The rigor and strength of science or lack thereof: “Sun-Shine” Vitamin D

In one of my talks at Taiwanese Bible Study a few months ago, vitamin D was one of the topics.  I showed many reports published in New York Times, Scientific American, Science or Gut; showing vitamin D is essential for most organs and good for many diseases or can even prevent colon cancer.

It makes sense that it happens as most cells in all organs have receptors for vitamin D.  Vitamin D is not just for the bone.

In a study published in Gut and New York Times (1/15/2015) showing “the higher the vitamin D level, the less likely one will develop colon cancer.”  We read the comment from Dr. Shuji Ogino (Dana-Farber Cancer Institute), “Vitamin D boosts immunity not just in cancer, but in fighting infections as well.”

An article in New York Times reported adults with low levels of vitamin D would have 35% increased risk of death from heart disease and 14% greater likelihood of death from cancer.

Reports link low vitamin D levels to Parkinson disease, autism or psychosis.  No wonder the vitamin D test skyrocketed the past 10 years or so. 

Is this the sound science or the hype? One New York Times article asked.

The Institute of Medicine (the most prestigious and authoritative institute in medicine) issued a report in November 2010 claiming vitamin D and calcium play a key role in bone health and evidences do not support other benefits.  It concluded that higher [vitamin D] level doesn’t confer greater benefit and may be harmful.

The Institute assessed more than 1000 studies/reports plus expert testimony related to various health outcomes.  They found evidences (other than bone health) to be mixed and inconclusive. Current evidences support a role in bone health but not in other health conditions.

US Preventive Services Task Force (USPSTF) also issued a similar report in July 2012, saying “found insufficient evidence to recommend supplement to healthy people to prevent broken bone or cancer.”

Why so many experts are non-believers?
Almost all vitamin D studies are “observational”, lacking scientific rigor and strength.  The experts are academicians who only have confidence on controlled double-blind trials.

making vitamin D in the garden

Correlation does not necessarily mean a cause-and-effect relationship
Some hold a view that high vitamin D level is the result, not the cause, of good health.  People may have high vitamin D levels because they exercise a lot and are getting ultraviolet-light exposure from working in the garden.

My recommendation
The experts do not recommend routine vitamin D blood test for healthy individuals.  I may have ordered vitamin D tests more often than I should.  However, if a normal vitamin D level is good for bone health; that alone is enough incentive to do the test, not that I believe in other potential benefits.

The normal vitamin D level: 25(OH) Vitamin D is 30-100 ng/ml.

National Osteoporosis Foundation recommends persons with osteoporosis to take 800-1000 IU vitamin D a day and 1200 mg calcium a day, whereas Endocrine Society recommends vitamin D 1500-2000 IU a day.



Vitamin  D test skyrocketed

On translating “A Dream of Red Chamber” (紅樓夢)

I have been reading “A Dream of Red Chamber” (紅樓夢) in Chinese and in English side by side, in an attempt to learn the skill of translating Chinese into English.  English version also helps me better understand Chinese version here and there.

紅樓夢 was written two hundred some years ago; the language was different from modern vernacular Chinese (白話); to me it was a more concise, more refined and more beautiful language.  I liken it to Shakespeare’s language, comparing with modern English.

I will write about 紅樓夢 as I read or as I please, focusing on the aspect of English translation.  I am not well versed on either language, so this is just a comment, not a critique.  Janice always wanted to read the book in English, I never encouraged her; as she cannot appreciate as much as I can.  No matter how good a translation, the beauty of the Chinese language was lost in translation.

There was an abridged (about half the length of the original) translation of the book by Lin Yutang.

今年方五十上下，只有薛蟠一子。還有一女比薛蟠小兩歲，乳名寶釵，生得肌骨瑩潤，舉止嫻雅
She was about forty years of age and Xue Pan was her only son.  But she also had a daughter two years younger whose infant name was Baochai, a beautiful, dainty girl of great natural refinement. (translation in book)

My comments:
Xue Baochai (薛寶釵) eventually married Jia Baoyu (賈寶玉). 生得肌骨瑩潤，舉止嫻雅 is how she was described when I first came across her on the page.  “a beautiful, dainty girl of great natural refinement” is a good translation; I can do no better, but Baochai would say “I am better than that.”

今年方五十上下 was translated as “She was about forty years of age”.  I think the Chinese says “more or less fifty years of age”, which is “about fifty years of age”.

乳名 was translated as “infant name”; “childhood name” would be better.

