We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Friday, October 21. 2016
"A third of Americans are obese"? Really? I don't think so but I do not see very many obese people in my life.
I could think that a third might be fat, though, aka "overweight." Being overweight is a bad idea because it slows you down, damages your joints, and plays a role in some diseases such as breast cancer and heart disease. Also, it is widely viewed as unattractive and as a sign of poor impulse control in Western cultures rather than a sign of prosperity as it is in some.
Donald Trump "fat-shamed" his employee "Miss Piggy" for being "an eating machine." Mr. Trump, who is fat, was attacked for that by Mrs. Clinton - who is fat and getting fatter. As for fat-shaming, even your doctor will do that to you when you visit.
I do not view being overweight or obese as a disease. They are physical "conditions." All behavior has physiological consequences and correlates, which does not make them diseases. We over-pathologize things these days in an effort to let people off the hook for their behavior or, sometimes, in search of an insurance code. In my view, if you do not mind being fat, that's fine. Your choice as long as you accept the consequences. Being underweight frightens me more, medically.
I'll briefly discuss two physiological correlates of overweight and obesity. First, satiety. A sense of satiety is managed by chemical signals from the gut to the brain. The signals are slow to inform you that "That's sufficient." Thus fast eaters do not get the memo in time to stop. Furthermore, some people have weak signaling, or just learn to ignore the signals. Heavy-duty eaters also have expanded stomachs which are less-readily satisfied and always seem to have room for more. Recreational eating is what I call that.
I think many people seem to ignore or misinterpret all sorts of physiologic signs and signals. Also, hedonism is, by definition, fun.
My second physiologic correlate for today concerns insulin. An excess of carbs (more than you need to stay alive that day) gradually causes "insulin resistance." That is not diabetes, but just an adaptation to the amount of carbs a person consumes. It is discussed here. It explains how carbs effect energy levels and fat accumulation.
A detailed examination of Medicare's problems, with some ideas for fixing them. Excellent if you think you may someday reach Medicare age without private insurance: Medicare’s Next 50 Years: Preserving the Program for Future Retiree.
Thursday, October 13. 2016
Phizzicle phitness consists of strength, endurance, and athleticism (plus body composition). A balanced fitness program will address all aspects.
Ordinary guys often tend to emphasize the strength component because it seems more rewarding, but if you have bulging biceps to impress the girls at the beach but can not sprint a mile or a half-mile, what good are you? Fact is, biceps are not very important in functional fitness. Triceps? More useful.
Ordinary gals tend to emphasize the cardio aspect but that is just as unbalanced. That's why we always say Weights + Cardio + Calisthenics (with sports counting as calisthenics unless it is TV football).
Today, more fun info re strength-building (for men and women).
- You can gain strength without dramatic growth in visible muscle size.
- An adult body can not grow new skeletal muscle cells. However, muscle cells can develop new and larger muscle fibers within the cells you were born with.
-Usable strength can only be increased by pushing, pulling, and carrying progressively heavy resistances (eg weights). Cardio and calisthenics do not generally build strength. Running one mile vs. 10 miles is not strength - it's endurance. Distance runners are often not very strong or powerful.
- Steroids work remarkably well to increase strength and size. Do not use them - go natural.
- After an initial phase of neuromuscular adaptation, strength improvement is discouragingly slow. Few good things come easily.
- Strength, endurance, and athleticism are rapidly lost without use. The older you are, the faster they disappear. Fitness is like money: Hard to get, easy to lose.
- Strength training is the best preventative for osteoporosis and general bone health, esp for women. Cardio exercise does no good for that.
- Serious strength-building programs require a diet high in protein and fats, plus adequate carbs unless overweight. A good dose of protein immediately after a painful work-out is recommended.
- Strength building is a mind-body challenge. Very difficult and unpleasant unless you love pain and extreme effort. Most people prefer comfort - just look around at people. It's more fun with a trainer or a group so there is a relational aspect to it.
Good basic strength info: How Do Muscles Grow? The Science of Muscle Growth
For strength-building for men and women, we recommend working one's way up over months or years to being able to condense a program down to multi-muscle exercises like bench press, deadlift, barbell squat, pull-up, rows, military press/inclined bench press. Together, those will stress pretty much every functional muscle group. That is my goal - a simple, basic, efficient strength regimen.
Wednesday, October 5. 2016
- As we enter flu season, it's a good idea to take the flu vaccine around now. I can possibly save you from a few days of lost work, and if you get it at CVS they will give you a 20% discount card for all the Halloween junk and other junk you buy there that day. Flu shots do not always work, because the viruses mutate so quickly. Still, it is something to do to minimize the risk of the unpleasantness.
