Wednesday, July 23, 2014

How accurate are food labels?

We take for granted that a label printed with calorie and other nutrition information is accurate, but is that true?

A short 6-minute documentary and editorial published last year in the New York Times shows how wrong labels can be. Casey Neistat took normal foods and ran them through an expensive calorimeter — the gold standard to see how many calories an item contains -- to check the accuracy of the labels. In his random sample, he found the discrepancies between the labels and actual calories added up to 500+ calories in a typical day’s eating — the equivalent of a missing Big Mac or a couple of snickers bars.  This, on “normal” foods like a sandwich from Subway, a yogurt muffin at a convenience store, a Chipotle burrito, a vegan deli sandwich.

In NYC, and soon everywhere in the US, calorie labels are mandatory, but how will that help if the labels are wrong?

Incidentally, I think this applies not just to calories but to virtually anything relating to nutrition: vitamins, carbohydrates, fat, protein. The active nutritional content of something like broccoli, for example, degrades quickly after it’s been picked. The way it was prepared, the other foods consumed at the same time, the microbes in its surface — there are so many variables that often matter just as much as whatever is on the label. I wonder what the point is.

The solution, of course, is better sensors: handheld, pocket devices that can test the food right before you eat it. We’re still a few years from that becoming ubiquitous and cheap enough for everyday use, but there are early prototypes: the $200 SCiO, for example, the $200 TellSpec, or the 6SensorLabs Canary gluten detector (though it’s difficult to tell yet how accurate these are).  Microsoft, working with the EE Department at the University of Washington has a simple, cheap sensor that can detect the type of beverage you're drinking. Alexander Scheeline, a chemist at the University of Illinois Urbana-Champaign, teaches how to make a cheap, cellphone-based spectrometer (see Wired) that may someday be able to tell if your food has mercury in it, for example.

Until those cheap sensors are widely available, though, I’m afraid it’s hard to rely on labels alone.

Tuesday, July 22, 2014

Using the AliveCor Heart Monitor

Every few months, I feel a slight flutter in my chest, almost like a cough but coming not from the lungs or throat but from something deeper inside. It seems to come and go randomly, though I’ve noticed it is often triggered if I’ve had wine to drink or if I haven’t had enough sleep. No big deal, just something I observe about myself. Long ago, by coincidence, one of these episodes happened while I was at the doctor’s office having an annual physical, and the doctor too shrugged it off: a heart arrhythmia, perfectly normal. He told me the technical term for the exact type of arrhythmia, but that was long ago and I’ve forgotten. Now, maybe I’ve found a way to know for sure.

For the past week I’ve been using the new AliveCor Heart Monitor, a $200 iPhone case that gives me a high-fidelity Lead I ECG any time, any where I carry my smartphone. Here’s the sample I took this morning, right after waking up:
ECG 20140722052227 pdf 1 page
The device is just a normal iPhone case — with a funny two-part metal bulge on the back that acts as a two-lead electrode. You hold it with your fingers and it measures your ECG. Just like that! With FDA 510(k) clearance and scientifically validated for "excellent sensitivity (0.962), specificity (0.975), and accuracy (0.968) for beat-to-beat discrimination of an irregular pulse during AF from sinus rhythm”, it’s got serious medical chops too. The first time you use it, you send your results to trained technicians, who send you back a report (in my case, summarized as “normal sinus rhythm”). Each time after that, you’re given the option to send the results again as an in-app purchase:  $12 to a US Board Certified cardiologist, $5 for a 30-min turnaround by a certified technician, or $2 for 24-hour turnaround.

Unfortunately, there’s apparently no API, so although you can send each result (PDF) by email, there’s no automatic way to upload to Zenobase, for example, so you can easily compare with other self-tracking results.

The technology was invented by cardiologist David Albert using hardware that communicates with the phone via a clever, patented process that uses low-frequency, inaudible sound waves picked up by the phone’s microphone. No need to pair bluetooth with the device, no need for any physical connection to the phone at all.

