AHS 2012: New Technologies, New Opportunities

AHS 2012 is in the books. It was very enjoyable. It’s so valuable to bring community members together once a year so that we can share ideas and maybe a few drinks.

I was going to resume blogging with an update of our supplement recommendations, but since AHS is so fresh in my mind, I’ll review the symposium over a few posts, starting with a panel I moderated: “New Technologies and New Opportunities.”

New Technologies

New technologies, especially wifi-enabled Quantified Self tools, have appeared that make it easy to track personal health data. For instance, Fitbit tracks the number of steps you take daily and the length of your sleep; Withings tracks your weight.

These devices automatically upload data to the Internet, allowing you to track data over time and share it electronically.

There’s also movement toward making medical data available over the Internet. Chris Keller, who served on our panel, is working to create a company that will allow us to share and view medical data online. Chris noted that AgaMatrix makes wifi and USB enabled blood glucose sensors, and the data can be tracked on iPhones. Perhaps before long these home blood testing kits will become capable of testing many biomarkers at will and, like Quantified Self tools, upload their data to sites of our choosing.

Another new source of personal health data is personal genomic profiling, such as that provided by 23andme.

The upshot: each of us could soon have extensive series of personal health data at our electronic fingertips. What can we do with it?

Dan’s Plan

Dan’s Plan is an interesting company started by Dan Pardi. Dan is a PhD candidate in cognitive neuroscience, but his interest turned to helping people implement a healthy lifestyle after his father John died prematurely at age 59.

Dan’s Plan aims to make it easy to implement a healthy ancestral lifestyle. It has three content areas: diet, movement, and sleep. We’ll contribute a Perfect Health Diet module to the diet section, and maybe a circadian rhythm enhancement module to the sleep section. But Dan’s Plan is a curated content platform – it will include multiple diet, fitness, and lifestyle modules. So anyone who produces ancestral content should consider contributing a module to Dan’s Plan.

Here’s what a Dan’s Plan page looks like:

Dan’s Plan integrates to Quantified Self tools like Withings and Fitbit, so it knows your weight, activity, and sleep. Its “scores” provide feedback on how you are doing at the three major areas of ancestral living.

Opportunity: Clinically Guided and Communal Experimentation

What intrigues me about these technologies is the opportunities they open up for improving our knowledge of what works for whom.

Chris Kresser was on the panel to provide a clinical perspective, and he emphasized the value of being able to track patients’ progress by calling up real-time charts. Suppose, for instance, that Dan’s Plan tracks members’ weight, activity, sleep, and other biomarkers, and that Dan’s Plan members can share data with their clinicians. Chris could put his patients on Dan’s Plan and be able to see how they’re doing at all times, and get an idea whether their latest program is working for them.

If users make (anonymized) data available for communal analysis, we could use software like Dan’s Plan to track results on each module. Suppose, for instance, users recorded medical diagnoses and goals: “I’m obese and my goal is to lose weight,” “I’m diabetic and my goal is to control blood sugar.” They could also record which content modules for diet, fitness, and sleep they were following. Then the system could track results to see what outcomes were on each program.

Suppose, for instance, that there were Perfect Health Diet and Rosedale Diet modules on Dan’s Plan, and the safe starches panel at AHS had been able to draw upon actual outcomes data for parameters like weight, blood sugar, and blood lipids. Because the data would be gathered automatically by Quantified Self tools, it would be unbiased and include negative as well as positive outcomes. This certainly would have given us something interesting to discuss.

For clinicians and those looking to improve their health, statistics on outcomes would be enlightening. I find it remarkable that we spend 16% of GDP on health care, yet we have very little data on what works. In comparison, chess is less than 0.001% of GDP, yet we have excellent data on chess outcomes. From the online chess openings explorer at 365chess.com, here is the data on outcomes for alternative moves three moves into the Sicilian Defense:

Imagine if a clinician had similar outcomes data for obesity, diabetes, hypothyroidism, whatever: “If you prescribe this treatment, the patient will improve x% of the time, remain unchanged y% of the time, and get worse z% of the time.” It would revolutionize health care.

