The danger of science denial: It happens even on Science-Based blogs.

Poor Benjamin Franklin. I know how he felt! ;-)

I do not believe that he wanted to be doing that!

This post will be highly critical of Dr. David Gorski MD, as some of his comments have been either trolling, downright stupid, or both. They're definitely in denial of science. This post is intended to encourage Dr Gorski to leave comments here, as I will never leave any further comments on any blogs that he edits, for reasons mentioned previously. I will be copying comments from his blogs and pasting them here, with my comments after. If this is considered to be "bad form", I really don't care. Leaving derogatory comments about me on blogs on which the commenters know that I will never return (because I told them so) is definitely "bad form".

I will also be quoting other commenters on Dr Gorski's blog, for the same reason. Everyone is free to leave comments here, that meet my fairly lax moderation criteria. In Vitamin D, cancer, cliques and flouncing. , a commenter from Dr Gorski's blog called flip was initially whitelisted, to allow his comments to appear without me having to moderate them. I eventually blacklisted flip after I detected intellectual dishonesty. That's how I roll. If you don't like my rules, don't let the door hit you on the way out! By the way, calling me a liar on here is a sure-fire way to get yourself blacklisted.

I've just turned Blogger word verification back on, as although Disqus automatically deletes anonymous comments containing links, I still get email notification of them. I've been getting a lot of email notifications. This may or may not have an effect on commenters.

Firstly, please read http://www.sciencebasedmedicine.org/index.php/a-closer-look-at-vitamin-injections/#comment-127850 , as it's my "letter of resignation" from that blog. With that in mind, read on.

# David Gorski on 27 May 2013 at 9:49 am
Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing. Also, cancer was not its primary endpoint. Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.
There is a recent review of the literature from the Endocrine Society, which includes Lappe et al and puts it into context:
*quoted text redacted*

# Nigel Kinbrum on 27 May 2013 at 11:16 am
David Gorski said…

Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing.

Irrelevant.

Also, cancer was not its primary endpoint.

Irrelevant.

Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.

Irrelevant.

# David Gorski on 27 May 2013 at 12:28 pm

Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.

Irrelevant.

How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.

#Nigel Kinbrumon 27 May 2013 at 1:42 pm
David Gorski said…

Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.

Irrelevant.

How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.

1) The RCT used Ca + D. Therefore, the conclusions apply to Ca + D. If they’d wanted to test D alone, they would have. They didn’t. Why don’t you write a letter of complaint to Joan M Lappe about it?

2) Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.

#David Gorski on 27 May 2013 at 2:34 pm

As I’m leaving permanently, what’s the point?

Ah, flouncing off again. It’s probably long overdue. I’ve been getting a few complaints about you here as well. Perhaps you should ask yourself why complaints seem to follow you wherever you go.

“Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.”

I rest my case that you do not understand clinical trial methodology and interpretation. I couldn’t have demonstrated it better myself to anyone who actually does understand clinical trial methodology and interpretation. Thanks!

You sir, are an asshole. I spelled it the American way, just for you!

I rest my case that you're either trolling, or stupid, or both. Whether the outcome is primary, secondary, tertiary, quaternary or n’ary is completely and utterly irrelevant. It always has been and it always will be. You're effectively saying that only the first item in a shopping list should be bought because all of the other items in the shopping list are irrelevant. Bullshit!

Denice Walter May 27, 2013
@ Marc Stevens Is Insane:
I believe that Nigel is like two bright guys I know: they are well educated and professional in fields outside of SBM/ life sciences (business). Thus they read alt med ‘research’ (also see today’s post by Orac) and don’t get how it DOESN’T work in reality. It sounds like nutrients can do all of these wonderful things – that they can’t- at least not in RL. But the woo-meisters don’t tell you that part. We do.

So of course they think that these products are very useful- and they need celtic salt or ground organic flaxseed- as I know all too well.

However, if they’re smart- we can talk to them:
explaining how that *in vitro/ in vivo* thing works.
Or- as I often do- illustrating how much of the so-called science they read ( woo) is actually more accurately called “advertising copy”.

Businessmen seem to grok that.

Denice, seriously? I'm disappointed. I thought that you were one of the few reasonable posters on Gorski's blog and then you go and write that crap?

I do not read "alt med ‘research’", unless you're calling what's on PubMed "alt med ‘research’"? I've been reading studies on PubMed for years, so I know about the use of shoddy methodology to fudge results. The Lappe study doesn't use shoddy methodology. It's a Randomised Controlled Trial using double-blinded placebos and randomly-selected subjects who were post-menopausal women. Try to pick holes in it.

flip May 29, 2013
Hmmm… it occurs to me I probably haven’t been that overt about one other thing:

Lilady, I am sorry that you were called those things, and I certainly don’t think you should have been called names. I do think Nigel was wrong and do think he should be called out for it.

And I’m sorry for not making that clearer before.

flip, I'm not going to question your intelligence. However, why you're apologising to lilady boggles the imagination. lilady is a despicable human being. She pushed me to the point where I called her rude names, names that were not misogynist and for which I apologised. I explained about "twat" on SBM. I even posted a link to Wiktionary! You don't read things thoroughly before commenting.

Marc Stephens Is Insane May 31, 2013
Oooooh, Nigeepoo is ANGRY! He’s pulled a DJT, posting a “rebuttal” to all the comments here and on SBM. I’m suprised it’s taken him this long.

He’s calling Orac an a**hole and stupid, among other things. He’s invited us all to comment on his blog because he has an “open moderation policy” and “allows all comments.”

http://nigeepoo.blogspot.com.au/

I see that you idiots on RI are still reading my blog. I'm not the slightest bit angry, so you can give the projection crap a rest. For the record, most of you come across as assholes. You can't even quote me correctly. I said that I have fairly lax moderation criteria. Do try to get something right, for once in your miserable lives.

