8, 2018: Ashton Lambie, vibrator myths, really old-timey pumpkin spice, Mac is skinny, and the thyroid diet

Since I’ve been hustling to finish a couple big projects the last month, we’ve fallen behind. Got some catching up to do!

Meet Ashton Lambie, Kansan and new World Record Holder in the 4k Individual Pursuit

I've watched that giant 'stache ride away from me in approximately 1,000 gravel races.

Your favorite party story about how doctors used to manually "stimulate" the genitals of hysterical women with vibrators? That one? It's probably a myth.

And we're all worse off for it. 

Even prehistoric Asians couldn’t resist the #PSL

“Look, it's not that hard. All you need to do is lift weights six days a week, stop drinking alcohol, don't eat anything after 7 p.m., don't eat any carbs or sugar at all, in fact just don't eat anything you like, get the personal trainer from Magic Mike, sleep nine hours a night, run three miles a day, and have a studio pay for the whole thing over a six to seven month span. I don’t know why everyone’s not doing this. It’s a super realistic lifestyle and an appropriate body image to compare oneself to.”

No more cultivation of mass for Mac. I hate, hate, hate the culture that pretends that models and actors/actresses can eat all they want and somehow magically stay thin. Maybe Rob McElhenney gets to say things that actresses can’t.

Is there such a thing as the “thyroid diet?”

Within reason, no. (registration required)

Links for Wednesday, September 5, 2018: docs are nervous about weight loss meds, risky low-carb diets, why I'm not a pediatrician, and continuity of care is good

Why don't more docs prescribe weight loss medications?

Speculation: 1) cost (and by extension, prior authorization requests); 2) residual fear from fen-phen, as one of the docs interviewed alluded to. We can surely put this to bed, since the current crop of meds has been on the market much longer than fen-phen had been when its harm was revealed; 3) nihilism. Five percent weight loss is meaningful from a medical perspective, but unless the doc is consciously, prospectively measuring outcomes like blood pressure, lipids, and fasting sugars, it won't knock her socks off. Patients won't be thanking her for getting them ready for bikini season; and 4) the old Risk Evaluation and Mitigation Strategy (REMS) for Qsymia was such a PIA that it scarred some docs to prescribing these meds.

Can we stick a fork in low-carbohydrate diets? (Ba Dum Tss)

What's a 32% increase in mortality among friends? Investigators (in a study that, to my knowledge, has not yet been published, so caveat emptor) found an association between the lowest quartiles of carbohydrate intake and death:

NHANES data. Model 1 is unadjusted for other risk factors. Model 2 is adjusted. These are ugly, ugly numbers. 

Remember: we can't draw causality from this. There is some chance that people who are sick and more likely to die from heart disease, cancer, or stroke are more likely to adopt low-carbohydrate diets. But it doesn't seem likely. The people at highest risk in this study were those over age 55 and "non-obese."

Reason # 1,001 I'm not a pediatrician:

Can. Not. Do. It.

Special shout-out to the 100 cell phone text alerts during the video. 

If lack of continuity is a mark against telemedicine, then it's a mark against the hospitalist model in general

Links for Thursday, August 30, 2018: don't try ballpoint pen cricothyrotomy, the Peterson family beef cleanse, 100 great 2018 articles, and 10k steps

"A cricothyrotomy just with a ballpoint pen is virtually impossible"

Aaaaaand I've found my new favorite study. It replaces my old favorite, which included the line "Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio."

Jordan Peterson's family seems to be on a "beef cleanse." Do we even need to point out that this is a bad idea?

No. We don't. But we do it anyway: 

[Jack Gilbert, the faculty director at the University of Chicago’s Microbiome Center and a professor of surgery] has done extensive research on how the trillions of microbes in our guts digest food, and the look on his face when I told him about the all-beef diet was unamused. He began rattling off the expected ramifications: “Your body would start to have severe dysregulation, within six months, of the majority of the processes that deal with metabolism; you would have no short-chain fatty acids in your cells; most of the by-products of gastrointestinal polysaccharide fermentation would shut down, so you wouldn’t be able to regulate your hormone levels; you’d enter into cardiac issues due to alterations in cell receptors; your microbiota would just be devastated.”

While much of the internet has been following this story in a somewhat snide way, Gilbert appeared genuinely concerned and saddened: “If she does not die of colon cancer or some other severe cardiometabolic disease, the life—I can’t imagine.”

