Rewiring Education: 9th Bridge Aims to Teach to the Brain

October 24, 2013 7:54 pm \ Leave a Comment \
Screen Shot 2013-10-24 at 3.50.26 PM

When school got underway this year in Las Vegas, Nevada, 15 children aged six weeks to 5 years walked, toddled and were toted into a brand new institution that’s founded on relatively novel ideas, including the notion that education should be delivered according to how the brain best processes it.

Working with few restrictions and plenty of moxie, 9th Bridge School has gathered consultants in cognitive neuroscience and psychology to help develop a learning plan that seeks to “redefine the experience of education.” Read more

Posted in: Education \ Tagged: , , , ,

Artist Raghava KK on learning to be creative

September 15, 2013 8:16 pm \ Leave a Comment \

Raghava KK is an artist, TEDMED/TED speaker and National Geographic Emerging Explorer.

Q. In your talk at TEDMED 2013, you showed us your latest work, in which brain wave technology helps viewers shape your art according to their thoughts and moods. How have people responded so far? 

Contrary to what I anticipated, my talk at TEDMED received an overwhelmingly positive response. I thought the TEDMED audience would predominantly think in fundamentals, and there would be a disconnect. But any science taken to a certain level becomes art. It goes into the ability to transcend to abstract the essence of its thing, and apply it beyond a single application. There’s only a limit to which you can be trained in any one thing.

998577_611085965588437_546891119_n

From doctors to scientists, there are now a lot of people who are in conversation with me about how we can add value to each other’s methods of inquiry. I’m really excited that I’ve gotten to write the forward to a textbook on cultural sensitivity using perspectives in psychiatry that is being brought out by Massachusetts General, Harvard’s teaching hospital.

Did you learn anything surprising about the brain during this project?

Yes! It shocked me the number of emotions we can go through in one minute.

We like to think about ourselves in absolutes, but we are dynamic and continually changing. Also, I’m surprised by the degree to which you can control brain activity. I can manipulate my art pieces on cue. When some people have that feedback, it can make them feel uncomfortable; with others, it helps neutralize their feelings of fear.

You’re working with an education innovation initiative, NuVu, that stresses creative problem solving skills, and have said, in an interview with Dowser, that education now should be about welcoming instability. Your art encourages dynamic perspectives as well. What is it about the world we live in that makes this so important? Can you point to something in your life or learning that led you to embrace the impermanent?

The one thing we know about the world for sure is that it’s constantly changing.  Evolution is not a ladder that’s built on linear progress. It’s more like a round treadmill, where we’re constantly adapting in relation to a dynamic environment.

So it seems appropriate that we learn in a manner that correlates to the state of the human condition and environment. I’ve reinvented myself many times. I’ve always felt that my education was great; it taught me who I am.

But it’s been my creativity that has constantly told me I can be much more. I could have never planned my whole art career and trajectory. I allowed it to unfold by taking an active role in my life and my future. I think that the incident that really sparked this idea was my decision to quit formal education, and to embrace and learn from impermanence. I haven’t had a formal education since high school, so the world has been my classroom.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

A screen for POP-IT, an iPad app designed by Raghava KK. Viewers change the characters by shaking the tablet.

In that same interview, you said, “Even in my own life, I keep putting myself in uncomfortable situations because of the amount I learn.” Can you give a few examples?

Here are three. First, I recently moved back to India, although I was well settled in New York. I wanted to have my third child here, and expose my children to this impossible democracy, which is an experiment in bringing together multiple, dissimilar perspectives and thus gives us so much to experience and to learn from.

Second, I’m starting a company from scratch and learning about entrepreneurship, because I really want to make an impact with this idea, to transcribe it among audiences. It’s a web-based and mobile educational platform called Flipsicle, and it allows you to actually see multiple visual perspectives on any topic. It’s a man-powered Google for images that uses collaboration and crowdsourcing.

We are producing and consuming more pictures than ever before, but desensitizing us to the fact that pictures are only a single view on an event and truth. Even in our schools, we start out with absolutes and go to abstract at a later stage, like high school, which is far too late. We need to disrupt this teaching and go to abstract thinking at a much earlier stage to really teach perspective.

Third: Once my wife and I accidentally found ourselves in a nudist resort.

