Stuff that occurs to me

All of my 'how to' posts are tagged here. The most popular posts are about blocking and private accounts on Twitter, also the science communication jobs list. None of the science or medical information I might post to this blog should be taken as medical advice (I'm not medically trained).

Think of this blog as a sort of nursery for my half-baked ideas hence 'stuff that occurs to me'.

Contact: @JoBrodie Email: jo DOT brodie AT gmail DOT com

Science in London: The 2018/19 scientific society talks in London blog post

Sunday, 26 June 2011

Some thoughts on the recent "Type 2 diabetes reversal" paper

"Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol"

Shortened URL for this post is

Let me first of all make it very clear that the following thoughts are mine alone - I do work for Diabetes UK but I'm not a spokesperson so in the unlikely event that anyone wants to attribute any of the following to someone, please make sure it's to me, Jo Brodie - thank you :)

I'm also going to dual-post this to my ScienceDiabetes blog.

Other important things to note are that (a) I'm not medically or dietetically trained and therefore in no fit state to give anyone medical, or dietary advice and (b) I'm writing this at home without full access to the full 'diabetesphere' that I can log in to from work. So I might come back to this.

I do not think anyone should try this drastic diet and certainly not without full medical support (don't forget these people were in a trial which meant that the researchers had to take a great deal of responsibility for their wellbeing). I also think it's rather too soon to be talking about 'cures' and that we've no idea what effect this diet will have on people who've had Type 2 diabetes for longer than four years, and who have complications.

What does reversal of Type 2 diabetes mean
Forgetting for a minute that this was a tiny study (11 people) I'm always a bit wary of the terms 'cure' or even 'reversal' as it's not really what I'm used to in discussions and readings about diabetes. I've heard endocrinologists refer to people having their diabetes "pushed back along the continuum / curve" if they've undergone bariatric surgery (eg stomach stapling) and it seems to be fairly well accepted that losing weight (often a combination of losing weight and increasing physical activity) can help delay progression to Type 2 diabetes in those at risk. And people making dramatic lifestyle changes / improvements do seem to be able to come off tablets (I suspect some people with Type 2 diabetes using insulin may also be able to come off that too).

But Type 2 diabetes is generally thought to be a progressive condition (however the authors of the latest study suggest that this mightn't be the case). Progressive in this means that the way in which Type 2 diabetes is treated tends to change over time, in a way that it doesn't really in Type 1 diabetes (people start on insulin and remain on it, whereas people with Type 2 might go through the stages from diet plus physical activity controlled to tablets plus diet plus physical activity controlled to insulin plus diet plus physical activity controlled. Note the constant through each of these (diet and physical activity!) - it's not quite diet > tablets > insulin.

When someone comes off medication I never think that they no longer have diabetes. I think they've jumped back a stage, perhaps even two - but I don't know if they're necessarily 'off the conveyor belt'. The progression of Type 2 diabetes involves a combination of insulin resistance (when the body is less able to respond to insulin produced - and in the earlier stages this can lead to hyperinsulinaemia because the pancreas secretes more insulin to compensate) and 'beta cell dysfunction' - basically the insulin-producing cells begin to struggle to produce enough insulin.

Type 2 diabetes takes a while to develop and during its development the person might have no symptoms whatever. It's estimated that, at diagnosis of Type 2, someone will already have had the condition for several years (~8-12, however with better awareness this is probably dropping). That's why doctors, and my employers, generally recommend a focus on risk factors in preference to symptoms as symptoms are notoriously unreliable anyway.

An important aspect of this could be that damage done to tissues and organs may, or may not (I don't know) be irreversible - even if glucose levels are brought back to normal later on. If someone has been hyperglycaemic (too much glucose in the blood) for some time, before diagnosis or a few or many years afterwards, then there's scope for damage.

Glycaemic memory / legacy effect and later complications
There is this idea of a "glycaemic memory" in which the body somehow retains an imprint of whatever the glucose status is now, later down the line.

This seems appears to work both ways (or I've misunderstood it!):

High blood glucose levels early on, and for a long time, can be 'remembered', so that even when glucose levels are normalised, complications can still arise several years later -

"... studies in type 1 diabetes (e.g. DCCT) and type 2 diabetes (e.g. UKPDS) have shown that a period of poor glycaemic control earlier in the course of the disease is associated with an increased burden of complications much later in the course of the disease, even when glycaemic control is latterly improved. The Veterans Affairs Diabetes Trial suggested that more than 12—15 years of poor control in older type 2 patients minimised the benefits of subsequently improved glycaemic control. The delayed adverse effects of hyperglycaemia emphasise the importance of effective early glycaemic control." Source: Bailey CJ and Day C (2008) Glycaemic memory British Journal of Diabetes & Vascular Disease 8 (5): 242-247. doi: 10.1177/1474651408098784

Or, a period of good control might have a protective effect down the line

"Furthermore, there appears to be a beneficial ‘legacy effect’ or ‘glycaemic memory effect’ following a period of intensive glucose control that has also been observed in other studies.(5)" Source: Younis N, Soran H and Hassanein M (2009) Cardiovascular disease and intensive glucose lowering in type 2 diabetes Quarterly Journal of Medicine 102 (4): 293-296. doi: 10.1093/qjmed/hcp001

It seems pretty clear to me that good blood glucose control is a good idea, but importantly it's not just glucose that needs to be considered, but blood pressure and blood fats (blood lipids) too.

If someone already has diabetic complications then it's not always a done deal that dramatic weight loss or improvements in glucose control is necessarily going to make that much difference to those complications (it depends on the complications though).

There are exceptions of course - sensory neuropathy can resolve over time by itself anyway, I think it can also be improved with better glucose levels too. Some eye damage can actually get temporarily worse with improving glucose levels although I think there can be some improvements there too. Not sure about kidney or cardiovascular damage though (yeah I should probably find out!). What I want to emphasise is that 'resolution' of diabetes doesn't automatically mean resolution of all accompanying complications. A point put forward much more pithily by @EvidenceMatters

For me, a cure would have to mean resolution of all threats, glycaemic (blood glucose), lipidaemic (blood lipids), hypertensive (blood pressure) and any complications. I don't think we know yet what the long-term effects or benefits are of the various gastric surgeries that resolve cases of Type 2 diabetes. It should be noted that these procedures are not risk free and one effect is poorer absorption of some nutrients (obviously this can lead to weight loss).

Drastic diets
There are potentially very serious risks to health from following a drastic diet without medical supervision or support. I have read a couple of anecdotal horror stories of young women going on extreme diets and dying from heart failure - bit grim (hat tip @landtimforgot). But in general, the body just needs energy to function. I didn't spot any mention in the paper suggesting the participants had an electrocardiogram / EKG / ECG.

The 11 people on this trial were not just sent off with diet packs but given access to telephone support and regularly monitored every four weeks (in weeks 1, 4, 8 and then 12 but they stopped the diet after 8 weeks). It's also worth pointing out that three trial participants dropped out because they didn't stick with the diet in the first month and 1 dropped out for other reasons (so 3 / 15 = 20% drop out). The diet was about 46% carbohydrate but this shouldn't be taken to mean that it was medium-high carbs because the overall amount of all nutrients taken in was so low.

A diet of 600 calories a day is tough going and not really something anyone should attempt without proper support from someone like a dietitian who knows what they're talking about (this usually excludes anyone calling themselves a 'nutritionist' as anyone can call themselves that). I'd suspect that such a low calorie diet would be 'prescribed' by a doctor first as it's pretty extreme. Most of the reports I've seen have stressed this which is good.

Enough people have tried to tell me, while hoping to get me to promote their miracle cure, that being off medication means they're cured of Type 2 diabetes but that's an oversimplification I think. Additionally, 'coming off medication' doesn't mean that that was actually the appropriate thing to do!

Having said that I've seen a couple of commenters on news sites raising the issue about relative risks - devastating complications from diabetes are rather serious too... I don't have a snappy answer I'm afraid.

Insulin physiology
The paper talks about the dual problems in Type 2 diabetes of beta cell failure and insulin resistance (it also distinguishes between hepatic (liver) insulin resistance and peripheral (I assume this refers to skeletal muscle) insulin resistance.

The liver produces its own glucose and can do so in two ways: gluconeogenesis (or de novo synthesis) which means creating from scratch from precursor molecules, and glycogenolysis which means freeing glucose previously stored as glycogen.

If the body gets the message that there's not enough glucose it takes steps to get some released from the liver. Unfortunately, in diabetes the bloodstream may be swimming with glucose but the cells aren't getting it and so they're 'reporting' a lack of glucose and the liver is chucking more into the bloodstream. This has been described as "starving in the land of plenty" as the cells go hungry but there's plenty of glucose available, but inaccessible without insulin (Type 1) or the ability to respond appropriately and to dwindling supplies of insulin (Type 2).

Insulin, when all is working well, suppresses this hepatic production of glucose. When all isn't working well, it doesn't.

Fasting glucose levels (ie, not after a meal) tell you what's going on in the liver in terms of it just getting on and chucking out some glucose into the bloodstream. It does this because it's failing to respond to the insulin signal which should be telling the liver to suppress its glucose production. But after following this diet for just a week, fasting glucose levels plummeted, as did hepatic glucose production.

Observations on the people studied in the paper
There were eleven people studied, two women, and they all had been diagnosed with Type 2 diabetes for less than four years. I thought it was interesting that no-one appeared to have an HbA1c of more than 7.7%. This is a reasonably high HbA1c (I think normal values are lower than 6% and people with diabetes are generally recommended to keep it lower than 6.5 per cent) but some poeple with diabetes will have really much higher HbA1c values than this.

They lost a lot of weight, very quickly - an average of 3.9kg in the first week (of which 61% was fat loss) and 5.7kg from weeks 1-4 (I assume they mean a total of 5.7kg over the four weeks and not 5.7kg each week which would be a bit alarming) of which 86% was fat. In the final stretch they los another 5.7kg over the last month (assumed) of which 94% was fat. Gosh. They shifted a rather large 15% of their bodyweight, an amount which is generally achievable (for most people) but over a much longer time.

But the rapidity with which the weight was lost is suggested to be behind the disappeareance of triacylglycerol (TAG or triglycerides) from the liver and pancreas. Triacylglycerol consists of a glycerol molecule (the 'backbone') to which is bonded, by an ester linkage, three fatty acids of varying length. Un-attached fatty acids (called free fatty acids FFAs, also known as non-esterified fatty acids NEFAs) can interfere with an organs ability to do its job and apparently impede the normal production of insulin from the pancreas.

I'll probably come back to this as I've written a few notes from my first reading of the paper, but I expect it will bear further reading and digestion.

Please let me know if you spot any mistakes or omissions, thank you.
Please don't go cutting your diet dramatically without speaking with your doctor.

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC and Taylor R (2011) Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol Diabetologia

[Published online 9 June 2011] doi: 10.1007/s00125-011-2204-7 (html) (PDF)

This was funded by Diabetes UK who also happen to employ me, but my blog post and thoughts are my own :)

Further reading

My entries for the Astronomy Photographer of the Year 2011 competition ;-)

Shortened link for this post is:

Edit 11 May 2012 - there will be a real transit of Venus on 5/6 June although people in UK will only be able to see it very very early on the morning of 6 June (it starts at ~23h on the 5th which is no use at all!). More details here

I don't exactly expect to win the competition (here are the rules) - maybe I'll get an honourable mention for entering into the spirit of things - but my entries might at least be unique in that they involve an orange sweet and a white pixel.

Faux-lar transit
First, the orange sweet - my local newsagents used to sell these yummy fruit-flavoured sour chewy discs (apparently made by Chewits and no longer available). I had a couple in a bag and held an orange one up to the light noticing how nicely it glowed. I also noticed that it bore a fairly strong resemblance to the pictures I'd seen of the Sun when viewed through some sort of Extreme UV filter, as used on Solar and Heliospheric Observatory, or SOHO (gorgeous UV-blue shot on the Wikipedia page and see this orange-yellow picture also from SOHO of a solar prominence). My thumb also bore a reasonable resemblance to the curve of a planet doing a solar transit, so I tweeted:
Recreating a solar transit as seen via Extreme UV Imaging, with an orange sweet, my thumb, and an actual sun ;-)
via TweetDeck
Fake solar transit :)

White pixel - the International Space Station or ISS
The iPhone 3GS is not famed for its camera prowess but nevertheless I was delighted to capture this shaky video of the ISS passing overhead... which I shared, along with the following tweet: - The white pixel doing all the work here against a black background is in fact the ISS whooshing overhead.

Sharing sightings of the ISS with other people has been one of the delights of the modern age - I've shown it to my dad, visitors and guests, family and friends and strangers. I've also joined in online via the #ISS or #ISSwave hashtags which has been a lovely shared experience with hundreds of people around the world. Attached to those hashtag people have shared their images of the ISS - and let's face it, some of them are really quite a bit better than mine (how eerie and wonderful is this shot, from an Earth telescope?).

Can't help but be a bit ":-o" though at the thought that my small hand-held device can look up into the sky and see a small white dot flying about 200 miles overhead and capture it. Also, the technology that allows me to instantly share this on Twitter is pretty :-o too.

I'm yet to find the website which will tell me nothing more than a) how fast the ISS is travelling b) how far away it is and c) how many people are on it (with this information being updated no more regularly than required) - I accept that information on when it can be seen depends more on my location and the ISS's path, but all the other three things are a bit less variable. I've found myself in Greenwich Park going 'ooh' of an evening and pointing up at the ISS and telling passersby what it is. Lots of people have no idea that there's a spaceship, with people on, in low earth orbit whizzing overhead several times a day.

Note on old tweets
You might be wondering how I got hold of these old tweets. The orange sweet one is from June 2010 and the ISS from March 2010. I found the first by using Google Realtime which allows you to access tweets from May 2010 onwards, and the second one I was able to access because I've always imported my tweets into FriendFeed for archiving purposes and sometimes the search plays ball. I knew the text to search for because it shows up on the TwitVid video.

I am a bit obsessed with people being able to access old tweets and have written fairly extensively on it, see A list of tools for finding or capturing tweets and How to find old tweets. Do let me know if you've found a good tool or strategy, thank you :)

Tuesday, 21 June 2011

Testing a fake article generator from Article Max

This is a fake article created solely to highlight the way in which spun articles are used to flog useless products. This blog post does not endorse anything in the text below - do not spend any money on any of these products, thank you :)

For more information on what this is about, please see my earlier post



Saturday, 18 June 2011

Seeding articles of woo with sensible information - an experiment

Shortened link for this post:

Well I haven't tried it yet so this might not work.

A while back I took a photo outside Holland & Barrett in Blackheath. It was flogging something called Cho Yung weight loss tea and since I'd never heard of a tea being of any serious use in weight loss (unless you give the dunked biscuits a swerve) I thought I'd investigate it for an Advertising Standards Authority investigation. I uploaded the photos to Flickr (almost all of mine are Creative Commons) and then forgot about it.

Occasionally I 'vanity google' for my Flickr username (Jodiepedia) and enjoy seeing the ways in which some of my photos are used, admittedly it's mostly a handful that are used and the most popular one is a photo of my mini food processor which has appeared in half a dozen blog posts but it's nice to see them used anyway.

Recently I discovered that my photo of Cho Yung weight loss tea was appearing on several websites that flog / affiliate market this product. More amusingly they'd taken not only the photo but the description, which at the time said "yet to find any evidence for this product" so this phrase appears on numerous pages trying to sell the tea. Tee hee.

It's probably too late to do much about the tea, although I've now retrospectively tweaked it so that the title is more critical and added further context and shall monitor the situation, but I wondered if I could seed the pages that try and flog weight loss patches with a picture that clearly states they don't work.

First, a word about these pages.

They're 'spun' articles. I have been learning quite a lot about article spinning from the More Niche affiliate marketing website which has been one of the more eye-opening websites I've ever come across. It's basically how to fleece the unwary using a combination of search engine optimisation (both 'white hat' and the dodgier, short-term (cos they get banned) 'black hat' methods) and creating websites that route customers to a selling page. The pages that route more customers get more cash. Spun pages are basically repurposed text - self-plagiarism really, or plagiarism of other sites with word swapping, there are even websites that maintain a massive thesaurus database and will automate the process of word swapping to turn one article into another. If you've ever come across a page which contains your search terms randomly embedded into something that doesn't appear to have English as its first language then it might well be a spun page, presumably using other keywords as some sort of smokescreen. It's a bit odd.

I've written previously about More Niche here, see the section below the dashed line in particular.

Given that a degree of cunning and sneakery is needed to be successful at this I don't think my ruse will fool that many of them but I will be delighted if one or two pages pick it up because it will make me chuckle.

So... I've created this image, in Powerpoint, and uploaded it with a relevant description. One can but hope.

Weight loss patches do not actually work

Update 23 June 2011
I posted this on 18 June and have been watching Google to see if and when the patch might make an appearance somewhere. It's only five days since I created the image above so I'd expect this to increase as time goes on.

I searched for things like Jodiepedia patch or Jodiepedia patches and even Jodiepedia weight loss - to ensure that I only picked up web pages that were likely to include this patch, rather than the Cho Yung weight loss tea woo that I posted on Flickr earlier, I used the Advanced Search function on Google to select only items posted within the last week.

Here's what I found:
  • The image above was posted on Flickr on 18 June (along with this blog post) and I added the title "Weight loss patches do not actually work" and phrase "Do not buy this product, it's a waste of money. It's quite hard to get drugs across the skin barrier, especially large complex molecules from plants." to the Flickr image for good measure.
  • It was picked up by a site that collects royalty free images on 19 June (current) (cache)
  • Also on the 19th it was picked up by 'RandomlyChad' blog whose author used it to poke fun at the secret of his weight loss (ie sensible diet and effort, not crap weight loss patches).
  • On 21 June 2011 the phrase that I used appeared as a tagline on what I think is a spun article, called "Weight loss patches do not actually work – Articles And Resources", however the image of the patch is absent. The phrase is also parsed into keywords and used in the comments, along with 'Jodiepedia - there is a tiny piece of embed code available from this page and I used it to create this post here.
  • I'm really not sure what to make of this article "Support Is Mutual for Senator and Makers of Supplements", also posted on 21 June 2011. It doesn't appear to be selling anything directly from that page although there's a tab for a diet store and options to download things (I've seen much 'sell-ier' pages). To me, the interesting bit is that it's tweaked the text I used with my picture so that it now reads "Do not get this product, it really is a waste of income. It is quite hard to get medicines across the skin barrier, especially huge advanced molecules from crops." - this transformation may have been software-automated, but is only slightly changed from the text I originally used (see italics above).
  • Using the same "...huge advanced molecules" phrase, which suggests one might be the source text for the other, this website uses my title as its own title "Weight loss patches do not actually work" also changes the title of my image to "Bodyweight loss patches do not truly function".

    I don't think this website fully understands what it's doing as it's picked up another image from a US Federal publication highlighting bogus weight loss claims but it does label these as "Some awesome excess weight loss item photographs" which is obviously very pleasing...
  • "Weight loss - 7 tips for better results" seems to use the picture to highlight that there are better ways to lose weight.
Conclusion: nothing major yet - the image hasn't appeared directly on any selling sites but hopefully it will and I'll be monitoring the situation.

Update 2 July 2011
Well, I don't think this has been my most successful project, but I have 'reflected' on the strategy, and created a new image.

This new image uses a tweaked strategy, it plays nice in the picture itself but is critical of weight loss / diet patches in the title, description and comments (with bonus snark). I've noticed, in general, that sometimes websites pinch the Flickr comments and add them to their page on which the Creative Commons image appears. I'm pretty sure comments aren't CC in the same way that images are.

While re-running the Jodiepedia searches I also happened to come across this page. It uses an image I took at Chelsea Physic Garden of a sign about plants used in herbal and homeopathy preparations. I mentioned in the description that several NHS trusts had come to their senses and ceased funding for homeopathy, and I was mildly critical of homeopathy in the comment. But both picture and comment show up here and this is the original.

Friday, 3 June 2011

14 sleeps until Homeopathy Awareness Week UK on sleeplessness

From 14 to 21 June the Society of Homeopaths (and presumably other homeopaths and homeopathic societies) will be promoting UK Homeopathy Awareness Week 2011. Not that long ago the world had World Homeopathy Awareness Week, or 'WHAW', and I like to imagine that people became a tiny bit more aware of this silliness.

The topic of 'HAW 2011' is sleeplessness and the promotion of the idea that homeopathy can help with this. I think SOH have scored a bit of an own goal though because the 'research evidence' they've posted on their website does not seem to include this, published by the Homeopathy Research Institute (hat tip @lecanardnoir) which says:
"Homeopaths often treat insomnia, however, there is currently a lack of high-quality sufficiently powered studies assessing the effectiveness of either homeopathic medicines or treatment by a homeopath for this condition. There is a need for further well-conducted clinical trials of treatment by a homeopath in order to examine fully the clinical and cost effectiveness of the therapeutic system of homeopathy in the management of insomnia. This evidence will enable patients, clinicians and healthcare commissioners/insurers to make informed decisions regarding the homeopathic treatment of insomnia."
They're also pushing a new website directory, called 'Let people choose', which will contain searchable details of local homeopaths (hopefully everyone participating in this has checked their content against the ASA's advice for what claims can be made on their website, otherwise this might just serve to flag up homeopaths making misleading claims). This directory seems like a good strategy when you don't have any good evidence.

I read an interesting blog post yesterday which highlighted that "homeopathy is a talking therapy reinforced by placebo" which I thought was a nice way of putting it. Given that the pills are a bit of an unnecessary crutch I'm suggesting that homeopaths 'ditch the stabilisers' and carry on with being nice and supportive to their patients - the pills are just a red herring really.