Here's your weekend reading list

How many steps per day should a person get, really?

“A company [in Japan] there created a man-po-kei, a pedometer. And man stands for ‘10,000,’ po stands for ‘step,’ and kei stands for ‘meter’ or ‘gauge.’” Ten thousand, it turns out, “is a very auspicious number” in Japanese culture, said Theodore Bestor, a Harvard researcher of Japanese society and culture, in an email. “That is, it seems likely to me that the 10,000 steps goal was subsidiary to having a good-sounding name for marketing purposes.” Whatever the reason for the adoption of this particular number, “It resonated with people at the time, and they went man-po-kei-ing all over the place,” said Tudor-Locke.

Pubmed indexes 175 articles published since June 2015, the date of the linked article above, containing the phrase "10,000 steps". And as weird as its origin story is, the recommendation has been validated, more or less, and has gone on to be endorsed fairly universally.

Links for September 11, 2017: insect burgers, lessons from the PURE Study, death row food, and plastic in the water

I'm not bothered at all by the thought of insect larvae burgers. Are you?

For reasons I can't figure out, Swiss law allows use of only mealworm larvae, house crickets and migratory locusts. But apparently they taste fine:

The burger itself has little white specks of rice inside with traces of carrot, paprika, chili powder and pepper. After a hesitant bite, the main flavors that come out are the spices. The texture is curious, a bit like a meaty falafel with a crunch. An aftertaste lingered — but maybe that was just my subconscious playing tricks.

Sales are apparently brisk in a very limited release so far. 

See also: Chapul cricket bars, which are delicious, and the Impossible Burger.

Marion Nestle points out what we already know about the PURE Study (that's Prospective Urban Rural Epidemiology): Fruits, veggies, and legumes are good for us.

And refined carbohydrates and sugar are bad. The study's "high fat" diet didn't even approach the amount of fat that most of us eat (18-30% versus 35% in the US), so it's impossible to really say what the study proved in regards to fat intake. 

See also: David Katz on PURE, James Hamblin on PURE.

On death row, food rivals porn as an obsession for inmates.

Text below, in case you want to avoid reading the grisly details of a murdered family:

The second-most-prevalent obsession is food. Longo says he actually has two photo collections: nude women and gourmet cuisine. His letters to me are filled with food cravings: "a salt bagel with a full plain cream cheese schmeer from Einstein or Brueggers — toasted, of course"; "a cinnabon with a good cup of coffee"; "a pizza"; "honey-dripping baklava." To make the institutional meals more palatable, the men sometimes hold death-row dinner parties. Several inmates will pass their trays down the row to one cell — frequently, to Longo's. He'll combine all the food together, add commissary-bought items like hot sauce, peppers, and shredded cheese, then rebuild the plates "Cadillac style," as it's called, and send the trays back.

How all this plays into the choice of a last meal, I don't know.

94% of US tap water is contaminated by plastic fibers

I cannot find data on bottled water, but considering that most of it is packaged in plastic, I suspect it's no better. Why does this matter? Well, besides the ick factor, plastics have a notorious reputation in the endocrinology world as "endocrine disruptors," meaning that they exert a hormone-like effect on tissues. The most notorious chemical within plastics with this effect is bisphenol A, which among other effects acts as an estrogen mimic.

Weekend links for Saturday, August 17, 2017: post-apocalyptic Rio, money makes the Mediterranean diet work, DNA testing may not change behavior, and the folly of clean eating

A year later, the Rio Olympic sites are ruin porn. 

Is money the secret to making the Mediterranean diet work? 

To be fair: I don't know a lot about this literature at all, but I suspect that the same claim could be made of many interventions, dietary and otherwise, were the data known. The more money you have, the healthier you are in general. (link via kottke.org)

Knowing our DNA risk doesn't make us change our behaviors.

I need to investigate this further. The thrust of this article--that knowing our risky mutations doesn't make us behave any differently--flies in the face of some data I've presented in the past. 

Have we all fallen for "clean eating?"

I remain convinced that eating food that looks like food, in the Michael Pollan sense, is generally what we should all be doing. Like most ventures that people look to capitalize on, though, it has been taken too far: see the "influencers" in this article that actually make themselves sick with adherence to an irrationally vegetable-based, uncooked diet. (link via longform.org)

Links for July 25, 2017: Cooking oil, Saving lives in New Jersey by raising the smoking age, and the cult of statin denial

Which cooking oil should you use?

