Women May Have an Alternative to Freezing Their Eggs

Here’s how it could go: Some day in the future, it’s routine for every young woman of a certain age—for argument’s sake, let’s say 21—to undergo a procedure to snip off a piece of tissue from one of her ovaries. Her doctor slices up the tissue into a half-dozen or so microthin sections; these are frozen, to be used whenever she’s ready for a baby. Her ovaries function normally, and she keeps menstruating and ovulating just as she has since puberty. But she doesn’t worry about rushing into baby-making. The timetable of how her life unfolds need not adhere to a pesky biological clock.

Later, maybe much later, maybe not for another 20 years, this woman wants to start a family. She remembers those strips of ovarian tissue in deep freeze. Each strip contains thousands of follicles, the proto-eggs of the ovary, preserved at their peak. The follicles in her body have been getting progressively less robust, but in the lab freezer her proto-­eggs have been in suspended animation, protected from the degradation of age.

So she goes back to the doctor, who defrosts one of the strips and implants it in her ovary. It becomes established there, starts pumping out hormones at the level of a younger woman, and transforms one follicle each month into a mature egg. Each menstrual cycle, the hardy egg of a 21-year-old is deposited into the fallopian tube, where it can be fertilized. Ideally, one of those youthful eggs turns into an embryo that embeds itself in the uterus and grows into a healthy baby. Ideally, that one strip of ovarian tissue keeps producing hormones and releasing eggs for years, long enough for the woman—who might be 45 or even older by the time it’s all done—to have a couple of children.

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Nik Mirus

If the first implant doesn’t work, or if it stops working before the woman’s family is complete, doctors can defrost and implant another strip. And if she doesn’t need the strips for childbearing—maybe she decides not to have children at all, or she gets pregnant naturally without needing to take any strips out of deep freeze—she can use them for a different purpose: postponing menopause. As she enters her fifties, this woman thaws a strip and has it implanted in her forearm, where it releases estrogen and other sex hormones in a way that mimics the feedback loop of a younger woman, in theory with fewer side effects than with artificial hormones. She still menstruates, which is the downside, but she also remains at lower risk of chronic conditions, like heart disease and osteoporosis, that usually get worse after menopause, at least in part because of the drop in estrogen. In this future, the one-two punch of nature’s timetable—first making it harder to have healthy babies after about age 35, then making it harder to stay healthy yourself after about age 50—is something women have finally transcended.

Here’s the reality of where things stand: At the Center for Human Reproduction in New York, there’s a room with a boxy machine that slow-freezes slices of ovarian tissue before they are transferred to a stubby deep-freeze tank that bears an uncanny resemblance to R2-D2. But of the 14 tanks in the room, most contain frozen embryos or frozen eggs or sperm, not ovarian tissue. That’s because right now, removing ovarian tissue involves an expensive surgery requiring a hospital stay. (Infertile men can have a bit of testicular tissue removed via a comparatively simple probe-and-snip procedure; the hope is that a similar procedure can be developed for women.) Transplanting the tissue later requires another operation.

Which is all to say, we already do live in a world where bits of ovarian tissue can be harvested, frozen, and then reimplanted later to make a woman fertile, but it’s harrowing. The process was developed for young women or girls with cancer, who face oncological treatments that are certain to make them sterile; since 2004, about 100 babies have been born to these women using the technique. In the view of most researchers and the American Society of Reproductive Medicine, ovarian tissue extraction is still too experimental to recommend for healthy women.

As she enters her fifties, the woman thaws a strip and has it implanted in her forearm, where it releases estrogen and other sex hormones in a way that mimics the feedback loop of a younger woman.

But soon, say experts like Sherman Silber, director of the Infertility Center of St. Louis, freezing ovarian tissue could become the next big form of what’s known as “social freezing” (or, as it’s called in some waggish circles, “AGE freezing,” short for “anticipated gamete exhaustion”)—whereby women try to prolong their fertility not for a medical reason but just to give themselves the option of delayed childbearing. For now, the only way to pause the biological clock this way is to freeze one’s eggs, a route taken by some 6,200 women in the US in 2015. But egg freezing is expensive (up to $18,000 per cycle) and uncertain. Experts calculate that each egg frozen before age 38 has just a 2 to 12 percent chance of turning into a baby one day. Egg freezing also requires women to inject themselves with hormones powerful enough to produce more than 10 times the normal number of mature eggs at a time. These hormones can lead to mood swings, nausea, and abdominal pain; a slight chance of the serious condition known as ovarian hyperstimulation syndrome; and an unknown risk of ovarian or breast cancer down the road.

So as women wait longer and longer to have kids—more than 26,000 women 40 or older became first-time mothers in 2016, an increase of nearly 30 percent over 2001—there’s plenty of incentive for the fertility industry to figure out how to make ovarian tissue extraction a better bet than egg freezing. For one thing, it would do away with the need for multiple rounds of in vitro fertilization. If all goes well, Silber says, the thawed and transplanted tissue will latch on to the rest of the ovary, become functional within about four-and-a-half months, and lead to pregnancy the old-fashioned way.

Roger Gosden, who helped develop the ovarian tissue-freezing procedure in sheep in the 1990s, worries that the social freezing of ovarian tissue will be fraught with the same hazards and anxieties as egg freezing: “A lot of commercial pressure and social pressure” will promote a procedure that most women end up not even needing—all “at great cost, great inconvenience, and a little bit of risk.” It’s also possible that the whole cold-storage approach to infertility could eventually be replaced by a better one: turning stem cells into egg cells, say, whenever a woman is ready to conceive.

But the biggest benefits of socking away young ovarian tissue may come at the other end of a woman’s reproductive life cycle. “One of the really big health challenges of the future is that we’re getting too old,” says Claus Yding Andersen, a professor at the Laboratory of Reproductive Biology at the University Hospital of Copenhagen. “The longer you’re in menopause, the greater your risk of osteoporosis and cardiovascular disease. The very best thing you can do to reduce those risks is to have your own menstrual cycles.” However they go about managing their fertility, women of the future who wait until their forties to start having children will probably want to put off the indignities of an aging body as long as possible. They will know they’ll need a spring in their step—not to mention sturdy hearts and flexible knees—if they’re going to keep up with those long-awaited kids.

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Robin Marantz Henig (@robinhenig) is a science writer and the author of nine books, including Pandora’s Baby.

This article appears in the April issue. Subscribe now.

Read more: https://www.wired.com/story/reboot-reproduction-modern-fertility/

Telomeres Are the New Cholesterol. Now What?

“I am a bit concerned about your telomeres,” the doctor told me, evenly. Telomeres are the caplike segments at the ends of the strands of DNA that make up your chromosomes—think of the plastic aglets at the ends of a shoelace—and some of mine, he could see, were not as long as he would have liked them to be.

Fifteen years ago, geneticists at the University of Utah published the results of a small test with the following finding: People older than 60 with short telomeres were three times more likely to die from heart disease and eight times more likely to die from infectious disease. It’s complicated, but essentially shorter telomeres make it more difficult for your cells to split and replicate, which can lead to diseased tissue, which, in turn, can lead to all manner of health problems. Other researchers have cautioned that larger, longitudinal studies are necessary before telomere length can be firmly established as a key indicator of aging. Still, at the edge of modern medicine, where the doctor I was seeing, Joseph Raffaele, practices, the length of your telomeres has become a key indicator, or what he calls a biomarker, of how well you’re aging. Raffaele talks of telomeres as a sort of “biological 401(k)”—molecular-­level security with which to fend off the health challenges of getting old.

Raffaele hadn’t literally seen those telomeres of mine. What he’d seen were the results of blood work carried out by a lab called Repeat Diagnostics, in Vancouver, British Columbia, which has become a leader in the burgeoning field of telomere diagnostics. Burgeoning because, as Raffaele posits, “telomeres are the new cholesterol”—by which he means they are (A) something measurable and understood to have explanatory powers and (B) something Big Pharma can aim at in the hope of finding the equivalent of a statin to make them more robust.

