Tuesday, January 31, 2012
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Wednesday, January 25, 2012
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Thursday, January 19, 2012
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Tuesday, January 10, 2012
Bridgetown, Barbados
Monday, January 9, 2012
Saturday, January 7, 2012
Friday, January 6, 2012
It is not as simple as 8 calories a day
TITLE PAGE 19: Twenty two pounds of inevitable fat.
“Over 30 years, the daily ingestion of only 8 kcal more than expended can increase body weight by 10 kg. This represents the average amount of weight gained by Americans during the 30-year period between 25 and 55 years of age. “
p. 1607
Williams Textbook of Endocrinology, 2011, 12 th. Edition by Shlomo Melmed et. al.
Saunders Elsevier
referenced from Rosenbaum M et. al., Obesity. N Engl J Med 1997;337-408.
Caveat Emptor:
“older people have a lower metabolic expenditure than younger ones and as a rule lose weight more slowly since metabolic rates decline by approximately 2% per decade (about 100 kcal per decade) (Lin et. al. 2003).
p. 179
A Guide to Obesity and The Metabolic Syndrome, Origins and Treatment by George A. Bray, CRC press, 2011
This math does not compute. Is it the extra calories or the slower metabolism or are they saying the slower metabolism comes out to be 8 extra kcal. per year?
“Over 30 years, the daily ingestion of only 8 kcal more than expended can increase body weight by 10 kg. This represents the average amount of weight gained by Americans during the 30-year period between 25 and 55 years of age. “
p. 1607
Williams Textbook of Endocrinology, 2011, 12 th. Edition by Shlomo Melmed et. al.
Saunders Elsevier
referenced from Rosenbaum M et. al., Obesity. N Engl J Med 1997;337-408.
Caveat Emptor:
“older people have a lower metabolic expenditure than younger ones and as a rule lose weight more slowly since metabolic rates decline by approximately 2% per decade (about 100 kcal per decade) (Lin et. al. 2003).
p. 179
A Guide to Obesity and The Metabolic Syndrome, Origins and Treatment by George A. Bray, CRC press, 2011
This math does not compute. Is it the extra calories or the slower metabolism or are they saying the slower metabolism comes out to be 8 extra kcal. per year?
The Moral Hazard implicit in Behavior therapy?
TITLE PAGE 18: Fat people have immoral behavior? Gluttony?
“Despite increased awareness and behavioral treatment advances, the worldwide prevalence of obesity and weight-related chronic illnesses continues to expound. Behavioral treatment is inherently challenging and time-consuming, and readily available only to a fraction of the population who may benefit from inclusion. Several investigators have cautioned that individual or group-based interventions are insufficient to serve the population masses requiring treatment.....”
Brent Van Dorsten PhD and Emily M. Lindley, PhD.
Med Clin N Am 95 (2011) 971 -988.
Sept. 2011. Number 5.
“Despite increased awareness and behavioral treatment advances, the worldwide prevalence of obesity and weight-related chronic illnesses continues to expound. Behavioral treatment is inherently challenging and time-consuming, and readily available only to a fraction of the population who may benefit from inclusion. Several investigators have cautioned that individual or group-based interventions are insufficient to serve the population masses requiring treatment.....”
Brent Van Dorsten PhD and Emily M. Lindley, PhD.
Med Clin N Am 95 (2011) 971 -988.
Sept. 2011. Number 5.
A scientist wishing the reduced obese good luck?
TITLE PAGE 17: “Luckily, with time”?
“Sporadic bursts of activity, such as “dieting,” are not effective; the behaviors that achieve and maintain a healthy body weight take a lifetime of commitment. Luckily, with time, these behaviors become second nature.”
p. 325 in Nutrition Concepts and Controversies 2011
Caveat Emptor:
“Maybe the obese eat differently, gulping their food or skipping breakfast only to binge later in the day? But no, that also turned out not to be true. Some overweight people eat quickly, some slowly. Some binge, some do not. Some eat when they are stressed; some lose their appetites in those circumstances. And, in every case, thin people are just as likely as the obese to exhibit those behaviors. There is no behavior that is typical of the obese.”
Conclusion reached by Mickey Stunkard based on the Midtown Manhattan Trial 1962 as reported by Tina Kolata on p. 93 in Rethinking Thin. 2007.
