Constrained Carbohydrate Common Denominators

It has been clear for some time that the direct and indirect costs associated with diabetes and related metabolic disorders, heart disease, Alzheimer's, cancer, etc. are outstripping any conceivable economic growth and are a a truly systemic threat.   To many of us, reversing many of the misguided notions of nutrition, reinforced by the agricultural and pharma industries, that have dominated the past 30yrs is key if there is a hope to counteract this trend on a global scale.

But what is the right approach?  Decision support is always a tricky trade-off between complexity and adoption. People need tools to make decisions about their diet but the tools that are optimized and capture the most idiosyncratic variation may not be the ones that have the most broad impact.

If you look across the Primal/Paleo/Perfect-Health/Rosedale/Whole30/DeVany/Taubes/Eades etc. guidelines there is a lot of commonality but a significant amount of variation, mainly coinciding with incomplete empirical evidence or where the underlying processes are still unknown leading to multiple consistent interpretation of the same experiment.  In any case, the proponents and followers of these approaches are likely to be significantly more intrinsically curious, educated, economically successful,  and fascinated by the challenges of  n=1 experiment, analysis and interation than the average population.   Many people involved in these communities have experienced first-hand the acute effects of metabolic damage and were highly motivated and equipped to solve their personal problems.

All the frameworks start off seeming very straightforward as far as approximate macro-nutrient guidelines, approved and disapproved foods, supplementation, exercise and other behavioral guidelines.  But under closer examination and experience, all sorts of fine tuning becomes desirable.  Some of this is very natural as the needs of a severely metabolically challenged obese person, vs someone just trying to maintain weight at a  comfortable level are different.  But then the question of objective function becomes more and more prominent: is it weight loss, general health and disease avoidance, longevity, reproductive success?  And of course it is logical to think that one's personal history to date has a significant impact on what nutritional tweaks are most effective.

Although the cost issue has gotten a fair amount of attention and some debunking, it also seems unavoidable that the diets mentioned above are expensive to execute and maintain.  Whether it is dependence on grass-fed meat, supplementation, protein bars, access to organic vegetables, or simply the time to analyze and make good choices,  these are luxuries of the developed world and perhaps only the economic elite thereof.

So the question is, what are the broad messages that can be extracted from all the epidemiology and great analysis that have been done in response to the current crisis.  Fortunately we can hold up hope that more general and compelling principles/guidelines/explanations will emerge from the data in coming years as these movements intensify.   But change needs to be implemented immediately and thus we need to isolate a few principal components (in statistical terms) of our current state of knowledge and use these as the basis for a general message.  This will not be sufficiently precise, optimal or 'perfect' enough for sophisticated practitioners but are intended to maximize impact on mass behavior.  The most important success criteria is that the guidelines can be applied practically at the largest possible population.

There are many different ways of tackling the problem and we are deliberately ignoring the complicated interconnections and nuances of cause and effect.  The point is to get results. Should inflammation be the primary focus, or is it avoiding insulin resistance or leptin resistance ?  Are there acceptable protein and fat sources that can be produced at the necessary scale ?  Should we be looking for a macro-nutrient oriented food pyramid or a few simple 'don't eat this' (eg Fructose) rules.  Are there candidate diets that fit the bill.  As an example, consider the popular Zone diet?  The amount of carb allowed and the fat avoidance compared to most of the diets mentioned above may make it unappealing to some... but maybe it is more practical for most people to limit high glycemic load foods, and not try to navigate the delicate balance of maintaining satiety with the right fats while severely restricting carbs.

We would love to get comments and suggestions.

Carb Addiction Part 3 -- filling the 'gap'

Apparently as drugs have moved out of improving neighborhoods, the carb pushers have rushed in to take their place.




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Upper West Side Momofuku Milk Bar Certified Open

•   Posted by Niko on September 24th, 2011

   
  

  
  

  The menu for the Upper West Side Milk Bar

   
  

  Updated: Sunday, September 25, 2011: David Chang’s Upper West Side Momofuku Milk Bar is now open.
  As I watched the line grow outside the shop on Sunday morning I had a thought about how much things have changed in NYC over the last 25 years. In the 1980’s (and even into the early 1990’s) they also sold “crack pies” on this corner of West 87th Street, although minus the “pie” part. Now, people line up to pay $5 for a thin slice of dessert or $6 for soft serve made from cereal milk. Crazy.

   
  

  

   
  The sign and the paper menu says “Open Every Day”.  They were serving croissants (pistachio) and cookies (compost, blueberries & cream, cornflake & marshmallow and corn), buns (pork, veggie) soft serve, pies by the slice, etc.  561 Columbus Ave at 87th Street.

