Brent Kearney

In this lecture entitled, “Sugar: The Bitter Truth”, Professor Robert H. Lustig, M.D., of the University of California at San Francisco argues that the metabolic syndrome epidemic and all of the health problems associated with it — obesity, heart disease, diabetes, and others — are due to a single dietary cause: the overconsumption of sugar in it’s most popular form, fructose.

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Current medical practice is largely a reductionist affair. An ailment to a particular part of the body is identified, and treated in isolation from the rest of the body. For example, cancer research is done for brain, breast, colorectal cancer, and others. However, some leading research suggests that a systems approach, viewing the body as a complex system in which disease emerges, will be more effective for understanding and curing disease. In this view, cancer (for example) is not something that happens to a particular organ, but is rather a process that develops in the body under certain conditions. This “big picture” approach is illustrated in the two videos below, which are from the TEDMed conference in 2009.

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This post started as my reply to another blog post that I came across, Obsoleting Doctors, by software developer Sammy Larbi. After I wrote a couple of paragraphs, I realized that this was an idea that I’ve been thinking about for awhile now, so I moved it here.

Sam’s post muses on the possibility of expert systems (computer software with specialized databases) replacing doctors for the diagnosis of illness. I don’t think that doctors will become obsolete, because I don’t think that disease and injury will vanish, and someone needs to provide care for the sick in an informed and experienced way. However, I agree with Sam that IT can help, and that change is afoot.

The problem with the medical establishment right now, and the way that doctors work, is that the system is so completely focused on pathology. This is an unfortunate irony because if they were focused on preventative care instead, pathologies wouldn’t develop nearly as often in the first place, and we would all live longer and healthier lives.

Today doctor visits are designed to identify symptoms of illness, and to treat “primary complaints”. Diagnostic tests are done to check that your health is within normal parameters. As it turns out “normal” is the same as mediocre. If the goal were optimal health instead, surely fewer health problems would arise, and those that do could be spotted at an earlier stage, where treatment stands a much better chance of success.

Information technology (IT) could help health care in a number of ways. One way IT can help is by recording health and fitness data on an individual level, and making it easily and directly available, so people know exactly where they’re at and where they need to improve in order to reach optimal levels of health and fitness. By “available”, I mean available to the patient. I hate to use the word “patient” because it implies illness, but what I have in mind is a person who is not yet ill, and who wants to stay that way.

For an example of this idea applied to fitness data, see Wired’s articles on Nike and “personal metrics”, Living by the Numbers. The average person isn’t concerned enough with their fitness to get this geeky about it, and the sick-care system, with it’s focus on mediocrity, is in part to blame. As Ray Kurzweil and Terry Grossman ask in their new book Transcend, “when was the last time your doctor counted the number of push-ups and sit-ups that you can do?” Maybe they should.

The real power of fitness data would emerge when combined with clinical data such as cholesterol levels, blood glucose and blood pressure, homocysteine, C-reactive protein, etc., with dietary information including what drugs or supplements you take, and with illness and treatment histories. Family health history should be included, and eventually personal genomic data could also be added. All of this together could form an individuals health profile. The health profile could be anonymously fed into intelligent software that cross-references the data with everyone else’s health profiles to help spot problems and identify trends. This process is known as data mining. It’s value to health care and life sciences would be staggering.

Google and Microsoft have both begun projects that will move us in this direction. Google’s system is called Google Health, and Microsoft’s is HealthVault. (Given Microsoft’s history and culture, the choice for me is clear). The Personal Genome Project is explicitly about data mining, only it is focused entirely on personal genomic data. These efforts represent the beginnings of crowdsourcing for health care.

These technologies, if adopted by large enough numbers of motivated individuals, and taken up by a significant number of researchers and forward-thinking medical practitioners, could bring about the change that is needed to move health care out of it’s rut of pathology obsessiveness and into a era where health is optimized and disease is prevented.

However healthy we try to be, disease will always exist. Information technology can help with that, too. It can be used to reform the badly broken regulatory system, and by being a catalyst in bringing new treatments to medical practice.

