August 2017: What Am I Doing Now?

This is my August Now Update based on a movement created by Derek Sivers

(previous updates are here)

2017.07.15 No Kings Collective 8 year anniversary block party Washington DC USA 7480
2017.07.15 No Kings Collective 8 year anniversary block party Washington DC USA 7480 #TransVisibility (View on Flickr.com)

Greetings from Washington, DC (of course) and welcome to my fifth now update.

My Now (@NowNowNow) Profile is visible at Link: Ted Eytan, MD Profile on NowNowNow.com & the regular tweeting of it is a reminder to update….

  • I just returned from Low Carb San Diego, continuing my education in optimal nutrition, which for physicians is still very much a DIY process, with huge implications for our nation’s health. See my blog post: Adventures at Low Carb San Diego
  • I’m continuing to understand the impact of #TransVisbility in our society or the lack thereof (and in the process changing it, it’s what my generation of physicians does)
  • I thank that National Museum of African American History and Culture for their twitter dialogue with me about LGBTQ visibility. Responsiveness like this in the era of social media is wonderful.
  • Finished Mistreated by Robert Pearl, MD

Emojis for the future

The collaboration continues: Proposal submitted to Unicode, August, 2017 update.

Now

  • Still reading Tools of Titans by Tim Ferriss.
  • Began reading The 17 Day Diet Breakthrough Edition by family medicine specialist colleague Mike Moreno, MD
  • Following up on the low carb adventures with deeper review of the literature
  • Going deeper in self-education on digital engagement and customer relations management (CRM). One word – trailhead. I think I like computers 🙂 .

And, this tweet:

My first real Washington, DC experience (or Bethesda adjacent…) was as a medical student at the National Library of Medicine informatics clerkship. During that time I taught myself perl programming (see comment about liking computers) and created a mini-expert system for preventive care services. I probably have the code for that project around here somewhere. This experience is responsible for bringing me, emotionally and ultimately physically, to Washington, DC, and I’ve never left.

It’s a special privilege to know the current Director, Patti Brennan, RN, PhD (@NLMDirector) and all of the ways she has championed a world learning to love better through her research and leadership.

The dream I had many years ago of a new generation of leaders shaping our society is coming true. That’s what I’m thinking about now.

Is there anything I should be doing that I’m not? Feel free to let me know in the comments.

Updated 2017.08.08 – Based on a movement created by Derek Sivers

Adventures at Low Carb San Diego

It's really getting low carb in here. And no afternoon snack because everyone is intermittent fasting, of course. #LowCarbSanDiego #AffordableCME #LCHF #ketogenicdiet #ketogenic
It’s really getting low carb in here. And no afternoon snack because everyone is intermittent fasting, of course. #LowCarbSanDiego #AffordableCME #LCHF #ketogenicdiet #ketogenic (View on Flickr.com)

“But morning is where you earn your carbs” – said the flight attendant when I declined the processed shortbread. At least the knowledge that a high-carbohydrate diet is not-so-great is changing…

I started this blog post before I attended Low Carb San Diego (@LowCarbUSA), and I’m finishing it as I’m leaving.

First, some facts about myself that are relevant

  1. The obligatory flashback. I now remember my first exposure to diabetes. It was when I was in 6th grade, and I was told that my teacher was not allowed to eat candy. I asked why and was told, “He’s diabetic, he can’t have sugar.”
    • And then, through my professional journey, all of this got convoluted and people with diabetes were being told to eat sugar, in the form of high carbohydrate diets. It never really made sense.
  2. I know what it’s like to live as a fat person. It’s a unique experience. As a result, the medicalization of obesity, as a disesase of willpower, that happened in the early 2000’s always concerned me. Now that we have data that the #1 explicit (openly expressed) bias that medical students possess is directed against obese people (greater than that expressed, also openly, against LGBTQ people) my concern level is justified.
  3. The conversation about medical students learning nutrition (and by nutrition I mean, “what to eat,” – there’s plenty on nutritional biochemistry) is not new. It was happening when I applied to medical school, I was aware that we wouldn’t get much teaching in this area, and much of the nutrition science I learned in college. Regardless, I did not go to the gym during the lectures we did have on nutrition 🙂 .

