Just Read: High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance (except that maybe it’s not)

This paper is just now starting to receive some discussion online, however, it came to be via the alerts service of my medical specialty society, the American Academy of Family Physicians (@AAFP).

This is a link to the actual brief, which caught my eye because of three things:

  1. Insulin Resistance
  2. NAFLD
  3. Red Meat
  4. Israeli researchers (homage to the homeland)

Research links red, processed meat consumption to insulin resistance, NAFLD
A study in the Journal of Hepatology revealed that adults with high consumption of total meat and red and/or processed meat were at an increased risk of developing insulin resistance and nonalcoholic fatty liver disease, compared with those with low meat consumption. Israeli researchers conducted a cross-sectional study and found that an increased risk of insulin resistance was independently associated with high intake of meat that was fried or grilled and contained heterocyclic amines.source: Family Medicine Smart Brief, American Academy of Family Physicians

And actually, the brief didn’t link to the study, it linked to this: Health News Articles | News for Physicians & Medical Professionals, which then linked to the study, which is actually paywalled.

In this situation how would the average busy physician (or even would they) be able to verify the claims in the study?

This is, unfortunately, how more physicians are getting nutritional information than they probably should. It continues the tradition established in the 20th Century which I wrote about previously, complete with images from the medical journals of the past: Physicians’ 20th Century Nutrition Education: via Medical Journal Advertisements (Food Has Always Been Medicine)

I Pulled the Paper and I have a ton of questions

I had so many questions that I asked other doctors the questions I had to see if they were the right questions.

  • The claim that non-alcoholic fatty liver disease (NAFLD) is caused by cholesterol, saturated fat, and lack of exercise
  • The claim that red meat is associated with the development of insulin resistance, Type 2 diabetes, and metabolic syndrome

With that lead in, looking at the study itself

Noting, by the way the very high prevalence of

  • diabetes, (14.8%),
  • insulin resistance (30.5%), and
  • NAFLD (38.70%)

The NAFLD prevalence is much higher than estimated previously (32 % – data derived from the same author of this study).

High meat eaters did not have significantly worse lifestyle habits, with similar levels of physical activity, smoking and sugared drink consumption, but had slightly higher alcohol consumption within the range of adequate intake, and as expected, higher consumption of saturated fat and cholesterol which were adjusted for in the multivariate analysis as potential confounding or mediating factors.

How did they know that they didn’t have significantly worse lifestyle habits, if they only controlled for these factors?

Especially when

  • Dietary cholesterol intake has not been shown to be a risk factor for metabolic disease
  • Saturated fat intake’s risk factor profile for metabolic disease is questionable

See this article for more information: Just Read: Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions

Did they control for the dietary determinants of Insulin Resistance and NAFLD?

  • No review of carbohydrate intake, which is a risk factor for insulin resistance (and NAFLD) – what actually travels with meat eating in Israel? And if vegetable and seed oils travel extensively with meat in Israel (see photo below), how is this accounted for. I’m being mindful of the heart-breaking Israeli paradox.

Here’s a sample meal from a recent trip (I curated carefully, not ingesting the carbohydrate content)

2016.07.07 Tel Aviv People and Places 06737
2016.07.07 Tel Aviv People and Places 06737 (View on Flickr.com)

Noting that the results changed to non-significance for “high processed meat” when adjusted for saturated fat.

Do the references represent the spectrum of scholarship on this topic?

I’m not sure about this. I am concerned that they don’t.

I think I’ll stop at 3 questions for now, because I did receive assistance from physicians who are more practiced in the review of nutritional science than I 🙂

