How easy is it to change your diet or start a new health regimen?

Many people talk about how good their health programs are, and they probably are good, at least for them. There are many changes that we can make to improve our health and at the surface it seems like they should be simple. If a few simple changes can make a big difference, why do people not do them? Or if it is not that hard of a program to follow, why not follow it?

An assumption is that people are lazy, or that they don’t want to get better. The advocate for them changing might tout all the benefits of the change, but it still does not often happen.

For instance, lets say that changing from a processed foods to a cook from fresh foods diet would make one feel better, give one more energy, help one to think clearer, and end up costing about the same. Why not change? It might take 5% more effort, but if your energy goes up 20% you will have some to spare, right? Lets break it down.

There are three things to look at when it comes to making a change; the effort/energy; the thought and planning; and the money. These three things are somewhat interchangeable. If you have more money, you can spend less effort, such as not shopping around to find the best prices. If you think and plan lots, you can spend less effort, by combining prep time, having good shopping list, and spend less money, buy figuring out the best deals. The amount of energy, knowledge and money each person has is varied but finite. Lets combine the three into one variable and call it energy/thought/expense.

Here is a graph, showing how difficult it is to be on our example processed food plan, and how difficult it is to be on the cook from fresh plan:

Look, not that hard right? If it comes with benefits, like increasing your energy, and eliminating brain fog, and that helps two of our three variables on the axis, increasing the total amount available to you, making eating be a smaller component of your energy/thought/expense total budget, leaving you with more for the rest of your activities, it is a no brainer, right? Lets add the total available to the graph:

Wow, there is more green that you can spend on other things in life!

So why do we not change? It is the missing part of the graph. It is the change itself. That takes a lot of effort, often more then is available, here is a third graph:

So changes in diet (or any other change to one’s health regimen) are not as simple as weighing the outcome, it can be the change itself that is impossible. Why is this? Because, at first when starting a new plan it takes a lot more energy to do it. In our example, one would need to start cooking more things from scratch, this does take more effort, especially if one does not usually cook. There will be a lot more effort then for an experienced cook. More prep time, things like less efficient chopping/stirring/prep work, having a less efficient kitchen set-up and the like will greatly increase the amount of effort it takes to get a meal on the table. Until you know lots of recipes, each dinner will take a lot of thought and planning, like reading and understanding recipes, making sure you have the right ingredients, figuring out how to shop differently and learning the techniques needed. Until you master some of these skills, you will have to put more energy into the meals. And lastly, money, until you have the skill and planning down, you will have a harder time figuring out what is the cheapest way to eat this new way, and there will be wastage, which is expensive.

Why did the green bar go down in the middle? Because changing is often hard on a body. If you read through any diet/lifestyle lists you will see mention of this. In vegetarian circles it is often called ‘detox’ in the low carb community, ‘carb flu,’ when you first start exercising the soreness is more pronounced. This decreases the total budget when the total expense of the change is highest.

There are many other reasons for not making changes, many, many other reasons. but this is one of the big ones. People often can not make the change, they do not have enough of the currency needed to change, even if the change would be better in the long run.

My example was just that, and example. It is true for many other changes. Even something as simple as adding a supplement can be a big change. You usually have to go through a few types/brands to figure out which one works best, have to learn to make it a daily habit and have to remember to keep it in stock. These things might look easy of the surface, but are all factors in any change.

Look at the graphs, what this means is that it is not possible for some people to make the changes, not that they are too lazy to do it.

What all those annoying weight loss TV shows teach us.

Yes, I tend to watch these things, kind of like watching a train wreck. Sometimes I watch while eating a big piece of chocolate cake, sometimes while riding my exercise bike. I usually get annoyed at a lot of stuff, and change the channel for spurts to keep some of my sanity points.

What have I learned, or at least had re-enforced in my way of thinking?

1. Getting fit while still fat is possible.
The first thing these shows do is start the people on an exercise regimen. They start to get fit. Then the get really fit. This is all while they are still fat. Often times when they are really fat. They are running, lifting weights, working out for hours, all while fat. They get fit before they get slim, if they even get slim at all.

