Category Archives: Well-Being – PersonaL

Well-Being, Personal Well-Being, Health, Obesity, Chronic Disease, Healthy eating, healthy drinking, healthy cooking, physical exercise, Prevention, Predictive Medicine, Genomics, Personalization, Forecasting, Public Policy, Assessment, Diagnostics, Adaptive Health Systems Design, Medicare, Obamacare, Active, Healthy Living

Amazon, BH, JPMorgan

With 1.2 million employees, Amazon, Berkshire Hathaway, and JP Morgan have decided to venture together into health care for their employees.

Following in the grand tradition of Henry Ford, who set up Henry Ford Hospital in Detroit, these three giants are stepping in too.

They have no illusions about how difficult it will be. But with premiums rising 19% per year, its clear that Congress is doing nothing, and someone has to do something.

“Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.”

The article points out that there are others working on this.

“Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.”

“Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care.”

“Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.”

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers”

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CREDIT: https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html?smid=nytcore-ipad-share&smprod=nytcore-ipad

TECHNOLOGY
Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

By NICK WINGFIELD, KATIE THOMAS and REED ABELSON
JAN. 30, 2018
SEATTLE — Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States.

The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses.

Major employers, from Walmart to Caterpillar, have tried for years to tackle the high costs and complexity of health care, and have grown increasingly frustrated as Congress has deadlocked over the issue, leaving many of the thorniest issues to private industry. About 151 million Americans get their health insurance from an employer.
(Why will health care be so difficult for these companies to untangle? Analysis from The Upshot.)
But Tuesday’s announcement landed like a thunderclap — sending stocks for insurers and other major health companies tumbling. Shares of health care companies like UnitedHealth Group and Anthem plunged on Tuesday, dragging down the broader stock market.

That weakness reflects the strength of the new entrants. The partnership brings together Amazon, the online retail giant known for disrupting major industries; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

They are moving into an industry where the lines between traditionally distinct areas, such as pharmacies, insurers and providers, are increasingly blurry. CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the changes underway. Separately, Amazon’s potential entry into the pharmacy business continues to rattle major drug companies and distributors.
(Here’s a look at how the even the threat of Amazon’s entry into an industry can rattle stocks.)

The companies said the initiative, which is in its early stages, would be “free from profit-making incentives and constraints,” but did not specify whether that meant they would create a nonprofit organization. The tax implications were also unclear because so few details were released.
Jamie Dimon, the chief executive of JPMorgan Chase, said in a statement that the effort could eventually be expanded to benefit all Americans.

“The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” Jeff Bezos, Amazon’s founder and chief executive, said in a statement. “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”

The announcement touched off a wave of speculation about what the new company might do, especially given Amazon’s extensive reach into the daily lives of Americans — from where they buy their paper towels to what they watch on television. It follows speculation that the company, which recently purchased the grocery chain Whole Foods, might use its stores as locations for pharmacies or clinics.
(We asked health care experts to imagine what the three corporations might do.)

“It could be big,” Ed Kaplan, who negotiates health coverage on behalf of large employers as the national health practice leader for the Segal Group, said of the announcement. “Those are three big players, and I think if they get into health care insurance or the health care coverage space, they are going to make a big impact.”

TAKING ON ‘THE HUNGRY TAPEWORM’
A look at the three companies that announced a joint health care initiative on Tuesday.

Total employees: 1.2 million 
Amazon: 540,000 
Berkshire Hathaway: 367,000
JPMorgan Chase: 252,000.
Individual strengths 
Amazon: logistics and technology
Berkshire Hathaway: insurance
JPMorgan Chase: finance.

Jeff Bezos of Amazon:
“The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.”
Warren E. Buffett of Berkshire Hathaway:
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
Jamie Dimon of JPMorgan Chase:
“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

But others were less sure, noting that the three companies — which, combined, employ more than one million people — might still hold little sway over the largest insurers and pharmacy benefit managers, who oversee the benefits of tens of millions of Americans.

“This is not news in terms of jumbo employers being frustrated with what they can get through the traditional system,” said Sam Glick of the management consulting firm Oliver Wyman in San Francisco. He played down the notion that the three partners would have more success getting lower prices from hospitals and doctors. “The idea that they could have any sort of negotiation leverage with unit cost is a pretty far stretch.”

Even the three companies don’t seem to be sure of how to shake up health care. People briefed on the plan, who asked for anonymity because the discussions were private, said the executives decided to announce the initiative while still a concept in part so they can begin hiring staff for the new company.

Three people familiar with the partnership said it took shape as Mr. Bezos, Mr. Buffett, and Mr. Dimon, who are friends, discussed the challenges of providing insurance to their employees. They decided their combined access to data about how consumers make choices, along with an understanding of the intricacies of health insurance, would inevitably lead to some kind of new efficiency — whatever it might turn out to be.

“The ballooning costs of health care act as a hungry tapeworm on the American economy,” Mr. Buffett said in the statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Over the past several months, the three had met formally — along with Todd Combs, an investment officer at Berkshire Hathaway who is also on JPMorgan’s board — to discuss the idea, according to a person familiar with Mr. Buffett’s thinking.

The three chief executives saw one another at the Alfalfa Club dinner in Washington on Saturday, but by then each had already had dozens of conversations with the small in-house teams they had assembled. The plan was set.

Mr. Buffett’s motivation stems in part from conversations he has had with two people close to him who have been diagnosed with multiple sclerosis, according to the person. Mr. Buffett, the person said, believes the condition of the country’s health care system is a root cause of economic inequality, with wealthier people enjoying better, longer lives because they can afford good coverage As Mr. Buffett himself has aged — he is 87 — the contrast between his moneyed friends and others has grown starker, the person said.

The companies said they would initially focus on using technology to simplify care, but did not elaborate on how they intended to do that or bring down costs. One of the people briefed on the alliance said the new company wouldn’t replace existing health insurers or hospitals.

Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.

One potential avenue for the partnership might be an online health care dashboard that connects employees with the closest and best doctor specializing in whatever ailment they select from a drop-down menu. Perhaps the companies would strike deals to offer employee discounts with service providers like medical testing facilities.

“Each of those companies has extensive experience using transformative technology in their own businesses,” said John Sculley, the former chief executive of Apple who is now chairman of a health care start-up, RxAdvance. “I think it’s a great counterweight to what government leadership hasn’t done, which is to focus on how do we make this health care system sustainable.”

How Amazon Rattles Other Companies
The e-commerce giant’s actions – some big, like buying Whole Foods Markets; some smaller, like Amazon meal kits – have led to stock sell-offs for a wide range of businesses.

Erik Gordon, a professor at the University of Michigan’s Ross School of Business, predicted that the companies would attempt to modernize the cumbersome process of doctor appointments by making it more like booking a restaurant reservation on OpenTable, while eliminating the need to regularly fill out paper forms on clipboards.

“I think they will bring the customer-facing, patient-facing thing into your smartphone,” he said.

Amazon has long been mentioned by health care analysts and industry executives as a potential new player in the sector. While the company has remained quiet about its plans, some analysts noted that companies often use their own employees as a testing ground for future initiatives.

The entry of Amazon and its partners adds to the upheaval in an industry where much is changing, from government programs after the overhaul of the tax law to the uncertain future of the Affordable Care Act. All the while, medical costs have persistently been on the rise.

Nationwide, average premiums for family coverage for employees rose to $18,764 last year, an increase of 19 percent since 2012, according to the Kaiser Family Foundation. Workers are increasingly paying a greater share of those costs — they now pay 30 percent of the premium, in addition to high deductibles and growing co-payments.
“Our members’ balance sheets speak for themselves — health care is a growing cost at a time when other costs are either not rising or falling,” said Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.

Other major employers have also sought more direct control over their employees’ health care. Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care. Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers, said controlling rising prices is especially hard in markets where a local hospital or medical group dominates. While some have tried to tackle the issue in different ways, like sending employees with heart conditions to a specific group, “it’s piecemeal,” she said.

She added, “There are so many opportunities to do this better.”

The issue is not solely a 21st-century concern: In 1915, Henry Ford became increasingly worried about the quality of health care available to his growing work force in Detroit, so he opened the Henry Ford Hospital. It is still in existence today.

Nick Wingfield reported from Seattle, Katie Thomas from Chicago and Reed Abelson from San Francisco. Michael J. de la Merced contributed reporting from London, and Emily Flitter from New York.

A version of this article appears in print on January 31, 2018, on Page A1 of the New York edition with the headline: 3 Giants Form Health Alliance, Rocking Insurers. Order Reprints| Today’s Paper|Subscribe

Prevention Revisited

The essay below is an argument for the quality of life benefits of prevention. But its conclusions about whether prevention saves money? Those conclusions are depressing.

But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

The source of this essay is worth considering. If you look below, Dr. Aaron just published a book arguing that bad foods are not so bad – in moderation. This is a conclusion I happen to agree with. I agree with “all things in moderation”.
 
For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!
 
I publish but do not endorse…..

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CREDIT: Essay in the New York Times

THE NEW HEALTH CARE

The essay below is depressing. But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

I definitely don’t trust the source of this essay, or its conclusions.

For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!

I publish but do not in any way endorse…..

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CREDIT: New York Times Essay

THE NEW HEALTH CARE

Preventive Care Saves Money Sorry, It’s Too Good to Be True

Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price.

By Aaron E. Carroll
Jan. 29, 2018

The idea that spending more on preventive care will reduce overall health care spending is widely believed and often promoted as a reason to support reform. It’s thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in emergency rooms, where it costs more. It should follow then that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run.
Unfortunately, almost none of this is true.

Let’s begin with emergency rooms, which many people believed would get less use after passage of the Affordable Care Act. The opposite occurred. It’s not just the A.C.A. The Oregon Medicaid Health Insurance experiment, which randomly chose some uninsured people to get Medicaid before the A.C.A. went into effect, also found that insurance led to increased use of emergency medicine. Massachusetts saw the same effect after it introduced a program to increase the number of insured residents.

Emergency room care is not free, after all. People didn’t always choose it because they couldn’t afford to go to a doctor’s office. They often went there because it was more convenient. When we decreased the cost for people to use that care, many used it more.
Wellness programs, based on the idea that we can save money on health care by giving people incentives to be healthy, don’t actually work this way. As my colleague Austin Frakt and I have found from reviewing the research in detail, these programs don’t decrease costs — at least not without being discriminatory.

Accountable care organizations rely on the premise that improving outpatient and preventive care, perhaps with improved management and coordination of services for those with chronic conditions, will save money. But a recent study in Health Affairs showed that care coordination and management initiatives in the outpatient setting haven’t been drivers of savings in the Medicare Shared Savings Program.

There’s little reason to believe that even more preventive care in general is going to save a fortune. A study published in Health Affairs in 2010 looked at 20 proven preventive services, all of them recommended by the United States Preventive Services Task Force. These included immunizations, counseling, and screening for disease. Researchers modeled what would happen if up to 90 percent of these services were used, which is much higher than we currently see.

They found that this probably would have saved about $3.7 billion in 2006. That might sound like a lot, until you realize that this was about 0.2 percent of personal health care spending that year. It’s a pittance — and that was with almost complete compliance with recommendations.

One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made.

This doesn’t mean it saves money.

In 2009, as part of the Robert Wood Johnson Foundation’s Synthesis Project, Sarah Goodell, Joshua Cohen and Peter Neumann exhaustively explored the evidence. They examined more than 500 peer-reviewed studies that looked at primary (stopping something from happening in the first place) or secondary (stopping something from getting worse) prevention. Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained.

But all of these analyses looked within the health care system only. If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all?

A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending. It found that such a tax would cause many people to quit smoking — the desired result. In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.
But in the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit — even with the increased revenue from taxing cigarettes.

But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.
There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.
Sometimes good things cost money.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of The Bad Food Bible: How and Why to Eat Sinfully.

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CREDIT: https://www.npr.org/sections/thesalt/2017/11/19/564879018/the-bad-food-bible-says-your-eating-might-not-be-so-sinful-after-all

The Bad Food Bible
How and Why to Eat Sinfully
by Aaron, M.D. Carroll and Nina Teicholz
Hardcover, 272 pages

There are some surprises in your book, like milk isn’t as nutritious as some might think?

This is one of those where, if you just look at nature, we’re the only animal that consumes milk outside of the infant period. Now there’s no need for it. Part of that is politics, and the fact that the United States got involved in promoting dairy and the whole dairy industry. But there’s really no good evidence outside of the childhood period that milk is necessary. One of the things that I tried to state in the book, and this is true of all beverages with calories, you should treat them like you treat alcohol. I mean, what else are you going to do with a good chocolate chip cookie? Of course you need a glass of milk with that. That’s like dessert — it’s something you should have because you want it, not because you need it.

Raw eggs often get a bad reputation, particularly when it comes to cookie dough. How bad are they, really?

The raw egg is another one where of course there is a risk. But you have to weigh that against joy again. The truth of the matter is that if you committed to eating raw eggs in cookie dough once a week every week for the rest of your life, you’d almost never come into contact with salmonella. If you did, you’d almost never get sick. If you got sick, you’d almost never notice. Even if you noticed, it would almost never result in something serious. The chance of you actually getting seriously ill is infinitesimal. … The joy of doing those kinds of things with your kids or enjoying the process of baking is much more satisfying and will lead to greater increases in quality of life than the infinitesimal risk that you’re hurting your health in some way.
So, it sounds like there’s a lot of misinformation surrounding what food is bad for us. What’s your eating advice then?

So I think you know, in general, one thing you can do is limit your heavily processed food as much as possible. Nature intended you to get the appley goodness from an apple, not from apple juice. But the more we can do to smile, to cook for ourselves, to know where our food is coming from, to be mindful of it, the better. But we shouldn’t be so panicked and fearful and constantly believing that if we don’t do what we’ve heard from the latest expert, that we’re going to get sick and die. That is just not true.

Of course, we are staring down the barrel of Thanksgiving, which for many of us can be a moment that produces a lot of anxiety, especially food anxiety nowadays. It just feels like it’s all so fraught. I’m evil if I eat meat. I’m bad if I like Diet Coke. Food is loaded.
It’s also really important, it’s one day a year! Your health and your eating habits are not established by one day a year. It’s perfectly fine to enjoy yourself and to live! You need to weigh — in all your health decisions — the benefits and the harms. And too often we only focus on the latter. And included in benefits are joy, and quality of life and happiness. There are times when it’s a perfectly rational decision to allow yourself to be happy and to enjoy yourself. I’m not sort of giving a license for people to eat whatever they want, anytime they want. Yes, the Diet Coke, the pie, these are all processed foods. So you should think about how much you’re eating them in relation to everything else. But on the other hand, a piece of pie on Thanksgiving is not going to erase everything else you’ve done the rest of the year. Thanksgiving is easily my favorite holiday and it’s not just because of the food, but also because of the meal and the fact that you get to enjoy it with family and friends.

