Event NEWS FLASH...

Arts for Health at MMU and

Greater Manchester Arts Health Network

present

An Un-Conference event

four separate sessions

on 20th October 2011

focusing on arts and culture for public mental health and wellbeing

with

Dorothy Rowe on Depression and Imagination

Mark O’Neill on Cultural Participation for Public Mental Health

Professor Lynn Froggett on Transformative Arts Practice

Phil Burgess and Langley Brown on Changing Mindsets - the realities of arts health engagement

at Manchester Metropolitan University, Manchester

Within an overarching public mental health context, these four separate sessions will involve active participation to expand and develop arts and health practice and foster dialogue across the arts , health and voluntary sectors.

Each free session is aiming to engage different audiences from across the North West with a primary focus on arts and health in Greater Manchester. We do not anticipate delegates will attend more than one or two of the four sessions. If you do wish to attend more than one session you must register separately for each, following the relevant booking links. Places will be confirmed at the end of September.

Full details and booking can be found at: http://www.eventbrite.com/org/1413180499?s=5079931


Please note that Clive Parkinson and Anne Crabtree are not dealing with enquiries for this event. If you have any booking queries please contact Events Northern Ltd on 01772 336639 or info@eventsnorthern.co.uk

...and something to get you in the mood (for those of you who missed it last week)

 

Men who are skinny-fat: There are quite a few of them

The graph below (from Wikipedia) plots body fat percentage (BF) against body mass index (BMI) for men. The data is a bit old: 1994. The top-left quadrant refers to men with BF greater than 25 percent and BMI lower than 25. A man with a BF greater than 25 has crossed into obese territory, even though a BMI lower than 25 would suggest that he is not even overweight. These folks are what we could call skinny-fat men.

The data is from the National Health and Nutrition Examination Survey (NHANES), so it is from the USA only. Interesting that even though this data is from 1994, we already could find quite a few men with more than 25 percent BF and a BMI of around 20. One example of this would be a man who is 5’11’’, weighing 145 lbs, and who would be technically obese!

About 8 percent of the entire sample of men used as a basis for the plot fell into the area defined by the top-left quadrant – the skinny-fat men. (That quadrant is one in which the BMI measure is quite deceiving; another is the bottom-right quadrant.) Most of us would be tempted to conclude that all of these men were sick or on the path to becoming so. But we do not know this for sure. On the standard American diet, I think it is a reasonably good guess that these skinny-fat men would not fare very well.

What is most interesting for me regarding this data, which definitely has some measurement error built in (e.g., zero BF), is that it suggests that the percentage of skinny-fat men in the general population is surprisingly high. (And this seems to be the case for women as well.) Almost too high to characterize being skinny-fat as a disease per se, much less a genetic disease. Genetic diseases tend to be rarer.

In populations under significant natural selection pressure, which does not include modern humans living in developed countries, genetic diseases tend to be wiped out by evolution. (The unfortunate reality is that modern medicine helps these diseases spread, although quite slowly.)  Moreover, the prevalence of diabetes in the population was not as high as 8 percent in 1994, and is not that high today either; although it tends to be concentrated in some areas and cluster with obesity as defined based on both BF and BMI.

And again, who knows, maybe these folks (the skinny-fat men) were not even the least healthy in the whole sample, as one may be tempted to conclude.

Maybe being skinny-fat is a trait, passed on across generations, not a disease. Maybe such a trait was useful at some point in the not so distant past to some of our ancestors, but leads to degenerative diseases in the context of a typical Western diet. Long-living Asians with low BMI tend to gravitate more toward the skinny-fat quadrant than many of their non-Asian counterparts. That is, long-living Asians generally tend have higher BF percentage at the same BMI (see a discussion about the Okinawans on this post).

Evolution is a deceptively simple process, which can lead to very odd results.

