Interview with Kate Matsudaira about Productivity and Work

Kate Matsudaira is a startup founder and technology executive with a passion for productivity. She has extensive experience building and managing high performance teams and has held leadership positions in companies such as Decide (acquired by eBay), Moz and In 2013, Kate started her own company Popforms with the mission of helping employees excel at work through innovative courseware. Popforns was acquired by O’Reilly Media in June 2014. In November 2014, Kate launched the Spark Notebook on Kickstarter after a decade-long journey trying to find “the perfect notebook.” Her goal was to raise $14,000, and she exceeded this by almost 10X raising almost a half-million dollars. Kate can be found musing about productivity, tech, leadership and life at:

1) Throughout your online authoring on goal setting, you discuss the importance of being mindful of your motive. I like that you move beyond the common Simon Sinek clichés of “start with why” and rather focus on the reality that people are going to be moved to action differently by different motivation. What are the best ways of overcoming being “lazy”?

Have you heard the word akrasia? The term means lacking command over one’s self. When someone acts against their better judgment, they kind of simply have this akrasia.  You know you should be doing something, but you don’t do it. I think most people’s lack of progress comes from this concept. Most people know what they should be doing at some level.

I believe there are two main ways people get stuck. The first way is, you know what you should be doing but you’re not sure how to make progress. For example, you know you really want to be a writer but you don’t know how to get a writing job. You have the skills of a writer, but you do not know how you actually make a living writing — or how to take those steps towards your goal. The challenge here is figuring out how to get started.

The second way people get stuck is, you have the knowledge to move yourself forward… you have the capacity to build a plan… but you cannot establish momentum. Using the writing example, you know that you need to create sample work. You need a few paid opportunities through freelance work so you can build a portfolio. You need to build the needed momentum to reach your goal. So, in this scenario the challenge is not putting a plan into place, but rather actually executing on a plan. This category of being stuck is where my notebook really helps, by turning bigger goals into actionable steps.

To overcome being lazy you need a plan. You need action. I think this is one of the bigger lessons for me in my life. When I first started my career, one of the things I would struggle with was that my boss would give me these huge projects. So, I would always ask, “Where do I start?” The goals were so big, and I was so new at what I was doing, I didn’t even know where to begin. I think that’s something that happens with a lot of people. You have these really big goals and you’re so far from the finish line it becomes tough to continue. One of the biggest lessons I learned during that time was to start with small steps.

2) Last year you became a mother. My wife and I just added our second addition to the family. How has parenthood changed the way you approach being productive (now that time is not exclusively your own)?

One obvious change in approach is prioritization. By necessity, I have now learned to say no to a lot more stuff too. When I got pregnant, I became really sick. I had a tough pregnancy. There was simply a lot I could not do during that time. So, at that point in my life, I started taking things off my plate because I physically was not capable of working the way I had in the past. The experience was a good primer for the way I operate now; I was forced to be economical with my time and I became very disciplined.

I have also learned you have got to focus on the task at hand. I talk a lot online about being present. Whether I am on a call, playing with my child or I’m writing an article, that is all I’m doing when I am performing that task. Always quality over quantity (with respect to completing tasks). When I am with my son, I’m not checking my phone. I leave my phone in the kitchen so I am not tempted. I am mindful of maximizing the output from any time spent, whatever the desired outcome might look like of the activity I’m immersed in — if I believe I won’t get positive ROI from time spent on something… I simply don’t do it.

I am up at 5:30 a.m. with my child now. So, time is the thing I don’t have. I have become really disciplined. When I have 15 minutes free, I don’t waste it on things like Facebook, I’m not screwing around with my extra minutes. I’m using all time really effectively nowadays. I have a predetermined plan for those 15 minutes that advantageously pop up. One of the real secrets to time management is knowing what to do with the spare 15 minutes life gives you.

3) Working with Michael Gervais, as well as buying into some of the arguments made by Gary Keller in the book The One Thing, I believe “balance” is a fallacy for high achievers. In my opinion, high achievers find more time than others because there is always more that can be done. You highlight this in your post about making the most of small slices. That said, prevailing science suggests that making time for renewal, and turning down, allows us to be more productive. How does the concept of renewal fit into your productivity paradigm?

You have to schedule it unfortunately. For me, exercise is a release so I try to schedule time to work out regularly. Fortunately, I consider time with my child downtime. I carve out time to spend time with my child and that’s not mentally taxing for me. For me, the time with my family is renewal and I have been really deliberate with how I spend my days. I also make it a point to take vacations every year.

In my car, I listen to good audiobooks, things that make you a better person. I have a pretty long commute, 45 minutes each way, so that’s a good amount of time that I can just kind of unwind if I want. So, I think it just depends on what you need (personally) to unwind. But, for me, I get enough renewal in my life. I’ve built my life around these things because I understand they’re important.  

4) You have an amazing amount of personal systems: for staying on task, organizing yourself and managing incoming information. Personally I feel overwhelmed by the information I have amassed and at times can find it limiting. For example, each year Evernote becomes less useful for me because it contains so much content now. Considering your interests, your proclivity for knowledge and writing, as well as being a continual innovator, what are your strategies to isolate what is important and/or simplify when you need to?

I have this thing I call my Monday Ninja Planning Session and I do it religiously every Sunday night or Monday morning. I start my week with it. I have time on my calendar for it that’s always either 30 or 60 minutes. The sessions are about going over what are the most important priorities and/or things I need to do that week. By engaging in this activity, it really makes sure that I’m not just working on time sucks (e.g. tactical messages in my inbox) or whatever superfluously comes my way. It also means that — by design — I am checking back into my goals every week. I ask myself, “How are my yearly goals going? What is going on with my monthly goals? How does this all fit together?” I make sure that I am actually moving forward with what is important. This method makes you critically look at your productivity and refocuses you to make sure that you’re working on things that matter. Establish this ritual at the beginning of the week, and you find yourself managing your time more effectively.

Also, if you work for someone else, send a status email every week outlining what you are going to do for the week. Make sure what you are working on is mapped with you and your manager’s goals. When I was an employee, this process created an ongoing conversation with my manager and allowed me to track and share my progress in a very tangible and meaningful way.

These are not really ways of simplifying your work I suppose, but rather ways of focusing on what is important which is keystone to being productive.

5) You have now created a movement of people who are going to use your product to aid them in making 2016 their best year yet. What are your plans and goals for evolving the Spark Project and the Spark community in 2016?

That is a really good question and I wish I had a really good answer for you. I am still consistently surprised by the success of the various Spark projects. Frankly, it is awesome. However, when you have a lot of unplanned success — which has led to not being able to fulfill all the orders in time for the new year — I am just trying to do my best just to make sure everyone is happy.

What the future holds is evolving. I am hoping to expand into some complementary products. We already have launched the meeting notes notepad. I also look forward to building other tools to help people be successful, so stay tuned for that. That’s it in terms of physical products for now. In terms of the Spark community, I am hoping to continue delivering strategies and free worksheets that help people achieve their goals (by way of the Spark email newsletter). We will likely use Kickstarter again next year for the 2017 planner because that platform has really worked well for us so far for launching these projects.


Interview with Laura Putnam about Employee Well-Being

Laura Putnam is a well-respected consultant, trainer and speaker on the topic of workplace wellness. She also writes on the topic for publications such as The New York Times and Entrepreneur, as well as authoring the book Workplace Wellness That Works. Laura is the CEO of Motion Infusion, a consulting and training firm that provides workplace wellness solutions to foster positive behavior change as well as improve employee engagement, performance and well-being. Laura has received various accolades for her work including the American Heart Association’s “2020 Impact” award.

1) As the workplace wellness industry tries to shift financial evaluation of wellness programs from ROI (return on investment) to VOI (value of investment), what are some ways you have seen organizations evaluate program success that are removed from these two equations that are still meaningful and measurable?

In the shift from ROI to VOI, we might say that there are three evaluation “buckets” to consider. The first bucket, which is what an ROI approach has primarily focused on, is medical cost-containment and risk reduction. This includes tracking the impact of wellness programming on medical costs, disability costs, workers compensation costs, rates of injuries, types of injuries and recovery time. The second bucket is productivity and performance, which includes effects on absenteeism, productivity, energy levels, team collaboration and customer loyalty. Finally, the third bucket is becoming an employer of choice. Companies now recognize that they cannot be competitive, especially when it comes to retention and attraction, without well-designed wellness programming. The reality is that employees, especially Millennials, expect their employers to care about them as people and to also care about making the world a better place. Data points in this third bucket include measuring rates of retention and attraction, job satisfaction scores, levels of employee and leadership engagement, quality of life for employees and even level of connection with a higher purpose.

In order to address the productivity and performance bucket, companies like Goldman Sachs and Google offer wellness programs that help employees to become more focused, more competitive and ultimately more resilient. In lieu of a potentially stigmatizing “reduce your stress” types of programs, they offer “I can become a more effective employee” types of programs. Goldman Sachs’ resiliency program, which is sold as a means to “sharpen one’s competitive edge,” attracts over 500 employees every quarter. The legendary “Search Inside Yourself” program, launched at Google, trains employees how to become both more mindful and emotionally intelligent. In both cases, the companies are less interested in ROI on medical costs and are more interested in performance enhancement.

This idea of using wellness as a means to better oneself and make the world a better place is something I am personally interested in. I love companies like Patagonia and Eileen Fisher that are going after this third bucket of impact. They are both invested in well-being as a means to not only become an employer of choice, but as a vehicle for protecting the environment. While Patagonia does not have a “wellness program” per se, every aspect of doing business breathes well-being and is deeply connected to its mission to “use business to inspire and implement solutions to the environmental crisis.” Eileen Fisher also connects well-being with environmentalism by encouraging employees to become “sustainability ambassadors,” acting as champions of well-being and advocates for protecting the earth.

Companies like and Square are using impact on the community as a metric for success. Salesforce just hit 1 million volunteer hours. Square has a clean streets initiative, where employees go out and clean the neighborhood. Leveraging the broken windows theory, the idea is that small changes can have a larger impact. So, something “meaningful and measurable” might be as simple as, “how much trash did we pick up?”

2) Big enterprises have some innate advantages to small and mid-size businesses when it comes to providing workplace wellness solutions: economies of scale, access to insurance brokers that provide various free wellness products as value-added services and better access to aggregate employee health data (to name a few). What are some of the advantages smaller companies have to larger companies when it comes to building a workplace wellness program?

In smaller organizations, there are inherently fewer leaders and fewer people. So, it’s much easier to: a) implement a program; and b) shift the culture. If a leader decides to support well-being, then it is easier for that to actually happen in a smaller organization. If an employee has an idea, it’s usually easier for them to be able to move on it. And, certainly, it’s much easier to shift the culture in a smaller organization.

