Drs. Francisco Cervantes and Marivic Torregosa, and the 2013 Ancestral Health Symposium

Last year I traveled to South Korea to give presentations on nonlinear structural equation modeling and WarpPLS (). These are an advanced statistical analysis technique and related software tool, respectively, which have been used extensively in this blog to analyze health data, notably data related to the China Study.

I gave a couple of presentations at Korea University, which is in Seoul, and a keynote address at a conference in Gwangju, in the south part of the country. So I ended up seeing quite a lot of this beautiful country, and meeting many people. Some of my impressions regarding health and lifestyle issues need separate blog posts, which are forthcoming.

One issue that kept me thinking, as it did when I visited Japan a few years ago as well, was the obvious leanness of the South Koreans, compared with Americans, even though you don’t see a lot of emphasis on dieting there. Interestingly, this phenomenon also poses a challenge to many dietary schools of thought. For example, consumption of high-glycemic-index carbohydrates seems to be relatively high in South Korea.

The relative leanness of South Koreans is probably due to a combination of factors. A major one, it seems, is often forgotten. It is related to epigenetics. This term, “epigenetics”, is often assigned different meanings depending on the context in which it is used. Here it is used to refer to innate predispositions that don’t have a primarily genetic basis.

Epigenetic phenomena often give the impression that acquired characteristics can be inherited, and are frequently, and misguidedly, used as examples in support of a theory often associated with Jean-Baptiste Pierre Antoine de Monet, better known as Lamarck.

A classic example of epigenetics, in this context, is that of a mother with type II diabetes giving birth to a child that will develop type II diabetes at a young age. Typically type II diabetes develops in adults, but its incidence in children has been increasing lately, particularly in certain areas. And I think that this classic example is in part related to the general leanness of South Koreans and of people in other cultures where adoption of highly industrialized foods has been relatively slow.

In other words, I think that it is possible that a major protection in South Korea, as well as in Japan and other countries, is the cultural resistance, particularly among older generations, against adopting modern diets and lifestyles that deviate from their traditional ones.

This brings me to Drs. Francisco Cervantes and Marivic Torregosa (pictured below). Dr. Cervantes is the Chief Director of Laredo Pediatrics and Neonatology, a pediatrician who studied and practiced in a variety of places, including Mexico, New Jersey, and Texas. Dr. Torregosa is a colleague of mine, a college professor and nurse practitioner in Laredo, with a Ph.D. in nursing and a research interest in child obesity.



As it turns out, Laredo, a city in Southwestern Texas near the border with Mexico, seems like the opposite of South Korea in terms of health, and this may well be related to epigenetics. This presents an enormous opportunity for research, and for helping people who really need help.

In Laredo, as well as in other areas where insulin resistance and type II diabetes are rampant, there is a great deal of variation in health. There are very healthy folks in Laredo, and very sick ones. This great deal of variation is very useful in the identification of causative factors through advanced statistical analyses. Lack of variation tends to have the opposite effect, often “hiding” causative effects.

Drs. Cervantes, Torregosa, and I had a presentation accepted for the 2013 Ancestral Health Symposium (). It is titled “Gallbladder Disease in Children: Separating Myths from Facts”. It is entirely based on data collected and analyzed by Dr. Cervantes, who is very knowledgeable about statistics. Below is the abstract.

Cholesterol’s main role in the body is to serve as raw material for bile acids; the conversion of cholesterol to bile acids by the liver accounts for approximately 70 percent of the daily disposal of cholesterol. Bile acids are then stored in the gallbladder and secreted to aid in the digestion of dietary fat. It is often believed that high cholesterol levels cause gallbladder disease. In this presentation, we will discuss various aspects of gallbladder disease, with a focus on children. The presentation will be based on data from 2116 patients of the Laredo Pediatrics & Neonatology. The patients, 1041 boys and 1075 girls, are largely first generation American-born children of Hispanic descent; a group at very high risk of developing gallbladder disease. This presentation will dispel several myths, and lay out a case for a strong association between gallbladder disease and abnormally high body fat levels. Gallbladder disease appears to be largely preventable in children through diet and lifestyle modifications, some of which will be discussed during the presentation.

Many people seem to be unaware of the fact that cholesterol production and disposal are strongly associated with secretion of bile acids. Most of the body's cholesterol is used to produce bile acids, which are reabsorbed from the gut, in a cyclical process. This is the reason behind the use of "bile acid sequestrants" to reduce cholesterol levels.

The focus on gallbladder disease in the presentation comes from an interest by Dr. Cervantes, based on his many years of clinical experience, in using gallbladder disease markers to identify and prevent other conditions, including several conditions associated with what we refer to as diseases of affluence or civilization.

Dr. Cervantes is unique among clinical practitioners in that he spends a lot of time analyzing data from his patients. His knowledge of data analyses techniques rivals that of many professional researchers I know. And he does that at his own expense, something that most clinical practitioners are unwilling to do. Dr. Cervantes and I will be co-authoring blog posts here in the future.

Ancestral Health Symposium 2012: Evolutionarily sound diets and lifestyles may revolutionize health care

The Ancestral Health Symposium 2012 was very interesting on many levels. Aaron Blaisdell and the team of volunteers really did a superb job at organizing the Symposium. Boston is a great city with an excellent public transportation system, something that is always great for meetings, and a great choice for the Symposium. Needless to say, so was Harvard. Even though the program was packed there were plenty of opportunities to meet and talk with several people during the breaks.

