Type 1

Over the last decade, there's been a bunch of new research around the idea that type 1 diabetes might actually be caused by allergic reaction to food. In short, in certain genetically susceptible individuals, specific foods might be the trigger that kicks off the autoimmune attack on islet cells in the pancreas, the core of the disease.

While that's interesting for discovering ways to prevent new cases of type 1 diabetes in the future, given the very slow regeneration of pancreatic beta cells, researchers long assumed that it didn't really apply to people who are already diabetic. Once those cells were gone, they appeared to be gone for good.

However, a recent set of mouse studies, and a follow-up set of studies with human pancreas biopsies, has shown that intermittent use of the Fast Mimicking Diet led to substantial regeneration of beta cells, even in current type 1 diabetics.

It’s all still preliminary stuff, but it’s certainly suggestive of a route to a cure for current type 1 diabetics, and, even better, a safe and non-invasive one. If you or someone you know has type 1 diabetes, keep an eye on this research going forward.

[And, while we’re on the subject, if you or someone you know has type 2 (‘adult onset’) diabetes, the news is even better: we already know it can be reversed by lifestyle change.]

Unexpected

“When I was young, I admired clever people. Now that I am old, I admire kind people.”
– Abraham Joshua Heschel

Crashing

A couple of years ago, to test out some software I was helping develop, I installed the MacOS and iOS developer betas on my iPhone and trusty MacBook. And, in short, it was an unmitigated disaster. Features suddenly disappeared (apparently still in development), both devices unexpectedly rebooted repeatedly, and my productivity ground to a near halt. Eventually, I ended up rolling back both to stable, released software, and all was well, save the week or two of lost time.

In the time since, I completely forgot about that episode. Until this past weekend, when I once again, with software to test-drive, installed the developer betas of iOS 11 and MacOS High Sierra. And, once again, both of my daily-use devices are a total mess.

Given their fairly late-beta stage, this time I may just try to limp along through subsequent releases. But, if nothing else, it’s a good reminder: apparently, I just never learn.

It’s the Shit

I get asked a lot of questions about gut bacteria these days, and for good reason; over the last decade, research on the importance of the intestinal microbiome for fitness and overall health has exploded.

Take, for example, one particularly persuasive study, which took fecal bacteria samples from pairs of identical twins in which one twin was lean and one was obese, and transplanted the samples into the intestines of germ-free mice. Lo and behold, the mice with transplanted microbiota from the lean twins stayed lean themselves, while the mice with obese twin microbiota quickly piled on weight.

Similar microbiota transplants between humans are already being used very successfully to fight deadly infections like C. difficile colitis, and are being researched for conditions ranging from multiple sclerosis to Parkinson’s disease.

Which leads to the obvious question: will poop transplants for weight loss be the next big fitness craze?

In short, I hope not. While I strongly suspect that managing our microbiome will be an important part of health in the decades to come, at the moment, we just don’t really know what we’re talking about. Clinical data is still scarce, and possible complications are immense. Even if getting microbiota from your skinniest friend did turn out to be a great diet plan, we still have no idea about all of the other effects of that same bacteria down the line.

And, based on historical record, there’s good reason to be concerned. In the 1950’s, for example, doctors began prescribing transplanted Human Growth Hormone to smaller children deficient in HGH. While the treatment proved effective for spurring growth, it wasn’t until decades later that hundreds of cases of the rare and fatal neurodegenerative Creutzfeldt–Jakob disease (colloquially “mad cow disease”) began to crop up in those HGH recipients. Scientists quickly discovered that prions (the cause of CJD) had inadvertently come along for the ride with the transplanted hormone.

So, in short, the microbiome is something we should be keeping an eye on.

And it probably would be wise to start doing the common-sense things that research has begun to show as likely to help your microbiome: eat a whole food diet, and include some pre-biotic (raw garlic, onions, etc.) and pro-biotic (pickled stuff, yogurt, etc.) foods; avoid unnecessary antibiotics; get a dog (seriously!); exercise; manage your stress.

