Archive for the 'Health' Category

The new heroin epidemic?

I caught a bit of the final Democratic primary debate last night. One question popped that I was not expecting, asking what the nominees would do about the heroin epidemic.

I wasn’t aware we were in the middle of a heroin epidemic and I remember being underwhelmed by the numbers present in the last one, during the grunge-filled 90s. So what are the details? This CNN article says…

In general, drug overdose deaths have been on the rise for the past two decades, but the number of deaths from heroin use is up by 39%.

That means 5,927 people died after using heroin in 2012 and that number jumped to 8,260 deaths in 2013. Those are the latest numbers available.

And to give context…

For perspective: The number of people dying after abusing drugs is higher than the number of people killed in traffic accidents.

Well, waitasec… they mean the total number of people dying from any type of drug (not just heroin) is higher than traffic fatalities? That’s what I will presume though they never in the article actually provide that number.

Of course, if you know me, you know I feel the “let’s compare fatalities from X to traffic fatalities” to be disingenuous as traffic fatalities have gone down substantially in recent decades. (Check out the graph titled “Trends in Automobile Fatalities” on this page.) As I always say, we ought to celebrating that auto fatalities have gotten so low as opposed to using the new lower number to make comparisons.

One final ironic point made in the CNN article. Efforts to prevent people from getting legal opioids may be what driving them to heroin.

Federal, state and local governments have been cracking down on illegal prescription drug sales with some success, according to the Journal study. That may have a connection to the rise in problems with heroin.

Law enforcement has shut down many pill mills. Governments have created rules that tighten prescription practices. Drug manufacturers have been creating more abuse-deterrent versions of their drugs.

All this effort to stop prescription drug abuse has made it much more of a challenge for addicts to get their drug of choice.

That may mean they turn to heroin, a drug that gives users a similar kind of high, but can be cheaper and now may be easier to get, according to the Journal study.

The Sarno-Sacks connection

It’s been a while since I’ve written on the theories of Dr. John Sarno who argues that much of physical pain and distress is caused by the upset mind. (I have to concede I don’t really believe in a “mind” anymore, at least as an entity in any way unattached from the brain, but the word will have to do.) I’m reading through Oliver Sacks’ autobiography and he makes some rather Sarno-esque observations. Sacks started out working at a migraine clinic and had a patient who had recurring migraines every Sunday. Via a pill, Sacks managed to banish the migraines. But they were then replaced with asthma. He offered to give the patient something for the asthma, but…

“No,” he replied. “I’ll just get something else…”
“Do you think I need to be ill on Sundays?”

I [Sacks] was taken aback by his worlds but I said, “Let’s discuss it.”

We then spent two months exploring his putative need to be ill on Sundays. As we did, his migraines got less and less intrusive and finally more or less disappeared. For me, this was an example of how unconscious motives may sometimes ally themselves to physiological propensities, of how one cannot abstract an ailment or it’s treatment from the whole pattern, the context, the economy of someone’s life.

This kind of talking cure is exactly the sort of thing Sarno recommended to his patients. It’s always interested to see these ideas mention by a different source.

Coffee fights diabetes?

I’m never one to miss a chance to tout the benefits of various maligned substances such as coffee and wine (and heroin!) Time mag reports that coffee may offer some protection against Type 2 Diabetes.

The link between drinking coffee and a lower risk of type 2 diabetes onset has been previously discovered, though scientists were unsure why the connection was there. While there was some speculation that the caffeine in coffee might have a role, other data has suggested that people benefit even if they’re drinking decaf.

When a person has diabetes, he or she become insulin resistant. Unregulated blood sugar levels also characterize the disease. The researchers found that cafestol increased blood sugar intake in the cells and that both cafestol and caffeic acid increased insulin secretion. The fact that the two components targeted systems and actions related to diabetes suggests they could be the components that give coffee its protective benefit. The dual benefit of cafestol was especially noteworthy to the study authors.

The usual caveats apply. The study was done on rats and scientists don’t think they understand all the details. Still, have another cup on me!

