A study found brief exposure to diesel exhaust fumes altered functional connectivity in a human brain in ways researchers suggest could affect cognitive function..Depositphotos
Researchers in Canada have, for the first time ever, demonstrated how acute exposure to traffic pollution can immediately impair human brain function, offering unique evidence of the connection between air quality and cognition. Healthy adults were exposed to diesel fumes before having their brain activity imaged in a fMRI machine.
Air pollution in urban environments has long been associated with poor cardiovascular, respiratory and brain health. But connecting the dots between air quality and human health has been challenging for researchers. It’s difficult to accurately quantify a person’s exposure to air pollution beyond associating rates of certain diseases in geographical areas of high pollution.
Plenty of cell and animal studies can demonstrate how air pollution affects organisms. But as we know, there can often be a huge chasm between the effects of toxins on a mouse in a lab and chronic exposure to a human in the real world.
So perhaps the final missing piece in the puzzle for researchers has been direct human exposure studies. Of course, it’s not exactly ethical to expose volunteers to high levels of toxic fumes just to watch what happens, so these kinds of experiments, unsurprisingly, have been lacking.
This new research used a model of human exposure to diesel exhaust fumes developed over a decade ago. The technique delivers controlled and diluted concentrations of diesel exhaust particulate matter to human subjects at levels deemed to be representative of real-world exposure but also proven to be safe. In a lab setting, 25 healthy adults were exposed to either diesel exhaust, or filtered air for two hours and had their brain activity measured using fMRI before and after each exposure.
The main focus of the study was on the impact of this kind of traffic-associated air pollution on what is known as the default mode network (DMN). This is a set of inter-connected cortical brain regions that play a crucial role in cognition, memory and emotion.
The findings revealed brief exposure to diesel exhaust caused a decrease in DMN activity, essentially yielding a drop in functional connectivity between different brain regions, compared to what was seen when subjects were exposed to filtered air. Jodie Gawryluk, first author on the study, said these kinds of DMN alterations have been linked to depression and cognitive decline.
“We know that altered functional connectivity in the DMN has been associated with reduced cognitive performance and symptoms of depression, so it’s concerning to see traffic pollution interrupting these same networks,” said Gawryluk. “While more research is needed to fully understand the functional impacts of these changes, it’s possible that they may impair people’s thinking or ability to work.”
Alone, these new findings are not particularly meaningful. No evaluations were performed in the study to suggest the observed DMN changes impacted cognition. But alongside a growing body of epidemiological and preclinical studies linking air pollution with a number of neurodegenerative diseases, these findings may be much more significant. They effectively demonstrate the acute effects of air pollution on the human brain in a way never before shown.
According to senior author on the study Chris Carlsten, it is unclear what long-term effects this kind of pollution exposure will have on a human brain. On the positive side of things the researchers did seen DMN brain activity return to normal relatively soon after the diesel fume exposure. So Carlsten is only able to hypothesize what the impact of more chronic, continuous exposure could be.
“People may want to think twice the next time they’re stuck in traffic with the windows rolled down,” said Carlsten. “It’s important to ensure that your car’s air filter is in good working order, and if you’re walking or biking down a busy street, consider diverting to a less busy route.”
Rich has written for a number of online and print publications over the last decade while also acting as film critic for several radio broadcasters and podcasts. His interests focus on psychedelic science, new media, and science oddities. Rich completed his Masters degree in the Arts back in 2013 before joining New Atlas in 2016.
Too much belly fat can increase your risk of certain chronic conditions. Drinking less alcohol, eating more protein, and lifting weights are just a few steps you can take to lose belly fat.
Too much belly fat can increase your risk of certain chronic conditions. Drinking less alcohol, eating more protein, and lifting weights are just a few steps you can take to lose belly fat. Belly fat is more than a nuisance that makes your clothes feel tight. It’s seriously harmful.
One type of belly fat — referred to as visceral fat — is a major risk factor for type 2 diabetes, heart disease, and other conditions (1Trusted Source). Many health organizations use body mass index (BMI) to classify weight and predict the risk of metabolic disease.
However, this is misleading, as people with excess belly fat are at an increased risk even if they look thin (2Trusted Source). Though losing fat from this area can be difficult, there are several things you can do to reduce excess abdominal fat.
Here are 19 effective tips to lose belly fat, backed by scientific studies.
1. Eat plenty of soluble fiber
Soluble fiber absorbs water and forms a gel that helps slow down food as it passes through your digestive system. Studies show that this type of fiber promotes weight loss by helping you feel full, so you naturally eat less. It may also decrease the number of calories your body absorbs from food (3Trusted Source, 4Trusted Source, 5Trusted Source).
