The Skinny on Obesity

Here is a great new video series from UCTV that gets it when addressing the obesity epidemic our country is facing. The series does not have all the answers but it does touch on most of the core issues that prevents physical health and wellness. We need to tap into the biological mechanisms that optimize our health and drive away . . . so have fun watching. I will add the rest as they are released.

Part 1:

Part 2:

Is the U.S. Healthcare system the best?

The simple answer is no. The U.S. healthcare delivery system can be separated into two areas to further clarify this answer: acute care and prevention.

The first: In the arena of trauma, acute onset of illness, and other unexpected or unanticipated emergent situations, our healthcare system can be very efficient and effective. We excel at moderating mechanical, chemical, structural, and functional acute dysfunctions such as 3^rd degree burns, drug overdoses, and fractures as just a few examples. There are very complex strategies designed to address large-scale events such mass injuries (think freeway pile-up), terrorist attacks, and natural disasters (CDC, 2012). 

The second, prevention: That is another story. The answer is complex and convoluted due to the great array of involved parties, opinions, and perspectives. What we do know is allopathic medicine does not generally consider optimizing naturally occurring biologic homeostatic mechanisms to moderate the vast myriad of physiological dysfunctions.

What appears to be happening with America’s collective health problems that are associated with complex symptoms such as obesity, heart disease, and cancer is a comorbidity co-occurring with accepted standard treatment modalities. Pathways commonly used in allopathic treatment may precipitate the problem. They shortsightedly target clinical manifestations of underlying condition(s). This type of symptom response does not address etiological factors and the treatment may cascade dysregulation to other systems.

Two examples: depression and heart disease. Antidepression medication and statins are two of the most commonly prescribed drugs in the U.S. (DeNoon, 2011). The overall data concerning efficacy of anti-depression medication is only 50% (Moncrieff, 2005). That means that 50% of people taking antidepressants are receiving no clinical benefit. Circadian rhythms, diet and environment all play important roles in depression and rarely are part of the treatment process when a 25-dollar copay will suffice. They also play important roles for statins.

Speaking of statins: A closer look at this preventive measure elucidates no reduction in mortality rates for healthy people of any age that have what is currently determined to be high cholesterol by allopathic standards (Ifti, Jackson, Ramsay & Wallis, 2001). Moreover, in this large meta-analysis mortality rates increased by 1% over a ten year period compared to placebo. The PROSPER trial demonstrated that statin use does not increase survival rates in the elderly population (Blauw et Al., 2002) which is a particularly vulnerable population that may be placed at higher risk for physical complications due to the known alterations of statins on cognitive function, muscle degeneration (MasterJohn, 2005), and mood disorders (Kaplan, 2010)

So no, we have a long way to go when it comes to prevention. Perhaps we need to look to our past, our bodies, and our environment for answers to health questions.

References

Blauw, G., Bollen, E., Buckley, B. Cobbe, S., Ford, I., Gaw, A., Hyland, M., Jukema, J., Shepherd J, Kamper, A., Macfarlane, P., Menders, A., Norrie, J., Pakcard, C., Perry, I., Stott, D., Sweeney, B., Twomey, C., and Westondorp, R. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. [Abstract]. Lancet. 23;360(9346):1623-30. Retrieved April 21, 2012 from www.ncbi.nlm.nih.gov/pubmed/12457784?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

CDC, (2012). Emergency Preparedness and Response. Centers for Disease Control and Prevention. Retrieved April 21, 2012 from//www.bt.cdc.gov/disasters/

DeNoon, (2011). The 10 Most Prescribed Drugs: Most-Prescribed Drug List Differs From List of Drugs With Biggest Market Share WebMD. Better Information. Better Health. Retrieved April 21, 2012 from www.webmd.com/news/20110420/the-10-most-prescribed-drugs

Ifti, U., Jackson, P., Ramsay, L., and Wallis, E. (2001). Statins for primary prevention: at what coronary risk is safety assured? [Abstract]. British Journal of Clinical Pharmacology. 52(4):439–446. doi: 10.1046/j.0306-5251.2001.01478.x Retrieved April 21, 2012 from www.ncbi.nlm.nih.gov/pmc/articles/PMC2014585/

Kaplan, A. (2010). Statins, Cholesterol Depletion—and Mood Disorders: What’s the Link? Psychiatric Times. 27(11). Retrieved April 21, 2012 from www.psychiatrictimes.com/mood-disorders/content/article/10168/1743257

MasterJohn, C. (2005). Statins Fry Your Brain and Scramble Your Memory Like an Egg A Review of Statin Drugs Side Effects and the Misguided War on Cholesterol by Dr. Duane Graveline, M.D. Self-Published, April 2005. Cholesterol-and-health.com. Retrieved April 21, 2012 from www.cholesterol-and-health.com/Statin-Drugs-Side-Effects.html

Moncrieff, J., (2005). Efficacy of antidepressants in adults. [Abstract]. British Medical Journal. 331(7509): 155–157. doi:  10.1136/bmj.331.7509.155

What about public health?

