"Urban Jungle" playground reduces accidents at elementary school

An "Urban Jungle" natural play area trialled at a Glasgow school has seen a reduction in accidents, it has been claimed.

Trees, hills, boulders and tunnels were installed in the playground of Merrylee Primary in 2009.
The £65,000 scheme was funded by Glasgow City Council and Forestry Commission Scotland.
A report suggested a marked decrease in pupil segregation and an increase in physical activity.

Over a two week period in 2009 there were 76 accidents, one incident of bullying and 53 other incidents, which include pushing, hitting and slipping.

A follow-up study in 2011 recorded six accidents and two cases of bullying. Both cases of bullying occurred when the natural play space was closed.

Simon Sinek: how leaders inspire

 Watch this TED talk every few months and ask yourself how you can use it to be a better leader.

expertise vs. accountability Part II

A slightly more succinct way of saying I meant to say in my earlier post:

When your engine is on fire, and you're out of gas, and your windshield is broken, you need to:

• put the fire out
• fill up the gas tank
• replace the windshield

in that order.

You don't need to know why method ABC of replacing the windshield is superior to method XYZ at that moment.

Adherence trumps programming most of the time. Poor people typically make less-than-optimal financial decisions, say, on payday when they spend it on beer (rather than saving up so that food doesn't run out at the end of the month). You can TELL people how to manage their money better, but if you can't get them to actually do it, you're useless to them.

Adherence trumps programming. It doesn't matter whether I tell my client to do conventional deadlifts or sumo deadlifts or Romanian deadlifts. It matters more that my client freaking show up twice a week, every week, for the next 12 weeks.

It doesn't matter (as much) if my client optimizes her vitamin K2 intake or her serum vitamin D levels. It matters whether she avoids processed junk, 90% of the time, for the rest of her life.

expertise vs. accountability

I've been at my internship at IFAST for just over six weeks. The amount that I've learned is a bit overwhelming, and I think it's a great stepping stone on the path to becoming a world-class coach.

As I pause to reflect on my time here, though, I can't help but think that expertise is not the most important thing. The guys at the gym are among the most knowledgeable in the field, but that hasn't made them millionaires in the industry. Why not? Part of the problem is that they know TOO much. When you need to get an oil change, you don't need to hire a Ferrari engineer at $500/hr. All you need is some guy who can do the oil change for $24.95.

The truth is that I know more than I will ever need to know -- to help most people change their lives for the better. Do I know enough to train Olympic-level athletes? No, and I probably never will. Do I know enough to treat acute dysfunctions and orthopedic issues? No -- I'd need to invest about 3-5 years in PT school for that.

But I do know enough to help people lose fat, gain muscle, get some relief from chronic pain, feel better about themselves, and live better lives. It's not that hard. All you have to do is eat real food, avoid processed crap, do some mobility work, do a little lifting, do a little conditioning, find/build a great community. The hard part is not so much figuring out what people need to do, but rather, getting people to make behavioral changes that stick.

I think the real future for me lies in efficient and intelligent lifestyle coaching. Step-by-step, or even better, day-by-day procedure manuals for people to follow.

For example: 

Day 1. Throw out all the vegetable oils in your pantry and go buy some butter and coconut oil.
Day 2. Walk around the block. Twice, if you can.

What vegetarians and vegans have going for them

From Jonah Lehrer:

Basically, viral videos tap into emotions, not facts.

It’s one of the most popular online videos ever produced, having been viewed 355 million times on YouTube. At first glance, it’s hard to understand why the clip is so famous, since nothing much happens. Two little boys, Charlie and Harry, are sitting in a chair when Charlie, the younger brother, mischievously bites Harry’s finger. There’s a shriek and then a laugh. The clip is called “Charlie Bit My Finger—Again!”

Why has this footage gone viral? The answer, according to a new study by Jonah Berger, an assistant professor at the University of Pennsylvania’s Wharton School, has to do with the visceral emotions it arouses in viewers.
Here’s the thing about Harry and Charlie—they are incredibly expressive kids. In the span of 56 seconds, we see their faces go from anticipation to agony to laughter. Just when we’re worried that Harry might actually be hurt, he breaks out in a wide smile. The relief is palpable, the delight infectious. (Harry’s adorable British accent doesn’t hurt, either.)

Mr. Berger argues that the popularity of such videos is rooted in the way they excite the body, inducing a spectrum of physiological changes. When we watch Harry and Charlie, we briefly enter into a state of “high arousal,” as the autonomic nervous system mirrors the flurry of feelings on-screen. Our heart rate increases and sweat glands open; the body prepares for action. These are the same physical changes that occur when we encounter any strongly emotional content, from a scary movie to a sappy love poem.

In his study, Mr. Berger demonstrates that such states of arousal make people far more likely to share information. For instance, when he had subjects jog in place for 60 seconds—Mr. Berger wanted to trigger the symptoms of arousal directly—the number of people who emailed a news article to their friends more than doubled. He also boosted levels of “social transmission” by showing his subjects frightening and funny videos first. “Levels of arousal spill over,” Mr. Berger says. “When people are aroused, they are much more likely to pass on information.”

This builds on previous work by Mr. Berger in which he analyzed 7,500 articles that appeared on the most-emailed list of the New York Times between August 2008 and February 2009. While Mr. Berger initially assumed that people would share articles with practical implications—he imagined lots of pieces on diets and gadgets—he discovered instead that the most popular stories were those that triggered the most arousing emotions, such as awe and anger. We don’t want to share facts—we want to share feelings.