This is what happens when an Indian books a holiday without knowing the difference because naturist and nature, because in California “naturist” means “nudist.”  We checked in late in the evening; everyone was wearing clothing, because it was cold.  In the morning I opened the window and saw a guy doing yoga in the buff. Then, my wife and I walked out and we were the only people clothed. So – do we stay here, or we go back home and pretend this never happened? But we thought,  ‘What the hell do we have to lose?’ And it led to an entire series of paintings I did on eros and nudity.  I discovered that it’s the continuum that’s erotic, not the absolute states of nudity. The feeling of the weight of clothing is something you just forget; it’s a change of the clothed state you notice.

"Untitled" by Raghava KK, acrylic on canvas, 2011.

“Untitled” by Raghava KK, acrylic on canvas, 2011.

You mention often that you hope your work will inspire empathy. Can you name a piece of art, or an artist, who inspired that in you, or who/that greatly changed your own perspective?

An artist need not look to art to be inspired, but to life. I see a need for empathy in the world, and that’s what inspired me.

Empathy is fashionable word right now, and it can be easy to misrepresent.

To me, empathy is a tool and it has survival value based on context.  For example, sometimes apathy is important. Extrovertism is overrated. Leadership is overrated; not everyone is a leader. We need to understand these things as continuums that have value based on context. So empathy means contextualizing where I come from, where you come from.

For example, I don’t measure myself by the same metrics by which others do, whether it’s the art world or the commercial world or the entrepreneurial world or the TED world. For someone to understand what I – or anyone — does, they have to have an understanding of how I measure my actions. The need for human dignity comes from these factors. It’s a constant need. And I need to be more than an artist. Life is just a tool. Art is just a tool.

Reprinted from TEDMED.com

 

Posted in: Education

Like mother, like daughter: Eating disorders run in families

September 15, 2013 7:57 pm \ Leave a Comment \

Deborah Belfatto worried that her daughter might have an eating disorder when the 12-year-old eliminated all fat from her diet and started getting very thin.

But she didn’t act on her suspicions until an older family friend commented on her daughter’s weight loss.

“The comment came from such an unlikely source that it gave me a jump-start into taking some real action,” Belfatto says.

A breast-cancer survivor, Belfatto considers herself someone who doesn’t shy away from hard truths. But she was not alone in her reluctance to confront her child’s anorexia. Many mothers resist acknowledging a child’s eating disorder, out of fear, guilt – and sometimes because they’re struggling with their own food issues.

Belfatto’s daughter fit the anorexic “profile,” in that she was a high achiever who rarely gave her parents cause to worry. Disordered eaters, particularly anorexics – who severely limit food intake — tend to be very successful in other areas, and Lindsay was an outstanding student and competitive ice skater.

“These high achieving, outgoing, activity-oriented girls are very perfectionist and anxious, and our perception is they respond differently to dieting than other kids do. They actually find caloric restriction calms their anxiety,” says Cynthia Bulik, M.D., author of “The Woman in the Mirror: How to Stop Confusing What You Look Like with Who You Are.”

Like mother, like daughter: Seeing her child with an eating disorder may hit too close to home for some moms. Research shows disorders run in families; a relative of a person with an eating disorder is ten times more likely to have the illness than someone without a family history of disorders. Read more on NBCNews.com

Posted in: Eating Disorders \ Tagged: , ,

Caregiving can hurt employee health — and increase employer costs

September 15, 2013 7:46 pm \ Leave a Comment \

Debbi Heffern was too busy caregiving to go for that colonoscopy.

A dietitian and lactation consultant in St. Louis, Missouri, Heffern had been a caregiver for decades; first, for her mother, who died of cancer; and then for her mother-in-law.

“My mother-in-law was determined to live on her own. I made sure we jumped through all the long-term care insurance hoops in the right order, and had to line up paid caregivers. When she took a turn for the worse or needed new equipment I had to be on top of all that. Then her identity got stolen. Untangling that was a nightmare,” Heffern says.

Sure, Heffern had recently turned 50, but she had a healthy life style, except for the stress, and who had time for a colon cancer screening? Unfortunately, she had an ugly surprise when she was tested three years later.

