Sunday, March 25, 2012

Fur Coat and No Knickers, The BOMB, an International Arts and Health Conference and The Queen...

It's Olympic year, and as the UK gears up for the 'ultimate national well-being campaign' and we invest millions of pounds in sports and culture, we are constantly told that the arts are a force for good, nurturing civic pride and engendering happiness. But is the drive for happiness in danger of skewing our understanding of well-being, and whilst we lavish money on the Olympics in a time of global austerity, some of us question the prescription of culture for happiness - aren't the arts more than that? 

And if they offer something more than a quick-hit, how is it that the quality of life of our older citizens is often institutionally neglected; worse still, those affected by dementia are relegated to 'warehouses of the dying'? This essay explores the relationship between art in the public realm and well-being. Clive Parkinson investigates public art's sometimes superficiality and its occasional potential to question societal norms, with blistering potency.
Read the paper by clicking on the image below:

Society for the Arts in Healthcare's
23rd Annual International Conference
Hosted by Children's Hospital of Michigan 
May 2-5, 2012 Detroit, Michigan, USA 
Experience the opportunity to immerse yourself in arts & health; best practices, model programs, and cutting-edge research. Click on image below.

Combining a poetic text and a bold, electrifying score for voice and sound, Autobiographer draws us into Flora’s slowly unravelling mind. In a tender and lyrical performance, fragments of stories and pulses of memory build layer upon layer into a curious, evocative portrait of a life refracted through the lens of dementia.

more details @  

As our Arts/Health agenda comes of age, our work is increasingly being seen as more than addressing morbidity in the individual. This is illustrated perfectly by the environmental, social and political health issues tackled by Tricycle Theatre in,  The Bomb, a partial history (in two parts)...

For those of you who missed the feverish bunting waving across Manchester on Friday, you may not have noticed we had a Queen in town. Not Russell Grant but Elizabeth herself, accompanied by the Duke of Edinburgh, when she opened Royal Manchester Children's Hospital, Manchester Royal Eye Hospital, Saint Mary's Hospital and a new wing at Manchester Royal Infirmary. The work of our colleagues at LIME featured heavily on this visit. The Queen unveiled the Lime commissioned glass designs by artist Martin Donlin.
Patients and staff at the Royal Manchester Children’s Hospital, musicians from the Royal Northern College of Music, (RNCM) Music for Health programme and artist Dawn Prescott from LIME also collaborated to create Diamonds, feathers and saxophones – from the Children’s Hospital, a new composition for The Queen.

Steven Jackson, who graduated from the RNCM last year, then incorporated the children’s rhythms, textures and shapes within the music he has written, and Dawn used their pictures and sculptures in the design of a book, containing the score and beautifully bound by Artisan Bookbinder Andrew Brown, which was presented to The Queen during her visit.  The final one-minute piece was performed to the monarch by the RNCM’s Absolution Saxophone Quartet: Anthony Brown, Jennifer Palfreyman, Spencer Moran and Fraser Johnstone.

Monday, March 19, 2012

The 2012 red meat-mortality study (Arch Intern Med): The data suggests that red meat is protective

I am not a big fan of using arguments such as “food questionnaires are unreliable” and “observational studies are worthless” to completely dismiss a study. There are many reasons for this. One of them is that, when people misreport certain diet and lifestyle patterns, but do that consistently (i.e., everybody underreports food intake), the biasing effect on coefficients of association is minor. Measurement errors may remain for this or other reasons, but regression methods (linear and nonlinear) assume the existence of such errors, and are designed to yield robust coefficients in their presence. Besides, for me to use these types of arguments would be hypocritical, since I myself have done several analyses on the China Study data (), and built what I think are valid arguments based on those analyses.

My approach is: Let us look at the data, any data, carefully, using appropriate analysis tools, and see what it tells us; maybe we will find evidence of measurement errors distorting the results and leading to mistaken conclusions, or maybe not. With this in mind, let us take a look at the top part of Table 3 of the most recent (published online in March 2012) study looking at the relationship between red meat consumption and mortality, authored by Pan et al. (Frank B. Hu is the senior author) and published in the prestigious Archives of Internal Medicine (). This is a prominent journal, with an average of over 270 citations per article according to Google Scholar. The study has received much media attention recently.