“Sporadic bursts of activity, such as “dieting,” are not effective; the behaviors that achieve and maintain a healthy body weight take a lifetime of commitment. Luckily, with time, these behaviors become second nature.”
p. 325 in Nutrition Concepts and Controversies 2011
Caveat Emptor:
“Maybe the obese eat differently, gulping their food or skipping breakfast only to binge later in the day? But no, that also turned out not to be true. Some overweight people eat quickly, some slowly. Some binge, some do not. Some eat when they are stressed; some lose their appetites in those circumstances. And, in every case, thin people are just as likely as the obese to exhibit those behaviors. There is no behavior that is typical of the obese.”
Conclusion reached by Mickey Stunkard based on the Midtown Manhattan Trial 1962 as reported by Tina Kolata on p. 93 in Rethinking Thin. 2007.
Sponge syndrome prevents energy deficiency
TITLE PAGE 16: The Sponge Syndrome protects humans from starvation
“THE PHYSIOLOGICAL SYSTEM CONTROLLING FOOD INTAKE AND ENERGY EXPENDITURE....
One common misconception is that this physiological system is dedicated to the prevention of obesity. Instead this system's essential role is in the prevention of starvation (ie, ensuring adequate energy intake to compensate for the energy requirements of basal metabolism, physical activity, growth, and reproduction). As a result, this physiological system is more strongly biased toward prevention of energy deficiency rather than excess storage.”
From Greenspans endocrine TEXT
“THE PHYSIOLOGICAL SYSTEM CONTROLLING FOOD INTAKE AND ENERGY EXPENDITURE....
One common misconception is that this physiological system is dedicated to the prevention of obesity. Instead this system's essential role is in the prevention of starvation (ie, ensuring adequate energy intake to compensate for the energy requirements of basal metabolism, physical activity, growth, and reproduction). As a result, this physiological system is more strongly biased toward prevention of energy deficiency rather than excess storage.”
From Greenspans endocrine TEXT
Sponge Syndrome
Title Page 15: Sponge Syndrome
“A new study published in the New England Journal of Medicine finds that hormone changes after weight loss from restrictive diets may make it extra hard to keep the pounds off.
The Study
Researchers at the University of Melbourne in Australia studied the weight loss of 50 obese and overweight subjects over a 10-week period. They found that the changes in hormones that occur during weight loss can last long term. During a deprivation-type diet, hunger hormones leptin and ghrelin, as well as insulin levels change and this study found, a full year after the initial weight loss, hormone levels were still not back to normal. This suggests you may generally feel hungrier than you did months after you reach your goal weight. In addition, you might not be able to clearly detect when you are full, resulting in overeating and weight regain. “
Quote from Calorie Count
These are the compensatory mechanisms that I call the Sponge Syndrome.
“A new study published in the New England Journal of Medicine finds that hormone changes after weight loss from restrictive diets may make it extra hard to keep the pounds off.
The Study
Researchers at the University of Melbourne in Australia studied the weight loss of 50 obese and overweight subjects over a 10-week period. They found that the changes in hormones that occur during weight loss can last long term. During a deprivation-type diet, hunger hormones leptin and ghrelin, as well as insulin levels change and this study found, a full year after the initial weight loss, hormone levels were still not back to normal. This suggests you may generally feel hungrier than you did months after you reach your goal weight. In addition, you might not be able to clearly detect when you are full, resulting in overeating and weight regain. “
Quote from Calorie Count
These are the compensatory mechanisms that I call the Sponge Syndrome.
Athletes can solve the energy gap with exericse?
TITLE PAGE 14: ENERGY GAP
"According to Hill, a weight loss of 40 pounds would result in an energy gap of 300-350 kcal. Thus, to maintain weight loss, an individual would have to either permanently reduce their energy intake by an additional 300 to 350 kcal a day or increase their energy expenditure by 300 to 350 kcal per day. This would roughly equate to taking an additional 6,000 steps or 3 miles per day"
p. 981
Van Dortsten and Lindley
Medical Clinics of North America
Sept. 2011. Volume 95. Number 5
Caveat Emptor:
After losing 10% of your body weight, the exercise metabolic rate decreases by 42%.
Thus the usual formula of burning roughly 100 kcal with each mile of walking is incorrect in the reduced obese.
