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Health Items from 2010:                                                  to enlarge a photo, click on it

Exercise surprises   Saturated fat was framed   Old age supplements   The magic bullet pill   What are trans fats?  Diabetes 1  Diabetes 2  Not all diseases are equal  Diabetes 3   Stress kills   A treatment for Alzheimers will be later rather than sooner    Personalized medicine  

Exercise surprises
Before I went to school, I didn't wear shoes very often in the warm or hot weather. One year I had as a surprise a pair of running shoes. They were called running shoes and I was pleased with them and so when they were put on my feet, I ran. I ran for a long time until I was unable to run any longer and so I took the shoes off and carried them home. It became one of those embarrassing stories that my parents told everyone.
But apparently, running shoes are not the perfect thing for running. It seems they protect your feet at the expense of your ankles, knees and hips. Comparing the forces on joints when running barefoot or in running shoes, the running shoes increased the hip internal rotation torque by 54%, knee flexion torque by 36%, and knee varus torque by 38%. The increase is due to the elevated heel and support under the arch in running shoes. A good part of the strain on leg joints is due to the arch support.
When I have done my little walk with the dog, I have used good running shoes in spite of noticing that it was less tiring on my legs when I wore sandals. From now on I'll be using the least rather than the most supportive shoes from my walking. For as soon as it is not slippery out, I will be walking again.
Another lesson to learn is that when one fasts and gets hungry, you get more alert and physically active. We metaphorically start to hunt for food in a restless way. When we are feed, we become inactive. We metaphorically curl up and digest while we snooze. I have been walking immediately after lunch because that was supposed to reduce the storage of fat. Maybe I should be walking before lunch. Decisions, decisions - nothing is easy.

Saturated fat was framed
The latest news in 'don't trust nutritionists' category: not all fat is bad for you.
We have been told that 'fads may come and go, but trust me, saturated fat is bad for your heart. Period.'
Now we have a new prospective. “Combined the results of 21 previous studies that followed 347,747 adults, aged 30 to 89, for five to 23 years (showed) 11,000 participants developed heart disease or suffered a stroke. Over all, there was no difference in the risks of heart disease or stroke between people with the highest and lowest intakes of saturated fat.” That is not very good evidence for avoiding saturated fat. Doesn't high saturated fat give high LDL cholesterol and high LDL cause plaque in arteries?
Well it turns out that there is LDL and there is LDL. There are small particles and large ones and the small ones are the 'bad cholesterol'. Unfortunately, it is the large particles that are associated with saturated fat consumption.
It also turns of that there is saturated fat and there is saturated fat. The type of saturated fat in meat and chocolate does not elevate LDL (large or small particles). And further, the saturated fat in dairy products, although it elevates LDL, also elevates HDL, 'the good cholesterol'. And to top it off, it needs to be said that the partially hydrogenated oil used to make the spreads that are promoted as healthy replacements for butter may contain trans fats which are more dangerous than saturated fat. Rule of thumb: don't eat food made in factories with non-biological chemical processes.
Finally there is the question of reducing saturated fat and not replacing it with other fat like vegetable oil or fish oil. If there is any value to reducing saturated fat, it is likely to be when it increases the consumption of polyunsaturated fat and changes the ratio between the two types of fat. Natural polyunsaturated fat is very healthy.
The most dangerous thing is to increase carbohydrate as a replacement – something that is common when people try to reduce saturated fat. Increasing carbohydrate can increase triglyceride fats and LDL in the blood while decreasing HDL. Too much carbohydrate is more likely to damage arteries than is too much fat.
Cutting animal or vegetable fats from the diet also cuts the fat soluble vitamins, essential fatty acids and other good things that come with them. Really starving the body (as in anorexia) cause the body to convert larger areas of bone marrow to make and store fat. This causes osteoporosis.

Old age supplements
A while ago I started to take vitamin D. I now have run across some additional evidence that it was a good idea.
“A team of researchers at Warwick Medical School carried out a systematic literature review of studies examining vitamin D and cardiometabolic disorders (cardiovascular disease, type 2 diabetes mellitus and metabolic syndrome). ... Researchers looked at 28 studies including 99,745 participants across a variety of ethnic groups including men and women. (14 USA, 8 Europe, 2 Iran, 3 Australasia, 1 India and most between 2004 and 09) The studies revealed a significant association between high levels of vitamin D and a decreased risk of developing cardiovascular disease (33% compared to low levels of vitamin D), type 2 diabetes (55% reduction) and metabolic syndrome (51% reduction).
Vitamin D is a fat-soluble vitamin that is naturally present in some foods and is also produced when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Fish such as salmon, tuna and mackerel are good sources of vitamin D, and it is also available as a dietary supplement.”

