The Growth of Paleo: Patrick Vlaskovits Interview

I wondered if Patrick Vlaskovits, who runs the question-answer site PaleoHacks, could shed some light on the recent growth of interest in a Paleo approach to health. So I asked him a few questions.

SETH What have you learned from PaleoHacks about the growth of the Paleo movement during the last year?

PATRICK Well, one thing is certain … the Paleo movement IS growing. One can look at various proxies for this — Google Trends – for example – https://www.google.com/trends?q=paleo+diet — or more frequent mentions in the mainstream media. But your question is about what I have learned from PaleoHacks.com with regard to growth. PaleoHacks.com’s traffic is definitely growing and my sense is that Paleo (by that I mean eating in an evolutionarily appropriate manner) is about to cross the chasm into the mainstream.

A few interesting measures of growth vis-a-vis PaleoHacks are:

1) The increasing frequency of meta-discussions on PaleoHacks –people who have been eating Paleo for some time are now looking to the future about what it means to be “Paleo” and how long-time Paleo eaters are changing their Paleo diets. This is, IMO, is a good thing as Keynes said: ”When the facts change, I change my mind — what do you do, sir?” We are learning more about how our health changes after some time eating Paleo – and what needs to be fine-tuned when it comes to things like bacterial/gut health (probably the most important thing to worry about) and hormonal changes relative to our environment, e.g. cortisol levels increasing due to lack of sleep which can result in unwanted/unhealthy weight gain or weight loss.

2) More people are blogging about Paleo and also more people are trying to monetize Paleo and I see them on PaleoHacks. (For the record, I have no problem with anyone trying to monetize Paleo as long as they are responsible about it as I feel that anyone monetizing Paleo should also be a good steward of Paleo.)

SETH How much has PaleoHacks traffic grown over the last year?

PATRICK Short answer: A lot. Longer answer: Depends on which metric you use — but still a lot. Ranges from 6x to 8x YOY increase in visits, uniques and page-views. Currently, PaleoHacks gets +500k page-views a month. [I double-checked my internal stats with public information on Compete.com & Quantcast – and it looks like they undercount (BTW this is a well-known and hotly debated topic).]

SETH What do you think is causing such fast growth? The broad idea is really old. Even the details are old — Weston Price wrote in the 1930s, for example. The Weston Price Foundation, which was started many years ago, is growing much more slowly.

PATRICK Cutting to the chase: no idea. Some thoughts:

Paleo’s growth appears highly correlated with CrossFit — but what has caused CrossFit’s growth? Not sure. It too has been around a while.

Social media have certainly accelerated/lubricated Paleo’s growth but I don’t if social media actually *caused* Paleo’s growth. What causes memes like Paleo to spark, and then die out or go dormant and then spark again to grow into a raging wildfire? I wish I knew.

Getting a little meta and perhaps off-topic — my assumption is that is true for most “Big Ideas”. We rarely recognize or know of their true “discovery” because for-whatever-reason the implications are not fully, if at all, appreciated at the time of discovery. For example, I believe this was the case with penicillin. A French medical student discovered it 1896, Fleming re-discovered it in 1928 and then it lay around until 1939 when Florey fully appreciated it.

I certainly didn’t put two and two together when I read Why We Get Sick back in 2000-ish. I thought it a fantastic book (and still do)– but I didn’t think of applying the evolutionary lens to diet/nutrition, even though in retrospect, it seems obvious.

Evolutionary Health Journal to Start

Building on the success of the Ancestral Health Symposium — it will be in August, but it’s already a success — Aaron Blaisdell is planning to start a scientific journal on the subject.

It will be an historic thing. The notion that ancient lifestyles are especially healthy has been around, and taken seriously, for at least a few hundred years. Serious data began to be gathered in the early 1900s. Weston Price is an example. For a very long time this idea seemed to go nowhere, or at least the mainstream ignored it. In the 1970s there began a small irregular stream of publications (e.g., a book called Western Diseases edited by my friend Norman Temple) but again the mainstream ignored it.