One of my favorite examples is The Sioux Empire United Way in Sioux Falls, South Dakota. A single employee, Colleen Thompson, finance director, decided to take up walking as a way to lose weight and support her newfound commitment to a healthy lifestyle. Rather than just doing it on her own, she invited coworkers to join her. To this day, eleven years later, she and her coworkers are still at it. Everyday – rain, shine, sleet or snow – employees walk together, twice a day, a mile each time. To ensure that weather doesn’t get in the way, they’ve mapped out both an indoor route and an outdoor route. This story is proof that one person can really have an impact, especially within a small organization.

Another important element to this story, of course, is the championing of well-being from the president, Jay Powell. In conjunction with this twice-a-day walk, he decided to try out standing desks with a few employees. Once it proved to be an effective, he extended the offer of a standing workstation to every employee. Because of its small size, the initiative was relatively easy to implement across the office.

3) In your book Workplace Wellness that Works you build a lot of your ideas on a wide range of concepts from established thought leaders. What I particularly enjoyed is in the spirit of a true “da Vinci approach” a lot of the concepts were taken from outside the field. Avoiding folks like Dee Edington and BJ Fogg, who are three “outside” thought leaders we in workplace wellness should get to know (and a quick reason why for each)?

  1. a) Barbara Fredrickson: Dr. Fredrickson is a positive psychologist affiliated with the University of North Carolina. She has really done some incredible studies on both positivity and positivity resonance, which is positivity in the context of others. Her work has really inspired my rethinking of the prevailing “identify what’s wrong and then fix-it” model, which I think creates a depleting experience for people. It’s no wonder why so many employees are opting out of wellness at work! The research suggests that over 80% of eligible employees are choosing not to participate in workplace wellness programs. In some programs, the participation rates are as low as 1-2%. I am convinced that these low rates of engagement are largely due to the overly invasive and negatively oriented wellness programs that we’ve developed.
  2. b) Chip Conley: Chip’s work, especially his book Peak, has had a huge influence on my understanding of the role of culture and how to go about building a positive culture. I am more and more convinced that when it comes to the practice of well-being, we are less “creatures of habit” and more “creatures of culture.” Therefore, as wellness practitioners, we must become experts in culture change – and not just experts in behavior change.
    As CEO of Joie de Vivre, Chip modeled a different way of leading. For starters, he dubbed himself the “chief emotions officer.” In addition, he facilitated open, transparent conversations with employees asking questions like, “Is this a job? Is this a career? Or is this your calling?” And, “If it feels like a job, what can we do here so that it feels like it’s more of a calling?”
  3. c) Arianna Huffington: In the field of workplace wellness, we have placed such a premium on science and research and have not paid enough attention to the importance of being able to share our message in a way that resonates for people. This is exactly what Arianna does so well in her most recent book Thrive. While it is not a perfect book, it speaks to people on an emotional level. In both her writing and her speaking, Arianna uses storytelling, humor and even tonality to deliver her message. These are all the kinds of things that I believe we have to do much more of to change behaviors. It is less about reaching people’s rational minds and more about reaching people’s hearts. This is why the first step in my book is titled “Shift your mindset from expert to agent of change” – and I cite Arianna as an example of an “agent of change.”
  4. d) Michael Gervais: I love Dr. Gervais’s message of imagining what’s possible and then planning from there. This approach dovetails well with a detour from a “what’s wrong with you and let’s fix you” approach toward a “what’s right with you and let’s build on it” approach.
  5. e) Firdaus Dhabhar: Finally, I am enthralled with the research of people like Dr. Dhabar, a researcher at Stanford. His research has uncovered many of the benefits of stress – and that it’s less about stress avoidance and more about acknowledging and even embracing stress. His work underscores the fact that stress can be leveraged as energy. He advocates actually intensifying short periods of stress and then offsetting that with proactive restoration, which really is in line with a lot of the stuff that people like Tony Schwartz, CEO and founder of The Energy Project, have been talking about for a long time.

4) Speaking of a “da Vinci approach” to wellness, for those that have not read your book yet, can you explain the essence of this method? And, can you provide an example or two of the most creative ways you have seen “da Vinci” put into action?

I’m more and more convinced that the only way we are going to have real impact is if we start to integrate wellness and well-being holistically, and not have myopic standalone programs. A great way to do that is by channeling Leonardo da Vinci, the Italian polymath, and taking an interdisciplinary approach toward promoting well-being in the workplace.

On an internal level, you need to engage multiple perspectives from multiple departments. As much as possible, break down silos and reach across to as many different departments as possible:  training and development, organizational development, community outreach, IT, marketing, compensation and benefits, health and safety, facilities, etc.

On an external level, I would encourage you to move away from a one-stop-shop vendor to a team of outside partners, which might include brokers, insurance carriers and even community resources. For example, the American Heart Association provides all kinds of support for organizations that are interested in creating cultures of health.

Schindler Elevator Corporation is a great example of a company that has taken a “da Vinci approach” toward promoting health and well-being in the workplace. Rather than delivering a stand alone wellness programs, Schindler has incorporated well-being concepts into non-wellness initiatives, such as leadership development programs and safety training initiatives. These interdisciplinary programs have partnered the OD department with both safety and HR departments, as well as a number of outside wellness, learning and culture vendors.

5) We are seeing some progressive employers move the corporate wellness conversation from concerns regarding employee “wellness” to thinking about workplace wellness in terms of improving employee “well-being”. Trying to improve population health has already proven to be a complex problem for most, could broadening our focus too fast potentially have risks in the sense that complexity can be inherently paralyzing and might lead to further inaction from organizations simply trying to get started?

Yes and no. Yes, the concept of “well-being” can feel amorphous and overwhelming. Certainly, this broader mission, that encompasses dimensions beyond healthy eating, physical activity and smoking cessation, might lead to inaction.

On the other hand, I think a lot of people are tired of the worn out healthy eating, physical activity and smoking cessation wellness programs. The idea that other factors, like social connections or meaningful work, play into our overall level of well-being is really inspiring and is actually catalyzing organizations and people into action. In my experience, “better health” is not that motivating for most, whereas, becoming one’s best self is. “Wellness” is more focused on (and associated with) the former, whereas “well-being” is more linked on the latter.

The truth of the matter is that well-being moves into areas that companies have already been addressing for a long time. Therefore, this shift actually allows for an opportunity to connect with pre-existing programming (like safety training and leadership development). This is certainly what I have seen in cases like Schindler.

I think the key is for each organization to first define what “well-being” means and based on this definition, identify the areas to focus on. For example, HubSpot, a fast-growing technology company based in Cambridge, Massachusetts, organizes its well-being programming around three different areas: physical activity, healthy eating, and mindfulness/stress reduction. The City of Sioux Falls, on the other hand, has organized its programming around five areas of well-being: physical, emotional/social, career, financial, and community.

This broader landscape of well-being provides each organization an opportunity to identify its “signature” program. For example, Treehouse, a technology company based in Portland, Oregon, has designed a four-day workweek for its employees. The CEO insists that people actually take the day off on Fridays to spend time with their families or engage in leisure time activities – not work. What he has found is that employees are more productive – and the program serves as a great recruiting tool. While Treehouse cannot possibly compete with the Google’s of the world in terms of salary, they can say, “Well, if you work at Google, are you going to have a four-day workweek? Probably not. But, here at Treehouse, you will.”

Ultimately, whether we’re talking about wellness or well-being, it comes down to carving out regular practices to be embraced by all levels of employees. Companies like LinkedIn have walking meetings as a regular practice. At Eileen Fisher, employees regularly begin meetings with emotion-boosting activities like a moment of silence. At Campbell’s Soup, former CEO Douglass Conant modeled the practice of saying thank you. It is fabled that during his 10-year tenure, he wrote over 20,000 thank you notes to employees. In his view, this practice played a key role in the company’s turnaround. The company went from having lost 54% of its market value to its stock rising over 30%.

Interview with Drew Schiller about the Future of Digital Health

Drew Schiller is co-founder and Chief Technology Officer at Validic, a health and wellness technology company that operates as digital health’s Rosetta Stone for disparate health data. Before starting Validic, Drew was the principal at a Web development firm as well as the founder and developer of a dietary nutrition website. Companies that benefit from Validic’s API are able to build products that pull data from a variety of mobile health apps, wearables and in-home medical devices. Drew is at the forefront of mHealth innovation. You can follow him at his personal blog:

1) When we first met, the ANT+ Fit SDK was being heralded as the way health apps were going to be able to communicate with one another. Obviously a lot has changed since then – but not enough. Data interoperability is still a major design hurdle for many digital health innovators. Now mobile manufactures like Google, Apple and Samsung are trying to become conduits and interpreters of these disparate data sources. How have the advent of Google Fit and Apple HealthKit affected Validic’s business model?

It has not actually changed our business model at all. In fact, it has accelerated things quite a bit. The entrance of Apple and Google into this area has created awareness. Anytime you have the world’s largest leading consumer electronics companies entering a new market, the entire ecosystem benefits. This has resulted in an accelerated interest from consumers in personalized generated data. We’re seeing accelerated interest from the investment community. These are signals digital health is here to stay — that all of these massive companies are placing huge bets. So, from that perspective, their entry has been tremendous for Validic.

Furthermore, these solutions are doing little to mitigate that a lot of digital health device manufacturers don’t use open standard protocols because they want to add additional security layers on their devices and/or they want to stream additional information that is not part of standard protocols. Also, you have fitness tracking devices that are streaming all kinds of proprietary information, and they do not want just anybody to have access to that because the analysis of that data is part of their secret sauce.

In order to actually connect with these devices at the device level, you oftentimes have to work direct with the manufacturer to get the proper SDK, the proper coding for it to decrypt the device’s serialization. In that sense, true interoperability has to happen at the data layer. So, once the data is off the device that’s where we can standardize and normalize the data. That’s where we can provide some sort of method to create interoperability. That’s where we play. We will connect directly to Bluetooth devices if that’s where we need to be. We will also connect directly to APIs in the cloud. We also have mechanisms with many companies to send data directly to us. So, we allow for interoperability wherever the data is coming from. Our methods are a different approach than a lot of other players in this space, which gives us an advantage.

2) Piggybacking off this topic, futurist Graeme Codrington made a bold prediction about Apple regarding Health Tech in a recent Fast Company article that by 2025, “There is no doubt that with their iOS 8 released Health app and their integration of myriad health apps with the Apple Watch, Apple are making a play in this space, and by 2025 are likely to be the world’s leading remote and proactive health care company.” Do you believe there is merit to assume a product company like Apple or Samsung will end up evolving into a health-care company?

I certainly think that they will have divisions of their companies that are successful, but can you name any dominant player in the health-care industry today? I mean, there is no one dominant player. So, I think that statement, albeit sensational, is a fallacy. Samsung already has a massive business building MRI machines. They build X-ray machines and X-ray equipment. They already have a pretty massive health-care business. It is not on the consumer side, but it certainly is something that’s core to their global entity.