This is what vegetarians and vegans have going for them. Emotions are very handy when you want to convert people to the cause.

The Paleo people think they have the facts on their side. But the most effective Paleo marketers tend to play on people's emotions, not on facts and information. Sometimes this comes at the expense of accuracy ("humans haven't evolved much in 10,000 years, and that's why the Paleo diet is best") or rigorous thinking.

I'd love to have both: facts and emotions. But it's important to know when to use one and then the other.

What I despise about the vegetarians and vegans is that they have the emotions down pat ("I don't feel good about killing an animal just so I can enjoy bacon") but they don't have the info ("Red meat causes cancer and it's so much more efficient to feed grains to animals than it is to humans").

How your gut bacteria keep you healthy (or sick)

This is entirely fascinating, from the always excellent Emily Deans. 

Lactobacillus and Bifidobacterium species are known to produce GABA.  Escherichia, Bacillus, and Saccharomyces produce norepinephrine.  Candida, Streptococcus, Escherichia, and Enterococcus produce  serotonin.  Bacillus and Serratia produce dopamine, and Lactobacillus species produce acetylcholine.  That's pretty much the entire hit parade of major neurotransmitters (there's histamine and glutamate and a few others - and histamine is known to be produced by some bacteria that infect shellfish, for example, causing food poisoning).   

What's clear is that gut bacteria affect our brain and vice versa. It's also clear that there are millions of other species of bacteria whose functions are entirely unknown to us. That's a scary thought.

Whenever someone talked about depression or other mental health issues as the result of "chemical imbalances" it used to make me cringe, since that sounds so appealingly pseudoscientific. But it's actually true.

Depression is largely unheard of in "primitive" cultures, and diet (as it affects gut bacteria) is one major pathway by which depression is modulated. Of course, having a great community, lots of sunshine exposure, etc. etc. etc. all helps, too.

One minute to a better you!!1!!111

From another column by the Heath brothers:

In One Small Step Can Change Your Life, Dr. Robert Maurer of UCLA's School of Medicine writes about his patient Julie, a divorced mother of two, who was 30 pounds overweight, depressed, and fatigued. He knew that the solution to her problems was exercise. He also knew that talking about thrice-weekly aerobics was likely to get him slapped. So he gave her a challenge: "How about if you just march in place in front of the television, each day, for one minute?"

That was the kick start she needed. One minute of low-intensity exercise did nothing to improve her health but everything to improve her attitude. When she came back for her next visit, she asked, "What else can I do with a minute a day?" Within a few months, as Dr. Maurer slowly stepped up Julie's challenges, her resistance to a serious exercise program disappeared.

The value of small, definable, too-easily-reached (?) goals.

Of course, I find it objectionable to say that the solution to her problems was exercise, much less aerobics classes... but let that go.

Commitment devices

Currently reading articles from the Heath Brothers and finding lots of good ideas in every column. This one is about commitment devices. E.g.,

A piggy bank is an example of a "commitment device" -- a way to lock yourself into an option you might otherwise dodge, like saving money, because you think it'll be good for you. One graduating Stanford business-school student used a commitment device to lock down his own career choice. As reported by Jim Collins in a Harvard Business Reviewarticle, the student wanted to start a company, but first he needed to pay down some debt. So he took a job at a big company, promising himself that he'd exit after five years and live his entrepreneurial dream. But he also worried about being seduced by the benefits-and-bagels comfort of corporate America. So he wrote a resignation letter, dated for five years into the future, and distributed signed copies to several people he trusted. His instructions: If I don't resign in five years, put this letter in the mail and do it for me.

In the gym, commitment devices are most often used by locking in the client to a certain set of behaviors or goals:

• If I don't lose 30 pounds by June 1, I will donate $1,000 to the Republican party (or whichever party you dislike the most).
• I will do 10 minutes of stretching every day for the next 30 days. If I fail, I will do something humiliating (like wear a funny outfit and do a workout in public).
• One of my favorites, from Dan John, I believe. The Aldo diet: I will lose/gain 20 pounds in six months. If I fail, I will eat a can of dog food. Highly motivating!

The Heath brothers suggest a couple of novel ideas that are based off of comparing shoulds and wants. The idea comes from a study on Netflix that showed that people put lots of highbrow movies in their queues (documentaries, foreign films) but they usually end up watching lowbrow movies (Die Hard, Transformers, Twilight) more often and moving them to the head of the queue.

Hence their idea for gyms:

For instance, exercising is a should, so what if your gym offered to receive your magazine subscriptions? That way, to read the new Vanity Fair (a want), you'd have to drop by the gym. ... It's a compelling idea: Might the future of business lie in encouraging shoulds rather than indulging wants? Could corporations help us bring out our better selves?

Also, here's an idea applicable to the business/administration side of things:

Norm Brodsky, an entrepreneur and a writer for Inc. magazine, runs a document-storage-and-retrieval business. He committed to taking four weeks of vacation a year, forcing himself to create systems that would allow his operation to run smoothly without him. He was successful, and since then, he has announced an even tougher commitment device: Now he'll take four months of vacation per year. This would appear to commit him to becoming French.

I can really see myself failing to plan for time off and making myself an indispensable part of the gym machinery, so I find very appealing the idea of forcing myself to design systems that run well in my absence.

Bad design: move-in day edition

Overheard in the hallway, tour guide talking to incoming freshmen and parents in a dorm:

"Our official move-in is Wednesday, but you can move in as early as Sunday. There's a $30 charge for each night, so that would be $30, $60, or $90. But I HIGHLY recommend moving in early. We love it when people move in early. It makes our jobs easier...."

It's almost like people don't understand what incentives are.

Knowledge does not change behavior

For my fifth year of college, I won a scholarship based on an essay I wrote about my passion for education and how education is vitally important for creating long-term, permanent change. I tried to avoid the clichés of teaching a man to fish, blah blah, but I did touch on how poverty is a vicious cycle that can't be broken without education.

Now, I'm not so sure that education is all that important. From an excellent article about combating malnutrition in Vietnam:
  

"Knowledge does not change behavior.... We have all encountered crazy shrinks and obese doctors and divorced marriage counselors."

Encapsulates perfectly the problems of educating clients. It's not enough to get them to understand. Actually, in some cases, making them understand is counterproductive. You have to get them to behave differently: behavioral economics + evolutionary psychology.

So what Sternin did was not lecture and educate, but organize and practice. He gathered the women with malnourished children and had them wash their hands and cook nutritious foods together.

The main point of the article is to demonstrate that the most effective way of solving problems is not to think about them academically and come up with a logical solution, but rather to see what works in the real world and copy/scale/adapt those pre-existing, grass-roots, organically discovered solutions. Sternin didn't know what to do until he went and visited all the households whose kids weren't malnourished (despite being just as poor as everybody else). He saw what they did, copied it, and had the additional genius to realize that education was not the answer.

How do you recognize a good coach?

You can't. Or at least, most people can't. They wouldn't really know the difference between, say, Cressey vs. me vs. the average globo-gym trainer. Most people's impressions of their trainers are predicated mostly on the trainer's personality and professionalism and looks, not their skills and knowledge.

But it's easy to recognize a bad trainer, even for the uninitiated.

Warnings signs (not necessarily 100% indicative of a bad coach):

• Doesn't regularly program squats, deadlifts, presses or pull (or some variation thereof) for most clients.
• Makes most clients very sore, very often. 
• Doesn't make clients sore, ever.
• Your program is predominantly on machines.
• Has a CrossFit Level 1 "certification" but no other qualifications, and has never coached anybody before getting their L1.
• Programs lots of crunches, but no planks or bird dogs.
• Does lots of curls on Bosu balls.
• Does lots of curls.
• Doesn't know most of these names: Cressey, Robertson, Hartman, McGill, Boyle, Dan John, Simmons, Tate, Wendler.
• None of the men can deadlift 2xBW despite training for >1 year. 
• None of the women can do pull-ups despite training for >1 year.

Note: most of these (although not all!) have applied to me at one point in time.

Actually, there is one rule of thumb for good trainers, but it's not really useful because the list is so small:

Anybody who's ever been excommunicated from CrossFit HQ is probably a good trainer.

It's not about carbs

A good diet is not necessarily a low-carb diet. It's a low-toxin diet.

Primary known toxins:

• excess sugar (particularly fructose?)
• excess linoleic acid (omega-6)
• wheat and soy
• trans fats

Similarly: a good diet is not necessarily a high-fat diet. It's a high-nutrient diet.

Some important nutrients:

• Fat-soluble vitamins ADEK
• Magnesium
• Zinc
• Selenium
• Omega-3 fatty acids
• Copper
• Potassium
• Other vitamins BCE
• etc.

The SAD is dangerous not because it's high in calories, or fat, or sugar, or salt. It's dangerous because it's high in toxins, substances (or quantities) that are outside the human evolutionary experience.

A Paleo or Primal diet is healthy, but not because it's low in carbs or high in fat. It's healthy because it's relatively low in toxins and relatively high in essential nutrients.

Macronutrients hardly matter at all. Evidence: Inuit and Masai high-fat diets vs Kitavan high-carb diets. Both are completely fine as long as you get lots of nutrients and avoid toxins. Keep the same macronutrient ratios and add toxins and subtract micronutrients, and you get a lot of very sick people.

Core message draft 02

• Most people are broken: overweight, chronic knee/hip/shoulder pain, diabetic, IBS, ulcers, acid reflux.
• You can fix all this and look sexier, feel healthier, and be fitter than you ever thought possible.
• You can have all this just by eating real food and training intelligently 1-2 hours per week.

The core of my message

Inspired by reading the first few pages of "Made to Stick: Why Some Ideas Survive and Others Die":

First draft:

• You can live pain-free again.
• You can be healthier, fitter, and sexier than you ever thought possible.
• You can have all this just by eating real food and training 1-2 hours per week.

Learned helplessness

Learned helplessness may be part of the reason that people fail to lose weight. They've tried so many different (ineffective) things -- low-fat, low-calorie, Weight Watchers, aerobics -- that they just kind of give up and accept their fate.

Just a thought... not really convinced on this one as it relates to weight loss.

Twins: distance runner vs sprinter

Just came across this photo of identical twins. Otto, on the left, trained as a distance runner. He is predictably scrawny and weak-looking.

Ewald, on the right, trained as a sprinter and thrower. He is nicely muscled. Yes, he is posing for the camera in the top picture, but the difference is stark. The bottom picture shows you a more natural pose that reveals the difference in the musculature of the upper back and shoulders. They are basically the same height but look at where their shoulders stand!

There's nothing wrong with being a distance runner if you are okay with being weaker and less useful -- not to mention less healthy and with a higher probability of osteopenia or osteoporosis in your future.

Distance running is also very healthy as a once-a-week activity.