A major problem with the medical establishment is that it adopts change at a glacial pace. It is decades behind in technology. For example, as noted in Transcend:

Consider ultrafast CT coronary artery calcium (CAC) scans of the heart. This technology has been available for over a decade and a half, and, even though multiple studies have shown that it is effective at detecting coronary artery disease very early in its course—at a time that effective preventative treatment can still be done—the American Heart Association still does not recommend its use for primary screening.

This sad situation is only going to get worse, since the pace of technology development continues to accelerate, and advances in medical research far outpace the regulatory approval process. The regulatory approval systems in place were conceived of and implemented in a much slower moving era, when major breakthroughs were seldom achieved. Now, science and technology breakthroughs are an almost daily occurrence.

Research is progressing so fast that individual scientific researchers in any given field are almost certainly not aware of all of the developments simultaneously taking place in his or her field. Thanks to amazing advances in communications technology, researchers are vastly more aware than they have been in the past, and many collaborate across the globe. However, the amount of new information is too verbose, diverse, and too fragmented across different systems and different languages that one person cannot keep track of it all. This problem is magnified by orders of magnitude when applied to the institutional level.

Information technology can help aggregate the fire-hose of research data and promote collaboration and communication between the research community and medical establishments. It could be used to streamline the regulatory process and promote more aggressive adoption of new technologies and therapies. The regulatory bodies could—and should—become more democratic, allowing more direct and open input from diverse sources including the research community, practicing doctors, and especially patients.

The hyper-intolerance to risk by the current regulatory bodies is completely out of touch with the reality that patients with real diseases are facing. I suspect that the litigation culture, born and nurtured in the United States, is largely at fault for this state of affairs. It is logically and ethically backwards: to have a fatal disease is itself a huge risk, and that risk should be balanced with the risk of experimental treatments. People suffering from fatal disease should be allowed the opportunity to possibly save themselves, and at the same time benefit science and medicine, whether the treatment works or not.

Encouraging all parties to participate in development and implementation of medical therapies would be to crowdsource medical research and practice. IT would be the medium through which the data would flow, the ideas exchanged, and results mined for further insight.

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It was a beautiful October evening in Banff, and I was home early — as I often am on Mondays — looking forward to getting out for a run before the sun set. Things were busy at work and at home, I had a lot on my mind, including ramping up training for the cross country ski season, and for my next adventure race in the early summer. I was feeling good, and started off with a strong pace towards the Sundance Canyon, just down the hill from my place.

I enjoy that route in the evenings, because the trail runs east-west, providing spectacular scenery at dusk, when the skies turn purple, yellow, pink and sometimes even shades of green. Given the time that I was leaving for my run, I would have been treated to this during my return from the canyon, if it weren’t for one of my neighbours, her little dog, and an old dead tree.

I had just picked up speed, running down-hill on the trail from my house, when I spotted the little dog, connected to it’s owners by one of those ever-expanding retractable leashes.

The dog was one of those hyper, yappy little dogs. It had spotted me running in their direction, and was going wild, running towards me. I looked at it’s owners, a mother-daughter pair, who saw me coming as well. I was approaching a bend in the trail where I turn off, onto a less traveled path through the woods. I picked up speed, figuring that I would make it to the turn-off before the dog did, and/or the leash-holder would do the sensible thing and pull the crazed animal back. I was wrong on both measures.

There are a lot of wind storms here in the mountains, and as a result, fallen trees are very common. I don’t think twice about jumping over them while running, or bunny-hopping them on my mountain bike. So I was habitually unconcerned that there was a fallen tree crossing my path. It just so happened that at the exact moment my feet left the ground, as I hopped over the tree, the hyper little dog made a last-moment lunge for me. I cleared the dog, but not it’s leash, which snagged my foot, tripping me onto the downed tree. Which was covered in branches…

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As the owner of the Heart Attack Grill explains the merits of lard-soaked buns and 4 ½-pound meat patties smothered in cheese and mayo in this interview, he remarks, “This is bad for you, and it’s going to kill you”. The dessert menu is composed of unfiltered cigarettes, and scantily clad girls in fantasy nurse costumes will push you to your car in a wheelchair.

I wonder if anyone has actually had a heart attack in the restaurant, half-way through a “triple bypass burger”…

The marketing angle here, and the fact that it is successful, is quite interesting. The tobacco industry could probably learn a thing or two from it. Let’s hope they don’t!