只打了個落花流水，生拖死拽，把個英蓮拖去，如今也不知死活
He stared a big fight, and then dragged her off by force more dead than alive. What’s become of her since, I don’t know. (translation in book)

My comments:
落花流水 comes from a poem of “流水落花春去也，天上人間”.  The idiom of 落花流水 now means “involving a big fight and often was beaten”.  如今也不知死活  “What’s become of her since, I don’t know.” is an excellent translation by any measure.

落花流水, when reversed as 流水落花, the meaning remains the same; examples abound; that’s the beauty of Chinese language.

The flowers watched the tilting sighingly in silence (感傷歎息)

A few days ago we’re tilting, which is part of the clean-up job at the end of the gardening.  The nearby flowers, mostly zinnia, marigold and Sylvia, watched sighingly in silence (感傷歎息) for their days remained which were not many.

Speaking of 感傷歎息 which means “sigh in a lamenting way”.  I am reading “A Dream of Red Chamber (紅樓夢)” in Chinese and in English and noticed in one sentence the  感傷歎息 was translated as “very upset”, which, in my view, was not the best choice of word. “Upset” is emotionally disturbed; more of agitating or angry, than lament and sigh.

我將緣故回明, 那太爺感傷歎息了一回。

He seemed very upset when I explained all that had happened.

Dear doctor, do I have to take Co-enzyme Q10?

Hans Krebs and Fritz Lipmann shared the Nobel Prize in medicine in 1953 for their discovery of citric acid cycle, now bears his name, Krebs cycle, and coenzyme A.  Krebs cycle is the furnace to burn the fuel of life producing energy (ATP) to keep us going.  In his Nobel Lecture, Krebs thanks Lipmann profusely for his discovery of coenzyme A, without which the concept of a cycle is incomplete. 

However, this is still not the end of the story as the last step of how ATP is produced was still elusive until 1961 when Peter Mitchell presented his bold chemiosmosis theory or electron transport chain, at which time no any experimental data to prove it. Mitchell was indeed one of greatest theoretic chemists/biologists.

Chemiosmosis showing ATP is produced  (from Mitchell's Nobel Lecture)

His audacious theory inspired or propelled numerous experiments during the ensuing 20 years.  In his Nobel Lecture, Mitchell quoted Max Planck, saying “a new scientific idea does not triumph by convincing its opponents, but rather because its opponents eventually die”, he then said “The fact that what began as the chemiosmotic hypothesis has now been acclaimed as the chemiosmotic theory - at the physiological level, even if not at the biochemical level - has therefore aroused in me emotions of astonishment and delight in full and equal measure, which are all the more heartfelt because those who were formerly my most capable opponents are still in the prime of their scientific lives.

Few may be aware that Krebs’ earth-moving, heaven-shocking (驚天動地) discovery of the citric acid cycle was initially rejected by Nature.

At the end of his Nobel Lecture, Mitchell talked about ubiquinone (coenzyme Q10) being the electron transporter (in the mitochondrial membrane) in the last step of producing ATP.  Thus Q10 is needed to convert the food into energy.  I cannot overemphasize the importance of it.

Chemiosmosis showing ubiquinone or Q10 in action--from Mitchell's Nobel Lecture)

Not that Q10 is not important enough; it is also an antioxidant, function of which is to protect cells from the damages caused by free radicals in many vital life processes.

With that being said, knowing how important Q10 is in the role it plays in vital life process. Does that mean everyone should take Q10 as a supplement every day? The answer is not as easy as it seems.

Coenzyme Q10 is found in most of the organs.  It is estimated that dietary intake contributes about 25% of plasma Q10 level.  Most people get enough Q10 through a balanced diet.  Food rich in Q10 include salmon, tuna, liver or whole grains.  No specific dietary intake of Q10 recommendation was ever issued by Institute of Medicine or other agencies.

When patients told me they are taking dietary supplements, including Q10, my position is that I will encourage them to take it if most randomized controlled trials are beneficial, even negligible.  I would counsel and caution them if most of the studies showing conflicting results.  I would discourage them if I am aware of the significant adverse effects.  In case of Q10 I found no reason to discourage, nor to encourage whole-heartedly, at least not yet.

But Q10 supplements may be of benefit in certain conditions, although not without controversy in most of the cases.  My personal view is that when in doubt, check it out or try it out (as patients please) as the known adverse effects seem negligible.

I will discuss some of the more specific medical conditions that the use of Q10 has been studied.

Using Q10 to prevent or treat myopathy (muscle ache) caused by cholesterol-lowering “statins”
The main reason why people stop taking cholesterol-lowering “statins” (the likes of Zocor, Lipitor, Pravachol, Crestor) is myopathy (causing muscle ache). Q10 depletion has been implicated in statin-induced myopathy; it seems logic to use Q10 to prevent or treat it.  There is anecdotal evidence for benefit, but there are no published controlled trials.  An UpToDate article doesn’t recommend using Q10 to prevent or treat statin-induced myopathy.