But the vast majority of training should be geared toward sprinting and lifting.

I really wish we had a picture of female twins like this. Then women would see that being a sprinter doesn't mean being grotesquely muscled, unless you are an Olympic-caliber sprinter and you take steroids.

Takeaway from this, other than bashing distance runners: environment is way, way more important than genes.

Hat tip to Art De Vany for posting this photo originally.

Why people don't floss

Watched Kstar's presentation on sitting and mobility at Google a few days ago and was struck by the flossing analogy.

People know they should floss. They know that if they don't, their teeth may fall out and they may get gingivitis and systemic inflammation and it could kill them. But they didn't floss yesterday and they haven't died today and their teeth didn't fall out today, so they're not going to floss tonight, either. They don't feel the tangible benefit from flossing.

(As an aside, I do floss frequently but it's mostly because it feels good. And I remember my friend G saying something to the effect that he loves flossing because "it's like, man, THAT was in my mouth?!")

Fear-mongering doesn't work. It doesn't promote widespread adherence.

People need to see that doing X makes a tangible, immediate, noticeable difference in their lives.

This is why it's so important to get ppl to realize that it takes very little effort and very little time to get to that advanced novice phase, where you're healthier and stronger and fitter than 80-90% of the population. In some people it may take as long as 6 months but in other cases it can be 3-4 months with as little as 2 hrs per week invested.

It's easier to encourage adherence by convincing ppl that they won't have to worry about their IBS acting up while on a date next week, than to convince them that avoiding linoleic acid and gluten will prolong their life and lower their risk of cancer.

It's easier to encourage adherence by pointing out benefits such as clearer skin, reduced/eliminated joint pain, than "this will align your joints" or "this will reduce systemic inflammation." Make it tangible, real, immediate.

4% of calories as PUFA or 15%?

Some Eskimos in their sample got as much as 15% of calories from EPA+DHA.

From the (ongoing) fascinating series over at Perfect Health Diet on total serum cholesterol in hunter-gatherers.

So much for the idea that 4% of calories as PUFA is the upper limit that we should aspire to?

Getting 10% of calories from linoleic acid is probably a terrible idea, and getting lots of omega-3 from potentially rancid, isolated, industrially produced fish oil is probably a terrible idea (although Robb Wolf and Dan John and Poliquin and a few others still seem to be keen on megadosing fish oil, at least for a few weeks/months).

I wonder if getting 15% of calories from actual marine animals is not that bad after all, or at least not as bad as getting 10% of calories from soybean oil.

Chronic pain affects 116 MILLION Americans

Wow.

The report, mandated by the healthcare overhaul law, estimates that chronic pain costs between $560 billion and $635 billion each year in medical expenses and lost productivity.

I guess that's job security for me.

From the LA Times.

Why Paleo isn't working for you

1. You're not eating Paleo. You're eating Faileo: processed meats, lean protein, canola oil, "Paleo pancakes" or "Paleo gluten-free banana bread."
2. You haven't given it enough time.
3. You're not sleeping enough or early enough or well enough.
4. You are eating all muscle meat and no fatty organs.
5. You've got some other health issue going on that can't be resolved 100% through diet: low-grade infection, systemic inflammation, some auto-immune component, whatever.
6. You've truly spent too much time fucking up your metabolism and you can't heal it 100% now, no matter what you do. Sucks, doesn't it?
7. Who knows, maybe it's just not right for you. Try something else and see what happens. If that works better for you, fuck Paleo. <-- this is what distinguishes us from the goddamn vegans who say that if your health gets worse on a vegan diet, you're "doing it wrong." No. Sometimes your health gets worse even if you do everything "right." Then it's time to try something else in practice, not beat yourself up for not being perfect in theory.

open letter on cholesterol

Dear XXXXX,

I promised you some info on cholesterol, fat, and heart disease. I apologize in advance for the large amount of information at once, which may be overwhelming, confusing, and perhaps unhelpful. (I actually trimmed this down from an even longer draft, if you can believe that.)

If you want to learn more, I'd be happy to send you more information. Please feel free to ask questions if you have any. Cholesterol is a very confusing substance and frankly, most medical doctors do not have a clue about it (in my humble and non-expert opinion).

Some of the links below to peer-reviewed journal articles may not work for you, since I have access to those articles through IU. If you want a copy of an article you can't access, just let me know.

Best regards,

Jae

Eating Cholesterol does not raise serum cholesterol -- the 1955 peer-reviewed article that demonstrated that increasing dietary intake of cholesterol has an insignificant impact on serum cholesterol in (adult male) humans. Humans self-manufacture the vast majority of the cholesterol they need. Why do the AHA, ADA, ACS all tell us to limit our cholesterol intake? It makes no sense. (The article was actually written by researchers who were trying to prove that eating cholesterol is harmful. When they discovered that it wasn't, they modified their hypothesis to say that eating fat, especially saturated fat, was harmful because it elevated serum cholesterol.)

"What if it's all been a big fat lie?" -- the NYT Magazine article by Gary Taubes, award-winning science journalist. Great summary article about major questions behind the idea that dietary fat causes heart disease.

The French Paradox: French people eat more saturated fat and yet have lower rates of heart disease.

The Israeli Paradox: Israelis eat a lot more polyunsaturated fat, which is supposedly healthy because it lowers serum cholesterol. But they have the highest heart disease rates in the region.

