September 11, Battle of Plattsburgh, & Royal Marine Band of Cobourg

Tomorrow is September 11th. Most Americans remember the day as the anniversary of the World Trade Center attacks. But there is another more uplifting anniversary that Americans can celebrate on that day as well.

In 1814--the last year of the War of 1812--the British advance from Canada was stopped on Lake Champlain and at the city of Plattsburgh, NY. This action, which potentially saved the integrity of the present US borders, has become known as the Battle of Plattsburgh, and the city hosts a commemorative celebration each year on this weekend.
For several years now, Her Majesty's Royal Marine Concert Band of Cobourg has attended the event as well, putting on a marching show during the day and a concert show at night.
I attended the night performance this evening, and it was quite a good show, starting with God Save the Queen, performed without irony. You can sample mp3's of their music, such as The Army of the Nile [mp3].

Celia Green: The Human Evasion & Letters from Exile

Earlier this week, I wrote about Lucid Dreaming, a book by Celia Green. Today, I briefly review two of her other works, The Human Evasion and Letters from Exile, looking for their applicability or usefulness to health care professionals.

Review: these books are not useful for healthcare professionals. Voila!
Although I believe Ceila Green (now about age 75) is a smart woman who did some pioneering work in lucid dream states, these two other books by her reveal her to be a crank with a massive chip on her shoulder. She was, apparently, a precocious child who went to university in England but was then not able to advance to a tenured academic position. She blames this failure on 'the system' and its insistence on conformity of different kinds. This history is chronicled ad nauseum in Letters from Exile...

I first ordered Letters from Exile because it has a section devoted to the medical profession, and I am always interested in the minority report. However, Celia Green's critique of the medical profession is pretty much limited to (1) it's unfair for the medical profession to be gatekeepers to medicines and treatments, and (2) medical professionals' insistance on performing their own physical exams and coming to their own conclusions is an unwarranted invasion of privacy.

The rest of Letters from Exile consists mostly of her repeating the story of how she wasn't allowed to enter university at a young age because the educational establishment wouldn't let her take the required exams. Yawn.

Frankly, while her critiques of the establishment have some merit, they are not original or insightful and have been made much better by various other people over the last 50 years. Letters from Exile is not worth buying or reading. The author tells us she is a good writer, but I could have been fooled into thinking otherwise.

In The Human Evasion, available online for free, Green takes a long time making the point that most people's analytic efforts are expended on food, reproduction, and day-to-day activities rather than on problem solving or scientific or philosophical questions. Since people are designed for eating and fucking and not for research, it is hard to understand what Green's point is, other than that the book allows her an opportunity to make some debating points with modern theologians and physicists on the irrationality of their respective fields. Green deals in radical skepticism, a perspective that is indubitably true on some level. On the other hand, the success of modern technology goes to show that it is not really a necessary assumption for the advancement of science and civilization. The fact that Green might be smarter and more insightful than some people who are publishing in peer-reviewed journals today is... yawn.

The Human Evasion, is essentially Green's apologia for being an ass in human affairs. She suggests that people who are interested in answering questions about the nature of the universe will feel a sense of urgency that justifies their eccentricities. Of course, it is not clear why Green or anyone else should feel a sense of urgency in answering questions about the universe. What will the knowledge get them, other than their name in lights? And what will that get them other than money, power, sex, and the other things Green derides? No, this too, while better written than Letters from Exile, is not worth the time and effort.

Armagnac

I recently had a patient who takes a shot of brandy every night before bed. For this essentially recovered patient, I was trying to get the routine re-normalized, so I obtained some brandy. I had to have someone go to the store for me, and the delivery ended up being Remy-Martin cognac.

That Remy-Martin smelled so good when I poured it over ice in a plastic hospital cup! So when I got home, I broke out my bottle of armagnac.

For a long time, I couldn't find armagnac in my town. When it turned up, it was a lot more expensive than cognac. But it is also a small production area. Since cost is a reflection of scarcity, armagnac's prohibitive price is no guarantee of anything. What are the chances of getting a good bottle of a rare spirit in a small town? But I decided to try it anyhow.

I have to say I have been disappointed.

Corvoisier, Remy-Martin, and Hennessy cognacs are all distinctive. Remy-Martin is sweeter, fruitier, and smoother. Corvoisier has more casket flavor, more appropriate for smoking than food. Hennessy is trending toward Corvoisier from Remy-Martin, but subtley.

I would say that this armagnac has earthier tones compared with the cognacs--more mineral and plant than fruit or casket. However, it is, comparatively, extremely harsh. I had to add water to open it up, as you would with a Scotch. Even then, from one mouthful to the next I am vasilating between thinking I can detect a variety of undertones of flavor and hoping the skin in my mouth will still be there when I'm done drinking.

Of the two armagnacs in my town, I purchased the cheaper, which was expensive. The other is aged 25% longer and costs 50% more. Knowing myself, I will buy it to try it, but unless there is a clear improvement, I am going back to my cognacs.

TSN baloney, cont'd

Does The Sexy Nurse baloney never end? An "artist" named Aya produces t-shirts with "pin-up art" on them.


Note the tacky, unimaginative captions. I draw attention to these particular examples, because I think it is instructive to see The Sexy Nurse portrayed alongside the nun and policewoman. The image below of "Nurse Jackie" is one that is probably unremarkable to most people. Is it to you?
Does it look ridiculous to portray a nurse like this? Or does Jackie simply look like a nurse to you? Now compare this photo to the "pin-up art" Sexy Nurse above. Almost exactly alike, no? Consider how foolish the nun and policewoman look. The Sexy Nurse art was produced by the same mind that produced the nun and policewoman, and it is equally as foolish an image. It should appear equally as foolish to us. And Nurse Jackie should appear to us just as foolish as that nun and policewoman as well.

more of The Sexy Nurse Report

(Incidentally, the ID badge Jackie is wearing in this photo is identical in design to the one at my hospital. Maybe there is one manufacturer that dominates in this market?)

Musk, for remembering cholinergic subtypes

Depending on where you went to school and what type of pharmacology class you had, you may or may not have gotten into receptor subtypes for drugs that affect the nervous system.

Of course, you might not find receptor subtypes helpful. I do. Remembering which pressors affect alpha-1, etc receptors helps me remember the therapeutic and non-therapeutic effects of Levophed, Dobutamine, etc.

