Friday, April 29, 2011

Calcium: U.S. adults still not getting enough

A new study suggests most U.S. adults continue to fail to get enough of the mineral through diet and supplementation to meet recommended levels.

University of Connecticut and Yale University researchers examined data from National Health and Nutrition Examination Survey collected from 9,475 adults between 2003 and 2006. They found that, although dietary calcium intake was reported highest in older age groups, the amounts remained insufficient to meet adequate intake standards for age groups 50 years and older.

These inadequate intakes come despite the fact that more than half of individuals ages 19 and older were taking a calcium supplement, according to the authors. For men, supplementation increased from 34 percent in the 19 – 30 age group to 54 percent in the 81 and older age group. The percentage of women taking supplements rose from 42 percent to 64 percent across the same range of age groups.

"Adequate lifelong calcium intake is essential to optimizing bone health," remind the study authors, who published their findings in the May 2011 issue of Journal of American Dietetic Association. They also recommend "new approaches to increasing the frequency and level of calcium supplement use to enhance calcium density in diets."

Calcium is the most abundant mineral in the body, primarily found in the bones and teeth. As bones develop, calcium, along with other minerals, crystallizes on the collagen matrix of the bone, making it denser and giving it strength and rigidity. The body loses calcium continuously, and if this loss is not replaced through diet, the body will remove calcium from the bones to perform necessary functions such as regulation of muscle contraction. This removal causes bones to become soft and brittle, making them prone to fractures.

Adequate calcium intake is necessary for strong and healthy bones. The current recommended intake of calcium is between 1,000 mg and 1,300 mg per day. Good sources (more than 300 mg per serving) of calcium include dairy products such as low-fat milk, cheese, and yogurt. Dark green vegetables such as broccoli, kale, and spinach can also add about 90 milligrams of this mineral to daily intake. In addition, calcium-fortified foods (orange juice and breakfast cereals) and dietary supplements can also help fill gaps.
Other important factors in optimizing bone health include engaging in weight-bearing exercise and obtaining recommended amounts of vitamins D and K2 daily.

Reference: Mangano KM, Walsh SJ, Insogna KL, Kenny AM, Kerstetter JE. Calcium Intake in the United States from Dietary and Supplemental Sources across Adult Age Groups: New Estimates from the National Health and Nutrition Examination Survey 2003-2006. J Am Diet Assoc 2011;111:687-95.


Time and time again, studies have shown that calcium when combined with vitamin D are effective in increasing bone density. However, there's been a lot of back and forth in the calcium world around the topic of supplements, particularly their efficacy and safety. A critical piece lacking in the conversation is of absorption since calcium is one mineral that depends on a few factors -- vitamin D, doses that oversaturate absorption, too much absorbed at once.

The best approach for obtaining calcium is perhaps to consume it as we would have back in the time of our hunter-gatherers ancestors before the agricultural revolution and pastoralism, which is by getting a little here and a little there when we only obtained it from the leaves of plants. That's not to say that we should only get it from plant leaves, but that we should get it in smaller amounts in sustained fashion over the course of a day.

Wednesday, April 27, 2011

Wake up, Neo-evolution

What would you change about your own naturally evolved, naturally flawed body? Would you choose genetics to avoid diseases like Alzheimer's, diabetes, and cancer? Would you enhance your brain to increase memory and to boost creativity? Would you choose more fast-twitch muscle fibers to run faster or longer? Would you live longer?

These are the questions that Harvey Fineberg, president of the Institute of Medicine, discusses in this new TED talk given in March that was posted only this month. Fineberg says that a new era of neo-evolution -- in which we, as humans, could guide the selection of traits that would define the course of humanity -- is upon us, and he called it "exciting," but "frightening."

I want to answer all of his questions with a "Yes, sign me up!" Who is insane enough to reject a world with an absence of disease, of aging, of dying and death?

Apparently, there are quite a few people. Hava Tirosh-Samuelson, professor of history at Arizona State University, is one of them. Earlier this month, at ASU's Origins Project Science and Culture Festival Tirosh-Samuelson was speaking about a completely different topic when she suddenly surprised us with a few critical words of the "so-called trans-humanist movement."

In a nutshell, her argument is that we still haven't a clue of what humanity is to begin with, so reason suggests against trying to define what it should be in the future. Naturally, after her talk, I decided to ask Tirosh-Samuelson a few questions about her views.

In my discussion with her, she conceded that eliminating suffering from disease was a good thing in its own right and also agreed that because of medicine and technology all of us are already trans-humanists in a sense. So, why the hostility toward neo-evolution, trans-humanism, the singularity?

She told me that a trans-humanist future -- in which everyone has enhanced faculties, superior brains, superior fitness, etc. -- has the grand possibility of ending up very boring.

After all, she said, "What defines happiness? We don't know. What defines humanity?"

You can see her essay on the subject here.

While discussing with Tirosh-Samuelson about these questions, I was reminded of several sci-fi movies including Gattaca and The Matrix (I can now think of at least a half dozen others now), where we're presented to two completely different stories of the human condition in a futuristic world governed by technological advances. In each, our hero defies imposed order and seeks to achieve his greatest potential.