What’s more, soluble fiber may help fight belly fat. An observational study in over 1,100 adults found that for every 10-gram increase in soluble fiber intake, belly fat gain decreased by 3.7% over a 5-year period (6Trusted Source).
Make an effort to consume high fiber foods every day. Excellent sources of soluble fiber include: flax seeds , shirataki noodles ,Brussels sprouts, avocados , legumes & blackberries
2. Avoid foods that contain trans fats
Trans fats are created by pumping hydrogen into unsaturated fats, such as soybean oil. They’re found in some margarines and spreads and also often added to packaged foods, but many food producers have stopped using them.
These fats have been linked to inflammation, heart disease, insulin resistance, and abdominal fat gain in observational and animal studies (7Trusted Source, 8Trusted Source, 9Trusted Source).
A 6-year study found that monkeys who ate a high trans fat diet gained 33% more abdominal fat than those eating a diet high in monounsaturated fat (10Trusted Source).
To help reduce belly fat and protect your health, read ingredient labels carefully and stay away from products that contain trans fats. These are often listed as partially hydrogenated fats.
3. Don’t drink too much alcohol
Alcohol can have health benefits in small amounts, but it’s seriously harmful if you drink too much.
Research suggests that too much alcohol can also make you gain belly fat. Observational studies link heavy alcohol consumption to a significantly increased risk of developing central obesity — that is, excess fat storage around the waist (11Trusted Source, 12Trusted Source).
Cutting back on alcohol may help reduce your waist size. You don’t need to give it up altogether, but limiting the amount you drink in a single day can help.
One study on alcohol use involved more than 2,000 people. Results showed those who drank alcohol daily but averaged less than one drink per day had less belly fat than those who drank less frequently but consumed more alcohol on the days they drank (12Trusted Source).
4. Eat a high protein diet
Protein is an extremely important nutrient for weight management. High protein intake increases the release of the fullness hormone PYY, which decreases appetite and promotes fullness. Protein also raises your metabolic rate and helps you to retain muscle mass during weight loss (13Trusted Source, 14Trusted Source, 15Trusted Source).
Many observational studies show that people who eat more protein tend to have less abdominal fat than those who eat a lower protein diet (16Trusted Source, 17Trusted Source, 18Trusted Source).
Be sure to include a good protein source at every meal, such as: meat , fish , eggs , dairy , whey protein & beans
5. Reduce your stress levels
Stress can make you gain belly fat by triggering the adrenal glands to produce cortisol, which is also known as the stress hormone. Research shows that high cortisol levels increase appetite and drive abdominal fat storage (19Trusted Source, 20Trusted Source).
What’s more, women who already have a large waist tend to produce more cortisol in response to stress. Increased cortisol further adds to fat gain around the middle (21Trusted Source).
To help reduce belly fat, engage in pleasurable activities that relieve stress. Practicing yoga or meditation can be effective methods.
6 . Don’t eat a lot of sugary foods
Sugar contains fructose, which has been linked to several chronic diseases when consumed in excess. These include heart disease, type 2 diabetes, obesity, and fatty liver disease (22Trusted Source, 23Trusted Source, 24Trusted Source).
Observational studies show a relationship between high sugar intake and increased abdominal fat (25Trusted Source, 26Trusted Source). It’s important to realize that more than just refined sugar can lead to belly fat gain. Even healthier sugars, such as real honey, should be used sparingly.
7. Do aerobic exercise (cardio)
Aerobic exercise (cardio) is an effective way to improve your health and burn calories. Studies also show that it’s one of the most effective forms of exercise for reducing belly fat. However, results are mixed as to whether moderate or high intensity exercise is more beneficial (27Trusted Source, 28Trusted Source, 29Trusted Source).
In any case, the frequency and duration of your exercise program are more important than its intensity. One study found that postmenopausal women lost more fat from all areas when they did aerobic exercise for 300 minutes per week, compared with those who exercised 150 minutes per week (30Trusted Source).
8. Cut back on carbs — especially refined carbs
Reducing your carb intake can be very beneficial for losing fat, including abdominal fat. Diets with under 50 grams of carbs per day cause belly fat loss in people who are overweight, those at risk for type 2 diabetes, and women with polycystic ovary syndrome (PCOS) (31Trusted Source, 32Trusted Source, 33Trusted Source).
You don’t have to follow a strict low carb diet. Some research suggests that simply replacing refined carbs with unprocessed starchy carbs may improve metabolic health and reduce belly fat (34Trusted Source, 35Trusted Source).
In the famous Framingham Heart Study, people with the highest consumption of whole grains were 17% less likely to have excess abdominal fat than those who consumed diets high in refined grains (36Trusted Source).