But I always have a hard time with the cholinergic system. I've been out of school and working for a while now, and every time I try to recall this information, I get it scrambled.

But now I think I have a trick for getting it right!


let's review:

The cholinergic system refers to those parts of the nervous system that use acetylcholine as a neurotransmitter. This pretty much comprises the entire peripheral nervous system except for the stimulation of various organs by adrenaline and noradrenaline.

The differences in the way acetylcholine affects the body have to do with the cholinergic system's different types of neurotransmitter receptors. There three major types. (Actually, the situation is a lot more complicated, but this works for our needs.) They are:

muscarinic receptors (M)
nicotinic_-M receptors (N_M)
nicotinic-_N receptors (N_N)

The three types correspond to three major functions of the cholinergic system. They are:

stimulating other nerves
stimulating skeletal muscles
stimulating organs

In the diagram below (original here), adrenaline and noradrenaline are basically the dotted red lines, and the cholinergic system is the solid red and blue lines.
The solid red lines stimulate other nerves, while the solid blue lines stimulate organs. Stimulation of the skeletal muscles isn't shown.

So how do you remember which receptors do what?

Well, one of them is easy. The stimulation of other nerves at neuronal ganglia require N_N receptors. N is for "N"erves and "N"eurons.

Likewise, we can remember that "M" is for skeletal "M"uscle. But this is where I always get mixed up because is it the M for muscarinic receptors or the M for nicotinic-_M receptors? So I have a new memory trick.

Remember that adreneline is mostly responsible for "fight or flight" symptoms. The odd man out is sweating. Although getting chased by a sabertooth tiger is going to make us sweat, it isn't adreneline that stimulates sweating. Sweating comes from cholinergic stimulation*.

And what does sweating cause? It causes "musky" scents. "Musk" for "muscarinic." Yes, it is the M receptors that are found on organs and sweat glands, and it is the "M" in N_M receptors that stands for "M"uscle. N_M receptors allow stimulation of skeletal muscle.

Voila!


* If you can't remember that sweating is cholinergic, you're probably screwed. But if you can, try to remember that during Operation Desert Storm, the army couldn't use atropine because atropine would stop sweating, and the soldiers would overheat in their biochemical warfare suits.

Sedation and lordosis

Other than the occasional inappropriate patient (male genital exposure + wink), I have experienced only two instances of the sexualization of caregiving since being in the ICU.

In the first instance, a middle-aged woman was engorged and obviously aroused during insertion of a foley catheter for bladder drainage.

In nursing textbooks, the matter of male arousal and erection during catheter insertion is explicitly discussed and addressed to female nurses. The possibility of female arousal is never mentioned. (Sociologists, make of this what you will.) Unlike an erection, female arousal doesn't really interfere with catheter insertion, but the position and movements of the hips as well as the appearance of the clitoris and labia can still be distracting and disconcerting when performing the procedure.

In the second instance, a younger woman was incontinent, needed to be cleaned, and presented herself in a posture that would be referred to as lordosis in other animals such as the rat.
Only partially awake, the patient was following commands in a limited way. I had asked her to turn onto her side to be cleaned but after a few passes with a washclothe still couldn't clean properly, so I asked her to move again. She then arched her back in a way that really did present everything that needed to get cleaned.

From Psychology Today:

Consider the rat... The female performs stereotyped physical actions associated with sexual interest... This culminates in lordosis: assuming a submissive stationary posture with arched back and raised hips. Lordosis is controlled by a specific region of the hypothalamus, a subcortical brain structure. An analogous part of the brain controls submission postures in female primates.

...a woman's preference for physical sexual submission appears to be controlled by the unconscious, inaccessible subcortical part of her brain...

Although Bancroft's Human Sexuality says "There is no equivalent of lordosis in the human female, and in non-human primates, a form of lordosis is only found in the prosimian suborder (e.g. lemurs) ..."

I believe what Bancroft means here is that unlike, say, the rat or the common house cat, female primates do not have a lordosis reflex reaction when they are fertile. Fertility cycles and mating patterns are different. But I think it's pretty clear that, as PT says, this sexual availability posturing behavior is programmed somewhere deep in the primate brain.

lordotic-like postures in P. troglodytes and H. sapiens

In this second case, the patient was sedated from overdose and, as I say, would follow commands without being fully alert. She was somewhat immodest about being covered, and the "history of present illness" touched on related issues. The patient's behavior was not a reflexive response to anything I did. It was also not, technically, following a command, as I did not instruct the patient how to move, only that she needed to.

My interpretation of her behavior is that it was not a response to a specific instruction per se but to instruction as such. Why that would be is another question to be taken up by psychologists and sociologists. I have wondered what was going on in that overdosed brain in terms of awareness. Was this behavior an indication of some previous sexual abuse? Or was it the response of an essentially "sub" personality to being given instructions? Or, because of the patient's low state of mental arousal, was some lower or older center of the brain predominating?

Lucid Dreaming review

When I was in early adolescence I woke up in my dream.

I was dreaming of running, of being chased through a floorless and horizonless red-brown haze by some threatening force. Of a sudden, I realized that I was asleep and in a dream. At the same time, I realized that since it was my dream I had complete power over it.

My fear immediately evaporated, and I turned around in my dream and started chasing the force that had been chasing me. I had an intense feeling of exhilaration, of god-like power over my circumstances. Then I woke up into reality, and the dream was over.

I never had nightmares after that all through my teens and into my twenties. When I did have a nightmare again, it was a dream about real-life circumstances in which I felt an intensified form of the anxiety and frustration I felt in real-life. Is that even a real nightmare? If not, I've never had nightmares again.

For a long time, I thought my "wake-up dream" was a significant and special experience, and I avoided talking about it. But then I overheard a conversation by some other people about their own experiences waking up in dreams.

It turns out, my experience was not special, and its significance is unknown. It even has a name--lucid dreaming, or dreams "in which a person becomes aware that he is dreaming." One of the primary researchers in this phenomenon is Celia Green, co-author of the book Lucid Dreaming: The Paradox of Consciousness During Sleep.
Lucid Dreaming is available as a Google Book, but the section discussing its use as medical therapy is blanked out, so I ordered it through the university's InterLibrary Loan.

