Albert Einstein mentioned in 1939: “All of science is nothing more than the refinement of everyday thinking.” "Physics and Reality" in the Journal of the Franklin Institute Vol. 221, Issue 3 (March 1936). It means we have to improve our way of thinking daily: reading, thinking, experiencing and experimenting, reevaluating our way of thinking, knowing our dark sides, etc. Science is related to our frames of thinking; Charles Darwin’s thoughts are according to the British Empire way of conceptualizing. We have our backgrounds with dark sides which are very difficult to see, but we have to see them in order to improve our personal science.
Covid 19 became the great equalizer. Two thousand people are predicted to die daily in the US a week from now. Science cannot be too political otherwise it promotes death; wear you mask all the time and you will be fine. It is simple, but politicians and doctors have difficulties with this statement. Science needs to be practical, ruthless, knowing that it is like pursuing a record in any sport, knowing that any record will be broken sooner or later. Einstein said it clearly when he mentioned: “We need to bring from the Olympus time and space and look at them differently to improve our science.” Einstein was taking a very different direction from the establishment when he said it in his book related to the Theory of Relativity.
Following a plan based on science has a great chance of achieving the goal even when it is not the best science; science approaches reality but it is not reality. Science improves when better approaches are taken. Better result if “the map approaches/looks like the territory.” Christian Blumenfeld is an example of following the plan strictly pursuing a goal even when it is not best plan.
We have been following what Christian is doing to improve since he was a teenager. We paid attention to his nutrition, and “biological markers” mentioned by his coach. He has followed the old school of thought regarding nutrition and it does work. He has taken this way of thinking to the last consequences following rigorously the plan. We can say that he drained everything from this reasoning, we cannot do any better going this way. I cannot imagine what he could do improving the train of thought regarding nutrition.
Marketing has done wonders for businesses, including elections in many countries. “Fake news” are not fake news if they are marketed well. Coca Cola and Marlboro dominate the market even when people know the products could be dangerous for our health. Trump in the US has many fans and AMLO in Mexico. Both of them have their own facts, “fake news.” Regardless of how obsolete and awkward they are; people will continue to vote for them in great numbers. The new kids on the block in Medicine are the SGLT2 inhibitors, sodium-glucose cotransporter 2 inhibitors. They are the most potent medications for preserving the function of the heart, kidneys and lives as the end point by decreasing glucose in people with diabetes and people without diabetes. They do it by blocking the reabsorption of glucose in the proximal tubules of the Kidneys as the main mechanism.
Is glucose a poison? It does appear that it is if we ingest too much of it. Too much could be 20% of our total calories for some people. Tim Noakes ripped many pages of his book, Lore of Running, after he learned it the hard way: He became diabetic. In the pages ripped, he talks about glucose, the main fuel for running and the need to consummate 70% of the total energy for runners. Noakes ripped the pages where Blumenfeld’s nutrition plan was sketched because he knew a much better way to tackle energy consumption for athletes and considered an anomaly to eat that quantity of calories from carbohydrates.
Should we use SGLT2 inhibitors for improving health and fitness? We know that a compound, beta hydroxybutyric acid, can produce the same effect in the kidney. It is not a doping substance, it is in our diet and we produce it in our body. This production happens when we decrease to 20% the caloric intake of carbohydrates compared to the total consumption of calories during the day. Dr. Stephen Phinney talks elegantly about the subject.
4)Facing
reality is inevitable, the sooner the better for someone.
5)Productivity
needs to be present at one point in our lives.
I had a taste of Cuba when working
at the University of Geneva (IUPG), where I met Cubans who were selling a
useful software called Neurotechnology.
I had the opportunity to test the software and I found it very useful. I met Guido Diaz and Mitchell Valdés. Guido was the worker behind the project.
Mitchell represented the government, stubborn, self-centered, fluently speaking
in English to the Swiss; he looked like Díaz-Canel speaking after the current
revolt. Mitchell was the one selling,
but he just had one product. He came to
Switzerland from Havana to sell the software.
He stayed to speak with Jean Michel Gaillard (my boss, already deceased)
two days and left.
Doctor in Medicine, PhD in Physiologic Sciences, Senior Researcher.
Member of the Cuban Society of Neurosciences, Member of the Cuban Society of
Physiology, Member of the International Organization for Psycho-Physiology,
Member of the Caribbean Organization for Brain Research, Member of the North
American Society of Cognitive Neurosciences. Working Specialty: Cognitive Neurosciences.
The Swiss wanted to buy the
software because it was at least three times cheaper than the others in the
market. They had four softwares to test
and to choose from. The Neurotechnology software
advantages were multiple: easy to use, Neurotechnology had a data base to
compare to normal Cuban subjects (but we had limited access to row data and the
Swiss believed the data was not statistically significant to compare with: very
few subjects), complicated measures were possible at one touch. The disadvantages were: limited maintenance because
just a very few Cubans were prepared to do so and they had to have freedom to
move around; limited access to use the data freely (we could not take pieces of
the EEG independently of the software) and we were in a research lab. We tested the software excessively because
the full data was not available to us.
I spent time with Guido and
learned more about Cuba. It was a few
years after the falling of the Soviet Union.
I used to invite the team to eat in the cafeteria, five of them. Guido said that they were a hundred people working
in the project but the five of them were doing the whole job. They did not accept
to come to my place for dinner. One time,
Guido called me from Cuba and ask me if I could send him a bunch of articles
because they did not have them in Cuba, they were close to 100. I asked the Secretary to send them by fax as
Guido said! I used to call Guido, but
the communication faded and I found out he left the island for Venezuela for
good in 1995. Good luck Guido if you
read me!
A few years later, I presented
in Havana a research done at the lab in Switzerland, using the Cuban software. I did not see Mitchell or Guido there. Guido told me that the research using
medications and measuring with the software developed by them was not possible
because they did not have medications to do it.
Balancing freedom and
equality is the key in any system.
Voicing corruption and other related problems is the beginning, but
solving the problem, is another thing.
In Latin America we are very good at voicing, but we come very short at
solving; Cuba, Venezuela and now Mexico are the examples. Our Federations in any sport have the same
problem in Mexico. Our triathlon
federation controls the athletes as the Cuban government controls the citizens,
we even have had an embargo on us, but we managed to have the only triathlon world
champion of Mexico. I leave you with
this beautiful analysis done by Claudia Hilb on Cuba:
A long time ago, when I went
to medical school, the concept of glucose production from ketones was
considered very small and very rare.It
was like a myth, because glucose level in blood was controlling hormones
related to metabolism minute to minute in normal people, and nobody wanted to
investigate ketones which were present in patients with diabetes. It was considered
irrelevant to study ketone bodies to win a Nobel prize.Severo Ochoa worked on glycolysis (breakdown
of glucose for fuel) and fermentation since 1936 and won the Nobel Prize in
1959 (https://en.wikipedia.org/wiki/Severo_Ochoa). The Krebs cycle was studied
from the point of view of glycolysis, I was told that glucose was needed in
order to burn fat. George Cahill lost the
political battle in science and his research on ketone bodies was not the one
to follow. Marketing carbohydrates
changed our lives and put us in this obesity crisis worldwide, as one of
Cahill’s students put it:
This story begins in the early 1960s when the
general level of knowledge about whole‐body
metabolism during human starvation was grossly deficient. This was partly
caused by a lack of accurate and specific methods for measuring hormones and
fuels in biological fluids, which became available about 1965.1 Rigidly
designed protocols for studying human volunteers or obese patients, who
underwent semi‐ or total
starvation for prolonged periods of time, were not widely employed, and much of
the published data regarding metabolic events during starvation were not
readily accessible. To complicate matters further, a great deal of the
available data was confusing because much of the supposition regarding
mechanisms used by the body to survive prolonged periods of starvation was
based upon information that was obtained from nonstandardized and often
erroneous procedures for studying metabolism… The pathway to knowledge on the nature
and regulation of human fuel metabolism has taken a long and circuitous route.
It is easy to understand how physician‐scientists
initially formulated erroneous concepts regarding the requirements of the brain
and other tissues for fuels such as glucose. Ironically, studies of diabetics
and patients with insulin‐induced
hypoglycemia complicated (rather than clarified) the understanding of the
normal metabolism of the brain. The treatment for diabetes became available
with the discovery of insulin at the University of Toronto in 1921–22. This
scientific breakthrough was one of the most dramatic events for the management
of any disease. By lowering the level of blood glucose, insulin's impact on a
diabetic patient was sensational and seemingly miraculous.2However,
initial research of brain metabolism was hindered by the widespread yet
erroneous hypothesis that developed as a consequence of treating diabetic
patients with insulin.3
Gluconeogenesis was
considered small because we were already eating great quantities of sugar
(glucose), and the need to produce our own glucose was not there according to
doctors. Ketones as fuel for the brain
was considered just in extreme cases. Over the years I learned the following:
16.3.5. The Generation of Free Glucose Is an Important Control Point
The fructose 6-phosphate
generated by fructose 1,6-bisphosphatase is readily converted into glucose
6-phosphate. In most tissues, gluconeogenesis ends here. Free glucose is not
generated; rather, the glucose 6-phosphate is processed in some other fashion,
notably to form glycogen. One advantage to ending gluconeogenesis at glucose
6-phosphate is that, unlike free glucose, the molecule cannot diffuse out of
the cell. To keep glucose inside the cell, the generation of free glucose is
controlled in two ways. First, the enzyme responsible for the conversion of
glucose 6-phosphate into glucose, glucose
6-phosphatase, is regulated. Second, the enzyme is present only in
tissues whose metabolic duty is to maintain blood-glucose homeostasis—tissues
that release glucose into the blood. These tissues are the liver and to a
lesser extent the kidney.
This final step in the
generation of glucose does not take place in the cytosol. Rather, glucose
6-phosphate is transported into the lumen of the endoplasmic reticulum, where
it is hydrolyzed to glucose by glucose 6-phosphatase, which is bound to the
membrane (Figure 16.29). An associated Ca2+-binding stabilizing protein is essential for
phosphatase activity. Glucose and Pi are then shuttled back to the cytosol by a
pair of transporters. The glucose transporter in the endoplasmic reticulum
membrane is like those found in the plasma membrane (Section
16.2.4). It is striking that five proteins are needed
to transform cytosolic glucose 6-phosphate into glucose.
But let’s continue with Dr.
Oliver Owen narrative:
Early insulin therapy was not perfect; insulin
saved the lives of experimental animals and subsequently humans, but
researchers initially had no way of knowing how much to administer or how to
best administer it. They recognized that in the absence of insulin the
concentration of blood glucose rose to high levels and death occurred. Also,
injecting too much insulin lowered the blood glucose to a point where a
“peculiar” behavior occurred; animals and humans began frothing at the mouth,
became unconscious, developed convulsions, and died. Eating carbohydrate‐rich foods (i.e. orange juice or candy) or receiving intravenous
glucose reversed these adverse effects. Glucose was clearly the key fuel
metabolized by the brain; the possibility that other fuels, such as ketone
bodies, were also metabolized by this organ was completely ignored. The
presence of ketone bodies in the blood and urine of insulin‐deficient diabetic patients was recognized in
the 1880s and was associated with severe disease states. In the 1920s, it
became evident that insulin lowered the content of glucose in the blood and
urine of diabetic humans, and it also removed ketone bodies. Nonetheless, the
idea that insulin controlled only glucose metabolism and that too little
glucose in the blood led to brain dysfunction led to the widely held concept
that glucose was the only fuel used by the brain. In the 1950–60s, researchers
learned that insulin lowered not only the concentration of glucose and ketone
bodies in the blood and urine but also a host of other fuels, including free
fatty acids and amino acids. Unfortunately, these isolated discoveries did not
correct the widely held misconception that ketone bodies were unhealthy and
that glucose was the only source of fuel for the brain.
