Growth of the Human: How Insulin Works

tldr:

insulin is a hormone secreted to lower blood sugar levels
insulin is a body wide signal for growth
high levels of insulin promote the storage of energy in the form of glycogen and triglycerides (fat)
high levels of insulin BLOCK the breakdown of fat
insulin is affected by type of food, timing of food, exercise, sleep, and many other lifestyle factors

Insulin is one of the most important molecules in our body. Remember that hormones are molecules secreted by one part of the body in order to communicate a message to another part. They are able to relay information through the bloodstream, allowing systemic responses to certain environmental conditions. Blood sugar is one of the most tightly regulated parameters in our body, as we run into serious problems with both high and low blood sugar levels. Insulin is a hormone secreted by the pancreas when elevated blood sugar has been sensed. Although insulin is one of our body’s primary tools to keep our blood glucose (sugar) in check, it is not a master tool. Insulin only acts to lower blood sugar levels. Typically in response to eating, our blood sugar levels rise. This is when insulin is excreted from the pancreas into the bloodstream. Once insulin is flying around our blood vessels, it starts screaming its message to all the cells it comes into contact with, and its primary message is: Energy is available! GROW, STORE ENERGY, and GROW MORE!

Throughout all levels of biology, a primary task of the organism is to sense energy availability. In the evolutionary world, energy was always hard to come by, so the ability to detect available energy was a crucial advantage that essentially all organisms developed. It would be a catastrophic failure for an organism to try to grow and divide while resources were scarce, and it would be an equally fatal mistake for the organism to fail to grow and store energy when the resources were available. As it turns out, the molecular switches that control this decision of anabolism (building) versus catabolism (breaking down) are often central to our health and longevity. There are a handful of these high level decision makers in our body, but today’s post will focus solely on insulin.

First we must keep in mind the big picture: when insulin is in the blood, it is a body wide signal for anabolism or growth. From here we can zoom in on some of the details of insulin’s action. As we mentioned above, a primary task of insulin is to lower blood glucose levels. When insulin comes into contact with muscle cells and fat cells, it induces a specific effect, essentially unlocking the cell for glucose entry. When a muscle or fat cell grabs (binds) a molecule of insulin from the bloodstream, a cascade of events is set off inside the cell. The end result of this process is the the insertion of the GLUT4 transporter into the cellular membrane of a muscle or fat cell. A quick digression on cellular membranes; these are structures that form the boundary of cells and organelles (smaller structures inside of cells). The membrane is the outer layer controlling what comes in and what goes out. If the bloodstream is a superhighway connecting the different parts of our body, the membranes completely control who is allowed to exit the highway and enter the city (cells). Back to insulin. So insulin binds to the fat or muscle cell, resulting in GLUT4 transporters being shoved into the cellular membrane. The GLUT4 transporter essentially acts like a very specific claw, searching the bloodstream for molecules of glucose, grabbing the glucose from the bloodstream, and transporting it inside the cell. Without GLUT4 transporters in the membrane, glucose cannot enter the cell, and it simply remains in the blood. This is a primary action of insulin. Recruit GLUT4 transporters to the surface of fat and muscle cells, allowing glucose to enter the cell and reduce the amount of glucose in the blood.

This is only the beginning of the effect of insulin. We have brought glucose, single molecules of sugar, into the cell. However, this is about creating stable, usable forms of energy, so getting energy into the cell is just the first step. The cell still needs to convert these singular sugar molecules into a form of energy that can be stored long term. As we already stated, there is a deep, hardwired desire for the organism to capitalize on available energy and prepare for a day when that energy is not accessible. We convert glucose into two energy forms that are better suited for storage: glycogen and triglycerides. Glycogen is essentially a bunch of individual glucose molecules strung together, creating a single, larger molecule. This certainly helps for storage, but it also retains functionality as glycogen can be broken down into usable forms of individual glucose molecules quickly. The primary issue with glycogen is that we run out of space. Each cell can only hold so much glycogen, and when the reserves are filled up, the remainder of the glucose is used to create triglycerides. Triglycerides are the body’s best and most efficient way to store large amounts of energy. These molecules are compact, energy dense, while also retaining the ability to be broken down into usable forms of energy. Triglycerides are colloquially referred to as fat, and most of us can see the abundant stores of energy we carry around our waist.

This system of energy acquisition and storage at the cellular level is quite impressive and sophisticated. It truly highlights the body’s ability to adapt and respond to dynamic environmental conditions. But the world we live in today is much different than the world in which these systems were developed. With our basic understanding of how insulin works to pull glucose into the cell and create stable forms of energy, we will now turn to how this might be problematic in our modern life. Just as we have systems to build and store energy, we of course have systems to break down those stored forms of energy. We have processes that break down glycogen and triglycerides into molecules that can fuel our energy demanding cellular processes. However, because we have these opposing processes (anabolism versus catabolism, or storing energy versus using energy) our body has to know which protocol to run. If we are manufacturing triglycerides to store energy, it would be counterproductive if the cell next door was breaking down its triglycerides to use for energy. Once again, this is a situation our body has developed protection against. Remember what insulin’s primary message is: energy is available, grow and store energy. So not only does insulin provide a pathway for energy into the cell (GLUT4 transporter), it blocks and amplifies certain other processes inside the cell. We have discussed how insulin stimulates the building of fatty acids (energy storage in the form of fats), but the presence of insulin also blocks the cell’s ability to break down fat stores, aka insulin blocks lipolysis. This of course is the outcome of a highly intelligent system, but it certainly promotes issues for our modern lifestyle. WHEN INSULIN CONCENTRATION IS HIGH, YOU CANNOT BREAK DOWN FAT STORES. A similar process is at play with glycogen. When insulin concentration is high, the breakdown of glycogen is blocked, and the formation of glycogen is amplified. This all fits under our big picture of insulin. Insulin is a body wide signal for growth, and in turn, a body wide signal to suppress utilization of previously stored forms of energy.