The book is fairly interesting, if dated now (it was published in 1994). Although lucid dream states usually result in a perceptually more "real" experience (full-color vs my monochromatic chase sequence), the book seems to confirm that my experience was of lucid dreaming--i.e., it is common for spontaneous lucid dreaming to first manifest itself as a response to nightmares.

The section of this book on using lucid dreaming as a therapeutic treatment is, unfortunately, very thin. It says, essentially, that lucid dreaming therapy is a theoretical possibility but that there isn't any evidence it works or has been tried seriously (outside of a few isolated psychoanalytical psychiatrists). The contention that lucid dreaming could perhaps be used in healing through changing the body's physiological states a la experienced Tibetan Buddhist monks seems too hypothetical to bear much interest. What, are cardiologists going to prescribe lucid dreaming instead of Beta-blockers to control heart rate?

For those interested, the book mentions several techniques that can be used to increase one's chances of experiencing lucid dreaming. I have read in a different scholarly source that lucid dreaming can be trained, so I suspect the matter is worth looking into.

The book touches on a few related phenomena such as false awakening. It is written fairly well, and was a fast read in 'brick & mortar' form.

lucid dreaming and sedation

Part of my interest in lucid dreaming was my initial idea that perhaps somehow it was like the experience of being sedated in the ICU with Propofol or Precedex. In fact, it is clear from this book that the experiences would not be alike.

Lucid dreaming involves a dream, awareness of the dream, and lack of perception. Moderate sedation (RASS~2) involves perception, not a dream-state. Unlike the forgetfulness that accompanies sedation, lucid dreams are often easily remembered in the waking state. Unlike sedation, which decreases motivation and control, lucid dreaming involves mental arousal and full control of the 'body' within the dream context.

ICU nurse t-shirt company

Somaphony is a t-shirt company started by a neuro ICU nurse out of Washington, DC. They were featured on Street Anatomy recently. They feature designs combining old-timey anatomic and musical illustrations.


I "dig" their designs, although I only wear t-shirts as undershirts with scrubs. I went to high school with our chief pulmonologist's son, who became a jazz musician. Gift?
order @ Somaphony

Health and the Rise of Civilization: a good intro to ancestral health

Healthcare is a top-down industry where news and changes move slow. In order to institute 'evidence-based medicine' or 'evidence-based nursing', information has to be spread widely and discussed. To that end, I recommend Health and the Rise of Civilization (HRC) by Professor Mark Cohen as an excellent introduction to the concept of "ancestral health" for health care professionals.
Author Mark Cohen (who was previously profiled on this blog and spoke at the recent Ancestral Health Symposium) is a professor of anthropology who pioneered the forensic study of ancient skeletons as a tool to learn about the health of ancient hunter-gatherers and farmers. HRC is his summary of our pre-historic ancestors' health and the effects on our own health of living in complex, modern societies. Spoiler: compared to us, cavemen were a lot better off than you'd guess.

HRC is a good introduction to ancestral health because, unlike The Paleo Diet or The Paleo Solution, it is not a fad diet book. There is no eating plan in this book and no controversial recommendations that contradict the American Heart Assoication or the government's 'food pyramid'. As a health care professional, you shouldn't be able to dismiss this book automatically.

HRC is a good introduction because it is real scholarship. Any MD or PA, or any BSN, should understand the importance of, and be interested in, real scholarship related to health.

HRC is a good introduction because it was written to be a good introduction. Cohen wrote this book back in the 1980s, before low-carb, CrossFit, Paleo diet, or any of the rest. But it is a highly accessible essay that works well as an introduction to any approach to health that criticizes our modern way of eating and obtaining food. Although the book has almost 100 pages of footnotes and 50 pages of references, these are all at the end of the book. The main text--the part you really need to read--is only about half the book's total pages. And it reads easily and quickly.

HRC introduces concepts from anthropology that health care professionals would need to know in order to make sense of the interdisciplinary approach to "ancestral health."

One chapter is devoted to explaining the evolution of societies from small groups of hunter-gatherers to complex, modern civilization. An anthropological understanding of this evolution is necessary in order to get over our modern idea of continuous progress in medicine and nutrition.

Another chapter documents changes in the human diet since pre-historic times. Although we've all grown up with images of cavemen hunting mastodons, many people also seem to have the contradictory belief that a more "natural" diet is a vegetarian one. The story is a lot more complicated than that.

Yet another chapter demonstrates that infectious disease is not simply a matter of our immune system fighting germs with the help of antibiotics. Changes in our pattern of living since ancient times have undermined some of nature's built-in defenses.

Health and the Rise of Civilization should be a common starting point for everyone interested in ancestral health. The "Paleo community" tends to be dominated by personality, thriving older men like Art Devany or thriving younger men like Robb Wolf. But this model is not appropriate for health care professionals or researchers. HRC provides a firm ground in scholarship from which modern nutritional and health advice can and should be examined.

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Hurricane Irene

Things aren't so bad here, although we do have a leak somewhere that is causing water to drip down from the ceiling on the first floor.

The problem with energy

Sugar... only 18 calories per teaspoon, and it's all energy.

There's a thesis somewhere in the mid-to-late-20th-century obsession with "energy" as a by-product of eating. I suspect it has to do with the progressively decreasing levels of motivation due to poor diet, increasingly sedentary activities, and socially-induced malaise.

My personal experience of "energy" is that if you eat for nutrition and satiety only when you're hungry, exercise or move your body regularly through the day, sleep enough and nap when tired, and avoid substances that throw off equilibrium, like coffee, tobacco, and alcohol, you'll have plenty of it. That's only anecdotal of course.

via bOINGbOING

Paleo Engrish

Following beer and pizza night, I was looking up something about sarsaparilla and found this image, with its apparently Paleo message.
No milk, no sugar. No beer, no mixers!

My knowledge of kanji is very weak, but this appears to be a sign for, maybe, a jewelry dealer ("pearls and gems", or "valuable trades" or something). Are they kindly warning tourists away from this trap? Or are they sending a subtle "no gaijin" message? Or something else altogether?

Anyhow, my update on beer and pizza night is that, although in the short term I felt pretty crappy, I actually had an excellent recovery from my previous workout and was able to bump up the weight on my dumbbell presses. However, I have continued with the beer cravings, especially for the Sah'tea.

UPDATE: oh, look, it's a T-shirt, too!

Fast evolution

Steve Hsu posts on rapid human evolution. The possibility of rapid evolution since the rise of agriculture seems to me the best possible critique of Paleo diets, and of the ancestral health paradigm in general. Why ancestral health in general?