I also found the components of a supplement that has been tested on animals with very good results. I think it is just a list of the popular supplements for the aged – I have visions of some researcher asking grandmother what to buy and putting all the pills together. At least some of the components are working but who knows which. It might only be Vit D and a couple of others for all we know.
Here is the list:
Vitamin B1 (thiamin)
Vitamin C (ascorbic acid)
Vitamin D
Vitamin E
Acetylsalicylic acid (aspirin)
Beta Carotene
Folic acid (vit B9)
Ginger root
Ginkgo biloba
Green tea extract
Cod liver oil
Flax seed oil

The magic bullet pill
Drug companies have been searching of the magic diet pill – what a money making coup that would be. The problem is not that they don't work: plenty of drugs cause weight loss, at least for as long as you keep taking them. But unfortunately, there's always a 'but'. Fenfluramine worked, but it caused heart valve defects, and was banned. Sibutramine works, but it's just been suspended from the European market due to concerns over heart disease (a different kind). Amphetamine-like stimulants such as phentermine work, but they're addictive and liable to abuse.
But maybe you remember (back in the '60s) that marijuana gave you an appetite. Well the drug companies have tried marijuana antagonists which block the cannabinoid receptor. These should have the opposite effect and they do. But...
The cannabinoid receptor, which is activated by the body's own naturally produced cannabinoid neurotransmitters as well as marijuana, is very important to memory, motivation, emotion, pain, hormone secretion etc. etc. The endocannabinoid system is a general neural feedback system that regulates all the other neurotransmitters at optimal levels. So blocking this system gives people psychiatric problems like depression and anxiety. Statistically CB1 blockers are more consistant at giving depression than antidepressants are at treating it. They (rimonabant, taranabant) are another diet pill failure.
Given the track record of diet pills, I would not agree to be part of any trial.

What are trans fats?
Ordinary fat is made of three fatty acid molecules bonded to a glyceride molecule (called triglycerides). Each fatty acid molecule is a long string of carbon atoms with an organic acid group at the end and hydrogen atoms along the chain occupying the spare carbon bonds. When each carbon atom in the chain uses two of its four bonding points for its bond to its neighbouring carbons and the other two for hydrogen then the chain is called saturated. This is the saturated fat found in meat and dairy products. If one pair of neighbouring carbons have a double bond, each uses three of their bonding points and leave only one for hydrogen (called mono-unsaturated fat). If more than one pair of neighbouring carbons double bond, we have poly-unsaturated fat. Most vegetable oils are polyunsaturated. Other types of molecule that will dissolve in these triglyceride fats are often also called fat, for example cholesterol.

Saturated fat can be made in factories from unsaturated fat by adding hydrogen in a catalytic process that breaks the double bonds between carbon atoms to leave single bonds. The change from unsaturated to saturated makes the liquid oil become a solid like lard. The process can be only partially done (partial hydrogenation) and this gives a fat with fewer double bonds but still some, an unsaturated fat but less unsaturated then the original oil. This is a solid but soft product with a consistency similar to butter. It was thought better than butter because it had no cholesterol and it was not saturated fat. (The consistency of butter is due to its water content and other factors, and not due to unsaturated fat.) As both saturated fat and cholesterol were considered problems in the diet, partially hydrogenated fats were welcomed.

But the partial hydrogenation process created a new type of double bond that was not in the original oil. There are two ways that the hydrogens can sit at a double bonds. It can be thought of as the two being on the same side (called 'cis') or on opposite sides ('trans'). The oils do not have 'trans' double bonds, but it the process of hydrogenation, they are formed. The standard way of partially hydrogenating oils produces fat that is 40% trans fat. Biological systems make extremely few 'trans' fats. When they do, the fats are conjugated making them chemically quite difference from trans fats made during hydrogenation and they are not known to be unhealthy. Biological systems cannot process trans fats – they just have not the enzymes. Lipase, for example, the main enzyme that breaks up fat, cannot deal with trans fats. Trans fats resist going rancid. Trans fats are straighter molecules than cis fats because cis bonds force a kink in the carbon chain. Cis fats are therefore softer than trans. Because trans fats have ideal consistency, withstand high temperatures, and keep well, they have been a favorite of the processed and packaged food industry. The concerns about animal fat and cholesterol have added to the popularity of unsaturated fat including trans fats.