Anyway, you lot are now boring me with your never-ending inability to discuss things either accurately or rationally, so I'm not going to bother polluting my blog with any more of your crap.

P.S. I still occasionally read the comments on Gorski's blogs, so for the benefit of you peeps who read mine:-
1) "Black-list" means exactly what it says. It means that you're banned from posting comments.
2) The Lappe et al 2007 study was a good study. Just because some Messiah-like person says that it's a bad study and applies false reasoning to back himself up, doesn't make him right and me wrong. As I've previously pointed out, surgery's not exactly rocket science is it? I designed complicated electronic communications systems for 29 years. Just saying! ;-) Denice, I've got nothing against you. You've just been drinking Gorski's Kool-Aid for way too long. That's not a euphemism, by the way! :-D

Look what I just found. Exposing Dr. David H. Gorski, M.D., Ph.D. who believes he can use a cloak of anonymity and character assaults to discredit opposing views. Sorry Doc, but your game is up.

He's not the Messiah. He's a very naughty boy! :-D

\ curves and U curves: Vitamins D3 and K2 again.

Here are some curves relating to Vitamin D. Ref: http://www.ncbi.nlm.nih.gov/pubmed/23601272

Hazard Ratios (HRs) vs serum Vitamin D level

The solid lines are the 95% confidence intervals (CI) & mean for all-cause mortality. 95% CI's are the values within which 95% of the subjects tested fall. 2.5% fall below the lower CI and 2.5% fall above the upper CI. The dashed lines are the 95% CIs & mean for coronary heart disease (CHD) mortality. Most of the curves follow a \ curve, indicating that more Vitamin D is better, up to 66ng/mL (150nmol/L, the level that I'm at). The interesting curve is the upper dashed line, which follows a U curve.

The U curve indicates that a Vitamin D level of greater than 30ng/mL (75nmol/L) increases the Hazard Ratio (HR) for CHD in the top 2.5% of subjects only, relative to 30ng/mL, even though the mean HRs for CHD & all-cause mortality (the more important parameter) are decreasing, up to 66ng/mL. What's occurring?

See Vitamin K. The increase in HR for CHD mortality above 30ng/mL in the top 2.5% of subjects only is almost certainly due to calcification within artery walls, due to under-carboxylation of osteocalcin in bone Matrix Gla Proteins, caused by insufficient Vitamin K2 rather than excessive Vitamin D. This is why I supplement with Vitamin K2. See also Vitamin D toxicity redefined: vitamin K and the molecular mechanism.

Is Coenzyme Q10 a supplement or a drug? It all depends.

This is the molecular structure of Coenzyme Q10.

Ubiquinone

I saw the following Tweet by Evelyn Kocur. Back in October 2009, a trial was started, to test the effect of CoQ10 supplementation on congestive heart failure (CHF). See Coenzyme Q10; an adjunctive therapy for congestive heart failure? See also Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial.

The results of that trial have just been made public, but are not yet available on PubMed. See First Drug to Significantly Improve Heart Failure Mortality in Over a Decade. Wait, what? Back in 2009, it was a supplement. Now, because it works, it's a drug.

Supplementation in meaningful amounts of a substance that the body needs but lacks makes the body work better. Who knew?

Bandaoke with Jukebox at the Falkners Arms, Friday 5th April 2013.

This was Jukebox's 1st time performing this song live and my 1st time singing it at the correct pitch (at karaoke, I would have the pitch shifted down 2 keys). Ouch!

Flogging a knackered horse, metaphorically-speaking.

Q. What do you get when you flog a knackered horse?

A dead horse.

A. A dead horse. Like, duh! However, some people do this to themselves.

Coffee is a Central Nervous System (CNS) stimulant. A coffee first thing in the morning after getting out of bed gives you "get up and go". What happens if you carry on drinking coffees or "Energy Drinks" throughout the day? Guess!

Don't worry, be happy.

Oh, all right then!

I was chatting to the check-out guy in the Co-op about the sad goings-ons in Oklahoma and he said: "If we shed a tear for every person in the world that's suffering, we'd never stop crying." I try to avoid watching or reading World News. It's just one bad or sad thing after another. As I have no control over bad or sad things that happen around the world, what's the point in bringing myself down by knowing about all of them? Local News is a bit more relevant. I try to concentrate all my effort into keeping my life running smoothly.

If something really bad is about to happen to me or happens, I do everything in my power to make things better. If the really bad thing is completely beyond my control, I have to accept it. There's no point in wasting time going through Kübler-Ross stages 1 to 3 (denial, anger, bargaining). Stage 4 (depression) is a tricky one, as sometimes it just happens.

Finally, I treat people the way I'd like them to treat me. If they treat me respectfully, I do likewise. If they treat me disrespectfully, they get 1-2-3 Magic!

I've just installed f.lux, which adjusts the colour "temperature" on my lap-top screen, to suit the time of day.

Prevention vs Cure, quackery, bias and conflict of interest.

I believe in the maxim "Prevention is better than cure".

Image from www.nationalarchives.gov.uk

Some definitions:

Prevention. Cure. Quackery. Bias. Conflict of interest. Logical fallacies. In the case of the maxim, prevention means hindrance, as it's impossible to 100% stop illness from occurring. To someone who already has an illness, the maxim is obviously moot!

Quackery:

I have been accused of quackery. Despite having provided evidence to refute the claim, the person has refused to retract the accusation or provide proper evidence (other than Logical fallacies) to support it. EDIT: I blocked the person on Twitter. I am no longer on that person's quackery list.

Bias:

A long time ago, I mentioned a study Intensive lipid lowering with atorvastatin in patients with stable coronary disease.

