Showing posts with label same. Show all posts
Showing posts with label same. Show all posts
Friday, March 20, 2015
New Look New Site New Book but its still all the same I promise
Hey! What happened to A Year of Slow Cooking?
its here! its all right here!
{if you are reading this in a reader or through email, none of this is going to make any sense. I urge you to click through to the main site to see what Im talking about}
Welcome to the great-big-huge-honking site redesign! Its new. Its different. But all of your favorite (and even your not-so-favorite) recipes are all here, and all of your bookmarks will continue to work forever and ever.
Ive wanted to tie my different writing endeavors together for quite a while now, and Jennette Fulda, of Make My Blog Pretty figured it out.
Because she is wonderful.
Im still playing around with the features and learning the ins and outs of the software (Im a slow learner) but I couldnt be happier.
I hope you enjoy the new design and the new features in the header. Theres also a brand new home page thats pretty cool (it moves! and has random generator thingies!) Youll find links to pretty much anything I could think of that you might want/need, and theres a shiny new downloadable page with free stuff on it.
Just for you.
This website makeover is in honor of my new book: Totally Together: Shortcuts to an Organized Life
I began writing this book when my oldest child was a baby---over nine years ago. I was running a drop-in childcare center at the local courthouse and my little one came to work with me every day. I was listening to time management seminars on tape while I worked, and kept thinking that there should be a day timer for moms. Not a blank one--- those already existed--- I wanted someone to TELL me what to do.
I wanted someone (or thing) to tell me to change the sheets, to disinfect the remote controls, to wipe down the blinds, and to call my mom. I wanted to be reminded to do a breast self-exam and to make dental appointments for me and the family. I wanted someone to walk me through the Winter Holiday months (in a non-preachy or judgmental way).
I wanted encouragement. And someone to tell me I was doing a good job, even when I was sleep-deprived and had spit-up in my hair.
So I emailed the Franklin Covey company and told them that they should make a planner for moms. I corresponded back and forth with their development department a few times before I was kind of blown off (they sent me a 15% off coupon and a form letter).
I then did what any good red-blooded American would do. I got mad and made one of my very own.
This book has had a rather long and difficult pregnancy. It took me 2 years for me to find and secure a literary agent, then another 3 years for her to find a publisher (Ive got an awfully nice collection of reject letters).
And then that publisher backed out (due to the economy) after it was ready to go to print.
(years 6 and 7)
and it took another year for me to find a new publisher.
(year 8)
meanwhile, the crockpot thing was taking on a life of its own, for which I am eternally grateful, because if it wasnt for the crockpot thing, this book wouldnt have come to life.
but its here. And its because of you.
Thank you.
I really hope you enjoy it.
reprinted from the Introduction:
"There is just too much to do and nowhere near enough time to do it!" All over the world women are faced with the daily dilemma of trying to cram more and more into an already over-crowded schedule. Who has time for a monthly breast self-exam when there is weekly dusting and vacuuming, daily meal planning, hourly diapers to change, a baby to nurse, and a sibling argument to referee every five to ten minutes? How on earth can moms take the time to exercise and floss when showering daily is a luxury in which many dont indulge?
As a new mom I found myself wishing for some sort of guide that laid everything out. Some sort of system that reminded me to make dental appointments for everyone in the family every six months. A planner to help with the daily, weekly, and monthly chores so nothing was forgotten. A little bird to whisper in my ear that its time to update the baby book and family scrapbook. A pat on the back and a friendly nudge to take a long bath and take the time to shave my legs properly.
I came up with Totally Together: Shortcuts to an Organized Life as a way to help me as I waded through the vast number of "shoulds" and "shouldnts" that I came across in parenting, housekeeping, and self-help books and magazines. Totally Together gave me the permission and tools I needed to whip through the daily chores and minutiae and move on to what I really wanted to do: spend time with my family and enjoy living life. My hope is that your Totally Together journal will be of help to you and your family, too.
Have a fantastic day. I hope you enjoy the new site, and thank you deeply for your love and support-- it means so very much. xoxo steph
p.s.: if you find any site snafus/weirdness, please email me at contact@stephanieodea.com
Saturday, March 7, 2015
Low Testosterone Low Life Expectancy Plus Chinese vs US Do the Same Reference Ranges Apply for Everyone
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| This is what Photoshop and creativity can tell us about aging men. |
Virile men live longer! Ca. 30% longer, to be precise.