9. Perform resistance training (lift weights)
Resistance training, also known as weight lifting or strength training, is important for preserving and gaining muscle mass. Based on studies involving people with prediabetes, type 2 diabetes, and fatty liver disease, resistance training may also be beneficial for belly fat loss (37Trusted Source, 38Trusted Source).
In fact, one study involving teenagers with overweight showed that a combination of strength training and aerobic exercise led to the greatest decrease in visceral fat (39Trusted Source).
If you decide to start lifting weights, it’s a good idea to get advice from a certified personal trainer.
10. Avoid sugar-sweetened beverages
Sugar-sweetened beverages are loaded with liquid fructose, which can make you gain belly fat. Studies show that sugary drinks lead to increased fat in the liver. One 10-week study found significant abdominal fat gain in people who consumed high fructose beverages (40Trusted Source, 41Trusted Source, 42Trusted Source).
Sugary beverages appear to be even worse than high sugar foods. Since your brain doesn’t process liquid calories the same way it does solid ones, you’re likely to end up consuming too many calories later on and storing them as fat (43Trusted Source, 44Trusted Source).
To lose belly fat, it’s best to completely avoid sugar-sweetened beverages such as: soda , punch , sweet tea , alcoholic mixers containing sugar
11. Get plenty of restful sleep
Sleep is important for many aspects of your health, including weight. Studies show that people who don’t get enough sleep tend to gain more weight, which may include belly fat (45Trusted Source, 46Trusted Source).
A 16-year study involving more than 68,000 women found that those who slept less than 5 hours per night were significantly more likely to gain weight than those who slept 7 hours or more per night (47Trusted Source).
The condition known as sleep apnea, where breathing stops intermittently during the night, has also been linked to excess visceral fat (48Trusted Source).
In addition to sleeping at least 7 hours per night, make sure you’re getting sufficient quality sleep. If you suspect you may have sleep apnea or another sleep disorder, speak to a doctor and get treated.
Keeping a food diary or using an online food tracker or app can help you monitor your calorie intake. This strategy has been shown to be beneficial for weight loss (50Trusted Source, 51Trusted Source).
In addition, food-tracking tools help you to see your intake of protein, carbs, fiber, and micronutrients. Many also allow you to record your exercise and physical activity.
You can find five free apps/websites to track nutrient and calorie intake on this page.
Although fruit juice provides vitamins and minerals, it’s just as high in sugar as soda and other sweetened beverages. Drinking large amounts may carry the same risk for abdominal fat gain (57Trusted Source).
An 8-ounce (240-mL) serving of unsweetened apple juice contains 24 grams of sugar, half of which is fructose (58). To help reduce excess belly fat, replace fruit juice with water, unsweetened iced tea, or sparkling water with a wedge of lemon or lime.
In a 12-week controlled study in men diagnosed with obesity, those who took 1 tablespoon (15 mL) of apple cider vinegar per day lost half an inch (1.4 cm) from their waists (63Trusted Source).
Taking 1–2 tablespoons (15–30 mL) of apple cider vinegar per day is safe for most people and may lead to modest fat loss. However, be sure to dilute it with water, as undiluted vinegar can erode the enamel on your teeth. If you want to try apple cider vinegar, there’s a good selection to choose from online.
16. Eat probiotic foods or take a probiotic supplement
Probiotics are bacteria found in some foods and supplements. They have many health benefits, including helping improve gut health and enhancing immune function (64Trusted Source).
Researchers have found that different types of bacteria play a role in weight regulation and that having the right balance can help with weight loss, including loss of belly fat.
Those shown to reduce belly fat include members of the Lactobacillus family, such as Lactobacillus fermentum, Lactobacillus amylovorus and especially Lactobacillus gasseri (65Trusted Source, 66, 67Trusted Source, 68Trusted Source). Probiotic supplements typically contain several types of bacteria, so make sure you purchase one that provides one or more of these bacterial strains.
17. Try intermittent fasting
Intermittent fasting has recently become very popular as a weight loss method. It’s an eating pattern that cycles between periods of eating and periods of fasting (69Trusted Source).
One popular method involves 24-hour fasts once or twice a week. Another consists of fasting every day for 16 hours and eating all your food within an 8-hour period. In a review of studies on intermittent fasting and alternate-day fasting, people experienced a 4–7% decrease in abdominal fat within 6–24 weeks (70).
There’s some evidence that intermittent fasting, and fasting in general, may not be as beneficial for women as for men. Although certain modified intermittent fasting methods appear to be better options, stop fasting immediately if you experience any negative effects.
EGCG is a catechin, which several studies suggest may help you lose belly fat. The effect may be strengthened when green tea consumption is combined with exercise (73Trusted Source, 74, 75Trusted Source)
19. Change your lifestyle and combine different methods
Just doing one of the items on this list won’t have a big effect on its own.If you want good results, you need to combine different methods that have been shown to be effective.
