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“Is there a weight of evidence that says we can totally ignore both dietary cholesterol and LDL? Absolutely not,” he said. “You can legitimately say we’re starting to rethink some things, but ignoring LDL could absolutely result in heart attacks and strokes.

The medical community’s understanding of the danger of cholesterol is changing. Many cardiologists are starting to think that independent of other considerations, the level of LDL in our blood may not be as important as it previously seemed.

In November, the American Heart Association and the American College of Cardiology released new guidelines that redefined the use of statins. While they continue to recommend that people at high risk for heart disease and people with LDL levels above 189 take a statin, the long-standing goal of lowering one’s LDL level to 70 is no longer deemed worthwhile to monitor.

Katz acknowledges that dietary cholesterol may be an innocuous part of an overall healthy diet. “The problem is that people are going to get their dietary cholesterol from things other than fish and eggs; they’re going to get it from meats and dairies. The problem with diets like that is if you eat more of A, you’re probably going to eat less of B. So people who are eating more meat and dairy and high-fat, high-cholesterol foods are eating fewer plants—they’re not eating beans; they’re not eating lentils. So yes, I think it’s entirely confabulated and contrived, and potentially dangerous on the level of lethal.”

Having talked to all of these people and read their work, here is how I walk away from this. Oxidative stress will increasingly be the target of medical treatments and preventive diets. We’ll hear more about the role of blood sugar in Alzheimer’s and continue to focus on moderating intake of refined carbohydrates. The consensus remains that too much LDL is bad for you. We do not have reason to believe that gluten is bad for most people. It does cause reactive symptoms in some people. Peanuts can kill some people, but that does not mean they are bad for everyone

I agree with Katz that the diets consistently shown to have good long-term health outcomes—both mental and physical—include whole grains and fruits, and are not nearly as high in fat as what Perlmutter proposes.

Though Hoover’s settings bop around America from Boston to New York to Texas to Vermont, the only contextual references pertain to pop culture, social media and the occasional local attraction.

Politics are confined to the daunting gulf between haves and have-nots, and even when Hoover’s striving heroines find themselves among the haves, their hearts remain forever with the have-nots.

In these novels what matters more than anything else is hardship: Hardship is everywhere, women must suffer, women can heal, and those who make it through all this have the capacity to find themselves/love/happiness. The reader can’t help feeling that the heroine/Hoover is speaking to me/for me/like me.

Fiction of this sort reflects a strain in the culture that has shifted from a fascination with the other — the rich, the powerful, the exclusive — to a more inward preoccupation with the self and the desire to see oneself reflected in the stories one consumes

Women’s popular fiction of the ’80s, when the glitter and glamour of “Dallas” and “Dynasty” dominated prime-time TV, offers a sharp contrast. In best sellers of that period, the settings jetted from Monte Carlo to Capri to Rodeo Drive, populated by the rich, famous and destined-to-be. Heroines could have been peeled off the cover of Cosmopolitan magazine

As with TikTok testimonials of adolescent mental health challenges and group-chat confessions, it’s about “relatability” and the willingness to reveal all. Even celebrities must bare all

I never shed a tear while reading Sheldon, but that wasn’t the point. The point was exuberant voyeurism, the literary equivalent of “Lifestyles of the Rich and Famous.” The heroines’ lives were nothing like mine nor were they meant to be. That’s what made them so absurdly entertaining.

Colleen Hoover paints on a more intimate canvas. Her stories aren’t about attaining worldly power on a grand scale, but about finding power within

Hoover offers readers an emotional road map to recovery from imposter syndrome, domestic abuse, betrayal, victimization. It’s a very different kind of achievement.

In a country where economic inequalities can seem insurmountable and systems of power ever more remote, this may be the best her hard-knock heroines — and readers — can hope for.

For readers invested in characters who are like themselves — if perhaps more beautiful and with more exciting sex lives — the emotional payoff can still feel hard-earned. And, just possibly, the story could happen to them.

The novel probes how nothing in life is fixed, including the legacies of the dead and the stories we tell about our pas

“The study of history shouldn’t be backward looking,” explains a historian in “Halcyon.” “To matter, it has to take us forward.”