Everyone’s telomeres shorten over time, and a lot of mine were fine enough, but the ones found in a type of cell called granulocytes were really short: bottom 10 percent for my age. Not good, should some serious disease come calling.

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I was, chronologically, about to turn 65, as the day’s mail—Medicare enrollment forms, Social Security statements, brochures for cemetery plots—regularly reminded me. But Raffaele has staked his practice and his reputation on the belief that an individual’s muscles, organs, and bodily systems tend to age physiologically at different rates. You might have been born in 1958, and your cardio­vascular system might be that of a 60-year-old, but your lungs could be more like those of a 50-year-old and your immune system that of someone in their early seventies. Raffaele is a practitioner of age-management medicine, and he assesses several dozen biomarkers—things like telomeres and arterial stiffness—in order to assess patients and assign them a different so-called Immuno­Age, CardioAge, TelomerAge, NeuroAge, CutoAge, and PulmoAge.

In truth, medicine has not yet reached a consensus on how aging comes about, much less Pulmo­Aging. Growing old is one of the most complex biological processes. The mystery of how it works has, if anything, only grown more elusive as our sense of the physical self extends to include our genes, our microbiomes, our stresses. Moreover, Raffaele’s embrace of biomarkers for aging is not universally accepted. The National Institute on Aging concluded, after 10 years of trying to establish a set of such biomarkers, that none of them could be scientifically validated.

Nonetheless, there are thousands of age-­management practitioners worldwide. Raffaele’s own practice licenses its PhysioAge technology and protocols to scores of physicians. He and other age-­management physicians are experimenters, and their patients—who tend to be affluent, as out-of-pocket costs can run to more than $5,000 a year—are willing to experiment along with them. Raffaele doesn’t promise that his patients will live longer, necessarily—that’s a big ask—but he suggests they could live out their last years better, spending less time immobile, pained, and befogged.

I wanted this, for sure, but I was also seeking something else: to better understand my aging identity, not only in terms of my mind’s involutions and attachments but no less crucially through the corporeal expressions of my organs, muscles, systems, and cells. This side of age-management medicine draws on the tools of molecular diagnostics, imaging, and data analytics. What has been my embodied life arc? Who am I, deep inside? And why?

The length of certain telomeres, Raffaele explained, not only tends to correlate with the healthiness of various organ systems; it “gives a history of all the assaults a person has been subject to over the course of her lifetime.” Hearing this, my mind drifted to the blockage from my stomach to my intestines that nearly killed me as a 6-week-old, as my mother regularly reminded me until her death two years ago; and then moved on to scarlet fever, which, when I contracted it as a 7-year-old, kept me quarantined for nearly two months and thus, in its way, determined what I would devote my life to: reading. Such are my memories. Were those short telomeres molecular memories?

It turns out that biological self-­knowledge is not easy even with a trail of biomarkers. Telomere shortening is often a result of chronic or acute inflammation, research suggests, but my inflammation was lower than average, according to another test Raffaele had analyzed. Stress? Not a problem—at least now, in semiretirement. My cortisol level (another lab test) was “optimal.” Still, when my data was analyzed in Raffaele’s system, I had the ImmunoAge of a 71-year-old. “I’m going to say it’s genetic,” Raffaele told me. Despite the efforts I made to eat right and exercise, my disease-fending self was old before its time.

Raffaele, 58, was trained as an internist. He was practicing in New Hampshire in the 1990s when his parents began showing signs of Alzheimer’s, and he was struck by how little he could do for them. Could there be preventive care with regard to aging?

Since then Raffaele has become one of the more outspoken proponents of evaluating biomarkers for physiological age. He was spurred, he said, by a remark from Robert Butler, the founding director of the National Institute on Aging and, until his death in 2010, arguably the country’s most prominent aging expert. Butler pointed out to Raffaele that conventional medicine had established multiple ways of measuring vital signs, like blood pressure, and setting them against baselines of a broader public. What, Butler wanted to know, was Raffaele using to determine a valid baseline? How did he know his therapies were working? “I went searching for the biomarkers of aging,” Raffaele says.

Biomarkers themselves are nothing new in medicine. When a series of tests over time reveals a rapidly rising presence of prostate-specific antigen in a man’s blood, it’s a valid indicator that he may be developing prostate cancer. But aging is far less specific than prostate cancer. And the search for its biomarkers is in its infancy, with no generally agreed upon number of biomarkers or standards for measurement among the practitioners of age-­management medicine. Raffaele’s system is proprietary and thus can’t be scrutinized, but he will say that he draws on large databases of patients who have taken his baseline exam, along with larger databases provided by the companies that do the blood testing and whose machines he uses for scanning. He also monitors the change over time in biomarkers he assesses. If my telomeres were to be no shorter 10 years from now, for instance, then they’d no longer be much of a concern.

My exam at Raffaele’s office began with a pretty typical form on which I filled in my medical history and recorded my diet and exercise habits. Next, I sat one morning for an hour at home, taking a series of neurological tests on my laptop: the CNS Vital Signs tests, which evaluate the main areas of cognitive function by taxing them relentlessly for 20 minutes; the Stroop test, which measures reaction time; and the Symbol Digit Coding test, to test the aging of the frontal lobes of the brain.

A week or so later, I showed up at the offices on Central Park South in New York: small but elegant, with walls of pale bamboo and a certain hush. I was the only patient there. Raffaele was off at a conference. I was led to a small room, where I was seated in a recliner and a technician drew eight full vials and a half-dozen half-vials of blood. It took a while. Then, after measuring my height and weight and taking my blood pressure, the technician walked me from one machine to the next, scanning, among other things, my carotid and other arteries (with an ultrasound imaging gadget) and obtaining a snapshot of my body fat and muscle distribution with an InBody body-composition-analysis device. It was painless and done in 20 minutes. It was, too, all but completely lacking in those small but psychically significant reassurances we expect from a physical examination. If this is the physical of the future, we are going to have to accustom ourselves to the indifferent graze of whirring, chirping machines.

Raffaele shook my hand when we met, a month after the office visit. Then he settled behind his desk and powered up a touchscreen computer. No lab coat, no stethoscope dangling from his neck: He wore a trim suit with a lavender tie and looked a good deal younger than 58.

There was good news as he walked me through his analysis. I’d entered my sixties training to become a serious senior tennis player, so it didn’t surprise me that my resting heart rate was “athletic,” my arteries were clear of plaque, and my resulting CardioAge was 43. My NeuroAge (processing speed) was “younger” than my chronological age, too.

But the short telomeres in my granulocytes cast a shadow. And then my PulmoAge turned out to be … 81! Really? I ran around a tennis court and regularly did interval sprints. Spirometry, which measures how much and how quickly you exhale, told a different story, however. Raffaele didn’t seem too worried. I had a small rib cage, which meant smaller lungs, he said. “Keep up the interval training.”

My overall PhysioAge, as he computed it, was 61. “You’re in good shape,” he said. But there was room for improvement. I needed to keep up the exercise and healthy diet. I should take vitamin D-3, he advised, to bolster my immune system. I might also consider human-growth-hormone therapy. “Hormone optimization,” as Raffaele put it, plays an important role in his practice. Raffaele himself has for 20 years been taking HGH, testosterone, thyroid hormone, and DHEA. There have been warnings about side effects of hormone therapies—from muscle and joint pain to the exacerbation of cardiac problems—but research to gauge the long-term benefits or risks of such therapies has been inconclusive so far.

The short telomeres in my granulocytes cast a shadow. And my PulmoAge turned out to be … 81!

So, being 61 PhysioAge-wise: Was it any different than being 65? It wasn’t. I did start to worry about the telomeres and my immune system. I’ve been surprised at how many of my friends seem to know about telomeres and seem concerned when I mention my shortened ones. Telomeres, in that sense, are the new cholesterol. I worried, too, that all this testing could be seen as a supreme act of vanity: A guy in good shape for his age dropping thousands of dollars on tests out of curiosity while much of his cohort nationwide struggles with hypertension and diseases like diabetes.

