Manifold Podcast #20: Betsy McKay (WSJ) on Heart Disease and Health

Steve and Corey talk to Betsy McKay, senior writer on U.S. and global public health at The Wall Street Journal, about her recent articles on heart disease. Betsy describes how background reporting led to her article linking the recent drop in life expectancy in the United States, often attributed to the opioid crisis or increases in middle age suicides due to economic despair, to the increasing prevalence of heart disease, driven by the rise in obesity. The three also discuss current public health recommendations on how to reduce heart disease risk and on the use of calcium scans to assess arterial plaque buildup. Steve describes boutique medical programs available to the super-rich that include full body scans to search for early signs of disease. Betsy elaborates on how she approached reporting on a new study linking egg consumption to higher cholesterol and increased risk of death, a result at odds with other recent findings and national recommendations that two eggs a day eggs is safe and healthy. Finally, they consider whether people are wasting money on buying fish oil supplements.

[ At about 20m I discuss how I got on the keto diet... ]

Transcript

Death Rates Rising for Young, Middle-Aged U.S. Adults

How to Reduce Your Risk of Heart Disease

New BP guidelines that set elevated BP as above 120mmHG/80 and Stage 1 hypertension is 120-130/80-90, Stage 2 140/90 or above.

New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension

Heart Attack at 49—America’s Biggest Killer Makes a Deadly Comeback

Study Links Eggs to Higher Cholesterol and Risk of Heart Disease

Fish Oil: Hunting for Evidence to Tip the Scales

Don’t Use Bootleg or Street Vaping Products, C.D.C. Warns


man·i·fold /ˈmanəˌfōld/ many and various.

In mathematics, a manifold is a topological space that locally resembles Euclidean space near each point.

Steve Hsu and Corey Washington have been friends for almost 30 years, and between them hold PhDs in Neuroscience, Philosophy, and Theoretical Physics. Join them for wide ranging and unfiltered conversations with leading writers, scientists, technologists, academics, entrepreneurs, investors, and more.

Steve Hsu is VP for Research and Professor of Theoretical Physics at Michigan State University. He is also a researcher in computational genomics and founder of several Silicon Valley startups, ranging from information security to biotech. Educated at Caltech and Berkeley, he was a Harvard Junior Fellow and held faculty positions at Yale and the University of Oregon before joining MSU.

Corey Washington is Director of Analytics in the Office of Research and Innovation at Michigan State University. He was educated at Amherst College and MIT before receiving a PhD in Philosophy from Stanford and a PhD in a Neuroscience from Columbia. He held faculty positions at the University Washington and the University of Maryland. Prior to MSU, Corey worked as a biotech consultant and is founder of a medical diagnostics startup.

Super Green Smoothie

Frozen Spinach (see picture)
Handful of frozen blueberries
Small handful of nuts (pecans, almonds, etc.)
1/2 scoop protein powder
1-2 cups milk (or 1+1 milk and water)

Makes 2 large glasses of nutritious green super smoothie. Give the other one to your spouse or kid or roommate, or just use half the recipe  :-)

Rinse out the blender container immediately with warm water for easy clean up.

Most of the volume is spinach, so calorie density is low, while antioxidant and nutritional content is high.

Smoothie diet: drink one glass (~250 calories, 20g protein), wait 15 minutes, all hunger will vanish for 90+ minutes.

(Photo quality meh because I took them using a $40 Moto E (Android) I have been experimenting with. Over Xmas last year I researched cheap Android phones for my kids. Lots of very good devices for ~$100 or less. The carrier / data costs dwarf the cost of the handset.)

Yoel Romero, freak athlete

Romero is 40 years old! He is a former World Champion and Olympic silver medalist for Cuba in freestyle wrestling. Watch the video -- it's great! :-)

He lost a close championship fight yesterday in the UFC at 185lbs. The guy he lost to, Robert Whittaker, is a young talent and a class act. It's been said that Romero relies too much on athleticism and doesn't fight smart (this goes back to his wrestling days). He should have attacked Whittaker more ruthlessly after he hurt Whittaker's knee early in the fight with a kick.

Crossfit Games 2015

Some great highlights.

Soylent is for people

New Yorker: ... I was relieved when factory-made Soylent arrived in the mail. It was basically Rhinehart’s formula, which I’d tasted in L.A.: a thick, tan liquid that is yeasty, grainy, and faintly sweet. Compared with the taste of my chocolate version, regular Soylent was pleasant. (Office taste-test results: “Naked protein shakes that are made of husks”; “One step better than what you drink before getting a colonoscopy.”)