But mainstream medicine doesn’t work very well. The notion that when you get sick you should take a dangerous expensive drug doesn’t make a lot of sense. You didn’t get sick because you lacked the drug. More plausible is that when you get sick you should reverse the environmental conditions that caused the sickness and find out if your body can heal itself. Even more, you should prevent disease from starting. Along with mainstream medicine’s implausible intellectual foundation has come pathetic results. Robin Hanson has emphasized the RAND experiment that found that a large fraction of medical spending produced little benefit. Tyler Cowen has pointed out that Americans spend far more than other countries on health care with no better results. A doctor at a county hospital once told me, “The truth is that we can’t help most people that come in.” They come in with diabetes, obesity, and so on. Why don’t you do something that does help? I asked. Because when you do prevention research, she said, you don’t get people thanking you. She was describing a protection racket: make people sick — if only by failing to tell them how to be healthy — so that they will come to you for help.

An academic journal with a steady stream of articles and supporting evidence is a big step toward getting the paleo alternative taken seriously. It will help researchers who take paleo ideas seriously publish their work, of course, but it will also help them get feedback. Because it will help them publish, it will help them get research support. Because the journal (like any new journal) will be open access, it will help those who want to learn about those ideas. When ideas about health are forced to compete on their merits (such as cost, safety, effectiveness, and quality of the supporting evidence) and becoming an M.D. confers less of a monopoly (on information and treatment), a great change will come. Richard Nikoley recently posted an example of what a difference this can make.

1.5 Years on the Shangri-La Diet

Alex Chernavsky has kindly given me several years of weight data he collected by weighing himself daily. He read about the Shangri-La Diet in 2005 and several years later decided to try it. The graph above shows what happened: Starting at 222 pounds (BMI = 32), over 11 months he lost 31 pounds, reaching a BMI of 27. Since then — while continuing the diet — his weight has increased at roughly the same rate it was increasing before he started the diet.

He started by drinking olive oil and sugar water, switched to olive oil alone, and then, finally, to flaxseed oil alone of which he drinks 3.5 tablespoons/day (= 420 calories/day). He does not clip his nose shut when he drinks it but he washes his mouth with water afterwards. More about his method here.

Almost all weight-control experts would say these results are impossible: 1. Alex lost weight because he ate more fat. Fat is fattening say most nutrition experts. 2. Atkins dieters, who don’t say that, think the secret of weight loss is to reduce carbohydrate. Alex didn’t do that (and eats plenty of carbohydrate). 3. He didn’t restrict what he ate in any way. 4. He didn’t change how much he exercised.

Quite apart from how it contradicts mainstream beliefs, including Atkins, the data are remarkable because the change was so simple, small, and sustainable, the weight loss so large, the rebound so minimal, and data period so long.

An ordinary clinical trial has obvious advantages over such one-person data, such as more subjects and more data per subject. Less obvious are the advantages of this sort of data over clinical trials:

1. Long pre-diet baseline. Clinical trials never have this. It allows one to judge if weight increase post-diet, often called “regain”, is due to the weight loss or other factors. In this case the rising pre-diet baseline shows that other factors are causing slow weight gain over time.

2. Motivation. In a clinical trial, the motivations of the researchers and the subjects are different. The researchers want to measure the effect of an intervention; the subjects want to lose weight. If paid, they may want to make money. The difference in motivations causes problems. How closely the subjects obey the researchers and how truthful they are is usually hard to know. This data does not have that clash of motivations and incentive to lie.

3. Realism — what methodologists call ecological validity. These data, unlike clinical trial data, come from the situation to which everyone wants to generalize: people trying a diet by themselves at home without professional support or guidance.

4. Level of detail available. You (the reader) have access to something resembling raw data. In clinical trial reports, the data available is heavily filtered (e.g., shortened, simplified) and the nature of the filtering rarely described. For example, you rarely learn in any detail what the subjects ate. With this sort of data, but not clinical trial data, you can get a better sense of whether the results are likely to apply to you.

Methodological Lessons From My One-Legged-Standing Experiment

A few days ago I described an experiment that found standing on one leg improved my sleep. Four/day (= right leg twice, left leg twice) was better than three/day or two/day. I didn’t know that. For a long time I’d done two/day.
I think the results also contain more subtle lessons. At the level of raw methodology, I found that context didn’t matter. The effect of four/day was nearly the same when (a) I measured that effect using four days in a randomized design (where the dose for each day is randomly chosen from two, three, and four) and when (b) I measured that effect using a dose of four day after day. Suppose I want to compare three and four. Which design should I use: (a) 3333344444, (b) 3434343434, or (c) 4433343434 (randomized)? The results suggest it doesn’t matter.

