Links for July 17, 2017: open streets, placebo diets, hair dyes and cancer risk, the sedgwick county CHIP, bad sleep and junk food, and the lengthening of your life with dietary choices

Open Streets ICT is coming. Are you ready?

Are diets just placebos?

Is your hair dye increasing your risk of breast cancer?

Hair products, conveniently, seem to never get the wrath that other "artificial" lifestyle products (artificial sweeteners, preservatives, herbicides) get. Does this study change that? I doubt it.

Have you seen the Sedgwick County CHIP?

That's Community Health Improvement Plan, which is even more delicious than what you were thinking of...

Sleeping poorly may make junk food seem a lot more appealing.

The data is still maturing on this topic, but it's starting to look pretty obvious that we should all sleep more, for reasons obvious and not-so-obvious. I can speak from experience. During my internship, one of the hospitals I covered had a cafeteria that was free--in unlimited quantities--to trainees. I fell into a nasty habit of 3 am cheesecake binges during my in-house nights on call. It was ugly...

This paper deserves to be mentioned much higher in the list, but I may have more to say about it later. So...for the one-thousanth time, we have evidence that dietary choices can prolong or shorten your life.

Using one of three diet indices, investigators publishing in the New England Journal of Medicine found that "[a] 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17%." For the sake of comparison, taking a statin medication for cholesterol in high-risk people is associated with about a fourteen percent reduction in mortality. And to stave off the angry emails, I know that the statin data comes from high-quality randomized trials, while the referenced dietary study is observational. But still. 

June 15, 2017 laser links: drones for cardiac arrest, aircraft noise and blood pressure, and BMI's effect on fetal malformations

Drones can deliver automatic external defibrillators (AEDs) to cardiac arrests 3 km away in 5 minutes. Drones!

We better hope those drones aren't noisy, though: a couple months ago I stayed in an AirBnB east of downtown San Diego for a few days. We were directly under the final approach for SAN, and except late at night, a plane would roar overhead every few minutes. Bad news for the people in that otherwise charming neighborhood: all that aircraft noise may increase their blood pressure.

In case you woke up in too good of a mood, here's evidence that women with a higher BMI have a higher risk of giving birth to a baby with malformations.

The effect size is small (adjusted risk ratios for any birth defect were 1.05 for BMIs 25–29.9, 1.12 for BMIs 30–34.9, 1.23 for BMIs 35–39.9, and 1.37 for BMIs over 40.

June 6, 2017 link-a-dink

The idea that good diabetes care isn't strictly an obsessive quest for an A1c level of 7% or less is finally hitting the mainstream press. This article also touches on the very real dilemma that doctors and patients face: Do we use old, cheap drugs that are effective at lowering the hemoglobin A1c level, or do we use new, astonishingly expensive drugs that have better evidence of actually reducing death?

Most people will never understand my eating disorder. "I am six feet tall and between 180 and 190 pounds, depending on the month. I am by no means the picture of health or even particularly muscular-looking—not for someone who exercises this much, and definitely not compared to most of the men I see at my gym. Or maybe I am? That's the problem, or one of them: What I see when I look in the mirror doesn't correspond with reality. I see a fat piece of shit, and then I think to myself that it's time to punish my body for letting me down."

Do patients make mistakes during doctor visits because they're put in a position that forces them to rely on intuition and makes them vulnerable to biases? 

RIP Warner Blackburn: sadness at the Dirty Kanza

I finished the Dirty Kanza 200 yesterday, and I plan to write about the experience in detail. But for now, I want to mention Warner Blackburn, a man who died during the 50-mile race. He was given CPR on the course by a friend of mine and taken to the hospital, where he died of an apparent heart attack.

