The Bell Curve: The Dosage Is the Poison

The Bell Curve, or normal distribution, is a useful tool in many areas. Here is a chart from the Wikipedia article on normal distribution:

Two Ends of the Bell CurveThe red line is the typical distribution that is called the bell curve. An example might be a chart of height. Along the horizontal axis would be height. Along the vertical axis would number of people. The most people would be along the top/middle of the curve. NBA players would be on the right, and very short people on the left.

An example of this as it relates to health might be vitamins. The vertical axis would be optimal health; the horizontal would be dosage of the vitamin. A little of a vitamin, because of the steepness of the curve, is very beneficial. As you increase the dosage the benefit increases. But there is a reduction in the benefit from each additional dose of the vitamin as the steepness of the curve decreases. At some point increases in optimal health stop and any additional vitamin decreases optimal health. While I supplement, the bell curve tells me that care is needed so no overdose occurs. The dosage is the poison.

Exercise is another example of a Bell Curve. For this curve the vertical axis is optimal health, and the horizontal is amount of exercise. A little exercise can have a tremendous impact on your health. Remember the curve is steep. But just as with vitamins, the dosage is the poison. You can very negatively impact your health if you do too much. (Did you really expect I would tell you what vitamins to take and everything would be alright? No, you will need to move your body. It is a little embarassing for me to write about this as it is cold where I am and exercise, moving, for me has dropped off considerably. )

The dosage being the poison is not a new concept. It has been know for hundreds of years going back at least to the medieval times. (If a history major like me cannot quote a medieval scholastic, who can?) So if you go to your granddaughter's birthday party, a small piece of cake isn't going to impact you much, assuming you are not allergic to wheat. But if you go to a "birthday" party every day, your health will suffer--the dosage is the poison.

Sorry, but today's homework is math. But an understanding of what a Bell Curve is will be helpful. 

Are you a Mutant? Or, the Myth of the Average Person

The average person should get a Pap smear every year. There is no controversy about this. This is because the "average" person is a woman. But if you are among the 49% of the population that is male this advice makes no sense. You are either male or female, there is no average. 

This same point applies across a wide variety of health issues. 

You either have a gall bladder or you don't. Since the gall bladder helps in fat digestion, someone without one needs to take particular care with fats in their diet. Someone who is diabetic needs to eat differently than someone who is not diabetic. If you have insulin resistance, your diet needs to be different than if your insulin functions well. (I do not want to get ahead of myself, but this will be discussed in the coming weeks.) 

Finally, you either have the MTHFR mutation that effects methylation, which mean it effects your whole metabolism, or you don't. This is not a trivial issue. I have seen various estimates on the prevalence of this genetic defect. It depends on your racial background. Caucasians seem to have it 20 to 40% of the time. Hispanics about 40%. US blacks about 14%. Japanese are about 35%. Since each of us receives one gene from each of our parents, there is the potential of having two copies of this mutation. This is very bad and this effects about 10% of the Caucasian population. 

This image is to remind us how genes work. Having two of these genes, one from the father and one from the mother, is not good., but I doubt it is as bad as the caption implies. Since I will post a presentation on this issue, I will not go into too much detail. This defect raises homocysteine levels. This is one of the markers that your doctor might test for if he fears heart disease. High is bad. This mutation also interferes with the absorbing of the vitamin folic acid, the vitamin that doctors give all pregnant women to reduce birth defects. I have read estimates that it reduces folic acid absorption by 40%. If you have two copies of the gene then it may reduce absorption as much as 80%! 

Before My Morning CoffeeYes, I am a mutant as I have two genes with the MTHFR variation. So this is not an academic issue for me personally. 

I have wondered about this issue in reference to the studies that show little health effect from vitamin supplementation. Someone with two copies of the mutated gene, and who take folic acid, have it building up in the body until it can be excreted. This might be a huge negative factor for vitamin supplements of folic acid for a portion of the population. So if you have this mutation the typical multivitamin may actually be subtly poisoning you. You need a methylated version of folic acid. Like the one I take. (Yes, I complain about the price too.)    You also may need to supplement with coQ10 as that may be an issue for those with this genetic variation. One may also need to limit niacin supplementation for cholesterol control. I have used niacin in the past to raise my beneficial cholesterol subcategories so this is something I am concerned about. 

The only way to know is to have a genetic test done. Sorry, but your insurance company probably won't pay for it, at least mine didn't. The test is about $150. This is not trivial, but the expense of a potential heart attack makes this expense seem trivial. But on the other hand, if your homocysteine levels are normal, I would not get the test. Click here to see a discussion of the test. I had one copy of C677T and one of A1298C so that means that my high homocysteine is genetic. 