I’ve got to ask you, what are you having for Thanksgiving?

As much as I can cram into my body on that day. But, I love turkey, really well-done turkey. I love mashed potatoes, and stuffing and gravy, and I think pie is the greatest dessert that exists, so I’m sure I’ll be having too much of that as well.

Producer Adelina Lancianese contributed to this report.

Homeostasis

One of the smartest guys in the room, Antonio Damasio, give his views about neuroscience and its relationship to pain, pleasure, and feelings. He points out that they all play a giant role in one of life’s most important concepts: homeostasis.

CREDIT: http://nautil.us/issue/56/perspective/antonio-damasio-tells-us-why-pain-is-necessary

Antonio Damasio Tells Us Why Pain Is Necessary
The neuroscientist explains why feelings evolved.

BY KEVIN BERGER
JANUARY 18, 2018

Following Oliver Sacks, Antonio Damasio may be the neuroscientist whose popular books have done the most to inform readers about the biological machinery in our heads, how it generates thoughts and emotions, creates a self to cling to, and a sense of transcendence to escape by. But since he published Descartes’ Error in 1994, Damasio has been concerned that a central thesis in his books, that brains don’t define us, has been muted by research that states how much they do. To Damasio’s dismay, the view of the human brain as a computer, the command center of the body, has become lodged in popular culture.

In his new book, The Strange Order of Things, Damasio, a professor of neuroscience and the director of the Brain and Creativity Institute at the University of Southern California, mounts his boldest argument yet for the egalitarian role of the brain. In “Why Your Biology Runs on Feelings,” another article in this chapter of Nautilus, drawn from his new book, Damasio tells us “mind and brain influence the body proper just as much as the body proper can influence the brain and the mind. They are merely two aspects of the very same being.”

BEYOND SCIENCE: Antonio Damasio, director of the Brain and Creativity Institute at USC, sings the glories of the arts in his new book, The Strange Order of Things: “The sciences alone cannot illuminate the entirety of human experience without the light that comes from art and humanities.”

The Strange Order of Things offers a sharp and uncommon focus on feelings, on how their biological evolution fueled our prosperity as a species, spurred science and medicine, religion and art. “When I look back on Descartes’ Error, it was completely timid compared to what I’m saying now,” Damasio says. He knows his new book may rile believers in the brain as emperor of all. “I was entirely open with my ideas,” he says. “If people don’t like it, they don’t like it. They can criticize it, of course, which is fair, but I want to tell them, because it’s so interesting, this is why you have feelings.”
In this interview with Nautilus, Damasio, in high spirits, explains why feelings deserve a starring role in human culture, what the real problem with consciousness studies are, and why Shakespeare is the finest cognitive scientist of them all.

One thing I like about The Strange Order of Things is it counters the idea that we are just our brains.

Oh, that idea is absolutely wrong.

Not long ago I was watching a PBS series on the brain, in which host and neurologist David Eagleman, referring to our brain, declares, “What we feel, what matters to us, our beliefs and our hopes, everything we are happens in here.”

That’s not the whole story. Of course, we couldn’t have minds with all of their enormous complexity without nervous systems. That goes without saying. But minds are not the result of nervous systems alone. The statement you quote reminds me of Francis Crick, someone whom I admired immensely and was a great friend. Francis was quite opposed to my views on this issue. We would have huge discussions because he was the one who said that everything you are, your thoughts, your feelings, your mental this and that, are nothing but your neurons. This is a big mistake, in my view, because we are mentally and behaviorally far more than our neurons. We cannot have feelings arising from neurons alone. The nervous systems are in constant interaction and cooperation with the rest of the organism. The reason why nervous systems exist in the first place is to assist the rest of the organism. That fact is constantly missed.

The concept of “homeostasis” is critical in your new book. What is homeostasis?

It’s the fundamental property of life that governs everything that living cells do, whether they’re living cells alone, or living cells as part of a tissue or an organ, or a complex system such as ourselves. Most of the time, when people hear the word homeostasis, they think of balance, they think of equilibrium. That is incorrect because if we ever were in “equilibrium,” we would be dead. Thermodynamically, equilibrium means zero thermal differences and death. Equilibrium is the last thing that nature aims for.

The importance of feeling is that it makes you critically aware of what you are doing in moral terms.

What we must have is efficient functioning of a variety of components of an organism. We procure energy so that the organism can be perpetuated, but then we do something very important and almost always missed, which is hoard energy. We need to maintain positive energy balances, something that goes beyond what we need right now because that’s what ensures the future. What’s so beautiful about homeostasis is that it’s not just about sustaining life at the moment, but about having a sort of guarantee that it will continue into the future. Without those positive energy balances, we court death.

What’s a good example of homeostasis?

If you are at the edge of your energy reserves and you’re sick with the flu, you can easily tip over and die. That’s one of the reasons why there’s fat accumulation in our bodies. We need to maintain the possibility of meeting the extra needs that come from stress, in the broad sense of the term. I poetically describe this as a desire for permanence, but it’s not just poetic. I believe it’s reality.

You write homeostasis is maintained in complex creatures like us through a constant interplay of pleasure and pain. Are you giving a biological basis to Freud’s pleasure principle—life is governed by a drive for pleasure and avoidance of pain?

Yes, to a great extent. What’s so interesting is that for most of the existence of life on earth, all organisms have had this effective, automated machinery that operates for the purpose of maintenance and continuation of life. I like to call the organisms that only have that form of regulation, “living automata.” They can fight. They can cooperate. They can segregate. But there’s no evidence that they know that they’re doing so. There’s no evidence of anything we might call a mind. Obviously we have more than automatic regulation. We can control regulation in part, if we wish to. How did that come about?
Very late in the game of life there’s the appearance of nervous systems. Now you have the possibility of mapping the inside and outside world. When you map the inside world, guess what you get? You get feelings. Of necessity, the machinery of life is either in a state of reasonable efficiency or in a state of inefficiency, which is most often the case. Organisms with nervous systems can image these states. And when you start having imagery, you start having minds. Now you begin to have the possibility of responding in a way that you could call “knowledgeable.” That happens when organisms make images. A bad internal state would have been imaged as the first pains, the first malaises, the first sufferings. Now the organism has the possibility of knowingly avoiding whatever caused the pain or prefer a place or a thing or another animal that causes the opposite of that, which is well-being and pleasure.

Why would feelings have evolved?

Feelings triumphed in evolution because they were so helpful to the organisms that first had them. It’s important to understand that nervous systems serve the organism and not the other way around. We do not have brains controlling the entire operation. Brains adjust controls. They are the servants of a living organism. Brains triumphed because they provided something useful: coordination. Once organisms got to the point of being so complex that they had an endocrine system, immune system, circulation, and central metabolism, they needed a device to coordinate all that activity. They needed to have something that would simultaneously act on point A and point Z, across the entire organism, so that the parts would not be working at cross purposes. That’s what nervous systems first achieve: making things run smoothly.

Now, in the process of doing that, over millions of years, we have developed nervous systems that do plenty of other things that do not necessarily result in coordination of the organism’s interior, but happen to be very good at coordinating the internal world in relation to the outside world. This is what the higher reaches of our nervous system, namely the cerebral cortex, does. It gives us the possibilities of perceiving, of memorizing, of reasoning over the knowledge that we memorize, of manipulating all of that and even translating it into language. That is all very beautiful, and it is also homeostatic, in the sense that all of it is convenient to maintain life. It if were not, it would just have been discarded by evolution.

How does your thesis square with the hard problem of consciousness, how the physical tissue in our heads produces immaterial sensations?

Some philosophers of mind will say, “Well, we face this gigantic problem. How does consciousness emerge out of these nerve cells?” Well, it doesn’t. You’re not dealing with the brain alone. You have to think in terms of the whole organism. And you have to think in evolutionary terms.

The critical problem of consciousness is subjectivity. You need to have a “subject.” You can call it an I or a self. Not only are you aware right now that you are listening to my words, which are in the panorama of your consciousness, but you are aware of being alive, you realize that you’re there, you’re ticking. We are so distracted by what is going on around us that we forget sometimes that we are, A-R-E in capitals. But actually you are watching what you are, and so you need to have a mechanism in the brain that allows you to fabricate that part of the mind that is the watcher.
You do that with a number of devices that have to do, for example, with mapping the movements of your eyes, the position of your head, and the musculature of your body. This allows you to literally construct images of yourself making images. And you also have a layer of consciousness that is made by your perception of the outside world; and another layer that is made of appreciating the feelings that are being generated inside of you. Once you have this stack of processes, you have a fighting chance of creating consciousness.

Why do you object to comparing the brain to a computer?

In the early days of neuroscience, one of our mentors was Warren McCulloch. He was a gigantic figure of neuroscience, one of the originators of what is today computational neuroscience. When you go back to the ’40s and ’50s, you find this amazing discovery that neurons can be either active or inactive, in a way that can be described mathematically as zeroes and ones. Combine that with Alan Turing and you get this idea that the brain is like a computer and that it produces minds using that same simple method.

Religions have been one of the great causes of violence throughout history. But you can’t blame Christ for it.

That has been a very useful idea. And true enough, it explains a good part of the complex operations, that our brains produce such as language. Those operations require a lot of precision and are being carried out by cerebral cortex, with enormous detail, and probably in a basic computational mode. All the great successes of artificial intelligence used this idea and have been concerned with high-level reasoning. That is why A.I. has been so successful with games such as chess or Go. They use large memories and powerful reasoning.

Are you saying neural codes or algorithms don’t blend with living systems?

Well, they match very well with things that are high on the scale of the mental operations and behaviors, such as those we require for our conversation. But they don’t match well with the basic systems that organize life, that regulate, for example, the degree of mental energy and excitation or with how you emote and feel. The reason is that the operations of the nervous system responsible for such regulation relies less on synaptic signaling, the one that can be described in terms of zeroes and ones, and far more on non-synaptic messaging, which lends itself less to a rigid all or none operation.
Perhaps more importantly, computers are machines invented by us, made of durable materials. None of those materials has the vulnerability of the cells in our body, all of which are at risk of defective homeostasis, disease, and death. In fact, computers lack most of the characteristics that are key to a living system. A living system is maintained in operation, against all odds, thanks to a complicated mechanism that can fall apart as a result of minimal amounts of malfunction. We are extremely vulnerable creatures. People often forget that. Which is one of the reasons why our culture, or Western cultures in general, are a bit too calm and complacent about the threats to our lives. I think we are becoming less sensitive to the idea that life is what dictates what we should do or not do with ourselves and with others.

What is love for?

To protect, to cause flourishing, to give and receive pleasure, to procreate, to soothe. Endless great uses, as you can see.

How do emotions such as anger or sadness serve homeostasis?

At individual levels, both anger and sadness are protective. Anger lets your adversary know that you mean business and that there may be costs to attacking you. These days anger is an expression of sociopolitical conflicts. It is overused and has largely become ineffectual. Sadness is a prelude to mental hibernation. It lets you retreat and lick your wounds. It lets you plan a strategy of response to the cause of the wounds.

You say feelings spurred the creation of cultures. How so?

Before I started The Strange Order of Things, I was asking friends and colleagues how they thought cultures had begun. Invariably what people said was, “Oh, we’re so smart. We’re so intellectually powerful. We have all this reasoning ability. On top of it all, we have language—and there you are.” To which I say, “Fine, that’s true. How would you invent anything if you were stupid?” You would not. But the issue is to recognize the motive behind what you do. Why is it that you did it in the first place? Why did Moses come down from the mountain with Ten Commandments? Well, the Ten Commandments are representative of homeostasis because they tell you not to kill, not to steal, not to lie, not to do a lot of bad things. It sounds trivial but it’s not. We fail to think about motivation and so we do not factor it into the process of invention. We do not factor in the motives behind science or technology or governance or religion.

How does consciousness emerge out of nerve cells? Well, it doesn’t. You’re not dealing with the brain alone.

And there’s one more thing: The importance of feeling is that it makes you critically aware of what you are doing in moral terms. It forces you to look back and realize that what people were doing historically, at the outset, at the moment of invention of a cultural instrument or a cultural practice, was an attempt to reduce the amount of suffering and to maximize the amount of wellbeing not only for the inventor, but for the community around them. One person alone can invent a painting or a musical composition, but it is not meant for that person alone. And you do not invent a moral system or a government system alone or for yourself alone. It requires a society, a community.

The assertion that intellect is governed by feelings can sound New Age-y. It seems to undermine the powers of reason. How should we understand reason if it’s always motivated by subjective feelings?

Subjective simply means that it has a personal point of view, that it pertains to the self. It is compatible with “objective” facts and with truth. It is not about relativism. The fact that feelings motivate the use of knowledge and reason do not make the knowledge and the reason any less truthful or valid. Feelings are simply a call to action.

If humans formed societies and cultures to avoid suffering and pain, why do we have violence and wars?

Your question is very important. Take developments of political systems. On the face of it, when you look at Marxist ideas, you say, “This is obviously homeostatic.” What Marx and others were trying to do in the 19th century is confront and modify a social arrangement that was not equitable, that had some people suffering too much and some profiting too much. So having a system that produced equality made a lot of sense. In a way that is something that biological systems have been trying to do, quite naturally, for a long time. And when the natural systems do not succeed at improved regulation, guess what? They are weeded out by evolution because they promote illness.
Biological evolution, through genetic selection, eliminates those mechanisms. At the cultural level something comparable occurs. Seen in retrospect, Marxism as applied in Russia resulted in one of the worst tragedies of humankind. But Russian communism was ultimately weeded out by cultural selection. It took around 70 years to do it, but cultural selection did operate in a homeostatic way. It led to the fall of the Berlin Wall and the Soviet empire. It was a homeostatic correction achieved by social means.
The same reasoning applies to religions. For example, we can claim that religions have been one of the great causes of violence throughout history. But you certainly can’t blame Christ for that violence. He preached compassion, and the pardoning of enemies, and love. It does not follow that good recommendations can be implemented correctly and always produce good results. These facts in no way deny the homeostatic intent of religions.