    • By the way, I semi-don’t knock medical school for not teaching me about what to eat – there is so much to learn about human physiology and pathology that you can’t learn anywhere else. More importantly, the skill of critically reading the literature is something that transcends medical schools and helps physicians learn throughout life.
  4. Despite the lack of formal teaching on diet, there were clues in medical school that the evidence base being promoted wasn’t itself based in evidence. I still remember those clues to this day – they were in our medical textbooks, even.
  5. Post-medical school, in several cycles of board certification (for the awesome specialty of family medicine), nutrition is barely addressed, so it’s still pretty DIY, and that means path of least resistance.

  6. However/and I am not a least resistance person. I live in the future, where innovation happens in the out of the way places. I am usually ahead of my time, sometimes joyfully, often painfully, ultimately happily, glass 3/4 fully. I like change, and I like innovation and I like interacting with people who are also ahead of their time.
Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on Flickr.com)

Which brings me to the present time and Low Carb San Diego

I came here, to this fully accredited continuing medical education course (thank you @JeffreyGerberMD) because after all that we’ve been taught/told, I keep finding out that

The challenge is made worse by the fact that many advocates of the low-fat diet are also expert in evidence-based approaches, but interpret the data differently. I’ve commented on this previously, that I can’t know what a study means unless I also read the comments, the twitter feeds, the financial interest statements.

Very fortunately, a lot of the people analyzing the evidence live in social media, unlike so many other health movements (cough environmental stewardship cough), so it’s easy to connect and learn more. So here I came for direct learning, reading can only get a person so far.

Interestingly, people who know me know I am not a fan of sitting in a dark room watching powerpoint presentations, however, I was on the thirsty side when it came to getting information, so this was not a problem for me. A few wall sits and isometric lunges keeps the BDNF flowing.

I am awaiting the presentations and videos, which I actually want to review again, because the breadth of topics and experts was pretty excellent.

Some key points of learning for me

  • diabetes and diet
  • diabetes and cardiovascular disease (and their inextricable linkage + maybe it’s the other way around)
  • diabetes and every other disease including Alzheimer’s (Diabetes Type III)
  • Non-Alcoholic Fatty Liver Disease (crazy high prevalence & correlation with glucose intolerance)
  • The human and global environment including sustainability (this image is terrifying)
  • the power of the medical profession to alternately create change or slow change, sometimes with great results, sometimes with devastating ones

In the history or Medicine compared to science, there have tended to be worship of ideas based on the people promoting them, with devastating results. Because my generation of physicians trained during the most profound ethical crisis in our profession's
In the history or Medicine compared to science, there have tended to be worship of ideas based on the people promoting them, with devastating results. Because my generation of physicians trained during the most profound ethical crisis in our profession’s (View on Flickr.com)

I’ll continue posting as I learn more of course.

A Note About the Medical Profession

As I type this I am sitting next to someone who is obviously a physician, dictating a patient chart note in a public place (hmmm HIPAA…), and it reminds me to remind others to avoid placing blame on the profession or the people in it. I cringe a little when I hear proclamations about what physicians need to do when they have at their base mal-intent on the part of physicians. As the implicit bias literature shows, physicians have the same amount of biases that their community colleagues do, no more, no less. I believe physicians want to perform well for their patients, when it is known what performing well is. This is a community-created issue and is owned by everyone.

Speaking of adventures, I also took a little sojourn into the realm of #TransVisibility at the Port of San Diego next door – again, challenging the norms that society imposes on humans that don’t have a basis in science. It’s all related…

As it says in the photo above, my generation of physicians trained during the most profound ethical crisis in our profession’s history, and when we witnessed what we did, we promised to change everything, in the interest of the people we serve. A part of that work is to know what change is needed. Embrace curiosity/if someone is doing something better than I am, I want to know about it.

Photos from the days 1, 2, 3, 4 below. Enjoy.




Just Read: Specific Macronutrients Promote Hepatic Steatosis in Mice – How did this become about Avocados?

A colleague recently wrote me with the news of this press release and tweet. Subject of the message was “We cannot win.”

And yet, despite the imagery and proclamations, I’m not understanding the conclusions made in the communication about the study.

Here are the statement via @UCSFHospitals on Twitter and via their website.

The study, linked to above, didn’t test the ingestion of avocados or olive oil, as depicted on the stock photos.

Although the Western diet is more nutrient diverse than the starch-oleate diet is, the 2 formulas have similar caloric densities and similar proportions of CHO and fat. The fact that starch oleate phenocopied the effect of the Western diet in mice provides a strong rationale to further pursue the disease- promoting potential of this nutrient pair.