2. They are very strong when they get there.
There was an episode of Biggest Loser when they were trying to shame the contestants about how fat they had been when the show started. One of them was paired up with a trainer and they made the trainer put on as weight in weight vests and the like until he was the weight the contestant started the show at. The trainer could barely stand up, he could not do much at all. And the contestant had come to the show weighing that much and started working out immediately. There is often a trial when the show starts, biking for 20 miles, running/walking on a treadmill for 5k of the like (split between two people, but still a lot,) if the super fit trainer had to sit after a less then minute or so, and the contestant had been running/biking and such, what does that say about the relative levels of strength of the two people?

3. It is not calories in-calories out.
At first, most contestants start dropping weight quickly, but then it tapers off. They are working hard the whole time, and on a controlled diet. They even wear body-bugs to keep track of the calories out. If it was pure calories in-calories out, they would know every week exactly how much they lost. Instead they are usually surprised, often by how little they lose, even when they 'work hard and watch what they eat.' They also tend to lose weight on weeks when they get a sugary treat. hmmm.

4. The desire to lose weight is really about appearance, not health.
The contestants/participants tend to increase their health measures, like level of fitness, blood sugar, circulation issues, way before they get slim, but that is not often talked about. Most of the language is around the number on the scale, the number on the measuring tape, the number on the label of their jeans. And about how they feel, how they feel "normal" now when they go out into the world. This is also reflected in the family and friends when the big reveal happens. Often even more then the contestants themselves. They start to cry tears of joy when the see the person, before the person even talks. They all say how much better the person looks. Occasionally they talk about an increase in energy or vitality, but the majority of the discourse is about appearance.

There are, of course many other things these shows teach us. The shows themselves don't go into how unhealthy it is to lose the weight this fast, of how many of the contestants put the weight (plus more) right back on again, often having more health issues then when they started.

I somehow don't think that I got the teaching they thought I was, so, what have these shows taught you?

Can People be Addicted to Food?

Can People be Addicted to Food?

A batch of articles have been in the press, citing a study out of Yale about food addiction. It was conducted by Ashley Gearhardt and Kelly Brownell. Of course as with a lot of popular reporting on science, finding a real reference to the article was hard to find. Here is where I found the first link to the actual article:
http://www.washingtonpost.com/blogs/the-checkup/post/yale-study-probes-food-addiction/2011/04/04/AFnXMggC_blog.html

If you want to read lots of articles about it, go to google news and search for food addiction.
It was published by the Archives of General Psychology, http://archpsyc.ama-assn.org/

A lot of the quotes in the popular articles are people not seeming to be surprised, and one common thread I see in the articles is the thought that:

Food addiction is like drug addiction.

I think this is backwards. It is interesting that our bodies can become addicted to drugs. That the body can take in a substance and change it’s functioning or homeostasis to the point where the normal state is having the drug in the system. It then sees the state of not having the drug as abnormal and takes measures to correct this. It induces a craving so that the organism will go out and correct the abnormal state.

How did this system come about? If you think evolutionarily, why would this happen? How would having such strong cravings for something that is causes the organism to go out and engage in possibly dangerous behaviors help in the long run. Maybe if it was something needed for life, like maybe food??? or water??? I think that the more accurate statement would be:

Drug addiction is like the need for food.

The drug addiction takes an evolutionary adaptation to eat when hungry, and to go out and perform a possibly dangerous task (hunting) to obtain food. In the short run, you could die today from hunting, but you will live for weeks or longer without food, so the body needs a way to motivate you to seek food. It does this by rewarding you when you eat. It increases the reward of eating (and drinking, and sex- reproduction is very important in evolution) to the point where it is worth it to sustain some danger and discomfort to get it, and it gives the body a craving for the substance that brings the reward.

It is drugs that hijack this system from food, not food that uses the addiction axis.

Insulin/Fat/Diabetes connection.

There are many vast oversimplifications in this, but is is a very complex system, and making it understandable to someone unfamiliar requires such.

The cast of players:
Hilde: a human

Insulin: a hormone, helps sugar get into cells, also passes messages around the body, produced in the pancreas.

Hungry Hormones: (Ghrelin) stimulates hunger, produced by the stomach and pancreas.