The data that would make such a healthcare database possible has been hard to collect. But with QS tools and systems like Dan’s Plan, it becomes much easier. Look at how an outcomes database would support routine clinical practice. When considering a prescription such as, “Follow the Perfect Health Diet module on Dan’s Plan,” both patient and clinician could immediately see what the odds of success are.

Enabling Better Analysis

Ned Kock of the Health Correlator blog was also on our panel, and he discussed the benefits of being able to perform nonlinear analysis on health data. Most health outcomes show a U-shaped profile, but most analysis in biomedical journals assumes a linear dependence of outcomes on dependent variables. Fitting a line to a U may give very misleading results!

The downside of using nonlinear analytical methods is that more data is required to constrain them. One of the great benefits of QS tools and online systems which aggregate data, such as Dan’s Plan, is that sufficient data to support more accurate analytical methods may become available.

Bringing Ancestral Health into the Mainstream

Most of us in this movement have confidence that ancestral diets and ancestral lifeways can tremendously improve health. Yet how do we prove that to skeptics?

The ancestral health movement is now in a position often experienced by entrepreneurial companies. A standard model of entrepreneurship states that innovators find their first audience among enthusiasts and visionaries inspired by where the company plans to go. They see the vision, and want to help bring it to fruition.

But at some point, a company can no longer rely on the support of visionaries. It has to be able to persuade skeptics that it has actually delivered the vision. This transition, from relying upon sympathetic visionaries to persuading skeptical pragmatists with convincing evidence, was dubbed “crossing the chasm” by Geoffrey Moore:

Ancestral health is like that. It has been embraced by enthusiasts and visionaries who believe in the ancestral health story. We see their enthusiasm in blog comments and at events like the Ancestral Health Symposium, which relies so heavily on the dedicated work of volunteers.

But ancestral health has not yet won over skeptical pragmatists – people who want proof before they’ll buy.

Reader success stories on blogs do not convince skeptics. Every diet, including extreme vegan and macrobiotic diets, has success stories.  Skeptics want to see unbiased data, including negative as well as positive outcomes.

This is what I think the new technologies give us the opportunity to do. Here is what I see as the formula for bringing ancestral health into the mainstream:

We have a large community – over a million unique monthly visitors to leading blogs. We have new technologies and innovative startups making possible the gathering of unbiased data. We are building institutions, like the Ancestral Health Symposium and the Ancestral Health Society’s planned journal, the Journal of Evolution and Health, that can disseminate evidence and arguments supportive of ancestral living.

We can leverage these assets into improved knowledge of what works. We can generate evidence persuasive to skeptics. And it is by this path, I believe, that ancestral health will enter the mainstream and prove itself the best way to heal disease and optimize health.

We’re in a very exciting time. Ancestral health is on the verge of crossing the chasm. When it does, the enthusiasts and visionaries who made it happen will have much to be proud of. Thank you for being part of the ancestral health movement!

Leave a comment ?

51 Comments.

  1. That all sounds awesome. Although I was hoping you had invented safe space starch. It’s like safe starch but space-age! Space potato? Mmm.

  2. Great thoughts Paul. And glad to see you back!

  3. This is very exciting! We’re really oooking forward to seeing your recipes integrated into Dan’s Plan.

  4. Paul, we need less gimmicks and more common sense. This is the “ancestral” spirit that corrects for the dubious byproducts of the modernity. Alas the AHS was infected to the core with the former.

  5. This sounds great, Paul. I like the idea of including genetics.

    Thanks,
    Mark

  6. My masters thesis was based on diffusion of innovation theory … and I had been considering a poster for 2013 on lessons for ancestral health. Only I was thinking of focusing on other aspects, like how best to use change agents and opinion leaders in target communities to increase reach and overcome skepticism.

    Very much looking forward to watching the session when it’s available!

  7. Three Pipe Problem

    Ben, it’s telling that you need to portray this incredibly powerful research tool as “gimmicky” in order to muster a claim that we can do without it.

    Is your critique of technology not strong enough to prevail against something useful?

    Why is it okay that you are reading and commenting on a blog, but not okay for people to gather and share data?