Maybe, just maybe, that is what happiness is -- seeking your own greatest potential. Or, maybe, happiness is simply in the journey. Either way, I'm inclined to suggest that we find happiness by heeding to the words of Joseph Campbell: "Follow your bliss."

And as for Fineberg and his neo-evolution and what it will mean to the future of humanity, we can all agree that it's just going to happen anyway -- so why be frightened? why not welcome it? why not just wake up to its possibilities? -- because what is really happening is humanity itself on its never-ending journey seeking survival, enhancement and comfort of itself, and happiness (whatever that is).

Sunday, April 24, 2011

Alcohol consumption, gender, and type 2 diabetes: Strange … but true

Let me start this post with a warning about spirits (hard liquor). Taken on an empty stomach, they cause an acute suppression of liver glycogenesis. In other words, your liver becomes acutely insulin resistant for a while. How long? It depends on how much you drink; possibly as long as a few hours. So it is not a very good idea to consume them immediately before eating carbohydrate-rich foods, natural or not, or as part of sweet drinks. You may end up with near diabetic blood sugar levels, even if your liver is insulin sensitive under normal circumstances.

The other day I was thinking about this, and the title of this article caught my attention: Alcohol Consumption and the Risk of Type 2 Diabetes Mellitus. This article is available here in full text. In it, Kao and colleagues show us a very interesting table (Table 4), relating alcohol consumption in men and women with incidence of type 2 diabetes. I charted the data from Model 3 in that table, and here is what I got:

I used the data from Model 3 because it adjusted for a lot of things: age, race, education, family history of diabetes, body mass index, waist/hip ratio, physical activity, total energy intake, smoking history, history of hypertension, fasting serum insulin, and fasting serum glucose. Whoa! As you can see, Model 3 even adjusted for preexisting insulin resistance and impaired glucose metabolism.

So, according to the charts, the more women drink, the lower is the risk of developing type 2 diabetes, even if they drink more than 21 drinks per week. For men, the sweet spot is 7-14 drinks per week; after 21 drinks per week the risk goes up significantly.

A drink is defined as: a 4-ounce glass of wine, a 12-ounce bottle or can of beer, or a 1.5-ounce shot of hard liquor. The amounts of ethanol vary, with more in hard liquor: 4 ounces of wine = 10.8 g of ethanol, 12 ounces of beer = 13.2 g of ethanol, and 1.5 ounces of spirits = 15.1 g of ethanol.

Initially I thought that these results were due to measurement error, particularly because the study relies on questionnaires. But I did some digging and checking, and now think they are not. In fact, there are plausible explanations for them. Here is what I think, and it has to do with a fundamental difference between men and women – sex hormones.

In men, alcohol consumption, particularly in large quantities, suppresses testosterone production. And testosterone levels are inversely associated with diabetes in men. Heavy alcohol consumption also increases estrogen production in men, which is not good news either.

In women, alcohol consumption, particularly in large quantities, increases estrogen production. And estrogen levels are (you guessed it) inversely associated with diabetes in women. Unnatural suppression of testosterone levels in women is not good either, as this hormone also plays important roles in women; e.g., it influences mood and bone density.

What if we were to disregard the possible negative health effects of suppressing testosterone production in women; should women start downing 21 drinks or more per week? The answer is “no”, because alcohol consumption, particularly in large quantities, increases the risk of breast cancer in women. So, for women, alcohol consumption in moderation may also provide overall health benefits, as it does for men; but for different reasons.

Friday, April 22, 2011

Health at Telomere's Length

A health checkup could soon incorporate a telomere measurement to estimate a person's biological age as a superior indicator of age-related degeneration and vulnerability to disease than chronological age, reports Mitch Leslie in an article entitled, "Are Telomere Tests Ready for Prime Time," published in Science magazine today.

The article reports that two companies have announced plans to start performing tests for the general public this year: Life Length of Madrid has already began offering the tests to patients and Telome Health, of Menlo Park, Calif., will begin to make them available to clinicians sometime later this year.

Already, medical researchers have employed telomere measurement for predicting illness and tailoring treatments to save lives, yet the article reports that skepticism exists about how effective telomere tests will be in predicting disease or determining lifespan in a clinical setting.

"By curtailing self-renewal, worn-down telomeres might promote the senescence of our bodies—although how much has been controversial," writes Leslie.

On one side of the issue is Telome Health co-founder Elizabeth H. Blackburn, a cell biologist at University of California, San Francisco (UCSF), who is quoted as saying "Telomeres are an integrative indicator of health."

Carol W. Greider, a former graduate student in Blackburn's lab and a molecular biologist at Johns Hopkins University School of Medicine in Baltimore, Maryland, disagrees saying, “Do I think it’s useful to have a bunch of companies offering to measure telomere length so people can find out how old they are? No.”

In 2009, Blackburn and Greider were awarded the Nobel Prize in Physiology or Medicine, along with Jack W. Szostack, for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase.

Telomeres are comprised of non-coding, repetitive sequences of coiled DNA that serve as protective caps at the end of chromosomes, preserving their integrity and keeping them from fraying and sticking to each other.

Shortened telomeres are linked with a greater chance of developing cardiovascular disease, diabetes, Alzheimer's disease, and other chronic diseases. In the last few years, studies have also showed that the rate of telomere shortening can be strongly affected by diet and lifestyle.

