2019.03.20 Thrive Kitchen, San Francisco, CA USA 00836 (View on Flickr.com)
These wonderful morsels of real food were handcrafted in the Thrive Kitchen at Kaiser Permanente Mission Bay in San Francisco (itself a LEED Platinum building) under the guidance of Chef Linda Shiue, MD (@SpiceBoxTravels).
Linda brought us her culinary skills, her medical acumen, and her creativity and enjoyment of the beauty of food as we made these, in lower carbohydrate and higher carbohydrate (with rice paper and whole grain rice) versions.
The photo and experience help explode some myths about what a low-carbohydrate healthy-fat (LCHF) diet is and is not:
Myth: LCHF is a high Protein diet (“Atkins”)
Fact: LCHF is a low carbohydrate diet. It is typically moderate protein. If you reduce one macronutrient (carbohydrate) you have to replace it with something (people need to eat something), and the replacement is fat, not protein.
Myth: LCHF is a meat-based diet
Fact: LCHF comes in variants including plant-based, plant-free, and meat/animal protein free. Any approach is easier when there are less exclusions, so a vegan LCHF diet will be harder to source, but not impossible. There is no health advantage to removing all meat from the diet according to the latest science (I am an omnivore myself)
Myth: LCHF is dependent on processed foods/supplements
Fact: Absolutely not 🙂 . It’s the opposite. Processed foods, currently making up a significant percentage of the calories ingested by Americans and Canadians pose serious risks to metabolic health. Real food is better.
Myth: Everyone should be on a low-carbohydrate or ketogenic (defined as less than 20 grams of carbohydrate a day) diet for health.
Fact: These diets may be necessary for people who are unable to metabolize carbohydrate (currently about 55% of the California population) to allow their insulin to become more effective and preserve pancreatic function. There is currently no pharmacologic treatment for non-alcoholic fatty liver disease or pre-diabetes (both are related to insulin resistance) – only food.
I did monitor my blood glucose following lunch. There was a signficiant, but not pre-diabetic level rise, probably due to some of the vegetables and the mango in particular. The wonderful thing about this technology is these recipes can be modified and their impact on metabolism can be measured instantly. This is how we prevent and reverse diabetes.
2019.03.20 Thrive Kitchen, San Francisco, CA USA 7889 (View on Flickr.com)
A delicious low(er) carbohydrate, health(ier) fat spring roll & cauliflower rice, custom made at the @KPThrive Kitchen, with @PermanenteDocs@SpiceBoxTravels. Only a minimal excursion on my #CGM probably due to the bits of mango in the rice. . Exploding the myth that #Ketogenic, #LCHF food is “high protein” (it’s not) or it’s meat-only (it’s not, even though there’s no health advantage from skipping meat according to the latest science). It is a method to reduce a near constant-flood of glucose which damages human metabolism resulting in a host of illnesses of western civilization. You can’t outrun a bad diet, and you can’t medicate your way out of pre-diabetes either. . #RealFood #LCHF #KetogenicDiet #LowCarbAndLowCarbon #SpringRolls #Collard #Food #FoodPhotography #FatAdapted #DiabetesPrevention #DiabetesReversal #EmbraceCuriosity #Science #FoodNotPharma 🕊🔥🌟👍
If you would have told me in medical school, “One day you are going to meet people who have reversed their diabetes,” I wouldn’t have believed you. If you would have added, “Many of their doctors won’t believe or support them,” that part I might have believed.
And yet, here we are.
It is said that the LGBTQ rights movement is the most successful social movement of our time – at meetings on social movements, the rooms with LGBTQ humans are the ones most crowded with people who want to learn “how” – and I see many of the same elements here. Elements in the way the medical profession reacts (rather than responding) to innovation, diversity, authenticity, elements in the way the science is advancing and experience is spreading at an impressive rate.
Citizen science continues to transform our understanding of human metabolism
If you would have told me in medical school that low density lipoprotein (aka “bad cholesterol”) is a dynamically changing, multi-functional molecule, I wouldn’t have believed you. Now, it’s very hard to refute what’s being demonstrated by people with a desire to know, and the resources to know it.
Ted Eytan, MD (he, him), Washington, DC, USA (physician, Capital TransPride Producers) – @tedeytan
Chad Cipiti (he, him), Washington, DC, USA (Capital TransPride Producers) – @chaddashwick
Monica Helms (she, hers), Atlanta, GA, USA (creator of the Transgender Pride Flag) – <a href=”https://twitter.com/MF_Helms>MF_Helms
Additional help from: * Seb Grubb (he, him), San Francisco, CA, USA (Google) – @seb_uk * Jennifer Daniel (she, hers), Berkeley, CA, USA (Google) – @jenniferdaniel * Olli Jones (he, him), London, UK (Microsoft) – [email protected]
The Transgender Pride flag was again excluded from the latest emoji update by @Unicode
Based on a repeated round of concerns raised based on the above across the globe, a group of individuals has provided assistance, support, and and an empathetic ear, and we are preparing to resubmit for the March, 2019
The Transgender Pride flag was again excluded from the latest emoji update by @Unicode
Based on a repeated round of concerns raised based on the above across the globe, a group of individuals has provided assistance, support, and and an empathetic ear, and we are preparing to resubmit for the March, 2019
From: UTC Document Submission
Subject: Re: UTC Document Submission: Transgender Flag and related symbols
Date: January 8, 2018 at 2:16:59 PM EST
This proposal was reviewed by the emoji subcommittee. Members would like to see better data.
There are multiple possibilities for this flag, so this issue could be discussed: https://en.wikipedia.org/wiki/Transgender_flags
As far as data goes, it would be helpful to include comparisons to the sum of the values terms such as for ‘gay’, ‘lesbian’, ‘bisexual’. Comparisons of usage of flags for transgender vs other causes or identity groups would be helpful.
Regards,
Based on the above, our plan is to re-submit with the following helpful information
Updated trend data
The significance of the transgender pride flag created by Monica Helms
We are open to any other feedback/suggestions, feel free to add a comment or contact me.
Update 7: December, 2017
We’ve joined with Alda Vigdís Skarphéðinsdóttir (she,hers) (@aldavigdis) from Berlin, Germany, an independent software developer to complete the technical specification for transgender symbols
Complete changelog:
New major revision
Additional authors
Detailed technical proposal
New Google Trends data
Aesthetic and layout changes
Additional data from the European Union
Some information on design moved from introduction article
Removal of Bianca Rey quote*
Additional Photo
Removal of Intersex CLDR keyword
Other minor changes
To respect the direction from @Unicode not to propose emoji’s based on “causes” we’ve moved @BiancaRey’s quote from the proposal to this blog post.
Making clear, in addition, that transgender person visibility in the emoji character set is not a cause nor is it political – the absence of the symbols from the set is a gap of exclusion (see data in the proposal) – as quoted by an earlier reviewer – “It’s a false assumption that emojis are only selected based on quantitative data – there are multifaceted considerations that go into determining what is selected… otherwise a female welder probably wouldn’t have made the cut.”
The Trans Pride Flag to me represents my identity as a trans person, that I belong to a community and that I’m visible – and I don’t think usage metrics can measure that feeling.
I think about a Trans person from a small town who feels like they are alone or they don’t have a community – with the emoji being available, it will be something that the individual can say “This is me!” or “Yay! Trans Pride Flag emoji”. It will bring happiness, a sense of community or support the identity to that individual.
Having the emoji available would reach so people in the world looking for something that allows them to say “there is an emoji for me. It reflects who I am.” It can also create conversation and education for many.Bianca Rey, Chair of Capital TransPride, Washington, DC USA November 2017
We’ve joined with Tea Uglow (@Teaelleu) who led us by a year in making this proposal to the Unicode consortium, to integrate her knowledge about the method to produce a transgender symbol and ZWJ sequence to produce a transgender pride flag emoji
Updated the Google trends data regarding searches for transgender emoji symbols – there has been significant change since June, 2017
Updated the narrative, as provided by Bianca Rey (@BiancaRey), for a societal and health perspective
Added additional photographs showing the use of the transgender pride flag symbol by more people in the United States’ capital, Washington, DC
…because while our proposal has some legitimate technical dependencies, there are other social considerations that come into focus, especially if the other emoji’s that are being proposed are the “heart with knife”, “sad poop” and pirate flag.
All of this said, as it is said, “don’t react, innovate” – important to understand how @Unicode and associated vendors work together and participate, even if we have to learn ZWJ sequences.
I believe Unicode is meeting this week.
And I never imagined that as a family doctor I would be participating in the formation of a language. On the other hand, these things matter for health, and so therefore it’s exactly the right place for a family doctor to be.
Update 4: August 8, 2017
Not approved at this time, appears to be grouped in with other flag proposals for consideration in October.
@PinkNews is reporting that the proposal has not been accepted by @Unicode. However, we have not received any communication from the Unicode consortium about this. See the dialogue about this on twitter.
Thank you again for your proposal. This is just a status-update. The emoji subcommittee needs a larger discussion about how to handle different types of flags. Your proposal is being held with some others pending outcome of that discussion.
Update 1: June 30, 2017
Thank you for your submission. This is to let you know it has been safely received, and will be reviewed by the emoji subcommittee.
As the title of the post says, this is the official submission to Unicode for the Transgender Pride Flag Emoji.
Monica Helms, the creator of the Transgender Pride Flag, is a signatory on the submission 🙂 .
The transgender pride flag signifies visibility in a world that’s learning to love better. A sticker may seem like a small innovation but it means a lot to a community that’s been marginalized.
This year at Capital Trans Pride, we lamented that the only emojis we could send to each other are the rainbow pride flag.
“My reason for wanting a trans flag emoji is so that a trans individual can feel a sense of belonging and visibility when using technology to communicate.” Bianca Rey (@BiancaRey), Co-Chair, Capital Trans Pride, Washington, DC (Trans Pride Sticker Set Site)
If you don’t like the news, go make your own. Hopefully the news will be good. Feel free to review the submission and provide us with your comments.
More people with health care = more humans living authentically and able to help the world learn to ❤️ better. Isn’t this century great? @equalitymarch2017 #EqualityEqualsHealth #dc #WeareDC @trans.equalityy (View on Flickr.com)
Type 2 diabetes is an increasingly common and progressive disease, the progression of which can sometimes be paused or even reversed using a low glycaemic-index (GI diet). Many patients with type 2 diabetes are on multiple drugs, yet are still not well controlled. This module describes the use of a low GI diet as an adjunct treatment for diabetes, using a case study of a real patient registered at the author’s practice. The physiology and evidence behind a low glycaemic-index diet are described, as well as how to implement it in real life.Type 2 diabetes and the low GI diet
I completed this course as an American specialist in Family Medicine and found it compelling and informative, in a short period of course completion (less than 30 minutes).
What most/all physicians appreciate is the care and rigor that must go into producing continuing education for a physician audience, and I could tell that Unwin and collaborators worked to ensure content is based in science, of the kind we were never taught in medical school (or taught incorrectly)
They included a patient story, which even for me was stunning in a good way.
My very different experience recertifying as an American family medicine specialist
At the same time, I recertified as a family medicine specialist at the end of 2018 and was disappointed to find learning modules riddled with inaccuracies and old information around the topics of diabetes prevention, diabetes reversal (no information), and nutrition. The modules allow learners to leave comments, and I found I was not the only physician disappointed in the content. This is my comment on one of the evaluation questions of one of the modules:
“Did you notice any problems with the content of the knowledge self-assessment activity? – Yes”
“Extremely out of date, especially the nutrition questions, which still mention “calories in, calories out” (no evidence that this valid) and focus on low-fat diets, which again have been proven unhealthy and without any evidence of support. I would overhaul this entire section.”
In my glass ¾ fully self, I was delighted to find fellow family medicine specialists question the information and embrace curiosity (it’s what we’re trained to do).
I am supportive of Maintenance of Certification – it’s about the content, not the concept
This is not a blog post decrying or diminishing the importance of maintenance of certification (MOC) for family medicine specialists.
As I wrote in this three part series on what it means to be a family medicine specialist (because apparently the public doesn’t know what we are), I am proud of the fact that we were the first medical specialty to mandate ongoing certification to keep current. Unlike other specialties which “grandparented” their members, the founders of family medicine guaranteed their obsolescence the day they created us.
I look forward to American specialty societies following the lead of the RCGP in producing learning modules for diabetes prevention, remission, reversal. Dr. Unwin and his patient’s goals are the same as ours – enjoy disability-free life-years with as low a pharmaceutical burden as possible and as high a enjoyment of life’s opportunities as possible.
Physicians have been receiving nutrition education all along, just not unconflicted information
When people say “physicians don’t receive nutrition education,” I challenge that statement, because I’ve found that we do receive education, just not from credible sources. A quick browse through the pages of the 1957 New York Academy of Medicine (!) tells the story. It’s been like this for over 60 years.
2018.02.11 Pharmaceutical Ads, New York State Journal of Medicine, 1957 291 (View on Flickr.com)
Here’s a gallery of additional advertisements from 1957 that will gently blow your mind.
2016.08.16 DC People and Places 07393 (View on Flickr.com) Thank you for publishing my photograph, @ggwash, in this in depth piece, which I will not try to summarize in this post.
I recall I took this photograph when I was first learning photoshop. Here’s what I created with it, how did I do (no endorsement of any candidate implied)?
Two groups of DC school parents are at loggerheads. In the heart of Shaw is a large, vacant building that once housed a junior high school. One group wants the school rebuilt and reopened as a neighborhood middle school, while others want to move Benjamin Banneker High School to the area. Can both get what they want?
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-620 – Hall KD. Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake. NutriXiv; [cited 2019 Mar 4]; Available from: osf.io/preprints/nutrixiv/w3zh2
Images and content used under a CC0 1.0 Universal License (View on Flickr.com)
This is a cool new study that, in a rigorous way, shows that without changing macronutrient (carbohydrate, fat, protein) proportions of a diet, ie. even if keeping carbohydrate intake high, there’s still benefit from eating un-processed (“real / whole”) food.
Ultra-processed foods have been described as “formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes” and containing minimal whole foods (Monteiro et al., 2018)” and have never been studied in a randomized control trial compared to unprocessed (“real”) food. 20 non-diabetic adults were hospitalized for 4 weeks and fed ultra-processed and un-processed diets for 2 weeks each, and told to eat as much or as little as they wanted, over a 60 minute period.Hall KD. Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake. NutriXiv; [cited 2019 Mar 4]; Available from: osf.io/preprints/nutrixiv/w3zh2
I really like that the pre-print paper includes photographs of the meals – I chose to highlight meals in this slide in each category that look somewhat similar, to demonstrate that a change is not as complicated as some people think it is (I made the change in my own life, like many physicians, I am recovering from a low-fat, processed diet that I was told was healthy, very incorrectly). Unfortunately, this is still what we’re presented with on a regular basis. I of course did not partake, except for a cup of coffee with cream:
Kevin Hall, PhD (twitter:KevinH_PhD), explains the significance in a tweetstorm, and he knows much more than I about double-labeled water and respiratory chambers:
This study is the first randomized controlled trial of ultra-processed versus unprocessed diets and suggests that limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment. 6/7
Speaking of not knowing of these things, if there’s anything inaccurate in my slide above, feel free to check my work, accuracy is better than speed, and my next point….
Is it a war, or really a desire to know how to help the people we serve achieve their life goals 🙂
The paper’s first sentence starts with the phrase “diet-wars” which I feel is inaccurate and contributes to a lack of curiosity about science. We are not at war with our patients; we are at peace with them. This is an approach/mindset physicians should not be using, especially given well-publicized incidents of academic bullying.
Reference
Hall KD. Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake. NutriXiv; [cited 2019 Mar 4]; Available from: osf.io/preprints/nutrixiv/w3zh2
Images and content used under a CC0 1.0 Universal License
2019.03.01 Continuous Glucose Monitor, Washington, DC USA 00333 (View on Flickr.com)
In the last century, people were told based on faulty science, “you are what you eat.”
In this century we now know “you are what you do with what you eat.”
Continuous glucose monitors (#CGM) confirm the science we were taught in medical school works as advertised. Combined with a #FoodNotPharma approach, we could end the (Type 2) diabetes epidemic in our lifetimes.
As predicted, thee was no increase in blood glucose from these meals.
Getting ready for Low Carb Denver, and reflecting on what I’ve learned in the last 2+ years – value of continuous learning as a family medicine specialist 🙂 .
2018.12.29 Rehoboth Beach by Drone, Rehoboth Beach, DE USA 0148 (View on Flickr.com)
I am doing video very sparingly (I’m more of a still photo person). There are also very few places in the United States where it’s legal to fly a drone. Rehoboth Beach, DE is one of them, and a beautiful one.
My original analyses of data not included in the main body of the DIETFITS paper, which shows evidence of poorer metabolic health among people eating a low-fat vs low-carb diet, despite the conclusion in the paper that the diets were equivalent for weight loss. See this blog post for more. 2018.02.16 Metabolic Health Calculations, DIETFITS Randomized Control Trial 333 (View on Flickr.com)
This heavily paywalled study is a more thorough analysis of something that caught my eye and was glossed over in the original publication of DIETFITS last year, which showed that weight loss was equivalent in groups of people who either ate a healthy low carbohydrate or a healthy low-fat diet.
The conclusion for some was “the diets are all the same.”
Except maybe they’re not…
The problem I noticed with DIETFITS not addressed in the main paper – worse metabolic health in the low-fat group
I took the time to dive into the supplemental materials where this information was (it wasn’t in the main paper) and made these pretty charts which show a visible tendency to insulin resistance and poorer lipid status (cholesterol,HDL, LDL, triglycerides) in the “healthy low fat” diet group.
This is a misleading statement in my opinion because of the “favored” status given low-fat diet. This statement also invokes our profession’s laser-light focus on LDL when we now know that the overall profile (HDL, triglycerides, and more recently particle type/size) is more important for cardiovascular health.
The dogma-challenging data here – people who increased their % of saturated fat (SFA) on the low carb (LCHF) diet:
didn’t increase the quantity of saturated fat they ate – their overall calories decreased as well as their protein and carbohydrate intakes. This explodes the myth that an LCHF diet means eating more saturated fat.
didn’t significantly increase their LDL cholesterol
increased their HDL (not significantly)
significantly decreased their triglycerides
Without getting too complicated, the low-carbohydrate group did these things better than the low fat group, who did not drop their triglycerides.
The researchers showed that the drop in triglycerides in the low carbohydrate group (a good thing for health) was strongly related to the drop in carbohydrate intake, which makes low-carbohydrate superior in this case for metabolic health.
These are similar to the findings in the paper cited below, which tend to be repeatable – an overall improvement in lipid profile when lipids are looked as a group, not as a single number (kind of like what we should do in life itself):
A study of 10 keto-adapted athletes and 10 high-carbohydrate adapted athletes describes typical cholesterol changes seen in people who go on low carbohydrate, healthy fat (LCHF) diets. Often only one number is looked at (LDL-C) in criticizing this approach, however there are other changes that may be compensatory at the same time. It’s not known exactly why this happens or if it increases CVD risk.
Noting also from the data above that while none of the athletes (high carbohydrate and low carbohydrate) met criteria for insulin resistance, markers of insulin sensitivity (TG/HDL-C ratio and Lipoprotein insulin resistance index) were significantly better in the low carbohydrate group.
“Ketogenic diets in normal-weight and overweight non-athletes result in a moderate increase in total, LDL-C and HDL-C concentrations relative to low-fat diets. The observation that highly trained, ultra-endurance athletes consuming a very low-carbohydrate/high-fat diet exhibited a more dramatic and uniform hypercholesterolaemia is counterintuitive since high-volume exercise tends to lower total and LDL-C levels. The explanation for this paradox may involve high intake of cholesterol and saturated fat combined with high-energy demands for lipid metabolism characteristic of the keto-adapted phenotype. LC athletes who adopt a ketogenic diet may experience an expansion of their endogenous cholesterol pool during the adaptation phase of the diet, after which they maintain greater circulating cholesterol levels.”
Individual lipid measures for high-carbohydrate (n=10) and low-carbohydrate (n=10) ultra-endurance athletes. Bars represent mean±1SD. HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol. TC, total cholesterol; TG, triglyceride. Source; Creighton BC, Hyde PN, Maresh CM, Kraemer WJ, Phinney SD, Volek JS. Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes. BMJ Open Sport Exerc Med [Internet]. 2018 Oct 4;4(1):e000429. Available from: bmjopensem.bmj.com/lookup/doi/10.1136/bmjsem-2018-000429 – Re-use permitted under CC BY-NC.
Despite the pitch for plant-based eating, there’s no evidence here of superiority
The term “plant-based” was sprinkled throughout the paper, however it’s acknowledged that there’s no evidence here of superiority of plant-based over plant-free:
This study did not separate the analysis between plant-and animal-based saturated fat. Thus, the differential effects of plant- and animal-based sources of saturated fat on cardiovascular outcomes should be investigated further.Shih CW, Hauser ME, Aronica L, Rigdon J, Gardner CD. Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment. Am J Clin Nutr [Internet]. 2019 [cited 2019 Jan 21]
“investigated further” is translated into english as “we failed to prove this” 🙂
Shifting the emphasis to weight loss (not as important) to metabolic health (more important)
The conclusion of the paper is well stated:
Specifically, these secondary analyses support shifting the focus from concern about percentage SFA intake on the overall lipid profile to instead aiming to maintain a relatively stable absolute level of saturated fat intake while focusing on improving the quality of the overall diet by incorporating more whole foods and decreasing processed carbohydrates as much as possible.Shih CW, Hauser ME, Aronica L, Rigdon J, Gardner CD. Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment. Am J Clin Nutr [Internet]. 2019 [cited 2019 Jan 21]
Dislcosure: I’m in the 12% of Americans in metabolic health, and I’m not cancelling my trip to #LowCarbDenver
By the way, I am in the 12 %, this is as a good a time as any to state that I am on a healthy fat, low carbohydrate diet
I have no other personal interests or conflicts to disclose – conflict-free is the way to be (see: My Disclaimers and Disclosures)
See everyone there. I continue to love this century 🙂
Reference
Shih CW, Hauser ME, Aronica L, Rigdon J, Gardner CD. Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment. Am J Clin Nutr [Internet]. 2019 [cited 2019 Jan 21]
2015 Greenbuild Tour Bike DC- Transit, Health, and Gardens Kaiser Permanente Center for Total Health 00244 (View on Flickr.com)
Thanks for publishing my photos, @DCPolicyCenter (and syndicated to @ggwash) in another excellent analysis involving data, insights, active transportation, and Washington, DC – many of my favorite things 🙂 .
DC Bike Party High Tide Ride Washington DC USA 46128 (View on Flickr.com)
D.C. is still a pioneer in bikesharing, but more must be done for it to be a part of local families’ car-free transportation options.