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And related

Amid increasing concern about the health impacts of sugar overconsumption, and particularly the addictive qualities of sugar, the first annual Sugar Addiction Awareness Day (SAAD) is kicking off October 30, 2011. The effort, supported by many leading physicians, researchers, nutritionists, and obesity experts, promotes a fun but sugar-free Halloween and aims to raise awareness of the potentially dangerous, and addictive, effects of excessive sugar consumption, especially for young people.

“Halloween candy seems like an innocent treat, but the reality is that millions of Americans are hooked on refined sugars, and it starts in their youth,” Jill Escher, founder of SAAD and author of the book, Farewell, Club Perma-Chub: A Sugar Addict’s Guide to Easy Weight Loss. “Chronic sugar consumption is a big contributor to the sweeping epidemics of obesity, metabolic syndrome and diabetes we see today. I am excited to stand with many leading lights in supporting Sugar Addiction Awareness Day as a big step forward in helping people break the cycle of sugar dependence.”

"The trouble with fructose: A Darwinian perspective" by Robert Lustig, MD from Ancestry on Vimeo.

Decisions under uncertainty: expectations, capital and an unfortunate current example

This is not a political site and we are not interested in making political or moral statements.  But we are deeply interested in how people and societies make decisions under uncertainty.

Theoretically one needs to account for both the expected value of the strategy and some cost of carrying uncertainty, as long as it persists.

What is the value in an execution?  Accepting the eye-for-eye 'logic' for a moment we have:

• Pright = probability guilty verdict is correct
• Cost of original crime = -1.0
• 'Value' of imprisonment to date = +0.25  (22 yrs)
• Incremental value of immediate execution =   0.50 
• 'Value' of imprisonment for rest of life = ?  = 0.25?
• Cost of being wrong and executing =  large negative (Let's be generous to the eye-for-eye perspective and call it -0.50 and neglecting the immense  societal costs.  We will also neglect the societal costs- if any- of life imprisonment when death-penalty was 'justified'.)

So for the execution strategy
      Expected value =  -0.75 (current state) + Pright*(0.50)+Pwrong*(-0.50)

For the don't execute strategy
      EV = -0.75 +0.25

So, to make execution a good decision (better expected outcome) we need
     -0.75+Pright(0.50)+(1-Pright)*(-.50) > -0.5    

                                            or    Pright>75%

So even on an expected basis we need to be very certain the verdict is correct.  Moreover, if one introduces the a more realistic assessment of the damage to the justice system and society of being wrong, the need for certainty will be greatly increased.

For instance:
if Cost of being wrong and executing = -2.0 we need to be 90% certain.

When the cost of uncertainty 'capital' (say, proportional to the standard-deviation of the payoff distribution)-- which will accrue until conclusive evidence is discovered is brought into the picture-- the demands on Pright will be higher still.

So even if one accepted the death penalty from a moral perspective, given the dubious nature of the legal case, it seems that a very bad decision was made.

Coexistence of food reward and carb theories of obesity? pt 2

Our own observations and reading of the literature strongly support the hypotheses that:
1. significantly reducing carbs, especially wheat and sugar leads to weight loss
2. wheat and sugar can have severe adverse health consequences, especially when excessively consumed

That said, obesity as a macro phenomenon (no pun intended) seems obviously a result of behavioral and fundamental biological factors. (Behavior is highly influenced by biological factors as well as other sensory inputs but is an emergent phenomenon). If food reward factors contributes significantly to high carb intake, then it seems reasonable to see the increase of availability of highly palatable food as a major "cause" of obesity.

It has been argued that, absent any other serious health conditions, one cannot become obese without eating a high carb diet.  This may be perfectly true but is it a sufficiently useful conclusion if it requires the caveat that “high” needs to be defined individually based on their genetics, individual history, and level of food addition (people who are following an on-average low carb diet who occasionally binge may do more damage to themselves than people on a higher average carb diet– negative convexity!)

So it seems that the debate boils down to whether the complex system involved has some natural regulation so that the behavior associated with food reward are only associated with high carb intake or whether other factors can significantly contribute to and perhaps exacerbate the food reward behavior.  It is generally assumed that there is effective regulation and so something has to fail (metabolic damage) in order to transition into the vicious cycle of weight gain and food reward.  However, this failure may be an abstraction in itself: perhaps there is a range of regulation effectiveness across the population and by moving into a new regime of food consumption we are seeing that variation in the form of the ‘obesity epidemic’. Alternatively one could hypothesize that on an individual level regulation is only effective within some range of inputs. When the frequency of exogenous shocks to consumption (of something) crosses some tipping point, the market feedback effect of making more highly palatable food leads to a systemic effect.

Our overarching point is that it may not be very fruitful (another unintentional pun) to try to isolate food reward from carb consumption as an underlying cause as they may reinforce each other in very complex ways.