I do believe companies like Apple will be a big factor in health care in 2025. I think that they are going to continue to make great devices. I think that they’re going to sell boatloads of them because that is the game that they’re in. If you look at what they have done with iPhones, look at what they have done with the iPad, these are transformative platforms and I think the Apple watch has the opportunity to do that too eventually. Do I think companies like Apple and Samsung are going to solve all of the world’s problems related to health care? No, I do not. But, do I think they’re going to provide a really valuable product that adds even more value to the health-care system over time? Yes, I do.

3) The narrative regarding wearables is fairly pervasive in health tech, but how is the Internet of Things (sensors outside of wearable devices) going to change health technology in ways that are currently unexpected?

One way that the Internet of Things in general is improving things is that there is now scale. The fact that sensors are becoming cheaper, and more cost efficient, and yet give higher resolution of data I think is really helpful.

You now have smart asthma inhalers that are able to measure your breathing; in real time when you’re inhaling the device it gives you the correct calculated dosage of medicine, as well as the GPS coordinates of the location that you’re taking that dosage. With this type of data we can start to look at casual factors at a population level. For instance, determine where people are having the most number of attacks and start to look at environmental conditions. At the population health level, you can ask questions like, “In this particular area, at this particular time of day, asthma rates are spiking by 50 percent. Why?” We are starting to be able to do interesting things like that at scale with these type of connections.

There is a company called Aldebaran building a prototype for a next generation robot. It is five and a half feet tall. It would be in your home and it has the ability to not only communicate with you, but also has the ability to help you up if you fall. So, this is great for in-home elder care. It also has the ability to help with medication adherence. It has the ability to help you decide the pill you’re supposed to take and it can record you actually taking it. Then, if there are any problems, it has the ability to call for help. It’s a 24-hour, always-on solution for care for people who need that in their homes.

A company called Proteus is doing amazing things with ingestibles. You wear a patch on your stomach and you ingest a pill, and when the pill is in your body it is activated and powered by the enzymes in your stomach and communicates with the patch (that’s on your skin). It tracks your dosage, the medication, and the time that it was taken. So, it knows what was in your body and at what time. This type of technology could save the health-care industry billions of dollars due to wasted and unused medication consumption.

4) Putting yourself in the role of a futurist, what are your hopes and predictions for health tech over the next decade?

We’re starting to see some really interesting things. One thing I will say about health care, is that unfortunately health care is slow to adopt new technologies. This is an industry that, for some good reasons actually, still largely relies on pagers and fax machines for everyday communication. The primary reason why adoption is slow is because new technologies that are brought into health care need to be bulletproof. They need to be perfect — or as perfect as you can get them — because when you are dealing with data and/or a message that could make or break a patient’s well-being you really need to make sure delivery is perfect.

Health care has the opportunity to have massive disruption from ideas that have taken place outside health care. I think that we are starting to see that already taking shape with the current wearables movement. Devices like Fitbits and Jawbone are now commonplace. What is exciting is we are starting to see new sensors that were developed in areas outside of health, but are starting to make their way to health care.

For example, there is a company called SunSprite that we connect with, which is a wearable tracker you wear on your person to measure the amount of sunlight exposure you get in a day. This is great for patients with Seasonal Affective Disorder. Sunlight trackers, light exposure meters, these things have been available for a long time, but never in a wearable context for health care (in this case specifically for patients with Seasonal Affective Disorder). So, that is one example of the future.

Another good example is we are seeing John Hancock Life Insurance, very recently, are starting to use wearable trackers as a metric for adjusting your life insurance premiums in real time. Just like you can go to your Progressive auto insurer and they put a device in your car, and they adjust your auto insurance rates based on how well you drive, this is something where your life insurance company is giving you a wearable tracker and adjusting your life insurance premiums based on how you live.

There is an abundance of opportunities for us to learn from other industries, and apply it to health, and apply new technologies to health in really innovative ways. I think that some of the most innovative things that we’re going to see moving forward are also better ways of making health care more frictionless and seamless.

5) Validic has had to keep up with a market that has been in a constant state of flux, iteration, and evolution. What are three key product development and/or product user experience concepts (specific to health) that you could highlight from your experience that can benefit digital health creators?

1) I would say getting the user experience right — and this is for app developers and device makers alike — in my experience patients who have a specific disease state… they’re happy to have monitoring around that disease, but they don’t want to be constantly reminded that they have a disease. So, for example, there is a company that’s developing a continuous blood pressure wearable. In their initial user testing, they had the blood pressure reading on the watch face every time you look at your wrist. Well, patients with hypertension, they are just trying to look at the time. They don’t want to be in a meeting at work wondering if the meeting is starting late and they look down for the time and they’re reminded that, oh, by the way, I have hypertension, right? So, from a user interface perspective, it’s important to provide users the quantification and provide the measurements, but don’t necessarily remind the patients of the problem. In fact, some of the user feedback that I’ve heard are things like, “Can you just not even show me the data and just send it directly to my physician because I want them to have it? It’s important that they have it, but it’s not important for me to see it all the time, right?” So, I think that getting UX right is always going to be important.

2) Patients only care about their health when they have to. So, what I mean by that is, for example, if I’m a 45-year-old, obese man and I know I need to cut down on my meat, and salt intake, and maybe drink less, certainly I already know all of that, right? But, I’m not going to be overly worried about it until I have a pre-heart disease episode where the situation highlights I need to make a change, right? This reality is a really hard problem to solve in health care. It is something that I think health-care companies often forget. They’re solving for future problems, as if people always care about what is going on today. Patients generally only care when something “happens.” That doesn’t mean that we can’t affect positive behavior change before that negative event occurs. We just need to incentivize the behavior change to something that the patient will care about. I think that’s something that is often missed, we design like the person or patient is going to care at the onset without a trigger or incentive.

3) What we’re starting to see is that patients who do use a wearable tracker are also more likely to keep track of other information. When you have a person that has genuinely adopted a wearable, you now have identified a person who has made self-tracking part of their routine. This trend is also being driven organically somewhat by the growing market share of wearables. This is important because the desirable experience for this segment is different than the casual user. If the digital health experience is tailored to this user type — knowing that the efficacy of a particular intervention can potentially have broader user experience implications — we likely can increase overall usage by lowering the adoption barrier.

Interview with Al Lewis about Workplace Wellness Programs

Al Lewis is an outspoken voice in health care and workplace wellness. He is the author of several books on these topics including Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health. He has founded and held senior positions at a variety of health-related organizations including the Population Health Alliance. Al’s latest endeavor Quizzify is one of only a few population health companies to measure its outcomes validly and guarantee savings for the organizations it serves.

1) Your graduate focus at Harvard was law. Before you discovered that most health-care measurement methodology is flawed, what was the initial impetus that led you to the pursuit of exploring, examining and developing a career that revolves around health care and corporate wellness?

I went from Harvard Law School and I was going to become a lawyer. I stumbled into this recruiting session for a consulting firm and there was this guy giving a recruiting presentation and I was just mesmerized by it. The guy was a manager at Bain and Company by the name of Mitt Romney. I applied for a job at Bain and I didn’t become a lawyer.

I worked at Bain for eight years and toward the end Bain was imploding at the time. I jumped ship and went to work at a health-care company and that’s how I got into health care. Then, I stumbled into a job as a Chief Executive and Chairman of a NASDAQ health-care company called Peer Review Analysis in 1993. In 1995, we merged with another company and I had to find another job. Once again, I kind of stumbled in a new role, this time in disease management, but I figured out that there was an opportunity there, especially in the Medicare population. There was so much chronic disease and yet doctors were getting reimbursed very little. Primary care doctors were getting reimbursed very little and there was nobody watching patients between visits.

At the time, I thought there was an opportunity for disease management and I started the company Disease Management Purchasing Consortium. During that time health plans — and to some extent employers — just jumped onboard. I started basically putting these programs in place, and was doing that merrily until somebody came along and essentially said that my measurement was wrong and that, in fact, disease management saved much more money using something called “prospective identification,” some wacky methodology that their actuaries told them to use. The belief is that they were actually saving a lot more money. I thought, this doesn’t look right. So, I sat down with a spreadsheet and compared my methodology to theirs and, guess what? My methodology overstated the savings and so did theirs. In my book Why Nobody Believes the Numbers I compare prospective identifications, annual requalification, and it turns out both overstate savings and you have to do something different altogether.

When I went back and looked at all the numbers I’d put together for people, they were all wrong. The savings didn’t exist. So, apparently, it is perfectly fine with other people to do this, but it was not fine with me. What happened next is detailed in the 2007 blog post: A Founding Father of DM Astonishingly Declares: “My Kid is Ugly”.

Since then, after writing Why Nobody Believes the Numbers, I basically went rogue and started naming names, built They Said What?, I call out the liars, etc. But, it wasn’t my first choice. I was essentially forced into it. I mean Rachel Carson wrote to Monsanto and pointed out the hazards of DDT very nicely and they didn’t do anything. So, that’s when she went rogue. I basically did the same thing, except that in my case, it’s more [Silent Spring author] Rachel Carson meets Dave Barry.

2) In a recent article about the folly of content curation and the way information now gets disseminated, the author Katie Herzog argues that in the age of the Internet we often herald things that distort the bigger picture. Beyond the frustration you have publicly shared that Baicker’s seminal research is continually used to support the efficacy of employee wellness programs, how does an organization effectively find the signal within the noise? How do you believe organizations should define success?

First, let’s define wellness as two types of wellness, wellness done for employees and wellness done to employees. Now, wellness done for employees is basically not quantifiable. It is things that employees want to do, and you are making it easy for them to do it. Maybe they want fitness facilities. Maybe they want better food. Maybe they want flex-time. Whatever it is, it is not things that they have to be bribed to do or punished if they don’t do. And that’s the big difference between wellness for and wellness to employees. I don’t think there’s anyone who objects to wellness for employees. I’m a big fan. But, what the Affordable Care Act is about and what the controversy is about is wellness done to employees.

The thing about wellness done to employees is that the results have to be quantitative to justify the expense. Wellness done to employees, you have to either bribe employees or fine them into doing it. If somebody likes something, they’ll do it for free. Coercion damages morale. This is, by the way, is according to a Health Education Research Organization (HERO) report.

HERO are the ones who admitted the morale impact, but you don’t have to be a rocket scientist. Just look at the comments on essentially any article in the lay media about wellness and it is all negative. So, advocates of wellness done to employees have to justify it with math. Math is shockingly easy to do.

Regarding math, some people do it, but many people don’t. Consultants don’t like it because they can’t really charge that much for it. In this case, done right it also shows the opposite of what they expect. You can start with page 22 or 23 of the HERO report that lists a bunch of diagnoses which have corresponding ICD-9 codes. HERO didn’t list them, but anyone who wants them can get them from me. I’m happy to send them. The June posting on the Quizzify blog has a Wellness ROI template all ready to go that has the ICD-9s in it.

The HERO report did their own ROI analysis and they found $.99 in in savings per employee per month from reduced hospital admissions. That, by the way, was without adjusting for the fact that many of the costs at the population level are coming down anyway. So companies are actually turning out an entire wellness program to save $1.00.

