July 16, 2018

Here’s an Idea for an App

brainHere’s an idea for an app: Wouldn’t it be great if there were a smartphone app that could scan my tummy & tell me why it’s hurting? Is it a stomach virus, gluten exposure, FODMAP related, lactose intolerance, corn intolerance, salmonella, too much guar gum or carrageenan, natamycin, not enough fiber, too much fiber, the frequency of meals, or the fact that my sister is coming to visit? I’m willing to do whatever it takes to make it stop hurting. The problem is, it’s often difficult to determine what that is.

I was recently part of a team that reviewed a pilot research grant for a study of the effectiveness of an app vs traditional treatment. While we ultimately chose not to fund that particular grant, I see great possibilities in the future of apps to assist healthcare professionals with diagnosis and treatment of disease and chronic conditions, the physical manifestations of trauma, and mental health issues in general.

While the human element offers insight that may be missed by technology, it also brings inherent bias and inconsistency. In the 1960s, the Oregon Research Institute set out to study how experts rendered judgments. Lew Goldberg, a psychologist, developed a case study in which researchers gathered a group of radiologists and asked them how they determined from a stomach X-ray whether a patient had cancer.

The doctors indicated that there were seven major cues that they looked for. In an effort to create an algorithm that would mimic the decision making of doctors, the researchers created a simple algorithm in which the likelihood of malignancy depended on the seven cues the doctors had mentioned, all equally weighted.

Researchers then presented the doctors with X-rays from 96 different individual stomach ulcers and asked them to rate each one on a seven-point scale from definitely malignant to definitely benign. Without disclosing what they were doing, the researchers showed the doctors each ulcer twice with the duplicates mixed in randomly so that the radiologists wouldn’t notice the duplication.

All data were transferred to punch cards and sent to UCLA for computer analysis. When UCLA sent back the analyzed data, it became clear that this simple computer model was surprisingly good at predicting the doctors’ diagnoses. Even more surprising, the data showed that the diagnoses were all over the place. In spite of the fact that they were trained experts, the radiologists didn’t agree with each other. In fact, they often didn’t agree with themselves. Every single doctor had sometimes contradicted his own diagnosis when given a duplicate X-ray.

The researchers also found that clinical psychologists and psychiatrists deciding whether it was safe to release a patient from a psychiatric hospital wildly differed from each other in their determinations. Further, those with the least training were just as accurate in their judgments as those with more training.

The Oregon researchers then tested the hypothesis that the simple computer model they had designed might be better than doctors at diagnosing cancer. Turns out, the algorithm outperformed even the single best doctor in the group of doctors being studied.

What Goldberg came to realize was that doctors had a good theory of the cues to look for in diagnosing cancer, but in practice they did not stick to their own ideas of how to best diagnose. They tended to weigh things differently. As a result, they were less accurate than a computer model.

Given our current reliance on experts to diagnose, this research isn’t particularly reassuring; however, it does bode well for the inclusion of artificial intelligence in diagnostic procedures. That’s right, just the sort of technology that could be deployed by an app on my handheld device.
floating apps
Here’s an idea for an app

A decade ago, I attended the Game Developers Conference in Austin, Texas. There were sessions on massively multiplayer online (MMO) games, animation for video games, avatar development, and artificial intelligence in video games. I remember thinking as I sat through one of the sessions – the highest and best use of characters in a game who can learn from conflict would be to develop “games” or tools for families to learn to resolve conflict and improve communication.

If I create an avatar that behaves like me at first, but learns better ways to navigate specific situations, I can learn to improve my game, i.e., my life. With the distance of “playing” myself, I gain perspective. I still think there’s great potential for emotional and social growth applications.

Here’s an idea for an app

A couple of months ago, I spoke to the Trauma Institute & Child Trauma Institute in Northampton, MA about a new progressive counting method used to treat PTSD and the effects of childhood trauma. Essentially, the patient verbalizes their first chronological memory of trauma while the therapist counts. This process continues until the distress associated with that memory is resolved. Then the patient moves on to the next distressing memory and repeats the process.

I’m sure it’s a little more complicated than that, but my first thought was – I wonder if you can make a phone count out loud? If so, it seems like a lot of this could be done with a smartphone. Maybe you’d do a couple of sessions with a practitioner at the beginning and periodically thereafter, but the rest could be done in the safety and comfort of your own home. We need an app for that.

Well researched and well designed apps have the potential to propel us forward. Whether or not they include my ideas, I’m excited about their incorporation into medical and mental health practices.

http://www.ori.org/scientists/lewis_goldberg

http://www.ori.org/

http://psycnet.apa.org/record/1970-12828-001

http://michaellewiswrites.com/#top

http://www.childtrauma.com/

http://www.gdconf.com/

http://www.cooking2thrive.com/blog/make-it-easier-to-stick-to-your-eating-plan/

July 10, 2018

Is the Secret Always to KISS?

