julie.a.ashworth

Computer programmer Zeynep Tufekci now writes about the impact of technology on society. In an opinion piece for the New York Times, Tufekci writes on "the shameful open secret" that earlier this week led Southwest airlines to suddenly cancel 5,400 flights in less than 48 hours. "The recent meltdown was avoidable, but it would have cost them." Long-time Slashdot reader theodp writes that the piece "takes a crack at explaining 'technical debt' to the masses." Tufekci writes: Computers become increasingly capable and powerful by the year and new hardware is often the most visible cue for technological progress. However, even with the shiniest hardware, the software that plays a critical role inside many systems is too often antiquated, and in some cases decades old. This failing appears to be a key factor in why Southwest Airlines couldn't return to business as usual the way other airlines did after last week's major winter storm. More than 15,000 of its flights were canceled starting on Dec. 22, including more than 2,300 canceled this past Thursday — almost a week after the storm had passed. It's been an open secret within Southwest for some time, and a shameful one, that the company desperately needed to modernize its scheduling systems. Software shortcomings had contributed to previous, smaller-scale meltdowns, and Southwest unions had repeatedly warned about it. Without more government regulation and oversight, and greater accountability, we may see more fiascos like this one, which most likely stranded hundreds of thousands of Southwest passengers — perhaps more than a million — over Christmas week. And not just for a single company, as the problem is widespread across many industries. "The reason we made it through Y2K intact is that we didn't ignore the problem," the piece argues. But in comparison, it points out, Southwest had already experienced another cancellation crisis in October of 2021 (while the president of the pilots' union "pointed out that the antiquated crew-scheduling technology was leading to cascading disruptions.") "In March, in its open letter to the company, the union even placed updating the creaking scheduling technology above its demands for increased pay." Speaking about this week's outage, a Southwest spokesman concedes that "We had available crews and aircraft, but our technology struggled to align our resources due to the magnitude and scale of the disruptions." But Tufekci concludes that "Ultimately, the problem is that we haven't built a regulatory environment where companies have incentives to address technical debt, rather than passing the burden on to customers, employees or the next management.... For airlines, it might mean holding them responsible for the problems their miserly approach causes to the flying public."

Read more of this story at Slashdot.

Police have warned students in the UK against using the Sci-Hub website, which they say lets users "illegally access" millions of scientific research papers. Specifically, the police say the website could "pose a threat to their personal information and data." The BBC reports: The police are concerned that users of the "Russia-based website" could have information taken and misused online. The Sci-Hub says its website "removes all barriers" to science. It offers open access to more than 85 million scientific papers and claims that copyright laws should be abolished and that such material should be "knowledge to all." It describes itself as "the first pirate website in the world to provide mass and public access to tens of millions of research papers." But Max Bruce, the City of London Police's cyber protection officer, has urged universities to block the website on their network because of the "threat posed by Sci-Hub to both the university and its students." "If you're tricked into revealing your log-in credentials, whether it's through the use of fake emails or malware, we know that Sci-Hub will then use those details to compromise your university's computer network in order to steal research papers," he said. "Students should be aware that accessing such websites is illegal, as it hosts stolen intellectual property," said Det Insp Kevin Ives. He warned that visitors to the website, whose Twitter account has been suspended, are "very vulnerable to having their credentials stolen."

Read more of this story at Slashdot.

In this episode of RHR, I talk with Bonnie Harris about how to use connective parenting to weather changes and build strong relationships with our kids.

The post RHR: How to Connect with Your Kids, with Bonnie Harris appeared first on Chris Kresser.

Facebook is using its vast legal muscle to silence one of its most prominent critics. The Real Facebook Oversight Board, a group established last month in response to the tech giant's failure to get its actual Oversight Board up and running before the presidential election, was forced offline on Wednesday night after Facebook wrote to the internet service provider demanding the group's website -- realfacebookoversight.org -- be taken offline. From a report: The group is made up of dozens of prominent academics, activists, lawyers, and journalists whose goal is to hold Facebook accountable in the run-up to the election next month. Facebook's own Oversight Board, which was announced 13 months ago, will not meet for the first time until later this month, and won't consider any issues related to the election. In a letter sent to one of the founders of the RFOB, journalist Carole Cadwalladr, the ISP SupportNation said the website was being taken offline after Facebook complained that the site was involved in "phishing."

Read more of this story at Slashdot.

More news about Berkeley from around the web.

In this episode, I sit down with my daughter to discuss the brutal death of George Floyd, and the aftermath we are watching unfold. Though I have no expertise in race relations, law enforcement, or police brutality, I do have some knowledge in the training of physicians, and it is that training of doctors that...

The post #113: Normative errors — a conversation with my daughter about current events appeared first on Peter Attia.

Research of the Week

Diabetic patients taking metformin had lower coronavirus mortality than diabetic patients not taking it.

“Increased cardiovascular disease in African-Americans with Covid-19.”

Unsaturated fat intake and deficiencies in calcium and albumin linked to higher coronavirus mortality.

“Financial relationships between the leaders of influential US professional medical associations and industry are extensive…”

New Primal Blueprint Podcasts

Episode 425: Robert Glazer: Host Elle Russ chats with Robert Glazer, founder and CEO of the global performance marketing agency Acceleration Partners.

Primal Health Coach Radio, Episode 62: Laura and Erin talk with Dr. Jade Teta about metabolism and hormones.

Media, Schmedia

Women are not just men with “boobs and tubes.”

Who’s still getting sick in New York?

Interesting Blog Posts

The case for red meat.

Social Notes

Astronaut breakfast.

How to slow down time (seriously).

Everything Else

“The human voice contains information about dynamic bodily states.”

ApoE4 gene predicts severity of coronavirus infection (in the UK).

A beautiful video about traditional wool clothing. Best part is how they “shear” the sheep without cutting the wool. Looks so satisfying.

Making CBD from orange peels.

Things I’m Up to and Interested In

Fascinating article: How loners help species survive.

Interesting result with big implications for hunger: High-carb meal results in initial increase in available energy followed by a drastic crash.

Great turn of phrase: Fructoholism.

Fact I was unaware of: Mice and many other animal models used in studies do not depend on vitamin D for their innate immune circuitry.

My favorite paradox: High-fat dairy linked to better health, again.