If you take a look at the link between serum testosterone, free testosterone and DHT and the all-cause mortality risk of the 16,451 community-dwelling older men from Perth in Western Australia it should be obvious that the third quartile of all these serum values, is where you want your androgen levels to be, if you intend to live to see your 90th birthday.
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| Figure 1: Relative reduction in all-cause mortality with total and free testosterone levels, as well as dihydrotestosterone levels in quartile 2,3 & 4 vs. quartile 1 (Yeap. 2013) |
Symptoms of low testosterone:
And while your androgen levels shouldnt be significantly lower, you also dont want them in the fourth quartile, where the all-cause mortality risk begins to rise again. Unless you dont want to lose the ~30% all-cause mortality of being in the zone, you shouldnt let the rumors about a causal (not corollary) link between testosterone replacement therapy (TRT) and the incidence of prostate cancer upset you. Why, well because ...Somatic: Gynecomastia, de- creased body hair, hot flashes, decreased lean muscle mass, decreased strength, anemia, frailty, osteoporosis, easy fatigue, sleep disturbances, increased body fat or body mass index
Psychological: Depressed mood, irritability, emotional lability, impaired cognition and memory, decreased energy
Sexual: Diminished libido, erectile dysfunction, decreased nocturnal and morning erections, difficulty achieving orgasm, decreased performance (Traish. 2011)."[...] to date, no study or review has definitively shown that androgen replacement therapy is an independent risk factor for development of prostate cancer." (Fisher. 2012)The thing you should ask yourself is thus whether you really want to give up on this 30% reduction in all-cause mortality, or the decrease in fatal cardiovascular events, Ramasay et al. list next to the reduction in body fat mass, and insulin resistance among the proven benefits of TRT in their 2012 review of the literature.
Its your decision and therefore you should make sure that its you and not your doctor who takes this decision. If you decide to help your low testosterone levels along, its your doctors job to help and assist you by ordering and interpreting regular hormone and, as Fisher et al. suggest, PSA tests.
Informed decisions, require information, lab values, and reference ranges!
Speaking about "interpreting" hormone panels. One of the problems youll be facing is that nobody can actually tell you what your normal testosterone level should look like. Of course, every med-school graduate will believe that he knew exactly whats good for you, but when its all said eand done, scientists (and doctors) tend to be a bit too egalitarian, when it comes to "normal ranges". So egalitarian, in fact that they simply assume that a lightweight Chinese pencil pusher must have the same testosterone levels as a 6.6 ft tall, 300lbs heavy Caucasian strongman.
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| Table 1: Normal ranges for total T. |
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| Figure 2: Total and bioavailable testosterone levels in US and Chinese young men (Xu. 2013) |
By this means, the researchers wanted to find out whether the potentially existing differences in androgen levels in Caucasian vs. Asian young men would warrant a revision / specification of the "normal" range for men from different ethnic backgrounds.
As you can see the results are not exactly easy to interpret (Figure 2) - is this a difference, or not?
If we take another look at the data in Figure 2 and compare the relative differences between the total testosterone levels of young US vs. Chinese men to those that made a significant difference, in the previously discussed study by Yeap et al. (see Figure 1), we will have to concede that the xisting differences can hardly be significant. They are after all a magnitude smaller than the quartiles in the Yeap study.
Free vs. total testosterone, measured vs. calculated: Direct measurement of free testosterone levels is different from using the total testosterone and SHBG levels (which were higher in US men, by the way; Xu. 2013) to calculate an estimated amount of free testosterone (cf. Vermeulen. 1999). Since its cheap and usually pretty accurate this is yet what most labs will do. You should however be aware that the values are accurate, only, if your SHBG and albumin values are "normal" as well. If those are out of range, its a good idea to get the free testosterone levels measured directly, to find out where you are standing.
That being said, there are at least three additional reason that speak against establishing specific testosterone cut-off values for different ethnic groups based on the Xu study:- The Xu study is not representative of "all" Chinese young men: The Xu study compares US citizens in the US to Chinese citizens in China. Who tells us that the values they obtained for young Hong Kongers are valid for 2nd generation Chinese immigrants to the US, as well? Environmental conditions, dietary factors, etc. all that could just as well be the reason for the measured differences as ethnicity-specific genetic differences.
- The Xu study, or rather the NHANES data is not representative of a specific ethnicity: By analogy to (1), the Xu study, which uses data from NHANES III to gauge the average testosterone levels of male US citizens, relies on data from Asian, African American, Native American, Hispanic and Caucasian US citizens. How on earth would you establish ethnicity specific normal values based on that?