The Diet-Heart Hypothesis -- a great blog post dissecting the lipid hypothesis. The author, Stephan, has a PhD in neurobiology but his passion is nutrition, and his posts are always well thought-out. In the past, some people have told me that they don't take my claims seriously because I keep linking to this blog and not to peer-reviewed articles. I hope you can see that 1) he cites peer-reviewed articles in his blog and 2) the level of thinking he exhibits is far greater than what you see in typical peer-reviewed articles on nutrition science.

Subdividing Lipoproteins -- a blog post by the same guy, about research on saturated fat and its impact on cholesterol profiles. Sat fat seems to improve cholesterol overall. The surprising conclusion is that eating saturated fat is probably the best way to improve your cholesterol profile, in direct opposition to what the AHA suggests. Now, the French/Israeli paradoxes are starting to make more sense.

Most cardiac patients have low or normal LDL. Then why do doctors insist on measuring it and prescribing statins if LDL is high? The article's conclusion is that "well, our guidelines for LDL may be too high. We need to push the LDL guidelines even lower." I think this is completely wrong. LDL is not a good indicator of heart disease risk, period. This makes more sense in light of the blog post above regarding "Subdividing Lipoproteins."

Did you know that most blood tests don't even measure LDL? They calculate it through a (sometimes wildly inaccurate) formula.

Forty eight (!) studies demonstrating that in the elderly, higher cholesterol is associated with lower mortality. (The site is in Portuguese but the studies are summarized in English.) Okay, so lowering your cholesterol might lower your risk of heart disease (although I think not); but what's the good if it increases your risk of dying from cancer, Alzheimer's, and other chronic illnesses? Personally, I'd rather die of a heart attack than after a prolonged and painful fight with cancer. (For info on cholesterol and Alzheimer's see the bonus section at the bottom of this email.)

Women may not benefit from statins. From the always dubious TIME magazine (although they happened to get this mostly right, in my opinion): "Yet there is little evidence that [statins] prevent heart disease in women. In past research, statin therapy has been shown to prolong the lives of people with heart disease. It has also been shown to stave off the onset of heart disease in healthy at-risk adults. But researchers who have broken out and analyzed the data on healthy female patients in these trials found that the lifesaving benefit, which extends to men, does not cross the gender divide. What's more, there's evidence that women are more likely than men to suffer some of the drugs' serious side effects, which can include memory loss, muscle pain and diabetes."

A peer-reviewed study on women and statins:Drug Treatment of Hyperlipidemia in Women: "Conclusions  For women without cardiovascular disease, lipid lowering does not affect total or CHD mortality. Lipid lowering may reduce CHD events, but current evidence is insufficient to determine this conclusively. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total mortality."

Here's one that may be of particular interest to you: Japanese subjects with total cholesterol higher than 240 mg/dL have the lowest risk of overall mortality (PDF, 2.2 mb). Particularly interesting for you may be this sentence: "We suggest that Japanese subjects with cholesterol levels ≥ 240... should not be regarded as hypercholesterolemic or dyslipidemic except when having some genetic disorders like familial hypercholesterolemia because they are in the safest ranges in terms of all-cause mortality." How confident can we be that a TC of 250 or even 300 is pathological? Not very.

Coronary heart disease is extremely rare -- nearly unheard of -- in "primitive" populations that do not eat industrially produced foods (processed food, sugar, trans fats, industrially produced "vegetable" oils such as corn oil, soybean oil, canola oil). Links:

Ischemic Heart Attacks: Disease of Civilization
Masai and Atherosclerosis
The Kitavans: Wisdom from the Pacific Islands


If you really want to dig deeper into a reputable source who has done research on cholesterol, I'd recommend checking out Gary Taubes's Good Calories, Bad Calories. He also has a shorter book called Why We Get Fat, which presents the same ideas and more research, but in language that is easier to read. In these books, Taubes criticizes the conventional medical thinking on cholesterol, fat, obesity, and heart disease (loosely speaking, the "lipid hypothesis"). He also presents his own ideas about what is really going on: the carbohydrate hypothesis. I happen to think that the carbohydrate hypothesis is incorrect, or at least very incomplete. However, his criticisms of the lipid hypothesis (and the related "diet-heart hypothesis") are excellent.

------
In summary:

I think the idea that serum cholesterol causes heart disease is probably incorrect. Cholesterol is probably more like the firefighters who are dispatched to the fire. Elevated LDL is not a cause of heart disease. It is probably a marker of something else that has gone wrong in your body. The best hypotheses we have now are that it is a sign of inflammation or of oxidizative damage. LDL is your repair staff, not your body's attempt to kill you.

I think that statins are frankly dangerous and do more harm than good for the vast majority of people who take them, especially women who have never had a cardiac event.

If there is any marginal benefit of taking statins (for men), it is probably due to the statin's anti-inflammatory effect. You can get the same benefit (actually much  more) from avoiding inflammatory foods -- namely, industrially produced vegetable oils, trans fats, sugar, wheat. (I suppose wheat is more of an agricultural product than an industrial one. Still, it tends to be pro-inflammatory.) The traditional Masai do not take statins, and they subsist on a high-saturated-fat and high-cholesterol diet. Same goes for the traditional Inuit. And the Tokelau. And their rate of heart disease is near zero. And it's not just genetics, because when these people start eating more industrialized foods, they start getting heart disease just like us.

Please keep in mind I am not a medical professional and am not qualified to give medical advice. However, as a person of reasonable intelligence who has read a lot of research that most medical doctors have not, I think it is reasonable to question whether the current medical thinking on cholesterol and statins is wholly incorrect.