Please consider this post in light of a preventive perspective targeting multiple etiologies and not correlations. This is not meant to disrespect all the great work public heath has been and is currently providing* 

The major causes of disease and death (DaD) in the 21^st century have never been scientifically proven although outcomes have been correlated and mistakenly identified as causes. This is one of the greatest mistakes in public health and medicine today (Taubes, 2012). It can be speculated that major causes of DaD are the standard American diet (SAD), iatrogenic comorbidity (Starfield, 2000), and toxic environmental factors (Walsh, 2010). Perhaps the greatest influence is our biological mismatch (Kruse, 2012). Our lives no longer synchronize with the Earth’s cyclical rotations affecting great influence on our collective behavior. Hormone, immunity, and metabolic functional alterations can result from mismatches with natural circadian rhythms (O’Connor, 2012), food availability cycles (Kruse, 2012), and seasonal sunlight temperature fluctuations all correlating with DaD (Hastings Maywood & Reddy, 2003).

Public heath has made great strides reducing pathogenic morbidity. Unfortunately, the factors mentioned above are not considered when attempting to moderate major diseases resulting from these influences. As a result, cardiovascular disease, cancer, and respiratory infections are free to develop and reveal themselves as top killers in our country (Leading Causes of Death, 2012). Public health and modern healthcare can provide invaluable service to their constituents by targeting pathways that optimize immunity, increase longevity, and improve health status by replacing methods that facilitate further disruption of our physiologic mechanisms. The disturbing effects on our homeostatic ability (MacDonald & Monteleione, 2005) in addition to perpetuating a dysfunctional healthcare system (Starfield, 2000) needs serious consideration.

One public health strategy used to reduce pathogenic disease is to regulate food production and distribution. Preventive practice in this area has fallen through the cracks. Animals and plants mass produced for consumption are now adulterated with pesticides, hormones, antibiotics, and genetic modifications. These are all factors influencing our epigenetic predisposition. Autism is now found in 1 of 54 boys and 1 of 252 girls (CDC, 2012). Genetics can only take so much responsibility. Environmental influences that predispose us to disease and death should be a major consideration for public interest.  How public health choses to move forward must include looking backward. What we consider causes are often merely symptoms.

References

CDC (2012). Autism Spectrum Disorders (ASDs). Retrieved March 31, 2012 from http://www.cdc.gov/ncbddd/autism/index.html

Hastings, M., Maywood, E., and Reddy, A. (2003). A clockwork web: circadian timing in brain and periphery, in health and disease. [Abstract]. Nature Reviews Neuroscience. 4:649-661. Retrieved March 31, 2012 from www.nature.com/nrn/journal/v4/n8/abs/nrn1177.html

Kruse, J. (2012). Why perspective Matters? Cellular theory of relativity. Living an Optimized Life. Retrieved March 31, 2012 from http://jackkruse.com/why-perspective-matters/

Leading Causes of Death, (2012). Centers for Disease Control and Prevention. Retrieved March 31, 2012 from www.cdc.gov/nchs/fastats/lcod.htm

MacDonald, T. and Monteleione, G. (2005). Immunity, inflammation, and allergy in the gut. [Abstract]. Science. 25(307) pp.1920-1925. DOI: 10.1126/science.1106442

O’Connor, A. (2012). Really? The Claim: Your Body Clock Can Determine When You Get Sick. New York Times. Retrieved March 31, 2012 from well.blogs.nytimes.com/2012/02/27/really-the-claim-your-body-clock-can-determine-when-you-get-sick/

Starfield, B. (2000). Is US Health Really the Best in the World? The Journal of American Medical Association. 284(4):483-485. doi: 10.1001/jama.284.4.483

Taubes, G. (2012). Science, Pseudoscience, Nutritional Epidemiology, and Meat. Retrieved March 31, 2012 from http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/

Walsh, B. (2010). Environmental Toxins. Time Magazine. Retrieved March 31, 2012 from www.time.com/time/specials/packages/article/0,28804,1976909_1976908,00.html

Startling Autism Data

Well, the CDC just published the new numbers of our birth rate and autism 1:88. We have changed our environment so much. Look at what we are doing to our kids. Here is a report from FoxNews and a link to the CDC.

