Kurt Harris MD

An Archevore is someone who eats based on essential principles, and also someone who hungers for essential principles. Take your pick.

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So you may find commentary here about other issues in medicine, health, other sciences, or just about anything.

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Monday
Feb282011

Proof that orthorexia exists

I am stunned at the number of comments and questions I have received regarding my offhand mention that I sometimes eat rice-based breakfast cereal in the mornings, in lieu of taking the time to boil or fry potatoes.

Apart from the "empty calories" argument (eating 7% of calories as rice is hardly going to deprive you of vitamins or give you rickets, is it?) there is much consternation over my claim that Rice Krispies are mostly starch, and have very little sugar, and hence very, very little fructose.

Now, is there anyone who is not aware that the average fructose consumption in the United States is at least 75 g/day? I would be willing to bet that the mean is actually closer to 100g, and more importantly that this is not a normal distribution at all - that there is a lot of skew to it. I'll bet there is a substantial plurality - maybe a third - that eat over 100g a day of fructose. Like a friend of mine who drinks at least one 2 Liter bottle of mountain dew per day while at work.

Not counting other intake, he is getting 1000 kcal per day from liquid sugar, and assuming HFCS at a 55/45 ratio, the fructose he gets is at minimum 143 g/day or 573 kcal or probably well over 20% of total calories - JUST FROM FRUCTOSE.

To put that in context, compare 143 g a day of fructose to Dr. Lustig's recommended upper limit. Granted, he thinks you can eat all the fruit you want, but thinks added fructose from sugar is safe if limited to 25-40 g/day.

IIRC, I believe it was T.L. Cleave who observed that the increase in western diseases in populations formerly naive to added sugar started to become evident at about 50 lbs per year (32 g/day fructose) - one third the level typically quoted for current american consumption of about 150 lbs/yr (about 100 g/day fructose)

So my friend is consuming about 143 g/day vs the Cleave number of 32 g/day and the lower limit Lustig number of 25 g/day - Lustig being the most fructose-fearing crusader I know of.

And my descripition of a bowl of generic rice krispies that has 3 g of sugar that is 1.5g of fructose, is met with shock and earnest questions, like "isn't that added sugar?" and "where can I find the cereal that has no sugar?" and " I am trying to find some that has less sugar." Etc..

I am really, really certain that neither Dr. Cleave nor Dr. Lustig would be concerned that you are damaging your liver or going to get diabetes or have a heart attack if you eat ONE-AND-A-HALF GRAMS of fructose.

Whether is is added or not is hardly the point is it?

If you really want to feed your orthorexia, and are flummoxed when you can't find totally fructose-free rice krispies type cereal at the store, just put on your thinking cap and say, "Gee, maybe there is some other kind of rice cereal that has absolutely no sugar in it.. Maybe it's even on the same shelf nearby...."

It's called puffed rice.

 

Monday
Feb282011

William Munny eats his vegetables


A while back I wrote a couple of essays expressing my skepticism about the notion that supplementing with plant compounds – resveratrol, acai, “antioxidants” - was a plausible route to improved health.

Do you believe in magic?

Plants and plant compounds are not essential or magic 

In the second essay I said:

Look, I don't read everything but I read a lot. I am not interested in dying early. The minute I see plausible evidence of some magic supplement working or an essential plant that is not common to all humans, I'll be the first one to promote it.

I've also expressed my skepticism that we could be evolved to be dependent on any particular plant or plant compound, inasmuch as the requirement for animal products at some level is an absolute, but probably not for plants, and in any case there is no one type of plant that has been consistently available across the variety of biomes occupied by humans.

At the same time, in posts like this, I have rejected the absurd idea that humans are not designed to eat any carbohydrate or plants. Note that this was written in August of 2009, so my agnosticism on macronutrient ratios and my emphasis on avoiding the putative NAD (neolithic agents of disease) has been a matter of record from the beginning.

I said:

I eat a VLC nearly carnivorous diet. The most important elements of this are no wheat or other grains, zero plant oils and very low fructose. Whether the carb level is 2% or 10% or even 20% with preservation of these more important parameters, I have not seen evidence there is a difference. 