If evolution has occurred since the rise of agriculture, barring coincidence, it has occurred differently in different geographic locations. So an "ancestral health" paradigm would not be as informative as an "ethnic health" paradigm.

Grueling foods

Don Matesz of Primal Wisdom recently posted on the 'vegetarianism' of Roman gladiators. Both his post and the archaeological article he critiques are examples of an important principle to keep in mind when discussing antique practices of diet and exercise, a la ancestral health. That principle is


anachronism

In case you aren't an SAT nerd, you need to know that anachronism is the application or attribution of contemporary modes of thought to ancient people. That is, ancient people and modern people think differently because of cultural differences, and sometimes modern people can accidentally assume that ancient people thought like us when they didn't.

Anachronism can come in simple and complex forms. A simple form of anachronism would be when a child who is ignorant of the old geocentric model of the solar system assumes that ancient people knew the earth traveled around the sun. A more complex and pernicious form of anachronism would be when modern Buddhist monks who know about neuropsychology re-interpret and teach Buddhist scriptures in light of this knowledge.

In the case of both Matesz and the archaeologist, they have made the assumption that Roman people thought of foods in relation to the body similar to the way we do. That is, they assume ancient people thought in terms of macronutrients and their effect on the accumulation of fat or muscle.

But anyone who has read about ancient ideas of physiology and anatomy knows that the Greeks and Romans simply did not think like we do about the body.

Our idea of the gladiators comes out of a modern, athletic paradigm--i.e., to win you need to eat for maximal physical performance. The ancient idea of gladiators came out of an antiquated, combat paradigm--i.e., to win you need to be 'tough' and 'ready to kill.' Diets for gladiators were designed within this antique paradigm*.

In other words, gladiators were fed barley because that was the food the Romans believed gladiators needed to eat to cultivate the physical and psychic constitution called for by their job.

Both the archaeologist's idea that gladiators needed to be fattened up for protection and Matesz's retort that there are modern vegetarian athletes are less wrong than they are irrelevant.


a clue from language

To see my point more clearly, consider the word "gruel". It has, essentially, two meanings: (1) a soft porridge; (2) hard work. While "gruel" is not a Roman word associated with gladiators, the two meanings demonstrate the association in the minds of earlier peoples between diet and activity.


anachronism in ancient images

Matesz posts a number of ancient images of gladiators on his website, and points out that they don't look 'fat,' like they should if the archaeologist is correct. Again, anachronism. While there was some realism in ancient art, as a rule artists were not like modern photographers. In fact, in some times and places, artists simply rendered figures according to ideal forms and not according to their appearance at all.

But just as an excuse to post some classical images here, let's take a look at two of the images Matesz did not post. They don't look very trim or muscular to me. I'll nickname them "stockius" and "softius." The results of an intense gladiatorial diet and exercise regimen?

stockius

softius

my experience on a gladiator diet

As it happens, I ate a "gladiator diet" for a whole summer, more by accident than design.

During the summer between my sophomore and junior years, I took a job working in McCabe Library. It didn't pay much, and in order to have a positive balance sheet at the end of summer, I ate instant oatmeal twice a day, every day, all summer. In the evenings, I would eat whatever I could scrounge from friends.

I lost weight, but I also lost muscle. As an athletic twenty-one-year-old with a naturally endomorphic build on a regular weight-lifting schedule, I actually lost strength over the course of the summer. I also suffered injuries from athletic activity for the first time in my life. I got depressed. And friends said I had an unhealthy look about me.

While it's true that I was probably in a caloric deficit in addition to subsisting on gruel, it remains the case that this diet of oats plus occasional vegetables and meats was a loser for performance.


Tour de France on vegan salmon

We shouldn't leave this particular topic without drawing attention to David Zabriskie, who was widely touted as the first vegan to ride the Tour de France. Only, in order to do it, he had to eat salmon. Vegan salmon?



* Incidentally, if you read the article about vegetarian wrestler Chris Campbell that Matesz links to, you will see that he essentially comes out of this antiquated paradigm himself. He calls his grey sweat clothes his "monk's robe," etc...

Beer and pizza night

It's been about three weeks now since I've had any wheat, so I'm set to conduct an N=1 experiment in Neolithic Agents of Disease, a reflection on drinking different types of alcoholic drinks.

In recent years, I've essentially stopped eating bread, pasta, rice, and beer. For the most part, this doesn't bother me, although I have the occasional hankering for beer and pizza.

As I documented before, my reaction to beer and pizza has been quite negative since cutting back on grains. I usually get "beer face," and the last time I had a beer, I was literally doubled on the floor with abdominal cramps.

So now it's been about three weeks, and while I've been drinking a little champagne (yeast) and a little whiskey (corn/wheat/rye) here and there, I've completely cut out other grain-based foods and fermented, sparkling drinks. So, I decided tonight was the night to try eating beer and pizza again, and see what happens.


drinks, a comparison

Although alcohol can be found in nature and is occasionally consumed by animals, man has raised it to the level of an art and an industry. I drink a variety of things, although almost always of the non-beer variety: wines, brandy, chambord, gin, tequila, sometimes whiskey.

Tonight, I would like to compare several drinks: wine, a martini (gin-vermouth-olives), a gin-and-tonic, (gin-HFCS tonic), a homemade margharita (tequila-lime), bourbon on the rocks (whiskey), and beer.

Wine: usually red. Usually before or with food. I have to drink quite a lot of wine to notice any effects other than good taste. Then it makes me comfortable, relaxed, and either quiet or talkative. Usually no headache. No GI effects. Quick recovery.

Neutral alchohol/wine: I find I can drink martini's only right before meals. They make me hungry, and they also make me too loopy. While not, apparently, affecting my speech much, martinis make me unsteady on my feet. They also let loose my imagination. I stop worrying about work and such and my mind floats off to any interesting topic, although I can't reason. While I can read after martinis, I cannot read well, and I often find myself saying, "I would love to read such-and-such, but I cannot concentrate well enough to get anything out of it." Martinis don't make me brooding, but they do make me quiet and introverted.

