Monday, February 25, 2013

Could the low testosterone problem be a mirage?

Low testosterone (a.k.a. “low T”) is caused by worn out glands no longer able to secrete enough T, right? At least this seems to be the most prevalent theory today, a theory that reminds me a lot of the “tired pancreas” theory () of diabetes. I should note that this low T problem, as it is currently presented, is one that affects almost exclusively men, particularly middle-aged men, not women. This is so even though T plays an important role in women’s health.

There are many studies that show associations between T levels and all kinds of diseases in men. But here is a problem with hormones: often several hormones vary together and in a highly correlated fashion. If you rely on statistics to reach conclusions, you must use techniques that allow you to rule out confounders; otherwise you may easily reach wrong conclusions. Examples are multivariate techniques that are sensitive to Simpson’s paradox and nonlinear algorithms; both of which are employed, by the way, by modern software tools such as WarpPLS (). Unfortunately, these are rarely, if ever, used in health-related studies.

Many low T cases may actually be caused by something other than tired T-secretion glands, perhaps a hormone (or set of hormones) that suppress T production; a T “antagonist”. What would be a good candidate? The figure below shows two graphs. It is from a study by Starks and colleagues, published in the Journal of the International Society of Sports Nutrition in 2008 (). The study itself is not directly related to the main point that this post tries to make, but the figure is.

Look at the two graphs carefully. The one on the left is of blood cortisol levels. The one on the right is of blood testosterone levels. Ignore the variation within each graph. Just compare the two graphs and you will see one interesting thing – cortisol and testosterone levels are inversely related. This is a general pattern in connection with stress-induced cortisol elevations, repeating itself over and over again, whether the source of stress is mental (e.g., negative thoughts) or physical (e.g., intense exercise).

And the relationship between cortisol and testosterone is strong. Roughly speaking, an increase in cortisol levels, from about 20 to 40 μg/dl, appears to bring testosterone levels down from about 8 to 5 ηg/ml. A level of 8 ηg/ml (the same as 800 ηg/dl) is what is normally found in young men living in urban environments. A level of 5 ηg/ml is what is normally found in older men living in urban environments.

So, testosterone levels are practically brought down to almost half of what they were before by that variation in cortisol.

Chronic stress can easily bring your cortisol levels up to 40 μg/dl and keep them there. More serious pathological conditions, such as Cushing’s disease, can lead to sustained cortisol levels that are twice as high. There are many other things that can lead to chronically elevated cortisol levels. For instance, sustained calorie restriction raises cortisol levels, with a corresponding reduction in testosterone levels. As the authors of a study () of markers of semistarvation in healthy lean men note, grimly:

“…testosterone (T) approached castrate levels …”

The study highlights a few important phenomena that occur under stress conditions: (a) cortisol levels go up, and testosterone levels go down, in a highly correlated fashion (as mentioned earlier); and (b) it is very difficult to suppress cortisol levels without addressing the source of the stress. Even with testosterone administration, cortisol levels tend to be elevated.

Isn't possible that cortisol levels go up because testosterone levels go down - reverse causality? Possible, but unlikely. Evidence that testosterone administration may reduce cortisol levels, when it is found, tends to be rather weak or inconclusive. A good example is a study by Rubinow and colleagues (). Not only were their findings based on bivariate (or unadjusted) correlations, but also on a chance probability threshold that is twice the level usually employed in statistical analyses; the level usually employed is 5 percent.

Let us now briefly shift our attention to dieting. Dieting is the main source of calorie restriction in modern urban societies; an unnatural one, I should say, because it involves going hungry in the presence of food. Different people have different responses to dieting. Some responses are more extreme, others more mild. One main factor is how much body fat you want to lose (weight loss, as a main target, is a mistake); another is how low you expect body fat to get. Many men dream about six-pack abs, which usually require single-digit body fat percentages.

The type of transformation involving going from obese to lean is not “cost-free”, as your body doesn’t know that you are dieting. The body “sees” starvation, and responds accordingly.

Your body is a little bit like a computer. It does exactly what you “tell” it to do, but often not what you want it to do. In other words, it responds in relatively predictable ways to various diet and lifestyle changes, but not in the way that most of us want. This is what I call compensatory adaptation at work (). Our body often doesn’t respond in the way we expect either, because we don’t actually know how it adapts; this is especially true for long-term adaptations.

What initially feels like a burst of energy soon turns into something a bit more unpleasant. At first the unpleasantness takes the form of psychological phenomena, which were probably the “cheapest” for our bodies to employ in our evolutionary past. Feeling irritated is not as “expensive” a response as feeling physically weak, seriously distracted, nauseated etc. if you live in an environment where you don’t have the option of going to the grocery store to find fuel, and where there are many beings around that can easily kill you.

Soon the responses take the form of more nasty body sensations. Nearly all of those who go from obese to lean will experience some form of nasty response over time. The responses may be amplified by nutrient deficiencies. Obesity would have probably only been rarely, if ever, experienced by our Paleolithic ancestors. They would have never gotten obese in the first place. Going from obese to lean is as much a Neolithic novelty as becoming obese in the first place, although much less common.

And it seems that those who have a tendency toward mental disorders (e.g., generalized anxiety, manic-depression), even if at a subclinical level under non-dieting conditions, are the ones that suffer the most when calorie restriction is sustained over long periods of time. Most reports of serious starvation experiments (e.g., Roy Walford’s Biosphere 2 experiment) suggest the surfacing of mental disorders and even some cases of psychosis.

Emily Deans has a nice post () on starvation and mental health.

But you may ask: What if my low T problem is caused by aging; you just said that older males tend to have lower T? To which I would reply: Isn’t possible that the lower T levels normally associated with aging are in many cases a byproduct of higher stress hormone levels? Take a look at the figure below, from a study of age-related cortisol secretion by Zhao and colleagues ().

As you can see in the figure, cortisol levels tend to go up with age. And, interestingly, the range of variation seems very close to that in the earlier figure in this post, although I may be making a mistake in the conversion from nmol/l to ηg/ml. As cortisol levels go up, T levels should go down in response. There are outliers. Note the male outlier at the middle-bottom part, in his early seventies. He is represented by a filled circle, which refers to a disease-free male.