"RESULTS: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P&lt:0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P&lt:0.001). There was no difference between the two treatment groups in overall mortality."

"CONCLUSIONS: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels."

Unfortunately, the statement "There was no difference between the two treatment groups in overall mortality." is incorrect. According to the full study (hidden behind a pay-wall) there were 26 more deaths in the 80mg/day group than in the 10mg/day group. That's not statistically significant, as the group sizes were ~5,000 each. However, the statement didn't mention statistical significance.

Therefore, the statement "Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day." is also incorrect. Dying is worse than having major cardiovascular events (heart attacks & strokes), which are survivable.

Why is there a disparity between the publicly-viewable abstract, the full study and reality? From the full study:-

"Funding for the study was provided by Pfizer Inc., New York, New York. Dr. Shepherd has received consulting fees from AstraZeneca, GlaxoSmithKline, Merck, Oxford Biosensors, Pfizer Inc., and Schering-Plough, and lecture fees from AstraZeneca, Merck, and Schering-Plough. Dr. Kastelein has received consulting fees and lecture fees from Pfizer Inc., AstraZeneca, Merck, and Schering-Plough, and grant support from Pfizer Inc. and AstraZeneca. Dr. Bittner has received consulting fees from CV Therapeutics, Novartis, Pfizer Inc., Abbott, and Reliant, and grant support from Pfizer Inc., Atherogenics, Merck, Kos Pharmaceuticals, Abbott, CV Therapeutics, and the National Institutes of Health. Dr. Deedwania has received consulting fees and lecture fees from Pfizer Inc. and AstraZeneca. Dr. Breazna, Dr. Wilson, and Dr. Zuckerman are all employees of Pfizer Inc. Mr. Dobson is an employee of Envision Pharma Ltd., which was a paid consultant to Pfizer Inc. in connection with the development of the manuscript. Dr. Wenger has received consulting fees from CV Therapeutics, Sanofi-Aventis, Schering-Plough, AstraZeneca, Abbott, Merck, and Pfizer Inc., and grant support from Pfizer Inc., Merck, and the National Heart, Lung, and Blood Institute."

Atorvastatin is manufactured by Pfizer Inc.

Conflict of interest:

I like the article Is Vitamin D Shooting Me in the Foot?, because Dr. Ken D. Berry prescribes his patients an effective dose of Vitamin D3, even though it results in him losing money due to the drastic reduction in the number of benign skin cancers for him to freeze-off. Now, that's what I call integrity!

Can a breast cancer surgeon (who receives payment for curing breast cancer using surgery) give a truly impartial opinion on other cancer cures, or cancer prevention? Does he always clearly state his competing interest? I think not!

Cancer, part 2.

In cancer, I discussed omega-3 and methylglyoxal.

Methylglyoxal

This time, I'm just going to do a Research Review, by publishing a list of PubMed searches with the following Filters activated: Abstract available, published in the last 10 years, Humans.

Cancer AND "Dichloroacetic Acid".

Cancer AND "Magnesium".

Cancer AND "Methylglyoxal".

Cancer AND "Omega-3".

Cancer AND "Vitamin D3".

Cancer AND "Vitamin K2".

I added searches for Magnesium and Vitamin K2, as I supplement with those and want to see if they have a positive or negative effect on Cancer. I added Dichloroacetic Acid (DCA), as I've read about it.

Evidence that Dihydrogen Monoxide is ineffective and toxic.

This just in...

Image from www.inquisitr.com

The RDI for DHMO is ~2,000ml/day.

Erstwhile group of researchers "A" ran an RCT. The placebo group ate & drank normally. The intervention group was given 167ml/day of DHMO (RDI/12) in addition to their normal food and drink. The trial lasted for 4 years.

RESULTS: There was no statistical difference between the placebo and the intervention group.
CONCLUSION: In this trial, DHMO made no difference to the subjects well-being, weight, body-fat percentage or anything else, apart from a statistically-significant increase in urinary volume. DHMO is therefore ineffective and long-term use may result in kidney damage.

Meanwhile, elsewhere...

Erstwhile group of researchers "B" ran an RCT. The placebo group ate & drank normally. The intervention group was given 60,000ml once a month of DHMO (RDI x 30) in addition to their normal food and drink. The trial was intended to last for 3 months, but was terminated after 1 month.

RESULTS: There was 100% mortality in the intervention group, compared to the placebo group.
CONCLUSION: In this trial, the RDI of DHMO killed 100% of the subjects. DHMO is therefore toxic.

Daily Mail Headline: Studies prove that DHMO kills! Parliament calls for an immediate ban.

DHMO is water (H2O).

The reason why I wrote the above spoof is because that's how Vitamin D3 is often tested in RCTs. Either daily "homoeopathic", or infrequent "standing on the sun" doses are used. Result? Failure. Therefore, Vitamin D is deemed to be either ineffective or toxic. See also Why randomized controlled trials of calcium and vitamin D sometimes fail.

The RDI for Vitamin D3 is 400iu/day, ~1/12 of what I take (5,000iu/day). Blood test results for 25(OH)D and Corrected Ca are in the RR (25(OH)D is near the top end and Corrected Ca is near the bottom end).

Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.

This is Fig. 2 from the study in the title.

FIGURE 2.

Kaplan-Meier survival curves (ie, free of cancer) for the 3 treatment groups randomly assigned in the cohort of women who were free of cancer at 1 y of intervention (n = 1085). Sample sizes are 266 for the placebo group, 416 for the calcium-only (Ca-only) group, and 403 for the calcium plus vitamin D (Ca + D) group. The survival at the end of study for the Ca + D group is significantly higher than that for the placebo group, by logistic regression. (Copyright Robert P Heaney, 2006. Used with permission.)

