Skin is a unique organ because it is subject to two types of aging. The normal kind plus environmental exposure, mainly sun, but also pollution. There is a lot of debate regarding what specific changes occur in the skin and what causes them. But, there is general agreement regarding the following.

With age:

1. The skin becomes lighter with areas of irregular pigmentation (e.g., age spots).

2. The core structure of the skin (e.g., dermis) becomes more disorganized and the skin becomes weaker and less elastic.

3. Dermal fat decreases; most prominently in areas of thin skin (e.g., the eyes). This loss has a negative impact on skin volume and strength.

Let’s recognize fat as the hero it really is

You may have heard that Adele recently lost weight.

Some have hailed the weight loss as inspirational, assuming that it was intentional.

Others have pointed out that we don’t know how or why Adele lost weight and that it could be due to psychological stress, in which case, we should not be celebrating.

Adele has been associated with an arcane “celebrity” diet that relies on SIRTfoods, a newly invented category of superfoods.

Articles have asked and answered the usual questions:

“What is it?”

“A fad?”

“What do experts say?”

Answers:

A restrictive diet that encourages consumption of “super” foods, like medjool dates, which are supposed to turn on your “skinny” SIRT gene.

Of course!

There is little scientific support for the diet; moreover restrictive diets seldom work.

So we are not going to beat those dead horses.

We are going to discuss something far more interesting. Fat shaming.

Why fat shaming?

Because the authors of the SIRTfood diet, like many others, make fat out to be a villain that has to be defeated, busted and burned.

They even use the term villain, on page 27 of the book. Villain, villain, villain.

Enough!

Fat is easy to pick on because it’s so visible.

Fat cells are the only cells in the body that can expand up to 4 fold in size without breaking a sweat. So naturally, we focus on fat quantity.

Less is more, unless we are talking boobs and butts, where some people feel more is more.

In doing so, we miss a critical point. It’s the quality of fat, not the quantity that determines whether fat is healthy.

“Healthy fat?” I can see the question simmering on the lips, the eyebrows furling. “Fat can be healthy?”

Think about it. Why should fat be any different from the other tissues in the body?

Scientists at Harvard, Ohio University, Stanford, and other top institutions have contributed to defining the healthy or fit state of fat.

Very simply, the fit state of fat is one where there are enough fat cells to handle the body’s metabolic demands.

(It’s a little more complicated. Exercise, for example, gives fat a special quality but more on that in a future post).

The body converts excess calories into lipids. It’s an efficient way to store and release energy. The problem is that lipids are toxic to most other cells in the body.

But not to fat cells. Fat cells have a superpower. They can handle lipids. No problem.

When there are not enough cells to handle the work, fat cells exercise another superpower. They increase their size to absorb the overflow. This is where fat the hero becomes fat the victim.

What happens when fat cells get too big? They start releasing inflammatory molecules (presumably to tell the body that something’s wrong).

However, those very same molecules end up damaging fat tissue. Inflammation make it harder for new fat cells to form. So the existing ones need to get even bigger. This fuels a vicious cycle that ultimately involves the immune system and cascades harm throughout the body.

Villain? Hardly.

We need to recognize fat as a hero and occasional victim and act accordingly. More on that later.

Punch line:

There is no evidence that Sambucus Nigra (black elderberry) fruit extract initiates or exacerbates cytokine storm in the context of a coronavirus.

I wake up to the sirens of ambulances arriving at Mount Sinai hospital on the upper, upper, east side of NYC. My wife is a pastor at a nearby church. She spends her days helping people through enormous wave after enormous wave of suffering.

I, too, wanted to help and sent out my plant-based anti-viral regimen to friends and strangers on March 21st. I was measured. I said in my note that I did not know whether this would help but that it felt better to do something than nothing. And I provided my sources, so people could check for themselves.

Elderberry syrup was on the list. I had been taking it since 2009. A friend, Randy Alberte, had clued in me. He went on to publish two papers showing that compounds in elderberry could prevent H1N1 and various HIV strains from entering cells.

Because I respected Randy, I started using elderberry. I didn’t use anything else. No vitamins, no supplements, just elderberry. My incidence of cold/flu went down by 80/90%, despite having young children. After a few years, my hard-headed, skeptical, wonderful wife noticed. The whole family started using it.

So it was on my list (along with licorice, carrageenan nasal spray and Wim Hof breathing). I added zinc subsequently.

I got a few appreciative responses and then I got one from my sister in law asking me about “cytokine” storm. I took a look.

I could not find any evidence that elderberry induced or aggravated cytokine storm. Pubmed searches of “elderberry” and “cytokine storm” or “sepsis” produced no results. Broadening the search to include general terms such as “risk” or “safety” or “adverse” did not produce any relevant results.