Take a look at the area highlighted in red, focusing on data from the Health Professionals sample. That is the multivariate-adjusted cardiovascular mortality rate, listed as a normalized percentage, in the highest quintile (Q5) of red meat consumption from the Health Professionals sample. The non-adjusted percentages are 1.4  percent mortality in Q5 and 1.13 in Q1 (from Table 1 of the same article); so the multivariate adjustment-normalization changed the values of the percentages somewhat, but not much. The highlighted 1.35 number suggests that for each group of 100 people who consumed a lot of red meat (Q5), when compared with a group of 100 people who consumed little red meat (Q1), there were on average 0.35  more deaths over the same period of time (more than 20 years).

The heavy red meat eaters in Q5 consumed 972.37 percent more red meat than those in Q1. This is calculated with data from Table 1 of the same article, as: (2.36-0.22)/0.22. In Q5, the 2.36 number refers to the number of servings of red meat per day, with each serving being approximately 84 g. So the heavy red meat eaters ate approximately 198 g per day (a bit less than 0.5 lb), while the light red meat eaters ate about 18 g per day. In other words, the heavy red meat eaters ate 9.7237 times more, or 972.37 percent more, red meat.

So, just to be clear, even though the folks in Q5 consumed 972.37 percent more red meat than the folks in Q1, in each matched group of 100 you would not find a single additional death over the same time period. If you looked at matched groups of 1,000 individuals, you would find 3 more deaths among the heavy red meat eaters. The same general pattern, of a minute difference, repeats itself throughout Table 3. As you can see, all of the reported mortality ratios are 1-point-something. In fact, this same pattern repeats itself in all mortality tables (all-cause, cardiovascular, cancer). This is all based on a multivariate analysis that according to the authors controlled for a large number of variables, including baseline history of diabetes.

Interestingly, looking at data from the same sample (Health Professionals), the incidence of diabetes is 75 percent higher in Q5 than in Q1. The same is true for the second sample (Nurses Health), where the Q5-Q1 difference in incidence of diabetes is even greater - 81 percent. This caught my eye, being diabetes such a prototypical “disease of affluence”. So I entered the whole data reported in the article into HCE () and WarpPLS (), and conducted some analyses. The graphs below are from HCE. The data includes both samples – Health Professionals and Nurses Health.

HCE calculates bivariate correlations, and so does WarpPLS. But WarpPLS stores numbers with a higher level of precision, so I used WarpPLS for calculating coefficients of association, including correlations. I also double-checked the numbers with other software, just in case (e.g., SPSS and MATLAB). Here are the correlations calculated by WarpPLS, which refer to the graphs above: 0.030 for red meat intake and mortality; 0.607 for diabetes and mortality; and 0.910 for food intake and diabetes. Yes, you read it right, the correlation between red meat intake and mortality is a very low and non-significant 0.030 in this dataset. Not a big surprise when you look at the related HCE graph, with the line going up and down almost at random. Note that I included the quintiles data from both the Health Professionals and Nurses Health samples in one dataset.

Those folks in Q5 had a much higher incidence of diabetes, and yet the increase in mortality for them was significantly lower, in percentage terms. A key difference between Q5 and Q1 being what? The Q5 folks ate a lot more red meat. This looks suspiciously suggestive of a finding that I came across before, based on an analysis of the China Study II data (). The finding was that animal food consumption (and red meat is an animal food) was protective, actually reducing the negative effect of wheat flour consumption on mortality. That analysis actually suggested that wheat flour consumption may not be so bad if you eat 221 g or more of animal food daily.

So, I built the model below in WarpPLS, where red meat intake (RedMeat) is hypothesized to moderate the relationship between diabetes incidence (Diabetes) and mortality (Mort). Below I am also including the graphs for the direct and moderating effects; the data is standardized, which reduces estimation error, particularly in moderating effects estimation. I used a standard linear algorithm for the calculation of the path coefficients (betas next to the arrows) and jackknifing for the calculation of the P values (confidence = 1 – P value). Jackknifing is a resampling technique that does not require multivariate normality and that tends to work well with small samples; as is the case with nonparametric techniques in general.