The experiment didn’t take long (a few months) but it took me a long time to begin. I noticed the effect behind it (one-legged standing improves sleep) two years ago. Why did I wait so long to do an experiment about details?

I was already collecting the data (on paper) — writing down how long I slept, rating how rested I felt, etc. But I wasn’t entering that data in my laptop. To transfer months of data into my laptop required motivation. Most of my self-experimentation has been motivated by the possibility of big improvements — much less acne, much better mood, and so on. That wasn’t possible here. I slept well, night after night.

What broke the equilibrium of doing nothing? A growing sense of loss. I knew I was throwing away something by not doing experiments (= doing roughly the same thing day after day). The longer I did nothing, the more I lost. To say this in an extreme way: I had discovered a way to improve sleep that was unconnected to previous work — sleep experts haven’t heard of anything like it. It was real progress. To fail to figure out details was like finding a whole new place and not looking around. Moreover, the experiments wouldn’t even be difficult. The treatment takes less than a day and you measure its effect the next morning. This is much easier than lots of research. Suppose you know that radioactivity is bad and you discover something radioactive in your house. A sane person would move that radioactive thing as far away as possible — minimizing the harm it does. I had discovered something beneficial yet wasn’t trying to maximize the benefits. Crazy!

An early lesson I learned about experimentation is to run each condition much longer than might seem necessary. If you think a condition should last a week, do it for a month. Things will turn out to be more complicated than you think, having more data will help you deal with the additional complexity that turns up. Now it was clear I had gone too far in the direction of passivity. I did the experiment, it was helpful, I could have done it a year ago.

The Shangri-La Diet: Why No Revolution?

David Mandel, CEO of Alliance United Insurance Company, asks a very reasonable question:

Despite all the success stories [on the Internet] regarding the Shangri-La Diet, and the mainstream media stories in 2006 after the book publication, the diet never picked up and seems almost unknown today.

Whether this is right or wrong depends on expectations. In December, SLD got a great push from being on the website of Tim Ferriss’s Four Hour Body under the attractive title “Alternative to Dieting”. Tim’s book was published in December and registrations to the SLD forums jumped dramatically. Yet even before that, forum traffic was growing. Traffic of course grew when the SLD book came out, later shrank, and now — surprisingly — is growing again. My interpretation is that the initial growth was caused by mainstream publicity and blogs. The current growth is caused by word of mouth.

If I google “Shangri-La Diet” I get about 800,000 hits, a decent amount. “Sonoma Diet” — the book came out the same time as mine — gets 200,000 hits. “Eat Right For Your [Blood] Type” and “Eat Right 4 Your Type” get a combined 150,000 hits. That book was a huge hit when it came out in 1997. The usual pattern is Google hits go down, but SLD hits have gone up over the years.

On the other hand, given that my book contained a new theory of weight control that made about 100 times more sense than the usual ideas and led to counter-intuitive new ways to lose weight that actually worked and that obesity is often considered the world’s #1 health problem — yeah, it is “almost unknown” compared to what one might have expected.

I was wondering if you had any insight as to why it did not go viral, if nothing more from word of mouth from success stories sharing with everyone who will listen to their excitement. It seems all but impossible to me that something this simple, and universally successful which can benefit the masses has managed to not go mainstream in all these years. I am utterly baffled, and assumed there must be a big downside, but all my searching online has revealed nothing but the success stories and initial feedback, mostly from 2006 and 2007, and little since. I am just overwhelmed with curiously as to how this did not become the norm for everyone.

When my agent circulated the proposal for the book, one editor regretfully declined to bid on it because she said the book was “15 years ahead of its time.” Perhaps she was just being nice, but when people tried the diet, and it worked, they wouldn’t tell other people because the diet sounded crazy. Which means it really was far ahead of its time. Good Morning America filmed me for a short Freakonomics-related segment and they played it for laughs: crazy professor.

So that’s my explanation for why it has spread more slowly than one might have expected: fear of ridicule.