According to the article, among factors that affect telomeres harshly are smoking, drinking heavily, obesity, and chronic psychological stress. On the other hand, meditation, exercise, a healthy diet, and higher blood levels in omega-3 fatty acids offer a buffer to help maintain longer telomeres.

The enzyme telomerase, which plays a role in helping to maintain telomere length, is a recognized target of pharmaceutical-nutraceutical companies for producing possible therapies in the future.

Monday, April 18, 2011

Low bone mineral content in older Eskimos: Meat-eating or shrinking?

Mazess & Mather (1974) is probably the most widely cited article summarizing evidence that bone mineral content in older North Alaskan Eskimos was lower (10 to 15 percent) than that of United States whites. Their finding has been widely attributed to the diet of the Eskimos, which is very high in animal protein. Here is what they say:

“The sample consisted of 217 children, 89 adults, and 107 elderly (over 50 years). Eskimo children had a lower bone mineral content than United States whites by 5 to 10% but this was consistent with their smaller body and bone size. Young Eskimo adults (20 to 39 years) of both sexes were similar to whites, but after age 40 the Eskimos of both sexes had a deficit of from 10 to 15% relative to white standards.”

Note that their findings refer strictly to Eskimos older than 40, not Eskimo children or even young adults. If a diet very high in animal protein were to cause significant bone loss, one would expect that diet to cause significant bone loss in children and young adults as well. Not only in those older than 40.

So what may be the actual reason behind this reduced bone mineral content in older Eskimos?

Let me make a small digression here. If you want to meet quite a few anthropologists who are conducting, or have conducted, field research with isolated or semi-isolated hunter-gatherers, you should consider attending the annual Human Behavior and Evolution Society (HBES) conference. I have attended this conference in the past, several times, as a presenter. That gave me the opportunity to listen to some very interesting presentations and poster sessions, and talk with many anthropologists.

Often anthropologists will tell you that, as hunter-gatherers age, they sort of “shrink”. They lose lean body mass, frequently to the point of becoming quite frail in as early as their 60s and 70s. They tend to gain body fat, but not to the point of becoming obese, with that fat replacing lean body mass yet not forming major visceral deposits. Degenerative diseases are not a big problem when you “shrink” in this way; bigger problems are  accidents (e.g., falls) and opportunistic infections. Often older hunter-gatherers have low blood pressure, no sign of diabetes or cancer, and no heart disease. Still, they frequently die younger than one would expect in the absence of degenerative diseases.

A problem normally faced by older hunter-gatherers is poor nutrition, which is both partially caused and compounded by lack of exercise. Hunter-gatherers usually perceive the Western idea of exercise as plain stupidity. If older hunter-gatherers can get youngsters in their prime to do physically demanding work for them, they typically will not do it themselves. Appetite seems to be negatively affected, leading to poor nutrition; dehydration often is a problem as well.

Now, we know from this post that animal protein consumption does not lead to bone loss. In fact, it seems to increase bone mineral content. But there is something that decreases bone mineral content, as well as muscle mass, like nothing else – lack of physical activity. And there is something that increases bone mineral content, as well as muscle mass, in a significant way – vigorous weight-bearing exercise.

Take a look at the figure below, which I already discussed on a previous post. It shows a clear pattern of benign ventricular hypertrophy in Eskimos aged 30-39. That goes down dramatically after age 40. Remember what Mazess & Mather (1974) said in their article: “… after age 40 the Eskimos of both sexes had a deficit of from 10 to 15% relative to white standards”.

Benign ventricular hypertrophy is also known as athlete's heart, because it is common among athletes, and caused by vigorous physical activity. A prevalence of ventricular hypertrophy at a relatively young age, and declining with age, would suggest benign hypertrophy. The opposite would suggest pathological hypertrophy, which is normally induced by obesity and chronic hypertension.

So there you have it. The reason older Eskimos were found to have lower bone mineral content after 40 is likely not due to their diet.  It is likely due to the same reasons why they "shrink", and also in part because they "shrink". Not only does physical activity decrease dramatically as Eskimos age, but so does lean body mass.

Obese Westerners tend to have higher bone density on average, because they frequently have to carry their own excess body weight around, which can be seen as a form of weight-bearing exercise. They pay the price by having a higher incidence of degenerative diseases, which probably end up killing them earlier, on average, than osteoporosis complications.


Mazess R.B., & Mather, W.W. (1974). Bone mineral content of North Alaskan Eskimos. American Journal of Clinical Nutrition, 27(9), 916-925.

Thursday, April 14, 2011

Stress Awareness Month and the baboon inside you

I love to read about Robert Sapolsky's baboons. They give me a kind of peace -- the kind received when you succeed in letting go of a stressful situation by thinking, "we're all just a bunch of baboons."

What you get from Sapolsky's books, apart from its enjoyable wittiness, is a unique snapshot on how baboons are affected by stress, which is more or less the same way that we are affected by stress. Only, while baboons are stressed occasionally -- by a more dominant baboon or to escape a predator, for example -- we humans have built ourselves an environment where we're stressed chronically.

This chronic stress of modern life leads to constant release of stress hormones (glutocorticoids) that continually harms the body, the brain, and brings about possible stress-induced disorders or even chronic diseases. In honor of Stress Awareness Month, it's a problem worth talking about.