  8. Nice summary Paul, and thanks for moderating the panel, and for your many other contributions to the Symposium. It was very nice meeting you face-to-face.

  9. Good write up, Paul. I enjoyed sitting on the panel with you, Ned, Chris Kresser, and Chris Keller. We’ve made a lot of progress since we first started to discuss these topics at AHS 2011. Excited to see how much we can get done before AHS 2013.

  10. Thanks for sharing the data collection ideas, Paul. I’d like to share some actionable thoughts, too.

    First some suggestions for measurement:
    1. Number of bar-coded items purchased per shopping trip or eaten at meals per week.
    Technology: exists
    Reasoning: Many/most bar-coded items are processed foods. Reducing bar-coded items consumed will likely result in more whole food items consumed. This is a very actionable and quantifiable item by an individual, regardless of diet system engaged.
    2. Number of meals eaten at fast food/chain restaurant.
    Technology: components exist (phone GPS, etc.), compilation needed.
    Reasoning: Reducing processed food intake should result in more consumption of whole foods and/or better compliance with chosen diet plan.
    3. Change supportive daily actions (these depend on where in the change process one happens to be e.g. pre-contemplation, etc.)
    Technology: Methodology exists, modification to specifics needed.
    Reasoning: Many/most people know they _should_ follow a healthy diet of some kind but _doing_ it in the face of ones “terrior”, if you will, seems to be what prevents appropriate individual action.

    Here’s the issue I see with the type of data proposed above: I want to take daily action. Just observing a trend chart of my weight or calories or REM sleep or whatever doesn’t help me know what to do today, right now, in the action I will take next (turn into that drive-thru, pick up that box of pasta, etc.)

    I’m a metrologist by profession. If you don’t have a “knob to turn” to effect something you’re measuring, collecting the data is not worth doing. What “knobs” do we, as individuals, have to effect the output parameters being considered above?

    • Terrific ideas, Cindy! You’d make a good entrepreneur.

      Some of those would be hard to implement but I can definitely see them happening in time. Indeed, it might be easier to get supermarkets to send purchase receipts to your computer or iphone (instead of printing a receipt) than to get hospitals to make medical data available!

      That would solve one of the trickiest problems, figuring out what people are eating.

      The knobs Dan’s Plan is trying to turn are food, exercise/activity, and factors affecting sleep like light exposure, time to bed, and so forth.

      • Not hard to implement… already done:
        http://quantifiedself.com/guide/

        Nice to get stores to make digital copy available (they’ve got it, they already track us) but not necessary. Google “receipt scanner”.

        Zeo does factors affecting sleep. I’ve used it for >2 years. Added f.lux to my computer, go to bed at 10pm, etc. Taking as many steps as Zeo suggested yet data did not stay changed. Not until I added Go Lite in the morning and collagen supplement (glycine) in the evening did I consistently get restful sleep. Actions impactful to my issue of offset circadian rhythm.

        I’ve used BodyBugg many years ago, religiously, despite it’s ugliness (big “wart” on the back of your arm.) I’ve used PeerTrainer for years. Yet, here I am still trying to consistently maintain a healthy lifestyle in the terroir I’m living in.

        I guess I’m not seeing how anything mentioned in this post is radically different from what’s been available for years. How does it help individuals fight back against the insidious forces derailing us in our respective environments (terroir)? It seems to be collecting data, anonymous or not, in order to be able to sell said data to marketers so they, the marketers, can continue to invade our terroir with influence which are likely not in our respective best health interests.

        What if the approach were one of identifying or quantifying the insidious forces preventing or waylaying our efforts with feedback (e.g. phone GPS identifies fast food restaurant, vibration with message “do you really want to drive into that restaurant?”, etc.) What prevents or waylays people from taking the actions to support their goals? Quantify those. Identify actions to suppress those. Provide immediate feedback to support those actions. Yes, trend ones weight but also trend food commercials watched (e.g. via TV programs watched). Messages transmitted from phone offsetting commercials’ message. Does that successfully decrease junk food purchases (as measured by (AMB) change in foods purchased on receipts scanned, etc.)