Dr. Arthur De Vany claims to have high T levels in his 70s. It is possible that he is like that outlier. If you check out De Vany’s writings, you’ll see his emphasis on leading a peaceful, stress-free, life (). If money, status, material things, health issues etc. are very important for you when you are young (most of us, a trend that seems to be increasing), chances are they are going to be a major source of stress as you age.

Think about individual property accumulation, as it is practiced in modern urban environments, and how unnatural and potentially stressful it is. Many people subconsciously view their property (e.g., a nice car, a bunch of shares in a publicly-traded company) as their extended phenotype. If that property is damaged or loses value, the subconscious mental state evoked is somewhat like that in response to a piece of their body being removed. This is potentially very stressful; a stress source that doesn’t go away easily. What we have here is very different from the types of stress that our Paleolithic ancestors faced.

So, what will happen if you take testosterone supplementation to solve your low T problem? If your problem is due to high levels of cortisol and other stress hormones (including some yet to be discovered), induced by stress, and your low T treatment is long-term, your body will adapt in a compensatory way. It will “sense” that T is now high, together with high levels of stress.

Whatever form long-term compensatory adaptation may take in this scenario, somehow the combination of high T and high stress doesn’t conjure up a very nice image. What comes to mind is a borderline insane person, possibly with good body composition, and with a lot of self-confidence – someone like the protagonist of the film American Psycho.

Again, will the high T levels, obtained through supplementation, suppress cortisol? It doesn’t seem to work that way, at least not in the long term. In fact, stress hormones seem to affect other hormones a lot more than other hormones affect them. The reason is probably that stress responses were very important in our evolutionary past, which would make any mechanism that could override them nonadaptive.

Today, stress hormones, while necessary for a number of metabolic processes (e.g., in intense exercise), often work against us. For example, serious conflict in our modern world is often solved via extensive writing (through legal avenues). Violence is regulated and/or institutionalized – e.g., military, law enforcement, some combat sports. Without these, society would break down, and many of us would join the afterlife sooner and more violently than we would like (see Pinker’s take on this topic: ).

Sir, the solution to your low T problem may actually be found elsewhere, namely in stress reduction. But careful, you run the risk of becoming a nice guy.

Sunday, February 24, 2013

...out of the office, but -

- need I say more?'s what the intelligent art critic Brian Sewell said in 2009:

"The two words 'graffiti' and 'art' should never be put together," said the art critic Brian Sewell. He added the council were "bonkers...The public doesn't know good from bad...For this city to be guided by the opinion of people who don't know anything about art is lunacy. It doesn't matter if they [the public] like it. It will result in a proliferation of entirely random decoration, for want of a better word...Any fool who can put paint on canvas or turn a cardboard box into a sculpture is lauded. Banksy should have been put down at birth. It's no good as art, drawing or painting. His work has no virtue. It's merely the sheer scale of his impudence that has given him so much publicity."

You can read more about Banksy and the tagging of the segregation wall in Palestine by clicking HERE.

Karst Country - infra-red timelapse from Glen Ryan on Vimeo.

Tuesday, February 19, 2013

Calories aren't right on labels and maybe that’s OK

Has it ever crossed your mind that the number of listed Calories (Kcals) of, say, a large, raw, whole apple at 116 Kcals and that of a glazed doughnut at 125 Kcals might not be an accurate comparison*? Surely, you might think, isn’t the doughnut more likely to add inches to your waistline?

You'd be right. The difference that you might have understood intuitively is that, although the number of listed Kcals are similar, your body is likely to extract more of them from the doughnut than the apple. Why the disparity then on the Kcals listing? You can lay blame on the shortcomings of the Atwater Specific-factor System.

Here's a little nutrition science history lesson: In the early 20th century, American chemist William Olin Atwater pioneered calculation of energy values from measures of heat combustion of proteins, fats and carbs. This is how we arrived to the familiar protein at 4 Kcals per gram, lipids at 9 Kcals per gram, and carbs 4 Kcals per gram. It would come to be known as the Atwater General Factor System. At the time, Atwater couldn’t account for fiber, so, in 1955, Bernice Watt and Annabel Merrill refined the system with specific Calorie conversion factors of foods, which has led to what the system is now.

But the Atwater Specific-factor System still doesn't take a lot of other variables into account. For example, it doesn’t consider digestion energy costs of one food versus another, such as those from chewing, secretion of gastric acid and digestive enzymes, intestinal movement (peristalsis) and production of heat after eating (diet-induced thermogenesis). It also doesn't account for losses to your friendly gut microbes, which can devour up to half of calories from any digestion-resistant starches (as found in a raw apple) that arrive in the large intestine after escaping breakdown by gastric acid and pancreatic enzymes in the stomach and small intestine.

Now, in the wake of news that McDonald's and other restaurants will start listing the numbers of calories next to menu items—a requirement under a new regulation included under the Affordable Care Act—comes a fresh challenge on the Atwater Specific-factor System and those Kcals listings for being inaccurate. That challenge is from an unlikely group of experts from diverse fields that include evolutionary biology and comparative physiology on mice and pythons. (Yes, pythons! I should spare you the yucky details, but I won't.)

On Monday, February 18, at the American Association for the Advancement of Science annual meeting (Twitter hashtag: #AAASmtg) in Boston, the group convened to summarize their findings. In addition, the group announced, they hope to write a position paper on the topic within the next few months. In some cases, the group reports, Kcal counts on food labels could be off as much as 15 percent or more.

Evolution and pythons

Richard Wrangham and Rachel Carmody of Harvard are not part of the so-called "nutrition establishment"; they are a pair of biological anthropologists who study primates and human evolution. Over the last decade and a half, Wrangham has studied the role of fire in the evolution of humans (as regular readers of my blog surely are aware). Carmody's research is in evaluating what effect basic food processing (e.g. pounding) and cooking (as adopted by our ancestors probably beginning with Homo erectus) had on freeing up available Kcals from raw foods so as to drive increase in survival and human adaptations including larger brain size.

