Archives for October 2009

I got an email from a new reader the other day.

…30 years old, MD in anesthesia and critical care in Italy, fed up with being 40 pounds overweight. I’ve always been the big girl, since I was little, and now that I’m a grown up i would really LOVE to shed the pounds at last. Tried it all: low-cal-low-fat; doesn’t seem to work. Went vegetarian and literally BALLOONED UP…

So now I’ve been on evolutionary for 6 days and it looks good. I’ve just subscribed to your freetheanimal site. A few questions; maybe you can help me out a bit:

• Do calories count when on pure EF?

• How often should I fast, if at all?

• Should I work out according to the power law workout max twice a week?

Very nice of this reader to donate a subscription, even having been reading the blog for only a few days. I really appreciate that. Here was my email response.

I actually don’t know if calories count or not if one keeps the carbs low. I tend to think there’s some "metabolic" advantage, but who really knows how it works (more heartbeats, higher respiration, more poop…?) and what the limits are. I have heard anecdotes of people eating upwards of 10,000 kcals per day of 80-90% fat, a little protein, and not gaining weight over weeks of the experiment.

But what’s the point?

The real power of EF is that you don’t need to count anything. Don’t be afraid of natural fats (animal, coconut, olive oil), eat plenty of then (60-70% of energy), moderate protein, low carb and everything seems to take care of itself. Just eat real food. When you do, you should find appetite begin to change. So, you never need to count anything because you’re shedding weight, your hunger is far different than before, and you should feel really good and energetic most of the time.

I’m a big proponent of intermittent fasting and have blogged a lot about it. See the category on the blog. I think that at first it should be regimented and formal, twice a week for losing and once per week for maintenance. Now that I’m about where I want to be, I just fast randomly, sometimes skipping a meal, and sometimes two or three: 18 hour fasts, 24, and sometimes 30 or 36. I usually try to do them in advance of my workouts. However, fasting isn’t essential — though I think skipping a meal or two here and there is important (look up autophagy) — but you can easily progress without it.

I have never worked out more than 1 hr per week, 2 x 30 minutes. The power law aspect is that in such brief time you can get far more intense. Nobody believes I only do 1 hr a week, when many overweight people I know trudge along at low-intensity for hours per week and never make any progress.

There was a follow-up email today with an important question and I thought I’d provide an answer here, along with the opportunity for anyone else to share experiences of insight.

So far I’ve been on EF for 7 days and lost 3 pounds. I do hope it will keep up… the last four days have seen a scale that will not move either way. plus, this might sound like psychological blabber but trust me I’m so scared that this, too, might fail like countless other methods, that I’m afraid of the scale… any suggestion about how to SANELY relate to a scale is greatly appreciated.

Well, first, you should understand that a lot of that initial 3 pounds is water that your body no longer needs to bind glycogen (since you’re depleting it). The goal is to convert your metabolism to that of a fat burner. You’ve got a few hours of glycogen stores if you’re eating a lot of carbs, and your body screams bloody murder when you’re not keeping those levels up with regular sugar intake. Conversely, you’ve got 3-4 months or more of fat stores (and you can make the needed glucose for brain and red blood cells with protein). When you become a fat burner your appetite should change radically.

But it’s a process. For some, it’s rapid, and for others, it just takes a while. But — and it’s a BIG BUT — you don’t need to be hungry all the time and you get to eat luxuriously. Check out the Food Porn category. I eat better than virtually every person on earth eating grains and sugar — and not just in terms of nutrition — but in terms of taste and satisfaction. Last night after eating the curry I blogged, I recall sitting there in such an amazing state of contentment for the longest time, and with none of the bloated or tired feeling one gets in the hours to come — and I ate a lot.

So, you know what? Even if I didn’t lose much weight, express my genes, and reset my body to the way evolution intended, I’d still eat this way for the way I simply feel. Give this at least a few months and don’t ever discount the way you feel. It’s critical.

It’s a feature of the modern, agriculture-backed church and state bedfellows that you are always called upon to sacrifice and to feel guilt when you feel pleasure and contentment by means of your own individual efforts. Conventional, fake "contentment" — the "contentment" of a slave — in a world where parasites run things demands that everyone produce to keep them in blood to suck, and their only viable long-term strategy for that is to instill unearned guilt. They do that by promoting fantasies as real, crating problems where no problems exist, and then provide a "solution" that of course requires allegiance, worship, obedience, sacrifice.

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary. –H. L. Mencken

And it’s that guilt, alarm, and clamoring for safety and salvation that causes you to torture yourself with low-fat diets of industrially processed garbage — and then try a burn it off in hours of toil on a treadmill or some other penance for your sins.

There’s the theory. For the practical, I would recommend that you don’t look at the scale very often. In an evolutionary context, we are simply not very good at gaining valid knowledge from observations of very complex systems (like metabolism). There was a book written a few years back that I highly recommend: Fooled by Randomness, by Nassim Nicholas Taleb. If you’ve read any of Art de Vany’s blog, you may have seen reference.

You don’t want to get yourself stressed, worried — or overly exuberant — by obsessing on the scale. Personally, I look at it twice per week, after each workout on the way to the sauna. In over two years at this, I can tell you that there have been a multitude of inexplicable swings up to 5 pounds in either direction. So, what you want to do is pay attention only to the highs & lows.

You are trying to shed fat and to keep and strengthen lean tissue. So, what you want over time is to observe lower highs and lower lows on the scale, and between those two established trends, never mind what happens, so long as you’re keeping your eating practices at 80-90% good.

Anyone else have anything to add?

If it is, then how come your own daughters — the young being at highest risk for contracting the H1N1 virus, according to the epidemiology so far — haven’t been vaccinated?

It’s "not available to them?" Come now, Barack. You don’t really expect anyone to swallow the notion that two doses of H1N1 vaccine can’t be made available to the children of the President of the United States, do you? …There’s more at Karen’s place, including a videe of the prez.

On the other hand, perhaps you would be wise to forego the risk of vaccination for yourself and children, which of course raises the question of why whip up all the hysteria? Well, I’m sure I know the answer to that; but alas, it’s not the subject of this post, merely an entrée.

I have stayed mostly away from this topic until now, except to point out in past posts that adequate vitamin D levels seem to be very protective against influenza, and perhaps specifically to H1N1.

Over the past few months I’ve been reading things here and there, not just about H1N1, but also concerning the effectiveness of flu shots in general. And, I have to ask:

Are Flu Shots An Enormous Scam?

I don’t see how anyone can conclude differently, once you dig into the data. One of the most interesting things I saw in my informal research was a chart of infection rates going back a very long time, prior to the advent of flu vaccination. Guess what? Little to no difference. Unfortunately, I seem to have forgotten where I saw that. If anyone else saw it can can point it out in comments, please do.

But before we dig into flu vaccinations in general, what can we say about H1N1? Well, what about the southern hemisphere that’s just coming out of the winter flu season, into spring and onto summer? According to the Junkfood Science blog:

Three months ago, public health experts and even the President of the Australian Medical Association were warning that one-third of the population would get swine flu. As late as last month, the Australian government had ordered 21 million doses of swine flu vaccine, enough to vaccinate the entire population.

In reality, as of noon today, the Australian Department of Health and Ageing reports that Australia has had 35,775 confirmed cases of pandemic H1N1. The experts had overstated the numbers who would get sick by 203-fold. There have been 162 deaths — a fraction (5.4%) of the 3,000 Australians who typically die from the seasonal flu each year. [emphasis added]

Moreover, it seems that a blog specifically dedicated to the swine flue in Australia lost interest around September 28, 2009, the date of the most recent post. And this is a "National Emergency?" I’ll tell you what’s a national emergency: stupid, ignorant, and/or gullible people waiting to be collectively led around by the nose.

There’s an article of amazing scope in the November, 2009 issue of The Atlantic: Does the Vaccine Matter? It’s authored by Shannon Brownlee and Jeanne Lenzer. This is one you might want to get in dead tree version for easier reading.

Let’s dive right in.

But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals.

Did you know that? Were you aware that even some top influenza researchers are skeptical of flu shots? Bet many of you didn’t.

Yet the flu, in many important respects, remains mysterious. Determining how many deaths it really causes, or even who has it, is no simple matter. We think we have the flu anytime we fall ill with an ailment that brings on headache, malaise, fever, coughing, sneezing, and that achy feeling as if we’ve been sleeping on a bed of rocks, but researchers have found that at most half, and perhaps as few as 7 or 8 percent, of such cases are actually caused by an influenza virus in any given year. More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness”; respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus are just a few of the bugs that can make a person feel rotten. And depending on the season, in up to two-thirds of the cases of flu-like illness, no cause at all can be found.

Yep, "the flu" has become ubiquitous in the language. I recall Dr. Dean Edell once mentioning on his show that most illnesses people ignorantly attribute to the flu are actually food-born maladies that come & go in a few days.

Here’s Australia, again.

In August, the President’s Council of Advisors on Science and Technology projected that this fall and winter, the swine flu, H1N1, could infect anywhere between one-third and one-half of the U.S. population and could kill as many as 90,000 Americans, two and a half times the number killed in a typical flu season. But precisely how deadly, or even how infectious, this year’s H1N1 pandemic will turn out to be won’t be known until it’s over. Most reports coming from the Southern Hemisphere in late August (the end of winter there) suggested that the swine flu is highly infectious, but not particularly lethal. For example, Australian officials estimated they would finish winter with under 1,000 swine flu deaths—fewer than the usual 1,500 to 3,000 from seasonal flu. Among those who have died in the U.S., about 70 percent were already suffering from congenital conditions like cerebral palsy or underlying illnesses such as cancer, asthma, or AIDS, which make people more vulnerable.

And there’s the rub — that unhealthful, sick people are more susceptible — that we’ll now get into.

But while vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.

Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winter—from any cause—as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.

In all my informal research, this aspect seems to be the chief crux of the matter; the one everyone hangs their hat on, and it’s true: if you compare the group of people who get vaccinated against those who don’t, those who do die half as much within the year as those who don’t.

Case closed, right? But, ah, as we’ve talked about many times: confounding variables. Let’s dig deeper.

Suppose someone were to track all-cause mortality against people who get annual checkups with their doctor vs. those who don’t. I have no doubt that the group who does get annual checkups will have a statistically significant reduction in all-cause mortality over those who don’t get checkups. So, getting annual checkups contributes to longevity? Maybe it does, but I doubt the actual contribution is anywhere near as profound as I’d expect the statistics to reveal.

Maybe you give yourself too little credit. Think about it. Is it the fact that you go to a white-coated doctor for 30-60 minutes per year that’s causing your better general health, or, is it more likely that you’re health conscious (which is why you bother with the checkups) that works for you the other 364 days of the year? Don’t be dumb, or gullible.

I know, understand, and agree that being a physician is a high calling. But the most honest among them will tell you point blank: they are no substitute for healthy living.

Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.”

Did you get that? He smells a rat. So, why the push for vaccination when the stats don’t work out right? Alright, lets get to an explanation of what I’ve already alluded to.

The estimate of 50 percent mortality reduction is based on “cohort studies,” which compare death rates in large groups, or cohorts, of people who choose to be vaccinated, against death rates in groups who don’t. But people who choose to be vaccinated may differ in many important respects from people who go unvaccinated—and those differences can influence the chance of death during flu season. Education, lifestyle, income, and many other “confounding” factors can come into play, and as a result, cohort studies are notoriously prone to bias. When researchers crunch the numbers, they typically try to factor out variables that could bias the results, but, as Jefferson remarks, “you can adjust for the confounders you know about, not for the ones you don’t,” and researchers can’t always anticipate what factors are likely to be important to whether a patient dies from flu. There is always the chance that they might miss some critical confounder that renders their results entirely wrong.

One must wonder. See, I think, intuitively, I’d have little problem listing a whole slew of variables likely to be more important than a flu vaccination. A good paleo diet — high in natural fats — would be one strong association, I’d guess (the strongest? probably). Any data to see how such people fared against death by flu, or all-cause mortality? Nope. Never’ll happen in this life. It’s the hugest blind spot ever; human evolution: as a principle, it does not exist hardly anywhere in the science as a driving force. We’re pre-Copernican. We’re in many ways far more primitive in perceptual understanding than primitives who lived 100,000 years ago. They lacked our methods and technology; so, they just resorted to what they could observe and logically deduce.

And while they were mostly helpless against the most ravishing of what mother nature could unleash, they at least knew how to eat and be as healthy as their environment would allow.

Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the “healthy user effect.” They hypothesized that on average, people who get vaccinated are simply healthier than those who don’t, and thus less liable to die over the short term. People who don’t get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn’t. Then they examined which group’s members were more likely to die of any cause when it was not flu season. […]

[…] In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all.

Suppose it was believed that some talisman protected people from death in the next year. Every spring, those who could would embark on a trek; say, a climb up Mt. Fuji (I picked that ’cause I’ve done it!). Over the next year, we tabulate the all-cause deaths and compare the stats for those who made the trek vs. those who didn’t. Any guesses as to who would have the lowest mortality? You would completely understand that the difference is a function of those healthy enough to make the trek, vs. those who aren’t — and that those who aren’t will doubtless have far higher general mortality in the year to come.

But suppose we were able to make the epidemiology better. How would one do that? Well, the easiest and surest way would be to not vaccinate at all for a year, and then compare the death rates to the years when many were vaccinated.

THE HISTORY OF FLU VACCINATION suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. […]

And how did that work out? It wasn’t a total moratorium on vaccination, but maybe it’ll lend a clue. But let’s wait. Maybe we can get even more data.

[…] In addition, vaccine “mismatches” occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. […]

There we go…and, the punchline:

[…] Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge. Sumit Majumdar, a physician and researcher at the University of Alberta, in Canada, offers another historical observation: rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate. In 1989, only 15 percent of people over age 65 in the U.S. and Canada were vaccinated against flu. Today, more than 65 percent are immunized. Yet death rates among the elderly during flu season have increased rather than decreased.

OMG!

And by the way, for the 2004 partial vaccination case mentioned first: "…Yet mortality did not rise."

Felling gullible and duped, yet? But, after all, I’m just a blogger who’s lost some weight — I had a "stint" of weight loss…

“Tom Jefferson has taken a lot of heat just for saying, ‘Here’s the evidence: it’s not very good,’” says Majumdar. “The reaction has been so dogmatic and even hysterical that you’d think he was advocating stealing babies.” Yet while other flu researchers may not like what Jefferson has to say, they cannot ignore the fact that he knows the flu-vaccine literature better than anyone else on the planet. He leads an international team of researchers who have combed through hundreds of flu-vaccine studies. The vast majority of the studies were deeply flawed, says Jefferson. “Rubbish is not a scientific term, but I think it’s the term that applies.” Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients, such as school-age children with no underlying health issues like asthma. The other two showed equivocal results or no benefit.

So take that!

Jefferson has a logical approach on principles, which is that the theory of vaccination is sound. It’s based on our immune systems. You never get the same cold virus twice in your life. Every time you get a cold, you are henceforth immune to that specific virus for the remainder of your days. But viruses, having short lifespans, succumb to evolution fast faster then we do, such that their rapid mutation ensures their survival within human hosts. Think about it.

So, if you take such a principled approach, to where will reason lead you? How about: healthy people have robust immune systems, and thus, healthy people — those who will fight off the virus normally — respond predictably well to the vaccine, produce the expected antibodies very efficiently?

There’s some merit to this reasoning. Unfortunately, the very people who most need protection from the flu also have immune systems that are least likely to respond to vaccine. Studies show that young, healthy people mount a glorious immune response to seasonal flu vaccine, and their response reduces their chances of getting the flu and may lessen the severity of symptoms if they do get it. But they aren’t the people who die from seasonal flu. By contrast, the elderly, particularly those over age70, don’t have a good immune response to vaccine—and they’re the ones who account for most flu deaths. […]

Yet both "National Emergencies" and associated corporate profits persist. In the end, patients die anyway, paid for by those who wouldn’t have, anyway.

Had enough? Well, much of the remainder of the piece is about resistance over controlled trials, which, if you read regularly: observational epidemiology only gets you to the hypothesis stage. You need to control variables to tease out real causes. So, let’s explore.

The annals of medicine are littered with treatments and tests that became medical doctrine on the slimmest of evidence, and were then declared sacrosanct and beyond scientific investigation. In the 1980s and ’90s, for example, cancer specialists were convinced that high-dose chemotherapy followed by a bone-marrow transplant was the best hope for women with advanced breast cancer, and many refused to enroll their patients in randomized clinical trials that were designed to test transplants against the standard—and far less toxic—therapy. The trials, they said, were unethical, because they knew transplants worked. When the studies were concluded, in 1999 and 2000, it turned out that bone-marrow transplants were killing patients. Another recent example involves drugs related to the analgesic lidocaine. In the 1970s, doctors noticed that the drugs seemed to make the heart beat rhythmically, and they began prescribing them to patients suffering from irregular heartbeats, assuming that restoring a proper rhythm would reduce the patient’s risk of dying. Prominent cardiologists for years opposed clinical trials of the drugs, saying it would be medical malpractice to withhold them from patients in a control group. The drugs were widely used for two decades, until a government-sponsored study showed in 1989 that patients who were prescribed the medicine were three and a half times as likely to die as those given a placebo.

Don’t have a short memory and don’t be dumb. Realize that those who are in power are in power because they like to be in power (Duh!); they don’t really give a damn about you or your family, and You. Are. On. Your. Own.

Personally, I would never have it any other way.

In the end, the myth of flu vaccination (I assume, but have not looked into the seeming clear benefit of polio, smallpox and other vaccines) efficacy may do us more harm than good.

In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill. Likewise, our encouragement of early treatment with antiviral drugs will likely lead many people to show up at the hospital at first sniffle. “There’s no worse place to go than the hospital during flu season,” says Majumdar. Those who don’t have the flu are more likely to catch it there, and those who do will spread it around, he says. “But we don’t tell people this.”

If you want to get sick, hang around hospitals.

Note: I’m really grateful to the authors of The Atlantic article who permitted me to put something coherent — perhaps entertaining — together in a few hours, based mostly on their work of weeks, or months.

10/27/09: Check out this CBS News investigative report.