PaNu is proscriptive (don't eat that food!) because the way to the EM2 is to avoid the neolithic agents of wheat, linoleic acid and fructose, not through duplicating a particular dietary composition from the paleolithic period - there was too much variety to even do that, and much of what I read about what “paleo man” ate is pure conjecture if not paleofantasy.

At the same time as I’ve scoffed at the cultural obsession with fruits and vegetables, it has always seemed plausible to me that eating some plant matter along with your animal products is probably healthier than otherwise. It’s just that most of the usual justifications for fruit and vegetables don’t ring true, and the few intervention trials where subjects have been exhorted to eat more fruit, vegetables or fiber have failed to show benefit. Such as:

 1) Women’s Health Study

2) WHEL Trial

3) Polyp Prevention Trial

Note that these trial results leave open the idea that eating some vegetables or fruits is healthier than none. They only refute the conventional wisdom that the more you eat of them, the better.

Analyses of RDA percentages, where vitamin requirements have been derived from the SAD, have never been convincing to me. I have tended to agree with Dr. Bernstein that eating some veggies is a hedge against going without unspecified beneficial compounds.

As I find meals garnished with and flavored by veggies more enjoyable, I’ve eaten plenty of veggies and some fruit even when I’ve been eating VLC. My addition of starchy vegetables (and limited rice) 6 months ago was purely for reasons of physical performance due to increased physical activity.

So to date I’ve felt that animal products should generally be favored over plants (If forced, take the steak over the potato) but eating some plant based whole foods has had two benefits besides the obvious one of palatability:

1)   Eating some starch/ sugars avoids chronic deep ketosis and improves physical performance and work capacity

2) Eating a variety of plants should be a hedge against micronutrient deficiencies in our Neolithic/industrial food environment

I’ve so far read nothing to change my thinking about these intuitions, but now Stephan has recently posted a two part series, replete with up-to-date references, which provide some scientific backing for my rejection of the “magic compounds” meme.

At the same time, he has provided an additional highly plausible reason to include a moderate variety of colorful plants in your diet, besides starch for fuel and the micronutrient hedge.

Polyphenols Part I

Polyphenols Part II

I’ve clipped some key quotes from these excellent essays, and followed with comments of my own in roman:

Stephan says:

Polyphenols are a diverse class of molecules containing multiple phenol rings. They are synthesized in large amounts by plants, certain fungi and a few animals, and serve many purposes, including defense against predators/infections, defense against sunlight damage and chemical oxidation, and coloration. The color of many fruits and vegetables, such as blueberries, eggplants, red potatoes and apples comes from polyphenols. Some familiar classes of polyphenols in the diet-health literature are flavonoids, isoflavonoids, anthocyanidins, and lignins. 

Polyphenols are often, but not always, defensive compounds that interfere with digestive processes, which is why they often taste bitter and/or astringent.

So we are not forgetting that plants can’t run. Plants elaborate defensive secondary compounds, some of which are specifically designed to mess with “plant predators” like herbivores, vegans and even normal people like us.

Polyphenols that manage to cross the gut barrier are rapidly degraded by the liver, just like a variety of other foreign molecules, again suggesting that the body doesn't want them hanging around.

Things that are rapidly arrested by the liver police should not be recruited en masse – this argues against taking antioxidant supplements or try to “load up” on one particular substance.

The most visible hypothesis of how polyphenols influence health is the idea that they are antioxidants, protecting against the ravages of reactive oxygen species.

This is the mainstream view of “antioxidants”. You can’t turn around without seeing an article advocating that we load up on blueberries, or red wine, or green tea, or whatever, for the supposed “antioxidant” effects.

For a good discussion of the basis for this meme - the idea that we need to fight the damage caused by leakage of free radicals from our mitochondrial furnaces with supplements - I recommend Sex, Power, Suicide by Nick Lane. This book is a must-read.

Suffice to say this antioxidant supplementation idea increasingly seems not just implausible, but totally back-asswards.

Here are a few references that show the perverse effects of trying to fight oxidation by eating excess antioxidants.

4) Antioxidants prevent health-promoting effects of exercise

5) Vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance

6) Lasting antioxidant effect of flavonoid-free diet

Stephan Continues:

The body treats polyphenols as potentially harmful foreign chemicals, or "xenobiotics" 

Both radiation and polyphenols activate a cellular response that is similar in many ways. Both activate the transcription factor Nrf2, which activates genes that are involved in detoxification of chemicals and antioxidant defense**(9, 10, 11, 12). This is thought to be due to the fact that polyphenols, just like radiation, may temporarily increase the level of oxidative stress inside cells.

