Dear Mr Pickles

Well, sir.  You've stirred it up again this time!   Like Father Christmas bringing the promise of happiness to the masses, dropping down our chimneys weekly to empty our overflowing rubbish bins!

Nice one!

Oh stuff any chance of this being an erudite post.  I haven't got time for that. Instead I'll just say it as it is.

The weekly rubbish collection bribe that your department has announced amounts to nothing but backtracking on any other forms of common sense that has come out of this year's Waste Review, especially with regard to encouraging greater recycling rates.

Today's media talks about treating the public with respect.  How about treating us with intelligence as well as  respect and not just a herd of sheep who will welcome your proposals with a happy bleat.

Our country would not have a problem with overflowing rubbish bins if manufacturers designed out unecessary packaging\product waste and the government invested in proper nationwide recycling infrastructure of mixed plastics.  Really, I cannot believe that we are in 2011 and the majority of the UK can't recycle a bloody yoghurt pot! 

Voters complain about smelly food waste hanging around for a fortnight.  I empathise.  So did I a few years ago and to honest, it's not nice!  But I did something about it.  I followed the advice of www.lovefoodhatewaste.com and even though I'm still not the picture of perfection, most weeks are better than others.  Yes I've had a blimmin' good stab at not creating the waste in the first place and saved a small fortune, thanks to listening to some common sense.

Of course my best advice for your Chicken Tikka Masala test, is instead of letting it become fodder for flies stinking out your bin, cut down your order at your local Indian or invite some friends around and get them to share it.

It's hardly rocket science.

But recycling is...needing well designed  innovations and scaleable solutions that can serve communities and support our economy.

That's where our money should be going Mr Pickles, to actually help provide solutions that wouldn't create the problem of overflowing or stinky bins.  Separate out that food waste and if the councils don't have the infrastructure to collect the caddies weekly, invest in community projects that can, by creating new jobs and feeding the revenues back into the communities themselves. 

There are even solutions in the UK for now recycling nappies and other absorbant waste products, that you could throw some of your money towards or better funded campaigns to support washables.

What's that old saying?  Rubbish In Rubbish Out! Well that's what this country's going to keep getting unless policy and investment change in line with the sustainable future this country and the global society needs.

Today's statement was far too broadbrush. Yes there will be councils that will value the funds, and this money should be used to support and develop the infrastructure in those areas that it's needed, even if it's in certain enclaves of a local authority's collection area, but please don't consider it as a single opportunity for all.  Not all of us want to go back to the dark ages.

Personally, I think this is a lot of fuss about nothing and if one good thing's come of it, there will be much chatter about rubbish as people debate the other solutions that are out there.

Yours sincerely,

Almost Mrs Average!

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As it's a Friday, I thought I'd dedicate this post to Kat's "Dear So and So" feature at Three Bedroom Bungalow.

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Calling self-experimentation N=1 is incorrect and misleading

This is not a post about semantics. Using “N=1” to refer to self-experimentation is okay, as long as one understands that self-experimentation is one of the most powerful ways to improve one’s health. Typically the term “N=1” is used in a demeaning way, as in: “It is just my N=1 experience, so it’s not worth much, but …” This is the reason behind this post. Using the “N=1” term to refer to self-experimentation in this way is both incorrect and misleading.

Calling self-experimentation N=1 is incorrect

The table below shows a dataset that is discussed in this YouTube video on HealthCorrelator for Excel (HCE). It refers to one single individual. Nearly all health-related datasets will look somewhat like this, with columns referring to health variables and rows referring to multiple measurements for the health variables. (This actually applies to datasets in general, including datasets about non-health-related phenomena.)

Often each individual measurement, or row, will be associated with a particular point in time, such as a date. This will characterize the measurement approach used as longitudinal, as opposed to cross-sectional. One example of the latter would be a dataset where each row referred to a different individual, with the data on all rows collected at the same point in time. Longitudinal health-related measurement is frequently considered superior to cross-sectional measurement in terms of the insights that it can provide.

As you can see, the dataset has 10 rows, with the top row containing the names of the variables. So this dataset contains nine rows of data, which means that in this dataset “N=9”, even though the data is for one single individual. To call this an “N=1” experiment is incorrect.

As a side note, an empty cell, like that on the top row for HDL cholesterol, essentially means that a measurement for that variable was not taken on that date, or that it was left out because of obvious measurement error (e.g., the value received from the lab was “-10”, which would be a mistake since nobody has a negative HDL cholesterol level). The N of the dataset as a whole would still be technically 9 in a situation like this, with only one missing cell on the row in question. But the software would typically calculate associations for that variable (HDL cholesterol) based on a sample of 8.