But who we are, physically, is a significant measure of our identity. And I suspect that science will reveal this more exactingly and profoundly in the years to come. Cicero thought that the body’s decline over time was a blessing in its way, leaving more time for learning and reflection by those truer aspects of ourselves, the mind and soul. That view is being challenged. The health of the mind (science doesn’t speak to the soul) may well depend to no small extent on genes and molecules in your gut that Cicero could not have imagined the existence of.

As those molecules become more measurable, and as the meaning behind their signals becomes clearer, it’s worth considering just how much self-knowledge we want. Do you want to know about your own shortened telomeres? Or worse, about some gene mutation, say, that suggests you have a better than even chance of developing an untreatable disease?

If you’re like me, you want to know everything: To comprehend is to live. The smalling down on the path to death is a diminishment that’s never been easy to navigate. It could be made less physically challenging by the kind of diagnostics and treatment Raffaele and others like him are working toward. But knowing yourself, never uncomplicated, is likely to get no less fraught. Just deeper.

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Gerald Marzorati is a former editor of The New York Times Magazine and author of Late to the Ball: A Journey into Tennis and Aging.

This article appears in the April issue. Subscribe now.

Read more: https://www.wired.com/story/biomarkers-age-management/

The dark truth about chocolate

Grand health claims have been made about chocolate, but while it gives us pleasure, can it really be good for us?

Chocolate has been touted as a treatment for agitation, anaemia, angina and asthma. It has been said to awaken appetite and act as an aphrodisiac. You may have noticed were still on the letter A.

More accurately, and to avoid adding to considerable existing confusion, it is the seeds of the Theobroma cacao tree that have, over hundreds of years, been linked to cures and therapies for more than 100 diseases and conditions. Their status as a cure-all dates back over 2,000 years, having spread from the Olmecs, Maya and Aztecs, via the Spanish conquistadors, into Europe from the 16th century.

The 19th century saw chocolate drinking become cheap enough to spread beyond the wealthy, the invention of solid chocolate and the development of milk chocolate. Later came the added sugar and fat content of todays snack bars and Easter eggs, which time-travelling Aztecs would probably struggle to associate with what they called the food of the gods.

Recent years have seen chocolate undergo another transformation, this time at the hands of branding experts. Sales of milk chocolate are stagnating as consumers become more health-conscious. Manufacturers have responded with a growing range of premium products promoted with such words as organic, natural, cacao-rich and single-origin. The packets dont say so, but the message were supposed to swallow is clear: this new, improved chocolate, especially if it is dark, is good for your health. Many people have swallowed the idea that its a superfood. Except it isnt. So how has this magic trick-like metamorphosis been achieved?

Its foundations lie in chocolate manufacturers having poured huge sums into funding nutrition science that has been carefully framed, interpreted and selectively reported to cast their products in a positive light over the last 20 years. For example, studies published last year found chocolate consumers to be at reduced risk of heart flutters, and that women who eat chocolate are less likely to suffer from strokes. Consuming chemicals called flavanols in cocoa was also linked to reduced blood pressure. In 2016, eating chocolate was linked to reduced risks of cognitive decline among those aged 65 and over, while cocoa flavanol consumption was linked to improved insulin sensitivity and lipid profiles markers of diabetes and cardiovascular disease risk.

Such studies have generated hundreds of media reports that exaggerate their findings, and omit key details and caveats. Crucially, most recent research has used much higher levels of flavanols than are available in commercial snack products. For example, the blood pressure study involved participants getting an average of 670mg of flavanols. Someone would need to consume about 12 standard 100g bars of dark chocolate or about 50 of milk chocolate per day to get that much. The European Food Safety Authority has approved one rather modest chocolate-related health claim that some specially processed dark chocolate, cocoa extracts and drinks containing 200mg of flavanols contribute to normal blood circulation by helping to maintain blood vessel elasticity.

cocoa
Cocoa pods harvested on the Millot plantation in the north-west of Madagascar. Photograph: Andia/UIG via Getty Images

Prof Marion Nestle, a nutritional scientist at New York University, uses the word nutrifluff to describe sensational research findings about a single food or nutrient based on one, usually highly preliminary, study. She points out that most studies on chocolate and health get industry funding, but journalists generally fail to highlight this. Industry-funded research tends to set up questions that will give them desirable results, and tends to be interpreted in ways that are beneficial to their interests, she says.

Research has repeatedly shown that when food companies are paying, they are more likely to get helpful results. US researchers who reviewed 206 studies about soft drinks, juice and milk, for example, found that those receiving industry money were six times more likely to produce favourable or neutral findings than those that did not. Most nutrition scientists who accept money from industry are in a state of denial, according to Nestle, whose book Unsavory Truth: How Food Companies Skew the Science of What We Eat is due to be published in October. The researchers involved feel it doesnt affect the integrity and quality of their work, she says. But research on drug industry funding shows the influence is generally unconscious, unintentional and unrecognised.

The public are also misled into believing chocolate is healthy through what scientists refer to as the file drawer effect. Two of the aforementioned studies those on blood pressure and markers of cardiovascular health are meta-analyses, meaning they pool the results of previously published research. The problem is that science journals, like the popular media, are more likely to publish findings that suggest chocolate is healthy than those that conclude it has no effect, which skews meta-analyses. Its really hard to publish something that doesnt find anything, says Dr Duane Mellor, a nutritionist at Coventry University who has studied cocoa and health. Theres a bias in the under-reporting of negative outcomes.

Then theres the problem that, unlike in drug trials, those taking part in chocolate studies often know whether they are being given chocolate or a placebo. Most people have positive expectations about chocolate because they like it. They are therefore primed, through the conditioning effect famously described by the Russian physiologist Ivan Pavlov to respond positively. They may, for example, become more relaxed, boosting levels of endorphins and neurotransmitters, and triggering short-term physiological benefits.

The responses of study participants can be affected by their beliefs and assumptions about chocolate, says Mellor. Research has also found people who volunteer for studies are more likely to be affected by their beliefs about an intervention than the population as a whole.

a
So hard to resist: a chocolate shop in Bruges, Belgium. Photograph: Alamy Stock Photo

Many of the studies that involve people being given chocolate and tracking their health over time are short and have small numbers of participants. This adds to the difficulties nutritional scientists have in separating out the effects of consuming one food or nutrient from the rest of their diet and other variables and interactions within the body.

So when and why did chocolate companies become so keen on using science as a marketing tool? The answer depends on whom you ask.

During the 1990s, scientists became interested in the French paradox the now discredited observation that heart disease rates were low in France despite a national diet high in saturated fats. One proposed explanation was relatively high consumption of flavanols, a group of compounds found in red wine, tea and cocoa which, at high doses, had been linked to the prevention of cellular damage. US researchers caused a stir when from around the turn of the century they concluded that Kuna people off the coast of Panama had low blood pressure and rates of cardiovascular disease because they drank more than five cups of flavanol-rich cocoa per day.

This undoubtedly stimulated chocolate industry research. However in 2000, a Channel 4 documentary reported on the use of child labour and slavery in cocoa production operations in Ghana and Ivory Coast the source of most of the worlds chocolate. This triggered a wave of media reports and negative publicity.

Some say the industry poured money into science at this time to divert attention away from west Africa. Efforts by many of the large chocolate companies to demonstrate health effects started side by side with the outcry over the use of child labour and slavery, says Michael Coe, a retired anthropologist formerly of Yale University, co-author of The True History of Chocolate. Some of it was legitimate science, but it was stimulated, at least in part, by the need to say something positive about chocolate.

Industry figures strenuously disagree. There was no connection between those two things, says Matthias Berninger, vice-president for public affairs at Mars, Inc, when asked whether Coe is correct. The Kuna story sparked a lot of interest. The level of investment and energy and intensity of research was much more driven by that than it was by the idea of creating a halo around chocolate.

Critics have accused Mars in particular of using nutritional science to cast its products in a good light. Through its scientific arm, Mars Symbioscience, it has published more than 140 peer-reviewed scientific papers on cocoa flavanols and health since 2005.