In other words, the benefit of low doses of radiation – the kind we get naturally all the time from cosmic rays and naturally occurring radioactive isotopes – and the slightly toxic colorful compounds called polyphenols found in fruits and vegetables, is that both act through hormesis.

Hormesis is when a small stress induces a healthy response in an organism, such that the organism is healthier than without the stress exposure. Any stress that we have defenses for, that we would expect to encounter on an evolutionary basis, is a candidate to be hormetic. Think of this as a necessary, but not sufficient, set of conditions, though.

The perfect example of hormesis is exercise. Exercise creates oxidative stress, and resistance exercise in particular literally destroys muscle tissue. Hormesis explains the “paradox” (which is no paradox at all) that marathon running and other extreme endurance sports could be quite bad for your health, but that more moderate exercise is much better than no exercise at all. This explains why I write posts like this and this, yet I continue to run about 8-10 K per week in addition to strength training twice a week.

Are you starting to see a pattern here?

Run 10-15 K/ week. Don’t run 100 K/week. 

Lift weights 1-2 x per week. Don’t lift weights every day.

Go hungry or fast now and then. Don’t be in ketosis 24/7

Eat a moderate variety of colorful plants. Don’t take Resveratrol pills.

We can extend this principle to some other areas once we understand hormesis.

Don’t freak out about dental or medical xrays if you need them.

Don’t obsess about unavoidable “microtoxins” in the food supply. The natural ones outnumber the unnatural ones, and we are designed to deal with them. Focus on the macrotoxins – the NAD (Neolithic agents of disease).

And more speculatively, we might think about other environmental exposures that are, or could be hormetic. A little is good, lots more might be bad. 

UV A and B from Sunshine – Non-burning exposure makes vitamin D and improves mood. Excess sun on white skin causes skin cancer and wrinkles.

Fructose – Creates oxidative stress and we’ve been exposed to it for millions of years. Our liver and gut defend us against large doses. In larges doses, fructose is a NAD. Could it be beneficial in small doses?

Stephan Continues:

Just as in the case of radiation, high doses of resveratrol are harmful rather than helpful. This has obvious implications for the supplementation of resveratrol and other polyphenols.

I think that overall, the evidence suggests that polyphenol-rich foods are healthy in moderation, and eating them on a regular basis is generally a good idea. Certain other plant chemicals, such as suforaphane found in cruciferous vegetables, and allicin found in garlic, exhibit similar effects and may also act by hormesis (27). Some of the best-studied polyphenol-rich foods are tea (particularly green tea), blueberries, extra-virgin olive oil, red wine, citrus fruits, hibiscus tea, soy, dark chocolate, coffee, turmeric and other herbs and spices, and a number of traditional medicinal herbs. A good rule of thumb is to "eat the rainbow", choosing foods with a variety of colors.

My food color palette is probably smaller than Stephan’s, but I do consume dark chocolate, coffee, tea and green tea in pretty decent amounts, in addition to colorful veggies like sweet potato, tomato and "Atkins vegetables" like salad greens, and limited citrus fruits.

Note the variety of plant matter mentioned, some of which (tea) does not even have caloric value. Remember, these are “plant poisons and other rotten stuff” and any particular substance will likely not be tolerated by everyone.

People say they don’t tolerate white potatoes. I believe them. People say they can’t eat tomatoes. I believe them. Some people are sensitive to coffee. Some people are lactose intolerant. Some people really are allergic to casein, shellfish, eggs or beef proteins.

So just like we are on theoretical and practical thin ice saying no one should eat dairy, or everyone should eat beef or shellfish, we can’t reasonably say everyone should eat any particular plant, only more so.

I say everyone should include some, if not a preponderance, of animal foods, and I even say for most people that ruminant products are the best, but I don’t really specify beef or lamb.

In the case of plants, because the beneficial compounds providing the hormetic effect are toxins, the effects on you personally are even more likely to be highly idiosyncratic. So how can I recommend which toxin will be best for you?

