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Category: health

I Watched Contagion: So Should You

Posted on by wotantx
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This started as a Facebook post and a Twitter thread, but I decided to post it here as well.

If you haven’t ever watched Contagion, I urge you to do so. This movie is a very good portrayal of the world we live in. The science is very good. It depicts the very panic buying we have seen. About the only thing missing is the politicization of the pandemic. I don’t know who the technical advisor was, but he or she was allowed free reign, and it definitely shows.

The virus, dubbed MEV-1, had its origins in bats, just as the SARS-like coronaviruses, including the cause of COVID19, does. In the movie, it passed through pigs. Influenzavirus type A does sometimes pass through pigs from birds to humans. It is believed that SARS-CoV-2 passed through pangolins, though I’m not sure how well determined that is.

I’ve heard people say no one could see COVID19 coming. That’s very not true. Contagion came out in 2011. And others, myself included, have expected things like this.

Using ILINet to track COVID19

Posted on by wotantx
Read Time:2 Minute, 12 Second

In my first writing on the COVID19 Pandemic, I mentioned that flu surveillance can be used as a way to track the spread and severity of COVID19. Let me take you through some of what appeared in the Week 12 edition of FluView (the CDC’s influenza surveillance product). I originally wrote this on Twitter.

This first image shows the prevalence of influenza-like illness (or ILI) present in the country for the week ending March 20, 2020.

It shows flu-like illness is elevated across the country. The percentage of visits for ILI is almost to the levels of the peak of the current flu season, and the amount of confirmed flu (positive tests) is way down.

This next map shows the ILI activity in each state. Keep in mind that we are late in the flu season, and we are past peak. The map is ugly; it shouldn’t be so red. I also do not know why Florida is showing low levels of flu activity. It should be much higher than that. Perhaps the data is lagging.

More troublingly, perhaps, is that pneumonia and influenza mortality (P&I) was above the epidemic threshold for week 11, the week for which we have the most recent data. Since the CDC does not count the number of flu deaths (except for children), P&I mortality is one of the proxies used to determine that.

At this time of year, P&I mortality should be leveling off and then declining. This uptick could point to COVID19 deaths that are not being reported in the official case counts due to inadequate testing. This is one of the metrics that will be used to estimate the actual number of deaths once the epidemic is over.

I want to stress that the official case counts are far smaller than the number of actual infections, and the number of fatalities are as well, though I don’t think either can be quantified at this point.

I will continue to monitor FluView and see if it shows us anything that might be useful in determining if social distancing measures are helping.

Note that I am not a doctor, virologist, epidemiologist, or any other kind of expert. Infectious disease has long been an interest of mine, and here I am simply applying my interpretation of public data.

A future post may talk about what we know of serious illness in young people, including the prevalence of acute respiratory distress syndrome (ARDS). We seem to be seeing quite a lot of that, and but for modern medicine, we would probably be seeing a much different type of mortality.

Thoughts on the COVID19 Pandemic

Posted on by wotantx
Read Time:3 Minute, 1 Second

I haven’t really got the first clue why I have not started blogging on the COVID19 Pandemic. Some of you may be aware that infectious disease is one of my many interests, so I have certainly been following it closely since I first learned of the virus now known as SARS-CoV-2 sometime in January.

One of the truly distressing things about the pandemic is the seemingly willful ignorance of the progression of the disease. A large swath of the US population, particularly those of certain political persuasions, has decided that, somehow, we know the exact number of cases in this country as well as the exact number of deaths. This despite it being extremely well-documented that we have inadequate ability to test in this country. Even countries that have done a great job in their response to the COVID19 Pandemic, such as South Korea, are going to be significantly undercounting their caseload. This is because you simply will not find every single person who is infected, in part because you can be asymptomatic. As of this writing (3/16/2020), the US has about 3500 known cases. Known is the important word. Actual cases are going to be a few orders of magnitude higher. We will absolutely never know the true number.