In fact, the results of a study presented April 4 at the American Association for Cancer Research's 102nd annual meeting has added to cumulative evidence that psychological stress may age you faster. Their research showed that psychological stress did so by speeding up the shortening of telomeres, which are repeating sequences of non-coding DNA coiled up in "knots" that act as protective caps on chromosomes. The telomeres the scientists measure were those of leukocytes, and stress's link to telomere shortening suggests a possible weakening of the immune system and perhaps a possible factor in the etiology of certain cancers.

Another new study (open access), this one led by Nobel laureate Elizabeth Blackburn and published in PLos One, also found that individuals with major depression had severely shortened telomeres, perhaps caused by the "glucocorticoid cascade" and chronic exposure to oxidation and inflammation  or by leukocyte turnover, which may explain why depressed individuals often have a high risk of chronic disease including diabetes, cardiovascular disease, and osteoporosis. (By the way, I was fortunate enough to meet Blackburn last weekend at Experimental Biology, where she likened telomeres to bookends on a shelf.)

For those of us who are interested in living long happy lives, these are eye-opening studies and we all may do better to find ways of coping with stress in our lives. Common tips are to take regular vacations, take up a fun hobby, exercise regularly, enjoy the outdoors, watch funny movies, spend time with your family, and so on.

I'll add that one major de-stressor for me has been Sapolsky. If you haven't read his books, I recommend you do because they will give you a unique perspective into stress and the perspective to be able to separate yourself from it. The first I read was A Primate's Memoir: A Neuroscientist's Unconventional Life Among the Baboons, then Why Zebras Don't Get Ulcers, and most recently with The Trouble With Testosterone: And Other Essays On The Biology Of The Human Predicament.

What African Americans should know about vitamin D and heart health

A while back, I was talking with a friend of mine. He was a giant of a black man and we spoke about his  blood pressure woes and his weight issues. So I asked him about his diet, his habits, and all that. He told me all about it: How he ate all the right foods, how he was trying to avoid the wrong ones, and how he recently started walking on his treadmill.

I said to him, "What do you do all day?"

He said, "I'm in the office all day."

"What do you do at lunchtime?"

"I usually have a protein shake or eat a salad with some chicken."

That's good, I tell him. But I want you to do one more thing. It's easy. While or after you eat, take a walk. Outside. In the parking lot. Once or twice a week.

OK, he says. "But why outside?"

I said, "Sunlight and vitamin D." Then, I told him a story we should all be familiar with by now, which went something like this:

Darker skin is a result of greater production of a pigment called melanin that rewards skin with a natural protection against ultraviolet light. Ultraviolet light would otherwise burn skin, destroy the body's stores of nutrients like folic acid that are needed for refurbishing DNA, increase risk of neural tube defects among other reproductive problems, and also raise risk of skin cancer.

So, in short, melanin is a good thing. Near the equator, with strong UVB rays aplenty to compensate slower vitamin D production, darker skin offers an evolutionary advantage that would only serve to sustain naked humans. But, as often is the case, reward comes with recompense. The downside of higher amounts of melanin is that the pigment interferes with the skin's ability to absorb enough UVB rays to activate Vitamin D's pre-cursor into a full-fledged hormone.
As is well-documented, humans at higher latitudes with dark skin would never have survived over the generations without shedding the extra melanin and opting for a lighter color. Lighter color would afford more UVB absorbed, more D created, stronger bones and, as evidence emerges to show, better cardiovascular health. During summer months, lighter-skinned humans who had migrated to higher latitudes collected vitamin D in fat as they gained weight, then released it into the bloodstream when they shed weight during sunlight-lacking winter months.

On the other hand, when darker-skinned humans live in a Northern latitudes of the United States -- as African Americans do -- you can bet that problems will arise.

Then, I gave him some details about asking his doctor for a 25-hydroxyvitamin D test.

A couple of weeks later, I spotted him outside walking around a parking lot. He tells me, "Thanks so much, David. I had no idea about vitamin D. Plus, my doctor says the walking and the vitamin D are helping my heart."

While attending Experimental Biology (#eb2011) over the weekend, one of the presentations had me thinking about my friend. And that was Richard Harris, Ph.D., of Georgia Health Sciences University in Augusta, presenting a study on vitamin D supplementation in African Americans.

What Dr. Harris and his fellow Georgia researchers found was that vitamin D supplementation in overweight African American adults in a single dose of 60,000 IU every for four weeks every 16 weeks improved blood vessel endothelial function – the equivalent of 2,000 IU since vitamin D has a half life of about three weeks.

It was notable that they used overweight adults, since extra weight can increase blood volume, raise blood pressure, resulting in rigid, inflamed vessels. Details are that the researchers used an inflatable cuff to increase blood flow in the brachial arteries of each of the participants, then an ultrasound to measure flow-mediated dilation.

What exactly vitamin D was able to do is what Dr. Harris calls the "million-dollar question," according to this press release. But it's likely that the hormone acted directly on endothelial cells, on a receptor perhaps, that helps dilate blood vessels when needed. The more dilation, the easier it is for blood to flow through vessels.

This study is great news, especially for this population at higher risk for cardiovascular disease factors like higher blood pressure. However, there is still too little vitamin D deficiency awareness.