You write, “The increasing knowledge of biology from molecules to systems reinforces the humanist project.” How so?

This knowledge gives us a broader picture of who we are and where we are in the history of life on earth. We had modest beginnings, and we have incorporated an incredible amount of living wisdom that comes from as far down as bacteria. There are characteristics of our personal and cultural behavior that can be found in single-cell organisms or in social insects. They clearly do not have the kind of highly developed brains that we have. In some cases, they don’t have any brain at all. But by analyzing this strange order of developments we are confronted with the spectacle of life processes that are complex and rich in spite of their apparent modesty, so complex and rich that they can deliver the high level of behaviors that we normally, quite pretentiously, attribute only to our great human smarts. We should be far more humble. That’s one of my main messages. In general, connecting cultures to the life process makes apparent a link that we have ignored for far too long.


What would you be if you weren’t a scientist?

When I was an adolescent, I often thought that I might become a philosopher or perhaps a playwright or filmmaker. That’s because I so admired what philosophers and storytellers had found about the human mind. Today when people ask me, “Who’s your most admired cognitive scientist?” I say Shakespeare. He knew it all and knew it with enormous precision. He didn’t have the nice fMRI scanner and electrophysiology techniques we have in our Institute. But he knew human beings. Watch a good performance of Hamlet, King Lear, or Othello. All of our psychology is there, richly analyzed, ready for us to experience and appreciate.

Fiber’s Role in Diet

In this post, I discuss the role of the microbiome and the role of fiber in supporting a healthy microbiome. A healthy microbiome is related to the amount and diversity of the bacteria found within it.

If I had to summarize, I would say this: new research strongly confirms that high fiber diets are healthy diets. Because of this finding, eat 20-200 grams of fiber daily, by eating nuts, berries, whole grains, beans and vegetables.

The Role of the Microbiome
Bacteria in the gut – the “microbiome” – has been the subject of intense research interest over the last decade.

We now know that a healthy microbiome is essential to health and wellbeing.

On a scientific level, we now know that a healthy biome is one with billions of bacteria, of many kinds.

And specifically, we now know that a healthy biome has a layer of mucus along the walls of the intestine.

“The gut is coated with a layer of mucus, atop which sits a carpet of hundreds of species of bacteria, part of the human microbiome.”

If that mucus layer is thick, it is healthy. If it is thin, it is unhealthy (thin mucus layers have been linked to chronic inflammation). (“Their intestines got smaller, and its mucus layer thinner. As a result, bacteria wound up much closer to the intestinal wall, and that encroachment triggered an immune reaction.”)

The Role of Fiber in Supporting a Healthy Microbiome
“Fiber” refers to ruffage from fruits, vegetables, and beans that is hard to digest. If fiber is hard to digest, why are they so universally hailed as “good for you”?

That’s the subject of two newly-reported experiments.

The answer seems to lie in bacteria in the gut – the “microbiome”. Much has been written about their beneficial role in the body. But now it seems that some bacteria in the gut have an additional role: they digest fiber that human enzymes cannot digest.

So some bacteria thrive in the gut because of the fiber they eat. And, in an important natural chain, apparently there are some bacteria in the gut that that thrive because the waste of the bacteria that eats fiber. An ecosystem of bacteria tracing to fiber!

This speaks to one of the most-discussed subjects in science today: how and why is one microbiome populated with relatively few bacteria numbers and types, and why is another microbiome much more diverse – with many more bacteria and bacteria types?

One study, shown below, reports from Tanzania, after reviewing data from tribes that sustain themselves on high fiber foods. The results, reported in Science, clearly show that an ultra-high fiber diet results in ultra high bacteria counts and diversity.

Other findings suggest that fiber is the food of many bacteria types. Because of this, a diverse, healthy bacterial microbiome is dependent on a fiber-rich diet. (“On a low-fiber diet, they found, the population crashed, shrinking tenfold.”)

Indeed, it may well be true that many types of fibers support many types of bacteria.

Proof of this?

Researchers, including Dr. Gerwitz at Georgia State proved that more fiber seems to be better:

Bad: high, fat, low fiber (“On a low-fiber diet, they found, the population crashed, shrinking tenfold.” “Many common species became rare, and rare species became common.“)

Good: modest fiber
Better: high dose fiber (“Despite a high-fat diet, the mice had healthy populations of bacteria in their guts, their intestines were closer to normal, and they put on less weight.”)

Best: high dose of fiber-feeding bacteria
(“Once bacteria are done harvesting the energy in dietary fiber, they cast off the fragments as waste. That waste — in the form of short-chain fatty acids — is absorbed by intestinal cells, which use it as fuel.”

(“Research suggests that when bacteria break down dietary fiber down into short-chain fatty acids, some of them pass into the bloodstream and travel to other organs, where they act as signals to quiet down the immune system.”)

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This article documents rich-in-fiber foods:

CREDIT: http://www.todaysdietitian.com/newarchives/063008p28.shtml

In recognition of fiber’s benefits, Today’s Dietitian looks at some of the best ways to boost fiber intake,from whole to fortified foods,using data from the USDA National Nutrient Database for Standard Reference.

Top Fiber-Rich Foods
1. Get on the Bran Wagon (Oat bran, All-bran cereal, fiber-one chewy bars, etc)
One simple way to increase fiber intake is to power up on bran. Bran from many grains is very rich in dietary fiber. Oat bran is high in soluble fiber, which has been shown to lower blood cholesterol levels. Wheat, corn, and rice bran are high in insoluble fiber, which helps prevent constipation. Bran can be sprinkled into your favorite foods,from hot cereal and pancakes to muffins and cookies. Many popular high-fiber cereals and bars are also packed with bran.

2. Take a Trip to Bean Town (Limas, Pintos, Lentils, etc)
Beans really are the magical fruit. They are one of the most naturally rich sources of fiber, as well as protein, lysine, vitamins, and minerals, in the plant kingdom. It’s no wonder so many indigenous diets include a bean or two in the mix. Some people experience intestinal gas and discomfort associated with bean intake, so they may be better off slowly introducing beans into their diet. Encourage a variety of beans as an animal protein replacement in stews, side dishes, salads, soups, casseroles, and dips.

3. Go Berry Picking (especially blackberries and raspberries)
Jewel-like berries are in the spotlight due to their antioxidant power, but let’s not forget about their fiber bonus. Berries happen to yield one of the best fiber-per-calorie bargains on the planet. Since berries are packed with tiny seeds, their fiber content is typically higher than that of many fruits. Clients can enjoy berries year-round by making the most of local berries in the summer and eating frozen, preserved, and dried berries during the other seasons. Berries make great toppings for breakfast cereal, yogurt, salads, and desserts.

4. Wholesome Whole Grains (especially barley, oats, brown rice, rye wafers)
One of the easiest ways to up fiber intake is to focus on whole grains. A grain in nature is essentially the entire seed of the plant made up of the bran, germ, and endosperm. Refining the grain removes the germ and the bran; thus, fiber, protein, and other key nutrients are lost. The Whole Grains Council recognizes a variety of grains and defines whole grains or foods made from them as containing “all the essential parts and naturally-occurring nutrients of the entire grain seed. If the grain has been processed, the food product should deliver approximately the same rich balance of nutrients that are found in the original grain seed.â€‌ Have clients choose different whole grains as features in side dishes, pilafs, salads, breads, crackers, snacks, and desserts.

5. Sweet Peas (especially frozen green peas, black eyed peas)
Peas,from fresh green peas to dried peas,are naturally chock full of fiber. In fact, food technologists have been studying pea fiber as a functional food ingredient. Clients can make the most of peas by using fresh or frozen green peas and dried peas in soups, stews, side dishes, casseroles, salads, and dips.

6. Green, the Color of Fiber (Spinach, etc)
Deep green, leafy vegetables are notoriously rich in beta-carotene, vitamins, and minerals, but their fiber content isn’t too shabby either. There are more than 1,000 species of plants with edible leaves, many with similar nutritional attributes, including high-fiber content. While many leafy greens are fabulous tossed in salads, saut ©ing them in olive oil, garlic, lemon, and herbs brings out a rich flavor.

7. Squirrel Away Nuts and Seeds (especially flaxseed and sesame seed)
Go nuts to pack a fiber punch. One ounce of nuts and seeds can provide a hearty contribution to the day’s fiber recommendation, along with a bonus of healthy fats, protein, and phytochemicals. Sprinkling a handful of nuts or seeds over breakfast cereals, yogurt, salads, and desserts is a tasty way to do fiber.

8. Play Squash (especially acorn squash)
Dishing up squash,from summer to winter squash,all year is another way that clients can ratchet up their fiber intake. These nutritious gems are part of the gourd family and contribute a variety of flavors, textures, and colors, as well as fiber, vitamins, minerals, and carotenoids, to the dinner plate. Squash can be turned into soups, stews, side dishes, casseroles, salads, and crudit ©s. Brush squash with olive oil and grill it in the summertime for a healthy, flavorful accompaniment to grilled meats.

9. Brassica or Bust (broccoli, cauliflower, kale, cabbage, and Brussels sprouts)
Brassica vegetables have been studied for their cancer-protective effects associated with high levels of glucosinolates. But these brassy beauties, including broccoli, cauliflower, kale, cabbage, and Brussels sprouts, are also full of fiber. They can be enjoyed in stir-fries, casseroles, soups, and salads and steamed as a side dish.

10. Hot Potatoes
The humble spud, the top vegetable crop in the world, is plump with fiber. Since potatoes are so popular in America, they’re an easy way to help pump up people’s fiber potential. Why stop at Russets? There are numerous potatoes that can provide a rainbow of colors, nutrients, and flavors, and remind clients to eat the skins to reap the greatest fiber rewards. Try adding cooked potatoes with skins to salads, stews, soups, side dishes, stir-fries, and casseroles or simply enjoy baked potatoes more often.

11. Everyday Fruit Basket (especially pears and oranges)
Look no further than everyday fruits to realize your full fiber potential. Many are naturally packed with fiber, as well as other important vitamins and minerals. Maybe the doctor was right when he advised an apple a day, but he could have added pears, oranges, and bananas to the prescription as well. When between fruit seasons, clients can rely on dried fruits to further fortify their diet. Encourage including fruit at breakfast each morning instead of juice; mixing dried fruits into cereals, yogurts, and salads; and reaching for the fruit bowl at snack time. It’s a healthy habit all the way around.

12. Exotic Destinations (especially avocado)
Some of the plants with the highest fiber content in the world may be slightly out of your clients’ comfort zone and, for that matter, time zone. A rainbow of indigenous fruits and vegetables used in cultural food traditions around the globe are very high in fiber. Entice clients to introduce a few new plant foods into their diets to push up the flavor, as well as their fiber, quotient.

13. Fiber Fortification Power
More foods,from juice to yogurt,are including fiber fortification in their ingredient lineup. Such foods may help busy people achieve their fiber goals. As consumer interest in foods with functional benefits, such as digestive health and cardiovascular protection, continues to grow, expect to see an even greater supply of food products promoting fiber content on supermarket shelves.

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This article documents the newly-reported experiments:

CREDIT: NYT Article on Fiber Science

Fiber is Good for You. Now we Know Why

By Carl Zimmer
Jan. 1, 2018
A diet of fiber-rich foods, such as fruits and vegetables, reduces the risk of developing diabetes, heart disease and arthritis. Indeed, the evidence for fiber’s benefits extends beyond any particular ailment: Eating more fiber seems to lower people’s mortality rate, whatever the cause.

That’s why experts are always saying how good dietary fiber is for us. But while the benefits are clear, it’s not so clear why fiber is so great. “It’s an easy question to ask and a hard one to really answer,” said Fredrik Bäckhed, a biologist at the University of Gothenburg in Sweden.

He and other scientists are running experiments that are yielding some important new clues about fiber’s role in human health. Their research indicates that fiber doesn’t deliver many of its benefits directly to our bodies.

Instead, the fiber we eat feeds billions of bacteria in our guts. Keeping them happy means our intestines and immune systems remain in good working order.

In order to digest food, we need to bathe it in enzymes that break down its molecules. Those molecular fragments then pass through the gut wall and are absorbed in our intestines.
But our bodies make a limited range of enzymes, so that we cannot break down many of the tough compounds in plants. The term “dietary fiber” refers to those indigestible molecules.

But they are indigestible only to us. The gut is coated with a layer of mucus, atop which sits a carpet of hundreds of species of bacteria, part of the human microbiome. Some of these microbes carry the enzymes needed to break down various kinds of dietary fiber.

The ability of these bacteria to survive on fiber we can’t digest ourselves has led many experts to wonder if the microbes are somehow involved in the benefits of the fruits-and-vegetables diet. Two detailed studies published recently in the journal Cell Host and Microbe provide compelling evidence that the answer is yes.

In one experiment, Andrew T. Gewirtz of Georgia State University and his colleagues put mice on a low-fiber, high-fat diet. By examining fragments of bacterial DNA in the animals’ feces, the scientists were able to estimate the size of the gut bacterial population in each mouse.

On a low-fiber diet, they found, the population crashed, shrinking tenfold.

Dr. Bäckhed and his colleagues carried out a similar experiment, surveying the microbiome in mice as they were switched from fiber-rich food to a low-fiber diet. “It’s basically what you’d get at McDonald’s,” said Dr. Bäckhed said. “A lot of lard, a lot of sugar, and twenty percent protein.”

The scientists focused on the diversity of species that make up the mouse’s gut microbiome. Shifting the animals to a low-fiber diet had a dramatic effect, they found: Many common species became rare, and rare species became common.

Along with changes to the microbiome, both teams also observed rapid changes to the mice themselves. Their intestines got smaller, and its mucus layer thinner. As a result, bacteria wound up much closer to the intestinal wall, and that encroachment triggered an immune reaction.

After a few days on the low-fiber diet, mouse intestines developed chronic inflammation. After a few weeks, Dr. Gewirtz’s team observed that the mice began to change in other ways, putting on fat, for example, and developing higher blood sugar levels.

Dr. Bäckhed and his colleagues also fed another group of rodents the high-fat menu, along with a modest dose of a type of fiber called inulin. The mucus layer in their guts was healthier than in mice that didn’t get fiber, the scientists found, and intestinal bacteria were kept at a safer distance from their intestinal wall.

Dr. Gewirtz and his colleagues gave inulin to their mice as well, but at a much higher dose. The improvements were even more dramatic: Despite a high-fat diet, the mice had healthy populations of bacteria in their guts, their intestines were closer to normal, and they put on less weight.