I suppose the most cyclist-y thing to say is that "Warner died doing what he loved" or some such crap. But I don't know that. I don't know that Warner even liked cycling. He left almost no trace on the internet. Maybe he was doing the DK 50 on a bet, or maybe he was trying to support a family member. My wife makes fun of me because I automatically assume that people in cycling and other outdoorsy pursuits are nice, even though I'm not the warmest cuddliest type around. So I'll say this: whether Warner liked cycling, or whether he was trying to support someone else, or whether he was trying to support a cool event for the local community, he went out on a high note. 

FWIW, for anyone thinking of starting exercising after a long period of physical inactivity, please take the Physical Activity Readiness Questionnaire first. It's a little too sensitive, meaning it may flag a few people who aren't that high risk, but if you have a "yes" anywhere on the form, it's worth talking to your doctor about before you go out and hit it too hard.

Here's to the MAMILs (Middle-Aged Men In Lycra)

*MAMIL nomenclature unabashedly stolen from Code Switch:

Since I'm a MAMIL most days, at least for an hour or so, and since I know that even weekend warrior-style sporting activity is associated with a 34% reduction in the risk of dying, a 40% reduction in the risk of dying of a heart attack, and a 17% reduction in the risk of dying of cancer, I headed out to Benton, Kansas today for the final race in the Rage Against the Chainring series, the "Rage of Oz." This is the Land of Oz, after all, or the "Land of Ahs" if you prefer:

And, well, we've got us some rage:

*may or may not be from Kansas. But probably is. 

So there we were, slippin' and slidin' through the Flint Hills south of Benton, Kansas, for 50+ miles: 

It's not as flat as it looks. And for all you mathy-types, it was a two-lapper. 

The end result was 4th place in the "B" class (sort of like scoring in double digits in the JayVee basketball game), but also a Saturday morning that I'm proud of and a statistically lower risk of dying today or tomorrow.

And some very muddy legs:

You can get a Belgian suntan even on cloudy days. In fact, more Belgian suntans are acquired on cloudy days than sunny days.

Sausage Linkfest April 21, 2017

Like them or not, soda taxes seem to work. That is, they work to reduce sugar-sweetened beverage consumption. Time will tell if we can trace any health benefit back to them, like we did with trans fat bans. 

School shouldn't start before 8:30, say the sleep people.

Biking to work is associated with a 41% reduction in the risk of dying over five years. Biking was also associated with 45% lower rates of cancer and a 40% lower risk of dying of cancer. And, as has been noted here before, it's associated with having a shitload more money in your bank account.

Even short-term corticosteroid use is harmful, says a review in the BMJ, with accompanying coverage from the NYT. This is ironic, considering a very recent well-publicized study advocating for 10 mg of dexamethasone in place of antibiotics for sore throat. So a couple comments: first, even the "low-dose" steroids the BMJ article talks about constitute a potentially huge dose (20 mg daily). Second, 10 mg of dexamethasone is just a gigantic, chemotherapy-level dose. It is saved by the fact that dexamethasone has a half-life of only ~3 hours, so most of it is gone by the second day. But still...whatever happened to chicken soup and time for things to get better? *sigh* I guess dexamethasone isn't any worse than the cursed "Z-Pak" that urgent cares seem to hand out like Halloween candy. 

My March WAMPO presentations

I was thrilled to get to speak to the Wichita Area Metropolitan Planning Organization about health effects of active transportation infrastructure. It was a great, receptive crowd. They gave me reason to hope for the future of a transportation system in which cars are a peripheral accessory and not the primary feature. 

Aaaaand I look a little like a wild-haired madman in the video, which I like. 

Richard Link-later April 18, 2017

Banning Trans Fats in NY reduced heart attacks by 6%. If this is true, it's astonishing. Researchers compared admission rates for the composite of myocardial infarction and stroke between New York counties implementing the ban in its eateries versus those that did not. The restricting counties showed an additional 6% drop in admissions relative to non-restricting counties after adjustment for an already-declining trend across the state. The difference became significant 3 years after implementation of the bans and benefitted men and women equally.

Newer, novel (and astonishingly expensive) diabetes drugs seem to have lower hypoglycemia, heart, and death risk than good old insulin: even though this study had a lot of warts (industry-funded, retrospective, yada yada), I'm having a harder and harder time justifying the addition of insulin to high-risk patients' regimens.

"My V-steam cost $50, which is a lot to pay for sitting over hot vapor. Is your money well spent on this stuff? It depends on what you’re looking for."

It's a "fear social media" bonanza! First up was Hidden Brain on the dangers of curating your social media presence to look universally positive:

And then (and then!) Ezra Klein, a journalist I've heard my fair share of thoughts from in regards to how social media doesn't make him happy, interviewed Cal Newport about his notoriously fuddy-duddy views on social media, which I'll cover briefly in the very near future on this very blog.

I was asked recently to name a book that changed my life. The book I chose was Cal Newport’s “Deep Work,” and for the most literal of reasons: it’s changed how I lived my life. Particularly, it’s led me to stop scheduling morning meetings, and to preserve that time for more sustained, creative work. Which is all to say that I’m a bit obsessed with Newport’s work right now, and especially his account of how the digital environment we inhabit is training us out of concentration and into distraction in ways that are bad for us, bad for our work, and ultimately bad for the world. Most of the conversations on this podcast are how to think about things differently. This one is too, but it’s more importantly about how to do things differently, and why you should do them differently. We discuss: -How Newport defines depth when it comes to work -Why the information revolution boosted productivity up until the 2000s, but then stagnated -What he thinks is problematic about the constant accessibility of technologies like email, Slack, and other communication tools -His perspective about how we’re still in an early age of the internet, and what looking back at periods like the Industrial Revolution can teach us about using new technology to work smarter -How to take productive breaks, rather than flicking through email and Facebook and Twitter -How “flow work” and deep work overlap, and how they’re distinct from each other -Why he consumes and produces information more slowly and more traditionally—through newspapers and radio, and why that might benefit people who work in the knowledge economy -His vision of the workplace of the future I hope you get as much out of Newport’s ideas as I have. Books: -Jaron Lanier, “You Are Not A Gadget” and “Who Will Own The Future" -Douglas Rushkoff’s “Throwing Rocks at the Google Bus”

For past thoughts on social media, check here and here.

And PS--I mean fuddy-duddy in the most admiring, sincere way, obviously.

Have a linkboy, not a poolboy April 10, 2017

Most of us eat chocolate bunnies ears-first. Better to not eat them at all, but...

The FDA has given clearance to 23andMe to perform genetic testing for ten diseases. The links are theirs, not mine:

• Parkinson’s disease,
• Alzheimer’s disease,
• Celiac disease, a disorder resulting in the inability to digest gluten that everyone thinks they have; maybe this will set their minds at ease,
• Alpha-1 antitrypsin deficiency, a disorder that causes your lungs and liver to literally digest themselves,
• Early-onset primary dystonia, a movement disorder,
• Factor XI deficiency, a blood clotting disorder,
• Gaucher disease type 1, an organ and tissue disorder in which white blood cells get abnormal sphingolipid deposits,
• Glucose-6-Phosphate Dehydrogenase deficiency, also known as G6PD, a condition that makes red blood cells fragile,
• Hereditary hemochromatosis, a disorder of iron metabolism that leads to excess iron build-up,
• Hereditary thrombophilia, a blood clotting disorder

Vitamin D supplementation probably doesn't prevent heart disease. After all the vitamin D promise (hype?) in the oughts, it's one negative trial after another nowadays.

Big swings in weight may be associated with increased risk of heart attack and stroke. I'm skeptical of the result, but if true, this is yet another way you can improve your chances of a long, healthy life. Eat good foods, get yourself around under human power, get some sleep, and watch your weight hit a natural level for your body. If you're very heavy or having complications of your extra weight, think about bariatric surgery. No need to have your weight swing back and forth 50 pounds a year for the rest of your life.