The family-owned company has traditionally remained tight-lipped about its involvement in cocoa research. However, last month it published its policies on conducting and funding research. Asked whether it had previously been involved in using research to suggest chocolate was healthy, Berninger says: I do believe that that was so tempting, Mars couldnt resist it. If you look back 20 years, there was this idea that this could create huge opportunities for us.

But he says this changed long ago. As a marketing strategy, we have not engaged in that for more than a decade. In 2007, the European Union tightened regulations on nutrition and health claims. Meanwhile, research was making it increasingly clear that health benefits claims for commercial dark chocolate products were unrealistic because of their low flavanol content.

Yet campaigners highlight how chocolate companies, including Mars, have fought public health regulations that might undermine their profits using third parties. US public health lawyer Michele Simon produced hard-hitting reports in 2013 and 2015, documenting how the Academy of Nutrition and Dietetics (AND) and the American Society of Nutrition (ASN), were receiving large sponsorship fees from major food industry companies. In 2014, the ASN had gone in to bat on behalf of its corporate backers, including Coca-Cola, Mars and McDonalds, against a US government plan for added sugar content to be included on food labels, and questioning the evidence on their negative health effects. A year earlier, the AND stated its support for a total diet approach, and opposition to the overly simplistic classification of specific foods as good or bad. Its about co-opting health organisations, and buying legitimacy among professionals and members of the public, says Andy Bellatti, co-founder of US-based Dietitians for Professional Integrity.

Chocolate manufacturers have also used the classic corporate strategy of using third-party lobbyists to manufacture artificial scientific controversy. Science is, by its nature, about evidence-based probabilities not absolute certainties. The exaggeration of uncertainty was perfected by the tobacco companies in the 1950s, and later copied by the asbestos and oil industries. Chocolate makers have done this through lobbying groups such as the Washington-based International Life Sciences Institute (ILSI), which campaigned against added sugar labelling in the US, and opposed the World Health Organisations 2015 advice that less than 10% of daily energy intake should come from free sugars those added to food and drinks and occurring naturally in honey and fruit juice.

Criticisms of these tactics seem to be hitting home. Mars broke ranks with fellow chocolate-making ILSI members including Nestl, Hershey and Mondelz, which owns Cadbury, in 2016 when it denounced a paper funded by the group questioning research linking sugar consumption and poor health, and related health advice. Last month Mars announced it was leaving ILSI.

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Dont count on it: large quantities of the flavanols found in chocolate need to be consumed before they will have an impact on blood pressure. Photograph: Anthony Devlin/PA

Marss Berninger agrees that the chocolate industry could do more to prevent the spread of health myths. Chocolate is a treat you should enjoy occasionally and in small portions, not a health food, he says. Did we say that loud enough over the last 10 years? I would say no.

Public health campaigners welcome Marss new stance. Some see it as a genuine attempt to do the right thing, while others highlight how large food companies are seeking to reposition themselves in the face of growing environmental and health concerns. Whatever the motivation, the gulf between the chocolate industry and its critics seems to be narrowing.

Children hoping to celebrate Easter in the traditional chocolatey style on 1 April will be reassured to hear the two sides also agree on another aspect of the debate. While chocolate is probably not healthy, its also not harmful when enjoyed in sensible amounts, says Mellor. Chocolate is candy, adds Nestle. As part of a reasonable diet, its fine in moderation.

You can say anything with figures

The role of the media in helping chocolate makers exploit our failure to grasp the complexities of nutrition science was laid bare in a 2015 expos. German television journalists set up a three-week study in which they asked one group of volunteers to follow a low-carb diet, another to do the same but add a daily chocolate bar, a third to make no change to their diet. Both low-carb groups lost an average of 5lb, but the chocolate group lost weight faster. By measuring 18 different things in a small number of people, the spoofers made it likely they would find statistically significant but fake benefits of eating chocolate.

The peer-reviewed International Archives of Internal Medicine agreed to publish a hastily written paper within 24 hours of receiving it for a fee of 600. John Bohannon, a Harvard University biologist and science journalist in on the hoax, put together a press release. Within days stories had been published in more than 20 countries. The Mail Online, Daily Express, Daily Star and Bild were among those that fell for it.

I was just really ashamed for my colleagues, says Bohannon. These are people who regurgitate whole chunks of press releases and almost never call on outside sources. In my book, thats not even journalism. Its just an extension of PR.

Big Food: Critical Perspectives on the Global Growth of the Food and Beverage Industry, edited by Simon N Williams and Marion Nestle, is published by Routledge

Read more: https://www.theguardian.com/lifeandstyle/2018/mar/25/chocolate-the-dark-truth-is-it-good-for-you-health-wellbeing-blood-pressure-flavanols

The Uneven Gains of Energy Efficiency

This story originally appeared on CityLab and is part of the Climate Desk collaboration.

On a rainy day in New Orleans, people file into a beige one-story building on Jefferson Davis Parkway to sign up for the Low-Income Heating and Energy Assistance Program (LIHEAP), a federal grant that helps people keep up with their utility bills. New Orleans has one of the highest energy burdens in the country, meaning that people must dedicate a large portion of their income to their monthly energy bills. This is due in part to it being one of the least energy-efficient cities in the country.

For many city residents, these bills eat up 20 percent of the money they take in, and the weight of the burden can be measured in the length of the line.

“We’ve got folks wrapped around the block,” said Andreanecia Morris, the executive director of a housing advocacy non-profit called HousingNOLA. “There are people here paying 300, 400, 500 dollars a month. Some are paying utility bills that are as much as their mortgage.”

Andreanecia Morris of HousingNOLA says that energy costs play a central role in housing affordability in New Orleans.
Michael Isaac Stein

These bills, as indispensable as rent or healthcare, have exacerbated the affordability crisis as cities become increasingly inhospitable to all but the affluent. Energy costs increased at three times the rate of rent between 2000 and 2010. This rise, paralleling a dramatic stratification of wealth in some American cities, has widened the disparity in energy burdens between low-income and well-off households.

A 2016 study by the American Council for an Energy Efficient Economy (ACEEE) and Energy Efficiency for All (EEFA) set out to quantify what many already assumed: that low-income, black, and Hispanic communities spend a much higher share of their income on energy. The results were unsurprising, but stark. The researchers found that median energy burdens for low-income households are more than three times higher than among the rest of the population.

Utility bills are the primary reason why people resort to payday loans, and play an outsized role in the perpetuation of poverty. But the impacts of soaring energy bills go beyond finances. Living in under-heated homes puts occupants at a higher risk of respiratory problems, heart disease, arthritis, and rheumatism, according to ACEEE and EEFA. Then there are the tragedies, like that of Rodney Todd, a University of Maryland kitchen worker who died of monoxide poisoning, along with his seven children, while using a gas generator to power his home after his electricity was shut off by Delmarva Power.

One reason for the energy-burden gap is that the energy bills of the rich and poor aren’t in fact very different. “Energy is not discretionary,” said Anne Evens, CEO of Elevate Energy, an urban sustainability non-profit. No matter our income level, “We need energy to refrigerate our food, to heat our homes.”

Another cause, the 2016 study found, is that low-end housing is significantly less energy-efficient than other housing stock. People with less money aren’t just paying a greater proportion of their income for energy—they’re paying more per square foot. “Far from being an intractable problem related to persistent income disparity, the excess energy burdens [that low-income communities] face are directly related to the inefficiency of their homes,” the study authors concluded.

“What you’ll see is people finding cheaper rents in buildings because they’re older,” Morris said. “But their savings are offset, because their homes are so energy inefficient.”

There is a great amount of potential for energy savings in these older buildings. ACEEE and EEFA found that 97 percent of the excess energy burdens for renting households could be eliminated by bringing their homes up to median efficiency standards. And a 2015 study by the U.S. Department of Energy found that the value of energy upgrades is 2.2 times their cost. This figure is even higher for the most inefficient homes.

The question is how to find the capital to realize those gains, and whether the benefits can reach those who need relief.

Energy efficiency for some

Energy efficiency programs can go a long way to closing the energy burden gap, but they often do just the opposite.