Full Hormones: (Leptin) stops hunger. Released by the pancreas.

Receptors for hormones: all hormones have receptors, they are usually produced by the individual cells. An important fact is that high levels of a hormone cause the cell to make less of the receptor, and can create a similar effect as having a low level of the hormone.

Muscle Cell: a metabolically active cell, it needs energy to do its job. It likes doing its job, if it does not have enough energy to do it, it will ask for more. It thinks in the short term, does not save much for the future.

Fat Cell: A cell with Hilde's long term survival in mind. It will take up energy in times of plenty, and keep it around for her to use when the going gets tough. It likes to think of the future, will sometimes make the other cells skimp on the present to save enough, especially if it thinks that hard times are likely because they have happened before.


The Story

Hilde eats carbs. They are changed to sugar in her digestive system, and absorbed into the blood stream.

Her stomach feeling full, releases Full Hormones.

The pancreas notices the sugar, and does it's job, releases insulin and Full Hormones.

Hilde is no longer hungry, she stops eating.

The insulin binds to the insulin receptors on various cells, the combination of insulin-insulin receptor transports the sugar into the cell. The cell gets energy and does whatever it's job is better.

The level of sugar in the blood goes down, the pancreas stops producing as much insulin, low blood sugar + low insulin causes a release of Hungry Hormones, Hilde gets hungry , eats again.

This goes on and on. Then something goes wrong:

Hilde eats carbs. They are changed to sugar in her digestive system, and absorbed into the blood stream.

Her body overreacts, produced too much insulin, quickly the blood sugar drops too low, she gets hungry again (a deep-down, can't ignore hunger, craving for what her body is low on, carbs, a craving in the lizard brain, one that sends signals of deprivation, her body thinks it is being starved, the part that sees and responds to the low blood sugar does not see that this all started from a bit of an over reaction, it just see that there is not enough fuel to run the body, and acts to correct this life-threatening condition), she eats more carbs.

This cascade of overreaction of the hormonal systems continues, resulting in an excess of insulin in the blood, and widely varying blood sugar levels.

Now, lets see what her individual cells see.

First, Muscle Cell (or other cells with a metabolic job, a non-fat cell). The part of it that is making the insulin receptors sees that there is an excess of insulin. Muscle Cell takes action to protect itself, it lowers the number of insulin receptors on it's surface. When there is low blood sugar, this lowered amount of receptors means that not enough energy can get into the cell. This low amount of energy, called starvation, causes the Muscle Cell to ask for more, it sends out signals to make more Hungry Hormones, to ask Hilde to eat more to send more energy its way. These two parts of the cell are doing their jobs, they have very overbearing bosses, so even when they meet at the water-cooler and decide they can correct each others problems, they go back to their desk and their bosses make them do what they were doing before, cutting down on insulin receptors and sending out signals that they are starving.

This leads to high blood sugar at the same time as high insulin. This is called Type 2 diabetes.

Now, Fat Cell, it sees the increase in blood sugar. It interprets this as the body having extra energy around. It was made for just this case, it steps up to action and fulfills its destiny. It uses the insulin (it loves it so much it is less likely to down regulate the receptors) to take in the extra sugar, and converts it to the most efficient (in terms of weight per unit energy) energy storage material it can, fat. During times of low blood sugar, it interprets this as starvation, a vindication for it, proof that it is needed, so it makes itself more efficient at making more energy to store. It gets a sense that it is very important, and starts taking energy at lower and lower levels of excess energy in the system.

This lowers the overall amour of available energy for Muscle Cell. Who gets hungry and asks for more. Also of note, if Hilde was starving herself, Fat Cell would see this, and increase its ability to grow in the future. It has done this every time she put herself on a diet in the past.

The initial over response to sugar, leading to an increase in insulin, and a subsequent decrease in insulin receptors what started this whole cascade. Individual people have vastly different likelyhoods that this will happen. It is when there are too many carbs for the individuals tolerance for a time longer then the individuals tolerance that it starts. Every body is different, some people can eat lots of sugar and never have it effect them, others can't.

