How to break up with your phone, Double Arrow Metabolism edition, Days 10 and 11

Playing catch-up here at Double Arrow Metabolism after being on the road for work. Today (yesterday, actually) is day three of Changing Your Habits week: Change Where You Charge It.

Catherine tells me that to break the automaticity of checking my phone before bed, in bed, and first thing in the morning, I need to create a charging station for my phone and other mobile devices that is outside my bedroom. In effect, I'm transforming my cell phone into a landline. So the ringer volume is going to the top, baby. 

This means I'll have to get an alarm clock, which I still haven't done. 

But in the meantime, I'm to pick a new charging station. I think my kitchen island is a good candidate: 

Then I'm supposed to take all my chargers from other places in the house (especially the bedroom) and move them to this spot. To enforce this for everyone in the house, Catherine tells me to start a "phone bank" where I'll have to pay money every time my phone gets charged somewhere else. I'll put my daughter on the case.

Day 11 is Set Yourself Up for Success day. Catherine tells me this is when we add triggers to make it more likely to do the things I want to do, or things I know I enjoy, instead of reaching for my phone. 

One thing that my phone delivers that I love almost without guilt is podcasts. Trouble is, sometimes podcasts don't play in the order I want them to, and I end up messing around with my phone at stoplights. I don't text and drive; Apple's Do Not Disturb While Driving feature, while the target of some criticism, has basically fixed that temptation for me. But the update to the Podcasts app that's system-delivered on iPhones was a nightmare for this. I never could figure out how to get it to auto-play, and I was constantly looking at my phone at stoplights, trying to get the next podcast to play. Mike Pesca, host of The Gist (one of my favorites), fixed this for me. He recommended the Overcast app. It's spectacular. It allows me to have podcasts enter my feed in order, and it'll just play them one after the other. I highly recommend it. I literally deleted the Apple Podcasts app after I tried it. 

Sometimes, though, I'm just not feeling the podcast I'm listening to. I can only take so much news about the dysfunction of the White House, for example, before I have to turn to something else. And there's not really a good control on the dash of my car that lets me go to the next podcast. So I end up janking around with my phone at intersections, trying to skip to the next show. I can think of a couple interventions for this: First, I'm going to try to set up a playlist before I get in the car for long trips. Second, I'm going to take advantage locally of a new radio station that I really like, or just listen to NPR when I get stuck on a podcast I'm not into. 

At home, I plan to keep going to the library and having a book from my "to read" list nearby all the time. That's not a big change, but it's a part of my routine that I like and that I'm proud of.

Links for Tuesday, October 10, 2017: anabolic steroids are terrible for you, spoon for health, and tabletop devices in restaurants

Anabolic steroids are terrible for your heart.

Just an FYI. By the way, the image above is an ad for WrestleMania VI, a place I think we can all agree had its share of anabolic steroid use. Over 1/3 of the competitors are now dead, all of them prematurely. 

Spooning, on the other hand, is the good stuff.

There is no cheatin' spoon. There's only the big spoon and the little spoon, and your size ain't nothin' but a number:

1. “I love being big spoon but he’s so big I feel like a sloth just hanging onto a branch.”

2. “I’m always the big spoon! Because of the height difference, it makes me feel like I’m a rocket pack!”

3. “I feel like a koala when big spooning my boyfriend because he’s way taller.”

4. “I say if you think you’re going to sleep facing away from me you best be prepared for a koala on your back through the night.”

5. “My boyfriend is almost always the big spoon, although sometimes in the middle of the night I roll over to him and am his ‘jetpack.’ I love being the little spoon but it makes me anxious because sometimes I fart on him when I fall asleep.”

Bonus: “I prefer to lie face down and have my partner lie flat directly on top of me. The weight is so calming and eases my anxiety. Not spooning per se…maybe spatula-ing?”

Tabletop devices in casual dining restaurants aren't going anywhere soon.

How long until they have these in fast food places, too? Even Sonic has started modifying their kiosks to be more interactive. Big potential public health downside: More desserts ordered. Like 30% more.