Some of the evidence presented here is rock-solid, while in others it is more controversial (e.g., in the articles on dementia and suicide, below). If you look for confounding or contradictory evidence, you will find it, and I encourage you to do so.
My goal is not to show you that my ideas about cholesterol are correct, but rather to demonstrate that the evidence behind the demonization of fat/cholesterol is weak and inconclusive at best, not incontrovertible as the AHA, AMA, ACS, ADA and the other abbreviated agencies would have you believe.

-----
Bonus links: I almost didn't include this because this email is already too long, but it's important information:

Low serum cholesterol is linked with dementia in hundreds of studies, as well as with depression, suicide, violent behavior, and even increased risk of deaths from accidents. Your brain needs cholesterol to function properly. Taking statins to lower cholesterol may increase your risk of Alzheimer's as well as other unpleasant things. Links:

Depression: Association of low serum total cholesterol with major depression and suicide.

RESULTS: Low serum total cholesterol was associated with low mood and subsequently a heightened risk of hospital treatment due to major depressive disorder and of death from suicide. CONCLUSIONS: Our resultssuggest that low serum total cholesterol appears to be associated with low mood and thus to predict its serious consequences. 

Suicide: Low serum cholesterol in suicide attempters

Cholesterol concentrations in suicide attempters were found to be significantly lower compared with both psychiatric and normal controls, when sex, age, psychiatric diagnosis, and physical conditions (serum total protein and red blood cell count) were adjusted for. This significant relationship was observed in mood disorders and personality or neurotic disorders, but not in schizophrenia spectrum disorders. These results support the previous claim that lowercholesterol level is associated with an increased risk of suicidal behavior.

Violent behavior: Cholesterol and violence: is there a connection? This one is especially interesting because the data include experimental studies (meant to establish causation rather than mere association).

DATA SYNTHESIS:

Observational studies (including cohort, case-control, and cross-sectional studies) consistently showed increased violent death and violent behaviors in persons with low cholesterol levels. Some meta-analyses of randomized trials found excess violent deaths in men without heart disease who were randomly assigned to receive cholesterol-lowering therapy. Experimental studies showed increased violent behaviors in monkeys assigned to low-cholesterol diets. Human and animal research indicates that low or lowered cholesterol levels may reduce central serotonin activity, which in turn is causally linked to violent behaviors. Many trials support a significant relation between low or lowered cholesterol levels and violence (P < 0.001).

CONCLUSIONS:

A significant association between low or lowered cholesterol levels and violence is found across many types of studies. Data on this association conform to Hill's criteria for a causal association. Concerns about increased risk for violent outcomes should figure in risk-benefit analyses for cholesterol screening and treatment.

Dementia and Alzheimer's: too many to wade through, but here's one article:

Twenty-six-year change in total cholesterol levels and incident dementia : The Honolulu-Asia aging Study

Results: Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents. Conclusion: A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.

sketches for how to think about fitness

1. Keith Norris's excellent graph on health vs fitness as an introduction to where most people are, where most people are interested in getting to, and where most fitness "trainers" doom their clients to hanging out. How most people want to maximize health with minimal effort, and they really don't understand how little effort it takes. 1-2 hrs a week is all it takes to get to the end of the easy gains. 1-2 hrs a week is all it takes to maintain that for life.

2. The Paleo template/heuristic as a useful way to start thinking about food. If it's wildly outside your evolutionary heritage, chances are it's not good for you. Paint this picture with examples from wild vs. zoo animals, then talk about zoo humans, then talk about exceptions.

3. Why I don't trust trainers and dieticians who talk a lot about macronutrients. Carbs are not carbs. Carbs from fruit != carbs from HFCS != from tubers != grains and legumes.

In fact, even among the grains, carbs from wheat != carbs from rice.

4. How mind-bogglingly complicated nutrition can be. High HDL is probably good except in certain cases where it may be indicative of inflammation. Omega-3 fish oil is great but it oxidizes easily. Excess fructose is harmful but fruit is probably okay unless you are already metabolically deranged.

5. Don't trust anyone who is very confident about vectors of causality.

6. Feel pretty good about #1 but the others need to be distilled down to basic principles.

7. I know more about cholesterol than your doctor does. And I know very little. That should scare you. Doctors never discuss:

High TC linked with lower overall mortality
Low LDL linked with large numbers of cardiac cases
Even among doctors who understand the need to screen for LDL profiles, they don't entertain the idea that small dense LDL may not be causative of heart disease but rather a marker of something else going wrong.

High-fat vs. Horrible-fat

Tom Naughton just skewered some "high-fat" studies done on mice and rats and came up with this very useful phrase:

A “Western” diet for rodents based on AIN-93G, providing 30% of fat from lard, 30% from butterfat, 30% from Crisco (hydrogenated vegetable oil), and for EFA, 7% from soybean oil and 3% from corn oil.  Approximate energy from fat 40%, carbohydrate 44%, protein 16%.

That’s not a high-fat diet by my standards — I probably get 60% of my calories from fat– but it’s certainly a high horrible-fat diet.  Of the fat calories, 40% come from hydrogenated oil, corn oil, and soybean oil.  In other words, oils that wouldn’t exist without the wonders of industrial extraction.

 (bolding is mine)

Emphasizing quality over quantity is one of the basic tenets of "the Paleo template" (another useful phrase, coined by Chris Kresser).

I've been thinking similar things about carbs (it's not high-carb diets that are harmful, it's the kind of carbs that matter) but Naughton's phrasing is exactly right.