The diabetes is causing the Fat Cell to grow and multiply. It is responding to the imbalance in insulin and sugar, and even protecting the body (in the short term) from even higher blood sugar. Once this all starts, the cycle behaves like a positive feed back loop, both types of cells are doing what they need to do in the moment to stay alive and perform their function. The overall loop gets worse and worse for Hilde, but the cells are all being somewhat self centered. Of course if all cells in the body sacrificed themselves for the good of the whole, the whole would not live. In each instant they are doing the best they can. They are in a type of crisis mode.

Now, how does Hilde stop this and get her system back to normal?

As long as there are too few insulin receptors on the muscle cell, it will continue to starve. One way she can increase the number is by exercise. Exercise directly increases the number of insulin receptors. Another way is to lower the amount of insulin in the blood stream. This means that she needs to stop stimulating the pancreas to produce it. This means she needs to lower her blood sugar concentration.

Again, a couple of ways to do this. Exercise immediately lowers blood sugar. And diet. Eating fewer carbs will slow down the cycle. They turn immediately into blood sugar. Protein will also slowly turn into blood sugar, it will take a bit of energy to do this, but if your system is calling for MORE SUGAR, I AM STARVING NOW, it will use high protein to make it, but not at the same levels as carbs. Fat bypasses this system, providing energy outside of the insulin/sugar system. Fat will keep you alive while you keep your blood sugar at a low enough level to stop stimulating your pancreas, lowering the amount of insulin in the blood, causing the cells to make more insulin receptors, allowing them to again use sugar as an energy source.

I have not said anything about glycogen stores in the liver or muscles, a simple way of looking at them is a sponge for extra blood sugar, a buffer against fluctuations. Sugar gets released when cells call for it. In order to lower blood sugar enough to lower the production on insulin, you need to stop dietary intake long enough to lower the glycogen stores.

This is why the Atkins diet works. Induction goes on long enough to use up some of the glycogen stores and lower the blood sugar long enough to lower the insulin levels. This causes a up regulation of insulin receptors, and allows the person to slowly increase the amount of carbs until they find their individual balance point, where they are getting good energy from the carbs, but not letting their body overreact to them.

This is also why the Atkins diet does not work. If your issues with weight are not caused by this system, you can loose some weight on Atkins, but it will not be the same dramatic, feel better, reset the metabolism diet that it is for some.

People are individuals, do what works for you! And make it about health, not weight. If you are diabetic, improving your metabolism by cutting back on carbs and exercising will cause you to lose a little bit of fat, the 10% or so that studies show helps diabetes. But it is the slowing of the diabetes that causes the weight loss, not the weight loss that slows the diabetes.

If all this had gone on for a long time (long being defined by Hilde's pancreas' individual tolerance) her pancreas would get tired, and start producing less insulin. Raising blood sugar more, stimulating the pancreas more, exhausting it more. Even if the number of receptors starts to increase in response to the lowered amount of insulin, it is not enough. The high blood sugar is damaging the body is many other ways, and that an immediate medical issue. That can impact immediate survival, immediate circulation, immediate kidney function. It is more important to get the sugar down now then it is to effect a long term cure, because if you don't, you will not be alive for the long term. This is why insulin is given by doctors, to keep the person alive for one more day.

An old post about H1N1 that belongs here

Reading what others have to say about it, and hearing stuff on the news and online, I have been thinking about this stuff lately. Here are my thoughts:

The new H1N1 vaccine is made the same way that seasonal flu shots are made, so it is as tested/untested as seasonal flu shots. It could have been included in this years regular flu shot if it had started a bit earlier. Medically it is no scarier then the yearly shot. It is different from the H1N1 shot in the 70's that had neurological side effects, medical science has come a long way in making vaccines since then. Every year the flu shot is a mix of new flu variants, and is not tested widely before distribution. And has very few side effects. That said it is not impossible for any years flu shot to have some unpredicted side effects, but this one does not have any larger chance.


The reason that H1N1 flu is so scary is that it is very contagious, and has an occasional really bad course. Those bad cases have involved issues with the lungs, and they are more likely (but not only seen) in people with preexisting conditions of the lung and pregnancy. And they are bad enough to be very scary, because they reduce the amount of oxygen your body gets. Lowered oxygen can mean brain damage. It can also cause organ damage/failure, which can lead to death. Again with a caveat, most cases are mild and this does not happen. It is just hard to predict which cases will go downhill. Pregnancy or lung issues can increase the chances, so can being in your 20's and having a really heathy immune system, or having a weakened system, or being really young. Like I said, the prediction of who will have issues is not possible.