People like to point to the number of seasonal flu cases and deaths to show that the COVID19 Pandemic isn’t as bad as flu. What they don’t understand, or don’t care to understand, is that those numbers are estimates. The United States, and probably the rest of the world as well, does not track cases of influenza, nor does it track fatalities, with the exception of pediatric influenza cases. The numbers that are reported are estimates based on incidents of Influenza-Like Illness (ILI) as well as Pneumonia and Influenza Deaths (P&I) that are tracked by various public health agencies in this country, including the CDC. A subset of cases is known through the administration of the Rapid Antigen test (the unpleasant swab of the nasal passages done in a Dr’s office) or through samples sent to a lab for Polymerase Chain Reaction (PCR) testing. One of the issues with this is that to Rapid Antigen test is notoriously unreliable. If memory serves, it has a false negative rate of about 50%. Now, as I will write about in a later post, the flu surveillance can be of importance in the tracking of COVID19 cases and fatality in this country, but most of that analysis will have to be done retrospectively once the epidemic in the US is over. It is worth noting that pandemics tend to come in waves of epidemics. For instance, the Spanish Flu had three distinct waves, with the second being the most lethal in the US.

The point of this post is to point out that we do not, and will never, know just how many people in the US will come down with the disease. Once it’s been established the community transmission has occurred, it is no longer possible to deny that there are uncounted cases precisely because we know we have a case not linked to anyone else. To ignore this is foolish at best, and very dangerous at worst. It leads to complacency, to people downplaying the severity of the disease, and this ultimately leads to further spread, and to people in high-risk groups, getting the disease.

Get your heads out of the sand and take reasonable precautions, including practicing social distancing to the extent possible. The life you save might well be a loved one.

My Story Isn’t Over Yet

Posted on by wotantx
Read Time:3 Minute, 24 Second

Those who have been paying attention to my social media may have by now noticed the proliferation of semicolons everywhere, including my current profile picture.

I’ve not been shy about telling people that I have bipolar disorder; the stigma associated with mental illness kills people. As part of my own therapy, I have decided to fight that stigma in my own ways, and that is primarily by sharing it and writing these blog posts.

It is a sad fact that people with bipolar disorder are much more likely to attempt suicide than the general population, and even more than people dealing with major depression in the absence of a mood disorder. People with bipolar disorder are also fairly likely to require at least one hospitalization in their lives as a result of their mood disorder.

There is no shame in mental illness. As I said above, the stigma associated with mental illness kills people. We are taught it is a weakness, and not a disease that is every bit as serious and deadly as cancer.

This is even more true for men. As men, as husbands, as fathers, society expects us to be stoic, to not talk about our feelings, to not show “weakness,” to be strong for our families. This may sound a little flippant, but at least society “allows” women to discuss their feelings. It is for the wrong reasons, but the “expectation” is that they will.

Thankfully, I have not experienced any pushback from friends and family on this. I know many do receive pushback. Times, and attitudes, are definitely changing, though there is still a lot of work to do. The number of celebrities coming forward about having bipolar disorder or other types of mental illness is certainly helping.

So now to the point of this article.

I will not discuss the details that actually lead up to, and I may well never want to, but it is time for me to explain why the semicolons are popping up.

I had been dealing with mild to occasionally moderate depression for much of the last half of 2019. Neither I nor my (wonderful) psychiatrist were able to determine where it was coming from. In mid to late January of this year (2020), a variety of personal problems hit all at once. My depression was already tending towards moderate, but these problems lead me to spiralling quickly into very severe depression. For those familiar with the PHQ-9 assessment, my score went from about 14 to 24 in the span of roughly 2-3 weeks.

Adding in an extremely stressful event at work and I reached my breaking point. In mid February, I attempted to kill myself. I did this in secrecy, away from my family. The attempt, obviously, was unsuccessful. More to the point, I gave up. I won’t provide further details on exactly what I tried to do, nor when or where or any other information regarding the circumstances.