Neutral alchohol/HFCS: Gin and tonics can be consumed only in company and only when one is planning to stay in for a while. I make them with only 1/3 to 1/2 tonic water and fresh lime. They make me happy and talkative but only if drunk while others are around. Conversations always start with how good my gin and tonic is (they're good), and digress from there. An afternoon of heavy G&T drinking ends in a night of conversation suddenly interrupted by intense sleepiness. Like martini's, I rarely drink them except before meals, but unlike martini's, they overpower the meal so that instead of getting hungry, the meal happens by accident.

Neutral alchohol/fruit: Margharitas are the drink that puts me under the table. Not sure why. I make them with 1-part anejo tequila, 1-part Grand Marnier, and 1-part fresh lime juice, without mixer. A couple glasses of these, and I'm sloppy and narcoleptic. Not pretty. Unavoidable, except by stopping early. The transition from nice buzz to drunk happens very quickly and without warning, although the alchohol in a margharita is less than a martini, even without mixer.

Grain-mash alchohol: if I drink bourbon, it is on the rocks and sipped over a long time. If I notice any effect from bourbon, it is simply relaxation. Often, I crave carbs in the morning after a night of work (I think this is a reaction to boredom as eating during the night does not help), and I sometimes have a bourbon instead, which makes me fall asleep when I've been awake all night.

Beer/pizza: I got a pizza tonight and started eating it along with Dogfish Head Sah'tea, and then Westmalle Trappist ale, which I had while sitting out on the deck looking at the rising moon and listening to Bach orgelwerke. While the Sah'tea was actually delicious--a great description by Burkhard Bilger in The New Yorker--it was ruined by pairing with spicey-sausage pizza--I feel that Trappist ale is the more quintessential beer, and in my imagination, Bach would have been drinking something similar.
Within 10 minutes of starting to eat and drink, I was experiencing "beer face" and feeling nauseous. Even while the beer and pizza was tasting good on the tongue, the rest of my body was saying "stop", "nein!" I was sitting on the deck with the above view and thinking, I may need to lean over the edge to puke. While feeling this way, though, I didn't really feel impaired much at all. I kept reading, which I rarely do if I feel drunk, and I kept eating and drinking, which I don't do if I feel drunk. With this beer and pizza, continued consumption felt as though it might make things better.
UPDATE p several hours: Interestingly, all nausea and ill feelings have passed. I am still sipping on Westmalle, and simply feel buzzed and comfortable. However, with this buzz my head feels muddled and fuzzier than when I get a buzz from martinis or margharitas. My GI system feels pretty good, with no indications of the intense cramping and gas that quickly followed my last episode of beer-drinking. I'm completely full feeling (full in the belly, not sated of food). The beer still tastes good, the body feels good, and the head is okay if just sitting and enjoying the night air or music but not while trying to think. My bed seems very appealing right now, but note that there is a world of difference--at least subjectively--between drinking until you fall asleep because you can't keep your eyes open and feeling like you want to sleep in order to escape the state you got into by drinking.

UPDATE p more hours: Fell asleep in chair after last Westmalle; now middle of the night. Still feel muddled. Slight stomach upset, vaguely like overeating. Not hungry, but the left-over pizza looks good and beer appeals, too: broke out a Midas Touch and had last piece of pizza. Did not enjoy the pizza, but thinking "a hot, fresh slice would be good."

UPDATE in AM: Beer face, check. Mental fuzziness, check. Tired. GI system feels pretty good/normal with exception of some increased flatulence. Still feel full in the belly. Curiously, cravings for more beer. Also craving water: I feel dehydrated.

UPDATE later in AM: late morning the morning after and flatulence has actually increased. Still craving more beer and feeling tired.


subjective effects vs. pathology

As Dr. Kurt Harris has pointed out before, the subjective effects of a food (e.g., excessive gas in the GI system) do not equate to pathological effects (e.g., inflammation). I'm not sure this completely invalidates subjective experiences/exams like this one, however. My guess is that following a food regimen that allows you to eat, drink, and still feel physically and mentally sound will lead to a better and more productive life over-all.


conclusions

When I think of beer, my two thoughts of usually of the quite good flavors and the several times I have experienced intense cramping. This last night of beer and pizza was less tastey but less bothersome as well.

Based on this experience, the main difference for me between a grain-heavy meal and a meal containing, say, red wine, greens, and meat is that the grain-meal has made me feel more sluggish--both mentally fuzzy and physically full and comfortable being sedentary.

I suppose it could be a volume difference. The amount of suds consumed in a night of beer-drinking is high compared with a glass of wine, and a salad and steak demarcates the scope of a meal clearly compared with having a pile of pizza slices laying around.

It's tempting to think otherwise, however. The fact that drinking gin either as a martini or with sparkling HFCS tonic results in different effects would tend to make one think otherwise. Likewise, there is this strange effect that grains have on me of making me feel like having more if they fail to satisfy or if I overeat.

According to the Neolithic Agents of Disease theory, it should be the grain proteins and not the carbohydrate causing any difficulty. I can buy into that as the results reported here don't occur in the same way after other sources of carbohydrate.

America: built on Coca-cola

A confession: I read Mencius Moldbug. I say confession because when I tried to read his blog at work, our hospital's Internet firewall blocked his blog, calling it a "hatespeech" website. Wow! Moldbug has sure ticked off some people to get on the radar of a corporate firewall retailer as a hatespeaker! Anyhow, I don't necessarily agree with all his perspectives, but his essential contention--that we live in a world where our historical memory and relationship to the past and reality is fundamentally misaligned--strikes a true chord with me.

I bring it up because tonight I'm engaging in a little "Neolithic Agents of Disease" (NAD) N=1 experiment, as I'll relate in my next post. So, as I'm sitting here drinking Dogfish Head Sah'tea and Westmalle Trappist Ale and listening to BWV 531, I'm reading about what I'm drinking and come across a New Yorker article with the following:

America used to be full of odd beers. In 1873, the country had some four thousand breweries, working in dozens of regional and ethnic styles. Brooklyn alone had nearly fifty. Beer was not only refreshing but nutritious, it was said—a “valuable substitute for vegetables,” as a member of the United States Sanitary Commission put it during the Civil War. The lagers brewed by Adolphus Busch and Frederick Pabst were among the best. In 1878, Maureen Ogle notes in her recent book “Ambitious Brew: The Story of American Beer,” Busch’s St. Louis Lager took on more than a hundred European beers at a competition in Paris. The lager came home with the gold, causing an “immense sensation,” in the words of a reporter from the Times.