From @GeorgiaEdeMD

1. Nutritional epidemiology almost always useless (weak associations, inconsistent trends, heavily biased, notoriously flawed questionnnaire-based methodology, more than 80% of nutrition epi studies later proved wrong in clinical trials). As the authors themselves write in their own conclusion: “This study has several limitations. Firstly, the cross-sectional design of the study does not allow causal inference. Secondly, meat consumption was self-reported and thus prone to reporting bias.”
2. Odds ratios in this article less than 1.5; OR less than 2 generally not considered worth paying attention to (signal:noise ratio too low).
3. the only type of carbohydrate they “controlled” for is sugary beverages; we don’t even have a basic total carbohydrate intake estimate, let alone a refined carb intake estimate–in other words, they didn’t ask questions or didn’t report answers to questions about processed carbs, which is a well-established risk factor for IR and absolutely must be taken into consideration in studies of IR-related diseases. Ignoring refined carb intake is the most common confounder of every anti-meat/anti-fat epi study I’ve ever wasted my time reading:)
4. Their *hypothesis* that HCAs are *associated* with disease is not only grounded in similarly weak epi studies (they acknowledge themselves in the paper there is no human clinical evidence), it also conveniently overlooks the facts summarized on the slide below (from my WHO red meat and cancer presentation). Those are just for starters.

Last thing, I did send a note to my colleagues at @AAFP – this is the last part of it:

Happy to discuss this further & especially if there’s a way to have studies about emotional topics like nutrition to only be linked to if they have a good basis in science. If there are workgroups at AAFP working on the nutrition question around diabetes and diabetes reversal, I am happy to connect with them in the interest of relaying information of high integrity to our membership :).

Many thanks for listening,

Ted Eytan, MD
Board Certified Family Physician
AAFP Member
Washington, DC USA

I received no response.

Just Read: The State of US Health, 1990-2016 – Noticing: Significant Fasting Plasma Glucose Increase, Impact of Current Dietary Recommendations, Non-mention of (non-acoholic) Liver Disease + (Mis)Understanding Washington, DC

This paper is comprehensive and well covered throughout the social media sphere, so just adding a few things in the nutrition realm as well as a point on Washington, DC.

Significant Increases in Fasting Blood Glucose for Americans

High fasting plasma glucose increased in all states; the increase ranged from 127.2% in Mississippi to 1.7% in PennsylvaniaMokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA [Internet]. 2018;319(14):1444–72.

Increase in fasting plasma glucose is across the board, every single state (Table 7):

  • 41 % in Washington, DC
  • 42.6 % in California
  • 105.4 % in New York

These are bad signs. They indicate increasing insulin resistance, metabolic syndrome, and ultimately (type 2) diabetes and non-alcoholic fatty liver disease (NAFLD) (which most people with diabetes have) which may become the #1 reason for liver transplantation in the United States.

This condition, insulin resistance, and its constellations are only preventable/treatable by diet.

Could Increased Fasting Blood Glucose have been caused by, rather than prevented by, current dietary recommendations?

In the body of the paper, the increase in fasting blood glucose is not connected to current dietary recommendations as a cause.

Current recommendations promote carbohydrate intake and may be partially responsible for this increase.

See the paper linked to in this post for more about what’s happened since 1977 (and really, 1961):

(More from my trip to the Library of Congress and incredible US News and World Report photo collection: 1968’s Harried Housewife Preparing Convenience Foods (and how her diet was re-engineered to be carbohydrate-rich))

The attached editorial says:

Resources such as the 2015-2020 Dietary Guidelines for Americans and the Physical Activity Guidelines for Americans offer evidence-based information to establish healthier eating patterns and to exercise more regularly.Koh HK, Parekh AK. Toward a United States of Health: Implications of Understanding the US Burden of Disease. JAMA [Internet]. American Medical Association; 2018 Apr 10 [cited 2018 Apr 17];319(14):1438. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.0157

Except here’s what happened when those guidelines were put in place:

Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic-353
Source: Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic. Lancet Public Heal [Internet]. 2018 Mar; Available from: linkinghub.elsevier.com/retrieve/pii/S2468266718300215 (View on Flickr.com)

Diabetes is increased, Non-alcoholic fatty liver disease is unaccounted for

  • Diabetes has gone from the #12 to the #8 cause of death and years of life lost in the United States
    • The age standardized death rate has gone down (presumably from better treatment), however it has gone down less than other causes of death
  • There isn’t a mention of non-alcholic fatty liver disease, even though it is now the overwhelming majority of chronic liver disease in the United States
    • Only cirrhosis from hepatatits and alcohol is discussed

All states experienced a considerable reduction in probabilities of death for ages 55 to 90 years, largely associated with reductions in the probability of dying from cardiovascular diseases (Figure 5). The highest point decline was observed in California at 12.6 points, compared with lowest decline of 3.5 points for Mississippi. These declines were somewhat offset by increases in the death rates associated with cirrhosis and other liver diseaseMokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA [Internet]. 2018;319(14):1444–72.