Sugar spikes caused by different events

I’ve talked a bit in the past of Gary Taub’s (and others’) argument that much mainstream advice on nutrition is wrong. Fat and meat have been condemned, they say, when the real culprits are carbs. The reason being that digested carbs convert to sugars which causes a blood sugar spike, raised insulin levels and increased fat storage. This leads to diabetes, heart issues and obesity. The message is: avoid carbs and sugars.

However, a new study discussed over at ScienceDaily says it’s not that simple. Not everyone gets a blood sugar spike from the same foods. One person can eat a banana and get a sugar spike and eat cookies and not get one, and the reverse is true. And…

The scientists were able to show that lifestyle also mattered: The same food affected blood sugar levels differently in the same person, depending, for example, on whether its consumption had been preceded by exercise or sleep.

This rings a bell for me. For a long time a treat for breakfast was waffles and syrup—basically all carbs and sugars. It was a great tasting meal but often I would get what felt like a sugar crash (meaning, I think, that I’d had a spike and it had depleted) just before lunch—I would get really really hungry fast. I don’t experience this with my usual breakfast of beans, a bit of potatoes and protein (eggs or meat.) However, I’ve also noticed that even if I eat a high carb dinner it’s never followed by this sugar crash. There’s something about the evening meal that just feels different, less likely to lead to a sugar spike.

I get high with a little help from my sugar

I’ve mentioned that I’ve been experimenting with a diet low in carbs and sugar. I haven’t been totally consistent—this weekend was my girlfriend’s birthday party and it was impossible to avoid sweets—but I find it easy to maintain. I’ve noticed one curious side effect: a subtle smoothing out of my mood. It’s hard to really pin down and it could be all in my head (which is, of course, where mood should be) but I feel more on an even keel.

This makes sense. We all know sugar amps us up and then gives us a sugar crash. So, if I’m avoiding those ups and down in body chemistry it should be no surprise that I feel calmer. But it’s interesting to actually observe this effect in myself.

I will say it is, at times, a calmness that borders on being bored. Whatever the evils of sugar, they make life interesting; sugar gives the day an added punch when one is lacking. And I suppose for some people that punch could be addictive.

An obvious question arises: Can sugar be blamed for people’s psychological problems? Since one can find evidence for almost any opinion on the web, we shouldn’t have to look long. And indeed we don’t. (In this case, a Psychology Today article.)

The roller coaster of high blood sugar followed by a crash may accentuate the symptoms of mood disorders. Research(link is external) has tied heavy sugar consumption to an increased risk of depression and worse outcomes in individuals with schizophrenia.

There’s more at the link. As with sugar, consume at your own discretion.

Nothing is certain

I’ve gotten a sense over the years of the futility of most debates about politics and related topics—history, philosophy, ethics etc. I can think of very few discussions where I changed someone’s mind or had mine changed. People seem very fixed in their opinions and unwilling to move in the face of evidence.

This may not be entirely unreasonable. I think we all have a certain sense that how evidence is presented can distort reality. For example, someone could say, “A 1998 study showed that people who ate mouse droppings lost weight,” while declining to mention all the studies that did not support this argument or the fact that the particular study that did was rife with methodology errors. We’re smart not to take things at face value.

But sometimes the evidence is pretty solid and people seem unwilling to change. I find myself guilty of this; I read something contrary to my beliefs and I almost feel physically resistant. We want our truth to be the truth. Which is really a matter of ego, I suppose.

I find myself particularly bothered by conspiracy theories. Donald Trump just recently repeated the idea that vaccines cause autism. This idea has been as disproved as possible but refuses to die. Because, I guess, people just want to believe it.

I’ve been reading an interesting book by Micheal Shermer called “The Believing Brain” where he examines why we are so prone to believe things that fly in the face of evidence. It’s stuff you’ve probably heard before: we want control over uncertainty and conspiracy theories give us knowledge which is a stepping stone to control Why’d your kid get autism? The correct answer is: who knows? The psychologically comforting answer is because he was poisoned by vaccines.

