Civilization, Whither Art Thou

To Eat, or Not to Eat; That is the Question

I took a look at the last two posts and noticed I was getting a bit scienc-y.  This blog is intended to focus on societal issues and not scientific issues; however, as we all know, science and society often intersect.  I have given the Rosie Heart Attack entry a bit of thought and decided to follow it up with one last post in the series (for now) with a focus on health and science.  The issue is what and how much to eat.

Let's start with butter.  In the 1800s margarine was invented.  It's history began in France, and it was supposed to be a substitute for real butter intended for the military and lower classes.  Eventually, it was found you could mix plant oils with animal fats and get a similar product to margaric acid (the first margarine).  However, it was still expensive to make, since it still relied on beef fat as the principal ingredient.  However, an advance in chemistry called hydrogenation came along in the early 20th century and allowed production of margarine that was almost all plant fats.  It might be clear to some readers that at this point no one is sure what margarine is; and in fact there was a clouding of the term margarine.  Many laws in various states tried to restrict names and other factors involved in the selling of butter substitutes.

Margarine reached a peak popularity probably in the 50s.  Many people thought that since it was based from plants it must be better for you; eat your vegetables, right?  But in fact the hydrogenation of the plant oils made the fats not only more similar to animal fats than plant oils, it also made the hydrogenated fats worse for you.  It wasn't for a while, though, until researchers figured out that hydrogenated oils lower your HDL, raise your LDL, promote inflammation, damage the epithelial cells that line your arteries, promote insulin resistance, which can lead to diabetes, and also promote obesity.  Everything I just said is backed up by years and years of research.  Thus, eating these fats is a multifaceted attack on your health.  

But many people just said that the researchers didn't know what they were talking about.  They would say, "Everyone said they were fine before, now they say they're bad.  I don't think they know anything."  And they go on eating hydrogenated oils.  The same can be said of salt, alcohol, chocolate, sugar/carbs, protein, fat, and many other dietary substances.  Society feels like they are being told one day that salt is bad, and then the next day that salt is good.  The same with all the others on the list.  One day grains on the base of the pyramid, the next the food pyramid is gone (which it is) and grains seem to be reduced and lean protein increased.  

Today I'm here to make it worse and better at the same time.  So after that somewhat lengthy introduction, humor me for a few more paragraphs and lets see if I can wrap up the gist of what I believe is going on below.

Well over a decade ago researchers realized that some individuals do not produce CCR5, a receptor mainly found on CD4+ cells.  Now, that may not sound like much, but what it did was more or less make the person with that mutation immune to HIV infection.  This was because HIV needs to bind to the CD4 receptor, and then it needs to use the CCR5 receptor to get into the cell.  If either are missing, then HIV doesn't get in.  Now if a person is missing CD4, then they are in bigger trouble than an HIV infection; but it turns out we as humans don't necessarily need CCR5 to function normally due to a redundancy built into our genetic makeup.  So there are people who are immune to HIV walking around (probably less than 1% to 2% of the population, give or take).  This sort of thing is called genetic variation -- in other words, we are all different.

Now let's take that information and apply it to food.  Perhaps the reason we are seeing such contradictory information regarding food and disease is at least partly due to genetic variability.  I think it is, and there is research to back that claim up.  For instance, there is a variant allele for NOS1 called rs7298903.  NOS1 is nitric oxide synthase 1, it is a gene that codes for an enzyme that makes nitric oxide.  If you have that variant allele, and you have a low fruit and vegetable intake, then you are at a 3-fold increased risk for chronic lymphocytic leukemia and/or small lymphocytic lymphoma (CLL/SLL); while if you eat a lot of fruits and vegetables then you have a 60% reduced risk of CLL/SLL.  But what about another variant of NOS1, say rs545654?

It turns out that with the variant rs545654 of NOS1 there is an interesting effect with just red vegetables.  In the low red vegetable intake group there is a 60% reduced risk of diffuse large B-cell lymphoma (DLBCL); but in the high red vegetable intake group there was a 1.7-2.4-fold increased risk for DLBCL.  In fact, there were many cases of variants of NOS1 that showed a similar pattern of increased risk with high red vegetable intake.  So in the one case, you should eat lots of vegetables; but with another variant you shouldn't.  What to do?

At this point in time none of us will likely be able to find out our true genetic makeup.  That is, it is too expensive and time consuming to go through and identify each persons unique genetic variations for each gene.  If you had that information you could start to make more informed decisions about gene-diet interactions; but the truth is, this is a nascent field and there is much yet to discover.  For instance, it has been suggested by researchers that eating tomatoes with garlic may interact with how the sulfur compounds in garlic work in our bodies.  Thus, a society like Japan, which eats garlic, but not as much tomatoes will exhibit a different epidemiological pattern than say in Italy, where they eat lots of garlic and tomatoes.