So each of us is quite different and what we should do for our health is quite different. As this series goes on for the next year, I will be offering "advice." Mostly what works for me. It may not work for you. The only way to know is to try it and see. It either works for you or it doesn't. There is no average. 

Unless you end up having the same genetic mutation I have, you will not find this presentation as interesting as I did. 



Note that this will be a pattern for my weekly posts. I will assign "homework"-various presentations or articles that I have found of interest. Hopefully you will find them worthwhile.

The Problem with Experts

The problem with experts is that you can find one who advocates whatever you want. Do you think I exaggerate? Consider the case of Peter Duesberg. 

Peter H. Duesberg, Ph.D. is a professor of Molecular and Cell Biology at the University of California. 

He isolated the first cancer gene through his work on retroviruses in 1970, and mapped the genetic structure of these viruses. This, and his subsequent work in the same field, resulted in his election to the National Academy of Sciences in 1986. He is also the recipient of a seven-year Outstanding Investigator Grant from the National Institutes of Health. 

Duesberg was, and is, an expert in retroviruses, like the HIV virus that causes AIDS. Well, we lay people think that HIV causes AIDS. Duesberg is not so sure:

On the basis of his experience with retroviruses, Duesberg has challenged the virus-AIDS hypothesis in the pages of such journals as Cancer Research, Lancet, Proceedings of the National Academy of Sciences, Science, Nature, Journal of AIDS, AIDS Forschung, Biomedicine and Pharmacotherapeutics, New England Journal of Medicine,nd Research in Immunology. He has instead proposed the hypothesis that the various American/European AIDS diseases are brought on by the long-term consumption of recreational drugs and/or AZT itself, which is prescribed to prevent or treat AIDS.  See The AIDS Dilemma: Drug diseases blamed on a passenger virus.

I will not talk anymore about Duesberg's AIDS theories, I do not have the training, nor the desire to get that training. But Duesberg illustrates my main point: you can find an expert that believes whatever you want to be true. 

That is the rub, "Whatever you want to be true." This is called confirmation bias. Wikipedia describes it:

Confirmation bias (also called confirmatory bias or myside bias) is the tendency of people to favor information that confirms their beliefs or hypotheses.[Note 1][1] People display this bias when they gather or remember information selectively, or when they interpret it in a biased way. The effect is stronger for emotionally charged issues and for deeply entrenched beliefs. People also tend to interpret ambiguous evidence as supporting their existing position. Biased search, interpretation and memory have been invoked to explain attitude polarization (when a disagreement becomes more extreme even though the different parties are exposed to the same evidence), belief perseverance (when beliefs persist after the evidence for them is shown to be false), the irrational primacy effect (a greater reliance on information encountered early in a series) and illusory correlation (when people falsely perceive an association between two events or situations). 

So if you do not like meat, you quote Dr McDougal; if you do like meat you quote Dr Perlmutter. If you think saturated fat is bad for you, there are many doctors that will agree with you, like Dr Barron at UCSF's obesity center. If you like saturated fat, then you can quote Dr Davis or Dr Sinatra, both expert cardiologists. I do not expect you to know who any of these doctors are, but as the weeks go on, if you stick with me, you will. 

So we will then rely on the consensus of the medical community. Well, er, no. According to Thomas Kuhn in his book  The Structure of Scientific Revolutions, one cannot rely on that. Here is Wikipedia's description of his theory. 

Kuhn made several notable claims concerning the progress of scientific knowledge: that scientific fields undergo periodic "paradigm shifts" rather than solely progressing in a linear and continuous way; that these paradigm shifts open up new approaches to understanding what scientists would never have considered valid before; and that the notion of scientific truth, at any given moment, cannot be established solely by objective criteria but is defined by a consensus of a scientific community. 

In other words, sometimes the consensus is dead wrong. 

The best example of this is the replacement of butter by margarine that started in the 60's. I special-ordered a used book written by a doctor in the 1960's. He wrote very much against the consensus of the time and advocated that people use margarine and not butter. Gradually his position became the consensus and butter was said to be a very bad food. (Sorry for being vague about this doctor's name, the book is in another state.) Just a few short years ago if you said margarine was not healthy, you would have been ridiculed. Well, the consensus has changed again! 

Wikipedia sums it up:

Although trans fats are edible, consumption of trans fats increases the risk of coronary heart disease by raising levels of the lipoprotein LDL (so-called "bad cholesterol") and lowering levels of the lipoprotein HDL ("good cholesterol").