Now, you have to subtract the cost of the program. Let’s say the program is $1.50 an employee a month. Good luck finding a wellness program that cheap. Most start at $100 a year per employee. So, then you compare the cost of the program to the reduced claims cost, and that gives you your best-case scenario for savings. I say best case because you have other costs of wellness besides the vendors, consultants, and lost work time, and that kind of thing.

So to somewhat answer your question, you cannot define success by monetary savings. That’s why I’m offering a $1 million reward to anyone who can show that it does, because it doesn’t. My million dollars is very safe.

3) In a recent interview with James Pshock from Bravo Wellness, Pshock resurfaced something for me that I think is at its core, true. Organizations — when they begin as entrepreneurial endeavors — are not generally created to shoulder the burden of employee health care. This is a burden progressively being assigned to enterprise through policy — although few would disagree that a business should be concerned with the well-being of their employees. Based on your experience and opinion of workplace wellness, what do you believe is the obligation of an employer when it comes to employee well-being? 

As an entrepreneur, my job is basically to not put up roadblocks, to stay out of their way, and to be responsive if they have health or personal issues. The staff I have at Quizzify is dedicated, highly productive, motivated.

I don’t have an “obligation” to provide for their well-being per se. But, if I don’t provide for their well-being, either their productivity might suffer or they’ll go somewhere else. So, I don’t need to be told by the ACA, by Congress or the President what I can and can’t do with my employees. I’m going to do the best thing for my employees regardless.

The absolute, positive, last thing that I would ever do to my employees is institute a pry, poke, prod, and punish wellness program. It would cost me money. It wouldn’t save me any money. It would damage their morale. And it would drive a wedge between me and them.

Since you brought up Bravo Wellness, if you go to my expose of their previous website (which they bowdlerized following my exposé) they were essentially bragging about how they can save an organization money immediately by “fining” employees. They also spend a lot of time talking about their appeals process. I would not — in a thousand years — put in a wellness program where I fine my employees for things that have nothing to do with work, where a wellness program was so unpopular that I needed an appeals process to get out of it.  Not to mention the very questionable screens they want to run on your employees.

4) In some of the assertions you make regarding the folly of using motivational tools to promote wellness you’ve used Penn State as an example of how things can go wrong when an organization utilizes extrinsic incentives in an attempt to persuade employees towards better health.  In a recent WellSteps seminar, Dr. Steven Aldana said that after checking in with Cassandra Kitko, an adjustment was made at Penn State that merely repositioned the penalty as a reward? In other words, little has changed there although the remarketing of economic incentive has muffled the criticism. In your experience have extrinsic motivators ever been effective? Or, in your opinion, are economic incentives always going to be “forced wellness”? If yes, how? If no, why do you think that is?

Dr. Steven Aldana is not one for fact-checking. He has called me a liar before, but has never provided an example of where I have allegedly lied. I don’t mind. As you can tell, I love the fact that he’s calling me a liar. The truth is Penn State’s original program is gone. It’s done. There’s no spinning of that statement. His statement is incorrect and I’m pretty sure he knows that he is incorrect. If you look at Dr. Aldana’s website, he’s got a wellness ROI calculator. If you put in zero for “annual cost increase”, it doesn’t matter what other variables you put in, by the year 2020, you always save $1,359 an employee. So, he essentially made it up.

In terms of extrinsic motivation, I actually do find that there is a place for extrinsic motivation. The thing about extrinsic motivation is that it only works once. It works to get somebody to try something. And, after that, they have to like what they are doing … they have to want to do it on their own. Otherwise, you simply have to basically keep paying them, and paying them, and paying them to perform the desired behavior. I, myself, was extrinsically motivated to do something healthy once. In fact, ironically — and here’s the fun part. This is that NASDAQ company I was telling you about, Peer Review Analysis, and we were going to switch to self-insurance. I looked around, and we had a lot of nurses there. Nurses, ironically, have horrible health habits. So, I thought: well, if we are going to go to self-insurance anyway, I should have a fitness contest and give people $50 as a reward for participating in fitness activities. What happened is that, of the 100 people in the company, the same 20 who played on the office Frisbee team and the volleyball team were the same people who signed up for this program. The other 80 could have cared less. I, myself, signed up for the program. What I started doing was, out in the western suburbs here of Boston, is I started riding my bicycle to work in mid-town to collect the $50. Well, guess what? That was 1994 and, essentially, every trip I take from mid-town Boston that doesn’t involve snow, rain, or dead of night, I do on my bicycle today because I basically paid myself $50 to do it once and I loved it!

So, I think motivation has a role, but it’s a role of trial and it’s a role of doing something once. It’s not a role of continuing to raise incentives until you get someone to do what you want them to do. We don’t need to force people to do things that they just don’t want to. It is not good for companies, and it is certainly not good for employees.

5) One thing I have found challenging about the recent affinity the workplace wellness industry has had with BJ Fogg is that his popular behavioral model softens the importance of environment. It takes the work of Kurt Lewin and then glosses over the significance of external factors. As a layman of your work, I get the sense that you also advocate that wellness “wins” can be made through environmental design. Is my assumption correct? And in addition to this assumption, right or wrong, where else do you see organizations getting it right?

Yes, without question. I am far from an expert in this field. In my opinion, what you want to do as a company, and if you listen to the wellness industry they advocate this, too, it’s all about creating a supportive culture. As the leader of a company myself, what I’m trying to do is I’m trying to make my organization be as valuable as possible. Part of that is creating an environment where people want to come to work. But, ironically, wellness vendors have essentially nothing to do with creating a culture that makes people excited to go work. To the contrary, the evidence shows many of these types of programs create cultures that do the opposite.

Simply being mindful of environmental factors can have a huge impact. I have an excellent example of that in my book with Tom Emerick, Cracking Health Costs. Back to Peer Review Analysis — it’s going to sound silly — after employees complained about the conditions of our bathrooms I contacted the management of our office building we were in and asked, “How much extra would I have to pay you to clean the bathrooms twice a day?”

We came to an agreement and I paid them probably less than what would have financed a wellness program for probably 20 people. So, for the cost of the wellness program for 20 people, I had the restrooms cleaned twice a day and I don’t think there was an employee in the company who didn’t take notice and was grateful.

What did this accomplish? The organization was telling the employees they mattered. And you weren’t telling them by making some pronouncement that they mattered or by giving them lunch once a month. What you were telling them on a daily basis, doing something very unglamorous — I mean you can’t get more unglamorous than that — is that they matter.

Interview with Bill McBride about Fitness Delivery

Bill McBride is the co-founder and CEO of Active Sports Clubs. He is an industry veteran in the field of health and wellness, and has served as the Chairman of the Board of Directors for IHRSA, a Board Member on ACE’s Industry Advisory Panel, and currently serves as a Medical Wellness Advisor for the Medical Wellness Association. Bill also sits on the advisory board of several other companies including Fit3D, Club Solutions, Club Industry and previously has worked with Zuberance and MiGym. Bill has been a mentor of mine for several years. You can learn more about Bill at his personal website

1) Given your vast experience in the wellness industry what are three universal truths in “getting it right” that apply to all fitness delivery (not just health clubs) that have surprised you in the sense that they are not industry standards?

  1. There is a lot of fitness delivery that is “contracted” on the assumption it is all homogeneous – a commodity. I need a clean “house”, so I hire a housekeeping company.  I need fitness, so I hire fitness people.  Fitness is very personal and people that are qualified and engaging are critical; but for a company, the brand delivery and standards that the brand represents are also critical.  Getting the right people on the bus, training, and “enrolling” fitness delivery professionals seems to be a constant challenge in all aspects of fitness delivery (regardless of distribution channel).  I am not surprised by this fact, but I am surprised by the slow progression in solving this problem on a broader scale.
  2. The true power of group fitness is often discussed and most people “get it”, but it hasn’t been truly leveraged as of yet. Think for example of “Debbie’s Class” – Debbie is a member.  Why not have a class just for Debbie and her friends?  Why not personalize group fitness further?  This could be done with school mom groups, civic groups (Girl Scouts), and neighborhood friends that walk together, etc.  Personalizing group fitness is rarely approached in this way. Approximately 44 percent of club members exercise with a friend. There is an opportunity there. 
  3. I’m surprised by how many health clubs look the same in regards to layout and offering. The lack of true differentiation and uniqueness in the space seems intriguing.  This is what Curves figured out earlier on.  We need different configurations and approaches to bring in new members. 

2) Why do you think the health club industry has not been more involved in the evolution of health technology? Only recently are you seeing health clubs really integrated with digital health devices, when the industry (as the experts in the area of wellness) could have had more of a hand in shaping these products?

Human nature seems to favor a scarcity mentality, instead of an abundance mentality.  I think club operators were (or in many cases are) afraid of outside “competition” that could cost them members.  Even my friends at MYZONE, whom I’m a big fan of, were reluctant to open their system for participants to download their data at home until recently.  I asked them over 4 years ago to open their system because I wanted our members to download and see their data in real time.  Their position back then was ‘no’, we want users to go to the club to download their data, this forces a club visit for our clients’ clubs/gyms. In their defense, they viewed their product as a club retention tool, not an activity increasing tool. While on the surface that may make some sense, just as scarcity mentality always seems to make sense in the short-term.  But long-term, an abundance mentality always wins out.  MYZONE came around and gave me some credit in their shift in thinking, but the world has already realized it’s a transparent, information-based reality now. Clubs have to realize this and embrace broader thinking as active lifestyles will always need professional human support.

3) You and I are both fans of Michael Porter. I just read Zero to One where Thiel builds off Porter’s ideas and suggests that the current entrepreneurial dogma of iterating off competitive ideas is a race to the bottom. In the book Thiel highlights using examples how perfect competition can destroy an industry. I believe a case could be made that is happening in the health clubs industry, especially anyone that goes up against the main chain operators. Where are people getting is right in the industry? Put another way, what are the common attributes of the players that are able to rise above the low cost health club model?

This is the million-dollar question.  The high-end that can’t be replicated with ease (cost of entry too high) will always serve a consumer need: Exclusive, lifestyle, family and prestige based. These companies create an emotional bond, evoke status and its members are brand connected and in many cases for generations (think Four Seasons, fine dining, etc.).  The low cost play will also have a steady stream (think fast food or Motel 6). It’s the accidental middle that are in the most trouble.  Middle price point players with a strong value proposition (reasonable but not low price) and a very controlled expense structure can do nicely if engineered properly.  Now for the current twist, we have the boutique offerings – not a high cost of entry, but a very high perceived service level.  In this modality, I think boutique hotel (Kimpton or Joie de Vivre).  These are high service offerings and very nice, but relatively small and some “nostalgically older”.  The concepts that are too trendy seem to be short-lived.  So anticipated trends versus modalities that stay around is another avenue of consideration worth thought. For example karate, yoga, Pilates and cycling have proven not to be trends. And how low can the low price point go? I heard recently of a $5 a month club.  At some point soon, I expect to see a “free” club model with all revenues and profits come from ancillary programming like retail, clothing lines and ads within the club. Free with premium offerings, or a play like Pact where you actually get paid to workout.  I agree with you that a large segment of the industry doesn’t appear to be working towards adaptation. 