- Using the Yeap study as a reference to determine "optimal levels" is unwarranted: With old men as study participants, the significance of the optimal total testosterone levels from the Yeap study (12.56 –15.75 mmol/L ≡ 362- 454ng/dL) is about as questionable as the assumption that older men are actually supposed to have significantly lower testosterone levels.
If you do that, i.e. compare free instead of total testosterone levels, you will find that the purported ethnic differences disappear. And this is true not solely for the comparison of the data from Chinese and US men Xu et al. analyzed, but also for the existing differences between Mexican-American, non-Hispanic black and non-Hispanic white men in the NHANES study by Rohrmann et al. (2007). Specific reference ranges for Asian, Caucasian, African American, Hispanics, ... are thus probably unwarranted (not sure about Aliens, though ;-).
The age related decline in testosterone is rapid: Accoring to Morley, et al. the average rate of decrement in testosterone concen-tration for men aged 60+ is 110 ng/dL every decade. A "normal" Caucasian man, who would still have a testosterone level of 500ng/dl when hes sixty (Rohrmann. 2013) would thus end up at 280ng/dl, which is right in the "highest risk of all-cause mortality" quartile (Q1) of the Yep study.
Bottom line: Despite the fact that our insights into the non-existent, or at least insignificant ethnic differences in free and total testosterone levels confirm the validity of the currently propagated "normal" ranges for young men, we are still left with the implications of the Yeap study and the questionable usefulness of "age adjusted" testosterone levels.
If we take into account that the age-induced androgen decline correlates with the aforementioned increases in all cause and cardiovascular mortality (Yeap. 2013), as well as lower levels of handgrip, hip flexors, hip extensors and abductors strength (Perry III. 2000) and an increase risk of development metabolic syndrome (48% higher risk; cf. Rodriguez. 2007), it would certainly appear that any "age-adjustment" thats based on observations in the average aging male is bogus...but I guess thats a topic for another SuppVersity article ;-)
If we take into account that the age-induced androgen decline correlates with the aforementioned increases in all cause and cardiovascular mortality (Yeap. 2013), as well as lower levels of handgrip, hip flexors, hip extensors and abductors strength (Perry III. 2000) and an increase risk of development metabolic syndrome (48% higher risk; cf. Rodriguez. 2007), it would certainly appear that any "age-adjustment" thats based on observations in the average aging male is bogus...but I guess thats a topic for another SuppVersity article ;-)
- Ramasamy, R., Fisher, E. S., & Schlegel, P. N. (2012). Testosterone replacement and prostate cancer. Indian journal of urology: IJU: journal of the Urological Society of India, 28(2), 123.
- Yeap, B. B., Alfonso, H., Chubb, S. P., Handelsman, D. J., Hankey, G. J., Almeida, O. P., ... & Flicker, L. (2013). In Older Men an Optimal Plasma Testosterone Is Associated With Reduced All-Cause Mortality and Higher Dihydrotestosterone With Reduced Ischemic Heart Disease Mortality, While Estradiol Levels Do Not Predict Mortality.
- Perry III, H. M., Miller, D. K., Patrick, P., & Morley, J. E. (2000). Testosterone and leptin in older African-American men: relationship to age, strength, function, and season. Metabolism, 49(8), 1085-1091.
- Rodriguez, A., Muller, D. C., Metter, E. J., Maggio, M., Harman, S. M., Blackman, M. R., & Andres, R. (2007). Aging, androgens, and the metabolic syndrome in a longitudinal study of aging. Journal of Clinical Endocrinology & Metabolism, 92(9), 3568-3572.
- Rohrmann, S., Nelson, W. G., Rifai, N., Brown, T. R., Dobs, A., Kanarek, N., ... & Platz, E. A. (2007). Serum estrogen, but not testosterone, levels differ between black and white men in a nationally representative sample of Americans. Journal of Clinical Endocrinology & Metabolism, 92(7), 2519-2525.
- Traish, A. M., Miner, M. M., Morgentaler, A., & Zitzmann, M. (2011). Testosterone deficiency. The American journal of medicine, 124(7), 578-587.
- Vermeulen, A., Verdonck, L., & Kaufman, J. M. (1999). A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology & Metabolism, 84(10), 3666-3672.
- Xu, L., Au Yeung, S. L., Kavikondala, S., Leung, G. M., & Schooling, C. M. (2014). Testosterone concentrations in young healthy us versus Chinese men. American Journal of Human Biology, 26(1), 99-102.
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