In science circles this is called a whoopsie. In fact, trans fats are so bad that the FDA may ban them. The same Wikipedia article tells us: 

The FDA has issued a preliminary determination that partially hydrogenated oils (which contain trans fats) are not "generally recognized as safe", which is expected to lead to a ban on industrially produced trans fats from the American diet.

(Note that many margarines have been reformatted and no longer contain trans fats. And also note that any deep-fried food will contain a small amount of trans fats from the frying process and the fact that fat is only changed once a week in a restaurant.) 

Of course the conclusion we should draw is to eat more butter. Well, again no, not necessarily. In the logic field this is called the fallacy of the false dilemma. It may be that both are unhealthy. I do not know. In fact my guess is that the evidence is inconclusive and no one knows. Since margarine is a fake food, I avoid it. But I also limit my butter use.  I think that a far better choice is olive oil. (This will be a blog post at a later time.) 

So you can conclude that I will not be following the current fad and adding butter to my coffee. 

I think the best way to conclude today's post is comedy. In the Woody Allen movie Sleeper, Woody, a hypochondriac Health Food store owner, is frozen. When he is revived, his doctors are shocked by his request for health food. 

Who Do You Think You Are?

I have decided to start up the health series I started before my blog's hiatus. Here is the first blog post in that series. I will repost these every week until I get to where I left off. 

As I begin to blog weekly on health related matters, I thought I would answer this rather obvious question. 

I have no letters after my name–well, technically I supposed I could add B.A. But no, this does not mean that I am going to disparage those that do have these letters. I have seen way too much of that in the religious circles I travel in. I am just a fat person (that is actually more polite than the word I should use, obese) who spent decades trying various methods to lose weight that did not work. I will share some of my failures over the next year that I plan to blog about health, hopefully every Friday. 

Who am I then? 

I am just an average person who has finally gotten a better handle on his weight problem. Am I now ready to be a Men's Fitness model? Er, no. I am still in the overweight category. I actually do not particularly care that I am overweight, as we will see there is evidence that being slightly overweight means you will live longer. What I do care about will be evident over the next year. I want to eat a healthy diet and have a healthy lifestyle, and "let the chips fall where they may"—hopefully they will fall in the trash where they belong.  I am confident that eating a healthy diet will mean a lower weight, but even if it doesn't, I know I am on the right track. 

Since my failures have taught me that sudden radical change does not work (at least for me), I will, after a few introductory posts, give each of you 52 steps over 52 weeks that you can take to improve your health and life. 

I invite you to take one step a week with me as we walk together toward better health. 

Leaving Babylon the Great

One of my fondest memories of this blog was a reaction of a reader to my discussion of food and Babylon the Great, in particular the Chick-fil-A controversy of last year. The reaction was,"Only Dennis can see Babylon the Great in a chicken sandwich, and you know he's right." 

My belief is that everything is interconnected to something else--I suppose this is my version of the six degrees of separation meme. As Jesus told his disciples at the Last Supper, "Be in the world, but not of the world." The inter-connectedness of the modern world makes not being in the world extremely difficult. I suppose one could get a homestead and grow a lot of one's own food. However, unless you have some income you will lose that property to not paying taxes. Generating one's own electricity is expensive, but you can do it in many climates. However, you are still relying on a manufacturer to provide the equipment for you to do it. 

My advice is to be as independent of the system as your circumstances allow.  

This is why I blog about health.  

The US health system is broken, and the best thing you can do is to eat properly, move your body, and not eat too much. If you are healthy you may be able to reduce your use of the healthcare system. Lately we have been getting new doctors. Obviously their first question is "What is your insurance?" The second question is "Is that the ObamaCare version?" Luckily for me it isn't. What use is insurance if no one will take it?  

I did a little "back of the envelope" calculations. It appears that we could live in Russia, and quite well, off of what we spend on health insurance. You are exempt from ObamaCare if you live in the The Virgin Islands or Guam. You are also exempt if you live in any foreign country 11 months out of the year. 

The healthcare situation can only get worse as illegal immigrants flood the emergency rooms, Baby Boomers age, and the consequences of our bad choices overwhelm us. 

Emigration out of the US is not practical for most of us, so eating a healthy diet and not eating the foods of Babylon the Great is crucial. While I have been talking about these foods on past Fridays, and will talk about them on future Fridays, you already know what they are. 

As Socrates famously said,"The unexamined food is not worth eating." So review the blog post where I discuss being aware of what you put in your mouth. Knowledge of that is always the first step in any attempt to eat healthy.