Satish Misra is a medical doctor who wrote a balanced and thorough review, pointing out the wonderful breakthroughs possible with such a device, but also noting that because it doesn’t detect some important heart ailments as well as a full-scale ECG, it can provide false security. He notes, incidentally, that the US Preventative Services Task Force rates ECG screening generally (not just for this device) a “D” as a medical test:   “recommends against routinely providing to asymptomatic patients”. (They say that about exercise treadmill tests and coronary calcium scanning too, for what that’s worth.)

We’ll see what happens in my case. I really want to know more about my arrhythmia and it’s nice to know that, the next time it happens it’ll be easy for me to log it accurately.

By the way, whether you have an AliveCor or not, I wish everyone would join the Health eHeart study at the University of California San Francisco. You fill out a medical survey, give them your email address, and agree to be a long-term participant in their study. They especially want people who like to use gadgets — like the AliveCor — so they can collect as much data as possible. (Obviously, they have top-notch privacy standards to ensure your data remains confidential). If everyone did this, science would have a big head start in finding how to prevent heart disease.

Sunday, May 25, 2014

Who has the most accurate health news?

The independent site Health News Review evaluated nearly 2000 health-related news articles since 2006, ranking their accuracy and usefulness according to these criteria: cost, benefits, harm, veracity, exaggeration, availability, and the source and conflicts of interest of the promoters:

Here are the rankings:

Associated Press 3.61
NPR 3.57
Los Angeles Times 3.51
New York Times 3.49
Wall Street Journal 3.4
Reuters Health 3.24
CNN Health 2.98
US News 2.97
HealthDay 2.9
Time 2.81
WebMD 2.77
MSNBC 2.38

I was surprised that AP did so well, and WebMD so poorly.

Sunday, May 18, 2014

The future of reading

The future of news is an important piece of the future of technology, so this leaked writeup from Nieman Labs on an innovation post-mortem from the New York Times caught my attention. Among the observations:

  • The homepage is irrelevant: only a third of readers ever visit it. But the concept of “top news stories” still drives too much of what the org does.
  • Technology, in the form of better structuring and mining of existing data or repurposing content in interactive ways, can drive engagement as much or more than great stories.
  • The newsroom (manufacturing) and marketing (sales) can no longer be separate. If anything, the future is making business/sales less and less of a standalone entity.

One thing I’ve always wondered is why people care so much about new content. Let’s face it: most of the best content was produced long, long ago. Much, perhaps most great content (e.g. recipes, travel, historical events) ages well and often I’d rather read a great past story than a mediocre one from today.

This whole article is worth reading.



Wednesday, May 14, 2014

My favorite books about diet and health

Making a list of favorite books is hard because your favorites change over time, often due to reading something that becomes a new favorite. 

Perhaps it’s easier to be like Tyler Cowen and simply read a ton, absorb what you can, and move on. With that attitude, books are like people you bump into on the street, or who you converse with once on a long train ride. They influence you to various degrees, sometimes more, sometimes less, but in the end it’s all about ideas. Good ones can be packaged in anything from a book to a blog post; don’t be too obsessed with the format, and certainly don’t feel you have to read the whole thing if you get distracted.

I don’t dispute that, but there’s another reason to track favorite books: as a handy introduction to yourself, so others can get a sense of who you are and where you’re coming from.

So with that said, here are my favorite books about diet and nutrition:

  • In Defense of Food: An Eater's Manifesto   Pollan, Michael
    If you’re confused about diet, this is the best advice yet. “Eat food. Not too much. Mostly plants”. 
  • Why We Get Fat: And What to Do About It     Taubes, Gary
    A well-researched, easy to read but thorough discussion of obesity that concludes that carbohydrates, not calories, are key. The simple, seemingly obvious belief that a person’s weight is a function of “calories in and calories out” will seem much less obvious and mostly wrong by the end of this book.
  • The Paleo Manifesto: Ancient Wisdom for Lifelong Health     Durant, John
    The best summary so far of the motivation and principles of ancestral health. The author is a student of Steven Pinker’s, from Harvard, and writes with a general, more academic orientation rather than as a how-to manual. The basic principle, that the modern world is not our natural habitat, makes much sense, and I like the way he applies that rule to diet and exercise, plus sleep and much more.
  • Eating on the Wild Side: The Missing Link to Optimum Health     Robinson, Jo
    A highly practical summary of fruits and vegetables: which are good for you and why. Every page includes interesting, often counter-intuitive tips to eat more healthily. Examples: frozen blueberries are just as healthy as fresh, but broccoli loses most of its nutrition within hours after picking. Carrots cooked with butter are much healthier than raw. Excellent and useful throughout.
  • All Natural: A Skeptic's Quest for Health and Happiness in an Age of Ecological Anxiety     Johnson, Nathanael
    Although frustratingly equivocal in its conclusions, I liked the survey of the advantages and disadvantages of “mainstream” versus “alternative” approaches to health, on everything from childbirth, vaccinations, and raw milk.

Far out theories

Some of my favorite health books go slightly beyond the known — or thought-to-be-known — science, and deliberately introduce some speculative ideas, useful both as a reminder of how little science can currently explain and also a hint of ways our view of the world could radically change in the future.

Plague Time: The New Germ Theory of Disease     Ewald, Paul

Published in 2002, this book raises the intriguing possibility that most (perhaps all) serious diseases are caused by infections. Certain types of cancers (e.g. HPV) are already known to have viral origins, but imagine how our thinking would change if — when — someday science discovers infectious agents behind other cancers, heart disease, diabetes, and more. Reading this with other books about the role of microbes has made me far more sensitive to the possibility that science and medicine could one day undergo a huge shift in the way that health and disease are diagnosed and treated.

An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases     Velasquez-Manoff, Moises

Another book that explains the provocative idea that our immune systems need regular stimulation by parasites and other infectious agents, without which we risk unpleasant side effects like allergies, diabetes, and many other nasty conditions. The remarkable correlation between the hygiene of modernity and the rise of autoimmune diseases makes for powerful evidence that science is far behind in understanding all the consequences of our current lifestyles.

Books I don’t like

Maybe later I’ll put together my list of the books (and authors) I don’t care to recommend. I read a ton, including of books that don’t resonate so well with me or about which I seriously disagree. Understanding that list can perhaps save you some trouble, either because you’d prefer to avoid the mistakes I’ve made, or because you’d like even more evidence that I am an incompetent idiot.

Sunday, May 11, 2014

Maybe Japan is not really lost

Japan’s decline has become such conventional wisdom that you pick up a book like this and immediately expect an explanation of Japan’s “lost decade” (now turning into two decades), a period that coincides nicely with my own career; I first lived in Japan during the Bubble heyday, leaving for good  in the mid-90s, after the Kobe Earthquake and the Sarin Gas Attacks that marked such a pivot in Japan’s history. Like many Japanophiles at the time, I too gave up on the country and found myself studying less and less about the place, switching instead to China, which seemed far more exciting and new. With David Pilling’s new Bending Adversity: Japan and the Art of Survival  (which I found from a Sinica Podcast recommendation) I feel much more caught up.

The title “Bending Adversity” is a rough translation of 災い転じて服となす, which is a great, untranslatable Japanese phrase that you use when suffering hardships. The author, a Financial Times journalist who lived there through much of the 2000s, uses the 3/11 Tsunami as the context for the book, showing the uniquely Japanese way that people there endured the aftermath of one of their worst disasters.

“Japan is a country of good soldiers but poor commanders,” says Shijiro Ogata, one of many first-hand interviews from the book. The cleanup after the tsunami, like so much of what appears to be rudderless Japanese politics, seems to indicate a lack of direction — leadership— that is only made up for by the orderly, well-behaved reaction of individual Japanese, who one-by-one work together to cooperate in ways unthinkable in other countries. Looting and hoarding — seemingly inevitable consequences of disaster anywhere else — just don’t happen in Japan.