Even with this basic understanding of insulin, it should be obvious that insulin levels are vitally important for anyone concerned with losing weight. As the weight we should want to lose is in the the form of triglycerides, and those triglycerides cannot be burned in the presence of high levels of insulin. I realize there is not much practical information here, or tips on how to actually utilize this information in our daily lives, but understanding this background biochemistry is fundamental to a sophisticated approach to weight loss and health in general. On this landscape we can explore how certain foods effect insulin levels, the fact that calories are NOT created equal, how movement can be leveraged to help with blood sugar control, how the timing of a meal directly affects its metabolic outcomes, how sleep is intimately connected to insulin sensitivity and glucose tolerance, and many other processes. There are so many pathways that all hinge on the metabolic control switch of insulin. Stay tuned for ideas on how to structure our lives in accordance with the biochemistry that governs our cellular processes.

Best explorations

-Ryan; 6/2/2020

Sleep I: An Evolutionary Imperative

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I think sleep is a crucial part of maintaining health. It is an insurance policy that is too good not to participate in. This will be the first in a series of articles discussing sleep and its importance to our overall well-being. Some of this can be considered anthropomorphizing and certainly hypothesizing, but we learn through stories. So if you would indulge for a story about sleep….

Travel back to our days as hunter gatherers. The rhythms of our day completely controlled by the light and dark cycles orchestrated by our rotation about the sun. As the sun slides down the horizon, it becomes much harder to find food. And in this ancient world of incredible competition for calories, our energy would almost always be best used in search of food. Therefore, when our ability to find food is limited, it would be beneficial to conserve our energy until we are in a situation that can leverage our unique tools developed for calorie acquisition, i.e. day time vision. From this very basic pattern of light and dark, along with a perspective of calorie conservation, we might develop two different modes of being, one of activity, and one of rest and repair.

That being said, sleep’s ability to withstand natural selection is nothing short of a miracle. Sleep is seemingly juxtaposed to many of the behaviors we know to facilitate the passing of our genes into future generations. When we sleep, we are not looking for food, we are not eating food, we are not having sex, we are not looking for a mate, and we are incredibly vulnerable. These are not trivial facts, they are pillars of what we know to be necessary for procreation. So how does something that fails to directly help us in these pursuits, while also making us the most vulnerable of prey, become so prominent in essentially every animal species on this planet? Ockham’s Razor would simply tell us that the benefit must outweigh the harm. Over the long experimental testing grounds of time, mother nature has weighed and measured sleep, and it has proven to be of essential utility. Sleep’s persistence proves its profits exceed its costs. By understanding the magnitude of what we give up through sleep (eating, sexing, security, etc.), we may begin to understand the value we receive through sleep. It simply has to be greater than or equal in value or sleep would not have proliferated.

We don’t know what all the benefits of sleep, and I’m not convinced we ever will. The system-wide effects of something like sleep are hard to tease apart in the discretizing manner demanded by modern science. However, it is being researched more and more and we will be able to increasingly understand the pieces of its puzzle. Our body is able to synchronize different processes through oscillating hormone levels. Throughout the day hormone concentrations rise and fall, creating a rhythmic balance for our cellular operations. There are numerous hormones, and they all have different effects. For example, melatonin ideally starts to increase in the evening, peaks in the middle of the night, and remains low throughout the day. The cyclic variation of hormones act as a internal clock, sending information throughout the body and allowing for different parts of the body to work towards common goals.

Two specific hormones I would like to discuss here are leptin and ghrelin. When discussing biochemistry, we will have to settle with some simplification. Keep in mind when people say something like “melatonin is the sleep hormone,” there is probably a good amount of truth to it, but there is also a vast complexity going on in the background. So while melatonin is certainly involved in sleep/wake cycles, its role is much more complex.

Leptin is a hormone primarily made by adipocytes (fat cells) and enterocytes (small intestine) that signal satiety. It is a huge part of that “full” feeling we get after eating a meal. Ghrelin is a hormone produced by your gastrointestinal system, closely correlated with our sensation of hunger. These two hormones have opposing effects, and are largely involved in appetite regulation. For example, ghrelin is often at its highest concentration before a meal and at its lowest levels after eating. The opposite is true for leptin, as its concentration is highest after eating.

Let’s look at how these hormones are affected by sleep. One of the most common ways to study something is to remove it, and then observe or measure the effect of its absence. Many studies have shown that when we are sleep deprived, the circulating levels of these hormones are changed. One study took a small group of participants and took them through two different scenarios. In the first part of the experiment the participants underwent two days of sleep restriction, then had blood levels of ghrelin and leptin measured, along with a subjective assessment of hunger. These same participants where then later allowed two days of extended sleep, and the same measurements where recorded. The study showed that after sleep deprivation, levels of ghrelin increased, levels of leptin decreased, and subjective hunger was increased [1]. Another study looked at a much larger cohort of patients over a longer period of time. Here they showed that short sleep duration was associated with higher levels of ghrelin and lower levels of leptin, independent of BMI, age, sex, and other confounding factors [2]. In this review article, researchers looked at the body of evidence regarding sleep loss and its effect on neuroendocrine and metabolic function, concluding short sleep is associated with an up-regulation of appetite, lower leptin levels, and higher ghrelin levels [3]. There are numerous other studies out there, and there seems to be a strong general consensus that shortened sleep is associated with lower leptin, higher ghrelin, and increased feelings of hunger. Obviously this is a bad combination for anyone who is concerned about their weight, and an extremely difficult situation to overcome if one is trying to lose weight.

Allow me to step back from the science, and return to our hunter gatherer ancestors to try and tell a story. I do not think it is a huge leap to assume that sleep was something we engaged in every night, and something we rarely sacrificed. If not for any other reason than our gift of vision was severely limited without the light of day. However, I can imagine at least one scenario when we would sacrifice sleep. Those nights when we were on the verge of starvation, when we had gone many days without food. At that point we had no other option but to continue moving in search of food, or at least significantly shorten the time we spent asleep. So if we were on the search for food, bargaining sleep for more exploration time, how might our bodies help us? We would be at a huge advantage if our appetite was tuned for high caloric intake. That way if we managed to finally come across food, we could fully take advantage of the available calories. We would not want to be forced to stop eating because we felt “full.” In this situation it would be a great development if in response to short sleep, our body increased its signal for hunger, and decreased its signal of satiety. Increased ghrelin and decreased leptin, in order to increase our appetite and ability to intake large amounts of calories. Shortened sleep would increase the instinctual drive to find calorically dense food.

Of course this is not science, the evolutionary story may or may not be true. However, viewing things through and evolutionary lens allows us to expand our thinking to why things might work as they do, and I certainly remember things better in story than factual bullet points. So take the evolutionary part with a grain of salt, but the elevation of ghrelin, reduction in leptin and overall increase in hunger in response to short sleep is well understood. If you or anyone you know is struggling with their weight, sleep is an essential first pillar to attack. Leptin and ghrelin are only part of this story. Short sleep also impairs glucose tolerance and causes other hormonal imbalances. Diet and exercise are what people often jump to when discussing weight control, but I would argue sleep should be the first stepping stone. Without prioritizing sleep you will be fighting an uphill battle. Stay tuned for further exploration of sleep’s wide ranging effects on our health.

Best explorations

References:

[1] Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141(11):846‐850. doi:10.7326/0003-4819-141-11-200412070-00008

[2] Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. doi:10.1371/journal.pmed.0010062

[3] Van Cauter E, Holmback U, Knutson K, et al. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res. 2007;67 Suppl 1:2‐9. doi:10.1159/000097543

-Ryan; 6/1/2020

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Food Rules 4: Valuing Food

Why we need Food Rules

Preface
Food is the greatest vehicle through which we expose exogenous (outside the body) substances to our body. What we ingest is no more than chemical information packets that direct our cellular machinery to behave and operate in specific ways. Food is the primary language we have to communicate with our body, and communication (information exchange) is key to a thriving ecosystem.

Everyone has dieted and everyone has failed. Food choice is a psychological game that we are not well equipped to deal with. Unless we educate ourselves on what is really going on, we are severely disadvantaged in an unfair fight. A big part of this is changing the language we use to describe the food we eat. This is not a diet. Diets are temporary and don’t work. We must focus on small changes that can be implemented for the rest of our lives. We wont’t be listing foods you “can’t have.” When you mentally tag a food as something “I can’t have,” you have just lost a battle in this realm of psychological warfare – there is always that small part of us that wants only what we cannot have. This is not about counting calories or joining a Facebook group for the newest fad diet. Food can get complicated and even tribal, so we will attempt to remove the extraneous information and focus on the things that actually make a difference. These are a a few simple rules to help you change your relationship with food.

Rule 4: Food is more than taste

Unfortunately most people think the taste of food and its usefulness are inextricably linked. They are one and the same, and food’s utility is solely determined by how we perceive the taste. This is a regretful perspective and the reason we need to shift the way we think about food. We must fundamentally change the meaning of food. Yes taste is a part of food, an important part, but it is by no means the sole or even primary characteristic. That would be selling food far too short.

Food is a connector of people. Food marks special occasions, like birthdays and holidays. Food changes how we perceive the world. It is the thing that connects you to nature. Food changes how we physically function. It is quite literally the fuel our body uses to move through the world. Food changes how we function mentally. I think most people have experienced what is called “brain fog,” or even generalized fatigue, and it’s certainly no way to experience your day. Therefore when we allow food to be completely characterized by taste, we are doing ourselves a terrible disservice. It is so much more, and in order to change the way we eat, we have to change the way we value food.

This is not to encourage complete disregarding of taste. There are certainly times when the hedonistic value of food should be welcomed. Sharing that piece of birthday cake with your daughter or splitting a dessert with you significant other is a special part of of our human experience. You shouldn’t skip out on your favorite dishes at Thanksgiving because it doesn’t fit your new diet. There are many times in our life when the health consequences of food should not factor into our food decisions, and we should simply enjoy the fleeting pleasures it may bring. But the fact is, most meals do not do not carry the emotional valence of a birthday, Thanksgiving, or some other special occasion. No, most of the time its Monday and its lunch time.

This idea is an extension of Rule 1. You cannot restructure your value hierarchy around food if you do not acknowledge the other characteristics associated with it. If you do not connect the feeling of needing an afternoon nap after you eat a big plate of pasta for lunch to the plate of pasta itself, then the pasta remains unblemished, tasting just as fantastic as always. If you fail to realize that the gas and bloating you feel after dinner are connected to the food choices you made, then the food choices don’t change and neither does the gas and bloating. So of course there are tangible examples like these that we must begin to incorporate into our valuation of food, but there also exists a less tangible aspect in the chemical composition of foods.