Interestingly, many of these methods are things generally associated with healthy eating and an overall healthy lifestyle. Therefore, changing your lifestyle for the long term is the key to losing your belly fat and keeping it off. When you have healthy habits and eat real food, fat loss tends to follow as a natural side effect.
There are no magic solutions to losing belly fat.Weight loss always requires some effort, commitment, and perseverance on your behalf. Successfully adopting some or all of the strategies and lifestyle goals discussed in this article will definitely help you lose the extra pounds around your waist.
Many young, single people assume they don’t need life insurance. Unfortunately, this misconception is difficult to reconcile before it’s too late. After all, life insurance is one of those investments that you can’t exactly buy after you need it, and if you wait too long, it’s going to cost a lot more to get it.
The purpose of life insurance is to provide a safety net so your family or loved ones won’t struggle to pay bills or handle other financial responsibilities after you’re gone—but that doesn’t mean you don’t have to think about it until after you have a family. Here’s what you need to know about that and other myths about life insurance that are best ignored, and what facts to consider instead.
Life insurance only matters after you die
In fact, life insurance is for the living. It’s in the name, and sure, the central reason to get life insurance is to financially protect your loved ones in the event of your death. But many life insurance policies also have living benefits, which allow you to tap into your plan in the event you are diagnosed with a terminal or chronic illness.
Another way you can benefit from your life insurance your plan while you’re still alive is through its cash value. Depending on your plan type, you may be able to build tax-deferred wealth through your policy, with the ability to make withdrawals from or take out loans against the value during your lifetime.
All life insurance is too expensive
Life insurance costs will vary depending on your age, gender, health, and specific policy. Predictably, the younger and healthier you are, the less expensive life insurance will be. For example, a healthy 35-year-old can pay under $28 per month for a term life insurance policy with a $500,000 death benefit payout and a duration of 20 years, according to Policy Genius.
If you’re concerned about costs, Business Insider advises you to start small. Get as much life insurance as you can afford for now, and then reassess when you are able to increase your coverage down the line. For your first plan, term life insurance is one of the most popular and affordable options. It’s a straightforward policy that provides a large assured sum assured for a low premium over an extended term, typically 10 to 30 years.
If you have health issues, consider looking into policies that don’t require medical exams.
You don’t need life insurance if you’re single with no dependents
This might be the most prevalent myth about life insurance: If no one is depending on you, why create a financial security blanket? The reality is that if you have transferable debt, like student loans, you could render your parents or other family members responsible after you’re dead. Life insurance is not just for married couples.
And while many think of life insurance as replacing lost income, even a stay-at-home parent who doesn’t receive a salary should take out life insurance. Although they may not be the traditional “breadwinner,” the cost of replacing childcare or other household duties is worth considering, and preparing for.
You should just stick with your employer’s life insurance
While many company life insurance policies are a low-cost (or even free) perk, they likely aren’t sufficient to meet your financial needs, typically offering around a year of your usual salary. Investopedia explains: “If you have dependents who rely on your income, then you probably need coverage worth at least six times your annual salary…Some experts even recommend getting coverage worth 10 to 12 times your salary.” It’s wise to supplement employer-provided insurance benefits with policies that are tailored to your needs.
The bottom line: Life insurance is not one size fits all
Take advantage of the fact that life insurance is highly customizable. And compared to other forms of insurance, your life insurance needs will change drastically over time. Think about it: Children, marriage, divorce, remarriage, caring for elderly family members, and retirement…and that’s just your thirties. (Kidding.)
Even if you don’t think you need it now, you should start with what you can afford and build coverage as your circumstances change. Nerd Wallet provides a handy table that will help you compare quotes now, and companies like Policy Genius make it easy to shop around for a good rate. But rather than rely solely on online platforms, it’s also worth consulting a real life professional.
Only a couple dozen doctors specialize in chronic fatigue syndrome (ME/CFS). Now their knowledge could be crucial to treating millions more patients. Kira Stoops lives in Bozeman, Montana—a beautiful mountain town where it sometimes feels like everyone regularly goes on 50-mile runs. Stoops, however, can’t walk around her own block on most days. To stand for more than a few minutes, she needs a wheeled walker.
She reacts so badly to most foods that her diet consists of just 12 ingredients. Her “brain fog” usually lifts for a mere two hours in the morning, during which she can sometimes work or, more rarely, see friends. Stoops has myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS). “I’m considered a moderate patient on the mild side,” she told me.
ME/CFS involves a panoply of debilitating symptoms that affect many organ systems and that get worse with exertion. The Institute of Medicine estimates that it affects 836,000 to 2.5 million people in the U.S. alone, but is so misunderstood and stigmatized that about 90 percent of people who have it have never been diagnosed.
At best, most medical professionals know nothing about ME/CFS; at worst, they tell patients that their symptoms are psychosomatic, anxiety-induced, or simply signs of laziness. While ME/CFS patients, their caregivers, and the few doctors who treat them have spent years fighting for medical legitimacy, the coronavirus pandemic has now forced the issue.
Even if that proportion is 10 times lower for SARS-CoV-2, the number of Americans with ME/CFS would still have doubled in the past three years. “We’re adding an immense volume of patients to an already dysfunctional and overburdened system,” Beth Pollack, a scientist at MIT who studies complex chronic illnesses, told me.
The U.S. has so few doctors who truly understand the disease and know how to treat it that when they convened in 2018 to create a formal coalition, there were only about a dozen, and the youngest was 60. Currently, the coalition’s website lists just 21 names, of whom at least three have retired and one is dead, Linda Tannenbaum, the CEO and president of the Open Medicine Foundation, told me.
These specialists are concentrated on the coasts; none work in the Midwest. American ME/CFS patients may outnumber the population of 15 individual states, but ME/CFS specialists couldn’t fill a Major League Baseball roster.
Stoops, who is 39, was formally diagnosed with ME/CFS only four years ago, and began receiving proper care from two of those specialists—Lucinda Bateman of the Bateman Horne Center and David Kaufman from the Center for Complex Diseases. Bateman told me that even before the pandemic, she could see fewer than 10 percent of the patients who asked for a consultation. “When I got into those practices, it was like I got into Harvard,” Stoops told me.
ME/CFS specialists, already overwhelmed with demand for their services, now have to decide how to best use and spread their knowledge, at a time when more patients and doctors than ever could benefit from it. Kaufman recently discharged many of the more stable ME/CFS patients in his care—Stoops among them—so that he could start seeing COVID long-haulers who “were just making the circuit of doctors and getting nowhere,” he told me.
“I can’t clone myself, and this was the only other way to” make room for new patients. Bateman, meanwhile, is feverishly focused on educating other clinicians. The hallmark symptom of ME/CFS—post-exertional malaise, or PEM—means even light physical or mental exertion can trigger major crashes that exacerbate every other symptom. Doctors who are unfamiliar with PEM, including many now running long-COVID clinics, can unwittingly hurt their patients by encouraging them to exercise.
Bateman is racing to spread that message, and better ways of treating patients, but that means she’ll have to reduce her clinic hours. These agonizing decisions mean that many existing ME/CFS patients are losing access to the best care they had found so far—what for Stoops meant “the difference between being stuck at home, miserable and in pain, and actually going out once or twice a day, seeing other humans, and breathing fresh air,” she told me.
But painful trade-offs might be necessary to finally drag American medicine to a place where it can treat these kinds of complex, oft-neglected conditions. Kaufman is 75 and Bateman is 64. Although both of them told me they’re not retiring anytime soon, they also won’t be practicing forever. To make full use of their expertise and create more doctors like them, the medical profession must face up to decades spent dismissing illnesses such as ME/CFS—an overdue reckoning incited by long COVID.
“It’s a disaster possibly wrapped up in a blessing,” Stoops told me. “The system is cracking and needs to crack.” Many ME/CFS specialists have a deep knowledge of the disease because they’ve experienced it firsthand. Jennifer Curtin, one of the youngest doctors in the field, has two family members with the disease, and had it herself for nine years. She improved enough to make it through medical school and residency training, which showed her that ME/CFS “just isn’t taught,” she told me. Most curricula don’t include it; most textbooks don’t mention it.
Even if doctors learn about ME/CFS, America’s health-care system makes it almost impossible for them to actually help patients. The insurance model pushes physicians toward shorter visits; 15 minutes might feel luxurious. “My average visit length is an hour, which doesn’t include the time I spend going over the patient’s 500 to 1,700 pages of records beforehand,” Curtin said. “It’s not a very scalable kind of care.” (She works with Kaufman at the Center for Complex Diseases, which bills patients directly.)
This also explains why the cohort of ME/CFS clinicians is aging out, with little young blood to refresh them. “Hospital systems want physicians to see lots of patients and they want them to follow the rules,” Kaufman said. “There’s less motivation for moving into areas of medicine that are more unknown and challenging.”
ME/CFS is certainly challenging, not least because it’s just “one face of a many-sided problem,” Jaime Seltzer, the director of scientific and medical outreach at the advocacy group MEAction, told me. The condition’s root causes can also lead to several distinct but interlocking illnesses, including mast cell activation syndrome, Ehlers-Danlos syndrome, fibromyalgia, dysautonomia (usually manifesting as POTS), and several autoimmune and gastrointestinal disorders.