4) Guessing that you do not think this question is an all or none proposition, how do you think the rapid expansion of workplace wellness programs, and the emergence of open access residential wellness solutions, will evolve how (and who) is providing fitness delivery today?

There are many corporate wellness companies in the space already.  The older ones are simply staffing agencies.  Nothing wrong with that, but there is an opportunity for the health club management providers to play a much bigger role than they do today.  Free fitness access is here in a lot of places and it will continue to grow.  Parks, trails, in hotels, on company campuses and residential complexes – access to activity and fitness is going to continue to rise.  Wellness is a nebulous term.  What does that mean?  Lifestyle engagement and promotion of activity through fitness, movement, sport and recreation will grow and prosper.  The industry (health club or health club/fitness center management) must realize the genie is getting out of the bottle..  Think abundant solutions and total well-being, not just fitness and not just what can accomplished in a single space.

5) I know you enjoy the guesses of futurists and are an inherent forward-thinker. Regarding fitness delivery, you wrote a great article for Club Insider (Are We Asking The Right Question?) where you answered the question, “what will be the same in ten years?” Your argument for taking this approach was it is a more compelling question than “what will be different in ten years?” This is probably true; however, it does leave me the opportunity open to ask it, “What will be different in how we will deliver fitness in ten years?”

I believe the industry will be forced to morph from sales and marketing with great facilities (as the current historic primary focus) and more towards programming, coaching, wellness/medical services in very engaging environments.  We will see different looking clubs (I hope) with much more holistic services and creative designs.  I envision it to Lifestyle Centers …not just rooms with equipment, as those rooms and outdoor spaces with equipment will be commonplace by then.  And not just studios to move around like we have today… It will be more about the “feeling” and “community”.  This is where technology and wellness/medical integration will be game changing.  I see more with wearables and digital health that support total well-being, disease management and prevention.  Technology that can help people form and maintain habits, make activity/exercise more “fun” or “tolerable” and support individuals utilizing wellness professionals to improve their quality of life.  A lot of people in our industry focus on results.  Results are a by-product of a great offering.  The focus should be on delivery and habits.  I do believe that great structural design, warm & friendly social activity and innovative programming will always be around …just as we will still have hotels for rooms away from home, and great restaurants for good meals on the go …but there will be disruption like hotels saw with the shared economy (Airbnb) and restaurants saw with social shopping (Groupon). There are big things on the horizon and I am excited for the future.


Interview with Dr. Robert Rucker about Nutrition and Academics

Dr. Robert Rucker is a Distinguished Professor Emeritus in the Department of Nutrition and the School of Medicine at the University of California at Davis. A list of his accomplishments include tenure as the President of American Society for Nutrition, an American Association for the Advancement of Science Fellow, as well as an American Society for Nutrition Fellow. Dr. Rucker has over 35 years of experience researching nutrition and biochemistry. He is also my father and is the ghostwriter for almost all of the pyrroloquinoline quinone (PQQ) content found on this website.

1) One of the debated topics in nutrition is whether weight management is really just a matter of calories in/calories out; or alternatively, significantly influenced by the types of calories that are consumed. Based on your rich understanding of nutrition and biochemistry, where have you landed on this debate?

This question is not as easy to address, as some would make it.  Energy regulation – the factors associated growth, work, and maintenance of body temperature – is complex and multifaceted.  Clearly when energy intake is less than needed, body tissue becomes a metabolic energy source; however, weight gain or loss as inferred from periodically weighing oneself on a scale is not a function of a simple algorithm, particularly in the short-term.  As it relates to weight gain or loss of body tissue, each of the major components contain differing amounts of energy.  For example, a pound of stored fat is ~ equivalent to 3600 kCal per pound.  Muscle tissue is the equivalent of 700-800 kCal per pound.  Independent of its water content, a well-nourished adult has about 400-500 grams or 1600- 2000 kcal of stored carbohydrates, mostly as liver and muscle glycogen.  When or how much of a given tissue is utilized as energy sources varies depending on the timing of meals, exercise, and a need to maintain body temperature. Utilizing tissue energy also causes varying amount of water release. Thus, 2-3 days of severe dieting (e.g., generating a 3000-4000 kCal deficit) could translate into a one-pound loss or a 5-7 pound loss, as measured on a bathroom scales, depending on factors in addition to only estimating calories-in minus calories-out.

Regarding diet composition, there are a number of scenarios wherein the composition of food also plays a role in net weight gain and loss.  An obvious one is a diet high in simple sugars, particularly fructose or high fructose corn serum (HFCS).  Our knowledge of the control energy homeostasis has increased dramatically over the last decade resulting in an appreciation that food or energy intake is orchestrated by complex signals originating from adipose tissue, the pancreas, and the gastrointestinal tract, plus others.  Differences in food composition can affect these signals, which in turn can influence food intake and body heat regulatory circuits.   With respect to fructose or HFCS, both are weak stimulators of insulin and the adipose-derived hormones that control food intake, in contrast to glucose, a much stronger stimulator.  Moreover, although fructose is eventually converted to glucose, the process is not rapid and fructose, as such, is not “stored”.  And, fructose is a better “driver” of triglyceride synthesis than glucose.  Add to this that body heat regulation is very precise.  Compounds, such as fructose, that are rapidly absorbed and are not easily sequestered or rapidly metabolized can compromise body heat regulation.  Thus, calories from fructose or HFCS are less likely to allow one’s metabolic system to regulate itself at least in the short term. 

What can happen? The liver slows oxidative metabolism when there are energy excesses, particularly if an abnormal elevation in the body core temperature can result.  What the liver may perceive as an excess of potentially hazardous fructose-derived calories are converted to triglyceride and next sequestered away in adipose as a protective strategy.  In this regard, some of the energy derived from fructose is rendered ‘out of the picture’ and may even result in some weight gain, because of its conversion and “storage” as fat.  

Again, these kinds of questions are not easily addressed.  An example that I sometimes use in lectures is that over the course of a year, most in the class will consume anywhere from ~ ½ to one million calories (at a daily expenditure of  ~1500 to 2500 kCal per day, which translates into consuming a ~ton of food per year).  Given that an annual normal weight gain or loss is usually no more than a pound or two, it says a lot about the exquisite precision of food intake regulation, as well as body mass and heat regulation.  Throw in dozens of genetic factors and other variables and it is easy to ascertain that there are good reasons for controversy and our inabilities to address (easily) weight management when it deemed important.

2) Given all that you have researched, what are the three most impressive compounds you have come across (other than PQQ)? You can choose either based on their historic significance and/or the fact you have been impressed by their demonstrated physiological benefit.

In the late 1700s – Antoine Lavoisier, the so-called “Father of Nutrition and Chemistry” described that metabolism and oxygen were inexorably linked.   He also demonstrated oxygen was related to animal heat production.  Accordingly, oxygen would be one of the molecules.  In the latter part of my career, concepts related to cell signaling and secondary signaling molecules begin to be major influences.  As a consequence, Nitric oxide (NO) and 3′-5′-cyclic adenosine monophosphate are two others that I would add.  NO is an important cellular signaling molecule involved in many physiological and pathological processes; cyclic-AMP works in part by triggering the activation of certain proteins involved in cell signaling.  Knowledge regarding their underlying mechanisms of action facilitated my way of thinking about the mechanisms of action of certain dietary biofactors, such as pyrroloquinoline quinone (PQQ).

3) As the world increasingly points to poor nutrition for the rise in healthcare costs, little has been done to improve the nutritional education in top-tier medical schools. You were a nutrition professor at a top-tier medical school. Why do you think this is?

A part of the answer is that there is no medical board certification for nutrition.  There are 24 boards that certify physician specialists.  Many hospitals demand that physicians must be board certified to practice or bill for a specialty.  Accordingly, when there are nutritional issues, they are usually handled by a paramedical (i.e. a dietitian or a nurse) or occasionally a pharmacist with nutrition as a sub-specialty.

With that said, many medical schools do give nutrition training some kind of “lip-service”, although it is often less than it used to be. Most medical schools have moved to more integrated curricula and problem-based learning. At Davis there used to be a strong course in nutrition, but as the Davis medical school curriculum became more and more integrated, the visibility of nutrition was truncated.  Regrettably, as long as nutrition remains as a non-board certified area, I don’t sense that there will be a move to make nutrition more visible, even though there is seldom an argument regarding its importance.

4) On the topic of research, some of the fondest conversations I’ve had with you are discussions regarding the thoughts of intellectuals who take either side of Thomas Kuhn’s work. We have discussed articles like The Truth Wears Off and books like Laboratory Life. Do you think there is “real world” truth to be found, or do you think as seekers of the “truth” we are tasked with inventing it?

As a starting point, I agree with Kuhn’s premise that scientific advances are characterized by dynamic shifts in thinking, i.e. what he defines as paradigms,  ” universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of practitioners”.  In my life time, the major paradigm shifts that have most influence my thinking as a biologist have been: 1) the Watson and Crick model of DNA and its importance, 2) concepts related to cell signaling, 3) concepts important to epigenetics (changes in metabolic regulation caused by gene expression rather than an alteration of the genetic code itself), 4) polymorphisms  (metabolic changes caused by point mutations in a gene or genes), and descriptions based on metabolic allometric scaling (ways of describing how the characteristics of living creatures change with size).  If I were to note more fundamental principles – Darwinian evolution, the principles of thermodynamics applied to biology, and the concept of nutritional essentiality in the context of given nutrients or metabolic processes would be at the top of the list.  Each of these paradigms can be described historically in the context of Kuhn’s stages of scientific development, which ends with the establishment of concepts that truly influence changes in how we think about a problem.

Regarding ‘Are there real world truths to be found?’ I certainly hope so. However, to find such truths, I would argue that one has to engage in clear rational thinking directed at seeking out evidence for the truth; a process along the lines of what Richard Dawkins implies, when he emphasizes the importance of asking the right question.  In contrast, inventors of “truth” in my experience tend to be more concerned with faith, authority, or profit (in a broad context).

Although far less philosophical, the Jonah Lehrer article in the New Yorker, The Truth Wears Off, also provides some very important perspectives that – as you note – have been the topic of several of our discussions.  With respect to nutrition, this has been an interesting period, particularly as it relates to the assessment of validity and reliability of certain nutrition-related assertions and their presumed relationship to important health issues.  In some instances, our lack of rational thinking has caused some “true believers” to promise too much.  For a premise to become health policy, the data and observations behind it must be reliable and reproducible.  Unfortunately, we too often let belief and personal perceptions over ride the facts of a given question or premise. 