This “trait-not-disease” idea may sound like semantics, but it has major implications. It would mean that many of the folks who are currently seen as diseased or disease-prone, are in fact simply “different”. At a point in time in our past, under a unique set of circumstances, they might have been the ones who would have survived. The ones who would have been perceived as healthier than average.

Riots...Consumer Culture...Violence and RSPH Awards

Bonjour à tous nos amis en France et bienvenue!

Amidst the bleakness of this social landscape, squinting all the while in the glare of a culture that radiates ultraviolet consumerism and infrared celebrity.

Hello again and welcome back. The year continues to progress with startling changes across society. There's been lots in the press about where we should apportion blame following the 'riots', but very little that links greed and consumerism. I was suprised to read article by Russell Brand that does make this connection and  links the unfolding unrest to banking. http://www.informationclearinghouse.info/article28835.htm

m a n i f e s t o
The first manifestation of our ideas and passion will be published this September and just thinking about how our arts and health agenda is increasingly being affected by politics and affecting politics, its worth reminding ourselves of the way the arts question society. Syrian cartoonist Ali Ferzat, has this week, been seriously assaulted for his provocative work. Like Ai Weiwei and many that have come before them, artists give voice to this experience of being human. Like Augusto Boal, many have been imprisoned for enabling debate, some have lost their lives.


Ali Ferzat

Who Cares? Big congratualations to all those involved in the Who Cares? programme that has won the RSPH Arts and Health Practice and Research awards.
http://www.mla.gov.uk/what/programmes/renaissance/regions/north_west/news/~/media/North_West/Files/2011/Who%20Cares%20Report%20FINAL%20w%20revisions.ashx 
http://newlightmanchester.files.wordpress.com/2011/06/whocares_final_midres.pdf

Refined carbohydrate-rich foods, palatability, glycemic load, and the Paleo movement

A great deal of discussion has been going on recently revolving around the so-called “carbohydrate hypothesis of obesity”. I will use the acronym CHO to refer to this hypothesis. This acronym is often used to refer to carbohydrates in nutrition research; I hope this will not cause confusion.

The CHO could be summarized as this: a person consumes foods with “easily digestible” carbohydrates, those carbohydrates raise insulin levels abnormally, the abnormally high insulin levels drive too much fat into body fat cells and keep it there, this causes hunger as not enough fat is released from fat cells for use as energy, this hunger drives the consumption of more foods with “easily digestible” carbohydrates, and so on.

It is posited as a feedback-loop process that causes serious problems over a period of years. The term “easily digestible” is within quotes for emphasis. If it is taken to mean “refined”, which is still a bit vague, there is a good amount of epidemiological evidence in support of the CHO. If it is taken to mean simply “easily digestible”, as in potatoes and rice (which is technically a refined food, but a rather benign one), there is a lot of evidence against it. Even from an unbiased (hopefully) look at county-level data in the China Study.

Another hypothesis that has been around for a long time and that has been revived recently, which we could call the “palatability hypothesis”, is a competing hypothesis. It is an interesting and intriguing hypothesis, at least at first glance. There seems to be some truth to this hypothesis. The idea here is that we have not evolved mechanisms to deal with highly palatable foods, and thus end up overeating them.  Therefore we should go in the opposite direction, and place emphasis on foods that are not very palatable to reach our optimal weight. You might think that to test this hypothesis it would be enough to find out if this diet works: “Eat something … if it tastes good, spit it out!”

But it is not so simple. To test this palatability hypothesis one could try to measure the palatability of foods, and see if it is correlated with consumption. The problem is that the formulations I have seen of the palatability hypothesis treat the palatability construct as static, when in fact it is dynamic – very dynamic. The perception of the reward associated with a specific food changes depending on a number of factors.

For example, we cannot assign a palatability score to a food without considering the particular state in which the individual who eats the food is. That state is defined by a number of factors, including physiological and psychological ones, which vary a lot across individuals and even across different points in time for the same individual. For someone who is hungry after a 20 h fast, for instance, the perceived reward associated with a food will go up significantly compared to the same person in the fed state.