Question I’m Asking

How much nature are you getting these days? (get some)

Recipe Corner

• Energy balls your vegan and paleo friends will love.
• Some people need to be careful with raw broccoli, but if you can handle it, try this broccoli salad with bacon.

Time Capsule

One year ago (May 24 – May 30)

• 4 Mushrooms You Need to Know – Fungi are not fungible.
• The Keto Carb Threshold: What Constitutes a “Keto” Meal– Well, what does?

Comment of the Week

“A note about sunglasses: Some folks should be wearing them. For instance, a lot of the fisherman in native tribes would go blind at a fairly early age from staring into the water for long periods of time. The Eskimos had really cool bone sunglasses, with little slits they would use, so they would not go snowblind. After my own daily sun exposure, I’m not averse to putting on my shades.”

– Nicely said, Nocona.

The post Weekly Link Love – Edition 83 appeared first on Mark's Daily Apple.

Florists, hair stylists, housekeepers, retail workers, security guards and booksellers: they're all in the same boat.

The district made the decision in the wake of Monday's extended order that includes additional restrictions, including dog parks.

A new study from Angie Alt and Dr. Rob Abbott shows promising results for the autoimmune protocol (AIP) diet as a way to treat Hashimoto’s disease. In this episode of Revolution Health Radio, I talk with Angie and Dr. Abbott about their findings, and we discuss how behavior and lifestyle interventions impacted their results.

The post RHR: A New Study on Hashimoto’s Disease, Diet, and Lifestyle appeared first on Chris Kresser.

A collection of almost 773 million unique email addresses and just under 22 million unique passwords were exposed on cloud service MEGA. Security researcher Troy Hunt said the collection of data, dubbed Collection #1, totaled over 12,000 separate files and more than 87GB of data. ZDNet reports: "What I can say is that my own personal data is in there and it's accurate; right email address and a password I used many years ago," Hunt wrote. "In short, if you're in this breach, one or more passwords you've previously used are floating around for others to see." Some passwords, including his own, have been "dehashed", that is converted back to plain text. Hunt said he gained the information after multiple people reached out to him with concerns over the data on MEGA, with the Collection #1 dump also being discussed on a hacking forum. "The post on the forum referenced 'a collection of 2000+ dehashed databases and Combos stored by topic' and provided a directory listing of 2,890 of the files," Hunt wrote. The collection has since been removed. You can visit Hunt's Have I Been Pwned service to see if you are affected by this breach.

Read more of this story at Slashdot.

I am running for city auditor with the intention of taking ownership of the two biggest problems in Berkeley: housing and homelessness.

With succulents growing off the exterior walls and a translucent interior, this experimental, livable cabin catches the eye and inspires wonder.

A homeless man who grabbed a woman and pulled her across a downtown Berkeley street early Sunday morning is now in custody, being held on suspicion of kidnapping, robbery and more.

The post Berkeley police arrest man who grabbed, dragged, chased woman near UC campus appeared first on Berkeleyside.

Richard Lehman reviews the latest research in the top medical journals

NEJM 22 Mar 2018

H pylori eradication and metachronous stomach cancer

Metachronous—what does that mean? The trouble is that like a lot of Greek prepositions, μετα can indicate a whole range of things, and there is no modern word beginning in “meta-” which would not be clearer with a different prefix. A metachronous cancer is one of the same type that is diagnosed more than three months after the first, according to some sources. So: some of the early ones are probably synchronous but hadn’t been detected, while others appearing later are new cancers of the same type. How about using the simpler word “subsequent”? Both occurrences are frequent in stomach cancer, which used to be the commonest cancer in the West but declined swiftly and is now most prevalent in the Far East. The reason for this is one of the unsolved mysteries of epidemiology. Could it be something to do with subtypes of Helicobacter pylori? Evidence that this ubiquitous bug plays a role comes from a trial in South Korea, which randomised 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma to receive either H. pylori eradication therapy with antibiotics or placebo. The treated group had lower rates of metachronous—i.e. subsequent—gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo. 

High flow oxygen for infant bronchiolitis

Oxygen makes the sky blue and burns things up. Generally speaking, we are best to breathe it diluted with nitrogen. One exception is in severe bronchiolitis up to the age of 12 months. The standard treatment to keep oxygen saturation levels between 92-98% is to use a standard nasal cannula delivering 2L of pure oxygen per minute. If that doesn’t work, babies have traditionally been admitted to intensive care to receive higher doses of oxygen by intubation. However, it’s now possible to deliver a higher flow of oxygen mixed with heated, humidified air through nasal cannulae, providing a degree of positive airways pressure in addition to more O2. A large Australia-New Zealand trial shows that used as first-line treatment, this can spare some babies with bronchiolitis and hypoxia from ICU admission and intubation.

Autoimmune polyendocrine syndromes

I have always been a dabbler, and expect I shall die one. Most of medicine is quite interesting, but to confuse it with life is a basic category error. When I was newly qualified in the mid-1970s, one of the few clinical topics which really intrigued me was the new science of immunology, and in particular how this played out in a few individuals that I came across with multi-endocrine disease. This review shows how far we have(n’t) got in 40+ years: “Autoimmune polyendocrine syndromes are insidious and are characterized by circulating autoantibodies and lymphocytic infiltration of the affected tissues or organs, eventually leading to organ failure. The syndromes can occur in patients from early infancy to old age, and new components of a given syndrome can appear throughout life. There is marked variation in the frequencies and patterns of autoimmunity in affected patients and their families, and the risk of the development of various organ-specific autoimmune diseases is most likely due to a combination of genetic susceptibility and environmental factors.” Ah, yes, quite so: I was right to go into general practice instead. But maybe this new classification indicates some progress: “We have now come to appreciate that these syndromes can be broadly categorized as rare monogenic forms, such as autoimmune polyendocrine syndrome type 1 (APS-1), and a more common polygenic variety, autoimmune polyendocrine syndrome type 2 (APS-2).”

JAMA 20 Mar 2018

Honey, I shrunk the P value

Being a lazy-minded dabbler, I have never really been able to engage with statistics. My problem with maths has always been that I need to understand what the end-goal is before I can engage with the process. P-values and confidence intervals are easy to understand, if one is a believer in a one-in-twenty standard of disproof of the null hypothesis. But I’ve always felt that it’s crazy to apply this across all types of hypothesis tested by a variety of methods. For this reason, the P-value has fallen into wide disfavour in the last three years or so. Why was it ever so popular in the first place? And would we be better off to demand a test of proof that is ten times stronger? In fact this would make surprisingly little difference, as John Ioannidis explains in this classic essay, which is open-access and well worth downloading.

