Mr. Heisenbug says that smoking is the best predictor of heart disease. (Not quite. A high Agatston score is a better predictor. For example.) It is the best lifestyle predictor. People who smoke, according to this, have a six-fold increased risk of heart disease compared to non-smokers.

Why would this be? Heisenbug points to a study that found that when smokers quit, the microbial diversity of their gut increased. He speculates that (a) smoking decreases microbial diversity, which is quite plausible and (b) decreased microbial diversity increases heart disease — which has some plausibility.

I commented:

It would be interesting to find other factors that have a big effect on microbial diversity and whether they are also associated with heart disease. The idea that smoking causes heart disease via its microbial effects predicts, or at least suggests, that a change that reduces microbial diversity a lot will increase heart disease.

Heisenbug replied:

The only lifestyle factor that we can safely say leads to a lack of microbial diversity is a diet that is low in fermentable fiber. And fiber intake is consistently linked (negatively) with heart disease. I’ve never seen data linking lower overall diversity to a decrease in risk for any disease. And lots showing the opposite.

I replied:

The stuff about diversity (fiber intake increases diversity and is associated with less heart disease, many associations of more diversity with less risk of Disease X, no associations in the opposite direction) is substantial support for your idea, in my opinion.

His theory, in other words, made a prediction that turned out to be correct. A large fraction of what we’re told about health hasn’t led to any correct predictions. Here is an idea about how to prevent heart disease, a major killer, that there is actually reason to believe. And Heisenbug can say whatever he wants, in contrast to a heart disease expert quoted, say, in the New York Times, who is under pressure to say certain things. So we can take what he says at face value.

Heisenbug replied:

I agree. Especially because there’s never been a good explanation WHY fiber has that effect on [he means “association with” — Seth] heart disease.

Suddenly I am a lot more interested in microbial diversity and the association of fiber and heart disease. Smoking has countless health effects — it increases many cancers, for example. Obviously it increases lung and throat cancer. This means there are many ways it could cause heart disease. Fiber is quite different than smoking and as far as I know has no effect on lung and throat cancer. If it could be established that fiber causes a reduction in heart disease (not just is associated with a reduction), that would be considerable evidence (but far from proof, of course) that microbial diversity influences heart disease.

• Stephen J. Gould, evolutionary theorist: appearing to be smart
• “ A revolution is when you change your thinking.” I agree. Via Danielle Fong.
• Brain glycogen. Not all glycogen is in the liver.
• Ethiopians (in Ethiopia) don’t eat dessert. Evidence that traditional diets may not be optimal.
• Katherine Reid on how dietary changes eliminated her daughter’s autism (talk)
• The Floyd Leg. A shockingly simple great idea.
• Eric Lander, a professor at MIT and Harvard, says we should spend a lot of money on genomics without providing examples where it has been helpful. “The rate of progress is just stunning,” says Lander, again without examples. Perhaps he borrowed this style of argument from the Nobel Prize press office. I am sorry to see James Fallows, the interviewer, be so credulous. Dear Dr. Lander: Why is it that doctors have no clue what causes heart disease or diabetes or depression or a dozen other major diseases — but think they do? Is more money for genomics going to help with that?

Thanks to Edward Edmonds and Bert Sutherland.

It isn’t well known that eggs (large amounts) can cause insomnia nor that caffeine — in special cases — can reduce insomnia. But a reader named Baeo Maltinsky recently made those discoveries:

Back around July 2012, I was trying to improve my diet but I didn’t want to give up my vegetarianism, so I started to eat a LOT of eggs, usually in the range of 10 to 14 per day. Not long after, I started having awful insomnia. I could lie awake all night just unable to fall asleep. There were suddenly just too many thoughts buzzing through my head keeping me up. I assumed that it was a result of ketosis disturbing sleep. I tried reintroducing carbs, but when that didn’t work I gave up on dietary modifications. I started cycling through OTC sleep aids, but I developed tolerance to anticholinergics very quickly.