So I feel confident now making the following recommendation about plant consumption. 

Eat enough plant material to keep you out of constant ketosis. Favor plants as whole foods rich in starch over fructose for caloric value, but try to include a moderate variety of colorful plants as well, for the likely hormetic effects. After these criteria, pick the particular plants you eat based on palatability and your individual tolerance.

Back to a final summary comment from Stephan:

Supplementing with polyphenols and other plant chemicals in amounts that would not be achievable by eating food is probably not a good idea.

I sometimes think Stephan may be more British than French.

 William Munny would re-phrase this sentence to say:

 “If you take antioxidant supplements, you have rocks in your head”


Thanks to Sean for a good laugh over dubbing me the “Clint Eastwood of Nutrition” with the following imagined quote on his blog:

"I've killed just about everything that walks or crawled at one time or another. And I'm here to kill you, Ancel Keys, for what you done to the nutrition".

- William Munny is the retired gunfighter in Unforgiven, played by Clint

 

Thanks to several of my friends - Peter for providing links and further background on antioxidants and vegetables. - Dr. Mike and Dr. Emily for providing full text papers to a man isolated at ice station zebra.

NOTE: Comments are OPEN for this post. I've decided to try opening comments on selected posts when I feel I have time to moderate and read them. We'll see how it goes....

Monday
Feb142011

A quick post on FH and statins

I've had a longer post in the works for a while now about FH and the lipid hypothesis and statins, but I keep getting sidetracked.

I keep getting emails asking about it and one person on Robb Wolf's site posted the following:

  • Dr. Harris,

    In regards to your statement “the Lipid Hypothesis is BS”: is that still applicable to myself (and other FH’s) being the lucky possessor of Familial Hypercholesterolemia? After my last exam, a CT calcium score of 206, at age 48, I’m about to give into Statin therapy. After adopting Paleo 5 months ago, my LDL went to 348 with the Lp(a) at 10. The particle sizes are leaning toward the Pattern A side of the scale, and all of my inflammatory markers are low.

    Can FH patients ignore their Lipid numbers?


    My reply follows and is a short version of my views on FH and statins.


    I responded:

    I can’t give you specific medical advice. I have a post on FH coming up .The thing to understand is that there may be increased risk of coronary disease with hetFH*, but that does not mean the elevated LDL is causing the disease.
    In FH, LDL is elevated because there are fewer LDL receptors. The paucity of receptors may increase intracellular cholesterol production or may make it hard to repair vascular damage, in either case the serum LDL has little to do with it. In fact, studies in both FH and non-FH populations show no relationship between LDL reduction and risk reduction. It is independent of the LDL level. it may be that statins, via their anti-inflammatory effects and completely independent of LDL levels, may reduce risk of MI, but the same thing is true for those without FH in secondary prevention.

  • Studies of families with FH show that before the mid 20th century, mortality in those identified by screening was about the same as the normal population. And families with FH identified through early heart attacks are not the same risk as those identified through screening of aysmptomatic persons, who are more likely at lower risk.

    So what do you think they were eating back then, maybe less sugar and vegetable oil? That would be my guess. I personally can’t think of a plausible mechanism where raising your serum LDL number with sat fat in the diet (FH or not) would do anything but decrease the rate of plaque formation. If you’ve been to my site you know what I think are the important elements of an anti-inflammatory diet. It’s all about the parts that are missing, not the macro ratios.

    A score of 206 is certainly high for age 48. The decision of whether to add statins to an anti-atherogenic diet is yours alone, and must be made with the knowledge that it may help, but there may be tradeoffs due to side effects.

    You might not know it listen to cardiologists, but there have been no randomized trials of statin therapy in FH to tell us for sure whether it helps or not. There are uncontrolled and restrospective analyses that suggests lower than “expected” mortality with treatment, but you know how unreliable that kind of study is.

    So it might be reasonable to take a small dose of statin if you have FH for the pleiotropic effects, but not specifically to decrease the LDL, and the LDL change will not predict how much your risk is decreased.

