Night shifts and appetite

• A recent study on sleep and appetite looked at 63 shift workers, mean age 36.7 years, 59% women. 84% of subjects reported weight gain since starting shift work.
• “Worse sleep quality and shorter sleep duration were associated with more food cravings, and worse sleep quality and hygiene were associated with higher appetitive drive to consume palatable food (greater hedonic drive).”
• Sleep deprivation makes you crave hyper palatable foods. Have a plan for healthy eating when working night shifts. 

Collagen

• We have talked about collagen in prior PWell newsletters. But this update from Marks Daily Apple on various benefits provides 42 references. Reduce sore joints, improve bone health, possible benefits in diabetes. 
• The glycine in collagen appears to improve sleep – eat a little collagen powder or bone broth when you are hungry at the end of a night shift.
• For vegetarians and vegans, you can buy marine collagen, but a truly vegan version does not yet exist (they are working on something with algae). 

Tribes

• Interesting story on a Hungarian nationalist politician who expressed antisemitic ideas, even wrote a book, but then found out his grandmother was a Jewish concentration camp survivor. Csanád Szegedi has since completely reversed his prior positions, even collecting copies of his book and burning them.
• This might not be a story of pure redemption (alleged attempts to cover up his history), but now Csanád Szegedi gives speeches,  to try to eradicate tribal, non-inclusive ideas and doctrines. People are complicated. Szegedi also asked for forgiveness from the Jewish community in 2012, meeting with Hungarian Orthodox Rabbi Slomo Koves. For a long read, check out the New Yorker piece.

Mutual fund fees

• Article from White Coat Investor on mutual funds – are they worth the fees? WCI covers survivorship bias, ie the funds that we have to choose from today are all survivors – the ones that folded are no longer in the running. Even of the surviving funds, 3.6% (19 out of 526) were able to beat the market. This is not even taking fees into consideration. 

• “If you are using actively managed mutual funds, why do you think you are going to be able to pick a winner, much less a winner in every asset class in your portfolio? Why would you gamble on such low-probability bets? If you are trying to pick stocks yourself, why do you think you’re going to be able to outperform the market when essentially not one of these folks was able to do so over the long run in any significant way? If you truly can pick stocks well enough to beat the market after the costs of doing so, why are you only managing your own money? Not only are you leaving billions on the table, but you’re doing a disservice to your fellow investors.”

• Moral of the story, repeated 10 times in a row:  Past performance does not indicate future results. 

Digging Holes or Weaving Tapestries

• Loved this medical humanities piece on understanding patients – works well for understanding friends and family too. The “digging holes” approach matches the ER mentality, lets get to the bottom of this problem: Run a bunch of tests, find an answer, a solution. We are somewhat expected in the ER to use this approach because patients come in with a defined problem and they dowant an answer. But physicians should think about the tapestry concept with our patients. We should strive to become “capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason.”
• “Digging a hole requires intense effort and single-mindedness. Weaving a tapestry involves immense delicacy and careful collaboration. One activity is practical, the other is aesthetic. At least in western cultures, digging holes has largely been a task for men, while tapestry-making has almost exclusively been the province of women. Doctors, I would suggest, need to be able to do both, and to realise when to move from one to the other.”

Leader

• Looking for an honest, no BS physician to follow online? Check out Vinay Prasad, MD. He is an oncologist who wrote a book called Ending Medical Reversal, about how to assess research to prevent the phenomenon of medical reversal (having to reverse practice patterns, often because we adopted new findings too quickly). He has a new book this year called Malignancy. He is very active on Twitter, advocating the medical community to pull the politics out of scientific discussion.
• See his recent appearances on ZDoggMD’s podcast. 

Pop Tarts

• Ok dont worry about the price tag. These brown sugar cinnamon pop tarts are legit. Taste extremely close to the real thing, but packed with fiber and protein. The price is similar to a protein bar, so chill out. I cannot vouch for the strawberry flavor. Shouldn’t be an every day item, but a nice dessert option or treat for adults wanting to feel like a kid again.  
• Looking for more protein, check out Ghost brand. The cereal milk flavor tastes amazing, and they ad enzymes to enhance absorption.