It turns out that trans fats are much more dangerous than animal fats. Many medical organizations want trans fats completely banned. A ban is now seen as the most effective public health measure that can be take to improve cardiac health. Too much saturated fat increases the LDL (bad cholesterol) in the blood, but much small amounts of trans fats not only increase LDL but decrease HDL (good cholesterol). Also some particular animal saturated fats are almost immediately converted in the body to unsaturated fats (cis not trans) and so do not raise LDL at all.

There is general agreement that trans fat contributes to heart disease more than any other component of the diet. Cardiac heart disease is roughly doubled for every 2% increase in trans fat calories consumed in place of carbohydrate calories. It takes a 15% increase in saturated fat to give the same effect. Replacing trans fat with non-trans unsaturated fat decreases risk by about a half.

As well as the proven case of heart disease risk, there are a number of other suspected dangers to trans fats: type 2 diabetes, Alzheimer's disease, cancer especially breast cancer, obesity, liver dysfunction, infertility in women. The links with these diseases are being studied to see if they are significant.

Many countries are moving to decrease the use of trans fats and many food companies are reformulating their products to lower the trans fat included. There are ways to reduce trans that do not cost too much or lower the quality of food. Labels including the amount of trans fat are also coming in more and more countries.

For those products that are not labeled there are rules of thumb. Any label that says 'partially hydrogenated vegetable oils', 'hydrogenated vegetable oils' or 'shortening' is may well contain trans fats. Commercial baked good such as cookies, cakes and donuts; chips and other packaged fried foods; some fast food chain products especially deep fried ones; snacks like microwaved popcorn; vegetable shortening and many margarines are the most likely products to have trans fat.

Diabetes 1
I have been waiting for this to happen for at least a third of my life. My fasting blood sugar is over normal. It is not just very close to the upper limit as it has been for years, occasionally a point or two over but within normal when repeated, it is actually, undeniably too high. The doctor said it was not quite high enough to make a diagnosis of diabetes yet.
So what is type 2 diabetes, what I will have soon if I don't watch out? Type 2 diabetes is not caused by destruction of the insulin making cells in the pancreas as in type 1, but rather by the resistance to insulin and the inability to produce enough extra insulin to overcome the resistance. The high blood glucose and other changes damage many organs especially the heart and blood vessels. So what I have is not the autoimmune type1 like my father and uncle on the Barmby side, but type 2 like my brother and my Wight grandfather.
The sequence involved in this disease is: metabolic syndrome (insulin resistance and over production of insulin to overcome resistance) progresses to type 2 diabetes not requiring insulin (high blood glucose because insulin can no longer be produced in enough quantity to overcome resistance) progresses to type 2 diabetes requiring insulin (the long term over production of insulin has damaged to insulin producing cells so that they cannot over produce anymore). I appear to be at the point of passing from metabolic syndrome to mild type 2 diabetes.
So I have a few early symptoms but not others.
Causes and risk factors
Although the disease has a genetic aspect, it is also due to lifestyle. This can be seen from the adoption of the Type 2 epidemiological pattern in those who have moved to a different environment as compared to the same genetic pool who have not. Immigrants to Western developed countries, for instance, as compared to lower incidence countries of origins.
The condition has to be controlled to avoid these dangers.
The information above is the conventional info and advice. In later months I will look at some of the areas where there is more recent and detailed scientific info.