Dr. Bäckhed and his colleagues ran one more interesting experiment: They spiked water given to mice on a high-fat diet with a species of fiber-feeding bacteria. The addition changed the mice for the better: Even on a high-fat diet, they produced more mucus in their guts, creating a healthy barrier to keep bacteria from the intestinal walls.

One way that fiber benefits health is by giving us, indirectly, another source of food, Dr. Gewirtz said. Once bacteria are done harvesting the energy in dietary fiber, they cast off the fragments as waste. That waste — in the form of short-chain fatty acids — is absorbed by intestinal cells, which use it as fuel.

But the gut’s microbes do more than just make energy. They also send messages. Intestinal cells rely on chemical signals from the bacteria to work properly, Dr. Gewirtz said. The cells respond to the signals by multiplying and making a healthy supply of mucus. They also release bacteria-killing molecules.
By generating these responses, gut bacteria help maintain a peaceful coexistence with the immune system. They rest atop the gut’s mucus layer at a safe distance from the intestinal wall. Any bacteria that wind up too close get wiped out by antimicrobial poisons.

While some species of gut bacteria feed directly on dietary fiber, they probably support other species that feed on their waste. A number of species in this ecosystem — all of it built on fiber — may be talking to our guts.

Going on a low-fiber diet disturbs this peaceful relationship, the new studies suggest. The species that depend on dietary fiber starve, as do the other species that depend on them. Some species may switch to feeding on the host’s own mucus.

With less fuel, intestinal cells grow more slowly. And without a steady stream of chemical signals from bacteria, the cells slow their production of mucus and bacteria-killing poisons.
As a result, bacteria edge closer to the intestinal wall, and the immune system kicks into high gear.

“The gut is always precariously balanced between trying to contain these organisms and not to overreact,” said Eric C. Martens, a microbiologist at the University of Michigan who was not involved in the new studies. “It could be a tipping point between health and disease.”

Inflammation can help fight infections, but if it becomes chronic, it can harm our bodies. Among other things, chronic inflammation may interfere with how the body uses the calories in food, storing more of it as fat rather than burning it for energy.

Justin L. Sonnenburg, a biologist at Stanford University who was not involved in the new studies, said that a low-fiber diet can cause low-level inflammation not only in the gut, but throughout the body.

His research suggests that when bacteria break down dietary fiber down into short-chain fatty acids, some of them pass into the bloodstream and travel to other organs, where they act as signals to quiet down the immune system.

“You can modulate what’s happening in your lung based on what you’re feeding your microbiome in your gut,” Dr. Sonnenburg said.
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Hannah D. Holscher, a nutrition scientist at the University of Illinois who was not involved in the new studies, said that the results on mice need to be put to the test in humans. But it’s much harder to run such studies on people.

In her own lab, Dr. Holscher acts as a round-the-clock personal chef. She and her colleagues provide volunteers with all their meals for two weeks. She can then give some of her volunteers an extra source of fiber — such as walnuts — and look for changes in both their microbiome and their levels of inflammation.

Dr. Holscher and other researchers hope that they will learn enough about how fiber influences the microbiome to use it as a way to treat disorders. Lowering inflammation with fiber may also help in the treatment of immune disorders such as inflammatory bowel disease.

Fiber may also help reverse obesity. Last month in the American Journal of Clinical Nutrition, Dr. Holscher and her colleagues reviewed a number of trials in which fiber was used to treat obesity. They found that fiber supplements helped obese people to lose about five pounds, on average.
But for those who want to stay healthy, simply adding one kind of fiber to a typical Western diet won’t be a panacea. Giving mice inulin in the new studies only partly restored them to health.

That’s probably because we depend on a number of different kinds of dietary fiber we get from plants. It’s possible that each type of fiber feeds a particular set of bacteria, which send their own important signals to our bodies.

“It points to the boring thing that we all know but no one does,” Dr. Bäckhed said. “If you eat more green veggies and less fries and sweets, you’ll probably be better off in the long term.”

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CREDIT: https://www.npr.org/sections/goatsandsoda/2017/08/24/545631521/is-the-secret-to-a-healthier-microbiome-hidden-in-the-hadza-diet

Is The Secret To A Healthier Microbiome Hidden In The Hadza Diet?

August 24, 20176:11 PM ET
Heard on All Things Considered

MICHAELEEN DOUCLEFF
Twitter

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The words “endangered species” often conjure up images of big exotic creatures. Think elephants, leopards and polar bears.

But there’s another of type of extinction that may be occurring, right now, inside our bodies.

Yes, I’m talking about the microbiome — that collection of bacteria in our intestines that influences everything from metabolism and the immune system to moods and behavior.

For the past few years, scientists around the world have been accumulating evidence that the Western lifestyle is altering our microbiome. Some species of bacteria are even disappearing to undetectable levels.

“Over time we are losing valuable members of our community,” says Justin Sonnenburg, a microbiologist at Stanford University, who has been studying the microbiome for more than a decade.

Now Sonnenburg and his team have evidence for why this microbial die-off is happening — and hints about what we can possibly do to reverse it.

The study, published Thursday in the journal Science, focuses on a group of hunter-gatherers in Tanzania, called Hadza.
Their diet consists almost entirely of food they find in the forest, including wild berries, fiber-rich tubers, honey and wild meat. They basically eat no processed food — or even food that comes from farms.
“They are a very special group of people,” Sonnenburg says. “There are only about 2,200 left and really only about 200 that exclusively adhere to hunting and gathering.”

Sonnenberg and his colleagues analyzed 350 stool samples from Hadza people taken over the course of about a year. They then compared the bacteria found in Hadza with those found in 17 other cultures around the world, including other hunter-gatherer communities in Venezuela and Peru and subsistence farmers in Malawi and Cameroon.

The trend was clear: The further away people’s diets are from a Western diet, the greater the variety of microbes they tend to have in their guts. And that includes bacteria that are missing from American guts.

“So whether it’s people in Africa, Papua New Guinea or South America, communities that live a traditional lifestyle have common gut microbes — ones that we all lack in the industrialized world,” Sonnenburg says.

In a way, the Western diet — low in fiber and high in refined sugars — is basically wiping out species of bacteria from our intestines.

That’s the conclusion Sonnenburg and his team reached after analyzing the Hadza microbiome at one stage of the yearlong study. But when they checked several months later, they uncovered a surprising twist: The composition of the microbiome fluctuated over time, depending on the season and what people were eating. And at one point, the composition started to look surprisingly similar to that of Westerners’ microbiome.

During the dry season, Hadza eat a lot of more meat — kind of like Westerners do. And their microbiome shifted as their diet changed. Some of the bacterial species that had been prevalent disappeared to undetectable levels, similar to what’s been observed in Westerners’ guts.

But then in wet season — when Hadza eat more berries and honey — these missing microbes returned, although the researchers are not really sure what’s in these foods that bring the microbes back.

“I think this finding is really exciting,” says Lawrence David, who studies the microbiome at Duke University. “It suggests the shifts in the microbiome seen in industrialized nations might not be permanent — that they might be reversible by changes in people’s diets.

“The finding supports the idea that the microbiome is plastic, depending on diet,” David adds.

Now the big question is: What’s the key dietary change that could bring the missing microbes back?

Lawrence thinks it could be cutting down on fat. “At a high level, it sounds like that,” he says, “because what changed in the Hadza’s diet was whether or not they were hunting versus foraging for berries or honey,” he says.

But Sonnenburg is placing his bets on another dietary component: fiber — which is a vital food for the microbiome.
“We’re beginning to realize that people who eat more dietary fiber are actually feeding their gut microbiome,”
Sonnenburg says.

Hadza consume a huge amount of fiber because throughout the year, they eat fiber-rich tubers and fruit from baobab trees. These staples give them about 100 to 150 grams of fiber each day. That’s equivalent to the fiber in 50 bowls of Cheerios — and 10 times more than many Americans eat.

“Over the past few years, we’ve come to realize how important this gut community is for our health, and yet we’re eating a low-fiber diet that totally neglects them,” he says. “So we’re essentially starving our microbial selves.”

The Dying Algorithm

CREDIT: NYT Article on the Dying Algorithm

This Cat Sensed Death. What if Computers Could, Too
By Siddhartha Mukherjee
Jan. 3, 2018

Of the many small humiliations heaped on a young oncologist in his final year of fellowship, perhaps this one carried the oddest bite: A 2-year-old black-and-white cat named Oscar was apparently better than most doctors at predicting when a terminally ill patient was about to die. The story appeared, astonishingly, in The New England Journal of Medicine in the summer of 2007. Adopted as a kitten by the medical staff, Oscar reigned over one floor of the Steere House nursing home in Rhode Island. When the cat would sniff the air, crane his neck and curl up next to a man or woman, it was a sure sign of impending demise. The doctors would call the families to come in for their last visit. Over the course of several years, the cat had curled up next to 50 patients. Every one of them died shortly thereafter.
No one knows how the cat acquired his formidable death-sniffing skills. Perhaps Oscar’s nose learned to detect some unique whiff of death — chemicals released by dying cells, say. Perhaps there were other inscrutable signs. I didn’t quite believe it at first, but Oscar’s acumen was corroborated by other physicians who witnessed the prophetic cat in action. As the author of the article wrote: “No one dies on the third floor unless Oscar pays a visit and stays awhile.”
The story carried a particular resonance for me that summer, for I had been treating S., a 32-year-old plumber with esophageal cancer. He had responded well to chemotherapy and radiation, and we had surgically resected his esophagus, leaving no detectable trace of malignancy in his body. One afternoon, a few weeks after his treatment had been completed, I cautiously broached the topic of end-of-life care. We were going for a cure, of course, I told S., but there was always the small possibility of a relapse. He had a young wife and two children, and a mother who had brought him weekly to the chemo suite. Perhaps, I suggested, he might have a frank conversation with his family about his goals?

But S. demurred. He was regaining strength week by week. The conversation was bound to be “a bummah,” as he put it in his distinct Boston accent. His spirits were up. The cancer was out. Why rain on his celebration? I agreed reluctantly; it was unlikely that the cancer would return.

When the relapse appeared, it was a full-on deluge. Two months after he left the hospital, S. returned to see me with sprays of metastasis in his liver, his lungs and, unusually, in his bones. The pain from these lesions was so terrifying that only the highest doses of painkilling drugs would treat it, and S. spent the last weeks of his life in a state bordering on coma, unable to register the presence of his family around his bed. His mother pleaded with me at first to give him more chemo, then accused me of misleading the family about S.’s prognosis. I held my tongue in shame: Doctors, I knew, have an abysmal track record of predicting which of our patients are going to die. Death is our ultimate black box.

In a survey led by researchers at University College London of over 12,000 prognoses of the life span of terminally ill patients, the hits and misses were wide-ranging. Some doctors predicted deaths accurately. Others underestimated death by nearly three months; yet others overestimated it by an equal magnitude. Even within oncology, there were subcultures of the worst offenders: In one story, likely apocryphal, a leukemia doctor was found instilling chemotherapy into the veins of a man whose I.C.U. monitor said that his heart had long since stopped.

But what if an algorithm could predict death? In late 2016 a graduate student named Anand Avati at Stanford’s computer-science department, along with a small team from the medical school, tried to “teach” an algorithm to identify patients who were very likely to die within a defined time window. “The palliative-care team at the hospital had a challenge,” Avati told me. “How could we find patients who are within three to 12 months of dying?” This window was “the sweet spot of palliative care.” A lead time longer than 12 months can strain limited resources unnecessarily, providing too much, too soon; in contrast, if death came less than three months after the prediction, there would be no real preparatory time for dying — too little, too late. Identifying patients in the narrow, optimal time period, Avati knew, would allow doctors to use medical interventions more appropriately and more humanely. And if the algorithm worked, palliative-care teams would be relieved from having to manually scour charts, hunting for those most likely to benefit.

Avati and his team identified about 200,000 patients who could be studied. The patients had all sorts of illnesses — cancer, neurological diseases, heart and kidney failure. The team’s key insight was to use the hospital’s medical records as a proxy time machine. Say a man died in January 2017. What if you scrolled time back to the “sweet spot of palliative care” — the window between January and October 2016 when care would have been most effective? But to find that spot for a given patient, Avati knew, you’d presumably need to collect and analyze medical information before that window. Could you gather information about this man during this prewindow period that would enable a doctor to predict a demise in that three-to-12-month section of time? And what kinds of inputs might teach such an algorithm to make predictions?
Avati drew on medical information that had already been coded by doctors in the hospital: a patient’s diagnosis, the number of scans ordered, the number of days spent in the hospital, the kinds of procedures done, the medical prescriptions written. The information was admittedly limited — no questionnaires, no conversations, no sniffing of chemicals — but it was objective, and standardized across patients.

These inputs were fed into a so-called deep neural network — a kind of software architecture thus named because it’s thought to loosely mimic the way the brain’s neurons are organized. The task of the algorithm was to adjust the weights and strengths of each piece of information in order to generate a probability score that a given patient would die within three to 12 months.

The “dying algorithm,” as we might call it, digested and absorbed information from nearly 160,000 patients to train itself. Once it had ingested all the data, Avati’s team tested it on the remaining 40,000 patients. The algorithm performed surprisingly well. The false-alarm rate was low: Nine out of 10 patients predicted to die within three to 12 months did die within that window. And 95 percent of patients assigned low probabilities by the program survived longer than 12 months. (The data used by this algorithm can be vastly refined in the future. Lab values, scan results, a doctor’s note or a patient’s own assessment can be added to the mix, enhancing the predictive power.)

So what, exactly, did the algorithm “learn” about the process of dying? And what, in turn, can it teach oncologists? Here is the strange rub of such a deep learning system: It learns, but it cannot tell us why it has learned; it assigns probabilities, but it cannot easily express the reasoning behind the assignment. Like a child who learns to ride a bicycle by trial and error and, asked to articulate the rules that enable bicycle riding, simply shrugs her shoulders and sails away, the algorithm looks vacantly at us when we ask, “Why?” It is, like death, another black box.