Many of the foods easily accessed today are calorically dense and nutrient poor, and the fastest way to gaining weight and feeling shitty are to eat more calories than you require, while failing to get the proper vitamins and nutrients from your food. Most people could probably use more protein in their diet. Most people could probably get by with less carbohydrates. Most people could use more fiber. This isn’t the place to dive into your specific dietary needs, as we are still setting the table. However, it is calling your attention to the nutrition labels of food. Start reading them, even if they don’t make sense. Try to understand that everything your eat is composed of fats, carbohydrates, and proteins, and those components are what give the food caloric content. If you have never looked at nutrition labels before, it would be a tremendous benefit to start tracking what you eat, at least for a few days. Right down everything you eat (or use one of the numerous food tracking apps) for the day. Track total calories, fat, carbohydrates, and protein. You do not have to know what a carbohydrate is, or how it is metabolized in the body. Just get an idea of what you are consuming.

Once you have a handle on what you are consuming, on a macronutrient (fats, carbs, proteins) basis, you now have another metric to value food. No longer are your eating a slice of pizza, you are eating 350 calories composed of 35 grams of carbs, 16 grams of fat, and 17 grams of protein. You have an objective metric with which to compare and value foods. You have an abstracted set of data that allows you to attach a different dimension to food. A numerical representation of what you may be gaining or losing when you sacrifice or indulge in the taste of food.

This will conclude our initial Food Rules. Hopefully it gives some mental structure on how to approach food. With the cognitive framework out of the way, we will turn focus to the biochemical processes associated with food. We will try to understand how food is working inside our body and what aspects of food are driving the epidemic of chronic disease.

Best explorations

-Ryan; 5/7/2020

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Food Rules 3: WHEN You Eat

Why we need Food Rules

Rule 3: It’s not just what you eat, but WHEN you eat

When we start thinking about losing weight or “eating healthier,” I would contest most of the thinking centers around what we eat and how much we eat. This is, in fact, only part of the story. The leg of the stool that often goes unnoticed is when we eat. This idea is gaining some popularity, and is often discussed under the terms intermittent fasting or time restricted feeding. I am going to focus here on time restricted feeding, or eating for certain hours of the day and fasting for the remaining hours.

Our bodies are beautifully complex units made up of numerous small machines (proteins) working together to transform energy (food) into usable forms. When we eat food, our body first breaks it down into its fundamental components. Clearly, there is no place for a carrot in our muscle or cardiac cells, but the chemicals components that make up the carrot can be salvaged by our intricate digestive processes. With the raw materials at hand, our body can distribute the resources and initiate processes that allow the body to grow and expend energy.

The pathway that food follows before it in a usable form is one where many different machines work together in harmony. Think about a factory that takes in all sorts of materials, but those materials come into the factory all stuck together. Stuck together in these big, conglomerates of cloth, wood, plastic, glass, and anything you can imagine. Now before any of those materials are usable by the factory, the mixture has to be separated into its component parts. But it’s not that simple. In this factory there are specific machines that can grab and sort glass, other machines that seek out the wood, special machines for the plastic, etc. All of the many different machines are required to fully disentangle the mass of raw material. It is also important that all of the machines be present and working together. If the bolus of resources arrives and only the plastic and wood devices are at the scene, you end up with a huge amount of unprocessed, improperly processed, and unusable material.

Now it would also be very inefficient for the factory to be fully staffed with all machines ready for action 24/7. Especially if the factory knew when the resources were going to brought in. If there are two major deliveries scheduled for the day, you would only want to have the machines powered up around the times when those deliveries would be made. The most profitable business plan would be to have all the machines show up just prior to the arrival of the first delivery, and then to send everyone home after the second package has been fully broken down.

This is the efficiency our body is attempting to orchestrate. Believe it or not, every system in our body has internal clocks that help it do determine daily patterns and reoccurring events. This is the essential fist step to optimizing the system. You have to have a scaffolding of something like time in order to recognize recurring events. When it comes to eating, these clocks are leveraged to ensure our body is fully prepared to break down the food and grab as many useful bits as possible.

Now being the incredibly adaptive animals we are, our machines don’t completely go on strike, or blatantly refuse to show up to work. When we eat at abnormal times we send a signal for everyone to come back to the factory. All the machines that had already been sent home return to the factory, reluctantly or otherwise. This feeding outside of the normal window also sends a signal to the internal clock system in order to influence a slight adjustment. Its a signal saying our predictions were not quite right today, lets adjust to this new information, and try a better prediction tomorrow. So if we are constantly changing when we eat, our body is never able to realize the incredible efficiency it is always attempting to create.

To make this concrete and applicable, try intaking all of your calories within a 12 hour section of the day. I think most people would be able to accomplish this. As soon as you have your first caloric intake (yes drinks with calories count), start your clock and make sure to finish your last meal before 12 hours later. As you get comfortable with this you can begin to shrink your feeding window and lengthen your fasting window. Not only does this help the biochemical processes in your body, you will also notice changes in the sensations of hunger and satiety. And remember Rule 1.

Going forward we will dive into the biochemical benefits of time restricted eating. Hopefully this post allows you to have a structural and foundational understanding of what the idea is. Thanks for reading.

Best explorations

-Ryan; 5/6/2020

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Food Rules 2: Eat REAL Food

Why we need Food Rules

Rule 2: Eat REAL food. If you have to question if it’s “real food,” it’s probably not.

Our bodies were not designed for environments where food is plentiful. The behavior and functionality we developed was shaped by the absolute necessity to acquire energy in a world where that energy was scarce and fleeting. We carry the same biology and psychology with us today, however we are inundated with calorically dense, easily accessed, unending supplies of food. The intricate reward systems that were crafted to help us find and acquire the energy of life are still very much alive and functioning. The problem is that in our modern food environment, these systems that underly our decision making processes no longer lead us to a productive and healthy life.