        Bottom line: Do something different!

        • Hi Cindy,
          I’ve had a foot in both areas – ancestral health and quantified self – for some time now. Here is how I see things. While technology is certainly a part of the problem in the genesis of disease of modern civilization, I think can also be a part of the solutions. At my company, dansplan dot come, we use technology to stimulate visibility into a person’s lifestyle patterns. What are actionable steps a person can/should take intrinsic to a healthy lifestyle, and then how can we use technology to promote the right behavior at the right time? For example, I’m a sleep researcher and I educate people on the importance of sleep all the time. If you had asked me how much sleep I get per night, I would have told you 8 hours. However, when I started to track, I realized I was only get 6.8 hours a night, which was surprising. I now have more visibility into how I’m actually living. So much information provided by QS companies is not actionable, and whenever non-actionable information is provided, it runs the risk of diluting attention away from the things that people can affect through their behavior. You can’t do much based on a report of your REM sleep. You can’t get more REM by squinting harder. You can, however, help people form an intension around the time they should aim to be in bed to get a full nights rest, then gamify that time so that people are more incented to accomplish that bedtime goal. We help you for those goals then use tracking to let you know – on a rolling basis – how you performing against these mundane but important lifestyle goals RIGHT NOW.
          Tracking food, in my opinion, is hard and not sustainable. So, we don’t track food but rather prime healthy eating by showing daily recipes that people can take action on today. You can track exercise – and we’ve devised a novel, simplified method to do so – but, like daily recipes, we also prime activity through our daily workouts. Check out Dan’s Plan, you might like our approach.

          • Dan, Thanks for providing your additional comments. Checked out the website. Sorry but I don’t see anything substantially different than any other data collection/aggregation service I’ve seen or used over the last 8-10 years. In addition, I don’t care for your privacy policy. Your policy states: “personal information, which may include your name, your email address, your gender, your age, your height, your weight, and any other personal or preference information that you choose to disclose.” More importantly and what I find more egregious: “In addition, in some cases, we may choose to buy or sell assets. In these types of transactions, user information is typically one of the business assets that is transferred. Moreover, if Dan’s Plan, or substantially all of its assets, were acquired, user information would be one of the assets that is transferred.”
            Quoted material copied from http://dansplan.com/company/legal-terms/privacy-policy

            Sigh. Too bad. No need for additional comments from me. Good luck with your business endeavor.

  11. inspiring post!

  12. In the diagram “Bringing Paleo into the Mainstream” I observed that there are a lot more of “them” than “us” (and we are assuming Unity or at least Cooperation among the various Paleo flavors). While I love the concept of collecting data to demonstrate effectiveness, are you bearing in mind the economic imperatives of most people? In particular, that Paleo represents self-governed health maintenance. That is the big “hump” for most people, I think. Could you see selling the program to health insurance companies?

    • Hi Kathy,

      Yes, I do think working with health insurers (or employers seeking to hold down health insurance cost) may be the major market for ancestral healthways. A number of people, including Dan’s Plan, are working on this. Robb Wolf gave a presentation at AHS about an effort in the Reno police and fire departments to use Paleo to improve the health of safety workers.

      • At my day job, we are focusing on employers on changing the defaults (e.g., making emplyers choose opt-out 401k plans) largely due to the improved return on investment. There isn’t the same equivalent in health (and there are issues re bias/stigma given carrot vs stick approaches), but there are plusses too, like you can get workplace cafeterias to cooperate (mine sells items that meet Corporate Athlete guidelines for example).

      • Also, I’d definitely encourage you or Dan to consider reaching out to BJ Fogg who is doing really cool stuff in the persuasive tech space. He may have a take on persuading skeptics that could be useful!

        • Thanks Beth! I think Dan may know BJ Fogg. Looks like great stuff.

          • Hi Beth,
            I’ve attended BJ’s Stanford Mobile Health conference the last two years. The CEO of weight watchers, David Kirchhoff, was the keynote last year. The conference is always superb and I can say that I am a disciple of his work. I have spoken to him a few times about what we are doing at dansplan and he’s extended several invitations to me for his behavior bootcamp, but I have not been able to attend yet; I look forward to joining him at one of those eventually. I have also not yet had the opportunity to show him the sustainable positive behavior model I devised but I would really love his input so I need to find a way to make that happen.