Then came Prohibition, followed hard by industrialization. Beer went from barrel to bottle and from saloon to home refrigerator, and only the largest companies could afford to manufacture and distribute it. A generation raised on Coca-Cola had a hard time readjusting to beer’s bitterness, and brewers diluted their recipes accordingly.

For those that don't remember, Prohibition in the US was the ban on the sale of alcohol from about 1920 to about 1935. Thus, the transition this article would be talking about to blasé modern American beers would have occurred in the post-Prohibition era of the 1930s and 1940s, just when America was undergoing some of the political changes Moldbug documents/asserts in his blog.

Really, it comes as no surprise to me that the rise of shallow, pointless modern political culture should have coincided with a rise in the taste for Coca-cola, or that progressivist agitators should have diminished Americans' lives by promoting an addictive, low-quality modern substitute for a subtle ages-old art form.

From an ancestral health, or archevoric eating, paradigm, I'm not sure returning to craft brewers like Dogfish Head is an absolute improvement over industrial sugar factories, but it is maybe a step in the right direction.

Oh, she's young and has good genetics and cosmetics

Somehow falling into a link tree related to macaroons, I came across a website called "Oh, She Glows," apparently based on the premise that a life of "natural" (in this case, Paleo) living will lead not only to good health but to beauty.
This is a tempting fallacy, and one that I am prone to myself. However, it needs to be pointed out that although fit and healthy people are often attractive in our society, beauty has as much or more to do with age, genetics, and grooming as with health and habits. As an example of this principle, take a look at the following photo of a !kung san woman. The !kung are "Paleo" par excellence, and no doubt this woman is healthier than many American women of her same age...
But does she glow? Mmmm, maybe not so much. Actually, she's quite a handsome specimen of homo sapiens, but she isn't a cover model.

Remember, beach body, run-way look, athletic performance, and longevity may all have some overlap, but they aren't synonymous.

Better wasted on the plate than in the stomach

When I was in high school, I had an acquaintance of Indian extraction whose father was a doctor and always told his children that, quote, "food is better wasted on the plate than in the stomach."

I remember when I first heard this statement it was mind-blowing for me, who had been raised in a clear-your-plate home. The logic of the principle is immediately clear and undeniable: if you have eaten your fill, there is no value to clearing your plate as the food is wasted either way--better to waste it on the plate than waste it and overeat at the same time.

Still, I struggle with the desire to clear the plate, for reasons completely non-gustatory and non-economic, such as avoiding a conversation about the quality of the meal, or embarassment at taking more food than needed. But these are foolish reasons for overeating.

J.S. Bach versus wind and crickets

Right now, having finished the meal I described in my last post and consumed a macchiato, I am sitting contemplating a glass of armangac.

While sitting here (like Marlon Brando, with my laptop in my lap), I am listening to cantatas by J.S. Bach (BWV 13, 116, 144), which are playing over a relatively still and mild summer night. Crickets and frogs but not much else is audible, and an afternoon rain has left the land smelling wet in the evening.
Would it be better to turn off Bach and just let the night be, with its night sounds? Similarly, would it be better to enjoy a fine bowl or let the fragrant landscaping predominate. In generality, are the glories of men better than the graces of nature?

As one who vasilates on this question, I leave it unanswered, but do acknowledge that civilization was conceived and built painstakingly by primitive men and fireplace sitters, not by the sons of the florescent lamp light. Make of this what you will.

Being single is expensive

My family is out of town right now. As a result, I am on my own for meals. I fear that despite my essential frugality, being single over the course of a month will turn out to be more expensive on a per capita basis than having a family.

Since being on my own, I have basically been eating herb salads and eggs at home. On days when I work, I fast except for a breakfast of poor man's huevos rancheros (scrambled eggs with salsa, sour cream, and celantro leaves). I've also eaten eggs for dinner several times, but on several occasions I have gone out for dinner.

Waste: combining Paleo with SAD

Tonight, I went to a local establishment and had a ribeye steak, served with salad, cooked vegetables and French fried potatoes, and a glass of red wine. The total for the meal plus tip was about $40.

Now, I strongly prefer vegatables raw or al dente, so they were wasted. Likewise, the steak was large enough to feed two people, and I ate some of the potatoes only because I had done spinning followed by a very heavy squat routine followed by a martini at home and was drunk by the time my meal arrived. Actually, I didn't enjoy the potatoes (and they were probably cooked in vegetable oil). So here is our line-up of wasted food:

• vegetable sides, uneaten
• staches, partially eaten but unwanted
• meat, eaten, but beyond point of satiety

For this waste, I paid what I would have paid to feed all members of my family a similar meal at home. A shame.

Men like to be served, so families are socially desirable

Some people might take offense at this principle, but I think it is a truism of life. Men like to be served. I would much rather put my life on the line in battle than spend a lifetime cooking and serving myself at home. I think most men feel the same. But restaurants are wasteful and have other negative externalities as well, so it is within society's interests for men and women to cooperate in the domestic sphere.

Dates are too sweet

Tonight was my first meal since coming back from the wedding over the weekend. Back to eggs and herb salad. It is a combo about which there can be few complaints. The eggs were cooked in ghee, and the herbs had olive oil and red wine vinegar.
As can be seen from the photo, the eggs and salad were paired with dates and champagne. I love dates, but tonight I thought they were almost too sweet.

Without milk solids, there is nothing left in the pan but clear grease--no browned bits at all.
After dinner I finished the champagne and the St. Andre cheese I didn't eat the other night. This was a meal I could repeat again and again, although as I say the dates were very sweet. Of course, olive oil, champagne and cheese are not strictly within the ancestral health paradigm. Hopefully I won't die.

Taubes, Guyenet, Pima @ AHS

Stephan of Whole Health Source had a run-in at AHS with Gary Taubes, who cited the Pima Indians as an example of the evils of carbohydrates in criticizing Stephan's Food Reward Theory. As Stephan notes, he replied that the example of the Pima actually supports his Food Reward Theory as the Pima transitioned from beans to refined flour. And here we start to see a problem with examining the Food Reward Theory (FRT).

To show that something is an example of FRT in action, you need to show (1) that the amount of food consumed has risen* and, more importantly, (2) that the rise in consumption is a result of changes in brain chemistry. Without at least these two components, you cannot give any person or population as an example of FRT.