“I’m still amazed at how often patients come in with Complaint No. 1, and then I find five to seven of the other things,” Kaufman said. These syndromes collectively afflict many organ systems, which can baffle doctors who’ve specialized in just one. Many of them disproportionately affect women, and are subject to medicine’s long-standing tendency to minimize or psychologize women’s pain, Pollack told me:
An average woman with Ehlers-Danlos syndrome typically spends 16 years getting a diagnosis, while a man needs only four. People with long COVID might have many of these conditions and not know about any—because their doctors don’t either. Like ME/CFS, they rarely feature in medical training, and it’s hard to “teach someone about all of them when they’ve never heard of any of them,” Seltzer said.
Specialists like Bateman and Kaufman matter because they understand not just ME/CFS but also the connected puzzle pieces. They can look at a patient’s full array of symptoms and prioritize the ones that are most urgent or foundational. They know how to test for conditions that can be invisible to standard medical techniques: “None of my tests came back abnormal until I saw an ME/CFS doctor, and then all my tests came back abnormal,” said Hannah Davis of the Patient-Led Research Collaborative, who has had long COVID since March 2020.
ME/CFS specialists also know how to help, in ways that are directly applicable to cases of long COVID with overlapping symptoms. ME/CFS has no cure but can be managed, often through “simple, inexpensive interventions that can be done through primary care,” Bateman told me. Over-the-counter antihistamines can help patients with inflammatory problems such as mast cell activation syndrome. Low doses of naltrexone, commonly used for addiction disorders, can help those with intense pain.
A simple but rarely administered test can show if patients have orthostatic intolerance—a blood-flow problem that worsens other symptoms when people stand or sit upright. Most important, teaching patients about pacing—carefully sensing and managing your energy levels—can prevent debilitating crashes. “We don’t go to an ME/CFS clinic and walk out in remission,” Stoops told me. “You go to become stabilized. The ship has 1,000 holes, and doctors can patch one before the next explodes, keeping the whole thing afloat.”
That’s why the prospect of losing specialists is so galling. Stoops understands why her doctors might choose to focus on education or newly diagnosed COVID long-haulers, but ME/CFS patients are “just so lost already, and to lose what little we have is a really big deal,” she said. Kaufman has offered to refer her to generalist physicians or talk to primary-care doctors on her behalf. But it won’t be the same: “Having one appointment with him is like six to eight appointments with other practitioners,” she said.
He educates her about ME/CFS; with other doctors, it’s often the other way round. “I’m going to have to work much harder to receive a similar level of care.” At least, she will for now. The ME/CFS specialists who are shifting their focus are hoping that they can use this moment of crisis to create more resources for everyone with these diseases. In a few years, Bateman hopes, “there will be 100 times more clinicians who are prepared to manage patients, and many more people with ME/CFS who have access to care.”
For any mainstream disease, such events—a report, a guideline revision, a review article—would be mundane. For ME/CFS, they felt momentous. And yet, “the current state of things is simply intolerable,” Julie Rehmeyer, a journalist with ME/CFS, told me. Solving the gargantuan challenge posed by complex chronic diseases demands seismic shifts in research funding, medical training, and public attitudes. “Achieving shifts like that takes something big,” Rehmeyer said. “Long COVID is big.”
COVID long-haulers have proved beyond any reasonable doubt that acute viral infections can leave people chronically ill. Many health-care workers, political-decision makers, and influencers either know someone with long COVID or have it themselves. Even if they still don’t know about ME/CFS, their heightened awareness of post-viral illnesses is already making a difference. Mary Dimmock’s son developed ME/CFS in 2011, and before the pandemic, one doctor in 10 might take him seriously.
“Now it’s the flip: Only one doctor out of 10 will be a real jerk,” Dimmock told me. “I attribute that to long COVID.” But being believed is the very least that ME/CFS patients deserve. They need therapeutics that target the root causes of the disease, which will require a clear understanding of those causes, which will require coordinated, well-funded research—three things ME/CFS has historically lacked.
But here, too, “long COVID is going to be a catalyst,” Amy Proal, the president of the Polybio Research Foundation, told me. She is leading the Long Covid Research Initiative—a group of scientists, including ME/CFS researchers, that will use state-of-the-art techniques to see exactly how the new coronavirus causes long COVID, and rapidly push potential treatments through clinical trials.
While they wait for better treatments, patients also need the medical community to heed the lessons that they and their clinicians have learned. For example, the American Academy for Family Physicians website still wrongly recommends exercise therapy and links ME/CFS to childhood abuse. “That group of doctors is very important to these patients,” Dimmock said, “so what does that say to them about what this disease is all about?”
