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.

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 15, 2017 laser links: drones for cardiac arrest, aircraft noise and blood pressure, and BMI's effect on fetal malformations

Drones can deliver automatic external defibrillators (AEDs) to cardiac arrests 3 km away in 5 minutes. Drones!

We better hope those drones aren't noisy, though: a couple months ago I stayed in an AirBnB east of downtown San Diego for a few days. We were directly under the final approach for SAN, and except late at night, a plane would roar overhead every few minutes. Bad news for the people in that otherwise charming neighborhood: all that aircraft noise may increase their blood pressure.

In case you woke up in too good of a mood, here's evidence that women with a higher BMI have a higher risk of giving birth to a baby with malformations.

The effect size is small (adjusted risk ratios for any birth defect were 1.05 for BMIs 25–29.9, 1.12 for BMIs 30–34.9, 1.23 for BMIs 35–39.9, and 1.37 for BMIs over 40.

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. 

March 23, 2017 links

NBA players play better on the road now because they get more sleep, among other proposed factors. Why do they get more sleep, you ask? They find their, *ahem* "dates" on social media instead of by going to clubs. You should get more sleep, too. But probably not this way.

Direct-to-consumer advertising is astonishingly effective at getting men testosterone prescriptions, many of them without even being tested (!).

Things you can control right now

There are a lot of things you can't control: the weather, the stock market, your neighbor's loud music. But many, many things are under your control, as pointed out by Lori Deschene. And how well you do at seizing control makes a huge difference in your health and happiness:

Right now, you can control:

1. How many times you smile today.

7. When you pull out your wallet for luxuries.

11. How often you notice and appreciate small acts of kindness.

17. The type of food you eat.

21. How much exercise you get.

22. How many times you swear in traffic. [I'd amend this to say that you can control how often you're in traffic at all. If you're swearing at traffic, chances are you are the traffic.]

27. The attention you give to your loved ones when you see them.

28. How much you enjoy the things you have right now.

41. Whether you formulate a new plan or act on your existing one. [this is my favorite]

44. Whether you smoke or drink. [unless you’re an alcoholic, in which case you are in control of whether or not you seek help from a qualified practitioner]

50. How much rest you get at night.

40 minutes

Who is the maniac posting here the last few days? 

What the hell is Double Arrow Metabolism? Doctors always think they know everything. And I don't like the looks of this guy. He was probably born skinny, and here he is trying to judge the rest of us for driving cars, smoking, eating processed foods, spending our money on whatever we want, and spending our free time on social media. Sure, maybe you can be healthy if you've got a good set of genes and luck into a doctor who's not a quack. But it's a roll of the dice. Life is hard, and this guy acts like we can all just "choose" to be healthy. Some of us have obligations! Kids at home, a mortgage to pay. So we get a little stressed out and watch some TV and maybe have a beer or two. Live a little for a change. So what? 

Yet some people live happily and healthily into their 90s, while the overall life expectancy is going down. Is it all just genetics, or is there something we can do to live longer and happier? Let's examine the thin grey line between being healthy and happy and being sick and depressed.

How thin is the line? How about 40 minutes a day?

Let's say you are holding your own, health-wise. On the Double Arrow Metabolism Wellness Index, you're a solid two or three. Then you decide that lying on your side for thirty minutes in bed each night flipping through your Facebook feed is more important to you than moving through space like you were designed to do. All the light from the screen blasting into your retinas throws off your sleep cycle, so you wake up in the middle of every night for ten minutes and raid the fridge to the tune of 200 highly-processed calories.

Then, since you couldn't sleep the night before, you wake up twenty minutes late and decide that you don't have time to make a sensible, non-cake-based breakfast at home.

Let's assume that you commute less than five miles to work, as a solid plurality of
Americans do. You're in a hurry and instead of biking, walking, or busing to work, you swing your fancy gas-powered wheelchair through McDonald’s on your way there and spend $5 on a meal that should have cost you less than $2. Let's be generous and say that this breakfast was no better and no worse than what you would've had at home (a generous assumption indeed). Say this routine (self-inflicted bad sleep, sedentary commuting, breakfast of processed crap, repeat) becomes a habit.

So that 40 minutes a day: 30 minutes of Gay French King scrolling Twitter or Facebook, then 10 minutes of late-night insomnia binging, all at the sacrifice of a more meaningful breakfast and commute, leads to this: 1400 extra highly-processed calories a week in food intake, 1148 fewer calories per week burned by missing your average 19.2 minute one-way cycling commute, $21 a week spent on food you didn't need and shouldn't have bought, and, at the current Federal rate of $0.52 per mile, $30 a week from gas-powered wheelchair driving. And, for the sake of being fair, let's say your fancy gas-powered wheelchair is a sensible car and not a gas-guzzling adult Tonka Toy:

Goodbye, one year's salary. I'll miss you.

If that's what you drive, these numbers would be far, far worse.

End result? One year later, if you started out at 150 lbs, you're now almost 60 pounds heavier. The extra $1440 you spent on your habit in that year, had you just put it in an indexed fund, would now be worth $1541.

And ten years later, if you really fell into a rut, that 40 minutes would have cost you $10,791! Your weight would eventually level out--we all hit our genetic max for obesity at some point--but you'd almost certainly have complications, like diabetes, heart disease, or sleep apnea.

And all this assumes you didn't even take on any credit card debt to pay for this, and assumes that the bad sleep you were getting didn't make your metabolic issues worse, and doesn't even take into account the $1184/year that your new diagnosis of diabetes cost you.

40 minutes a day to stay out of this swirling vortex. 40 minutes.