Maggie's Farm

It is hubris to imagine that all problems have solutions. It is nihilistic to imagine that none of them do. Curing death and other ills

This concerns myelin. Could be a theory:

 Researchers Link Autism To A System That Insulates Brain Wiring

 Brain Connectivity and the Role of Myelin in Autism Spectrum Disorders

 Inadequate Myelination of Neurons Tied to Autism: Study

A reader wondered about an article about the politics of medical research, with Alzheimer's as an example.

Everybody knows that academic politics are ugly. Alzheimer's is uglier than that, and there is lots of money available too.

The problem with searches for cures is that the #1 risk factor for Alheimer's is genetic, via the maternal line.  If your Mom has it, your odds for it are worrying but not certain. The second risk factor is being overweight. The viral idea doesn't really seem to fit with the genetic. Maybe they are synergistic? Who knows?

Genetic testing for Alheimer's risk is available at any age. With certain genetic conformations, your risk is almost certain. Bad news.

From all I have read about it (not an expert at all), the brain rot begins long (years, even decades) before there are obvious clinical symptoms other than, maybe, being less energetic, social, and driven.  My amateur guess is that the brain tangles and brain shrinkage are not causal, but results of a genetic brain rot, a sort of programmed obsolescence. 

"Cures" for genetically-weighted diseases are elusive, of course, because they are baked in the cake. Unbaking a cake is a tough challenge. 

Carpe diem. 

If you are serious, you get with the program today, not next year. January 1 is for suckers.

Of interest,  Exercise linked to lower risk of 7 cancers, study finds. Cancers of the kidney, liver, breast and colon may all be fended off by increased physical activity.

A recently-retired friend decided to take up EMT training. He wants to remain a useful citizen. Thus far, he loves it more than he ever liked his job. The chance to save a life is an appealing thing, while learning all sorts of new skills.

As an MD, I have to admit that these people can do things that I have no clue about how to do. Never learned, or can't remember. Most of the car crash victims I saw in ERs were DOA, and most MI people were beyond saving. Death happens, often, as it must. That was a while ago, though.

There are several levels of it, so you can keep aspiring. There is always work too, part-time or full, or volunteer.

When we walk into a patient’s room, we are entering a story.

That's the correct medical attitude. It doesn't apply to the purely technical specialties, though. 

Why Hard Belly Fat Is More Dangerous Than Soft Fat

People always say "Diet and Exercise." Unless you hike 10 miles daily, or work out 2 hrs/day, I just say "Nutrition" to lose bad fat. Not "diet," "nutrition" because diets fail but appropriate nutrition is a way of life. Just enough of pretty good things for the fitness you want. That article more or less says the same thing. 

Daily exercise is great for fitness, but not for fat. The bonus is that the less fat you are carrying, the better your exercise and activity endurance. 

That's enough annoying preaching for today. 

Brief article here.

Never forget that pain relief is one of the miracles of modern medical practice. 

Joseph Henry Green  (1791-1863), an English surgeon who became the literary executor of Samuel Taylor Coleridge.  The word was spoken upon checking his own pulse.

Joseph Henry Green, a surgeon and professor of anatomy, suffered from inherited gout and died of an acute seizure at his house in 1863.  

An account of his final moments has been given by Sir John Simon:

“I would show that not even the last sudden agony of death ruffled his serenity of mind, or rendered him unthoughtful of others. No terrors, no selfish regrets, no reproachful memories, were there. The few tender parting words which he had yet to speak, he spoke. And to the servants who had gathered grieving round him, he said, ‘While I have breath, let me thank you all for your kindness and attention to me’.

Next, to his doctor, who quickly entered – his neighbour and old pupil, Mr. Carter – he significantly, and pointing to the region of his heart, said – ‘congestion’. After which, he in silence set his finger to his wrist, and visibly noted to himself the successive feeble pulses which were but just between him and death. Presently he said – ‘stopped’. And this was the very end. It was as if even to die were an act of his own grand self-government. For at once, with the warning word still scarce beyond his lips, suddenly the stately head drooped aside, passive and defunct for ever. And then, to the loving eyes that watched him, ‘his face was again all young and beautiful’. The bodily heart, it is true, had become more pulseless clay; broken was the pitcher at the fountain, broken at the cistern the wheel; but, for yet a moment amid the nightfall, the pure spiritual life could be discerned, moulding for the last time into conformity with itself the features which thenceforth were for the tomb.”

You have to admire someone who takes his own pulse and pronounces himself dead.  Now that’s cool.

"To lengthen the life, lessen the meals."

Benjamin Franklin 

That's in Bill Bryson's excellent new book The Body: A Guide for Occupants. Even doctors can enjoy it.

The terror of medical opioids is on an upswing. I have seen the upswings and downswings during my career. I wish we could find a middle course, because medical opioids are a blessing to suffering people. Yes, I include Oxycontin in that because it is an excellent medicine.

Of course opioids are habit-forming. For refractory pain, they are also life-giving. For people with life-impairing chronic pain, there is something called "pseudoaddiction."  AGAINST AGAINST PSEUDOADDICTION

These days, I have seen people in that category treated like drug addicts. Sooner or later, there will chemicals with the pain effects of opioids but without the habit-forming effects. Not yet.

Excellent summary on the mental and physical benefits of exertion: The New Science of Exercise:

Doctors, researchers, scientists--even ancient philosophers--have long claimed exercise works like a miracle drug. Now they have proof.

As I have said before, a rigorous exercise program might not extend your life. It will definitely enhance and extend your quality of life even if you begin it at any age. Everybody knows that they ought to do it, but it's hard and it hurts and we're lazy and "busy."  Plus there is that terrible part: delayed gratification. Everybody hates that. As I say, "The flesh is willing but the spirit is weak."

Our quite well-informed recommendations for general fitness and conditioning for the ordinary person who wants to achieve or maintain maximal functionality for life:

1. Nutrition: Don't be visibly overweight - it's the worst thing you can do to yourself besides being an addict, and no exercise can help being fat. Does a demanding exercise program require a specific pattern of nutrition? Yes. We have discussed that in previous posts here. With a serious exercise program, you have to keep up with the protein and fats - approx. 70-90 gms of protein/day.
2. Weight training - as heavy as possible, approx 50 minutes twice a week
3. 1-2 hrs total of calisthenics/wk for mobility, balance, and athleticism
4. 2 or 3 twenty-min sessions of cardio intervals/wk  (HIIT). (For HIIT, I do stairs once, elliptical once, rowing once. Occasionally sprints in the pool.) Can add an hour of endurance cardio.

Under age 35, it can take 12 months to be whipped into decent shape. Over 35-40, depending on your fitness starting point, 18-24 months. Intense sports like basketball can substitute for calisthenics. Yoga is excellent, but does not substitute for any of the above. Many men find Yoga to be quite challenging and helpful. Lots of pro football players do it. If your day job is physical, all of the above recommendations would differ.

Choosing a Good Death

It's never too soon to have a Will, and a Living Will. Trouble can strike at any time as we all have seen.

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

The press makes it all even worse, just to make a story. People of the press rarely have STEM degrees. 

It is well-known that vigorous exercise does not "work up an appetite." On the contrary, it tends to reduce hunger and appetite.

That might not apply to 8 hours on the Appalachian Trail or a day job as a lumberjack, but it is certainly true for me with my 1-hr daily exercises. The more consistently I exercise, the less interest I have in food and the smaller the portions I can handle. This effect is most pronounced with demanding cardio and calisthenic exercise, not with strength exercise or with sports. There is a theory that the effect has something to do with Peptide YY.

Nobody wants to eat anything after a hour of tough cardio exercise and that suppressive effect tends to last 24 hrs. at least. 

Maybe it makes some genetic sense. If you need to move yourself vigorously and frequently, the less fat you have on you the better you can avoid becoming part of a Tiger Dinner Party. Hunger is an interesting instinct and only recently has it been studied biochemically. One thing we know for certain is that subjective hunger or attraction to food is not a signal for a need for nourishment for most adults in a food-rich environment.

Overweight people seem to have the strongest subjective hunger, and sedentary people tend to have stronger appetites. Cause or effect?

Not what they were cracked up to be: Meta-analyses were supposed to end scientific debates. Often, they only cause more controversy.

When and why did "medical care" become "health care"? It has been a puzzlement to me. When I first heard the term, I thought "What?!?"

Is it just euphemisn, or something more?  

At least 80%,  likely more. Genes plus errors in wiring.

Given the complexity, I have always been amazed by how often the wiring works fairly well. 

I still think it's a good idea to get your share of natural sunlight daily, and even more so if healing or recovering from something.

Still, much of the Vit D research was apparently wrong:  Millions of Americans take vitamin D. Most should just stop. Outside of rare cases, rigorous studies of the supplement don’t find any health benefit.

Like many other stories, the moral of this one is that there is no settled science. 

Yes it is. Your waist size is not your belt size or jeans size though, especially if you wear them on your hips which most people do these days. Your waist is above your belly button, the potentially narrow space below your rib cage.

How to Measure Your Waist

How do you measure your waist? Sounds simple enough, but it’s not always obvious where your waist is. Posture and other variables can affect the reading, so here are some basic guidelines to follow:

Position a tape measure at the narrowest point between your lower rib and the top of your hip bone, or at the midpoint in between. It should be snug but not compress the skin. If you can’t find the narrowest point (it may be difficult if you’re very overweight), measure just above your belly button.

Stand straight and breathe out normally; don’t suck in your belly.

Measure your waist first thing in the morning, before breakfast.

Though there’s no magic cutoff point, values over 37 inches for men and 32 inches for women indicate increased health risks, according to the World Health Organization; values over 40 for men and 35 for women represent substantially increased risk.

Doctors have become fearful of prescribing opioids. I hear stories about terminal cancer patients being denied adequate analgesia out of "fear of addiction."

Until new non-opioid and promising pain meds are available,  I am in favor of adequate dosing for pain when nothing else works. Chronic pain is a terribly disabling thing, mentally, spiritually, physically, etc.

The two best things medicine has provided mankind have been antibiotics, and anesthesia/analgesia.

 Can the Damage Done by the CDC's Opioid Guidelines Be Reversed?

Celebrities are always touting the latest nutritional fads like "clean eating", veganism, etc.  Now it's the Fasting Plan. Of course, these people know nothing. In fact, little is known about human nutritional needs but we do know some simple things to prevent starvation. For example, your nutrition requires fats.

There seem to be all sorts of variants of the Fasting Fad, but there may be something useful in it. For example, no adult without an all-day manual labor job (or a heavy lifter or a distance runner) needs three meals/day unless they are underweight. Three meals/day was designed for farmers, just like summer school vacation.

Furthermore, most hunger is what we have described as "false hunger" (meaning it represents no need for significant nutrition) for anybody even 5-10 lbs overweight. Our fat cells are a massive storage battery waiting to be used.

So what about fasting, whether it means just skipping one of the conventional meals or even taking a day or two off from food every week?  Not as a weight-loss plan, but just as a plan. Many find it increases their energy.

When you think about it, during almost all of the 300-500,000 years (except the past few thousand agricultural years) of human life and evolution, food scarcity was the norm. Humans are designed for food scarcity rather than for today's abundance. That's why eating is fun rather than necessary.

This is interesting:  MIT study: 24-hour fasting regenerates stem cells, doubles metabolism. This gives credence to the 5–2 diet, which has recently gained in popularity thanks to a large celebrity following.

Thank you, reader:

This month’s Harvard magazine has an article on just this topic. Scroll down to the section titled, ‘Eating to Excess: Metabolic Inflammation’.

“The metabolic stress that is a hallmark of modern life, the stress that the body has not evolved to handle, is constant eating, he continues. When people eat, energy and nutrients enter the body rapidly, are processed, produce in turn a lot of by-products, and then need to be reduced to “functional substances that are distributed throughout the body, and then disappear very quickly. Many cells and tissues actually undergo a huge amount of stress during this process,” he explains, “as they store appropriate nutrients and dispose of harmful intermediates.” Part of this process also involves mounting an immune response. “The pancreas, for example, must secrete four to five hundred milliliters of enzymes every day” to be able to manage the incoming energy load with every meal. “If you place these organs under constant stress, they start malfunctioning.” The consequence is that “right now, one out of every 10 individuals has diabetes. One out of every four individuals has fatty liver disease. And if you reach a certain age, one out of every three individuals will develop neurodegenerative disease.”

The metabolic stress that underlies these conditions comes from the daily imbalance between how much energy people consume and how much they need, and can process in a healthy manner. The long-term consequence of overconsumption, combined with lack of sufficient expenditure, is stored energy—the accumulation of fat...”

Also interesting in that article is a bit about the benefit of muscle inflammation due to stressful exercise. Muscle damage, of course, is how we build strength. 

Inflammation and health in Harvard Magazine

It's a crazy subject, fraught with myth. Animals do not need to read articles about when to have a drink of water, but seemingly humans do. 

Where I live most of the time, females go around with a plastic bottle of water. In the car, in the gym, on the tennis court, at the supermarket, as if living in the Sahara. There are hardly enough public bathrooms for them all.

A few points:

Coffee is not dehydrating. Beer is hydrating. When you work out hard, especially in the heat, a little water is good. There seem to be extremes: people who are insensitive to their thirst, and people who drink too much. If confused about one's needs for liquid, the frequency of peeing, and the concentration of one's pee, are good indicators.

I have had outdoor adventures when my fatigue was entirely due to a touch of dehydration, when I perked up like a wilted plant with a bottle of water. 

A healthy body alerts us to dehydration by making us feel thirsty. How much water should you drink a day Whether you’ve had fatigue or even dry skin, you’ve probably been told to drink more water as a cure. But this advice comes from decades-old guidance… and may have no scientific basis.