  13. Cool to meet you at AHS, Paul, and a great summary for those of us geeked out on this stuff!

  14. Hi Paul,

    Forgive me for posting here, I was not sure where to post.

    I’ve started PHD and am gaining weight (42 female, normal height/weight) and wondering if anyone has posted their daily diet here on your website anywhere? I’m unclear as to exact amounts of food I should be eating.

    MANY THANKS!!! I absolutely adore your website and so appreciate all the advice you have given. It’s been incredibly informative!!!

    • Hi McCourt,

      Our food is tasty and appetite may be driven by nutrient status, so you may have a tendency to overeat until your body becomes well nourished. So I would focus on nourishing foods — egg yolks, shellfish and seafoods/seaweed, organ meats, bone and joint broths, vegetables, berries, cheese and yogurt, potatoes.

      In terms of amount, I typically eat 2 meals a day. Lunch fits in a bowl, safe starches half way up, 3 egg yolks, some coconut milk and vinegar, leftover meat and vegetables, microwaved. Dinner is a meat, vegetable, and safe starch, with glass of wine; often a bowl of soup too. May have a bowl of berries or cherry tomatoes for breakfast. Sometimes I’ll snack on cheese and fruit.

  15. This is great, Paul! I’m very excited at the potential that the merging of quantified self, data aggregation, and ancestral health (and other approaches) can bring to the table. Each year, the symposium and journal will be sure to reflect this growth. Thanks to all the panelists, I wish I had more time to chat with you all and learn more about what each of you is doing.

    And I’m sorry to miss the festivities at your and Shou Ching’s house. I’ll have to visit Boston again to make up for it!

  16. It was nice meeting you at AHS11, sorry I couldn’t get to AHS12. As an avid tournament chess player, I can’t help but comment on the chess database regarding the Sicilian. Databases can contain bad data (poorly played games) that can lead to bad decisions. It looks at first glance that 3. Nd4, which is rarely played, has a high statistical chance of success relative to other moves. But, looking closer, it just hangs a piece (the knight) and outright loses, which is why a grandmaster (or any decent chessplayer) would never play it in a serious game. I still like 3. d4 in this position, even though the questionable 3. b4 seems statistically better. 3. b4 may do better based on it’s shock value (speculative gambit).

    • Ha, good catch. Some of the games in this database are blitz games between low-rated players, so maybe the games are valid, or maybe it is just bad data. Probably d4 was played.

  17. Having used calorie tracking tools religiously before switching to paleo I can tell you that manually tracking food intake even with good tools won’t be very accurate. It takes a strong (wo)man to own up to those night-time incursions by writing them down, especially the next day.

    Other than having a camera implanted into our small intestine I think measuring food intake accurately is near impossible.

    • I think it’s relatively doable for hyper-obsessive types armed with a mobile device, food scale, a dash of skepticism when reading labels, and little shame.

      (To wit: I weigh my rum on Friday nights…)

      So, other than those six people, I agree.

      • I wonder if simply adding a “how accurate is this” question at the end of a day would help… Then at least people could say “not very” and that could be accounted for…

        Another important metric about diet plans is adherence, which would then be somewhat measurable…

  18. The assumption is that knowing what one ate (past tense) has the effect of adjusting what one eats in the future. My point is that humans are not PID controllers where knowing the delta between target and actual calories consumed changes the proportional, integrative or derivative response to future intake. Food logging as it seems to exist in many/most/all other food logging tools appears to make this assumption. I don’t need another healthy recipe. I’ve got several of the recent Paleo cook books. I like making and eating PHD and Paleo-compliant meals for my family. I’ve got The Perfect Health Diet book. I just ate 9 gluten-free lemon crispy wafers. I walked by the end of that row on my way to the check-out stand at the grocery store. I saw them. I remembered the flavor/enjoyment. I put them in my grocery cart. Grocery stores are laid out to “catch” us on the way to check-out. Food marketers are using behavioral methods to induce us to buy/eat their products.