With regard to why there is so much controversy as it relates to nutrition, some reasons that are developed in the Lehrer article, such as those offered by John Ioannidis (e.g., Why most published research findings are false. 2005; PLoS Med 2: e124) are provocative.  However, they are mostly statistically in nature.  Now that we have larger and presumably better databases and better tools to examine them, plus the ability to ask better questions, it should not be surprising that some amount of previously published research may not be easily or consistently replicated.

I tend not to throw barbs, if the studies in question are complex in nature and initially were carried out for a good purpose.  As an example – In studies of osteopenic bone diseases, such as osteoporosis, the highest rates for hip fracture, as an outcome measure, are often observed in those of Scandinavian decent, who are located predominately in the North Central parts of the US. The lowest rates for hip fracture are observed in those of African decent, who are located predominately in the South.  Consequently, it is not unreasonable to surmise that observations related to hip fractures made 3-4 decades ago in studies performed in Minnesota or North Dakota may not match the results of similar studies, if repeated using a contemporary and highly diverse Californian or Floridian based subject pool, some of whom may be a blend of an identifiable Scandinavian and African-derived gene pool. Further, studies for purposes of comparisons are often difficult to match with respect to the age, sex, and/or activity levels of subjects.  It is now more difficult to control environmental and epigenetic factors than in the past, because of our ability and freedom to travel or consume more diverse diets.  With more genetically diverse subject populations and more complexity in lifestyle, there is greater likelihood that there may be regression to some kind of statistical mean, i.e. less significance noted in a study than may have been noted previously. 

Other issues are barriers that we have rightly put into place for the protection and more ethical treatment of subjects. For example, many of the early paper regarding basic human nutritional requirements were reasonably correct in their conclusions.  However, the studies were often performed using institutionalized individuals (prisoners or mental patients) who could be studied for long periods or subjected to metabolic risks using protocols that simply cannot be used today. 

The ways that we report and characterize research can also present problems. Current research often uses past research as a potential starting point or platform, i.e. Kuhn’s second level of discovery before an actual paradigm emerges.  However, most research (past and present) is/was not published unless its outcome demonstrates some type of statistically significant positive effect.  It is the common practice of most journals not to publish null or negative observations.  Again, it is not unreasonable that some current replications of past work may differ, particularly when there is a better sampling of subjects and use of improved analytical methods. 

More troubling to me is the mismanagement of data by those who should know better.  The reason why some health-oriented work cannot be reproduced is because it is the product of data dredging designed mostly to identify relationships with some arbitrary level of statistical significance. If the “data dredge” is merely a search for statistical significance, it is too easy to make wrong inferences.  There is little wrong in using an arbitrary statistical endpoint to better define a hypothesis or question, but to report such findings as facts without some type of independent conformation or validation is disingenuous at best.  More egregious, of course, is reporting only selected data in order to show some kind of statistically positive effect.  There is also dishonest reporting.  When I was more involved in journal editing and management, it was troubling to discovery that work using the same pool of subjects had been published in different formats in other journals.   The issue was not so much self-plagiarism or lack of consolidation; rather, it was the implication that the observation submitted to a given journal was from different sets of independent observations. The number of independent research papers on a given substance is sometimes used as a measure that the product is safe or efficacious. One may have a different opinion of efficacy or safety with the knowledge that the reported data was from a single set of subjects, rather than multiple independent sets of subjects and each reported in separate papers.

Regrettably, the commercial nutritional supplement business is perhaps the worst offender.  Very little research is done independently and most often is driven by marketing goals.  As we now know, it is possible to buy the results that you might want from some of the commercial research outlets for publication in one of the dozens of online journals, many of which serve as “vanity presses”.  The other areas that compromise good nutritional practice are the constraints placed on the policing of the supplement industry, because of the Dietary Supplement Health and Education Act and the impact of having it as a part of our National Institutes of Health, a National Center for Complementary and Alternative Medicine.  The Center’s goal is to support research and provide information about complementary health products and practice, but what it defines as evidence-based medicine often isn’t, and credibility is given to alternative concepts, where little is deserved.

5) Piggybacking off that, as I embark on my own journey aspiring to be an expert in the field of workplace wellness, based on your vast experience, what advice can you pass down to me as I continue the search for “truth” with a drive to contribute to the greater good?

Success, particularly the effective movement of ideas, is all about “networking”.   Bruno Latour and Steve Woolgar clearly make this point in their book, LABORATORY LIFE: The Construction of Scientific Facts. I was lucky enough to be mentored by individuals who can trace their academic history back to those who discovered or defined the functions of given vitamins or nutritionally essential minerals.  What was transferred to me, as a part of that network, was a way thinking; also the importance of maintaining a high integrity. It is also essential to have a thought out, as well as thoughtful, work plan; and, as Latour and Woolgar note, one’s credibility rests on whether you are perceived as reliable.  The challenge is to maintain integrity in workplaces (e.g., the commercial aspects of nutrition and wellness) that often talk about integrity and validly, but seldom want to test for it, and that are driven in large degree by the marketing of what are sometimes shallow promises.


Interview with James Pshock about Workplace Wellness

James Pshock is a well-established thought leader in the area of workplace wellness. He is the president and founder of Bravo Wellness, whose mission is to deliver exceptional services and products to organizations seeking to help their workforce achieve optimal health through incentives. His experience in the health insurance and wellness industry spans over two decades. James is an Ernst & Young Entrepreneur of the Year Award winner, and is also a committee member of HERO, an advocacy group for the advancement of workplace wellness.

1) The recent documentary, Fed Up, presented evidence that lobbyists potentially have garnered a narrative regarding obesity to be too heavily focused on activity, resulting in a lackluster focus on nutrition and food intake. In parallel, there seems to be an abundant focus on physical activity with regards to workplace wellness in comparison to other areas of behavior change. In your opinion, why do you think that is?

I am not sure I completely share this observation, although it’s true most programs are activity-based (in the sense that many programs involve activities, like taking part in a step challenge or watching an instructional video) and I think in many ways it’s because activities can be measured, and because these programs are relatively easy to implement. Whereas, with food, we can think back to second grade when your mom sent you to school with an apple in your lunchbox, and you would trade it for a Twinkie, and she would never find out. You can educate people. You can give them the food, but it doesn’t mean they are actually going to eat it. And, plus, you have the complexities of allergies, and food preferences, and people who just don’t like the taste of what you’re telling them to eat.

Focusing on nutrition can open a Pandora’s Box. If you’re going to go down that path of telling someone what they ought to be eating, then you’re going to have to be willing to deal with a lot of personalization and accommodations, which is no easy feat. We tend to focus more on the “why” than the “what”, and sharing the message of personal accountability for your health… this empowers the individual with a directive, but also the power of autonomy to achieve it.

2) In a 2014 New York Times article about Workplace Wellness the author contends that programs that focus on lifestyle change potentially do not reduce costs but move them from the employer to the employee. Putting aside there is evidence to refute this claim as factual, where does the responsibility of the company end and the responsibility of the employee start?

There are a lot of deep issues loaded in this question, everything from an entitlement mentality to employees who recognize health insurance as a “benefit”. Almost any company was not founded on the premise of being a health insurance provider. Insurance is meant to be a benefit. Yet, so many people just kind of have an entitlement mentality that really shelters them from understanding the true cost. Most people are unaware of the role that they individually play in determining what that cost is. Dental insurance is a great example. Historically, dental insurance has had 100% coverage for preventative services and something like 50% coverage for restorative or repair services. Look at the statistics. The result has been a phenomenally high rate of prevention because the benefits are typically pretty inadequate for major restorative services. People take better care of their teeth. Prescription utilization versus generic utilization is another good example. For years organizations asked people to use generics and told them how much money the company would save if they used generics, but it was not until employees saw a pretty dramatic difference between the co-pays for generics versus the co-pays for branded drugs that companies began benefiting from the shift in consumerism to utilizing more generic drugs.

A final example is pension plans versus 401(k)s. For decades, the norm was to have a pension plan and your employer would pay you after you retired. And, as that shifted to a 401(k) model – you put money away, we’ll match it – it shifted the responsibility for post-retirement security to the individual versus the expectation that the company I work for is going to take care of me regardless of how I behave.

I believe we are just on the forefront of that happening in health insurance, where it’s not a cost shift thing. It’s simply shared responsibility. And, as that message of shared responsibility takes root, there are people who are going to say, “Well, you just shifted the cost to the people who refused to do anything about their personal health or their preventative risks.” And you could absolutely look at that and say, “I guess that’s one way to look at it.” But, the lens we look at it through is really more in line with the concept of transparency and shared responsibility. And for those who have a hard time accepting responsibility, they will likely be resistant to this change because their perception skews towards entitlement.  

3) For a small to midsize business (SMB) with limited resources, how does a SMB choose what aspect of wellness to focus on and what role does a company like Bravo Wellness play in that decision making process?

There is a value in having some type of wellness program regardless of the size of your organization. However, when you talk about the concept of workplace wellness, it is important to note that it is enormous and complex. For example, you might be looking at something as basic as smoking and say, “Well, you’re going to add years to the end of your life if you quit. Don’t believe us? Here, we can show you all these studies of morbidity rates improving if you stop smoking.” But smoking is not the problem, in this case it is a symptom of severe depression. I mean the last thing on their mind is living longer, and we are discussing morbidity. We are making all these assumptions that what is important to us is important to them.

There is not a one size fits all unfortunately. What I have seen is that where you might see fantastic results in one environment, you take that exact same program and put it in a different company, with a different environment and culture, and it could fail. An environment that is based on teamwork, and very collectively working towards common goals adopt things differently than siloed organizations. Bravo Wellness helps organizations think through what they are trying to accomplish. What has been surprising for me is how many companies want a wellness program, but have no idea what they’re trying to accomplish. If your goal is to try to be recognized as the “healthiest employer in your city”, what does that mean to you? Your health related costs are going up 20% a year but the health of your organization has vastly improved, that might be what you are after. An assessment needs to be done of the organization: What are they trying to solve for? How will they handle those issues that will appeal to the broadest number of people? If further down the road they still have some people who aren’t making any good choices, how will they pivot?

4) The definition of wellness coined in 1995 by Anspaugh, Hunter, & Mosley talks about wellness in the context of the workplace as ‘a composite of physical, emotional, spiritual, intellectual, occupational, and social health’; Given the complexity of what constitutes one’s “wellness” is it even realistic to expect workplace wellness programs to encompass all the components of wellness? Or is it suitable to assume that programs should focus on maximizing efficacy by doing a few things really well in concert with other wellness providers (outside of work)?

How wellness is defined and how you start to educate your population, you treat this as a mission. I like the fact that we’re not just saying wellness means the five biometrics mandated by legislation. Like in our case, we’re limited somewhat in that by way of regulation we really only have five things that we can tie into and have contingent incentives or penalties against. That doesn’t mean in any way we are not trying to identify other risks, educate people, and equip them to take positive action for their emotional health, spiritual health, and other things that could really have a profound impact in their life. You should put it all out on the table. Where you’re going to focus your actual interventions, after all my experience on the TPA side as a buyer of wellness programs, and then our experience in the last six years facilitating them …I have landed on saying: educate and equip, provide the tools and resources, but reward people for results, not how they chose to get there.

