Fiber Fueled is a new book by Will Bulsiewicz, a young gastroenterologist who has embraced lifestyle medicine. His approach emphasizes the importance of the gut microbiome in controlling most aspects of health. Our genome is 99+% the same as everyone else’s but our microbiome is unique, created by inheritance and environment but mainly what we eat.

In general the more diverse the microbiome the better. This diversity is fueled by fiber and micronutrients in our food. Not only do we need lots of fiber but we must have maximum diversity in our whole plant foods and whole grains to create a wide spectrum of gut flora controlling our health. Bulsiewicz’s goal is thirty different whole plant foods a week. I tried for this goal and found I could easily do 30 in a day using different nuts and seeds, a variety of sprouts, beans, fruits and vegetables. He explains the mechanisms whereby whole plant foods change the bowel flora and goes through scientifically demonstrated benefits in various conditions. His explanation for the value of organic foods is the importance of bacteria which are destroyed by non-organic farming. A quick wash gets rid of most pathogenic bacteria; those remaining are beneficial in creating a biodiverse, healthy gut flora.

The author’s experience was very similar to mine: very little training in lifestyle in medical school, residency and fellowship; study of scientific literature which offers volumes of irrefutable evidence for a WFPB diet; personal weight loss, more energy, fewer minor illnesses; a feeling of well being. He approached dietary change gradually. Deb and I did it quickly. All three of us soon realized that we didn’t want the unhealthy foods any more.

He explains the difference between celiac disease, true allergy and food sensitivities like FODMAP, excess gas from legumes and irritable bowel aggravated by certain foods. Most Americans have a poor bowel flora which is unable to handle many foods because we have not developed the necessary bowel organisms. The solution is desensitization with gradual introduction of small quantities of many healthy foods building tolerance with the development of a diverse, health gut flora. The book offers an elaborate, step by step, 28 day introductory diet to accomplish this.

Fiber Fueled is well referenced and acknowledges the work of many scientists and clinicians. My only major complaint is lack of mention of Denis Burkitt whom I have discussed in a prior blog. Burkitt’s biography was entitled The Fibre Man since he spent the last decades of his incredible career lecturing at medical schools and to physician groups about his observations in Africa documenting the critical role that the fiber from whole grains, fruits and vegetables plays in our health.

Martin Ford’s popular 2015 book, Rise of the Robots, only came to my attention with the extra reading time offered by current stay at home policy. I’m sorry I hadn’t read it before and would love to see it updated to 2020.

The extent of AI’s impact on our economy, job markets and income disparity was already much greater in 2015 than I suspected was true now. The impact on factory workers and other rote physical work is well recognized and, in many areas, already fait accompli. Office work, including much now done by college graduates, and even computer and software jobs are quickly disappearing. In the last 20 years the investment business has realized greatly increased profits while employing many fewer people; legal work formerly done by young attorneys is done faster, more accurately and far more cheaply by computer; programming and computer system analysis is likewise often better done by machines.

Young people making educational and career decisions would be well advised to read this book. Ford views much education related debt to be wasted, never to retrieved.

A long chapter examines robots and AI in health care. New jobs will be abundant in health care but most will be menial and low paid such as elder care. Certain professional areas will be almost entirely replaced: pharmacy; radiology film reading; pathology slide reading. Optimal treatment plans in oncology and some other areas will replace current professional decisions. Ford feels there will be a need for many nurse practitioner type jobs: a professional who can interact with patients and input information from the patient into the system. Most basic acute problems and much chronic disease follow up can be handled at this level, replacing the primary care physician, a field most MD’s avoid anyway.

In the course of the book Ford digresses into societal problems. He reviews our dysfunctional medical system controlled by for profit decisions which are often dangerous to health and which divert huge amounts of money into profits for drug companies, specialty physicians and medical centers. Specific issues of abuse include billings of twenty times or more Medicare allowable; drug and equipment advertising; no negotiated drug prices by Medicare; the conflict of interest in fee for service medicine where the medical center or physician profits from extra studies and procedures. The result is that new technology often is greatly overused with lots of expense but little patient value.

He recognizes that American society is not ready for Medicare for All even though many analysts conclude it is the best system. A simple viable alternative is successful in several European countries: the government sets all-payer maximum rates (he suggests 120% of Medicare.) but this still does not resolve drug prices and fee for service abuses. He would ban advertising (as does most of the rest of the world) and set drug prices.

Incremental change to a poor quality, hugely overpriced American medical system may soon be off the table. If the economic consequences of COVID are as dire as many predict there will be no money for this wasteful approach. Medical, and to be fair, other hugely profitable businesses have shown little altruism in the past and have manipulated government and a gullible public. I think they will fight to keep as much as they can. Amusingly, and I am not a Bernie fan, his policies might be what would allow America to best endure the upcoming years.