“I ended up with stage four colon cancer, which required multiple surgeries and 32 rounds of chemo. While my employer was very accommodating, recovering from surgeries and all that chemo meant a lot of time away from my own job. If I had gotten my screenings when they had been recommended, I’m told I might have had only stage two or three, and perhaps wouldn’t have needed two of the surgeries or so much additional follow-up chemo,” she says.

“Four in 10 adults in the U.S. are caring for an adult or child with significant health issues, up from 30 percent in 2010,” according to a recent national survey by Pew Research Center. Given our aging population, that number is almost certain to increase, with employers taking a chunk of the burden, at least financially: A 2011 Gallup study says full-time employee absenteeism due to caregiving duties costs employers some $25 billion annually.

What is less obvious is the hidden impact caregiving has on employee health. Byproducts of unrelenting stress, such as depression and poor sleep, and a lack of attention to personal health, including nutrition and exercise or — as in Heffern’s case — neglecting preventive care, take a toll. Eliza Corporation of Danvers, Mass., a leader in health engagement management, in partnership with Altarum Institute, developed the Vulnerability Index (VI) to help insurers and employers measure how life issues like caregiving, financial troubles or marital problems impact employee health. The Company says the index has three times the predictive power of self-reported health problems than traditional measures.

According to their research, these vulnerability factors make people much more susceptible to chronic conditions such as mental illness, lower back pain and diabetes. Caregiving shows a particularly strong link; caregiving employees are nearly three times more likely to be highly vulnerable to health issues than non-caregivers. The Pew study also showed that caregivers were more likely to have faced a recent health crisis than non-caregivers.

Caregiving measurably impacts employer health costs, too; according to a 2010 study of the MetLife Market Institute and the National Alliance for Caregiving, health care costs for caregivers are roughly eight percent more than non-caregiving employees, costing employers an estimated $13.4 billion per year extra.

Tracking a clear relationship can be tough, however, as employees are not likely to bring topics like caregiving — Eliza Corporation calls them “The Unmentionables” — to the fore.

Jon Seaman, Director of Caregiver Solutions at Care Innovations, an Intel-GE joint venture that develops technology for remote care, survived kidney disease and a transplant, then helped his wife care for his elderly mother-in-law through a series of health crises. In talking with him, one gets the feeling that the latter was the more stressful experience.

“I think because it was so obvious that I was ill at work, I was very up front. ‘I’ve got these things going on. Can you support me? But with caregiving, some of the details that would help explain where my time went were very private to my mother-in-law. I didn’t know what I could share. I didn’t think I could really talk about her incontinence, for example. The whole situation was so harrowing and depressing,” Seaman says.

Further, many caregivers don’t self-identify as such.

“People don’t even know they’re doing it. It’s just what they’re supposed to do as a family member. They often have no choice but to be a caregiver. We’re trying to get people to say, “It’s an important point in life to be a caregiver, but you need support,” he says.

The VI research says people are eager for help; about 80 percent of respondents are willing to accept help from their doctor or health plan on an “Unmentionable” issue like financial stress; that rate jumps to 96 percent of people wanting help from either their doctor, their health plan – or just as importantly, their employer – with their caregiving stress. Just being surveyed brings overwhelmingly positive feedback, says Alexandra Drane, Eliza Corporation’s Founder and Chief Visionary Officer.

“The reason people like it is because they know these life stresses are why they’re not feeling well, but nobody asked them these questions before,” she says.

“There is a lot of counseling for cancer patients available both through our insurance company and where I was treated. But I don’t think anybody ever asked me about the caregiving stress,” Heffern says.

Drew Holzapfel, who convened ReACT, a coalition that aims to assist both employees and caregivers, says employers rarely have processes in place to deal with the issue.

“Our data show high awareness of the caregiving responsibilities of employees by their front line manager. What is missing is the action. How do you start the conversation? The tools are not readily available to empower the front line manager,” he says.

Even those organizations that already have invested in tools like this to address caregiving and other life-context issues often have trouble gaining traction – simply because people don’t know about them.

“For the past few years, Cigna has been refocusing its business on the individual,” said Joan Kennedy, vice president for consumer health engagement for the health service company. “We have invested in resources and experts to help people with coaching services, care management programs, and employee assistance programs. The challenge is that many people just don’t realize these resources are available to them.”