- The Pneumonia vaccine? Not a bad idea for high risk groups (especially very young and senior citizens)
- Tetanus? (or Tetanus-Diptheria-Pertussis) vaccine? Adults who have had their booster shot long ago probably do not need to repeat, but people caring for infants usually get an adult booster dose. Most people who have had puncture injuries or sutures in the ER have gotten a tetanus shot on a precautionary basis.
- There is a recent Shingles (Herpes zoster) vaccine too for adults.
Anyway, ask your doctor of course.
The placebo idea has a long history, back to ancient Greek medicine. However, in my experience the placebo effect, such as it is, seems most powerful in the ignorant and the suggestible. Hence the enduring popularity of quackery like naturopaths and homeopaths.
While it remains true that modern physicians often recommend treatments with marginal effects, those marginal effects are likely not imaginary.
Saturday, September 17. 2016
A review of how government food advice got it all wrong and gullible citizens ate it up. They went high-carb, low fat, no red meat, etc all to either zero effect or by getting fat. A quote:
Related, Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat - Newly released historical documents show
That is a major but unknown scandal. Think of all of the gullible Americans who avoided "red meat" and "animal fat" over a generation, for no reason at all.
Wednesday, September 14. 2016
The cheap and easy way to cure overweight and Type 2 diabetes. No need for a doctor to get involved because in most cases people can do it themselves.
Gary Taubes promoted this, but I was on it long before him. The physiology of it is basic and simple.
Please do not tell me that you can lose fat by exercise alone. It doesn't happen. Exercise is great, but not for fat loss although many people find that strenuous exercise reduces appetite.
Wednesday, August 31. 2016
Bone weakness is mainly seen in post-menopausal women. It is asymptomatic until a bone breaks and you face a real problem. When men have it, it tends to be at least ten years later than women, on average.
You do not need to appear frail to have bone fragility, but osteopenia is one component of what we term "frailty" - vulnerability to things breaking. While being underweight is one risk factor, being heavy is not a protection. Vit D deficiency and inactivity are other factors, along with bad habits, unlucky genes, and a life style lacking in daily resistance exertion.
Hip fractures are one of the common presentations of previously-undiagnosed bone weakness. Contrary to common belief, people do not "fall and break their hip." It is usually the opposite: their femur just fractures from weakness, causing them to fall. People with bone weakness, though, are more prone to any bone fracture anytime they fall or have an accident.
Diagnosis is usually via a routine Bone Density Scan or after a fracture.
Prevention and Treatment: Besides getting some sunshine daily (not just on your face) and taking Vit D along with a good diet, the prevention and treatment for bone weakness is strength training. The medicines for osteoporosis are problematic and often ineffective. Cardio exercises - things like walking, running, swimming, etc. are not effective in building muscle or bone strength. (It is not unusual for runners to be weak-muscled - or for weight-lifters to be unable to run a mile. Balanced fitness means strength, a little cardio, and calisthenics for athleticism but only the strength component is relevant here). Some full-body calisthenics might be helpful (eg squats, farmer's walks, push-ups, step and press) but what really helps is moving heavy weights against gravity with all the muscles you can engage for a couple of hours each week.
That works because muscle stress and muscle growth put the good kind of stress on the bones to which they are attached. This naturally stimulates bone development. Bone-ligament-muscle is a functional unit. Weight training can not damage your bones. Quite the opposite.
For strength training for post-menopausal women, I recommend working towards multi-muscle-group exertions like barbell or goblet squats, bench press, deadlifts, assisted pull-ups, military press, leg press, etc with ever-increasing resistance. The uninitiated should not do these things without an experienced and savvy trainer with some nutritional sophistication. Being overweight is no obstacle to strength training, but a low BMI is a major obstacle to strength-building and requires remediation.
Bone weakness aside, any non-casual fitness program should include strength training, some cardio, and calisthenics. In addition, a nutritional plan that supports your conditioning goals.
Wednesday, August 17. 2016
Medically, good posture helps prevent back problems.
Computer monitors, age, shame and shyness, muscle atrophy, and general slovenliness are the enemies of good posture: shoulders back, head up, no slouch, belly tucked in, etc. Look good, not proudful but self-respecting.
10 Ways to Have Great Posture as You Age - Here are 10 tips to keep you standing tall at any age.
Posture Power: How To Correct Your Body's Alignment
In recent years, Americans have become so heliophobic that they become Vit D deprived, raising the risk for many diseases. My dermatologist told me that many American kids are now Vit D-deprived due to excessive sunblock use. Oral Vit D is an unreliable source. Your skin produces sufficient Vit D via exposure to the UV rays in natural sunlight for about an hour per week (assuming your body is not mostly covered up).
Nobody wants skin cancer, but the scary one is the rare but dangerous Melanoma. It seems to be associated with sunburn. Do dark-skinned people get Melanoma? Yes.
