The book has been released!
Ok, so I’ve been busy with other projects in my life but I felt I had to pop in to address something serious. I know, I know, some of you are thinking “not another article about the health care reform” but hear me out here. For those of you who haven’t had enough opinions about the health care reform, you’re in the right place.
First off, a little background as to why I feel I need to address this issue. The main reason is this: As a health professional working in the public health sector, as a concerned American, and as a human being, I firmly believe in health as a human right, like freedom and equality. In fact, without your health it’s damn hard to feel free or equal in any society. Beyond that, however, I feel I need to address this issue because I am both an American citizen, who has lived first hand the degraded version of health care in America, and a Swiss citizen, who has spent considerable time in this foreign country seeing a quite stark opposition to the American health care system and one that is arguably less socialized than that in the States. Moreover, I have spent close to the last year living in Norway, and for some of that time working in the government public health sector, and am beginning to see the insides of one the world’s most “socialized” countries version of health care.
That being said, here are a few of my thoughts on the health care reform and the recent Supreme Court hearing:
1. You can have universal health care without “socializing” the nation. Look at Switzerland, for example, who has privatized all of it’s health insurance providers (but regulated by government), creating an “artificial” marketplace where businesses can compete and make profits, while still offering universal coverage at a relatively low cost with a high quality of care and very little waiting periods. (In fact, although this “socializing” argument is one of the mainstays of Republican banter, the likely Republican nominee, who will run against Obama for the presidency, created and implemented a health care system much like the Swiss system in his home state.)
2. You can’t have real (functional) universal health care without the mandate. It has been said over and over again but it must be stressed: without the individual mandate, health insurance companies will not have enough of a consumer base to support the cost of covering their clients who actually need high rates of care. In essence, the finances coming in will not be high enough to support the finances going out and these companies will invariably go bankrupt, with the whole health care system collapsing with them. Unless of course the government pays the bills. In reality then, the only way to keep universal health care from going fully socialized, with the government footing the health care bill, is to implement an individual mandate.
3. The “health” of the country, in every way, relies on this reform. The country is at a paradigm crossroads. In one direction, the country can move closer to supporting the social system and all of it’s people – to supporting the “you’s” and “me’s”. In the other direction, the country can move away from this focus, increasingly supporting big business and the financial elite – and their special interests – at the expense of the “you’s” and “me’s”. This decision by the Supreme Court on whether or not to strike down a bill supporting universal health care will set a precedent that has rarely been seen in this country. It will determine, quite honestly, whether this nation is moving in a direction that is more selfish – more interested in immediate personal gains – or selfless – more interested in national solidarity.
4. We are at a human rights crossroad. I believe that America is in the midst of a second civil rights movement – albeit different from the first. From health care to gay marriage, modern government has become increasingly responsible for deciding key human rights issues. The only problem is that the very people responsible for deciding whether or not these constitute human rights issues are also in a position to lose power, as ownership over these civil liberties are passed down from government and big business to the people. In many ways American people are less free without universal health care, bound by the constraints of an unequal distribution of coverage and services in a system that is more interested in the bottom line than the health and well-being of the people, than if all were “forced” to have health care coverage. (I write forced in quotations because the only people that will see a difference with the mandate are the people that wanted health care before but couldn’t afford it – everyone who has already bought health insurance because they could afford it, wanted it anyway.)
The reality is that this health care reform issue is far bigger than the individual mandate and it is even far bigger than the health care system. This reform touches on elemental issues of the American cultural system. It will help determine the environment in which our children are raised and in which we get old. It is sad and unacceptable to deny millions of hard-working Americans the right to health care but it is absolutely preposterous to deny our children and the children of millions of others, regardless of whether we can afford to buy coverage for our own children, of this fundamental right. Politicians are right that this is a freedom issue, but the freedom is not being stripped from us by requiring that everyone have health care coverage, it is being granted to us so that every member of the American family has an equal opportunity to a fundamental human right.