Ackerman was in college on Sept. 11, 2001, but what he remembers more vividly is watching the premiere of the TV miniseries “Band of Brothers” the previous Sunday. “If you wanted to know the zeitgeist in the U.S. at the time, it was this very sentimental view of World War II,” he says. “There was this nostalgia for a time where we’re the good guys, they’re the bad guys, and we’re going to liberate oppressed people.”

Ackerman, who also covers wars and veteran affairs as a journalist, says that America’s backing of Ukraine is essential in the face of what he calls “an authoritarian axis rising up in the world, with China, Russia and Iran.” Were the country to offer similar help to Taiwan in the face of an invasion from China, he notes, having some air bases in nearby Afghanistan would help, but the U.S. gave those up in 2021.

With Islamic fundamentalists now in control of places where he lost friends, he says he is often asked if he regrets his service. “When you are a young man and your country goes to war, you’re presented with a choice: You either fight or you don’t,” he writes in his 2019 memoir “Places and Names.” “I don’t regret my choice, but maybe I regret being asked to choose.”

Serving in the military at a time when wars are no longer generation-defining events has proven alienating for Ackerman. “When you’ve got wars with an all-volunteer military funded through deficit spending, they can go on forever because there are no political costs

The catastrophic withdrawal from Afghanistan in 2021, which Ackerman covers in his recent memoir “The Fifth Act,” compounded this moral injury. “The fact that there has been so little government support for our Afghan allies has left it to vets to literally clean this up,” he says, noting that he still fields requests for help on WhatsApp. He adds that unless lawmakers act, the tens of thousands of Afghans currently living in the U.S. on humanitarian parole will be sent back to Taliban-held Afghanistan later this year: “It’s very painful to see how our allies are treated.”

Looking back on America’s misadventures in Iraq, Afghanistan and elsewhere, he notes that “the stories we tell about war are really important to the decisions we make around war. It’s one reason why storytelling fills me with a similar sense of purpose.”

“We don’t talk about the world and our place in it in a holistic way, or a strategic way,” Ackerman says. “We were telling a story about ending America’s longest war, when the one we should’ve been telling was about repositioning ourselves in a world that’s becoming much more dangerous,” he adds. “Our stories sometimes get us in trouble, and we’re still dealing with that trouble today.”

(An early conclusion: while we were late to understand how angry white voters were, a perhaps even more serious lapse was in failing to recognize how many disaffected Democrats there were who would stay home rather than support their party’s flawed candidate.)

Stories that would have killed any other politician—truly worrisome revelations about everything from the federal taxes Trump dodged to the charitable donations he lied about, the women he insulted and allegedly assaulted, and the mob ties that have long dogged him—did not stop Trump from thriving in this election year

the Oxford Dictionaries announced that “post-truth” had been chosen as the 2016 word of the year, defining it as a condition “in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.”

Meantime, Trump personally blacklisted news organizations like Politico and The Washington Post when they published articles he didn’t like during the campaign, has openly mused about rolling back press freedoms enshrined by the U.S. Supreme Court, and has now named Stephen Bannon, until recently the executive chairman of Breitbart—a right-wing fringe website with a penchant for conspiracy theories and anti-Semitic tropes—to serve as one of his top White House advisers.

none of this has any modern precedent. And what makes it unique has nothing to do with the outcome of the election. This time, the victor was a right-wing demagogue; next time, it may be a left-wing populist who learns the lessons of Trump’s win.

This is no mere academic argument. The election of 2016 showed us that Americans are increasingly choosing to live in a cloud of like-minded spin, surrounded by the partisan political hackery and fake news that poisons their Facebook feeds.

To help us understand it all, there were choices, but not that many: three TV networks that mattered, ABC, CBS, and NBC; two papers for serious journalism, The New York Times and The Washington Post; and two giant-circulation weekly newsmagazines, Time and Newsweek. That, plus whatever was your local daily newspaper, pretty much constituted the news.

Fake news is thriving In the final three months of the presidential campaign, the 20 top-performing fake election news stories generated more engagement on Facebook than the top stories from major news outlets such as The New York Times.