100 X 0.42 = 42
100 - 42 = 58 kcal burned with each mile.
Thus a person who has lost all that weight actually has to walk an additional 5-6 miles each day to maintain body weight.
The idea that the energy gap of the reduced obese can be solved by simply walking another 6,000 steps is way too simplified. There is muscle memory as well that decreases burning calories.
"According to Hill, a weight loss of 40 pounds would result in an energy gap of 300-350 kcal. Thus, to maintain weight loss, an individual would have to either permanently reduce their energy intake by an additional 300 to 350 kcal a day or increase their energy expenditure by 300 to 350 kcal per day. This would roughly equate to taking an additional 6,000 steps or 3 miles per day"
p. 981
Van Dortsten and Lindley
Medical Clinics of North America
Sept. 2011. Volume 95. Number 5
Caveat Emptor:
After losing 10% of your body weight, the exercise metabolic rate decreases by 42%.
Thus the usual formula of burning roughly 100 kcal with each mile of walking is incorrect in the reduced obese.
100 X 0.42 = 42
100 - 42 = 58 kcal burned with each mile.
Thus a person who has lost all that weight actually has to walk an additional 5-6 miles each day to maintain body weight.
The idea that the energy gap of the reduced obese can be solved by simply walking another 6,000 steps is way too simplified. There is muscle memory as well that decreases burning calories.
The Science of Obesity is just beginning
Title page 12: Rewrite all the books on obestiy
“For instance, the recent discoveries in genetics have found that people differ in their perceptions of hunger and satiety on a genetic basis and that predisposed subgroups of the population may be particularly vulnerable to obesity in “obesogenic” societies with unlimited access to food. This notion must lead to a more open attitude toward obese people and a reduction in discrimination against them [123], it is clear that obesity cannot be considered as a consequence only of indolence or lack of will, as often thought in our societies. In the long term, we are confident that progress in genetics will help to develop useful diagnostic and predictive tests and design new treatments.”
Curr Genomics. 2011 May;12(3):169-79.
Genetics of Obesity: What have we Learned?
Choquet H, Meyre D.
Source
Ernest Gallo Clinic and Research Center, Department of Neurology, University of California, San Francisco, Emeryville, California 94608, USA.
Abstract
Candidate gene and genome-wide association studies have led to the discovery of nine loci involved in Mendelian forms of obesity and 58 loci contributing to polygenic obesity. These loci explain a small fraction of the heritability for obesity and many genes remain to be discovered. However, efforts in obesity gene identification greatly modified our understanding of this disorder. In this review, we propose an overlook of major lessons learned from 15 years of research in the field of genetics and obesity. We comment on the existence of the genetic continuum between monogenic and polygenic forms of obesity that pinpoints the role of genes involved in the central regulation of food intake and genetic predisposition to obesity. We explain how the identification of novel obesity predisposing genes has clarified unsuspected biological pathways involved in the control of energy balance that have helped to understand past human history and to explore causality in epidemiology. We provide evidence that obesity predisposing genes interact with the environment and influence the response to treatment relevant to disease prediction.
“For instance, the recent discoveries in genetics have found that people differ in their perceptions of hunger and satiety on a genetic basis and that predisposed subgroups of the population may be particularly vulnerable to obesity in “obesogenic” societies with unlimited access to food. This notion must lead to a more open attitude toward obese people and a reduction in discrimination against them [123], it is clear that obesity cannot be considered as a consequence only of indolence or lack of will, as often thought in our societies. In the long term, we are confident that progress in genetics will help to develop useful diagnostic and predictive tests and design new treatments.”
Curr Genomics. 2011 May;12(3):169-79.
Genetics of Obesity: What have we Learned?
Choquet H, Meyre D.
Source
Ernest Gallo Clinic and Research Center, Department of Neurology, University of California, San Francisco, Emeryville, California 94608, USA.