A revolution in efficiency programs and home weatherization has opened the door to the world’s cheapest energy source: avoided energy waste. But for the most part, it is only accessible to people who can afford an upfront investment. Think of someone who’s renovating their kitchen and decides to replace the appliances with more energy-efficient ones, or a person who puts solar panels on the roof of his house, motivated less by cost savings and more by a bumptious desire to be the chief environmentalist on the block.

An A/C unit in a house in New Orleans. Gaps in windows and walls can cause air to leak out, and energy bills to rise.
Michael Isaac Stein/CityLab

“Energy inequity is about the energy system as a whole,” said Evens. “As we make this transition to cleaner energy, who is really benefiting? As we become more energy efficient, is that benefiting all people? Who’s being left behind?”

Even programs that subsidize efficiency upgrades may be inaccessible to, or underutilized by, low-income households because they still require upfront investment and won’t yield benefits for years. For many, the need for aid is immediate.

A growing network of programs, both private and public, is trying to correct the imbalance. Local housing authorities all over the country have upgraded their public housing units and designed affordable-housing tax credits that ensure a high degree of energy efficiency. Non-profits and utility companies are helping homeowners make upgrades to their homes by deferring upfront costs and using energy savings to pay down the debt.

But for all the good they do, many of these initiatives sideline a large and vulnerable group of low-income individuals: renters. The number of Americans who use HUD vouchers in the private market greatly outnumbers the public-housing population. And the number of urban renters is only increasing as home prices soar out of reach.

Renters are left out of the efficiency boom because they’re left to the whims of their landlords’ investment decisions. If a tenant pays their own utility bill, there isn’t much incentive for the landlord to make improvements. And renters are unlikely to make long-term efficiency improvements themselves, uncertain of whether they’ll be able to stay there long enough to reap the benefits.

Shrinking resources

Policymakers will continue to experiment with new forms of incentives and targeted funding. Whatever solutions they construct, advocates agree that success will require a bigger pot of money than currently exists. Unfortunately, funding for low-income energy efficiency is shrinking.

“There are so many different programs that have been cut, rolled back, or attacked,” said Michelle Romero, the deputy director of Green For All, a non-profit founded by Van Jones. “Without programs that invest in helping low-income communities afford energy efficiency, you’re going to see the disparity increase.”

LIHEAP is the government’s largest grant focused on low-income energy affordability. But it’s been cut by a third since 2009. Trump has threatened to eliminate LIHEAP entirely, along with similar programs like the Department of Energy’s Weatherization Assistance Program. For now, the programs are still funded, but advocates remain uneasy. “We don’t know what’s going to happen,” said Evens. “Predictability has kind of gone out the window. So we have to be really, really vigilant.”

As funding contracts, efficiency initiatives are the first to go. Only 14 percent of LIHEAP dollars go to energy-efficiency investment. The rest is used for direct bill assistance for those whose needs are too immediate to focus on long-term efficiency.

“You can’t tell someone, ‘We’re not going to help you pay your light bill this month, but in a year we can guarantee your apartment will be energy efficient.’ Well, they may not make it through the year,” Morris said. But prioritizing short-term fixes isn’t a real solution: “We can’t end up in these positions where we’re spending all this money on direct assistance so we can’t do anything else.”

Read more: https://www.wired.com/story/the-uneven-gains-of-energy-efficiency/

Meet the man who lent Stephen Hawking his voice

A man and a voice who will be missed.
Image: Karwai Tang/Getty Images

Stephen Hawking’s computer-generated voice is so iconic that it’s trademarked — The filmmakers behind The Theory of Everything had to get Hawking’s personal permission to use the voice in his biopic.

But that voice has an interesting origin story of its own.

Back in the ’80s, when Hawking was first exploring text-to-speech communication options after he lost the power of speech, a pioneer in computer-generated speech algorithms was working at MIT on that very thing. His name was Dennis Klatt.

As Wired uncovered, Klatt’s work was incorporated into one of the first devices that translated speech into text: the DECtalk. The company that made the speech synthesizer for Hawking’s very first computer used the voice Klatt had recorded for computer synthesis. The voice was called ‘Perfect Paul,’ and it was based on recordings of Klatt himself. 

In essence, Klatt lent his voice to the program that would become known the world over as the voice of Stephen Hawking.

Hawking passed away on Wednesday at the age of 76. The renowned cosmologist lived with amyotrophic lateral sclerosis, or ALS, for 55 years. His death has prompted an outpouring of love, support, and admiration for his work and his inspirational outlook on life. It’s also prompted reflection on how he managed to have such an enormous impact on science and the world, when his primary mode of communication for the last four decades was a nerve sensor in his cheek that allowed him to type, and a text-to-speech computer. 

Though Hawking had only had the voice for a short time, it quickly became his own. According to Wired, when the company that produced the synthesizer offered Hawking an upgrade in 1988, he refused it. Even recently, as Intel worked on software upgrades for Hawking over the last decade, they searched through the dusty archives of a long-since-acquired company so they could use the original Klatt-recorded voice, at Hawking’s request.

Klatt was an American engineer who passed away in 1989, just a year after Hawking insisted on keeping ‘Perfect Paul’ as his own. He was a member of MIT’s Speech Communication Group, and according to his obituary, had a special interest in applying his research in computational linguistics to assist people with disabilities.

Hawking has been known to defend and champion his voice. During a 2014 meeting with the Queen, she jokingly asked the British Hawking “have you still got that American voice?” Hawking, like the sass machine that he is, replied “Yes, it is copyrighted actually.”

Hawking doesn’t actually consider his voice fully “American.” In a section on his website entitled “The Computer,” Hawking explains his voice technology:

“I use a separate hardware synthesizer, made by Speech Plus,” he writes. “It is the best I have heard, although it gives me an accent that has been described variously as Scandinavian, American or Scottish.”

It’s an accent, and a voice, that will be missed.

You can find Hawking’s last lecture which he gave in Japan earlier this month on his website. It’s called ‘The Beginning of Time.’

Read more: https://mashable.com/2018/03/14/stephen-hawking-voice-origin-story/

Is vitamin D really a cure-all and how should we get our fix?

Evidence is growing that the sunshine vitamin helps protect against a wide range of conditions including cancers

Vitamin D is having quite a moment. In the past few months, evidence has been growing that the sunshine vitamin not only has an important role in bone and muscle health, but might also help prevent a range of cancers, reduce the chance of developing rheumatoid arthritis, protect against multiple sclerosis and cut the risk of colds and flu.

But is vitamin D truly a cure-all? And if the benefits are real, should we all be taking vitamin D supplements or even fortifying our foods?

Vitamin D is not one chemical, but a label that covers a group of substances, including vitamin D2 and D3. The latter is the form made when sunlight hits your skin and is also found in other animals. Non-animal sources such as fungi and yeasts primarily produce the D2 form. Once in the body, these substances are converted into biologically active steroids that circulate in the blood.

One area where the impact on health appears to be clear is vitamin Ds role in keeping bones and teeth healthy and improving muscle strength.

The musculoskeletal stuff is really good and really strong, said Helen Bond, a spokesperson for the British Dietetic Association, pointing out that vitamin D is important in calcium and phosphate absorption.

Too little vitamin D can be serious: the skeletal disorders osteomalacia and rickets are known to be caused by a vitamin D deficiency, and the latter is on the rise in the UK, a finding some put down to the impact of poverty on poor nutrition.

But do the wider health claims stand up?

Intuition suggests that it cant all be right, said Julia Newton-Bishop, professor of dermatology and vitamin D expert from the University of Leeds. But while a recent review of evidence by the scientific advisory committee on nutrition only found strong evidence in the case of bone and muscle health, Newton-Bishop says a growing body of research is exploring other conditions.

Newton-Bishop says the fact that receptors for vitamin D are present on a huge array of body cells suggests the substance might indeed play a central role in our health, adding that human history offers further evidence: as humans moved to higher latitudes, skin tone became paler. [One] explanation is that vitamin D was so important that that was a selective pressure, she said. The fact that Inuits arent pale-skinned and for millennia they have had an exclusively fish diet is an argument for the fact that vitamin D was a driver, because why would they be different to everyone else?