Here's what I say, Why not teach African Americans why they have a greater need for vitamin D from an evolutionary perspective?

In the case of my friend, it really helped put things in perspective. There's an easy solution for this mess, which is to take a walk around the block for a few minutes when UVB rays are out (mostly just in summer months) or, simply, by just taking a vitamin D supplement as they did in the summer. Lots of benefits to come from such an easy habit of getting D daily like better blood pressure along with better bone health.

Another thing is that the Institute of Medicine's recommended daily intakes of vitamin D (although they are based as if there were no sun-produced D at all) just make little sense when they don't treat all adults the same, not bringing high-risk groups into consideration. Until more research is available and the IOM can build on current guidelines by raising them for high-risk groups, African Americans should take health into their own hands by getting tested to make sure they keep 25-hydroxyvitamin D in healthy ranges continually.   

Monday, April 11, 2011

Beef meatballs, with no spaghetti

There are pizza restaurants, whose specialty is pizza, even though they usually have a few side dishes. Not healthy enough?

Well, don’t despair, there are meatball restaurants too. I know of at least one, The Meatball Shop, on 84 Stanton Street, in New York City.

Finally a restaurant that elevates the "lowly" meatball to its well deserved place!

Meatballs are delicious, easy to prepare, and you can use quite a variety of meats to do them. Below is a simple recipe. We used ground grass-fed beef, not because of omega-6 concerns (see this post), but because of the different taste.

- Prepare some dry seasoning powder by mixing sea salt, parsley, garlic power, chili powder, and a small amount of cayenne pepper.
- Thoroughly mix 1 pound of ground beef, one or two eggs, and the seasoning powder.
- Make about 10 meatballs, and place them in a frying pan with a small amount of water (see picture below).
- Cover the pan and cook on low fire for about 1 hour.

There is no need for any oil in the pan. On a low fire the small amount of water at the bottom will heat up, circulate, and essentially steam the meatballs. The water will also prevent the meatballs from sticking to the pan. Some moisture will also be released by the meat.

Part of the fat from the meat will be released and accumulate at the bottom of the pan. If you add tomato sauce and mix, the fat will become part of the resulting red sauce. This sauce will add moisture back to the dish, as the meatballs sometimes get a bit dry from the cooking.

Five meatballs of the type that we used (about 15 percent fat) will have about 57 g of protein and 32 g of fat; the latter mostly saturated and monounsaturated (both healthy). They will also be a good source of vitamins B12 and B6, niacin, zinc, selenium, and phosphorus.

Add a fruit or a sweet potato as a side dish to 3-5 meatballs and you have a delicious and nutritious meal that may eve impress some people!

Friday, April 8, 2011

Office for National Statistics Consultation on Well-Being...

On Thursday 7th April, I took part in a consultation event with the Office for National Statistics (ONS) at Bolton University called; Are the Best Things in Life Free? A Public Discussion and Debate. Alongside fellow panelists Dr John Howarth – (Expert on wellbeing), Gillian Halliwell – (Manager of £17m Big Lottery Wellbeing Projects), Reverend Canon Mike Williams – (Spirituality and Wellbeing) and Rachel Burke – (Bolton Lads and Girls Club), I took the position that creativity, culture and the arts have a significant part to play in the ‘well-being’ agenda. This event gave each of us the opportunity to make a ‘pitch’ for our area of interest and, we hope, influence the ONS.

The event was chaired by Carole Truman, Professor of Health and Community Studies at Bolton University, and an opening address on the ONS consultation process was given by Stephen Hicks, Assistant Deputy Director of the Measuring National Wellbeing programme, Office for National Statistics.

Whilst I’ll make brief reference to them, I can’t aim to cover all the speakers’ contributions here, but want to give a taste of what I crammed into my far-too-brief 5 minute overview; some of the questions raised and some thoughts that didn’t have time to be aired.
An exhausted Clive tries in vain to keep his fellow panellists riveted.
It was significant that Stephen opened the session by framing well-being as being more than the subjective ‘happiness’ that seems to be the flavor of the month, and he gave a definition of the ‘dynamic’ nature of wellbeing that would be typified in the new economics foundation definition;

‘Well-being is most usefully thought of as the dynamic process that gives people a sense of how their lives are going, through the interaction between their circumstances, activities and psychological resources or ‘mental capital.’1
He went on to outline the coalition governments commitment to better understand of well-being and how it can be ‘measured’, expressing a clear understanding that subjective measurements of well-being fall outside the traditional ‘market model’. John Howarth talked about the intensity of work and family commitments and its impact on work/life balance. Gillian talked eloquently about the importance of personal resources in dealing with the stresses of life and the importance of positive social relationships.

Mike talked about faith communities as being ‘gold-mines’ of resources for community well-being; a point I’d agree with, but in my opinion he over-egged the point that well-being and spirituality are inseparable and can only be achieved through a belief in God. For me his comments about the ‘myth of the happy poor’ could warrant a full debate in itself, particularly when one considers the doctrine of some organised religion that places an emphasis on suffering in this life to gain eternal salvation. Rachel gave a full and rounded picture of the very real impact of the work of youth work and sporting activity on the well-being on children and young people as an investment in tomorrow’s citizens.