Carmody detailed what was the first Harvard lab experiment on effects on energy gain that mice experienced when they ate foods—sweet potatoes and lean beef—that were either raw and whole, raw and pounded, cooked, or pounded and cooked. She found that pounding increased energy gain of the meat by 8 percent, cooking by 15 percent. Pounding increased energy gain from the tuber by 3 percent, cooking by 39 percent, the combination by 40 percent. The mice also showed greater preference for foods that were pounded and cooked after the trial.

In addition, Carmody presented preliminary data that cooked versus raw food made an impact on gut microbial communities and genetic expression related to nutrient metabolism and immunity—the raw beef induced the most expression from immunity-related genes (possibly in response to pathogen load), which costs more energy. As hypothesized by Carmody, the pounding and cooking reduced diet-induced thermogenesis in the mice and, thus, reduced energy expenditure.

Diet-induced thermogenesis, aka specific dynamic action (SDA) as it's referred to often by comparative physiologists, is the subject of research by biologist Stephen Secor of University of Alabama. "There's no such thing as a free meal," Secor likes to remind. "Every time you consume a meal, there's a metabolic expense." Again, that is not accounted for in the Atwater system.

Secor, whose research is in reptiles, explains that contributions to SDA involve pre-absorptive (chewing, swallowing, bile and pantreatic secretions, peristalsis) and post-absorptive (nutrient breakdown and transport) phases. The gastric acid production, however, can heavily influence digestion costs—up to 25 percent for some foods—and varies greatly depending on the animal. "There are more mitochondria in cells responsible for acid production than anywhere else," Secor said.

X-ray image of a Burmese python while digesting its meal.
OK, about the pythons: when pythons eat a rat whole, Secor says, they have a huge gastric acid and SDA response (they get so hot, it's like "they're on fire"). That makes them a perfect model to study the effects of processing and cooking as it relates to reduction in SDA. To study these effects, Secor's lab wrapped a steak around a rat and fed it to the snake (apparently, "you can feed anything to a python as long as you put a rat's head on it"). The research group also blended up a rat smoothie and delivered it via tube down a snake's throat and deposited it directly into the snake's stomach (bypassing the swallowing phase). From these experiments, Secor estimates that cooking and grinding reduces SDA by a whopping 25 percent.

Knowing what we do about how the size of meals increasing gastric secretion, especially those containing protein, Secor's findings suggest there are greater digestion costs on a less processed or raw diet, particularly if consisting of large meals with protein.

The fate of carbs

Cooking and processing also strongly affects the gastrointestinal fate of carbohydrate in meals and their energy contributions. When starch is provided as intact granules, it can be resistant to hydrolysis from enzymes during digestion, explains Klaus Englyst of Englyst Carbohydrates Ltd, Southampton, UK. Once heated, especially if moisture is involved, the starch gelatinizes allowing amylase (starch enzyme) to more easily break it down for rapid digestion and absorption. The resistant starches, on the other hand, might end up in the intestine where microbes will ferment it using some of its energy up and producing short-chain fatty acids (which we absorb).

Englyst hints that resistant starches and fibers (cellulose, beta-glucan, etc.) deserve more attention for their possible role in providing the protective effects as seen in studies on low-glycemic diets. In fact, he said he's concerned that the term low glycemic in itself is an inconsistent message. Low glycemic refers to a diet based on the glycemic index (as developed by David Jenkins of University of Toronto) that quantifies blood glucose level rises after eating specific foods. One could argue that a hamburger is low glycemic, since it may not spike blood sugar, yet it contains very little resistant starch or fiber.

Despite shortcomings of low glycemic as a term overall, Dr. David Ludwig, a physician at Boston Children's Hospital (who filled in on behalf of Peter Turnbaugh at the conference), says it's useful for discussing the different kinds of carbohydrates. Unprocessed grains have fiber and intact grain structures causing pancreatic enzymes to really have to work at breaking them down, whereas today’s highly processed grains have their kernels milled to fine particulate and fiber stripped away. That’s how they become high glycemic (able to spike blood sugar). "You're left with Wonder Bread and there are thousands of iterations of this product," he said.

He also shares the view that the USDA's "low-fat" message and the Food Pyramid (with grains as its base) has been harmful over the last few decades. "You can take fat out, replace it with highly processed starch molecules that are immediately susceptible to attack from amylase," Dr. Ludwig said. Last June, Dr. Ludwig and his colleagues published a study in JAMA that found that a low glycemic diet made it easier for subjects to maintain weight loss over time as compared to a low-fat or low-carb diet.

Dr. Ludwig also hinted that there may be more to the low-glycemic story in ways beyond greater digestion costs of resistant starches and fibers and into the bloodstream. Interesting new findings, he told me after his talk at the conference, suggest high-glycemic meals could have an impact on hormones in terms of how they influence appetite, metabolic rate, and energy storage (I wonder what he thinks of "insulin hypothesis").

Nutritional biochemist Geoff Livesey, of Independent Nutrition Logic Ltd., is the lead author of a meta-analysis of prospective cohort studies that Dr. Ludwig told me was the most well-designed study available on low-glycemic diets to date. The study, just published in American Journal of Clinical Nutrition, indicated a "strong and significantly lower type-2 diabetes risk" in those consuming low-glycemic diets. Livesey added that it’s unclear whether or not it’s the lack of highly processed carbs and fats that make the low-glycemic diet protective, or the inclusion of more protein and fiber that produce the protection; protein and fiber, for example, have a greater satiety effect than do carbs and fats that could contribute to an easier time eating reduced calories.

Livesey agreed with the panel that the Atwater Specific-factor System had failures and could be improved to be more accurate, but he cautions that the group had an uphill battle if they were going to change it. It would take changing the position of the Food and Agriculture Organization of the United Nations (FAO). Also, many in the "nutrition establishment" (Ludwig's choice of words) are likely to disagree that the Atwater system needs to change at all.

Does it matter if food labeling is inaccurate?

The FAO, in fact, brought together an expert committee to write a report after a technical workshop in Rome that evaluated the topic of food energy and the Atwater Specific-factor System in 2002. In the report, the committee concluded that, yes, it was true that foods can differ substantially in terms of their "net metabolizable energy." But more data need to be collected before determining any major changes and, in the context of the total diet for most countries, the Atwater Specific-factor System isn't likely to introduce a lot of error—they estimated less than 5 percent, except on a few subsistence diets, which rely on a lot of native foods, where errors may increase to up to 18.5 percent.