JAMA Intern Med Mar 2018

Treating postmenopausal vulvovaginal symptoms

I can’t do better than quote the Key Points section of this trial

“302 postmenopausal women with moderate-to-severe vulvovaginal symptoms, vaginal 10-μcg estradiol tablet plus placebo gel and vaginal moisturizer plus placebo tablet were not more efficacious than dual placebo at reducing symptom severity or improving sexual function.

Meaning: Shared decision making for treatment of postmenopausal vulvovaginal symptoms can be based on cost and patient formulation preference; vaginal estradiol tablets appear not to add benefit beyond vaginal gel or moisturizer.”

But as the accompanying editorial comments:

“women and their physicians may want to take this one step further and conclude that postmenopausal women experiencing vulvovaginal symptoms should choose the cheapest moisturizer or lubricant available over the counter—at least until new evidence arises to suggest that there is any benefit to doing otherwise.”

Ann Int Med 20 Mar 2018

America declines

“Cardiovascular health has declined in the United States, racial/ethnic and nativity disparities persist, and decreased disparities seem to be due to worsening cardiovascular health among whites rather than gains among African Americans and Mexican Americans.” So concludes an analysis of data from the NHANES (National Health and Nutrition Examination Survey). We can’t just blame the Republicans: this survey covered 1998 to 2014. We can’t blame pre-existing cardiovascular disease either, because these adults didn’t have any. And as we’ve seen from the wording, we can’t blame institutional racism, because the decline is worst in the poorer white population. As with all the problems arising from decreasing demand for unskilled labour, neither American party has a policy for addressing this.

The Lancet 24 Mar 2018

Sirolimus for SLE

Another underpowered, open-label phase 1/2 trial in The Lancet this week; but at least it addresses a clinical dilemma in what can be a horrible disease. It took from 9 March 2009 to 8 December 2014 to enroll 43 patients, three of whom did not meet eligibility criteria. 11 of the 40 eligible patients discontinued study treatment because of intolerance (n=2) or non-compliance (n=9). However, patients with treatment-resistant systemic lupus erythematosus who stuck with sirolimus treatment showed clear signs of improvement in the course of a year and were able to reduce their doses of steroid. This is the stuff of hope, but nowhere near to proof.   

Atraumatic adoption

I began this week’s reviews by proposing the abolition of meta- as a prefix. I include meta-analysis; a clumsy cacophonous word which was adopted because it once seemed new and clever. It isn’t really. It often disguises a pointless exercise in combining evidence about a variety of end-points arising from different procedures done in different contexts. Not so this one: the population consists of anyone undergoing lumbar puncture and the choice is simple and binary. You either have it done with a conventional needle or an atraumatic needle. 110 trials were done between 1989 and 2017 from 29 countries, including a total of 31 412 participants. These are just the better ones. For about a couple of decades it’s been perfectly clear that atraumatic needles produce fewer post-LP headaches and hospital admissions. So why isn’t everyone using them? A good question for your next EBM class. Evidence reaches a tipping point and becomes proof (discuss), but that does not equate with adoption (discuss).

The BMJ 24 Mar 2018

Dipeptidyl peptidase-4 inhibitors and IBD

Like everyone else, I keep having to look up the difference between pharmacokinetics and pharmacodynamics, but I have no problem with pharmacovigilance. Except that it should be done much better. For uncommon associations, like dipeptidyl peptidase-4 inhibitors and inflammatory bowel disease in this instance, there should be an alarm cohort and a replication cohort, as in genome-wide association studies. There should be a special set of statistical tests. Maybe someone is already on to this—I am making it up as I go along. But I’m struck by how many papers on emerging drug harms have conclusions like this one: “In this first population based study, the use of dipeptidyl peptidase-4 inhibitors was associated with an increased risk of inflammatory bowel disease. Although these findings need to be replicated, physicians should be aware of this possible association.” Is that really good enough, when there are so many replication databases around for comparison? This study was based on the UK Clinical Practice Research Dataset: in 2018 it really shouldn’t need more than a Skype call to Taiwan or Denmark to check if it’s happening over there too. Physician awareness is a poor substitute for actual data.

Plant of the Week: Teucrium fruticans “Compactum”

The ordinary form of the shrubby germander is a big tousled thing which can get to 2m high and across. It needs full sun and preferably a bit of wall protection. It has aromatic grey leaves and blue flowers almost the whole year round. We’ve always had one because it is such a delightful thing for leaf and flower, but they’ve been a devil to keep under control and often sulk after pruning and die in cold winters.

But now a more desirable form has appeared, which is nowhere near so large and not at all straggly. It is just about the prettiest thing in the garden at the moment, with lots of emerging clear blue flowers which sit perfectly next to the pinks of a young Daphne bholua. It would also be lovely next to daffodils.

Ours was planted last year but has proved perfectly hardy through a bitter winter by a low wall. This form of T fruticans might well be a good substitute for lavender if grown as an edging shrub in the open. But at the slightest brush-past it will shed some broken stems. Turn this to your advantage and stick them carefully in compost or soil: they will all strike, and soon you will have dozens of new plants to use or give away.

The post Richard Lehman’s journal reviews—26 March 2018 appeared first on The BMJ.

“Back in my day, science came harder. We may not have had your fancy longitudinal data analyzing software, your iterated pool of available data upon which to build, or your worldwide network of instantaneous communication and information transmission, but we rolled up our sleeves and got to work just the same. And man did we do some science and discover some things. Boy, you don’t even know the half of it.”

When I turn my sights back to older research, I realize that a lot of this stuff we “discover” in health and nutrition has already been found, or at least hinted at. Today, I’m going to explore some of my favorite research from years past that, if posted to Science Daily or linked on Twitter today, would get a huge response.

Carnivory and Aging

It’s 2018, and very low-carb eating is on the rise. From Bitcoin carnivores to the success of the Keto Reset to the zero-carb movement, there’s a growing acknowledgement that eating as little glucose as possible may stave off some of the aging-related maladies that plague us. But it’s not exactly new. Back in 2006—okay, not that long ago, but longer you think at first glance (12 years!)—researchers were exploring the role a carnivorous diet could play in anti-aging.

Bacon and Colon Cancer

In 1998, scientists set out to induce colon cancer in rats using different sources of protein and fat. Since “everyone knows” red meat causes colon cancer, they wanted confirmation. There were ten groups of rats with different fat and protein sources and amounts. One diet was based on casein and lard. Another was casein and olive oil. Another was beef. Another was chicken with skin. And the last was a diet based on bacon. For each diet, one group got 14% fat/23% protein and the other got 28% fat/40% protein. They tracked ACF multiplicity—the formation and spread of aberrant crypts, the structures that presage the beginning of colon cancer.

All of the rats experienced about the same degree of increase in ACF multiplicity—except for the bacon-fed rats. The rats on the 30% bacon diet had 12% lower ACF multiplicity. The rats on the 60% bacon diet had 20% lower ACF multiplicity. The bacon was protective against colon cancer, and it was dose-dependent protection.

Flummoxed, the authors hypothesize that the nitrate-induced hyperhydration—the bacon-fed rats drank more water than the others—was able to counter the carcinogenic effects of all that bacon. Sure.

This is a rat study and far from definitive, but I almost never see anyone cite it. It’s one of my all-time favorites.

Magnesium and Heart Disease

A doctor tells his patient that he has heart disease. Gives him a list of prescriptions to fill, tells him to cut out the fat and lower the salt, recommends he “exercise regularly.” Standard stuff. Why isn’t “take magnesium” on that list of best practices? Why isn’t getting a blood magnesium test standard alongside a blood lipids test? A 1981 paper found convincing evidence that low serum magnesium had the strongest correlation with heart disease. A 2013 review had the same conclusion.

Mildred Seelig studied this for decades, exploring the mechanistic underpinnings of magnesium deficiency and heart disease, the role of magnesium in congestive heart failure, the utility of magnesium infusion in acute myocardial infarction, She and her results received little acknowledgement by the medical community.

As recently as 2004, Seelig was showing that magnesium accomplishes many of the same effects as statins without the negative side effects. We really should have listened to her.

Sugar and Heart Disease

In the late 60s and early 70s, as most nutrition researchers focused their ire on saturated fat and cholesterol using spotty data, John Yudkin was exploring the role of dietary sugar in heart disease. He actually showed back in 1969 that sugar consumption made blood “stickier”—increased platelet adhesion, an indication of arterial injury—and insulin skyrocket in certain people, and these people were at a greater risk of heart disease. He highlighted the strong connection between elevated insulin and atheroma (the degeneration of arterial walls).

If only we’d adopted his paradigm then.

Cheese, Meat, and Colon Cancer

“No, because I make sure to eat lots of meat and cheese, especially together in the same meal.” Say that next time anyone asks if you’re worried about getting colon cancer on your “caveman diet.” They’ll laugh, but it’s true. Researchers have known this for decades.

Don’t believe me? In order for animals to develop colon cancer from eating red meat, researchers must deprive them of calcium. Calcium, particularly in the form of cheese and in the context of a meat-rich diet, protects against colon cancer.

One study even cooked the hell out of Swiss cheese to modify the casein in the cheese, supposedly turning it carcinogenic. But when the rats ate the cooked cheese, their ACF multiplicity dropped.

Low Cholesterol and Mortality

Recent research has established connections between high cholesterol and longevity (0r low cholesterol and mortality). PD Mangan just wrote a great blog post detailing the results of some of this research, but this “problem” of low cholesterol and high all-cause mortality goes back decades.

And it is a problem for the lipid hypothesis. What do you do when you “just know” that lowering cholesterol is healthy, but the data doesn’t want to cooperate? When Japanese-American men with the lowest cholesterol have the highest mortality? You blame “unadjusted analyses.” Raw data showing an increase in total mortality from lipid lowering must be massaged!

Science progresses by building upon the scaffolds previous generations have erected—on older research. And those older studies are often just as powerful, groundbreaking, and illuminating as the newer studies. You just have to look.

I’m interested in hearing from you. Hop on Pubmed, filter out any results published in the last twenty or so years, and report what you find. I bet you’ll be pleasantly surprised and the breadth and depth of research.

Thanks for reading, everyone. Take care and share your favorite pieces of older research!

The post 6 Older Studies That Got No Love but Should Have appeared first on Mark's Daily Apple.

Intel plans to release chips that have built-in protections against the Spectre and Meltdown attacks later this year, company CEO Brian Krzanich said during company's quarterly earnings call this week. From a report: The company has "assigned some of our very best minds" to work on addressing the vulnerability that's exploited by those attacks, Krzanich said on a conference call following Intel's quarterly earnings announcement. That will result in "silicon-based" changes to the company's future chips, he said. "We've been working around clock" to address the vulnerability and attacks, Krzanich said. But, he added, "we're acutely aware we have more to do."

Read more of this story at Slashdot.

One of Britain's biggest car insurers has admitted increasing premiums for drivers who apply using a Hotmail account. From a report: Motorists seeking cover from Admiral could be charged $45 extra if they use certain email addresses. The insurer said some domain names were "associated with more accidents" than others, raising applicants' risk profile. Figures from the Association of British Insurers to be published today show that the cost of car insurance has increased by more than a quarter over the past three years. Admiral said that hundreds of factors were used by underwriters in setting car insurance, with riskier motorists paying more. Issues included the age of a driver and their postcode.

Read more of this story at Slashdot.

On January 8^th I’ll be “retiring” this blog and launching a new and improved one which hopes to provide much more content. More on that, below.

What started as a weekly email to a handful of friends grew into a substantially longer list of friends, then friends of friends, and quickly expanded to complete strangers. By late 2011, I decided to start putting my emails into long format and posting them as blogs. I mostly wrote about nutrition, but soon my interest in slightly more esoteric topics—such as lipidology—influenced what I wrote about.

Over the last few years competition for my time and energy have resulted in blogging dropping to the bottom of the priority list, somewhere just above watching reality TV (which I don’t watch) and just below rec league bocce ball (which I don’t play). But as my time for blogging has gone down, my reading and writing has actually gone up, just for a different reason.