Martin Hewison, professor of molecular endocrinology at the University of Birmingham, who carried out the recent study into vitamin D and rheumatoid arthritis, said evidence from cell studies backs up the idea that the vitamin is important.

In most of the models, vitamin D appears to have quite a positive effect, he said. If you are using cancer cell lines or cancer cells, vitamin D has anti-cancer effects, and likewise in cells that have been used for models for infection and immune disorders, vitamin D has quite clear antibacterial and anti-inflammatory effects.

But when it comes to studies in humans, the picture is far from clear-cut. While some studies find links to diseases, others do not.

That, say experts, could be partly down to the way they are conducted for example, not all studies take into account the starting levels of vitamin D in participants, or they may have been carried out in populations with different genetic factors that might affect the impact of vitamin D.

Other experts have doubts about vitamin Ds influence. Prof Tim Spector, author of The Diet Myth, wrote in the Independent: The evidence so far suggests (with the possible exception of multiple sclerosis and some cancers) that low vitamin D levels are either irrelevant or merely a marker of the disease.

Hewison says that while vitamin D might help prevent certain conditions such as tuberculosis, respiratory infections and autoimmune diseases,it should not be seen as a cure for them. It is good at protecting against things, he said, but once a disease is settled in, it is unlikely you are going to be able to give somebody who has got prostate cancer vitamin D and it is going to get dramatically better.

What about the case for supplements? With some having previously been found to cause more harm than good, Newton-Bishop says caution towards this apparent panacea is unsurprising. Everyone within the cancer world is nervous about supplements, she said. I would say to patients dont take supplements, with the exception of avoiding a low vitamin D level.

But how low is low? With the amount of sunlight needed varying with genetics, skin colour, time of day, how much one covers up and a host of other factors, the scientific advisory committee on nutrition said it was too difficult to say how much sun we need to make sure our vitamin D levels are up to scratch. In any case, from October until March the sun in the UK isnt strong enough to do the job.

The upshot is that national guidelines now recommend that during the autumn and winter at least, individuals should consider taking supplements or boosting their intake of vitamin-D-rich foods to get an intake of 10 micrograms a day, with higher-risk individuals such as some ethnic minority groups advised to follow the guidelines all year round.

However, Bond says it is hard to get enough from diet alone.

There are very few naturally rich sources of vitamin D, and most really good sources are of animal origin, which doesnt bode well for vegans and vegetarians, she said. A serving of oily fish like mackerel will give you easily your 10 micrograms of vitamin D a day, but if you drop down to a tin of canned tuna, you are only getting 1.5 micrograms.

And as Adrian Martineau, clinical professor of respiratory infection and immunity at Queen Mary University of London, points out, even in the summer, sunshine isnt going to be the answer, especially because there is an associated risk of skin cancer.

If you are considering taking supplements, it might be worth checking which form of vitamin D they contain. Some people dont want an animal form of vitamin D, said Hewison. However, What studies have shown is that if you want to raise your blood vitamin D levels, vitamin D3 is much more efficient at doing that.

Dr Benjamin Jacobs, a consultant paediatrician and spokesperson for the Royal College of Paediatrics and Child Health, says supplements are not enough as it is hard to make sure people actually take them. Instead, he suggests the UK consider food fortification.

Some countries, including Canada and Finland, have embraced fortification of milk. But although infant formula and some breakfast cereals, plant-based milks and fruit juices are already fortified in the UK, most foods are not.

Hewison believes the government should consider a national fortification plan and that the risks of it resulting in dangerously high vitamin D intake are negligible: I think most people in the field agree that if you want to have a large-scale improvement in peoples vitamin D levels then it can only really be done through fortified foods.

Read more: https://www.theguardian.com/science/2018/mar/09/is-vitamin-d-really-a-cure-all-and-how-should-we-get-our-fix

KardiaBand is the Apple Watch band that can run EKGs and detect irregular heartbeats

Kardia Band is the wearable EKG monitor that can detect dangerous heart patterns.
Image: alivecor

Heads up: All products featured here are selected by Mashable’s commerce team and meet our rigorous standards for awesomeness. If you buy something, Mashable may earn an affiliate commission.

Listen up, Apple Watch users: A new FDA-approved band is on the market and it can help you monitor your heart in a whole new way.

Yes, you can feel when your heart is beating fast after a run or a nerve-racking situation — but most of us aren’t doctors and can’t tell whether this is normal or an actual problem. Detecting when a heart has a truly irregular rhythm by yourself is a toss up, and the only way to confirm an atrial fibrillation (AFib) is to get an electrocardiogram (EKG) from a cardiologist. 

AliveCor is a company known for their mobile heart monitors that can be stuck on the back of a smartphone and run an EKG. After two years of testing, AliveCor was given the green light by the FDA to market the KardiaBand as a heart-monitoring wristband for the Apple Watch.

According to a study conducted by heart doctors at the Cleveland Clinic, researchers found that the band’s algorithm correctly distinguished AFib hearts from normal functioning hearts over 90 percent of the time. Basically, this means that the KardiaBand can give people an instant and pretty accurate idea of whether they have something to worry about — an analysis that could only previously be done during a trip to the doctor. 

Here’s how the KardiaBand runs a 30-second EKG:

What’s the big deal about irregular heart beats, you ask? If the abnormality is serious and not caught early, irregular rhythms can cause stroke, blood clots, or heart disease — so heart rhythm really isn’t something to be ignored.

This isn’t to say that AFib is always a life or death situation — not every too-fast or too-slow heart is an emergency, so don’t freak out. However, many people are deterred from going to the doctor because they don’t want to admit something is wrong, and overlooking possible AFib risks can lead to serious consequences. But thanks to KardiaBand, EKGs can now be done in the comfort of your own home. (Note: A doctor’s analysis should still be sought out if the band tells you something’s up.)

Mashable’s Mark Kaufman writes:

As more health and fitness devices are designed to work with popular consumer tech, like Apple iPhones and smartwatches, it’s helpful that doctors are scrutinizing some of these devices to ensure they work as advertised — even after they pass the FDA’s rigorous protocols. 

For $199, you can get a 38mm or 42mm KardiaBand here — and if you want the KardiaBand but don’t have an Apple Watch yet, you can snag the Apple Watch 3 here. If you don’t have an Apple Watch and don’t want an Apple Watch, AliveCor’s mobile EKG monitors for smartphones are also up for grabs for $99.

Read more: https://mashable.com/2018/02/28/kardiaband-apple-watch-irregular-heart-rhythm/

With AI, Your Apple Watch Could Flag Signs of Diabetes

Before modern chemistry brought doctors blood and urine tests for diagnosing diabetes, they had to rely on their taste buds. Sweet-tasting pee has long been the disease’s telltale biomarker; mellitus literally means honey. Too much sugar in your bodily fluids means your metabolism has gone haywire—either your cells aren’t making insulin or they’re not responding to it.

But a little over a decade ago, a group of researchers discovered a less obvious link. One of the complications of diabetes is nerve damage, and in the cardiovascular system that damage can cause irregular heart rates. Which you can measure, either with electricity or light. So one day soon, doctors might diagnose diabetes with their patients’ wrist bling instead of blood pricks or pee strips. Oh, what difference a few centuries make.

In 2005, heart rate sensors were something only elite athletes and very sick people used. Today, one in five Americans own one. Which is why there’s now a deep learning company trying to make something out of the connection between heart rate and diabetes. On Wednesday, at the annual AAAI Conference on Artificial Intelligence in New Orleans, digital health-tracking startup Cardiogram presented research suggesting the Apple Watch’s heart rate sensor and step counter can make a good guess at whether or not a person has diabetes—when paired with the right machine-learning algorithms, of course.

Apple has been eyeing a career change—from personal trainer to personal physician—for its signature wearable for a while now. In November the company teamed up with health insurer Aetna to give away more than 500,000 Apple Watches as part of a pilot to try to reduce health costs. And it embarked on a study with Stanford to test the watch’s skills at detecting irregular heartbeats, which can lead to stroke or heart attack. This most recent collaboration between Cardiogram—a San Francisco-based startup staffed by former Google engineers—and a landmark UC San Francisco heart health study is just the latest in these moves.