Please put the health and the well-being of every American citizen ahead of your big-business interest groups and the “top 1%,” of which many of you are a part of. After all, your job, by definition, is to look out for the best interest of your nation’s people. (Remember, you are representatives, not politicians.) Your job is not so tough, really. Freeze defense spending and bring home most of the nation’s troops and your budget woes are virtually solved. Then, while you’re at it, you can increase funding for social supports, increase taxes on the rich and big business, and restructure agricultural subsidies. America will thank you and you and your children too will live in a better nation, contributing to a positive global future (although you may have to trade in the porsche for a volkswagon – but after all, you did choose to be a civil servant).
Another concerned, informed, educated (and frustrated) citizen.
Note: if you would like to send your own letter to the Supercommittee, contact them here.
As the preliminary writing of the book has now concluded and the release date draws nearer, this will likely be my last post for some time (although, if I find the time, I may pop in with a surprise post here or there). This will surely be my last posting of excerpts from the book, however. The editing has begun and, in the words of the great Bob Dylan, the time they are a changing. These excerpts have all come from the rough copy so, although similar to the final product, do not expect the book to read exactly the same. Expect a more refined, sophisticated version of these excerpts. So, to wet your appetite one last time while I bust my ass to finish this book on time (and, concomitantly wrestle with my recent move to Norway – ya, I know, great timing, right?) here is my final excerpt from Life as we should know it, due out at the end of this year. Enjoy, spread the word, and look for the book soon…
The reality of the situation is that the American way of life, which has spread (to one extent or another) to a growing number of other nations, is based on a fundamental idea that has acted to propagate a theme of overconsumption. The culture is one where a sense of pride is bestowed upon the person who can be wasteful. The person who drives a Cadillac Escalade and resides in an enormous mansion, large enough to house a small community in other parts of the world, and who, metaphorically or (possibly) literally, can wipe their ass with the dollar bill, is elevated to a position of status and respect. The idea is that a person who can afford to be wasteful has “made it” in life. But this sentiment completely ignores the fact that there are major consequences, both socially (as we will see later) and environmentally, to this way of life. As one study from the University of Calgary purports, “at the core of ecological degradation are escalating levels of natural resource drawdown to provide satisfaction, convenience and novelty to a consuming public caught on a ‘hedonic treadmill’.” This way of life, this “hedonic treadmill” is, in many ways, damaging both to the individual who lives it and particularly to the lives of others who share the world with this type of individual (or community, for that matter). In this respect, the environment suffers from a culture supportive of this way of life and, as a consequence, the people involved also suffer. To support this type of lifestyle, this type of selfish disregard for the people and environment throughout, is crudely irrational and downright destructive. Change, in this respect, must be a mindful objective…We must begin to open a serious dialogue, not just with ourselves but as a national and global community, that places a deep emphasis no longer on materialism and wealth but on environmentalism and health.
I’m going to switch gears a bit here and post something a bit out of the ordinary. This next post is less of an investigation into the scientific and the academic (as I general tend to focus on) and more an exploration into the creative. I am not much of the creative writer but I came across this little piece of writing as I was sifting through some work I had done for one of my Master’s Degree courses, “Sustainable Development.” The unusually creative nature of the writing (for me) is punctuated by an essence of thought based on sustainability and, in a more general sense, health. It is this characteristic which I feel allows it not to be out of place on the front page of this blog. I hope you enjoy it…
Vast are the differences in which adults and children interact and perceive the natural environment. The natural environment, which every human being exists in and passes through, offers endless possibilities for learning and exploration. Abound are the life lessons in which the natural environment has the potential to reveal, from how we treat everything around us, especially those things which are special, to the interconnectedness of our species with the earth and the humility by which this is realized. Unfortunately, the human race, especially as they age, has seemingly lost much of its valuable connection with the natural environment, which is ultimately responsible for supporting its existence. It seems as though we could all benefit from shifting the way we perceive the natural environment to an outlook which is more like that of our children.
As a child, my most fond memories are generally those which have a deep connection with the outdoors and the natural environment. As a child, you are forced to make do with what you have and you grow from this understanding. You don’t have endless supplies of raw materials to build your forts or tree houses (and you sure as hell don’t have any money to go out and buy some). So you find dead branches and old 2×4’s and rotting plywood. You salvage everything you can and discover new uses for the old. Without knowing it, you recycle. This is the essence of sustainability.
As a child, cars are such a daunting piece of human ingenuity, only reserved for boring adults, that they seem as unattainable and foreign as ice cream before dinner. So you discover other modes of transportation. Bikes become spaceships that transport you from one end of the known universe to the next (in reality, this is just a couple blocks of suburban streets). And this mode of transportation seems so perfect. Car rides are dull and uninteresting, disconnecting you from the outdoor environment as it swooshes by at 60 mph. But on a bike, you can feel the wind in your hair and move slowly enough to notice the newly ripened lusciously red plums dangling from the neighbor’s yard. You stop to pick some. On a bike you don’t just move through the natural environment, you experience it!
It has been theorized, and in many ways proven, that we human beings are simply a product of our environment. The question of free will and the degree to which environment shapes us as human beings still has yet to be fully answered (and may never be) however it is certain that to some degree we are all products of the environment in which we come from. And it seems that the environment never has as much of an impact on our development as it does when we are children. The environment in which we grow up seems to have a significant impact on our views regarding sustainability and how we interact with and care for the natural environment. Whether our environment composed of green fields, elegant pastures and dark forests or of rough asphalt, high fences and dirty overpasses has much to do with how we perceive the natural environment. Surely, many of the lessons learned are the same however those individuals who, at a young age, are exposed to more of a natural environment where they can explore and play will likely age with more of an appreciation for the natural environment and be more inclined to strive for its preservation. This is important to note because as more and more people are raised in a city landscape, more determined planning will need to be taken in order to incorporate the natural environment into the landscape. Without the opportunity for interaction with the natural environment we as a species are doomed to misallocate resources, abuse our environment and wither in our own pollution.
(This article is a follow up to my previous article entitled Thoughts on Diet: Demystifying the Macronutrient, which can be found here)
Fat. What comes to mind first? Sure, the possibilities are endless. For every person, this word is likely to incite a different cognitive response. One major theme is likely to exist however. This is fear. Not the kind that leaves a person paralyzed, overwhelmed with a sense of danger. This is the kind of fear that comes with uncertainty. Uncertainty of what, in this case, the word truly means and how strongly it can influence a person’s life. In this case, as we have been told, it can kill. That is, if we fail to manage it correctly. But what does “managing correctly” mean? The plethora of conflicting information seems to imply that nobody really knows. What about carbs? Or protein? These words, notably the former, seems to garner a similar sense of xenophobia. The major macronutrients (fat, carbohydrates and protein) have amassed an unthinkable amount of attention in regards to their influence on health and disease. The common message is that there is no common message. Every message seems to be different. However, one thing is for certain and that is the fact that what we eat has a major influence on our state of health.
Similarly to the manner in which I attempted to shed some enlightening views on the macronutrient’s influence on human health in one of my previous articles (of which the link can be found above), I will attempt to do the same with the macronutrient’s influence on chronic diseases. These are the major killers that, as we are reminded of again and again, are largely influenced by the composition of our diet. Here are my thoughts on the major themes, developed over years of exploring, sifting, and deciphering academic and educational material on the subjects.*
Heart Disease (Cardiovascular Disease - CVD) and Fat: Although total fat has little, if any, effect on CVD risk, reducing saturated fat intake does. By reducing saturated fat intake we can lower CVD risk however, too often then not, this effect is negatively counteracted by an increase in dietary sugars and simple carbohydrates (such as white breads) leading to increased subcutaneous (under the skin – the kind hat makes us look fat) fat and again increasing the risk of CVD. This is the trend we have seen for the past 40yrs.
Diabetes, Obesity and the Effect of Diet: These illnesses are mostly attributable to an increase in dietary sugars and simple carbohydrates (like above) leading to an increase in subcutaneous fat storage as well as an increased desire to consume more sugars and simple carbohydrates, due to an elevated insulin response, leading to increased insulin resistance and, eventually, diabetes. One note here, which I will mention because it gets so much attention, is that physical activity does have an effect on controlling obesity and, consequently, diabetes but only to keep bodily systems running smoothly and efficiently (such as insulin sensitivity and glucose metabolism). It has a fairly small impact by way of “burning calories,” as we are repetitively reminded.
Lifestyle vs. Macronutrient Composition: Lifestyle behaviors tend to have as much, if not more, of an effect on health and body size/composition than does macronutrient composition (as long as dietary needs are met). These include choices related to dietary content, eating behaviors, activity behaviors, influence of unhealthy social and cultural cues, etc.
*If you are interested in resources for any of the claims I have made in this article, please feel free to email me and I will be happy to provide you with many
One of many excerpts I plan to post from my upcoming book, Life as we (should) know it…
The trouble with American perceptions regarding physical activity stem from a cultural characteristic similar, in many ways, to that which we see with diet. The problem is that media and industry shape many of our views and opinions. There is a fundamental flaw with receiving most of our information from these sources. Neither, generally, are reliable and, in terms of industry, there is an enormous conflict of interest. How can we expect to receive reliable and effective information and education regarding physical activity from a company who is in the business of selling a particular product or service to those who are physically active? These companies are in the business of selling what they do, not altruistically providing the public with educated information. And it manifests itself in many forms.
The health and fitness industry (that which is generally responsible for convincing people to become more physically active) and the various companies which operate within it present many faces, few of which are concerned with providing the public with well supported, unbiased information regarding health and physical activity. Instead, the public is presented with a myriad of reasons why it is important for their health to buy a particular product or service. We are generally convinced, via some unscientific diagram or illustration that these products or services are something necessary for our health. (My favorites are commercials for fat-loss pills, which show some dots of varying colors released from the gut after taking their pill, that subsequently track down the fat deposits stuck to the outline of a human being and make them disappear as if by magic). The message these companies are selling is: “you can’t live (at least not healthily) without our product.” But people have for centuries. And people still are today. In most cases these companies are trying to sell us something which is completely unnecessary (I mean, the Shake Weight, c’mon!) and, in some cases, even completely useless (Power Balance wrist bands? Seriously?). And if, by chance, any of these products are truly necessary for people than it is, most assuredly, an issue that needs to be addressed at a much deeper level. In any case, these companies are, in most cases, attempting to do something very difficult. They are attempting to convince people that it is necessary to spend money on a product that is unnecessary (isn’t this all marketing?). A very effective method of accomplishing this goal is to supply the consumer with an abundance of conflicting information, which does not necessarily have to be based off sound science or even be true. With this approach, the consumer is kept uninformed, always guessing as to what they should believe. Consequently, if a person does not know what to believe, they are more likely to believe just about anything as, in many cases, it seems better to accept this information as truth than to be subjected to the consequences which may be incurred by ignoring the information altogether. This effect is only compounded when a feeling of dissatisfaction with body image is incited. Although I will talk about this more in a bit, the point here is: make a person feel like they should not be happy with what they have and they will always struggle to have more (or better). This person will always look for the next best way to gain what they feel is missing – in this case it may be tighter hips, broader shoulders, a leaner physique, the list goes on. The search to fulfill this dissatisfaction may come in the form of behavior change but, more likely, this will come as a product that is promised to fill the void (which, most likely, will not). As we will soon see, this may be good for business but it surely is no good for the health of any nation.
It’s no surprise that most American find it difficult to understand exactly what healthy eating looks like. The number of mixed messages is endless: Eat more fat. Eat less fat. Eat more carbohydrates. Eat less carbohydrates. Eat more plant protein. Eat more animal protein. High protein diets will kill you. High carbohydrate diets will kill you. High fat diets will kill you. Contradictions, rather than the exception, have become the norm. No one source of information can bear full responsibility for this misfortune. Instead, all major sources of information share, to some extent, the responsibility. The government, the media, the “experts” and, possibly more so than any other source, the research establishment all contribute to this national state of confusion. What the nation is left with are massive amounts of information on diet which have little effect on improving understanding.
I have spent years sifting through this information, investigating countless claims to the bitter end of their relevant material. Some have presented logical conclusions, others have left me more confused than when I started. Ultimately though, these investigations have allowed me to build a framework, largely independent of the messages so frequently purported by the usual “authorities”, for understanding the true effects of dietary behavior. In effect, it has allowed me to uncover the vail largely shrouding in secrecy the most objectified scientific findings.
The following are conclusions, which I have gathered through analyzing years of research and resources too numerous to list*, that I believe unbiasedly represent the current body of research surrounding healthy eating. They may just shed some light on the general understanding of what it means to eat healthy. And although any well-educated perspective is constantly evolving, as developing research and insights are created, to date this may be the most objectively complete, simple set of guidelines any person is likely to find…
Dietary Fat: First and foremost, dietary fat is not the demon it’s so often made out to be. Although it is important to regulate the amount of fat in your diet, the health consequences generally associated with dietary fat have much more to do with the type of fat rather than total intake. In fact, total dietary fat intake has very little, if any, association with adverse health effects. What does however, is the amount of saturated and trans fats in a person’s diet. Total dietary fat, as is often wrongly proclaimed, has little to do with an individuals level of subcutaneous fat (the fat stored under the skin – that which generally makes a person look fat). Instead, diets high in saturated and trans fats tend to increase visceral fat (that which surrounds vital organs) which is generally more dangerous than subcutaneous fat (although subcutaneous fat is itself far from harmless). Diets high in these particular fats also tend to decrease HDL levels (what is considered “good cholesterol”) and increase not just the amount of LDL (aka “bad cholesterol”) but concentrate it into smaller and more dense particles, making them more dangerous than other types of LDL particles. Both the decrease of HDL and increase in smaller, more dense LDL particles are markers of increased cardiovascular risk.
A caveat must be made here however. It must be noted that dietary fat (that which is eaten) is very different than body fat (that which is found stored on a persons body). Although total dietary fat may not be associated with increases in total subcutaneous fat, subcutaneous fat levels are very much associated with health. Generally, as subcutaneous fat deposits increase, the likelihood of contracting a myriad of various illnesses also increases.
Protein: Similar to fat, this macronutrient is not the demon it is so often made out to be. It can be, however, if it includes high amounts of saturated fats. Animal protein does contain relatively high amounts of saturated fat but as long as general consideration is taken to reduce the amounts of saturated fat in meat choices, this should not be an issue. For this reason, among others including the high levels of Omega-3 fatty acids, fish is a better choice than meat. Plant proteins can be excellent sources of protein but animal sources should also be included as these are generally more complete sources of protein, containing some nutrients, such as B-12, found in very limited or nonexistent quantities in most plants. Moreover, fermented dairy products such as cheese and yogurt can be acceptable sources of protein (and are quite healthy) when consumed in moderate amounts.
Now, although protein (and, arguably animal protein) is a necessary component of any diet, a high protein diet is suggestively not healthy for the long term (though reasons for this are sparse). One supportive explanation suggests that excessive protein in the diet is attributed to increased oxygen use due to protein’s thermogenic effect (because the body does not have a mechanism by which to store protein). This is good in one way, by increasing energy expenditure, however has also been attributed to greater levels of cell oxidation, leading to oxidative stress and the formation of free radicals. High protein diets have also been suggested to increase the circulation of growth hormone, which has been implicated in hastening the aging process and increasing stress to the body.
Note: When choosing protein sources of which are animal based, please, please, please, do your health, my health and the health of this beautiful planet we all call home (and which provides us all with life) a favor by supporting local and sustainable meat and dairy farmers whenever possible. It is truly the only senseful way for the human population to consume animal products…
Carbohydrates: Contrary to protein and fat, carbohydrates (although not all) are the demon they are made out to be and it could be argued are more demonic than they are sometimes made out to be. The danger lies mostly with the consumption of simple carbohydrates such as sugar and white bread (complex carbohydrates, which are more difficult to digest, bear less consequences). High carbohydrate diets should generally be avoided as they tend to include a fair amount of these simple carbohydrates, generating an increased insulin response. This response generally results in greater levels of subcutaneous fat deposition, leading to increased hunger (generally for more of these fast digesting types of carbohydrates). This results in further insulin secretion and, given enough time, ultimately leads to insulin resistance, type 2 diabetes and obesity. Furthermore, high carbohydrate diets (which limit total fat intake) also tend to decrease HDL and increase the amount of small, dense LDL – similar to consuming high levels of saturated and trans fats – (although this is associated with simple carbohydrate intake much more than complex carbohydrates). Conclusively, carbohydrates should be limited to complex carbohydrates, especially in the form of vegetables (and some whole grains), and very few, if any, simple carbohydrates and sugars.
*If you are interested in resources for any of the claims I have made in this article, please feel free to email me and I will be happy to provide you with many
One of many excerpts I plan to post from my upcoming book, Life as we (should) know it…
I saw a very good quote today, pinned to an office door at the department of psychology at NTNU, Norway’s version of MIT. It read, “Perception is deception.” And, in this case, we are all being deceived. The reality is that a person does not need to look as though the only thing they do in life is exercise and eat cabbage to be healthy. In fact, this body image, in most cases, is vastly unhealthy! And, as previously stated, says absolutely nothing of a person’s true health status. Nor does anyone need to run the equivalent of an ultra-marathon every week or run a sub 5-minute mile or bench press 300lbs to be healthy. Not that these are commonly used as such, by leading health experts or organizations, but these benchmarks do not belong in the same conversation as health and physical activity. These are benchmarks for elevated levels of athletic performance. Yet these seem to be the type of standards that have been set collectively by the sub-culture of our society. They are standards that say, “become the best or don’t bother.” This message is not one that is (generally) overtly stated but is one which, seen through the eyes of my experiences and education, I have seen subliminally circulated from one person to the next (and, as we will see soon enough, I am not alone). And this perfectionist attitude is one that is crushing many people’s chances of confidently and competently incorporating physical activity into their daily lives and, in the most severe of cases, is even contributing to body image issues and eating disorders.
The result of this cultural phenomenon is that society is segregating itself into those who fail to get enough physical activity and those who get plenty of physical activity but go about it all wrong*.
Sure, there are those who fall in the middle – there are many of them – but the cultural standards society is setting for itself do not include these outliers. These centrists are generally ignored and, instead, what society seems to do so often is focus on the extremes. At the extremes is where people tend to find more to talk about and where companies find it easier to market their products. However, it is at these extremes where the damage to society is done. Those who find themselves as one of many who do not get enough physical activity generally find themselves there due to motivational issues. However these motivational issues are not individual deficiencies, as they are so many times deemed, but instead are caused by societal and environmental factors. They are caused by a pressure to perform. It is for this reason that so many attempts to become physically active are stifled from the very beginning or fail to ever amount to much … Why? Because society is demanding a desperate proposition from these people. Society is demanding something which is impossible for many of these people. And desperate situations demand desperate actions. The result is a downward spiral, a vicious cycle, of diminished motivation due to unrealistic standards which generally results in a state of helplessness. Conversely, those who find themselves as one of the many who get plenty of physical activity but go about it all wrong generally find themselves in this position due in part to the same motivational issue plaguing the previous group (however this group is motivated in the opposite direction) and in part due to a societal deficiency in education – specifically in proper physical activity education. The fact is that many people are getting their education, determining what is and is not healthy, from all the wrong places (which I will discuss shortly). The result is a subculture very different, starkly opposite, of that which characterizes the unmotivated.
*In reality, this is a gross oversimplification of the issue but was stated in this way to prove a point.