By October 2013, I was going crazy. I couldn’t sleep well. It was making me depressed and seriously impairing my academic performance. I was exhausted constantly, but then I noticed something. I slept better when I consumed a lot of caffeine in the morning. I noticed there was a clear dose dependent relationship between how much caffeine I consumed and how well I slept. I had a hunch that the caffeine was depleting my acetylcholine levels, serving a similar function as OTC anticholinergics like diphenhydramine and kava.

I wondered what would happen if I sharply reduced my intake of acetylcholine precursors. A lot of people advertise eggs as “choline packed”, so I cut back to less than 3 per day. Suddenly, I was sleeping much better. Now, it could be something else in the eggs (I’m not really attached to my choline hypothesis), but either way I feel confident blaming them for my sleep troubles. My insomnia returns whenever I start eating them again.

I asked him why he hadn’t realized earlier that eating so many eggs was the problem. He replied:

I just didn’t think there was anything special about the eggs. I googled around for it and the only things I could find were about ketosis induced insomnia, so it didn’t occur to me that eggs specifically were likely to be problematic. I tried consuming enough carbs to knock myself out of ketosis, but when that didn’t improve the situation, I just assumed that something else was going on aside from diet. Eggs seemed like the perfect food. Cheap, nutrient rich, paleo, easy to prepare, and compatible with my (then) vegetarianism. It would have been hard for me to find a suitable replacement, so while the idea of testing it probably occurred to me, performing the test itself wouldn’t be trivial and the results wouldn’t be actionable.

As it got worse, I tried treating it more aggressively with OTC sleep aids, and that worked well enough that I stopped worrying about it. I wasn’t sleeping great, but it was enough to get by. Eventually they stopped working, but not long after that I made the caffeine connection and decided to try removing eggs. It was easier to do at that point because I had given up on paleo and vegetarianism and could just substitute chicken and sprouted lentils, and I had a (probably
incorrect) neurochemical explanation to support it. Moreover, it had become VERY difficult to eat the eggs. My body just didn’t want to consume them and I had to slowly force them down. Something seemed to know it was bad for me, but I wasn’t listening to the signs. My behavior was not at all rational, and believe me after I discovered eggs were the problem I was kicking myself for not trying it sooner.

I asked him what he learned from this, apart from how to sleep better. He replied:

1. Costly experiments sometimes need to be performed.
2. Sometimes your values are bad for your health.
3. Don’t give up just because there’s no evidence to support a hypothesis.
4. Simple things can easily go unnoticed.

Those are good lessons.

Joseph Biederman is a professor of psychiatry at Harvard Medical School. It makes a certain sense. According to Wikipedia, in 2007 he was

the second highest producer of high-impact papers in psychiatry overall throughout the world with 235 papers cited a total of 7048 times over the past 10 years as determined by the Institute for Scientific Information.

And he has won several awards:

Biederman was the recipient of the 1998 NAMI Exemplary Psychiatrist award. He was also selected by the Massachusetts Psychiatric Society Awards committee as the recipient of the 2007 Outstanding Psychiatrist Award for Research. In 2007, Biederman received the Excellence in Research Award from the New England Council of Child and Adolescent Psychiatry. He was also awarded the Mentorship Award from the Department of Psychiatry at the Massachusetts General Hospital.

But there’s also this:

Biederman had pioneered the diagnosis of bipolar disorder in children and adolescents, a disorder previously thought to affect only adults. One of the world’s most influential child psychiatrists, Biederman’s work led to a 40-fold increase in pediatric bipolar disorder diagnoses and an accompanying expansion in the use of antipsychotic drugs – developed to treat schizophrenia and not originally approved for use in children – to treat the condition. However, Biederman and his colleagues Spencer and Wilens failed to accurately disclose the large consultancy fees they were receiving from pharmaceutical companies that make antipsychotics whilst conducting this research.

For which Biederman received a slap on the wrist from Harvard.

And there’s this:

Dr. Biederman pushed [Johnson & Johnson] to finance a research center at Massachusetts General Hospital, in Boston, with a goal to “move forward the commercial goals of J.& J” [said Biederman in an email]

In other words, he felt no shame in admitting that he considered the commercial goals of Johnson & Johnson more important than the health of children with severe problems. One of the few people who can really help these children — by doing good research — he preferred to help Johnson & Johnson.