Diabetes 2
What can I do with my diet?
Glycemic index
Glycemic index and glycemic load are measures of how quickly and how high certain foods affect blood sugar compared to pure glucose. The index is based on a standard weight and load is based on normal serving amounts. Eating low glycemic foods limits the blood sugar rise after a meal and therefore the need for insulin response.
So it seems a good idea to eat primarily low glycemic load foods to postpone diabetes. Unfortunately, I do this already for other reasons. Because of my adult celiac condition, I long longer eat any bread, pasta or couscous, if fact I eat nothing with any wheat or barley in it. That cuts out a lot of high glycemic foods.
I also watch my weight so it does not rise. So although I can tolerate rice, potatoes and corn, I do not eat much of them. Harry has potato with his evening meal and I often put a little slice on my plate. I cook rice about once a week for our evening meal and have a serving (sometimes a large serving). We no longer have polenta but I eat canned sweet corn probably every other day. I sometimes have some cornflakes, maybe once a month. I eat very little candy – a bit at Christmas, some when Ciara and Ryan are here, and a piece of dark chocolate occasionally. I eat canned beans/peas only about once a week when I put them in my chicken soup. There is a small amount of sugar in my yogurts. The only high glycemic fruit or vegetable I eat is a couple of bananas a day. That is it for high and medium glycemic index foods. Otherwise I eat fruits and vegetables, often raw, and proteins (meat, fish, cheese and eggs). My snack when I'm peckish is peanuts, roasted, not salted. I do not want to cut out anything completely from what seems a healthy diet for me and so about all I can do with my diet is to eat less of the banana and cut out rice and take the little milk I have without the cornflakes. That does not seem a big change and so not that much can be gained from this corner.
Specific nutrients
Over and above the foods that are not glycemic, there may still be foods that are helpful in other ways such as directly counteracting the resistance to insulin that is the root of the disease. There are some foods that are particularly helpful:
       -Virgin olive oil – Virgin olive oils contain polyphenols as well as some particularly healthy fats found in all olive oils. This polyphenols have been shown to be one of the important components of the Mediterranean diet's healthiness. Consumption of virgin olive oil in conjunction with a Mediterranean diet can positively impact lipid and DNA oxidation, insulin resistance, inflammation, carcinogenesis, and tumor suppression and these effects are thought to involve changes to the way genes are expressed.
Red wine and red grapes – The active ingredient is resvertrol which actives sirtuins in various tissues and this activation is thought to be anti-diabetic. There is also a theory that resvertrol is anti-inflammatory.
       -Antioxidants (Vit C, Vit E, selenium, carotenoids found in fruits, vegetables, legumes and nuts) - Antioxidants improve many metabolic syndrome symptoms including insulin resistance. However, this is something of a two edged sword because taking in too much antioxidant can interfere with energy production, in particular the delivery of oxygen to the muscles. Many of the compounds that antioxidants eliminate are active in increasing the diameter of blood vessels and stimulating energy production. A lot of people don't realize is that the antioxidant and pro-oxidant balance is really delicate. (Some experts want the recommended intakes of nitrate, nitrite and nitric oxide raised for good cardiac health and these are some of the chemicals lost to the actions of antioxidants – the N compounds are found in many vegetables and preserved meats).
       -Coffee – The caffeine in coffee can reduce the risk of type 2 diabetes and is beneficial in limiting fatty liver and inflammatory cytokines from fat tissue.
       -Vitamin D – Vitamin D deficiency is prevalent and is especially found in aging people. The deficiency appears to be a risk factor for type 2 diabetes and vitamin D supplements are beneficial in treatment of it.
       -Soy (the isoflavones, daidzein and equol, specifically) – they activate a transcription factors and signaling molecules that are important for glucose uptake and insulin sensitivity, in a similar manner to anti-diabetic drugs.
       -Citrus fruit (the flavonoid, naringenin specifically) – effect in reducing weight gain, insulin resistance and cartiovascular disease. It has an insulin-like effect.
       -Low fat – a high fat diet is believed to cause inflammation leading to insulin resistance. (It is also believed to cause obesity but a high carb diet is even worse for weight gain. The inflammation problem is separate from the weight gain problem although they are often confused.)
So what is there here that I can do? Not much is not in my current diet; I can add soy and reduce the fat a little. That is it.
Sleep apnea
Another factor to consider is sleep apnea. It is hard to tell if I suffer from this, both I think I do to a small extent. Both intermittent hypoxia (sleep apnea) and continuous hypoxia (living at high altitude) affect glucose tolerance but only intermittent reduces insulin sensitivity. Obesity make people more prone to sleep apnea so, again, I should lose weight.

More in future...

Not all diseases are equal
(thanks to Mind Hacks blog) There is a hierarchy of prestige in medicine. It's interesting that doctors who specialise in working with people who have the least status in society (children, the 'mad', the 'old') also have the least status in medicine. The Norwegian researchers asked senior doctors, general practitioners and medical students to rate diseases and came up with the following list, which ranks diseases from the most prestigious at the top, to the least prestigious at the bottom.
Myocardial infarction [heart attack]
Spleen rupture
Brain tumour
Testicle cancer
Pulmonary embolism [normally blood clot on the lung]
Angina pectoris
Extrauterine pregnancy
Thyroid cancer
Meniscus rupture ['torn cartilage']
Colon cancer
Ovarian cancer
Kidney stone
Ulcerative colitis [inflammation of the bowel]
Kidney failure
Duodenal ulcer [peptic ulcer]
Pancreas cancer
Ankle fracture
Lung cancer
Sciatica ['trapped nerve']
Bechterew's disease [arthritis of the spine]
Femoral neck fracture
Multiple sclerosis
Inguinal hernia [abdominal wall hernia]
Apoplexy [internal organ bleeding]
Cerebral palsy
Depressive neurosis
Hepatocirrhosis [cirrhosis of the liver]
Anxiety neurosis

Diabetes 3
And then there is activity...
Sarcopenia is a condition of low skeletal muscle mass and strength that occurs in older people and the obese. It is associated with insulin resistance and elevated blood glucose. Dieting is not enough to avoid type 2 diabetes; it is important to be fit and avoid sarcopenia.
Exercise is important for avoiding type 2 diabetes, over and above its body fat reduction. Not that much is required 150 minutes of walking a week or 60 minutes of more strenuous activity will give beneficial changes in lowering insulin resistance. More than this does not seem to have any extra advantage other than weight loss (decreases hunger signals) and general fitness. One thing that is important is that the exercise is regular.
It may also be the case that adrenaline production during exercise can cause the uptake of blood glucose by muscle without the action of insulin. I have read this but have not yet found corroboration.
I have re-started a lunch time walk which I used to do.
The amount of time spent sitting (independent of the amount of activity and exercise) influences triglycerides, high density lipoprotein, cholesterol, blood glucose, blood pressure and leptin – all markers of obesity, cardiovascular disease, metabolic syndrome and type 2 diabetes.
In seems that bone is not just a rigid framework, the place where blood cells are formed and a reservoir of calcium, potassium and fat. It is an active player in metabolism. There is interplay between bone and blood sugar, based on signals sent via insulin and a bone-derived hormone known as osteocalcin.
Bone is continually broken down by osteoclasts and built up by osteoblasts. The density of bone is a balance between the activity of these two cell types. Too much re-absorption and too little creation gives osteoporosis.
Osteoblasts have insulin receptors and when not stimulated by insulin decrease bone formation – insulin is needed to maintain bones. But also, bone produces osteocalcin which stimulates the pancreas to make more insulin and various cells to be more sensitive to insulin. This appears to be a positive feedback loop. It is more complicated because insulin stimulates osteoblasts to produce inactive osteocalcin which sticks to the bone and cannot circulate in the blood to stimulate the pancreas and other cells. It cannot increase insulin or insulin sensitivity. A built up of this inactive osteocalcin stimulates the osteoclasts to break down bone. The action of osteoclasts create acid and this converts the osteocalcin to become active and escape into the circulation.

Stress kills
Now that there are preventions, cures and treatments for the majority of the diseases that killed our great grandparents and their ancestors, we die of accumulated mishaps. Our fears are cancer, the result of a series of uncorrected metabolic damage, or heart attacks, the result of the wear and tear of life. Now our greatest enemy is stress because stress makes us tear out faster and repair our little damages less well.
It is becoming clear that it is not just stress that is dangerous – there is good stress and bad stress. The really damaging situation is to have stress consisting of very high demands and very low control. This is the type of stress that kills.
There are some recent figures giving a feel for how important stress is. “The list of ailments connected to stress is staggeringly diverse and includes everything from the common cold and lower-back pain to Alzheimer's disease, major depressive disorder, and heart attack. Stress hollows out our bones and atrophies our muscles. It triggers adult onset diabetes and is a leading cause of male impotence. In fact, numerous studies of human longevity in developed countries have found that "psychosocial" factors such as stress are the single most important variable in determining the length of a life.” and “The Whitehall study, an exhaustive longitudinal survey launched in 1967 that has tracked some 28,000 British men and women working in central London. The differences are dramatic. After tracking thousands of civil servants for decades, Marmot was able to demonstrate that between the ages of 40 and 64, workers at the bottom of the hierarchy had a mortality rate four times higher than that of people at the top. Even after accounting for genetic risks and behaviors like smoking and binge drinking, civil servants at the bottom of the pecking order still had nearly double the mortality rate of those at the top. Promotion from the lowest level in the British civil service reduced the probability of heart disease by up to 13 percentage points. ”
When I was younger I thought that I was just one of those people that was immune to stress. I was not someone who got angry and smoldered; I was not a worrier either. As I got older, my jobs tended to have more and more control. I was usually lucky with my immediate bosses. When I retired I was very surprised at the difference it made. The stress I had not thought was there was noticeable in its absence. Over several months my health seemed to improve. Now I really savour the lack of stress in my life. Or maybe I am just savouring life. Here is the way our outlook changes as we age. “In measuring immediate well-being — yesterday’s emotional state — the researchers found that stress declines from age 22 onward, reaching its lowest point at 85. Worry stays fairly steady until 50, then sharply drops off. Anger decreases steadily from 18 on, and sadness rises to a peak at 50, declines to 73, then rises slightly again to 85. Enjoyment and happiness have similar curves: they both decrease gradually until we hit 50, rise steadily for the next 25 years, and then decline very slightly at the end, but they never again reach the low point of our early 50s.”