Once again, talk to your doctor.  Talk to a trusted nutritionist.  Listen to your body.  Keep a food journal.  If you like certain food and feel good eating certain food, then your body probably needs them (and no this doesn't apply in the same way to deserts and alcohol).  We live in an exciting time where scientific information can tell us so much about the world.  But we are just beginning to discover the interactions of food with our genes.  Give it some time, and perhaps one day we will have personalized diets for each individuals genetic makeup.

What all of this doesn't mean, however, is that when doctors and researchers say something is just plain bad, that you can use this as an excuse to ignore it.  Hydrogenated oils aren't good for anyone.  Cigarettes aren't good for anyone.  Excessive alcohol isn't good for anyone.  Eating an unbalanced diet of mainly animal products and starch isn't good for anyone.  We all need certain things.  While we each do have variations, and these variations do play a role in disease, at our core we are all very similar and our needs are likewise very similar.  I hope this entry was both informative and helpful in its own way.      

Rosie O'Donnell and Heart Attack Symptoms

Rosie came out recently about her heart attack and how she missed the symptoms.  Everyone knows it seems that when the heart feels pain it can be felt in your left arm, cheat, neck, and jaw; but what people don't seem to know is that there are a variety of symptoms that people experience.  The problem I have with Rosie's special concerning acute myocardial infarctions (AMIs for short and the technical term for a heart attack, I'll just use MI here) is that she makes it sound like women have their own set of symptoms and that she knows exactly what they are.  The truth is that there are multiple types of MIs and they each can have their own set of symptoms; further, not everyone experiences all of those symptoms associated with that specific MI or even any of them sometimes (a silent heart attack).

To aggravate the problem, even organizations like Go Red For Women seems to not have many of their facts straight.  In the first link of this post you can find an article where GoRed editors post that an "EKG revealed that she had 99 percent artery blockage, a situation called “the widow maker.”  The truth is, "the widow maker" is a term that comes from a specific coronary artery, the left anterior descending coronary artery (LAD for short).  The LAD supplies around 50% of the blood to the left ventricle and also most of the blood to the septum of the heart.  If it goes, then the left ventricle is in big trouble.  Clearly, it's very important, hence it's name as the "widow maker."  Also, you can't tell the percentage of occlusion from an EKG.  You can get a really good idea of where it is and even possibly how bad it is, but not a percentage.  Further, all these numbers are estimates.  You can read about estimating percent occlusion here -- if you'd like.

But I want to move onto talking about symptomatology of MIs.  Let's start with the scariest one there is...having no symptoms at all, called a silent MI.  Whose at risk?  The truth is, we could all experience this.  It is estimated that up to 25% of all MIs are silent.  However, those with diabetes and the elderly are at the most risk for silent MI.  So what in the world can you do to mitigate this?  Well, first of all, manage your lifestyle so you minimize the risk for diabetes; second, exercise and try and live a healthy lifestyle (including managing stress).  You can't do anything about getting old, it is simply a privilege that only some of us have.  Lastly, you can visit your doctor if you think you are at any risk, and they can visualize your coronary arteries or run tests to see the health of your heart (preventative medicine!).

Alright, so what about the classic symptoms.  These would include chest pain that radiates down the left arm and/or up into the neck and jaw and maybe just not feeling well.  The truth is, that when angina hits, it often really hurts.  Nitroglycerin is a drug that treats angina, but it often doesn't manage the pain during an MI.  In fact, very often stronger drugs are given to manage the pain.  It is usually the case that these people are diaphoretic as well (sweating a lot).  Sometimes they are also pale, from either a lack of peripheral circulation or intense vasoconstriction in response to the sympathetic nervous system.  What to do if this happens to you: don't wait, call 911.  The longer the heart goes without getting oxygen and nutrients, the more tissue will die.  Barring advancements in science and medicine, that heart tissue will never come back, it will only scar over.

Well those two are relatively easy, but what about these other symptoms?  Alright, so the other major symptoms I haven't already mentioned include nausea, vomiting, shortness of breath, JVD, rales in the lungs, pain in the upper back, and fatigue; and of course, there are also symptoms I'm sure people who had MIs experienced and are thinking why don't I see that on the list.  Well, these are just the most common non-chest pain associated symptoms.  It does seem to be true that women experience these non-typical MI symptoms more than men, but it needs to be pointed out that the typical symptoms are still the most common symptoms in women as well as men!  Rosie states in her show that "we [women] don't even know our own symptoms."  The truth is that men can have these non-typical symptoms as well, not just women.  It just turns out that women have them more often than men, statistically speaking.