Despite all evidence to the contrary, many clinicians and researchers still don’t see ME/CFS as a legitimate illness and are quick to dismiss any connection between it and long COVID. To ensure that both groups of patients get the best possible treatments, instead of advice that might harm them, ME/CFS specialists are working to disseminate their hard-won knowledge.
Bateman and her colleagues have been creating educational resources for cliniciansand patients, continuing-medical-education courses, and an online lecture series. Jennifer Curtin has spent two years mapping all the decisions she makes when seeing a new patient, and is converting those into a tool that other clinicians can use. As part of her new start-up, called RTHM, she’s also trying to develop better ways of testing for ME/CFS and its related syndromes, of visualizing the hefty electronic health records that chronically ill patients accumulate, and of tracking the treatments they try and their effects.
“There are a lot of things that need to be fixed for this kind of care to be scalable,” Curtin told me. Had such shifts already occurred, the medical profession might have had more to offer COVID long-haulers beyond bewilderment and dismissal. But if the profession starts listening to the ME/CFS community now, it will stand the best chance of helping people being disabled by COVID, and of steeling itself against future epidemics.
Pathogens have been chronically disabling people for the longest time, and more pandemics are inevitable. The current one could and should be the last whose long-haulers are greeted with disbelief. New centers that cater to ME/CFS patients are already emerging. RTHM is currently focused on COVID long-haulers but will take on some of David Kaufman’s former patients in November, and will open its waiting list to the broader ME/CFS community in December.
(It is currently licensed to practice in just five states but expects to expand soon.) David Putrino, who leads a long-COVID rehabilitation clinic in Mount Sinai, is trying to raise funds for a new clinic that will treat both long COVID and ME/CFS. He credits ME/CFS patients with opening his eyes to the connection between long COVID and their condition.
Every ME/CFS patient I’ve talked with predicted long COVID’s arrival well before most doctors or even epidemiologists started catching up. They know more about complex chronic illnesses than many of the people now treating long COVID do. Despite having a condition that saps their energy, many have spent the past few years helping long-haulers navigate what for them was well-trodden terrain: “I did barely anything but work in 2020,” Seltzer told me.
Against the odds, they’ve survived. But the pandemic has created a catalytic opportunity for the odds to finally be tilted in their favor, “so that neither patients nor doctors of any complex chronic illness have to be heroes anymore,” Rehmeyer said.
Long-term health management of metabolic and chronic diseases is the largest cost burden on the U.S. healthcare system. Basys.ai, founded by Amber Nigam and Jie Sun in June 2021, is a “B2B SaaS platform supporting clinical decision-making for doctors at hospitals” by using deep learning algorithms. Currently, the startup has been bootstrapped since inception. Basys is based in Cambridge, MA.
The startup has six employees. Basys’s main competition are firms like Omada Health, Virta Health and Innovaccer. Their business model is tailored to meet the needs of B2B customers such as providers and payors by selling access to their software. John L. Brooks III, Founder of Insulet and a Basys.ai advisor, says, “Diabetes remains a global crisis, despite the many advances in new therapeutics and smart devices.
AI is poised to deliver a profound impact in the treatment of diabetes. The surge in relevant healthcare data can now be harnessed to provide insights and clinical decision support recommendations that enable individuals and their clinical team to optimize their treatment. basys.ai is strongly positioned to lead this effort, given their strong team and robust AI platform, and they have already achieved great traction in a short time.”
Frederick Daso: What drives the significant share of diseases caused by metabolic health issues?
Amber Nigam and Jie Sun: It starts with the food that we eat here in the U.S. American-style diet doesn’t help as people gorge on burgers, fries, and soda. Diabetes is one factor that drives a significant share of diseases as it is usually concurrent with other chronic diseases like cardiovascular diseases and chronic kidney diseases.
Daso: What impact are these metabolic health issues impacting the greater U.S. healthcare system?
Nigam and Sun: At a macro level, metabolic health issues burden the U.S. healthcare system. Also, the doctors and hospitals are swamped with avoidable work, and patients have long queues to be treated, directly contributing to bad patient outcomes. The total spending on metabolic health issues (including chronic conditions and mental health) is 90% of the total spending on US healthcare. At a micro level, patients and their caregivers do not have personalized guidelines. So, they face anxiety and stress managing their or their loved ones’ diseases.
Daso: How do doctors and hospitals leverage AI-based solutions in their standard of care for patients today?