I lived on the mixture, more or less, for a three-day weekend. Many of the tips I’d heard proved true. Soylent tastes better when it’s been in the fridge overnight. (A D.I.Y. user told me that this is “because the ingredients have been able to congeal.”) It’s more appealing after physical activity—when you’re hungry, you find that you actually crave it. The smell is a downside. On Friday, after a few hours, the doughy fragrance seemed to be everywhere—in my mouth, on my breath, my fingers, and my face. And the stomach takes a while to adjust to liquid food: by the afternoon, I felt like a walking water balloon.

Living on Soylent has its benefits, though. As Rhinehart puts it, you “cruise” through the day. If you’re in a groove at your computer, and feel a hunger pang, you don’t have to stop for lunch. Your energy levels stay consistent: “There’s no afternoon crash, no post-burrito coma.” Afternoons can be just as productive as mornings.

But that is Soylent’s downside, too. You begin to realize how much of your day revolves around food. Meals provide punctuation to our lives: we’re constantly recovering from them, anticipating them, riding the emotional ups and downs of a good or a bad sandwich. With a bottle of Soylent on your desk, time stretches before you, featureless and a little sad. On Saturday, I woke up and sipped a glass of Soylent. What to do? Breakfast wasn’t an issue. Neither was lunch. I had work to do, but I didn’t want to do it, so I went out for coffee. On the way there, I passed my neighborhood bagel place, where I saw someone ordering my usual breakfast: a bagel with butter. I watched with envy. I wasn’t hungry, and I knew that I was better off than the bagel eater: the Soylent was cheaper, and it had provided me with fewer empty calories and much better nutrition. Buttered bagels aren’t even that great; I shouldn’t be eating them. But Soylent makes you realize how many daily indulgences we allow ourselves in the name of sustenance.

Rinehart spends a lot of time in Soylent discussion forums, discovering how people have tweaked his formula. He told me that he relishes criticism, as long as it’s evidence-based, rather than “emotional”: “Putting a lot of eyeballs on the problem is only going to help.” In L.A., after our stop at the taco truck, I accompanied him to meet some D.I.Y.ers: a group of students in Ricketts House, a dorm at Caltech, who he’d heard were subsisting on Soylent. ...

... At Ricketts, Rhinehart asked the students if there were any more questions. Nick asked, “How do you feel about the fact that, after a lot of people eat Soylent, Soylent becomes people?”

Rhinehart smiled. “It’s pretty awesome,” he said. “I think about this a lot, actually.” He held out his arms, displaying his healthy torso. “I’ve been on it for a year now, and pretty much everything you see is built out of Soylent.”

Sprints, interval training and energy expenditure

I've read studies in the past that found jogging or running at a moderate pace burns calories at a rate of about 100 calories per mile. This rate of energy expenditure depends on bodyweight, but only weakly on the actual running speed. Thus if you run, e.g., 2 miles you probably burned about 200 calories (depending on how big you are), whether you ran at 7 minute pace or 11 minute pace (i.e., you covered the distance in 14 minutes or 22 minutes).

However, from personal experience it seems that sprinting increases the rate of calorie consumption per unit distance (or per unit time) significantly. The study below is the first I've seen showing this kind of nonlinear dependence of energy consumption as a function of level of exertion. Note, some of the 200 calories resulting from 2.5 minutes of sprinting is consumed during post-exercise recovery, due to elevated metabolism.

See also Tabata or High Intensity Interval Training (HIIT).

American Physiological Society : ... the men then checked in to a research facility at the University of Colorado Anschultz Medical Campus that was outfitted much like a typical hospital room. However, this room was completely enclosed, with air intake and exhaust regulated and equipment installed to analyze oxygen, carbon dioxide, and water content. Based on the results of this analysis, the researchers could determine how many calories the volunteers burned while each stayed in the room.

For two days, each volunteer lived in the room, continuing to eat the prescribed diet and spending the majority of their time in sedentary activities, such as watching movies or using a computer. However, on one of the days, they engaged in a sprint interval workout that involved pedaling as fast as possible on a stationary bicycle in the room that was set at a high resistance for five 30-second periods, each separated by four-minute periods of recovery in which they pedaled slowly with very little resistance. During the intense, 30-second bouts, the researchers coached the volunteers over an intercom system, encouraging them to give 100 percent effort.

Analyzing results from the room calorimeter system showed that the volunteers burned an average of an extra 200 calories on the sprint interval workout day, despite spending just 2.5 minutes engaged in hard exercise. ...

Crossfit Lullaby

Crossfit competitor Blair Morrison does a brutal but very basic workout. AMRAP = As Many Reps As Possible.

Morrison was a wide receiver for Princeton and it's interesting to hear him in other videos talk about mental toughness and overcoming challenges.