Regarding the CHO, it seems very clear that refined carbohydrate-rich foods in general, particularly the highly modified ones, disrupt normal biological mechanisms that regulate hunger. Perceived food reward, or palatability, is a function of hunger. Abnormal glucose and insulin responses appear to be at the core of this phenomenon. There are undoubtedly many other factors at play as well. But, as you can see, there is a major overlap between the CHO and the palatability hypothesis. Refined carbohydrate-rich foods generally have higher palatability than natural foods in general. Humans are good engineers.

One meme that seems to be forming recently on the Internetz is that the CHO is incompatible with data from healthy isolated groups that consume a lot of carbohydrates, which are sometimes presented as alternative models of life in the Paleolithic. But in fact among influential proponents of the CHO are the intellectual founders of the Paleolithic dieting movement. Including folks who studied native diets high in carbohydrates, and found their users to be very healthy (e.g., the Kitavans). One thing that these intellectual founders did though was to clearly frame the CHO in terms of refined carbohydrate-rich foods.

Natural carbohydrate-rich foods are clearly distinguished from refined ones based on one key attribute; not the only one, but a very important one nonetheless. That attribute is their glycemic load (GL). I am using the term “natural” here as roughly synonymous with “unrefined” or “whole”. Although they are often confused, the GL is not the same as the glycemic index (GI). The GI is a measure of the effect of carbohydrate intake on blood sugar levels. Glucose is the reference; it has a GI of 100.

The GL provides a better way of predicting total blood sugar response, in terms of “area under the curve”, based on both the type and quantity of carbohydrate in a specific food. Area under the curve is ultimately what really matters; a pointed but brief spike may not have much of a metabolic effect. Insulin response is highly correlated with blood sugar response in terms of area under the curve. The GL is calculated through the following formula:

GL = (GI x the amount of available carbohydrate in grams) / 100

The GL of a food is also dynamic, but its range of variation is small enough in normoglycemic individuals so that it can be treated as a relatively static number. (Still, the reference are normoglycemic individuals.) One of the main differences between refined and natural carbohydrate-rich foods is the much higher GL of industrial carbohydrate-rich foods, and this is not affected by slight variations in GL and GI depending on an individual’s state. The table below illustrates this difference.

Looking back at the environment of our evolutionary adaptation (EEA), which was not static either, this situation becomes analogous to that of vitamin D deficiency today. A few minutes of sun exposure stimulate the production of 10,000 IU of vitamin D, whereas food fortification in the standard American diet normally provides less than 500 IU. The difference is large. So is the difference in GL of natural and refined carbohydrate-rich foods.

And what are the immediate consequences of that difference in GL values? They are abnormally elevated blood sugar and insulin levels after meals containing refined carbohydrate-rich foods. (Incidentally, the GL  happens to be relatively low for the rice preparations consumed by Asian populations who seem to do well on rice-based diets.)  Abnormal levels of other hormones, in a chronic fashion, come later, after many years consuming those foods. These hormones include adiponectin, leptin, and tumor necrosis factor. The authors of the article from which the table above was taken note that:

Within the past 20 y, substantial evidence has accumulated showing that long term consumption of high glycemic load carbohydrates can adversely affect metabolism and health. Specifically, chronic hyperglycemia and hyperinsulinemia induced by high glycemic load carbohydrates may elicit a number of hormonal and physiologic changes that promote insulin resistance. Chronic hyperinsulinemia represents the primary metabolic defect in the metabolic syndrome.

Who are the authors of this article? They are Loren Cordain, S. Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A. Watkins, James H O’Keefe, and Janette Brand-Miller. The paper is titled “Origins and evolution of the Western diet: Health implications for the 21st century”. A full-text PDF is available here. For most of these authors, this article is their most widely cited publication so far, and it is piling up citations as I write. This means that not only members of the general public have been reading it, but that professional researchers have been reading it as well, and citing it in their own research publications.