    My request is to do something different with these quantifying tools. Are there recommendations in Kessler’s “The End of Overeating” that can be instrumented for individuals? Are there specific actions recommended in “Change for Good” based on successful self-changers that can be instrumented for individuals? If we don’t have tools available to us to negate the insidious and ever improving marketing of “bad” foods how can we expect to maintain any health improvement our limited will power gains us?

  19. Oh, oh, how about this? Give me a tool that runs on my phone which allows me to map my local grocery store with “good” and “bad” aisles. Then, when I go grocery shopping I put in my head phones and have chatter in my ears that says “don’t go there” when I get near/in the “bad” aisles and gives me positive feedback when I’m in the “good” aisles. You can imagine doing the same where I can map my regular environment with “good” and “danger” zones so I can put my head phones on to give me anti-marketing input to stay away from “danger” zones.

    • Google goggles will be able to do this (if they actually work :)). There will probably be apps that cover up “bad” products or put up unpleasant imagery of yourself in a bathing suit or something 🙂

      In any case, all our consumer gear will get smarter and more connected so quantifying more of what you do will almost be an inevitability. It’s a step up over food questionnaires so here’s hoping that Paleo can cross the chasm.

    • Hi CindyB,
      I’ve had the same problem with binging on sweets. I do think the temptation to binge has been greatly reduced now that I follow the PHD and take the recommended supplements. Paul has said that cravings can be a sign of missing nutrients. It was much more difficult when I was eating low/very low carb and often low fat for 10+ years. The safe starches in PHD have made a huge difference, I think, as well as eating some fruit and making sure I was getting enough omega 3 and saturated fat and not too much omega 6. And I think the Intermittent Fasting has helped too. Although I thought that IF would make it near impossible for me to resist tempting treats, it’s actually made it easier and I’m less anxious about when I’ll eat or being hungry. I’m not that hungry during the fast and when I am a little hungry, it’s not a big deal and I can wait until it’s time to eat and I’m not suffering and I don’t eat like crazy because I haven’t been starving. I can even go to the grocery store and exercise during the fast – no problem! Unheard of before. And I don’t get as hungry as I used to get when I ate every 3-4 hours and ate breakfast! Also, I’ve noticed that I do have some cravings before the beginning of my menstrual cycle, so I might enjoy some dark chocolate (or even unsweetened bakers chocolate) during that time. Seems to work for me. So that may be a time when you need more tricks and more willpower. Another thing I do is that I try to visualize succeeding and not giving in to the temptations. So when there are donuts in the kitchen at work on Friday, I prepare myself for seeing them and visualize walking past them. I think that helps too. You could try this with the checkout stand at the grocery store. Just some ideas!

  20. I was pleasantly surprised that you are into chess.

    Your rating is…?

    • Hi Palo,

      I haven’t played since school days, when it was 1975. Then I got into bridge. Now I don’t have time for either, but once in a while I distract myself by playing the computer. My rating would be much worse than 1975 now. So, not a serious player.

      • Your use of the chess opening as a tool to display data outcome gives you a 2,500 rating.

        I’m looking forward to the new book and hope it will include smart data outcome charts like the chess opening. These charts convey your concepts concisely, precisely and elegantly.

        Keep up the good work!

  21. Thanks for this article, Paul!

    I’ve been reading about how difficult it is for medical practitioners to bring paleo into their practice because they can so easily be sued / have their licenses revoked. I’ve also seen how some scientists doing research on ancestral health have a difficult time getting funds for research.

    Here’s an idea: crowd-funded research!

    Alex and Shawn, two brilliant young inventors, raised thousands of dollar on Kickstarter to fund their solar technology innovation.

    I imagine ancestral health related research could be funded in this way, too. 🙂

  22. PaleoFX, AHS, and Building Institutions | Perfect Health Diet - pingback on November 1, 2012 at 10:38 pm
  23. Good article. I was gonna do a facebook like but I couldn’t locate that module anyplace to click on it. I’m using Firefox.

    … isn’t that possible to accomplish that in this web browser?

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