Abstract
Candidate gene and genome-wide association studies have led to the discovery of nine loci involved in Mendelian forms of obesity and 58 loci contributing to polygenic obesity. These loci explain a small fraction of the heritability for obesity and many genes remain to be discovered. However, efforts in obesity gene identification greatly modified our understanding of this disorder. In this review, we propose an overlook of major lessons learned from 15 years of research in the field of genetics and obesity. We comment on the existence of the genetic continuum between monogenic and polygenic forms of obesity that pinpoints the role of genes involved in the central regulation of food intake and genetic predisposition to obesity. We explain how the identification of novel obesity predisposing genes has clarified unsuspected biological pathways involved in the control of energy balance that have helped to understand past human history and to explore causality in epidemiology. We provide evidence that obesity predisposing genes interact with the environment and influence the response to treatment relevant to disease prediction.
Running Everyday is not sufficient to prevent weight gain
TITLE PAGE 11: Aging Metabolism
“..older people have a lower metabolic expenditure than younger ones and as a rule lose weight more slowly since metabolic rates decline by approximately 2% per decade (about 100 kcal. per decade) Lin et. al. 2003.”
p. 178
A Guide to Obesity and Metabolic Syndrome. Origins and Treatment by George Bray
2011 CRC Press
This is why even joggers put on weight as they age. Only marathon runners keep the weight off as they age.
“..older people have a lower metabolic expenditure than younger ones and as a rule lose weight more slowly since metabolic rates decline by approximately 2% per decade (about 100 kcal. per decade) Lin et. al. 2003.”
p. 178
A Guide to Obesity and Metabolic Syndrome. Origins and Treatment by George Bray
2011 CRC Press
This is why even joggers put on weight as they age. Only marathon runners keep the weight off as they age.
The Reduced Obese are doomed & damned
TITLE PAGE 10: Can you eat 7 calories/pound a day and walk 5 miles everyday of your life to maintain your weight?
“Treatment of Obesity obviously must lead to a negative energy balance, preferably through reducing food intake and increasing energy expenditure. Even though this strategy sounds simple in theory (according to the first law of thermodynamics), decades of advocating weight loss have failed to stop the obesity epidemic.”
p. 940
Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011
Weight maintenance and the reduced obese
“A clue may be found when studying a ‘rare’ clinical subject: a reduced obese person who has succeeded in losing weight and maintaining the new body weight for more than a year. The National Weight Control Registry documented the metabolic and behavioral cost of maintaining a reduced obese state of maintaining a reduced obese state for more than 5 years. “
Men 1225 kcal/d net after exercise
Women 918 kcal/d net after exercise
p. 945
Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011
Caveat emptor:
There are 6,000 of the reduced obese that have succeeded by maintaining a sub-starvation diet.
How many of the reduced obese failed due to the many compensatory mechanism of the body to prevent starvation? Millions.
Low calorie diets ultimately fail due to the reduced obese suffering from the Sponge Syndrome. They increase weight like a sponge.
After my diet I weighed 200 pounds. The NWCR suggests 7 cal/lb X 200= 1,400 calorie a day.
My five miles walking would burn not 500 calories but 250 calories. This is for maintenance!
This is a life sentence of sub-starvation and vigilance that affects our psyche and requires changes in the life style that are monumental and non-sustainable. Thus the reduced obese are damned by the people who preach moral hazard of poor will power and doomed by the Sponge syndrome.
“Treatment of Obesity obviously must lead to a negative energy balance, preferably through reducing food intake and increasing energy expenditure. Even though this strategy sounds simple in theory (according to the first law of thermodynamics), decades of advocating weight loss have failed to stop the obesity epidemic.”
p. 940
Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011
Weight maintenance and the reduced obese
“A clue may be found when studying a ‘rare’ clinical subject: a reduced obese person who has succeeded in losing weight and maintaining the new body weight for more than a year. The National Weight Control Registry documented the metabolic and behavioral cost of maintaining a reduced obese state of maintaining a reduced obese state for more than 5 years. “
Men 1225 kcal/d net after exercise
Women 918 kcal/d net after exercise
p. 945
Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011
Caveat emptor:
There are 6,000 of the reduced obese that have succeeded by maintaining a sub-starvation diet.
How many of the reduced obese failed due to the many compensatory mechanism of the body to prevent starvation? Millions.
Low calorie diets ultimately fail due to the reduced obese suffering from the Sponge Syndrome. They increase weight like a sponge.
After my diet I weighed 200 pounds. The NWCR suggests 7 cal/lb X 200= 1,400 calorie a day.
My five miles walking would burn not 500 calories but 250 calories. This is for maintenance!