In summary, the CHO and the palatability hypothesis overlap, and the overlap is not trivial. But the palatability hypothesis is more difficult to test. As Karl Popper noted, a good hypothesis is a testable hypothesis. Eating natural foods will make an enormous difference for the better in your health if you are coming from the standard American diet, and you can justify this statement based on the CHO, the palatability hypothesis, or even a few others – e.g., a nutrient density hypothesis, which would be closer to Weston Price's views. Even if you eat only plant-based natural foods, which I cannot fully recommend based on data I’ve reviewed on this blog, you will be better off.

Living Food Walls for Disadvantaged Youth, Sustainable Communities

The first living wall as it's constructed in South Africa.

My friend Warren Te Brugge has taken on a project that deserves the attention of all who are interested in the ideals of sustainable communities and food security in all parts of the world.

His new foundation My Arms Wide Open® is building the first-ever living food walls with the objective of providing fresh fruits and vegetables to disadvantaged youth in both Vancouver Downtown Eastside and in rural South Africa.

The sister walls will be constructed based on the design of South African artist, Dylan Lewis, who created the exhibition "Untamed" (pictured above) at Kirstenbosch National Botanical Gardens (see more pics of the living plant wall construction here). The exhibition was originally constructed in celebration of the country's hosting of the 2010 World Cup.

The two identical vertical gardens -- one in Vancouver and the second in Cradock, South Africa -- will yield several harvests throughout the year and offer educational opportunities. The main goal: inspire youth to make their own "mini walls" contributing to their health and sustainable communities.

How are these walls being constructed? All the details are here (.pdf). In short, each will be designed as an "S" shaped arc that is 40 feet long and 6 feet high. The design is ideal for allowing the young children to tend the lower parts and older youth to tend the higher areas. A concrete footing will support individual slots for plastic 2-liter pop bottles cut to hold each plant.

"During the fall and winter, the garden’s bottles not being used for vegetables and fruits will be replaced with suitable plants to maintain the wall during the off-season and allow for preparation of new vegetable seedlings for the spring," Warren writes on his blog. "In addition to the fruit plants grown in the bottles, we intend to plant several fruit trees around the wall to support the surrounding community’s need for fresh fruit."

He also writes, "These food walls are about 'more than just crops'. Projects like this can help create a sense of real community as families learn about how to grow and maintain the walls, volunteer to help and share the harvests."

Sounds like a project that could make a big difference? A few think so, which is why Warren was recently nominated for an award from Katerva, a UK-based charity organization that recognizes publicly what they see as "the very best sustainability initiatives on the planet. 

I also think the food walls are a pretty cool plan, so I'm contributing to the cause at Global Giving here. Check it out: The project has only 10 more days to raise $4,000 from 50 donors and, as of the time of this writing, there are 42 donors and only $660 remaining. 

Book review: Sugar Nation

Jeff O’Connell is the Editor-in-Chief for Bodybuilding.com, a former executive writer for Men’s Health, and former Editor-in-Chief of Muscle & Fitness. He is also the author of a few bestselling books on fitness.

(Source: Bodybuilding.com)

It is obvious that Jeff is someone who can write, and this comes across very clearly in his new book, Sugar Nation.

Now, with a title like this, Sugar Nation, I was expecting a book discussing trends of sugar consumption in the USA, and the related trends in various degenerative diseases. So when I started reading the book I was slightly put off by what seemed to be a book about a very personal journey, written in the first person by the author.

Yet, after reading it for a while I was hooked, and literally could not put the book down. Jeff has managed to write something of a page-turner, combining a harrowing personal account with carefully researched scientific information, about a relatively rare form of type 2 diabetes.