    If you take a powerful statin like crestor, your LDL could become lower than mine (190 particle number 1100 pattern A, etc.) but your risk may still be higher than mine as you still have fewer receptors or altered intracellular cholesterol metabolism etc. In the same manner, folks who have already had an MI become “only” 4 times more likely to die instead of 5 times with statins, even if their LDL gets into the Davis zone of 60… More proof the serum LDL number is not "causing" anything. In the case of FH, elevated LDL is an effect of the actual abnormality, which is the receptor mutation.

    So to summarize, a person with strong family history of CAD and hetFH is probably in the same boat as the secondary prevention population, but with a mortality benefit actually less established than those who've had a heart attack.  May be at higher risk for MI (especially on the SAD), and may have reduced MI risk with statins, but may be trading MI risk for a higher risk of cancer, muscle dysfunction, liver toxicity, memory problems. etc.

    Of course, with the availability of CAC (calcium scoring) you have a little help in your decision. If you are age 50 and have a trivial or zero calcium score, you are probably like the rest of us risk wise, but if your score is sky-high, you might be more like the secondary prevention population.

    But everyone would benefit from a less atherogenic diet, I would think.

    Sijbrands

    Japanese Study

    Oxford Study

    *hetFH = heterozygous FH - the most common type, about one in 500 people

  • Friday
    Feb112011

    Philosophical Influences


    The universe works on a math equation

    That never even ever really ends in the end

    Infinity spirals out creation

    We're on the tip of it's tongue, and it is saying:

    We ain't sure where you stand

    You ain't machines and you ain't land

    And the plants and the animals, they are linked

    And the plants and the animals eat each other

    -       Isaac Brock of Modest Mouse – Neverending Math Equation

     

    I think this beats the King James Bible for plausibility and A Brief History of Time for accessibility. Isaac has surely read Dawkins if not Darwin.

    I get quite a few emails from readers similar to the one that follows, which is from Simon.

    I really enjoyed your post today and decided to shoot you a line. Been following your blog for a while and have been meaning to ask you if you could give me a reading lists for your favorites outside health/nutrition. I'm no stranger to Philosophy of Science, Political Phil etc. but I'm curious which books (you've mentioned Rothbard, Foucault, Kuhn etc.) have influenced you and your world view the most. I'm currently doing a year of research at Vanderbillt on Obesity/Diabetes (our lab colloborates with Stephan's) before medical school. I'm trying to take the (relative) free time I have to get as much culture in me before school work takes over. Again, thanks so much for your blog, especially your post today. The perpetual existential/somatic crisis of the health blogosphere is quite troubling!

     

    -Simon

    Not sure how much I can help to acculturate anyone. Fair warning, you might end up a skeptical intellectual dilettante like me.

    Let me start by first saying that the way to become a writer is to read. A lot. And the way to become a thinker is to read more than you think. And it is best if you both read and think much more than you write.

    When I was in college and even medical school, I’m pretty sure I read at least 2 or 3 pages of non-assigned material for every page that was assigned. Currently I average several books a week. I regret that I’ll die before I get to everything I’d like to read. I find it so pleasurable that it mystifies me that everyone doesn’t look at it the same way I do. But I suppose that’s how it is with anything a person can enjoy.

    Aside from Isaac Brock, there have been many influences on my world view and thinking.

    I won’t expand much on the influence of medical school hazing and 23 years of reading xrays, CTs, MRIs, et cetera, but this has been a huge influence, especially in making me a medical nihilist.

    A medical nihilist posits that in a world where the entire medical system (alternative and complementary not exempted) disappeared in some selective rapture, that the net effect would be positive for the economy, and no worse than neutral for the aggregate level of health and wellness*.

    My experience and years of observation of the medical sausage factory have made me a medical nihilist.

    But Simon is already planning on medical school, and so he will already be offered the same opportunity at learning to be a heretic that I had.

    And he’s only asked me about books, so here is a list of books, in no particular order, that have influenced the way I think about, well, everything.

    Philosophy and The Mirror of Nature – Richard Rorty

    Philosophy with a small p. Never trust anyone who claims to be a “Philosopher”. The most important book I’ve ever read.

    Contingency, Irony and Solidarity – Richard Rorty

    Argues that the values of classical liberalism cannot be grounded outside of our empathy and a kind of faith. Not as good as PTMR, but worth reading.