In science, unlike politics, there is value in saying, “I don’t know,” or “We don’t really know, but it might be this,” or “Actually, what I believed last year is no longer likely correct.” Once you actually embrace this notion—that you can’t know everything, that facts have a half-life, and that humility is a blessing more than a curse when it comes to trying to understand the natural laws of our universe—you become obsessed with research. But there is an obstacle to consuming research (there are many obstacles, actually, but this one seems particularly troublesome): time. There are 168 hours in a week. Sleep, patient care (“work”), time with family, exercise, all chip away at this magic 168 number.

One of the great joys of practicing medicine is the frequency with which a patient asks you a question you don’t know the answer to. This is learning! Without it, the job could get boring. This happens to me about 5 or 6 times every week. Other times a patient asks a question to which I think I know the answer, but a day later I realize the answer I gave them was based on my last reading of the literature, which on that given topic was circa 2007. Maybe it’s no longer valid? Do PPIs really increase the risk of Alzheimer’s disease? Which fasting protocol is “better,” 5/25 or daily intermittent fasting? If one is only willing to exercise 3 times per week, what should the workouts look like?

The sheer volume of published work in the English language alone is staggering. At last check (based on 2016 publications), every month 98,197 new papers make their way onto PubMed. Yes, every minute that goes by, more than 2 papers are indexed on PubMed.

David Hamilton, writing in Science (1990), noted the following statistics: an estimated 80% percent of papers that are published in academic journals were never cited more than once. (In addition, self-citation accounted for up to 20% of all citations. It may not be a stretch to think that some of those solo citations came from the eponymous author[s].)  On top of that, 10% of the academic journals probably got 90% of the citations.

Let me re-state this: 80 percent of studies that are peer-reviewed and published are (or were), it seems, so utterly useless that no one ever cites them more than once. (In a follow-up study, estimates revealed that in the field of medicine, the percentage of papers without a single citation was about 46%; in the field of arts and humanities, an estimated 98% of papers go uncited.)

OK, so let’s pause for a moment and regroup. First, when I read/hear “thought leaders” (who shall remain nameless) claim to read all of the literature out there, I have to call BS. It’s simply not possible. Second, why would you want to? The above observations lead to the inevitable conclusion that most (by volume) of the published work on PubMed is barely fit to line the bottom of a bird cage.

(For the reader who gets all verklempt hearing that most published research is nonsense, it might be helpful to read this article on the chicanery in the modern scientific publishing world.)

It’s not lost on us that a heavily cited paper can be worse than useless and a thinly-cited one can be invaluable. A keen eye and good mental models can only get one so far. With more and more papers published by the minute, just how much noise is generated in the current landscape? Our conservative calculations show that, “these go to eleven.” To be sure, there’s still a formidable amount of information and knowledge waiting to be plucked from the literature. And a limited amount of time.

The best investment I’ve ever made

In 2015 I came to the realization that I was slipping. My “work” obligations, even with the huge reduction I deliberately made in exercise time, made it too difficult for me to keep up. The list of “To read” papers on my desktop was becoming an eyesore. I actually contemplated spending even more time on airplanes since that seemed to be best time for me to read. Yes, elective flights around the world just to read at 40,000 feet. The solution was obvious. I needed more brains. Literally more brains. So I hired them. Today, my practice employs a team of research analysts who are not just exceptionally bright and voracious consumers of literature, but also people who are so naturally curious (arguably the one skill I can’t really teach) that when you give them a problem, it’s just a matter of time until our collective knowledge on the topic will be increased.

Over the past year the volume of reports we’ve created—both in response to patient questions and our more elaborate proactive research agenda—has been impressive, though largely underused. In many cases, a particular report may only be shared with the one patient who asked for it. In other cases, maybe a dozen patients read it. But this work has largely remained internal. We’ve even created an internal helpdesk to moderate, organize, prioritize, and keep track of our work. (I love sending my requests to an email address that begins with Support@…)

Earlier this year one of my patients expressed his gratitude for the reports we had prepared for him. He suggested we make our work public as part of a subscription service. While we may indeed do this in the future, the other takeaway from his comment was that it was time to re-organize the blog, create a few different types of posts, and most of all, get back to some regularity.

Nerd Safari

Bob Kaplan, our head analyst, is a really amazing guy, and not just because he’s done more pullups than pretty much any one on earth, though that helps. (At a bodyweight of 185 pounds, Bob did a weighted pullup of 195 pounds [i.e., 195 pounds hanging from a chained waist-belt] … just 35 pounds shy of the world record.) Bob immediately had three great ideas when we kicked this idea around:

1. Don’t worry about trying to figure out what everyone wants to read, write the blog I would want to read and let like-minded people find it.
2. We should create three different types of posts and regularly put them out:
   1. A personal blog, which is basically what I do now; we’ll aim to put out one new post per month; and one blast from the past (previous post with updates).
   2. Reviews, specifically one “Bob’s book report” per month and one review of a scientific paper (i.e., journal club) we deem illustrative for the purpose of interpreting research papers.
   3. Nerd Safari, a weekly blog that focuses on, well, some of the more nuanced and detailed stuff that people like me (and you, if you’re reading this) have come to love. Bob also gets credit for this name, which I find pure gold. Some of the cognoscenti may have noticed I’m starting to hashtag this… #nerdsafari on Twitter.
3. At some frequency, and ideally weekly, do a live video session on Facebook, to add commentary and address questions to that week’s Nerd Safari article.

As I get closer to the publication of the book (if I had to guess, Q4 2019), we’ll also start to release some other content related to the book, such as our on-camera interviews with some of the top scientists in the fields related to longevity. Once the book is out, we’ll also publish the “outtakes” (i.e., the stuff the publisher felt was too dense for the book).

And—eventually—what I really hope will come of all this is something that so many of you have been asking of me for years: an online forum where patients and doctors can find each other. Every week I get asked, at least a dozen times, some variant of the following question: “Peter, I live in the city of so-and-so and I really wish I could find a doctor who understands X, Y, Z. Can you point me in the right direction?”  [X, Y, Z can be anything from ketosis to HRT to nutritional approaches to cancer care to lipidology.]  I usually don’t have an answer for them but I’m convinced there is a way to play match.com for like-minded doctors and patients to find each other.

The Upshot

When over 3,000 articles are published daily on PubMed, and when the vast majority of the subsequent reporting on those articles appears dubious (at best), it pains me to even think of computing the signal-to-noise ratio people face when they want the straight dope on any given subject relating to their health.

I want to visit a site that publishes meaningful information that makes me wiser for having read it. This almost always requires me to do some of the lifting. Many of the topics I love so much cannot be summarized in a listicle. If the title of an article starts with “8 Essential Foods for…,” or the like, chances are it’s not worth reading. To really learn something requires contemplation and thinking—even as the reader—and over time this leads to new insights, which is one of the most rewarding experiences I have come to know. It’s the reason why I get so excited when a patient asks me a question I don’t know the answer to. I want to learn more each day, ask better questions, create and connect more dots, and engage my curiosity.

The new site is my attempt to create this environment for you. Buckle up.

Bye, bye Eating Academy…. hello Nerd Safari.

NB: Comments from this post will not move over to the new blog, so Twitter or FB are probably better avenues to comment or ask questions.

(My parting joke and a reference to my formative years…)

The post Welcome to a blog I’d like to read appeared first on . See the original post Welcome to a blog I’d like to read.

The city could pull in an estimated $800,000 in new taxes on short-term rental units by the end of June, aided in part by an agreement with Airbnb to help collect that money.

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I’ll take the holiday bait today. It’s true…with its emphasis on candy consumption, many Primal types feel lost on Halloween. They don’t know what to do with themselves.

The costumes are fun, and being with friends is always a good time, but how should they react to all that sugar? It’s a hard thing.

Luckily, today I have 6 ways you can observe Halloween while staying true to your Primal roots.

Do Some Ancestral Reenactment

Everyone knows, deep down, that going Primal is really all about re-enacting ancient hunter-gatherer life. Personally, my mode of communication and utilization of Internet technology is a source of deep shame. I’d much rather cite PubMed entries while sitting around a campfire. If I could, I’d smash my laptop, renounce antibiotics, toss my toothbrush. That I cannot find the courage to do so is slowly killing me on the inside.

But I can’t. I’m in too deep. So I use Halloween as the one day out of the year that I can fully embody the paleolithic hunter-gatherer that yearns to burst free. I suggest you do the same. Put on a loincloth. Grab an atlatl. Contract a parasite. Live the dream, if only for one night.

Dress Up As Your Favorite Obscure Ancestral Health Community Celebrity

Sure, almost no one will get your costume. But when you meet someone who does, you’ll know you have a friend or lover for life. A few ideas:

Robb Wolf: Wear a jiu jitsu gi and a big broad smile; refer to everyone as “folks.”

Mark Sisson: No shirt, paint-on abs, and a Frisbee.

Chris Masterjohn: Carry a cup of egg yolks, and hand out vitamin K2 capsules.

Bill Lagos: Blue blockers and a blow torch.

Peter Attia: Ride a road bike while wearing only a speedo and carrying a gallon bag of cashews.

Stephan Guyenet: Wear a peasant’s burlap tunic, and carry around a dinner plate containing boiled cabbage, boiled chicken breast, boiled potato.

Petro Dobromylskj: Dress as a molecule of palmitic acid.

Emily Deans: Doctor’s lab coat made of mammoth fur, stethoscope made of bone; hand out samples of magnesium glycinate and SSRIs.

Michelle Tam (NomNomPaleo): Carry an Instant Pot filled to the brim with Red Boat fish sauce.

Richard Nikolay: Naked, dusted with raw potato starch, with Bitcoin hash emblazoned in Sharpie across chest.

Give Out Healthy Primal Treats To Trick-or-Treaters

There’s nothing kids love more than healthy treats on Halloween. Some options that the kids in our neighborhood just love:

Teaspoons of Cod Liver Oil: Keep capsules on hand for kids with costumes that restrict mouth access.

Raw Liver Shake: Blend up some raw liver (beef, lamb, or chicken) with a little OJ and frozen blueberries. Serve in tiny, decorative Dixie cups.

100% Cacao Dark Chocolate: Everyone knows that kids love chocolate.

Kale Chips: Fill a big serving bowl with loose kale chips and let the kids grab as many as they like.

Mini Bottles of Natural Dry-Farmed Wine: Reduced alcohol content makes it perfect for minors.

Dark Chocolate Covered Brussels Sprouts: Fill snack-sized Ziplocs with 3-4 Primal “truffles.” Tell them to eat it quick before it melts!

Magnesium Oil Spritzes: Spray everyone who comes to the door. Tell the irate parents it will help their kids sleep, so they should thank you.

4-inch PVC Pipe Sections for Foam Rolling: As kids approach, be rolling out your quads as an example. Actual foam rollers are best but get rather expensive.

Single-Serving Kerrygold Butter Slivers: Just cut each stick of butter into 8 pieces, wrap in foil, keep in fridge, and hand out. Tell them it’s expensive and they should appreciate it.

Offer Lessons in Evolved Fear

In this Sunday’s Weekend Link Love, I linked to an article about the evolution of fear. It turns out that most of the things we innately fear, like snakes, spiders, heights, the dark, and deep water correspond to real dangers faced throughout the course of human evolution. Halloween is the perfect time to give a lesson on how it all works.

Gather three tarantulas, three black widows, two scorpions, one snake (ideally not venomous), 1000 fly larvae, two bats, and assorted cobwebs and other bugs. Set up shop on the edge of a rocky cliff. The possibilities are endless.

Rail Against the Sins of Sugar Consumption On the Busiest Trick-or-Treating Corner

Now’s the perfect time to change hearts and minds. Dress in your Sunday best, grab a big sandwich board sign, and scrawl quotes from Gary Taubes and yours truly. Wear the sign and hit the busiest trick-or-treating street near you.

Hand out printed out copies of “The Definitive Guide to Sugar.” Have the article on sugar alcohols handy in case you get into nuanced discussions.

Tell kids that “Sisson saves” and “Gary loves you but hates the sin.”

Burn a pile of granulated sugar in the street. Make sure it burns, rather than turns into delicious caramel.

Hand out stevia packets.

Go On a Candy Bender

It’s Halloween night. Your kids are down for the count, having eaten their nightly allotment. Cleaning up, you come across a Baby Ruth candy bar. It used to be your favorite one. In your heyday, you’d go through five King-Sized bars every week. How long has it been?

You’re doing so well. You just read The Keto Reset and finally beat that stall you hit a few months back. The weight’s flying off, and by the looks of it appears to be almost all lost body fat. Your wife’s even taken notice. You feel her eyes all over you, lingering in the best of ways.