I asked John Peters, Chief Strategy Officer of the New Health and Wellness Center at the University of Colorado Anschutz Medical Campus, to comment further on the topic. He told me, "Every step of the digestion and metabolism process introduces multiple variables that will be unique to the individual." For example, he told me, the "digestible energy of lard (made of palmitic, stearic and oleic acids) will depend on the calcium level in the diet of the organism consuming the lard because calcium will bind to stearic acid in the gut and reduce its absorption."

Individual variability adds complexity that is compounded by the metabolic energy costs that are heavily determined by protein content of meals because of the need to remove amino acid waste, along with fermentable fiber content, rate of absorption of foods into the body, and other elements of nutritional status. "As you can imagine," he told me, "these are variable from meal to meal and from individual to individual. Because of this complicated mix of effectors, the current labeling system was an attempt to blend simplicity with the 80:20 rule… it's about right for most things found in most diets.”

Mark Haub, a professor of human nutrition at Kansas State (aka the Twinkie diet professor), explains that his belief is that people misunderstand or simply fail to remember the components of thermodynamics. "One factor is that food contains a constant amount of energy, and then the potentiallly incongruent piece is that the energy in the food may or may not be bioavailable" (as metabolizable energy). So, a processed food would, indeed, tend to have energy that is more bioavailable than raw food because the energy is more difficult to extract because it's more difficult to digest.

Yet he agrees that when it comes to changing food labeling, "that becomes tricky." The absorption of energy from oranges, for example, can change simply depending on how much is eaten. When large amounts are eaten, more will likely "get dumped" into the large intestine. In addition, Haub told me, the rate of digestion can change depending on accompanying foods like those containing fiber or protein. "Do we digest an apple the same every time we eat it? I have a hard time thinking that is the case."

He's right about the differences in apple absorption considering that people are likely to eat them raw sometimes, processed (as in apple sauce), and cooked (as in apple pie on Thanksgiving). When eaten raw, according to Carmody's findings, it would yield fewer Kcals. But since the Atwater Specific-factor System basically assumes all foods are processed or cooked, at least consumers can safely predict that the apple would not yield more than the listed 116 Kcals.

So, perhaps that's a better way to look at the problem: labels wouldn't be so misleading if we thought of their Kcal listings not as total Kcals, but as max Kcals you could get from any given food. And, if one is to determine some kind of main takeaway dietary message from all this discussion, it may be simply this: that by eating more whole, raw foods (like other animals and like our pre-human ancestors did), you can count on fewer Kcals (thank your microbes for halving the amounts of Kcals you absorb once food reaches your intestine); and you can count on greater digestive and metabolic costs by eating well-balanced meals containing plenty of fiber and protein per meal (think "python diet").

*Kcals from USDA's nutrient database.

Photo credits: iStockphoto and Inside JEB.

Sunday, February 17, 2013

£5.45 BILLION 2-year budget announced for Arts and Public Health*

A short and sweet blog this week. Things have been exceptioanlly busy - but all good and productive. Next week, I should be able to report on the Dementia and Imagination research project that I know so many of you want to hear about. I’ll be heading off on a break to cooler northern climbs this week, so sorry no email response.

We want to remind anyone who’s interested in the networking session here at MMU on the 28th of Feb between 6 and 8PM - that we’ll be exploring where this arts and health journey came from, where we’re at now and where we think we might be going. It’s not directly part of the manifesto sessions, but is connected in that I want us to be thinking about how we explore this visually. How we plot our lineage (so to speak) and how we might make sense of where we are in the here and now. So - it will be an interactive session.

I was hoping to work with a graphic designer ‘live’ on the evening, somehow capturing what we say and plotting this field, but she’s out of the country! If anyone is comfortable capturing conversation and the salient points, please let me know. Although remember, I won’t be answering email this week.

OK - final thought on this. “What’s he on about - visualising the field?” Well, we’ve had frameworks, flowcharts and all manner of pseudoscientific illustration and the occasional positive-peak-flow-gibberish - but what about the The Great Bear (Patterson) - what about Acid House and Brass Bands (Deller)? What about the film-makers and animators? There are a few images and films peppered through the blog today - treat them as a stimulus and remember you’ll need to register at 

International Culture, Health & Wellbeing Conference
Bristol, June 24 – 26th
I’ve got my ticket for this event and I very much look forward to meeting up with those of you I know, those of you I’ve emailed but never met - and complete strangers!

The Early Bird registration for the conference ends on February 28th. The fee is £350 for three days - June 24th, 25th and 26th. This includes the full programme with a choice of workshops, breakout sessions, performances and visits, lunch and refreshments every day. The conference will inform international perspectives on:
  • Healthy and Creative Ageing
  • Global Health Inequalities and Culture
  • Culture and the Social Determinants of Wellbeing
Please click on the Thames Valley 616 (GJB254) Bristol LWL6B's for more details.

Community Libraries in the 21st Century
Arts Council England and LGA have published a report that looks into the different ways in which communities are involved in library service delivery. Research shows that in July 2012, 5% of public libraries had some element of community involvement, ranging from independent community libraries that own their own assets through to council-led and funded libraries whose paid professional staff are supported by volunteers. The findings indicate that this figure could rise to around 12% in the near future. From this national picture, guiding principles have been developed to assist local authorities who are considering reviewing the delivery of their library services to work with their communities. Follow this link for details. 

Funding To Support Poetry and Literature (UK)
So, with libraries in mind, the Clore Duffield Foundation has announced that round 5 of its Poetry and Literature Awards Fund is now open for applications. Through the Fund, schools, FE colleges, community groups, libraries and other arts/cultural organisations can apply for grants of between £1,000 and £10,000 to support participatory learning projects and programmes focused on literature, poetry and creative writing for under 19s.
The deadline for applications is the 1st May 2013. Read more by clicking on the splendid bonce of the poet-librarian below! 