Danger of Low-Carb Diet: Not Enough Vitamin C

I eat a low-carb diet for reasons that have nothing to do with weight loss: To keep my blood sugar down. I am sure high blood sugar is bad. A few months ago, I noticed that my lips were chapped, which was unusual. I suspected it was due to lack of Vitamin C. About two months before that, I had stopped doing two things that I usually did: taking a multi-vitamin pill (which had Vitamin C) and eating fruit. I don’t know if the Vitamin C in the pill is absorbed but I’m sure the Vitamin C in fruit is. I started eating kumquats — the skins of four kumquats/day. (One kumquat contains about 15% of the recommended daily allowance of Vitamin C). My lips returned to normal.

Paul Jaminet, author of Perfect Health Diet, had a similar experience, which I knew nothing about when I noticed my chapped lips. While eating “a lot of vegetables but no starches and hardly any fruit,” he developed outright scurvy, including wounds that wouldn’t heal. This happened while he was taking a multi-vitamin pill with 90 mg Vitamin C (my four kumquats contain only 35 mg Vitamin C). “Four grams a day of vitamin C for two months cured all the scurvy symptoms,” he found.

Why do we like sweet foods? The usual answer (so that we will eat more calories) is nonsense (except for children). The striking thing about our liking for sweetness is that it disappears when we are really hungry, which is the opposite of what the calorie-seeking explanation predicts. Desserts are served at the end of a meal because they taste much better then. But our liking for sweetness (when we’re not hungry) is so strong and obvious it must mean something important. I think it is pushing us to eat more fruit so that we will get enough Vitamin C. Fruits are much sweeter than other food groups and they are much higher in Vitamin C. We don’t like sweet things when we are hungry because a high-fruit diet is terrible (it is low in omega-3, other necessary fats, several minerals, and microbes, for example). But a small amount of fruit may be a big help. Paul and my experiences suggest it may be hard to get enough Vitamin C in other ways.

More Paul has a different idea about why we like sweetness.

Effect of One-Legged Standing on Sleep

In 1996, I accidentally discovered that if I stood a lot I slept better. If I stood 9 hours or more, I woke up feeling incredibly rested. Yet to get any improvement I had to stand at least 8 hours. That wasn’t easy, and after about 9 hours of standing my feet would start to hurt. I stopped standing that much. It was fascinating but not practical.

In 2008, I accidentally discovered that one-legged standing could produce the same effect. If I stood on one leg “to exhaustion” — until it hurt too much to continue — a few times, I woke up feeling more rested, just as had happened when I stood eight hours or more. At first I stood with my leg straight but after a while my legs got so strong it took too long. When I started standing on one bent leg, I could get exhausted in a reasonable length of time (say, 8 minutes), even after many days of doing it.

This was practical. I’ve been doing it ever since I discovered it. A few months ago I decided to try to learn more about the details. I was doing it every day — why not vary what I did and learn more?

One thing I wanted to learn was: how much was best? I would usually do two (one left leg, one right leg) or four (two left leg, two right leg). Was four better than two? What about three?

I decided to do something relatively sophisticated (for me): a randomized experiment. Every morning I would do two stands (one left, one right). In the evening I would randomly choose between zero, one, and two additional one-legged stands. Sometimes I forgot to choose. Here are the results for three sets of days: (a) “baseline” days (baseline(2), baseline(3), baseline(4)) before the randomized experiment and during the experiment when I forgot and (b) the “random” days (random 2, random 3, random 4) when I randomly choose and (c) a later set of days (“baseline 4″) when I did four one-legged stands every day.

Each morning, when I woke up I rated how rested I felt on a scale where 0 = not rested at all (as tired as when I went to sleep), and 100 = completely rested, not tired at all.

 This shows means and standard errors. The number of days in each condition are on the right.

The main results are that three was better than two and four was better than three. The three/four difference was large enough compared to the two/four difference to suggest that five might be better than four. The similarity between random 4 and baseline 4 means that the amount of one-legged standing on previous days doesn’t matter much. For example, on Monday night it doesn’t matter how much I stood on Sunday.

These differences were not reflected in how long I slept. Below are the results for “first” sleep duration, meaning the time from when I went to sleep to when I woke up for the first time — which is when I measured how rested I was (the graph above). On a small fraction of days, I went back to sleep a few hours later.

These results mean that one-legged standing increased how deeply I slept, what you could call sleep “efficiency”.

I also computed “total” sleep duration, which included first sleep duration, second sleep duration, and nap time the previous day (e.g., nap time on Monday plus sleep Monday night). If I took a long nap, I slept less that evening. Here are the results for total sleep duration.

The results also support the idea that one-legged standing made me sleep more deeply.

The randomized experiment had pluses and minuses compared to a simpler design (such as an ABA design, where you do each treatment for several days in a row). The two big pluses were that the conditions being compared were more equal and you could simply continue until the answer was clear. The two big minuses were that I often forgot to do the randomization and lack of realism. If I decided that four was the best choice, I’d do four every day, not in midst of two’s and three’s.

Overall, it was clear beyond any doubt that four was better than two, and clear enough that four was better than three (one-tailed p = 0.02). The results suggest trying larger doses, such as five and six. I’ve only done six once: before a flight from Beijing to San Francisco. It was one of the few long flights where I slept most of the way.

If you try this and you do more than one right and one left, leave plenty of time (two hours?) before the second pair, to allow the signaling molecules to be regenerated.

Growth of Quantified Self (more)

At the Quantified Self blog, Alexandra Carmichael has posted several graphs showing how much the Quantified Self movement has grown during the past year. The number of QS meetup members has grown by a factor of 3; the number of groups has grown by a factor of 6.

Measuring yourself is a step toward controlling yourself — especially, controlling your health and well-being. Almost everyone wants more control of these things. I believe that the idea, which the Quantified Self movement encourages, that ordinary people can do useful science is a shift with implications on the order of the shift from religion (the Sun revolves around the Earth) to science (the Earth revolves around the Sun). When ordinary people begin to do science, I predict we will learn a lot more about how to control our bodies.

Before science became powerful, people knew lots of correct useful stuff (e.g., metallurgy). But there were limits on what could be learned (e.g., Galileo was imprisoned). Now religion is much less powerful but most people believe that science can only be done by certain people (e.g., professors). This too places serious limits on what can be learned. For control of the outside world (e.g., material science, physics), I don’t think these limits matter (although the case of Starlight suggests that even here amateurs can make important discoveries). But for control of the inner world (our bodies), the message of my work is that these limits matter a lot. By studying myself I managed to learn a bunch of useful things that professional scientists could learn only with great difficulty. For example, I could learn from accidents how to sleep better; I could easily test ideas about how to sleep better. Few if any professional sleep researchers measure sleep night after night for long periods of time; nor do they do cheap fast experiments.

My Talk at EG

Last year I gave a 20-minute talk at EG (EG is short for Entertainment Gathering) titled “You Had Me at Bacon” about my self-experimentation. I described some of the things I’ve discovered by self-experimentation. Then I tried to say why it had been successful — why I had managed to discover such useful stuff. My conclusion is that my success came from the combination of four things: 1. Self-experimentation. Much faster, more flexible than ordinary research. 2. The Stone Age = good idea. I used the idea that our bodies were shaped to work well under Stone-Age conditions to choose what experiments to do. 3. Subject-matter knowledge. My knowledge of psychology, experimental design, and data analysis helped a lot. My weight-control theory, for example, was based on ideas from animal learning. 4. Freedom. I could do and say what I wanted. Most scientists cannot. They fear career damage. The combination of these four things is why my work was effective.

After my talk, a few people asked: Were you serious? No doubt you’ve heard Arthur Clarke’s maxim that “any sufficiently advanced technology is indistinguishable from magic.” Let me propose a related idea: Any sufficiently advanced science is indistinguishable from a joke.

Miso Bar

At a hotel buffet restaurant near Tsinghua I had fermented food in a form new to me: a miso-soup “bar”. You serve yourself from a tureen of miso soup and have a wide choice of add-ons: carrot, turnip, tofu, pickled ginger, green onion, Japanese pickle. Adding color, visual diversity, crunch, and DIY to the soup makes it taste much better — and it already tastes really good.

If I made a scatterplot of all the foods I can make, with difficulty on one axis and deliciousness on the other, this would be a bivariate outlier: very easy and very delicious.