Cigna has a pilot program in collaboration with Eliza, using the Vulnerability Index to reach out to individuals that might help, and then connecting them to the resources best matched to their needs, Kennedy says.

As caregiving becomes more common, managers may at least better understand its impact. For one, more executives like Seaman may themselves be caregivers.

“It really does matter if your leadership or direct management has gone through it. When I was a young manager in my early thirties, I had 29 people working for me. I was a stickler at the time for being present in the office during work hours.

“Would I have given them more schedule leniency? Would I have had a team member provide additional support to help them cover issues? I wonder if I would have reacted differently knowing what I know now,” he says.

Published on The Huffington Post

Posted in: Stress \ Tagged: , ,

A young caregiver helps three generations

July 13, 2013 10:39 pm \ Leave a Comment \

Reprinted from TEDMED.com

At least five days a week for the past four and a half years, 17-year-old Jimmy Braat has been traveling two miles to the home of his 73-year-old grandmother in Lake Worth, Fla. Along with his mother, Debbie, he usually stays a few hours, doing household chores, helping to change the wrappings on his grandmother’s legs that prevent swelling from lymphedema, giving her medicine.

Then, he and Debbie may take her grocery shopping. At least once a week he also accompanies her on one of her many doctor visits – to the endocrinologist, podiatrist, pulmonologist, cardiologist, or sleep specialist – lifting the wheelchair that’s too heavy for his mom to manage.

His “Grandma Del” suffers from a range of ailments that limit her mobility, including diabetes, neuropathy, and pulmonary hypertension. Jimmy’s dad passed away in 2008 from heart failure. Debbie, 52, has pulmonary hypertension and is easily winded. His family can’t afford private care, Del does not qualify for Medicaid, and Medicare covers home care only for limited situations and periods of time.

Del refuses to go to a nursing home and doesn’t want to move in with Debbie. So much of the work caring for her has fallen to Jimmy, who is an only child.

“He doesn’t mind.  He never complains,” Del says.  “I took care of him when he was a baby, and now he takes care of me.”

Jimmy is one of more than a million children providing some or all care for ill family members or special needs siblings. According to a survey by the National Alliance for Caregiving and the United Hospital Fund in 2005, at least 1.3 million children ages 8 to 18 help care for a sick or disabled relative, with 72 percent of these caring for a parent or grandparents.

A Growing Problem, Yet Largely Hidden

There are no recent national studies, though as many as several million youths could be caregivers now, says Connie Siskowski, Ph.D., president of the American Association of Caregiving Youth (AACY), an advocacy and resource organization. Demographics may be pushing more children into the role: People are living longer with chronic illness, and single-parent or multi-family households are increasingly common, as are grandparents raising grandchildren.

While adult caregiving has gotten more awareness, the issue of a child helping is less known, says Suzanne Mintz, co-founder and CEO emeritus of The National Family Caregivers Association.

Jimmy Braat

“It’s always been assumed that family cares for family, and that, of course, is true. But in the modern age when medical science performs miracles that help people live so much longer, it’s not just kids helping dad or helping grandma, it’s them actually doing medical procedures.  And it’s not just for a couple of months, it’s for years and years,” she says.

A Born Helper

Jimmy’s caregiving journey began at the age of nine, when he began helping to care for his great grandmother, who suffered from dementia. He brought her newspapers, ground her pills into applesauce, and warmed meals in the microwave. She passed away when he was 13.

“He’s always been such a sweet little boy,” says Debbie Braat. “When he was real little, around six years old, I had to have surgery on my feet — one foot one year, one foot the other year. When I had the surgery I couldn’t walk around at all, but he would get up and he would do the laundry. He couldn’t even reach the washing machine, but he would pull himself up and sit on the machine.”

Of his grandmother, of whom he has always been close, Jimmy says, “She’s a difficult person. It’s not really her illness. She’s got a one-track mind. My trick is, when me and her start to argue, I just put my headphones on.”

Still, he says, ” I had a period of time when my grandmother was in the hospital for a few months and on life support for two of those months. The hardest thing for me was seeing her on life support for the first time.”