Eventually, I came to think of the major media outlets of that era as something very similar to the big suburban shopping malls we flocked to in the age of shoulder pads and supply-side economics: We could choose among Kmart and Macy’s and Saks Fifth Avenue as our budgets and tastes allowed, but in the end the media were all essentially department stores, selling us sports and stock tables and foreign news alongside our politics, whether we wanted them or not. It may not have been a monopoly, but it was something pretty close.

This was still journalism in the scarcity era, and it affected everything from what stories we wrote to how fast we could produce them. Presidents could launch global thermonuclear war with the Russians in a matter of minutes, but news from the American hinterlands often took weeks to reach their sleepy capital. Even information within that capital was virtually unobtainable without a major investment of time and effort. Want to know how much a campaign was raising and spending from the new special-interest PACs that had proliferated? Prepare to spend a day holed up at the Federal Election Commission’s headquarters down on E Street across from the hulking concrete FBI building, and be sure to bring a bunch of quarters for the copy machine.

I am writing this in the immediate, shocking aftermath of a 2016 presidential election in which the Pew Research Center found that a higher percentage of Americans got their information about the campaign from late-night TV comedy shows than from a national newspaper. Don Graham sold the Post three years ago and though its online audience has been skyrocketing with new investments from Amazon.com founder Jeff Bezos, it will never be what it was in the ‘80s. That same Pew survey reported that a mere 2 percent of Americans today turned to such newspapers as the “most helpful” guides to the presidential campaign.

In 2013, Mark Leibovich wrote a bestselling book called This Town about the party-hopping, lobbyist-enabling nexus between Washington journalists and the political world they cover. A key character was Politico’s Mike Allen, whose morning email newsletter “Playbook” had become a Washington ritual, offering all the news and tidbits a power player might want to read before breakfast—and Politico’s most successful ad franchise to boot. In many ways, even that world of just a few years ago now seems quaint: the notion that anyone could be a single, once-a-day town crier in This Town (or any other) has been utterly exploded by the move to Twitter, Facebook, and all the rest. We are living, as Mark put it to me recently, “in a 24-hour scrolling version of what ‘Playbook’ was.”

Whether it was Walter Cronkite or The New York Times, they preached journalistic “objectivity” and spoke with authority when they pronounced on the day’s developments—but not always with the depth and expertise that real competition or deep specialization might have provided. They were great—but they were generalists.

I remained convinced that reporting would hold its value, especially as our other advantages—like access to information and the expensive means to distribute it—dwindled. It was all well and good to root for your political team, but when it mattered to your business (or the country, for that matter), I reasoned, you wouldn’t want cheerleading but real reporting about real facts. Besides, the new tools might be coming at us with dizzying speed—remember when that radical new video app Meerkat was going to change absolutely everything about how we cover elections?—but we would still need reporters to find a way inside Washington’s closed doors and back rooms, to figure out what was happening when the cameras weren’t rolling.

And if the world was suffering from information overload—well, so much the better for us editors; we would be all the more needed to figure out what to listen to amid the noise.

Trump turned out to be more correct than we editors were: the more relevant point of the Access Hollywood tape was not about the censure Trump would now face but the political reality that he, like Bill Clinton, could survive this—or perhaps any scandal. Yes, we were wrong about the Access Hollywood tape, and so much else.

These days, Politico has a newsroom of 200-odd journalists, a glossy award-winning magazine, dozens of daily email newsletters, and 16 subscription policy verticals. It’s a major player in coverage not only of Capitol Hill but many other key parts of the capital, and some months during this election year we had well over 30 million unique visitors to our website, a far cry from the controlled congressional circulation of 35,000 that I remember Roll Call touting in our long-ago sales materials.

, we journalists were still able to cover the public theater of politics while spending more of our time, resources, and mental energy on really original reporting, on digging up stories you couldn’t read anywhere else. Between Trump’s long and checkered business past, his habit of serial lying, his voluminous and contradictory tweets, and his revision of even his own biography, there was lots to work with. No one can say that Trump was elected without the press telling us all about his checkered past.

politics was NEVER more choose-your-own-adventure than in 2016, when entire news ecosystems for partisans existed wholly outside the reach of those who at least aim for truth

Pew found that nearly 50 percent of self-described conservatives now rely on a single news source, Fox, for political information they trust.

As for the liberals, they trust only that they should never watch Fox, and have MSNBC and Media Matters and the remnants of the big boys to confirm their biases.

And then there are the conspiracy-peddling Breitbarts and the overtly fake-news outlets of this overwhelming new world; untethered from even the pretense of fact-based reporting, their version of the campaign got more traffic on Facebook in the race’s final weeks than all the traditional news outlets combined.

When we assigned a team of reporters at Politico during the primary season to listen to every single word of Trump’s speeches, we found that he offered a lie, half-truth, or outright exaggeration approximately once every five minutes—for an entire week. And it didn’t hinder him in the least from winning the Republican presidential nomination.

when we repeated the exercise this fall, in the midst of the general election campaign, Trump had progressed to fibs of various magnitudes just about once every three minutes!

By the time Trump in September issued his half-hearted disavowal of the Obama “birther” whopper he had done so much to create and perpetuate, one national survey found that only 1 in 4 Republicans was sure that Obama was born in the U.S., and various polls found that somewhere between a quarter and a half of Republicans believed he’s Muslim. So not only did Trump think he was entitled to his own facts, so did his supporters. It didn’t stop them at all from voting for him.

in part, it’s not just because they disagree with the facts as reporters have presented them but because there’s so damn many reporters, and from such a wide array of outlets, that it’s often impossible to evaluate their standards and practices, biases and preconceptions. Even we journalists are increasingly overwhelmed.

So much terrific reporting and writing and digging over the years and … Trump? What happened to consequences? Reporting that matters? Sunlight, they used to tell us, was the best disinfectant for what ails our politics.

2016 suggests a different outcome: We’ve achieved a lot more transparency in today’s Washington—without the accountability that was supposed to come with it.

"messages of shame are organized around gender." For women, she said, there are whole constellations of often contradictory expectations that, if not met, are sources of shame.

But for men, the overarching message is that any weakness is shameful. And since vulnerability is often perceived as weakness, it is especially risky for men to practice vulnerability.

men's shame is not primarily inflicted by other men. Instead, it is the women in their lives who tend to be repelled when men show the chinks in their armor.

Ironically, she explained, men are often pressured to open up and talk about their feelings, and they are criticized for being emotionally walled-off; but if they get too real, they are met with revulsion. She recalled the first time she realized that she had been complicit in the shaming: "Holy Shit!" she said. "I am the patriarchy!"

there are three main practices men, in particular, need to engage in. The first is asking for help. The second is setting boundaries; for example, not taking on work or activities that you don't want to do. And the third is apologizing and "owning it" when you are wrong.

Numbers become not just part of the way we judge and assess, but the only way.

when students are researching a paper, how do they decide where to turn for the greatest expertise? Often, he said, by looking at what articles or papers online have the most hits.

“Just because we have the skills and ability to put metrics on everything doesn’t mean we should. People are ever-changing, fascinating and incredibly frustrating.”

black-and-white statistics, while arguably irrefutable in one way, really tell us almost nothing. Amazon’s rankings of book sales, for instance — which anyone can view — can vary wildly based on the sale of very few books.

“For almost anybody in the United States under the age of 25, the only models are quantifiable rankings,”

“Should it be that whatever has the most hits or the most editors makes it better than someone who spent his life studying Kant?”

The obsession with numbers, he said, means we don’t trust or even look for the intangibles that can’t be measured, like wisdom, judgment and expertise.

“What I’m most troubled by is the desire of individuals (especially myself) to constantly check up on these numbers, and to accept these measurements as a measure of something meaningful.”

“I have to stop worrying about numbers. I have to reclaim the ambiguous part of my own intelligence.”

Scientists have done studies where they give people different colored candies and ask if they taste differently

Your brain is constantly filtering it through your sense of taste, touch, smell, and – most importantly – your memories.

The human eye is actually really bad at perceiving color.

Your brain has to fill in the gaps.

"When color is processed by the brain, a lot of information has to be extracted from not very much incoming information," said Mathan. "The color that we perceive doesn't correspond - at all - with the colors that are in the world."

But Marshall demonstrated that capitalism advances not by immiserating the poor, but by boosting productivity. Factory owners make relentless small improvements that allow them to produce both higher wages and lower prices, thereby spreading the gains of material progress throughout society.

Schumpeter further expanded the idea of productivity increases. The economy doesn't simply get bigger and bigger. It goes through a constant process of discombobulation as entrepreneurs invent new products and processes.

Marx got it upside down: capitalism's recurrent crises actually make it stronger.

Will Wright, inventor of bestselling “The Sims” videogame series, heaps similar praise.  “Montessori taught me the joy of discovery,” Mr. Wright said, “It’s all about learning on your terms, rather than a teacher explaining stuff to you.  SimCity comes right out of Montessori…”

Hal Gregersen of globe-spanning business school INSEAD surveyed over 3,000 executives and interviewed 500 people who had either started innovative companies or invented new products.

being self-motivated, questioning what’s going on in the world, doing things a little bit differently.”

most highly creative achievers don’t begin with brilliant ideas, they discover them.

We can change the way we’ve been trained to think.  That begins in small, achievable ways, with increased experimentation and inquisitiveness. 

Manne also reported in the book that women are less likely to be perceived as competent. When they are considered competent, they're often disliked and considered polarizing. She said female candidates are also often judged to be untrustworthy "on no ostensible basis" and women's claims are viewed as less credible than claims by men. Then, when women defend themselves from unfair attacks, they're accused of "playing the victim."

Yet Bernie Sanders -- the frontrunner among declared Democratic candidates -- has also been accused of mistreating his aides, but those allegations don't seem to have gotten the same media attention. One former staffer told the Vermont newspaper Seven Days in 2015 that Sanders was "unbelievably abusive" and claimed "to have endured frequent verbal assaults." The paper reported that others who worked for Sanders also said that "the senator is prone to fits of anger." A spokesperson for Sanders responded to Seven Days and said that Sanders "had very positive relations with people who have worked with him.") And Sanders, in response to the article, told the Des Moines Register, "Yes, I do work hard. Yes, I do demand a lot of the people who work with me. Yes, some people have left who were not happy. But I would say that by and large in my Senate office, in my House office, on my campaigns, the vast majority of people who have worked with me considered that to be a very, very good experience..."

Ultimately, the solution to women not appearing to fit the role of president because a woman has never been president seems obvious: Voters need to elect a woman president. But, in order for that to happen, even those of us who are eager to empower women may need to rethink how we judge female candidates.

Educating yourself on the history and current state of racism is one way to show positive allyship, as reported in CNN's guide to being an ally.

Influencing the people in your circle is another -- and part of that can include sharing books about racism with friends and family and discussing how oppression affects marginalized groups.

"13 Reasons Why" is based on bestselling author Jay Asher's 2007 young adult book of the same title, following the story of a teenage girl who leaves behind 13 audio recordings on cassette tapes before killing herself. Each tape is addressed to a person who she says played a role in her decision to die.

“The Fallout universe lends itself really well to Shakespeare. It’s very desolate, very grotesque, very tragic, really,” says North. In this world, Shakespeare existed before the bombs fell, so it seemed logical that North and his friends could role-play a company keeping culture alive in the ruins of civilisation – like the troupe of actors in Emily St John Mandel’s post-apocalyptic dystopia, Station Eleven.

It takes months to pull a show together. First, North picks the play and adapts it. Hundreds of pages of script are shared with the crew, so set design and rehearsals can commence. “It’s just like a real theatre company, where you start with an idea and a few folks sitting together and figuring out what our season is going to look like,”

There are no ticketed seats, and the company makes no money. The majority of audiences stumble across the performances accidentally in the wasteland, and sit to watch the show for free – or tune in on Twitch, where the company broadcasts every performance live

n 2022 Fallout 76 claimed to have over 13.5 million players, some of whom North believes “may never have seen a Shakespeare play. Ninety-nine per cent of those who find us sit down and quietly watch the show … It’s really quite moving, performing for people who might not go to the theatre in their own communities or haven’t thought about Shakespeare since high school. We are tickled silly knowing that we are potentially reaching new, untapped audiences and (re)introducing Shakespeare to so many. I hope Shakespeare academics who study comparative drama will take note of our use of this new medium to reach new audiences

“I think we’re a perfect example of how video games inspire creativity, and celebrate theatre and culture and the arts. I hope that other gamers out there know that there’s so much potential for you to be able to express what you’re passionate about in video games.”

Colonisation exposed us to new ideas that shocked and confused us. Graeber & Wengrow focus on the French coming into contact with Native Americans in Canada, and in particular on Wendat Confederacy philosopher–statesman Kandiaronk as an example of European traders, missionaries, and intellectuals debating with, and being criticized by indigenous people. Historians have downplayed how much these encounters shaped Enlightenment ideas.

this thought-provoking book is armed to the teeth with fascinating ideas and interpretations that go against mainstream thinking

ather than yet another history book telling you how humanity got here, they take their respective disciplines to task for dealing in myths.

Its legacy, shaped via several iterations, is the modern textbook narrative: hunter-gathering was replaced by pastoralism and then farming; the agricultural revolution resulted in larger populations producing material surpluses; these allowed for specialist occupations but also needed bureaucracies to share and administer them to everyone; and this top-down control led to today’s nation states. Ta-daa!

this simplistic tale of progress ignores and downplays that there was nothing linear or inevitable about where we have ended up.

ake agriculture. Rather than humans enthusiastically entering into what Harari in Sapiens called a Faustian bargain with crops, there were many pathways and responses

Experiments show that plant domestication could have been achieved in as little as 20–30 years, so the fact that cereal domestication here took some 3,000 years questions the notion of an agricultural “revolution”. Lastly, this book includes many examples of areas where agriculture was purposefully rejected. Designating such times and places as “pre-agricultural” is misleading, write the authors, they were anti-agricultural.

The idea that agriculture led to large states similarly needs revision

correlation is not causation, and some 15–20 additional centres of domestication have since been identified that followed different paths. Some cities have previously remained hidden in the sediments of ancient river deltas until revealed by modern remote-sensing technology.

“extensive agriculture may thus have been an outcome, not a cause, of urbanization”

And cities did not automatically imply social stratification. The Dawn of Everything fascinates with its numerous examples of large settlements without ruling classes, such as Ukrainian mega-sites, the Harappan civilization, or Mexican city-states.

These instead relied on collective decision-making through assemblies or councils, which questions some of the assumptions of evolutionary psychology about scale: that larger human groups require complex (i.e. hierarchical) systems to organize them.

e what is staring them in the face

humans have always been very capable of consciously experimenting with different social arrangements. And—this is rarely acknowledged—they did so on a seasonal basis, spending e.g. part of the year settled in large communal groups under a leader, and another part as small, independently roving bands.

Throughout, Graeber & Wengrow convincingly argue that the only thing we can say about our ancestors is that “there is no single pattern. The only consistent phenomenon is the very fact of alteration […] If human beings, through most of our history, have moved back and forth fluidly between different social arrangements […] maybe the real question should be ‘how did we get stuck?

Next to criticism, the authors put out some interesting ideas of their own, of which I want to quickly highlight two.

The first is that some of the observed variations in social arrangements resulted from schismogenesis. Anthropologist Gregory Bateson coined this term in the 1930s to describe how people define themselves against or in opposition to others, adopting behaviours and attitudes that are different.

The second idea is that states can be described in terms of three elementary forms of domination: control of violence, control of information, and individual charisma, which express themselves as sovereignty, administration, and competitive politics.

Asking which past society most resembles today’s is the wrong question to ask. It risks slipping into an exercise in retrofitting, “which makes us scour the ancient world for embryonic versions of our modern nation states”

I have left unmentioned several other topics: the overlooked role of women, the legacy of Rousseau’s and Hobbes’s ideas, the origins of inequality and the flawed assumptions hiding behind that question

There are so many historical details and delights hiding between these covers that I was thoroughly enthralle

If you have any interest in big history, archaeology, or anthropology, this book is indispensable. I am confident that the questions and critiques raised here will remain relevant for a long time to come.

I was particularly impressed by the in-depth critique by worbsintowords on his YouTube channel What is Politics? of (so far) five videos

Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis

ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."

"There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.

On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.

"What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.

"It's a redundant name, real medicine is functional."

Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).

Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.

As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.

"If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.

GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…

"Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.

Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.

"The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."

"There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.

"Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."

GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.

"It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.

"I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.

"Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."

Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."

For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.

"Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.

l What are the principles?

"There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."

He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.

Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.

"My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises