Book Recommendations

In 1-2 sentences, what is the book about as a whole? People want to develop the social skills that lead to others acting charitably and agreeably toward them, but they are not taught in schools. This book compiles a set of key concepts that collectively work to foster positive and rewarding relationships with others, especially during potentially hostile engagements. What are the 3-4 central questions it tries to answer? How should you interact with other people to elicit positive responses? How can you get people to like you? How can you get people to agree with your way of thinking? How can you get others to change and be happy about it? Summarize the answers in one paragraph each. How should you interact with other people to elicit positive responses? Absolutely nobody likes being criticized or condemned. When we experience this, humans by nature raise our defenses and close ourselves off to the speaker. To get a positive reaction from others, the first and foremost advice is to avoid finding something wrong in others (criticism) or deeming something is bad about others (condemnation). Instead, lavish them with honest and sincere praise and appreciation. Go out of your way to notice and comment on positive aspects of the person or their work. Finally, consider what the other person wants rather than what you want. The author’s analogy here is to fishing: he baits the hook with worms (that fish like) not strawberries and cream (that he likes). How can you get people to like you? There are six specific suggestions to make people like you. Most can be grouped into a focus on the other person.

1. Smile
2. Learn and use their names
3. Be interested in them
4. Listen to them and encourage them to talk about themselves
5. Talk in terms of their interests
6. Make them feel important

The author’s business teaches these principals and more in schools across the country. The book is filled to the brim with student’s anecdotes about how this advice led to relationships that immediately yielded fruits for the student. How can you get people to agree with your way of thinking? The book is sorted into very deliberate chapters with one lesson each.

1. Arguing doesn’t work, so avoid arguments — especially ones that you win. It’s good for your ego at the expense of your objective.
2. Don’t say “you’re wrong” with words, looks, or body language. Don’t let anyone know you’re trying to prove something either.
3. If you’re wrong, quickly and emphatically admit it and you will gain good will. Don’t wait for someone to come at you on the offensive.
4. Begin the conversation with a drop of honey. Do not come out swinging or with aggression.
5. Find and establish as much common ground as possible. Get the other person to say yes, yes and avoid a person saying no.
6. Let the other person do the talking and don’t interrupt, even if you disagree with something. Encourage them to express their ideas fully.
7. Let the other person feel that the idea is his or hers. Make suggestions and let the other person think out the conclusions.
8. Try honestly to see the other person’s point of view and put yourself in his place.
9. Be sympathetic with the other person’s ideas and desires. “If I were you I would undoubtedly feel just as you do.”
10. Highlight the nobler version of others to encourage them to act accordingly. “I knew right away you were a man of your word.”
11. Dramatize your ideas with showmanship. A big dramatic show or act can get a point across that a logical argument would struggle to. The example is of a newspaper who published a days worth of news as a 300-something page book to combat rumors that it had become bloated with ads.
12. Last ditch effort: throw down a challenge. The example showed how Charles Schwab of Carnegie Steel created a spirit of competition between night/day shifts by simply writing their output on the ground with chalk.

How can you get others to change and be happy about it? Sometimes as a leader you need others to improve their work. Here, too, being direct with criticism of shortcomings poses a challenge, as it can offend or arouse resentment. So Carnegie counsels to approach indirectly.

1. Begin with praise and honest appreciation. “A barber lathers a man before he shaves him.”
2. Call attention to people’s mistakes indirectly. The example is of Charles Schwab giving cigars to workers to “smoke outside” rather than pointing to the No Smoking sign above their heads.
3. Talk about your own mistakes before criticizing the other person. It’s easier to listen to your faults after the speaker begins by pointing out their own faults.
4. Ask questions instead of giving direct orders. Give people the opportunity to do things themselves, and they’ll feel better about themselves.
5. Let the other person save face. Avoid criticism in public that harms people’s egos.
6. Lavish praise at even the slightest improvement. “Praise is like sunlight to the warm human spirit.”
7. Give the other person a fine reputation to live up to. “Your work has not lived up to your own old standards.”
8. Make the fault seem easy to correct. Minimizing errors and praising the things someone is doing correct encourages others to keep going.
9. Make the other person happy about doing the thing you suggest. Deliver unfavorable news with context that makes it easier to accept. For example, you weren’t selected because we need someone less popular.

What are the most important things you have learned personally? I write this on the verge of 38 years of life. In too many ways, my past behaviors were the antithesis of this book. I am all-too adept at arguing, finding fault, criticizing and complaining. Thanks to Carnegie’s book, I now see myself promoting my ego over my ambitions all too often. As I made progress reading, I endeavored to close the gap between my actions and those proscribed by the author. I’ll be lavish in my praise, hearty in my approbation, sincere in my appreciation, and eager to listen to others talk about themselves and their interests. Above all I’ll avoid arguing, criticizing or complaining!

I read somewhere that writing summaries is more important than reading books. So I decided to take that author’s advice, and also his template.

I recently finished reading The Expectation Effect: How Your Mindset Can Change Your World by David Robson. In summary, I thought it was great!

In 1-2 sentences, what is the book about as a whole?

Humans are profoundly influenced by our expectations, which not only color our perception of the world but also causally influence physiological processes. The well-known placebo and nocebo effects are one version of the broader expectation effect.

What are the 3-4 central questions it tries to answer?

1. To what extent do our expectations influence our perceptions and outcomes?
2. Why should we believe that this effect is causal?
3. How can we harness the power of the expectation effect to improve our lives?

Summarize the answers in one paragraph each.

1) To what extent do our expectations influence our perceptions and outcomes?

The human brain is a prediction machine. It does not process all of the inputs from our senses to understand reality, but rather it instead makes predictions about reality based on a sample of inputs and proceeds accordingly. When faced with a mismatch between prediction and inputs, the brain will sometimes sound an alarm to resolve the conflict, but often enough it will simply discard the conflicting inputs. The brain engages in this smoothing over of reality so regularly that we are rarely surprised as we go about our day. This aligns well with plenty of anecdotes that we’ve heard about human biases. For example, when the sommeliers fall for the ‘re-labeled cheap wine’ trick, or when they fail to distinguish white wine with food coloring from red wine, their taste buds are being influenced by their expectations. The same logic applies to the idea that we ‘first eat with our eyes’.

2) Why should we believe that this effect is causal?

The author makes use of evidence from the vast volume of placebo-controlled studies in the scientific and medical literature. We know from the literature that the placebo effect is responsible for real physiological outcomes, often with effects comparable to pharmaceutical and surgical interventions. The more dramatic the placebo the more powerful the effect. Placebo pills works, placebo injections work even better, and sham surgeries work best of all. There are examples of placebo drugs providing pain relief almost as effective as opioids and placebo surgeries working just as well as real ones. There are also examples of cultural beliefs leading to population-level health variances. There are also non-medical examples of this causal effect. One is the famous study (also referenced in Carol Dwek’s Mindset) about housekeepers’ improved metabolic markers when they were told that their work counts as exercise.

3) How can we harness the power of the expectation effect to improve our lives?

The author suggests that knowing about the expectation effect and believing in its power can create virtuous cycles that improve our lives. Of course this does not mean that any old expectation manifests in reality — believing you don’t have cancer when you really do won’t make it go away, for example. However, there is plenty of evidence in support of the power of positive thinking and beliefs. Those who expect to be able to retain their youth and vitality as they age are more likely to do so. Those who expect exercise to be energizing rather than draining are more likely to get their way. Those who expect stress to be bad for them are more likely to suffer its ill effects. So by working earnestly to believe that good outcomes can happen to us and framing challenges and struggles in positive ways, we can tip the scales in our favor.

What are the most important things you have learned personally?

When I first heard about studies that showed the placebo effect worked even when subjects knew they were taking a placebo, it stuck with me. I recounted this oddity to plenty of folks over the years, and it was always with some awe. This book gave me a broader base from which to appreciate this fact of nature. This base fits with my past learnings from Mindset about the power of the so-called growth mindset. It incorporates my understanding that positive thinking leads to more positive outcomes. And that there’s a 2-way relationship between our mind and our bodies. Smiling can make us happy. Posture can impact our mood. Breathing can impact the state of our nervous system. I’ll be working to set my own expectations to my advantage, and by doing so I believe I will influence reality to my benefit.

 

Author: Ben Horowitz

“Your culture is how your company makes decisions when you’re not there.”

Ben Horowitz is the best kind of “weird guy.” His father, David Horowitz, is a well-known conservative writer. Ben, meanwhile, opens chapters and essays with rap lyrics. A Berkeley kid , steeped in Silicon Valley, Ben fled to New York City for college. His first company, LoudCloud, formed in 1999, burst with the first dotcom bubble. From LoudCloud’s tattered remnants, Horowitz built Opsware, a network software company, which he sold to HP for $1.65 billion in 2007. Then he joined Marc Andreessen to start a venture capital firm that’s become one of the best in the business.

What You Do Is Who You Are is a how-to guide for defining the culture of an organization. Horowitz draws not only from his own business successes, but also cultural examples from prison gangs, samurai, professional militaries, and rebel slaves.

“The best way to understand your culture,” Horowitz says, “is not through what managers tell you, but through how new employees behave. What behaviors do they perceive will help them fit in, survive, and succeed? That’s your company’s culture.”

Four historical sketches form the book’s core:

• Ghenghis Khan, the Mongol leader who built the largest empire on Earth spanning Europe to China. 
• Toussaint Louverture, the Haitian slave who led the only successful slave revolt in human history, defeating both the Spanish and French militaries.
• Shaka Senghor, who became the leader of a violent prison gang then reprogrammed their culture toward peace.
• The Bushido Code of the Samurai. Driven by personal virtues rather than societal values, the Bushido Code successfully guided Samurai’s behavior for hundreds of years.

These cultural studies inform Horowitz’s 6 rules for creating a strong, intentional culture. Keep what works, create shocking rules, incorporate outside leadership, make decisions that demonstrate cultural priorities, and make ethics explicit. 

Keep What Works

• Louverture integrated pre-existing cultural strengths to improve his slave army. For example, slave culture included voodoo songs that traveled with slaves across plantation lines. Louverture turned these songs into advanced technology: long-distance encrypted communication.
• Steve Jobs returned to Apple 12 years after his ouster to find an unfocused organization. So he focused them on their greatest strength: building integrated hardware + software products.. Though obvious in hindsight, it seemed risky as Microsoft dominated operating system software and hardware was quickly commoditizing. 

Create Shocking Rules

For a rule to be shocking, it must be memorable. It must beg, “why?” Its cultural impact must be straightforward. People must encounter the rule almost daily. Horowitz highlights some truly shocking rules: 

• Louverture forbade concubines among married officers. Why? “Because in this army, nothing is more important than your word. If we can’t trust you to keep your word to your wife, we definitely can’t trust you to keep your word to us.”
• Diane Greene, cofounder of VMware decreed, “Partnerships should be 49/51, with VMware getting the 49.” Why? Because, in a business dependent on partnerships,  one-sided deals are bound for failure. This is more explicit than simply saying partnerships  should be “win-win.”
• Mary Barra, as CEO of General Motors in 2014, removed 10 pages of dress code policy and replaced them with “Dress appropriately.” The new code “empowered—and required—managers to manage.”

Incorporate Outside Leadership

Horowitz praises leaders who, “…transform a culture by bringing in leadership from a culture whose ways she wants to adapt.”

• Louverture often left vanquished leaders in place, “so that they could govern the region using their superior understanding of the local culture.” And despite a history of oppression rooted in skin color, in his army he incorporated, “mulattoes … and … deserting French royalist officers … to organize an efficient staff and train his army in the orthodox military arts.”
• At LoudCloud, Horowitz hired Mark Cranney to run sales. At first glance, Cranney, a brash east coast mormon republican, seemed to clash with LoudCloud’s Silicon Valley culture. This “clashing,” though, was exactly what LoudCloud needed to develop a successful enterprise sales culture. 
• Ghenghis Khan’s integrated Chinese scholars to administer his empire. It worked so well that, “every time he captured a city he would have its scholars brought in for interrogation — essentially interviewing them for open job postings.” He captured the knowledge from foreign engineers, “to build the most technically advanced fighting force ever assembled; in this way he adopted such weapons as the trebuchet and the catapult.”

Make Decisions that Demonstrate Cultural Priorities

• Louverture allowed plantation owners to keep both their lives and their land. He knew losing their institutional knowledge of farming would be ruinous to the island economy.. In this way, he demonstrated that the new nation’s success was the highest priority.
• Reed Hastings, Netflix’s founder, transitioned the business from mail-order to online streaming, despite the DVD-by-mail service delivering all of the company’s revenue and profit. To demonstrate his commitment to the nascent streaming business, he “kicked all the executives who ran the DVD business out of his weekly management meeting.”
• NationBuilder struggled to collect payment from clients. Its CEO, Lea Endres, turned to Horowitz for advice. “If you have a crisis situation and you need the team to execute, meet with them every day and even twice a day if necessary. That will show them this is a top priority. At the beginning of each meeting you say, “Where’s my money?” — It worked. The team grew to love hearing her say “Where’s my money?!?!” and collected even more than the original target.”
• The “Silicon Valley” we often think of: open floor plans, casual dress codes and employee ownership, is owed mostly to Robert Noyce, founder of Intel. Prior to Intel, Noyce ran the California-based Fairchild Semiconductor, jettisoning its strict, almost feudal hierarchy in favor of an egalitarian culture of empowerment. He took this approach a step further with Intel.  No offices for executives. Everyone worked in one big room. Instead of relying on VPs and Execs, he bestowed enormous decision-making power on middle managers. And, “crucially,” Noyce gave engineers and office workers “substantial stock options. He believed that in a business driven by research and products, the engineers would behave more like owners if they actually owned the company.”

Make Ethics Explicit

Telling people to “do the right thing” sounds nice, but offers little guidance when values conflict. “[T]he people who created the [Samurai] code understood that doing right is harder in some circumstances than others, so they provided case studies.”

• A famous samurai story demonstrates the value of sacrifice. An attendant of Lord Soma ran into a burning house to retrieve the family tree. When he couldn’t escape, he cut himself open and put the scroll inside to protect it from the fire. The servant led a mediocre life, but by carving a hole in himself to save the scroll he became immortal.
• Uber CEO Travis Kalanick carefully planned the culture. The culture he crafted emphasised winning. Some interpreted this as, “if the choice is integrity or winning, at Uber we do whatever we have to do to win.” This drove early market success, but also consumer backlash when the media started reporting on Uber’s “toxic” culture.
• Slack founder Stewart Butterfield preached empathy. It backfired when some employees proposed outlawing critical feedback that hurt their feelings. “So, he began to shift the emphasis away from empathy and toward one of the core attributes he wanted to build into the culture: being collaborative.”

Reading Horowitz’s book reminds me of a personal anecdote: I once asked a religious leader to reconcile his actions with his teachings. He replied, “Do as I say, not as I do.” Needless to say, I no longer look to him for advice. That is the lesson I take from What You Do is Who You Are: those who look to our leadership  do as we do, regardless of what we say.

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Author: Annie Duke

Despite her World Series of Poker-winning bona fides, Annie Duke wants you to know her book, Thinking in Bets, isn’t a poker book. So much so, “Why This Isn’t a Poker Book” is the first chapter title. Duke doesn’t entirely escape her past, though; Thinking in Bets draws from the skills honed over years at the poker table to help improve our own decision making.

Describing the world as probabilistic and full of unavoidable uncertainty, Duke provides practical advice for making better decisions. Despite providing remedial lessons on behavioral economics and decision theory and belaboring many examples, Thinking in Bets is useful for those who want to make better decisions more often.

For starters, Duke gives us a great new term for an old behavior: “resulting.” Resulting, Duke says, is combining uncertainty and hindsight bias to tell ourselves our result was the only possible result. Bet on red and lost all your money? Of course, it turned out that way! Never mind doubling your money was almost as likely. Late for work and speeding?? You were bound to get that ticket! Never mind most speeders do so without consequence. Even when we know an outcome occurs 20% of the time, we nevertheless feel it was inevitable when the unlikely 20% occurs.

Duke also encourages uncertainty. Even if there is an objectively correct answer, saying “I’m not sure” is perfectly acceptable! When we’re thinking hastily, we have a tendency to jump to conclusions. In my own decision-making, I try to stay at “I’m not sure” as long as possible. Otherwise, I’m increasing my risk of being sure of something that isn’t so—and that’s dangerous.