One can’t hurt…. You unwrap it, take a bite. You take another. And another. It’s gone. You’re on to the next one.

You hit the chocolates first. Snickers, Kit-Kat, Milky Way. Then the fruity candies: Skittles, Starbursts, Sour Patch Kids, Sweet Tarts. Then the weird stuff you hated as a kid. candy corn, Twizzlers, Tootsie Rolls. You don’t care anymore. You eat it all.

Your child’s stash exhausted, you move onto the drug stores. CVS is selling fun-sized Three Musketeers for a buck a bag. You don’t even like nougat, but you buy out the store anyway. That’s the last thing you remember.

Three months later, you have no teeth. Your insulin is so high you can feel it. All the weight’s back on, and more. You stumble to a pay phone and dial your house. A stranger picks up. “There’s no one here by that name.”

Well, that’s it for today. If you’ve got any other ideas for observing Halloween as a devoted Primal type, share the joy below.

Thanks for stopping by today. Happy Halloween, everybody.

The post 6 Ways Primal Types Can Observe Halloween appeared first on Mark's Daily Apple.

An anonymous reader quotes security researcher Brian Krebs: The web site that Equifax advertised as the place where concerned Americans could go to find out whether they were impacted by this breach -- equifaxsecurity2017.com -- is completely broken at best, and little more than a stalling tactic or sham at worst. In the early hours after the breach announcement, the site was being flagged by various browsers as a phishing threat. In some cases, people visiting the site were told they were not affected, only to find they received a different answer when they checked the site with the same information on their mobile phones. TechCrunch has concluded that "the checker site, hosted by Equifax product TrustID, seems to be telling people at random they may have been affected by the data breach." One user reports that entering the same information twice produced two different answers. And ZDNet's security editor reports that even if you just enter Test or 123456, "it says your data has been breached." TechCrunch writes: The assignment seems random. But, nevertheless, they were still asked to continue enrolling in TrustID. What this means is not only are none of the last names tied to your Social Security number, but there's no way to tell if you were really impacted. It's clear Equifax's goal isn't to protect the consumer or bring them vital information. It's to get you to sign up for its revenue-generating product TrustID. Meanwhile, one web engineer claims the secret 10-digit "security freeze" PIN being issued by Equifax "is just a timestamp of when you made the freeze."

Read more of this story at Slashdot.

By Dr Caroline Tuck and Dr Jane Varney

Our team at Monash University are excited to be able to share with you results from one of our latest studies, recently published in the American Journal of Gastroenterology. The results are especially important for vegetarians and vegans following a low FODMAP diet.

The study measured whether an oral enzyme supplement 'alpha-galactosidase' could help people with IBS to better tolerate galacto-oligosaccharide (GOS) containing foods.

Methodology:

Thirty one people with IBS were randomised to the order in which they completed a series of 3-day ‘test periods’. During each test period, they took either a full-dose, half-dose or placebo (dummy) enzyme treatment. Prior to each test period they were instructed to follow a diet low in FODMAPs and fibre for 3 days. During each test period they consumed a diet provided by the researchers that was low in all FODMAPs except GOS. Between each test period they ‘washed-out’ for up to 2 weeks to avoid what is called a ‘carry-over effect’.

The study revealed a number of interesting findings:

Firstly, it showed that the addition of GOS to a diet that was low in other FODMAPs induced symptoms in approximately 2/3 of participants. This suggests that approximately 1/3 of people with IBS are not GOS-sensitive. This is an interesting finding in itself and highlights the importance of establishing your individual level of FODMAP tolerance.

Secondly, it showed that the full-dose enzyme treatment improved IBS symptoms in GOS-sensitive individuals. This effect was not observed with the half-dose or placebo treatment, suggesting that a sufficient dose of enzyme supplementation (300 GALU) is needed to achieve tolerance of GOS containing foods.

Although not specifically measured in this study, the timing of enzyme treatment may be important in determining efficacy. In this study, participants were instructed to take ½ the enzyme treatment immediately before their meal (of GOS containing foods) and half during the meal. Timing the enzyme treatment in this way may ensure that the enzyme has sufficient access to GOS that enters the gut. Similar advice regarding the timing of enzyme treatment is given to people taking oral enzyme treatments for other conditions, such as lactase for lactose intolerance and pancreatic enzymes for pancreatic enzyme insufficiency.

This study did not reveal the ‘mechanism of action’, that is the means by which the enzyme exerted its effects, and while a number of theories were proposed, more work is needed to better understand these mechanisms.

So what do these results mean for the use of the enzyme in practice?

Who should use it: The enzyme is only useful in patients with IBS. The results from our study showed that the enzyme worked best in ‘GOS-sensitive’ individuals. So if you have re-challenged FODMAPs and found that you react to high GOS foods such as legumes/pulses, then you may find this enzyme beneficial. Many foods rich in GOS represent important protein sources for vegetarians and vegans (for example nuts, legumes, lentils and some soy-products), so improving tolerance to GOS containing foods may help to minimise dietary restrictions and ensure nutritional adequacy.

What foods to use it with: High GOS foods that this enzyme is likely to assist tolerance with include:

• Legumes (e.g. red kidney beans, chickpeas, baked beans, split peas)
• Cashews and pistachios
• Hummus dip
• Soy milk made from whole soy beans
• Drinks made with soy milk containing GOS e.g. soy cappuccino
• Oat milk
• Freekeh
• Thawed green peas, butternut pumpkin, beetroot
• Custard apple
• 
  

When to use it: This enzyme only targets GOS, so it should only be used when consuming GOS containing foods. As mentioned earlier, we also think that it is important to take the enzyme with food (half the dose immediately before the meal and half during the meal) to ensure that the enzyme travels through the gut with the food.

Where to get it: The enzyme is called 'alpha-galactosidase'. There are a number of different brands available, some with different doses. If you are based in Australia you will not find it on pharmacy shelves but it can be ordered online.

Thank you to the wonderful members of our @monashFODMAP community who participated in this research study, we couldn’t do it without you!

If you want to read the full article see the link here: http://rdcu.be/u1j2.

Reference: Tuck CJ, Taylor KM, Gibson PR, Barrett JB, Muir JG. Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by [alpha]-Galactosidase Treatment. Am J Gastroenterol. 2017.

