It’s not very often that I read a book that makes me alternate between tears of outrage and a deep sense of gratitude and wonder.

Dr. Marty Makary’s book, The Price We Pay, is one of those rare books.

In it, Dr. Makary (a Johns Hopkins cancer surgeon), shares his quest to understand what’s gone wrong with healthcare in America - and what we can do to fix it.

I found myself overwhelmed with outrage to read about patients who’s lives had been shattered by the unjust and predatory practices of a system that claims to be committed to healing.

Just a few pages later, I found myself marveling at the good fortune I have to live in a time and place where there are people struggling mightily to right the wrongs of a bad system.

To be clear, while there are unscrupulous individuals involved in American healthcare, much of the suffering patients encounter stems from emergent properties of the system - they’re basically collateral damage caused by poorly-designed incentive and feedback loops.

That is to say, it’s not that American healthcare is evil. It’s just that many people with the authority to make systemic decisions about healthcare (and how it’s financed) benefit monetarily from the status quo, while the people who suffer most - the average American patients - are far-removed from the rooms where decisions are made.

One of the concrete results of Dr. Makary’s work is President Trump’s November 2019 Executive Order that stipulates that federally-funded hospitals must disclose prices for hospital procedures to patients upfront.

Though many corporate interests sued President Trump in an attempt to maintain the highly-profitable status quo, their lawsuits failed, and beginning in 2021, patients will be able to see what they’re being charged for, and so “shop around” to avoid price-gouging.

I’m grateful to Dr. Makary, his team, and his collaborators around the country, who are striving mightily to protect people of all backgrounds.

Truly, if you have any interest whatsoever in medicine, healthcare, or even understanding maladaptive incentive systems, this book is worth reading and owning.

One of the challenges of seeking to grow as an individual is filtering and curating what sources are trustworthy.

One of the thinkers whose ideas and process I trust is Ray Dalio.

His resumé is impressive, but I find his thinking and writing to be even more so.

I first read his book, Principles, 3 or 4 years ago. I was, and am, impressed, at the simultaneous breadth and depth of the thinking he shares in the book.

In truth, Principles consists of two books: one about the Principles behind living well (ethically, sustainably, with a sense of fulfillment and vitality), and another book about the Principles of working well (habits, productivity, addressing bias, navigating human interactions/relationships).

Since publishing Principles, he has also published an impressive, 30-minute animated video that distills How the Economic Machine Works.

Even more recently, he has written a book titled The Changing World Order: Why Nations Succeed and Fail.

It’s interesting to note that Ray has actually published the first three chapters of this latest book online, to be read for free.

If, like me, you’ve been searching for a broader way to understand the way that life in America has shifted in the last several decades, Ray’s are some Big Ideas worth considering.

There’s an old saying about picking and choosing your battles carefully.

Another element of this is deciding where to fight the battles you choose.

In his book, UNSCRIPTED, MJ DeMarco uses the example of the fight to lose weight.

Most people, when they think of this “battle”, think that the fight is won in the kitchen.

That is, you go into the kitchen and internally war with yourself over whether to make a salad or microwave a burrito; or you go into your pantry and fight with the choice to eat raisins or potato chips (which are both unhealthy, by the way).

DeMarco argues that this is the wrong battlefield - that it’s too late in the fight to make an effective decision consistently.

Instead of the kitchen, DeMarco suggests that the “real battlefield” in the fight to lose weight is found at the grocery store.

Basically, the thinking goes, if you don’t have unhealthy stuff in your fridge/pantry/cellar/etc., then you can’t eat poorly, even if you wanted to.

Of course, you could always order food delivered or hop in the car and hit up the drive-through.

But the point is that it’s more convenient for you to just eat the healthy food that’s in your house, tipping the odds over time that you’ll just suck it up and eat some gosh darn kale.

Naturally, as I write this, I find myself scraping the bottom of a bag of sugary-sweet kettle corn that I just should not have bought. Ever.

Ever!

See? Just because you know better doesn’t mean you always do better.

Actions count more than knowledge, and consistent action is wisdom incarnate.

Let your consistent actions win the battle for you.

But make sure to choose the right battlefield first.

I’m not sure who needs to hear this.

Could it possibly be you?

In my early twenties, I stumbled upon Tony Robbins and his work.

One of the things Tony writes and speaks about is what he calls his Ultimate Success Formula.

The first time I read about it, I thought, “Well, duh! Of COURSE you’re going to succeed, if you frame it like that! Pfft, no big deal.”

But that was the point.

It’s literally a formula. It gets you what you want - IF you follow through.

It’s not easy. It’s not necessarily quick.

But it works.

So, here it is. Tony Robbins’s Ultimate Success Formula:

1. Know Your Outcome - Before anything else, decide - including specifics - what you want your “success” to look like.

2. Define Your “Why” - Get really specific about why you want this particular form of success; what do you want to be able to feel, have, do, and be?

3. Take MASSIVE ACTION - Don’t just browse Amazon for some new books or daydream about getting new gear. Do something that will transform you. Learn a skill, build something, reach out to people you’ve been too scared to ask for help. (Seriously, if you were able to get what you want from your current abilities and actions, wouldn’t you already have what you want?)

4. Notice Your Results - Pay attention to the consequences of your Massive Actions. Are they moving you closer to your goal? Are you getting the results you really want? If you are, then keep doing what you’re doing until you achieve the success you defined in Step 1. If you’re not getting what you want, then you should…

5. Change Your Approach - Choose a different path to the success you defined earlier. Once you decide on your new strategy, go back to Step 3 and take Massive Action, and then go on to Step 4 and notice if your new approach is working. If it is, that’s great! Keep going. If it’s not, here we are at Step 5 again.