In the above and linked infographic (from the outstanding work of informationisbeautiful.net), look for oils with a big green bar, a small red bar, and no blue at all. Here's olive oil, which is generally recognized as being one of the best oils health-wise for cooking:

This dovetails nicely with the recent re-discovery that coconut oil isn't great for you (link here; look toward the bottom).

I've become a big fan of sauteeing with avocado oil, which you see at the top of the graphic, because of its high smoke point and high monounsaturated fat content. Don't take this as an endorsement of its health effects, though. Almost no data exists on the topic. 

New Jersey just raised its smoking age, and it will probably save lives. 

"About 90 percent of adults who become daily smokers report first using cigarettes before 19 years of age, and almost 100 percent report first use before 26, according to the IOM report."

Is denial of the benefits of statin medications a cult?

"We are losing the battle for the hearts and minds of our patients to Web sites developed by people with little or no scientific expertise, who often pedal 'natural' or 'drug-free' remedies for elevated cholesterol levels."

Whether or not these websites collectively reach the threshold of "cult," their message definitely causes people to die younger than they should. (link is subscription only)

Links for July 17, 2017: open streets, placebo diets, hair dyes and cancer risk, the sedgwick county CHIP, bad sleep and junk food, and the lengthening of your life with dietary choices

Open Streets ICT is coming. Are you ready?

Are diets just placebos?

Is your hair dye increasing your risk of breast cancer?

Hair products, conveniently, seem to never get the wrath that other "artificial" lifestyle products (artificial sweeteners, preservatives, herbicides) get. Does this study change that? I doubt it.

Have you seen the Sedgwick County CHIP?

That's Community Health Improvement Plan, which is even more delicious than what you were thinking of...

Sleeping poorly may make junk food seem a lot more appealing.

The data is still maturing on this topic, but it's starting to look pretty obvious that we should all sleep more, for reasons obvious and not-so-obvious. I can speak from experience. During my internship, one of the hospitals I covered had a cafeteria that was free--in unlimited quantities--to trainees. I fell into a nasty habit of 3 am cheesecake binges during my in-house nights on call. It was ugly...

This paper deserves to be mentioned much higher in the list, but I may have more to say about it later. So...for the one-thousanth time, we have evidence that dietary choices can prolong or shorten your life.

Using one of three diet indices, investigators publishing in the New England Journal of Medicine found that "[a] 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17%." For the sake of comparison, taking a statin medication for cholesterol in high-risk people is associated with about a fourteen percent reduction in mortality. And to stave off the angry emails, I know that the statin data comes from high-quality randomized trials, while the referenced dietary study is observational. But still. 

Don't wanna see the sausage links made, July 7, 2017: New endocrine society statement on obesity pathogenesis and the danger (danger!) of placenta capsules (placenta capsules?)

"...obesity is caused by two distinct processes: energy homeostasis and energy imbalance – specifically, energy intake greater than expenditure."

This is an excerpt from the Endocrine Society's new statement on obesity pathogenesis. I'm relieved to see it. In the past couple of years, as investigators have (rightly) cast light on some of the shortcomings of the calorie as a measure of energy consumption or energy expenditure, the internet has drowned in chatter about how obesity isn't a matter of energy in versus energy out. When of course it is. You simply can't make fat out of air or sunshine. At some level, people who carry more weight than they'd like are eating an excess amount energy or expending an insufficient amount of energy or both. The fact that we don't have a perfect way to measure or quantify it doesn't change that fact. So this nugget from the Endocrine Society's press release is welcome, too: 

“Because of the body’s energy balance adjustments, most individuals who successfully lose weight struggle to maintain weight loss over time,” said Michael W. Schwartz, M.D., of the University of Washington in Seattle, Wash., and the chair of the task force that authored the Society’s Scientific Statement. “To effectively treat obesity, we need to better understand the mechanisms that cause this phenomenon, and to devise interventions that specifically address them. Our therapeutic focus has traditionally been on achieving weight reduction. Most patients can do this; what they have the most trouble with is keeping the weight off. Healthcare providers and patients need to view this tendency as the body’s expected response to weight loss, rather than as a sign of a failed treatment regimen or noncompliance with treatment,” Schwartz said."

In case you were wondering, the CDC is warning against the consumption of dried placenta capsules because of a risk of group B streptococcal infection.

Why am I so late getting to this news? Anyway: there goes my best baby shower side-hustle idea...