Still, when you pry the box open to look at individual cases, you see expected and unexpected patterns. One man assigned a score of 0.946 died within a few months, as predicted. He had had bladder and prostate cancer, had undergone 21 scans, had been hospitalized for 60 days — all of which had been picked up by the algorithm as signs of impending death. But a surprising amount of weight was seemingly put on the fact that scans were made of his spine and that a catheter had been used in his spinal cord — features that I and my colleagues might not have recognized as predictors of dying (an M.R.I. of the spinal cord, I later realized, was most likely signaling cancer in the nervous system — a deadly site for metastasis).
It’s hard for me to read about the “dying algorithm” without thinking about my patient S. If a more sophisticated version of such an algorithm had been available, would I have used it in his case? Absolutely. Might that have enabled the end-of-life conversation S. never had with his family? Yes. But I cannot shake some inherent discomfort with the thought that an algorithm might understand patterns of mortality better than most humans. And why, I kept asking myself, would such a program seem so much more acceptable if it had come wrapped in a black-and-white fur box that, rather than emitting probabilistic outputs, curled up next to us with retracted claws?

Siddhartha Mukherjee is the author of “The Emperor of All Maladies: A Biography of Cancer” and, more recently, “The Gene: An Intimate History.”

Neo.Life

This beta site NeoLife link beyond the splash pagee is tracking the “neobiological revolution”. I wholeheartedly agree that some of our best and brightest are on the case. Here they are:

ABOUT
NEO.LIFE
Making Sense of the Neobiological Revolution
NOTE FROM THE EDITOR
Mapping the brain, sequencing the genome, decoding the microbiome, extending life, curing diseases, editing mutations. We live in a time of awe and possibility — and also enormous responsibility. Are you prepared?

EDITORS

FOUNDER

Jane Metcalfe
Founder of Neo.life. Entrepreneur in media (Wired) and food (TCHO). Lover of mountains, horses, roses, and kimchee, though not necessarily in that order.
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EDITOR
Brian Bergstein
Story seeker and story teller. Editor at NEO.LIFE. Former executive editor of MIT Technology Review; former technology & media editor at The Associated Press
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ART DIRECTOR
Nicholas Vokey
Los Angeles-based graphic designer and animator.
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CONSULTANT
Saul Carlin
founder @subcasthq. used to work here.

EDITOR
Rachel Lehmann-Haupt
Editor, www.theartandscienceoffamily.com & NEO.LIFE, author of In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family

Laura Cochrane
“To oppose something is to maintain it.” — Ursula K. Le Guin

WRITERS

Amanda Schaffer
writes for the New Yorker and Neo.life, and is a former medical columnist for Slate. @abschaffer

Mallory Pickett
freelance journalist in Los Angeles

Karen Weintraub
Health/Science journalist passionate about human health, cool researcher and telling stories.

Anna Nowogrodzki
Science and tech journalist. Writing in Nature, National Geographic, Smithsonian, mental_floss, & others.
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Juan Enriquez
Best-selling author, Managing Director of Excel Venture Management.

Christina Farr
Tech and features writer. @Stanford grad.

NEO.LIFE
Making sense of the Neobiological Revolution. Get the email at www.neo.life.

Maria Finn
I’m an author and tell stories across multiple mediums including prose, food, gardens, technology & narrative mapping. www.mariafinn.com Instagram maria_finn1.

Stephanie Pappas
I write about science, technology and the things people do with them.

David Eagleman
Neuroscientist at Stanford, internationally bestselling author of fiction and non-fiction, creator and presenter of PBS’ The Brain.

Kristen V. Brown
Reporter @Gizmodo covering biotech.

Thomas Goetz

David Ewing Duncan
Life science journalist; bestselling author, 9 books; NY Times, Atlantic, Wired, Daily Beast, NPR, ABC News, more; Curator, Arc Fusion www.davidewingduncan.com

Dorothy Santos
writer, editor, curator, and educator based in the San Francisco Bay Area about.me/dorothysantos.com

Dr. Sophie Zaaijer
CEO of PlayDNA, Postdoctoral fellow at the New York Genome Center, Runway postdoc at Cornell Tech.

Andrew Rosenblum
I’m a freelance tech writer based in Oakland, CA. You can find my work at Neo.Life, the MIT Technology Review, Popular Science, and many other places.

Zoe Cormier

Diana Crow
Fledgling science journalist here, hoping to foster discussion about the ways science acts as a catalyst for social change #biology

Ashton Applewhite
Calling for a radical aging movement. Anti-ageism blog+talk+book

Grace Rubenstein
Journalist, editor, media producer. Social/bio science geek. Tweets on health science, journalism, immigration. Spanish speaker & dancing fool.

Science and other sundries.

Esther Dyson
Internet court jEsther — I occupy Esther Dyson. Founder @HICCup_co https://t.co/5dWfUSratQ http://t.co/a1Gmo3FTQv

Jessica Leber
Freelance science and technology journalist and editor, formerly on staff at Fast Company, Vocativ, MIT Technology Review, and ClimateWire.

Jessica Carew Kraft
An anthropologist, artist, and naturalist writing about health, education, and rewilding. Mother to two girls in San Francisco.

Corby Kummer
Senior editor, The Atlantic, five-time James Beard Journalism Award winner, restaurant reviewer for New York, Boston, and Atlanta magazines

K McGowan
Journalist. Reporting on health, medicine, science, other excellent things. T: @mcgowankat

Rob Waters
I’m a journalist living in Berkeley. I write about health, science, social justice and policy. Father of 1. From Detroit.
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Yiting Sun
writes for MIT Technology Review and Neo.life from Beijing, and was based in Accra, Ghana, in 2014 and 2015.
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Michael Hawley
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Richard Sprague
Curious amateur. Years of near-daily microbiome experiments. US CEO of AI healthcare startup http://airdoc.com
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Bob Parks ✂
Connoisseur of the slap dash . . . maker . . . runner . . . writer of Outside magazine’s Gear Guy blog . . . freelance writer and reporter.

CREDIT: https://medium.com/neodotlife/review-of-daytwo-microbiome-test-deacd5464cd5

Microbiome Apps Personalize EAT recommendations

Richard Sprague provides a useful update about the microbiome landscape below. Microbiome is exploding. Your gut can be measured, and your gut can influence your health and well-being. But now …. these gut measurements can offer people a first: personalized nutrition information.

Among the more relevant points:

– Israel’s Weitzman Institute is the global leader academically. Eran Elinav, a physician and immunologist at the Weizmann Institute and one of their lead investigators (see prior post).
– The older technology for measuring the gut is called “16S” sequencing. It tell you at a high level which kinds of microbes are present. It’s cheap and easy, but 16S can see only broad categories,
– The companies competing to measure your microbiome are uBiome, American Gut, Thryve, DayTwo and Viome. DayTwo and Viome offer more advanced technology (see below).
– The latest technology seems to be “metagenomic sequencing”. It is better because it is more specific and detailed.
– By combining “metagenomic sequencing” information with extensive research about how certain species interact with particular foods, machine-learning algorithms can recommend what you should eat.
– DayTwo offers a metagenomic sequencing for $299, and then combines that with all available research to offer personalized nutrition information.
– DayTwo recently completed a $12 million financing round from, among others, Mayo Clinic, which announced it would be validating the research in the U.S.
– DayTwo draws its academic understandings from Israel’s Weitzman Institute. The app is based on more than five years of highly cited research showing, for example, that while people on average respond similarly to white bread versus whole grain sourdough bread, the differences between individuals can be huge: what’s good for one specific person may be bad for another.

CREDIT: Article on Microbiome Advances

When a Double-Chocolate Brownie is Better for You Than Quinoa

A $299 microbiome test from DayTwo turns up some counterintuitive dietary advice.

Why do certain diets work well for some people but not others? Although several genetic tests try to answer that question and might help you craft ideal nutrition plans, your DNA reveals only part of the picture. A new generation of tests from DayTwo and Viome offer diet advice based on a more complete view: they look at your microbiome, the invisible world of bacteria that help you metabolize food, and, unlike your DNA, change constantly throughout your life.
These bugs are involved in the synthesis of vitamins and other compounds in food, and they even play a role in the digestion of gluten. Artificial sweeteners may not contain calories, but they do modify the bacteria in your gut, which may explain why some people continue to gain weight on diet soda. Everyone’s microbiome is different.

So how well do these new tests work?
Basic microbiome tests, long available from uBiome, American Gut, Thryve, and others, based on older “16S” sequencing, can tell you at a high level which kinds of microbes are present. It’s cheap and easy, but 16S can see only broad categories, the bacterial equivalent of, say, canines versus felines. But just as your life might depend on knowing the difference between a wolf and a Chihuahua, your body’s reaction to food often depends on distinctions that can be known only at the species level. The difference between a “good” microbe and a pathogen can be a single DNA base pair.

New tests use more precise “metagenomic” sequencing that can make those distinctions. And by combining that information with extensive research about how those species interact with particular foods, machine-learning algorithms can recommend what you should eat. (Disclosure: I am a former “citizen scientist in residence” at uBiome. But I have no current relationship with any of these companies; I’m just an enthusiast about the microbiome.)

I recently tested myself with DayTwo ($299) to see what it would recommend for me, and I was pleased that the advice was not always the standard “eat more vegetables” that you’ll get from other products claiming to help you eat healthily. DayTwo’s advice is much more specific and often refreshingly counterintuitive. It’s based on more than five years of highly cited research at Israel’s Weizmann Institute, showing, for example, that while people on average respond similarly to white bread versus whole grain sourdough bread, the differences between individuals can be huge: what’s good for one specific person may be bad for another.

In my case, whole grain breads all rate C-. French toast with challah bread: A.

The DayTwo test was pretty straightforward: you collect what comes out of your, ahem, gut, which involves mailing a sample from your time on the toilet. Unlike the other tests, which can analyze the DNA found in just a tiny swab from a stain on a piece of toilet paper, DayTwo requires more like a tablespoon. The extra amount is needed for DayTwo’s more comprehensive metagenomics sequencing.

Since you can get a microbiome test from other companies for under $100, does the additional metagenomic information from DayTwo justify its much higher price? Generally, I found the answer is yes.

About two months after I sent my sample, my iPhone lit up with my results in a handy app that gave me a personalized rating for most common foods, graded from A+ to C-. In my case, whole grain breads all rate C-. Slightly better are pasta and oatmeal, each ranked C+. Even “healthy” quinoa — a favorite of gluten-free diets — was a mere B-. Why? DayTwo’s algorithm can’t say precisely, but among the hundreds of thousands of gut microbe and meal combinations it was trained on, it finds that my microbiome doesn’t work well with these grains. They make my blood sugar rise too high.

So what kinds of bread are good for me? How about a butter croissant (B+) or cheese ravioli (A-)? The ultimate bread winner for me: French toast with challah bread (A). These recommendations are very different from the one-size-fits-all advice from the U.S. Department of Agriculture or the American Diabetes Association.

I was also pleased to learn that a Starbucks double chocolate brownie is an A- for me, while a 100-calorie pack of Snyder’s of Hanover pretzels gets a C-. That might go against general diet advice, but an algorithm determined that the thousands of bacterial species inside me tend to metabolize fatty foods in a way that results in healthier blood sugar levels than what I get from high-carb foods. Of course, that’s advice just for me; your mileage may vary.

Although the research behind DayTwo has been well-reviewed for more than five years, the app is new to the U.S., so the built-in food suggestions often seem skewed toward Middle Eastern eaters, perhaps the Israeli subjects who formed the original research cohort. That might explain why the app’s suggestions for me include lamb souvlaki with yogurt garlic dip for dinner (A+) and lamb kabob and a side of lentils (A) for lunch. They sound delicious, but to many American ears they might not have the ring of “pork ribs” or “ribeye steak,” which have the same A+ rating. Incidentally, DayTwo recently completed a $12 million financing round from, among others, Mayo Clinic, which announced it would be validating the research in the U.S., so I expect the menu to expand with more familiar fare.

Fortunately you’re not limited to the built-in menu choices. The app includes a “build a meal” function that lets you enter combinations of foods from a large database that includes packaged items from Trader Joe’s and Whole Foods.

There is much more to the product, such as a graphical rendering of where my microbiome fits on the spectrum of the rest of the population that eats a particular food. Since the microbiome changes constantly, this will help me see what is different when I do a retest and when I try Viome and other tests.

I’ve had my DayTwo results for only a few weeks, so it’s too soon to know what happens if I take the app’s advice over the long term. Thankfully I’m in good health and reasonably fit, but for now I’ll be eating more strawberries (A+) and blackberries (A-), and fewer apples (B-) and bananas (C+). And overall I’m looking forward to a future where each of us will insist on personalized nutritional information. We all have unique microbiomes, and an app like DayTwo lets us finally eat that way too.

Richard Sprague is a technology executive and quantified-self enthusiast who has worked at Apple, Microsoft, and other tech companies. He is now the U.S. CEO of an AI healthcare startup, Airdoc.

====================APPENDIX: Older Posts about the microbiome =========

Microbiome Update
CREDIT: https://www.wsj.com/articles/how-disrupting-your-guts-rhythm-affects-your-health-1488164400?mod=e2tw A healthy community of microbes in the gut maintains regular daily cycles of activities. A healthy community of microbes in the gut maintains regular daily cycles of activities.PHOTO: WEIZMANN INSTITUTE By LARRY M. GREENBERG Updated Feb. 27, 2017 3:33 p.m. ET 4 COMMENTS New research is helping to unravel the mystery of how […]

Vibrant Health measures microbiome

Home

Microbiome Update
My last research on this subject was in August, 2014. I looked at both microbiomes and proteomics. Today, the New York Times published a very comprehensive update on microbiome research: Link to New York Time Microbiome Article Here is the article itself: = = = = = = = ARTICLE BEGINS HERE = = = […]

Microbiomes
Science is advancing on microbiomes in the gut. The key to food is fiber, and the key to best fiber is long fibers, like cellulose, uncooked or slightly sauteed (cooking shortens fiber length). The best vegetable, in the view of Jeff Leach, is a leek. Eating Well Article on Microbiome = = = = = […]

Arivale Launches LABS company
“Arivale” Launched and Moving Fast. They launched last month. They have 19 people in the Company and a 107 person pilot – but their plans are way more ambitious than that. Moreover: “The founders said they couldn’t envision Arivale launching even two or three years ago.” Read on …. This is an important development: the […]

Precision Wellness at Mt Sinai
My Sinai announcement Mount Sinai to Establish Precision Wellness Center to Advance Personalized Healthcare Mount Sinai Health System Launches Telehealth Initiatives Joshua Harris, co-Founder of Apollo Global Management, and his wife, Marjorie has made a $5 million gift to the Icahn School of Medicine at Mount Sinai to establish the Harris Center for Precision Wellness. […]

Proteomics
“Systems biology…is about putting together rather than taking apart, integration rather than reduction. It requires that we develop ways of thinking about integration that are as rigorous as our reductionist programmes, but different….It means changing our philosophy, in the full sense of the term” (Denis Noble).[5] Proteomics From Wikipedia, the free encyclopedia For the journal […]

Alzheimer’s Genetic Risk Assessment

CREDIT: NPR article

CREDIT: Bill Gates 11.13.17 Blog Post on Alzheimer’s

FDA Approves Marketing Of Consumer Genetic Tests For Some Conditions

April 7, 20171:40 PM ET
JESSICA BODDY

23andMe is now allowed to market tests that assess genetic risks for 10 health conditions, including Parkinson’s and late-onset Alzheimer’s diseases.
Meredith Rizzo/NPR
The U.S. Food and Drug Administration approved 23andMe’s personal genetic test for some diseases on Thursday, including Alzheimer’s, Parkinson’s and celiac diseases.
The tests assess genetic risk for the conditions but don’t diagnose them, the FDA says. The agency urges consumers to use their results to “help to make decisions about lifestyle choices or to inform discussions with a health care professional,” according to a press release about the decision.
Jeffrey Shuren, the director of the FDA’s Center for Devices and Radiological Health, wrote, “it is important that people understand that genetic risk is just one piece of the bigger puzzle, it does not mean they will or won’t ultimately develop a disease.” Other known factors that can play into the development of disease include diet, environment and tobacco use.