The reason why I'm making this post is because I was accused (on Twitter) of being a danger to women who had breast cancer and I was added to a Quackery list. I was alleged to have claimed that taking Vitamin D reduces the risk of getting cancer in the first place and/or of getting recurring cancer.

Obviously, I wasn't happy about this! I do not recall ever having made such a claim. If I have, please point it out and I will make a full retraction and apology. The study in question is Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.

Please note: Ignoring cancer diagnoses within the first 12 months removes results from women who had undiagnosed cancer at the start of the study.

What the study shows:

Taking 1,100iu/day of Vitamin D3 + 1,400-1,500mg/day of Calcium: When analyzed by intention to treat, cancer incidence was lower in the Ca + D women than in the placebo control subjects (P < 0.03). When analysis was confined to cancers diagnosed after the first 12 mo, RR for the Ca + D group fell to 0.232 (CI: 0.09, 0.60; P < 0.005). 0.232 is a reduction of 77%.

What the study doesn't show:

Taking Vitamin D3 only reduces the RR for cancer incidence. I believe that it probably does.
Taking Ca + D reduces the RR for cancer recurrence. I believe that it probably does.
Taking more than 1,100iu/day of Vitamin D3 reduces cancer incidence more. I believe that it probably does.
Taking Ca + D reduces the RR for cancer incidence in pre-menopausal women. I believe that it probably does.
Taking Ca + D reduces the RR for cancer incidence in men. I believe that it probably does.
Taking Ca + D increases the RR for breast cancer mortality. I believe that the opposite is the case.
Anything other than what the study shows.

See also Is Vitamin D Shooting Me in the Foot?

Keep 'em tight, Part 2.

Keep 'em tight was about the ramifications of excessive gut permeability, a.k.a."Leaky Gut".

Graphic From: www.leakygutcure.com

Almost as an afterthought, I added to that post a link to Physiology and Immunology of Digestion. As this article is interesting & informative and since only 706 people have read the first post since it was published (the link was added quite some time later), I thought that I'd give it another airing, with a picture to make the post more attractive.

A little moderate to vigorous physical activity does more than you think.

There are others!

Hat-tip to Bill Lagakos for tweeting this:- The Influence Of Physical Activity On Vascular Complications And Mortality In Patients With Type 2 Diabetes Mellitus.

"RESULTS: Forty-six percent of participants reported undertaking moderate to vigorous physical activity for >15 minutes at least once in the previous week. During a median of 5 years of follow up, 1,031 patients died, 1,147 experienced a major cardiovascular event and 1,136 a microvascular event. Compared to patients who undertook no or mild physical activity, those reporting moderate to vigorous activity had a decreased risk of cardiovascular events (HR 0.78, 95% CI 0.69-0.88, p < 0.0001), microvascular events (HR 0.85, 95% CI 0.76-0.96, p0.010) and all-cause mortality (HR 0.83, 95% CI 0.73-0.94, p0.0044)."

A HR of 0.83 is a reduction of 17%. That's quite impressive, for at least 15 minutes of moderate to vigorous physical activity at least once a week. Must. Get. Off. This. Sofa. More. Often.

Monday musings.

Firstly, a video.

Sometimes you gotta fight, when you're a man.

Secondly, another video!
Need I say more? No, but I'm going to, anyway!

On the internet, there is no such thing as anonymity. I can find every post made by an anonymous keyboard warrior and cross-reference the information within. I'm a nerd, lol!

Last night, after telling her how I found someone's name and address in a few minutes, a karaoke friend challenged me to find her real name (she uses a nickname), address & photo of her house taken from Google Street View and PM it to her on Facebook. She gave me 24 hours.

I got home at ~1am this morning. At ~2am, I PM'ed her real name, address & (a link to a) photo of her house taken from Google Street View to her. The file-name of the photo included the names of the other people living in the house. She loled!

Vitamin D, cancer, cliques and flouncing.

First Google Image Search result for Vitamin D, cancer, cliques and flouncing.

This is a continuation of my previous post Enzyme kinetics, standing on the sun and weird blog comments sections.

Apparently, I didn't like the answers that I received on the blog in my previous post, so I flounced. The study that I asked for opinion on was Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. If I showed you an RCT where deaths from all cancers fell by 77%, what would be your reaction? My reaction would be "That looks promising. More work is needed to investigate it". One person (sophia8) reacted thusly. Other reactions that I received (with their logical fallacies) were as follows:-

Pure coincidence. Argumentum ad ignorantiam.

More than 1,100iu/day of Vitamin D is harmful. Straw man. I didn't say that people should take more than 1,100iu/day of Vitamin D (even though I take 5,000iu/day, which isn't harmful). Also, argumentum ad ignorantiam. See enzyme kinetics in the previous post.

You're cranky. Ignoratio Elenchi.

The study wasn't testing Vitamin D on its own. Straw man. I didn't say that it did.

By the way, “Nigeepoo”, taking supplemental vitamin D is not a proven way to prevent sunburn and is not an adequate method of protection from getting skin cancer (despite assertions in your blog). Straw man for the first part of the sentence. I didn't say that it was. Argumentum ad ignorantiam for the last part of the sentence.

Going for long drives with the top down and broiling gently without sunscreen on a repeated basis is dumb. Straw man. I didn't say that I did. I obviously don't go for long drives with the top down in the middle of the day on a sunny Summer's day. That is dumb. Like, duh!

I'm curious why you found my response to be satisfactory but lilady’s to be unsatisfactory. Could you explain? Ignoratio Elenchi.

Did I mention all of the mis-quoting?... Oy!

Maybe they should have done a bit of basic research, like:-

Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.

