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For people with bipolar disorder, manic episodes can be euphoric, but they can also be terrifying. In the throes of mania, some people feel like they are superhuman. They start new projects and stay up all night to work on them. In the worst cases, they cease thinking coherently: They might attempt to walk into the sea or fly off the roof.

Though medications can help manage the symptoms, no pill is perfect, and all of them have side effects. Bipolar disorder appears to be at least partly genetic, but environmental factors also play a role, perhaps by switching different genes on and off, which might spark manic episodes. And the thing that might be switching on some of these genes, according to a new study, is rather surprising: a category of preservatives in beef jerky called nitrates.

For the study, recently published in the journal Molecular Psychiatry, researchers asked people being treated for psychiatric disorders at the Sheppard Pratt Health System in Baltimore whether they had ever eaten dry cured meat, undercooked meat, or undercooked fish. Those who had eaten cured meats—which include jerky and meat sticks—were three and a half times more likely to be in the group that was hospitalized for mania compared with the control group.

Meanwhile, cured meats were not significantly associated with other types of psychiatric disorders, such as major depression, and none of the other foods participants were asked about was significantly correlated with mania.

Here is where I pause and let you compose your tweet: “Correlation does not imply causation!”

This is true, and even though the authors controlled for a lot of different factors, it doesn’t prove that beef jerky caused mania. After all, it could just be that people who were already about to go manic were staying up late, ambling down to 7-Eleven, and stocking up on Slim Jims. (The authors controlled for the subjects’ mothers’ education, which is a proxy for socioeconomic status, but not a perfect one.)

So they decided to test this hypothesis further. They turned to rats.

First, they fed one group of rats normal food, and fed another group a piece of beef jerky every other day. They tried to make the rat-adjusted version roughly proportionate to the amount that a human would eat for a snack. Within two weeks, the jerky-eating rats began sleeping irregularly and behaving more excitedly. In other words, they seemed manic.

“We were able to get an effect in rats that was pretty consistent with what we were seeing in people,” said Robert Yolken, a professor of neurovirology at the Johns Hopkins University School of Medicine and one of the authors of the study.

They found the same difference when they compared rats that were given jerky with rats that were given a special, nitrate-free meat. The nitrate-free-meat rats? Normal. The beef-jerky rats? Extremely hyper.

Yolken and his team then looked inside the brains and guts of the rats. Their brains exhibited gene and molecular-pathway changes that are similar to the kind seen in people with bipolar disorder. What’s more, the manic rats, the ones with nitrate in their diet, had different kinds of bacteria living in their guts than the control rats did.

The researchers don’t know exactly why the nitrates had this effect. Nitrates have antibacterial properties, and Yolken thinks the preservative might have been altering the microbiomes of the rats and the humans. In past research, he and his colleagues found that when people who were hospitalized for a manic episode were given probiotics, they were less likely to be rehospitalized in the next six months.

It’s not totally clear how these microbiome changes affect the brain. According to the researchers, the bacteria might be sending signals through the vagus nerve, which connects the gut and brain. Or they could be releasing chemicals called butyrates that travel through the circulatory system to the brain, where they influence the production of mood-setting hormones called neurotransmitters.

Yolken and his colleagues “took the innovative approach of finding something in humans and testing it in the animal model,” said Melvin McInnis, an expert in bipolar disorder at the University of Michigan who was not involved in the study. “That brings credibility to the study in a way that would lead us to take these results as valid.”

Based on this study alone, Yolken said, it’s too early to say that people with bipolar disorder should avoid nitrates.

But there are already other health risks associated with eating too much processed meat. As McInnis put it, “Eating a lot of foods with nitrates is not a good idea anyway, and this adds another piece of evidence to that.”

Either way, we need many more studies before we can conclusively prove that anything in beef jerky is sparking manic episodes. In the meantime, this research adds to the pile of evidence that there are strong connections between what we eat and how we feel.

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No single wolf can take down a bison on its own, but the pack has strength in numbers. A lone army ant is little threat, but an entire colony is a mighty destructive force. The natural world abounds with examples of predators that cooperate to take down their prey. And such teamwork also exists at a microscopic scale, among things that some scientists wouldn’t even classify as alive: viruses.

Most viruses don’t infect humans; instead, they target bacteria. These viruses, known as phages, are like miniature syringes. They commandeer bacteria by landing on them and injecting their genetic material inside. But bacteria can defend themselves from these incursions. They can store phage genes within their own DNA to build up a dossier of enemies past. They then use this cached information to guide destructive, scissor-like enzymes, which seek out any matching viruses and slice them up.

This defense system is known as CRISPR. It’s the basis of the gene-editing technique that is being used to treat human diseases, control invasive species, and inspire movie plots. But for billions of years before scientists realized that CRISPR could be used to alter DNA, bacteria were using it as part of their immune systems.

CRISPR doesn’t always work. In 2012, the microbiologist Joseph Bondy-Denomy pitted phages against CRISPR-wielding bacteria. Some of the viruses were destroyed, but others unexpectedly survived and infected the bacteria. Bondy-Denomy showed that those phages succeeded by relying on proteins that could shut down CRISPR inside the bacteria, by sticking to the scissor-like enzymes and blunting them.

So, bacteria and phages are locked in an arms race. The bacteria use CRISPR to defang the phages, and the phages use anti-CRISPRs to subvert the bacterial defenses. The only problem is that the anti-CRISPRs shouldn’t work.

It’s all a matter of timing. Once the phages inject their genes into their bacterial victims, some of those genes serve as blueprints for manufacturing anti-CRISPR proteins. That takes time. By contrast, the bacteria have their CRISPR defenses ready-made. These ought to immediately start destroying the phages before they can construct their anti-CRISPR countermeasures. Based on that, “we didn’t think the anti-CRISPRs would work,” says Bondy-Denomy, who now works at the University of California at San Francisco. “It seemed like a race against time.”

His colleague Adair Borges showed that the slower phages can still win this race—as long as there are enough of them. The first one attacks the bacterium, and is destroyed by CRISPR before it can make enough anti-CRISPR countermeasures. Still, whatever anti-CRISPRs it does manage to make will linger in the bacterium, partly suppressing its immune defenses. The next phages to invade might also be destroyed, but each one weakens the CRISPR defense even further, until finally, the viruses overwhelm their victim.

A second group of scientists, led by Stineke van Houte from the University of Exeter, independently found the same thing. They, too, showed that anti-CRISPRs are imperfect, and that their success depends entirely on how many phages there are. As long as there are enough phages to successively attack the same bacterium, the later ones will eventually succeed even if the first ones fail.

Indeed, it’s only because the first ones fail that any succeed at all. The first phages are like kamikaze bombers, throwing themselves at enemy forces. They sacrifice themselves, but they give the next wave a chance of breaking through. “Those next phages benefit from what the first phage leaves behind,” says van Houte. “That’s how they cooperate.”

There are very few microbes that can successfully infect a host from a single cell or particle, says Britt Koskella from UC Berkeley, who studies phages. Infections are almost always a numbers game. Still, the phages are unusual in that “previously unsuccessful infections can increase the success of future ones,” she says. “This is the opposite of what happens in most other systems, where previous exposure to pathogens typically primes the immune system and decreases the likelihood of future infection.”

To Bondy-Denomy, the phages’ behavior looks a lot like the altruism of, say, ants and bees, in which individuals make sacrifices to help others who share the same genes. Similarly, in sacrificing themselves, early phages help out later ones that are likely to be genetically identical. Bondy-Denomy admits that the term “altruism” is a loaded one, and seems like a stretch for viruses, which clearly don’t have any agency, and which straddle the boundaries between living and inanimate. “But it fits if you accept that altruism can be a non-neurological process, that doesn’t have to come from decisions by a member of a community,” he says.

These studies open more questions than they answer. When anti-CRISPR proteins suppress the immune systems of the bacteria, how long does that last? If one type of phage starts to weaken the bacteria, could another type cheat by exploiting the immunocompromised targets without making any anti-CRISPRs of its own? And how important is any of this in nature? It depends on “how many phages the average bacterial cell typically encounters,” Koskella says. “If it’s not very many, then the CRISPR system should be adequate in most environments. But if bacteria are constantly facing a barrage of phages, then this tipping point where phages override bacterial defenses could be commonly reached. The answer is probably somewhere in between.”

These battles are unlikely to affect the use of CRISPR in gene editing, but they “could have profound implications for phage therapy,” says Karen Maxwell from the University of Toronto. She’s talking about attempts at using phages to cure bacterial infections in humans. Phage therapy was long dismissed in the West as a kooky fringe idea, but it’s enjoying a resurgence after several recent successes at treating bacterial infections that resisted standard antibiotics.

But as Maxwell notes, numbers matter. “If too few phages are delivered, the therapy will fail, since the phages will be driven to extinction,” she says. By studying the battles between bacterial CRISPRs and phage anti-CRISPRs, researchers will be able to fine-tune the doses of virus that are needed to cure different infections.

“There are also implications for our understanding of viral infections in humans,” Maxwell adds. Our own cells can shut down viral genes in a way that’s analogous to CRISPR in bacteria, and several of the viruses that infect us get help from proteins that suppress these defenses. These arms races might help explain why some viruses are more infectious than others.

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As a young child I missed a question on a psychological test: “What comes in a bottle?”

The answer was supposed to be milk. I said beer.

Milk almost always came in cartons and plastic jugs, so I was right. But this isn’t about rehashing old grudges. I barely even think about it anymore! The point is that the test was a relic of a time before me, when milk did come in bottles. It arrived on doorsteps each morning, by the hand of some vanishing man. And just as such a world was alien to me as a kid, the current generation of small children might miss a similar question: “Where does milk come from?”

Many would likely answer almonds or beans or oats.

Indeed, the already booming nut-milk industry is projected to grow another 50 percent by 2020. Much of this is driven by beliefs about health, with ads claiming “dairy free” as a virtue that resonates for nebulous reasons—many stemming from an earlier scare over saturated fat—among consumers lactose intolerant and tolerant alike. The dairy industry is now scrambling to market milk to Millennial families, as the quintessential American-heartland beverage once thought of as necessary for all aspiring, straight-boned children has become widely seen as something to be avoided.

Should it be?

It all happened quickly. In the 1990s, during the original “Got Milk?” campaign, it was plausible to look at a magazine, see supermodels with dairy-milk mustaches, and think little of it. Now many people would cry foul. With nut milks dominating the luxury café-grocery scenes frequented by celebrities, an image like that would surely elicit cries of disingenuousness: There’s no way you actually drink cow’s milk! And if you do, it’s probably skim or 2-percent milk, which leave no such thick mustache!

Difficult as it may be for Millennials to imagine, the average American in the 1970s drank about 30 gallons of milk a year. That’s now down to 18 gallons, according to the Department of Agriculture. And just as it appears that the long arc of American beverage consumption could bend fully away from the udder, new evidence is making it more apparent that the perceived health risks of dairy fats (which are mostly saturated) are less clear than many previously believed.

A new study this week in The American Journal of Clinical Nutrition is relevant to an ongoing vindication process for saturated fats, which turned many people away from dairy products such as whole milk, cheese, and butter in the 1980s and ’90s. An analysis of 2,907 adults found that people with higher and lower levels of dairy fats in their blood had the same rate of death during a 22-year period.

The implication is that it didn’t matter if people drank whole or skim or 2-percent milk, ate butter versus margarine, etc. The researchers concluded that dairy-fat consumption later in life “does not significantly influence total mortality.”

“I think the big news here is that even though there is this conventional wisdom that whole-fat dairy is bad for heart disease, we didn’t find that,” says Marcia de Oliveira Otto, the lead researcher of the study and an assistant professor of epidemiology, human genetics, and environmental science at the University of Texas School of Public Health. “And it’s not only us. A number of recent studies have found the same thing.”

Hers adds to the findings of prior studies that also found that limiting saturated fat is not a beneficial guideline. While much similar research has used self-reported data on how much people eat—a notoriously unreliable metric, especially for years-long studies—the current study is noteworthy for actually measuring the dairy-fat levels in the participants’ blood.

A drawback to this method, though, is that the source of the fats is unclear, so no distinction can be made between cheese, milk, yogurt, butter, etc. The people with low levels of dairy fats in their blood weren’t necessarily dairy free, but they may have been consuming low-fat dairy. All that can be said is that there was no association between dairy fats generally and mortality.

The researchers also found that certain saturated fatty acids may have specific benefits for some people. High levels of heptadecanoic acid, for example, were associated with lower rates of strokes.

De Oliveira Otto believes that this evidence is not itself a reason to eat more or less dairy. But she said it could encourage people to give priority to whole-fat dairy products over those that may be lower in fat but higher in sugar, which may be added to make up for a lack of taste or texture. She points to the classic example of chocolate milk, the low-fat varieties of which are still given to schoolchildren under the misguided belief that it is a “health food.”

The latest federal Dietary Guidelines for Americans, which guide school lunches and other programs, still recommend “fat-free or low-fat dairy.” These guidelines are issued by the U.S. Department of Agriculture, so they have long been biased toward recommending dairy consumption in a country that is rich in dairy-production infrastructure. Veganism is not encouraged given a national interest in continuing to consume the dairy the country produces. But promoting low-fat and fat-free dairy over whole milk has no such economic defense.

The takeaway is that, from a personal-health perspective, dairy products are at best fine and reasonable things to eat, and avoiding butter and cheese is less important than once believed. While the narrative that cheese and butter are dangerous is changing, it also remains true that dairy isn’t necessary for children or adults. A diet rich in high-fiber plants has more than enough protein and micronutrients to make up for a lack of dairy—and the vitamin D that’s added to milk can just as well be added to other foods, taken as a supplement, or siphoned from the sun.

With every new study that tells us more about the complexities of human nutrition and stymies efforts to fit nutrients into simple good-bad binaries, the easier it should be to direct our concerns productively. This study is another incremental addition to an ever-expanding body of knowledge, the point of which is that we should worry less about the harmful effects of single nutrients and more about the harms done by producing food. At this point, the clearest drawbacks to consuming animal products are not nutritional but environmental, with animal agriculture contributing to antibiotic resistance, deforestation, and climate change. While there is room for debate over the ideal amounts of saturated fat in human blood, the need to move toward an environmentally sustainable food system is unambiguous.

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With the prospect of a more conservative Supreme Court on the horizon, some progressive women have begun to fear what will happen if Roe v. Wade, the case that legalized abortion, is overturned. Some of these prophecies have centered on a popular meme in the pro-choice community: The coat hanger.

During a recent rally, New York gubernatorial candidate Cynthia Nixon held up a wire coat hanger as a warning that we should not return to the previous generation’s means of obtaining illicit abortions. And Representative Lois Frankel, a Democrat from Florida, banged a coat hanger on the table at a briefing while discussing the latest Supreme Court nominee, Brett Kavanaugh.

And this isn’t counting the many happy hours in progressive cities that have become peppered with gallows-humor cracks about coat hangers and back alleys.

But medical technology has progressed significantly since Roe was decided in 1973, and we—realistically, fortunately—won’t see a return to women using coat hangers or other implements to self-abort. Instead, it’s more likely that more and more women will turn to shady online pharmacies to buy abortion pills through the mail—a practice that is already occurring with surprising frequency and effectiveness around the world.

Women who want to have an abortion early in their pregnancies can take a combination of two drugs: misoprostol, whose brand name is Cytotec, and mifepristone, which is also called RU486. They are both on the World Health Organization’s “List of Essential Medicines,” which means they are considered safe and effective. The combination can be used until about the tenth week of pregnancy, and the medications are already used in roughly a third of all abortions.

Misoprostol, which also treats ulcers, is available in pharmacies, and it’s about 85 percent effective in inducing an abortion on its own. It is much more effective when used with mifepristone, but FDA restrictions dictate that patients can’t receive mifepristone even at a retail pharmacy, and possibly not through the mail, either. Most abortion providers think it’s really only legally safe to dispense mifepristone to patients directly, in person. In some places, like the Hawaiian island of Kauai, there are no abortion providers, and women must take a 300-mile round-trip flight to get an abortion. So instead, many turn to Google.

Abigail Aiken, an assistant professor of public affairs at the University of Texas at Austin, conducted interviews with 32 people from 20 states who sought out abortion pills online for a study she and her colleagues published last week. She found women turned to mail-order abortions because a clinic-based abortion was too expensive, or because state restrictions around abortions—like waiting periods and ultrasound laws—were too onerous. Some just preferred the privacy and convenience of doing their own abortion at home.

These online abortion pill pharmacy websites, though, seem to give the women pause. They seem illegitimate and are riddled with broken English: “In this recession growing economy were we can’t afford more childrens, we need some source which can be easily available online,” one website notes. Some of the websites pop up, then shut down unexpectedly. It would be difficult for these same pharmacies to open up in the U.S., since FDA regulations require pharmacy patients to have prescriptions. In the end, none of the people Aiken interviewed ordered the pills, instead opting for unreliable herbal treatments or a last-minute clinic visit.

For a study published earlier this year, Elizabeth Raymond, a senior medical associate at the research organization Gynuity, Googled phrases like “buy abortion pills online.” The researchers ended up ordering 18 of the pill combinations from 16 different websites, none of which required a prescription. The pills came from India, where there is a large generic-drug industry. Shipments cost between $110 and $360, and the packages took between three days and three weeks to arrive.

Even then, it wasn’t entirely smooth sailing, as Raymond and her co-authors write:

Two buyers received troubling communications from product vendors. One warned about the legality of purchasing online: “Please do not share this info with any other side because investigation team is searching the details for this type of medicine.” In the second case, the vendor complained that he was unable to get payment from the online payment platform and threatened to withhold shipment until the buyer paid another way. After some convincing, he finally sent the product. In addition, one buyer who paid with Western Union received two fraud alert calls—one from Western Union advising against purchasing pharmaceuticals online and another from her credit card company.

Raymond noticed that some of the blister packs of pills were broken. “It’s our speculation that the shippers are afraid that the customs service will be able to feel through the packaging and see that that there are pills in there, so they crush the blister pack,” she says.

Although the mifepristone pills contained the expected amount of the medication, most of the misoprostol pills contained less than the labeled dose. (They might still work, even at a lower dose, Raymond says.) What’s more, none of the pills came with instructions for use.

Still, says Daniel Grossman, an obstetrics professor at the University of California, San Francisco, “it doesn’t appear that women are having serious complications” from these DIY regimens. If the pills are taken late, they could still work, but are less likely to. Mifeprex, the brand name for mifepristone, has been used by more than three million women in the United States and has caused 19 deaths, a rate of adverse events that’s lower than that of Viagra.

Pro-life groups, meanwhile, insist that the pills are not safe. Because of the risk of ectopic pregnancy, among other reasons, “the practice of obtaining abortion pills over the internet is risky, and it ought to be illegal,” says Steve Aden, chief legal officer at the pro-life group Americans United for Life. (Grossman says that while attempting to self-abort could delay the diagnosis of an ectopic pregnancy, the pills don't affect ectopic pregnancies or make them worse.) The people held accountable, Aden says, should be the companies providing the pills, rather than the women themselves.

If Roe is overturned, Raymond says, the abortion landscape will roughly look like this: “In some states, abortion will still be legal, so people will travel to those states. Some people won’t get abortions. Some people will get abortions, but later. And more people will probably use these alternative methods for getting the service.”

Women on Web, a Canada-based service, ships the abortion pills to patients who live in countries where abortion is illegal. Rebecca Gomperts, the organization’s founder, says the organization gets 10,000 emails each month asking for help and staffs a help desk that speaks 17 languages. The service asks women to fill out an online form about their health status, which doctors in various countries review, then fill prescriptions for the abortion pills. In 12 years, she estimates they’ve helped 70,000 women perform their own abortions.

Women on Web doesn’t ship pills to the United States, however, because as Gomperts told me, in America “there’s such an aggressive anti-abortion movement that will do anything they can to close down services. It could potentially jeopardize all the other work of Women on Web.”

The United States, she said, “should be able to solve its own problems” regarding abortion access. “It’s a very rich country,” she added. “The problem there is caused by the huge inequality in the society. There’s no reason the situation in the U.S. should be the way it is.”

If women do start turning to web-based services in greater numbers, it raises the question of whether they’ll face legal risks. Gomperts says it’s legal, in most countries, to receive medicine through the mail for personal use. But other experts I spoke with were not so sure.

The SIA Legal Team, a group of lawyers who specialize in women who induce their own abortions, knows of 21 people who have been arrested or prosecuted for ending their pregnancies outside a medical setting, or for helping someone else do so. (It might be an undercount, since the organization relies on news reports to track cases.) The charges brought against women who self-abort can range from child abuse, to the abuse of a corpse, to a failure to report a death, says Jill Adams, SIA’s chief strategist.

None of the women were prosecuted for buying abortion pills, specifically. But Adams notes that buying pills online and even Googling “buy abortion pills” can leave a paper trail that can be used as evidence in a trial.

Because of this risk, Plan C, an organization that provides information on self-abortion, says some people seeking abortion pills try installing private networks on their computers in order to hide their search history, use secure texting services like Signal, or pay with Bitcoin and other private methods.

In seven states, self-induced abortion is already illegal. In 2015, a woman in Indiana named Purvi Patel was sentenced to 20 years in prison for feticide after she allegedly used abortion pills she ordered online. Prosecutors claimed her fetus had been born alive, and she allowed it to die. Her conviction was later overturned on appeal.

Sites like Women on Web tell women that if they require medical attention after aborting at home, they should just tell the doctors they had a miscarriage. The doctors shouldn’t be able to perceive the difference, they say. “The police in some countries put a lot of pressure on women to confess,” Gomperts said. “They should never confess that they did [abort].” If women are further along than 10 weeks, the service sometimes advises them to go to the emergency room of a hospital and take the pills there, in case complications occur.

If Roe is overturned, abortion laws would be up to the states, and about 22 states would likely ban abortion, Amy Myrick, staff attorney at the Center for Reproductive Rights, recently told Kaiser Health News. In those states, Grossman speculated, doctors might begin to practice harm-reduction by, for example, giving women information about how to use the pills, without providing the actual pills themselves.

However, it’s not likely that, say, a doctor in California could prescribe abortion pills to a woman in Texas over the internet, since Texas has already outlawed the practice of telemedicine abortion, and it would likely continue to do so.

It’s also possible that Roe won’t be overturned outright, but abortion restrictions will tighten further under a more conservative Supreme Court. That’s already the reality for women in many states. Across wide swaths of the country, women must take multiple days off work and drive for hundreds of miles to get an abortion because their home states have imposed waiting periods or created restrictions that have caused clinics to close. In the past seven years, states have enacted nearly 1,200 such restrictions.

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Completing a marathon has long been the ultimate feather in the cap of an amateur endurance athlete. But the idea of trotting along a boring old paved road for 26.2 miles doesn’t thrill everyone. For the endurance athlete who gets bored easily, a new genre of race has emerged—peppered with obstacles requiring feats of strength and dexterity (Crawling under barbed wire! Climbing a rope! Throwing a spear! Burpees!), and designed to be an over-the-top spectacle where participants emerge covered in mud (and maybe blood), as if they’ve survived a battle.

The two biggest names in the world of obstacle course races (OCRs) are Spartan and Tough Mudder. These organizations put on OCRs that cover distances between 3 and 30 miles with the addition of up to 35 obstacles along the way. In some of the most intense races, participants might be asked to army crawl under live electrical wire or carry 60 pound sandbags up a ski slope in the middle of running a half-marathon.

Participation in traditional road races like marathons and 5K’s, while still high, is on the decline in the United States. After peaking at 19 million finishers in 2013, participation fell to just over 17 million in 2016, according to the New York Times. Running USA’s annual report stated that only 3 percent of those running road races in 2016 completed a marathon. At the same time, participation in Spartan, Tough Mudder and other OCRs are on the rise. Since each was founded in 2010, Tough Mudder reports 2 million total participants and Spartan claims 5 million.

In a phone interview with Spartan’s founder Joe De Sena, I asked him about the appeal of OCRs compared to traditional road racing. Basically, he said, OCRs are more fun than marathons. “Look, at the end of the day, most of us are extremely lazy and our modern environment allows us to be lazy. If someone wants to change that and feel good and go exercise, does a 26.2-mile run on pavement sound appealing?” De Sena asked. “In contrast, with [Spartan], it’s just badass and more fun. The imagery, the videos, it’s just more likely to rip someone off the couch.”

De Sena also believes that the longest OCRs are tougher than marathons, and help people get in better shape. “When I look at the starting line of a marathon, the human beings I see don’t look like they have maximized their potential,” De Sena told me. “But when I look at the human beings at the start of a Spartan Championship Race, it’s like, wow, that’s the perfect body.”

De Sena obviously has his reasons for saying that, but others from the world of marathons might agree that it’s beneficial to mix some strength and agility training in with the intense endurance of distance running. In a profile in Runner’s World, Ryan Hall, the American record holder in the marathon with a time of 2:04:58, confessed that while he was at the peak of his marathon physique he felt weak and underdeveloped. Since retiring from competitive distance racing at the age of 33, Hall has added strength training to his routine, as well as 40 pounds of muscle (documented in a shirtless Twitter selfie). Hall remarked that he felt like strength training was “giving life to my body instead of taking it away.”

I reached out to dozens of OCR participants online to ask them about their race experiences and many echoed De Sena’s pronouncement that OCRs were more challenging than a marathon.

Daniel Norton, 41, a software engineer from Charlotte, North Carolina, is a former marathon runner who insists that his Spartan experience was far tougher than any marathon. Norton had a single word to describe what it was like to complete the Super Spartan Race in Asheville, North Carolina, a course covering 10 miles and 29 obstacles spread out over the rugged terrain of a mountainside granite quarry: “grueling.”

“I saw several people just stop and sit down,” Norton said. “There were times I was desperate to do the same [...] but I certainly enjoyed the journey.”

The added challenge of an OCR, which may be a deterrent for some, is the thing that makes it appealing for others. Philip Wilson, a professor in the department of kinesiology at Brock University in Canada, says that variety can keep people motivated, even if the exercise is challenging.

“The notion of difficulty is tied to the perception of challenge that comes with the activity. It is a fine line. Too much difficulty and people feel like they are a failure and are likely to quit ... too little difficulty and people likely find it monotonous and not stimulating,” Wilson said. “So, yes—challenge matters—and the research suggests it is all about how the person interprets the challenge and whether the challenge is optimal in relation to the person’s own capabilities or not that makes the difference in motivational terms.”

So while couch potatoes may not find the OCRs’ obstacles to be an “optimal” challenge, many OCR competitors are likely “already highly competent exercisers” looking for a push, Wilson says.

“Running a marathon has totally lost its cachet,” said Travis Macy, an endurance coach in Evergreen, Colorado. “Among the athletes I coach, it’s not uncommon to hear them say, ‘It was just a marathon’ or ‘I might hop in a marathon as a tune up’ for another, longer race they’re doing.’” Further evidence that the marathon is no longer the pinnacle of endurance running: the rise of ultramarathons. While marathon participation has been on the decline since 2013, over the same period of time Ultrarunning Magazine reports that the number of finishers in ultrarunning events—any distance over a marathon and typically at the 50-mile and 100-mile distances—has increased by 34 percent from 79,046 in 2013 to 106,033 in 2017.

Macy has run more than 120 ultra-endurance events, and is a veteran of OCRs as well—he was the winner of the 2015 Breckenridge Beast Spartan Race in Breckenridge, Colorado. Lately, he says he’s training more clients specifically for OCRs, with some of the trail runners he coaches going from “dabbling” to becoming full-time obstacle course racers. “In my opinion, obstacle course racing does a great job fulfilling two innate human needs: one, be primal, and two, be communal,” Macy said.

By “primal,” Macy explained, he means simply that people have an urge to use their bodies. With “communal,” he’s referencing the almost tribal communities that have sprung up around Spartan and Tough Mudder. At the start of a Spartan race I attended at Dodger Stadium this past April, for example, I saw teams wearing matching uniforms and coordinated body paint as they chanted “Aroo!” in guttural unison. In contrast, at the start of the Los Angeles Marathon this past March, I did not notice any such thing.

The professional endurance athlete Amelia Boone, who is both a Spartan and Tough Mudder world champion, agrees with the communal explanation for OCR’s appeal. “There’s something to be said for shared suffering,” Boone said. “When most people run their first Spartan race, as I did when I started out, you sign up with friends or family and you do it as a team. You see people helping each other over obstacles. In a 5K [road race], there might be verbal encouragement, but nobody is literally pushing your ass over a wall.”

While marathons are not inherently communal, obstacle course races show that the loneliness of the long-distance runner need not be a chronic condition of the sport. Consider also that while marathon participation is on the decline, Running USA reports that relay races have been growing in participation over the last decade. According to one Harvard study, the social pleasure of shared experience tends to outweigh the joy of doing something extraordinary on your own.

So can the growing popularity of OCRs be explained by their inherent knack for “ripping people off the couch” to exercise as Spartan’s De Sena puts it? Or are they merely a more fun, communal alternative for those already intrinsically motivated to exercise, as Wilson’s research might indicate? It’s difficult to say for certain, but research from the CDC on overall exercise trends suggests that since 2010 when Spartan and Tough Mudder were founded, the United States has not seen a statistically significant increase in overall exercise.

Still, it seems like the social aspect of these races has given at least a few people who have never run any type of race before a reason to sign up. Jonathan Fine, Spartan’s head of global brand communications, confirmed this in an email exchange: Close to 80 percent of Spartan racers in the United States sign up as part of a team. And according to the Tough Mudder website, of the 2 million participants since 2010, 95 percent competed as a part of a team.

Potluck Mittal, 27, a software engineer from San Francisco, signed up with his co-workers. “I’d never really done an athletic competition before,” Mittal said. He ended up enjoying the event, describing it as a “social activity crossed with fitness ... a dope combo.” He has already signed up for another Spartan and is looking for some friends to do it with him.

“A lot of people beat around the bush and wait until they’re in shape to sign up for one of these things,” Macy told me. “I’d say if you’ve been thinking about it, just do it.”

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In 1907, the German psychiatrist Alois Alzheimer published a description of a 50-year-old woman who suffered from memory problems, hallucinations, and delusions. In the woman’s brain, Alzheimer noticed unusual lumps, or “plaques,” which “were caused by the deposition of an unusual substance.” Eight decades later, the mystery substance was finally identified as a protein called amyloid beta. Though small, it can accumulate in large clusters that are somehow toxic to neurons. Those harmful plaques are one of the hallmarks of the disease that bears Alzheimer’s name.

What amyloid beta normally does in the brain isn’t clear. Robert Moir, a neurologist at the MassGeneral Institute for Neurodegenerative Disease, says that many researchers have cast it as a villainous molecule with no beneficial function.  “It’s just bad, bad, bad,” he says. “But it has become increasingly obvious that this isn’t true.” Moir thinks that amyloid beta has a more heroic role, as a foot soldier of our immune system. It protects neurons from infectious microbes—and from herpes viruses, in particular.

William Elmer, a member of Moir’s team, demonstrated this protection by injecting the common herpes virus HSV–1 into the brains of two kinds of mice: normal rodents and ones that were genetically engineered to produce high levels of amyloid beta in their brains. The latter were better at resisting the viruses. Elmer then got similar results when he injected a different herpes virus, HHV–6, into human cells growing in a dish.

Amyloid beta protects against these viruses by latching onto them in large numbers, imprisoning them in self-assembling cages. That’s typically a good thing, but Moir argues that if the process goes on for too long, it builds up to the problematic plaques of Alzheimer’s. According to him, amyloid beta is still at the heart of the Alzheimer’s story, but it isn’t the villain. “In our model, Alzheimer’s is caused by amyloid beta’s reaction to something else, and most likely some kind of infection” like herpes, he says.

Moir notes that amyloid beta also exists in most other backboned animals. The protein first evolved around 400 million years ago, which is also roughly when the herpes virus family first appeared on the scene. “It’s clear that herpes and amyloid beta have been slugging it out since before there were insects,” Moir says. “One’s tuned to escape and the other to capture.”

This gives credence to the long-dismissed idea that viruses—and herpes, in particular—are involved in Alzheimer’s in some way. That’s not to say that the disease is contagious, nor that everyone with herpes infections is at risk. After all, HSV–1 and HHV–6 are extremely common. Two in three people have been infected by the former, which mostly causes cold sores. Almost everyone has encountered the latter.

In the past three decades, more than 100 papers have described correlations between the presence of HSV–1 and the risk of Alzheimer’s. Ruth Itzhaki from the University of Manchester notes that “hostility or derision occurred with most of my papers on this topic, and many people simply ignored them.” But evidence continues to grow. Most recently, Ben Readhead and his colleagues at the Icahn School of Medicine at Mount Sinai showed that two herpes viruses, HHV–6A and HHV–7, were more common in the brains of Alzheimer’s patients than in those of healthy people. The team confirmed this in three separate groups of patients. And they found that the more abundant the viruses, the worse the patients’ symptoms.

It’s possible that these herpes viruses are mere hitchhikers that are more likely to infect brains that are already deteriorating. But Readhead also showed that they can influence the activity of many human genes, including an unexpectedly large number that affect the risk of Alzheimer’s and the progression of the disease. “Some of these viruses are interacting with genes that are in the middle of known Alzheimer’s biology,” he says.

For example, the most infamous Alzheimer’s-related gene is ApoE. It comes in three forms, and the E4 version is the problem. People with one E4 copy have a threefold-higher risk of Alzheimer’s than those who have no copies, and those with two E4 copies have up to a twelvefold-higher risk. Readhead and his colleagues have shown that the more E4 copies someone has, the more HHV–6A and HHV–6B viruses they are likely to have in their brains.

“We can’t make any causal inferences” from these studies, cautions Maria Carrillo, the chief scientific officer of the Alzheimer’s Association. “Their findings don’t prove the viruses lead to Alzheimer’s progression, but there is a relationship, and we need to understand what herpes viruses are doing in the brain.”  

Moir suspects that as we get older, herpes viruses take advantage of our weakening immune systems to spread from other parts of the body into the brain. Amyloid beta rises to meet them in battle, and deposits of amyloid-entrapped viruses start to accumulate in the brain. This goes on for years, and slowly but surely leads to the other hallmarks of Alzheimer’s.

This is all conjecture for now. It’s also possible that herpes simply exacerbates a process of amyloid accumulation that has been triggered by something else, or that other changes in the brain allow long-standing herpes infections to run amok. “It’s going to be more complicated than a simple case of an infection leading to disease,” Moir says.

“These studies suggest a possible role of viral infection as a contributing factor to Alzheimer’s disease,” says Li-Huei Tsai, a neuroscientist at MIT who studies the disease. “But it remains to be seen if drugs used to treat herpes-virus infection can be protective against Alzheimer’s.”

Hints that they can already exist. One study published earlier this year tracked the health of about 78,000 Taiwanese people, half of whom had been diagnosed with shingles within a 16-year period. Shingles is caused by a herpes virus called VZV, which also causes chicken pox in children. Among adults, the study found that people with a recent shingles flare-up had an 11 percent higher risk of developing dementia than healthier peers. And strikingly, those who were treated with anti-herpes drugs had a 45 percent lower risk of developing dementia than their untreated peers.

A second Taiwanese study looked at more than 8,000 people who had been recently diagnosed with HSV–1. Over the next decade, those people were 2.5 times more likely to develop dementia than uninfected peers. But again, that risk fell by 80 percent among those who had been treated with anti-herpes drugs. “That’s perhaps the strongest epidemiological data to emerge so far,” Moir says.

These drugs would have to be tested in clinical trials. And even if they can reduce the risk of Alzheimer’s, “they aren’t very pleasant and you can’t treat everyone,” Moir says. “The problem is how do you find people who have a herpes infection that warrants targeting with medications? It’s not clear.”

Scientists have spent decades trying to develop treatments for Alzheimer’s by creating drugs that get rid of amyloid beta. This approach has been catastrophically unsuccessful, with hundreds of clinical trials and nothing to show for them. Perhaps a better understanding of what amyloid beta actually does, and how it interacts with viruses, could lead to better strategies for beating Alzheimer’s—a disease that affects almost 30 million people worldwide.

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It was an issue over which a strong show of American exceptionalism wasn’t exactly expected: breast milk.

According to a recent report from The New York Times’ Andrew Jacobs, American officials at the World Health Assembly in Geneva this spring wanted to modify a breastfeeding resolution, and they went to the mat to do it, threatening other countries unless they promised to drop it.

The American delegates wanted to ditch language in the nonbinding resolution that called on governments to “protect, promote, and support breastfeeding” and another passage that called on policymakers to restrict the promotion of unhealthy food products. When that didn’t work, they threatened Ecuador, the country that intended to introduce the breastfeeding measure, with punitive trade and aid measures. Ultimately, it was Russia that agreed to introduce the breastfeeding resolution, and the U.S.’s efforts were “largely unsuccessful,” the Times reported.

A spokesperson for the U.S. Department of Health and Human Services, which led the negotiation on the resolution, denied that trade sanctions were part of the discussion about the resolution. “Recent reporting attempts to portray the U.S. position at the recent World Health Assembly as ‘anti-breastfeeding’ are patently false,” HHS national spokesperson Caitlin Oakley told me. “The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies.”

Nevertheless, the episode shocked health-policy advocates because breastfeeding seems so, well, wholesome. To some critics of the U.S. delegation’s actions, it seemed like an example of the Trump administration bowing to the food industry and infant-formula manufacturers. “What this battle in Geneva showed us is that we have a U.S. government that is strongly aligned with the interests of the infant-formula industry and dairy industry, and are willing to play hardball,” said Lucy Sullivan, the director of 1,000 Days, an advocacy group that works on nutrition for mothers and children.

Sullivan and other health advocates point to a “stakeholder listening session” that the U.S. Department of Health and Human Services held with industry groups and nonprofits two weeks before the World Health Organization meeting in Geneva. As usual, dairy, grocery, and baby-formula groups gave their opinion to the U.S. delegates about the WHO resolutions. What seemed different this year, health advocates told me, is how forcefully the U.S. delegates acted on the trade groups’ opposition.

A representative from Nestle, which makes baby formula and baby food, spoke out at the session, according to Mary Champeny, a program officer with the nutrition group Helen Keller International who was at the listening session. The company said it opposed the resolution because of its reference to an earlier, 2016 World Health Assembly resolution, which they said “restricts complementary feeding,” the gradual introduction of solid foods along with breast milk starting at around six months of age. Champeny remembers another group, a supermarket lobby, also speaking out against part of the resolution at the same session. In talking points from the listening session provided to The Atlantic, a Nestle representative wrote, among other things, “We believe that to significantly increase breastfeeding rates and promote healthy diets, the Guidance when implemented by Member States should consider other important measures other than simply recommending additional restrictions on the promotion of commercial baby food.”

In prepared remarks written for the listening session, a coalition of dairy interest groups seemed to take issue with the fact that WHA guidance “redefines all milk products for children up to age three as ‘breastmilk substitutes,’” and said they “urge the U.S. government to ensure the WHA does not endorse the Guidance or call on member states to implement the Guidance.” Regarding another provision, the dairy groups said, “We encourage the United States to ensure that any future recommendations from WHO explicitly recognize the benefit of engaging with the food and beverage industry.”

This latest tussle in Geneva follows a decades-long battle by infant-formula makers to promote themselves as essentially on par with breast milk. And while health experts instead say “breast is best,” as this incident shows, policymakers aren’t always willing to put legislation behind that message.

Formula makers have responded to the cultural battle over breastfeeding in true corporate form: by lobbying for their interests and marketing their products. For example, Abbott Laboratories, which makes Similac and other formulas, spent $790,000 on lobbying this year, according to the Center for Responsive Politics. Though the company has spent more in past years, this year their disclosure lists having lobbied the U.S. Trade Representative, among others, on “proposals regarding infant nutrition marketing.”

“We support the WHO’s goal of increasing breastfeeding rates, including promoting exclusive breastfeeding during the first six months of life, where possible, and continued breastfeeding up to and beyond two years of age,” an Abbott spokesperson told me via email. “It is also important for all mothers and their health-care teams to choose the best feeding options for their babies and themselves.”

Some women rely on formula because they can’t or prefer not to breastfeed. Many women, especially working mothers in economically prosperous countries, breastfeed and supplement with formula. But health experts have concerns that poor women in developing countries buy formula because they think it’s better than breastmilk, then dilute it, sometimes with unsafe water, when they run low. In developing countries, formula has been found to increase the risk of infant death, when compared with breastfeeding. While the consequences of formula are not as severe in rich nations, the World Health Organization and the American Academy of Pediatrics both recommend exclusive breastfeeding for the first six months of a baby’s life because of breast milk’s health benefits. A British charity went so far as to call formula “The Baby Killer” in the 1970s. (Though formula maker Nestle sued for libel and won, a worldwide boycott of the company ensued.)

For decades, formula manufacturers went to creative lengths to get their product in the hands of new moms. In New York City in the 1970s, for example, the maker of Similac had a guarantee that every new mom leaving a city hospital would get a free supply of the formula, as Stephen Solomon wrote in The New York Times in 1981, and some companies employed nurse-like saleswomen who would give advice to new moms in maternity wards while subtly promoting infant formula. At the time, a doctor who worked for USAID blamed the reliance on infant formula for about a million infant deaths each year in developing countries.

That same year, the World Health Organization voted 118 to 1 to adopt a nonbinding code that advocated the end of promoting infant formula to the public. That one holdout vote? The United States. “Despite our governmental interest in encouragement of breastfeeding,” explained Elliott Abrams, then the Assistant Secretary of State for International Organization Affairs, according to The Times, the restrictions on formula advertisements “run counter to our constitutional guarantees of free speech and freedom of information.”

Today, countries that ban the advertising or promotion of infant formula, such as Brazil, tend to have higher rates of breastfeeding than those that don’t, like the United States. Still, even countries that adopted the WHO code into law don’t always crack down on formula manufacturers that break it.

Though 130 countries restricted advertising in the wake of the WHO code’s passage, a study in 2010 documented 500 violations of the code in 46 countries. One billboard in Laos, for example, showed a child happily eating “Bear Brand Formula Milk.” “This type of widespread marketing results in mothers’ recognizing certain brands and believing their children will be healthier with formula,” wrote the pediatrician June Pauline Brady in the Archives of Disease in Childhood in 2012.

In 2004, the U.S. Department of Health and Human Services tried to do the opposite: to advertise breastfeeding. Health officials were going to release ads showing some of the health issues—in the form of insulin syringes and inhalers—that they claimed babies who aren’t breastfed are more likely to face, according to a Washington Post story from the time. But the infant-formula industry hired lobbyists to appeal to the department, and the ads were toned down to feature happier pictures of ice cream and flowers. The new campaign, in the end, did nothing to boost breastfeeding rates.

Two years later, Massachusetts went further, becoming the first state to ban gift bags filled with infant formula in maternity wards. But the decision, crafted by the state’s Department of Public Health, was reversed by then-Governor Mitt Romney. The following month, Bristol-Myers Squibb, which makes formula, announced it would build a plant in Massachusetts. (“The decision to build our facility in Devens did not involve any consideration of our Mead Johnson business,” said a Bristol Myers Squibb spokesperson, referencing a former subsidiary.)

As recently as February of this year, a report by the group Changing Markets Foundation found that Nestle pitched its baby formulas as “closest to,” “inspired by,” and “following the example of” human breast milk, The Guardian reported. In some cases, the company contradicted itself, promoting Brazilian formula as being free of sucrose “for baby’s good health” while tucking sucrose into its South African formula. (A Nestle spokesperson told me, “The Changing Markets Foundation report on infant formula raises some important points. We engaged with CMF in a dialogue to clarify these points. We hope to collectively address the critically important challenge of ensuring access to the right nutrition for infants.”)

A few weeks later, an investigation by The Guardian and Save the Children found that infant-formula makers were offering health workers in the Philippines “free trips to lavish conferences, meals, tickets to shows and the cinema and even gambling chips, earning their loyalty,” in violation of the country’s laws. The investigation found:

TV advertising campaigns for follow-on milk by brands such as Bonna—which portray the “Bonna kid” as one who is smarter and succeeds in life—convinced them, they said, that bottle feeding is not only as good for the baby’s health as breast milk but will bolster their IQ and future prospects. Store displays of formula were splashed with claims such as “clinically proven to give the IQ + EQ advantage.”

The reporters spoke with one woman who could only afford to give her baby half-bottles of the formula. The girl’s stomach, they wrote, was visibly swollen from malnutrition.

Since 1981, the infant-formula WHO code has been updated through resolutions at the World Health Assembly. The last update was in 2016, during the Obama administration, and it was a big policy push, according to Elizabeth Zehner, a project director with Helen Keller International. As they often do, industry groups spoke out against it, said Sullivan, the 1,000 Days director who attended the 2016 session. The World Health Assembly “welcomed” the 2016 resolution “with appreciation,” a notch below endorsing it.

However, this year’s resolution wasn’t about updating the code. It was more modest, simply intended to remind countries of the importance of promoting breastfeeding, Sullivan said, and notify them about best practices around breastfeeding and HIV, or during natural disasters.

So it surprised health advocates that the United States would use such heavy-handed efforts to try to kill it. “They used very aggressive tactics to get rid of a resolution that really wasn’t a policy grab,” Zehner said.

Of course, aggressive is often the way of the Trump administration. As President Trump wrote on Twitter yesterday, “The failing NY Times Fake News story today about breast feeding must be called out.”

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ČELADNÁ, Czech Republic—The Beskid Rehabilitation Center sits on a rolling plot of land in the boomerang-shaped Beskid mountain range, a stretch of the Carpathians reaching from the Czech Republic across Poland and Slovakia, fading into western Ukraine and the Transylvanian Alps. Full of “alternative” therapies, the BRC is the kind of place you might visit if you were feeling fine, but wanted to feel great, or if you were suffering from a low-level chronic ailment that standard Western medicine had failed to resolve. There’s a cryotherapy chamber kept at a brisk -184 degrees Fahrenheit. There’s an open-air “healing pyramid,” a bare-bones wooden-beam structure said to have healing properties. (“Research shows that pyramid energy, thanks to its deeply relaxing effects, harmonizes the psyche,” the website alleges.) And famously, there’s Vila Mátma, or “My Darkness Villa,” where clients spend seven days or longer alone and in complete absence of light.

Many modern-day practitioners of what Czechs now call terapie tmou, or “darkness therapy,” point to a 49-day Tibetan retreat called yang-ti as its most important forebear. In the modern West, the therapy was promulgated in the 1960s by the German anthropologist Holger Kalweit as Dunkeltherapie (literally: “dark therapy”). The concept has particularly taken hold in the Czech Republic, where darkness-therapy centers now can be found across the country to serve a population of just 10.6 million, according to Marek Malůš, a psychologist who researches the technique. Staff at the best-known of these centers, the Vila Mátma at the BRC, say that prospective clientele will now spend two years on its waiting list. On its website, the BRC alleges that darkness therapy is “very effective” in preventing “lifestyle diseases,” including cancer and metabolic disorders, and that it sharpens the senses, stimulates creativity, and most notably, “regenerates the psyche.”

There’s not much to do in the dark, at Vila Mátma or any other darkness-therapy center. And that’s more or less the point. Depending on the facility, clients sleep, exercise, and meditate. They eat and bathe in the dark. They sometimes write, draw, sculpt, or play an instrument, all in total darkness. Without access to their phones or to the internet—or even to a clock or calendar—they tend to spend a lot of time alone with their thoughts, and on occasion chatting with a therapist or “guardian.” Not infrequently, clients report intense audiovisual experiences, most likely vivid dreams or hypnagogic imagery (the sort of micro-dreams you experience in between wakefulness and sleep), which can be pleasantly mind-expanding or downright terrifying. At the BRC, the procedure costs 2,000 Czech Koruna a day, or just under $100, and patients must reserve the one-person facility for a minimum of a week at a time.

Malůš, an assistant professor of psychology at the University of Ostrava’s Faculty of Arts, considers darkness therapy a variation of restricted environmental stimulation therapy (REST), the procedure once known as sensory deprivation. (The technique got a rebrand in the early 1980s in order to shake a pervasive connotation with torture and brainwashing.) REST is commonly classified into two categories: flotation REST, familiar to a mass audience thanks to the emergence of commercial saline flotation tanks, and chamber REST, in which a subject usually lies alone on a bed in a dark, quiet room for 24 to 48 hours. In studies, flotation REST has been linked to a host of psychological and physiological benefits, from elevated mood to reduced stress to improved athletic ability and increased creativity, and chamber REST has been linked in a handful of studies to successful habit modification.

Malůš invited Peter Suedfeld, a pioneer of REST research, to visit a few of the facilities in Central Europe several years ago, and the two recently collaborated on a chapter for a book. As Suedfeld explains, however, the extended length of time that people spend in darkness therapy and the fact that they can move freely about the chamber and communicate with therapists make it a markedly different procedure than the one he studied, in which subjects were left in complete isolation. He says he urged Malůš and his colleagues to perform more research, an entreaty he repeated to me over the phone. “I think it’s very interesting,” he said of darkness therapy, “and I wish people would collect data so we know exactly what the effects are.”

I paid a visit to the Beskids on a balmy afternoon this April, to speak with darkness therapy’s proponents and to spend a night in the chamber myself. In his emails prior to our meeting, as well as in person at the BRC, Andrew Alois Urbiš, who runs Vila Mátma, took pains to distinguish himself as a medical professional and to emphasize the villa as an operation run by a team of accredited physicians, rather than the kind of amateurish moneymaking venture he said he sees across the country. Urbiš’s office, however, also indicates an omnivorous appetite for alternative therapies and mystical disciplines: Photos in the entrance hall show him in the BRC cryotherapy chamber and alongside a man he met in Christchurch, New Zealand, whom he calls a “wizard.” A collection of statues behind his desk includes a figurine labeled with acupuncture points and a dark-green statue with a giant phallus. A manual for Vila Mátma staff requires that guardians should have “extensive theoretical knowledge” of a long list of unscientific practices and beliefs, including “basic cosmic laws,” books of the dead, dreaming techniques, quantum mind, shamanism, and fairy tales.

Even in the Czech Republic, where this therapy is particularly popular, few doctors will prescribe their patients a stay at the villa. “In a way, they’re not very inclined toward us, they don’t like us much,” Urbiš says of the greater Czech medical community, “because physicians prefer those chemicals, you know, that medication. But on the other hand, there’s a string of doctors who come here and stay repeatedly.”

Whatever ails you, it seems there’s someone to claim that darkness therapy will cure it. One client suffered from a “very unpleasant” patch of nasal eczema for 20 years, Urbiš alleged, before a week in Vila Mátma supposedly cleared it up. Urbiš’s friend and sometime assistant Karel Černin told me that it was darkness that ultimately relieved him of an infection that several rounds of antibiotics had failed to knock out. And Urbiš himself says that his 50 consecutive days in the villa left him with improved sensory perception. “I started to hear better, my memory was significantly improved, I began to better manage various stressful situations,” he said. His pace of life has slowed down, he said, but his productivity has increased. “And as you can see,” he added, “I was rejuvenated.” (With no basis for comparison, I can confirm that, for a 71-year-old, he seems quite spry.)

There’s also a theory held by Urbiš and others within the community that spending an extended period of time in darkness will raise an individual’s levels of the hormone melatonin, which is linked to sleep regulation and a host of other physiological processes, including cardiovascular functioning, reproductive cycles, and the development of cancer. Malůš and his colleague Pavol Švorc are currently co-piloting a study at the Darkness Therapy Center in Kozlovice, another small town in the Beskids, to measure the effects of the procedure on melatonin and cortisol secretion, the results of which they hope to publish this fall.

Exposure to artificial light at night does indeed suppress the production of melatonin—a consequence of modern life that could, in theory, be avoided during darkness therapy. Existing research into REST procedures, however, shows no evidence to back up the notion that prolonged light restriction boosts the amount of melatonin that the pineal gland might otherwise secrete. For Švorc, the known unknowns in this field of research present an opportunity: “The funny thing is, we don’t know what should we expect,” he says. “Maybe there will be some changes in [melatonin and cortisol] production dynamics, or maybe there will be some changes in the concentrations. We don’t really know because no one did [darkness-therapy] research before."

David Blask, the head of the Laboratory of Chrono-Neuroendocrine Oncology at Tulane University School of Medicine, says the notion that exposure to darkness outside of nighttime could raise melatonin levels is “simply not true.” The internal clock that regulates melatonin rhythm runs autonomously without the need for alternating light and dark, although melatonin secretion can be suppressed by light exposure, and light and dark can synchronize that clock, Blask says. Spending time in total darkness won’t boost the amount of hormone produced by the pineal gland; it will only desynchronize the timing of secretion, so that people who come out of the procedure may experience its peak later or earlier in the day than they would otherwise. “You effectively are having a free-running [unsynchronized] melatonin rhythm, which is not healthy for you” in the long run, Blask says.

The chronobiologist Debra Skene, who studies circadian-rhythm sleep disorders in the blind at the University of Surrey, says that there’s no evidence that blind people produce any more melatonin than sighted people. “The only thing you could say is that when we sleep in our bedrooms, or when we get up to go to the toilet at night, [sighted people] are exposed to artificial light, and we know that that light can suppress your melatonin,” Skene explains. For that reason, people in darkness therapy may produce more melatonin than individuals in their own homes. “But I wouldn’t be putting my money on thinking that the little bit of extra melatonin you get there is really going to have huge health benefits,” Skene says.

In his office at the BRC, Urbiš explained that he needed to put me through a couple of tests to make sure I was fit for the darkness. He pulled up an image of eight different-colored squares on his computer screen and asked me to rank them in order of preference, a test he told me he had devised himself based on Chinese medicine. The results were unfavorable, if not exactly shocking: I work too much, Urbiš said, and I don’t take good enough care of myself. He then showed me a new set of squares, and, though I was careful to choose differently this time, things seemed to go from bad to worse. A pie chart on the screen showed that about 60 percent of my “energy” was consumed by stress (I have “very bad energy business,” Urbiš noted in English). Worse, something traumatic happened in my childhood, or perhaps in utero, that I still hadn’t processed, he said.

Then Urbiš looked at my palm. Was I angry a lot, he wanted to know? I didn’t think so, but Urbiš said my liver was on overdrive, probably working to process all my emotions. He pushed a pen-like instrument into my hand to read the flow of energy along the acupuncture meridians in my body. My living situation was unfavorable. My diet was out of balance. I ate the wrong thing for breakfast. This information was all gathered in order to find out whether I was fit for the villa, so I was surprised when, quite suddenly, Urbiš announced, “So! That would be good. We’ll go to the dark.”

And off we went to the dark.

Not surprisingly, the freestanding Villa Mátma is a no-frills kind of place, but it’s also perfectly cozy. Clients enter the building through a small kitchen area, outfitted with a sink and a shelf where fruit, bottled water, and a hot meal are kept for the client to consume at will. This first room is sealed off from the light by a double set of doors; once a day or so, when a staff member or guardian enters the space bringing fresh food or to visit the client, they ring a bell to alert them to retreat to the main chamber. Inside is a twin bed, a recliner, and an elliptical machine. There’s also a desk, stocked with paper, colored pencils, and a lump of clay. (Urbiš keeps a couple of sculptures made by clients in the darkness in his office.) A narrow hallway leads to a closet, including a lockbox for electronics, a toilet, and a washroom.

A week of sensory restriction, it may go without saying, isn’t for everyone. Vila Mátma’s prospective clientele receive a fairly lengthy list of contraindications, including epilepsy, claustrophobia, and severe hypertension. Some providers are particularly cautious not to admit individuals with a history of psychiatric illnesses. I went in with no medical complaints, but I did carry with me a history of depression and anxiety, which for some providers could disqualify me from the procedure. Suedfeld told me that over the course of his research, he found that only depressed subjects responded poorly to chamber REST. “If I were running a commercial enterprise or a therapeutic enterprise, I would make sure that before people go into this environment they’re in a good mood,” Suedfeld said. “Because to some extent I think the environment is a mood enhancer: Whatever mood you go in with, it will strengthen it.”

Malůš has studied the psychological consequences of darkness therapy since 2011, when it became the subject of his Ph.D. dissertation. Now he oversees University of Ostrava research performed at the commercial Darkness Therapy Center in Kozlovice. His work has indicated that people who undergo the procedure come out of the chamber with significantly lower self-reported levels of depression and anxiety than before the week of REST. But Malůš sees particular promise in the use of darkness therapy as an aid for psychotherapy. “In this condition, the mind is much [calmer],” Malůš explained. “You can concentrate more, you can consider almost everything more clearly.” He said he believes that the unconscious mind can be revealed “spontaneously” in the dark.

According to several people I spoke to who had been through the procedure, it takes a few days to get properly oriented—or disoriented, as it may be—to the dark. Malůš says that on their first day, clients can generally estimate how much time they’ve spent in the chamber, but after going to sleep and waking up for the first time, night and day become indistinguishable. This can be one of the most distressing phases of darkness therapy, Malůš says, and it’s one of the reasons that centers like Vila Mátma ensure someone is available via intercom 24 hours a day to talk to clients.

I wasn’t in the villa long enough to lose track of time completely, but I did stay long enough to feel bored, and then anxious, and then uncomfortably alone with my thought processes. Urbiš and his team brought me into the villa at around 6 in the evening and gave me a tour of the space with the lights on. After a brief test run, they switched off the lights for good and left me until the morning. At first, the darkness felt like a minor annoyance—I kept catching myself reaching out for a light switch, just for an instant, every time I moved from room to room. But I appreciated the chance to zen out, without the burden of email or the torment of the news. I had a nice session on the elliptical, ate the meal that was left for me (rice, carrots, soy sausage) and sang to myself to fill the silence. A Polish friend had recently taught me to make pierogi, and I folded a pile of little dumplings with the clay on the desk.

But moving about the lightproof space came to make me feel vulnerable and fearful, and the darkness itself soon struck me as somewhat sinister. With little else to capture its attention, my mind went to places I normally wouldn’t allow it the time or space to go—what (and who) wasn’t working in my life, what role I was playing in maintaining my own dissatisfaction, how seldom I was willing to go after what I really wanted. Hugging my knees to my chest in the recliner, I got choked up; before I knew it, I was weeping. And then, because there was nothing else to do, I got into bed and waited until the darkness of sleep overtook the darkness of the room.

At 7 the next morning, Urbiš, his assistant Martina Vortelová, Malůš, and Karel Černin opened the door to the villa and called me back to consciousness and into the light. All important life events are celebrated with a meal, Urbiš had told me, so all darkness therapy stays end with a breakfast with the team. Over coffee in the dining room of the BRC, they discussed funding possibilities for the construction of a second villa on the premises and a new raw-food regimen Urbiš wanted to create for clients. And back in his office, Urbiš presented me with a few souvenirs he gives to all his clientele: a certificate confirming my stay, a Vila Mátma refrigerator magnet, and an empty aluminum can. Contents: “Čeladná darkness.”

It wasn’t until later, in the psych department at Ostrava University, that I told Malůš how intense my brief experience had been. In the dark (and with my iPhone under lock and key) it was easy to see how the mind could make worthwhile connections in the absence of distraction—and also possibly drive a person mad.

Malůš told me about a student who took part in one of his studies, a high achiever who exhibited no signs of instability prior to entering the chamber. At first, he began to have what Malůš called “semi-hallucinations” of snakes, visual experiences that he was able to write off as unpleasant but purely imaginary. But over the course of his stay, the visual stimuli grew into increasingly intense bodily experiences. He didn’t share the experience with the researchers until after the study had ended and Malůš performed a series of crisis-intervention psychotherapy sessions with him. “He [didn’t have] the support he needed during the stay; he wasn’t wise enough to quit it, because his ego would suffer,” Malůš recalled. “And then he wasn’t wise enough to continue, even though I told him, ‘Well, I see very clear connections between your life experience, your earlier experience, and those hallucinations.’” Half a year later, he says, the student was still afraid of the dark, traumatized by his experience in the chamber.

Listening to Malůš talk, I couldn’t help but wonder if that kind of gamble was worth it. What Malůš describes is a therapeutic method powerful enough to reveal the unconscious, yet so powerful that it can only be applied with extreme caution. For someone with depression in remission, like me, it could provide a rich opportunity for psychological discovery; for someone suffering from an acute episode, it could make matters worse. Neither Blask nor Skene believed that the procedure was likely to be beneficial on a physiological level, but both conceded that it was unlikely to do healthy people any lasting damage. Psychologically, though, while it may be high-reward, it’s certainly high-risk.

It’s all a bit of a catch-22, and for now, there isn’t enough funding for Ostrava University to conduct research at a facility like the BRC, where subjects would receive the on-call support they need to remain safe for the duration of a study. But the potential is there, Malůš says. At the moment, it’s just hard to see.

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It’s fairly well known that a bad diet, a lack of exercise, and genetics can all contribute to type 2 diabetes. But a new global study points to an additional, surprising culprit: the air pollution emitted by cars and trucks.

Though other research has shown a link between diabetes and air pollution in the past, this study is one of the largest of its kind, and it’s unique because it both is longitudinal and includes several types of controls. What’s more, it also quantifies exactly how many diabetes cases in the world are attributable to air pollution: 14 percent in 2016 alone. In the United States, it found, air pollution is responsible for 150,000 cases of diabetes.

The study, published in The Lancet Planetary Health, linked data from 1.7 million American veterans who had been followed for a median of 8.5 years with air data from the EPA and NASA. It also aggregated past international research on diabetes and air pollution to devise a model to estimate diabetes risk based on the level of pollution, and it used the Global Burden of Disease study to estimate how many years of healthy life were lost due to this air-pollution-induced diabetes. Globally, 8.2 million years of healthy life were lost in 2016 to pollution-linked diabetes, it showed.

The study authors controlled for things like obesity and BMI, so it wasn’t the case that heavier people simply lived in more polluted neighborhoods and were also more likely to get diabetes.

The particles examined in this study are known as PM2.5, or particulate matter that’s 2.5 micrometers big—30 times smaller than a human hair. They are emitted by various types of industry and fuel burning, but in the United States, the biggest source of PM2.5 is cars, says Ziyad Al-Aly, the study’s senior author and an assistant professor of medicine at Washington University at St. Louis. When there’s lots of PM2.5 in the air, the air might look smoggy or hazy. In lighter concentrations, the particles are invisible.

Scientists are just beginning to understand what exactly makes PM2.5 so harmful, but a major reason is that it’s so small and contains toxic metals. Its size allows it to penetrate the lungs and enter the bloodstream. There, it can circulate to different organs and cause inflammation. The inflammation increases insulin resistance. Eventually, this insulin resistance can become so severe the pancreas becomes unable to pump out enough insulin to compensate, and diabetes can set in.

Previous research has found that Latino children living in areas with more air pollution had a greater risk of developing type 2 diabetes. But other studies on the association between the two have generated mixed results.

This new study makes an even stronger case, suggesting that the current limits on air pollution in the United States might be too high. The EPA’s pollution threshold on particulate matter is 12 μg/m3, or micrograms per cubic meter of air, but this study says the risk of diabetes starts at about 2.4 μg/m3. Among people exposed to between five and 10 μg/m3 of particulate matter, about 21 percent developed diabetes. At the threshold of current “safe” levels, 24 percent do. For each 10 μg/m3 increase in particulate matter, the risk of developing diabetes goes up by 15 percent. This risk is present regardless of whether the individual becomes obese or not.

But this study and others might not lead to a tightening of the PM2.5 standards because, under a rule proposed by the Trump administration in April, all studies used by the EPA to make air and water regulations must make their underlying data publicly available. As my colleague Robinson Meyer reported, studies like this and others, which show the detrimental health impacts of pollution, are based on health data that is confidential and cannot be de-anonymized.

That will greatly undermine regulations that have made for cleaner air, says Sanjay Rajagopalan, a cardiologist at University Hospitals Cleveland Medical Center, about the proposed rule. “Documents that have gone into EPA regulations go through rigorous peer review,” he says. “We have some of the cleanest air in the world, and there’s scientific data that this has protected millions of lives and contributed to the longevity of American citizens.”

The consequences of PM2.5 are more severe for developing countries that do not have strict limits on air pollution. For example, the study says countries like Afghanistan and Papua New Guinea face a higher risk of lots of air-pollution-related cases of diabetes, while the United States has a moderate risk.

Still, experts told me the connection between PM2.5 and various health risks is now so clear that people should try to avoid large amounts of particulates, if they can. “Live away from the major sources of emission. Don’t live right near the 405,” Al-Aly told me, referring to a notoriously congested freeway in Los Angeles. “Short of that, anywhere that’s high in pollution, like some cities in China or India, many people wear masks.”

Tanya Alderete, who studies the connection between air pollution and disease at the University of Colorado at Boulder, says people might rethink biking in heavy traffic, for example. “We shouldn’t be engaging in strenuous physical activity during rush hour or near major roadways,” she says.

But everyone I spoke with said the real answer lies with public policy—stricter limits on fossil-fuel emissions and a move to cleaner energy sources. After all, globally, pollution of all kinds kills three times more people than AIDS, tuberculosis, and malaria combined.

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For journalists, being hated is part of the job.

People will hate things you write, and they’ll tell you. They’ll hate the media in general, and they’ll let you know. They may hate you for your race, gender, religion, or sexual orientation; thanks to the visibility that comes with the job, you’ll hear about that, too. In the age of email and social media, it seems like more than ever, hateful messages are the cost of doing business, in the news business.

Five staffers at the Capital Gazette in Annapolis were killed on Thursday by a shooter with a longstanding grudge against the newspaper. The man had been harassing the paper and its employees since 2011, according to The Baltimore Sun, and he had also personally threatened the Gazette’s former editor and publisher, Thomas Marquardt, as my colleague Emma Green reported. Marquardt told Green he wasn’t surprised when he learned who the suspect was.

In the aftermath, Libby Nelson, the news editor at Vox, tweeted: “Every journalist knows their version of That Guy. And most of us just shrug it off and laugh about it, because what else are you going to do? The idea that they might do something about it—if that’s what happened here—is bone-chilling.” Perhaps motivated by a similar worry, police officers in Chicago and New York City were deployed to several major media outlets on Thursday after the shooting.

Every journalist knows their version of That Guy. And most of us just shrug it off and laugh about it, because what else are you going to do?

The idea that they might do something about it — if that’s what happened here — is bone-chilling.

— Libby Nelson (@libbyanelson) June 29, 2018

The majority of Americans do not trust the news media. There are many complex reasons why, and there’s enough blame to go around to many different parties, journalists included. So it’s hardly surprising that they get some rude messages. “But I’m not talking about the rudeness. I’m talking about intimidation,” says Elana Newman, a psychologist who works with the Dart Center for Journalism and Trauma. “I’ve been working for the Dart Center for 20 years in some capacity, and when we used to ask people what the most stressful parts of journalism are, they would talk about the hours, or getting it right. They would talk about all sorts of things. Now what comes up is really this kind of stuff.”

According to research by the psychologist Kelsey Parker in 2015, 63 percent of journalists from several English-speaking countries said they had experienced occupational intimidation in the past 12 months. Globally, almost two-thirds of female journalists “experienced acts of ‘intimidation, threats and abuse’ in relation to their work,” a report from the International Women’s Media Foundation and the International News Safety Institute found. Another study, of Swedish journalists, found that a third had experienced a threat in the past year. A far greater number—74 percent—had received “abusive comments which are unpleasant but do not involve any direct threat.”

Journalists have had their families harassed, had their addresses and other personal information published (a practice known as doxxing), and had SWAT teams sent to their houses by trolls.

“Raise your hand if you know (or are) a journalist who has received a death threat in the last year,” Sam Escobar, the deputy director of Allure magazine, tweeted on Thursday after the shooting. The tweet received replies from journalists on every beat imaginable—health, politics, music, gender, tech, beauty—and a cartoonist.

Raise your hand if you know (or are) a journalist who has received a death threat in the last year.

— Sam H. Escobar (@myhairisblue) June 29, 2018

Some of my colleagues shared stories with me of their own experiences. “A man once told me to kill myself and that he wanted me dead because he didn’t like my review of the movie Sing,” said Sophie Gilbert, a staff writer at The Atlantic. “Then he left threatening Instagram comments on a picture of me and my baby niece, and the cops got involved. It was scary but also absurd because it was related to a movie about a singing koala.”

Caroline Kitchener, an associate editor who works on the The Atlantic’s membership program, told me about a time she wrote a piece on political extremism and went on CSPAN to talk about it. Afterward, the members of the subreddit The_Donald, an online forum for Donald Trump supporters that, as Kitchener explained in her piece, is “often associated with the alt-right,” found pictures of her on Google and “put them on The_Donald with Pepe the Frog between my legs,” she said. Pepe, a cartoon frog often used in racist memes, is classified as a hate symbol by the Anti-Defamation League.

All of this takes its toll, affecting both job performance and journalists’ mental health. “There are few studies of the impact of harassment on journalists,” a report from the Dart Center reads, but individual journalists have reported symptoms including “anxiety attacks,” “insomnia,” “ weight loss” “extreme and excessive vigilance,” and “social isolation.”

In the Swedish study, 17 percent of respondents avoided covering certain issues or people because of comments they received. Sixty-eight percent felt hurt by the comments. Nine percent of respondents had considered quitting the profession altogether because of them. How do they cope? Mostly by just trying to ignore it. The researchers found that after receiving threats, 66 percent of the time, journalists did nothing. This was the case 85 percent of the time for “abusive comments.”

It can feel wrong to dwell on your own relatively minor hostile encounters when in the course of your job you are exposed to the breadth and depth of human suffering. Many of my colleagues who reached out to me with stories qualified them by saying in the scheme of things it wasn’t that bad, or that other people had surely experienced worse.

“You’re used to reporting on others and not becoming part of the news,” Newman says. “So I understand that. But it’s not a reason not to be safe. Yes, it’s true: You are privileged. But when your life is in danger? That’s a freedom of the press issue. At what point does it become a way of preventing journalists from telling stories that need to be told? I understand that it feels self-indulgent. But that doesn’t mean this isn’t an important opportunity for people to understand the risks that journalists are taking.”

“Our results show that intimidation and harassment indeed constitute an effective way to silence journalists, even in the context of a stable democratic society like Sweden,” the researchers behind the Swedish study wrote. This might also be effective in the United States, where the far-right extremist Milo Yiannopolous has said “I can’t wait for the vigilante squads to start gunning journalists down on sight” in response to requests for comment on stories, according to the Observer. Where President Donald Trump, at a rally three days before the Annapolis shooting, referred to the press as “the enemy of the people,” a preferred term of his. (Trump has since offered his condolences to the victims; when CNN’s Jim Acosta shouted to Trump to ask if he would stop using the phrase, he did not respond.) And where on Reddit and other forums, people celebrated the news of the Gazette journalists’ deaths.

Threats and hateful messages are an occupational hazard for all working journalists. But it’s sometimes hard to tell where the line is between an annoyance and a danger. How do you know when the threats are real? When a hailstorm of emails might transmute into a shower of bullets?

“What makes this so difficult,” Newman says, “is we can’t tell what’s a disagreement and what’s a threat. You can tell at the extremes … [but] it’s the middle stuff that has everybody confused.”

The Capital Gazette on Thursday lived through a journalist’s worst fear upon receiving such a message. But through the grief, despite whatever intimidation the shooter may have intended, the Capital Gazette journalists honored their colleagues in the best way they could: They put out a paper. They told their stories anyway.

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