Calling self-experimentation N=1 is misleading

Calling self-experimentation “N=1”, meaning that the results of self-experimentation are not a good basis for generalization, is very misleading. But there is a twist. Those results may indeed not be a good basis for generalization to other people, but they provide a particularly good basis for generalization for you. It is often much safer to generalize based on self-experimentation, even with small samples (e.g., N=9).

The reason, as I pointed out in this interview with Jimmy Moore, is that data about oneself only tends to be much more uniform than data about a sample of individuals. When multiple individuals are included in an analysis, the number of sources of error (e.g., confounding variables, measurement problems) is much higher than when the analysis is based on one single individual. Thus analyses based on data from one single individual yield results that are more uniform and stable across the sample.

Moreover, analyses of data about a sample of individuals are typically summarized through averages, and those averages tend to be biased by outliers. There are always outliers in any dataset; you might possibly be one of them if you were part of a dataset, which would render the average results at best misleading, and at worst meaningless, to you. This is a point that has also been made by Richard Nikoley, who has been discussing self-experimentation for quite some time, in this very interesting video.

Another person who has been talking about self-experimentation, and showing how it can be useful in personal health management, is Seth Roberts. He and the idea of self-experimentation were prominently portrayed in this article on the New York Times. Check this video where Dr. Roberts talks about how he found out through self-experimentation that, among other things, consuming butter reduced his arterial plaque deposits. Plaque reduction is something that only rarely happens, at least in folks who follow the traditional American diet.

HCE generates coefficients of association and graphs at the click of a button, making it relatively easy for anybody to understand how his or her health variables are associated with one another, and thus what modifiable health factors (e.g., consumption of certain foods) could be causing health effects (e.g., body fact accumulation). It may also help you identify other, more counter-intuitive, links; such as between certain thought and behavior patterns (e.g., wealth accumulation thoughts, looking at the mirror multiple times a day) and undesirable mental states (e.g., depression, panic attacks).

Just keep in mind that you need to have at least some variation in all the variables involved. Without variation there is no correlation, and thus causation may remain hidden from view.

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Measure your recycling with the new Recyclometer

Measuring the impact of recycling is always a challenge, especially when trying to communicate the wider benefits of what is, let's face it, a pretty mundane household task.

However, during the summer, along with other bloggers, I was brought in to help road-test Coca-Cola's Recyclometer, a brand new stats-crunching tool, which has been developed in association with WRAP.   After a few tweaks, the Recyclometer has now been officially launched, on the company's website and at Recycle Now. providing consumers with a means of calculating the wider impact of their recycling activity, by simply translating the action into energy saving data.

Saving energy and fuel resources are one of the key beneficial outcomes of recycling and the Recyclometer tool demonstrates the savings across a wide range of materials that you'd find on your cupboard shelves.

For example, simply totting up the contents of my recycling actions today reveals that I've saved enough energy to power a lightbulb for 12 hours.   Widen the impact of this nationally and the figures highlight that enough energy would be saved to power over 84,000 lightbulbs for a whole year.   That's quite an incredible figure from just a few juice bottles, a can, our local newspaper, a breakfast cereal box and a loo roll tube.  It also demonstrates how wasteful it would be if I just bunged these into landfill.

To work out your own stats, just click on the image above.  Alternatively visit  the company's own website, where there are also links to the organisation's waste-reduction actions, including lightweighting innovations, implementation of recycled materials and, more recently, their usage of plant-based fibres in plastic packaging.

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Being glucose intolerant may make you live only to be 96, if you would otherwise live to be 100

This comes also from the widely cited Brunner and colleagues study, published in Diabetes Care in 2006. They defined a person as glucose intolerant if he or she had a blood glucose level of 5.3-11 mmol/l after a 2-h post–50-g oral glucose tolerance test. For those using the other measurement system, like us here in the USA, that is a blood glucose level of approximately 95-198 mg/dl.

Quite a range, eh!? This covers the high end of normoglycemia, as well as pre- to full-blown type 2 diabetes.

In this investigation, called the Whitehall Study, 18,403 nonindustrial London-based male civil servants aged 40 to 64 years were examined between September 1967 and January 1970. These folks were then followed for over 30 years, based on the National Health Service Central Registry; essentially to find out whether they had died, and of what. During this period, there were 11,426 deaths from all causes; with 5,497 due to cardiovascular disease (48.1%) and 3,240 due to cancer (28.4%).