If there’s been an overall trend in my thought for the past 8 or so years it’s been that things are pretty uncertain and we basically need to embrace that. As I’ve recounted a million times, I had pretty solid faith in the medical establishment until I came down with a dizziness they could not explain. I had hand pain that lasted for years and was impervious to any number the “fixes” medicine offered. To solve these problems you basically have to stumble around in the dark until you find something. Few experts saw the economic bust of 2008 coming. It seems like nobody predicted the rise of ISIS in the middle east. Did anyone six months ago seriously think Donald Trump would be the leading Republican candidate? The experts on these matters seem to be largely a group of know-nothings*. But if they know nothing, then we know nothing and that’s not solid ground to stand on.

But maybe that’s where we are. And maybe accepting that is the best course of action. Embrace the mystery of life and all that.

*I’m reminded of the study that political pundits are mostly spectacularly wrong in their predictions.

Are carbs the embodiment of evil?

i never been anywhere near what people might call fat. But my weight has fluctuated over the years. At one point several years ago I was down to about 160 (after a trying a non gluten diet to cure the dizziness I’ve complained about. It didn’t work.) A couple years after that I ballooned up to 180 or so and it showed. Since then I probably float around 170. I usually don’t look fat but I sometimes have a smallish belly—sort of like the characters from Doonesbury.

As you can tell from reading this blog lately, I’ve been reading about diet and have been intrigued by the argument that carbs are the real cause of fattening. So for the past month or so I’ve been “sort of” avoiding carbs—not eating much toast, rice, pasta etc. It’s not something I’ve put much thought into, just a general disinclination towards carbs. (Not total avoidance. I had a hamburger with a white bread bun last night.) And I have clearly slimmed down quite a bit.

(To be more precise, I’ve really been avoiding simple carbs and sugars. I still eat a fair amount of beans which are a complex carb.)

So what is the crux of the argument against carbs? Gary Taubs is a science writer and the leading voice in the anti-carb movement. He has a semi-recent NY Times op-ed stating his point:

If obesity is a fuel-partitioning problem — a fat-storage defect — then the trigger becomes not the quantity of food available but the quality. Now carbohydrates in the diet become the prime suspects, especially refined and easily digestible carbohydrates (foods that have what’s called a high glycemic index) and sugars.

The obvious mechanism: carbohydrates stimulate secretion of the hormone insulin, which works, among other things, to store fat in our fat cells.

Basically, carbs are sugar, and sugars spike your insulin causing your body to hoard fat (and ultimately set you up for diabetes.)

As Taubs states at the end of the piece, this is not an ironclad argument. More research needs to be done, blah, blah, blah. But he does voice the obvious thought.

From this perspective, the trial suggests that among the bad decisions we can make to maintain our weight is exactly what the government and medical organizations like the American Heart Association have been telling us to do: eat low-fat, carbohydrate-rich diets, even if those diets include whole grains and fruits and vegetables.

Now, I mentioned before that there was another time my weight dropped: when I was avoiding glutens (as well as dairy and a few other things. Not meat though.) When you skip glutens you avoid a lot of carbs—glutens are in bread, cereal etc. My one junk food treat in that time was potato chips which are gluten free. So, I was probably on a low carb diet, just not really thinking of it in those terms.

As a counterpoint to all this I offer my Dad who ate plenty of carbs, drank a fair amount, basically put no thought into his diet yet remained thin his whole life. (He did have heart issues though.) So there’s probably no one-size fits all method here. But I suspect fat’s reputation is going to rise in coming years and carbs’ will decrease.

Defending Saturated Fats

I mentioned a while back that I was reading the book “The Big Fat Surprise” which argues that—contrary to conventional wisdom—a diet high in saturated fats (e.g. meat, dairy etc) is good for you. This should not be understood to say that a diet high in trans-fats (e.g. Cheetos, crackers, etc.) is good for you. Because it is not.

The book also states that a diet high in carbs is bad for you, leading to obesity and diabetes.

These are controversial assertions, certainly, and they basically imply that the U.S Government has been recommending an awful diet (high carbs, low fats) for years.

Nonetheless, I’ve noticed several pieces popping up recently on a science blog I frequent called Science Daily that seem to support the arguments made by “The Big fat Surprise.” Consider…

Trans fats, but not saturated fats like butter, linked to greater risk of early death and heart disease

A study led by researchers at McMaster University has found that that trans fats are associated with greater risk of death and coronary heart disease, but saturated fats are not associated with an increased risk of death, heart disease, stroke, or Type 2 diabetes.