This is pretty impressive as elderberry is quite popular. It was the #3 supplement in the “natural” products channel in the US in 2019, with sales almost doubling from the prior year. That means millions of people have been exposed and no adverse events have made their way into literature. At least that come up on cursory search.

So I took to social media. I found a post from Stephen Harrod Buhner, the author of “Herbal Antivirals.”

He posted that he did not like elderberry fruit as an anti-viral. That surprised me because his book devoted several pages to the benefits of elderberry fruit extract for anti-viral prophylaxis/treatment without any concerns. But, that’s OK. Knowledge evolves.

Stephen was measured in his post. He pointed to the potential of elderberry exacerbating T Helper 1 (TH1) adaptive immune response to coronavirus based on a mouse malaria infection study. Maybe, maybe not.

OK, it’s malaria, not a virus but still I had to investigate.

I eagerly (honestly!) read “The Immunomodulatory Effect of Sambucol on Leishmanial and Malarial Infections” by Judith Waknine-Grinberg and colleagues at Hebrew University Dept. of Parasitology. The study was clear-cut. Giving elderberry to mice inoculated with malaria parasites (protozoans) DID NOT exacerbate disease. No cytokine storm.

I do not blame Stephen one bit. He is very knowledgeable and helps a lot of people. A lot more than I do. He was probably just caught off guard by lots of anxious people, who are themselves not to blame.

In this context, it is always better to say: “I don’t know”, than to cry wolf, even in a measured way. It’s not sexy, but it’s better for everyone.

PS By the way, I am not saying that elderberry doesn’t cause or exacerbate cytokine storm. I am saying I can’t find any obvious evidence of it. None.

If you are like me, you come across bad advice on Medium on a regular basis. I take it in stride. My subconscious is less forgiving, however. Yesterday, when I came across a particularly flagrant (or fragrant?) example, it screamed:

“THIS, THIS is what bad advice looks like.”

What follows is my take on some of the features that comprise bad advice. This is not an exhaustive list but a framework for building a consensus. Please comment, add and subtract and I will synthesize your thoughts and re-publish. The elements are generally listed in the order that they emerged in this particular post, not in order of importance.

As you read, consider that this post has already attracted 28K claps.

Number 1. A click-baity title combining specificity, certainty and an obscene quantifiable benefit.

“This Morning Routine Will Save You 20+ Hours Per Week”

Since good advice often comes packaged in click-bait as well, the title alone is indeterminate. But it should put you on alert. The author wants to get noticed.

Number 2. A little known or exotic case is used to make a grand generalization.

“People in countries like Luxembourg are working approximately 30 hours per week (approximately 6 hours per day, 5 days per week) and making more money on average than people working longer workweeks.”

In this case, both the example and the generalization are false. Following the link provided, I learned that people in Luxembourg work on average just 3 fewer hours per week than we do in the US. The fact that they are so much better off is due other factors.

Number 3. Straw men are attacked to create a “us v. them” dynamic.

In this case, the author attacks another self-help guru, Gary Vaynerchuck, for working 20 hours per day.

“Gary Vaynerchuck wants to own the New York Jets. He’s also fine, apparently, not spending much time with his family.”

Just in case, that’s not enough, he picks on everyone’s favorite target: millennials.

“Millennials are the worst, often wearing the openness to work “whenever” as a badge of honor. It’s not a badge of honor.”

Number 4: Make categorical assertions in the name of “science” or “research”, ideally while referring to a brain compartment that readers may recall but not understand.

“Research confirms the brain, specifically the prefrontal cortex, is most active and readily creative immediately following sleep.”

This is actually not what the paper referenced in the link concludes. The article modestly discusses differences in brain connectivity in the morning vs. the evening. It does not focus on the activity of the prefrontal cortex and does not even consider the concept of creativity.

Number 5: Experts are invoked out of context, while prestigious institutions are name-dropped.

“Typically, we have a window of about three hours where we’re really, really focused. We’re able to have some strong contributions in terms of planning, in terms of thinking, in terms of speaking well,” [Ron] Friedman told Harvard Business Review.

Anyone reading the quote would think that Ron Friedman is agreeing with the author’s assertion that we are most creative right after sleep. Actually, in the attached article, Ron tells us just the opposite.

From the same Harvard Business Review article:

“The other thing that I talk about in my book, The Best Place to Work is how we’re actually better at being creative when we’re fatigued, which is kind of an interesting and counter intuitive insight … So scheduling a creative task for the time in your day when you know you’re a little bit tired can actually be beneficial.”

Number 6: Superficial and false analogies are made, invoking research or science.