Dan Gilbert: people are terrible at figuring out what makes them happy

From his TED talk:

if you were to go into a wine shop and you had to buy a bottle of wine, and you see them here for 8, 27 and 33 dollars, what would you do? Most people don't want the most expensive, they don't want the least expensive. So, they will opt for the item in the middle. If you're a smart retailer, then, you will put a very expensive item that nobody will ever buy on the shelf, because suddenly the 33-dollar wine doesn't look as expensive in comparison.

 So in price sheets we should put some outrageously expensive option for private training.

Another, bigger issue for a future blog:

Well, the question with which I'd like to end is this: If we're so damn stupid, how did we get to the moon?Because I could go on for about two hours with evidence of people's inability to estimate odds and inability to estimate value.

The answer to this question, I think, is an answer you've already heard in some of the talks, and I dare say you will hear again: namely, that our brains were evolved for a very different world than the one in which we are living. They were evolved for a world in which people lived in very small groups, rarely met anybody who was terribly different from themselves,had rather short lives in which there were few choices and the highest priority was to eat and mate today.

The issue is that many people will screw up in figuring out their priorities in diet, training, etc. because they will underestimate the value of doing so for the future, and overestimate the value of eating that pizza or brownie today.

Bernoulli's gift, Bernoulli's little formula, allows us, it tells us how we should think in a world for which nature never designed us. That explains why we are so bad at using it, but it also explains why it is so terribly important that we become good, fast. We are the only species on this planet that has ever held its own fate in its hands. We have no significant predators, we're the masters of our physical environment; the things that normally cause species to become extinct are no longer any threat to us. The only thing -- the only thing -- that can destroy us and doom us are our own decisions. If we're not here in 10,000 years, it's going to be because we could not take advantage of the gift given to us by a young Dutch fellow in 1738, because we underestimated the odds of our future pains and overestimated the value of our present pleasures.

Just as ppl underestimate the odds of getting cancer in the future and overestimate the value of junk food today.

Notes from Robert Cialdini's podcast on persuasion

Fascinating podcast with transcript available. Lots of great ideas for persuading people to join a gym, sign up for personal training, commit to a nutrition plan, whatever. 

6 basic principles:

1. reciprocity -- do something for them before you ask them to do something for you. Don't say "if you buy this, I'll donate 10% to a charity." Say "I've ALREADY given this money to charity -- now will you buy this for me?" The order is important.

Amplify the effect by personalizing the thing we give to that person. Not a generic gift to everybody.

Find ppl you can help out. Figure out what you can give them that is personalized.

Ben Franklin; ask your rival to lend you a book. As soon as they've done it, they say to themselves, I just lent a book to this guy. He's not so bad after all. When you return it, say "Thanks -- great book -- maybe we could talk about it sometime. Oh, and here's a book you'd like." They have to think "wait a minute, why would I go out of my way to help this person? He must not be so bad" and now you've created an opportunity that was previous a dead-end.

2. scarcity -- the iphone and the Wii for example. Great products, but the reason ppl lined up in sleeping bags in Nov was because of scarcity. scarcity can be a function of time -- for a limited time only! it can also be an issue of framing: real estate uses this all the time: this is the last house in the neighborhood, not gonna last long.

3. authority -- tell ppl why you're qualified

4. consistency -- ppl will try to be consistent with what they've said they'd do. Before delivering any recommendations: Get ppl to speak and to write down their priorities, their values, and their goals -- because people want to live up to what they write down. Super important for client intakes, especially for fat loss, adherence, compliance. Get them to write down what their goals, their priorities, and then match those priorities with a fitness/nutrition plan so they'll be more likely to succeed.

5. liking -- if they like you, they're more likely to say yes. 3 simple things to increase the rapport before we try to influence: 1. identify similarities. commonalities (hobbies, values, shared struggles). 2. give genuine praise where they deserve it. 3. identify opportunities for cooperative goals where we can work toward mutual purposes (work together on fat loss goals).

6. consensus. give them evidence that ppl just like them have been saying yes to it. ppl don't want to be outliers. ppl don't want to go against the wisdom of the crowds of ppl just like them that have already said yes. TESTIMONIALS are important. the more you can provide, the more similar the voices of those testimonials to the target market, the more effective. Prioritize the video testimonials from ppl who dress, talk, look like the ppl of your target audience.







Misc notes:
 
The one word that can increase sales 50%: "Because" -- ppl need REASONS for what they do. Study involving a copier "may I cut because I'm in a hurry?" 94% agreed. "Can I jump ahead to use the copier?" 63% said yes. "Can I use the copier b/c I need to make copies?" 93% said yes even though the sentence provides a nonsensical reason.


When people are UNCERTAIN, the three principles that are most potent:

scarcity
authority
consensus (social proof)


The moment of power: when someone says "Thank you," that is a moment of power offered to you. You don't say: "yes, now you owe me one." You say, "I was glad to do it. You'd have done the same for me." You frame that moment to empower you for a future moment. "Of course, it's what partners do for one another."


Notes from other Cialdini interviews:

Motivating people in the middle

Interesting study that demonstrates that people might retain motivation better if their progress is framed in certain ways. Basically, if they're just starting out on something, measure their progress in terms of how far they've come. If they're nearing the end of a task, measure their progress in terms of how much work remains. From Psychology Today:

In a final study, the authors looked at people's motivation to do a boring proofreading task.  They had to proofread 9 documents.  Some people got a progress bar showing how many they had done so far.  Some got a progress bar showing how many documents were yet to be completed.  A third group knew that they were going to do 9 essays, but they just had a marker showing where they were in the task.