I’m intepreting this that the issue is not the type of fat, but the proportion of fat and carbohydrate in the diet.

Notably, our earlier studies combined nutrients in a 60:20 CHO:fat ratio rather than the 42:42 ratio used in the current experiments. Dietary formulas with 60:20 CHO:fat provoke more hepatic DNL than those with 42:42 CHO:fat when compared with chow (A. A. Pierce, 2013 and C. C. Duwaerts, 2014 data not shown). Moreover, in the presence of abundant amounts of simple CHO, even a small amount of dietary saturated fat can accentuate DNL by inducing the enzymes in the lipogenic pathway.

I am unable to reconcile what’s being said to the public and what’s in the study, which worries me because this is what adds to confusion about what it is recommended that people eat.

Just Read: Dietary fat guidelines have no evidence base: where next for public health nutritional advice?

This is the 4th in a series of papers looking at the justification for recommending low-fat diets for humans. Authored by Zoe Harcombe, PhD (@ZoeHarcombe), it's a summary of three previous metanalyses. I wrote about 2 of the 3 previous papers. One is behind a paywall and i only have so much control over time and space….

The headline is as it says in the title of this post: Dietary fat guidelines have no evidence base.

This paper goes into some of the consequences of this advice and points out some logic traps that we're still engaged in around diet.

  • A low-fat diet is not just a low-fat diet; it's a high-carbohydrate diet, because there are only three macronutrients and fat would need to be replaced with something in the diet.
  • Plant-based sterols (found in vegetable oils) have been shown to reduce cholesterol levels, however they do not result in reduction of CHD risk and "much evidence that they are detrimental"
  • If saturated fat is harmful, the highest intake of saturated fat in the diet today comes from processed foods
  • Saturated fat cannot be cut out of the diet without cutting out all fat – "It is worth noting that every food that contains fat contains all three fats: saturated; monounsaturated and polyunsaturated.65 The notion that saturated fat is harmful and unsaturated fat is healthful is illogical given their coexistence in foods required for human survival."

There is opportunity for strong agreement among health pro- fessionals. If the public health message were revised to advise citizens to eat natural food and not processed food, saturated fat intake would fall accordingly, although the health benefit would most likely be the concomitant reduction in sucrose, trans fats, refined carbohydrates and other processed ingredients deleteri- ous to human health.

There are no responses written to the article at British Journal of Sports Medicine.

Just Read: Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis.

This is a follow up to my last post on the subject (Just Read: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis), and is a follow up paper by Zoë Harcombe, Phd (@ZoeHarcombe) et al.

Note the word change in the title of this paper – from “did” to “does,” because the next question to be asked if dietary fat guidelines were created without an evidence base in 1977 (US) and 1983 (UK), is: is there evidence now, 40 years later?

And the answer is still no

10 studies meeting review criteria (“RCTs that examined the relationship between modified or reduced dietary fat intake, serum cholesterol and mortality from CHD and all causes) were analyzed

This meta-analysis of 10 RCTs, in comparison with Harcombe et al’s review of 6 RCTs, increased the number of people studied from 2467 to 62447. It increased the number of women studied from 0 to 53 499, the majority. It increased the number of primary prevention subjects from 676 to 56291.

The big increase in subjects studied is due to the Women’s Health Initiative, which, despite demonstrating the successful reduction of calorie intake from fat and saturated fat, was a negative study.

The various methodological problems as well as the data failing to show reductions in CHD deaths from the other studies is laid out in detail.

There’s an additional summary paper that I’ll post on next. As Harcombe points out, the 2015 United States dietary guidelines no longer limit dietary cholesterol, and the UK guidelines never had a limit. The guidelines about fat intake are also changed, without a limit on total fat intake, but still with a recommended limit on saturated fat intake.

There are no responses to this paper listed on its web site. I’ll post on the fourth paper next.

Just Read: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis

This paper is the first in a series of four, looking at four questions, by lead author Zoë Harcombe, PhD (@ZoeHarcombe), whose work I have been following on social media and via postings on this blog – all of it interesting to me.

  • The first review examined RCT evidence available to the dietary guideline committees in 1977 and 1983.
  • The second review examined epidemiological evidence available to the dietary guideline committees.
  • The third review examined RCT evidence available today, to see if extant dietary guidelines have been proven in retrospect.
  • The fourth review examined epidemiological evidence available today, to see if extant dietary guidelines have been proven in retrospect.