For my part, I used a number of stories in an attempt to paint a picture of how the arts/cultural engagement can impact on individuals and communities, by opening up new opportunities and offering a means of transformation. Here I’ll make reference to the points I made, and some I didn’t have opportunity to expand on.

Because this was a public event, I spelt out some clear messages: that this agenda went beyond murals on hospital corridors and that I was not a therapist, but grew as an artist within a tradition of community and participatory arts.

I shared the story of a man marginalised by learning disabilities in a long-stay hospital I worked at in the 1980’s, and how the arts enabled him not only to express his individualism, but impose some order on his chaotic life. For me, this was a significant stage in my understanding of the transformative impact of the arts.

Making sense of this individual story in relationship to wider community impact, I shared research findings from the Invest to Save: Arts in Health Project2 which illustrated not only the reduction in symptoms of ill-health, depression and anxiety in the participants of robust arts/health projects; but the increased well-being, evidenced through environmental mastery, autonomy and social connectedness. In fact, much of what are commonly referred to as the 5 Ways to Well-being3.

I discussed the range of questionnaires used, but emphasised the importance of story in making wider sense of this work and talked briefly about the importance of the arts/health community getting better at telling a richer story, of how we create value. I wanted to stress the importance of both longitudinal studies in the field, as well as embracing some of the ideas posited by John Knell and Matthew Taylor around Contingent Value and Social Return on Investment4; a point I later laboured with Stephen, and one that should be taken seriously by the ONS and the coalition government. These are areas that I would be keen to explore with partners in the field.

I spent some time equating the reported rise in anti-depressant prescribing in England over the last four years by over 40%, with consumerism and the pathologising of our day-to-day anxieties and worries, in our bid to be ‘happy’, and as Pascal Bruckner observes, “unhappiness is not only unhappiness, it is worse yet, a failure to be happy.'5

Whilst the World Health Organisation tell us that over the next 20 years, depression will become the single biggest burden on society6, I see some of the social and economic issues affecting society, married with our blind faith in well-marketed pharmacology, as contributing to high levels of social disconnectedness and isolation.

Previous editor of the BMJ, Richard Smith comments, ‘More and more of life’s inevitable processes and difficulties—birth, sexuality, ageing, unhappiness, tiredness, and loneliness —are being medicalised, and we are growing the budget of health care to tackle them. But medicine cannot solve these problems, and…I believe…that the humanities can help us with a problem as pressing as that of attitudes to death (and) climate change. Scientists have long identified the problem, but we have failed to act effectively– largely, I believe, through our evolutionary flaws of selfishness and lack of imagination.7

I did find time to describe yet another story of people whose lives had been turned around through organizations like START in Salford8, that not only give people a sense of community and pride, but through challenging art experiences give opportunity make informed choices and flourish.

If time had allowed, I would share some of the remarkable work that I’m engaged in with Derbyshire Community Health Services, where we have evidenced astounding changes in the lives of people affected by dementia; where again, engaged in challenging art activity and not soporific reminiscence, we have evidence sentience in a number of people, who’s prognosis is in itself, the biggest discriminator. On the basis of this early work, we are embarking on an action research process to better understand this remarkable affect of the arts. And this work is not about finding a magic-bullet cure, but is focused on the quality of our existence in our later years.

Darren Browett
It is here we must strive to develop more than statistical analysis of our findings and marry the numerical data with real stories to affect cultural change in the way we perceive aging and dying, and how we care for growing numbers of people affected by dementia.

It seems that the backlash to current NHS reforms has encouraged the coalition government to enter a ‘listening exercise’, and I hope that the arts are seen as a valuable way of exploring issues around health, education and well-being. We know that the arts contribute hugely to the UK economy and according to a DCMS report in 2008 the creative industries employ 2 million people in Britain and contribute £60 billion to the economy each year, 7.3 percent of UK GDP.9

Sceptics of the arts/health agenda still call for a cold measurement of impact, holding up the Randomised Controlled Trial as the ‘gold standard’. Stephen and the panel seemed to agree that measuring well-being is far more subtle than this, and I illustrated how the figures can be manipulated, citing an article in the BMJ that showed drugs manufacturer Pfizer, chose to hold back back 74% of patient data from the clinical trials of the antidepressant Reboxetine, that showed that it is, ‘overall an ineffective and potentially harming antidepressant’.10 As Jonah Lehrer in Proust was a Neuroscientist quips, ‘…measurement is always imperfect, and explanations are easy to invent.’11

I’m not going to suggest that it’s wrong to attempt to measure well-being, or indeed the way that the arts may, or may not, contribute to this agenda. I’d go so far to say that statistics, and what we can garner from mass observations, are incredibly useful to society and knowledge. What I’d like to do though, is raise the level of this debate and the profile of our work. We observe that the arts connect people; encourage activity, learning and imagination, and through active engagement with high quality arts experiences, there is the potential to impact on public good and civic society.

The participatory arts offer us potential to flourish as humans and I urge us all to think less about illness, and disease and more about salutogenesis; the focusing on the factors that create health and well-being. I suggest to you that the arts offer us all, a way of making sense of the world, communicating our aspirations and facilitating change.

Please feed your comments into the Office for National Statistics, Measurement of National Well-Being @

5. Perpertual Euphoria: On The Duty To Be Happy, By Pascal Bruckner

Thursday, April 7, 2011

News, Views and Opportunities...