 The group that had a progress bar showing how far they had come from the start was most effective at proofreading (as measured by the number of typos they found per second) when they were near the beginning of the task than as they progressed.  The group that had a progess bar showing how much remained to be done was most effective as they neared the end of the task. 

 And in the middle? 

 Of interest, the group that did not have a frame of reference that focused on either the beginning or the end of the task was effective on the first few and last few documents, but performed worst in the middle.

Give them regular feedback at smaller intervals to keep them motivated.

Lots of implications for fitness clients, weight-loss goals, and everyday life in general.


I remember talking to a friend who said that he'd come up with an idea for a gym that would function essentially like Chuck E. Cheese -- where clients would earn tickets or tokens for completing their workouts (or for running a certain number of miles, say), and then they would be able to cash in those tickets for prizes (like shirts and water bottles). 


I think there are some problems with this model, since I want my clients to be intrinsically motivated (mostly), but I think the larger concept is useful. People like frequent feedback; they like milestones and landmarks; they do better with concrete rather than abstract goals. 


If you can only do 1 pull-up, setting a goal of being able to do 40 is daunting. It would be better to set a goal of doing 5, then 10, then 15, and so on... -- and celebrate those milestones in some tangible way. We need an adult equivalent of getting a gold star next to your name in kindergarten. Sounds silly, but it can be powerful. 

Priorities

With food, the most important things to do in (approximate) order, no matter what your goals are:

1. Stop eating toxins. In rough order of importance from high to low: 
• junk food, processed food, and trans fats (usually these are a package deal)
• seed/vegetable oils
• sugar
• wheat and soy
• other grains and legumes
• dairy (for some people)
2. Sleep adequately. This means 8+ hours a day for most people.
• Most people will put this lower on their list or leave it off altogether, since sleep isn't directly linked to nutrition -- or is it? 
• Chronic sleep deprivation has a greater impact on long-term health, fat loss, and cancer prevention than any of the items that follow. 
3. Improve the quality of the food you do eat (switch to pastured meats, wild-caught fish, local/organic produce, add or increase intake of organ meats).
4. Supplement minimally and only as necessary (magnesium, vitamin D3, possibly zinc, selenium, vitamin K2, small doses of cod liver oil, etc.)
5. If and only if 1-4 are satisfied, then you can move on to tinkering with macronutrient ratios, macronutrient timing, intermittent fasting, more supplements, and so on. 

This can basically be distilled down to "Eat Real Food Only (and get lots of sleep)."

With exercise, the most important things to do in order, from the perspective of long-term health, longevity, and quality of life:

1. Stop being sedentary. Even the worst, most poorly designed exercise program is better than sitting on the couch watching TV. Daily walks are an excellent place to start.
2. Stop sitting all day. This is a corollary to #1. Basically, sitting all day is the equivalent of not sleeping enough. It seems harmless, but it is a huge cause of chronic pain, muscle loss, and fat gain. 
3. Rehabilitate any chronic injuries and resolve chronic pain through mobility/stability/posture training. 
• A good physical therapist is invaluable, but hard to find. In my experience, most PTs are a waste of time and money, and good PTs are rare. If you find a good PT, you should see him or her as often as you can afford it. 
• Daily mobility work is a must. MobilityWod.com is one of the best places to start for beginners who don't know what they are looking for (and it's free!). 
• If you have serious joint issues or chronic pain/injuries, and are serious about resolving them, I would highly recommend visiting a gym like IFAST or Cressey Performance and getting a personalized assessment and program. Do this even if you have to fly across the country to get there. 
4. Develop some basic strength. 
• Starting Strength alone will be better than 90% of fitness programs out there. (Yes, it's better than P90X and CrossFit.) Buy the book. It will be the best $30 you've ever spent on fitness. 
• Any reasonably healthy adult male under the age of 50 should, at minimum, be able to 
• back squat 1.5x his bodyweight, 
• deadlift 2x his bodyweight, and 
• do 5-10 dead-hang chin-ups, 10-20 push-ups -- all with perfect form.* 
• This should take around 1-6 months to develop for most people, with exceptions for morbid obesity and orthopedic issues. These will arguably be the most important 6 months of your training career, in terms of potential impact on long-term health and quality of life. If you can squat 1.5x your body weight at the age of 75, you are not going die in a nursing home. 
5. Do some conditioning ("cardio") that doesn't interfere with #3. 
• Short intervals of skipping rope, hill sprints, rowing, prowler/car pushing, etc. 
• CrossFit-type workouts can be useful here, but only if they are intelligently programmed and kept short (under 10 minutes, preferably under 7 minutes). The majority of random CF workouts that you'll find on the web do not fit this pattern, so do not go this route if you do not know what you are doing.
6. If and only if 1-5 have been satisfied, move on to more specific goals (sport-specific goals, competition, body composition**).

*These are conservative benchmarks. For adult women, I'm guessing:

• BS 1xBW, 
• DL 1.5xBW, 
• 1-3 DH chin-ups, 5-10 push-ups (not on knees). 

**For most people, body composition is their #1 priority when they sign up for a gym. As a trainer, my job is to figure out how I can accomplish this enough to make you keep coming back, without sacrificing too much of the more important items above (mobility, stability, strength). Luckily, strength training actually does a great job of improving body composition anyway, if you can get your client to just shut up and do it.