The graph below shows the age-adjusted survival rates against time after diagnosis. Presumably the N values refer to the individuals in the glucose intolerant (GI) and type 2 diabetic (T2DM) groups that were alive at the end of the monitoring period. This does not apply to the normoglycemic N value; this value seems to refer to the number of normoglycemic folks alive after the divergence point (5-10 years from diagnosis).

Note by the authors: “Survival by baseline glucose tolerance status diverged after 5-10 years of follow-up. Median survival differed by 4 years between the normoglycemic and glucose intolerant groups and was 10 years less in the diabetic compared with the glucose intolerant group.”

That is, it took between 5 and 10 years of high blood glucose levels for any effect on mortality to be noticed. One would expect at least some of the diagnosed folks to have done something about their blood glucose levels; a confounder that was not properly controlled for in this study, as far as I can tell. The glucose intolerant folks ended up living 4 years less than the normoglycemics, and 10 years more than the diabetics.

One implication of this article is that perhaps you should not worry too much if you experience a temporary increase in blood glucose levels due to compensatory adaptation to healthy changes in diet and lifestyle, such as elevated growth hormone levels. It seems unlikely that such temporary increase in blood glucose levels, even if lasting as much as 1 year, will lead to permanent damage to cells involved in glucose metabolism like the beta cells in the pancreas.

Another implication is that being diagnosed as pre-diabetic or diabetic is not a death sentence, as some people seem to take such diagnoses at first. Many of the folks in this study who decided to do something about their health following an adverse diagnosis probably followed the traditional advice for the treatment of pre-diabetes and diabetes, which likely made their health worse. (See Jeff O’Connell’s book Sugar Nation for a detailed discussion of what that advice entails.) And still, not everyone progressed from pre-diabetes to full-blow diabetes. Probably fewer refined foods available helped, but this does not fully explain the lack of progression to full-blow diabetes.

It is important to note that this study was conducted in the late 1960s. Biosynthetic insulin was developed in the 1970s using recombinant DNA techniques, and was thus largely unavailable to the participants of this study. Other treatment options were also largely unavailable. Arguably the most influential book on low carbohydrate dieting, by Dr. Atkins, was published in the early 1970s. The targeted use of low carbohydrate dieting for blood glucose control in diabetics was not widely promoted until the 1980s, and even today it is not adopted by mainstream diabetes doctors. To this I should add that, at least anecdotally and from living in an area where diabetes is an epidemic (South Texas), those people who carefully control their blood sugars after type 2 diabetes diagnoses, in many cases with the help of drugs, seem to see marked and sustained health improvements.

Finally, an interesting implication of this study is that glucose intolerance, as defined in the article, would probably not do much to change an outside observer’s perception of a long-living population. That is, if you take a population whose individuals are predisposed to live long lives, with many naturally becoming centenarians, they will likely still be living long lives even if glucose intolerance is rampant. Without carefully conducted glucose tolerance tests, an outside observer may conclude that a damaging diet is actually healthy by still finding many long-living individuals in a population consuming that diet.

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Almost Mrs Average gets to speak at waste exhibition

It was a real honour to speak yesterday at RWM, the UK's largest recycling and waste management exhibition, especially as I was sharing the stage with the very inspiring Joy Bizzard, chair of the Local Authority Recycling Advisory Committee (LARAC)

The context was very much how local authorities can engage with householders to help individuals and communities reduce waste.  Joy's presentation was packed with advice on how councils can raise awareness and find new ways to inspire new audiences, despite the current economic culture of squeezed budgets.

The area that particularly interested me was the subject of peer endorsement, i.e., the difference that can be made by engaging ordinary members of the public to share their own stories amongst their peer groups.  It's a subject that has fascinated me for a long time and certainly set the scene for me telling my own tale of the Zero Waste challenge that I undertook in 2008 and the events that have unfolded since.

It is an extremely surreal experience addressing an audience of waste and recycling professionals.  I've done it a couple of times before and it's very difficult not to feel like a waste geek groupie, especially when you know how hard officers are working to battle against the problem of waste, which comes with its own set of economic and contractual constraints, misguided government strategies and often divisive public opinion.

And as I said yesterday, I am no expert in behaviour change. I can only tell my own personal story.  However, since taking St Edmundsbury's Zero Waste Week challenge in 2008, I have become more aware of the challenges that exist, the opportunities that are available and the need for formerly disparate groups to work together in accepting increased responsibility, whether that's producer responsibility, local authority responsibility, individual responsibility or from further along the waste chain.