Using Q10 for the therapy of heart failure
A randomized trial found that Q10 reduced mortality and hospitalization in patients with moderate to severe heart failure. 

However, a systemic review included seven randomized trial with a total of 914 patients with heart failure comparing Q10 with placebo.  It showed no benefit of Q10.  Based on this the 2013 American College of Cardiology/American Heart Association guidelines do not recommend using Q10 as a therapy for heart failure.

Neuroprotective effects of coenzyme Q10 in Parkinson disease
Interest in Q10 was inspired by evidence that mitochondrial dysfunction may play a role in the pathogenesis of Parkinson disease.  But studies showed Q10 has no neuroprotective effect for patients with Parkinson disease.  One study involved 80 patients using high dosage of 1200 mg/day, another study involved 131 patients.  Another Phase III study, involving 300 patients, was halted for “futility after an interim analysis, showing neither neuroprotective nor symptomatic benefit of Q10.

Using Q10 to treat diabetes
A report in Diabetes Medicine (in 1999) showing supplementation with 100 mg/day of Q10 for three months neither improved blood sugar control nor decreased insulin requirement in type 1 diabetics compared to placebo.  Numerous other studies showed conflicting results; some suggested harm from taking Q10.

Some claim the favorable response to Q10 in treating diabetic neuropathy.  In an UpToDate article of treating diabetic neuropathy, Q10 was not even mentioned.

NIH Cancer Institute has a lengthy post about Q10, too.
Q10 has been shown to protect the heart from anthracycline-induced cardiotoxicity (anthracyclines are a family of chemotherapy drugs, including doxorubicin, that have the potential to damage the heart.)

The list goes on

Idiosyncratic idioms

I always think idioms are invented to 欺負 (take advantage of) the foreigners or ones with a foreign tongue, as the meaning of which, more often than not, cannot tell literally from its component words.

“neck of the woods” (neighborhood) is nothing to do with the neck. What’s “raining cats and dogs” (heavy downpour) got to do with cats and dogs?  It is hard to guess “to let the cat out of the bag” is to reveal a secret. If she “has a bee in her bonnet”; she is obsessed.  If a doctor says “it sounds like run of the mill cases”; it means cases being discussed are “average, nothing special”.

Bill Watterson likes to use idioms in his Calvin and Hobbes comic strips.  “give someone a run for the money” means “to be as good at something as someone who is very good”.

“hit the spot” or “hit the bull’s eye” is to be exactly right.

In A Dream of Red Chamber, “雨村閒居無聊” is translated as “Then Yucun, finding time heavy on his hand”, which is a good translation as time seems to go slowly [the heavier the slower the time travels] when one has nothing to do.

“born with a silver spoon in one’s mouth” is to say born into wealth and privilege.  In A Dream of Red Chamber we read “胞胎 嘴裡便啣下一塊五彩晶瑩的玉來” (the birth of a son who came into this world with a piece of clear, brilliantly colored jade in his mouth”.) Since this was talking about a prominent family, so I think East and West thought are in the same line.

Color is unique to each culture. “Once in a blue moon” (occurs rarely) and “out of the blue” (unexpected). “Feeling blue” is a melancholy mood.  One should never give a Chinese gentleman a green hat, as “戴绿帽” (wearing a green hat) tells he is being cheated by his wife.  黄色小說 (yellow novel) is often referred to sex or pornographic novels.  After reading D.H. Lawrence’s Lady Chatterly’s Lover, I am not sure I would call it 黄色小說 or not.  To compare Fifty Shades of Grey with Lady Chatterly’s Lover  is to elevate the former.  Call one’s wife 黄臉婆 (yellow face old lady) is very unflattering.

Charles told me there are thousands of set phrases in Chinese and gave some examples, such as 相見恨晚, 招蜂引蝶, 拈花惹草, and  窈窕淑女，君子好逑 , which were first used 2,300 years ago.  Chinese set phrases or idioms are much more poetic and cannot be translated literally.

How to make a long lasting garden?

These photos of our garden were taken yesterday (October 6)—a birthday of one of our loved ones.  If we couldn’t deliver the flowers, we at least transmit the photos of them.  They certainly do not look like they’re on their way out.

To maintain a garden this size, one needs flowers, lots of them; so all the flowers can paint our garden with delight (paraphrasing from a song of Spring in Love’s Labour’s Lost).  They should be long lasting; this is one of the criteria in choosing the flowers.  A good friend of us told me the Chinese name of zinnia is 百日草, which means they will bloom for 100 days.