Each one of these non-typical symptoms is usually associated with a certain type of MI.  For example, 😲vhcv8&index=5&list=PLDF989DA794DC983F" target="_blank">rales are a certain type of lung sound heard on auscultation; they are associated with congestive heart failure (CHF for short) and are usually caused by fluid buildup in the lungs (pulmonary edema).  The failure of the heart is on the left side, and since the left side of the heart receives blood from the lungs, if it can't receive then the fluid backs up in the lungs.  Many people, including women, end up with CHF after a left sided MI.  Following this logic, JVD (jugular venous distension) can occur due to backup in the jugular veins due to right sided MI.  The right side of the heart receives blood from the superior and inferior vena cava, and the superior vena cava receives blood directly from the jugular vein.  Thus, when the right side backs up we can see it as JVD due to the convenient anatomy of the jugular vein to the surface of the neck.

It is important to note, however, that rales and JVD are signs of other disorders, and not just MI.  You can get fluid in your lungs, have fatigue, and probably some mild chest discomfort from a cold.  Clearly you can have nausea and vomiting from many things other than an MI.  So how do you know when to make that call to the emergency room?  It's a great question, and one that researchers are trying to figure out.  I can only tell you how we in a hospital or ambulance determine if it is very likely an MI (medical jargon: "have a very high degree of suspicion").  

First, we usually take a history.  This clearly involves why we are seeing you today.  Then, if you have any of the following it raises our suspicion that you might be having an MI: hypertension, diabetes, previous MIs or heart disease, smoker, or if you're over 50.  In fact, if someone comes in with abdominal pain and is over 50 the hospital will almost always do an EKG (truth be told, MIs are so variable that many people get hooked up to at least some rudimentary EKG).  If why we're seeing you today is for chest pain, and you have one of those risk factors, we're worried about MI and are going to run an EKG.  While the EKG is getting set up we can listen (auscultate) the heart and lung sounds as well (this is where we'd listen for rales).  We look for certain features on EKGs that are indicative of MIs, and if we see them we can (with a 12 lead) get a good idea of which artery is affected.  But even if the EKG is clean, the hospital will still probably run blood work and look for a certain protein that is highly specific for MIs.  If any of those tests turn up positive you get sent to the cath-lab and are treated for acute myocardial infarction by balloon angioplasty, maybe some drugs, and possibly a stent.  If you get into the cath-lab quickly enough, then the chances of survival are actually pretty good.

What of this can you do at your house?  Probably not much besides the history taking.  You can't interpret an EKG because you aren't trained to and also due to the fact you don't have the machine!  You don't have the equipment to check blood work.  You also probably don't have a great stethoscope or even if you do you probably don't have the experience to definitively say, oh yeah, those are rales or, oh yeah, my lungs sound fine (plus it's damn hard to listen to your own lung sounds, trust me).  And you definitely don't have a cath-lab in your house.  Thus, the best defense you have for MIs is, again, good diet, exercise, and regular check ups with your doctor.  If you know you're at risk for an MI, you have a huge advantage over someone who doesn't.     

To conclude, if you know you are at risk and you are unsure if you're experiencing an MI, then get to the ER and consider calling 911.  If you have no idea if you're at risk, get evaluated.  Hopefully, this little post helps to elucidate the variability of the symptomatology of acute myocardial infarctions, and we didn't even really get into comorbidities or confounding factors.  So yes, Rosie is right, and she is also a bit misleading.  Her songs, which are really fun, suggest that women feel hot, exhausted, are pale, puking, and pain (she calls it HEPPP).  It's a really good list.  The problem is that not everyone is going to have all those symptoms, and that men have those symptoms as well.  Her show and her interviews make it seem so clear cut.  Women are like this, men are like this; but that isn't the case.  In most cases women will experience a heart attack the same as a man; and in some cases men and women will experience non-typical symptoms with heart attacks, and women will experience those non-typical symptoms more than men on average. 

If you don't like men as the reference point, then just flip it all around!  In most cases men will experience heart attacks the same way as most women; and in some cases men and women will experience non-typical symptoms, with women more likely to experience those non-typical symptoms.  But again, here are the big risk factors that need to be managed!  Hypertension, high cholesterol, diabetes, and smoking.  If you don't smoke, then don't start, if you do, then quit.  If you don't have hypertension or diabetes, then make sure to try and keep it that way by eating right and exercising.  If you don't have high cholesterol then great, keep it up; if you do then get it under control.  Heart attacks almost always happen because a coronary artery becoming blocked with fatty stuff (atherosclerosis).  All of those risk factors increase the chance of the arteries from getting that type of blockage.  In the end, for most people, you have the most control over your heart's health.  