This story by investment blogger Mish Shedlock about a prostate cancer diagnosis illustrates the bias of doctors toward dangerous expensive treatments:

The biopsy showed I had cancer. My “Gleason Score” was 6. The surgeon who performed the biopsy strongly recommended surgery. He gave me a cost of $20,000.

Bad recommendation. Shedlock got rid of his cancer, as measured by PSA (Prostate Specific Antigen) tests, without surgery or any other expensive or dangerous treatment.

The surgeon said something else also highly misleading. He told Shedlock he was “10% cancerous”. When Shedlock repeated this to his oncologist,

The oncologist replied “That’s not correct. Of the 12 samples, only one had cancer and one was questionable. The cancerous sample was 10% cancerous.” Now that is a hell of a lot different than being 10% overall cancerous.

His oncologist seemed unfamiliar with data:

I informed the oncologist that I was going to have a PSA test every month. He commented something along the lines of “Why do you want to do that? Every six months is sufficient. The tests are not that reliable.” . . . [I thought:] The more unreliable a test is, the more tests one should take to weed out erroneous outlier results.

This reminds me of the dermatologist I had in graduate school. After I tested the two medicines he had prescribed for my acne, and found that one of them didn’t work, and told him this, he said, “Why did you do that?” Haha.

The oncologist predicted that the cocktail that cured Shedlock “would not do [him] any good”.

I am sorry Shedlock does not name the doctors involved, as I did in a similar situation. I too avoided recommended surgery and my surgeon made highly misleading statements. Shedlock wrote about bad health care more generally here.

Thanks to Steve Hansen.

Six years ago I started using a reaction-time (RT) test (a test where you press a key in response to something as fast as possible) to track my brain function. I took the test daily. It must use only a small part of the brain but I assumed that something that made me faster would probably improve overall brain function. Behind this belief, which I call better RT, better brain, were countless studies of brain anatomy and physiology, which had shown that neurons and glial cells all over the brain share many features. Cells in different parts of the brain are much more alike than different. More support for this assumption was that certain doses of flaxseed oil improved both RT and other measures of brain function, such as balance.

I also assumed that changes that improved RT would probably improve overall health — what I call the better RT, better body assumption. It was less plausible than the better RT, better brain assumption because the cells in different organs of the body differ so much. They have many similarities but also many differences. I believed it for two reasons. (a) Flaxseed oil not only improved several measures of brain function, it improved my gums, no doubt because it reduced inflammation. It had been far from obvious that improving gums was so easy or that flaxseed oil (in the right dosage) would do so. The assumption better RT, better body had made a surprising prediction, you could say, that turned out to be true. (b) The brain gets much the same blood as the rest of the body. (Not exactly the same, because of the blood-brain barrier.) In the same way, all plug-in electrical appliances use the same house current. Just as all appliances have been designed to work well with that current, all our organs should have been shaped by evolution to work well with same mix of nutrients. You can’t feed your brain differently than your heart.

When I discovered that butter improved RT, the better RT, better body assumption made a second even more surprising prediction: Eating more butter improved my health. This contradicted the claims of all mainstream health experts, who say saturated fats cause heart disease. I stuck with my assumption — I still eat a lot of butter. The data I’ve seen since then has supported my conclusion. For example, my Agatston score got better, not worse, after a year of eating lots of butter. The Agatston score is currently the best predictor of heart disease.

I recently found more support for the better RT, better body assumption. Several studies have found that RT is a good predictor of health (better RT, better health). Even more impressive, it is a better predictor than many of the predictors we already know of. The RT test used in these studies is close to the test I now use, which I developed independently. The RT test in these studies involves showing a digit (0-4), after which the subject presses one of five keys (labelled 0-4) as fast as possible. My current RT test is very similar but uses 7 digits instead of 5.

A 2005 study looked at the oft-reported correlation between higher IQ and lower mortality. The IQs and RTs of about 900 persons were measured in 1988. Deaths until 2002 were noted. RT was associated with lower mortality, even after taking out associations with smoking, education and social class. RT and IQ are correlated (better RT, higher IQ). When the RT-death association was removed, IQ no longer predicted death. So RT does a good job of capturing whatever it is about IQ that predicts mortality.