The quote below is confusing, because chronic liver disease from alcohol and hepatitis has been relatively stable or decreasing, while non-alcoholic fatty liver disease is going up, and accounts for the majority of chronic liver disease now.

For cirrhosis, intervention strategies to treat hepatitis C and decrease excessive alcohol consumption are important.

Just Read: Where and when did non-alcoholic fatty liver come from and connection to carbohydrates – Common Causes of Chronic Liver Diseases in the United States

Prevalence of Chronic Liver Disease-359
Prevalence of Chronic Liver Disease-359 (View on Flickr.com)

In addition, the connection between high fasting glucose and liver disease is not made in figures 2A and 2B, given the connection between these and NAFLD. For more about the mechanism underlying non-alcoholic liver disease, insulin resistance, and increased fasting glucose: Just Read: Putting insulin resistance into context by dietary reversal of type 2 diabetes

Misunderstanding of Washington, DC as a High sociodemographic index (SDI) future-state

This is repeated in this paper that is in so many others, that don’t look at sub-county level data.

In the United States in 2016, the SDI ranged from 0.874 in Mississippi to 0.978 in Washington, DC (global SDI values in 2016 ranged from 0.268 in Somalia to 0.978 in Washington, DC)Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA [Internet]. 2018;319(14):1444–72.

These posts help:

The Data Presented Are Useful Across Many Dimensions

  • They tell us about our past, and our potential future
  • They encourage us to look outside, in our own community, to see what they really mean

Conflict of interest disclosures

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Singh reports receipt of grants and personal fees from Savient, Takeda, and Crealta/Horizon; personal fees from Regeneron, Merz, Iroko, Bioiberica, Allergan, UBM LLC, WebMD, and the American College of Rheumatology during the conduct of the study; personal fees from DINORA; and nonfinancial support from Outcomes Measures in Rheumatology outside the submitted work. Dr Degenhardt reports receipt of grants from Mundipharma, Indivior, and Seqirus outside the submitted work. Dr Bell reports receipt of grants from the US Environmental Protection Agency and the National Institutes of Health (NIH) during the conduct of the study, and honorarium and/or travel reimbursement from NIH, the American Journal of Public Health, Columbia University, Washington University, Statistical Methods and Analysis of Environmental Health Data Workshop, North Carolina State University, and Global Research Laboratory and Seoul National University. Dr Mozaffarian reports receipt of personal fees from Acasti Pharma, GOED, DSM, Haas Avocado Board, Nutrition Impact, Pollock Communications, Boston Heart Diagnostics, and Bunge; other for serving on a scientific advisory board from Omada Health and Elysium Health; a grant from NIH and the National Heart, Lung, and Blood Institute; a grant from the Bill and Melinda Gates Foundation; and royalties from UpToDate outside the submitted work.

Thanks to the authors for their work.

Source: Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA [Internet]. 2018;319(14):1444–72.

Photos: 2018 Science March DC, Washington, DC USA

2018.04.14 Science March, Washington, DC USA 01289
2018.04.14 Science March, Washington, DC USA 01289 (View on Flickr.com)

I have been using this expression a lot lately, and then it turned up on this sign. The other side of the sign appeals to me as well 🙂 .

Rest of the photos below.

#ScienceMarchDC #theta360 – Spherical Image – RICOH THETA

Just Read: Where and when did non-alcoholic fatty liver come from and connection to carbohydrates – Common Causes of Chronic Liver Diseases in the United States

Prevalence of Chronic Liver Disease-359
Prevalence of Chronic Liver Disease-359 (View on Flickr.com) Source: Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008. Clin Gastroenterol Hepatol [Internet]. Elsevier; 2011 Jun 1 [cited 2018 Mar 14];9(6):524–530.e1. Available from: http://linkinghub.elsevier.com/retrieve/pii/S154235651100317X

As I’ve written here previously, the condition of non-alcoholic fatty liver disease (NAFLD) has seemed to come out of nowhere, is still creating confusion within the medical profession, and is continuing to grow in prevalence. It’s a follow-up to a previous post here, see: Just Read: Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.

This paper, published in 2011, is a trek back in time, to see when this phenomena started,

There was a starting point – 1988 -1994

Researchers used NHANES data from 1988 to 2008 to compare the presence of markers of metabolic disease. I’ve charted the relevant ones in the image above.

What can be seen is that in the 1988-1994 time period

  • About the same percentage of Americans had diabetes type II and NAFLD
  • NAFLD was a much smaller percentage (but not trivial) – 46 % of chronic liver disease

Contrast that to 2005-2008

  • Diabetes increasing to 9.1 %
  • NAFLD to 11 %
  • Percentage of liver disease from NAFLD – 75 %

These eclipse the formerly dominant causes of liver disease – the causes those of us who trained in the 20th Century were used to: hepatitis, and alcohol, which didn’t increase very much at all during this time period ( 0.34 % – 2.0 % )

Together, these studies indicate that NAFLD is poised to become the most important cause of CLD with a substantial clinical and economic impact.

These estimates are an under-estimation by as much as 50 %

This paper precedes the newer one I previously referenced, that uses more accurate methods for determining NAFLD. This paper uses blood testing, which can take a lot longer to show the effects of NAFLD. As a comparison, the newer paper showed a prevalence of 24 % in North America by imaging, 12 % by blood testing.

What happened?

For one thing:

Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic-353
Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic-353 (View on Flickr.com) Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic. Lancet Public Heal [Internet]. 2018 Mar; Available from: linkinghub.elsevier.com/retrieve/pii/S2468266718300215

Is obesity the cause or is it a symptom of the same cause, looking at carbohydrates:

There is no known drug treatment for non-acoholic fatty liver disease, and good evidence that’s made worse by the same things that make obesity and diabetes worse, so it may not be “because” of obesity but rather an effect of the same thing that causes obesity.

Note in the chart above that insulin resistance (as roughly calculated) was also increasing, from 23 % to 35 % in 2005-2008.

These are connected: Just Read: Putting insulin resistance into context by dietary reversal of type 2 diabetes

During chronic positive calorie balance, any excess carbohydrate must undergo de novo lipogenesis. There is no other available pathway, and it can only occur in the liver. This particularly promotes fat accumulation in the liver. As insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will increase liver fat more readily than others due to the higher plasma insulin levels. The increased liver fat will cause relative resistance to suppression of hepatic glucose production by insulin. Over many years, this will bring about a small increase in fasting plasma glucose level, and hence increased basal insulin secretion rates. The consequent hyperinsulinemia will further enhance the conversion of excess calories into liver fat. A vicious cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established.

It’s been thought that losing weight was the treatment. However, this recently published study disputes that, in that changing the diet without weight loss resulted in immediate changes (for the better) in fat deposition in the liver.

Just Read: How a low-carbohydrate diet rapidly reverses risk factors in people with high liver fat, in the disease we’ll all be hearing about – NAFLD, NASH, Diabetes Reversal

Citation: Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008. Clin Gastroenterol Hepatol [Internet]. Elsevier; 2011 Jun 1 [cited 2018 Mar 14];9(6):524–530.e1. Available from: http://linkinghub.elsevier.com/retrieve/pii/S154235651100317X

Thanks for Using my Photo, (and for the included education) – Executive Director Yesim Sayin Taylor discusses D.C.’s housing stock on the Kojo Nnamdi Show – D.C. Policy Center

2016.04.06 DC People and Places 03926
2016.04.06 DC People and Places 03926 (View on Flickr.com)

Thanks (again) for using one of my photographs, @DCPolicyCenter.

I love all of the education I receive via the photographs I take, long after they are taken.

This photograph used to adorn this post about a recent @KojoShow on the topic of DC’s housing stock, which is well worth a listen if you’re interested in what make places inclusive or not.

The photograph was taken in April, 2016.

This is what the same location looked like in April, 2017

2017.04.29 Vermont Ave Garden-Work Party Washington, DC USA 4131
2017.04.29 Vermont Ave Garden-Work Party Washington, DC USA 4131 (View on Flickr.com)

This location (Vermont Avenue, NW and V street, NW) are just a few blocks north of photos that adorn this post, from Greater Greater Washington (@ggwash):

Richard Rothstein lays out the reality of government-mandated segregation in “Color of Law” – Greater Greater Washington

Which are used as examples (I believe) of micro-segregation. I’ll post on that separately.

In the meantime, I appreciate the value that Washington, DC brings as a learning lab for our nation.

From the report the show references:

Another factor is what an inclusive city could (or should look) like and how market forces and government programs can be combined to help the city get there. Inclusivity could mean many things: mixing incomes, mixing households of all sizes, or having residents of all ages and all races and ethnicities, or a combination of these. But beyond that, the term remains underdefined because it is extremely hard to build an infallible vision around a more granular or neighborhood-level view of inclusivity. The District has a long history of segregated neighborhoods, by both income and race, and recent demographic and economic growth has not reversed this type of segregation. In fact, concentrated poverty and segregation has increased. The city’s housing policies—both historical and current—have contributed to this outcome.Taking Stock of the District’s Housing Stock: Capacity, Affordability, and Pressures on Family Housing – D.C. Policy Center

Executive Director Yesim Sayin Taylor discusses D.C.’s housing stock on the Kojo Nnamdi Show – D.C. Policy Center

Source: Executive Director Yesim Sayin Taylor discusses D.C.’s housing stock on the Kojo Nnamdi Show – D.C. Policy Center

Thanks for Publishing my Photo, in Color riot in the Flickr pool – Greater Greater Washington

2018.02.03 Howard Theatre at Dawn, Washington, DC USA 2
2018.02.03 Howard Theatre at Dawn, Washington, DC USA 2 (View on Flickr.com)

Thanks again for publishing my photograph, @ggwash.

It was taken on my morning commute, via #ActiveTransportation (of course)

Here are a few of our favorite colorful images submitted to the Greater and Lesser Washington Flickr pool, showcasing the best (and sometimes the worst) of urbanism in the greater Washington region.

Source: Color riot in the Flickr pool – Greater Greater Washington

Thanks for Using my Photos, in Challenging the Cappuccino City: Part 2: The limits of ethnography | City Observatory

2017.11.23 DC People and Places 0657
2017.11.23 DC People and Places 0657 (View on Flickr.com)

Thanks for using two of my photographs in this part 2 of 3 review of the Derek Hyra (@DerekHyra) book “Race, Class, and Politics in the Cappuccino City.” by @AlexBaca, for @CityObs.

2018.02.06 DC People and Places, PaintTheSky, Washington, DC USA 09835
2018.02.06 DC People and Places, PaintTheSky, Washington, DC USA 09835 (View on Flickr.com)

My review of the book along with photographs of the neighborhood is here (Thoughts and photos from the gilded ghetto | Race, Class, and Politics in the Cappuccino City, by Derek Hyra)

I appreciate the scholarship which has added a lot to my understanding of the situation written about in Hyra’s book. Baca makes an interesting point about the limitations of Hyra’s ethnographic approach:

Cappuccino City doesn’t consider a control group, selection bias, or comparative analysis. Hyra does not examine other neighborhoods within D.C. or outside of it, much less ask long-term residents in neighborhoods other than Shaw how they view change. If he had, he may have found that in some places, there are few “oldtimers” left behind to interrogate: Very poor neighborhoods that don’t rebound, or “gentrify,” are much more common than gentrifying neighborhoods, and essentially hemorrhage residents.

The piece links out to another series of blog posts about the book on the blog Truxton is In Shaw (@TruxtonTwit): Problems with the Derek Hyra Book: Part II WTF is Going On? – Truxton Is In Shaw.

In the above blog post, the author writes “I’m not sure who is reading this blog anymore anyway.”

I’m reading it.

It’s incredible to live in a place and time where whole books are written about the neighborhood you live in, and the associated commentary helps you/me understand what it takes to build a society where everyone has what they need.

I’ll post on Part 3 separately – there’s a photo in that piece that’s attributed to me, however, I don’t think it’s mine (I could be wrong, though).

In any event, thanks to Alex and City Observatory for allowing a snap of a shutter to bring me more knowledge about what I was seeing through the lens, and pointing out what I am not seeing. This is a heat map of the photographs I uploaded to Flickr in 2017. My goal in 2018 is to expand the area of heat.

Cursor_and_2017_FLickr_Photos_Heatmap-221
Cursor_and_2017_FLickr_Photos_Heatmap-221 (View on Flickr.com)

The City Observatory is a study of modern-day cities and urban development practices.

Source: Challenging the Cappuccino City: Part 2: The limits of ethnography | City Observatory

Thanks for Using my Photo, in this review of Journal of Adolescent Health’s Chosen Name Use in Transgender Youth Linked to Reduced Depression and Suicide

2013 Rally for Transgender Equality 21166
2013 Rally for Transgender Equality 21166 (View on Flickr.com)

Thanks for using my photograph, @Mad_in_America in this review of an article published in @JAdolesHealth.

I pulled the article and reviewed it:

For transgender youth who choose a name different from the name given at birth, use of their chosen name in multiple contexts appears to affirm their gender identity and lower mental health risks known to be high in this group.Russell ST, Pollitt AM, Li G, Grossman AH. Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. J Adolesc Heal [Internet]. 2018 Mar [cited 2018 Apr 13]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S1054139X18300855

This finding from the study strongly corroborates my experiences from the KPLantern project and the incredible mismatch between the expectations of medical professionals and the people they serve.

We/I learned there that one of the most important things health care can do to support our patients who are transgender or gender nonconforming is to use people’s names correctly.

This is also tied to a recent study I blogged about here, which shows that it’s far more costly to humans and the health care system to deny care than to provide it for these populations:

Just Read: Temporal Trends in Gender-Affirming Surgery Among Transgender Patients, Insights from Study Authors, Evidence that Providing Medical care is more Cost-effective than Denying It

Also relevant here is this story from Diana Forsythe, given to me by @SusannahFox 10 (!) years ago:

Involving Patients: Her (Diana Forsythe’s) paper should be inscribed on cubicle walls…

The ability of transgender youth to use their chosen name is connected to reduced depressive symptoms and suicidal thoughts/behaviors

Source: Chosen Name Use in Transgender Youth Linked to Reduced Depression and Suicide

Thanks for Publishing my Photograph, in Election links: It’s equity and education, stupid – Greater Greater Washington

2018.04.04 The People’s March for Justice, Equity and Peace, Washington, DC USA 01176
2018.04.04 The People’s March for Justice, Equity and Peace, Washington, DC USA 01176 (View on Flickr.com)

Thanks for publishing my photograph, @ggwash.

It was taken as part of the march honoring #MLK50 in Washington, DC.

Additional photos of the event can be found here:

Photo Friday: People’s March for Justice, Equity and Peace, Washington, DC USA

This week the Maryland GOP targets Aruna Miller, a billionaire sets his sights on Virginia, Charles Allen pushes to lower the age of voting in DC, the chattering classes evaluate the politics of Maryland’s busy legislative session, and more in our election link roundup.

Source: Election links: It’s equity and education, stupid – Greater Greater Washington

Thanks for Publishing my Photo, in Breakfast links: Navy Yard is set to boom – Greater Greater Washington

2017.06.08 DC Pride People and Places, Washington, DC USA 6143
2017.06.08 DC Pride People and Places, Washington, DC USA 6143 (View on Flickr.com)

Thanks for publishing my photograph, @ggwash.

It was taken in the Navy Yard neighborhood, as part of 2017’s @CapitalPrideDC celebrations.

Here’s a view on that celebration. Isn’t Washington, DC, beautiful?

2017.06.08 DC Pride People and Places, Washington, DC USA 6138
2017.06.08 DC Pride People and Places, Washington, DC USA 6138 (View on Flickr.com)

I don’t claim to be a decent Navy Yard photographer – that title belongs to JDLand.com: Near Southeast DC Redevelopment – you (and I have) could spend hours touring the then-and-now photos of Washington, DC.

Navy Yard is expecting massive growth, including 3,400 new residential units. Metro says you’ll be able to pay fare by phone next year. The DC Council approved Tenant Opportunity to Purchase Act (TOPA) exemptions for single-family homes.

Source: Breakfast links: Navy Yard is set to boom – Greater Greater Washington