Insulin:

• Yes we need insulin. Without it, our cells could not go into storage mode and the first winter humans encountered would have been our last. Problem of course is that now we have no winter (metaphorically). We don’t have a period of a few months with less food availability (and cold exposure). So we have insulin floating around all the time. 
• This study in The New England Journallooks pretty cutting edge. Except that it was published in 1996! Yes two decades ago we had pretty solid evidence that fastinginsulin level independently predicts subsequent ischemic heart disease. And they excluded diabetics from analysis (diabetes was also a big predictor). 
• How many of us have fasting insulin levels checked at your annual doctor visit? If you are treating patients, are you checking it? When they controlled for other known risk factors (smoking, weight, meds, blood pressure, fam history, cholesterol, and some other ones) fasting insulin remained an independent predictor. 
• Who has elevated fasting insulin? People with insulin resistance – your body has to release more for it to be effective (think about drinking more and more caffeine or alcohol as your tolerance increases). Who has insulin resistance? People who always have insulin floating around because they eat food too often and eat foods that cause insulin release (carbs [and protein]). What should you do? Limit carbs and fast so your body can clear all of the insulin. 

Wellness Program:

• Enjoyed an interactive presentation yesterday by Tony Simms and Jennifer Brueckner-Collins on creating a culture of wellness.      • Salient points: UofL offers a very wide array of quality wellness activities to students, residents and faculty. Take advantage of them if you’re at UofL, and if not, look for what your company offers. 
• Taking that first step, overcoming the inertia / static friction of inactivity is difficult, but each step after that is easier and easier. Positive behavior reinforces itself. Call it an upward spiral. 
• In small groups, we asked if entertainment = happiness. Probably not. Good instructors should be engaged and should illustrate to learners the value of the material. But learning is sometimes difficult and requires effort. 
• Students will not believe our recommendations for self-preservation if they don’t see us exhibiting these behaviors. 
• Enjoyed the focus on wellness, rather than dwelling on burnout. Forward facing and constructive talk!

Caffeine ceiling?: 

• We know drinking coffee offers overall mortality benefit. But several studies have hinted at a ceiling effect, at about 5 cups per day, or 4-500mg of caffeine. 
• In this study of a Mediterranean cohort, there appeared to be a continued benefit even in the group who had >4 cups per day. They did not subdivide this highest consumption group, but no drop-off occurred. 
• For a more straightforward summary, see this link(thanks uncle Fred). 

Sleep tips:

• Ok so after you have had your >4 cups of coffee, how do you get to sleep at night. Step 1, stop caffeine intake by 3pm or even earlier if you think you are a slow metabolizer. 
• Then check out this link from Staci Saner. From The Learning Scientists, a collection of cool links on sleep habits. One is a podcast with Dr Christopher Winter, who wrote one of the best sleep books out right now (covered in prior newsletters). The link to 45 tips for good sleep covers almost everything, with links to go into more depth. Don’t forget sleep helps you learn!

Instrumental:

• Cellist and singer Takénobuhas several albums now. I just discovered his 2016 album Reversal, which is excellent study / writing music. The second song Reversal is haunting and complex, as is Things Fall Apart.
• His website description: ‘Takénobu is the middle name and all encompassing band and artist name for Nick Takenobu Ogawa. It is a combination of the Japanese Kanji characters in his father and grandfather’s names, and loosely translated means “Iron Will”.’
• Check him out on Spotify, Apple Music, or download from his site.

Quote: 
The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth.
– Niels Bohr
One of my favorite quotes of all time. So many paradoxes when you delve into philosophy and how the world works.