A 2009 study compared RT to more conventional health predictors (“risk factors”). About 7,000 subjects were followed from 1984 to 2005. RT in 1984 was a good predictor of all-cause mortality compared to classic risk factors. Smoking was by far the best predictor, followed by RT. RT was a better predictor than physical activity, blood pressure, a questionnaire measuring “psychological distress”, resting heart rate, waist/hip ratio, alcohol intake, and body mass index.

A third study, based on the same subjects as the 2009 study, found that amount of decline (slowing) in RT (from one test to a second test seven years later) predicted death. People with more decline were more likely to die.

All this supports studying how your RT is controlled by your environment, especially what you eat. You have to choose wisely what to study. The point is not to be as fast as possible regardless of everything else. Lots of drugs (stimulants, such as caffeine) decrease RT for short periods of time. I doubt they improve health. (If they harm sleep, they probably worsen health.) What makes sense is to look for two things: 1. Poisons. Things that slow you down. I discovered that tofu did so. I gave several reasons for thinking that tofu affects many people this way, not just me. Billions of people eat tofu, unaware of this possibility. 2. Deficiencies. Study things that are missing from your life now but were likely to be present when we evolved. It is quite plausible that our ancient ancestors ate more omega-3 (in fish, but also in flaxseed) and more animal fat (from big animals, but also in butter) than we do now. My data suggest omega-3 and animal fat are nutrients necessary for health whose importance mainstream nutrition researchers have not fully appreciated.

My RT data have shown me there’s a lot I didn’t/don’t know about how my food affects me. Maybe everyone can say that. Unlike almost anyone else, however, I can reduce my ignorance myself. I don’t need to rely on experts.

Via a website, I asked about the flavonoid content of Dove dark chocolate. In China, a package of Dove dark chocolate has a picture of a heart — meaning the food is “heart-healthy”. The heart benefits are believed to come from flavonoids. Mars has been exploring this idea in various ways, such as this special process and these special chocolates.

An email from Mars said I should call a hotline. The woman who answered did not know what flavonoids are. “Do you want to know the cocoa content?” she asked more than once. No, the flavonoid content, I said. She looked. “We don’t have that information,” she said. Haha!

I said the flavonoids in chocolate are believed to be responsible for the health benefits of chocolate. (That’s true, but I might have said flavanols — a type of flavonoid — instead of the much broader term flavonoid.) “We don’t make health claims for our chocolates,” the Mars representative said. (As if a picture of a heart on a package is not a health claim. No doubt there is an important difference between US and Chinese law.) I can see why she would say that. Our brilliant government, protecting us from crazy ideas such as chocolate and yogurt are healthy, but not from the exaggerations of doctors and drug companies. Which is more dangerous, (a) eating chocolate or yogurt or (b) being cut open?

Although the blog Mr. Heisenbug (“Respect the microbiota”) is quite new, I have learned a lot from it, especially about the importance of fiber. I interviewed the blogger:

A reader named Sam, an engineer in Irving, Texas, writes:

I am a long time reader of your blog. Based upon your writings, I have taken Vitamin D in the morning and Magnesium Glycinate powder at night for over a year. Both have helped. So I do not have any sleep issues that needed to be addressed. I took the honey only to see if it would make any further difference. I was a bit wary to begin with as I do not usually consume honey. I have had a mild allergy to eating honey until at least several years ago. Even a teaspoon of honey would within an hour give me abdominal cramps that would last for an hour or more.

I started a Primal/Paleo/PHD way of eating 3 years ago. No processed foods, no wheat, only fermented dairy (kefir/cheese/cultured butter/ghee), occasional alcohol and occasional desserts (generally fresh fruit or some ice cream) and regular use of home fermented food like sauerkraut, beet kvass and lemonade.

So the honey experiment was also to test whether the changed diet had fixed the allergy.