Nigam and Sun: There are legacy Electronic Health Record (EHR) companies that provide some boilerplate services. Although, doctors and hospitals are increasingly becoming more aware of the importance of data. Many hospitals we work with have been proactively searching for AI collaboration and accounted for that in their annual budgets. Interventions at the providers’ side, or ‘prescriptive analytics,’ is the key to this paradigm shift in managing metabolic health.
On another note, we should also remember that payors are indispensable players in this paradigm shift. Payors will benefit greatly from AI-based solutions, especially those derived from a large amount of clinically-validated data—the insights from both EHR data and claims data complete a patient’s profile. We understand individual patients’ progression patterns better by adding longitudinal depth to their health history.
Daso: Specifically, how much money is spent annually through insurance or out-of-pocket costs for treating metabolic diseases such as diabetes?
Nigam and Sun: The annual cost of diabetes in the US is $327 billion. Most of that cost is borne by payors in the US, which means a great unmet need for more cost-effective solutions based on prescriptive analytics. The solution will come from combining insights from the EHR data with the claims data, i.e., we understand individual patients’ progression patterns better by adding longitudinal depth to their health history.
Daso: How have you built Basys to seamlessly integrate with providers’ existing workflows and processes to treat patients suffering from metabolic diseases?
Nigam and Sun: We have been conscious that our service can be used with/without EHRs, given the long wait time for integrating with traditional incumbent EHRs. We have a scalable and interoperable platform that can integrate with any hospital and payor system.
Daso: What are the challenges in validating Basys’s deep learning algorithms concerning how a patient’s metabolic health evolves with proper treatment?
Nigam and Sun: The first adoption of good habits – although to derisk it, we are partnering with the changemakers, the doctors, and the insurance. The second is gathering microdata like food and exercise – one derisking strategy is partnering with device and hardware companies, although food is still a tough entity to measure. Our access to the largest and most clinically validated healthcare datasets gives us an essential competitive moat.
Besides, the founders’ backgrounds in health Data Science from Harvard and their work experience in the health ecosystem of Boston is a strong value add too. Last, we have attracted some of the best people in healthcare, including business leaders who have led the largest diabetes institute globally and have founded multi-billion dollar startups. All these factors help drive down the challenges and risks typically associated with the slow and regulated nature of the healthcare industry.
Daso: For Basys’ company culture, how will the startup maintain its flat hierarchy and autonomy-driven environment while scaling up to address the needs of a heavily-regulated and structured industry?
Nigam and Sun: We have a hiring policy that places integrity and ethics on top. In addition, the passion for innovating and creating an impact in healthcare is crucial. It is about teaming up with the right people and providing them with the right platform to shine.
We spent significant time with our team members in building their capacity and being aligned. The vision is to forge a resilient company culture, fearless of challenges, and always on the forefront of creating excellent solutions. Most importantly, we are united by our commitment to making healthcare better for everyone.
I write extensively on college students’ triumphs and failures in their journeys in entrepreneurship. I graduated from MIT with my Bachelor’s and Master’s in
Imagine standing on a ledge with your eyes closed, not knowing if your next step forward is to go plummeting downwards or continue climbing up a wall. That is what it is like to have insulin-requiring diabetes and monitor your blood sugar levels just 4 times per day. Insulin is one of the most powerful medications we use, yet is subject to more variation in response than almost any other treatment.
Inject too much, exercise more than usual, or eat too little and blood sugar levels can fall fast and hard, at times to the point of a loss of consciousness. Too much carbohydrate causes glucose levels to skyrocket back up. Any patient taking insulin will tell you that it is tough being a surrogate pancreas. An emerging technology called continuous glucose monitoring is making life a little easier.
Patients insert a small sensor under the skin which beams an infrared signal to a receiver where the blood sugar levels are displayed. The pager-like receiver reveals what the blood sugar level is and in which direction it is going. A “normal” blood glucose level of 100 mg/dL that is rising quickly requires a different action than a blood glucose level of 100 mg/dL that is falling quickly. More importantly, these devices alarm at night, alerting patients to potential hypoglycemic reactions.
However, all advances come with a price, which includes taking the time to learn and understand this device. Continuous glucose monitoring suddenly provides up to 1440 daily blood glucose values and it might not reduce A1C levels, because both rates of highs and lows are reduced, leaving the average blood sugar the same. But this technology is worth the price of learning.
It is new, imperfect, and somewhat cumbersome, yet it stands to help patients with diabetes lead less precarious lives. And ultimately it may evolve into a true “closed loop” system that will make the guesswork of insulin administration a thing of the past. That’s my opinion. I’m Dr. Anne Peters, Professor of Medicine at the University of Southern California, Keck School of Medicine.
A study found brief exposure to diesel exhaust fumes altered functional connectivity in a human brain in ways researchers suggest could affect cognitive function..Depositphotos