In context to yesterday's event, I really feel that to work towards the UK's 2020 Zero Waste goal, local authorities are going to need to work harder and smarter in engaging their immediate community groups and actively seek out more formal relationships with individuals, who are themselves happy to inspire others within their own communities.

Last week, I made this very point at the Making 2020 Zero Waste Work conference in Coventry.  So you can just imagine my delight, whilst returning home from yesterday's exhibition, I read news of a volunteer training programme that's been rolled out by Zero Waste Scotland.  It's fabulous news that the Scottish agency has already created a blueprint for this and are putting such ideas into practice, having itself been inspired by the Master Composter network.

And for any doubters, who might raise an eyebrow over the effectiveness of such action, I could highlight many examples of personal stories that I've received from my own community where I've seen the impact locally.  But even more significantly than that, I'd like to point readers in the direction of one of the most successful peer endorsement case studies of the last three years, and that's the story of  "My Zero Waste".

You may have to enlarge the photo below, but pictured at the centre of the presentation slide is the Strauss family, who were unknown to me four years ago.  However, thanks to St Edmundsbury Borough Council engaging me in a Zero Waste challenge, and as a result of me writing about it on the Internet and my story being broadcast widely on national radio, word soon got around.  Rachelle Strauss noticed and consequently felt empowered to reduce her own family's household waste.  Driven by environmental concern, she led the way in creating her website, www.myzerowaste.com, attracting a growing community of people keen to seek advice and share ideas about reducing their waste.  This year Rachelle hosted her 4th National Zero Waste Week, a simple grassroots campaign that received over 12,000 hits within just a few days of being announced at the end of August.

Yesterday's visit to RWM was most certainly an interesting one and my only regret is that I didn't get a chance to have a proper gander around the exhibition, but that's only because I was too busy catching up with some of the folk who spend their professional lives trying to inspire others.  I'll just have to make sure I visit next year.

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Fasting blood glucose of 83 mg/dl and heart disease: Fact and fiction

If you are interested in the connection between blood glucose control and heart disease, you have probably done your homework. This is a scary connection, and sometimes the information on the Internetz make people even more scared. You have probably seen something to this effect mentioned:

Heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl.

In fact, I have seen this many times, including on some very respectable blogs. I suspect it started with one blogger, and then got repeated over and over again by others; sometimes things become “true” through repetition. Frequently the reference cited is a study by Brunner and colleagues, published in Diabetes Care in 2006. I doubt very much the bloggers in question actually read this article. Sometimes a study by Coutinho and colleagues is also cited, but this latter study is actually a meta-analysis.

So I decided to take a look at the Brunner and colleagues study. It covers, among other things, the relationship between cardiovascular disease (they use the acronym CHD for this), and 2-hour blood glucose levels after a 50-g oral glucose tolerance test (OGTT). They tested thousands of men at one point in time, and then followed them for over 30 years, which is really impressive. The graph below shows the relationship between CHD and blood glucose in mmol/l. Here is a calculator to convert the values to mg/dl.

The authors note in the limitations section that: “Fasting glucose was not measured.” So these results have nothing to do with fasting glucose, as we are led to believe when we see this study cited on the web. Also, on the abstract, the authors say that there is “no evidence of nonlinearity”, but in the results section they say that the data provides “evidence of a nonlinear relationship”. The relationship sure looks nonlinear to me. I tried to approximate it manually below.

Note that CHD mortality really goes up more clearly after a glucose level of 5.5 mmol/l (100 mg/dl). But it also varies significantly more widely after that level; the magnitudes of the error bars reflect that. Also, you can see that at around 6.7 mmol/l (121 mg/dl), CHD mortality is on average about the same as at 5.5 mmol/l (100 mg/dl) and 3.5 mmol/l (63 mg/dl). This last level suggests an abnormally high insulin response, bringing blood glucose levels down too much at the 2-hour mark – i.e., reactive hypoglycemia, which the study completely ignores.

These findings are consistent with the somewhat chaotic nature of blood glucose variations in normoglycemic individuals, and also with evidence suggesting that average blood glucose levels go up with age in a J-curve fashion even in long-lived individuals.

We also know that traits vary along a bell curve for any population of individuals. Research results are often reported as averages, but the average individual does not exist. The average individual is an abstraction, and you are not it. Glucose metabolism is a complex trait, which is influenced by many factors. This is why there is so much variation in mortality for different glucose levels, as indicated by the magnitudes of the error bars.

In any event, these findings are clearly inconsistent with the statement that "heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl". The authors even state early in the article that another study based on the same dataset, to which theirs was a follow-up, suggested that:

…. [CHD was associated with levels above] a postload glucose of 5.3 mmol/l [95 mg/dl], but below this level the degree of glycemia was not associated with coronary risk.