But when it comes to more invasive ideas – whether fecal transplant or even just probiotic supplements (which are currently a bit of a wild west), I’d hold off for now. Whatever the short-term upsides, from my perspective, at least, the long-term unknown risks are just too great.

Less Messy

Real problems are messy. Tech culture prefers to solve harder, more abstract problems that haven’t been sullied by contact with reality. So they worry about how to give Mars an earth-like climate, rather than how to give Earth an earth-like climate. They debate how to make a morally benevolent God-like AI, rather than figuring out how to put ethical guard rails around the more pedestrian AI they are introducing into every area of people’s lives.

– Maciej Cegłowski, Notes from an Emergency

Weighty

My parents are in their late 60s, but they remain in very good shape. They’re avid travelers, which regularly requires them to walk 10-15 miles in a day, with stairs and hills climbed, bags toted, etc.

Primarily, they’ve kept fit with ‘cardio’ workouts in their living room, using Leslie Sansone’s solid and much-loved Walk at Home DVDs (or, as my brother calls it, ‘frumping to the oldies.’)

However, recent research has made clear that also focusing on strength training is particularly important as we age. As one recent review paper put it:

Strength-training exercises have the ability to combat weakness and frailty and their debilitating consequences. Done regularly [it] builds muscle strength and muscle mass, and preserves bone density, independence, and vitality with age. In addition, strength training also has the ability to reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and type 2 diabetes, while also improving sleep and reducing depression.

In short, strength training is powerful stuff. And as further research has shown, those benefits are specific to lifting weights; it’s not sufficient to simply maintain a high level of physical activity in general.

So I suggested that my parents also consider hitting the gym once or twice a week. To which my mother replied that they do currently use dumbbells in those Sansone workouts. While that’s great, I clarified that she needed to go to the gym to focus on progressive overload. The health improvements of strength training come from consistently increasing the weight used over time; thus, if you’re using the same ten-pound dumbbells month after month, you’re no longer reaping the same benefits.

To illustrate, here’s an amazing pair of before and after MRI scans showing the increase in leg muscle mass after just twelve weeks of weight training, in a 92-year-old subject. (!!!)

If you want to live longer, healthier, then staying active (in a general, ‘use it or lose it’ sort of way) is hugely important. But adding in weight training, too, is an extremely powerful tool. And, as the scans show, it’s never too late to start.

Hotel Delmano

While I was still an undergrad at Yale, coming down regularly to NYC for my startup, I was thrilled to discover the then newly-opened Campbell Apartment. When the current Grand Central Station was built in 1913, John Campbell, who chaired the board of the New York Central Railroad, had the space built in as a private office. After his death a few decades later, the apartment was abandoned, eventually repurposed into a little-used storage closet. Then, in 1999, the architects upgrading Grand Central rediscovered the space, with its 1910’s decor, stained glass windows, etc., still intact. With a few million dollars in renovations to return it to its previous opulence, The Campbell Apartment opened as a semi-secret speakeasy. It was, in a word, perfect.

This past year, that version of the bar closed, soon to reopen as a cheesy, DJ-centric nightclub. But a slew of great, semi-secret speakeasies remain – places like Bathtub Gin, Raine’s Law Room, Angel’s Share, Employees Only, and Please Don’t Tell.

But I’m always thrilled to discover another addition to that list. So, this weekend, while out in Williamsburg, I was particularly happy to stumble across Hotel Delmano.

As my go-to restaurant review site The Infatuation put it, “Hotel Delmano is probably the best date spot in Williamsburg. It's dark, cozy, and feels like an ocean liner that sank a long time ago.” Which is precisely right:

It seems like a place where Hemingway would have been thrilled to enjoy five or six daiquiris. Though, in the picture above, we’re instead testing out the Junebug (dill-infused gin, lemon, sugar snap peas, fino sherry, suze) and the San Francisco Handshake (thyme-infused gin, st germain, lemon, fernet branca).

If you’re in Williamsburg, or even if you’re not, consider heading their way to enjoy it yourself.