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This week, there was a bit of a splash in science news about results of a study out of Professor David Sinclair’s lab at Harvard (Oberdoerffer, et al.) — “potential universal mechanism of aging” discovered, was the media spin. A salient bit of the report for many people was that resveratrol (rez-vair-a-trol) was used to stimulate the production of sirtuin in mice, which in turn allowed them to live up to 46% longer. Does this mean we should all be supplementing with resveratrol?

The Wikipedia article on resveratrol is filled with contradictions on its efficacy as a fountain-of-youth supplement. Some studies have it extending the life of some creatures by as much as 56%, while others showed no significant results at all. I had been convinced by Ray & Terry that it was a promising enough compound to add to my supplement regime. However, since some studies failed to show health benefits in mammals, and others showed that there is practically no evidence of efficacy in humans due to resveratrol’s lack of bioavailability, I grew skeptical and stopped buying it.

After researching this latest finding from Harvard, I was intrigued to discover that those in the know — namely, Dr. Sinclair and his team of Resveratrol researchers — personally supplement with the substance. The bioavailability problem can apparently be mitigated by microencapsulation, which protects resveratrol from oxidation and damage from heat and light, and allows it to by-pass the harsh digestive environment of the stomach so that it can be absorbed into the blood stream when it reaches the intestines. Including quercetin in the formulation also helps absorption.

There may be side-effects to supplementing with resveratrol, however. One of them may be ligament and tendon troubles:

It is possible that the anti-angiogenesis effect of resveratrol can cause ligament or tendon issues; those tissues are so poorly supplied with blood a reduction of angiogenesis could delay or prevent healing, and a series of micro-tears or other injuries would compound the situaton. Quercetin has a similar effect on agiogenesis.

That is from the sci.life-extension discussion group. If resveratrol slows exercise recovery time for tendons and ligaments, it is probably not a good thing for athletes to take. As a rock climber and distance runner, I’ve decided against it.

On another note, a recent study showed that, like resveratrol, endurance exercise can have similar SIRT1 effects! Note also that sweating is a natural iron chelator. The moral of this story is that intense exercise will do you much more good than resveratrol will, and will save you a lot of money too.

Here are some relevant links:

• http://en.wikipedia.org/wiki/Resveratrol
• http://www.fightaging.org/archives/001020.php
• http://science.slashdot.org/article.pl?sid=08/11/28/2315209
• http://www.sciencedaily.com/releases/2008/11/081126122203.htm
• http://scienceblogs.com/terrasig/2006…
• http://www.rayandterry.com/itemdesc.asp?ic=RESVER

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This NY Times article has summarized the latest physiology research on warm-ups: the age-old practice of static stretching (stretch & hold) before exercising actually does more harm than good. Studies show that static stretching can weaken your pre-workout muscles by up to 30%.

Instead, athletes should do a short aerobic warm up, followed by dynamic stretching, which basically involves doing similar motions that will be involved in your actual work out. For running, do some squats and lunges, for example.

The embedded video on that page is worth watching. In it, manager of sports science for the U.S. Tennis Association Mark Kovacs says that the most important part of the warm up is — surprise — warming up, i.e. getting blood flowing to your muscles by doing a light jog, for example. After that, dynamic movement will further help your muscles warm up and get ready for action. It is also mentioned that static stretching is a good thing to do for cooling down. Damn, I too often skip that part.

An example of dynamic motion that makes for a good warm up is The Spiderman, which involves crawlng on hands & feet, bringing your foot up beside your hand while leaving the other way behind, sort of like a crouching lunge. Thankfully, Duke University’s Sports Medicine people have posted a helpful video on YouTube:

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I bought my first mountain bike last year, so I’m still pretty much a newbie. However, I’ve been riding as often as possible since then, and what I found the most difficult in the beginning — pedaling up mountains — is now much easier. Here’s a few things I’ve learned about uphill mountain biking:

1. Lean forward, and don’t be afraid to stand up if you need to.
   Some experienced mountain bikers told me to remain seated on the uphills, at all time. I took this advice, but since then, I’ve found that in some circumstances, staying in a higher gear and standing up to pedal, while really leaning right over the handlebars to keep the front tire down, works better. Try not to wobble the bike back and forth when you do this. The trick is balancing your weight properly to give the back tire enough traction not to spin out (the higher gear helps with this), and not to let the front tire come off the ground.
2. Don’t rush.
   I used to find it amazing how I would be busting my lungs to get up long, steady hills, while more experienced riders didn’t seem to be working nearly as hard. They weren’t. For some reason, on hills, I felt the urge to pedal as fast as possible in the lowest gear. This is entirely inefficient: it causes the front tire to jump (too much torque on the rear tire), makes it more likely to spin-out the rear tire, and worst of all, makes you work way harder than you need to. Intentionally go slowly, pick the highest gear that you can “comfortably” pedal for that hill and your present physical state, and concentrate on a slow, steady cadence instead of how fast you’re moving. Relax and breathe easy.
3. Psychologically, use baby steps to get up those long, grueling hills.
   A huge hill can be intimidating, and that anxiety makes getting up it even more difficult. It’s best not to think about it. Pick a place on the ground a few metres in front of you and focus on getting to that spot. As you reach that spot, re-set your goal for another spot, further ahead. Climbing the hill in these increments makes it seem a lot easier.
4. Shift your weight forward on the seat.
   On most hills, you won’t be standing up, or at least not the whole time. When you’re in the saddle and pedaling uphill, move your weight forward so that you’re sitting as far ahead as possible on the front of the seat. Lean forward, moving your chest toward the handlebars. When you breathe, try to fill your chest with air, not your belly. Remember my second tip (don’t rush).
5. Steer around the bumps.
   If possible, go around those roots and rocks instead of over them. All you need is an inch of space for your tires; if there is room to go around a root, rock or trench — take it. Your front tire will be more likely to stay on the ground, and your back tire less likely to spin out.
6. Relax your upper body.
   Flexing the muscles in your chest, arms and shoulders uses a significant amount of energy, and your heart needs to pump blood into those muscles faster when you do. Reserve as much of your heart’s capacity for your legs as you can by keeping the rest of your body relaxed. Of course, you’ll need your arms to hang onto the handlebars, steer, and maybe pull yourself forward, but try to be aware of how much energy that you’re giving to your upper body. Your legs can use all of the O₂ that you can give them!

If you have any other tips, I’d love to hear them. Have a great summer!

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Feeling tired or sleepy during the day? Nubella has published Five Ways to Boost Your Energy. They are:

1. Drink half your body weight in pounds, in ounces of water, per day. So if you weigh 180lbs (82kg), you should drink about 90oz (2.7L) of water per day. This does not include juice, soda, coffee or tea — just water. Water helps many bodily functions, and you will feel better if you drink enough of it.

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It has been quite awhile since my last post on the 5-Peaks series of trail running races that I’ve been doing this summer. Today I ran the 4th race in the series, which took place in Calgary again, but this time at Fish Creek Provincial Park. The 2nd and 3rd races took place in Kananaskis Country, a massive national park.

In my first race, my calves cramped in the final few kilometers, forcing me to slow down, continuing uncomfortably. A couple of people suggested that I was probably not well hydrated enough, prior to the race. So for the second race, I drank plenty of water in the days before, and in the morning before the race. I drank over a litre before the race started. I knew in the first 30 seconds of running that it was a mistake.

The course was 12km through a beautiful trail system at a place called Sibbald Flats. The weather was perfect for running: cool and moist, rain threatening at any moment. The sound of water sloshing around in my belly was mildly entertaining, but terribly uncomfortable. I felt like throwing up after about 10 minutes, and that feeling never left me. I managed to finish OK though, placing 8th in my category (out of 20), and 20th overall, out of 150.

For the 3rd race, I decided to get a jump on everyone and go out to the course for a practice run a few weeks before the race. The map provided by 5 Peaks sucked ass, but together with the map at Delta Lodge in K-country, I was able to discern the course. Although, I thought the website had said the course was 12-15km, but my GPS told me that it was only 11. It was easy running on wide road-like trails, nothing too steep, but the hills were super long. One section was about 2km of downhill, which just pounded my knees. So I thought the best preparation would be to work on power, so I trained on steep mountain trails, doing plenty of interval training.