    The Rhetoric of Economics – Dierdre McCloskey

    Fascinating person from my alma mater – The University of Iowa. Most famous for having formerly been “Donald”. Rhetoric of Economics is a Wittgenstein inspired critique of method and science that any thinking person can and should read. McCloskey is now a prominent libertarian thinker.

    After Virtue – Alasdair MacIntyre 

    Proposes ethics based on classical ideals. Nice counter to christianity, but ultimately fails, I think. An important book, though.

    Moby Dick – Herman Melville

    Simply stunning American novel on every level.

    Zen and the Art of Motorcycle Maintenance – Robert Pirsig.

    First read this when I was in 9th grade – got me thinking about these things for the first time. Making a shim for your BMW with a beer can really is quality. Your reaction to this kind of kluge may determine if you are a person of substance.

    Psychological Defenses in Everyday Life – Robert Firestone

    I’ve read all of Firestone’s books, but this one is the best. The title is deceptive. It’s really an ethical how-to manual and a great one at that. He comes at things as a psychodynamic therapist, but ignore the details of the theories. They are mostly correct, and if you are a pragmatist like me it makes no difference exactly why he is right.

    Alice Miller – Prisoners of Childhood 

    Eye-opening thoughts on what most affects our behavior in later life.

    Zen Mind, Beginners Mind – Shunryu Suzuki

    Great introduction to zen

    Opening the Hand of Thought – Uchiyama

    Another good zen book

    Breath by Breath – Larry Rosenberg

    A very good book on vipassana meditation – the kind I try to practice now.

    The Science of Enlightenment – Shinzen Young

    A series of audio lectures that present a very appealing and pragmatic unified field theorem of consciousness.

    Pema Chodrom – When things Fall Apart

    All of her books are good but this is the best.

    Gravity’s Rainbow – Thomas Pynchon

    Famously long and dense postmodern novel with soulless two-dimensional characters that is nevertheless fun to read. When I first read it I thought it was profound, but now I know it’s not profound, it’s just a salad of ideas and purposefully dark inscrutability. Are you brave enough to point out that the emperor is naked? Or do you think Jeff Koons and Andy Warhol are artists? Bad analogy, Pynchon is entertaining, at least. The real Ulysses is fantastic, by the way.

    Richard Dawkins – Everything by Dawkins.

    No one understands and communicates evolutionary biology and what it means better than Dawkins. And I wish I had read The God Delusion in high school.

    Christopher Hitchens – Anything by Hitchens

      - especially God is Not Great. No nits to pick with may favorite former Trotskyite, other than his support for the Iraq debacle.

    Sam Harris – The End of Faith

    Sam is simultaneously too pessimistic and overestimates the degree of reason among even atheists. Compartmentalization is what allows peace, not eradicating religion. His current attempt to ground ethics in neuroscience is, well, probably groundless. Most of his critique in End of Faith is spot-on, but I about choked when he started talking about Rupert Sheldrake

    Anything by TC Boyle

    Comic genius who finds inspiration in actual historical events. No need for fantasy.

    Here are some more philosophical influences. I did not read them in the original greek. I can’t quote all the exact titles and sources as much of my library is packed away in boxes.

    Greek Pyrrhonists and Skeptics – that should be obvious, huh?

    Plato – ruined things for all time

    Aristotle – tried to undo the damage and was ruined by the Christians in turn

    David Hume – Way ahead of his time

    Ludwig Wittgenstein – learn from secondary sources or primary

    Arthur Schopenhauer - learn from secondary sources or primary

    Ayn Rand

    Learn from as a negative example. Fountainhead is an inspiring book. Atlas Shrugged is am overwrought tedious slog with cartoon characters and not an ounce of wit. Rand’s formal “philosophy” is highly derivative, weak, and in operation, is lacking in imagination and needlessly cruel. Homo economicus as the model ethical agent? No thanks.

    Friedrich Nietzsche –

    What does not destroy me makes me stronger?

    Except for when what does not destroy me just causes permanent damage.

    Learn from him as a negative example. Even translated from german, he's pretty easy to read.  A perennial staple of college kids everywhere. Considered individualist by some, but more rightly seen as reflecting a deeply authoritarian and collectivist urge in Europe, and an inspiration, along with Henry Ford, to Adolf Hitler. Bet you think I am kidding about Ford, huh?