Time, Money

“No person hands out their money to passers-by, but to how many do each of us hand out our lives! We’re tight-fisted with property and money, yet think too little of wasting time, the one thing about which we should all be the toughest misers.”
– Seneca

Mise

Recently, I was talking to a friend who is trying to improve his cooking skills. Knowing that I attended culinary school, he asked if I had any tips. First and foremost, I told him, he needed to cook using ‘mise en place.’

A French term that roughly means “everything in its place,” mise en place is about setting up all of the ingredients needed before you start to cook. Like on a television cooking show, it’s placing all the prepped ingredients – peeled, chopped, ready to go – in little bowls and containers you can pull from when the time is right.

More than anything else, cooking well is about paying full attention to the food. Watching, listening, and smelling as food cooks, tasting and seasoning along the way.

If you go the route of most home cooks, you toss in the first ingredients right away, slicing and assembling the rest in parallel as you go. And though experienced chefs can make that work in a pinch, it’s far too much distraction for anyone still honing their skills.

Setting up your mise first adds only a few minutes to the total cooking time, but it pays huge dividends in the quality of food you can produce. So if you want to improve your cooking, try it out yourself. Prep first, then cook. Mise en place.

BHAG

Right now, the US is facing a terrible, relatively new problem: a surge in chronic disease.

One in two Americans suffers from chronic disease (more than half of those from multiple chronic conditions), which is responsible for more than seven out of every ten deaths annually. We spend more than $2.3 Trillion each year (about 12 percent of our GDP) treating chronic disease, and it’s likely only going to get worse going forward, as the rate of chronic disease in kids has more than doubled in the last twenty years.

Our healthcare system wasn’t built to deal with these kinds of chronic conditions. A century ago, our leading causes of death were acute, infectious disease (the top three: tuberculosis, typhoid, and pneumonia), and most other doctor visits were also for acute problems like appendicitis, gall bladder attacks, etc. For those kinds of issues, the medical system is incredibly effective: go see a doctor, get an antibiotic / have surgery, recover. And with new treatments and technologies coming online, we get better and better at acute treatment every year.

But that same system isn’t well-equipped to deal with chronic disease, where doctors’ current tools are largely focused on suppressing symptoms rather than dealing with underlying causes. If you have high cholesterol or high blood pressure, you can get a drug to take (for the rest of your life) to lower them, but rarely a serious look at why either is high in the first place.

Recent research suggests that more than 85% of chronic disease is caused by environmental factors, like diet, behavior (including movement / exercise), and lifestyle. Dealing with the root causes of those chronic diseases, then, involves helping patients build and sustain new patterns and habits over the long-haul.

Given the heavy load we already place on physicians, it’s not reasonable to expect them to accept responsibility for driving that kind of behavioral change, too. The average primary care provider has about 2500 patients on their roster, and sees each for visits lasting on average just 10-12 minutes. That’s enough time to diagnose symptoms, prescribe medication, and then follow up a few weeks later. But while most people will take a course of antibiotics their doctors prescribe, drastically fewer will make wholesale changes to their lifestyle, without substantial ongoing support.

Currently, the fitness industry is failing equally when it comes to providing that kind of support. Indeed, the vast majority of people who start a diet or join a gym today will be no better off (and often worse) a year from now, having seen little results, given up, and returned to their prior behavior. Roughly, the fitness world today is akin to where medicine was in 1850: a lot of new science is emerging, and a slew of potentially helpful tools and technologies are being developed, but it’s yet to coalesce into an effective standard of care.

Which, in short, is what Composite is really about. Our big, hairy, audacious goal is to bring the rigor of medicine into the world of fitness, to try and develop clinically-demonstrable effectiveness in treating the underlying causes of the majority of today’s chronic disease.

There are a number of other companies, too, living at the intersection of fitness, technology, and medicine, developing new best practices, to whom we look for ideas and inspiration. I strongly believe that, over the next twenty years, we’ll see a whole new fitness industry emerge from those kinds of companies, one that can work hand-in-hand with the existing medical system, to help the US address the problem of chronic disease. And I’m hoping that, with the right team, a bit of luck, and a lot hard work, Composite can help drive that change, can become a leader of that pack.