The recommendations we’re talking about are these, adopted by the United States in 1977 and the UK in 1983:

The dietary recommendations in both cases focused on reducing dietary fat intake; specifically to (1) reduce overall fat consumption to 30% of total energy intake and (2) reduce saturated fat consumption to 10% of total energy intake.

What’s the evidence?

There wasn’t convincing evidence available regarding fat intake reduction when the guidelines were introduced.

From the literature available, it is clear that at the time dietary advice was introduced, 2467 men had been observed in RCTs. No women had been studied; no primary prevention study had been undertaken; no RCT had tested the dietary fat recommendations; no RCT concluded that dietary guidelines should be introduced.

An exchange between Dr Robert Olson of St Louis University and Senator George McGovern, chair of the Dietary Committee, was recorded in July 1977. Olson said “I pleaded in my report and will plead again orally here for more research on the problem before we make announce- ments to the American public.” McGovern replied “Senators don’t have the luxury that the research scientist does of waiting until every last shred of evidence is in”.

And the only way to interpret this literature is to use the responses and social media

Unlike almost any other topic in medicine/health I have encountered, it is clear that it’s not enough to read the journal article – you have to read the responses to the journal article, the declared interest statements, and then go to social media to critically analyze the analysis.

For this paper, the responses are here. The amended competing interest statement is here – the study wasn’t funded by private, charitable, or government institutions.

The responses to the paper inquire about evidence that was available after the guidelines were introduced, which is covered in papers 2,3,4 that I’m reviewing.

Regardless, it’s worth noting that the responses do not dispute that there wasn’t convincing evidence available when nutritional guidelines for 220 million Americans and 56 million UK citizens were created.

And as I have stated previously, I am very happy that the people doing work in this area are engaged in social media where they are accessible and can answer questions. Again, like almost any other topic in medicine/health, I haven’t seen this level of engagement and it’s a great exemplar for all things health. (see: Just Read: Does Hyperinsulinemia cause obesity, and academic discourse on Twitter (finally))

Just Read: Always Hungry, by David Ludwig, MD

I actually didn’t just read this book, I read it awhile ago, but haven’t posted on it, until now (thanks for the nudge @ePatientDave).

I recommend this book as a companion to the others I have reviewed here (Why We Get Fat, Big Fat Surprise, The Case Against Sugar) because it’s more practical, written for a non-clinician audience by an experienced physician expert in the field, David Ludwig, MD (@davidludwig).

(Editorial comment, unlike other heath-oriented movements I have interacted with, I am pleased to see so many in the nutrition movement to be using social media to communicate their ideas. This is not the case among other physician-involved health movements I have seen, and it’s a loss for them, because there’s nowhere to go to ask questions.)

The Science

David covers just enough of the science to be useful for someone to understand the why of this approach:

So, in the 1970s, prominent nutrition experts began recommending that everyone follow a low-fat diet, in the belief that eating less fat would automatically help lower calorie intake and prevent obesity. Thus began the biggest public health experiment in history. Over the next few decades, the U.S. government spent many millions of dollars in a campaign to convince Americans to cut back on fat, culminating in the creation of the original Food Guide Pyramid…

Ludwig, David. Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently (p. 18). Grand Central Publishing. Kindle Edition.

And one example of the answer to whether this approach worked (the Look Ahead Study):

The study, conducted in sixteen clinical centers in the United States, assigned about five thousand adults with type 2 diabetes to either a low-fat diet with intensive lifestyle modification or to usual care. The study, published in the New England Journal of Medicine in 2013,33 was terminated prematurely for “futility.” Analysis by independent statisticians found no reduction of heart disease among participants assigned to the intensive low-fat diet, and no prospect of ever seeing such a benefit emerge.

Ludwig, David. Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently (p. 59). Grand Central Publishing. Kindle Edition.

There’s tons of published information about these findings, though, this book is more directed at successful behaviors.

The Behavior

The book is really designed as a plan to change dietary habits to ones that are more consistent with maintaining a healthy weight. Ludwig appropriately diminishes the argument that being overweight is about lack of self-control or too-large portion sizes or calories-in vs calories-out.

Although the focus on calorie balance rarely produces weight loss, it regularly causes suffering. If all calories are alike, then there are no “bad foods,” and the onus is on us to exert self-control. This view blames people with excess weight (who are presumed to lack knowledge, discipline, or willpower)—absolving the food industry of responsibility for aggressively marketing junk food and the government for ineffective dietary guidance.