An important consideration is the privacy aspect of wellness, employer’s limitations on asking certain wellness questions (even if well-intended), let alone obvious legal exposure regarding spirituality and things of that nature …there’s certain angles here that no employer, after they talk to their attorney, are going to be willing to do or should do for that matter.

5) Looking back at your extensive experience in the industry, what are the key elements that contribute most to the success of a corporate wellness program? Have there been any surprises?

The sole message of equipping people versus mandating how they need to get to “wellness”, the right tools, and a focus on results is what I have become more and more convinced is critical. Trust throughout the entire organization is also important. There needs to be transparency, so the employer can share the true cost of benefits. For example, a company says, “We get charged $1,100 a month from Blue Cross. We’re paying 80% of it. But, we are willing to pay up to 90% of it if you do these things.” It is eye-opening for a lot of employees who had no idea how much the employer was already paying on their behalf and what they were basically getting for free. And that certainly adds to their acceptance of responsibility, as well as better buy-in which is at the heart of success of any wellness program that is used as a tool to improve some aspect of employee well-being.

Interview with Dr. Chris Bingham about Fostering Innovation

Dr. Chris Bingham is an award-winning professor of Strategy and Entrepreneurship at the Kenan-Flager Business School at the University of North Carolina. Dr. Bingham received his undergraduate accounting degree and MBA from Brigham Young University, and received his PhD in strategy, organizations and entrepreneurship from Stanford University. Currently Dr. Bingham’s focus is the process of accelerated learning in the context of seed accelerators. Dr. Bingham’s complete biography can be found here.

1) You have presented how one can use the Nadler and Tushman’s Congruence Model to foster and/or improve innovation within an organization. Is this more a function of a healthy organization being more innovative, or are there certain aspects specific to the Congruence Model that lend itself to creating an innovative environment within an organization?

There are different components of the Congruence Model, right? You’ve got task, you’ve got structure, you have got people, and you have got culture. And, sometimes, people will tweak this model a little bit, but those are basically the four parts. The whole point is, if one of them is off-kilter, then you can have some problems.

So, I believe in the model. I believe in the congruence. If I were to look at one of the elements that I find the most intriguing, it’s probably structure and here is why: Because I believe the counter-intuitive insight when you’re trying to innovate is that when markets become more dynamic, more ambiguous, often the best strategies are the most simple. And that’s an insight that a lot of people don’t get because what happens over time in organizations is you build up more and more structure – that is, more policies, more rules, more manuals, more routines… what that ultimately does is create inertia. It creates bureaucracy. It makes it difficult to change. Organizations are trying to become more efficient and that’s what the structure does, organizations become efficient but at the expense of flexibility.

So, if you think about a spectrum, you’ve got efficiency on one end and you have got flexibility on the other. There is a natural force pushing firm imperceptibly towards efficiency at the expense of flexibility. And so I think, as leaders, what you have to do – if innovation is key for you – is you’ve got to deliberately pare back structure. I’ve been looking at innovative companies across many different industries, and what you see is they will provide a little bit of structure, but within that structure, there’s a lot of room to adapt. For example, Yahoo, in its early years had a few simple rules shaping their partnerships: (1) don’t do deals if it jeopardizes the user experience, (2) no exclusive deals, and (3) the product or service must be free.  Those rules provide some structure and guidance (securing some efficiency), but within those rules there was a lot of room to adapt.

2) You have also stated that there is evidence to suggest a diverse team dynamic promotes an innovative culture (highlighting Under Armour’s Board as an example of this). In addition to simply gaining expertise outside of an organization’s industry, are there other considerations or strategies one can use in building an effective team through diversity?

You can think about diversity from lots of different angles, right? Functional diversity, gender diversity, age diversity. But, I believe the key point here is trying to find people who disagree with you. And that’s a little non-obvious. You want to create task conflict (i.e. when people disagree with you) without creating affective or personal conflict. Task conflict often is helpful because an organization can avoid premature convergence on what might be a suboptimal plan. It keeps you from jumping into things too quickly. Also, studies show task conflict leads to improvement in team decision making effectiveness. And when this works, team decision making effectiveness improves not only satisfaction with the team, but also team performance.

The other question is, how can you find these sort of disagreements naturally occurring within organizations and what do you want to do about it? I think what you want to start looking for is internal disagreements that might come up when you are trying to develop a new service or a new product. Marketing and finance almost always are going to support the status quo because their incentives generally come from knowing the existing product. New innovation presents a risk to their livelihood.

Engineers and R&D folks are often the ones who will be pushing new and disruptive ideas. They are looking for what’s going to be best from a customer perspective and/or from a product perspective. This natural tension is good. Look for those natural disagreements to find balance.

Diversity is also key for brainstorming. A dictum at IDEO is, “Go for quantity” in its brainstorming sessions. So, it’s not untypical in an hour-long brainstorming session at IDEO for them to come up with ~100 different ideas for something. Without this practice guideline what will often happen is the power players in the room are going to get out their ideas first. And, then other players in the organization start conforming. They are going to start saying, “Oh, yeah, that’s a good idea.” Any idea they might have had gets stifled and factions start to form around the power people’s suggestions and you don’t get much further than that. And, then, it becomes just sort of a power game. In contrast, if you can just start saying, “Hey, look. Let’s get out 30 ideas in the next 30 minutes and let’s get 100 ideas in the next hour,” what happens is it quickly becomes more objective. So, you actually depersonalize it by getting high numbers of ideas out there from a diverse group maximizing the organization’s available choices.

3) One way an organization can successfully tap their market for ways to innovate is to ask themselves, “what job is our customers hiring us for?” What are some other key strategies an organization can use to tap their external market for ways to innovate, rather than simply continuing to iterate and improve?

There is an innovator’s series of books: Innovator’s Dilemma, Innovator’s Solution, Innovator’s DNA. There is now a new one out, Innovator’s Method. What I believe these books are missing is an understanding about the social innovator. Not social in the sense of social causes, but in the sense of innovators that tap community. Crowdsourcing is a great example. For example, Monopoly fans voted on Hasbro’s Facebook page to get rid of the old flat iron playing piece and adopt a new cat playing piece instead. Scrabble players vote on which new word to add to the Scrabble dictionary. It is a really powerful channel when an organization taps into its external constituents.

The other thing you’re starting to see, from a social perception, is innovation tournaments. Netflix did this a couple years ago to improve one of their predictive algorithms. My understanding is it was a very diverse team of academics and industry experts that came together for this. You are starting to see more of these innovation tournaments produce some really amazing ideas. Customers prove to be really helpful for insights. They can help you identify problems and solutions in ways that prove difficult for internal resources (for a variety of reasons).

4) It appears that health-related wearables are in the process of “crossing the chasm” and are here to stay. In your opinion, what is important to get right as we move on from early adopters, to catering to the early majority regarding these products?

So I think your question, simply put is, “how can you help the early majority?” In other words, how can you help cross the chasm, right? What do you need to do to help this new market? If you look at innovation diffusion theory, it’s actually a pretty old, well-established theory. We know early adopters are a fairly small group, where the early majority is a bigger category (more than double that of the early adopter group). If you look at differences between early adopters and the early majority, what you will see is the early majority is more pragmatic, a little more cautious, and want some proof of benefit. What they really want is the understanding that this is going to become a social norm, not just a benefit. They want refined technology to improve ease and convenience. They want a lot of stories of the innovation’s effectiveness. An interesting thing that builds on this diffusion model is actually looking at how adoptions occur. And what you’ll find – and this is actually pretty interesting – is in the early years adoption is generally based on mass media, but when you start hitting the early majority, what becomes really critical is adoptions occur more due to interpersonal communication. The social component therefore becomes really critical to get the early majority onboard.

5) The way people consume fitness is changing, especially with regards to modality, delivery, and provider. Michael Porter says a disruptive technology is, “one that would invalidate important competitive advantages.” Now that you have examined the health and wellness landscape, what are some of your predictions about how people will consumer fitness and wellness over the next five to ten years, and what does that mean for traditional health clubs?

I wish I could look into my crystal ball and get a more precise answer for you. There are broad trends that are affecting lots of different industries we can discuss. One key trend is mobility. If you look at the time spent in mobile apps in 2014, it’s gone up 50% from 2013. And that’s crazy, 50% in one year, and most of this is coming from just mobile apps. How does that exactly work for the fitness industry? I’m not quite sure. But, I think ignoring it or assuming that you don’t need to address it is not the right approach. So, I think that’s one very big influence that’s going to affect how people consume fitness and wellness over the next five to ten years.

Another trend is the idea of accessibility and simplicity. Some think of innovation as additive. I’m adding new features, new services, or whatever. Yet some companies like Google are innovating by subtracting things, and pulling things out, and making their product simpler, and more accessible. With Google Docs you don’t get all the features of Word, but you get the most essential ones. I think if you think about these three big trends of mobility, simplicity and accessibility; I think that’s going to really influence the way that people consume fitness and wellness over the coming years.

Interview with Ben Greenfield about Elite Fitness and Endurance Training

Ben Greenfield is an ex-bodybuilder, Ironman triathlete, professional Spartan racer, coach, speaker and author of the book “Beyond Training: Mastering Endurance, Health and Life” ( In 2008, Ben was voted as NSCA’s Personal Trainer of the year and in 2013 was named by Greatist as one of the top 100 Most Influential People In Health And Fitness. Ben blogs and podcasts at, and resides in Spokane, WA with his wife and twin boys.

1) There appears to be an uptick in reports lately about the role and importance of conscientious thought as it relates to longevity and performance. In your opinion, (when looking to optimize performance) what is the relationship between adjustments of the mind/thinking and adjustments in nutrition? We tend to discuss these subjects separately, but should they be?

When we talk about conscious thought as it relates to longevity and performance, we can talk about gut/brain access and the thought that both are pretty intimately intertwined. The two elements of the nervous system, the central and the peripheral nervous systems, are essentially connected and stay connected via the vagus nerve as we grow and reach adulthood.

Whenever you talk about optimizing performance, you have to understand that anxiety and disruptive thought patterns can affect the gut, and there is also a lot of evidence showing that what you eat can have an effect on cognitive performance. So there is no doubt that a synergistic relationship exists between the two.

2) When you’re working with clients, how do you effectively make adjustments and/or additions to nutrition? How do you determine which interventions are beneficial and which are arbitrary? When making recommendations regarding nutrition — specifically any supplement recommendations — how important are therapeutic windows, considering ADME will be unique in different individuals?

We live in an era where genetic testing, gut testing, hormone testing and full blood panel testing are pretty convenient and becoming more and more affordable too. I always recommend at a minimum to get a blood panel, and if you really want a gold standard (especially in regard to nutrition), get a gut test. Get a genetic test, too. A spectral cell analysis will give you a look at micro-nutrients and minerals. If someone is experiencing a lot of autoimmune food allergen-type issues, the tests I recommend are a Cyrex Panel 4 or Cyrex Panel 5.