An excerpt for your tastebuds:

For 2008, the overall estimated prevalence of ASDs among the 14 ADDM sites was 11.3 per 1,000 (one in 88) children aged 8 years who were living in these communities during 2008. Overall ASD prevalence estimates varied widely across all sites (range: 4.8–21.2 per 1,000 children aged 8 years). ASD prevalence estimates also varied widely by sex and by racial/ethnic group. Approximately one in 54 boys and one in 252 girls living in the ADDM Network communities were identified as having ASDs. Comparison of 2008 findings with those for earlier surveillance years indicated an increase in estimated ASD prevalence of 23% when the 2008 data were compared with the data for 2006 (from 9.0 per 1,000 children aged 8 years in 2006 to 11.0 in 2008 for the 11 sites that provided data for both surveillance years) and an estimated increase of 78% when the 2008 data were compared with the data for 2002 (from 6.4 per 1,000 children aged 8 years in 2002 to 11.4 in 2008 for the 13 sites that provided data for both surveillance years). Because the ADDM Network sites do not make up a nationally representative sample, these combined prevalence estimates should not be generalized to the United States as a whole. 

HEALTHY DIETS AND SCIENCE: Low levels of zinc may be a risk factor for diabetes and heart disease

HEALTHY DIETS AND SCIENCE: Low levels of zinc may be a risk factor for diabetes and heart disease

Cinnamon, Which type should we be eating?

I have been looking into cinnamon since it is proclaimed to be very healthy. Did you know there are a few types of cinnamon? We will cover the two most used forms, ceylon and cassia.

Here are some of my findings:

There are two general types of cinnamon, cassia and ceylon cinnamon. A distinction in taste can be made between the two types. The important point is that ceylon cinnamon contains low levels of coumarin (a potential liver and kidney toxin). By contrast, cassia cinnamon contains high levels of coumarin up to 63 times more than Ceylon cinnamon powder. On the other hand, cassia cinnamon sticks consisted 18 times more coumarin compared to Ceylon sticks. So get some ceylon cinnamon in your cupboard, especially the powder form.

It is almost impossible for us to distinguish between the two types of cinnamon in powder form. I believe ceylon cinnamon is harder to find. A recent example occurred when I went to Clark's Organic Foods grocery store and their employees did not even know about ceylon cinnamon.  So, the distinction is not commonl even among proclaimed healthophiles. Starbucks uses cassia from China, and I have not found cinnamon labeled as ceylon in any brick and mortars anywhere yet. Hopefully, that will change . . .

The situation is different when distinguishing cinnamon in the stick form. Cassia cinnamon has a relatively thick layer of the bark and is rolled into a stick. The cross-section of a Ceylon cinnamon stick looks more like a cigarette: several thin layers of bark rolled haphazardly, making its cross-sectional view appear more compact.

The origin of the cinnamon is not generally indicated on the package. If it is made in China or India, chances are it is cassia. Ceylon is usually grown in Sri Lanka, Seychelles, and Madagascar. So dump the cassia and find some ceylon cinnamon. It is better for your kidneys, liver, and packed full of antioxidants to maintain and improve your (intra/extracellular) health. If you would like to delve deeper into the complexities associated with cinnamon including nutrient content just review these two great resources, whfoods.com and Marksdailyapple. They both elucidate the many benefits of cinnamon nutritionally, medically, and provide interesting contrast between the two.

Brick and mortar update: I just found organic ceylon cinnamon sticks from Sri Lanka at Cost Plus WorldMarket.