SHOTS – HEALTH NEWS
23andMe Bows To FDA’s Demands, Drops Health Claims
The FDA has previously scolded the company for marketing the personal genetic testing kits without the agency’s consent. In 2013, the agency told 23andMe to stop selling its personal genome kits in the United States until they gained FDA approval by proving they were accurate.
The company agreed to work with the FDA, as we reported, and a recent FDA review of peer-reviewed studies found more consistent links between certain gene variants and 10 diseases, the FDA says.
As a result, the FDA is now allowing 23andMe to market tests that assess genetic risks for the following 10 diseases or conditions:
▪ Parkinson’s disease, a nervous system disorder impacting movement 

▪ Late-onset Alzheimer’s disease, a progressive brain disorder that destroys memory and thinking skills 

▪ Celiac disease, a disorder resulting in the inability to digest gluten 

▪ Alpha-1 antitrypsin deficiency, a disorder that raises the risk of lung and liver disease 

▪ Early-onset primary dystonia, a movement disorder involving involuntary muscle contractions and other uncontrolled movements 

▪ Factor XI deficiency, a blood clotting disorder 

▪ Gaucher disease type 1, an organ and tissue disorder 

▪ Glucose-6-phosphate dehydrogenase deficiency, also known as G6PD, a red blood cell condition 

▪ Hereditary hemochromatosis, an iron overload disorder 

▪ Hereditary thrombophilia, a blood clot disorder 


The company’s $199 Health and Ancestry test is available directly to consumers, without seeing a physician or genetic counselor. Consumers’ DNA is extracted from a saliva sample. After mailing in their sample, people can see their results online.
“This is an important moment for people who want to know their genetic health risks and be more proactive about their health,” said Anne Wojcicki, the CEO and co-founder of 23andMe, in a company press release.
Sharon Terry, the CEO of the Genetic Alliance, a nonprofit organization that advocates for health care for people with genetic disorders, likens it to another consumer test. “Women learn they are pregnant using a test directly marketed to them and buy it off the shelf in a drugstore,” she told NPR. “In 10 years we will marvel that this is an ‘advance’ at all. Imagine pregnancy tests being only available through a doctor!”
Robert Green, a professor of medicine at Harvard Medical School, says people should be able to access genetic information in whatever way is best for them. “Some people really want this [genetic] information on their own, and others want it through their physician,” he said. “Both those channels are legitimate. People should just be aware that this information is complicated.”
But some are still concerned about whether the genes in question actually correspond to a higher risk of disease reliably enough to warrant direct-to-consumer marketing and testing, as opposed to genetic testing with the guidance of a professional.

SHOTS – HEALTH NEWS
Don’t Get Your Kids’ Genes Sequenced Just To Keep Up

SHOTS – HEALTH NEWS
Personalizing Cancer Treatment With Genetic Tests Can Be Tricky
Some health professionals worry that consumers will “take the results and run,” as Mary Freivogel put it. Freivogel, a certified genetic counselor and the president of the National Society of Genetic Counselors, added that genetics are just “one piece to the story when it comes to developing a disease.”
Freivogel said speaking with a genetic counselor before getting tested for disease is important. “Direct-to-consumer testing takes away a pre-test conversation,” she said, where counselors can help patients think about questions like: “What do you want to know? What are you going to do with this information? Is it something you’re prepared to know, or is it going to just make you anxious?”
And it isn’t clear what consumers should do with their newly calculated disease risk, especially for conditions like Alzheimer’s for which there isn’t a cure or even a course of action to prevent the disease.
What’s more, having the genes is not the same as having the diseases the genes are associated with. A person may have genes that are associated with Alzheimer’s, for example, but that doesn’t mean he or she will ever get the disease. Conversely, some people develop Alzheimer’s without the identified risk genes.
The Alzheimer’s Association does not recommend routine genetic testing for the disease in the general population because it can’t “productively guide medical treatment.”
A genetic test result for Alzheimer’s is “not going to provide useful information even if you’re at an increased risk,” said Keith Fargo, director of scientific programs at the Alzheimer’s Association. “It’s not like there’s a drug you can take right now [to prevent the disease] or a lifestyle change you can make that you shouldn’t make anyway,” such as exercising and eating right to keep your brain healthy.
John Lehr, the CEO of the Parkinson’s Foundation, says personal genetic tests can help identify risk for Parkinson’s disease. But, he wrote in a statement following the FDA’s announcement, the foundation recommends “that people who are interested in testing first seek guidance from their doctors and from genetic counselors to understand what the process may mean for them and their families.”

Telic and Atelic

Telic and Atelic

Telic activities have goals. Atelic activities have more to do with “being”.

CREDIT: NYT

As Aristotle wrote in his “Metaphysics”: “If you are learning, you have not at the same time learned.” When you care about telic activities, projects such as writing a report, getting married or making dinner, satisfaction is always in the future or the past. It is yet to be achieved and then it is gone. Telic activities are exhaustible; in fact, they aim at their own exhaustion. They thus exhibit a peculiar self-subversion. In valuing and so pursuing these activities, we aim to complete them, and so to expel them from our lives.
Atelic activities, by contrast, do not by nature come to an end and are not incomplete. In defining such activities, we could emphasize their inexhaustibility, the fact that they do not aim at terminal states. But we could also emphasize what Aristotle does: They are fully realized in the present. “At the same time, one is seeing and has seen, is understanding and has understood, is thinking and has thought.” There is nothing you need to do in order to perform an atelic activity except what you are doing right now. If what you care about is reflecting on your life or spending time with family or friends, and that is what you are doing, you are not on the way to achieving your end: You are already there.

Anti-Dieting

This is a rather long article published in the NYT Magazine about dieting, and the new trends toward anti-dieting.

CREDIT: NYT Magazine Article in its Entirety

Losing It in the Anti-Dieting Age

The agonies of being overweight — or running a diet company — in a culture that likes to pretend it only cares about health, not size.
BY TAFFY BRODESSER-AKNER
AUG. 2, 2017

James Chambers was watching membership sign-ups on Jan. 4, 2015, like a stock ticker — it was that first Sunday of the year, the day we all decide that this is it, we’re not going to stay fat for one more day. At the time, he was Weight Watchers’ chief executive, and he sat watching, waiting for the line on the graph to begin its skyward trajectory. Chambers knew consumer sentiment had been changing — the company was in its fourth year of member-recruitment decline. But they also had a new marketing campaign to help reverse the generally dismal trend. But the weekend came and went, and the people never showed up. More than two-thirds of Americans were what public-health officials called overweight or obese, and this was the oldest and most trusted diet company in the world. Where were the people? Weight Watchers was at a loss.
Chambers called Deb Benovitz, the company’s senior vice president and global head of consumer insights. ‘‘We’re having one of the worst Januaries that anyone could have imagined,’’ she remembers him telling her. In the dieting business, January will tell you everything you need to know about the rest of the year. ‘‘Nothing like we had anticipated.’’ Chambers and Benovitz knew that people had developed a kind of diet fatigue. Weight Watchers had recently tried the new marketing campaign, called ‘‘Help With the Hard Part,’’ an attempt at radical honesty. No one wanted radical honesty. Chambers told Benovitz that they needed to figure out what was going on and how to fix it before the February board meeting.
Benovitz got to work. She traveled the country, interviewing members, former members and people they thought should be members about their attitudes toward dieting. She heard that they no longer wanted to talk about ‘‘dieting’’ and ‘‘weight loss.’’ They wanted to become ‘‘healthy’’ so they could be ‘‘fit.’’ They wanted to ‘‘eat clean’’ so they could be ‘‘strong.’’
If you had been watching closely, you could see that the change had come slowly. ‘‘Dieting’’ was now considered tacky. It was anti-feminist. It was arcane. In the new millennium, all bodies should be accepted, and any inclination to change a body was proof of a lack of acceptance of it. ‘‘Weight loss’’ was a pursuit that had, somehow, landed on the wrong side of political correctness. People wanted nothing to do with it. Except that many of them did: They wanted to be thinner. They wanted to be not quite so fat. Not that there was anything wrong with being fat! They just wanted to call dieting something else entirely.

A study out of Georgia Southern University’s Jiann-Ping Hsu College of Public Health, published in The Journal of the American Medical Association in March, monitored attitudes toward losing weight over three periods between 1988 and 2014. In the first period, 1988-94, 56 percent of fat adults reported that they tried to lose weight. In the last period, 2009-14, only 49 percent said so.
The change had been spurred not just by dieting fatigue but also by real questions about dieting’s long-term efficacy. In Weight Watchers’ own research, the average weight loss in any behavior-modification program is about a 5 percent reduction of body weight after six months, with a return of a third of the weight lost at two years. There were studies that appeared to indicate that the cycle of weight loss and weight gain could cause long-term damage to the metabolism. Those studies led to more studies, which suggested that once your body reaches a certain weight, it is nearly impossible to exist at a much lower weight for an extended period of time. Even more studies began to question whether or not it’s so bad to be fat in the first place; one notably suggested that fatter people lived longer than thin ones.
These questions began to filter into the mainstream. Women’s magazines started shifting the verbal displays on their covers, from the aggressive hard-body stance of old to one with gentler language, acknowledging that perhaps a women’s magazine doesn’t know for sure what size your body should be, or what size it can be: Get fit! Be your healthiest! GET STRONG! replaced diet language like Get lean! Control your eating! Lose 10 pounds this month! In late 2015, Women’s Health, a holdout, announced in its own pages that it was doing away with the cover phrases ‘‘drop two sizes’’ and ‘‘bikini body.’’ The word ‘‘wellness’’ came to prominence. People were now fasting and eating clean and cleansing and making lifestyle changes, which, by all available evidence, is exactly like dieting.
Diet companies suffered for being associated with dieting. Lean Cuisine repositioned itself as a ‘‘modern eating’’ company, not a diet company. In fact, Lean Cuisine went so far in their pivot that in 2016 they introduced a Google Chrome extension that would filter mentions of the word ‘‘diet’’ and ‘‘dieting’’; it apparently did this to show that just because it was called Lean Cuisine, that didn’t mean it was a diet company. You can’t be held responsible for what your parents named you!
Weight Watchers saw all this happening and concluded that people didn’t have faith in diets. The company decided that what it offered was not a diet program but a lifestyle program. It was a behavior-modification program. (For the sake of expediency here, I will call its program a diet because it prescribes amounts of food.) When Deb Benovitz returned from her travels with news of dieting’s new language changes, the company realized that something had to change more than its marketing approach.
Weight Watchers’ chief science officer is Gary Foster, a psychologist — the first in that position, which previously had been held by dietitians. What he and his team realized from Benovitz’s research was that dieters wanted a holistic approach to eating, one that helped really change their bodies, yes, but in a way that was sustainable and positive. He got to work creating a new approach that would become known as Beyond the Scale: He used all available mind-body research to try to figure out a way for members to appreciate benefits of the program besides weight loss. This would help them stay on the program during setbacks and beyond their weight-loss period and allow the program to infiltrate their lives beyond mealtime and beyond plain old eating suggestions.
The company would move away from giving its members goal weights. It expanded its cognitive-behavioral strategies, which taught members to challenge unhelpful thinking and to respond to their emotions with reason, as opposed to with food or despair. It developed workshops that used meditation and qigong and didn’t once mention food or weight. It updated its apps and introduced a social-media program, Connect. It became as holistic-minded as the people told Benovitz they wanted a program to be.
But Weight Watchers was still a company called Weight Watchers, and it had to figure out a way to communicate all of this change to the public. People had too many associations with the brand. It needed someone other than the usual celebrity spokesdieter, a fat famous person who could be paid somewhere between $250,000 and $2 million to do the talk show circuit and People covers for a year. It needed someone who could fast-track the message that it was worth taking a new look at Weight Watchers.
When the company called Oprah Winfrey in July 2015, she was standing on the lawn of her home in Maui with a sprained ankle, an injury she sustained while hiking in the mountains. In the month since her convalescence began, she had gained 17 pounds. Her struggles with weight were, at this point, a cultural meme. How could you explain the failure of someone so goal-oriented and successful — someone so successful that her name was invoked as a symbol of success as often as it was ever used to summon her? Weight Watchers had reached out to her in the past, but she politely declined. This time she bought a 10 percent stake in the company for $43 million, and Weight Watchers stockholders rejoiced.
But the verbal changes around dieting had indicated something deeper than just a marketing issue; they pointed straight back to the fatigue that was hurting Weight Watchers in the first place. So, yes, many people celebrated the new partnership. But others — meaning, anyone who for a majority of their lives had been watching Oprah cycle up and down through different sizes — felt a little confused by the move. What was Oprah, a person whose very brand meant enlightenment and progress, doing on another diet? It was hard not to suspect that she was trapped, like so many of us are, in a culture that says one thing about fatness and means something very different.