¿Are we over the
persecution? Tim Noakes lost his job when he mentioned what it is here (2014),
and blamed the high carb diet marketed for the obesity epidemic.He even was accused in court, in a trial that
looked like the Greek trial of Socrates.No wonder Noam Chomsky says that our civilization is “involuding:”
The trial of Socrates (399 BC)[1] was
held to determine the philosopher’s guilt of two charges: asebeia (impiety)
against the pantheon of
Athens, and corruption of the youth of the city-state; the accusers cited two
impious acts by Socrates: "failing to acknowledge the gods that the city
acknowledges" and "introducing new deities".
I let you with this video
from GCN which is well done and illustrates what we should do.The induction time for the diet should be
longer, three weeks at least.
The creation of the Superleague is a sign of our times. Macca came with this solution because, as an athlete, he knew that the control of Federations and ITU was limiting the potential and fun of athletes. He did it for athletes and for himself as athlete and entrepreneur. Good for him! He is setting an example needed for humanity, creativity. He actually developed a different triathlon: ARENA TRIATHLON.
¿What is happening with Football? This is quite different. The solution is not for athletes or footballers in this case, it is for the clubs and owners. Clubs take as a leverage the corruption in the international organizations. We are familiar with the corruption in Concacaf, UEFA, FIFA, etc. This corruption of the ones in power is a problem that Noam Chomsky voiced since Vietnam War, but he falls short when talking about the corruption in the organizations like United Nations and WHO that came after their creation, perhaps because the movements to destroy such organizations is very strong and we need them; and more importantly, we need them to be useful. We got to know how corrupted the WHO is because of the coronavirus pandemic (please see the articles written about coronavirus in this blog). The WHO is full of “amigos” that has very little to do with science and advising people using science. The football clubs use the same pretext for forming the Superleague as Trump used to stay out of WHO: "Chinese officials ignored their reporting obligations to the World Health Organization and pressured the World Health Organization to mislead the world when the virus was first discovered by Chinese authorities," Trump said. "Countless lives have been taken and profound economic hardship has been inflicted all around the globe."
https://www.youtube.com/watch?v=OEdfJP9S4NE
The problem would come in triathlon if Arena Triathlon wants to be an Olympic sport.
We are familiar with these
terms from the COVID vaccines.In
triathlon it is quite similar.Training
heroes are not the winners in a competition; and vice versa, champions perform
much better in a competition.Let’s take
a look at the vaccines now that we have new information.Perhaps the post should be called: “Covid 19
effectiveness in Israel.”I was tempted
to put such a title, but I want to make a correlation with triathlon.
We have data from the Pfizer
clinical trials related to Covid 19 vaccine.
Bozena Riedel-Baima1,MD; Roman Zielinski2,PhD;
Kornelia Polok2,PhD
Table 3. Group III: cases between the first and second dose
BNT162b2
Placebo
Cases
39
82
Participants
21669
21686
AR
0.0018=0.18%
0.0038=0.38%
ARR
0.38%-0.18%
= 0.2%
NNT
100:
0.2=500
500 people
must be vaccinated in order to protect 1 person from developing
symptoms of COVID-19
More than 180,000 people
inoculated and PCR tested after first dose represented the cohort.6.6% (more than 12,000) became PCR positive
after the first dose, compared to 0.18% in the clinical trials.In simple terms, the clinical trials represent
the efficacy of the vaccine and the Israel experience the effectiveness.It does not say much about mortality which
apparently decreased in Israel after vaccination.What we have learned from the experience and
the questions that followed are below.
1)Measures
were not followed after the vaccination: distance between person to person, use
of masks and avoiding gatherings.
2)Measures
could be more effective than the vaccines to stop the propagation of the virus.Measures were in place before the vaccine and
when clinical trial were done.
3)Due to
the degree of people infected after the first dose, the mortality in number of
people per 100,000 citizens does not change much.
There are many hard working
people in the world but very few aspire to be champions.The problem of efficacy vs effectiveness is
there.Effectiveness has to do with the
mental preparation and the mental work we put into.The discipline to keep our way of thinking, believing
in what we have to believe in order to have an edge, i.e. Mohamed Ali would
believe that he was the greatest.When
somebody is born with privileges, he/she does not have to believe like Mohamed.The mental work is the most important job in
underserved environment to overcome it.Effectiveness is a mental work that starts with administrating our time
and efforts after looking carefully at the data available.
We have guidelines from last
year. Things have changed since then,
but the 2020 guidelines are below in this article. Why are we updating the guidelines? New research is available that helps to
understand even better how to protect ourselves. In particular, one from New Zealand, where
they studied the entire flight from Zurich, Switzerland to Auckland. They kept the passengers for 14 days after arriving. They tested the passengers in the flight when
arriving to Auckland. The flight last
about 18 hours, plenty time to be exposed to the coronavirus. Most of them where in proximity or they were
family members. They said they wore
masksexcept
for one. The science of aerosols tells
us that the closer we are to the source of infection, the greater the chances
of infection. It also tells us that
masks can be helpful if we are two meters away from the infected one in a moving
plane. Most likely, we can get
protection sitting even closer than two meters in a plane but we have to
consider the following:
a) The type of mask we wear.N95 can make the trick.
b) Time spent eating. Do not eat in the plane.
c) The interaction with the
one sat next to the one who brought the virus in the plane is
not mentioned in the study.Do not speak
if you do not need to.
We started learning since the
beginning of the pandemic about the virus, to face the situation. We
have learned the following:
1)The virus is
transmitted via aerosol in addition to saliva
drops. Why? We have the story about the chorus rehearsing
and apparently keeping the distance between two people. They said:
“No one sneezed or coughed.” One-day rehearsal, 60 people practicing,
45 sick, two deaths. https://edition.cnn.com/2020/04/01/us/washington-choir-practice-coronavirus-deaths/index.htmlThis is more
anecdotal, if you wish, but we have other sources of information.
We have the studies mentioned in the
New England Journal of Medicine:
Surgical
Masks Provide Source Control of Respiratory Viruses
Richard T. Ellison III, MD reviewing Leung
NHL et al. Nat Med 2020 Apr 2 Bae S et al. Ann Intern
Med 2020 Apr 6
Surgical face masks were
found to reduce presence of influenza and coronavirus RNA in respiratory
droplets and aerosols from infected individuals.
The CDC has just
recommended that the general U.S. population begin wearing cloth face coverings
to decrease the community-based transmission of the SARS-CoV-2 virus. Two new
studies provide some support for the CDC guidelines.
In the first,
researchers at a Hong Kong hospital obtained nasal and throat swabs and
respiratory droplet and aerosol samples from 246 individuals with presumed
symptomatic acute respiratory viral infection seen year-round between March
2013 and May 2016. During a 30-minute collection of exhaled breaths when
patients were breathing and coughing normally, 124 individuals were wearing a
face mask and 122 were not; 49 provided second 30-minute samples of the
alternate type.
By reverse transcriptase
polymerase chain reaction (RT-PCR) there were 54 individuals with rhinovirus
infection, 43 with influenza infection, and 17 with human seasonal coronavirus
infection. For all three viruses, the viral load was higher in nasal than in
oral secretions, and all three viruses were detectable in both respiratory
droplet (particles >5 μm) and aerosol (particles <5 μm) fractions of the
exhaled breath. Masks led to a notable reduction in the number of
RT-PCR–positive respiratory droplet and aerosol samples for patients with
either coronavirus (in respiratory droplets, from 30% to 0%; aerosols, 40% to
0%) or influenza infection (respiratory droplets, 26% to 4%; aerosols, 35% to
22%); there was no meaningful reduction seen with rhinovirus infections.