The direct effect of diabetes on mortality is positive (0.68) and almost statistically significant at the P < 0.05 level (confidence of 94 percent), which is noteworthy because the sample size here is so small – only 10 data points, 5 quintiles from the Health Professionals sample and 5 from the Nurses Health sample. The moderating effect is negative (-0.11), but not statistically significant (confidence of 61 percent). In the moderating effect graphs (shown side-by-side), this negative moderation is indicated by a slightly less steep inclination of the regression line for the graph on the right, which refers to high red meat intake. A less steep inclination means a less strong relationship between diabetes and mortality – among the folks who ate the most red meat.

Not too surprisingly, at least to me, the results above suggest that red meat per se may well be protective. Although we should consider a least two other possibilities. One is that red meat intake is a marker for consumption of some other things, possibly present in animal foods, that are protective - e.g., choline and vitamin K2. The other possibility is that red meat is protective in part by displacing other less healthy foods. Perhaps what we are seeing here is a combination of these.

Whatever the reason may be, red meat consumption seems to actually lessen the effect of diabetes on mortality in this sample. That is, according to this data, the more red meat is consumed, the fewer people die from diabetes. The protective effect might have been stronger if the participants had eaten more red meat, or more animal foods containing the protective factors; recall that the threshold for protection in the China Study II data was consumption of 221 g or more of animal food daily (). Having said that, it is also important to note that, if you eat excess calories to the point of becoming obese, from red meat or any other sources, your risk of developing diabetes will go up – as the earlier HCE graph relating food intake and diabetes implies.

Please keep in mind that this post is the result of a quick analysis of secondary data reported in a journal article, and its conclusions may be wrong, even though I did my best not to make any mistake (e.g., mistyping data from the article). The authors likely spent months, if not more, in their study; and have the support of one of the premier research universities in the world. Still, this post raises serious questions. I say this respectfully, as the authors did seem to try their best to control for all possible confounders.

I should also say that the moderating effect I uncovered is admittedly a fairly weak effect on this small sample and not statistically significant. But its magnitude is apparently greater than the reported effects of red meat on mortality, which are not only minute but may well be statistical artifacts. The Cox proportional hazards analysis employed in the study, which is commonly used in epidemiology, is nothing more than a sophisticated ANCOVA; it is a semi-parametric version of a special case of the broader analysis method automated by WarpPLS.

Finally, I could not control for confounders because, given the small sample, inclusion of confounders (e.g., smoking) leads to massive collinearity. WarpPLS calculates collinearity estimates automatically, and is particularly thorough at doing that (calculating them at multiple levels), so there is no way to ignore them. Collinearity can severely distort results, as pointed out in a YouTube video on WarpPLS (). Collinearity can even lead to changes in the signs of coefficients of association, in the context of multivariate analyses - e.g., a positive association appears to be negative. The authors have the original data – a much, much larger sample - which makes it much easier to deal with collinearity.

Moderating effects analyses () – we need more of that in epidemiological research eh?

Sunday, March 18, 2012

Women's Health Choices, Loneliness, Binge Drinking, 2 Dance Opportunities and more...

Thinking about the reach of the arts on public health, often results in ‘nanny state’ productions that often leave the target audience feeling either patronised, or humiliated. Popular culture however, has the power to engage with hot political issues and reach huge numbers of people. Amid heated debate about pre-termination ultrasound laws in the USA, cartoonist, Garry Trudeau has decided to take on the abortion wars head-on in his cartoon strip Doonesbury, which, because of its contentious subject matter for Americans in election year, has been pulled from several newspapers. In an interview with the Washington Post, Trudeau commented:
‘I chose the topic of compulsory sonograms because it was in the news and because of its relevance to the broader battle over women's health currently being waged in several states. For some reason, the GOP has chosen 2012 to re-litigate reproductive freedom, an issue that was resolved decades ago. Why [Rick] Santorum, [Rush] Limbaugh et al. thought this would be a good time to declare war on half the electorate, I cannot say. But to ignore it would have been comedy malpractice.’
To read more of this interview with Trudeau, click on the cartoon below. To see some of the  cartoon strips, click on the cartoon above!

Loneliness is as big a killer as smoking, obesity and alcohol, campaigners warned as they held the first major summit on loneliness last week.