Back in 1963, when Jean Nidetch held the first what-would-be-known-as-Weight-Watchers meetings above a movie theater in Queens, things seemed clearer: It was bad to be fat, and it was good to be thin, and fat people wanted to be thin, and thin people wanted to help them get there. Her memoirs, ‘‘The Story of Weight Watchers,’’ reads about as current as a cigarette ad featuring smoking babies. ‘‘If strawberry shortcake made you break out in purple spots, you wouldn’t eat it,’’ she wrote. ‘‘You’d be allergic to it. But, do you think fat is prettier than purple spots? It’s uglier and harder to get rid of.’’
Its frankness seems like an anachronism now, but you have to consider that at the time, this kind of straight talk was a glass of cold water in the desert for many fat people, who privately wondered why it was so hard for them to reduce the size of their bodies when it seemed so effortless for the people who walked around thin. Nidetch lost her weight in her late 30s, after a lifetime of self-loathing and embarrassment; the last indignity was the time someone asked when her baby was due when she was definitively not pregnant. She went to a city-run obesity clinic, and when she left the program, she kept the diet it gave her. She mimeographed it and handed it out to people whom she had gathered to spread the word about how weight loss could provide freedom and hope. (The diet would evolve from an eating plan to a more democratic system of balanced exchanges to an absolute laissez-faire system of points, as the company realized that the more autonomy and the less deprivation people experienced in their dieting — limitless choices, if not limitless amounts — the more likely they’d be to stay on the diet.) But Nidetch knew that it wasn’t just the food that was the problem; it was the problem that was the problem. What fat people needed was one another. They needed a space in which they could talk openly about the physical struggles and daily humiliations of walking around in a fat body, and just how much that sucked.
These same ideas were articulated more starkly a few years later, but with a different prescription. In 1967, a fat man named Lew Louderback unleashed an essay in The Saturday Evening Post arguing that the wisdom around thinness could be applied only to thin people — that fat people suffered physically and psychologically when trying to maintain thin-person weights, and that this maintenance seemed to be temporary at best and largely destructive emotionally.
He went on to write a book called ‘‘Fat Power,’’ which helped give birth to what would become known as the fat-acceptance movement. That movement has varying degrees of militancy, but generally asks the public to put aside its bias and learn something new — to not think of fat people as lazy; to not deny them medical care; to not exclude them from their basic rights. It suggests that we re-examine what we think we know about fatness, that we consider trying to love and care for our bodies at whatever size they are now.

There were more books and more essays and more challenges to the status quo in the decades to come. In 2008, Linda Bacon, a researcher who holds graduate degrees in physiology, psychology and exercise science with a specialty in nutrition, wrote a seminal fat-acceptance book, ‘‘Health at Every Size: The Surprising Truth About Your Weight,’’ which used peer-reviewed research to bolster these ideas. She gave seminars to doctors on fat phobia and weight bias in an effort to help them understand how their views on obesi­ty were hurting their patients and not allowing them to examine fatness neutrally. For example, there is evidence that stress and discrimination play a strong role in the insulin resistance and diabetes and heart disease for which weight typi­cally takes the blame.
With the rise of social media, the movement began to infiltrate the culture in other ways, too. Fat-acceptance and body-positivity activists began posting pictures of themselves on Instagram — just regular pictures, defiant for their lack of apology. There were intuitive-eating workshops and body-positivity training camps. There were bloggers and authors asking exactly how much of your life you were willing to put off in pursuit of a diet, or until you got to a certain weight, even temporarily. Normal, nonmilitant, nonactivist people began asking themselves if it was that bad to be fat — if it was that unhealthy, or that ugly, to be fat. And yet the most telling thing about the way the fat-acceptance movement is received in our society may be that its Wikipedia entry contains two quotes from people criticizing it before it mentions even one person who espouses it. In this world, we are witness to a moment when the word “optimal” is used in conjunction with the word “body,” when people are trying to mold themselves into high-performance, precision machines. The idea of a fat machine makes no sense when you are easily fueled and refueled on Whole Foods and Soylent.
In other words, all this activism didn’t make the world more comfortable with fat people or dieting. Society doesn’t normally change the words for things unless we’re fundamentally uncomfortable with the concepts beneath them. Consider the verbal game of chicken we’ve played with the people all this affects: Fat people went from being called fat (which is mean) to being called overweight (a polite-seeming euphemism that either accidentally or not accidentally implies that there is a standard weight) to being called zaftig/chubby/pleasingly plump (just don’t) to curvy (which seems to imbue size with a sexuality and optimism where it should just be sexually and emotionally neutral) and back to fat (because it’s only your judgment of fat people that made it a bad word in the first place, and maybe being fat isn’t as bad as we’ve been made to believe). It bears mentioning that Weight Watchers doesn’t have a standardized word for its demographic, but Foster uses the term ‘‘people with overweight.’’
As the ideas that sprang from the fat-acceptance movement began to trickle into the mainstream, fat people began to wonder what it might be like to put all this aside and just live their lives. Some asked themselves if they thought they could figure out a way to not want to be thin; some began to ask themselves if they actually liked the way they looked. They began to wonder if there was even a proven and effective way to become and stay thin anyway. They began to ask themselves if they should be dieting at all.

Last fall, I was with Foster, Weight Watchers’ chief science officer, as he walked the halls of Obesity Week, the annual conference of the Obesity Society. The conference includes study presentations, each one a possible clue to the mystery of fatness. We attended a presentation on a new study of a weight-loss medication. People on the medication lost weight, but once they were off, the weight came back. If only we could get people’s weight down, the presenters said, they could have a fresh start. Out in the hall, Foster shook his head. ‘‘There’s a bias and a stigma: ‘We’ll give these people medication for a short period, but then they’ve got to fly straight and get will power.’ It’s nonsense. This tough love — I’m going to be hard on myself — you know, in some perverse way, if it were true, we might try to leverage it, but it’s not. The harder you are on yourself, the worse you do.’’ In his career before Weight Watchers, Foster was the founder and director of the Center for Obesity Research and Education at Temple University. Neutralizing the morality talk and stigma that surround obesity, he says, would make it a lot easier to figure out how to deal with it.
By the time of the conference, the Oprah-Weight Watchers partnership had proved a clear success. Within a year, the company was up to 2.8 million members; by the first quarter of 2017 it would be 3.6 million. Oprah had brought an audience to Beyond the Scale, the holistic model Foster helped create. He says that initial weight loss on the program in 2016 was up 15 percent from what it was the year before. Of course people should want to manage their weight, he said, the same way they’d want to manage their diabetes. ‘‘It would seem preposterous if we would say to people with diabetes, ‘Don’t manage your diabetes.’ ’’ Or their asthma. All three are chronic conditions; why, he asks, would we assume we should give up on weight? When people lose weight, he points out, they see improvements in risk factors. Data is data. Modifying your eating is hard, he says, but it’s worth it. No one can tell you that lowering weight doesn’t also lower other health factors like hypertension and high cholesterol and joint pain.
Some fat people began to wonder if there was even a proven and effective way to become and stay thin anyway. They began to ask themselves if they should be dieting at all.

Maybe that’s true. Most mainstream sources agree on this, but there are definitely some researchers who don’t; there are some who think that people who end up fat have different physiologies, and that fatness is just one component of them. Consider the ‘‘uptick,’’ as Foster calls it, that comes after two years on a diet when, say, the person who lost 5 percent of her weight has gained a third of it back. Think about those numbers. If you weigh 300 pounds, you will lose 15 pounds in six months. You’ll keep it off for a year or two, maybe. Five pounds is likely to return. Of course, these are people who don’t stay on a diet-maintenance plan; but the average dieter certainly doesn’t, and it’s worth it to ask why a person wouldn’t stay on a program that offered such rewards. Is it because they couldn’t? It’s worth it to ask if the programs are right and all these humans trying very hard at them are wrong. And also, where are the 300-pound people who want to lose just 15 pounds in the first place? I haven’t met those people. But mainly, what it comes down to is this: Weight Watchers is designed to be successful only if you can stay on Weight Watchers forever.
And there were also questions about dieting’s long-term effects on the body. A study done by the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health. The study followed contestants who had appeared on the eighth season of ‘‘The Biggest Loser,’’ all of whom had normal resting metabolisms for their size when the season began. As the contestants experienced radical, sweeps-week weight loss, their metabolisms slowed, and stayed slow afterward. To maintain his weight loss, one contestant’s resting metabolism now required 800 calories fewer per day than a man of his size. It might be that when you have been fat, your body doesn’t behave the way a thin body does, even when you become thinner.
Foster shook his head at that one. He hears about the ‘‘Biggest Loser’’ study a lot, but he doesn’t think it conveys accurate information. It uses a very small sample under extreme conditions. He cited his own and others’ studies examining the metabolic rate, fat distribution and psychological state of people before they lose weight, after they lose weight and after they regain the weight. ‘‘Nothing is changed,” he said. ‘‘I’m not saying that’s a good outcome or something we should celebrate — but this idea that the act of managing your weight and losing weight has somehow set you up to be in a worse spot just isn’t borne out by the science.’’
Here is the thing about this particular debate at this particular moment: Everyone has much the same data, but there are plenty of people who would interpret the data differently from the way Foster does. I’ve spoken to countless (I literally stopped keeping count) obesity researchers and dietitians and biologists and doctors. The answer becomes one of point of view: Is fat inherently bad, or can it be neutral?
We can’t answer that yet. There is still too much debate. So in the meantime, a fat person has to consider the data she has access to — meaning studies, yes, but also her own experience and the experience of her fat peers — and ask: Do you believe that you, a fat person, can ever be meaningfully thinner for a meaningful amount of time? Is a diet successful if it stops being successful once you’re done with it? I’ve interviewed Foster before. Back in 2011, when he was at Temple, he published a study about the efficacy of different kinds of diets. They all led to similar losses, and they all led to similar rates of recidivism. When I spoke with him back then, I asked him why we should continue dieting if the outcomes were so bad. He was concerned that I would suggest to my readers that dieting wasn’t worth it. He told me that people didn’t need that kind of discouragement. This attitude is what makes him so credible to me — his message was the same long before he worked for a corporation — but it’s also what makes this so depressing.
I do not recommend being a fat person at Obesity Week. Over the years, the event has become a week long, and it contains a robust trade show. After Foster left me to go to a meeting, I walked the trade-show floor and saw all the products being shown to the obesity specialists in attendance. I watched a video of a new kind of retractor that will more easily hold open belly skin while part of a stomach is cut out and sewn up, because you can’t eat as much if your stomach is made smaller. I watched a person showing a model of a balloon you’d insert into the stomach of a patient that would take up volume so that she wouldn’t be so hungry, to be removed later once her behavior had been modified. I drank a smoothie with a superfood ingredient I can’t pronounce or remember while someone told me that my readers would really be interested in their something-metrics plan for hydration and portion control. I narrowed my eyes thoughtfully because it felt rude to be drinking this guy’s smoothie without taking him seriously. ‘‘There’s no such thing as magic, Taffy,’’ the smoothie man was saying. I nodded in solemn agreement.
Before he left me, I told Foster that Obesity Week made me sad. First, it was the profusion of educated people in the room studying me and my people as if we were problems to solve. But second, it was because if you have this many hundreds of smart and educated people trying to figure this out, and nobody has anything for me but superfood and behavior modification and an insertable balloon and the removal of an organ, it must be that there is no way to solve fatness.
Foster doesn’t see it that way, he told me. ‘‘I look around this room,’’ he said, ‘‘and I see hope.’’

By the time Oprah announced that she was signing on with Weight Watchers, I was celebrating my 25th anniversary of my first diet, at age 15, which I found in an issue of Shape magazine. I was 5-foot-3 and weighed 110 pounds. In the intervening years, I did cleanses and had colonics and refilled the prescriptions on three rounds of those diet pills that made my teeth sweat and ate two shakes for lunch and just protein and just good carbs (carbs are divided into good and bad, like witches in Oz) and just liquid and just fruit until dinnertime and just food the size of my fist and two glasses of lukewarm lemon water. I had stood up in a room and said, ‘‘Hello, my name is Taffy, and I am a compulsive overeater.’’ I had stuck my finger down my throat, a shot in the dark that I hoped would be more sustainable than it was. I had South Beached, I had Atkinsed, I had Slim-Fasted. Put it this way: The Amazon algorithm recently recommended to me, based on my previous searches, a book-and-CD combination, ‘‘Hypnotic Gastric Band: The New Surgery-Free Weight-Loss System,’’ which offered a hypnotic equivalent to bariatric surgery. Put it this way: When I arrived at Weight Watchers, despite the fact that I was there as a journalist, I registered for the diet under the ra­tion­ale that this was experiential journalism. When I gave my name at the counter, the person registering me furrowed her brow and said: ‘‘That’s strange. There are three other people named Taffy Akner.’’ I said, ‘‘No, those are all me.’’
‘‘In Brooklyn?’’
‘‘Yes, when I was in high school.’’
‘‘In Los Angeles?’’
‘‘Yes, right before I was married.’’ I stopped her before she could go on. ‘‘They’re all me.’’

By then I was all in, as if I ever hadn’t been. When I arrived at the Union, N.J., meeting at 8 a.m. on a Saturday, it was a few weeks before Thanksgiving. Thanksgiving is marketed as a fun, festive holiday of family gathering, but everyone at that meeting knew the truth: Thanksgiving is an existential threat. Thanksgiving is a killer.
The year leading up to Thanksgiving hadn’t been much better for this group. There had been family deaths and illness. There had been foreclosures and unemployments and high-school reunions, and someone’s daughter was always baking sticky buns; someone’s husband wanted to know where his steak was; someone’s son wanted to know why the meatloaf tasted different; someone’s co-worker was always leaving doughnuts and bagels on the communal table at the office. The people, mostly women, in the folding chairs had one rule, though: No matter what happened during the week, you showed up. ‘‘This is my church,’’ a woman named Donna told me. A few months before, she buried her mother on a Friday; on Saturday she came to the meeting.
Dayna, the group leader, stood at the head of the room. How could you not love Dayna? She took such care with her appearance — she wore tall boots and wrap dresses and makeup, even on Saturday mornings when everyone else wore sweatpants at best (or leggings; leggings weigh less). She gave them star-shaped stickers off a large roll when they lost weight or when they had acted in their best interests over the week. She remembered their names, even the ones who hadn’t shown up in months; she gave them hugs.
Today, Donna had gained weight. She had been holding steady at six pounds short of her goal. Since 2009 — 2009 — she had shown up every week and by now had lost 132 pounds, which is an entire other Donna. But these last six pounds, my God, what would it take? She’d been down last week by a pound, and now that pound was back. She’d been going to the gym ‘‘religiously’’ for two weeks, but thought maybe the not going to the gym three weeks ago had caught up with her. Sometimes being six pounds away from her goal was harder than being 321 pounds.
‘‘I’m so frickin’ aggravated,’’ she said. She asked me how I did. I shrugged and told her I had lost three pounds. ‘‘But I just started, so, . . . ’’ I said. I didn’t want her to feel bad. Another woman, Amy, whispered to me, ‘‘You never want to say ‘I only lost, . . . ’ because then everyone will go, ‘Oh, jeez.’ ’’
Weight isn’t neutral. A woman’s body isn’t neutral. A woman’s body is everyone’s business but her own.