Jimmy is about three years behind in high school, he says; according to a 2006 report sponsored by the Bill & Melinda Gates Foundation, some 22 percent of high school dropouts surveyed left to take care of a family member. Now he takes high school classes through an online course offered by Palm Beach County. He is often so tired that, he says, “I end up passing out in at least one of my classes each day.” He also suffers from depression; research suggests caregiving raises the risk for depression and anxiety in child caregivers.

When he does have free time, Jimmy joins activities like camping, cooking classes and dinners sponsored by The Caregiving Youth Project in Palm Beach County, Fla., a pilot program that offers kids ages 10 and up who help family members care instruction, tutoring, home visits and activities. Though the AACY hopes to start a national network, to date it’s the only support program of its kind.

Jimmy will care for his grandmother, he says, “Up until the point where she passes away. There’s no exit strategy. Besides, there’s no one else to do it. “

Posted in: Uncategorized \ Tagged: , , , ,

How does living with purpose inspire good health?

July 13, 2013 10:28 pm \ Leave a Comment \

Reprinted from TEDMED.com

Why don’t we always do what’s best for us?

It’s a question that has long preoccupied Vic Strecher, founder and head of the Center for Health Communications Research at University of Michigan and TEDMED 2009 speaker.

After years of teaching health education and helping to create computer-based interactive programs that inspire better personal choices, Strecher is working on a website and a graphic novel based on new thinking in the field and on his own momentous life experience. TEDMED spoke with him about his new projects.

So…why don’t people make more healthful choices? There’s no lack of available health information, and yet lifestyle choices have led many to develop chronic diseases.

VS We know that the choices we make can slowly kill us, like frogs that will stay in water that’s slowly heated until they literally boil to death without jumping out of it. And we’re learning that one reason we resist health messaging is defensiveness. We have this wall around our ego for evolutionary reasons, and ironically our wall has been getting thicker with all the societal messaging we’re getting. With the barrage of junk information and all the choices we face, we’re less able to make competent decisions.

How do you prod people out of that warming water?

VS There’s a relatively new idea being explored called self-affirmation theory. It says that the process of affirming your fundamental beliefs — core values — reduces defensiveness. For example, if you write down or are rating your core values, such as your faith or your commitment to family, and then are exposed to a health message that you may normally process defensively, you’re more likely to accept it.

When you start to put things in writing, you realize, “Hey, my values differ from my behaviors, don’t they?” Research shows that cigarette smokers who affirm their core values are more open to anti-smoking messaging.  People are more likely to participate in diabetes risk assessments if they have just completed their values list.  So how can we get people to start making that kind of connection?

Some of your recent talks have mentioned how empathy can lead to healthier behaviors.  Can you explain? 

VS Jennifer Crocker of Ohio State University, a psychologist who studies self-esteem, wanted to take a look at people’s thoughts while they were affirming their values. And what they were doing was thinking of a connection with loved ones, their friends and family and community, and things bigger than themselves; it drew on something called self-transcendence.

What started you down this path of looking at the bigger picture?

VS Two years ago my daughter passed away; she was 19 years old. I went through a significant grieving process, which included struggling with lethargy, and as a behavioral scientist I was noting my own reactions. I began studying the old philosophers – the Stoics, Existentialists – some like Kierkegaard who were very religious, and some who were atheists.  They all said you have to have a purpose or meaning in your life. Victor Frankl, a Holocast survivor, found out people who were losing their purpose were dying faster in the death camps.

That started me thinking about the epidemiology of this in the medical and health field. People that have a purpose in life are 2.4 times less likely to die from Alzheimer’s Disease, less likely to have a heart attack, and more likely to have good sex. Having a purpose can also help repair our DNA, potentially promoting a longer life. We spend so much time scaring the crap out of people about death and disease, and we should be thinking about teaching them to have purpose in life. We’re so used to telling people, ‘Smoking is bad for you,’ and then ratcheting that fear up. Why not just focus on a totally different direction for this?

You’re working on several new projects with this in mind. Can you share details?

VS I’m self-publishing a graphic novel, “On Purpose,” working with a comic book illustrator and a screenwriter. I decided to put together a story that connects my own personal tale with the related science. It will be about the importance of finding purpose in your life in a nihilistic world, basically. It touches on themes from ancient and modern philosophy, literature, neuroscience, and Egyptology.