    OK, I’ve tried to do all this without looking at the bookshelf so the most influential are reflective of what comes to mind the easiest. And like I’ve said, many of my books are packed in boxes, so I can’t quote all the titles. I’ve been too lazy to make amazon links for each one, but you can click through my portal and then search for them easily. If you buy any, I’ll get a small kickback to help support the blog.

    I’ll do a separate one on economics, finance and politics some time, as that deserves its own post, really.

     

    * This does not mean that some medical interventions are not highly useful, just that in the aggregate they are balanced out by all the negative ones - the side effects and the nutritional advice, etc.

    Thursday
    Feb102011

    Primum Non Nocere

     

    Emily Deans, of the justly popular blog Evolutionary Psychiatry, has just posted some nice commentary on "Therapy versus Life"

    She says:

    ......My style is to think out loud in blog form (such a wretched word, "blog," sounds like some sort of mucousy allergy problem). Some of the ideas are early, not fermented as it were, and I will likely change my mind about some things over the months. There are so many unknowns - it can get frustrating when you realize how much money, effort, and time have been spent looking at nutrition, metabolism, and mental health in such a way as to discover nothing at all.

    But there is exhilaration too, especially in the sharing of ideas, and to have (if someone wants to listen) an enhanced ability to heal. Myself, my family, my patients. ........

    She clearly gets the point of the post and reflects my own thoughts exaclty.

    ....Sometimes we are broken, and modern medicine can actually help with the fix. Sometimes we are broken, and there is no perfect fix....

    And she seems to clearly "get" me as well. She is a shrink, after all.

    ....It always settles me a bit when I find myself in agreement with Kurt Harris. Mostly because I can tell he thinks about things. He reads and sits back and asks some questions and reads some more and he thinks about it again, and then he posts. He is not as even-tempered as Stephan Guyenet, but if he jumps at being questioned, I'm pretty sure it is because he's done the time, the reading, and the thinking.

    No, I am not as even-tempered as Stephan Guyenet. Who is?

    But even Stephan may react if you flick ashes on his Buddha, in his own way. And my blog is unabashedly a blog of cultural criticism in the realm of science, more than it is a nutrition blog. Thinking about medical science, its application and its use in our culture. It is something I've always done, now I'm just sharing a bit of it. For my own pleasure, and for yours if you like to read it and get something out of it. If you don't like it, that's fine. Just move along to some other domain.

    And Stephan and I do have something in common besides health/science blogging. We both meditate and have been influenced by Buddhist ways of thought.

    Read this post by Stephan - Dogen Zenji on Nutritionism. Dogen Zenji is the partiarch of the Soto Zen branch of buddhism. And note the Kensho symbol in Stephan's clever logo.

    Being a complete atheist and having no patience for metaphysics or fairy tales, I'm actually more comfortable philosophically with plain-vanilla theravada than with zen, but there is plenty to be gained by any of these "systems" in helping you deal with life.

    As far as mental stability, zazen (sitting meditation) can do wonders for your mental health and stress hardiness. To help you cope a bit when things can't be fixed, when there are no solutions.

    You know, like accidents, death, unemployment and your 401K being destroyed and all those things that even the hackers and tricksters may not have any good suggestions for...

    I find sitting even more powerful than running in this regard, but actually somewhat harder to stay disciplined about.

    The main thing these traditions can teach you is to be comfortable with doubt, to become good at being uncertain, and that not everything has a solution.

    Facing the idea of your own inevitable death with equanimity - a buddhist exercise, if not an easily achievable goal, seems like pretty good practice for facing up to insoluble problems.

    There are insoluble problems. I am sorry if this makes anyone uncomfortable, but it is what I think.

    The positivist western conceit that every difficulty is a problem, and every problem has a solution is just that, an unfounded conceit.

    If we believe everything we don't like is a problem and that all problems have a solution, we are very likely to take possible bad situations, and make them much, much worse. I've seen it all the time in my career as a physician. Side effects, complications, the law of unintended consequences.

    Have you noticed how the way I make people angriest is when I doubt their certainty? I doubt the efficacy of their method, their supplement, etc..

    I am only trying to encourage skepticism to avoid unnecessary harm and disappointment and time-wasting. I am just trying to help people see that we should first do no harm. To ourselves.

    Primum Non Nocere