The effect of calcium and vitamin D supplementation on obesity in postmenopausal women: secondary analysis for a large-scale, placebo controlled, double-blind, 4-year longitudinal clinical trial.

Vitamin D, cardiovascular disease and mortality.

Why randomized controlled trials of calcium and vitamin D sometimes fail. Essential reading.

I'm the sort of person who's not interested in cliques or secret societies. I'm therefore not interested in joining a cliquey, ivory-towery blog where you have to conform to a set of unwritten "rules" to be accepted, some of which are eccentric (Question: Which blogs insist on the use of manually-typed blockquote tags? Answer: Only that one). I decided to leave. I even apologised to some commenters for my language in some of the arguments.

I wondered why that blog and its owner annoyed me so much. Then it hit me (like a discarded boomerang)!

Hmmm. See Brain Surgeon meets Rocket Scientist ;-)

Other comments:-

Orac
May 19, 2013
Nigel, you need to tone it down, too.
I’ve warned both of you once already. This is the second warning. There won’t be a third. To show you I mean business this time, your comments are going into automatic moderation. You two have already wasted more of my time than you’re worth.

Which part of "Can people please stop leaving comments aimed at me, unless it’s an acknowledgement. I don’t want to have to leave any more comments on here – ever." did you not understand?

MI Dawn
May 19, 2013
@Nigel: we responded to the Lappe information. It didn’t prove what you say it proved. Now, if you do have something to say, give the peer-reviewed proof.

Straw man. I didn't say that it proved anything.
Which part of "Can people please stop leaving comments aimed at me, unless it’s an acknowledgement. I don’t want to have to leave any more comments on here – ever." did you not understand?

lilady
May 19, 2013
Thank you Orac for your intervention.
The bottom line for Nigel and Lisa is that they, by their vicious unwarranted personal attacks, have drawn unfavorable publicity to themselves and their blogs.

There's no such thing as unfavorable (sic) publicity for my blog, as far as I'm concerned. What you have done, by your vicious, unwarranted, lying and malicious defamatory personal attacks on me, is to draw unfavourable interest from me.

flip
In a place where no federal police turned up today
May 20, 2013
What a pity they both seem to have flounced off without bothering to respond to the questions put to them. I am not surprised though.

Which part of "Can people please stop leaving comments aimed at me, unless it’s an acknowledgement. I don’t want to have to leave any more comments on here – ever." did you not understand?

Enzyme kinetics, standing on the sun and weird blog comments sections.

Firstly, enzyme kinetics.

How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology from Edward Hutchinson

Secondly, see Standing on the Sun Will Not Prevent Depression.
"It is probably safe to say that giving 70 year old women massive doses of vitamin D3 once a year is a bad idea - bones and mental state accounted for. "Clinical studies of vitamin D in clinical populations with documented insufficiency remain warranted." And, indeed, at no time in history would we ever have been exposed to 500,000 IU vitamin D3 in a single day."

Thirdly, bearing all of the above in mind, see The quack view of preventing breast cancer versus reality and Angelina Jolie, part 2. I soon became aware of a weird "dynamic" in the comments section. Trolling of newbies (that was my first and last time posting comments there) was not discouraged by the blog owner. In fact, the blog owner (David H. Gorski, MD, PhD, FACS) implied that I was an old troll that had returned. Charming! If someone attacks me, I do not turn the other cheek. I "hit" them back - hard. I did a lot of "hitting".

The trolls noticed that I replied to every comment aimed at me, as that's how I roll. They then bombarded me with a large number of comments, riddled with logical fallacies to try to tie me in knots. I replied to every one. I was then put in "detention" (pre-moderation) by the "Principal" (David H. Gorski, MD, PhD, FACS) for posting too many comments. The victim got punished. The trolls remained free. What a way to run a comments section!

I've decided to not leave any more comments there - ever. That's the only blog I've been on where newbies are expected to instinctively know the "correct" way (typing the tags "blockquote" and "/blockquote" in every comment) to quote the commenter to whom you're replying (I was putting quoted text in ""). Ivory Tower, much?

@Everyone: Which part of "Can people please stop leaving comments aimed at me, unless it’s an acknowledgement. I don’t want to have to leave any more comments on here – ever." did you not understand? Sheesh!

Impaired Glucose Tolerance: also between a rock and a hard place.

A high percentage of people with excessive visceral adiposity (belly fat) have Impaired Glucose Tolerance (IGT). This post is about them.

Image from http://carbsanity.blogspot.co.uk/2013/03/insulinproinsulinetc-in-normal-igt-and.html

IGT is caused by excessive NEFAs spewing into the blood and/or deficiencies and/or sedentariness.

If nothing is done about it, IGT will progress to full-blown Type 2 Diabetes, which will get worse and worse as per the graphs to the right of the IGT one.

To do something about it, see http://nigeepoo.blogspot.com/2011/02/insulin-resistance-solutions-to.html

What to do if subjected to a Denial of Service attack.

A couple of weeks ago, I lost internet access for about 30 mins due to a Denial of Service (DoS) attack.

I feel honoured that I've annoyed someone on the internet so much that they spent time and effort DoS attacking me!

Brute-force attacks from individuals are difficult, as my downlink speed is much faster than most people's uplink speed. To mount an effective brute-force attack requires multiple computers infected with a trojan. This is known as a Distributed Denial of Service (DDoS) attack and requires a lot of computer knowledge.

A much simpler approach is the SYN flood attack. I believe that I was subjected to one of these, as on rebooting, I temporarily had internet access but lost it after a few seconds when all of the available connections on my pooter became "half-open".

To defeat such an attack is simple. All that you have to do is harden the TCP/IP stack. See also http://msdn.microsoft.com/en-us/library/aa302363.aspx and http://www.pctools.com/guides/registry/detail/1237.