I’m also working on a web site. There will be a blog app for people to share their stories. I want to build a community where people can record their purpose and see others’. There will be some kind of filter to group people through their common core values, in a way they might not expect. Some of the real beauty of life is discovering things that you wouldn’t expect to discover or to agree with.

Posted in: Mind-Body Medicine, Uncategorized \ Tagged: , , , ,

The Smartphone Physical: Checkup of the Future?

June 30, 2013 7:20 pm \ Leave a Comment \

Imagine a comprehensive, clinically relevant well-patient checkup using only smartphone-based devices. The data is immediately readable and fully uploadable to an electronic health record. The patient understands — and even participates — in the interaction far beyond faking a cough and gulping a deep breath. For real?  From The Huffington Post

Johns Hopkins medical student and Medgadgeteditor Shiv Gaglani says it is not only possible, but may in fact be the checkup of the future. Gaglani and a team of current and future physicians will do a first-of-its kind demo of a “smartphone physical” for hundreds of attendees at TEDMED 2013 on April 16 to 19 in Washington, D.C.

The checkup will capture quantitative and qualitative data, ranging from simple readings of weight and blood pressure to more complex readings such as heart rhythm strips and optic discs. Measurements and instruments will include:

• Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

• Heart electrophysiology using the AliveCor Heart Monitor.

• Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patients lungs and heart.

• Carotid artery visualization using a Mobisante probe.

While it all sounds very slick and tech-y, Gaglani says the smartphone-enabled checkup will actually improve doctor-patient relationships. For one thing, the related medical devices are generally smaller and less invasive than their predecessors.

“For example, thanks to the AliveCor Heart Monitor, it has never been easier to get a one-lead ECG reading. Similarly, the Withings and iHealth blood pressure cuffs are plug-and-play so a clinician doesn’t have to fumble around with both a stethoscope and sphygmomanometer to assess whether her patient is hypertensive,” Gaglani says.

Second, smartphone-based devices usually provide a visual or auditory output that patients can actually see and hear, hopefully increasing their understanding of their bodies and engagement during the checkup. For example, the Welch Allyn iExaminer captures an image of the retina that is displayed on the phone screen, and digital stethoscopes like ThinkLabs’ record heart and lung sounds that can be replayed through the microphone.

Third, the patient can participate in data gathering. As Gaglani says:

“These devices can abstract away the mundane and standardize the unreliable aspects of the physical exam. Measurements such as weight and blood pressure are so variable day-to-day, or even hour-to-hour, that an annual exam doesn’t provide much insight into an individual patient’s health status. Some of the smartphone devices are already being used by patients to collect and store their data so when they see their clinicians they can have productive and informed conversations, rather than relying on fragmented and unreliable metrics.”

Hypothetically, once the data is uploaded to an electronic medical record, back-end clinical decision support software can help both patients and clinicians come up with treatment plans.

The technology may of course be particularly helpful for mobile physicians, particularly in emergency health care settings, and for global health workers, as even untrained staffers can carry the tools to low-resource settings to collect data and then, via telemedicine, receive instructions for how to treat patients. Some of these tools are already being combined into a versatile clinical data-gathering device, called a Tricorder, Gaglani says.

How long will it be before we’re all having our own smartphone physicals every one or two years? Devices such as the body analysis scale, blood pressure cuff, pulse oximeter, and ECG are already in use as teaching devices in med schools and by some patients, and some early adopting clinicians are using them in daily life. Dr. Eric Topol, for example, has used his AliveCor not once but twice to diagnose patients with arrhythmias on airplanes.

While there will be an inevitable learning curve and hopefully constant assessments of cost-effectiveness and value to patients, Gaglani says some of these devices, or at least second and third generation versions, will successfully make their way into the clinic.

Posted in: Technology \ Tagged: , , ,

Why Stress is Public Health Enemy Number One

June 21, 2013 10:16 pm \ Leave a Comment \
shutterstock_92175616

The following is an interview with Elissa Epel, a UCSF psychologist who has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades. Published on The Huffington Post, 4/3/2013

Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?

EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.

I was surprised to see your study showing educational attainment is also related to telomere length. Why might that be?

EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ -which helps us think clearly under stress.

Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status). Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress. Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel. For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.

There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness - focusing on what we’re doing right now, in the present moment – the missing link, do you think?

EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.

And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.

Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.

In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.

One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.

EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.

But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!

There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.

If you had the power to enforce one public health measure based on your research, what would it be?

EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life. Social scientists understand which social and structural factors need to change to help individuals change.

A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.

Has your research changed any of your own personal or work habits?

EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.

 

Posted in: Eating Disorders, Mental Health, Mind-Body Medicine, Public Health, Stress \ Tagged: , , ,

Can simple math help solve science’s big questions?

June 21, 2013 9:38 pm \ Leave a Comment \

As scientists struggle to publish, collaborate and keep up with current research, mathematicians and computer scientists are finding new ways to crunch data and answer big questions. Published on The Huffington Post, June 21, 2013

Following is an email interview with Max Little, Parkinson’s Voice Initiative founder, TEDMED speaker and TEDGlobal Fellow, who seeks to answer big questions using relatively simple algorithms.

You’ve been working to discover the practical value of abstract patterns in various fields, with surprising results in areas as varied as diagnosing Parkinson’s disease over the phone to predicting the weather. Can you explain your approach?

As an applied mathematician, my training shows me patterns everywhere. Electricity flows like water in pipes, and flocks of birds behave like turbulent fluids. In my projects, I collate mathematical models from across disciplines, ignoring the assumptions of that discipline. To a large extent, I put in overly simple models. I use artificial intelligence to throw out inaccurate models. And this approach of exploiting abstract patterns has been surprisingly successful.

For example, during my PhD I stumbled across the rather niche discipline of biomedical voice analysis, originating in 1940?s clinical work. With some new mathematical methods, and combining these with recent mathematics in artificial intelligence, I was able to makeaccurate medical predictions about voice problems. The clinician’s methods were not accurate. This sparked off research in detecting Parkinson’s disease from voice recordings – the basis of the Parkinson’s Voice Initiative.

But success like this raises suspicions. So, with collaborators, I tried to make this approach fail. We assembled 30,000 data sets across a wide range of disciplines: exploration geophysics, finance, seismology, hydrology, astrophysics, space science, acoustics, biomedicine, molecular biology, meteorology and others. We wrote software for 9,000 mathematical models from a deep dive into the literature. We exhaustively applied each model to each data set.

When finished, a very revealing, big picture emerged. We found that many problems across the sciences could be accurately solved in this way. In many cases, the best models were not the ones that would be suggested by prevailing, disciplinary wisdom.

Are you doing other research that might have implications for clinical diagnosis?

Here is another example: There is a decades-old problem in biomedical engineering: automatically identifying epileptic seizures from EEG recordings. But we found over 150 models, some exceedingly simple, each of which, alone, could detect seizures with high accuracy.

2013-06-20-MaxLittle.jpg
Max Little at TEDMED 2013. Photo: Jerod Harris/TEDMED
This challenges quite a few assumptions — but it is not as if we are the first to find this. It happens often when new approaches to address old problems are attempted: for example, in obesity, a new, simple mathematical model revealed some surprising relationships about weight and diet.

You’ve also used fairly simple algorithms to successfully predict weather.

After my PhD, I teamed up with a hydrologist and an economist. We wanted to try weather forecasting using some fairly simple mathematics applied to rainfall data. Now, weather forecasting throws $10m-supercomputers and ranks of atmospheric scientists together, and they crunch the equations of the atmosphere to make predictions. So, competing against this Goliath with only historical data and a laptop would seem foolhardy.

But after two years of hard work, I came up with mathematics that, when fed with rainfall data, could make predictions often as accurate as weather supercomputers. We even discovered that models as simple as calculating the historical average rainfall, and using this as a forecast, were sometimes more accurate than supercomputers. We were all surprised. but this finding seems to line up with results that others have found in climate science: it is actually possible to make forecasts of future global temperatures using simple statistical models that are as accurate as far more complex, general circulation models relied upon by the Intergovernmental Panel on Climate Change.

Is this a new way of doing science?