Really, the goal is to get a good idea of where someone is at from a food summary standpoint. Once you put all of that information together, then you can make a decision, but until then you are taking a shot in the dark. If your budget is limited, you might say “okay, whatever, I’ll start on a full spectrum multivitamin” and skip the testing. In those cases, basically I would recommend best practices for someone based on symptoms and goals, but it is always better to test. People generally get better results when they test, and continue to retest.

Testing can also include something like heart rate variability, where you look at how the sympathetic and parasympathetic nervous systems are responding to a change or intervention. In short, you put an intervention in place and you test to see what’s going on with the blood, or gut, or salivary gland to access the response to treatment. A lot of the folks I work with are testing at least one parameter every eight to twelve weeks.

3) In my interview last year with Dr. Howard Jacobson, we discussed the downsides of using reductionist research when addressing broad nutritional questions. Presumably you make some of your assertions based on this type research. How do you mitigate any potential risks?

I am a proponent of using natural whole food sources when possible. My recommendations come down to assessing whether a supplement or dietary strategy is going to get you a lot of bang for your buck. Take phosphorus compounds for example, they likely have some sort of anticarcinogenic effect — as such I am a bigger fan of incorporating broccoli, cauliflower and onions as staple components of a diet, versus suggesting someone use a sub-level glutathione.

But ultimately there are some situations where, by taking a food group or ingredient down to its complete reductionist form, you can concentrate it and get higher amounts of it. A good example is Chinese adaptogenic herbs, something that I use. I can take the isolated compound in a tiny little packet and it’s the equivalent of 40 pounds of the whole herb, which I physically couldn’t consume all at once.

4) In my 2009 interview with Chris Talley, he indicated there would likely be future developments for those interested in hacking their myostatin levels if they’re willing to experiment with antisense therapies (note: he highlighted the potential for considerable risks, too). I saw this year you mentioned cold thermogenesis as a safer alternative (since this type of therapy might have an effect on irisin). Do you find this to be effective with your clients who are looking to gain muscle? And, do you have any other suggestions regarding reducing myostatin?

With myostatin, one of the big goals is to not be in a consistent anabolic state. I think what you are referring to with a cold thermogenesis type of approach is the upregulation of m4, which is going to essentially downregulate myostatin, helping with muscle cell growth. However, you could potentially get undifferentiated cell growth.

I like cold thermogenesis because you do get hormones like irisin that help activate m4, and yet at the same time you are getting the upregulation of AMPK. That’s actually a perfect example of a strategy I like: an anabolic approach that uses caloric cycling on certain days that have higher levels of physical activity coupled with cold thermogenesis, because strategic fasting is also a way to reduce myostatin.

5) Piggybacking off cold thermogenesis: If you ask Tim Ferriss for his cliff notes on unconventional tried-and-true tips for weight loss he’s likely to tell you ice baths, his PAGG regimen, and 30 grams of protein within 30 minutes of waking up. What are a few of your unconventional tried-and-true tips for amateur endurance athletes looking to improve performance?

If you are asking for tips that fly under the radar, I am a fan of isometric protocols like long 30-second eccentric contractions and holds for 3, 4, or even 5 minutes in lunge or squat positions. Basically, it’s filling your muscles with a bunch of lactic acid, so you are upregulating your lactic acid buffering capacity.

If someone has a lot of inflammation and muscle damage from chronic repetitive motions, I am a fan of curcumin. I have been using a lot of curcumin phytosome, and there is a brand called Meriva, which a lot of supplement manufacturers are using now. It is a form that is well-absorbed and has really good anti-inflammatory effects.

Lastly, it’s not sexy, but I am a big fan of making sure that you engage in low-level activity all day long — basically standing on your feet, getting a standing work station, or even using a treadmill desk. Avoid sedentary positions for a long periods so that all day long you are building low-level physical endurance, which you can then rely on during your interval training and endurance training. A lot of people do not understand that a lot of your available endurance simply comes from your daily routine. If you are trying to improve performance you are not doing yourself any favors by sitting at a desk all day long.

Interview with Nir Eyal about the Hook Model and Product Development

Nir Eyal is an educator, entrepreneur, author, and blogger who maintains the website In addition to his blog, Nir has written articles for TechCrunch, Psychology Today, and Forbes. Nir’s new book, “Hooked: How to Build Habit-Forming Products,” debuted on the Wall Street Journal business best seller list this year.

1) What is a creative “growth hacking” method you have seen bolted onto the Hook Model that can positively influence the viral coefficient (or alternative variable) and amplify the effect of your model? Clickbait is one potential example (adding a trigger to a hijacked audience); are there any better ones?

Clickbait is an okay example. I tend to think of engagement and growth as two things that can be connected, but that do not necessarily have to be. So when I look for opportunities to invest in or consult with companies, the three criteria I always look for are: growth, engagement, and monetization. A startup must possess two of these at the onset, with a strategy to obtain the third, or I’m likely not going to be interested.

Most viral strategies have nothing to do with engagement. This is important to note; most viral growth strategies lack engagement. These strategies are usually just a way to get people in the door. Sometimes you see innovators get so hung up on virality that they stop there, and unfortunately stop short of incorporating engagement into their product. For me that is what is interesting: how can you make engagement part of the product itself, part of the growth strategy? It is pretty rare to see engagement as part of the overall growth strategy. It’s pretty hard to do well unless you are a social network. Most others are doing it as a bribe: “Here is ten dollars; invite your friend.”

2) In your teachings, you speak about the power of negative valence and how feelings such as boredom, fear, and depression can be effective mechanisms to get someone to act. In your opinion, why have emotions with positive valence (such as a joy) proven to be less effective action triggers?

When we feel happy, we don’t have a problem. Every solution is used to address a problem. Negative valence states are painful. They create pain points and we seek to correct those pain points. One could also argue this is teleosemantic… two sides of the same coin. For instance, is someone lonely or do they simply desire connection? I like to focus product makers on the negative so they understand that they should be solving a problem. Unfortunately opportunities are generally not found when people are hunky-dory; opportunities are found when people are suffering from something.

3) In the process of your research, what are one or two of the most effective reoccurring external triggers you’ve seen that do not use the computer or mobile phone as the conduit? Is there anything on the horizon that might match or come close to the utility of smartphones with regard to effective trigger conduits?

Mobile devices are fairly new, but visual triggers obviously are not… advertising, storefronts, etc. Smartphones simply let us interact more effectively with these triggers. As far as something on the horizon, I think the smartwatch is going to be huge. Whenever there is a broad base interface change, it opens a world of opportunities to build innovative products. And as simple as this sounds, some of the most powerful triggers are often hidden in your pocket. You cannot see that you have an incoming email if you have put your phone on silent. A watch is ever-present; however, the downside is there is a lot less real estate to grab your attention (than a phone). This is going to make creating habits more important because with less real estate there will be less opportunity to grab your attention. It creates a more competitive environment for app makers.

4) In a previous conversation, you and I discussed that fitness is hard to position as a reward because fundamentally it’s punishment, making it inherently difficult to inspire this action. Are there strategies to help bolster the perceived intrinsic value of a difficult action in an attempt to strengthen the perceived reward?

It is not my position that fitness is “fundamentally” punishment. I don’t think it creates pain for everyone; some people are clearly passionate about fitness and get a lot out of it. They get pleasure from exercise. It is rewarding and they love it. It is what they like to do in their spare time.

What I do suggest is that those who do not enjoy exercise feel that way because it is potentially perceived as punishment and not viewed as rewarding. I believe that these people view exercise as not fun; simply put if they thought it was fun they would be doing it. The problem is people who don’t already enjoy it make up a majority of the general market, right? People making fitness products, or at least most of them, are trying to create behavior change in the hope of making inactive people become active. It is the proverbial brass ring that people in the fitness industry are reaching for.

From what I have seen to date, it just doesn’t work; it is just punishing users. Look at the phenomenon of “moral licensing”: when we do something that we feel punishes us, when we feel we are suffering in one area of our lives, we tend to go overboard in other areas. That’s been shown with charity giving, and it’s been shown with recycling: sacrificing in one area of life leads to indulgence is other areas of life.

If someone gets into this spiral — for instance they workout each day and burn 300 calories but then reward themselves with a 400-calorie Jamba Juice — what happens over time when they do not see results? They ask, “why am I gaining weight? I guess I am just a fat person.” In the end they come to a conclusion, “well, I’m just fat; it’s who I am.” And that’s the saddest part of this story, because “being fat” has become a part of their identity, and identity is much harder to change than behavior.

At a global level, a person’s environment is going to play a major factor in the obesity crisis. People make poor choices about what they eat because unhealthy food is easy to get. If we had better access to healthy choices, I believe that would go a long way. In that regard I love what the company Pantry Labs is doing. Pantry Labs makes it easy for companies to offer fresh foods to their employees through vending machine innovation. If you enable people to make healthy choices, I think this is an easier intervention to implement than expecting everyone to pick up exercise.

5) Continuing the theme of influencing healthy behavior change, in your TechCrunch article Why Behavior Change Apps Fail to Change Behavior you state, “When our autonomy is threatened, we feel constrained by our lack of choices and often rebel against doing the new behavior.” I believe this to be true as well. However, I also believe Barry Schwartz’s contention that choice can often be paralyzing. Personally I struggle with the coexistence of these concepts when it comes to prescribing varying fitness modalities to a population (especially in light of data that suggests you get higher participations rates when you limit choice). Where do you believe the balance exists, if there is a way to find balance? 

I believe you are talking about two different things here, I don’t think it is apples to apples. When we talk about the “paradox of choice,” we address things we desire, like picking between 24 flavors of jelly. We want the jelly, but we cannot decide which one we want. When we are talking about issues of autonomy and choice, we’re addressing things that we do not want to do. “I do not want any jelly; I hate jelly,” is different than the statement, “I want jelly, but which one do I get? It’s just too difficult to decide.”

There is some crossover — there is the concern that making choices, even simple choices, may tax one’s willpower — and there is this other issue of behavior, high willpower versus low willpower. The “behavior change matrix” can be helpful in explaining the difference and how it relates to forming positive habits.

Automatic behaviors — in other words, our habits — fall into one of four modes: amateur, expert, habitué and addict. I categorize them by how much self-control is required (high willpower vs. low willpower) and whether motivation can be classified as pleasure seeking or pain alleviating. Amateur and Expert are both pleasure-seeking modes, but amateur requires little willpower while expert requires a high degree of willpower. Both modes tend to result in beneficial behaviors that people want to increase.

Habitué behaviors are pain alleviating but require little willpower. They may be beneficial or destructive. Addictive behaviors are primarily negative and people seek to rid themselves of them. If you want to change someone’s behaviors, or help them develop new ones, you need to understand the matrix and use techniques in line with these four behavior modes. In other words, we do not need to frame this as “finding balance” rather understand that various desired behavior change types call for different strategies depending on the situation.