Just Watched: Low-Carb High Fat Diet in Type 1 Diabetes

The origin of this post is that I sent a tweet earlier this week regarding the current crisis in insulin pricing referring to the Banting Diet, which is the precursor of the low-carb high fat diet (or LCHF diet). I sometimes do this (sending unclear messages) assuming that people will figure them out, and usually, that’s not the outcome πŸ™‚ . At least it starts conversation (maybe I do this subconsciously, I don’t know).

In any event, I have been interested in nutrition for a long time and more interested recently (see:Just Read: Why Eating Fat May Not Make You Fat (The Big Fat Surprise) ), as more data is being produced about where our dietary guidelines came from. In the case of diabetes, I have been curious about the ways the medical and other professions counsel patients on diets in ways that may actually increase their risk of diabetes and increase their insulin requirement.

My question, therefore, has been whether the need for insulin could be eliminated in some people and reduced in others, which would blunt the impact of pricing and make living with diabetes more affordable. The other question I have is about the whether reducing the use of specialized insulins for some population would have an added effect, making the pricing power, less powerful.

I’ve read a few papers about this. I don’t feel comfortable doing a literature review myself because these days it’s really hard to interpret papers if hidden biases aren’t known. That and I may be a physician, but I do not know what it is like to live with diabetes. I do know what it is like to live as a former fat person so there is some relevance here for me.

Through the magic of YouTube, Dr. Troy Stapleton (@drtroystapleton) explains his own journey as a person with type 1 diabetes and the LCHF diet. He’s going to to have much more credibility than I and this is a good science-based + authentic overview from a patient perspective. Watch:

A person who produces insulin on this diet is going to have an insulin production curve closer to a person with type 1 diabetes (flat) compared to a person without diabetes (insulin spikes), with the idea that insulin and specifically too much insulin is a requirement for obesity.

#ILN innovating in nutrition, too. #LCHF in Chicago. #ketogenic #ketogenicdiet #lessinsulin

A post shared by Ted Eytan (tedeytan) on

I’m planning to do some more study this summer. At the same time, there are far more experienced researchers, journalists, physicians and scientists engaged in this work, so I’m more interested in dialogue than leadership (they are doing just fine). I always say if there’s a better way to do something, I want to know about it.

This is life in the family medicine revolution (#FMrevolution), where unlimited curiosity reigns in the interest of a person, family, community’s long healthy life. Feel fee to let me know your thoughts in the comments.

Animation: The Center for Total Health Capital Bikeshare station No. 353 is alive

The animation goes from midnight to midnight, showing peak times of usage.

With tremendous gratitude to Michael Schade (@mvs202), the our nation’s capital’s digital transportation storyteller, and leader of Transportation Techies (@TechiesDC)

The animation is based on released Capital Bikeshare (@Bikeshare) data for 2nd Quarter, 2015, which means there is only about 2 weeks of function included in this dataset, because our station was installed on June 18, 2015 (but who’s counting? πŸ™‚ ).

The station is located next to the busiest in the system (Union Station) and since it’s been “discovered” it is experiencing more frequent empty docks:

Capital Bikeshare Tracker for Center for Total Health Station Number 353 3
Capital Bikeshare Tracker for Center for Total Health Station Number 353 – Data is from opening of the station through to Thanksgiving (June 18-Nov 25) (View on Flickr.com)

Capital Bikeshare Tracker for Center for Total Health Station Number 353 2
Capital Bikeshare Tracker for Center for Total Health Station Number 353 – Data is from the most recent operating month of the station (October 28 – November 25, 2015), showing more acute shortages of bikes, especially in the late morning time period (View on Flickr.com)

These and other datasets show us that our city’s infrastructure is more alive than we think it is, and in this case, this infrastructure helps people be healthy.

For more on the station’s installation: Photo Friday: The Brand New #CTHNext Capital Bikeshare Station – Out-of-Box Experience

Just Watched: “Managing Unconscious Bias” , for Facebook employees

Via the magic of Twitter, I was treated to access to Facebook’s publication of their own Managing Bias training for their employees. It’s an approximately one hour video of an actual training, also broken up into modules, plus slides and references, which you can view/download on demand.

Interestingly (and authentically) the notice didn’t come from Facebook’s Learning & Development organization:

I watched the one hour training and reviewed the materials as someone who’s been studying unconscious bias for a little over a year now, with the support of Kaiser Permanente’s own National Diversity and Inclusion Organization (thank you!).

Impressed by

  • The sharing of the video of the training by Facebook. It’s hard to find companies that are this open about a sensitive topic within any organization. The video shows employees working through (and maybe exhibiting) biased behavior. This is good. It’s human.
  • The teaching approach – with a video of several employees who are different introducing themselves to an invisible viewer. I honestly thought after watching that part, “I don’t have a preference for any of the individuals.” Some of the employees in the training did, which starts a good dialogue.
  • Use of validated tools – employees were asked to take the Implicit Association Test in advance. And they were asked, not ordered to, which is the correct way to introduce the test.
  • Counteracting behaviors like having structured decision making and clear criteria are great and important, really good discussion.
  • Connection to impact, and business impact. A good job was done, in my opinion, of making a case for eliminating bias for a better company.

Things worth further exploration

How I would add to/amend (as suggested at the bottom of the web site):

  • Explain the “unconscious” nature of unconscious bias. This bias is not something you can recognize and tell yourself not to have. If it was, it would be “conscious” (or “explicit” as they say in the literature). In an audience that’s more likely to have a preponderance of scientists/engineers (doctors/nurses), it’s helpful to explain how our brain wiring results in these associations that happen so fast, you can’t ask yourself if you have them, and often you can’t notice the behavior that comes from them. (A good paper that I wrote about helps: Just Read: Unconscious bias is like an iPhone version 20 inside your brain, and walking helps manage it (?) | Ted Eytan, MD).
  • Modulate suggestions like “don’t make assumptions.” These don’t really get at the unconscious nature of bias or de-bias a workplace. Again, this bias is not conscious, you can’t talk your way out of it.
  • Add a discussion about how to de-bias a workplace
  • Lori Goler (Facebook’s VP of People), Maxine Williams (Facebook’s Global Diversity Officer) and Mike Rognlien (Facebook Learning and Development) do a great job of introducing all the topics, including the importance of giving fair credit. However, the website in which their work is housed doesn’t list their names anywhere – you have to dive into the video to get them. Model giving fair credit – these trainings are not easy to create or perform.
  • I and others had the good fortune of a session with Professor Mahzarin Banaji (@banaji), one of the developers of the Implicit Association Test, earlier this year. One thing she did that was useful, was a live version of the Implicit Association Test, using hand claps. It’s very illustrative, but takes some setting up.

Of course, I have assessed my own biases. It’s a good thing to do because we all have them, which means we are human.

It’s nice to know, even at Facebook, that to train people on something, you still need to bring them into a room and teach them. Not everything can be learned virtually. Thanks to Facebook for sharing it with the world.

If the diversity team was available on any social network to continue the conversation as part of a community committed to eliminating bias that would be great. Regardless, the commitment is visible and it’s appreciated, we’re all here to make sure everyone has the opportunity to achieve their life goals.