1-2-3 Magic: effective discipline for children 2-12.

It works for adults, too!

Now that's Magic!

Hat-tip to Jason Sandeman for mentioning this ages ago in reference to someone who was behaving badly on the internet. I did some research into the method and was impressed by how clever it is.

It relies on the parent having an "Ultimate Deterrent", i.e. a punishment that's so horrible, a child won't risk suffering it more than once, but which causes no physical, mental or emotional harm (e.g. the loss of something precious, including a single meal). It also relies on the parent actually using the "Ultimate Deterrent", as failing to do so results in a total loss of credibility.

Having explained to the child the "Ultimate Deterrent" that will happen if the child fails to comply with the request by a count of 3, the parent then gives the child time to comply by counting 1 . . . 2 . . . 3. If, by the time 3 is reached, the child hasn't complied, the "Ultimate Deterrent" is dealt.

Hopefully, the "Ultimate Deterrent" is so horrible, the child won't risk suffering it more than once. Job done!

See also 1-2-3 Magic: Effective Discipline for Children 2-12 (Google Books).

Disqus is da bomb!

I'm the small yellow sphere with a big grin.

That's me, that is.

Disqus deletes comments from Anonymous commenters that contain links (clickable and plain text) without putting them in the Spam folder. I've been flooded with these, recently. I only get a Blogger notification email for my information, which I delete.

I can Whitelist trusted commenters, so their comments appear immediately without me having to moderate them. Deep Joy!

Oops, I did it again! Part n+1.

After a week of relative peace and quiet (I had viral laryngitis), the world groaned once again.

Last night, RoadRunner played at The Falkners Arms, Fleet. I asked the lead singer if I could have a go. I got to do the backing harmonies & other vocals on Mustang Sally. No pictures or videos were taken, so here's a picture of me performing with Jukebox at the beginning of March, instead.

That seemed to go well.

Type 2 diabetes: your good signalling's gonna go bad.

A little bit of Tammy Wynette.

 

Good signalling:

There's a famine. You've got nothing to eat. Your body's glycogen stores have just run out. What happens next? As food intake is zero, serum insulin level is minimised, so lipolysis (fat mobilisation) is maximised. Serum NEFAs are maximised. High serum NEFAs provides fuel for tissues that utilise NEFAs (e.g. skeletal muscle) and a "stop utilising glucose!" signal, in conjunction with low serum insulin.

High serum NEFAs and low serum insulin increase ketogenesis in the liver, to give the parts of the brain that can utilise ketones an alternative choice of fuel, to reduce glucose utilisation to a minimum. Ditto for nerves. Glucose utilisation must be minimised during a famine, as it's generated by the liver & kidneys from glucogenic amino acids, obtained from lean body mass (LBM) by hypercortisolaemia.

Gone bad:

You're a type 2 diabetic with a fat belly. For reasons that I don't fully understand (better blood supply? close proximity to liver?), belly fat deposits spew NEFAs into the blood at a much higher rate than arm, boobs, love-handles, bum & thigh fat deposits. On a very-low-carb diet (less than 50g/day carbs), serum insulin level is minimised, so lipolysis (fat mobilisation) is maximised. Serum NEFAs are maximised. High serum NEFAs provides fuel for tissues that utilise NEFAs (e.g. skeletal muscle) and a "stop utilising glucose!" signal, in conjunction with low serum insulin.

A type 2 diabetic with a fat belly has underlying insulin resistance, due to over-full muscle, adipose and/or liver cells (making the liver spew glucose into the blood at too fast a rate, and the muscles & adipocytes take it out of the blood at too slow a rate). The very-low-carb diet makes the underlying insulin resistance worse and high serum NEFAs in a milieu of caloric sufficiency or excess wreak havoc. Serum glucose level increases. Serum LDL-c level increases. Serum TG level increases. Serum just about everything level increases, except for serum HDL-c level, which decreases.

Marketing Food to Children: Anna Lappe at TEDxManhattan 2013.

As per title.

We have free will, huh?

Diabetes: which are the safest carbohydrates?

In my previous post, I stated that people with T2DM should eat ~150g/day of carbohydrate.

Soak & cook your own beans al-dente, for slowest release carbs.

See International table of glycemic index and glycemic load values: 2002. Below is a list of carbohydrates that have a low glycaemic load, or GL (GL = glycaemic index * grams of carbohydrate in the serving).

Non-nutritive sweeteners:

It's often claimed that non-nutritive sweeteners produce a cephalic phase insulin response. The mere anticipation of eating produces a cephalic phase insulin response. See How neural mediation of anticipatory and compensatory insulin release helps us tolerate food. An insulin response suppresses serum NEFAs, so it's not all bad.

Sugars and Sugar alcohols:

Fructose is not recommended for people with T2DM, as it "barges its way" into the liver via Glu-T5 and fructokinase. People with T2DM who have a high fasting serum glucose level almost certainly already have full liver glycogen stores, so adding to them isn't advisable. Whole fruits (not juices) are fine.
Lactose has a virtually zero GL, isn't very sweet and has/hasn't a laxative effect in large quantities (lactase-dependent). Heating lactose turns it into lactulose.
Lactulose has a virtually zero GI, is sweet and has a laxative effect in large quantities.
Galactose is not recommended, as large amounts may accelerate ageing.
D-mannose has a virtually zero GI, is sweet and doesn't have a laxative effect in large quantities. It can be used to treat urinary tract infections (UTIs) caused by e.coli, due to the fact that the kidneys filter it out of the blood and pass it out in the urine. Mannose in urine reduces the adhesion of e.coli to the inside wall of the urinary tract. See Intervening with urinary tract infections using anti-adhesives based on the crystal structure of the FimH-oligomannose-3 complex.
Trehalose has a virtually zero/moderate GI, is sweet and has/hasn't a laxative effect in large quantities (trehalase-dependent).