If we divide science into three branches: experiment, theory and computer simulation, then what I am describing here doesn’t quite fit. These are not just simulations: the results are entirely reproducible with just the data and the mathematics. This approach mixes and matches models and data across disciplines, using recent advances in artificial intelligence.

I don’t know what to call this approach, but I’m not the only one doing it. The most enthusiastic proponents are computer scientists, who do something like this regularly in mass-scale video analysis competitions or one-off prizes financed by big pharma for molecular drug discovery as do statisticians working in forecasting.

In your TEDMED 2013 talk, you expressed concern that advances in science have stagnated. Can you explain?

Like many scientists, I’m concerned that science is becoming too fragmented. So many scientific papers are published each year that it is impossible to keep track of most new findings. Since most articles are never read, much new research has never been independently tested.

And, unfortunately, scientists are encouraged to ‘hyper-specialize,’ working only in their narrow disciplines. It is alien to we applied mathematicians that a scientist who studies animal behavior might never read a scientific paper on fluid mechanics! In isolation from each other, could they just be duplicating each other’s mistakes?

What can we do to create a more unified approach?

First of all, open up the data. There is far too much politics, bureaucracy and lack of vision in sharing data among researchers and the public. Sharing data is the key to eliminating the lack of reproducibility that is becoming a serious issue. Second, don’t pre-judge. We need to have a renewed commitment to radical impartiality. Too often, favoured theories, models, or data persist (sometimes for decades), putting whole disciplines at risk of missing the forest for the trees.

Collaboration would greatly speed advances. Is first-to-publish attribution of scientific findings really that productive? I think of science as a collaborative journey of discovery, not a competition sport of lone geniuses and their teams.

Scientific theories that can withstand this “challenge” from other disciplines will have passed a very rigorous test. Not only will they be good explanatory theories, they will have practical, predictive power. And this is important because without this mixing of disciplinary knowledge, we will never know if science is really making progress, or merely rediscovering the same findings, time and again.

Posted in: Science

What if everything we think we know about obesity and nutrition is wrong?

June 18, 2013 10:47 pm \ Leave a Comment \
Peter Attia testing a metabolic chamber that will be used in his upcoming research.

What’s really driving our scourge of obesity and its related metabolic diseases, including diabetes, Alzheimer’s disease, cancer, and heart disease? For starters, what if all of our efforts to fight weight gain have been based on inconclusive science? What if our “treatment” is then incorrect, rather than conventional wisdom that says people just can’t follow it?

Peter Attia testing a metabolic chamber that will be used in his upcoming research.

Peter Attia testing a metabolic chamber that will be used in his upcoming research.

The medical community generally holds that we eat an overly large number of calories, causing an “energy imbalance” that leads to fat accumulation — and most of its advice to the general population speaks to that: “Eat less and exercise more!” Yet, after 50 years of studying the problem and about a decade trying hard to fix it — mainly via health messaging — we continue to gain weight exponentially. Obesity has increased 250 percent since the 1960s, and diabetes more than fivefold.

Physician and TEDMED speaker Peter Attia and his non-profit organization, Nutrition Science Initiative (NuSI), hope to help science, and eventually public policy, reach the truth. Attia and co-founder Gary Taubes, a science and health journalist and author of Why We Get Fat, founded NuSI a year ago. They hold that research on nutrition has not been nearly rigorous enough to date to make existing claims about the relationship between nutrition and health due a host of factors, including a lack of proper controls, difficulties in meticulously monitoring subjects, and insufficient resources to conduct the necessary experiments to show cause-and-effect.

Supporting their claim, a meta-search published in the New England Journal of Medicinelast January concurs, saying that most popular dietary recommendations concerning obesity, from the value of eating breakfast and more fruits and vegetables, to the evils of snacking, are unproven.

To begin its quest, NuSI is funding and facilitating what it hopes will be the most rigorous research to date on the relationship between nutrition, obesity and metabolic disease, starting with three large experimental collaborations at six leading academic institutions over the next three years.

NuSI will release details on the projects in the next few months. We do know that, as theWall Street Journal reports, the Laura and John Arnold Foundation (LJAF) of Houston, Texas has recently agreed to fund approximately $40 million of research over the next three years. Stay tuned for updates. Published on The Huffington Post, June 12

Posted in: Nutrition \ Tagged: , ,