Cardiogram offers a free app for organizing heart-rate data from the Apple Watch and devices with similar sensors—from companies like Fitbit, Garmin, and Android Wear. It uses the same kind of artificial neural networks that Google uses to turn speech into text, and repurposes them to interpret heart-rate and step-count data. On its own, that data is mostly meaningless for detecting disease, and not just because the sensors themselves have significant errors. Training a model that can pick out condition-specific patterns requires labeled data. To learn what a diabetic heart rate signature looks, it needs some diabetics.

That’s where UCSF comes in. In 2013 it kicked off a major heart disease project called the Health eHeart study, aiming to collect massive amounts of digital health data on one million people. As of mid-January, the study had registered 196,000 participants, who each fill out a survey about known medical conditions, family histories, medications, and blood test results. About 40,000 of them have also opted to link that information with their Cardiogram app.

“That’s where we get our labels,” says Cardiogram co-founder Brandon Ballinger, who previously worked as a tech lead on Google’s speech recognition software. “In medicine, your labeled answers each represent a life at risk. Compared to what an internet company is working with, it’s actually a very small number of examples.”

So Cardiogram has had to adopt some tricks from the tech world to train its neural network, DeepHeart, to spot human disease. One of these is a technique called semi-supervised sequence learning, which was originally invented to work on text data like Amazon product reviews. But instead of a sequence of words, they sub in a sequence of heart rate measurements—about 4,000 per week. Some fancy math compresses that information into a single number summarizing the amount of heart rate variability. Then those summaries are what get tied to labeled patient data, and the real training can begin.

Using this method, DeepHeart was able to spot diabetics who weren’t part of the training group 85 percent of the time. The results are on par with the company’s previous work: Last year, the Cardiogram and UCSF released results showing that DeepHeart could wrestle one week’s worth of a person’s Apple Watch data into predictions for hypertension, sleep apnea, and atrial fibrillation with accuracy rates between 80 and 90 percent.

So how do Cardiogram’s algorithms make good guesses without directly measuring the amount of sugar in someone’s blood? Nobody really knows.

“Diabetes is very clearly a cardiovascular condition, but it’s not one with an obvious physiological connection to heart rate variability,” says Mark Pletcher, one of the principal investigators of the Health eHeart study and a co-author on the paper presented Wednesday. When you train machine learning algorithms on data without knowing the mechanisms behind the underlying patterns, you often get a signal without understanding why. “It makes me nervous, frankly. We’ve had a lot of internal discussions about whether this could be picking up medications diabetics use or some other extraneous factor. But we haven’t come up with anything.”

That’s the kind of thing that sends up red flags for Eric Topol, a cardiologist and Director of the Scripps Translational Science Institute, where he’s leading the digital health arm of the NIH’s billion dollar Precision Medicine Initiative. “This combines features of the black box of algorithms and the black box of biology,” he says, of the Cardiogram study. “It’s unconvincing and shaky. At best it would be considered hypothesis-generating.” The hypothesis here being that DeepHeart might be picking up a diabetes signal. But it might be picking up something else.

Ballinger is quick to counter these kinds of criticisms. If your wearable tells you you’re at increased risk for diabetes, and you go to the doctor and get diagnosed by traditional means, then you’re still getting the standard quality of care, he says. So what if it’s a black box that gets you in the door? Still, he recognizes the need for prospective validation to really demonstrate the AI’s accuracy—screening people who have not yet been diagnosed with diabetes, and following them to see if they did in fact develop the disease. He says the company is actively investing in those kinds of future studies.

With the right testing, Ballinger sees business potential in his black box intelligence. Cardiogram’s app for Apple Watch and other devices is free today. But the startup plans to add features that advise a user be tested for atrial fibrillation, high blood pressure, sleep apnea, or diabetes as soon as later this year. To stay on the right side of the US Food and Drug Administration, the app can’t function as a standalone diagnostic, more like some friendly advice. But the kind of advice an insurer might cover if they thought it would get people into treatment earlier and save healthcare costs.

Which leaves them a long way to go, given the evidence that’s currently out there. Or rather, lack thereof. “Setting aside the accuracy piece, which is something the FDA would want to know about, there’s almost no data out there on whether or not these wearables can actually change patient outcomes,” says Brennan Spiegel, a gastroenterologist and the director of Health Services Research at Cedars-Sinai in Los Angeles. “Creating the tech isn’t the hard part. The hard part is using the tech to change patient behavior. And that’s really hard to do. It’s not a computer science, it’s behavioral and social science.”

Still, if the Health eHeart and Cardiogram studies can say one thing pretty definitively at this point, it’s that people are eager to engage with apps capable of medical-grade measurements, if and when they become available. The question is if a healthier you is truly just a push notification away.

Intelligent Wearables

Fitbit's new smart watch wants to be a personal medical device.

Science says fitness trackers don't work. Here's why you should wear one anyway.

Don't know the difference between supervised, semi-supervised, and unsupervised deep learning? The WIRED Guide to Artificial Intelligence can help you with that.

Read more: https://www.wired.com/story/with-ai-your-apple-watch-could-flag-signs-of-diabetes/

Tom Brady’s Dangerous Alt-Science Blitz

"What are you willing to do and what are you willing to give up to be the best you can be?" are Tom Brady's first words in the Facebook Watch documentary, Tom vs. Time. The premise of the series is neatly summarized in the title, and put on repeat throughout the premiere of the show: Brady is 40 years old, at an age when he should be retired, yet somehow brought his team back from what seemed like imminent loss in 2017s stunning Super Bowl win against the Atlanta Falcons. On Sunday, Bradys New England Patriots will take on the Philadelphia Eagles.

Brady, the documentary suggests, is superhuman and on a race against time. And Bradys on a mission to show his secrets, first with last Septembers release of The TB12 Method: How to Achieve a Lifetime of Sustained Peak Performance and now with the companion series of episodes profiling Bradys life, directed by Gotham Chopra.

It might not be surprising, then, that the first episode of Tom vs. Time, The Physical Game, features a scene in which Brady goes to his business partner and long-time trainer Alex Guerrero for a pounding, seemingly painful massage he terms pliability training, after he noticed that bumps and bruises hed gotten from football were really starting to take a toll. The segment shows Guerrero examining Bradys heel, rubbing it and commenting, This is better, a vague note that suggests that something about pliability training has somehow improved Bradys heel .

Even Brady notes skepticism when he recalled initially meeting Guerrero. I was like, Yeah, what can he do? What can he do thats been different than what everyone else has done for me, which is just ice your shoulders and take some rest? Brady gazes into the camera and swallows. Boy did I learn a lot.

The next shot illustrates pliability training, what appears to be a really intense Thai massage, as Guerrero (credited as Bradys body coach) swiftly and stringently rubs Bradys legs. He pounds Bradys back so hard that the quarterbacks body bounces up and down, Bradys face crunched in discomfort. He pokes and prods, pushes and pinches Brady all over his body. Prior to the season starting, we really try to get his brain to understand that theres going to be impact, then prepare his body for the impact, to almost feel as if its normal behavior for him.

What Tom vs. Time fails to mention: Guerrero has been investigated by the Federal Trade Commission for making unsubstantiated health claims, like promoting a supplement purported to protect athletes from concussions. (The FTC decided not to pursue a full-fledged investigation in exchange for Guerrero refunding customers money and closing shop.)

Over the years, so many muscle contractions or through all the workouts that we do, we shorten our muscles. So if you can get them to lengthen, then when you contract, they can fully contract and relax.
Tom Brady, New England Patriots quarterback, on pliability training

Speaking of concussions, its troubling that the series makes no mention of them. Brady doesnt address the effects of head impact that a football player experiences, whichas has been widely reportedcan lead to concussions and chronic traumatic encephalopathy, or CTE. Pliability training is, by definition, aimed at massaging an athletes muscles, which is well and good, but the vast majority of scientific and medical criticism about football has been around head impact and brain injuries, which are more complex and devastating than muscle tears. But Brady is silent on the fact that his colleagues have suffered some of the most violent traumatic brain injuries a human body can endure, resulting in mental and physical trauma that may have led to death and suicide.

