The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Haven't heard of him, but looking at it briefly looks like total quackery as per usual.
Here's why.
The advice "live a healthy life" is known to all, prescribed by doctors 100% of the time, totally ignored, and incredibly hard to intervene in. "You are missing some common sense lifestyle intervention X" is included within things like "eat a healthy diet for fucks sake." The few people who grab onto something (like thiamine or whatever) tend to ignore all else including extremely important medical intervention (fun fact: Steve Jobs died from one of the more survivable pancreatic cancers because he refused mainstream medicine). Outcomes in "healthstyle fad" type people tend to be incredibly bad, and then we see them avoidably dying in the hospital for no reasons with something preventable and demanding last second intervention.
Admittedly nutritional type interventions like OP's comment are a bit trickier because establishing evidence burden is hard, but that's not really what your link is getting at.
I work in software and academia. The idea that the best solutions win was something i believed in until i started to observe things a bit more critically. Now it just seems like a laughable statement. A reason for this is that certain things are extremely complicated, which makes measurements on how well something works, or will work in the future, difficult. Add in the fact that most people are good at following processes, not building coherent models of something that's hard to see, but is none the less real. What you get seems to be a certain kind of system that sort of works if you don't zoom out enough. Why do we have 5 guys solving the problems that are created by another 5 guys? It's just patches upon patches upon patches. And eventually the system gets stuck in a local (hopefully) maximum.
I would assume medicine works similarly, but since everything is even harder to measure there, and the fact that as you said, patients suck. The default should therefore be that nothing works even close to as well as it should. I have IBD along with extreme fatigue. Conventional medicine does not really have a solution to this. To combat this I've changed up my diet in multitude of ways. I saw the most improvements using Carnivore, to the point where it felt unbelievable, but it introduced other problems so it was not sustainable. So if Carnivore, a very "woo" thing with a hint of "bro-science" works well. What other things that are deemed "woo" actually works?
I tried a bunch of things, most did nothing, some had temporary positives, some negatives. Some, like folinic acid has minor but long term positive improvements. But I swear that something about B1 therapy that that Doctor proposed worked, in the sense that it's solving the problem. I've been a lurker on the internet my entire life, simply because it's never been worth the effort to type without a clear reward (money from work), but now writing feels easy and fun. Another, more objective measurement is that my hamstring/hip mobility has gone from -2 to almost normal. I can almost touch my toes now. I've attempted to fix this problem for 5+ years through PT and exercise. Nothing had any impact before.
Here's a study that I found, there are more if one looks around. Indicating it improves things in all kinds of problems https://pubmed.ncbi.nlm.nih.gov/33210299/. As another anecdote is that it also worked for my girlfriend with her POTS. First it made the symptoms a lot worse, then much better. And it improved her anxiety massively. His book also attempts to explain the science behind it. It would be interesting if those explanations also sound like woo since I don't have enough knowledge to know if they are wrong.
But if you think about it, different nutrients do different things in the body. It makes certain processes work faster / slower depending on what is available. If say fighting a virus needs certain nutrients, unless proof that we have enough, the reasonable assumtion is that more of these nutrients will help in that fight right?
If you have some good arguments that this is the wrong path to go down on I'd be very happy to hear it, since I'm still skeptical despite the fact that it's obviously working for me. I mean if there is something real here, and "real" medicine does not touch it, the "woo's" are the only ones that will.
Thanks for your time!
There's a few layers of problems here.
First:
Yes I need to acknowledge that a lot of medicine is guess work and throwing up our hands and going "this makes sense" or "anecdotally this works." This is because proper research is extremely expensive, difficult, and is often unethical to do correctly (a lot of research in Peds is just not performed because nobody wants to test shit on kids). We do have things that we have really good quality research for, or know with a good deal of certainty. Medicine has some of the strongest validated research evidence and some of the weakest. It is totally a shit show and it's important to acknowledge that.
Second:
Again most medical care is centered around reducing mortality and morbidity. Optimization is considered less important and rewarding but it is what most people want since most people aren't actively dying at any given time.
Third:
Optimization is orders of magnitude more complicated. Individual genetics, lifestyle, life history, gut microbiome and so on radically impact the effect of these types of interventions. You'll see vegan or paleo diet advocates, touting the general wisdom of something that may have worked for that specific person. We don't have the research base and money for too much personalized medicine at this point which is a weakness of ours but any of this type of evangelism is fundamentally worse since people are bad at nuance and anyone involved in fad diets or whatever has a tendency to be extremely bad at "try it for a little bit and see if it works for you" type preaching instead of "behold, this is magic."
Fourth:
As alluded to above some people are capable of responsibly using this type of information, but by the numbers most people (or just enough) who get into "alternative medicine" (or however you want to label it) decide to abandon traditional medicine, and that includes the wealthy, intelligent, and educated. A common path is starting on a "fad" intervention and then just refusing mainstream medicine leading to future poor outcomes which can be extremely disturbing for the patient and care providers. This also makes most of us reflexively hate this shit which isn't productive but is the reality. Most people who are suffering are very willing to engage in black and white thinking and assume that mainstream medicine doesn't have much to offer them if this other plan helps with relief.
Vaccine refusal is a parallel - there's some nuanced discussion to be had on the COVID vaccines but any doctor who has seen a kid avoidably die from measles is going to want to put an anti vaxxer into a woodchipper because in their head it's the same crowd that is letting kids die.
Fifth:
One of the reasons for the difficulty in good research for this stuff is subjectivity vs objectivity. "I don't feel right" is a lot harder to chase, scale, and improve than "my blood pressure/sugar is elevated." This also means that the placebo effect and psychiatric impacts are extremely important and in all honestly might predominate.
People don't like to be told "this only works because you think it does" or "no there's nothing physically wrong with you it is a complicated psychiatric problem" but the reality is that many things are like this.
Unfortunately POTS is a good example, as is CFS/EDS/Long-COVID. People do appear to really have these diseases but the vast majority of people who say they have them, don't. This is magnified because of the importance of patient reviews and lack of time to actually speak to patients. Your doctor might be sitting in the back room going "yeah no way does this chick have POTS, but I don't have time for this fight so whatever I'll go along with it" and of course the fact that the physical and psychiatric side of things are tightly linked together doesn't help anything.
Ultimately almost all symptoms of these kinds of things (examples: tiredness, weakness, sleep problems, concentration problems) are equally or better explained by just depression/anxiety and are known to be symptoms of such. Treat the depression adequately and they go away, but identifying the issue as medical is more ego-syntonic and often impairs recovery.
You also see patients identifying as having ADHD because they can't concentrate and its really depression, bipolar, or personality and they refuse to acknowledge it but ADHD seems like a "better" disease to have and importantly has a clear treatment.
For a wildly different example: aging men demanding testosterone because they are feeling symptoms of aging or unhappy with their life course. It's not wise, but people refuse to not pursue it.
Fundamentally PEOPLE (all people) aren't really psychologically equipped to navigate these sorts of things in the modern world and it adds an enormous layer of complexity to the proceedings.
Sixth:
Assuming the previous point didn't turn you off the next layer is the assumptions of the math brain type person. If you've seen me post here before or on my previous account on Reddit you'll have seen me going at it with a bunch of hard science/math/finance people about how hard medicine is. People used to working in fields with way less ambiguity struggle to understand the realities of health and medicine (and research on the same). Your code runs or does not, the $$$ goes up or down. Why can't you turn medicine into an algorithm just like in our fields?
Medicine is an art as much of a science, translating what patients are actually saying, interacting with patients, figuring out how to interpret p-hacked and clearly biased research, navigating legal environments and regulatory burden all make the field way more complicated and subjective than you'd expect from something that seems to so firmly abut hard science.
Epistemic certainty on the vaguer things is going to therefore be shitty as hell.
Seventh:
Okay so what does all of that boil down to?
I have no idea if what you are doing is working because you think it's working, because it's turning some corner psychologically, or because it is doing something biochemically useful for you. I have no idea how likely it is that it would work for you specifically and you just got lucky.
Nor do I really care, and perhaps you shouldn't either. If it makes you feel better than power to you!
You just have to be careful and have some insight. Still get regular medical care. Don't overdo it. Don't do it if your medical status changes in some way that makes it unsafe.
B-vitamins are pretty benign but lots of people end up overdosing on some supplements.
Is your improvement really for the reason you think it is? Probably not...but maybe? However because actually verifying that is nearly impossible it isn't something we can reasonably roll out as population level advice.
I'll leave you with one final example - one of the common ways to hack research studies for novel psychiatric drugs is to take advantage of improvement in an inpatient setting. Turns out that being checked in on and cared for every day, being surrounded by peers and social opportunities, and getting regular therapy makes people feel a lot better. Do these things and dump a new psych drug on them and they'll get better! But uh, not clear it really is the medicine doing it.
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Speaking as someone whose mother's go-to crazy for disease and illness was that magical eating would make all things better, I just want to second this skepticism. Diet and nutritional supplements did not cure my little brother's ADHD, diet and nutritional supplements did not cure my father's dementia and Alzheimer's, my own diet and (lack of) nutritional supplements did not cause my acute appendicitis when I had that, etc.
Yeah. Unfortunately all this is not a theoretical problem, or annoying but harmless - seeing people come in with completely avoidable but fatal disease because they were led astray by alternative medicine isn't every day, but it is extremely common.
For some reason these people have no liability and it's nearly enough to make me want to fedpost.
Hard agree, as you might imagine from my previous post, I have had a lot of exposure to alternative medicine in my life and while it's not all awful (I've had good success with chiropractic care specifically for back pain and posture issues, for example) it's almost all noise and no signal there. The example of Steve Jobs is particularly poignant there, why he wouldn't have taken the known successful treatment is beyond me except now that I'm typing that, I'm remembering that I occasionally saw some strong BPD Reality Distortion Field vibes from him on occasion (the whole you're holding your phone wrong bit is one of the most memorable ones) so the alternative medicine cancer cure could have easily been more of the same.
RE: Chiropractors.
They can do some useful and real stuff but from everything I've seen everything they can do that is "real" is encompassed within the scope of practice of PTs and DOs doing OMM. And with much lower risk of random BS or ya know, sudden death.
RE: Jobs.
It's interesting you bring him up in that context, I was just thinking the other day about Trump and how he seems to exhibit a level of resiliency that is inconsistent with the way NPD seems to manifest itself. Obviously you could label him with some of the traits but everyone can get that accusation at times. So back to Jobs, the level of functional impairment in those two means they probably don't meet formal criteria...and then that makes me have a think about what kind of things pull people out of a formal disorder. In Jobs case maybe he that BPD brain but is absent the life history that manifests it in a clinically significant way? Or just that the visionary thought patterns and reality distortion stuff are correlated in some way?
This whole line of thinking isn't fully fleshed out but if you've got some thoughts, please share.
Sure thing. Quick tl;dr about chiropractors is that I had one and just found another one that was around $40 for an adjustment, so to go from moving gingerly because back pain to just a little soreness and full range of motion when I need it is worth that and then some for me when I need it.
WRT Steve Jobs in particular, for me it's all about the alternative medicine plus his patented Reality Distortion Field. We have heard the widespread stories about him being very difficult to work with/for, being mercurial, difficult, manipulative, deceptive, often angry, etc. Then there's the house he bought and left to rot because he despised it and the book Small Fry that his daughter wrote about how he was mostly terrible to her but sometimes wonderful as well. Weird diets, driving without license plates, etc. etc. To me, it definitely smells like Cluster B behavior and the liver cancer is a prime example of the kind of outrageous refusal to truck with reality that I've seen in the borderlines in my own life that puts me in the BPD camp with Steve as opposed to the NPD camp. There's a certain breed of entitled borderlines that at first blush look almost identical to narcissists unless and until they display their flat-out refusal to live in reality, although they may visit there and even room there for a while.
When we get to clinical criteria, I of course am not Scott, but I think Jobs would have to have been one of the highest functioning cluster Bs that we've seen in a long time if he was. Playing armchair therapist/psychiatrist anyway, I think he definitely met the criteria for intense anger, emotional instability, and splitting. Jobs having chronic feelings of emptiness is strongly supported by anecdotal data, eg crying when he got badge #2 at Apple, despair at not being named Time's man of the year in '82, etc. Impulsive behavior is a bit of a harder sell but it's definitely there, so yeah, that's 5 criteria, and I don't think it'd be completely shocking to dig up enough to support frantic efforts to avoid real or imagined abandonment and severe dissociation and perhaps paranoid ideation when under stress.
Just keep em away from your neck lol.
Hmmm you make a good case.
I think the counter argument would be going all map vs. territory invalidation and then pointing out that their didn't seem to be much functional impairment, but that's to some extent luck given the way Apple went and the obvious retort is "avoidable cancer."
I guess he does pattern match to "tortured genius artist" types, and outside of obvious bipolars that's gotta be cluster-b.
Yeah, that's a good counterargument for sure. When it comes to functional impairments, that's the terrifying thing about the higher functioning cluster-b types: they're so good at manipulating people that they don't have much trouble compensating for and otherwise masking their PD behaviors and largely passing as normies. According to Andy Herzfeld Jobs' ability was so good that even though Apple employees were aware of it, it was still effective in the moment and only after Steve left would it begin to wear off. He goes on to say that most employees would eventually give up and accept it as a force of nature, which is really the only thing you can do when even quitting is difficult.
PS: I've taken to sleeping with a cervical pillow to help out my neck, seems to have helped! Now if only I could get back into the habit of using my inversion table...
...you know that anecdote makes me wonder if another interpretation of the reality distortion is just nerds being shocked to interact with someone with actual charisma.
If you've ever met with someone high level (especially while young and impressionable) it can be quite stark, your ego gets totally consumed and you just go along with it (and for some people it's not even temporary).
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Good thing I looked up what a cervical pillow was, because I was going to say if a pillow for your cervix helps your neck pain you may a very bad sleeping posture.
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