Note: I think it was good that Rosie came out with her story.  And I like her HEPPP song.  It is getting people out there looking into heart attacks and their own health.  That's a good thing.  The reason I wrote this was to point out that it is much more complicated than what Rosie is saying.  I don't want someone to watch Rosie in an interview or on her special and think: "Oh, well, I'm a woman and I'm not hot, exhausted, puking, or in pain.  I'm a little pale and there are these veins sticking out of my neck, but that's probably something else.  I guess I'm not having a heart attack."  If you watch the Dr. Oz interview with the Today Show, you'll see that his list of symptoms is different from Rosie's HEPPP list.  Again, I like that Rosie is out there, and I like that people are talking about this, but people need to go to their health care providers, get evaluated, and learn about their risks and talk to a professional.  We cannot be a society that gets its information from comedy specials.   

Do We Only Use 10% of Our Brain?

A new movie, Lucy, has taken some immense liberties with a common misconception about the brain.  The "10% of brain myth," as many call it, has murky origins.  There are many claims to the origins, some blatantly incorrect such as the attribution to Einstein, but regardless there is no actual scientific evidence of this claim whatsoever.  I have my own take on how it may have taken some form today with fMRI studies and maybe PET.  These commonly seen images of the brain with some colors interpolated over it are told to people to represent areas of activity in the brain.  Now in the most clear examples, which are the ones you want to post in articles to the lay person, there are very few areas lit up.  This makes sense.  Instead of having to say, the such and such area in the superior frontal gyrus is lit up which demonstrates blah blah blah, you can just say, the areas that are lit up appear to represent such and such function.  Easy.

Now you can go and read the Wikipedia article on the 10% myth, and I think it's pretty good.  But here I want to give an analogy of the brain and brain activity to help show how the entire notion of the 10% brain thing is more or less idiotic.  Here it is.

Imagine you want to build a house, the whole thing.  What would you need?  Aside from the raw materials and a design you would need tools and people to use those tools.  So, what's the first thing you need to do to build a house?  Build a foundation, yes?  You need specific tools to build a good foundation.  Not included in those tools would be things like electrical wiring, lights, paint brushes, paint, siding, roofing, ect. ect. ect.  After the foundation you start to build the frame.  You need certain tools for that job.  Eventually you'll need the plumbing, the electrical wiring, the siding, the roofing, the flooring, the windows, the woodwork, and everything else.

Clearly, you aren't using every person and every tool simultaneously.  And even if you tried, it would result in a huge mess.  That is how your brain works.  Each part of your brain, which has a quite complex architecture (pun intended), has a unique function (as far as we neurobiologists can tell).  In fact, you can just think about this and it makes some sense, given you have some very elementary knowledge of the brain.

You have memories I assume.  How those memories are actually stored is extremely complicated and yet to be fully understood; but, it would be impossible for all those memories to be stored in a single cell.  In fact, it seems that memory isn't really even stored in one location in the brain, but that's getting away from the point.  The crux being that if those memories are in multiple cells and/or locations, then if you used all of them at the same time you'd experience every memory all at once (this is a simplification of course).  That would be crazy.  

What about another example?  There are famous gyri in the brain called the primary motor and primary somatosensory cortex.  In those areas you experience all superficial sensations of touch, pain, temperature, vibration as well as control all voluntary motion.  Imagine that each little portion of those two gyri was firing off all at the same time.  You would simultaneously feel pain, cold, hot, light touch, deep touch, vibration, ect. ect. ect. on every part of your body and at the same time every muscle in your body would try to be moving.  This would of course result in catastrophe.  Disregarding mechanics, you'd die shortly from this experience.

I hope it is very clear that just like building a house, performing a task requires certain parts of the brain and yet not others.  If you want to play the piano from memory, you must remember the piece you want to play, feel the keys, use certain muscles and not others.  And such is it so with all things in life.  

Thus, not only is the 10% of the brain myth incorrect, it is not even thinking about the brain in a way that makes any sense.  We clearly aren't "using" 100% of our brain at any given time because just as it makes no sense to beginning roofing the foundation of a house it makes no sense to use a part of our brain responsible for a memory of our father when we really want to remember the phone number of the girl we met last night.  There may be a time when we figure out how to enhance the brain; and in some ways we already have (see memory and caffeine) by finding and creating drugs.  But until we truly understand the how the brain is wired, it will be almost impossible to figure out how to drastically rewire it to give the superhuman abilities seen in Hollywood films today.