Diabetes testing is for the [puppies and hoglets and billies]?

The Ad Council (with pro bono help by the ad agency Ogilvy) has released an admittedly adorable set of ads to encourage people to get tested for prediabetes. I agree with them in principle: testing for prediabetes is cost-effective in the long-term as long as it's paired with a lifestyle program that reduces the risk of advancing to full-blown diabetes:

 (mandatory conflict of interest disclosure here: I'm a consultant on a CDC 1422 grant that aims in part to increase screening, detection, and referral of pre-diabetic patients into the Diabetes Prevention Program)

Baby hedgehogs are called hoglets.

But unfortunately, the "testing" offered in these ads is probably far too sensitive. That is, it picks up too many possible pre-diabetes cases and over-diagnoses people.

The evidence for my contrarian stance is here:

Investigators publishing in JAMA Internal Medicine found that, according to a test very similar to the one in the commercials, almost 60% of patients over age 40 would qualify as "at risk" for pre-diabetes, and 81% (!) of those over age 60 would qualify. These numbers are clearly too high; the total population of pre-diabetic persons in the United States is about 86 million:

That's less than 30% of the population. Yet the puppies-and-hoglets-and-goats test says that almost twice that number is at risk. The United States Preventive Services Task Force, on the other hand, says that testing should be done based on only two factors: age (between 40 and 75) and Body Mass Index (25.0 or above). This is a more reasonable strategy based on risk of heart disease, but it unfortunately misses almost half of cases. Investigators publishing in PLoS Medicine found that, by looking at 1.6 years of electronic health record data from 2008-2010, only 45% of patients ultimately diagnosed with diabetes or prediabetes would have been screened under the USPSTF criteria. 78% of the missed cases would have been missed because they were under age 40, and 29% would have been missed because they were too thin, with a BMI under 25.0.

So what's the answer? The answer is to keep yourself from ever transitioning from "person" to "patient" in the first place. If you think you're at risk, based on the puppies-and-hoglets-and-goats test, a hunch, a past blood test, or a soothsayer, make a change. Jump into a new life and reduce your risk. It'll be cost-effective in its own right: Ride your bike to work. Pledge to eat only food that comes from the produce section without packaging for a month. Go to bed earlier at night. Give up bug juice for good. Make a change. And then, only after you've adopted the life you want and deserve, think about whether or not you want to get tested on your own terms.

Links for July 27, 2017: lead levels and crime, CTE, happiness in bariatric surgery, and the Fda's cheese problem

Are high lead levels associated with high crime rates?

In a sample fraught with selection bias, 99.9% of autopsied NFL brains had chronic traumatic encephalopathy.

This bothers me less than I might have thought it would. NFL players are small in number, they have a job that they know is risky, and they're pretty well paid for the work. The fact that they have a now well-documented complication of their employment is only mildly interesting. Where this research needs to go now is into lower levels of play. If evidence begins to accumulate that college, high school, or younger players are at risk for CTE, then wholesale changes are going to be needed in football or the sport is in real danger. 

People with a BMI under 40 are happier and healthier after their surgeries.

I'm a big, big fan of bariatric surgery for people with morbid obesity. We simply have access to no other treatment that improves quality of life and prolongs life to the extent that surgery can. But now there's some evidence (albeit weak) that people should have surgery earlier, not later. In a study published in JAMA Surgery, investigators found that people who had surgery before their body mass index, or BMI, hit 40 were about 12 times as likely as people with higher BMIs to get to a non-obese BMI (that is, less than 30) after surgery. A couple things to consider here: first, surgeons want to operate, so we should acknowledge their bias in this study; of course they want people with lower BMIs to qualify for surgery. It opens up more patients for them and they get to operate on a less sick, less complicated population of patients. But second, weight isn't the only thing we worry about post-surgery, so why does this matter? Because people who got to a BMI of less than 30 were much more likely to be able to stop medications for cholesterol, diabetes (especially insulin), and blood pressure. They were also much more likely to see a remission in their sleep apnea. Finally, the people who got to a lower BMI were just happier, with a satisfaction rate of 92.8% vs 78.0% for folks who didn't get to a non-obese BMI. The study can be tossed into the growing pile of studies showing that gastric banding sucks. Patients who had any other surgery--sleeve gastrectomy, gastric bypass, or duodenal switch--were 8 times, 21 times, and 82 times more likely, respectively, to get to a BMI less than 30 compared with those who got gastric banding. And that doesn't even take into account the disturbingly high complication rate of gastric banding. Take-home points? If you're considering bariatric surgery, get it sooner rather than later, and don't get a gastric band. 