Ludwig, David. Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently. Grand Central Publishing. Kindle Edition.

As I have mentioned previously, I am a former-fat person, and even before I went to medical school, I felt the medicalization of obesity had serious shortcomings from my own personal experience – it appeared to me that the creators of this approach had never experienced being overweight, like so many other things in medicine that have been designed TO people and not WITH people.

One of the challenges of moving away from a low-fat diet, though, is that there are extreme versions of the opposite, such as ketogenic diets. These may be successful for some, however, they require a level of commitment and medical supervision that’s not feasible for everyone.

From my read, Ludwig takes a very reasonable patient-centered approach (since he’s a physician, after all :)), and steers away from extremes into a slow modification approach that a person could follow if they were thusly motivated (and that’s the caveat, see below). He does not permanently forbid foods and the book is obviously written with enough guardrails (he is a physician after all…) that it appears safe relative to other guides I have seen.

The Motivation

The book is great for those who are motivated and want to make a change. At the same time, it’s also very well known from studies that giving people information is not sufficient for them to change their behavior (see this review from the American Heart Association – the smartphone app graveyard continues to grow in size: Just Read: Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention).

I have recommended this book to some people, and my assessment of the uptake is “marginal,” not because of the book, because of where people are in their journey. Which is fine, that’s where information fits in, for the times that support is there and people are ready.

As Ludwig states, we’re in the middle (maybe the end?) of a 40-year failed experiment in changing the nutrition habits of the world. The data shows that people did in fact listen to the advice given and changed their habits (yet another perpetuated myth – “if people would just do as they were told”). It’s going to be an exciting next 40 years….

Just Read: “Why We Get Fat,” by Gary Taubes

I actually read this book some time ago and didn’t post on it until now.

This book would be a companion to 2017’s “The Case Against Sugar” also by Gary Taubes (see my review of that book here) (@GaryTaubes). Written in 2010, it explores the causes of obesity, and makes the case away from a “calories in-calories out” approach to an endocrine (hormonal) mediated one.

The reason I am interested in exploring this is because of the potential harm I see in blaming culture around obesity. What if the medical profession is telling people to do the wrong things, and then blaming them when their biology achieves the goals of their physician-directed behavior?

A recent (2012) study of medical students has shown that the explicit biases (ones they are willing to endorse) are:

  • Bias against lesbian, gay, bisexual, and transgender (LGBTQ) human beings
  • Bias against human beings who are obese

In fact, the bias against obese people is stronger than that against LGBTQ:

Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on Flickr.com)

Of all the dangerous ideas that health officials could have embraced while trying to understand why we get fat, they would have been hard-pressed to find one ultimately more damaging than calories-in/ calories-out. That it reinforces what appears to be so obvious— obesity as the penalty for gluttony and sloth— is what makes it so alluring. But it’s misleading and misconceived on so many levels that it’s hard to imagine how it survived unscathed and virtually unchallenged for the last fifty years. It has done incalculable harm.

Taubes, Gary (2010-12-28). Why We Get Fat: And What to Do About It (Kindle Locations 1187-1191). Knopf Doubleday Publishing Group. Kindle Edition.

This book is clearly not intended to guide a person on how to alter their diet in a step by step method – it is aimed more at a scientific explanation around the causes of obesity. There are other books to guide a person through a different dietary approach, most notably “Always Hungry,” by David Ludwig, MD (@DavidLudWigMD), which I’ll post on separately.

Just Watched: Low-Carb High Fat Diet in Type 1 Diabetes

The origin of this post is that I sent a tweet earlier this week regarding the current crisis in insulin pricing referring to the Banting Diet, which is the precursor of the low-carb high fat diet (or LCHF diet). I sometimes do this (sending unclear messages) assuming that people will figure them out, and usually, that’s not the outcome 🙂 . At least it starts conversation (maybe I do this subconsciously, I don’t know).

In any event, I have been interested in nutrition for a long time and more interested recently (see:Just Read: Why Eating Fat May Not Make You Fat (The Big Fat Surprise) ), as more data is being produced about where our dietary guidelines came from. In the case of diabetes, I have been curious about the ways the medical and other professions counsel patients on diets in ways that may actually increase their risk of diabetes and increase their insulin requirement.

My question, therefore, has been whether the need for insulin could be eliminated in some people and reduced in others, which would blunt the impact of pricing and make living with diabetes more affordable. The other question I have is about the whether reducing the use of specialized insulins for some population would have an added effect, making the pricing power, less powerful.

I’ve read a few papers about this. I don’t feel comfortable doing a literature review myself because these days it’s really hard to interpret papers if hidden biases aren’t known. That and I may be a physician, but I do not know what it is like to live with diabetes. I do know what it is like to live as a former fat person so there is some relevance here for me.

Through the magic of YouTube, Dr. Troy Stapleton (@drtroystapleton) explains his own journey as a person with type 1 diabetes and the LCHF diet. He’s going to to have much more credibility than I and this is a good science-based + authentic overview from a patient perspective. Watch:

A person who produces insulin on this diet is going to have an insulin production curve closer to a person with type 1 diabetes (flat) compared to a person without diabetes (insulin spikes), with the idea that insulin and specifically too much insulin is a requirement for obesity.

#ILN innovating in nutrition, too. #LCHF in Chicago. #ketogenic #ketogenicdiet #lessinsulin

A post shared by Ted Eytan (tedeytan) on

I’m planning to do some more study this summer. At the same time, there are far more experienced researchers, journalists, physicians and scientists engaged in this work, so I’m more interested in dialogue than leadership (they are doing just fine). I always say if there’s a better way to do something, I want to know about it.

This is life in the family medicine revolution (#FMrevolution), where unlimited curiosity reigns in the interest of a person, family, community’s long healthy life. Feel fee to let me know your thoughts in the comments.

How much does it cost to not have a designer? #ILN Day 1-2

2017.05.10 Innovation Learning Network #ILN Chicago IL USA 4625
2017.05.10 Innovation Learning Network #ILN Chicago IL USA 4625 (View on Flickr.com)

This was my conclusion based on a question asked by a colleague which was “How much does it cost to have a designer on your team?” at this year’s first Innovation Learning Network in person meeting. With new streamlined hashtag (#ILN) and twitter handle – @ILNMuse

2017.05.10 Innovation Learning Network #ILN Chicago IL USA 4601
The physicians of Innovation Learning Network – organized with care every year by Lyle Berkowitz, MD (@DrLyleMD) 2017.05.10 Innovation Learning Network #ILN Chicago IL USA 4601 (View on Flickr.com)

It’s seven years later than the last time I was here, when the space was called Gravity Tank (now it’s part of Salesforce) and my photography was not as evolved – only 7 photos back then. And because of the way-back ness of a blog, it’s all here: Mama knows! A week of innovation thinking at AHRQ and GravityTank (Innovation Learning Network).

It almost appears that ILN was a sideline to a busy week back then, but it was a lot more than that. My blogging has also evolved sinc ethen.

This time, more organizations are seeing the value of design and designers and asking critical questions more about “why not have a designer” rather than “why have a designer / design” as part of innovation.

And…through the work of colleague Christi Zuber, RN, PhD candidate (@czuber) we have an understanding of the characteristics of people who achieve success in innovation, in a way that crosses organizational structure, job titles, etc. Check it out in the photos below.

#ILN innovating in nutrition, too. #LCHF in Chicago. #ketogenic #ketogenicdiet #lessinsulin
#ILN innovating in nutrition, too. #LCHF in Chicago. #ketogenic #ketogenicdiet #lessinsulin (View on Flickr.com)

Also check out our delicious low carb, high-fat meal (LCHF) at our dinner with strangers. We know a lot more about nutrition than we did seven years ago. Actually, we know now what we were supposed to know about nutrition 7 years ago. Always good to prototype life and ILN is the place to do it.

Check out this group in 360 degrees, doesn’t learning look great on everyone? (Didn’t have one of these cameras 7 years ago)

Innovation Learning Network #ILN #ILN360 @ILNmuse w @SalesforceIgnite @NorthwesternMed #theta360 – Spherical Image – RICOH THETA

Thanks to our hosts Northwestern Medicine (@NorthwesternMed) and Salesforce (@Salesforce) Ignite as well as to Chris McCarthy (@McCarthyChris) and the team from Hope Lab (@HopeLab), who I hope will read this post and tag themselves in the social networks of their choice 🙂 .

PS, Photos, repeat after me, @CreativeCommons licensed, use as you see fit.