Elephant Trust fund for visual arts projects
Deadline: 15 April 2013
The Elephant Trust offers grants to artists, and for new, innovative visual arts projects based in the UK. Its aim is to make it possible for artists and those presenting their work to undertake and complete projects when confronted by lack of funds. The Trust supports projects that develop and improve the knowledge, understanding and appreciation of the fine arts.

Priority is given to artists and small organisations and galleries who should submit well argued, imaginative proposals for making or producing new work or exhibitions. Arts Festivals are not supported. The Trust normally awards grants of up to £2,000, but larger grants may be considered. Read more by clicking on the happy elephant!

...and finally that £5.45 billion 2-year budget for local public health services...

*Whoops - did I say Arts and Public Health? Sorry, I meant Public Health. But wait, don't give up so soon. Read this. Digest it. Think about the new configuration of services. Who is your Public Health champion? How can you engage with strategic commissioning. Is the time right for re-imagining our relationships with Local Authority Arts Officers (where they've not been slashed) and Public Health?

A £5.45 billion two-year ring-fenced public health budget for local authorities has been announced by the Department of Health. From April 2013, public health budgets will be protected for the first time, with local authorities taking the lead for improving the health of their local communities. This aims to drive local efforts to improve health and wellbeing by tackling the wider determinants of poor health. It is claimed that funding is specifically targeted, for the first time, at those areas with the worst health outcomes. In 2013/14 the total budget for local public health services will be just under £2.7 billion. In 2014/15 the budget will be just under £2.8 billion. Every local authority will receive a real terms increase in funding.
For full details by clicking on the healthy food option.

Cut grass lies frail:
Brief is the breath
Mown stalks exhale.
Long, long the death...

An extract from the Philip Larkin poem, Cut Grass

Thank you for reading this blog - please share far and wide...C.P.

Monday, February 11, 2013

Experts on the evolution of human nutrition

Want to eat a diet that mimics that of our Paleolithic ancestors? It might be a little more complicated than what the popular books say.

The fact is, there was never one Paleo Diet; it's more likely there were hundreds of them and that they were continually changing and broadening over evolutionary time.

That was the overarching message of an impressive lineup of experts on ancient human diets at a symposium entitled "The Evolution of Human Nutrition" organized by the Center of Academic Research and Training in Anthropogeny (CARTA) at UC San Diego on December 7, 2012.

Now, I'm happy to report, the videos of a few of the talks have been made available (embedded in this post below). You can also read what other folks on Twitter had to say about the event using the #CARTAsymp hashtag in my Storify story.

President of the Wenner-Gren Foundation for Anthropological Research Leslie Aiello, who chaired the symposium, expressed some amusement over folks who aspire to the great lengths of trying to live like cavemen in the big city.

However flawed their premise, she noted, the gaining interest into the diet of our ancestors was one to be welcomed. After all, it could lend clues into current causes of epidemics of obesity, type-2 diabetes, and cardiovascular disease.

What we still don't know

Aiello gave a refreshing perspective on the history and complexity of studying ancient human diets. Back in 1995, she and Peter Wheeler were the first to propose the "expensive tissue hypothesis" -- one that proposed that we gained our energy-hungry brains by sacrificing our large guts.

Yet as early 2011, Aiello explains, even the well-founded theory she and Wheeler had proposed was challenged. Ana Navarrete, Carel P. van Schaik, and Karin Isler of the University of Zurich found no evidence of a brain-gut tradeoff among any other mammals.

Navarrete and her colleagues now have a competing theory: that larger brains came as a result of our abilities to store body fat. Among mammals, they suggest, those with larger brains acquire them by sacrificing adipose tissue for energy storage. But humans "buck the trend," Aiello said.

But there are so many other variables that could have also played important roles -- perhaps even billions of them.

The relationships that hominins had with microbes at the time might have contributed to adaptations, according to biological anthropologist Steven Leigh of University of Illinois, Urbana-Champaign. Microbes in the intestine continue to contribute for up to 7 percent of our daily energy supply in form of short-chain fatty acids and they also supply valuable B vitamins and hormones.

Leigh's preliminary findings are that microbial communities can change drastically depending on where primates live. Rainforest monkeys, for example, harbor more species of microbes in comparison to those living in semi-deciduous forests or in captivity. Changes affecting early humans may have factored into adaptations over evolutionary time.

What we may know  

Current hunter-gatherers offer a "window" into how early humans lived and ate, according to Alyssa Crittendon. But the nutritional anthropologist and behavioral ecologist of University of Nevada, Las Vegas, adds, "Hunter-gatherers are not living fossils. They are contemporary modern populations just like you and I."

Based on her research analyzing energy values of foods eaten by the Hadza of Tanzania, Crittendon said hunter-gather diets can vary widely depending on plants and animals of the season. During the dry season, for example, Hadza get most of their energy from meat. In the wet season, the energy contribution shifts dramatically to plant foods, especially berries.

Honey is Hadza's most preferred food being made up of 80 to 95 percent sugar and they have learned to obtain it more regularly through unusual means. A bird aptly named the greater honeyguide has learned to lead Hadza men to beehives in exchange for a share of the honeycomb. It is an extraordinary partnership of food sharing.

A look into the past is also provided through the diets of other primates such as chimpanzees, according to Peter Ungar of University of Arkansas. For example, judging from the jaw structure of chimpanzees one can find similarities with that of Ardipithecus ramidus.

This direct ancestor was likely to have eaten fruit, soft leaves, and soft legumes as chimpanzees are fond of doing today (depending on their region).

But the best evidence available on ancient human diets is from fossil teeth, Ungar adds. Clues from tooth size, shape, and structure can be combined with dental microwear and enamel chemistry.

Summarizing evidence from teeth "food prints," Ungar shares:

  • Australopithecus likely ate mostly soft or tough foods like fruits, and leaves in a mixed setting 4 to 2 million years ago, but could handle a fairly broad diet. Around 2.5 may, there was a fork in the evolutionary road.
  • Our Paranthropus cousins had more specialized teeth and likely had different diets in different places. Some ate tough savanna foods like grasses and sedges; others had harder items such as nuts and seeds in a mixed setting. 
  • Our early Homo ancestors had less specialized teeth and likely had a broader or more variable diet including both savanna and forest resources, along with some meat. 