Care Services Minister Paul Burstow announced that councils, responsible for public health from April 2013, will be urged to conduct an audit of health and care services and identify how they can help reduce levels of isolation. Mr Burstow said: 

"Loneliness is the great unspoken public health issue. Research suggests it is more harmful to health than obesity and that there is a 50 per cent reduction in mortality if you have a strong social network. Research has shown that loneliness can be as harmful to your health as alcohol and tobacco, but we also know that people who have day- to-day contact live longer and healthier lives. The Government is working with the Campaign to End Loneliness to raise awareness about just how important even a simple phone call or visit can be to someone's health." Read the full article here.
Research published in 2006 from the American Sociological Review and based on surveys of 1,531 people in 1985 and 1,467 in 2004 show that in 1985, the average American had three people to whom they could confide matters that were important to them, but in 2004, that number dropped to two, and one in four had no close confidants at all. The same research illustrated the percentage of people who confide only in family increased from 57% to 80%, and the number of people who depend exclusively on a spouse is up from 5% to 9%. (Thanks CMG)

‘Americans have a third fewer close friends and confidants than just two decades ago — a sign that people may be living lonelier, more isolated lives than in the past.’'

For those of involved in the arts/health field, we know just how true this is and that engagement with culture and the arts can have a profound impact on anyone who is socially isolated. Of course the pleasure of friendship and solidarity is wonderful, but so to is the challenge and stimulation that the participatory arts offer. We mustn’t lose sight of the ever-changing political and social climate that we currently inhabit and if politicians are identifying the burgeoning issues associated with isolation, particularly amongst our older citizens, it’s an area we should be clear to assert both our role, and our potency.

And if you missed this in the weekend papers, there's an interesting piece of research that points to the 'dark side' of Facebook linking it and other social media platforms to socially aggressive narcissism, obsession with self-image and shallow friendships. Read it and weep, or laugh maniacally. (Thanks Dr S)

This week, the comment on manifesto part one, and the power of the arts for giving voice, comes from a friend and colleague in Kabul, artist Shamsia Hassani.
‘There are some unknown words in my mind: some unclear feeling in my heart which is removing me to an unknown world, the world that everyone is writing with their own inside alphabet. I call this world ART.’

Ommolbanin - Shamsia Hassani, Artist

To find out more about Ommolbanin and Freedom to Create, click on the image above.

Fri, 23 Mar 2012
12.00 PM - 3.00 PM
Dance Conversations presents a free opportunity for Merseyside Dance artists and companies working in the field of dance and health and professionals from the health and social care to network and share ideas and practice and information on existing or future projects and research.

This is an amazing opportunity for 12 North West Graduates and Artists.
Auditions for the FIRST EVER North West Graduate Dance Company

INFO - Supported by Arts Council England, NWGDC will create original and exciting work to tour the region and will offer training in Teaching and Learning as well as develop Business and Entrepreneurial skills to support a career in dance.

AUDITION DATES - Auditions are Saturday 14 April 2012 at Edge Hill University, Ormskirk and Sunday 15 April at The Lowry, Salford Quays.
Applicants will be required from 10.00am until 6.00pm DEVISING - Based at Edge Hill University, the first devising process to create new work with  Alesandra Seutin begins  Monday 28 May until Sunday 10 June  2012.  The second devising with Gary Clarke and Antonia Grove begins Monday 20 August until Saturday 25 August 2012. 

TOURING - Rehearsals and tour begin September 2012 and run until beginning of December  2012. Please note that successful applicants will be required for additional rehearsal dates which will be confirmed before the audition.

INTERNSHIPS - Internships are scheduled for Spring 2013. These will provide company members with work based learning opportunities.

WHO CAN APPLY? - Anyone who has graduated since 2007 with a degree in Dance
or an appropriate degree in Performing Arts .   All applicants must live in
the North West of England. All applicants MUST be available during the above periods for devising, touring and internships.

DEADLINE - Deadline for applications is 12.00 mid-day, Friday 23 March 2012

WHAT TO DO NEXT - For more information and an application pack please contact Gil Wilson-Graystone, Project Manager at 

VOCAB dance video  


Did stone age cave women and men talk to each other in symbols? This is a fascinating article bringing together research around the symbols that adorn many cave paintings. Click on the image for more. Beautiful and resonating across time.

An excellent article by Alice Jones in the Independent exploring alcohol in contemporary culture, and how two theatre companies have used the arts to tell an all to familiar story.
‘Last summer, the performance artist Bryony Kimmings locked herself in a warehouse in Bethnal Green, east London and got drunk for a week. Not for fun, you understand, but in the name of art: her aim was to explore the links between intoxication and creativity, or to find out whether she was a better artist when she was drunk.’ (7 Day Drunk)
‘The Paper Birds trawled the pubs and clubs of London and Leeds to find the raw material for their latest show, Thirsty. They set up a hotline, printed up business cards with the words "Are you drunk? Call this number" and used the voicemails they received as the inspiration for their play about young women and binge drinking, performed to a shouty soundtrack of karaoke classics on a set made out of toilet cubicles.’ (Thirsty)

'Thirsty', touring to 2 April (; '7 Day Drunk', to 31 March, Soho Theatre, London, then touring to 26 May (

...and finally, in a spirit of high self-esteem and Facebook-induced, deluded, dance-flavoured blogging, here is Gene Kelly tap dancing on roller-skates. What better start to our week? Life is good...C.P.

Thursday, March 15, 2012

Walking Off The Influence of "Thrifty Genes"

"I can't help it, it's my genes" is a familiar phrase among frustrated dieters and gym goers who feel they can’t make the scale budge despite all efforts to reduce calories and exercise more. There may be something to their justification. After all, weight can depend partly on genetic makeup (among several other factors).

Luckily, the genetic revolution continues to churn out exciting news giving us hope that, no, we're not completely left at the mercy of the wrong kind of genes. The latest example is a study presented March 14 at the American Heart Association meeting in San Diego. The study found that people could keep their obesity genes under wraps by doing as little as turning off the tube and taking a brisk walk.

The study found that a brisk one-hour walk daily cut the influence of genes on obesity by as much as half! On the other hand, every couple of hours of watching television appeared to increase the influence of obesity genes by a quarter. That can make a major difference for the average American who watches TV for four to six hours a day.

To identify individuals for their study, the researchers determined genetic predisposition score based on more than 30 genetic variants in 7,740 women and 4,564 men from the Nurses' Health Study and Health Professionals Follow-up Study. Each variant had been previously established to have an influence on body mass index (BMI), a ratio based on an individual's height and weight used as criteria for determining overweight and obesity. 

How do genes affect weight exactly? The mechanisms aren't yet clear, say the researchers, but a look at humanity's evolved past could offer some clues. The "thrifty gene" theory, for example, has it that the human body hasn’t changed much in the last 50 thousand years. The situation back then was quite different from the days of food aplenty today—in those near-famine times, our ancestors used up a lot of energy and time just searching for food, and they often went without.

A set of "thrifty genes" may have once served our ancestors to stockpile fat for use when calories were scarce. Unfortunately, those same genes in a person today can mean a serious disadvantage for shedding unwanted pounds and inches. 

While genetic screening for obesity isn't available for everyone yet, it doesn't mean that people, especially those who know they have a family history of obesity, can't make use of this study's findings right away. Since our hunter-gatherer ancestors often sought out food by making long, cross-country treks, it's only sensible that the same kind of behavior today—brisk walking an hour or more a day—could lead to the release of fat.

Matt McMillen writes more about the research presented at AHA's meeting in Health Magazine and republished in CNN's The Chart.  


American Heart Association Walking may lessen the influence of genes on obesity by half. March 2012. Retrieved March 15, 2012, from

Debusk R & Joffe Y. (2006) It's Not Just Your Genes! San Diego: BKDR. 

Monday, March 12, 2012

Gaining muscle and losing fat at the same time: A more customized approach based on strength training and calorie intake variation

In the two last posts I discussed the idea of gaining muscle and losing fat at the same time () (). This post outlines one approach to make that happen, based on my own experience and that of several HCE () users. This approach may well be the most natural from an evolutionary perspective.

But first let us address one important question: Why would anyone want to reach a certain body weight and keep it constant, resorting to the more difficult and slow strategy of “turning fat into muscle”, so to speak? One could simply keep on losing fat, without losing or gaining muscle, until he or she reaches a very low body fat percentage (e.g., a single-digit body fat percentage, for men). Then he or she could go up from there, slowly putting on muscle.

The reason why it is advisable to reach a certain body weight and keep it constant is that, below a certain weight, one is likely to run into nutrient deficiencies. Non-exercise energy expenditure is proportional to body weight. As you keep on losing body weight, calorie intake may become too low to allow you to have a nutrient intake that is the minimum for your body structure. Unfortunately eating highly nutritious vegetables or consuming copious amounts of vitamin and mineral supplements will not work very well, because the nutritional needs of your body include both micro- and macro-nutrients that need co-factors to be properly absorbed and/or metabolized. One example is dietary fat, which is necessary for the absorption of fat-soluble vitamins.

If you place yourself into a state of nutrient deficiency, your body will compensate by mounting a multipronged defense, resorting to psychological and physiological mechanisms. Your body will do that because it is hardwired for self-preservation; as noted below, being in a state of nutrient deficiency for too long is very dangerous for one's health. Most people cannot oppose this body reaction by willpower alone. That is where binge-eating often starts. This is one of the key reasons why looking for a common denominator of most diets leads to the conclusion that all succeed at first, and eventually fail ().

If you are one of the few who can oppose the body’s reaction, and maintain a very low calorie intake even in the face of nutrient deficiencies, chances are you will become much more vulnerable to diseases caused by pathogens. Individually you will be placing yourself in a state that is similar to that of populations that have faced famine in the past. Historically speaking, famines are associated with decreases in degenerative diseases, and increases in diseases caused by pathogens. Pandemics, like the Black Death (), have historically been preceded by periods of food scarcity.

The approach to gaining muscle and losing fat at the same time, outlined here, relies mainly on the following elements: (a) regularly conducting strength training; (b) varying calorie intake based on exercise; and (c) eating protein regularly. To that, I would add becoming more active, which does not necessarily mean exercising but does mean doing things that involve physical motion of some kind (e.g., walking, climbing stairs, moving things around), to the tune of 1 hour or more every day. These increase calorie expenditure, enabling a slightly higher calorie intake while maintaining the same weight, and thus more nutrients on a diet of unprocessed foods. In fact, even things like fidgeting count (). These activities should not cause muscle damage to the point of preventing recovery from strength training.

As far as strength training goes, the main idea, as discussed in the previous post, is to regularly hit the supercompensation window, with progressive overload, and maintain your current body weight. In fact, over time, as muscle gain progresses, you will probably want to increase your calorie intake to increase your body weight, but very slowly to keep any fat gain from happening. This way your body fat percentage will go down, even as your weight goes up slowly. The first element, regularly hitting the supercompensation window, was discussed in a previous post ().

Varying calorie intake based on exercise. Here one approach that seems to work well is to eat more in the hours after a strength training session, and less in the hours preceding the next strength training session, keeping the calorie intake at maintenance over a week. Individual customization here is very important. Many people will respond quite well to a calorie surplus window of 8 – 24 h after exercise, and a calorie deficit in the following 40 – 24 h. This assumes that strength training sessions take place every other day. The weekend break in routine is a good one, as well as other random variations (e.g., random fasts), as the body tends to adapt to anything over time ().

One example would be someone following a two-day cycle where on the first day he or she would do strength training, and eat the following to satisfaction: muscle meats, fatty seafood (e.g., salmon), cheese, eggs, fruits, and starchy tubers (e.g., sweet potato). On the second day, a rest day, the person would eat the following, to near satisfaction, limiting portions a bit to offset the calorie surplus of the previous day: organ meats (e.g., heart and liver), lean seafood (e.g., shrimp and mussels), and non-starchy nutritious vegetables (e.g., spinach and cabbage). This would lead to periodic glycogen depletion, and also to unsettling water-weight variations; these can softened a bit, if they are bothering, by adding a small amount of fruit and/or starchy foods on rest days.

Organ meats, lean seafood, and non-starchy nutritious vegetables are all low-calorie foods. So restricting calories with them is relatively easy, without the need to reduce the volume of food eaten that much. If maintenance is achieved at around 2,000 calories per day, a possible calorie intake pattern would be 3,000 calories on one day, mostly after strength training, and 1,000 calories the next. This of course would depend on a number of factors including body size and nonexercise thermogenesis. A few calories could be added or removed here and there to make up for a different calorie intake during the weekend.

Some people believe that, if you vary your calorie intake in this way, the calorie deficit period will lead to muscle loss. This is the rationale behind the multiple balanced meals a day approach; which also works, and is successfully used by many bodybuilders, such as Doug Miller () and Scooby (). However, it seems that the positive nitrogen balance stimulus caused by strength training leads to a variation in nitrogen balance that is nonlinear and also different from the stimulus to muscle gain. Being in positive or neutral nitrogen balance is not the same as gaining muscle mass, although the two should be very highly correlated. While the muscle gain window may close relatively quickly after the strength training session, the window in which nitrogen balance is positive or neutral may remain open for much longer, even in the face of a calorie deficit during part of it. This difference in nonlinear response is illustrated through the schematic graph below.

Eating protein regularly. Here what seems to be the most advisable approach is to eat protein throughout, in amounts that make you feel good. (Yes, you should rely on sense of well being as a measure as well.) There is no need for overconsumption of protein, as one does not need much to be in nitrogen balance when doing strength training. For someone weighing 200 lbs (91 kg) about 109 g/d of high-quality protein would be an overestimation () because strength training itself pushes one’s nitrogen balance into positive territory (). The amount of carbohydrate needed depends on the amount of glycogen depleted through exercise and the amount of protein consumed. The two chief sources for glycogen replenishment, in muscle and liver, are protein and carbohydrate – with the latter being much more efficient if you are not insulin resistant.

How much dietary protein can you store in muscle? About 15 g/d if you are a gifted bodybuilder (). Still, consumption of protein stimulates muscle growth through complex processes. And protein does not usually become fat if one is in calorie deficit, particularly if consumption of carbohydrates is limited ().

The above is probably much easier to understand than to implement in practice, because it requires a lot of customization. It seems natural because our Paleolithic ancestors probably consumed more calories after hunting-gathering activities (i.e., exercise), and fewer calories before those activities. Our body seems to respond quite well to alternate day calorie restriction (). Moreover, the break in routine every other day, and the delayed but certain satisfaction provided by the higher calorie intake on exercise days, can serve as powerful motivators.

The temptation to set rigid rules, or a generic formula, always exists. But each person is unique (). For some people, adopting various windows of fasting (usually in the 8 – 24 h range) seems to be a very good strategy to achieve calorie deficits while maintaining a positive or neutral nitrogen balance.

For others, fasting has the opposite effect, perhaps due to an abnormal increase in cortisol levels. This is particularly true for fasting windows of 12 – 24 h or more. If regularly fasting within this range stresses you out, as opposed to “liberating” you (), you may be in the category that does better with more frequently meals.

Sunday, March 11, 2012

Call to NW Artists, Ah Kong, Studentship, Funding and Pearly Kings and Queens...


HEALTHGAIN 2012  Event & Showcase  
21 March at Piccadilly Place 4 Manchester
12.30 for lunch until 4,30pm

North West Arts and Health Network members are invited to attend and showcase at this exciting event. Arts and Health practitioners Helena Edwards and Christine Simms will be coordinating the creativity element of this event on 21 March and would welcome input from other network members who can make a contribution and also enjoy the fabulous range of taster sessions and workshops. 

The creativity unlocked by integrating arts and healthcare is key to empowering patients, improving health outcomes and overall quality of care and reduced costs and there is a growing body of research evidence demonstrating that the arts can lower blood pressure, reduce patients use of analgesic medication and length of hospital stays as well as improving compliance with recommended treatments.
Demonstrate the potential of arts in healthcare using objects of art and the creative process as a catalyst to enhance physical, mental and emotional recovery and help give meaning to our lives. Showcase your work in integrating a range of artistic genres into community and healthcare settings to humanise the health system, help clinicians connect to their patients (the people behind the conditions!)  and demonstrate the power of the art sto connect people with the power of creativity at key moments in their lives for therapeutic and expressive purposes.
Healthgain2012 Event & Showcase

In attendance will be a range of representatives from NHS organisations who are seeking innovative inspiration in order to 'Make every contact with patients and communities count' . There will be an excellent workshop (1.30-2.30pm) that you can attend where 20 plus NHS projects will showcase their current work and, led by an Appreciative Inquiry facilitator, will learn from one another as well as think outside of the box in order learn from outside their field.
Be part of a Northern Healthgain Learning Community. Highlight the positive impact of 'arts in healthcare' and recovery.
Please contact Chris WITHOUT DELAY to discuss what you can bring to the party and to book your place at this exciting event

"A favourite grandson attempts to restore his grandfather’s ailing memory. A famous chicken seller, a charming dancer and a ladies’ man… this is what his grandfather used to be, before he was diagnosed with dementia. However it’s not the past his grandfather forgets. In fact, it’s all he can remember. What he has forgotten is how to live in the present." I receive a lot of links to films relating to dementia and I wonder what you think about this?

A big thanks to Lilli Brodner-Francis, Music for Health Project Manager at the RNCM for drawing my attention to this. The Children and Young People’s Health Outcomes Forum is gathering views on the health outcomes that matter most for children and young people and how the different parts of the health system will work together to deliver these. The consultation focuses on four areas in particular: acutely ill children; mental health; children with disabilities; and long-term conditions public health. It would be fantastic if we could all talk about the benefits of music making and other art activities for children in healthcare settings in this consultation by the Department of Health.

It closes on 30th April 2012.

Although this specific studentship isn’t managed by Arts for Health, it is something I would strongly support. Proposals are invited that explore how participation and participatory processes within arts make a difference to individual and community well-being. Full details at

From the pen of Staricoff and Clift, comes the latest update on the medical literature between 2004 and 2011. Arts and Music in Healthcare at the Chelsea and Westminster Health Charity.

And another piece of news from das capital, is the appointment of Nikki Crane to Head of Arts Strategy at the Guys and St Thomas’s Charity. Nikki has been Head of Social Inclusion at Arts Council England, where she led work on arts and criminal justice and arts in health. We wish Nikki well in this exciting new role that places the arts at the centre of the charity’s vision. 

The Lankelly Chase Foundation has announced that it is inviting applications from arts based organisations through their Arts Programme.  Through this programme the trustees are focussing their grant making on three specific areas: promoting the use of the arts by people with severe mental ill health: encouraging vulnerable young people to participate in arts activities: helping young artists to pursue a career in the arts (this programme is currently closed to external applications).

Grants awarded are generally between £10,000 and £15,000 a year. In some exceptional cases the fund will consider larger grants. The foundation will only consider applications from registered charities, industrial and provident societies, exempt charities and community interest companies or organisations applying for charitable status.  Applications can be submitted at any time. For more information click:

The Allan & Nesta Ferguson Charitable Trust is open to charitable organisations that support the promotion of education, international friendship and understanding as well as world peace and development. The Trust seeks to fund projects that have an educational aim, element or content. Applications for core funding or the construction of buildings in the UK will not be considered. However, the trust will consider to fund aid projects overseas such as; water treatment, food and medical supplies or the provision of basic facilities that are the pre-requisite of an educational or development initiative.

Applications from organisations for grants of up to £50,000 can be made at any time. For larger grants, applications will be considered in March and October each year. For more information visit:

M A N I F E S T O Part One   

"The arts and health manifesto is a love filled slap in the face of consumerist society. It brandishes our interconnectedness like a sword, calling for cutting through, teasing out, writing and re writing ourselves until we get closer to getting it right. It's about Social justice, about joined up thinking, its about a courage we fear might not happen in our lifetime.

It says - Stand up! Be fair! Be kind! Show respect! Risk it all! Get a grip! Have a laugh! go on I dare you....It challenges us to take personal action and taunts us with the promise of a better world if we can treasure others as we treasure ourselves.

It is at once bleak and hopeful, a troubled text searching for answers, asking questions and promising nothing if we don't start working (creatively) together.
It is a starting point. It faces us towards the global revolution we simply cant afford not to have." Jami Bladel CEO/Artistic Director, KickStart Arts

A little song for the week ahead, by the underrated Darkstar...C.P