As I have said zinnia led me to Emily Dickinson, or the other way around, I no longer remember.  It doesn’t matter.

Roses have seen their best days, but they are not the last rose of the summer yet.

How long do the vivacious canna blooms last? Many weeks, but not 100 days.  So I planted the canna over a period of 5 or 6 weeks; the early bloom has long faded, some are blooming and beaming with the bright red color now; some haven’t even bloomed yet.   This is why some of the celosia are still “burning with dazzling flame” while most have lost their luster.

Some like it hot, especially the luffa, warm and hot days are conducive for luffa growth; we  no longer have that luxury.  These luffas are like teenager girls, anxious to grow and mature, before the first frost comes.  Like Thomas Jefferson who recorded the date of the first fall frost each year in his garden Journal, we are watching the first frost with a vigilant eye.

A comment from a good friend (see photo below),

只見一張空椅子，沒有主人，故作一首打油詩，為其抱屈。

問君何處桃源(花園，或絲瓜園)可避暑，

空有涼椅等君半夜回。

This is another poem by our good friend.  If our garden can bring forth all these beautiful poems from our friends, the beauty of our garden must be aesthetic and exquisite.

    蔡家花園
誰家花園百花開？
引得蜂蝶過牆來，
閒坐書生瓜棚下，
又吟又飲且開懷。

            Tsai's Garden
Who's garden with hundreds of flowers still blooming?
Drawing the bees and butterflies fence crossing ,
A reader leisurely sitting under the squash awning,
Heartily enjoying by reading and drinking.

There will be a game at PNC Park Wednesday (10/7/15)

With one day left for the MLB season yesterday (Oct. 3, 2015) Pittsburgh Pirates (97:64) was one game ahead of Chicago Cubs (96:65).  If Pirates loses and Cubs wins the last game, then Pirates will lose the home field at PNC Park for the one-game wild card game on Oct. 7.  The stakes are high; we have to go; we got to go; we went.

Judging from the fact that the gigantic “waves” ran through the entire ball park more than 5 or 6 times, the PNC Park was a happy place this afternoon (3PM to 6PM); euphoric, Jolly Roger waving, noisy hand-clapping, loud laughing, even louder shouting, everything but silent.  Pirates beat the Cincinnati Reds 4 to 0, clinching the home field.  It has been my observation that the attempt of making “waves” can never succeed unless host’s team is winning; a collective euphoric and exuberant mood is a prerequisite for making the “waves”.

While singing “Take me out to the ball game” before the bottom of the 7^th inning, I was thinking about Chicago Cubs, as the tradition of singing this song began in the Cubs field long ago.  But I have been keeping an eye on the MLB score boards from the very beginning of the game.  Cubs was playing with the Brewers at Milwaukee.  Cubs scored 3 at the first inning and eventually beat the Brewers 3 to 1, at which time Pirates was winning 4 to 0 in the 8^th inning.  Pirates had no choice but winning.

Now Pittsburghers can sing “Take me out the ball game” at PNC Park, not Wrigley Field in Chicago.

The closer, Mark Melancon (with a major league-high 51 saves--see photo below), came out to close the game even it was not a “save” situation as Pirates was leading 4 to 0.

A very nice gentleman showed us a photo of us in his camera (with lens as long as your arm, a professional one), asking our email so he can send us the photos of us. One of the photos shows both Katy and I are busy “in action” with our cameras.  We appreciate his thoughtfulness.

Chicago Cubs will use their ace pitcher, Jake Arrieta, who is 13-1 with an ERA 1.60 on the roads.  Chicago Cubs are 6-4 at PNC Park this season.  It will be a daunting task to face this formidable enemy, but Pirates (53-28 at PNC Park), along with its most loyal fans can manage it to get the job done.  Gerrit Cole will meet the challenge facing Jake Arrieta. Let’s Go Bucs!

Oeil-de-Boeuf and poem of poet, 李啇隱

What’s Oeil-de-Boeuf got to do with poem of poet, 李啇隱 (813-858)?  Let me tell the story.

登樂游原   
向晩意不適，驅車登古原，
夕陽無限好，只是近黃昏。

Going up to the Lo You Height                 
(translated by our friend, Charles)

I felt sorrow toward the evening,
I drove up to the ancient highland,
The evening sun is so beautiful ,
But it is approaching the night fall.