Alison Brooks of George Washington University adds that Neandertal teeth, as well as their large caloric needs, indicate that they too must have eaten plant foods.

The microfossil evidence reveals starchy grains that also suggest Neandertals cooked and boiled their food. Now it's up to archaeologists to find pots, Brooks said.

That Neandertals ate plants is despite what the nitrogen isotope data show, anthropologist and research archaeologist Margaret Schoeninger of UCSD said.

It's necessary to rethink the nitrogen isotope data, Schoeninger said, because all humans -- whether subsisting on plants or animals -- and some plant themselves return a signal as a "top predator."

Cooking may also play in as a factor, she suggested.

What we know were crucial for modernity and leaving Africa: Cooking, food sharing, division of labor

Understanding that the introduction of fire was a major precursor to modern humans has long been argued by Primatologist Richard Wrangham of Harvard to be an essential part of better studying early human diets.

He presented new data showing that cooked carbohydrates and proteins also contribute more calories than when raw. The data support that cooking could have helped lead to expansion of large brains while at the same time reducing gut size.

Clues into what early humans ate in a setting can also be gathered through study of decisions that might our ancestors may have made based on "return on investment" scenarios, anthropologist Mary Stiner of University of Arizona said.

For example, hunting a large or small animal each can take a lot of effort, yet the larger one yields a higher return and is preferable. Comparatively, some plant foods represent greater or lower effort with higher or lower yields compared to others depending on investment into obtaining them, processing them, and/or cooking them.

It would make sense, she reasons, that cooking, food sharing and division of labor were crucial for humans to insulate infants and children (which need a great deal more attention, compared to those of other primates) from variations in food supply.

The likelihood is that each of these human characteristics -- cooking, food sharing, and division of labor -- were apparent at the time of our direct ancestor Homo erectus around 1.89 million and 143,000 years ago.

Homo had evolved to be "eating machines," Schoeninger said in an earlier discussion on the topic at Eleanor Roosevelt College (video embedded below).

Schoeninger noted that it was H. erectus that first left Africa and needed fire to stay warm. On their journey, Schoeninger suggests, it was likely that they subsisted on animal foods during the winter and on seed heads from grasses (cereal grains) as familiar food when traveling into Asia and Europe (because of unfamiliarity with fruits and vegetables of other regions).

Agriculture and population health decline

By 15 to 10,000 years ago, modern humans had taken over the landscape and were already shifting from foraging to farming, which represented a major transition in the human diet, Schoeninger said.

The shift was was one from a varied, broad diet that changed with seasons to be replaced with one that included specific plant foods such as cereal grains as a dietary staple, according to anthropologist Clark Spencer Larsen.

This reliance on single foods such as grains as staples with characteristically low nutritional quality, along with more availability of food and more sedentary lifestyle, he said, was the start of health decline as evidenced by study of bones and teeth of the era.

Barry Bogin, a biological anthropologist of Loughborough University, UK, has witnessed this sort of population health decline first-hand while studying the Maya who in recent years have made the switch from their traditional varied diets to ones that are more modern and containing a great deal more animal products, cereal grains, and added sugars.

Unfortunately, Maya children will ultimately suffer the most from the dietary transition with higher risk of obesity and chronic diseases such as type 2 diabetes.

Judging from the history, isn't it understandable that folks would be compelled to change their diets (and propose that others change theirs) to one that is relatively more similar to that of our hunter-gatherer ancestors?

But when asked about dietary advice (including what food groups to be consumed and to not be consumed) that can be gathered from an extensive knowledge of evolution of the human diet, Ungar simply shrugs and responds, "I tell people to go see a nutritionist."

Videos from CARTA

Steven Leigh, Peter Ungar, Alison Brooks, and Margaret Schoeninger:

Mary Stiner, Alyssa Crittenden, and Steven Leigh:

"Eating Machines" - Margaret Schoeninger from Feb 20, 2012 at Eleanor Roosevelt College:

The War of the End of the World: The health puzzle posed by its survivors

The War of Canudos took place in Brazil in 1896 and 1897. Canudos was a settlement of several thousand deeply religious Christians, led by a man known as Antonio Conselheiro. They opposed the recent establishment of the Republic of Brazil, particularly the institution of income taxes and civil marriage; the former was considered government-sponsored theft and the latter a sacrilege. The republic had been declared in 1889 following a military coup that deposed Dom Pedro II, an emperor beloved by the common people and under whose rule slavery had recently been abolished.

Canudos was located in the Brazilian sertão, an inhospitable semi-arid region in the northeastern part of the country. The inhabitants of Canudos were the sertanejos. The term jagunço was used to refer to the males, especially the outlaws. Many of the sertanejos lived in semi-starvation, in poor sanitary conditions, and with very limited (if any) access to healthcare. Infant mortality was very high at the time. Those who reached adulthood were typically of small stature, and very thin; not lean, thin – often described as “skin and bones”.

Below is what a typical young jagunço would look like at the time of the War of Canudos. (Some authors differentiate between jagunços and cangaceiros based on small differences in cultural and dress traditions; e.g., the hat in the photo is typical of cangaceiros.) The jagunços tended to be the best fed among the sertanejos. They were also known as cold-blooded killers. The photo is a cropped version of the original one; the grizzly original is at the top of a recent blog post by Juan Pablo Dabove (). The blog post discusses Vargas Llosa’s historical fiction book based on the War of Canudos, the masterpiece titled “The War of the End of the World” ().

Jorge Mario Pedro Vargas Llosa, a Peruvian-Spanish writer and politician, was the recipient of the 2010 Nobel Prize in Literature; “The War of the End of the World” is considered one of his greatest literary achievements. Euclides da Cunha wrote the most famous non-fictional account on the War of Canudos, another masterpiece that has been called “Brazil’s greatest book”, titled “Rebellion in the Backlands” (). The Portughese title is “Os Sertões”. Vargas Llosa’s book is based on da Cunha’s.