As for pliability training itself, its a fuzzy concept. Brady explains it as such: I see pliability as lengthening and softening muscles to get them back into balance. Over the years, so many muscle contractions or through all the workouts that we do, we shorten our muscles. So if you can get them to lengthen, then when you contract, they can fully contract and relax. Soft muscles, Brady contends, allow a player to get slammed by another body repeatedly; denser, tougher muscles tear and dont bounce back.

On paper, this explanation of how muscles work makes very little sense and is oversimplified. Slow-twitch muscles carry oxygen and are able to sustain energy and function before feeling tired; fast-twitch muscles are key for sprinting and short bursts of strength and speed. The development and usage of these muscles can be sports-specific, so that in football, which is a game that requires both running for a distance and short bursts of speed, these muscles can be individualized for each role. Football is a physiologically intensive sport; for a quarterback like Brady, though, action is often limited to throwing and calling plays, with occasional running of the ball. That means that in both arms and legs, Brady is mostly using short-twitch muscles. Now, according to the Gatorade Sports Science Institutes analysis of the physiological demands of football, most muscle damage is enzymatic and highly conditioned athletes [are] able to withstand the stress of 10 days of two-a-day practice sessions. In fact, the report says, elite players often have muscles desensitized to repeated blows.

The lengthening and softening of muscles to allow them to contract and relax? A massage certainly has beneficial effects for how a body recovers after a stressful event. A stretch feels amazing, and getting a professional to knead sore, tired muscles can be crucial for recovery after any extremely physical event. But Bradys insistence that muscles experience ultimate performance when they are lengthened and softened so that they can fully contract has next to no scientific backupthere are literally zero studies on muscle pliability. As an expert in muscle physiology told The New York Times: Its balderdash.

And thats the crux of the problem with Tom Bradys TB12 method to promote health and wellness: It seems to suggest there is something happening that is good for you, something science doesnt even know or understand.

This line of thinking is always dangerous (see: anti-vaxxers, homeopaths), and its also dangerous for Brady to peddle his alternative therapieswithout any scientific research to back them upas something that should be believed as fact.

It doesnt help that the Tom vs. Time has the sheen of earnestness. Filmed in the type of inspirational montage-style that will become ubiquitous in February with the Olympics, the documentary homes in on Brady. We see shots of him peeling a banana (sans chef) before popping it in a blender and swirling the contents into a purple smoothie. We see him at the gym, sweating through resistance exercises. We see him at home, taking his rings out of a locker and chuckling, I need to shine these.

Bradys everyman routine is grating, but is instrumental in setting the stage for his second coming, a career that could propel him into the time part of his series: as a health and wellness guru. After all, whats better than a social media-only documentary in promoting Brady as a health expert? Chopra has seemingly obtained countless clips of commentators and coaches and even Brady himself robotically repeating ad nauseum the fact that Brady is 40 and far older than most athletes. Its impossible to ignore Bradys attempt to be the male Goop, a sort of Gwyneth Paltrow for men.

And while that might seem like an odd place to be for an all-American icon like Brady, its a savvy move. Brady is heralded by a significant portion of this country as an American hero, and in a land where football is second to church in godliness on autumn Sundays, Bradys is a presence that marks him as a prime individual for being able to kickstart a health and wellness revolution among men.

Thats huge, given the sorry statistics that surround mens health in this country: According to the Center for Disease Control and Prevention, 12.8 percent of men in America are in poor health; nearly half of American men dont meet federal guidance on physical activity; 17.8 percent of men smoke cigarettes; 34.5 percent were obese; mortality was overwhelmingly higher than those of their female counterparts, particularly due to cancer, heart disease, and accidentsthe first two of which are preventable with diet and exercise. For whatever reason, men dont take care of their health as much as they should.

But Brady, the quintessential American man, does, and how. Indeed, the series highlights very few of Bradys health practices that have been widely covered, analyzed, and often scorned: His refusal to eat nightshade vegetables to avoid inflammation, his misguided logic that drinking water will prevent sunburn.

Its impossible to ignore Bradys attempt to be the male Goop, a sort of Gwyneth Paltrow for men.

But could it be that Brady is actually doing good? Hes promoting health and wellness for a segment of the population that probably wont go see a doctor or eat some greens without someone they look up to promoting that lifestyle. Brady is, after all, just a normal, average American: a 9-to-5 man with a family, a job he works hard at, hitting the gym and hanging with his buddies (never mind that he's got a personal chef, an exercise routine that involves specialists, and moneylots of it).

In fact, thats a huge part of the problem in Bradys proselytizing about health and wellness: It requires a certain income and class. The nutrition manual alone that comes with Bradys recent book rings in at a hefty $200. Bradys diet is primarily vegan and local, which is arguably expensive for an average American man. He dumps electrolytes into everything he drinks along with specially-selected, top of the line supplements. His vegetables are most often raw and organic. The vegetables he has are limited to those that are alkalizing. Its not feasible for a middle- or lower-income American to go against time in the way Tom Brady does.

To be fair, Brady's diet falls into the nutritionally-lauded Michael Pollan philosophy: Eat food. Not too much. Mostly plants. But it doesnt erase the fact that it takes money to follow the TB12 Method, it takes money to be able to eat well in America, and it takes money to be able to have vitamins and minerals splunked into every single drink you drinkmoney that many Americans just cant afford to spend on designer meals.

Whats even sadder, and more terrifying, about the series is the fact that Sundays Super Bowl offers Brady essentially free advertising for his "method." Regardless of if the Patriots win or lose, Brady will have won more exposure. Never mind that his physique and health have been honed after years of training, genetics, and professional investmenthes brought his scientific flim-flam to the biggest stage American television affords. And by doing so, by showcasing himself as proof of a wellness initiative founded on body coaches and questionable advice like not eating tomatoes and strawberries or shrugging off sunscreen off as unnecessary, Brady is able to establish legitimacy.

Bradys TB12 method is reflective of a wider debate in American culture about the perception of medicine and science and the rising distrust of those fields in favor of alternative theories that often dont have any basis in fact. Anti-vaxxers who want to protect their children from autism, women sticking jade eggs up their steamed vaginas in hopes to improve their sexual health and the burgeoning (vastly unregulated) wellness industrypeople are so afraid and distrustful of science that they are willing to seek out snake oil in a desperate effort to feel better about themselves and their health. While Bradys TB12 method certainly has some harmless aspects to itthe core of what he preaches is to eat well and to work out regularlythat he pits himself against time and offers some sort of miracle solution to aging if you just sign up makes for a worrisome precedent.

Never mind that his physique and health have been honed after years of training, genetics, and professional investmenthes brought his scientific flim-flam to the biggest stage American television affords.

"I could beI should be perfect," Brady says in a closing scene of the first episode, pulling into practice with an audio array of commentators wondering (for the umpteenth time) if Brady can continue to perform in his 40s. What Brady has achieved as a 40-year-old athlete is astounding. The fact that he's able to run, throw, tackle, and be tackled at the highest, arguably most brutal intensities, makes the fact that Brady has emerged time and again victorious remarkable. He's in peak health and capable of doing far more physically than the vast majority of his peers.

But while Brady might want to attribute this to his TB12 system, the fact is that what he's promoting has never been evaluated by factual, evidence-based science. And while it's important to question the status quo, to test what we believe is true, the pseudoscience Brady is peddling has the power to affect men who arent in a position to rigorously verify his claims.

Youve got to play harder, tougher, play for everything! Brady yells at his team in the lows of the Super Bowl last year. Modern-day Brady voices over: Being mentally tough is putting all that bullshit aside … all the noise, all the hype, and just focusing on what you've got to do.

The problem is, much of what Brady is promoting seems to be noise and hype itself.

Read more: https://www.thedailybeast.com/tom-bradys-dangerous-alt-science-blitz

Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Read more: https://www.theguardian.com/society/2018/jan/24/even-one-cigarette-a-day-greatly-raises-cardiovascular-risk-experts-warn