Internet users identified Cole White in images of Charlottesville protesters.

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I was beginning to rest on my laurels. It had been months since the inbox had flooded with upset readers asking me to address the latest episode of the conventional establishment’s attack on healthy food and living. Until last week, when people starting freaking out about the American Heart Association’s attack on coconut oil. As USAToday put it, “Coconut oil isn’t healthy. It’s never been healthy.”

I was surprised. While I get most of my scientific references from USAToday (the “Works Cited” section of my upcoming keto book is just a single link to USAToday.com) and they’ve never let me down in the past, I didn’t know what to make of their coconut oil claims.

Had I entered an alternate timeline? Did the Tokelau people of the South Pacific obtain 50% of their calories from PUFA-laden soybean oil, and not saturated fat derived from coconuts? Did the Kitavans thrive on an admittedly high-carb diet not by supplementing it with coconut cream and meat, but by dousing their yams and fish in Unilever margarine shipped in from across the ocean?

I did some digging, revisited some other sources I’ve used in the past. Turns out I wasn’t crazy. Everything was the same. The Tokelau people really did show zero signs of heart disease despite eating a 50% coconut fat diet. They really did start getting fat and diabetic and heart diseased only after the introduction of wheat, sugar, and vegetable oils. And the Kitavans did eat a high-coconut oil, high-carb diet and thrived while doing it.

I could probably stop this post here. I mean, 50% of calories from coconut oil and pristine health is about as resounding a debunking of the AHA’s position you could produce. Let’s keep going, though….

When it boils down to it, the AHA’s condemnation of coconut oil is just another salvo in their futile war against saturated fat consumption. They focus only on the tendency of coconut oil to increase LDL and ignore everything else it does, even referring to coconut oil’s lack of “offsetting favorable effects.”

LDL has something to do with heart disease. Maybe it’s the LDL particles. Maybe it’s the oxidized LDL. Maybe it’s all that and more. I just wish the AHA would branch out a bit is all. For example, you’d think the American Heart Association would find it interesting that PUFA metabolites are actually biomarkers of non-alcoholic steatohepatitis (fatty liver + liver inflammation). If you want a non-invasive way to diagnose it, just look at how much PUFA they’re metabolizing. They don’t. Maybe they haven’t seen the research.

It’s hard to blame them; their entire world rests on the foundational axiom that LDL cholesterol drives heart disease. If they question that axiom, everything starts falling apart real fast. Their continued existence depends on them not noticing “offsetting favorable effects.” 

About those supposedly missing favorable effects, coconut oil does many different things besides raise LDL, many of which are “good.”

Coconut oil consistently raises HDL in humans who eat it. Higher HDL is linked to protection from heart disease, and higher HDL:Total cholesterol ratios are often the best predictors of protection from heart disease, beating the AHA’s favorite HDL:LDL ratio in predictive power.

It even improves cardiometabolic status in heart disease patients—the group the AHA is convinced coconut oil will kill. Patients who ate coconut oil saw reductions in waist circumference and body weight and increases in HDL. Another study also found that coconut oil reduces waist circumference, albeit with the biggest effects seen in males. That said, an even earlier study found that overweight women were able to reduce abdominal fat using dietary coconut oil. Seems to be good for goose and gander, even if the geese have heart disease.

To the AHA’s credit, a doctor quoted in the USA Today article noted, “You can put it on your body, but don’t put it in your body.” You just got permission to rub it on your skin as lotion, make it into deodorant and apply it to your armpits, and use it to condition your hair. 

Personally, I put stock in actual clinical research into the topical effects of coconut oil—without the same fear-mongering around its dietary intake.

In hair, the shorter-chained fatty acids allow coconut oil better penetration to the hair proteins. This protects them from sun damage and results in less hair protein loss when compared to mineral oil or sunflower oil.

On the skin, coconut oil performs admirably against mineral oil in the treatment of scaly skin. It also beats mineral oil in dermatitis patients.

Oil pulling with virgin coconut oil (swishing it around in your mouth, making sure to get between the teeth, before brushing or eating in the morning) reduces the presence of cavity-causing bacteria in the saliva. Just don’t swallow.

The late Seth Roberts eliminated toenail fungus with virgin coconut oil. He applied a thin layer to the affected foot each day, then covered them with socks. This is just an anecdote, but we know that lauric acid—one of the primary fats in coconut oil—is antimicrobial.

In the interest of fairness, I’ll follow up with some negatives. Coconut oil isn’t a panacea.

It’s terrible for frying eggs. Maybe I’m doing something wrong, but my eggs always stick when I try to use coconut oil as the frying medium. No, I’m not adding the eggs too early. This doesn’t happen with other fats. The taste isn’t great with eggs, either, to be honest.

Coconut oil is not the same as whole coconut. The cultures that did so well on high-coconut fat diets weren’t eating spoonfuls of refined (or even virgin) coconut oil. They were by and large processing and using the whole coconut—flesh, juice, fiber, and all. It’s one of the reasons why I’ll often turn to coconut butter over oil, like if I’m making a curry. Coconut butter is flesh and fat and fiber. If you intend on emulating the Tokelau diet with 50% of calories from coconut fat, stick to whole coconut, not straight oil.

It does raise LDL. This doesn’t worry me, especially given all the “offsetting favorable effects,” but it may be an issue for certain people. Anytime you make a big dietary change—like suddenly eating a bunch of coconut fat—you should track changes to your physiology and biomarkers.

I will say this for the AHA: At least we can dispense with the accusations of conflicts of interest. After all, the coconut industry of America just pledged to donate up to $500k from coconut seed sales to the American Heart Association. For the AHA to come out strongly against coconut oil after getting such a sweet deal only confirms the objectivity of the assessment. Even if they’re wrong, they’re not biased.

Oh, wait. It was the soybean industry that pledged to donate the money to the AHA? Never mind.

Anyway, that’s my take on the latest AHA attack on coconut oil. What’s yours?

Thanks for reading, everyone. Take care!

The post Coconut Oil Is Going to Kill Us All (or Maybe Not…) appeared first on Mark's Daily Apple.

Vegan taqueria faces demolition under housing plan (East Bay Times) Nonprofit opening mental health center (East Bay Times) First Congregational Church opens doors after fire (Daily Cal)

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