Ceylon Cinnamon:

Cassia Cinnamon:

Cold Adaptation

Dr. Kruse's Cold Thermogenesis Protocol (link)

3/9/2012: I have been reading how our bodies adapt to various stimuli. Recently this fantastic neurosurgeon has been writing about his n=1 experiment with cold adaption or cold therapy known as cold thermogenesis (CT). If anyone is interested in learning about this concept please view this blog. Dr. Kruse is providing a wonderful platform to learn and apply many principles associated with this in relation to longevity, and optimal health. He is doing a lot of investigating and deserves special notoriety and he just added a forum to the site. I think it is going to get big like Mark Sisson's blog (they are writing a book together too!). As a result, I started an experiment on my own to see how it impacts my system. We have a pool, unheated at 62 degrees. So yesterday I slowly entered for about 20 minutes. It was cold but afterwards I felt great. Afterward, I showered with hot water and ended with a cold dose of shower water. I was cold for a while afterward but noticed I did not sweat as much at work and had more energy for a while. My muscles also were more constricted and I was comfortably cold for a period after CT.

Here is the best example of someone who has chronicled his CT adaptability. I believe his etiological explanations are symptomatic and correlary rather than causative and believe that science can explain it as Dr. Kruse graciously depicts here. Sure yoga can improve our breathing, help us to focus, and optimize our physical abilities, but I believe science can explain the physiologic changes occurring in cold adaptation. Anyway, here is a video showing some of Wim Hof's abilities via cold adaptation. This leaves open to inquiry primary and secondary prevention implications and how this hormetic effect may impact longevity.

3/10/2012: Today, I waded up to my neck and stayed for 40 minutes. I will be doing this for two weeks in addition to taking cold showers, wearing fewer clothing, and driving with the AC on high. I am not taking any lab tests at this time but plan to explore relative data if what I observe with this experiment begins to reveal a cold adaptive response. Our bodies are amazing and I will add to this post as the process unfolds. It is hard to believe but my body is tolerating more after just one day. We will see how two weeks of this (and perhaps more) fares.

3/11/2012: Today I stuck it out for 45 minutes. I began to shiver at the 30 minute mark and had a resting pulse of 62. Normally it is about 73-75. I am not an athlete and appreciated this adaptive response. I felt great afterward so I decided to run. After about a half mile, my body gave out. I felt light-headed, nauseated, and really bad. I took a warm shower, rested outside in the sun, and put my head between my legs. After about 20 minutes the severity subsided. Then I went inside reclined in bed and shivered for about 20 minutes. After the shivering ended, I was fine. No more exercise after CT. That was a lesson learned.

3/15/2012: I took a couple of days off after the reaction my body had but continued to wear less clothing, windows down and AC on high in the car when I drive, and top off my daily showers off with a nice cold dose of H20. Today, I went back in the pool for 27 minutes AFTER sprinting to see how that worked. It was great. My left leg cramped up so I decided to get out, walk it off, and get ready for work. The funny thing was after I walked it off, I took a shower. The water was way too hot. It felt like it was burning so I turned the temp down all the way and did not even notice the cold. When I put my head in the cold shower, I definitely noticed since that was the only part of my body not exposed in the pool.

I have not noticed any real changes yet with the exception of increasing urination some days. This may also be due to my coffee intake, nonetheless, it is noted. I am also slightly more tolerant to cold on a more consistent basis.

3/22/2012: Yesterday I reintroduced the pool to my routine of cold showers, less clothes, and AC on high in the car. One thing of note. I was able to walk deep all the way to my neck with less dramatic effect on my body's cold perception. I am beginning to acclimate to colder temperatures.

Here are some of my observations to date: I have a general sense of well being including just feeling more positive about things, having more energy, and liking life more. One thing is interesting. My body has a strong sense of imperviousness to pathogenic infection. It is like an invisible barrier is in place. You know the feeling you had as a teenager, you thought that nothing could happen to you? It is kind of like that. I believe it is related to hormonal stimulation such as DHEA, testosterone, GH and others. On that note, I recently woke up with an early morning erection. I cannot remember the last time that happened.  In addition, my hairline has seemed to slow or stop its receding but this started much earlier in my experiments . . . when I cut out sugars and carbs.

Another thing, after I did CT, @ 1:00 pm., I had a bullet proof coffee and some grass fed hamburger. I was not hungry all day and am going to bed without craving carbs or being hungry. I think leptin secretion is changing because I actually felt satiated without thirst until 8:00pm.

3/25/2012: The last few days my hunger has been really suppressed. I eat a BAB (big breakfast) and don't lose the full feeling for about 6 hours. Today we went to the mountains. A storm was coming in as we played in the snow. I took off my shirt and was comfortable while it snowed/sleeted. I even lifted some downed trees and carried some chainsawed logs around; A good workout added to a little CT. When we arrived home I was sore. We went to the hot tub for some soothing therapy. I soon jumped into the cold pool and started total submersion holding my breath. When my head is under water my body does not perceive the cold as much. This is my next step: total immersion holding my breath longer and longer.