It was in the days following this that I started adding a semicolon to my social media bios.

On the strong advice of my psychiatrist and my therapist, I admitted myself to a mental health hospital for about a week. Getting me away from the stressors that lead to this did wonders for me. As of March 5, my PHQ-9 score was a 3(!). All of those stressors are still present in my life, but between the mental “vacation” and greatly increased therapy, I am better equipped to handle them.

As I’ve written in another post, dealing with mental illness is like being in a daily battle with your own brain. No amount of medicine or of therapy will stop that. Those are tools. I still have to do the work myself.

As always, I am writing about this both as therapy for myself, and also in the hopes that I will reach someone else who deals with mental illness, perhaps in silence. You are not alone. There are people who care and will help you.

My story isn’t over yet; neither is yours.

;

Posted on by wotantx

The Carb Conundrum

Posted on by wotantx
Read Time:6 Minute, 33 Second

Many of you are aware that I have had weight loss surgery (vertical gastric sleeve). I am on a support group on Facebook for people who have had wls. One thing I have learned is that just about every surgeon has a different nutritional program. Many, maybe most, of them involve counting things: calories, carbs, protein, fat. People are constantly asking questions about how much of this or that should they have. Many people try to eliminate almost all carbs, regardless of source.

My plan is quite different. Instead of counting, we are supposed to focus on certain types of foods in certain orders. Eat all the fresh fruits and vegetables you want. Eat lesser amounts of nuts and whole grains. Lean meats, such as fish and chicken, healthy oils such as olive oil, and then red meat (beef, pork, and lamb).

This is not only different in that there is nothing to count, but also in terms of restricting carb intake. Given how different this is, I have been doing some reading up on the so-called good and bad carbs,

You’ll get radically different answers from people on the number of carbs people should be consuming. Certainly, this depends on a well as factors, including weight and severity of diabetes and metabolic syndrome, people often lose sight of what types and sources of carbs should be consumed.

My recommended diet (Mediterranean) is intentionally high in carbs, but it is the source of those carbs that is important. Here’s a good reference I found discussing the differences: https://www.healthline.com/nutrition/good-carbs-bad-carbs

A few quotes from the article, as well as some of my commentary, follow:

Dietary carbohydrates can be split into three main categories:

Sugars: Sweet, short-chain carbohydrates found in foods. Examples are glucose, fructose, galactose and sucrose.
Starches: Long chains of glucose molecules, which eventually get broken down into glucose in the digestive system.
Fiber: Humans cannot digest fiber, although the bacteria in the digestive system can make use of some of them.

The main purpose of carbohydrates in the diet is to provide energy. Most carbs get broken down or transformed into glucose, which can be used as energy. Carbs can also be turned into fat (stored energy) for later use.

Fiber is an exception. It does not provide energy directly, but it does feed the friendly bacteria in the digestive system. These bacteria can use the fiber to produce fatty acids that some of our cells can use as energy.

Sugar alcohols are also classified as carbohydrates. They taste sweet, but usually don’t provide many calories.

“Not all carbs are created equal.” Something I’ve been starting to say. The same is true of fats.

“Although carbs are often referred to as “simple” vs “complex,” I personally find “whole” vs “refined” to make more sense.” This statement matches what my surgeon told me a couple of weeks ago, as well as what we heard in my nutrition classes.

Whole carbs are unprocessed and contain the fiber found naturally in the food, while refined carbs have been processed and had the natural fiber stripped out.

Examples of whole carbs include vegetables, whole fruit, legumes, potatoes and whole grains. These foods are generally healthy.

On the other hand, refined carbs include sugar-sweetened beverages, fruit juices, pastries, white bread, white pasta, white rice and others.

Numerous studies show that refined carbohydrate consumption is associated with health problems like obesity and type 2 diabetes (1, 2, 3).