Jeff has a genetic propensity to insulin resistance, just like his father did. What makes Jeff’s case a little unusual is that Jeff is thin, and apparently has difficulty gaining weight. The most common type of diabetes is type 2, and most of those who develop type 2 diabetes do so via the metabolic syndrome. Typically this involves becoming obese or overweight before getting diagnosed as a diabetic.

In fact, in a thin person who is insulin resistant it seems that body fat cells become resistant to the normal actions of insulin much sooner than in the obese. This essentially means that they start rejecting fat. This is a problem, because fat should either be stored in fat cells (adipocytes) or used for energy; as opposed to being deposited in other tissues or remaining in circulation. Apparently this makes it even more difficult for them to control glucose levels once insulin resistance sets in; there is no “cushion”, so to speak.

Still, Jeff appears to believe that his case was that of a skinny-fat person, where body fat percentage is a lot higher than expected based on a low body mass index, and where excess visceral fat is a main culprit. In fact, Jeff seems to think that most cases of thin folks who developed type 2 diabetes are like this, as they follow the metabolic syndrome progression pattern. Fasting triglycerides go up and HDL cholesterol goes down, among other things, but in a skinny-fat body.

Somewhat predictably, what Jeff found out is that, in his case, adopting a low carbohydrate diet made an enormous difference. In fact, it made the difference between having a fairly normal life versus constantly suffering through hypoglycemic episodes. And, at the stage in which Jeff caught the problem, he did not have to avoid all natural carbohydrate-rich foods, not even things like apples. (He had to control portions though.) It is the refined carbohydrate-rich foods that were the problem for him.

I must say that I disagree with a few of the statements in the book. For example, the author seems to believe that excess saturated fat and salt may be quite unhealthy. I think that foods rich in refined carbohydrates and sugars are much more of a problem; cut them out and often excess saturated fat and salt either cease to be a problem, or become healthy. Jeff doesn’t seem to think that excess omega-6 fats can also cause diabetes; I believe the opposite to be true, via a pro-inflammatory path.

Still, this is a great book on so many levels. Jeff meticulously records his experience dealing with doctors, most of whom seem to be clueless as to what to do to prevent the damage that is caused by abnormally high glucose levels. This happens even though diabetes is those doctors’ main area of expertise. He talks about himself with complete abandon, and manages to mix that up with quite a lot of relevant research on diabetes. He gives us an insider’s view of the professional bodybuilding culture, including its use of insulin injections. His description of the Amish is very interesting and somewhat surprising.

For these reasons and a few others, I think this is a great book, and highly recommend it!

Lindeberg: Focus on Food Choices, Bioactives, not Nutritionism

Dr. Lindeberg weighing a Kitavan man. 

While training in family medicine, Staffan Lindeberg, M.D., Ph.D., read a paper (published in 1985) in the New England Journal of Medicine that would alter the course of his future research. It was entitled "Paleolithic Nutrition" and one of the authors was Boyd Eaton, M.D.

It was about the same time Dr. Lindeberg had heard from a neighbor that humans had the guts of vegetarian -- to which he responded, "Oh yeah?" His neighbor was  influenced by one of a number of nutrition "stories," as Dr. Lindberg calls them, and not based on actual scientific investigation.

"People like John Harvey Kellog [inventor of corn flakes and strong proponent of a vegetarian diet] has had more influence on thinking about a healthy diet than Darwin has," Dr. Lindeberg says.

So began his journey to discover more about evolutionary biology's connections to human health, diet and Western-style chronic diseases. Twenty-six years later, last weekend on Aug. 5 in Los Angeles, Dr. Lindeberg presented alongside Dr. Eaton and several other proponents of a  "Paleo-style diet".

However, unlike most of the other presenters, Dr. Lindeberg clarified he doesn't necessarily recommend a diet containing high amounts of meat (rich in protein and fat) along with little to no carbohydrates. Instead, he said that based on his research he's convinced that the main difference from a Western-style, modern diet and that which hunter-gatherers eat is the concentration of bioactives. These bioactives, he explains, must be the real basis by which ancient diets protect from disease.