This is a life sentence of sub-starvation and vigilance that affects our psyche and requires changes in the life style that are monumental and non-sustainable. Thus the reduced obese are damned by the people who preach moral hazard of poor will power and doomed by the Sponge syndrome.
Confounds Calories In Calories out Paradigm
TITLE PAGE 9: Very Low Calorie Diets (VLDL)
“the weight loss observed in patients given a liquid diet providing 420 kcal/day was not significantly greater than that observed in persons who consumed a liquid diet providing 800 kcal/day.”
“This suggests that patients treated with VLCDs are either less compliant with the diet or sustain a greater decline in energy expenditure than those treated with LCDs.”
p. 1619
Williams Textbook of Endocrinology, 2011, 12th edition, Shlomo Melmed et. al., Elsevier Saunders.
Reference sited, Foster et. al. A Controlled comparison of three very-low-calorie diets: effects on weight , body composition , and symptoms. Am J Clin Nutr. 1992;55:811-817
Thursday, January 5, 2012
Big Gov't to prevent obesity?
TITLE PAGE 8: The Government Knows how to prevent obesity?
“Our public health leaders must replace prevarication with imagination.”
From the editorial concerning obesity in “The Catastrophic failures of public health.”
Lancet 2004; 363-745
Caveat Emptor:
“Two large studies in the 1990’s, for example, asked whether the measures usually advocated to prevent children from gaining weight are effective.”
See:
Benjamin Caballeo did an 8 year, 20 million dollar project sponsored by National Heart, Lung and Blood Institute with 1,704 third graders in the Southwest.
American Journal of Clinical Nutrition 2003.
Also:
Archives of Pediatrics and Adolescent Medicine in 1999.
5,106 children from 96 schools in California, Louisiana, Michigan and Texas sponsored by the National Institutes of Health.
In neither of these large studies did government intervention help prevent obesity.
From Rethinking Thin by Gina Kolata, pages 197 to 199.
“Our public health leaders must replace prevarication with imagination.”
From the editorial concerning obesity in “The Catastrophic failures of public health.”
Lancet 2004; 363-745
Caveat Emptor:
“Two large studies in the 1990’s, for example, asked whether the measures usually advocated to prevent children from gaining weight are effective.”
See:
Benjamin Caballeo did an 8 year, 20 million dollar project sponsored by National Heart, Lung and Blood Institute with 1,704 third graders in the Southwest.
American Journal of Clinical Nutrition 2003.
Also:
Archives of Pediatrics and Adolescent Medicine in 1999.
5,106 children from 96 schools in California, Louisiana, Michigan and Texas sponsored by the National Institutes of Health.
In neither of these large studies did government intervention help prevent obesity.
From Rethinking Thin by Gina Kolata, pages 197 to 199.
Medical textbook has cognitive dissonance with NCEP guidelines
TITLE PAGE 7: Hey Joe, say it ain’t so.
p. 1202 :
“Little Progress has been made in prevention or treatment (of obesity).....”
p.1204:
“Using conventional dietary techniques only 20% of patients will lose 20 lb. and maintain the loss for over 2 years; 5% will maintain a 40 lb loss.”
Robert B. Baron, MD, MS
2011 Current Medical Diagnosis & Treatment
Stephen J McPhee, McGraw Hill, LANGE
p. 1202 :
“Little Progress has been made in prevention or treatment (of obesity).....”
p.1204:
“Using conventional dietary techniques only 20% of patients will lose 20 lb. and maintain the loss for over 2 years; 5% will maintain a 40 lb loss.”
Robert B. Baron, MD, MS
2011 Current Medical Diagnosis & Treatment
Stephen J McPhee, McGraw Hill, LANGE
Gary Taube responds to the Fat Trap article
www.ipetitions.com
I
just visited www.ipetitions.com and signed an important petition. I
really care about this cause and hope you'll show your support for it.
Wednesday, January 4, 2012
Dr. Dayspring on Sugar
http://www.youtube.com/watch?v=-k5sCpl0nrI&list=UUVmf3paZBKOgE-VO9P2L9jw&index=6&feature=plcp
Energy Expenditure
TITLE PAGE 6: Resting Metabolic Rate
“Basal Metabolic rate accounts for ~70% of daily energy expenditure, whereas active physical activity contributes 5-10%. Thus, a significant component of daily energy consumption is fixed.”