But what is the source of unique Japanese, orderly response to adversity? and will it continue? The author provides a nice overview of ideas like nihonjinron, so big back in the Bubble Days when the best-selling book was Ezra Vogel’s Japan as Number One. Then there’s a nice refresh of Japan’s historical rise, including the early victories over China and Russia back in the 1890s, continuing to the triumphs and ultimate tragedy of the War, followed by its unlikely recovery. By the time you get to the Bubble Days, you come away with an understandable awe at how such a success was possible, made even more incredible by the seeming inability to grow again after the early 90s crash.

Reviewing the various responses by Japanese governments since then — from the early, temporary defeat of the LDP in the 90s, to the unlikely rise of Koizumi in the 2000s, you are left with a sense of one dashed hope after another, and a real disappointment that the seemingly invincible country that rose after the Meiji Restoration has disappeared and may never come back again.

Still, behind the raw GDP numbers that show little or no progress in twenty years, and the overtaking by China in the number two spot worldwide, the author reminds us of all that is still great about Japan. If the impeccable design, cleanliness, great food, well-educated and orderly society with the world’s highest life expectance — if that’s a failure, then is it really so bad? Many parts of Japanese society have been restructured, with a greater awareness of the simple things in life, beyond the dreary economic numbers. As the author points out, Nelson Rockefeller, who died in 1979 one of the wealthiest and most powerful men in the world, had no iPhone or internet or any of the wonderful day-to-day luxuries that any Japanese person, living in a peaceful and generally cooperative society can take for granted. 

What I realized while reading this book is that maybe, instead of being “lost”, the last few decades are really how Japan has found itself.

Saturday, May 10, 2014

Call it processed milk

Our middle schooler came home from school yesterday and noticed for the first time that our family drinks whole milk, not the skim milk that her teacher had just recommended as the “healthier choice.” Delighted to have learned something at school that could immediately benefit the family, she suggested we switch.  Uh, not so fast.

Turns out there is no evidence that skim or low-fat milk is better for you than whole milk. In fact, a large five-year study of 12,000 middle schoolers found that kids who drink skim milk actually gain weight. A later study among two year olds found the same thing. So did another one, conducted on 10,000 kids published last year.

The American Academy of Pediatrics specifically recommends low-fat milk for all kids over 2. So does the official Kids Eat Right web site of the Academy of Nutrition and Dietetics. None of the web sites gives sources for their recommendations, but I assume they are simply following the decades of research that pretty conclusively shows a link between high cholesterol and heart disease. Whole milk has more fat, which means more cholesterol, which means more heart disease. Right?

Well, that sounds good in theory, but it appears to be based on research into a key component of milk (the fat), not milk itself. The best of science knows so little about how food reacts in the presence of other foods; it's not surprising that large studies often appear to disprove the received wisdom about something that seemed sound in theory. It could be that fat, by itself, causes high cholesterol and heart disease, but that fat consumed as part of a dairy product is good. In fact, I think that’s likely.

My opinion is converging on something that I first saw articulated by Michael Pollan (“eat food” — i.e. things your grandmother would recognize) and of course by many others in the natural food as well as ancestral health movements. Get as close to nature as you can.  When food is processed, it changes; whether that’s good or bad  — well, it depends. After all, heating something (aka “cooking”) is just a form of processing food. Salt is a type of rock, a mineral that you wouldn’t normally just go eat; but it can be a perfectly safe and healthy food additive. It depends. Still, when in doubt it pays to go back to basics. You step away from tradition at your peril. Thousands of years of dairy tradition — especially it’s associated with your genetic heritage — are not something to lightly deny. 

Bleeding out a natural component of cow’s milk (the fat) is a recent addition to the set of food choices we can make. Do you really know what you’re doing when you deprive your body of something that nature intended?

Non Fat Milk