Whether it’s clean eating, a plant-based diet, or a healthy lifestyle, is the secret always to KISS? A lot of us want to live as healthily as possible. There’s plenty of information out there to help us. A search for clean eating lends 507,000,000 results, plant-based diet 231,000,000 results, and healthy lifestyle 748,000,000 results. If you have time, you can read more than a billion articles. If not, it seems that they all boil down to one idea that could be expressed as KISS (Keep It Simple Stupid)!
simple
Looking back at the food I ate as a child, I had a cleaner diet than many people who deliberately attempt one today. We ate at home. Our beef came from our field. Our pork came from the pigs that almost killed me when I tried to play with their babies. My plate was always full of vegetables fresh from the garden – lettuce, tomatoes, cucumbers, green onions, cabbage, squash, carrots, peas, okra, corn, and potatoes.

In the summer, there was watermelon. Honeybees lived behind our front porch. There was always a line of them flying across the driveway. Once a year, my dad hired a man to rob the hive. Each jar of rich, thick honey had a bit of honeycomb included.
There was no elaborate preparation in the kitchen. None was needed. Flavor burst from lightly sautéed squash or boiled corn on the cob. I ate tomatoes like apples. They were so sweet and juicy, I never added salt.

Our tomato juice was home canned. Pickles were home made. We rarely ate sandwiches or pasta and hardly ever at restaurants. A picnic at the river was left-over fried chicken, deviled eggs, potato salad, and bright green sweet pickles. All of them were made by my grandmother.

I remember this food as the tastiest I ever had. I rarely find produce in the grocery store to match. Even the farmers market often falls short. Maybe that’s why my children and grandchildren seem satisfied with food full of flavor enhancers or additives.

Maybe it’s why many people are satisfied with mediocre restaurant or packaged convenience foods. And maybe some of these people think that great food requires lots of equipment and lengthy preparation.

Perhaps that’s why they sometimes miss the fact that clean eating, a plant-based diet, and a healthy lifestyle all begin with keeping things simple. Start with fresh. Process as little as possible. Let the flavors of the ingredients shine through – keep it simple stupid.

http://www.cooking2thrive.com/blog/?s=the+hive

July 3, 2018

Your Gut Has a Mind of Its Own

If you feel like your gut has a mind of its own, it’s because it does. The billions of neurotransmitters in your intestine are of the same type as those in your brain and house the Enteric Nervous System. The gut is capable of a level of independent intelligence equal to that of your dog.
diet
Does that mean our stomachs can be trained?

It’s kind of a funny idea, but it’s one that’s currently being explored. Some scientists hypothesize that we can treat stomach pain using hypnosis — essentially curing our tummies by talking to them.

The gut is host to 100,000 billion bacteria. When researchers mapped the DNA of one study participants’ microbiomes, they first reported that each of us falls into one of 3 enterotypes.

Subsequent research has called this limited number and the specific characteristics within each type into question. Things may be a bit more nuanced and complicated than originally indicated. Research continues and will bring a clearer picture over time.

We do know that the gut communicates with the brain via the vegas nerve and can affect our emotions. That could be why it feels like the gut has a mind of its own that sometimes controls us.

Ninety-five percent of the seratonin in our bodies is produced in the gut where it regulates the immune system and sets the pace for intestinal transit. Seratonin is also released into the bloodstream acting on the hypothalamus and registering in the upper brain as a sense of well-being.

With conditions like irritable bowel syndrome (IBS) in which there is no observable organic malfunction, it is theorized that there could be a problem between brain and gut communication. One of the brains may send the wrong message or a message may be misinterpreted resulting in the symptoms experienced.

Learning more about this possible process may lead to innovative treatments for the 1 in 10 of us who suffer from IBS. It also has potential benefit for those who have become hypervigilant as a result of trauma.

An examination of the microbiome can increasingly assist in diagnosis and treatment of disease. The microbiome can show a propensity for Type II diabetes, heart disease, and liver disease and may influence obesity. Patients with inflammatory bowel disease (IBD) show an increase in pro-inflammatory molecules and a decrease in inflammatory dampening bacteria. Altering microbial composition could possibly be used to reduce inflammation or calm down the immune system.

Researchers have successfully diagnosed Parkinson’s disease through intestinal biopsy paving the way for additional exploration of the possibility that the gut and brain share diseases. This could be key to a greater understanding of autism spectrum disorders and alzheimer’s disease.

Dr. Michael Gershon, Professor of Pathology and Cell Biology at Columbia University Irving Medical Center who is sometimes referred to as the father of neurogastroenterology has, along with Dr. Anne Gershon, demonstrated that shingles can occur in enteric neurons and may be the cause of several gastrointestinal disorders currently of unknown origin.

It’s a little unclear whether the DNA of a microbiome is a set entity that changes slowly over time or whether researchers were simply mapping a DNA moment in a constantly changing microbiota. Studies have shown that the microbiota can change within one day with a change in diet.

That sounds like great news to me! It’s possible that a change in diet could bring symptom relief fairly quickly once we better understand what in the diet needs to be altered.