How good is Morrison? In earlier years he qualified for and placed highly overall in the Crossfit Games, but as the talent pool deepens that's getting much harder. At the end of the open competition (anyone can compete by submitting video of their performance on the 5 workouts), he's ranked 12th in the NorCal region and 125th overall in the world.

Crossfit 2011

The guy in the video is Chris Spealler, a little 150 pounder (former collegiate wrestler) who is one of the top Crossfitters in the world.




This year's Crossfit Games are going to be very interesting, as their open qualifying process and the increasing popularity of the sport have attracted a much larger pool of athletes. It reminds me a bit of MMA 10 years ago, and even of what happened in physics in the 20th century. The Crossfit champions of today will soon be surpassed by the supermen of tomorrow, due simply to the increasing size of the gene pool.

Spealler and Mikko Salo (see below) are my favorite Crossfitters, but if the sport continues to grow it's only a matter of time before they are eclipsed.

Statins, cholesterol and medical science

Do statins work? Does high cholesterol cause heart disease? Are people who doubt the conventional wisdom on these two topics excessively skeptical conspiracy wonks? Or is big pharma pulling a fast one on the public by pushing statins?

See also this paper which is mentioned in the article below and which summarizes results of studies from 2008-2010 (response by authors to criticism). See here for earlier discussion on the overall quality of medical research.

MedConnect: ... Dr. Kausik K. Ray of the University of Cambridge (England) and his associates performed a meta-analysis of 11 randomized controlled trials that assessed the effects on all-cause mortality of statins versus a placebo or control therapies on all-cause mortality. They restricted their analysis to data on high-risk patients with no known cardiovascular disease and included previously unpublished data, “to provide the most robust information to date” on statins as primary prevention in this patient group.

The metaanalysis involved 65,229 men and women in predominantly Western populations, with approximately 244,000 person-years of follow-up. There were 2,793 deaths during an average of 4 years of follow-up.

All-cause mortality was not significantly different between patients taking statins and those taking placebo or control therapies. This suggests that “the all-cause mortality reduction of 20% reported in JUPITER is likely to be an extreme and exaggerated finding, as often occurs when trials are stopped early,” Dr. Ray and his colleagues said (Arch. Intern. Med. 2010;170;1,024-31).

This meta-analysis shows that statin therapy as primary prevention in high-risk patients is less beneficial than is generally perceived, and it can be inferred to be even less helpful in low-risk patients, they added.

We're different on the inside

Hmm... I wonder how many pounds of gooey visceral fat are encasing my internal organs? Good thing I just got back from the gym :-)

I'm quasi-paleo and refuse to take statins. Any advice?

NPR: ... The Afghan soldiers, police and civilians he treated in Kandahar had radically different bodies from those of the Canadians he took care of back home.

"Typical Afghan civilians and soldiers would have been 140 pounds or so as adults. And when we operated on them, what we were aware of was the absence of any fat or any adipose tissue underneath the skin," Patterson says. "Of course, when we operated on Canadians or Americans or Europeans, what was normal was to have most of the organs encased in fat. It had a visceral potency to it when you could see it directly there."

... "Type 2 diabetes historically didn't exist, only 70 or 80 years ago," says Patterson. "And what's driven it, of course, is this rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin."

For a long time, the human body can compensate — the pancreas secretes even larger amounts of insulin, which regulates blood sugar levels. But over time, the pancreas begins to fail to secrete enough insulin, and that is when diabetes develops.

He explains that the increase in abdominal fat has driven the epidemic of diabetes over the last 40 years in the developed world — and that he's now seeing similar patterns in undeveloped regions that have adapted Western eating patterns.

See also the essay below.

Maisonneuve: ... Excessive fattiness is precisely why, when caring for the critically ill in North America, glucose levels are tightly controlled with insulin—a procedure necessary even for those not thought to be diabetic. Stressed by the infection, or the operation that has brought us to the intensive care unit, our sugar levels rise, paralyzing our white blood cells and nourishing the bacteria chewing upon them. But it was never necessary to give the Afghans insulin, no matter how shattered they were.

Among North American adults, 40 percent of us maintain normal glucose levels only by secreting larger than normal quantities of insulin from our pancreas. So we wander in and out of our family doctors’ offices and, if some blood work is done, we are reassured that our glucose levels are normal, that we don’t have diabetes. Mostly, they are and mostly, we don’t. But our bodies are not normal. The Afghans’ bodies are normal. We are so commonly ill we take it to be normal.