“To get the best results in your fitness, research has found that shorter but more intensive exercise is more effective than longer drawn-out exercise. The concept is simple: Intensive activity followed by high quality rest and recovery.”

Again, the “research” that is invoked is quite a bit more modest than claimed and not on point. This was a small study involving only 27 subjects.

One group did low intensity activity — walking — 5 days per week and the other group did low intensity activity two days per week and high intensity activity — walk-jogging and jogging — three days per week. Both groups exercised the same amount, completely undermining the author’s point.

Even if we accept that short intense activity is a better form of physical exercise — does this tell us anything at all with respect to mental exercise? Actually, no.

Number 7: Arbitrary rules of thumb are introduced, supported by buzzwords, rather than data.

“For best results: Spend 20% of your energy on your work and 80% of your energy on recovery and self-improvement. When you’re getting high quality recovery, you’re growing. When you’re continually honing your mental model, the quality and impact of your work continually increases. This is what psychologists call, “Deliberate Practice.” It’s not about doing more, but better training. It’s about being strategic and results-focused, not busyness-focused.”

There is no data to support this “20/80” rule. But this is made up for with buzzwords like “Deliberate Practice” which is capitalized for some strange reason.

Number 8: Personal anecdote is treated like axiomatic truth.

“I used to exercise first thing in the morning. Not anymore. I’ve found that exercising first thing in the morning actually sucks my energy, leaving me with less than I started.”

OK.

Number 9: Opposing points of view are not considered

“I understand that this schedule will not work for everyone. There are single-parents with kids who simply can’t do something like this.”

This is as close as the author comes to considering that another point of view may be valid.

Number 10: Irrelevant digressions are brought forth to “round out the case.”

Mind-Body Connections.

Don’t Forget to Psychologically Detach and Play

Listen to Brain Music or Songs on Repeat

Nearly 1000 words are devoted to these largely irrelevant topics.

The comments are telling

There were 97 comments regarding this blog post on my last check. They can be grouped into two categories. Fawning and critical. The fawning comments are vague endorsements, along the lines of “you’re so great and this also great” with the occasional “so true, man.” The critical comments tend to be specific and informative. One commenter who lived in Luxembourg for some time points out that people there work pretty long hours. Another points out that a considerable amount of wealth in Luxembourg in inherited, hence the inflated earnings per hour.

Why is this happening?

This advice was proffered on Medium, where claps determine how popular posts are and how much money the advisors make. Wisely, authors contort their advice to maximize claps. Most readers won’t first follow the advice and then clap if it turns out to be good. They clap on whether the advice seems good. So maximizing the “appearance” of wisdom is more important than providing advice that actually works for people. Since there are no negative claps, it doesn’t really matter if a few people find fault with some of the assertions. These are relegated to the comments, which most people don’t read.

What would have been a better post?

“My morning routine.”

“I [followed by detailed description of ‘I’ and the “I’s” circumstances, e.g., the type of work “I” does, so that readers can determine how comparable ‘I’ is to them] was inspired by Ron Friedman’s research describing the optimal 2–3 hour window we have for productivity in the morning. I changed my morning routine from exercise for 1 hour followed by 3 hours of work to work for 3 hours followed by 1 hour of exercise. I derived the following benefits from this routine: [listing of measurable and quantifiable benefits].

Caveat: this does not always work for me. I suspect that other factors (e.g., sleep, mood) can affect my performance.”

Properly structured, such a post could serve as a data point in a larger set with other similar posts. We could then learn from such data.

The potential of intermittent fasting to impact health is undisputed.

Short term, fasting improves body composition and enhances mental clarity. Long term, fasting can delay age-related brain impairment (in humans) and increase lifespan (in animals).

Autophagy — the process by which cells clear their accumulated debris — is responsible for the long-term benefits of fasting.

There are a lot of big questions about how to make intermittent fasting work:

1. When do you need to start?
2. How long do you need to do it?
3. What impact does diet or exercise have on the effects?

This post is not concerned with these big questions.

Rather, I focus on a small but selfishly important question:

Can I consume Stevia without breaking my fast?

I do intermittent fasting because I want to harness the benefits of autophagy. And Stevia is critical to my intermittent fast.

I can drink sweetened black coffee and I can drink unsweetened coffee with milk but I can’t drink unsweetened black coffee.

There are other people like me. A search of “Stevia” and “intermittent fasting” produces 679K results on Google.

You will find wellness gurus positioned on both sides of this question.

In a youtube video that has been watched more than one million times, Thomas DeLauer, a health and business coach, puts Stevia on the list of foods that will not break a fast. Good news. Unfortunately, DeLauer does not explain why Stevia is OK. And without a good, verifiable explanation, I am not convinced.