I tried regular store bought honey (Kroger) first. I took a tablespoon approximately 10 minutes before going to bed. It could be a bit more than a tablespoon as I would dip a regular tablespoon in the jar and eat it as soon as the stringing ended. The first day there was anxiety in expectation of an allergic reaction. No cramps but there was some mild abdominal pain, I would just call it discomfort. I thought this could be psychological. So I tried it for 3 more days. Still the same discomfort within the hour. But I would fall asleep at some point and wake up feeling the same as I used to earlier.

I almost quit after this – when my wife reminded me that we had some Manuka honey in the pantry that we got as a gift and that could be worth trying. So I did. This is a honey produced in New Zealand and has some number on it – that claims to have medicinal properties. This honey was thicker, so easier to measure. About one tablespoon each night, same time as before. Same discomfort – no change in overall sleep quality or post waking up energy. I tried this for 4 days.

It may seem that the obvious course of action would be to quit the experiment at this stage. However, around this time, I read a comment on one of the blogs I follow, describing the process of refining honey for bottling. Apparently it is heated and filtered as a minimum and maybe more processing in most cases. I know a friend who cured his allergy to homogenized milk (skin redness after consumption) by shifting to raw milk which he pasteurizes himself at a low temperature. So I looked for raw unprocessed honey and stumbled upon a source – which curiously had regular raw honey and fermented raw honey. I ordered a jar of each.

Initially I tried the raw honey, in the morning, in white tea just to test for the abdominal discomfort. Surprisingly, there was none. So I decided to take it at night and continue to see if there are any benefits. One tablespoon as before. I usually fall asleep within a few minutes of turning off the lights. This time, I noticed that I would toss around a bit longer before getting to sleep. However, I did notice that I would wake up more energetic. As I said it is subjective – hard to describe. But I would get ready faster and finish up a few chores that I would be lazy about on other days.

After a week I reduced the dosage to one teaspoon. The only observable change was that the tossing in bed now ceased and I would fall asleep quickly. So I stayed with this dose as a smaller dose is difficult to measure accurately.

After a total of 10 days on regular raw honey, I decided to try the fermented raw honey – only because I had ordered it and had it with me. I stayed with the one teaspoon dose just before bed and immediately noticed one remarkable change besides the increased energy in the morning. Normally, I wake up once at night, around 2AM, to go to the bathroom. The very first night, I slept through till the morning. Subsequently, I have noticed that occasionally I wake up at 5AM but most nights I just sleep through.

It is has definitely increased my sense of well being and post wake up energy.

His main conclusions are:

1. Raw honey works better than ordinary (cooked) honey. Manuka honey is no better than ordinary honey. Fermented raw honey is even better than ordinary raw honey.

2. One teaspoon is better than 1 tablespoon — fell asleep faster.

3. The benefits include less waking up at night, more energy in the morning, an increased sense of well being, and better motivation (e.g., to do chores).

I fall asleep quickly whether or not I take honey at bedtime. But it is curious that fermented honey works better than non-fermented. Fermented honey has less sugar; maybe that’s the reason for the difference.

This graph from Andreas Eenfeldt (via Mark’s Daily Apple) shows heart attacks (left axis) and butter consumption (right axis) in Sweden over the last quarter-century. Heart attacks have been going down, at least in men. What interests me is that when butter consumption suddenly increased, starting in 2006, heart attacks went down more quickly. If you fit a straight line to the heart attack rates for 1988-2005, you will see that the remaining rates (2006-2012) are below the extrapolation of the line, both for men and women. The Swedes made other dietary changes when they started eating more butter (the butter replaced other foods, for example). Nevertheless, these data make it more plausible that if butter has any effect on heart attacks, it reduces them, the opposite of what we’ve been told.

I eat a half stick (60 g) of butter daily. It improves my brain speed. After I gave a talk about this, a cardiologist in the audience said I was killing myself. I said I thought my experimental data was more persuasive than epidemiology, with its many questionable assumptions. The new data suggests I was right — butter does not increase heart attacks. It also supports my belief that by learning what makes my brain work best, I will improve my health in other ways (such as reduce heart attack risk).

No doubt a low-carb high-fat diet is better than what many people eat, but I believe the never-eat-sugar part of such a diet is a mistake. There are plenty of reasons to think sugars eaten at the right time of day improve sleep. Whatever you think about nutrition, don’t get too comfortable.