The team found no clear association between higher intake of saturated fats and death for any reason, coronary heart disease (CHD), cardiovascular disease (CVD), ischemic stroke or type 2 diabetes.

However, consumption of industrial trans fats was associated with a 34 per cent increase in death for any reason, a 28 per cent increased risk of CHD mortality, and a 21 per cent increase in the risk of CHD.

Or…
Low saturated fat diets don’t curb heart disease risk or help you live longer

Diets low in saturated fat don’t curb heart disease risk or help you live longer, says a leading US cardiovascular research scientist and doctor of pharmacy in an editorial in the open access journal Open Heart.

Now I’m the first to admit that one should tread carefully here as none of these statements has really been “proven.” (Studies need to be replicated about a billion times to really have merit.) But “The Big Fat Surprise” did make some interesting anecdotal points that stuck with me. Consider Eskimos. For years they basically ate a diet of fatty fish and game—and had rates of cardiovascular disease much lower than non-Native Americans* (e.g. white people.) Then they shifted over to the high carb diets of the white man and they were assaulted with such disease. The Masai in Africa are a similar case study.

* Here’s an interesting Discover magazine article about this called “The Inuit Paradox.”

So it seems fair to ask questions.

Omega-6 fatty acids and violence?

I’ve been reading the book “The Big Fat Surprise” which strongly makes the argument that foods high in saturated fat have been unfairly chastised for being unhealthy. I think the author is probably on to something though there’s so many variables at play in these discussions it’s hard to keep it all straight in your head.

The book does bring up an interesting point that I have seen made before (specifically in a book I discussed here called “The Anatomy of Violence.”) There seems to be a real correlation between consumption of Omega-6 fatty acids (which are found in the vegetable oils that became popular as alternatives to oils high in saturated fats) and suicide and violence. The following Psychology Today article looks specifically at the violence part of the equation.

Violence: Are There Dietary Causes?

https://www.psychologytoday.com/blog/perfect-health-diet/201212/violence-are-there-dietary-causes

One major dietary change that may have contributed to rising rates of violence has been the shift toward omega-6 rich seed oils, such as soybean oil and corn oil, in foodstuffs.

Joseph Hibbeln and collaborators had the idea of comparing omega-6 consumption to rates of violence. They found, across countries and over a period of decades, that omega-6 consumption was correlated to homicide rates…

It seems pretty absurd that diet could cause violence (we all jokingly recall the Twinkie defense) but I think we do have some sense that our mood is affected by what we eat. Certainly I’m less likely to go out and kill after having a satisfying meal.

I’m not sure what to make of it all but it’s an interesting observation.

What’s up with cholesterol?

I’m often talking about the foibles of the medical establishment, though usually as related to pain management and such. But I’ve been reading a bit about cholesterol and it seems like conventional wisdom about several aspects of the topic has been turned on its head.

For example, the decades old advice about avoiding foods with high cholesterol (like eggs) doesn’t seem to hold up. Avoiding these foods doesn’t have much correlation with the cholesterol levels of your body. (Cholesterol is actually produced by your body.) In this case, you aren’t what you eat. Don’t take my word for it.

In February, however, the Dietary Guidelines Advisory Committee (DGAC) rocked the nutrition and medical worlds by changing their tune.

In its report, the committee states: “Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol. … Cholesterol is not a nutrient of concern for overconsumption.”

Perhaps more interesting is the news on saturated fats which we’ve been advised to avoid for years because it raises cholesterol levels. You probably know that there are two types of cholesterol: Good HDL cholesterol and bad LDL cholesterol. But is LDL really bad? It turns out there are different subtypes of LDL

LDL comes in four basic forms: a big, fluffy form known as large LDL, and three increasingly dense forms known as medium, small, and very small LDL. A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms. The big, fluffy particles are largely benign, while the small, dense versions keep lipid-science researchers awake at night.

So, by advising people to avoid saturated fats and eats more carbs, health advisors may have been inadvertently raising people’s levels of really bad, small LDL cholesterol.

Oops.