They tend to cause major spikes in blood sugar levels, which leads to a subsequent crash that can trigger hunger and cravings for more high-carb foods (4, 5).”

However, it makes no sense to demonize all carbohydrate-containing foods because of the health effects of their processed counterparts.

Whole food sources of carbohydrates are loaded with nutrients and fiber, and don’t cause the same spikes and dips in blood sugar levels.

Hundreds of studies on high-fiber carbohydrates, including vegetables, fruits, legumes and whole grains show that eating them is linked to improved metabolic health and a lower risk of disease (10, 11, 12, 13, 14).

On the subject of low carb diets:

Over 23 studies have now shown that low-carb diets are much more effective than the standard “low-fat” diet that has been recommended for the past few decades.

These studies show that low-carb diets cause more weight loss and lead to greater improvement in various health markers, including HDL (the “good”) cholesterol, blood triglycerides, blood sugar, blood pressure and others (15, 16, 17, 18, 19).

For people who are obese, or have metabolic syndrome and/or type 2 diabetes, low-carb diets can have life-saving benefits.

Restricting carbs can often (at least partly) reverse obesity.

However, this does not mean that the carbs were what caused the obesity in the first place.

This is actually a myth, and there is a ton of evidence against it.

While it is true that added sugars and refined carbs are linked to increased obesity, the same is not true of fiber-rich, whole-food sources of carbohydrates.

Humans have been eating carbs for thousands of years, in some form or another. The obesity epidemic started around 1980, and the type 2 diabetes epidemic followed soon after.

Keep in mind that many populations have remained in excellent health while eating a high-carb diet, such as the Okinawans, Kitavans and Asian rice eaters.

What they all had in common was that they ate real, unprocessed foods.”

Brown and wild rice are not bad for you. It’s the white rice, so common in Western cuisine, that is.

On the subject of the quantity of carbs that are required, or if they are at all:

Many carb-containing foods are healthy and nutritious, such as vegetables and fruits. These foods have all sorts of beneficial compounds and provide a variety of health benefits.

Although it is possible to survive even on a zero-carb diet, it is probably not an optimal choice because you’re missing out on plant foods that science has shown to be beneficial.

And now, the tie in to the Mediterranean diet, which I mentioned earlier is intentionally high in carbs:

Good Carbs:

Vegetables: All of them. It is best to eat a variety of vegetables every day.
Whole fruits: Apples, bananas, strawberries, etc.
Legumes: Lentils, kidney beans, peas, etc.
Nuts: Almonds, walnuts, hazelnuts, macadamia nuts, peanuts, etc.
Seeds: Chia seeds, pumpkin seeds.
Whole grains: Choose grains that are truly whole, as in pure oats, quinoa, brown rice, etc.
Tubers: Potatoes, sweet potatoes, etc.

And now for the carbs to avoid or minimize:

Sugary drinks: Coca cola, Pepsi, Vitaminwater, etc. Sugary drinks are some of the unhealthiest things you can put into your body.
Fruit juices: Unfortunately, fruit juices may have similar metabolic effects as sugar-sweetened beverages.
White bread: These are refined carbohydrates that are low in essential nutrients and bad for metabolic health. This applies to most commercially available breads.
Pastries, cookies and cakes: These tend to be very high in sugar and refined wheat.
Ice cream: Most types of ice cream are very high in sugar, although there are exceptions.
Candies and chocolates: If you’re going to eat chocolate, choose quality dark chocolate.
French fries and potato chips: Whole potatoes are healthy, but french fries and potato chips are not.

In closing:

The “optimal” carbohydrate intake depends on numerous factors, such as age, gender, metabolic health, physical activity, food culture and personal preference.

If you have a lot of weight to lose, or have health problems like metabolic syndrome and/or type 2 diabetes, then you are probably carbohydrate sensitive.

My surgeon recommends this diet because, according to him, research has shown that is has a higher rate of long-term compliance than other types of diets.