Lactitol has a virtually zero GI and has a laxative effect in large quantities.
Sorbitol has a virtually zero GI and has a laxative effect in large quantities.
Xylitol has a virtually zero GI, minty overtones and reduces dental plaque. However, it has a laxative effect in large quantities.
Erythritol has a virtually zero GI, minty overtones and is wee'ed-out like D-mannose, so it doesn't have a laxative effect in large quantities.

Starches:

Note: Tinned starches are usually overcooked, so cook your own. Don't overcook starches, as that makes them faster-absorbing. Al dente is best.

Gram dhal a.k.a. chana dal.
Long-grain rice. Refrigerating boiled rice for 24 hours lowers the GL, by forming resistant starch. See item 275 in the table in the first link.
New potatoes. Refrigerating boiled new potatoes for 24 hours lowers the GL a lot, by forming resistant starch. See item 605 in the table in the first link. You can boil old potatoes, but they're probably not as good.
Pearl barley.
Sweet corn.
Beans.
Chickpeas.
Lentils.
Peas.
Starchy nuts e.g. peanuts , cashews and chestnuts.
Vegetables.
Root vegetables.
Raw carrots.

If even low-GL carbs spike BG too much, this indicates severe IR in liver and/or skeletal muscle. See Insulin Resistance: Solutions to problems.

The above lists also apply to people with T1DM who are having difficulty keeping their blood glucose level between 3 and 7mmol/L.

Type 2 diabetes: between a rock and a hard place.

About 85% of type 2 diabetics have excessive visceral adiposity (belly fat). This post is about them.

Which is better - the rock or the hard place?

 

1) The rock:

This is serum glucose. People with type 2 diabetes can measure their own serum glucose. Eating carbohydrates makes serum glucose increase, the rate of increase being proportional to the glycaemic index and the magnitude of the increase being proportional to the grams of carbs consumed. By limiting the intake of dietary carbohydrates, large spikes in serum glucose can be avoided. The occasional spike above 7.8mmol/L (140mg/dL) doesn't hurt. It's spending long periods of time above 7.8mmol/L that's harmful (by glycation).

A low-carb diet (~150g/day of carbohydrate) halves serum glucose fluctuations compared to a higher-carb diet (~300g/day of carbohydrate). A very-low-carb diet (~75g/day of carbohydrate) further halves serum glucose fluctuations compared to the low-carb diet. This seems like an improvement, at first glance.

2) The hard place:

This is the invisible "elephant in the room", as it's not measured by doctors and people with type 2 diabetes can't measure it themselves. It's serum Non-Esterified Fatty Acids, or NEFAs (a.k.a. Free Fatty Acids, or FFAs). Serum NEFAs are high when fasting and fall after eating foods that raise serum insulin (carbs & certain proteins). People with type 2 diabetes and excessive visceral fat (belly fat) have higher-than-normal serum NEFAs due to adipocyte insulin resistance (IR). See Insulin Resistance: Solutions to problems.

Just like with serum glucose, there's nothing wrong with serum NEFAs going up & down. It's chronically-high serum NEFAs that's harmful (except during periods of caloric restriction). See Showing posts sorted by relevance for query NEFA "type 2 diabetes" .

See Fig. 1 in Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. On a very-low-carb (less than 50g/day carbs) diet that's not calorie-restricted, serum insulin remains low all of the time. To insulin-haters, that sounds like a good thing. Unfortunately, it means that there is no insulin spike to suppress serum NEFAs by shifting the balance of NEFAs going in/coming out of fat cells. Serum NEFAs stay high all of the time, which is harmful.

Therefore, people who have type 2 diabetes and excessive visceral fat and who are permanently on a very-low-carb diet that's not calorie-restricted are harming themselves.

The danger of science denial - Michael Specter.

As per title.

“The good thing about science is that it’s true whether or not you believe in it.” Neil deGrasse Tyson.

Greased lightning.

What video could it possibly be?

I've just had the RAM in my pooter quadrupled to 8GB and had the paging file turned off. Oh, wow!

Fun with coupled-pair tuned circuits.

I'm not being rude! It's a couple of these, uh, coupled together...

LC Tuned Circuit.

A coupled-pair tuned circuit has a frequency response something like...

Passes signals at fo. Attenuates signals at other frequencies.

One of my missions was to design a frequency-agile (capable of changing frequency in less than 1ms) coupled-pair tuned circuit that maintained a constant width (Δf) as fo varied.

As Q = fo/Δf, for Δf to remain constant requires fo/Q to remain constant i.e. Q must vary in proportion with fo.

In the top diagram, inserting a resistance of value "R" in series with the L and the C sets the Q.

Q = ωL/R, where ω = 2*π*fo. For Q to vary in proportion with fo requires R to be constant.

This was achieved using wideband RF transformers to transform the source & load impedances from 50Ω down to a suitable "R" value. Here endeth today's trip around my brain.

PROLONGED MEAT DIETS WITH A STUDY OF KIDNEY FUNCTION AND KETOSIS.

BY WALTER S. MCCLELLAN AND EUGENE F. Du BOIS.
It's the 1 year study on Vilhjalmur Stefansson and K. Andersen at Bellevue Hospital.

Vilhjalmur Stefansson

See http://www.jbc.org/content/87/3/651.full.pdf The reason why I'm posting this is because of what Stefansson and Andersen drank. I was under the impression that the men drank water only. That was not the case. They drank coffee, black tea, meat broths and water. Black tea is high in tannins, which bind somewhat to haem iron and very strongly to non-haem iron.

Therefore, if you like to eat lots of red meat but you don't like your greens (not even a tablespoonful of spinach), drink strong black tea or eat foods rich in phytates and/or calcium. Vitamin E supplements also help. See Red meat and colon cancer: should we become vegetarians, or can we make meat safer?

Sun exposure doesn't increase the risk of getting Malignant Melanoma. It probably reduces it.

Wait, WHAT?!?! I've done it again!

Here comes the sun, doo doo doo doo.

According to Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation,
"Vitamin D production in the skin seems to decrease the risk of several solid cancers (especially stomach, colorectal, liver and gallbladder, pancreas, lung, female breast, prostate, bladder and kidney cancers). The apparently protective effect of sun exposure against second primary cancer is more pronounced after non-melanoma skin cancers than melanoma, which is consistent with earlier reports that non-melanoma skin cancers reflect cumulative sun exposure, whereas melanoma is more related to sunburn."

See also Is Vitamin D Shooting Me in the Foot?

Insufficient sun exposure increases the risk of getting cancer. This isn't surprising, as cancer cells are constantly being created in our bodies due to defects occurring in DNA etc. Our immune system constantly destroys them. Only when cancer cells manage to evade the immune system (by pure chance) does cancer develop. Cells & an immune system weakened by Vitamin D insufficiency is asking for trouble. See Kelsey Nicole Olson.

Excessive sun exposure increases the risk of getting cancer.

Chronically-excessive sun exposure (outdoor workers) increases the risk of getting Basal Cell Carcinoma & Squamous Cell Carcinoma. These skin cancers are rarely malignant and rarely fatal.

Acutely-excessive sun and/or UVA exposure (holidaymakers & tanning booth users) increases the risk of getting Melanoma. This skin cancer is always malignant, and often fatal.

Combining insufficient sun exposure for 50 weeks of the year with acutely-excessive sun exposure for 2 weeks of the year is really asking for trouble. What makes the situation even worse is that Vitamin D insufficiency makes the skin burn more easily.

I take 5000iu/day of Vitamin D3 and my skin is far more resistant to burning than it used to be. I can go for long drives on a sunny day with the top down and not burn. My face goes pink, but that's all.

I've already read on Facebook about friends burning themselves to a crisp in the wishy-washy May English sun. It's not sun exposure that increases the risk of getting Malignant Melanoma. It's ignorance, apathy, stupidity and/or bad luck.

Be careful out there!

See also Vitamin D

Fun with LEDs.

Warning! Techy, nerdy stuff.

Pretty!

When I were a lad (!), I remember the invention of the Light-Emitting Diode (LED). They were originally made out of Gallium (Ga) & Arsenic (As) instead of Germanium (Ge and now I'm really showing my age!) and Silicon (Si). Gallium & Arsenic are used to "dope" Silicon to form P & N regions respectively (Gallium has 3 electrons in its outer shell & Arsenic has 5. Germanium & Silicon have 4).

GaAs red LEDs weren't very bright. By adding Aluminium, Indium, Phosphorus, Nitrogen etc, new colours & higher-efficiency old colours were invented. Orange. Yellow. Green. Brighter green. Even brighter green. Really bright green. I thought that blue LEDs would never be invented. Wrong!

Nowadays, OLEDs are so efficient that they can be used for lighting and they are more efficient and longer-lasting than CFLs. I thought that OLEDs would never catch on. Wrong! The superb display on my Samsung phone uses AMOLED technology. But anyway...

What I found interesting about GaAs red LEDs was their I-V characteristic.

Pretty techy!

Over a wide range of currents, the voltage is ~1.75V. The steep slope means that the dynamic resistance (δV/δI) is very low. I thought to myself "Hmmm, voltage regulator!" Zener diodes are usually used as voltage regulators, but they are very noisy. A forward-biased P/N junction produces less thermal noise than a resistor with the same value as the dynamic resistance of the P/N junction. As the voltage (~1.75V) is temperature-dependent (-2mV/ºC), the relative temperature variation of a red GaAs LED is less than that of a Silicon diode (~0.7V when biased on).

I used two "strings" of red GaAs LEDs as an ultra-low-noise voltage limiter in a high-power oscillator using LDMOS MOSFETs that had just been invented by Mullard (which later became Philips). It produced 1W (+30dBm) over a frequency range of 30 to 88MHz and had a Carrier to Noise Ratio (C/N) of >190dBc/Hz @10% frequency offset. Typical RF Signal Generators of that era had a C/N of ~145dBc/Hz at that offset.

I hope that you've enjoyed this little tour around my brain!

Ketogenic diets - when they're not ketogenic, Part 2.

Continued from Ketogenic diets - when they're not ketogenic.

If I said that Eskimos eating their traditional diet were eating processed carbs, what would you think?

Structure of the chitin molecule, showing two of the N-acetylglucosamine units that repeat to form long chains in β-1,4 linkage.

Eskimos eat marine mammals & oily fish, also any edible vegetation that they can find. Marine mammals eat oily fish which in turn eat crustaceans. Crustaceans have an exoskeleton made of Chitin. Chitin has a structure similar to cellulose and a function similar to keratin (hair & fingernails/claws). Humans cannot digest chitin unless it's first powdered and hydrolysed. Certain fish and bacteria are able to digest it using chitinases.

If Eskimos consume the stomach contents of the animals that they kill for food (they usually consume the whole animal, sometimes after leaving it for a long time to auto-digest), there is likely to be a significant amount of pre-digested chitin in their diets. Freshly-killed animals also contain glycogen. Therefore, Eskimos eating a traditional diet ate more carbohydrate than you would expect, which would reduce/eliminate ketogenesis.

Then there's the protein... See STUDIES ON THE METABOLISM OF ESKIMOS.