I’ve moved
If you’re looking for Double Arrow Metabolism, go here:
Doublearrowmetabolism.com
No title available
Keni
Misplaced Lens Cap

tannertan36
TVSTRANGERTHINGS
NASA
Stranger Things
No title available

titsay
todays bird
let's talk about Bridgerton tea, my ask is open
YOU ARE THE REASON
tumblr dot com
d e v o n
Not today Justin

No title available
will byers stan first human second
dirt enthusiast
PUT YOUR BEARD IN MY MOUTH
Alisa U Zemlji Chuda

seen from Canada
seen from Türkiye
seen from Indonesia

seen from France
seen from United States

seen from Malaysia

seen from Malaysia

seen from Spain
seen from United States

seen from Japan

seen from United Kingdom

seen from United Kingdom

seen from South Korea
seen from United States
seen from Maldives
seen from United States

seen from Malaysia
seen from Canada

seen from Singapore
seen from Poland
@doublearrowmetabolism
I’ve moved
If you’re looking for Double Arrow Metabolism, go here:
Doublearrowmetabolism.com
From the Desk of Necktie B. Moore
A wedding toast
To two of my favorite people, on their (slightly late) first anniversary. My sincere, sentimental, slightly edited toast. Happy anniversary:
I am so honored to toast this couple. So I'm going to do what I normally do when I'm asked to speak, and that's talk about myself. And what I'm most proud of is the company I've managed to keep. I am one of four people on planet earth to my knowledge--the others are my wife and kids--who knew Katie and Colby before they knew each other. An exclusive group. Colby is now so ingrained in my memories that I think I remember his first words to me: "Hey naked dude." It sounds weird. But if you were in Manhattan, Kansas between 1994 and 1998 I don't need to explain it to you. If you weren't there I can't explain it to you. I've been unable to escape him since. If I inventory the best days of my life since I met him, he's there in a shocking number of the memories. Worst days, too. But those weren't all his fault. He is easily the most loyal friend most of us have. He's the person in our group most afraid that someone is being left out. The guy who casually brings up a friend that the rest of us have forgotten about but who he talks with monthly. And though maybe I've not always been as good a friend to Colby as he was to me, he has consistently forgiven me for it. Colby has never taken up much space; he's skinny. But he fills space with words. And if you know his son Jack, you know it may be genetic. Colby is a storyteller, and his principle genre is the tall tale. Every one of us has heard the same stories about ourselves or our friends over and over. I've discovered over time that the purpose of this retelling isn't to grow the protagonist into heroic dimensions through repeated telling. He already thinks we're heroic. Colby's intentions are based in love. With each retelling, your rough edges are being worn down to match the person that Colby sees when he looks at you. Katie's first words to me? I don't remember, really, but considering I met her at a camp for diabetic kids, they were probably kinder and more sober than Colby's. I immediately liked and trusted Katie so much that Tracy and I exploited her to babysit our kids. Then I invited her out one night to keep me company while I tried to set Colby up with one of my nurses. Katie promptly sabotaged my plans. Don't let the kind exterior fool you--she takes what she wants. I can't wait to hear future stories about Katie. But she needs no polishing. She's already the nicest person in the room. The person who my wife assured me only laughed at my jokes because she was trying to make me feel better about myself. Katie is so kind that a conversation with her has a cleansing effect. She's soap and water beautiful inside and out. I hope the rest of you will join me in thanking Colby and Katie for the gift they've given us. We just got to watch two people we all love--people who see things in each other that are secret, and that the rest of us can't see--stand face to face in front of God and all of us and make a promise to each other. For the rest of my life, you'll never be alone. (Considering Colby's age, the expiration on that promise may come sooner than we hope.) I promise that I will be kind, even when it's exhausting. I will remember that my world isn't the vast place I've explored to this point; it begins and ends within the space we share. And all I will ever need from another person on this earth is for them to remind me of you. So here's to loyalty. And to forgiveness. And to love. And to kindness and to beauty. But most of all here's to the beginning of the next epic story.
A tribute to coaches
I’ve had the chance to do some writing recently, and I decided to start cataloging it here. A brief tribute to my now-deceased high school basketball coach:
My high school basketball coach died this week. I’m ashamed to admit that his life and career haven’t recently crossed my mind much other than in the generic ways most people think of past coaches and mentors: memories of punishments meted out, the time I was elbowed in the forehead during a district playoff game (requiring sutures after the game), the pre-game we all stifled laughter at his diarrhea in the locker room, his use of corny phrases like “sucking eggs” and “confounded” in place of actual curse words. But like most people who’ve come and gone in my time on Earth, real reflection on his contribution to my life has received depressingly short shrift. Until now, when it is too late for him to hear it.
Coach, circa 1992: “How badly do you want to be on a team, to be part of something bigger than yourself?” Bad enough to trim your Chris Cornell hair and tuck in your Eddie Vedder flannel? Bad enough to wear a tucked-in, collared shirt on gameday? Bad enough to keep your hair above your ears to hear, above your eyes to see, and off your collar so that people will take you seriously? Fine. These were difficult standards to meet for a style-conscious kid, even in pre-internet rural Kansas, during the grunge era. But if you cared, these weren’t a big deal, and he knew it.
Medical school professor, circa 2001: “How badly do you want to be a doctor, to be part of something bigger than yourself?” Bad enough to wear flimsy scrubs that are two sizes too big or small because the residents have hoarded all the ones that fit? Bad enough to wear a short, bulky, grungy, awkward white coat over your shirt, tie, and slacks on days hot and cold? Bad enough to wear a bouffant cap over your fly-away hair, inviting comparisons to the lunch lady? Bad enough to sacrifice your weekends (your twenties!) to the fluorescent lights of the hospital? Fine. If you care enough, it’s not a big deal.
In spite of my astonishing mediocrity as a basketball player, Coach cared about my performance, or more accurately, my improvement. I have a white-hot memory of being congratulated for making an extra pass during a fast break drill (this was the early 1990s, the dawn of attention to “secondary breaks” and transition defense). “It’s nice to have somebody follow directions,” said Coach in passing. It was one of the first times I remember being exposed to the importance of attention to detail. Sure, my upbringing on a corn farm had instilled some gnawing anxiety around any delay or interruption of the inevitable, slow advance of mother nature: seasonal awareness of crop germination, insect metamorphoses, and the like. Things that Coach--a farmer who also coached and taught, or vice-versa--knew intimately. But mostly farming taught me a work ethic, or more accurately the consequences of resistance to delayed gratification. Make a mistake now, and four months from now you’ll suffer. Basketball, on the other hand, unveiled the immediate consequences of small, almost imperceptible mistakes or wrong decisions. What happens when you use the wrong foot to drop step near the basket? Your shot gets blocked. Set a screen on the block instead of at the elbow, a mere 10 feet away? Prepare to watch the person you’ve screened for get bottled up as the defender uses the baseline as a double team. Medicine requires both. Want to be respected by patients now? Dress like a doctor and treat them like humans. Want to see your patients live to see their kids’ weddings? Pay attention to the numbers. Pay attention to the little details in their stories. Pay attention.
Justin Moore, circa 1994: Airballs free-throw in league tournament game. A low point in a mediocre career. Coach tells him in private, not in public, to move his right foot two inches in front of his left at the line, and it won’t happen again.
Justin Moore, MD, circa 2004: Floats Swan-Ganz catheter in a patient he will later discover is chemically paralyzed, but not sedated. A low point in a mediocre internship. A thoughtful Chief resident privately, not publicly, introduces a checklist to avoid just such mistakes.
Competitive sports played by adolescents are inherently humiliating. But most college graduates don’t know the meaning of the word humiliation until they hit medical school. Coach was not above the use of gentle humiliation as a motivational tool. Once, after turning the ball over on two consecutive possessions in an intrasquad scrimmage, I was queried in front of my teammates if I was aware for which team I was playing. Having given an unsatisfactory answer, I was instructed to stand apart from my teammates to reflect on the question. This technique, in contrast to the harsh, high-volume discipline to which Kansas farm boys are more accustomed, introduced me to accountability to a group. There is not a more valuable lesson in to be learned in preparation for the practice of medicine in the modern era of team-based patient care. I, and virtually every other trainee I’ve ever encountered in medicine, has had a similar experience on the wards, in the clinic, or in the operating room. Lessons learned.
Skyline High School boys’ basketball win-loss record, circa 1993: ~0.500. Excuses be damned; get better.
Justin Moore’s aggregate achievement of appropriate lipid levels, hemoglobin A1c levels, and blood pressures the first year of endocrinology practice, circa 2008: 12%. Excuses be damned, I got better.
Not all Coach’s techniques were perfect in the medical sense. I was encouraged to play through the pain of an avulsion fracture of my right fibula, the defense being that ankle injuries responded poorly to rest. But he defended me too: That elbow to the head in a district playoff game? He ran onto the court and protested, nearly earning an ejection. And not all lessons are reflected in a win-loss record; sometimes the win-loss record is the lesson. We were generally a couple games over 0.500, even versus the decidedly low-stakes competition of small-town Kansas basketball. Kentucky had nothing to fear. But I would guess a survey of former players would reveal that, like mine, their lives were made better in the long run by having played under Coach. He’ll live on in the spirit, if not the exact methods or strategies or win-loss records, of thousands of other small-town coaches, teaching kids the value of paying attention to inches and seconds. And his loss makes me hope that upon my death, be it tomorrow or in 60 years, I leave some legacy. Not a legacy of fame or of wins and losses, at least not in the Krzyzewski or Knight or Osler sense, but a legacy of change. He molded young men and women, some of whom went on to medical school. What pliable, malleable part of planet Earth can I alter slightly to make the future world a shade better than the present one? My answer to that question will be my tribute.
Coach, you didn’t suck eggs. Darn the confounded cancer.
Is the Dietary Guidelines Advisory Committee Report based on “unsound evidence?”
On July 7, 2015, Senators Lamar Alexander (R-TN) and Pat Roberts (R-KS) sent a letter to Secretary of Agriculture Tom Vilsack and to Secretary of Health & Human Services Sylvia Burwell expressing concerns regarding the Dietary Guidelines Advisory Committee’s (DGAC) 2015 scientific report. Specifically they contend that the report “...included recommendations that are not based on a preponderance of scientific and medical knowledge.” This is a potentially influential letter since the DGAC report will play heavily in the final draft of the 2015 Dietary Guidelines for Americans. Those Dietary Guidelines in turn form the basis for all Federal nutrition education and assistance programs for the next five years.
Though the senators do not mention specific recommendations, it can be reasonably assumed--based on prior spending bills passed by the Republican-controlled house--that they are most concerned about recommendations by the 15 physician and scientist committee members that diets higher in plants and lower in animal-based foods are both more health promoting and associated with less environmental impact than the current animal-heavy U.S. diet. That senators from Kansas (third nationally in beef production) and Tennessee question recommendations for a plant-based diet from an economic standpoint is no surprise. But from a scientific standpoint? In her preface to the report, committee Chair Dr. Barbara Millen states that “..the current evidence base has never been stronger.” Who is right? What of the senators’ skepticism regarding the evidence behind the recommendations?
The report is a daunting 571-page document, its length largely owing to its sophisticated methodology. Roughly a quarter of its recommendations were based on newly performed systematic reviews now available at the United States Department of Agriculture’s (USDA) Nutrition Evidence Library: http://www.nel.gov/category.cfm?cid=50. Importantly, the methodology for these systematic reviews was adapted from that of the Agency for Healthcare Research & Quality (AHRQ), the Cochrane Collaboration, the Academy of Nutrition and Dietetics, and the 2011 Institute of Medicine standards for systematic reviews. The purpose of such strict standards was twofold: first, to comply with the 2001 Data Quality Act, whose purpose is to “maximiz[e] the quality, objectivity, utility, and integrity of information (including statistical information) disseminated by Federal agencies,” and second, to ensure that the review was “systematic, evidence-based, and transparent.” Recommendations based on these systematic reviews were then given grades familiar to anyone who has read professional society guidelines before: “Strong,” “Moderate,” or “Limited.” Qualitatively, such a methodology exceeds that of several organizations currently offering guidelines.
Another 45 percent of recommendations were based on existing systematic reviews, meta-analyses, or reports. Any identified systematic reviews or meta-analyses were subjected to scoring by the Assessment of Multiple Systematic Reviews (AMSTAR) tool, which grades reviews on a 0-11 scale. Only systematic reviews or meta-analyses scoring 8-11, indicating high quality, were considered for inclusion in the report.
The remaining one third of recommendations were based on “data analyses and food pattern modeling analyses.” All Federal data used to conduct new analyses were made available during the project through www.dietaryguidelines.gov during drafting, and since publication of the report, the data has been publicly available through the report’s indices and references. The source of this data was primarily the National Health and Nutrition Examination Survey (NHANES) and its dietary component, What We Eat in America. NHANES has its detractors; it and its components rely in part on 24-hour dietary recalls of subjects and is therefore subject to recall bias. But supporting organizations like the Academy of Nutrition and Dietetics have noted that past criticisms of NHANES were “...exaggerated, based on flawed methodologies, and awash in conflicts of interest.” Furthermore, NHANES data was augmented in this report with data from the National Health Interview Survey, the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) statistics, the 2014 report of the American Heart Association, and the USDA’s National Nutrient Database for Standard Reference, release 27, 2014.
For its core mission, that is the articulation of the evidence on the relationship between diet and health, the committee relied on USDA Food Patterns, as it has in the two prior (2005 and 2010) reports. Briefly, Food Patterns suggest amounts of food to consume from food groups, subgroups, and oils to meet specific nutrient intakes at different calorie levels to constitute a “nutritionally adequate diet” (model here). For example, the 2005 Guideline reported an analysis of, among other models, different fat levels as a percentage of total calories on nutritional adequacy. The current report includes seven modeling analyses testing questions ranging from how easily vitamin D can be consumed without the use of fortified food products, to the impact on food choices of eliminating saturated fat, to the impact of Mediterranean or vegetarian diets on food choices. From these analyses, the committee generated and modeled three new patterns: a “Healthy US-style” diet, a “Healthy Mediterranean-style” diet, and a “Healthy Vegetarian” diet.
If there is a criticism to be leveled at the committee methodology-wise, it is in its use of a few reports that did not employ a systematic methodology. In these cases the reports were “discussed by subcommittees and determined to be of high quality.” It is unclear from the report exactly what criteria were used to determine high-quality status, nor is it clear how many, if any, recommendations were based on such reports.
But the methodology of the report, when held to nearly any academic standard, is strong, as is its seeming commitment to recommending only conclusions that merit “moderate” or stronger ratings. I suspect the true flaw of the report in the eyes of Senators Roberts and Alexander is not its methodology but its conclusions, specifically that 1) a healthy dietary pattern is, among other things, lower in red and processed meat (DGAC grade: Strong for cardiovascular disease; Moderate for colon cancer), and 2) a diet higher in plant-based foods and lower in animal-based foods “...associated with less environmental impact than is the current U.S. diet” (DGAC grade: Moderate). If investigators and physicians are to remain independent arbiters of their own and others' work, such politically-motivated opinions, even if motivated by sincere concern for the economies of their constituents' states, should be ignored, or better, refuted.
Today’s seven slides or less: we keep finding new ways that secondhand smoke is bad for us.
To practice any art, no matter how well or badly, is a way to make your soul grow. So do it.
Kurt Vonnegut, A Man Without a Country (via thatkindofwoman)
That’s all.
#boneshaker Elrod's: 20 mi, 2 flats, 1 broken dérailleur, 1 sad face. But the @RitcheyLogic Swiss Cross survives
Aaaaaand this... It's about time.
Yep. #eatrealfood
Unaffiliated
This blog is not endorsed by, and has no relationship, with Aldi.* *But we think Aldi is awesome.
Given the history of stimulants in other weight-loss “supplements,” this comes as no surprise, I guess:
An amphetamine-like compound that has never been tested in humans is present in a range of popular diet pills and sports supplements, a study in a pharmacological journal has found.
Bold prediction: this finding will actually increase the demand for this plant/supplement/compound/fairy dust until the FDA acts.
“Our health care system simply cannot sustain the growing number of people developing diabetes.”
If you’ve ever stumbled across this blog before, you’re probably aware of my opinion of excessive meat intake. As with most dietary advice, moderation is key, as pointed out by @aaron3carroll:
If you’re eating multiple servings of red meat a day, then, yes, you might want to cut back. I would wager that most people reading this aren’t eating that much. If you eat a couple of servings a week, then you’re most likely doing fine.
#wind in Montezuma, KS.
Nice to see that supplement manufacturers haven't changed their marketing much in 100 years...