And there you have it. If you commit to following this formula, one of a few different things will happen:

You’ll achieve the success you wanted.

You’ll make mistakes, learn from them, improve your process, and then you’ll achieve the success you wanted.

You’ll make mistakes, learn from them, and then decide to change your definition of success.

…and then you can apply the Formula to your new version of success until you achieve what you want.

Seriously, if you’re committed to following through on this, you will get what you consistently work towards.

Like I said, I’m not sure who needs to hear this.

But if it was you, now’s your chance.

Good luck and God Bless.

Tony Robbins is one of the world’s most renowned life and business coaches. He was once hired to use his knowledge of human psychology and performance to design a training protocol that would improve the shooting accuracy of American soldiers.

The solution he came up with sounds so…obvious. But it also proved very effective.

Under Robbins’s protocol, soldiers began shooting at targets that were so close, it was nearly impossible to miss and very easy to hit a bullseye. After several successful shots at a particular distance, the targets would be moved back at small intervals, and the soldiers would shoot at the new distance until they achieved a minimum level of accuracy.

The distances continued to be increased as long as consistent accuracy was achieved within a reasonable number of shots, and any deficiencies in shooting technique were addressed and improved upon as the training went on.

Sounds simple, right? When you’re starting with the target only a foot away, it’s pretty hard to miss!

And that’s where the magic is.

By setting the initial bar very low, the soldiers internalized a pattern of success early on, and then made refinements gradually - a great illustration of the principle of kaizen.

By starting with an achievable goal, soldiers laid a foundation of confidence on which to build their training. Improvement was then only a matter of maintaining consistency while also gradually increasing the challenge level and allowing technical skills to adapt.

It’s a simple system, but a powerful one.

How can small-but-consistent improvement help you in your own life?

A: Not when they’re paired with foods that change how your body absorbs the calories.

I’ve just finished listening to Dr. Peter Attia’s 2018 interview with Dr. Robert Lustig, who is a researcher, an expert in fructose metabolism, and a former pediatric endocrinologist.

One of the major takeaways from their discussion is the importance of “context” when it comes to your diet; specifically, the impact that sugar can have on your body, and the way that eating other foods in conjunction with sugar changes the way that your body reacts.

Essentially, here’s what I hope you’ll find useful to know (and what I want to remember):

1. Glucose is used by virtually all forms of life. It’s the default fuel for human brains and is a vital part of a normal, healthy diet.

2. Fructose is not naturally a large component of human diets, and excess fructose in the body can lead to liver dysfunction.

3. Sugar (a.k.a. sucrose) is made up of… GLUCOSE + FRUCTOSE. So sugar (in all its forms) gives us nutritional value (glucose) as well as a potentially harmful substance (fructose).

   To be clear, fructose is not inherently bad. But high levels of fructose will lead to metabolic dysfunction, such as diabetes, and/or death (secondary to cancer, for example).

   Now, here’s where we get to my point about all calories not being created equall

4. It turns out, other foods can affect how your body absorbs sugar by physically impeding or delaying its uptake.
   
   Take fiber, for example. When you have adequate levels of soluble and insoluble fiber in your digestive tract, they come together to form a physical barrier that slows down your body’s absorption of sugar. Imagine a mesh strainer, covered with a layer of petroleum jelly. Like the mesh and the petroleum jelly, he insoluble fiber (e.g., the stringy bits of celery), plus the soluble fiber (e.g., the pectin in gelatin) combine to form a hydrophobic barrier. This is basically what happens in your gut when you have adequate amounts of both types of fiber. (Note that the barrier will not form if either soluble or insoluble fiber is missing.)
   
   This barrier allows your body to process small amounts of sugar at a time, thus avoiding the insulin resistance which comes from being biochemically overwhelmed with sugar processing.

5. This is also why eating a whole apple is better for you than drinking apple juice; the soluble and insoluble fibers from the fruit slow down the absorption of sugar in the gut. Instead of the fructose being absorbed quickly once it hits the duodenum, the fiber barrier keeps most of it from being absorbed and allows the sugars to make it to the jejunum, where your body will absorb some of it, and much of it will be used as fuel by your gut bacteria, many of which thrive on fructose. This saves the liver from quite a lot of damage over time.

6. At this point in the discussion, Dr. Lustig pointed out that if you don’t have enough fiber, and most of the sugar you eat is absorbed in the duodenum, the gut bacteria in the jejunum will then start eating the lining of your intestine to make up for the lack of food. Dr. Lustig speculates that this might be the source of colitis, leaky guy syndrome, and even Crohn’s disease.

7. Most importantly, Dr. Lustig points out that you can’t outrun a bad diet. That is, no amount of exercise or training can make up for a body that’s being biochemically assaulted by the food that it’s taking in.

So, there you have it: my imprecise notes from Peter Attia’s interview with Dr. Lustig. There are a lot more details and nuances to keep track of, but these are the main points.

I mentioned to my mom in passing that I’ve been blogging regularly for a while now.

Guess that brings my total readership to a grand total of…two.

100% growth in less than one year. Man, I’m really starting to get the hang of this.

#hangloose

The opinions with the most sincerity behind them are the ones that ""cost” something to hold.

For example, if I said I think brownies are the best dessert ever, there are definitely those who would disagree with me, but relatively few people would think me completely unreasonable. In another realm, if I said I didn’t think highly of Beyoncé’s music, well…that would definitely cost me some social points among many of my friends. (The truth is, I think some of her work is brilliant, but much of it is forgettable).

Maybe it’s a frivolous example, but the point still stands: you can trust an opinion more when it obviously costs someone (in terms of social status, regard, or some other metric) to hold it.