The USDA is all about cheese right now.

I have mixed feelings on this. On the one hand, it seems a little absurd that we so misallocate food subsidies that dairy farmers are literally pouring milk into holes in the ground:

Farmers poured out almost 50 million gallons of unsold milk last year—actually poured it out, into holes in the ground—according to U.S. Department of Agriculture data. In an August 2016 letter, the National Milk Producers Federation begged the USDA for a $150 million bailout.

On the other hand, given the growing evidence that excess meat intake is shortening American lives, diverting some of that desire for meat toward cheese, yogurt, and other dairy products isn't the worst thing in the world. 

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. 

June 9, 2017 better living through hyperlinks: alcohol and your hippocampus, eating late is bad for you, and stop it with the hCG

Even moderate alcohol consumption is associated with atrophy of the hippocampus, the part of your brain that consolidates short-term memories into long-term memories.

More evidence that eating (instead of sleeping) late in the day is bad for you.

Small, small study, and data not available in a peer-reviewed publication yet, but "After controlling for sleep duration, the laboratory study involving healthy volunteers found that compared to eating during the daytime, prolonged eating that began at noon and went as late as 11 p.m. was associated with weight gain, increases in insulin and cholesterol levels, and impaired fat metabolism." My previous warnings about data presented only at conferences applies here, but considering the apparent care put into the study, and its funder (NIH), this'll probably end up published. 

For God's sake, stop taking hCG for weight loss.

It's been shown time and time again not to work, and it's expensive and weird. Stop it. 

Links for May 17, 2017

A patient once 3-D printed this owl for me. It was pretty badass. But nowhere near as badass as a functioning 3-D printed ovary that allows mice to get pregnant(!).

Kids who eat meals at regular times, go to bed on time, and don't drool in front of a screen hours a day have a lower risk of obesity later in life. Huh. "Three-year-old children who had regular bedtimes, mealtimes, and limits on their television/video time had better emotional self-regulation. Lack of a regular bedtime and poorer emotional self-regulation at age 3 were independent predictors of obesity at age 11."

Are the flame retardants in your house putting your cat (and you?) at risk of hyperthyroidism? As much as I'm fascinated by the topic, I'm even more in love with the idea of an "animal endocrine clinic." 

Sausage Linkfest April 21, 2017

Like them or not, soda taxes seem to work. That is, they work to reduce sugar-sweetened beverage consumption. Time will tell if we can trace any health benefit back to them, like we did with trans fat bans. 

School shouldn't start before 8:30, say the sleep people.

Biking to work is associated with a 41% reduction in the risk of dying over five years. Biking was also associated with 45% lower rates of cancer and a 40% lower risk of dying of cancer. And, as has been noted here before, it's associated with having a shitload more money in your bank account.

Even short-term corticosteroid use is harmful, says a review in the BMJ, with accompanying coverage from the NYT. This is ironic, considering a very recent well-publicized study advocating for 10 mg of dexamethasone in place of antibiotics for sore throat. So a couple comments: first, even the "low-dose" steroids the BMJ article talks about constitute a potentially huge dose (20 mg daily). Second, 10 mg of dexamethasone is just a gigantic, chemotherapy-level dose. It is saved by the fact that dexamethasone has a half-life of only ~3 hours, so most of it is gone by the second day. But still...whatever happened to chicken soup and time for things to get better? *sigh* I guess dexamethasone isn't any worse than the cursed "Z-Pak" that urgent cares seem to hand out like Halloween candy. 

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.