A treatment for alzheimers will be later rather than sooner
It seems that ideas are not working out for finding treatments or cures for alzheimers. That is a shame but it can be predicted to happen every so often. Years back researchers thought they knew where the problem was – the amyloid plaques caused the malfunction and death of neurons. Find a way to stop plaques from forming or getting rid of them after they formed was the answer. Many (probably most) drug companies started projects to attack amyloid plaques and many other funders gave money to researchers who had good ideas along this line.
Of course there were indications early on that amyloid plaques might not be the only cause or even a cause at all for the symptoms of alzheimers. Some people looked at tau tangles and various metals. But this is always the case even if the main work is on a successful track. Eventually others were looking at blood vessels, energy metabolism, inflammation and calcium signals. But the bulk of the money did not go on these other possibilities but on the amyloid plaque hypothesis. Now it looks like the plaque thing is going to fizzle and it is going to take time for it to run its course so that the big money can go into other hopes.
First it appears that people who do not have alzheimers or any similar condition, do still have amyloid plaques. Second, the actual amount of mental degradation in alzheimers does not seems to follow closely the actual amount of plaque. Third, the free precursors of plaque seem to be somewhat toxic to neuron cells whereas they lose their toxic nature when bound in plaques – ie plaques may be a sign of some sort of protection mechanism. Fourth, the genetic link between amyloid processing genes and alzheimers that was found for the rare early onset alzheimers does not seem to hold for the common age related alzheimers. Finally, so far the drugs and vaccines that have had trials for ridding the body of amyloid from plaques have either shown no benefits or have made patients worst. Many more trials are in the pipeline but hope is fading for them.
Occasionally you can still read quotes from scientists and more often from science journalists that just state boldly that amyloid plaques are the cause of alzheimers without any hedging. I guess that if you have enough years of your life invested in the idea, it is hard to question it.

Personalized medicine
Personalized medicine is intended to predict the risk of disease or response to a drug based on a person's genetic makeup. Sounds like a great idea. It is being hyped, but is it possible?
The way genes work is greatly influenced by their environment. Even in simple organisms, like yeast, the effects of gene combinations are not predictable from one group of food sources to another. It is pretty hard to get a system that is simpler than that – combinations of a handful of genes and a handful of sugars, only a few hundred ways to put them together.
We can't even describe human environments in scientific usable ways. Even when we might understand all the genetic variations in people, it will still be a long time to understand our environments and the interactions between them and the genes.
We are stuck with statistical medicine for some time before we have personalized medicine. (Of course a certain amount of understanding of the patient's genetics may help to make the statistics were accurate.)
Why is a purely genetic approach to diagnosis being hyped as a near-future possibility? This is one of my pet peeves – we should forget about 'nature vs nurture'; there is almost nothing that is controlled by pure genetics or pure environment. Our ignorance of the interaction between the two is enormous, still that is where the better medicine will be found. I feel like screaming out loud every time I read 'nature vs nurture'. It should be 'and'. I do not understand why people keep trying to find evidence that one or the other is the more important. How can a reasonable person think that either is unimportant?
The environment cannot yet by quantified, the genetic map is not yet understood and the interaction is a mystery, but still some people want to fight about whether genes or environment wins some sort of paper crown.