Now, exaggerating the facts, to the point of creating fictitious results, may have a positive effect. It may scare people enough that they will actually check their blood glucose levels. Perhaps people will remove certain foods like doughnuts and jelly beans from their diets, or at least reduce their consumption dramatically. However, many people may find themselves with higher fasting blood glucose levels, even after removing those foods from their diets, as their bodies try to adapt to lower circulating insulin levels. Some may see higher levels for doing other things that are likely to improve their health in the long term. Others may see higher levels as they get older.

Many of the complications from diabetes, including heart disease, stem from poor glucose control. But it seems increasingly clear that blood glucose control does not have to be perfect to keep those complications at bay. For most people, blood glucose levels can be maintained within a certain range with the proper diet and lifestyle. You may be looking at a long life if you catch the problem early, even if your blood glucose is not always at 83 mg/dl (4.6 mmol/l). More on this on my next post.

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Shedwyn gets her skates on for the end of National Zero Waste Week 2011

To celebrate the last day of National Zero Waste Week, I sent the 1000 Bins mascot Shedwyn, into Suffolk's  rollerskating venue CurveMotion, to check out their recycling.

They have great recycling facilities behind the scenes, but don't have any specific recycling bins in the public zones.  Consequently customers end up throwing their empty bottles and cans into the general rubbish bin.

Even if there were public recycling bins, there is a real issue that the number of unemptied containers that are often thrown away by the customers, would quickly contaminate any efforts to recycle properly. So Shedwyn was on a mission to think of ways that could improve recycling without having to rely on expensive and sticky recycling bins.

After a spell of whizziness with the laptop and a touch of lamination, a simple methodology was born.  A  sign advising customers to leave their containers at the servery counter instead of shoving them in the bin!

Whether it's an effective solution, only time will tell, but it is an idea that's worth trying and if response is low it's well worth testing out new wording or different poster designs.

So with the job done, Shedwyn was ready to do a few laps around the roller rink before scooting off home to put her feet up for the rest of the day, but the bonkers old bird got so inspired by CurveMotion's Charity Skateathon that she challenged herself to 50 laps, "Anything for charity", she said, knowing it would be a struggle to keep on her feet for even 25.

However, fifty laps later she was still going strong.

After a wobbly start, taking a tumble over a fallen-down child at lap 75, and peforming a spectacular forward-slide-and-knee-bounce herself during the 200th lap, our recycling bin champion knocked us off our chairs as she made it to 211 laps, the equivalent distance of a half-marathon!

The poor old girl couldn't walk for ages after she'd come off the rink and was soon caught napping when she should have been on binwatch.

211 laps eh!  Who'd have guessed that would happen this Sunday, rounding off National Zero Waste Week  with bruised knees.

So, could the moral of the story be that no matter what your goals, assumptions or expectations, Shedwyn has shown that it's possible to exceed these, even if obstacles and setbacks get in the way?  We just need to to keep setting our sights much higher and pushing ourselves just that little bit more whether that's about recycling, reducing waste or other ambitions (government and industry are you listening?)

Then again, as a friend suggested after Shedwyn's super-impressive tumble, perhaps the moral of the story is that she really should have worn kneepads! 

So, while the bespectacled roving reporter nurses her knees, I wish you a happy end to National Zero Waste Week. I hope it's been a great week for you.   Of course, if like me, you've enjoyed Shedwyn's expoits with the 1000 Bins Challenge, it would be fab if you could sponsor her for her charity skateathon today.  It would help her knees get better much more quickly and it's for a a brilliant cause too:  St Nicholas Hospice in Bury St Edmunds, which needs as much money as it can get to continue its great work.  You can find all you need at my Justgiving page or click the blue fundraiser badge at the top of the page.

So thank you all for your support this week and during the last three months's 1000 bins challenge.  It's been spectacular.  Here's to National Zero Waste Week 2011.  Special thanks go to Mrs Green at MyZeroWaste for organising it.  With another successful week over, who knows what will happen next year! Whatever happens, I bet your bottom dollar it will be exciting.

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This post has been written in support of National Zero Waste Week 2011, which is hosted and organised by www.myzerowaste.com. This year's theme is reducing waste away from home.  The photo competition for the 1000 Bins project, promoting "recycling on the go", ends at midnight today (11/9/2011).  See www.1000bins.com for details.  Huge thanks to CurveMotion for extending a very warm welcome to Shedwyn today.  More information about their Charity Skateathon and other events can be found at www.curvemotion.com.

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