I asked the women there, most of whom were repeat joiners as well: Shouldn’t we be moving toward acceptance? Here we all were — smart, accomplished, successful women (and one man) — and we couldn’t maintain what was proved to be the most effective diet you could ever try. If we couldn’t stay on this, could we stay on anything? What if the flaw wasn’t in us but in the system?
They furrowed their brows and shook their heads and gave me funny looks. What was I talking about? How could a fat person not want to be thin? Donna’s sisters were all on diabetes medication, and she wasn’t. Her back had hurt until about 20 pounds ago, and now she could crawl on the floor with her grandson as if it were nothing.
I couldn’t counter very hard. Each time I came to a meeting, I was seduced by the possibility, by the clean, Calvinist logic, that if you ate less you would weigh less, that your body would feed on itself and its fat reserves until you became smaller and smaller and more pleasing to the world and its standards — until you practically disappeared (we are a culture that fetishizes something called Size 0). I looked forward to these meetings, feeling as if these people were the only ones who seemed to truly understand my predicament. But my optimism and motivation didn’t survive my walk out the door. By the time I got to my car, I had no idea what to do. I knew that if this could be done, I would have done it, and yet I didn’t know why I couldn’t do it. Just eat less, right? It’s so simple!
About two years ago, I decided to yield to what every statistic I knew was telling me and stop trying to lose weight at all. I decided to stop dieting, but when I did, I realized I couldn’t. I didn’t know what or how to eat. I couldn’t fathom planning my food without thinking first about its ability to help or hinder a weight-loss effort. I went to a nutritional therapist to help figure this out (dieting, I have found, is its own chronic condition), and I paid her every week so I could tell her that there still had to be a way for me to lose weight. When she reminded me that I was there because I had realized on my own that there was no way to achieve this goal, I reminded this wonderful, patient person that she couldn’t possibly understand my desperation because she was skinny. I had arthritis in my knees, I said. Morality and society aside, they hurt. I have a sister with arthritis in her knees, too, but she’s skinny and her knees don’t hurt.
I went to an intuitive-eating class — intuitive eating is where you learn to feed yourself based only on internal signals and not external ones like mealtimes or diet plans. Meaning it’s just eating what you want when you’re hungry and stopping when you’re full. There were six of us in there, educated, desperate fat women, doing mindful-eating exercises and discussing their pitfalls and challenges. We were given food. We would smell the food, put the food on our lips, think about the food, taste the food, roll the food around in our mouths, swallow the food. Are you still hungry? Are you sure? The first week it was a raisin. It progressed to cheese and crackers, then to cake, then to Easter candy. We sat there silently, as if we were aliens who had just arrived on Earth and were learning what this thing called food was and why and how you would eat it. Each time we did the eating exercise, I would cry. ‘‘What is going on for you?’’ the leader would ask. But it was the same answer every time: I am 41, I would say. I am 41 and accomplished and a beloved wife and a good mother and a hard worker and a contributor to society and I am learning how to eat a goddamned raisin. How did this all go so wrong for me?
They tried to soothe me. They told me that hatred of fat was a societal construct, but I never understood why that should comfort me. I live in society. I hurt my ankle playing tennis, activating an old injury, and an internist I was seeing for the first time, without taking any medical history or vital signs — my blood pressure is pristine, just so you know — told me he couldn’t do anything for me until I lost weight and gave me a rusty photocopy about food exchanges. (Another doctor prescribed three months of physical therapy, and now my ankle is fine.) I was in Iceland, for a story assignment, and the man who owned my hotel took me fishing and said, ‘‘I’m not going to insist you wear a life jacket, since I think you’d float, if you know what I mean.’’ I ignored him, and then afterward, back on land, after I fished cod like a Viking, he said, ‘‘I call that survival of the fattest.’’ A woman getting into a seat next to me on a plane said, ‘‘Looks like this will be a cozy ride,’’ and a Manhattan taxi driver told me he liked to watch my ‘‘jelly’’ shake, by which I can only presume he meant a part of my body. I have been asked if it was my first time taking Pilates at a studio where I’m on my fifth 10-pack. I have been told at a yoga class that I have ‘‘a really great spirit’’ and it’s important that I ‘‘just keep coming.’’ (I’ve been taking yoga for 12 years.) I was told by a seamstress that she had never seen a bride not lose weight for her wedding until she met me. A crazy man tried to give me candy outside the Met, and when I politely declined he screamed at me that of course I didn’t want it, I was fat enough, and my sister asked me why I was so upset, clearly that guy was crazy, and I said, ‘‘You don’t understand because you’re skinny,’’ and on and on forever. (By the way, I am writing this despite the myriad degradations that I know will appear in my inbox and in the comments section when it is published. I am someone who once wrote a body-image essay for a women’s magazine in which a comment in the margins from an editor read, ‘‘Why doesn’t she stop eating so much?’’)
Back in Union, Dayna stood at the front of the room. The conversation had shifted to Thanksgiving foods, how sons home from college depend on the stuffin’ muffins, how husbands will know if there’s no butter in the mashed potatoes. Donna makes an Easter pie with more kinds of pork than there are pigs roaming the Earth. Really, the group members were worried that despite their weight loss, they would forget that they were really fat people on the inside. Thanksgiving is a killer.
‘‘It’s just one day,’’ Dayna said. And all those around her heaved heavy sighs.
‘‘Please hold for Ms. Winfrey.’’
When Oprah called me, she was on the same mountain in Hawaii where she sprained her ankle two years ago. After a monthslong search, Weight Watchers had hired a new C.E.O., Mindy Grossman, formerly of the Home Shopping Network. In her office, Grossman had talked to me about personalizing the company’s mobile app and creating greater moments for connection. She is tan and very blond, with pink lipstick; she looks like the second coming of Jean Nidetch. Weight Watchers had found its business leader. She was joining the company after its fourth consecutive quarter of revenue growth because it had finally found its spiritual one.
On the release day of the commercial in which Oprah told the world she loved bread and was excited to be able to eat it every day and still lose weight, the graph line shot up tall and straight at Weight Watchers. But a lot of us wondered if maybe Oprah had finally fallen out of touch. She said in one commercial, ‘‘Inside every overweight woman is a woman she knows she can be,’’ saying she’d been buried in her weight to the point where she couldn’t recognize herself, and the internet did not love this sentiment, asking exactly why Oprah thought that women were worthless if they weren’t thin. They asked if she was ‘‘disempowering women.’’ They said her investment in Weight Watchers was ‘‘bad news for women everywhere.’’ One blogger wrote that she was ‘‘disappointed that she is choosing to participate in and endorse a company whose sole purpose is to tell women that they are not enough.’’ The journalist Melissa Harris-Perry gave a five-minute ‘‘Letter of the Week’’ on MSNBC saying: ‘‘But, O! You are already precisely the woman so many are striving to be,’’ and ‘‘there is not one thing that you have done that would have been more extraordinary if you’d done it with a 25-inch waist.’’ Oprah’s $43 million investment was now worth $110 million. Maybe that’s what this was all about in the first place.
They tried to soothe me. They told me that hatred of fat was a societal construct, but I never understood why that should comfort me. I live in society.

Oprah was used to criticism. Back in 1985, Joan Rivers brought Oprah on ‘‘The Tonight Show,’’ and without so much as a warning in the pre-interview, told her she shouldn’t have ‘‘let’’ her weight gain happen to her. ‘‘You’re a pretty girl, and you’re single,’’ Rivers said. Oprah explained that she had done everything so far — everything! By 1985! She had done the banana-hot-dog-egg diet (in which you just eat a banana and a hot dog and an egg). She had done the pickles-and-peanut-butter diet (in which all you eat are pickles and peanut butter).
In 1988, she pulled a wagon full of fat onto the stage of her show to show off her 67-pound weight loss. In 1991, she went on the cover of People and declared she was never dieting again. In 1996 she wrote a book with Bob Greene about having found the solution. In 2002, she wrote a story in her magazine, O, called ‘‘What I Know for Sure About Making Peace With My Body,’’ in which she announced that she had made peace with her body. In 2005, the cover of O, which usually features just one Oprah, featured two: a thin one with an exposed midriff leaning on the shoulder of another thin one in a fancy dress. In 2009, she published another two-Oprah cover. This one was the midriff-bearing one from the 2005 cover, leaning on a larger Oprah in a purple jogging suit. The cover line said, How did I let this happen again?
Oprah sounds like Oprah when you talk with her — she sings your name, ‘‘Taffy!’’ and her voice registers in you in a way that is as familiar to your body as your mother’s voice. She told me she doesn’t care if she’s never skinny again. She cares that she feels as if she has control. For her whole life, she said, her only goal has been to find a higher level of consciousness, to remain more in the moment than she has ever been in any other moment. She had never felt stress, even during all those years when she was doing three shows a day. She just ate instead. She had bags of potato chips, and people would say, ‘‘Don’t you get stressed?’’ and she’d think, What’s stress? She had seen the cultural changes for years. She knew that you were no longer supposed to say that you wanted to diet or be thinner. You had to want ‘‘fitness’’ and ‘‘strength’’ and just general health. But this thinking was a prison. So was the one where you just accept yourself and move on. “This whole P.C. about accepting yourself as you are — you should, 100 percent,” she said. But it was that thinking that made her say yes to Weight Watchers. ‘‘It’s a mechanism to keep myself on track that brings a level of consciousness and awareness to my eating. It actually is, for me, mindful eating, because the points are so ingrained now.’’ Meaning, Oprah wasn’t interested in ceding to a movement. She was wondering how to finally make this work.
‘‘In the particular moment in time that I got the call,’’ she told me, ‘‘I was desperate: What’s going to work? I’ve tried all of the green juices and protein shakes, and let’s do a cleanse, and all that stuff. That doesn’t work. It doesn’t last. What is going to be consistent, keep me conscious and mindful?’’
But this thing about acceptance? Why couldn’t accepting herself mean not accepting her weight? Why wasn’t it an act of love to use any available means to avoid her genetic predisposition to diabetes? Sure, she could have abandoned her efforts. She could have gone hard on acceptance. A million people would have bought ‘‘Oprah’s Guide to Body Acceptance.’’ But she couldn’t get there. ‘‘For your heart to pump, pump, pump, pump, it needs the least amount of weight possible to do that,’’ she said. “So all of the people who are saying, ‘Oh, I need to accept myself as I am’ — I can’t accept myself if I’m over 200 pounds, because it’s too much work on my heart. It causes high blood pressure for me. It puts me at risk for diabetes, because I have diabetes in my family.’’
I nodded into the phone because I didn’t want Oprah to hear me crying. I wanted to quit dieting, but had come to realize that dieting was all I had. I was completely perplexed by food — food! Stupid food! That’s what this was about! I dieted because I wanted to maintain hope that I could one day manage my food intake, because my bewilderment around the stuff was untenable. When I didn’t have that hope, I was left with too much worry about pain, about how much my knees hurt now and how much more they would in just a few years. I could be enlightened about my body. I could have acceptance. But nobody would tell that to the people who saw me as a target; nobody would tell that to my knees.
And yet, I told Oprah, in admitting this, I couldn’t stop feeling as if I were betraying everyone I knew who was out there trying to find peace with herself. I couldn’t stop thinking that nothing would change in the world until there was a kind of uprising.
‘‘Oh, my God, Taffy,’’ Oprah said. ‘‘I have to have a talk with you. I used to say this to my producers all the time. We are never going to win with this show looking back to see what other people are doing on their shows. The only way you win is to keep looking forward for yourself. What’s best for you?’’
The ‘‘you’’ threw me. I didn’t know if she meant ‘‘you’’ as in my body or ‘‘you’’ as in me, and it occurred to me that she could mean both, that some people think of those two things as the same thing. I treated my body with such contempt, but my body wasn’t different from me. There were no two of me to put on a magazine cover, just the one of me.
Weight isn’t neutral. A woman’s body isn’t neutral. A woman’s body is everyone’s business but her own. Even in our attempts to free one another, we were still trying to tell one another what to want and what to do. It is terrible to tell people to try to be thinner; it is also terrible to tell them that wanting to lose weight is hopeless and wrong.
I don’t know if diets can work in the short term or the long term. For the first time, I began to think that this was something worth being made crazy over. Our bodies deserve our thoughts and our kindness, our acceptance and our striving. Our bodies are what carry our thoughts and our kindness and our acceptance and striving.
On Saturday, March 18, Donna, of the meeting in Union, made her goal weight. Six weeks later, having maintained the weight, she became a lifetime member. If she stayed within a few pounds of her goal, she could keep using the program free. There were other lifetime members in our meeting. There were also former lifetime members who were starting over.
Eileen, a lifetime member who sat next to Donna at every meeting, had bought her a plastic tiara. Donna wore leggings this time, not sweatpants as usual, with her traditional Uggs and a fleece, and someone pointed out that you could finally see her shape. She passed around some old pictures; she was unrecognizable in them, if you could find her behind all the other people in the picture.
‘‘I don’t think I’ll ever feel like a thin person,’’ Donna said. Her hope is that she’ll continue to at least look like one.

Dayna, near sobbing, gave her a bunch of star stickers off her roll. ‘‘My heart just feels so happy today,’’ she said.
We all cheered for Donna, and when I left, I walked around outside. A skinny woman was eating a cupcake and talking on her phone, tonguing the icing as if she were on ecstasy. Another skinny woman drank a regular Dr Pepper as if it were nothing, as if it were just a drink. I continued walking and stopped in front of a diner and watched through the window people eating cheeseburgers and French fries and talking gigantically. All these people, I looked at them as if they were speaking Mandarin or discussing string theory, with their ease around their food and their ease around their bodies and their ability to live their lives without the doubt and self-loathing that brings me to my arthritic knees still. There’s no such thing as magic, Taffy. I shook my head at the impossibility of it all, and sitting here writing this, I still do.

Taffy Brodesser-Akner is a contributing writer for the magazine. In September, she will become a features writer for The Times’s culture desk and a staff writer for the magazine.