What Is Health?: Allostasis and the Evolution of Human Design (Mit Press) Hardcover – February 25, 2020

Peter Sterling has produced a streamlined opus on the revolutionary concept of Allostasis and how dynamic, diverse, adaptive predictive regulation is the major underpinning of our human condition and design. We have evolved for 4 billion years, yet much of our inner-workings are based on distant ancestors from hundreds of millions of years ago. Take our Dopamine reward system---that was worms who first developed that one. Pulses of dopamine in early neurons of worms allowed a worm to learn where to find the best food sources. These tiny little pulses of dopamine are how we humans best learn as well---well times, small spikes dopamine in anticipation of something we want to connect to or learn and another spike once we actually get it or learn it. Yet, in our modern times, we've learned to overstimulate our dopamine through drugs, sex, social-media, fast-foods, rock and roll, shopping, gambling and other things that did not exist 500 million years ago when our dopamine reward system was developed. What has that brought, more pleasure and more satisfaction? No, our post-modern times, according to Dr. Sterling, has brought us unprecedented levels of loneliness and despair---robbing us of the simple, diverse pleasures our ancestors flourished on. We have shifted from an adaptive, learning use of small dopamine spikes into a storm of massive booms and busts that eventually lead us into addictive, rather than adaptive behaviors. These addictions then downregulate our dopamine sensitivity and trap us thinking only those things that stimulate big bursts of dopamine are worth pursuing---in an ever growing big wheel of suffering likely beyond even what the Buddha might have imagined.Shifting from a Homeostatis to an Allostatic mind-set is just what Dr. Sterling has ordered for us to begin to shift away from thinking the pursuit of "stability and comfort" is the goal, toward recognizing as humans we have dynamic build-up of energy in our metabolic systems---like ATP and ADP ratios that best suit optimum health---that invest large amounts of energy to Allostatically keep us well. Health is not a pursuit of the norm---it is a dynamic balance of energy we must sustain through growth when growth is needed and reduction when reduction is most adaptive. Our species, Homo Sapien, is the only species that has flourished across all continents and all conditions. That is our great super-power. A super-power that comes at great cost. Our Collective Diversity and difference---which gives our species great adaptive powers beyond any other species---also makes for individual suffering, isolation and "othering" with constant conflict, misunderstanding, and unreconciliable differences. By embracing our diversity across a spectrum of what it is to be human---that we are designed to be different in order to be adaptive as a species---and looking to allostatic, rather than homeostatic framework to evaluate our health, we can begin to heal and adapt even now.The enlightment, he teaches us, has brought us revolutionary new technologies that will continue to transform our lives for centuries to come. We co-evolve with our technologies, yet we have now created technologies that overstimulate and over"click" our Dopamine receptors in ways that are mal-adaptive and desctructive.Returning toward simple, diverse, small and frequen int pulses of Dopamine and engaging in spiritual and sacred rituals may be a way for us to regain our flourishing posture and endure beyond our individual suffering in these times.His book is futuristic, dynamic, compelling, and inspiring of a way of life that I believe will sustain and nurture our Human Healthspan one small dopamine pulse to the next !!A must read for anyone trying to re-imagine health and healthcare.Jeremy Fish, MD

What is Health is a very rare book—an example of deep integrative thinking that spans almost all levels of biology and health care—from molecular switches all the way up to social structures. Sterling does a brilliant job at conveying tough ideas in a simple, witty, and logical sequence. I laughed out loud when I got to Newton standing on the shoulders of his extinct worm predecessors. That is a Far Side cartoon we need Gary Larson to add to the second edition of this great book.You will just want to keep reading and learning. His main thesis—buttressed with impressive evidence, is spelled out front-and-center in the introduction—it is all about what Sterling (and now others) calls "allostasis". Bottom line—right now on Planet Earth our complex stress-addled societies make is exceedingly difficult to reach and stay within the allostatic ranges that are optimal for most humans.The first four chapters set the scientific and empirical stage for his thesis on allostasis, with an intense focus on bioenergetics as a core cause and mediator—as the main driver of how we humans acquire and use energy, and of how our brains and bodies have been sculpted by selection and drift to enhance energy use in the name of reproduction and fitness. Allostasis is also all about how we proactively anticipate and predict—put our minds a bit into the future—in order to more efficiently and smoothly meet our many needs and wants.While I loved it all, it may be heavy going for some readers, not because the subject is hard or because the explanations are unclear—but hard because Sterling does not waste your time or his words. You have to fly with him at high velocity through about 191 pages. Great figures help you to visualize key ideas.If you find the pace too fast, then skip ahead to for a short breather to Chapter 5: "What Went Wrong" with modern post-enlightenment society. Not that there is anything fundamentally wrong per se with enlightened scientific progress. It is just that societies and humans are not necessarily well "co-evolved for a world in which environments changes radically even within generation. Our children are often strangers to us in the same ways as a different culture or a different tribe. Mary Catherine Bateson explains this in her beautiful book: "Full Circles, Overlapping Lives (Culture and Generations in Transition)". And if you think this does not apply to WEIRD "first- and second-world" countries, then see Graham Robb's eye-opening book "The Discovery of France".The core bits and pieces of "modern" societies are not nearly as well integrated for optimal human health as are the cells and organ systems that make up a human body. As a result we now usually fail to fit our environments very well, and this contributes to disease and kills many of us prematurely under high stress. True that human lifespan is generally doing much better now than a few centuries ago. And I am not ready to concede that the situation was any better in Uruk or Gobekli Tepe thousands of years ago. Our species has been racing cultures now for 50,000 years. We are always out of equilibrium.But now we know this—thanks in large measure to Sterling's clear explanation. We can do something about it all. There is huge room for rational improvement in the design of all our many diverse sociopolitical environments. Can each of us find a more suitable environment for a real life?We are racing ahead with social change—a Red Queen's race that is now getting very close to a social singularity, There is one big question. Will we be crashing humanity into a solid concrete wall at high velocity in the next century or will we gracefully pass through this awkward phase of teenage technology and come out on the other side of 2121 in a sensibly sublime world of fully realized human potentials. Dystopia or utopia.I'm with Elon and Jeff—hedging with side-bets on Mars, the Moon, Lagrangian points, outer space, large asteroids, and global machine intelligence. But we know that there will never be another home planet Earth. We should fight hard against our species' ugly tendencies toward self-immolation. We should fight hard to keep our home planet as pristine and allostatically useful for as many peace-loving humans and species as we can for as long as we can. We are now our own shepherds.Peter Sterling highlights the philosophy and provides the key data and the rich empirical context that may make a soft landing possible.Read it, think about it critically, and if you are like me—follow his lead.(One figure from Chapter 5 uploaded to Jeff's Empire to gives you a feel for the topic: the figure legend is there to help if the graph itself is not obvious. )