We had our panel “New Technologies and New Opportunities”, which Paul Jaminet moderated. The panelists were Chris Keller, Chris Kresser, Dan Pardi, and myself. The first photo below, by Bobby Gill, shows Chris Keller speaking; I am on the far left looking at the screen. The second photo, by Beth Mazur, shows all the panelists. The third photo, also by Bobby Gill, shows a group of us talking to Stephan Guyenet after his presentation.

I talked a bit toward the end of the panel about the importance of taking nonlinearity into consideration in analyses of health data, but ended up being remembered later for saying that “men are women with a few design flaws”. I said that to highlight the strong protective effect of being female in terms of health, which was clear from the model I was discussing.

There is a good evolutionary reason for the protective effect of being female. Evolution is a population phenomenon. Genes do not evolve; neither do individuals. Populations evolve through the spread or disappearance of genotypes. A healthy population with 99 men and 1 woman will probably disappear quickly, and so will its gene pool. A healthy population with 99 women and 1 man will probably thrive, even with the drag of inbreeding depression. Under harsh environmental conditions, the rate of female-to-male births goes up, in some cases quite a lot.

I was able to talk to, or at least meet briefly face-to-face with, many of the people that I have interacted with online on this blog and other blogs. Just to name a few: Miki Ben-Dor, Aaron Blaisdell, Emily Deans, Andreas Eenfeldt, Glenn Ellmers, Benjamin Gebhard, Stephan Guyenet, Dallas Hartwig, Melissa Hartwig, Paul Jaminet, Chris Keller, Chris Kresser, Mathieu Lalonde, Robert Lustig, Chris Masterjohn, Beth Mazur, Denise Minger, Jimmy Moore, Katherine Morrison, Richard Nikoley, Dan Pardi, Kamal Patel, David Pendergrass, Mark Sisson, Mary Beth Smrtic, J. Stanton, Carlos Andres Toro, and Grayson Wheatley.

It would have been nice to have Peter (from Hyperlipid) there, as I think a lot of the attendants are fans. I attended Jamie Scott’s very interesting talk, but ended up not being able to chat with him. This is a pity because we share some common experiences – e.g., I lived in New Zealand for a few years. I did have the opportunity to talk at some length with J. Stanton, who is an inspiration. It was also great to exchange some ideas with my panelists, Miki Ben-Dor, Emily Deans, Stephan Guyenet, Chris Masterjohn, Kamal Patel, and David Pendergrass. I wish I had more time to talk with Denise Minger, who is clearly a very nice person in addition to being very smart. Talking about a smart person, it was also nice chatting a bit with Richard Nikoley; a successful entrepreneur who is in the enviable position of doing what he feels like doing.

I could not help but notice a tendency among some participants (perhaps many, judging from online threads) to pay a lot of attention to how other people looked in a very judgmental way. That person is too fat, his/her face is too red, she/he looks too old etc. So was this supposed to be the Ancestral Health Pageant 2012? There is nothing wrong with looking good. But many people adopt an evolution-inspired lifestyle because they are quite unhealthy to start with. And this includes some of the presenters. It takes time to change one’s health, relapses occur, and no one is getting younger. Moreover, some of the presenters’ ideas and advice may have much more dramatic positive effects on people other than themselves, because of their own pre-existing conditions. The ideas and advice are still solid.

A message that I think this Symposium conveyed particularly well was that an evolutionarily sound diet and lifestyle can truly revolutionize our health care system. Robb Wolf’s talk in particular, based on his recent experience in Nevada with law enforcement officers, made this point very effectively. The title of the talk is “How Markets and Evolution Can Revolutionize Medicine”. One very interesting idea he put forth was that establishments like gyms could expand the range of support activities they offer their customers, officially becoming the beginning of the health care chain. There are already health insurance plans that offer premium reductions for those who go to gyms. Being part of the health care chain would be different and a significant step forward - diet and exercise are powerful "drugs".

One thing that caught me a bit off-guard was Robb’s strong advocacy of the use of a drug, namely metformin (a.k.a. glucophage); even preventively in some special cases, such as with sleep-deprived law enforcement officers. I have to listen to that talk again when it is up online, to make sure that I understood it correctly. It seems to me that changing the nature of shift work among law enforcement officers, at least partially, may be a better target; current practices appear not only to impair the officers’ health but also their effectiveness in law enforcement activities. Besides, I think we need to better understand the nature and functions of cortisol, which is viewed by many as a hormone that exists only to do us harm.

Sleep deprivation is associated with an elevation in cortisol production. Elevated cortisol levels lead over time to visceral fat accumulation, which promotes systemic inflammation. Systemic inflammation is possibly the root cause of most diseases of civilization. But cortisol itself has powerful anti-inflammatory properties, and visceral fat is generally easy to mobilize through intense exercise – probably one of the key reasons why we have visceral fat. I think we need to understand this situation a bit better before thinking about preventive uses of metformin, which nevertheless is a drug that seems to do wonders in the treatment of type 2 diabetes.

Beth Mazur was kind enough to put up a post with links to various Ancestral Health Symposium 2012 summary posts, as well as pictures. Paul Jaminet has a post with an insightful discussion of our panel at the Symposium.