Harrison’s Principles of Internal Medicine 18th Edition, McGraw Hill. Longo et. al. p. 623.
The body can be a miser with calories. Just as a nickel can be stretched to a quarter, a calorie can be stretched and saved quickly as fat. The energy expenditure that decreases in terms of the basal metabolic rate when the reduced obese state is achieved can not be compensated by extra exercise as exercise metabolism is also reduced by 42%.
Brian
“Basal Metabolic rate accounts for ~70% of daily energy expenditure, whereas active physical activity contributes 5-10%. Thus, a significant component of daily energy consumption is fixed.”
Harrison’s Principles of Internal Medicine 18th Edition, McGraw Hill. Longo et. al. p. 623.
The body can be a miser with calories. Just as a nickel can be stretched to a quarter, a calorie can be stretched and saved quickly as fat. The energy expenditure that decreases in terms of the basal metabolic rate when the reduced obese state is achieved can not be compensated by extra exercise as exercise metabolism is also reduced by 42%.
Brian
Tuesday, January 3, 2012
Two Giants reponsible for the Sea Change together
This is a great youtube for physicians and other health care professionals. They talk fast and you may have to watch it a few times to see what beautiful minds and ideas they present.
Dr Thomas Dayspring: Lipidologist
Gary Taubes : Why We get Fat and What to do about it
Youtube.com/specialtyhealth
Skip the top video and scroll down
and enjoy
This is about calories in and calories out controversy:
Weight lifting is to protect joints not lose weight
TITLE PAGE 4: Resistance training is good but not essential
Tim Church’s Ultimate Workout:
High Intensity one day a week
Resistance training (weights) 1-2 days a week
Aerobic 45-60 minutes a day
Stretching 4-5 days a week
Presented at the Core Conference at the Obesity Meeting in Orlando in Oct. 2011.
Caveat emptor
“Weight lifting has virtually no effect on resting metabolism.”
“If the man lifts weights and gains 2.2 kg (4.4 lbs) of muscle, his metabolic rate would increase by 24 calories a day”
Claude Bouchard as related by Gina Kolata in her book, The Ultimate Fitness p230. 2003.
As a physician I am happy if I can get my patients to walk 20 minutes a day.
For people with metabolic syndrome, pre-diabetes or diabetes, the more exercise the better as it helps insulin resistance.
I do not suggest exercise to lose weight. It only works in the long run for Marathon runners.
Tim Church’s Ultimate Workout:
High Intensity one day a week
Resistance training (weights) 1-2 days a week
Aerobic 45-60 minutes a day
Stretching 4-5 days a week
Presented at the Core Conference at the Obesity Meeting in Orlando in Oct. 2011.
Caveat emptor
“Weight lifting has virtually no effect on resting metabolism.”
“If the man lifts weights and gains 2.2 kg (4.4 lbs) of muscle, his metabolic rate would increase by 24 calories a day”
Claude Bouchard as related by Gina Kolata in her book, The Ultimate Fitness p230. 2003.
As a physician I am happy if I can get my patients to walk 20 minutes a day.
For people with metabolic syndrome, pre-diabetes or diabetes, the more exercise the better as it helps insulin resistance.
I do not suggest exercise to lose weight. It only works in the long run for Marathon runners.
Monday, January 2, 2012
Outside the USA use this conversion table
Cholesterol lab conversions
For Canadians, Australians and Europeans, go to OnlineConversion.com to convert your lab results that are in mmol/l to mg/dl.
mg/dl mmol/l
LDL-C 100 2.58 Goal for high risk
90 2.32
80 2.06
70 1.81 Goal for very high risk
60 1.55
50 1.29 Level achieved in Jupiter trial
30 0.90
HDL-C 60 1.55 Positve risk factor in Framingham
50 1.29 Goal for American Diabetic Ass.
40 1.03 < 40 is one criteria for Metabolic synd.
35 0.90 < 35 is major risk factor
Total Cholesterol 300 7.75
200 5.17
190 4.91
160 4.13
120 3.10
100 2.58
Triglycerides 200 2.25 Abnormal level for non-fasting
170 1.91
150 1.69 NCEP upper limit of normal
100 1.12 Better upper limit of normal
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