Here is our normal: 40 percent of North American adults have metabolic syndrome. The syndrome is caused by being fat, even at levels North Americans would not recognize as abnormal. Obesity prompts the receptors that insulin acts upon to become numb to its effects. As we grow fatter, and insulin resistance proceeds, higher and higher levels of insulin are necessary to get the sugar out of the blood. Eventually, overt diabetes may supervene, as it has for 8 percent of North American adults, a tenfold increase since the turn of the last century. But even prior to the development of diabetes, metabolic syndrome insidiously eats away at the bodies of those it affects.

Metabolic syndrome’s elevated insulin level is why we order a second Whopper; getting fatter, cruelly, stimulates our appetite. It is also why high blood pressure is more common among Westerners, too, and why our cholesterol panels are more alarming. Ultimately and especially, it is why heart attacks are almost unknown among traditional peoples like the Pashtun, while half of us will spend our last minutes with the impression that a large kitchen appliance is sitting on our chests.

CrossFit Games

I love this video. I don't do CrossFit, mostly because I'm a bit too old and creaky, although I do use HIIT and Tabata.

Check out the 2010 CrossFit Games -- see link to videos, of training as well as competition. The sport is kind of wacky -- kind of like the early days of triathlon, I guess. The competitors are wannabes in each of the core movements: weak Olympic lifters, clumsy gymnasts, slow sprinters, etc. But they have an all-around versatility.

I like the sisu (toughness) of this Finnish guy, Mikko Salo.

Max the METs

According to this study regular exercise does not entirely counteract the negative health effects of a sedentary lifestyle. There is an independent benefit from low-level activity throughout the day. That is, risk of heart problems is a function of two (exercise-related) parameters:

1. whether you work out
2. your baseline level of activity.

Remind me to do a few burpees in between every article or calculation! A treadmill in the office isn't a bad idea... :-)

NYTimes: ... In a study published in May in the journal Medicine and Science in Sports and Exercise, they reported that, to no one’s surprise, the men who sat the most had the greatest risk of heart problems. Men who spent more than 23 hours a week watching TV and sitting in their cars (as passengers or as drivers) had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less. What was unexpected was that many of the men who sat long hours and developed heart problems also exercised. Quite a few of them said they did so regularly and led active lifestyles. The men worked out, then sat in cars and in front of televisions for hours, and their risk of heart disease soared, despite the exercise. Their workouts did not counteract the ill effects of sitting.

Most of us have heard that sitting is unhealthy. But many of us also have discounted the warnings, since we spend our lunch hours conscientiously visiting the gym. We consider ourselves sufficiently active. But then we drive back to the office, settle at our desks and sit for the rest of the day. We are, in a phrase adopted by physiologists, ‘‘active couch potatoes.’’

... adults spend more than nine hours a day in oxymoronic ‘‘sedentary activities.’’ For studies like these, scientists categorize activities by the number of METs they demand. A MET, or metabolic equivalent of task, is a measure of energy, with one MET being the amount of energy you burn lying down for one minute. Sedentary behaviors demand one to one and a half METs, or very little exertion.

Decades ago, before the advent of computers, plasma TVs and Roombas, people spent more time completing ‘‘light-intensity activities,’’ which require between one and a half and three METs. Most ‘‘home activities,’’ like mopping, cooking and changing light bulbs, demand between two and three METs. (One exception is ‘‘butchering animals,’’ a six-MET activity, according to a bogglingly comprehensive compilation from 2000 of the METs associated with different activities.) Nowadays, few of us accumulate much light-intensity activity. We’ve replaced those hours with sitting.

The physiological consequences are only slowly being untangled. In a number of recent animal studies, when rats or mice were not allowed to amble normally around in their cages, they rapidly developed unhealthy cellular changes in their muscles. The animals showed signs of insulin resistance and had higher levels of fatty acids in their blood. Scientists believe the changes are caused by a lack of muscular contractions. If you sit for long hours, you experience no ‘‘isometric contraction of the antigravity (postural) muscles,’’ according to an overview of the consequences of inactivity published this month in Exercise and Sports Sciences Reviews. Your muscles, unused for hours at a time, change in subtle fashion, and as a result, your risk for heart disease, diabetes and other diseases can rise.

Regular workout sessions do not appear to fully undo the effects of prolonged sitting. ...

One MET for a 180 pound male is just over 80 calories per hour, or about 2000 calories per day. Walking is 3-4 METs and doing light work is 1-3 METs. I guess that means on those long travel days I'm burning hundreds of extra calories by walking through airports, standing in line, and staying awake for 24 hours.

Height loss and aging

I had a physical today and they measured me at 183 cm. I seem to recall being 184 cm (six foot and a half inch or so). Have I lost height, or is it just measurement error? :-) How much does height actually vary throughout the day?