The alternative hypothesis of several researchers is that the chronic habit of postprandial (after meal) increase in glucose leads to Western disease. It's not proven, Dr. Lindeberg says, and because so current nutritional advice rests mainly on epidemiological studies.

"It's difficult to make clinical trials, to have two groups eat what they think is the same type of hamburger. One group eats hamburger with real meat, one group eats placebo meat. Of course it's impossible to do it. Maybe some time in the future," Dr. Lindeberg said.

So, lacking randomized clinical trials, it's important to begin thinking evolutionarily. That's not to say that whatever is natural is good for you. This is "nature romanticism," Dr. Lindeberg warns. For example, it is wrong to think that soy formula because it is "natural" is as healthy as breast milk. After all, a lot of these plants evolve their own defense system deliberately to target we herbivores.

Closely attached to developing a hypothesis based on evolutionary terms, is observations from hunter-gatherers. When Dr. Lindeberg studied the Kitava of New Guinea, in 1990, they chose that particular population because they had enough ethnic people and large enough population to obtain data.

Unlike other hunter-gatherers like the Inuit of Greenland that eat a low-carb diet or the Ache of Paraguay, the Kitavans are more easily described as "primitive horticulturalists." They eat plenty of yams, sweet potatoes, fruits, and coconut. They eat pork meat only on occasion. Yet, despite their diet, as a population they enjoy relatively little incidence of myocardial infarctions, stroke, and atherosclerosis.


Dr. Lindeberg dismissed criticism that he may have made a mistake in his observations and that the Kitavans were eating more pork than reported in his data. "These people are in love with the low-carb hypothesis," he said.

His findings are consistent with those from East Africa in 1920s, where stroke was absent among the population, but then it became the most common neurological disease. History repeated itself in Papua New Guinea.

Any traditional population that migrates to a Westernized diet develops high incidence of hypertension and stroke including those where the so-called  Mediterranean diet is widely eaten have a high incidence of stroke. So, in comparison to a the paleo concept, it's logical to accept it as a better diet. However, Dr. Lindeberg says, our "logic is not working."

Kitavan girl

But, what it is it about the diets of the developed world that contribute to disease? Is it carbs? No, because Kitavans can live to a ripe old age -- even some reaching centenarian status -- lacking any Western diseases while on a high-carb diet. Is it exercise? No, Kitavans are active but not anymore than an average construction worker in Sweden, Dr. Lindeberg said.

"I don't think you need to eat a low-fat diet. I think you need to stay away from Western food."

Again, Dr. Lindeberg stresses the need to stop talking about calories, carbs, and fats as "big villans" and begin focusing on bioactives. Initial controlled trials he has led that investigate the effects on a "paleo diet" rich in lean meats, fruits and vegetables have led to intriguing results.

"We've found with early diabetes or impaired glucose intolerance (pre-diabetes) all of them reverted to improved glucose tolerance," he said.

There are other benefits from eating similar to the way our hunter-gatherer ancestors did. He notes that by eating only paleo food, most people find they automatically achieve calorie restriction. Eating less is also better for the planet.

And paleo is not too far off from conventional nutritional advice. If you look at a DASH (Dietary Approaches to Stopping Hypertension) eating plan -- which is rich in lean meats, low-fat dairy products, whole grains, and fruits and vegetables -- Lindeberg says, "it's more or less paleo." (I was glad to hear that since I've been recommending the DASH eating plan for years to everybody.)

Dr. Lindeberg clarifies that what he thinks the problems lie is in focusing on fats, carbohydrates and calories instead of food choices.

"I think nutritionism [a term coined by Gyorgy Scrinis and popularized by author Michael Pollan] has been too much on the agenda," Dr. Lindeberg said.

To read more about Staffan Lindeberg and for photo credits, see  http://www.staffanlindeberg.com/KitavaPhotos.html