A good friend of ours emailed us talking about how he was excited and stirred while visiting Xi’an (西安), during which he saw a poem (see above) of poet, 李啇隱  (of 1,300 years ago), engraved in the stone.  He wrote,

“當我登上樂游原時，想起一千三百年前名詩人李啇隱，帶著「向晚意不適」的心情，在這裡兩手背後躊𨀉而行，我心中覺得我們是那麼接近，心情的喜悅與感觸不可言喻”

No need to translate as it is the same as what Lin Yu-Tang said in his “Art of reading” essay in The Importance of Living, (Charles read all books in English and Chinese by Lin Yu-Tang; I only read his English books.)

“Scholars seemed to have lived in different ages, separated by centuries, and yet their modes of thinking and feeling were so akin that their coming together across the pages of a book was like a person finding his own image.”

My friend wrote, “説不定我們會碰頭呢！” (We may meet one day!), I wrote, “but, you have met.”

It was the same stir in me when I saw “Oeil-de-Boeuf” in Versailles Palace September of 2014.  After marveling at the splendor and majesty of Grande Galerie (or called Galerie des Glaces because of its grand mirrors), we turned around the corner; Oeil-de-Boeuf immediately came into view.

The room is actually a short hallway connecting the King’s (Louis XVI) and Queen’s (Marie Antoinette) bed chambers.  It is best known as Oeil-de-Boeuf (bull-eye) as there are windows looking like “bull-eye” in it.

One will come across “Oeil-de-Boeuf” hundreds of times reading Thomas Carlyle’s The French Revolution.  Oeil-de-Boeuf is no longer just the name of a room, it is a symbol.

The fateful day was October 5 of 1789. Women in the market place were protesting the high price and shortage of bread; they quickly became a rioting mob, tens of thousands, gathering all the weapons they could lay their hands, marching to Versailles; as one historian said “the female insurrectionary force resembles the English Naval one.”

They broke through the guards, killing two of them, chasing Queen Marie Antoinette through Oeil de Boeuf to King’s bed chamber.  The photo (above) shows the small back door, through which she ran to the Oeil de Boeuf.  Next day they were forced to move to Paris, never returned.

The chasing at Oeil de Boeuf is as important an event as the storming of Bastille (7/14/1789) although less well known.  These events marked the turning points for violence in the unpredictable and uncontrollable revolution process.

While in Oeil de Boeuf, seeing the “bull eye” window, Janice and I quickly realized where we were; we thus fired up our imagination, seeing how the queen ran for her life; hearing the clamorous shouting of the mob; the scene was just like evening TV news to us.  Marie Antoinette (the most unfairly vilified woman in history) was not just the portrait hanging in her bed chamber; she was real; history came alive.

You may be interested in reading what Thomas Carlyle wrote about the chasing in Oeil de Boeuf in his The French Revolution, written in 1837, forty some years after the event.

Trembling maids of Honour, . . . hastily wrap the Queen; not in robes of state.  She flies for her life, across the Oeil de Boeuf; against the main door of which too Insurrection batters.  She is in the King’s Apartment, in the King’s arms; she clasps her children amid a faithful few.  The Imperial-hearted bursts into mother’s tears. “O my friends, save me and my children!”  The battering of Insurrectionary axes clangs audible across the Oeil-de-Boeuf.  What an hour!

The following paragraph is three years after the revolution began,

Three short years ago there was still Versailles and an Oeil-de-Boeuf: now there is that watched Circuit of the Temple, girt with drag-on-eyed Municipals, where, as in its final limbo, Royalty lies extinct.  In the year 1789, Constituent Deputy Barrere ‘wept’ in his Break-of-Day Newspaper, at sign of a reconciled King Louis; and now in 1792, Convention Deputy Barrere, perfectly tearless, may be considering whether the reconciled King Louis shall be guillotined or not.

This paragraph described the mood in Versailles in 1787 in the early days of the revolution.

What a France, through these winter months of the year 1787! The very Oeil-de-Boeuf is doleful, uncertain; with a general feeling, among the Suppressed, that it were better to be in Turkey . . . in the Trianon little-heaven, her majesty, one evening, takes Besenval’s [The last Commander of the Swiss Guards of France] arms; asks his candid opinion.  The intrepid Besenval’s—having, as he hopes, nothing of the syncophant in him, plainly signifies that, with a Parlement in rebellion, and an Oeil-de-Boeuf in suppression, the King’s Crown is in danger; whereupon, singular to say, her Majesty, as if hurt, changed the subject.

The following is the happier days in Oeil-de-Boeuf in 1783,

On the 3^rd of November 1783, the Oeil-de-Boeuf rejoices in its new Controller-General. . . . Great, in any case, is the felicity of the Oeil-de-Boeuf.  Stinginess has fled from these royal abides: suppression ceases; . . . .