Apparently people don't shrink quite as much with age as they think they do:

Self-report overestimates true height loss: implications for diagnosis of osteoporosis

Abstract The Newcastle Thousand Families birth cohort dates from 1947; assessments have included height measurement at 22 and 50 years, when height loss was also assessed by self-report. A total of 388 attended for 50-year review of bone health, of whom 57 reported a median height loss of 2.5 cm, and 8 reported height loss of >3.5 cm. However, of 24 subjects for whom true height loss could be calculated, 7 had gained height, 9 were unchanged and only 8 had lost height since age 22 years. Self-report leads to over-reporting of height loss, and therefore should not be the sole measure of height loss. In clinical practice, objective confirmation of reported height loss should be undertaken, wherever possible, prior to further investigation.

At 180 lbs I'm basically the same weight as when I was a senior in high school. In case you are wondering, I do a very compressed paleo style fitness routine -- only 30 minutes per workout. When I was younger I would have considered one of my current workouts a "rest day" :-)

If you are pressed for time and a former athlete, I recommend Tabata training and sprints. (The guy in the video, Mark Sisson, is in his fifties! Love the footgear :-) I dream that I'll someday be able to get back on the mat and train BJJ/MMA, but who knows when that will happen... Sometimes, to get motivated, I watch videos like these.

Crossfit: cult or ultimate training?

Having played a lot of sports and done a lot of physical training, it's not often that I see something in the gym that shocks me.

But recently I came across the Crossfit training system. It's based around short, hyper intense workouts using basic bodyweight gymnastic moves (pushups, pullups, burpees, rope climbing), olympic and power lifts (cleans, jerks, presses, squats) and track sprints and rowing. The goal is to engage the large muscle groups and push them to both anaerobic and aerobic failure at the same time. For experienced athletes, the idea of using olympic lifts for cardiovascular stress training seems over the top, but anyone who can survive this is going to get very, very fit.

The founder of Crossfit, former gymnast Greg Glassman, is the guru behind this movement. He rails against bodybuilders who lack functional strength, and runners, cyclists and triathletes who are so specialized that they lack overall athleticism. (He doesn't have any bad words for ultimate fighters, though, some of whom use his system :-) The point I think Glassman overlooks is that the traditional training methods are meant to minimize injury and allow regular performance by an average person. It's telling that Glassman, 49, doesn't Crossfit train anymore. (See this NYTimes profile from a few years ago; the followup reader discussion is very good.)

If you have any athletic background at all (endurance training doesn't count -- it's gotta be something with a little explosiveness and testosterone ;-), watch the videos and tell me you are not freaked out.





More video:

Uneven Grace mov wmv
(check out the women doing 30 clean and jerks with 85lbs in 5-7 minutes!)

GI Jane mov wmv
(pushup, burpee, pullup -- basic, but so brutal. Greg Amundson is a badass!)

Interview: Coach Greg Glassman

CFJ: What’s wrong with fitness training today?

Coach Glassman: The popular media, commercial gyms, and general public hold great interest in endurance performance. Triathletes and winners of the Tour de France are held as paradigms of fitness. Well, triathletes and their long distance ilk are specialists in the word of fitness and the forces of combat and nature do not favor the performance model they embrace. The sport of competitive cycling is full of amazing people doing amazing things, but they cannot do what we do. They are not prepared for the challenges that our athletes are. The bodybuilding model of isolation movements combined with insignificant metabolic conditioning similarly needs to be replaced with a strength and conditioning model that contains more complex functional movements with a potent systemic stimulus. Sound familiar? Seniors citizens and U.S. Marine Combatant Divers will most benefit from a program built entirely from functional movement.


CFJ: What about aerobic conditioning?

Coach Glassman: I know you’re messing with me – trying to get me going. Look, why is it that a 20 minute bout on the stationery bike at 165 bpm is held by the public to be good cardio vascular work, whereas a mixed mode workout keeping athletes between 165-195 bpm for twenty minutes inspires the question, ”what about aerobic Conditioning?” For the record, the aerobic conditioning developed by CrossFit is not only high-level, but more importantly, it is more useful than the aerobic conditioning that comes from regimens comprised entirely of monostructural elements like cycling, running, or rowing. Now that should start some fires! Put one of our guys in a gravel shoveling competition with a pro cyclist and our guy smokes the cyclist. Neither guy trains by shoveling gravel, why does the CrossFit guy dominate? Because CrossFit’s workouts better model high demand functional activities. Think about it – a circuit of wall ball, lunges and deadlift/highpull at max heart rate better matches more activities than does cycling at any heart rate.