Since preference for tastey food is conceptually tautological and, practically, would seem a given outside taboo practices, and since access to tastey food [=subset of all food] is greater in modern societies, it is almost a given that the transition to or contact with modern societies will result in a preference for consumption of tastey foods. However, this observation is different from the question of why people would choose to overconsume in modern societies**. So, searching for examples of FRT puts you in constant danger of falling prey to the correlation-causation fallacy by the very nature of the problem. The fact that FRT seems to put a "scientific" veneer on the "evil modern society" paradigm of many Paleo people only means that people with that paradigm are in constant danger of bias.

Whether Taubes is wrong about the Pima is irrelevant. Theoretically, sugar could be causing body fat gain via Taubes' paradigm and causing increased overconsumption via Guyenet's paradigm. The two are not mutually exclusive. My only point here is to remind us that FRT requires evidence of brain changes. Even if you were to do an interventional study with bland foods vs. tastey foods, it could not be used as evidence of FRT without showing that, in such a study, brain changes between the study and control groups occurred.


* Or, (1b) that, if not more, the food consumption is directly responsible for a decline in activity level thermodynamically equivalent to an increase in caloric consumption. It should be remembered that FRT relies on traditional calorie-counting

** Vis-a-vis their body fat and disease: whether someone overconsumes in an absolute sense or only in relation to certain macronutrients is another question.

Bite or not: an IC problem

Infection control quiz: you are a Physician Assistant in an office or a nurse in a hospital and see the following on a patient. What's your first reaction and final conclusion?
A linear series of lesions looks like... bed bugs. There aren't many linear aspects to the human body. A line of marks might follow a dermatome, as in shingles (where the virus breaks out in a pattern following the nerves it lives in), but other than that there aren't many differentials.
Of course, you have to know the history. On Friday morning, my back itched. On Friday, I was on public transportation, and on Friday and Saturday night, I spent the night in a foreign bed. It was on Saturday morning that I saw the above in the bathroom mirror and had someone take a photo.

My normal pattern is to go from work to home to gym to grocery store to restaurant, and that's about it. It's been months since a stranger has spent the night in my bed or I in another bed. And I don't have pets. This isn't the history of someone likely to have picked up an infestation.

What are the possibilities? (1) I picked up bed bugs in the ICU. (2) I picked up bed bugs on public transportation on Friday. (3) I picked up bed bugs in the foreign bed, and the itching Friday was a coincidence.

I ended up going to employee health and the infection control office. There hasn't been an outbreak in the ICU. In the end, the diagnosis was a shrug of the shoulders, based on the appearance of the lesions. They don't in fact look like bites. It's possible that I scratched my itch on Friday and had a reaction including an outbreak. Or perhaps it was something else. The solution: go home and see if more marks appear.

No wedding cake

My cousin was married over the weekend (and still is!). Here she is with one of my other cousins before the celebrations started later in the evening. I was determined not to eat any wedding cake. I easily avoided cheap dinner roles at the reception (New York strip steak entre), but I was wondering how I was going to avoid the wedding cake when she broadsided me by not having one.
It wasn't easy to fit the wedding into my schedule as I had wanted to go to the Ancestral Health Symposium in LA. But agreeing with Joseph Pieper that festivities are a natural expression of the fundamental goodness of creation, I decided a celebration with relatives I haven't seen in years was a better use of my time.
I am not short, but my family is one of the few groups I can get together with where I am the short, non-athletic one. I'm still better dressed, though.

On the way back, I had a difficult time finding food. The Martini Lounge in the Detroit airport made me choose between shrimp cocktail and salmon patte in order to "stay Paleo". Everything else was a sandwich or "panini." The shrimp ended up being limp and tasteless. But the martini was okay. (Paleolithic man would have drunk martini's had he known about them...)


Whitey's Paleo breakdown

Although I avoided most items with sugar over the weekend, I broke down when it came to Whitey's Ice Cream. The Quad Cities area of Iowa was an early, local battleground for the Dairy Queen chain (founded 1940) and Whitey's (founded 1933). While DQ went national and its product suffered, Whitey's stayed local.
They produce a mean chocolate malt. Note that the shake machines are built into the wall. This is because the malts and shakes are very thick. They'll hand them to you upside down if you want (we wanted). I could easily give up bread, pasta, and cake for good, but I really love ice cream.

Planet of Viruses review

A Planet of Viruses by Carl Zimmer was a huge disappointment. I had pre-ordered it from Amazon, so I wasn't able to preview it before purchase. If I had been, I probably wouldn't have purchased it, and I advise you to preview it as well.
The main thing you have to know about this book is that it was written with grant money that came from a Science Education Partnership Award from the NIH as part of the "World of Viruses project." In other words, this isn't a book for a science nerd, it is a book for someone with a Bio 101 level of knowledge about viruses, a book designed to educate the public.

The book is only 109 pages, but the acknowledgements start on page 95. Moreover, the writing is large, and there are a few blank pages as well as photos that are present for purely decorative purposes (not to illustrate concepts). I was able to read the book over a couple short connecting flights, in between inadvertent naps.

The content does not delve much into the research or biochemistry of viruses. It stays at the level of "viruses are sooooo small that..." and "viruses can doing wacky things to the human body like..." I think this may be the first science book I have ever read where I--a Classicist at heart and not a biologist--was actually already aware of everything in the book. I could have written this book myself. In fact, I have told the 'amazing story' of the true-life jack-a-lope (one of the chapters in this book) as part of a web project in Introductory Microbiology. The only thing that was news to me was the Balmis Expedition, but that's history not virology.

Is this a good book for health care workers to read? Hard to say, but probably yes. I say yes despite the book's limitations because in my experience most HCW are relatively ignorant of viruses compared with bacteria. Many cannot even identify correct symptoms of flu and are still fairly ignorant of the history and prognostic course of HIV/AIDS. Nurses I know seem to have as much knowledge of virology from the movie Outbreak as from science literature. A general heightening of awareness of viruses would probably be of use. But if you are enough of a science nerd that you have ever once dipped into a professional virology journal and understood what you are reading, you can definitely pass on this book.

Ancestral Health Symposium early-birds

UPDATE 8/8: A lot more tweeting. Still not much on blogs as far as I can tell. Free the Animal most bully.
UPDATE 8/9: Summary of several talks from Chris Masterjohn.