3/31/2012: Well, I actually caught a bug about 4 days ago. First, sneezing. I thought it was allergies due to walking by freshly caught grass in the spring. Later, I had pressure in my ears. The next day I woke up with scratchy ears and throat. I felt fine and the symptoms were more like an irritant than anything. Even so, I decided to take CT easy for a while. Well, the cold has been so mild I decided to take a cold dip in addition to my daily cold showers. I went straight in today, a cold day @ 68 degrees. I even swam underwater. My kids joined me on my back and did not seem bothered by the cold water. It was great. I'm still adapting and pathogens seem to be easier and easier to overcome. I'm really starting to like CT not only for the benefits but I never once thought cold would be more comfortable than warm, especially showers and pools. I was wrong. Until next update, see you later . . . .

Here is an interesting video of a Native American woman describing cultural use of CT.

Phenomenology, grounded theory, or ethnography: which approach is best?

When considering which method of qualitative research to use, it really is the question that matters. Take the example: What is the experience of waiting for service in a hospital emergency room? Asking this will undoubtedly raise more unknowns than answers. We will frame the question three ways in order to fit phenomenology, grounded theory, and ethnography.

If we leave the it unchanged, the experience of waiting for service in a hospital emergency room (ER) is best suited for an approach such as phenomenology. This broad design probes people's general experience and perceived meanings associated with phenomena (Smith, 2008). Knowing how people identify with waiting in the ER can provide researchers with data to improve hospital experiences.

There are three basic elements to phenomenology. The first is a process known as bracketing. Researchers must table their preconceived ideas in order to gain more representative views of other people’s perspectives and beliefs, which leads to the second second element of phenomenology known as intuiting. These two foundational principles enable collected data to be qualified through the third step, analyzing and describing. This is when the researcher categorizes and extracts significant meaning from an experience. Once variables of the experience are qualified, more specific methods of inquiry could be used. Two of these methods are grounded theory and ethnography.

The grounded theory is not suited for the general experience of waiting in an ER since it is geared toward accounting or understanding people’s actions in a scenario (Polit & Beck, 2012). If the question was framed: How do people cope with the experience of waiting for service in a hospital room, then the grounded theory could be used to identify coping mechanisms or people’s actions within the experience of waiting in the ER.

If the question was designed to identify the behaviors of a specific population, ethnography could be used. Ethnography is the evaluation of a specific culture’s framework within phenomena (Hoey, 2011). The data would be all over the place if we used the general population. A target population needs to be identified before using an ethnographic approach. Our country is the great melting pot, so the question would need restructuring. One example of an ethnographic approach could be: How do Amish people experience waiting for service in a hospital emergency room?

Phenomenology, grounded theory, and ethnography are all excellent research methods in their own right. It is the framing of the question that determines the method of inquiry and the ability to explain the silhouettes that shape our human experience.

References

Hoey, B. (2011). What is ethnography? Retrieved February 20, 2012 from http://www.brianhoey.com/General%20Site/general_defn-ethnography.htm

Polit, D. and Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice [9th ed.]. Philadelphia, PA: Lippincott Williams & Wilkins.

Smith, D. (2008). The Stanford Encyclopedia of Philosophy. Phenomenology. Retrieved February 20, 2012 from http://plato.stanford.edu/entries/phenomenology/

Ye Olde Fashioned Root Beer

Tonight we made seven 32 oz. bottles of olde fashioned root beer from scratch. Literally, I used water, whey, and a mix of roots such as sassafras, sarsaparilla, and licorice root. We also used wild cherry, birch bark, in addition to other roots, barks, and herbs. The concoction comes from a great blog authored by Jenny McGruther, a cooking instructor specializing in real and traditional foods.

Anyway, the link to the recipe is here. She explains the history and how this wonderful concoction achieved popularity. My kids are not allowed to drink soda and that is about to change. After our experiment has fermented four days and chilled for two more we plan to pour it over homemade vanilla ice cream made from raw cream. I haven't looked forward to a root beer float this much since my family frequented the local drive thru A&W in Mentone, California nearly 40 years ago.

Next on the list . . . ginger ale. If popular, these both will become new staples and tonics for what occasionally ails us.

I used whey from my curds to ferment the root beer and plan to try kefir grains next. I think we will try ginger bug for the fermenting agent in our ginger ale. Both of these concoctions should help in our long journey of optimizing our gut flora. Since some in my family are sensitive to grains and we all have received multiple doses of antibiotics, we cannot do enough to repair the damage done to our gut's natural flora. Fortunately, we were all breast fed and have that advantage.

For new or expecting mothers: If you are interested in learning more about optimizing your children's (and your health), I recommend this site by Chris Kressler. He is an excellent practitioner and a true inspiration for those practicing genuine preventive healthcare.

Random Bias vs. Systemic Bias

I tried to keep this short and limited the controversial elements as this was a topic of discussion in my nursing research class:

Random and systemic bias can occur any time in any study. Early apology for ranting but this is my pet peeve. Surprisingly, bias has been shown to exist too often in renowned journals such as the Journal of the American Medical Association (JAMA). This problem has been building upon itself for decades (Freedman, 2011). As a result, we have been travelling down a road filled with iatrogenic injury and death. Amazingly enough, this has also been reported in JAMA (Starfield, 2000) with medical care listed as the third leading cause of death in the United States.  Starfield (2000) points out that complexities related to this problem have multiple factors of which we all agree. Unfortunately, what we cannot count out are the implications of EBP from historically biased research data. Freedman also notes that biased research has helped shape modern standards of practice such as hormone replacement therapy, coronary stents, and low-dose aspirin used to mitigate cardiovascular events. According to Freedman (2011) Dr. John Ioannidis has demonstrated a 40% error rate in 49 of the most respected and cited research articles in the last 13 years.

When it comes to real-world practical prevention of bias, it is extremely difficult to eliminate in the medical field since research is often driven from inventions that incorporate pharmaceutical or mechanical means and funding sources often drive the research. Nursing tends to follow medical, so we are just as vulnerable. Even the gold standard, randomized trials, has a reported rate of 25% inaccuracies due to bias (Freedman, 2011).

Random bias occurs when a participant or researcher makes an assumption about data (Polit & Beck, 2012). The assumption is not an accurate representation of what is or has occurred in the study (Peterson, 2009). One example is food diaries. They have been reported to often be inaccurate. People forget and underrepresent consumption or over represent their food intake. One strategy to reduce bias here would be to photograph every meal. The researcher could review the diary, make comparisons with pictures and have tighter correlation with reality.

Systemic bias is a little different. One example is The China Study. The primary researcher Dr. T. Colin Campbell conducted the study under the premise that there was something inherently harmful with consuming animal protein. The data he presented in his book revealed this correlation (Campbell & Campbell, 2006). Further analysis of the data reveals an inverse correlation with animal protein consumption and other foods were found to correlate positively with all cause mortality, (Minger, 2011). How do we avoid this type of bias? The solution may be three-fold: Utilization and  re-utilization of multiple null-hypotheses based upon ongoing collection of data and representation of all data positive, negative, and ambiguous.

During any study we need to remain vigilant in order to reduce random or systemic bias. Multiple contrarian viewpoints should be integrated as this my help identify confounding factors or other variables in need of deeper analysis.

References

Bogl, L., Kaprio J., Korkeila, M., Pietilainen, K., Rissanen, A., Westerterp, K., and Yki-Jarvinen, H. (2010). Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labeled water and co-twin assessments. International Journal of Obesity. Mar;34(3):437-45.

Campbell, T. and Campbell, T. (2006. The China Study: Startling implications for diet, weight loss, and long-term health. Dallas, TX: BenBella Books

Freedman, D. (2011). Lies, Lies, Damned Lies, and Medical Science. The Atlantic Monthly. Retrieved February 6, 2012 from www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

Minger, D. (2011). The China Study, wheat, and heart disease; [sic] Oh my! Raw Food SOS: Troubleshooting on the raw food diet. Retrieved February 18, 2012 from rawfoodsos.com/category/china-study/

Peterson, (2009). The Mathematical Tourist. Mathematical Association of America. Retrieved February 18, 2012 from www.maa.org/mathtourist/mathtourist_11_08_09.html

Polit, D. and Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice [9th ed.]. Philadelphia, PA: Lippincott Williams & Wilkins.

Starfield, B. (2000). Is US Health Really the Best in the World? The Journal of American Medical Association. 284(4):483-485. doi: 10.1001/jama.284.4.483

A Research Idea

I was doing my rounds reading some of the great blogs I follow and came across one topic I am really starting to appreciate, the importance of our gut physiology. 

My real love and curiosity is related to optimum physiological functioning arising from primary and secondary holistic preventive methodologies. This goes well beyond nursing and includes a variety of scientific disciplines and causeways. The connection to nursing is often opaque and unrefined, even though the relationship is stronger than we realize.

One clinical problem requiring greater understanding are the long-term implications antibiotics have on our immunity, metabolism, and disease progression. This is not generally considered, since antibiotic use is standard practice and routinely administered prophylactically and for nonemergent circumstances. I am not implying they should not be used. The salient point here is not their short-term benefit, rather their long-term implications.

This type of study would be observational in nature, reviewing decades of antibiotic administration and bowel disorder data. It could take on meta-analysis like characteristics. Factors affecting feasibility would not include cost since the study could follow current and past administration of an antibiotic use. The focus could be narrowed to ciprofloxacin since it is considered one of the most benign perturbative antibiotics (Dethlefsen, Huse, Relman & Sogin, 2008). Pooling available data would generally require just the researcher’s time.

Further narrowing the focus: identifying previously known perturbations antibiotics play on our gut flora may elucidate implications with gastrointestinal disorders such as celiac spree, inflammatory bowel disease, and Crohn’s disease. Feasibility of the implications applies to the type of practicing clinician. How preventive and holistic a practitioner may be may determine the research's applicability. From an integrative or holistic perspective, this information can provide significant implications for treatment.

Other problems that may arise: confounding the extent antibiotics play a role when consideration other factors such as vaginal or cesarean birth (Bessi, et Al., 2010), underlying gastrointestinal disorders, chronic disease status, and functional or structural alterations. There may be other factors requiring further exploration. The goal with this type of inquiry is twofold: to reveal potential harm unnecessary use of antibiotics have on our health and to understand the importance healthy gut flora diversity contributes to our long-term health.

References

Dethlefsen, L., Huse, S., Relman, D., and Sogin, M. (2008). The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biology. 6(11): e280. Doi: 10.1371/journal.pbio.0060280

Bessi, E., Biasucci, G., Morelli, L., Retetangos, C., Riboni, S., and Rubini, M. (2010). Mode of delivery affects the bacterial community in the newborn gut. [Abstract].  Early Human Development. Jul(86), Suppl. 1:13-15. Retrieved February 10, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/20133091

Qualitative vs. Quantitative Research

Qualitative research (QlR) and quantitative research (QnR) each have their own strengths and weaknesses. When it comes to the rubber meeting the road, both types of research are immensely important. Some researchers have argued that neither is genuinely independent of each other while others go as far as proclaiming, “There is no such thing as qualitative data” (Writing@CSU, 2012). I personally believe that both are so intricately linked, one without the other is generally inadequate for effective evidenced-based treatment outcomes. Both types should be considered in order to address behavior and clinical issues. Now on to my brief and limited perspective about some of the shortcomings . . .

If you are a strict researcher interested in facts substantiated by definitive measurements, then qualitative research is not your thing. Qualitative research focuses on holistic processes through a narrative and subjective analysis (Polit & Beck, 2012). Since people’s perspectives are the receptacle of inquiry, numerical data, questionnaires, and other inventories are generally unnecessary. The researcher often works with the subjects in the field to learn about the interested phenomena. The results can often reflect the researchers’ original bias or the subjects’ worldview. It may be difficult to determine exact mechanisms of underlying principles since the researcher is striving to find out the how or why phenomena occur in the absence of scientific experimentation (Polit & Beck, 2012). It is generally observational in nature and as a result is challenged when determining causal factors.

Quantitative research seeks to understand variables and causal pathways with quantifiable data and controls (Answers Research, 2011). What QnR often fails to do is see the 30,000-foot picture since it is focusing on specific variables. Since the bigger picture is usually missed, additional or alternative causal factorsn, and confounding variables are overlooked. Even though this type of inquiry's lens is limited, some of the things touted as strengths are statistical power and large amounts of data. This can be expensive and complicated. As a result, financial interests can creep into bias, reported, data, and outcomes (Freedman, 2011). QnR also tends to be shorter in duration not allowing for deeper, long-term statistical intervention analysis. In addition, misuse of data, simple errors, and research bias can reduce the validity and accuracy of the underlying hypothesis (Freedman, 2011).

References

Answers Research, (2011). Articles: Quantitative vs. qualitative. Retrieved February 6, 2012 from www.answersresearch.com/article9.php

Freedman, D. (2011). Lies, Lies, Damned Lies, and Medical Science. The Atlantic Monthly. Retrieved February 6, 2012 from www.theatlantic.com/magazine/ archive/2010/11/lies-damned-lies-and-medical-science/8269

Polit, D. and Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice [9th ed.]. Philadelphia, PA: Lippincott Williams & Wilkins.

Writing@CSU, (2012). The qualitative vs. quantitative research debate. Colorado State University. Retrieved February 6, 2012 from http//:writing.colostate.edu/guides/research/ gentrans/pop2f.cfm

One area of prevention

I was discussing with a classmate how I believed women could improve their chances with prevention and early detection of breast cancer. This was my response. Being a man, this is what I would start with. I would also look much more deeply into the subject rather than the 5 minutes I spent contemplating this:


I think one of the best things we can do is include a diet and lifestyle that enhances immunity and upregulates apoptosis of oncogenic activity. I know the research indicates false positives can be high with mammograms especially before 50. Also, cancer lesions can be missed when obscured by normal breast tissue. If a woman starts mammograms at 50 instead of 40, she cuts radioactive exposure and risk of oncogenic damage in half. 

There is no easy answer as you know. I personally think routine self-breast exams may be one of the best things a woman can do since she is aware of the ongoing changes occurring in her tissue as she goes slowly through life's changes that may include weight gain, loss, and other variables only intimately known to the self-examiner. 


Reference

Fernadez, E. (2011). HIgh rate of false-positives with annual mammograms. University of California, San Francisco, School of Medicine. Retrieved February 6, 2012 from www.ucsf.edu/news/2011/10/10778/high-rate-false-positives-annual-mammogram

Getting into fitness

Last week I started to workout using Dr. McGuff's principles in his book Body by science. Push ups, squats, dips, and let me ins all done with my body weight only took about 8 minutes. During the workout I felt nauseated as the pain peaked. It was a brief but intense workout.

It is a couple of hours later since my second workout (1 x/week) and I have never felt this way after exercise before. I want to do more, I feel super strong, and have an intense sense of well-being. I am looking forward the the long-term results as I already believe this type of exercise will be very effective in producing  consistency with health and fitness.

Here is a video of Dr. McGuff describing the science behind the activity.

Middle Range Nursing Theory - The Tidal Theory

Well, I am happy to say that I think I found a middle range theory that is workable within my philosophy and current specialty (psychiatric nursing). Here is a basic introduction in addition to the complexities associated with implementation of such a practice.

Giving direct care always starts at the beginning. Using the Tidal theory, identification of risks and strengths that will help propel the patient forward independent of nursing care or any needed service is buy and large, the first step. Oftentimes, a patient has already suffered from many conditions be it chronic health or psychiatric abnormalities, psychological or physical abuse, and even socioeconomic stress. There are often combinations of stressors that make synthesis of treatment challenging.

The point of this approach is to help the patient develop a plan that will enable them to develop, refine, and achieve personal goals (McEwen & Wills, 2011). If a patient came into my psychiatric unit suffering from obesity, diabetes, and schizophrenia, my approach would be directed by the influencing factors surrounding these conditions. Always keeping in mind the patient’s basic need to command their life, goals, and course correction when considering recommendations for treatment. The whole philosophy of recovery encapsulated in the Tidal theory is entirely dependent upon collaboration between professional disciplines and the patient (Tidal Model, 2000). This means the nurse would have to be working with like-minded professionals in order to achieve the desired goals of this theory.

Practical application is to find a method of stabilizing the patient’s psychiatric symptoms to better serve his or her needs on the physiologic level. The patient presents with a complex array of abnormalities and meeting the micro/macro nutrient needs associated with psychiatric symptoms, glucose fluctuations, and fat metabolism should be incorporated as a supportive measure to help with the stabilization and recovery process.

Utilizing this first method will help to achieve the goal of the Tidal theory which is to enable a person to reclaim their life, personal direction, and rediscover their voice (Tidal Model, 2000).

References

McEwen, M. and Wills, E. (2011). Theoretical Basis for Nursing. [3^rd ed.]. Philadelphia, PA: Wolters, Kluwer/Lippincott, William, and Wilkins

Tidal Model, (2000). Reclaiming Stories, Recovering Lives. Retrieved January 14, 2012, from www.tidal-model.com/What%20is%20the%20Tidal%20Model.htm