Sergio Rezende’s movie, “Guerra de Canudos” (), is a superb dramatization of the War of Canudos. I watched this movie after reading Vargas Llosa’s and da Cunha’s books, and was struck by two things: (a) the outstanding performances, especially by José Wilker, Cláudia Abreu, Marieta Severo, and Paulo Betti; and (b) the striking resemblance of the latter (Betti) to Royce Gracie (), a very nice man whom I interviewed () for my book on compensatory adaptation (), and who is no stranger to Ultimate Fighting Championship and mixed martial arts fans ().

In a nutshell, the War of Canudos went more or less like this. There were four military campaigns against the settlement. The third was a major one, led by one of Brazil’s most accomplished military leaders at the time, Colonel Antônio Moreira César. The jagunços, resorting to guerrilla warfare, fought off the government troops in the first three. The fourth, led by General Arthur Oscar de Andrade Guimarães, saw the jagunços defeated in a war of attrition primarily due to lack of access to food and water, after heavy losses among government troops. At the end, nearly all of the surviving jagunços were executed, by knife – to their absolute horror, and the perverse pleasure of the executioners bent on revenge, as the victims believed that they would not go to heaven if their lives were ended by knife, even against their will.

Ned, what is your point regarding health!?

After going through numerous sources, paper-based and online, academic and non-academic, I am convinced that a significant number of the survivors of the Canudos War lived to their 90s and beyond. This conclusion is based chiefly on comparisons of various dates, especially of interviews with survivors. No single source dedicated to this particular health-related aspect of the War of Canudos seems to exist. There is a video clip that shows some of the survivors (), speaking in Portuguese, with their ages shown in subtitles (“years”, in Portuguese, is “anos”). One of them, a man, is listed as being a supercentenarian.

In modern USA those who live to the age of 90 and beyond are outliers. Less than 2 percent of the population reach the age of 90 (). Most of them are women. My impression is that among the survivors of the War of Canudos, the 90+ percentage was at least 5 times higher; even with access to sanitation and healthcare in modern USA being much better at any age.

If my impression is correct, how can it be explained?

I think that some of the readers of this blog will be tempted to explain the high longevity based on calorie restriction. But the empirical evidence suggests that poor nutrition, in terms of micronutrients and macronutrients, is associated with increased mortality, not the other way around (, , ). Mortality due to poor nutrition is frequently from infectious diseases, in the young and the old. Degenerative diseases are widespread among the overnourished, not the well nourished, and kill mostly at later ages. It is not uncommon for infectious diseases to “mask” as degenerative diseases – e.g., viral diabetes ().

Often people point at hunter-gatherer populations and argue that they are healthy because of their low calorie intake. But mortality from infectious diseases among hunter-gatherers is very high, particularly in children. Others point to the absence of industrial foods engineered for overconsumption, which I think is definitely a factor in terms of degenerative diseases. Some say that a main factor is retention of lean body mass as one ages, referring mostly to muscle tissue, a hypothesis to which the case of the sertanejos poses a problem – what lean body mass!? And, on top of all of their problems, the sertanejos regularly faced long droughts, which may be why they typically had a “dry” look.

Yet others point to low stress. It is reasonable to think that stress is a mediating factor in the development of many modern diseases. Still, the sertanejos living in Canudos have had to endure quite a lot of stress, before and after the War of Canudos. In fact, the depictions of their lives at around the time of the War of Canudos suggest very stressful, miserable lives, prior to the conflict; which in part explains the early success of a religious settlement where life was marginally better.

By the way, the traditional Okinawans have also endured plenty of stress (), and they have had the highest longevity rates in recorded history. Food scarcity has frequently been combined with stress in their case, as with many other long-living groups. Causality is complex here, probably changing direction in different subsets of the data, but I have long suspected that the combination of stress and overnourishment is a particular unnatural one, to which humans are badly maladapted.

A main factor is almost always forgotten: the effective immune systems of those who have been subjected to starvation, poor sanitation, lack of healthcare, and other challenges – especially in childhood – and survived to adulthood. And here some counterintuitive things can happen. For example, someone may be very sickly early in life and barely survive childhood, and then become very resistant to infectious diseases later, thus appearing to be very healthy, to the surprise of relatives and friends who remember “that sickly child”. Immunocompetence is something that the body builds up in response to exposure.

As they say in northeastern Brazil, in characteristic drawl: “Ol’ sihtaneju ain’t die easy”.

Sunday, February 10, 2013

新 年 快 樂

I wish a happy and peaceful year to anyone celebrating Chinese New Year and welcome in Year of the Snake.

What a week! Thank you to everyone who came and shared their ideas and stories at the first Arts, Health and Recovery networking event here at MMU on Thursday evening - what, you didn’t know this is a regular event? Well, following the passion and drive of those in this packed event, there’s clearly a space for it. So - lets do it, lets think of this as a space that we can get together - share ways forward and perhaps develop new projects that relate to recovery, wellbeing and the arts.

SO - a little about the event and the preceding days. Arts for Health is working with artists and people in recovery from substance misuse, in Pescara and Pistoia in Italy; Kütahya in Turkey and here in the UK in Manchester and Liverpool.

Partners from all the countries gathered here in Manchester to plan a series of events and the artists residences and exchanges. We’re recruiting a lead artist from the UK to oversee the project and the artists in Italy and Turkey who will develop work in substance recovery communities. Alongside the lead artist, all three will be involved in cultural exchange with recovery communities in each country, working with people affected by alcohol or drug addiction and around a theme of self-portraiture. Shortly we’ll have a dedicated blog page for this emerging work. 

So, the networking evening was a way of bringing people together from the recovery community alongside artists and health professionals and what a great event it was to be part of, with a high number of people in recovery in attendance and one or two very personal and inspiring stories shared. I was particularly thrilled to hear people saying that it was their first time in a university - and on my word - it won’t be the last. For the first time in my ‘professional’ career, I was inspired to share a little chaos from my own early family life.

We also shared the Finnish film that I posted on the blog last week, Fragile Childhood -Monsters. I was cautious showing it, but relieved I did, as it opened up some difficult, but cathartic and grounded conversations.

For those of us who compared notes on the night, the overriding feeling was that this work was about making substance addiction and recovery visible.