Influenza virus was able to be grown from 4 of 5 studied RT-PCR–positive
aerosol samples from individuals not wearing masks.
The second study, by Bae
and colleagues, recruited 4 patients with SARS-CoV-2 infection to cough five
times onto petri dishes containing viral transport media approximately 20 cm
from their face while wearing either no mask, a surgical face mask, or a
two-ply cotton mask. The median nasopharyngeal viral load was 5.66 log
copies/mL, and the cough samples found viral loads of 1.4 to 3.5 logs/mL
whether or not a mask was present for three of the four patients. Swabs of the
outer surfaces of both types of masks were positive for all four patients.
COMMENT
The work by Leung raises
the theoretical concern of viral transmission through aerosols as well as
respiratory droplets although, as the authors note, there was no attempt to
grow either coronavirus or rhinovirus from the RT-PCR respiratory samples to
confirm the presence of viable virus. Still, this novel study provides strong
evidence that the use of surgical masks can provide source control for both
human coronavirus and influenza virus infections when individuals are sitting
for 30 minutes. In contrast, the very small study by Bae shows that neither
surgical nor cotton face masks will prevent the spread of virus from a coughing
individual — at least at a distance of only 20 cm. While both studies have
clear limitations, together they suggest that the use of a surgical face mask
can provide some source control in individuals infected with coronavirus or
influenza, although the efficacy is likely diminished in coughing individuals
(and we can't extrapolate the findings to other types of masks). Still, in my
mind these limited data do support the broad use of face masks until this
pandemic is brought under control.
2)The German expert
who instituted the program in Germany challenged the notion that the virus is
primarily acquired touching infected material. The assumption was
that the coronavirus is transmitted via air and not so much by contact.
Researchers have so far come to
different conclusions on how long the virus can survive on surfaces. But now a
team of scientists in Germany are trying to find answers.
"So far, no transmission of the
virus in supermarkets, restaurants or hairdressers has been proven,"
explained Bonn virologist Hendrik Streeck on the ZDF Markus Lanz talk show.
Instead, the major outbreaks have
been the result of close get-togethers over a longer period of time, he said.
That's demonstrated in, for example,
outbreaks that have stemmed from après-ski parties in Ischgl, at football
matches in Bergamo or at carnival celebrations in the municipality of Gangelt
in the Heinsberg district of North Rhine-Westphalia.
3)The lakes, ocean
are not infected to the degree of being a source of infection. The
problem is that we still get aerosol from infected people because those places
are crowded most of the time. The infection is not in the water.
Coronaviruses (CoV) are a large family
of viruses that cause illness ranging from the common cold to more severe
diseases. According to WHO, while persistence in drinking-water is possible,
there is no current evidence that coronaviruses are present in surface or
groundwater sources or transmitted through contaminated drinking-water.
The spread of the virus is closely related to water and
sanitation.Cleaning hands can reduce the transmission and help people stay
healthy but today billions of people lack safe water, sanitation and
handwashing and funding is inadequate.
Based on the above:
1)Keep your distance,
two meters from other human being.
2)Wear a face mask
according to what you do. Driving a car with other triathletes, wear
a N95 mask; use a surgical mask when riding or running with other mates,
keeping most of the time the two meters of separation.
3)Swim in an empty
swimming pool, one member per lane or in a lake (keeping distance).
4)Wash your hand as
frequently as you can or use gel (alcohol above 60%).
5)Avoid public places
or wear your N95 if you need to be in a close room, even if you keep the two
meters distance (remember the chorus rehearsal).
6)Train with
responsible people that is concerned about his/her health and the health of
others. This is the moment to define your friends.
7)This should be in
place until we obtain the vaccine or we get 70% infected people. I
hope the vaccine comes first.