Our immediate job in this modern food environment is to realize those moments of bliss experienced while eating some sugar soaked dessert are not serving your organism as a whole. It is activating a particular reward pathway in the brain. Setting off a brilliant electrical display – the perfect pattern in the perfect rhythm of time that we interpret as perfected happiness. That is the very moment were everything else, the pain, the anger, the hunger, the to-do list, all fade away. It is so obvious why so many of us comfort ourselves though food. But it only last a moment. Just as mysteriously, the fleeting feeling of bliss fades as the food passes from our mouth to the later stages of our digestive system. Simply clearing mouth real estate to make room for the next bite that will assuredly set off the same beautiful sequence of events.

The mouth pleasure is not the problem. The problem is what now masquerades as food. Food is, and always has been, that which we consume from our surroundings to nourish our energetic requirements. Think of food as an idea, a symbol. This symbol that has taken many forms throughout time. It has imbued roots, flowers, berries, organs, muscles, eggs, hamburgers, laboratory constructed hamburgers, grain, and even shelf-sustainable-indestructible-conglomerations of sugar and fat with the life sustaining force that we identify as food.

Throughout our existence food has been sacred. It is that which allows us to move through time and space. It becomes the body. Somewhere along the way we have lost the life-sustaining dimension of food. In our blistering pursuit of reward pathways in the brain, we have disregarded those aspects of food that nourish the body as a whole. We must reconnect to those life-giving qualities of food.

The easiest way to do this is to eat REAL food. That stuff on the outer rim of the the grocery store. If it doesn’t look like it came from the earth or from a creature that once inhabited the earth, it was most likely engineered for shelf life and reward pathways in the brain. When you eat plants and animals from the earth you are trusting that most masterful engineer, Mother Nature. That engineer that crafted the intricate harmony of life itself. She understands food goes beyond mouth pleasure. She understands that what is eaten becomes the body, for that cyclic interdependency is her law.

Thanks for reading.

Best explorations

-Ryan; 5/3/2020

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Food Rules 1: Give Me Your Attention

Why we need Food Rules

“Eat food, not too much, mostly plants.”
Michael Pollan

Rule 1: Pay attention. Try to feel hunger and satiety. Connect what you eat to how you feel.

Try to feel when you are hungry and when you are satisfied. Do no eat because you just woke up, or because it’s 12:30 in the afternoon and that is lunch time. Hormones circulate throughout our body and occasionally cause us to feel what we label as hunger and satiety. This is the clock which we should be eating on. Three square meals a day is nothing more than a product of society and culture, and has zero connection to how the body actually works. “Breakfast is the most important meal of the day,” is no more than a brilliant marketing ploy from someone selling you breakfast. Eat when you are hungry. Stop eating when you are full. Don’t listen to the other bullshit.

However simple this sounds, it is not simple to accomplish. You are just beginning to push back against the artificial patterns and routines that have directed your life. You can bet that if you have been eating at 7 AM, 12 PM, and 7 PM for years, you will have created a pattern your body is accustomed to. You are likely to feel a strong sensation, that you would label hunger, just before 7 AM, 12 PM, and 7 PM, as you have programmed your body to prepare for digestion at those times. However, there is no law of the human body demanding we eat three meals a day, and we are all aware that if we were forced to skip one of those meals, we would be just fine. This tells me that those hunger pangs we get around our scheduled eating times are very much artificial – at least biologically artificial, in the sense that they do not denote your body actually needing food. So I challenge you to one small experiment. Simply skip one of your regular scheduled meals (preferably the first or last, more on this later), and PAY ATTENTION to how you feel. When that sensation of hunger arises, acknowledge it. What does it feel like? Where do you feel it? Does it change your mood? How long does it last? When it passes, how do you feel? This is a simple exercise to become more conscious of when and why we are eating.

Let’s jump to our meal. We need your attention again. Before you take a bite, take a breathe and bring your awareness to the food and the people you are eating with. Try turning off the television and putting away the cell phones, if only for the fact they detract our attention. When our attention is divided, it makes being able to detect the feelings of hunger and satiety much more difficult. Have you ever wondered how you can eat the whole box of popcorn or the entire container of ice cream and not feel anything until the movie has finished? When we are focussed on something else, it is easy for eating to shift to autopilot, outside our conscious awareness. If you have trouble with portion control, try eliminating the distractions around your meals.

Lastly, let’s move to after the meal. Again this will require your attention. I hope you see the obvious theme here. We have eaten, so the taste of the food has come and gone. It is now time to sharpen our skills of examining how food actually affects us. How do you feel? Energized and sharp? Lethargic and ready for a nap? Bloated and gassy? Running to the bathroom as fast as possible? We often ascribe these characteristics to “this is just the way I am,” when our body is actually sending distress signals to us on a daily basis. I met a patient in the emergency room recently who told us she has diarrhea multiple times a day, everyday, but that was just how her body works. This is not how our bodies work. This is your body screaming something is wrong, begging for your attention. In this particular lady’s case, I have no idea why she had diarrhea. It could be anything, but the point is we need to pay attention to the signs our body is giving us. If you have consistent swings in energy around your meals, examine that. Maybe you are eating too much at once, maybe its too many carbohydrates, maybe you need smaller and more frequent meals, or maybe you just aren’t eating enough. This is not meant to get into the diagnostics of what is going wrong. The first step is simply paying attention to how food makes you feel.

More Food Rules to come. Thanks for your attention

Best explorations,

-Ryan; 5/2/2020

Health and Compound Interest: A Mental Model for Building a Lifestyle

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Compound interest is the addition of interest to a principal sum. It is interest on interest. It is a principle that allows something to increase at faster and faster rates over time. For those visually inclined it is something like this…

https://www.fool.com/knowledge-center/compound-interest.aspx

Economics lesson over. We will apply the idea of compound interest to our approach to health.

This can take many forms. It can be purely psychological, as in a single good decision today makes me more likely to make a good decision tomorrow, and maybe even two good decisions the following day. Another way to describe this is something like the feeling of momentum. *Before we go any further, we will clarify this vaguery, ‘good decision,’ as anything objectively benefiting your health, ie. eating a serving of broccoli, walking outside for 10 minutes, doing a push-up, etc. This would be specific to you and these are general examples.* The compounding principle can also operate in a purely physiologic realm. If I do a set of push ups today, maybe I am able to build some small amount of muscle. If I build muscle, my body’s ability to dispose glucose is improved. If I can dispose of more glucose, my blood sugar goes down. That muscle it not likely to disappear any time soon, therefore I am better at disposing glucose everyday in the future. My average blood sugar over time (HA1c) goes down.

But here is where it gets fun. That same muscle (built from my push-up) that helps me regulate blood sugar helps me move more functionally, increasing my ability to meet the physical demands of life. It increases my resting metabolic rate, allowing my body to “burn” more calories throughout the day. It will help regulate certain hormones circulating in my body. Hell, doing the push-ups might just make me feel better afterwards. The single ‘good’ decision of doing push-ups generates health benefits in multiple dimensions. And the principle of compounding applies in every dimension! The general idea of health compounding is that no matter how insignificant a single ‘good’ decision today may seem, the majority of its benefit exists in your future. So cherish each and every positive decision you make, you just sacrificed a small amount today for a potential windfall tomorrow.

My favorite example of health investment and compound interest is sleep. I have learned to love sleep. We can view investment in our health through the lens of time. How many hours of the day am I doing something productive for my health versus how many hours I am doing something neutral or even negative? I will be the first to admit how difficult it is to make health conscious decisions in today’s environment. We have endless entertainment streaming right to our favorite device, delicious foods that someone would happily deliver to our very own door, not to mention all the gyms are closed! Needless to say, decisions in the best interest of our health are difficult to make. This is what makes sleep the king (or queen) of health decisions. If you prioritize giving yourself 8 hours in bed each night, you just banked 8 hours of good health decisions! You just optimized one-third of your day. Thankfully our unconscious state during sleep makes it rather difficult to be tempted by those beautiful desserts or “Click to play the next episode.” So from the abstracted point of view of wanting to make more ‘good’ decisions than ‘bad’ decisions throughout our 24 hour period, prioritization of sleep is paramount. In a more concrete view, sleep provides numerous physiologic benefits. Chronic short sleep can promote weight gain, hinder weight loss, dysregulate blood sugar levels, cause hormone imbalances (including those that regulate appetite), to only mention a few manifestations. If you are interested in the science of sleep and its physiologic outcomes, stay tuned.

I don’t want to dive too deep into the science right now as this post is more about the conceptual framework we need to adopt towards our health. Every single decision we make is a node in a network. The output from that decision node affects many other aspects of our life, it compounds. My sleep affects my energy, my energy affects my workout, my workout affects my sleep. My food affects my hormones, my hormones affect my appetite, my appetite affects my food choices. My movement affects my hormones, my hormones affect my energy levels, my energy levels affect my desire to move! Our body is a symphony. Every individual piece playing some minor role in the overall function. Don’t downplay a ‘good’ decision, regardless of how insignificant it may seem. Celebrate eating a serving of vegetables, acknowledge the victory of going for a walk, and throw a party for yourself tomorrow if you give yourself 8 hours in bed.

Best explorations

-Ryan; 4/30/2020

Health Unrefined

*This is a combination of previous posts. I wanted to have the entire idea collected in a single page.

Medical Problems of the 21st Century

Pause and think about what diseases concern you you today. What diseases do you see or hear about frequently? Which conditions affect someone close to you? Those that populate my mind are cancer, heart disease, obesity, diabetes, depression, and dementia, among others. There is something that connects these seemingly disparate diseases, they are all chronic diseases. A chronic condition can be defined as a physical or mental health condition that lasts more than one year, causes functional restrictions, and requires ongoing monitoring or treatment [1]. Let’s break down this definition.

Chronic disease can be physical or mental. We interpret the world through differentiation. We like to have clear cut distinctions, labels, and discrete entities which have specific meaning. The disease process, of course, exists in the natural world, outside of our psyche and outside of our distinctions. In the natural world these clear boundaries we perceive are not so well defined, as things exist on a continuum or gradient. I make this point to emphasize that although we separate physical and mental diseases, they are not exclusive to one another. From the perspective of the disease, there is no distinction between the mind and the body. This means that even though we may consider depression to be a “mental” condition, there are very real physical effects of depression. Just as there are very real psychological effects of cancer. Disease is not limited to the artificial boundaries we use to perceive the world.

A chronic condition lasts more than one year and requires ongoing monitoring or treatment. There is a lot to unpack here. Many of us may believe that modern medicine has a drug or procedure to fix the majority our ailments. The so called silver bullet. However, if a disease is still lingering after a year, then clearly there has been no drug, no treatment, and no procedure that has done anything to remove or reverse the disease. We certainly have many tools to suppress symptoms that arise from the disease, but the root, the disease state itself, remains relatively untouched. And when the disease remains untouched, you get exactly what the definition tells us, ongoing monitoring and treatment. Ongoing monitoring and treatment is a euphemism for lifelong prescription medications (often with side effects that instigate the need for additional medication), frequent visits to the doctor, numerous referrals to specialists, occasional trips to the emergency room – all while the actual disease remains largely unchanged beneath its cloak of symptoms. And lastly, we get to the real kicker with chronic disease, chronic disease causes functional restriction. So not only do you get to deal with the disease for an extended length of time, but the life that you are able to live is no longer the life you have lived. There is the obvious loss of time and money associated with the ongoing monitoring and treatment, but the real problem is the decrease in quality of life. Dependencies are limitations. Chronic disease erodes the body’s ability to thrive, reduces its capacity to function, and forces dependencies on medical interventions that seem to only be bailing water from a boat riddled with holes.

Modern medicine has saved countless lives, and it will save and improve the lives of many more. However, I think it is largely missing the mark when it comes to the prevention and treatment of chronic disease. The numbers almost seem fake. 45% (and growing) of Americans have at least one chronic disease. 25% have multiple chronic diseases. Chronic disease is responsible for 7 out of 10 deaths in the United States. 96% of all Medicare spending goes towards the treatment of chronic disease and 83% of Medicaid spending [1]. And these are just a few of the statistics. Chronic disease is clearly demanding a different approach. *Side note, you may not use Medicare or Medicaid, but if you think you are not paying for these expenses, you would be dead wrong.*

How Chronic Disease Manifests

Chronic conditions affect the entire human organism. They are not limited to a single organ or tissue, but manifest complications throughout the body and mind. It seems that something so ubiquitous can only arise from that which is just as commonplace. These are lifestyle diseases.

Our lifestyle is an ecosystem in which the components of our body are forced to function. It is no different than the way other aspects of life organize all around us. The plants and animals that flourish in the tropical rainforests are vastly different than those that inhabit the northern hardwood forest, which look nothing like the creatures of the desert. Life suits itself to its surroundings.

Ecosystems are a collection of energy transforming machines. The outputs of one machine are the inputs of the next, and this cycle allows for different pieces to function and grow together. Each ecosystem contains unique sets of raw materials, or primary inputs. These would include things like amount of sunlight, rainfall, soil conditions, temperature, and diversity of organisms. These parameters are essentially the gatekeepers of what type of life will develop in that particular environment. Life is dynamic, diverse, and infinitely creative. These primary inputs drive the creative output of life. Only the organisms (energy converting machines) that are best suited to their particular environment will survive the endless competition for resources.

Chronic disease is a form of life that emerges from the primary inputs of our body. It is the group of machines best suited to the inputs of the way we live our life. It is type of life selected for through the environment we live in! Therefore, if the inputs are not changed, the disease state will continue to thrive, and we will be forced to live a life confined by chronic disease.

Disease is a confluence of genetic predisposition and environment, more heavily influenced by the latter. Our genes are no more than a starting point. A beginning state from which we can move largely in any direction. There are certainly those diseases in which the individual’s fate is sealed from the beginning, but these are few and far between, and much less interesting for no other reason than they are entirely out of our control. The vast majority of disease can be viewed as an opportunistic drive, capitalizing on particular set of environmental factors at a particular time.

We need a definition of our environment. It will function as an all encompassing term, denoting any phenomena, internal or external, that exerts any level of influence on the human organism. This includes, but is not limited to, the food (or food like products) we consume, physical movement (or lack thereof), our thoughts, social and family interaction, light exposure, sleep, emotional state, etc. These environmental factors represent the tools we have at our disposal to create a state which minimizes probability of disease gaining a foothold. These are our primary inputs.

These are the levers with which we can influence our health outcomes. You will notice I did not list medications, surgical procedures, or any other “medical interventions.” The goal is to construct a suitable environment so that we do not develop the conditions requiring complex medical intervention. Disease is constantly probing for a chink in our armor. This has been clearly displayed in the recent COVID-19 pandemic. It affects individuals in vastly different ways, posing a more significant risk to those already dealing with underlying health conditions (diabetes, obesity, etc.). We cannot control when our bodily ecosystems are going to be challenged by some external threat, but we can certainly try to maintain our defenses. We can push back against those lifestyle diseases that increase our risk. We can stack the deck in our favor.

Gambling On Health

We largely proceed through our days with little to no surprise. That is to say, what we expect to happen, largely does happen. In a way, this is what our nervous system has developed to do. It reduces the infinitely complex world around us to groupings of patterns, allowing us to process our surroundings and act. However, even with this predictive modeling capability that is hardwired into us, we also know that the unexpected will eventually happen. At some point, at some place, our models and predictions are completely shattered, and chaos dominates our perspective.

Imagine we each have a 365 sided dice, and every morning we have to roll the dice one time. If the dice lands on 2-365 (any number besides 1), our day is to proceed completely as expected. However, if the dice lands on 1, life is going to demand much more from us on that day. Maybe that is the beginning of a common cold, a bout of depression, an especially stressful event, the onset of neurodegeneration (that won’t be be detectable for another 20 years), back pain, a blood clot, a broken hip, stroke, heart attack, etc. Each outcome would certainly be unique to every individual, but the idea holds true for all. We all have to roll the dice every day, and chaos is lurking right around the corner.

I am proposing that we have the ability to change the size the dice we throw. We have the tools to create a robust organism that is capable of withstanding the chaos that life throws our way. I believe we have the capability to throw a 10,000,000 sided dice. That we can dramatically decrease the odds of a disease being able to capitalize on our health. The actual numbers are completely irrelevant. The idea is that we can continuously add to our dice, become more resilient, more vigorous, and more adaptable. But the 1 will always be present – even that illusory person of optimum health can be outmatched by the forces of mother nature. We should all look to increase our odds because the pursuit of health is a game we are forced to play everyday, and it only gets harder.

It should be emphasized that we can certainly decrease the numbers on our dice. In fact, the world we live in today is conducive to many behaviors that would reduce our chances of avoiding disease. Society often promotes (sometimes below the level of our conscious awareness) actions that diminish our resiliency and increase the probability that some disease will take hold. If we do not act with intention and awareness, the gravitational pull of our environment will slowly deteriorate the dice we have to throw. The ecosystem we find ourselves in today cultivates those machines of chronic disease. And it almost certainly becomes a matter of when instead of if.