Thank you for all of you who came and shared your thoughts, stories and ideas.

With the annual pressure to send or receive commercial tokens of affection on Valentines day, its been with a wry smile that I notice many of the newspapers are citing the University of Oxford researchers, Savulescu & Sandberg and their Neuroenhancement of Love and Marriage: The Chemicals Between Us, which discusses the possibility of chemically enhancing flagging romance in long-term relationships! A pill not only to make you happy in your long years of monotony, but to synthesize that feeling of amor. Alongside our deluded belief in some over-the-counter prescribed answer to all of life's grief.

Leon Jakeman
Following on from last weeks fleeting comments on the 50th anniversary of Sylvia Plath and The Bell Jar, the writer Jeanette Winterson wrote a lovely succinct reflection of what Plath means to her. Here it is in full.

"The early 60s was a terrible time for women. Worse for clever ambitious women. Valium had been on the market for two years in 1963 and by this time was being advertised aggressively at healthy women who felt trapped and desperate and whose distress had to be medicated away. This is the world of The Bell Jar.

The Bell Jar was published at the same time as Henry Miller's Tropic of Cancer was reissued after its long ban in the USA. The misogynist masterpiss billets half the population to the whorehouse. All women are for sex. Rich women are for cash. Poor women are for housework. Why wouldn't a woman go mad in a world like this? Why wouldn't a woman as gifted as Plath become terminally depressed and end in suicide? Pills don't change the world. Feminism did.

The Bell Jar was a call to action because it is a diary of despair. Plath was gifted. She could have been great. Wrong generation. Wrong medication."

Arts and Health Research (part 1)
I want to give a very warm welcome to the newest member of the Arts for Health team, Rebecca Gordon-Nesbitt who will be joining us for 3 months to research arts and health archives both in the UK and internationally, making where possible strategic links and connections. This work is being undertaken with the generous support of the AHRC and in collaboration with LIME Arts. If you want to meet Rebecca and here more about her background, she’s giving one of the Tuesday Talks at The Whitworth Art Gallery this Tuesday. here are some details.

The Tuesday Talks series invites leading artists, thinkers and curators to explore the driving forces, influences and sources of inspiration within contemporary art. The series is programmed by Professor Pavel Büchler and is a collaboration with Manchester Metropolitan University.

12 February
11.00am – 12.30pm, free, no booking necessary 
Rebecca Gordon-Nesbitt 
Having worked as a curator of international contemporary art for more than a decade, Rebecca Gordon-Nesbitt receded from direct participation to embark upon an extensive interrogation of the European cultural field. Increasingly deploying an investigative methodology, she has exposed the endemic corruption in commercially derived approaches to culture, most recently as Researcher-in-Residence at the Centre for Contemporary Art, Derry, in relation to UK City of Culture 2013. Seeking alternatives to the prevailing model of cultural organisation, Rebecca spent five months in the libraries and archives of Havana, tracing the socially inflected approaches to culture that emerged in the wake of the 1959 Cuban Revolution. It is this research she will present at this talk, in the context of broader trends in cultural policy and their effect on the production of art.

Arts and Health Research (part 2)
Did you know that there is an emerging arts and health research network being developed? You can find details at

School Residencies: Call for Artists (Round 1), Blackburn and Darwen
10 x artist school residency fees worth up to £10,000 each
Blackburn and Darwen's Building Schools for the Future (BSF) continues with the latest phase of an extensive school building programme. Linked to this, Blackburn with Darwen Borough Council’s Arts Service are launching the first round of an ongoing Artist Call targeting artists from all creative disciplines with an interest in educational and community engagement, and further developing their collaborative practice.
At this initial stage, they are asking for artists to consider the brief on their website: and if interested to log your Expression of Interest by registering online and uploading some examples of your work to the private ‘intranet’ section. As well as your basic registration, they encourage you to also upload some practice information as well.
The deadline for your received registrations for this first round is 1st March 2013, but other Artist Calls will continue straight afterwards too.

Wellcome Trust Small Arts Awards (UK)
The Wellcome Trust has announced that the next application deadline under its Small Arts Awards is the 28th June 2013.  The Small Arts Awards provides grants of up to £30,000 to projects that engage the public with biomedical science through the arts. The aim of the awards is to support arts projects that reach new audiences which may not traditionally be interested in science. 

Funding for Creative Young People (UK)
IdeasTap, a non-for-profit initiative supports young creative people between 16 and 25 years of age, has announced that its Ideas Fund Innovators is open to applications. During this funding round the Ideas Fund Innovators aims to offer ten projects £1,000 each to help get them off the ground. In the past, Ideas Tap has funded everything from dance and film projects to music videos and photography collectives.  Applications from any creative field will be considered. Ideas Tap are looking for projects that are inspiring, original, innovative and that Ideas Tap think you can deliver. This brief closes on Thursday 4 April 2013 at 5pm and is open to IdeasTap members aged 16 to 25 on the closing date. Read more at: 

Nominet Trust: Digital Edge Programme (UK)
The Nominet Trust has announced that the 2nd call for applications under its £2 million Digital Edge Programme is now open for applications.  The programme aims to support projects that use new technology to engage young people in new, more meaningful and relevant ways and enable their participation in building a more resilient society. There is no upper or lower funding limit as the Trust like to encourage applicants to be realistic about what they need to achieve their project objectives.  The closing date for applications is the 1st May 2013. Read more at:

Europe for Citizens Programme: 
Citizens Projects (UK)
The European Commission has announced a new call for proposals under its Europe for Citizens Programme – Action 1 – Measure 2.1 Citizens' projects.  The measure “Citizen’s projects” aims at exploring innovative methodologies and approaches to encourage citizens’ active participation at European level and to stimulate the dialogue between European citizens and European institutions. Under this measure a variety of projects of a transnational and cross-sectoral dimension, directly involving citizens will be supported.  Priority is given to projects aimed at encouraging local level participation.  Eligible organisations that can apply include civil society organisations and local authorities.   A project must involve organisations/institutions from at least 5 participating countries of which at least one is an EU Member State.

The Grants available range from €100,000 - €250,000 and the closing date for applications is the 1st June 2013.Read more at: