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Zooko Wilcox-O'Hearn
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Zooko Wilcox-O'Hearn's posts

Hey +Danno Ferrin. I sent you a twitter DM. Dunno if you read those, and dunno if you read these, either. This is what the world has come to! Maybe we should go back to snail mail…

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Seven experiments and two position papers about low-carb diet as the best known treatment for diabetes

[I just wrote the following comment in reply to https://srconstantin.wordpress.com/2015/12/14/contra-science-based-medicine/#comment-562. I'm cross-posting it here.]


No, low-carb diet as a treatment for diabetes does work in trials.

(Even though, in my opinion, the trials that have been done so far all have design flaws, some of which I think bias them in favor of the control group.)

Here's a good recent trial: it's an RCT, it was large (n=115), and long-running (52-wk):

* Tay-2015-“Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial”

  http://ajcn.nutrition.org.sci-hub.bz/content/early/2015/07/29/ajcn.115.112581

Patients in the low-carb arm had improved glycemic control, even while simultaneously reducing their medications, and had improved markers of cardiovascular health (which is consistent with other experiments in non-diabetics — see http://www.ketotic.org/2013/09/the-ketogenic-diet-reverses-indicators.html (self-citation)).

My caveat about this Tay-2015 study is that the diets (of both arms) were low-calorie diets. This confounds the results about carbs per se. Also it is unrealistic because patients, with very few exceptions, cannot go on a life-long semi-starvation diet, as has been demonstrated many times in both clinical observation and in RCTs. Unfortunately anecdote, folklore, and mainstream nutritional pseudo-science continue to tell us that prolonged semi-starvation is not only possible, and not only healthy, but even necessary! Which is why it often shows up in experiments like this.

A final objection to the low-calorie confounder is that it biases the experiment to make the control group look better, since the high-carb control arm also reduced their carb intake.

There are indicators of this confounding in the results — the low-carbers didn't lose body fat any better than the high-carbers did. (In fact, the high-carb arm lost more body fat and less muscle than the low-carb arm, non-statistically-significantly.) This is inconsistent with numerous other RCTs (in non-diabetics) where low-carb almost always does better at shedding excess body fat and at preserving or building lean mass.

I interpret this as meaning that both groups were rapidly losing both body fat and muscle due to the semi-starvation and due to being obese to start with. Such rapid weight loss under semi-starvation has a lot of consequences that could confound some of these results (and isn't healthy and shouldn't be recommended to patients).

But, let's not lose track of the main point here: evidence from well-controlled studies such as this one supports the hypothesis that low-carb is superior to the alternative for glycemic control and other clinically important effects in diabetics. I'm just quibbling about how much better I think the effects would be in my ideal experiment.

Here are more studies that are less reliable in various ways — smaller, shorter-running, and in some cases not full RCTs — but that are in my opinion worth reading if you're interested in this topic:

* Saslow-2014-“A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes”

  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091027

* Westman-2008-“The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus”

  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/

* Gannon-2004-“Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes”

  http://diabetes.diabetesjournals.org/content/53/9/2375.full.pdf+html

* Krebs-2016-“A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account”

  http://www.ncbi.nlm.nih.gov/pubmed/26965765

* Nielsen-2012-“Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit”

  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583262/pdf/1758-5996-4-23.pdf

  Read the first three paragraphs of the Discussion section!

* Maekawa-2014-“Retrospective study on the efficacy of a low-carbohydrate diet for impaired glucose tolerance”

  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063858

Finally:

A "position paper" by some of the leading lights of the heterodox position on this (these ones happen to be from New Zealand). The arguments are very strong!

* Schofield-2016-“Very low-carbohydrate diets in the management of diabetes revisited”

  http://profgrant.com/2016/04/01/very-low-carbohydrate-diets-in-the-management-of-diabetes-revisited/

A longer, more detailed position paper by the (mostly-American) leaders, also packed with compelling arguments:

* Feinman-2015-“Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base”

  http://www.sciencedirect.com/science/article/pii/S0899900714003323

(That's the Feinman that I mentioned in my earlier comment, as having contrasted the sociology of mainstream cancer researchers with that of mainstream diabetes researchers.)


P.S. See what you did in your comment, when you said "perhaps it doesn't work in trials?"? You were guessing at an explanation that would be consistent with the hypothesis that mainstream diabetes medical theory and practice is based on good science. I'm arguing that there isn't such an explanation. ;-)

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+Olof Johansson +Bill Richardson

I recently upgraded from Linux-4.1.17 to Linux-4.4.1 on my Chromebook Pixel 1, and the only thing that broke was that the suspend/resume bug (or something that acts a lot like it) is present in Linux-4.4.1 but not in Linux-4.1.17. I updated https://bugs.launchpad.net/ubuntu/+source/linux/+bug/1224689 and https://code.google.com/p/chromium/issues/detail?can=2&start=0&num=100&q=&colspec=ID%20Pri%20M%20Stars%20ReleaseBlock%20Cr%20Status%20Owner%20Summary%20OS%20Modified&groupby=&sort=&id=221905 . Hope this helps! I'd be happy to do any testing or diagnostics that would help, and of course I'd love to figure out how to run a recent Linux kernel and have working suspend/resume on my Chromebook Pixel 1, if you can help me do that.

Thank you both very much!

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Why capabilities? Short statement for SOSP History Day.

SOSP History Day http://www.ssrc.ucsc.edu/sosp15/workshops/HistoryDay/ was a superb event. It was all recorded and the recordings will be made public. Capabilities were repeatedly mentioned in the presentations much more often than I expected, and mostly positively.

I was on a panel at the end of the day whose topic was 
"Is Security a Hopeless Quest?"
Each panelist opened with a 5 minute statement. I tried to boil down the case for capabilities into the shortest clearest statement I could for an informed audience. Here is what I said. Feel free to forward. 


In the ‘70s, there were two main access control models:
the identity-centric model of access-control lists
and the authorization-centric model of capabilities.
For various reasons the world went down the identity-centric path,
resulting in the situation we are now in.
On the identity-centric path, why is security likely a hopeless quest?

When we build systems, we compose software written by different people.
These composed components may cooperate as we intend,
or they may destructively interfere.
We have gotten very good at avoiding accidental interference
by using abstraction mechanisms and designing good abstraction boundaries.
By composition, we have delivered astonishing functionality to the world.

Today, when we secure systems, we assign authority to identities.
When I run a program, it runs as me.
The square root function in my math library can delete my files.
Although it does not abuse this excess authority,
if it has a flaw enabling an attacker to subvert it,
then anything it may do, the attacker can do.
It is this excess authority that invites most of the attacks we see in the world today.

By contrast, when we secure systems with capabilities,
we work with the grain of how we organize software for functionality.
At every level of composition,
from programming language to operating systems to distributed services,
we design abstraction boundaries so that a component’s interface
only requires arguments that are somehow relevant to its task.
If such argument passing were the only source of authority,
we would have already taken a huge step towards least authority.
If most programs only ran with the least authority they need to do their jobs,
most abuses would be minor.

I do not imagine a world with fewer exploitable bugs.
I imagine a world in which much less is at risk to most bugs.

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One of the great visioneers. I learned a lot from him. Very sad to see him go.

FWIW, my review of one of his books:
http://reason.com/archives/1996/12/01/learning-curve
Despite my criticisms, I hope my respect for him shows through.

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I wrote this on Facebook, but I can never find things over there, so I'm copying it over here. Someone had mentioned the keto diet as a treatment for epilepsy, and that it was discovered in 1921.

-------

It is an interesting moment in history. You know what else was developed in 1921? Insulin — the first life-saving miracle drug, for the treatment of diabetes.

These two stories — the discovery of insulin for diabetes and the discovery of keto for epilepsy — are intimately related, because it seems like the scientist who published the keto diet as a treatment for epilepsy — R.M. Wilder — may have "borrowed" it without attribution from a diet that had been used for the treatment of diabetes.

This may have been one of those moments that changed history, because if Wilder had cited the earlier diets used to treat diabetics, then the keto diet used to treat epilepsy would have been recognized as a new use of a diet that had already been used for more than 100 years to treat diabetes, instead of being derived in 1921 from the practice of fasting. (For example, http://en.wikipedia.org/wiki/Ketogenic_diet#History describes keto diet as having been derived from fasting, in 1921.)

But if the true origins of the diet had been known, then perhaps it would not be seen as needing calorie-restriction, because perhaps the discoveries of Newburgh's experiments on a high-fat keto diet for diabetics would have informed the epileptologists. Then epileptic children would not have been subjected to harmful calorie-restriction for the next 100 years. I don't know for sure, but I wouldn't be surprised if epileptic children are still being subjected to harmful calories restriction to this very day, largely due to this unfortunate historical accident.

When did Newburgh publish those experiments on using a high-fat keto diet? Coincidentally, it was in 1921.

And of course as we now know one of the most profound and important effects that keto diet has is to regulate blood insulin levels. So it is an irony and a shame that the discovery of the first miracle drug — exogenous insulin — in 1921 eclipsed the scientific investigation into the miracle diet. :-)

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Reasons not to restrict calories or protein when doing a ketogenic diet as a treatment for cancer:

My brilliant ex-wife, +L. Amber Wilcox-O'Hearn, wrote the following in a thread (https://www.facebook.com/groups/105005229541718/permalink/849028105139423/) about using keto diet as a therapy against cancer:

"""
With all due respect, I think the idea of calorie restriction / protein restriction (CR/PR) in the context of a keto diet for cancer is mistaken, for 4 reasons.

1. The idea comes from rodent models. Rodents need caloric or protein restriction to get into deep enough ketosis to suppress tumours, but humans get into similarly deep ketosis without CR/PR.

2. The effects of CR/PR on humans are severe. They cause hunger and mood problems, hormonal problems. If you think you have to do CR/PR to do keto for cancer, you will probably give up, and that's a tragedy, because it's not established that humans need that for the therapy to be effective.

3. I know ad libitum can work. I have an acquaintance who was in advanced stages of astrocytoma, given up on by his doctors, and in a lot of pain. He tried an ad libtum zerocarb (i.e. carnivorous, meat-only, not just keto) diet, and all measurable evidence of his cancer receded.

4. This parallels what has happened in the medicalisation of keto for epilepsy. Many children were given so little protein that their very growth was affected. They suffered many side effects from the way keto was administered, and doctors had stern warnings that this was not to be done without supervision. These days it is recognised that a "modified Atkins" protocol (without CR or PR!) works about as well.

The medicalisation of keto is harmful in my opinion, and disempowers people.
"""

Check out this résumé and hire this person: https://www.lumiere.net/~mrdavid/resume/david415-resume.pdf … “software developer seeking to anonymize and encrypt all the things”

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I gave a five-minute talk about keto diet as a potential therapy for cancer. It went well! I was proud of it. Here it is: “Try This At Home! How I'm Using An Experimental Cancer Therapy On Myself Even Though I've Never Had Cancer” https://www.youtube.com/watch?v=YJ3C0mrZ3ZY

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http://zooko-and-amber.blogspot.com/2014/12/commemoration-of-our-union.html

the union of Amber and Zooko, 1999–2014

We met and fell in love in the year 1999, and were married the next year. Some of you reading this were present at that wedding, which was a joyous occasion.

We have had fifteen years of love together, and have brought three wonderful children into our families and community.

This year, we decided to separate. It is the most difficult and painful process either of us has ever undergone.

We hereby ask our friends and family to support us and our children in our new post-marriage lives. We will be closely cooperating in the parenting of our children. We will each continue to be friends and family to the other, and we each ask our friends and family to treat our ex- as a member of our family.

Although this change is accompanied by grief and sorrow, we feel optimism about our future, and ask not for condolences, but for compassion, encouragement, and for well-wishes for our new lives.

posted by Zooko Wilcox-O'Hearn and Amber Wilcox-O'Hearn, December 11, 2014
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