The possibilities are huge and the research has just begun. Changing the microbiome through diet, prebiotics, and probiotics may have a much greater effect in preventing and reducing disease than we previously believed. Diet may not just be fuel to keep the body strong, it may be real medicine that can be used to reduce inflammation, revise autoimmune response, and change the messages transmitted from the gut to the brain.

Knowing that my gut has a mind of its own sounds like relief to my upper brain!

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

http://sales.arte.tv/fiche/3707/VENTRE__NOTRE_DEUXIEME_CERVEAU__LE_

http://stm.sciencemag.org/content/1/6/6ra14.short

https://www.mdedge.com/jfponline/article/105514/gastroenterology/targeting-gut-flora-treat-and-prevent-disease

https://www.ncbi.nlm.nih.gov/pubmed/25786900

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

June 27, 2018

What’s Your Favorite Summer Cover-Up?

What’s your favorite summer cover-up? It’s summer & time for the beach. You may have a beach cover-up, but what about your food? Sometimes it can use a good cover-up too!

As we approach the 4th of July, I’m dreaming of slow cooked ribs, smoked pork butt, burgers blackened on the grill, salmon and corn covered in grill marks, and because it’s hot, ice cream for dessert! All of these are delicious simply seasoned with herbs and spices, but this year I think I’d rather slather them until they’re covered in sticky goodness. 
grill
The question is, what cover-up will I choose for a rack of tender ribs? Actually, I may cheat on this one. My lawn care man has promised to deliver a sample of his newly created BBQ sauce. He describes it as tangy & spicy. Those are the qualities I prefer in BBQ sauce and his is getting rave reviews from friends.

Purists may prefer only Memphis-style dry rub on their ribs. I like them rubbed and then basted with a thick sauce that caramelizes on the edges. This only applies to ribs. I want my pork butt covered up after it’s put on my plate if I cover it at all.

For variety, I like mango salsa or sauce, you might prefer apple, apricot, peach, plum, or strawberry. I want to try a cherry based sauce or possibly a mixture of sweet cherries and raspberry. In my head, pineapple sounds like a good compliment to cherries and raspberry, but I’ll have to do a taste test to see if it works like I think it will. Orange might work better.

Moving on to the pork butt, I think I’ll shred the meat and cover it with slaw. Mayonnaise and vinegar cabbage coleslaw is probably the most common version served with pulled pork. I’m going to use my mom’s vinegar coleslaw recipe.

Mom’s Cabbage Slaw

2 large heads of cabbage, shredded
6 or 7 white or red onions, grated or finely minced
2 cups sugar
1/4 cup salt
1 3/4 cups salad oil
1 3/4 cup apple cider vinegar
2 tablespoons dry mustard
2 tablespoons celery seed
Fresh ground black pepper

In large bowl, combine cabbage onion, sugar, and salt. Toss and set aside.

In saucepan, combine oil, vinegar, dry mustard, and celery seed and bring to boil.

Once cabbage has produced juice (about 5 minutes), drain it through a colander, then place in large bowl. Pour the boiling dressing mixture over drained cabbage. Add fresh ground black pepper and toss with a fork.

Allow to sit until cool. Cover and place in refrigerator for at least 8 hours prior to serving.

I’m going to keep the burgers homestyle as well by mixing Cavender’s All Purpose Greek Seasoning into the meat. Homestyle? Well, not for everybody, but this blend of 13 spices and seasonings originated in my hometown and was always in our pantry. When I was a kid, a glass jar of Cavender’s was a standard Christmas gift for relatives who lived far away and could not purchase it in their local stores. I don’t think they have the glass jars anymore, but the seasoning is still tasty. For a light touch, I’ll serve the burgers with thinly sliced seedless cucumbers and tzatziki.

Honey glazed salmon sounds appealing. Salmon can handle some strong flavors. I often feel like what I’m served in restaurants is under seasoned. A good dose of salt, pepper, garlic, and lemon or lime along with the honey should give me moist, full-flavored salmon.

I really can’t think of a better cover-up for corn than butter. If the corn is sweet & fresh, I’ll skip the salt and just use salted butter. Anything else seems to detract rather than enhance.

Now, for dessert! Obviously, there are hundreds of ice cream topping choices. I prefer fresh fruit or chocolate or a combination of the two, but rather than limit my friends to my choices, it’s easy to set out small dishes of shredded coconut, a variety of chopped nuts, cookie pieces, cereal, fruit and chocolate sauce. I make them all gluten-free so I can enjoy any leftovers.

Truthfully, most of this is long-term planning. This 4th comes on the heels of too many months of family caregiving to make the actual execution sound appealing. I think I’ll choose a mindless float in the pool. Nonetheless, I’m excited about the ideas!

The 4th of July will come around again next year. Maybe that will be a good time to invite a few friends over to enjoy a favorite summer cover-up!

https://greekseasoning.com/

http://www.cooking2thrive.com/blog/?s=cole+slaw

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”