When I turned to the Reddit fasting community — r/fasting has 176K members — I found a widespread countervailing opinion, this time with an explanation.

As can be seen in the photo shared on r/fasting of page 172 of The Obesity Code, Dr. Jason Fung explains why he says “no” to Stevia.

“Despite having a minimal effect on blood sugars, both aspartame and stevia raised insulin levels higher even than table sugar.”

Insulin shuts off autophagy, so this would be bad news me and my Stevia-enhanced coffee.

Fortunately, this is not true. At least, not according to the reference that Fung provides.

The paper he cites found the exact opposite of what he would have us believe: Stevia, unlike aspartame, lowered post-meal blood glucose and insulin levels compared to table sugar.

Unfortunately, the paper doesn’t directly address the question that I and r/fasting are interested in. The volunteers in the cited study consumed Stevia as part of a pre-meal snack (cream cheese and crackers); not on its own.

I abandoned the guru-mediated shortcuts and decided to consult the scientific literature myself.

The answer I found is believably complicated. It turns out that Stevia does promote insulin secretion — it’s actually used to treat diabetes in Brazil — but only when blood glucose levels are relatively high (above 8.3 mmol/L glucose). At typical fasting blood glucose levels (3.9 to 5.5 mmol/L glucose), Stevia will not promote insulin secretion. Multiple researchers using different models have found the same result.

This small question revealed some important issues about how we consume wellness information.

We rely on gurus with big personal brands (and, unfortunately, with the associated big financial interests) to synthesize the science for us. We seldom check the footnotes and read the papers ourselves.

This does not need to be the case.

We can build up knowledge ourselves through a communal effort. Each of us can contribute a small piece that is of particular interest to us. The contribution can take many forms. We can contribute knowledge itself. We can contribute data. We can even contribute by cleaning up and sorting the data that others contribute.

Interested?

Three years ago, I sold the first business I ever started. I didn’t want to sell it and the experience was traumatic. My wife suggested I attend a mindfulness retreat for business people. I went to appease her. It was fantastic.

The highlight was learning about the Inner Critic (IC). The teacher told us we all have one because it is biologically necessary. Babies, he taught, develop an IC to explain to themselves why caregivers fail to understand and respond to their needs. When caregivers fail to respond, the IC tells the baby: “It is your fault; you were bad.” The IC provides a critical alternative to randomness. Babies could not handle randomness. It would make their heads explode.

We did a group exercise where we wrote a secret about ourselves on a piece of paper. The papers were collected and distributed and we read out each other’s secrets. We wrote horrible untrue-sounding things about ourselves. That proved it: we all had ICs.

Importantly, it was not our fault. We had to have one. Our baby selves couldn’t handle the randomness. The explanation was so cool I trotted it out at cocktail parties. People nodded their heads in amazement or disbelief.

Recently, I came across a blog post about managing one’s IC. It did not mention randomness and babies’ heads exploding. I read a few more. They failed to mention it either.

Puzzled, I searched and found a few alternative origin stories:

1. An aspect of Superego: In Freud’s structure of the psyche, the Superego serves as the conscience or internalization of societal mores to counteract the Id’s hedonistic impulses. The Superego grows to embody all of the rules of society.

2. Inner Speech derived from External Speech: Soviet psychologist Lev Vygotsky proposed a model of development where children adopt external speech to regulate their thoughts and behavior. The first step in this transition is private speech, whereby toddlers talk to themselves, for example, while performing a difficult task.

3. Inner Critic as Parent Avatar: Parents guide their children with explicit and implicit criticism. Children perceive this criticism as a threat that could lead to abandonment. They develop an inner critic as a warning mechanism — to anticipate and prevent their parents’ criticism.

4. An Evolutionary Artifact: Evolution favors collecting and attending to negative thoughts to ensure procreation. Inattention to a single worry — a rustling of leaves or a threatening stare — could mean death, so we learn to devote outsized resources to storing and minding potential threats.

All of these have merit. They also complement each other.

The last one appealed to me for a number of reasons:

1. Testable. We can measure negative bias, for example, by testing how long it takes the brain to recall negative memories vs. positive memories.

2. Neutral. It’s hard to blame our distant ancestors for passing along the genes that ensured their survival.

3. Universal. Evolution has given each of us an IC. And not only us humans. Our furry friends also have ICs.

So why does it matter? Why is important to understand how the IC came about?

For one, knowing creates conviction.

The “alternative to randomness” story lasted for a few cocktail parties. But it lost steam. The evolutionary artifact explanation may not be as cool but it will stick.

Conviction — when paired with freedom from blame and awareness that we are all in the same boat — drives determination, motivating us to help ourselves and others.