Health Innovation Challenge Fund (UK)
The Department of Health and the Wellcome Trust are inviting proposals from organisations and research groups seeking to draw on funding from the Health Innovation Challenge Fund to further the development of innovative healthcare products, technologies and interventions, and to facilitate their development for the benefit of patients in the NHS and beyond. The theme for this funding round is Smart Surgery: Innovative technologies or interventions to reduce, replace or refine invasive surgical procedures. Up to £10 million is available to organisations such as NHS organisations (including NHS Trusts and NHS Foundation Trusts), and equivalent UK authorities; universities, and research institutes and not-for profit organisations; start-up companies founded to capture and develop intellectual property of relevance to healthcare; and biotechnology, pharmaceutical, bioinformatics, engineering or other companies; etc that will deliver ‘Smart Surgery’ solutions that will translate into safe and cost-effective practice into the NHS. The deadline for submitting preliminary applications is 5pm on the 28th April 2011. For more information visit: Fund/index.htm

Artist to work with Arts for Health group for Culture Shops
The Arts for Health service are looking to run two eight week creative courses. The courses run weekly for two hour sessions. The artists will need to have experience of working with adults suffering with mental health difficulties. The artist would work with the Arts for Health group to produce work which would then be exhibited as part of the Blackpool Culture shop programme, whereby work is displayed in an empty shop in Blackpool. The first course would be April- June 2011 and second course to be June-August 2011. Details at:
Arthur and Martha

An Interesting Project to Watch
Arthur and Martha engagement project with older people in St.Helens.
Over the course of this week the Arthur and Martha are working in diverse settings such as the local health centre, library and bingo group... These initial pilot taster sessions will shape how we move forward from this period and develop the activity. As well as delivering the project Arthur and Martha will be blogging about the work and I thought you would be interested in being kept up to date on how the project is progressing.
The link to the blog can be found here:

Knowledge Lives Everywhere
Arts and Health week 2 - 8 June 2011
Do you work with arts and health? Are you an individual or an organisation with something to contribute to the new FACT exhibition Knowledge Lives Everywhere? Throughout this exhibition there are themed weeks being held in Gallery 2, programmed by FACT collaborators and guests. We would like to hear from you if you work within arts and health and have a film you would like to screen (or suggest a topical film), give a talk, do a performance or wish to have a change of scene and hold a meeting in the space! Do you have any burning issues surrounding arts and health you wish to communicate to the world via a webcast? We will try and accommodate your content and ideas. Please use this opportunity to put the spotlight on arts and health during an exciting exhibition which celebrates all things creative and collaborative! We look forward to hearing from you. If you are interested in taking part please contact Angy or Kat on 0151 707 4416 or  

Reading for Wellbeing: The Reader Organisation’s Second National Conference
Tuesday 17th May 2011
Floral Pavilion, New Brighton, Wirral
“Get Into Reading helps patients suffering from depression in terms of: their social well-being, by increasing personal confidence and reducing social isolation; their mental well-being, by improving powers of concentration and fostering an interest in new learning or new ways of understanding; their emotional and psychological well-being, by increasing self-awareness and enhancing the ability to articulate profound issues of self and being.”
‘Therapeutic Benefits of Reading in Relation to Depression’, Billington et al., 2011
Further details at

Music & wellbeing: Making Music Conference
10 – 11 September 2011, Glasgow
The impact and application of music to improve mental, physical and social wellbeing has many advocates and well-established initiatives demonstrating positive impact. Making Music will be looking at programmes taking place across the UK and the opportunities these create for voluntary music.

Arts in Health – a new prognosis
In this article, our friend and colleague Mike White looks at how the arts community can adapt and respond to changes in healthcare provision and organisation. In recent years the arts in health field has acquired the expertise to address a wide spectrum of medical, health and social care issues. It has the resilience and resourcefulness to weather the impending health service reforms in an era of austerity. But it will need to adapt conceptually and in delivery to healthcare environments in which patient choice, GP commissioning power and a new public health workforce are the drivers of change.  

Monday, April 4, 2011

The China Study II: Carbohydrates, fat, calories, insulin, and obesity

The “great blogosphere debate” rages on regarding the effects of carbohydrates and insulin on health. A lot of action has been happening recently on Peter’s blog, with knowledgeable folks chiming in, such as Peter himself, Dr. Harris, Dr. B.G. (my sista from anotha mista), John, Nigel, CarbSane, Gunther G., Ed, and many others.

I like to see open debate among people who hold different views consistently, are willing to back them up with at least some evidence, and keep on challenging each other’s views. It is very unlikely that any one person holds the whole truth regarding health matters. Unfortunately this type of debate also confuses a lot of people, particularly those blog lurkers who want to get all of their health information from one single source.

Part of that “great blogosphere debate” debate hinges on the effect of low or high carbohydrate dieting on total calorie consumption. Well, let us see what the China Study II data can tell us about that, and about a few other things.

WarpPLS was used to do the analyses below. For other China Study analyses, many using WarpPLS as well as HealthCorrelator for Excel, click here. For the dataset used here, visit the HealthCorrelator for Excel site and check under the sample datasets area.