All our decisions are bets on the future. Choosing a college is a bet. Choosing an entree at a restaurant is a bet. We can improve decision outcomes by explicitly framing our decisions as bets. I just bet the Quinoa bowl I ate for lunch would be tasty and filling without being too heavy. It was a good bet, but a bad outcome because the restaurant drowned it in oil. Even good bets bust sometimes, so instead of focusing on outcomes, we’re best served by focusing on our decision process. A better process would have included inquiring about this specific restaurant’s recipe before ordering. Evaluating potential outcomes against their likelihood and “betting” helps us make better, more rational choices.

If every decision is a bet on the future, then every outcome provides feedback. We either win or lose our bet. This isn’t necessarily useful alone, but in aggregate, this feedback helps us improve our decision-making by honing our ability to set odds.

Humans generally believe what we hear. Even when we later learn what we heard is false, we tend to hold on to the belief anyway. In the early 1990s, Harvard psychologist Daniel Gilbert demonstrated that hurried people tend to believe everything they read as true (even when false statements are color-coded). As social animals, our brains are wired to work this way: first, we believe, then, later, we unbelieve if we must.

Duke suggests using the buddy system to mitigate our biases. We often fool ourselves. Including a second person aids our decision process. Our buddy walks through the decision to make sure we’re considering each angle.

A decision accountability group is a collection of such buddies, adding social pressure to stay true to our decision process. In Duke’s case, fellow poker pros pressured her to follow through on daily loss limits. When she instinctively wanted to put more money on the table after hitting her loss limit, the pressure of explaining this decision to her accountability group helped her walk away.

When neither a buddy nor an accountability group is available, Duke suggests Jerry Seinfeld. Specifically, she references a Seinfeld episode where Jerry distinguishes between “Day Jerry” and “Night Jerry” as if he were two different people. Night Jerry wants just one more drink, but Day Jerry will suffer the consequences. This mental time travel can help us consider the consequences for our future selves. 

Another form of mental time travel is the 10-10-10 process. Consider a decision’s impact in 10 minutes, in 10 months, and in 10 years. This process forces us to explicitly look beyond our decision’s immediate consequences. 

Ulysses, sailing home to Ithaca after the Trojan war, was aware of the perilous Island of the Sirens. The monsters, pretending to be beautiful women, lured sailors to their rocky doom with enchanting voices. To avoid the Sirens’ temptations and remain on course, he ordered his crew to fill their ears with wax and bound himself to the ship’s mast until they cleared the dangerous islands. Duke calls this the “Ulysses Contract.” We should bind ourselves to decisions we’ll be tempted to rethink to our detriment. Deciding not to drunk dial your ex is easier when their phone number is removed from your contacts. Avoiding a 2 A.M. chocolate binge is easier when there’s no chocolate in the house.

For weightier decisions, Duke suggests more thorough tools. They tend to work well in groups where multiple people can offer diverse contributions. 

• “Scenario Planning” imagines a variety of future outcomes and assigns each a likelihood.
• “Backcasting” imagines the desired outcome then works backward to fill in how it happened.
• “Pre-mortems” are a form of backcasting which helps spot danger. Imagining a bad future outcome then predicting events and decisions leading up to it creates a map of pitfalls to avoid.
• “Wargaming” involves role-playing a scenario to learn how events might unfold over multiple decisions.
• “Red Teaming” is a form of wargaming where a group role plays an active adversary: the Red Team. The enemy’s efforts can identify weaknesses that might lead to bad outcomes. 

Thinking in Bets encouraged me to treat each decision as a bet and analyze it accordingly. Duke’s terms, like resulting and Ulysses contracts, help me a label and standardize my decision analysis. Tools like Day/Night Jerry and 10-10-10 remind me to evaluate decision outcomes over time. Given the number of decisions we make each day, even small improvements will compound to make a world of difference.

Author: Thomas Hager

Before a drug can change the world, it must be discovered. Ten Drugs tells stories of these fateful discoveries. Taken together, they paint a picture of humanity’s long and complicated relationship with drugs. We often hear polarized views about “big pharma”, so this historical context about the pharmaceutical world is very relevant. Author Thomas Hager provides that context in an entertaining package. Below are some highlights I think worthy of remembering.

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Opium & Friend

Humanity has had a long relationship with opium and it’s the source, the poppy plant. I mean a really long relationship — since 3,400 BC. The ancient Sumerians called the poppy “the joy plant.” As with most things ancient, people created customs around the special poppy plant, it’s processing and its usage. It spread from place to place over the years, too, eventually making its way throughout the known world via the Silk Road. Centuries of trial and error led to various processing methods, potencies, and preparations. In addition to opium, the Papaver somniferum gave us morphine and codeine as well as derivatives like heroin, Vicodin, oxycodone, and more. It’s really the workhorse of pain-killer drugs. All, unfortunately, suffer from extreme addictiveness. Scientists have long attempted to discover a drug that has the benefits of pain-killing without the addictiveness but to no avail. The current US opiate crisis is an echo of prior crises in the UK, China, and even the Civil War era US. It’s a useful example of history rhyming, as Mark Twain once quipped.

Variolation, Inoculation, Vaccination

I almost never think about smallpox. That’s great news because long ago it defined lives and eras even more powerfully than COVID-19 defines ours. Hager tells the story of Lady Mary Montagu, an English aristocrat born in 1689. In her time, smallpox outbreaks were both common and unstoppable. The best practice during an outbreak was to pack up and leave town because there was no effective treatment. Her brother died of smallpox in 1713, and she contracted the disease in 1715. She luckily survived the virus, though her face was forever pox-scarred. When her husband became Ambassador to Turkey, she joined him on the trip abroad. She noted a curious absence of pox scars on the locals and soon learned of the custom of variolation (aka inoculation). Practitioners would take live virus from a mild case and infect a healthy person via deep arm scratches. Once recovered, the patient would have lasting immunity. Determined to prevent her son from suffering the same fate as her brother, she had him inoculated under the watch of the embassy surgeon shortly before their recall to London. This proved effective protection, and at the start of the next outbreak in London, she had her daughter inoculated. This time, she invited an audience that included the Princess of Wales, mother of the heir to the throne. The inoculation practice spread among high society, largely protecting them from smallpox outbreaks, but with some serious safety risks. Almost 80 years later, Edward Jenner found cowpox afforded similar protection from smallpox with a significantly lower safety risk. In fact, vaccination takes its name from the Latin vacca — cow. 

Sulfa

I thought penicillin was the first antibiotic, but the story of Sulfa predates it. If you watch World War II movies, you’ll sometimes see medics using white powder on open wounds. That’s sulfa. Researchers searched for a “magic bullet” that would kill a microorganism but leave its host unaltered. Unlike penicillin’s accidental discovery, the researchers were searching specifically for an antibacterial drug. Arsphenamine became the first Sulfa drug, used to fight syphilis infections. This success led to the search for more magic bullets, significantly increasing the funding for drug discovery research.

Chlorpromazine

Historically, we locked the mentally ill away in asylums without much prospect for treatment. The best-in-class treatment was electroconvulsive (shock) therapy. While a French pharmaceutical company searched for new antihistamines, they accidentally discovered the first drug that could help psychiatric patients. However, they didn’t realize its value at the time. A couple years after its discovery, a surgeon used the compound on his patients to prevent death from surgical shock. Eventually, clinical trials at the asylum Sainte-Anne Hospital in Paris demonstrated a remarkable ability to improve the well-being of psychiatric patients. Until this discovery, the world’s asylums grew in population and expense with no end in sight. Chlorpromazine, the first antipsychotic, led to the entire mental health care drug market. 

Birth Control Pill

The concept of a birth control drug came from the knowledge that women couldn’t get pregnant while they were already pregnant. Researchers learned that during pregnancy, women secreted progesterone, a hormone that blocked further pregnancy. They figured that giving women progesterone might enable them to avoid pregnancy. They tried to find a good source of the hormone, but it proved extremely hard to extract. Somebody found that a Central American Yam made loads of progesterone, then figured out how to extract and commercialize it. The other interesting story is the pill’s journey into the US market. Katharine McCormick, then the richest woman in the world, funded its development with $2 million — worth around $20 million today. When it was finally ready, they submitted for FDA approval for menstrual disorders rather than contraception to circumvent the restrictive Comstock laws against birth control.

Statins

High levels of cholesterol are associated with cardiovascular disease, heart disease, and other health conditions. Statins, a class of drugs, are amazingly able to lower cholesterol and its associated health risks with few side-effects. Statins work by blocking an enzyme in the liver that’s upstream of cholesterol production. It’s a life-saving tool for those at high risk of heart disease. Nowadays, it’s being prescribed much more widely for those who are only at moderate risk. During this part of the book, the author takes a long detour to share his personal experience with his health system pitching him statins without a doctor’s involvement. He continues with a long discussion of the US healthcare industry’s incentives to overprescribe.

Monoclonal Antibodies

Seven of the top ten best-selling drugs in 2018 were monoclonal antibodies (mAbs). Researchers figured out how to fuse specific cells that produce an antibody with cancerous myeloma cells. Each pair becomes a biological drug factory that pumps out a single specific antigen. mAbs are now some of humanity’s most powerful anti-inflammatory and anti-cancer drugs.

Ten Drugs covers each of these stories in detail, as well as some others I haven’t touched on. Anyone with an interest in the history of medicine can learn a lot from the book. 

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“He was going to live forever, or die in the attempt.” – Joseph Heller, Catch 22

What if we treated aging as a disease? Already you can imagine the controversy. It would feel wrong to call granny sick just because she’s old. Aging has always been integral to the human experience. Generations of forefathers lived predictable lifespans with predictable maximums.

David Sinclair, a researcher at Professor at Harvard Medical School, believes that’s about to change. He argues in Lifespan: Why We Age―and Why We Don’t Have To that there’s no law of nature that says humans have to die at a certain age, but there is an underlying cause. If we discover the cause of aging, maybe we can slow or reverse it. Sinclair’s Information Theory of Aging might be that discovery.

Sinclair’s Information Theory of Aging posits that aging is the result of information loss at our bodies’ epigenetic level. Epigenetics regulate how and when our genes express. If our genes are like computer code, epigenetics are the keyboard that enters commands. As our epigenetic information is lost, we see the hallmarks of aging: genetic instability, shortened telomeres, mitochondrial dysfunction, cellular senescence, and more.

This is such a big idea that I spent weeks seeking informed opinions opposed to Sinclair. Frankly, none hit the mark. The biggest criticism of anti-aging science is a lack of experimental human research. There are many animal studies but relatively few controlled human experiments. Any one of them alone proves nothing, but together they are very compelling. I believe Sinclair’s logic and data are strong, and I’m excited for additional research results.

The mechanics of aging

Long ago, a single-cell organism evolved a genetic circuit essential to survival. When external forces damaged its DNA, its genes diverted resources away from cell division (reproduction) and toward DNA repair. This trade-off promotes cell survival by not spending resources reproducing damaged DNA.

This trade-off is also, per Sinclair, the cause of aging. Mammal cells carry an advanced repair/reproduce circuit, with seven genes that create sirtuins (SIRT1 to SIRT7). Sirtuins are proteins that regulate core cellular functions. They require a molecule called nicotinamide adenine dinucleotide, or NAD. Sinclair believes that age-related NAD loss and the resulting decline in sirtuin activity is the main reason older bodies develop more disease.

Scientists have discovered other longevity-related genes that create proteins like mTOR (mammalian target of rapamycin) and enzymes like AMPK (AMP-activated protein kinase). Modulating these longevity genes triggers a daisy chain that causes cells to hunker down and repair damage, rather than spend energy dividing.

The effects of aging

Aging, therefore, is the underlying cause of the diseases we see in elderly populations: cancer, Alzheimer’s, COPD, Osteoarthritis, Sarcopenia, etc.

Modern healthcare is like “whack-a-mole.” We treat whatever disease emerges and then wait for the next to pop up. Playing this game cures specific illnesses but does not measurably improve lifespan. Curing all cases of cancer or cardiovascular disease would only add a couple years each to average lifespan.  That’s because we’re still aging, and “your chance of developing a lethal disease increases by a thousandfold between the ages of 20 and 70, so preventing one disease makes little difference to lifespan.”

Instead, we want to modulate our longevity genes to prevent age-related diseases and the effects of aging. Researchers have confirmed we can do this with lifestyle choices. Recent science also suggests certain molecules can achieve the same results. Medicine can mimic the benefits of lifestyle choices.

Live longer without pharmaceuticals

Longevity genes often activate in response to cell stress or damage. Over time, researchers have demonstrated we can activate those genes without actually damaging our cells. Eat less often, exercise more, expose yourself to cold, and avoid harming yourself.

Eat Less Often

Sinclair tells us that, “After twenty-five years of researching aging and having read thousands of scientific papers, if there is one piece of advice I can offer, one surefire way to stay healthy longer, one thing you can do to maximize your lifespan right now, it’s this: eat less often.”

• Okinawa. Japan’s island of Okinawa is famed for its centenarian population. In 1978, researcher Yasuo Kagawa learned Okinawans eat 20-30% fewer calories than their mainland Japan counterparts. This increased not only lifespan, but healthspan as well, “with significantly less cerebral vascular disease, malignancy, and heart disease.”
• Biosphere 2. In the early 1990s, this research project took an unexpected twist when the researchers weren’t able to farm enough food to maintain a typical diet. Though not malnourished, team members were often hungry. One resident researcher, Roy Walford, was coincidentally studying the effects of caloric restriction in mice. He observed the same biochemical changes in his roommates that he saw in long-lived calorie-restricted mice: decreased body mass, blood pressure, blood sugar level, and cholesterol levels.
• Rhesus monkeys. Our close genetic cousins, rhesus monkeys, don’t live past 40. But of twenty monkeys on calorie-restricted diets, six reached 40. This is roughly equivalent to humans reaching 120. However, not all studies show lifespan benefits to calorie restriction.

Intermittent fasting yields similar anti-aging benefits. Sinclair tells us, “Today, human studies are confirming that once-in-a-while calorie restriction can have tremendous health results, even if the times of fasting are quite transient.”

• Fasting mimicking diet. In 2017, University of Southern California researchers studied a 5-day-per-month restricted diet of vegetable soup, energy bars and supplements. They found the “fasting mimicking diet” improved aging markers and risk-factors: weight loss, reduced body fat and lower blood pressure.
• Religious fasting. “Blue zones” are regions where people regularly live much longer than average. In Ikaria, Greece, for example, one-third of the population lives past age 90. Most are staunch disciples of the Greek Orthodox church, adhering to many religious fasts. This is anecdotal data, though, and therefore weaker than we’d like.
• Skipping breakfast. Bama County in China offers more anecdotal longevity linked to intermittent fasting. Sinclair describes centenarians in Bama who skip morning meals, eat a small lunch then a large meal at twilight, “typically spend[ing] sixteen hours or more of each day without eating.”

The contents of our meals also likely impact longevity. For example, “When we substitute animal protein with more plant protein… all-cause mortality falls significantly.” While this evidence is compelling, debate around nutritional science remains.

Tying this back to longevity, calorie restriction inhibits mTOR. When the enzyme is inhibited (by limited availability of amino acids), “it forces cells to spend less energy dividing” and more energy recycling damaged proteins.

Exercise More

Telomeres are like the endcaps of our chromosomes. They shorten as cells divide, creating a sort of countdown clock to genetic instability. Preserving telomeres and mitigating genetic instability therefore leads to longer and healthier lives.

This is where exercise comes in. Researchers found a striking correlation in thousands of adults: those who exercised more had longer telomeres in their blood cells. Intensity matters, too. Researchers at the Mayo Clinic studied the effects of resistance training, high-intensity interval training, and a combination of the two across varying age groups. Sinclair tells us, “it’s high-intensity interval training (HIIT)—the sort that significantly raises your heart and respiration rates—that engages the greatest number of health-promoting genes, and most of them in older exercisers.”

Moreover, Sinclair says, “AMPK, mTOR, and sirtuins are all modulated in the right direction by exercise…,” irrespective of caloric intake.

Cool Off

Newborns start with ample adipose tissue (“brown fat”) on their back and shoulders. Sirtuin-rich, it burns energy and glucose to generate heat but decreases as we age. Luckily, mild cold exposure stimulates brown fat growth. Studies have shown that animals subjected to shivering cold for three hours a day have much more of the mitochondrial, UCP-boosting sirtuin, SITR3, and experience significantly reduced rates of diabetes, obesity, and Alzheimer’s disease.

So, “Exercising in the cold…appears to turbocharge the creation of brown adipose tissue.”

The body of evidence for cold-induced longevity is, however , the weakest among those covered.

Avoid Harm

We manage nutrition, exercise and temperature to modulate longevity genes without damaging DNA. Avoiding undue DNA damage is a key for extending lifespan and healthspan. Therefore, Sinclair recommends we avoid:

• Smoking
• Air polluted with DNA damaging chemicals
• Foods with N-nitroso compounds (cured meats, cooked bacon)
• Radiation (UV light, X-rays, gamma rays, radon)

Live longer with pharmaceuticals

If Sinclair merely proposed we’ll live longer through lifestyle, Lifespan would be uninspiring. Luckily, Sinclair also offers his unique perspective into the cutting edge of research on molecules that mimic diet, exercise and cold. Research suggests drugs can modulate the body’s longevity genes without causing genetic damage. Of particular interest are  drugs that inhibit TOR, activate AMPK and Sirtuins, or kill off senescent cells.

Rapamycin & Rapalogs (TOR Inhibition)

Rapamycin is an antifungal compound discovered on Easter Island (“Rapa Nui”) in 1972. It’s also an immune system inhibitor. Perhaps most importantly, Rapamycin consistently extends life. It inhibits the TOR pathway, mimicking calorie restriction without any hunger.

It’s been shown to extend the lifespan of yeast cells, fruit flies, and even mice in the final months of their lives by 9-14%. Sinclair says the latter, “translates to about a decade of healthy human life.”

However, “Longer-lived animals might not fare as well on [Rapamycin] as shorter-lived ones do; it’s been shown to be toxic to kidneys at high doses over extended periods of time; and it might suppress the immune system over time.”

Researchers are exploring avenues to mitigate toxicity. Some are testing intermittent Rapamycin dosing with positive results. Hundreds of others, per Sinclair, are “…working in universities and biotech companies to identify ‘rapalogs,’ which are compounds that act on TOR in ways similar to rapamycin but have greater specificity and less toxicity.”

Metformin (AMPK Activation)

Metformin, derived from the French lilac in 1922, is commonly used to treat type 2 diabetes. Recently, though, researchers, “noticed a curious phenomenon: people taking metformin were living notably healthier lives—independent, it seemed, of its effect on diabetes.”

Metformin mimics calorie restriction by slowing cellular conversion of macro-nutrients into energy. This activates AMPK, an enzyme which restores mitochondria and activates sirtuins in response to low energy levels. Sinclair makes metformin’s case with strong language: “In twenty-six studies of rodents treated with metformin, twenty-five showed protection from cancer.” Outside his book, he links to human trials showing metformin reduced the likelihood of dementia, cardiovascular disease, cancer, and more.

Sinclair explains that through AMPK activation, “[Metformin] makes more NAD and turns on sirtuins…engaging the survival circuit.” This slows epigenetic information loss and suppresses metabolism, “so all organs stay younger and healthier.”

STACs (Sirtuin Activating Compounds)

Resveratrol, though discovered in 1939, only came to prominence when a 1997 paper linked it to cancer prevention. Sinclair’s research into Resveratrol’s effects on yeast classified it as the first of many sirtuin activating compounds (STACs). Resveratrol has issues with bioavailability, but other STACs don’t.

NAD, mentioned before, boosts all seven human sirtuins. Our bodies produce NAD from niacin, Vitamin B3. Without NAD as fuel, sirtuins don’t work efficiently.

Sinclair noticed that “NAD levels decrease with age throughout the body.” Since sirtuins require NAD, Sinclair decided to test the effects of boosting NAD. Adding extra copies of the NAD-producing gene to yeast resulted in a 50% longer lifespan. With that knowledge, researchers began seeking molecules to boost NAD without the danger of adding extra genes into humans.

Two molecules have emerged: nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). Sinclair writes, “In the body, NR is converted into NMN, which is then converted into NAD. Give an animal a drink with NR or NMN in it, and the levels of NAD in its body go up about 25 percent over the next couple hours, about the same as if it had been fasting or exercising a great deal.”

Safety studies are ongoing. However, Sinclair asserts, “so far, there has been no toxicity, not even a hint of it.”

Senolytics

When telomeres, our choromonal endcaps, become too short, the cells cannot continue to reproduce. Typically they’ll self-destruct as a form of recycling. Sometimes, though, they’ll become cancerous or senescent instead. 

Think of telomeres as the plastic aglets protecting the shoelace of our chromosomes. Shortened or broken telomeres expose DNA to fraying and damage, triggering cellular repair processes. This can go awry, though. Two incorrectly fused chromosomes can lead to uncontrolled growth: cancer. Alternatively, the sirtuins tasked with DNA repair might not find another end of the DNA shoelace to tie up, permanently shutting down cellular reproduction instead: senescence. The senescent cells no longer grow and divide, but also don’t die, leading some to call them “zombie cells.”

Researchers have found that killing senescent cells has restorative effects in mice, delaying the onset of age-related diseases. Medicines designed to kill zombie cells and delay aging are called, “Senolytics.”

James Kirkland from Mayo Clinic “needed only a quick course of two senolytic molecules—quercetin, which is found in capers, kale, and red onions, and a drug called dasatinib, which is a standard chemotherapy treatment for leukemia—to eliminate the senescent cells in lab mice and extend their lifespan by 36 percent.”

Other Advances

Newer advancements in medical science, not yet rigorously tested and more likely to fail, may also contribute to an increased human healthspan and lifespan. Cellular reprogramming, for example, can turn one type of cell into a completely different type. One such test, though not peer reviewed, restored vision in mice. 

Precision medicine and DNA sequencing can also help doctors to better understand our bodies and our diseases to prevent misdiagnoses and better tailor treatment options. 

The myriad consumer biometric devices can also help us track our health over time to better inform our choices.

Sinclair’s Conclusion

“Thanks to the technologies I’ve described, a prolonged, healthier human lifespan is inevitable. How and when we’ll achieve it is a bit less certain, although the general path is quite clear. The evidence of the effectiveness of AMPK activators, TOR inhibitors, and sirtuin activators is deep and wide. On top of what we already know about metformin, NAD boosters, rapalogs, and senolytics, every day the odds increase that even more effective molecule or gene therapy will be discovered, as brilliant researchers around the world join the global fight to treat aging, the mother of all diseases.

All of that comes on top of the other innovations that are on track to further lengthen our lives and strengthen our health, such as senolytics and cellular reprogramming. Add to that the power of truly personalized care to keep our bodies running, prevent disease, and get ahead of problems that could be troublesome down the road. That’s not to mention the very easy steps we can all take right now to engage our longevity genes in ways that will provide us with more good years.”

My Conclusion

The current scientific implications are huge. And I believe there’s much more to come. Some paths will certainly dead end. All of them failing, though, seems unlikely. Continued publicity and funding will bring new researchers and fresh ideas, yielding even more interesting pathways to explore.

The idea of living a healthy life past 100 is a possibility, and one I have some control over. Knowing this, I believe it’s time to make the choices to get there. As science fiction writer William Gibson told us, “The future is already here – it’s just not evenly distributed.”

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Human digestion is a sticky, complex subject. Even in previous reading on the gut microbiome, I didn’t know how digestion actually worked. Reading Gut: The Inside Story of Our Body’s Most Underrated Organ by Giulia Enders helped fill in some blanks. Enders presents the facts in plain language. Gut explains the digestive system detail by detail, from common bodily functions and misfunctions to microbial digestive contributions.

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An Anatomy Lesson

Literally, everyone knows food enters via the mouth. Lesser known is how quickly digestion starts. While our teeth break food down, increasing its surface area, saliva begins the digestive process.

• Per Enders: “Saliva is basically filtered blood” excreted from papillae in our cheeks. “The salivary glands sieve the blood, keeping back the red blood cells…” This is why we can test hormones, including stress hormones, with saliva samples.
• Saliva also contains a painkiller, opiorphin, “that is stronger than morphine.” This is why sore throats feel better after a meal.
• If you follow your tongue into your mouth far enough, you’ll encounter the root of your tongue. Its nodules, filled with immune cells, investigate everything we swallow. This is part of a ring of immune tissue encircling our throat.

The esophagus, a 1-inch wide tube, connects the mouth to the stomach. However, the esophagus connects not to the top of the stomach, but the side. This prevents gastric pressure from forcing its way up and out. As a result, there’s a “gastric bubble” of air at the top of the stomach.

• Enders offers two examples of the gastric bubble in action. 1) Swallowing air helps air trapped in your stomach make its escape (aka the burp). 2) Flipping to your left side when lying down will often relieve gastric pressure.
• The shape of the stomach encourages liquids to move quickly along the short edge toward the small intestine while forcing solids to linger longer.

The small intestine is 10-20 feet of twisty tube between the stomach and the large intestine. While that sounds long, its many folds increase surface area to make it relatively compact.

• As partially-digested food enters the small intestine, our body squirts digestive enzymes and fat solvents onto it.
• Each square inch of its surface contains about 20,000 villi, “tiny fingerlike projections … [protruding] into the mush of partly digested food…” Villi are covered by microvilli, which, “are, in turn, covered with a velvety meshwork made of countless sugar-based structures that look a little bit like antlers.”
• Our body absorbs most of the nutrients from our food in the small intestine. “Each individual villus contains a tiny blood vessel—a capillary—that [takes in] the absorbed molecules.”
• Our “rumbling stomach,” mistakenly attributed to hunger, is actually a cleanup process in our small intestines. “Our bellies don’t rumble when we’re hungry, but when there is a long enough break between meals to finally get some cleaning done!”

We find the appendix near the junction where small and large intestines meet. Mostly made of immune tissue, it’s home to a large population of bacteria.

• Conventional wisdom states the appendix is useless. Not so! Enders clarifies: “[The appendix] acts as a storehouse of all the best, most helpful bacteria.”
• Diarrhea can flush away gut microbes, leaving the terrain open for new microbes to settle. This is a risk! The wrong microbes can cause trouble. To help, “the appendix team steps in and spreads out protectively throughout the entire large intestine.”

The large intestine, digestion’s penultimate stop, extracts the last bits of usefulness from the small intestine’s leftovers.

• The large intestine goes to work on the leftovers for about sixteen hours. Without an extended time, we’d miss out on many useful substances from our food. 
• The majority of our gut bacteria live in the large intestine. There, they break down the last nutritious substances that our human cells weren’t able to liberate. 
• Our symbiosis with microbes yields, “energy-rich fatty acids, vitamin K, vitamin B12, thiamine (vitamin B1), and riboflavin (vitamin B2).”

The last bit of the large intestine is called the rectum. There, two sphincters, one internal and one external create a barrier between the large intestine and the outside world. They collaborate to ensure a balance between waste disposal and social standing.

• Proper #2 position is squatting, as validated by experimental analysis. “Hemorrhoids, digestive diseases like diverticulitis, and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool.”

The Microbes

Microbes and digestion go together like horse and carriage. After explaining the various digestive organs, Enders discusses microbes’ roles. Most of us know that bacteria impact our nutrition. They take what’s left of our food and extract nutrients we previously missed.

• We get the good stuff. “Different bacteria manufacture different substances: acids, gasses, fats,” Enders writes. These useful substances are ones we can’t extract on our own. About 90% of our nutrition comes from our food, while the rest is a byproduct of our bacteria. And another fun fact: “Bacteria produce nutrients that are so tiny we can absorb them directly into the cells of our gut.”
• The recipe for yogurt. Bacteria sometimes pre-chew our food like mother birds. “Yogurt is nothing other than milk that has been predigested by bacteria. Much of the sugar in the milk (lactose) has already been broken down and transformed into lactic acid (lactate) and smaller sugar molecules. That is why yogurt is both sweeter and sourer than milk.”

We should thank the bacteria for their service! But where do we find them?

• Location, location location. Some bacteria reside in the upper gut, but the vast majority live in the large intestine and rectum. Some bacteria prefer the small intestine, while others live exclusively in the colon. “More than half the bacteria that grow in our digestive tract are just too well adapted to living there to…survive outside the gut.”
• Home sweet home. “If we say a microorganism is particularly suited to our gut, we mean it appreciates the architecture of our gut cells, copes well with the climate, and likes the food on the menu.”
• The “seat’s taken” defense. A big way microbes keep us safer is by occupying space. Bacteria can only latch at specific locations. Friendly or benign microbes keep harmful ones from moving in.
• Have we met? New microbial research regularly surprises us. We don’t even always know where we’ll find microbes. “In 2011, a group of researchers in the United States decided to examine the flora of volunteers’ belly buttons, just for fun. One subject naval was found to contain bacteria that were previously known to live only in the seas off the coast of Japan—despite the fact that the volunteer had never been to Asia.”

Other interesting tidbits about bacteria.

• Tylenol and the gut. “The pain-relief drug acetaminophen can be more toxic for some people than others: some gut bacteria produce a substance that influences the liver’s ability to detoxify the drug. Whether you can pop a pill to cure your headache without a second thought is decided partially in your gut.”
• Bacteria can modulate cholesterol. In a 2011 experiment, 114 Canadians ate yogurt rich in digestive-resistant Lactobacillus reuteri bacteria. “Within six weeks, their levels of bad LDL cholesterol sank by 8.91 percent. That’s about half the improvement attained by taking a mild anti-cholesterol drug—but without the side effects.”

Everyday Cleanliness

Though I finished Gut earlier this year, April 2020 sees us amidst a viral pandemic. Popular opinion swings toward the absolute eradication of microbes with hand sanitizer and disinfecting spray. Considering some pathogens are quite hazardous, this is appropriate at times. However, it’s also useful to consider what it means to be “clean.”

“Cleaning means removing a film of fats and proteins from surfaces. Any bacteria living in it or under it will be removed along with the film. We usually use water and cleaning fluid to achieve this.” The aim of cleaning, “…should be to reduce bacteria numbers—but not to zero. …A couple thousand Salmonella bacteria in the kitchen sink are a chance for our immune system to do a little sightseeing. They become dangerous only when they turn up in greater numbers.”

Enders offers a few tidbits on cleanliness that should help us manage our bacterial exposure. 

• Why we wash produce. “Washing [fruit and vegetables] dilutes most soil-dwelling bacteria to such a low concentration that they become harmless to humans.”
• Avoid kitchen sponges! “[Sponges] offer the perfect home for any passing microbe—nice and warm, moist, and full of food.”
• And dish towels. “The same is true for [damp] dishtowels or drying-up cloths. They are most useful for spreading a nice even layer of bacteria on your utensils than for drying them.”
• Drying surface. “Bacteria cannot breed on dry surfaces. Some cannot survive [dryness] at all. A freshly mopped floor is at its cleanest after it has dried.”

Reading Gut felt like diving into the deep end of a pool, not quite knowing the water’s depth. Swimming through the digestive system, though, proved exhilarating. In addition to learning about digestion and microbes, I even gained some useful, timely tidbits about cleanliness. Even as long as I’ve rambled, this summary is a kiddie pool compared to Enders’ book. It’s highly recommended reading for anyone who’s enjoyed splashing around here!

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Author: Kelly McGonigal

Kelly McGonigal preached the danger of stress to anyone who would listen. For many years. She was a health psychologist working to translate science into practical strategies for everyday life. In 2012 she abruptly changed her mind. McGonigal’s book, The Upside of Stress, challenges the narrative that people should avoid stress.

Researchers led by Abiola Keller published a study in Health Psychology: “Does the Perception that Stress Affects Health Matter? The Association with Health and Mortality.” Participants reporting ‘a lot of stress,’ who perceived ‘stress affects health a lot,’ had a 43% higher risk of dying. However, the high-stress group who didn’t perceive stress as bad had the lowest risk of death among the ~30,000 participants.

The finding shocked McGonigal. She dove into academic literature to discover the nuances of stress.

Everything I had been taught about stress management started from the assumption that stress is dangerous… Once [people] understood how bad stress was, they would reduce their stress, and this would make them healthier and happier. But now, I wasn’t so sure.

Despite her best intentions, McGonigal may have been contributing to the problem. This book is her attempt to course correct.

The link between mind and matter

The Upside of Stress builds on a foundation from Carol Dweck’s Mindset. Both books demonstrate how our beliefs (“mindset”) have real-world consequences. Mindsets, whether growth or fixed, impact actions. Beliefs about stress have physiological consequences.

Stanford professor Alia Crum conducted a study on professional housekeepers. Housekeepers can burn 300 calories an hour. Lifting mattresses to make beds, scrubbing, pushing heavy carts and vacuuming — that’s a lot of work! Most housekeepers, though, are unaware that their work counts as exercise. Crum used a variety of tactics to inform some housekeepers. She then waited four weeks and compared the informed housekeepers to a control group.

Those who had been informed that their work was exercise had lost weight and body fat. Their blood pressure was lower. They even liked their jobs more. They had not made any changes in their behavior outside work. The only thing that had changed was their perception of themselves as exercisers. In contrast, housekeepers in the control group showed none of these improvements.

Crum’s study reinforces the idea that our perception of stress impacts our bodies’ reactions to stress.

A life without stress

Consider typical causes of stress: the death of a loved one, divorce, loss of a job, marriage, moving to a new home, etc. Many are unavoidable. Even minor stressors–hectic schedules, errands, commutes, cooking, cleaning, repairs–are unavoidable. McGonigal writes, “You may find yourself complaining about these experiences as if your life has gone off course.”  As if there is some mythical stress-free version of your life.

Wait. Do you actually want a stress free life? Think about it. The only true path to no stress? No life.

The stress response is more than a basic survival instinct. It is built into how humans operate, how we relate to one another, and how we navigate our place in the world. When you understand this, the stress response is no longer something to be feared. It is something to be appreciated, harnessed, and even trusted.

We are not served by removing stressors. Instead, we should harness stress to create a meaningful life. 

Fight-or-flight is only one stress response

Many discussions about stress are one-dimensional, ignorant of humans’ multiple stress responses and their varying consequences. 

Most people believe that the body’s stress response is uniformly harmful. Stress hormones are seen as toxins to be eliminated, not as potential therapies to be explored. From the conventional point of view, your body betrays you every time your hands get clammy, your heart races, or your stomach twists into knots.

Many stress discussions focus on fight-or-flight. First described by Walter Cannon in cats and dogs, it’s “present in any species with a pulse.”

Their hearts race, their breathing quickens, and their muscles tighten—they become ready for action. Their digestion and other non-emergency physical functions slow or stop. The body prepares for battle by increasing energy reserves and mobilizing the immune system.

If you’re staring down a lion on the African Savannah, the utility of this automatic response is obvious. It’s less useful, however, when staring down next month’s mortgage payment. Fight-or-flight was often useful for our ancestors, but not so much in modern society. This concept, called the “mismatch theory” of stress, leans on the fight-or-flight response. An oversimplification, it completely ignores other stress responses.

Useful stress responses for modern humans

Humans have a variety of responses to stress that, “activate multiple biological systems, each supporting a different coping strategy.” Fight-or-flight is just one response. 

The specific cardiovascular changes, ratio of hormones released, and other aspects of a stress response can vary widely. Differences in your physical stress response can create very different psychological and social responses, an increase in altruism among them.

The challenge response to stress boosts self-confidence, motivates action and promotes learning from experience. The challenge response overlaps with another book that recently influenced me, Mihaly Czikszentmihalyi’s Flow. Csikszentmihalyi studies the link between happiness and the ‘flow’ state–when you’re fully immersed in the task at hand and everything else drifts away. Flow is a great example of a challenge response. McGonigal writes:

Artists, athletes, surgeons, video gamers, and musicians all show this kind of stress response when they’re engaged in their craft or skill. … [T]op performers in these fields aren’t physiologically calm under pressure; rather, they have strong challenge responses. The stress response gives them access to their mental and physical resources, and the result is increased confidence, enhanced concentration, and peak performance.

I’ve been searching for more opportunities to find flow in my life. Now I understand that also means more time spent under stress. It’s a good thing I no longer fear stress!

A tend-and-befriend response promotes courage, caregiving and social relationships. It’s primarily driven by the release of the hormone oxytocin. The hormone encourages people to connect with their support networks. It also makes them more responsive to others, strengthening their most important relationships. This response may kick in when threatened in a social environment like a workplace. It drives people to think about family, friends and pets and protecting their tribes.

How we choose a stress response

Situation, life history and genetics impact stress response. Absent conscious choice, we may end up with an undesirable response.

To explain situational differences, McGonigal offers the example of a trial lawyer’s daily grind. In the courtroom, she’ll have a challenge response to win her case. As her kids fight for attention at home, she’ll have a tend-and-befriend response to make peace. And if a fire alarm sounds at midnight, a fight-or-flight response will help her get her family to safety.

Life histories prime our stress responses. Adult stress responses, specifically with oxytocin, depend on youth experiences like a life-threatening illness or abuse.

Genes also play a role. Some genes increase the tendency for fight-or-flight responses. Others promote tend-and-befriend responses, and some even impact overall sensitivity to stress.

McGonigal also explains how our influences are not strictly deterministic. People can choose how they respond to stress by learning during stress. She writes, “Every moment of stress is an opportunity to transform your stress instincts.” You can program your reaction to face challenges confidently, seek social support instead of withdrawing, and more. 

[Y]our stress response is extremely receptive to the effects of deliberate practice. Whatever actions you take during stress, you teach your body and brain to do spontaneously. If you want to respond to stress differently … there is no better way to change your habits than to practice this new response during stress. 

As with the teachings in Flow and Mindset, awareness creates opportunities for change. Practice helps us apply a growth mindset, increase time in flow and alter our stress responses.

More insights about stress

McGonigal’s book is too deep for me to summarize. Instead of attempting a summary, I’ll simply highlight a few more points that I’d like to take away.

• There’s a correlation between a meaningful life and a stressful life. You can’t have one without the other.
• A study by the U.S. Dept of Veterans Affairs found that trying to avoid stress predicted increases in depression, conflict, and negative events over a decade.
• Reframing mindset around stress response is effective. View anxiety as our bodies gearing up for a challenge, not succumbing to pressure. Turn the nerves into excitement.
• Sometimes both a challenge response or a threat response could fit. Focus on the resources at hand to promote a challenge response.

The Upside of Stress taught me to think about stress differently. Stress is a tool to be harnessed, not a harm to be avoided. I’m fascinated by the interplay of stress, mindsets, and flow. Together, the three provide a wonderful toolset to understand my psychology and how I can mold my mind to better serve me.

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Author: Carol S. Dweck, Ph.D.

Mindset is my new lens for seeing the world. As Carol Dweck explains in her book Mindset: The New Psychology of Success, there are two available mindsets: fixed and growth. As you could probably guess, the growth mindset is preferable. Unfortunately, it’s not typically our default. Looking back on my own life, I see a fixed mindset more often than I’d like to admit.

I use the word preferable in the prior paragraph because the growth mindset is most useful in our modern world. As we grow, we form beliefs about the world. Often we simply copy/paste beliefs of parents, teachers, friends, etc. Mindset, whether growth or fixed, tends to develop from our social environment rather than our deliberate choice. The problem? Research shows growth mindsets are simply more useful. So, if your childhood belief system instilled a fixed mindset, every passing day leaves you disadvantaged.

The two mindsets.

Let’s begin by describing the two mindsets. First, I present to you the Fixed Mindset.

“Believing that your qualities are carved in stone—the fixed mindset—creates an urgency to prove yourself over and over. If you have only a certain amount of intelligence, a certain personality, and a certain moral character—well, then you’d better prove that you have a healthy dose of them. It simply wouldn’t do to look or feel deficient in these most basic characteristics.”

The Growth Mindset:

“…is based on the belief that your basic qualities are things you can cultivate through your efforts, your strategies, and help from others. Although people may differ in every which way—in their initial talents and aptitudes, interests, or temperaments—everyone can change and grow through application and experience.”

The mindsets are not universal—it’s possible to be fixed in some areas of thinking and growth in others. Dweck uses a short survey to identify mindsets.

Read each statement [about intelligence] and decide whether you mostly agree with it or disagree with it.

1. Your intelligence is something very basic about you that you can’t change very much.
2. You can learn new things, but you can’t really change how intelligent you are.
3. No matter how much intelligence you have, you can always change it quite a bit.
4. You can always substantially change how intelligent you are.

Agreeing with numbers 1 and 2 reflect the fixed-mindset while favoring 3 and 4 reflect the growth mindset. While you can have a mix, most lean toward one or the other.

How mindsets impact us.

Let’s consider intelligence. If I believe my intelligence is fixed, and that more intelligence is better, then my focus will be on continually proving my smarts. Ask me a question? I will prove I know the answer! When I can’t, my self-image might collapse, causing my biases to kick in and convince me I’m right anyway. Psychologist Daniel Kahneman discusses this in his book, Thinking, Fast and Slow:

A remarkable aspect of your mental life is that you are rarely stumped. True, you occasionally face a question such as 17 × 24 = ? to which no answer comes immediately to mind, but these dumbfounded moments are rare. The normal state of your mind is that you have intuitive feelings and opinions about almost everything that comes your way. You like or dislike people long before you know much about them; you trust or distrust strangers without knowing why; you feel that an enterprise is bound to succeed without analyzing it. Whether you state them or not, you often have answers to questions that you do not completely understand, relying on evidence that you can neither explain nor defend.

I won’t suggest the growth mindset is an antidote to bias. I will instead suggest bias powerfully reinforces a fixed mindset, making its outcomes even more pronounced. If I believe intelligence is fixed and I don’t have much, I might choose to avoid situations that feel like tests altogether – both consciously and subconsciously. If I believe I can’t change, why bother trying?

The meanings of effort & failure.

Fixed Mindset:

• Effort: If I have to work hard, it means I lack the ability.
• Failure: If I fail, it’s because I’m not good enough, and that won’t change.

Growth Mindset:

• Effort: However skilled I am today, improvement requires effort.
• Failure: Failure is a signal to apply more effort, not a reflection of my permanent limits.

Dangers of praise & being ‘smart.’

It feels natural to praise people’s abilities, especially in children. Dweck writes, “…more than 80 percent of parents told us it was necessary to praise children’s ability so as to foster their confidence and achievement.” Unfortunately, it backfires. Praising ability drives children toward a fixed mindset. Instead, praise effort. This delivers better outcomes as it drives toward a growth mindset.

One of Dweck’s experiments tested two variations of praise.

Ability: “Wow, you got eight right. That’s a really good score. You must be smart at this.”

Effort: “Wow, you got eight right. That’s a really good score. You must have worked really hard.”

As we feared, the ability praise pushed students right into the fixed mindset, and they showed all the signs of it, too: When we gave them a choice, they rejected a challenging new task that they could learn from. They didn’t want to do anything that could expose their flaws and call into question their talent. … In contrast, when students were praised for effort, 90 percent of them wanted the challenging new task that they could learn from.

I try to remember this study each time my instinct to praise our toddler’s intelligence kicks in.

Parenting & messages about success and failure

With our words and actions, we teach children how to think about themselves.

Children love praise, of course. Dweck writes, “They especially love to be praised for their intelligence and talent. It really does give them a boost, a special glow—but only for the moment. The minute they hit a snag, their confidence goes out the window and their motivation hits rock bottom. If success means they’re smart, then failure means they’re dumb. That’s the fixed mindset.”

Dweck advises against reassuring children about their intelligence or talent. It makes them afraid to show a deficiency. Instead, she suggests messages reinforcing, “skills and achievement come through commitment and effort.” Dweck even suggests avoiding praise for a job well done, draconian as it may sound.

So what should we say when children complete a task—say, math problems—quickly and perfectly? Should we deny them the praise they have earned? Yes. When this happens, I say, “Whoops. I guess that was too easy. I apologize for wasting your time. Let’s do something you can really learn from!”

The ‘natural’ in sports.

People love seeing incredible displays of athleticism. When we’re watching an NBA center dunk or an NFL wide receiver catch a long pass, it’s normal to marvel at their talent. We awe at their natural-born ability. Dwek writes, “We like to think of our champions and idols as superheroes who were born different from us. We don’t like to think of them as relatively ordinary people who made themselves extraordinary.” This misses something that’s by now obvious: it’s not natural-born ability that enabled their success. It’s years of hard work and practice. Aptitude alone isn’t enough.

Dweck uses a number of anecdotal examples to demonstrate growth mindsets in sports. I’ll highlight Muhammad Ali and Michael Jordan.

Muhammad Ali didn’t measure up to the traditional metrics of reach, chest expansion, and weight. He didn’t have the physique of a great fighter, the strength, nor the classical moves. This was all in contrast to his adversary Sonny Liston who “had it all—the size, the strength, and the experience… It was unimaginable that Ali could beat Sonny Liston. The matchup was so ludicrous that the arena was only half full for the fight.” What did Ali have in his corner? Effort and the growth mindset. “I read everything I could where he had been interviewed. I talked with people who had been around him or had talked with him. I would lay in bed and put all of the things together and think about them, and try to get a picture of how his mind works.”

The other great example of growth mindset is Michael Jordan: the greatest basketball player of all time was famously cut from his high school basketball team. Dweck writes, “He used to leave the house at six in the morning to go practice before school. At the University of North Carolina, he constantly worked on his weaknesses—his defensive game and his ball-handling and shooting. The coach was taken aback by his willingness to work harder than anyone else. Once, after the team lost the last game of the season, Jordan went and practiced his shots for hours. He was preparing for the next year.”

The dangers of ‘talent’ — Enron.

There’s a book titled The Smartest Guys in the Room. It’s the story of the rise and fall of Enron. A darling company of the 1990s, its core business was operating energy pipelines. They hired Jeff Skilling, a brilliant former McKinsey consultant, as a business unit CEO. As he became CEO of the entire company, he created a culture that valued intelligence above all. Enron’s story ended in bankruptcy, driven by large-scale accounting fraud.

Dweck theorizes Enron’s organizational fixed mindset led to its accounting fraud. Enron’s incentive structure under Skilling rewarded intelligence over learning. Leadership’s believed talent is everything and talented people don’t fail. As a result, employees inflated successes and hid failures. If something wasn’t working, executives pretended it was. This strategy is unsustainable and disastrous. While pretending to be great, it’s hard to spend time getting better.

While it’s difficult to know whether Dweck’s theory explains Enron, it does fit other studies showing a fixed mindset leads to increased cheating. One of Dweck’s studies found 10-year-olds exaggerate performance after receiving ability praise. The below chart summarizes the findings from another study of 300 preschool children (ages 3 and 5) in China.

Growth mindset in relationships

Dweck also studied how mindset affects relationships. The evidence here is more anecdotal, yet remains powerful. She shares two beliefs common to fixed mindset relationships: “If You Have to Work at It, It Wasn’t Meant to Be” and “Problems Indicate Character Flaw.” It’s easy to imagine what happens to a relationship where work equates to a lack of destiny. The latter statement is even more interesting. If character traits are fixed, and I view my partner’s traits as flawed, resentment can only grow. This literally dooms relationships!

Mindset also comes into play after relationships end. Dweck and her fellow researchers recruited more than a hundred people to share stories of rejection. How did the mindset impact what happened next? 

“[Fixed mindset individuals] felt judged and labeled by the rejection. Permanently labeled. It was as though a verdict had been handed down and branded on their foreheads: UNLOVABLE! And they lashed out.” Their mindset offered no recipe for healing the wound. So, they desired revenge, hoping to wound back.

In contrast, those with a growth mindset reacted differently to similar hurt. “For them, it was about understanding, forgiving, and moving on. Although they were deeply hurt by what happened, they wanted to learn from it…”

Changing Mindsets

It’s a learning process—not a battle between the bad you and the good you.

Dweck believes mindset change is possible. Through intention, effort and persistence, we can shift into a growth mindset. Because mindsets exist side-by-side, it’s easy to slip into old habits. The prerequisite to a growth mindset is belief that growth is possible.

Some things to note:

• The process can be uncomfortable and disorienting.
• It starts with opening yourself up to growth.
• A growth-oriented plan is the best response to failure.
• Avoid reliance on willpower. Setbacks are learning experiences, not reasons to give up.

Dweck offers four steps to mindset change:

1. Embrace the fixed mindset. Everyone has one. Don’t fear it.
2. Become aware of situations and thoughts that trigger a fixed mindset.
3. Assign a name, like “Gertrude” or “Hank,” to the fixed mindset’s persona. Describe what the persona is like to develop insights about its associated feelings and triggers. 
4. Educate the fixed-mindset persona. Acknowledge its fears, and explain to “Hank” the plan moving forward.

I believe a growth mindset will serve me, so I’m committed to making the change. I know it’s a process, not an immediate shift. If you ever catch me slipping into a fixed mindset, please take a moment to alert me so I can grow!

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Author: Graeme Simsion

Looking for a book that’ll make you laugh? This third book of the series is a fun conclusion to the story of Don Tillman, a geneticist with a clear (and undiagnosed) case of Asperger’s. It’s fun reading the level of detailed thought that Don puts into every decision and action – from meal planning to social interactions. If you’re new to this series, you’ll definitely want to start at the beginning with The Rosie Project.

The first book, The Rosie Project, starts with his project to find a wife and ends with the successful courting of Rosie. The second book, The Rosie Effect, finds Don about to become a father and undertaking a project to prepare himself. In the Rosie Result, Don’s son Hudson is now 10 years old and is having challenges of his own. So, once again Don undertakes a project that leads him to reconfigure his life (and open a cocktail bar).

If you can’t tell, I’m quite fond of this series! Check it out if you’re looking for an entertaining read in the fiction category.

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