Why is it so contagious? The first reason is evolution, the contagious virus wins the race. Flu viruses are found in many species, human, dog, pig, bird, horse . . ., and they can often infect more then one species, but usually don't hit the second species as hard. But, sometimes, an organism is infected with more then one virus, and they share information, the strongest virus that emerges from the sharing spreads quickly in the single organism, and if the new combination is very contagious, it spreads throughout the population. The second reason is that this is a novel virus, no recent flu virus that has circulated in human population recently has created antibodies that are also effective against this one, so there is very little resistance to it. The H and N antigens are not the only ones, so other H1N1 viruses are not identical to this one, and don't always offer co-immunity. The only people who seem to have natural antibodies against this one are over 70 or 80 years old. The H1N1 that was circulating in the 70s does not seem to offer much if any protection against this one.

So if we look at this all together, should you get the vaccine? On an individual level, as with any vaccine, you have to look at how likely you are to get the illness (quite high in many areas), how likely you are to have a bad course (low, but not zero), and how likely you are to have a bad reaction to the vaccine (low, unless you have a specific reason, such as egg allergy), and how likely you are to give the virus to someone else who could have a bad reaction, and you need to weigh these against each other. You also have to decide if the risk of mild reaction to the vaccine is worth avoiding a mild illness. Personally, I think that the risk-benefit analysis should use mostly the really bad and deadly consequences, the mild ones are just that, mild.

On a population level the best thing would be for everyone who can get the vaccine to get it, so that the flu does not spread quickly. Then the people who can not get the vaccine will then be less likely to get the flu because it will not be around as much, so they will not get exposed. This is the principal of herd immunity.

Now, what is the individuals responsibility to society? The more people that are vaccinated, the less likely it is for it to spread, so the fewer bad cases, fewer deaths. For any individual the best scenario is for them to not have the chance of vaccine reaction, not getting the vaccine, but for everyone else in the community to get the vaccine so they also don't have a chance of catching the illness. This is a variation on the prisoner's dilemma. If everyone follows the most self-serving path, then everyone loses. I would maintain that the individual has some responsibility to society, not just getting vaccinated, but also stopping at stop signs, not shooting your gun in the direction of your neighbors house, and all those other things that might inconvenience us but help to protect our neighbors.

What does this mean about other vaccinations? That the risk-benefit analysis should also be done, not only on a personal level, but on a population level. I think that an almost religious zeal in believing that everyone should get every vaccination is dangerous, as is the same thing in the other direction. The truth is that we don't know if some of the current vaccinations cause things like an increase in allergies, autoimmune diseases, neurological/behavioral conditions, chronic fatigue, fibromyalgia, and all those other things that are thought of as "modern medical issues". We also don't know if high fructose corn syrup causes it, or pollution, or wearing polyester. And even if it turns out that vaccination can cause painful purple spots (pps) (or any other thing) we have to look at what it is preventing, if 5,000 people will die from a disease, or 10,000 will get non-lethal pps, what is the best course of action. If we can predict who is more likely to get pps, then they can avoid the vaccine, and everyone else getting it can offer herd immunity to protect them, that would be the biggest benefit to society. But we are not at that level of knowledge. There is no condition, other then acute allergic reaction, that is reliably tied to vaccination. You also have to look at whether the reaction is better or worse then the disease that the vaccine prevents.

First!

Yup, a new adventure. I have been thinking about health related stuff lately, and this is a place for me to talk about various issues from my perspective. What qualifies me to do so? First, the internet is free, so what justification is really needed. You decide if you believe me or not. Use your own free will and best judgment on that one. Second, I have a degree in Biology from Cornell University. Third, I have been working in a medical genetics/genomics lab for over 10 years. Forth, I have several years of training as an herbalist, studying with the likes of 7song and Rosemary Gladstar. And lastly, I am well read on these subjects.