The Ancestral Health Symposium--the first conference dedicated to the relationship between our evolution, heritage and modern health--took place this Friday and Saturday in LA. So far, although there were a few posts in the Paleo blogosphere of people saying "I'm off to AHS...," there hasn't been much follow-up. Minor amounts of tweeting. Seth Roberts gave us a post saying that all the Paleo celebrities were at a BBQ together. Richard Nikoley has a few photos up. And Melissa McEwen seems to have the first thoughts posted.

Hopefully, the less than enthusiastic response so far has been because the attendees are enjoying LA today and not because the conference was a bust. I was a little concerned that there might be a lot of "here's a PowerPoint that could have been a blog post" style presentations. Also, the qualifications of the presenters were drastically imbalanced, ranging from lauded scholars to those who have only the fame of snarkiness.

AHS indicated to me over e-mail that they were going to post videos of all the talks, and they do have accounts at SlideShare and Vimeo, but no videos yet.

I was most interested to hear the talk of Dr. Guy-André Pelouze, a cardiovascular surgeon. Until the video or a transcript is posted, here is the abstract:

Atheroma and paleo diet: a cardiovascular surgeon’s perspective
By Guy-André Pelouze, MD


Atheroma is a chronic disease of the arterial tree which evolution leads to severe and potentially lethal ischemic events in different organs (brain, heart, disgestive tract, kidneys and limbs). For complex and largely ignored reasons the retention of lipid particles in the subendothelial space of arteries initiates a local humoral and cellular response which progressively leads to a plaque formation by recruitment of systemic macrophages and multiplication of smooth muscle cells of the artery. This plaque formation is followed by expansion/rupture/calcification and eventually causes thrombosis of the vessel. Diet connection with health was first formulated by Hippocrates (360 BC), connection with atheroma suspected by Keys (1904-2004) and later by Ornish in 1990... They popularised Mediterranean diet and vegan style diet but the recognition of diet as a major part of treatment of atheroma occurred still later. Now it is largely admitted in the literature that atheroma is diet dependent but also paradoxically that it's a ""natural"" phenomenon in the arterial tree especially with aging. Paleo diet is a rather new topic in medicine although Boyd Eaton described the hypothesis of an evolutionary discordance between industrial diet and our genomics in the NEJM in 1989! Since numerous studies increased our knowledge and shed a very transparent light on what ate our ancestors. Aside the fact that they ate raw fruits, vegetables, meat and fish, the nutrients of these foods were quite different from those present in the products we eat today. We describe the huge differences between paleo food and industrial food and the consequences on human metabolism. Both archeo-anthropology and present studies of populations consuming paleo diets revealed strong evidence about the absence of atheroma in the paleo era despite the fact that life span was shorter. Clinical trials of diets with selected characteristics of paleodiet and also paleodiet trials in humans suggest that paleodiet is far more efficient in preventing atheroma than conventional AHA recommendations or even Mediterranean diet. We conclude that paleodiet should be more extensively studied despite the fact that at the present time no industrial lobby could support these studies, that involving agrobusiness in the production of paleo food is another key issue for public health and eventually that public health policies should take in account paleo diet studies in the body of evidence that roots their recommendations about the prevention of atheroma both primary and secondary, alone or in association with efficient drugs.

Paleo joies

It is a perfect summer night, and I celebrated it well. Tomorrow I race through the sky, hoping not, like Icarus, to tempt the gods, but tonight I relax and celebrate a little. The family is out of town, and I don't have to negotiate my time and meals.

broken yoke is from a supermarket egg

I trifled with iron this afternoon--not a long passionate embrace over hours, but quickly some sprints, flat bench dumbbells, and squat machine to slack my craving. The garden was tended and the late afternoon heat dissipated into a mild and clear summer night. I fixed thick-cut bacon, brown eggs, and an herb salad. One dirty martini for cooking, and one for dinner, accompanied by a dose of RadioDerb.

After dinner, some laundry and a trip to the coffee shop for espresso macchiato and a taste of 70% cacao. The light is just visible as the silhouette of treetops on the western horizon. The waxing crescent is distinct, white on a deep blue canopy. The shop is close by, and so I ride my bike a short way through winding suburban streets without sidewalks. Insects and frogs are interrupted only by the whirring sound of tires on pavement, to my regret. No one is out but a Chinese woman, speaking some dialect (not Cantonese) with a young girl and a toddler. Where does she come from? How did she make it to this little town of Irish and French Canadians? She has the good sense to enjoy a perfect summer night like this one.

The trees are still, and the unearthly howling of the interstate can be heard in the distance. It would be a good night for a pipe and jasmine tea, but I need to pack my clothes. And I am out of good weed. Instead there is St. Andre and Paul Laurent to lighten my task.

People are made for nights like these when the earth complements its bounty with perfectly balanced weather.

On my lonesome--first meal

Family is out of town. I have been cleaning and eating up the stores. My first meal on July 24 was seaweed (海苔 nori), Vermont pepperoni, dates, and water. Actually, it was quite good.
I find nori is an excellent substitute for salad for the bachelor-inclined. It keeps well, you can eat it without preparation, and it tastes okay to grand depending on how you pair it. And I love dates!

The crisis in men's hospital scrubs

One of the great perks of the ICU was having your scrubs provided, rather like the OR. We used to have green surgical scrubs available--no laundry necessary, just dump them in the clothes hamper. But now our hospital is adopting an institution-wide dress code, and the surgical scrubs are out. We are providing our own and washing them.

I went to the local outlet a couple days ago and purchased some scrubs off the men's rack. They were 3x as I'm a large fellow. They looked odd to me, but the scrubs available locally are cheap, so who knows? But when I got to work that night and went to clip my name badge onto the V-neck, I discovered that the right side of the collar crossed over the top of the left side. Women's scrubs!! I'd been had!

Most of the staff I talked to didn't even realize there was a left-over-right vs right-over-left gender difference in clothes. If the collar, button-holes, or pants fly crosses left over right, the clothes are men's or unisex. If they cross right over left, they are women's. This is a universal rule of clothing manufacture and, kept in mind, can prevent a typical bachelor from purchasing a women's blouse to wear with his suit.

Further invesitgation shows that my scrubs, made by "White Cross", are supposed to have a right-over-left design. Someone forgot to these "designers" about the rules. My name tag popped off while it was clipped to the wrong side.