The two graphs below show the relationships between various foods, carbohydrates as a percentage of total calories, and total calorie consumption. A basic linear analysis was employed here. As carbohydrates as a percentage of total calories go up, the diet generally becomes a high carbohydrate diet. As it goes down, we see a move to the low carbohydrate end of the scale.

The left parts of the two graphs above are very similar. They tell us that wheat flour consumption is very strongly and negatively associated with rice consumption; i.e., wheat flour displaces rice. They tell us that fruit consumption is positively associated with rice consumption. They also tell us that high wheat flour consumption is strongly and positively associated with being on a high carbohydrate diet.

Neither rice nor fruit consumption has a statistically significant influence on whether the diet is high or low in carbohydrates, with rice having some effect and fruit practically none. But wheat flour consumption does. Increases in wheat flour consumption lead to a clear move toward the high carbohydrate diet end of the scale.

People may find the above results odd, but they should realize that white glutinous rice is only 20 percent carbohydrate, whereas wheat flour products are usually 50 percent carbohydrate or more. Someone consuming 400 g of white rice per day, and no other carbohydrates, will be consuming only 80 g of carbohydrates per day. Someone consuming 400 g of wheat flour products will be consuming 200 g of carbohydrates per day or more.

Fruits generally have much less carbohydrate than white rice, even very sweet fruits. For example, an apple is about 12 percent carbohydrate.

There is a measure that reflects the above differences somewhat. That measure is the glycemic load of a food; not to be confused with the glycemic index.

The right parts of the graphs above tell us something else. They tell us that the percentage of carbohydrates in one’s diet is strongly associated with total calorie consumption, and that this is not the case with percentage of fat in one’s diet.

Given the above, one may be interested in looking at the contribution of individual foods to total calorie consumption. The graph below focuses on that. The results take nonlinearity into consideration; they were generated using the Warp3 algorithm option of WarpPLS.

As you can see, wheat flour consumption is more strongly associated with total calories than rice; both associations being positive. Animal food consumption is negatively associated, somewhat weakly but statistically significantly, with total calories. Let me repeat for emphasis: negatively associated. This means that, as animal food consumption goes up, total calories consumed go down.

These results may seem paradoxical, but keep in mind that animal foods displace wheat flour in this dataset. Note that I am not saying that wheat flour consumption is a confounder; it is controlled for in the model above.

What does this all mean?

Increases in both wheat flour and rice consumption lead to increases in total caloric intake in this dataset. Wheat has a stronger effect. One plausible mechanism for this is abnormally high blood glucose elevations promoting abnormally high insulin responses. Refined carbohydrate-rich foods are particularly good at raising blood glucose fast and keeping it elevated, because they usually contain a lot of easily digestible carbohydrates. The amounts here are significantly higher than anything our body is “designed” to handle.

In normoglycemic folks, that could lead to a “lite” version of reactive hypoglycemia, leading to hunger again after a few hours following food consumption. Insulin drives calories, as fat, into adipocytes. It also keeps those calories there. If insulin is abnormally elevated for longer than it should be, one becomes hungry while storing fat; the fat that should have been released to meet the energy needs of the body. Over time, more calories are consumed; and they add up.

The above interpretation is consistent with the result that the percentage of fat in one’s diet has a statistically non-significant effect on total calorie consumption. That association, although non-significant, is negative. Again, this looks paradoxical, but in this sample animal fat displaces wheat flour.

Moreover, fat leads to no insulin response. If it comes from animals foods, fat is satiating not only because so much in our body is made of fat and/or requires fat to run properly; but also because animal fat contains micronutrients, and helps with the absorption of those micronutrients.

Fats from oils, even the healthy ones like coconut oil, just do not have the latter properties to the same extent as unprocessed fats from animal foods. Think slow-cooking meat with some water, making it release its fat, and then consuming all that fat as a sauce together with the meat.

In the absence of industrialized foods, typically we feel hungry for those foods that contain nutrients that our body needs at a particular point in time. This is a subconscious mechanism, which I believe relies in part on past experience; the reason why we have “acquired tastes”.

Incidentally, fructose leads to no insulin response either. Fructose is naturally found mostly in fruits, in relatively small amounts when compared with industrial foods rich in refined sugars.

And no, the pancreas does not get “tired” from secreting insulin.

The more refined a carbohydrate-rich food is, the more carbohydrates it tends to pack per unit of weight. Carbohydrates also contribute calories; about 4 calories per g. Thus more carbohydrates should translate into more calories.

If someone consumes 50 g of carbohydrates per day in excess of caloric needs, that will translate into about 22.2 g of body fat being stored. Over a month, that will be approximately 666.7 g. Over a year, that will be 8 kg, or 17.6 lbs. Over 5 years, that will be 40 kg, or 88 lbs. This is only from carbohydrates; it does not consider other macronutrients.

There is no need to resort to the “tired pancreas” theory of late-onset insulin resistance to explain obesity in this context. Insulin resistance is, more often than not, a direct result of obesity. Type 2 diabetes is by far the most common type of diabetes; and most type 2 diabetics become obese or overweight before they become diabetic. There is clearly a genetic effect here as well, which seems to moderate the relationship between body fat gain and liver as well as pancreas dysfunction.

It is not that hard to become obese consuming refined carbohydrate-rich foods. It seems to be much harder to become obese consuming animal foods, or fruits.