Can you get sunburned on cloudy days? I did an experiment on myself last week. After 4 hours of kayaking on a hazy day with thin clouds, I got semi- scorched. Can You Still Get A Sunburn When It’s Cloudy Out?
I think it makes sense to get some time in unprotected sun but if you are going to be outside all day nude or in a bathing suit, spray the stuff on after that and use a hat. It can't hurt.
Friday, August 12. 2016
We recently posted about abdominal muscles and abdominal wall fat, but fat of course is widely-distributed on the body. It's not all subcutaneous. Much of the excess fat you have is intramuscular and most of it is stored amongst your guts in the large packets of soft lard which produce the belly.
The human body is a sponge for carbs. It is designed to be a prepper for the next famine. If you have ever assisted with surgery on a heavy person, those giant yellow blobs of adipose clinging to the organs and intestines mean trouble. They ooze a slippery oil that make it difficult to hold onto a tool and get in the way of everything you try to do. Disgusting. Surgeons hate working on heavy people because of that. It pisses them off but they deal with it. Risky, though.
But, with the first incision when the yellow subcutaneous globules billow up and flow out onto your skin, they will say things about you that you would not like to hear. It's one reason they knock you out first. Handling all of that goo in my youth helped motivate me to stay fit in middle age.
Around 15% body fat is considered good, athletic fitness for men, and about up around 19-23% for women. Women naturally carry somewhat more fat in their hips, butts, and boobs. Less than 19% in women is for under-30 year-olds, body-builders, the naturally-skinny, and if it gets too low, those with eating problems. No need for expensive tests to assess yourself. Just compare your image below the fold, from here.
Continue reading "Sizzler"
Wednesday, August 10. 2016
I am looking forward to this series about medicines which may be "safe and effective," but not effective enough to be clinically relevant.
The first example used is medicines for Benign Prostatic Hypertrophy (BPH).
Wednesday, July 20. 2016
I resist the underlying idea of one-size-fits-all, or even the idea of a tyranny of "best practices." Each patient is unique. Furthermore, most areas of medicine are in constant controversy and dispute, with new ideas always emerging. For one example, the nutritional bureaucracies are about 20 years behind the times.
I have seen plenty of people poorly-served because of fear of rules or of law suits.
Thursday, July 14. 2016
In the process, the doctor loses his autonomy. The patient loses a person who works just for him. And everything costs more.
Sunday, July 10. 2016
In other words, Americans are the last people in the world who ought to fetishize the idea of "healthy" food. That is probably why we are the only people who do.
The nutritional science which has the most value involves diseases of malnutrition, which are absent in the Western world. The knowledge that has general applicability concerns the roles of protein, carbs, and fats in the diet, perhaps the role of vitamins, and the new information about how people become fat.
Furthermore, some foods are disparaged as unhealthy for no reason. Consider steak and burgers, ice cream, and so forth. People say "Eat fruits, greens, and vegetables." Why? They are just sometimes-tasty fillers with minimal nutrients but which can be fun to eat if done right. Is orange juice "healthy"? Depends what you mean. It's flavored sugar water and some people prefer it to plain water. Is chocolate "bad for you"? Of course not. It is wonderful food.
People talk about what foods are "nutritious." In the Western world, that is an absurd notion. Lots of guys in the NBA were raised on Frosted Flakes, Doritos, hot dogs, Coke, MacDonalds, and school lunch slops. Highly nutritious. The only people who should eat brown rice and whole wheat bread are people who prefer the flavor. The only people who should pay any attention to nutrition are parents of growing kids, people who are overweight, and athletes and others with heavy physical work.
In the prosperous Western world, you are not what you eat - so people ought to eat what they like and what they can afford and ignore the health marketing hype and ignore the health superstitions. I can tell you why our family meals consist of what they do: Tradition, preferences, and nothing more.
Does Classifying Food as 'Healthy' or 'Unhealthy' Miss the Point? A handful of experts weigh in on a survey of nutritionist and consumer perceptions.
What do/did traditional cultures eat? One quote:
Also, the traditional English country diet: Bread, cheese, and ale
Thursday, July 7. 2016
The saddest part of the story is how quickly training gains are lost during periods without regular (meaning 3+ days/wk) strenuous activity. There is measurable decline in cardio functioning and muscle strength in weeks, and training gains can be lost in a few months. Use it or lose it. That is just how it is after age 30 or 35.
Physical fitness, like mental fitness, is a life-style choice.
Tuesday, June 28. 2016
How the Feds Fund Quacks
Friday, June 24. 2016
In public, we cover ourselves up literally and metaphorically. We put our best foot forward, if sober. The only real exception is at the beach where everybody wears highly-exposing underwear and our flaws are out there for all the world to see.
My topic is shame, whether about our physical or our psychological beings. Most of the time, shame is not neurotic but a healthy human response to exposure of our flaws, imperfections, and general instinct for privacy. We all have all sorts of dirty laundry. We are all on some spectrum between shame-paralyzed and shameless. The extremes are problems.
What sorts of things are often on many peoples' shame/privacy lists?
Physical self must be exposed sometimes: physical exams, weight, strength, physique, dentist(!), beach, sexual encounters, excretory fuinctions
Psychological exposure: Our private thoughts, fears, fantasies, mental flaws and weaknesses. Sometimes we will cautiously expose these to close friends or to shrinks.
Other personal attributes: Money, personal habits and home, rotten behavior, political views, failures, public performances, job status, childrens' difficulties, etc.
Intimacy means showing aspects of our unadorned selves to somebody else. It is not something to be done lightly because our private selves are not necessarily appealing to others (note the expression "TMI").We know that better than anybody, hence shame.
Caveat: Sociopaths are quite good at faux intimacy for purposes of ingratiation and manipulation.
Thursday, June 16. 2016
Mitochondria are complex little buggers which live in our cells almost like little bacteria. They are the cell's, and thus the body's, power source (they burn sugar and only sugar but, only if necessary, the body will convert body fat or body protein into sugar for them to burn). They have their own DNA which is separate from your personal DNA.
In recent years, the identification and understanding of Mitochondrial Diseases has been progressing. Most of these diseases are disabling or fatal: What is Mitochondrial Disease?
Wednesday, June 15. 2016
Unless you give yourself 4 or more hours in the gym daily like an anorectic, no. For practical purposes, it is of no use for that.
All exercise which fatigues and stresses the body is good for mental health, fitness, and vitality, and it probably slightly raises calorie-burning and is better than sitting, but exercise alone can never help you lose 10 lbs of belly lard. It's wishful thinking.
As Dr. Phil would say, "Has it worked for you?"
Wednesday, June 1. 2016
If you must use running for the cardio component of a fitness program, two to four quarter-mile or even half-mile sprints per week is plenty. Treadmill sprints are kinder on the joints than a road. The comparable anaerobic sprint approach applies to any cardio exercises. For cardio, it is the spurts of max. intensity that matter, not time wasted.
(I am reminded to add that, for those over 75 or 80, aerobic cardio is great and much better than sitting.)
Monday, May 23. 2016
Prevention is overrated. Screening should be targeted, not to save money but to be rational.
Sunday, May 15. 2016
The best-organized and rational program I have seen is the New Atkins.
If you want to look good, have maximum vigor, and save your joints, back, and heart, it's a good tough program which will shrink your belly, your stomach, and your appetite.
Once you reach your target, the plan focuses on maintenance. Not easy in a world of temptation.
They are physiologically correct in general, and especially in noting the trivial effect of exercise on fat loss. Exercise is for strength and vitality for white-collar and otherwise sedentary people, but not for fat loss. Lose fat, exercise better, get stronger, feel better, and fight aging.
Medically, each pound of spare adipose tissue over-stresses your heart, and your knees and hips. Not good. Also, strong and thin is good for sex.
If you just don't care, that's fine too. It's a free country. Very few have the self-discipline needed to do hard things persistently and obviously many people do not care very much about how they look or feel.
I have no problem with overweight people. I just assume that other things are more important to them than physical fitness, and they are right about that. It is not for everybody.
Monday, May 2. 2016
It's not really new news, but getting fat at some point in life does seem to alter some physiologic processes for the long term. It seems to retrain the body for a high-caloric life, for a fat life; resets some homeostatic buttons including altering or almost eliminating satiety signals for some period of time.
We have discussed the insulin effects of excess dietary carbs, but there is more: After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight
Despite the interesting physiology, I feel the article overstates the thesis and minimizes the role of human agency, human choice. Resisting temptation, calculating consequences, etc. is what makes us different from other animals. For those who have been heavy at some point in life, though, that is more challenging. Mind over matter.
Moral of the story: Don't "let yourself go" because you may live to regret it.
Monday, April 25. 2016
I read this short piece, Death and the Psychiatrist, and do not feel that it was worth publishing (or linking, except as an example of a weak essay). Of course, I saw plenty of dying during my medical training. There are many ways to die, but the worst one is to die in agony and terror. Nobody needs that.
It seems common enough these days to see terminally-ill patients tortured by heroic medical efforts. I hate to hear about this. Physicians, of all people, should know when to let go even if families do not. Hope is not a plan.
When your 104-lb body is packed with cancer and wracked with pain, would you chose one more round of chemotherapy, or hospice care where you would be gently eased out of it all, floating on a sea of morphine?
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