The morning of the race, I didn’t over-hydrate, and arrived ready to run, with a strategy. A friend of mine who used to run a lot of cross-country races advised that its best to push hard at the beginning of the race, hold a good pace in the middle, then burn whatever you have left in the final bit. I knew that the beginning had about 1km of uphill followed by about 2km of down, and after that it was more or less flat for the rest of the race. So my strategy was to conserve energy up the big hill at the beginning, although keep a decent pace, and then burn really fast on the downhill, passing any ground that I lost.

That part worked like a charm, I was sprinting down the hill with huge bounding steps, and passed dozens of runners at twice their speed or more. At the bottom of the hill, the trail wound back to a fork in the trail, where I had taken a left during my practice run. To my surprise, the race course went right, instead. This worried me — suddenly I had no idea what was ahead, and I had just burned a substantial amount of energy. As it turned out, the course was indeed 15km, and there were plenty more big hills in the course. It was a major psychological struggle as I turned corner after corner to discover more and more climbs, and more and more distance. The sun was beating down, and it was around 30 °C. Normally for a 10-15k run, I would wear a hydration pack, but I thought it would be a quick 11k run at race pace. Ouch. In the end, I placed 8th in my category again, and 20th overall out of 150. Weird! I felt like death afterwards though, and it took days to recover.

My training between the 3rd and 4th race was sporadic and random. I did a few runs here and there, some short and fast, others long and easy, or long and grueling, and plenty of mountain biking. I did a few duathlon style runs, which I really enjoy. One of them was the most extreme run I’ve done, with about 10k of mountain biking, followed by around 20k of mountain trail running with around 1000m of elevation gain, followed again by another 10km of trail riding home. That was a week before the race, and I was worried that I wouldn’t have time to recover (my knees were aching from all the downhill). I did though, and even managed to do some speed work a couple of days before the race.

This morning I woke up a bit late — I stayed overnight at a friend’s place in Calgary — and rushed off to a late breakfast. I *hate* running before breakfast; it feels like I’m running in slow motion, on empty. So I ate a typical breakfast, hoping that two hours would be sufficient time to digest it before the race. It was and it wasn’t; when I was really pushing it, my guts were not happy at all. I could have used another hour to digest breakfast, but aside from some gross coffee-flavored burps and a pressing desire to visit a toilet, it wasn’t a huge problem.

My strategy this race, after some experimentation during training, was to pace myself for the first half so that I could really rip for the second half. In previous races, I found that the second half was always much, much slower, and I’d get passed by a dozen people. So I wore my heart-rate monitor, and tried to keep a pace that was as fast as possible while sustainable. There is a magic heart-rate, for me somewhere between 178 and 181 beats per minute, that is sustainable for a long time, probably hours. Above that, I’m running significantly faster, but I can only sustain it for 25 minutes or so before hitting a wall.

It was tough holding back for the first half of the race, watching people ahead of me that I knew I could pass if I just pushed it a bit harder. But then, after 5km or so, it was rewarding passing some of those people who had hit their wall, after passing me a few minutes earlier. It worked out well, but afterwards I felt that I could have pushed myself a lot harder than I did in the second half. I felt really good after the race, in contrast to the morbid pangs following the 3rd race. I even considered going mountain biking when I got home today, but opted for a hot bath and a movie instead. Strangely, I placed 8th in my category again, and 20th overall! This time there were 300 racers instead of 150, however, so I guess that it was relatively a better placing.

Hopefully I can break the mystical 8th-place barrier in the next race; placing in the top-5 would be great. The next one is in Canmore in September, and I’ve heard that its a gruesome course. I’m looking forward to it!

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There is a story coming through the Associated Press today about a new generation of anti-smoking drugs. This one is more like a vaccine than the nicotine-replacement therapies presently on the market. Pfizer Inc.’s “Chantix“, and Sanofi-Aventis SA’s “Acomplia” work as a vaccine, stimulating the smoker’s immune system to fight nicotine as if it were an infection. Additional treatments cause the production of antibodies that prevent nicotine from crossing the blood-brain barrier, ridding cigarettes of their most addictive effect. This is promising news for civilization!

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