The things I will talk about are nothing new. It is not cutting edge science coming to save the day. It is about finding a way to do the hardest thing in life, change the way we live. Will power sucks, it comes and goes with the wind. Diets don’t work. And the answer is not sleeping less so we can do more. We all have access to incredible levers that completely influence our state of health or lack thereof.

This concludes the table setting of our health situation in the 21st century. Going forward we will be more focussed on the strategies available to push back against chronic disease. There are issues on all levels from the healthcare institutions and laws to the individual choices we all make. We will discuss many of them, but the focus will be on the individual and the choices we can each make on a daily basis to improve our lives and the lives of those around us. I will be starting medical school in less than four months. I am going in with the acknowledgement that there are big problems with our healthcare system. Chronic disease is the downstream effect of the way we live our lives. Every individual has to take the responsibility on themselves. If we fail to give proper importance to sleep, food, movement, and our mental or emotional state, we are selecting for chronic disease. It starts today, and health is a conscious decision we all have to make day in and day out. Through food, movement, sleep, and management of stress you can create the ecosystem that pushes against chronic disease.

Best explorations

-Ryan; 4/30/2020

Sources:

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018;15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431

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The Archetype of Food

“From food all creatures are produced,
All creatures that dwell on earth.
By food they live
And into food they finally pass.
Food is the chief among beings,
Therefore they call it the panacea.
Verily he obtains all food
Who worships Brahma as food.
For food is the chief among beings,
Therefore they call it the panacea.
All creatures are born of food,
By food they continue to grow.
Creatures feed on it, it upon creatures,
Therefore it is called food.”
Taittiriya Upanishad 2.2

“Transformation for the body cells through food intake is the most elementary of animal changes experienced by man. How a weary, enfeebled, and famished man can turn into an alert, strong, and satisfied being, or a man perishing of thirst can be refreshed or even transformed by an intoxicating drink: this is, and must remain, a fundamental experience so long as man shall exist.”
Erich Neumann, The Origins and History of Consciousness

Let’s travel back to the times of our hunter gatherer ancestors, and focus on the availability of calories. Let’s also not forget that this lifestyle carried on for hundreds of thousands of years, making it extremely influential in shaping our Homo sapien biology and psychology. The consumption of calories was undoubtedly more difficult in those times, and was likely often an issue of life and death. It is quite possible groups would go weeks and even months without substantial sources of food. This is the environment where are our connection to food developed. Food was not an implied part of our everyday schedule, it was not a treat, it was not something we could purchase, it was literally life itself. The ticket to the continuation of life. Every calorie we consumed bought us more time to find the next meal. It was the drive to life. Think about the psychological representations that were created during this time. Whatever instincts are, this would be the environment in which they developed. If one group had an instinctual drive to seek and consume food, they would have an advantage over those who didn’t. We are certainly descendants of those humans with a developed instinct for food identification and consumption.

“There is good reason for supposing that the archetypes are the unconscious images of the instincts themselves, in other words, they are patterns of instinctual behaviour.”
Carl Jung, The Archetypes and the Collective Unconscious

Instincts come from inside of us, they are a part of us. Archetypes come from the collective unconscious, also a part of us. To illustrate their relationship, think of a pair of attractive magnets. Put one magnet on you, representing your instinctual drives. The opposite magnet resides on the the archetype. The instinct then essentially pulls you toward the representations of the archetype. The archetype is the reward which the instinct seeks. We should also clarify the difference between archetype and the incarnation of the archetype. For this, visualize a submarine surfacing from the ocean. As it breaks the surface there is a coating of water surrounding the submarine. Pretend that we could give this coating of water a particular color and make in non transparent, so we actually can’t even see the submarine, just the outer colored coating. The submarine is the archetype, and the colored coating is the incarnation of the archetype. We only perceive the outer coating, but the entity giving it psychic energy or meaning is the submarine that we are unable to see.

The archetype of food is so intimately connected to our human instincts, an undeniable attraction. This attraction is at the level of the archetype; the submarine that we are drawn to, but do not perceive. I am concerned with today’s coloring of the archetype of food, its current incarnation. We are inundated with things claiming to be food, drawing on our instinctual drives, but not rewarding us with the type of nourishment that created these deep connections. When companies label things as food, they are hitching a ride on psychological realtionships that humans formed hundreds of thousands of years ago. Unfortunately, the “food” that is most easily accessed today does not adequately nourish the body, energize the body, nor satisfy the body. This incarnation of the archetype has become far removed from the qualities that originally formed the instinct-archetype connection. Instead of creating nutrient dense foods, we made calorically dense food. Instead of seeking satiety with food, we created addiction manifesting food. Instead of finding value in the health and wellness created from food, all value was placed in the taste of food.

These are only a few of the problems with the archetype of food. Therefore if our food decisions are left unconscious, we will continue down the path of the chronic disease epidemic we are currently experiencing. Food is the major input of information we give to our body on a daily basis. It is information that generates billions of cellular decisions downstream. It is an essential part of the blueprint our cells use to create our body. Food can no longer exist outside of medicine. It can no longer solely be an instrument of the nutritionist. It must be an integrated part of everyone’s healthcare. Until we can change what food means to us as a society, we must individually become conscious of the food we are consuming.

Best explorations

-Ryan; 4/28/2020

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Health Unrefined Part Three: Gambling on Health

Preface: This is a continuation of previous two posts regarding the ubiquity of chronic disease, and the necessity of a new approach to health. This post will hopefully stand alone, but reading the first two pieces will provide more context.

Best explorations

-Ryan; 4/27/2020