by August Hurtel

I live in Shreveport, Louisiana and work in the interlibrary loans department at Shreve Memorial library. I am 39 years old.

I believe, due to experiences I will expand upon below, that excess sulfur compounds, especially sulfites, may contribute to and even cause irritable bowel syndrome (IBS). If you have IBS, you can try to verify this in a few ways.

1) Try molybdenum. I take Carlson Lab’s Moly-B 500 mcg tablets (one tablet/day).

2) Avoid foods and supplements high in sulfur.

3) If you have already purchased the services of 23&me or want to, you can look at this thread in the forums — “Reactions to food containing sulfites, sulfur dioxide, bisulfite, metabisulfite. SUOX gene” — and see if you have the same polymorphisms, though if you just do the first two, you’ll be able to guess.

The woman who started that thread at 23&me goes by the name Red Ringlets. She asked if anyone with four polymorphisms involved in sulfur processing experience reactions to sulfur compounds commonly added to foods as preservatives and/or for antibacterial purposes. I have three of these polymorphisms. I knew I was allergic to certain medicines, but I had not thought about the effect of sulfur coming from my food and supplements largely because I associated reactions to sulfur with hives and headaches.

Several years ago once the appetite suppression the Shangri-La diet kicked in, I adopted what most would consider a paleo template for my diet. This means I generally avoid grains, legumes, and dairy with caveats (like rice, now that I work out, and butter because it is animal fat and therefore good according to evolutionary thinking). Additionally a substantial amount of the meat that I buy comes from conventional sources.

Despite not being technically paleo, I enjoyed coffee, chocolate, and red wine, which are all high in sulfur. Sulfur is also added to various coconut products, shrimp, fish, dried fruit — many products a person trying to eat paleo might eat. I ate them. And I would have gastrointestinal distress that I could not explain despite getting leaner.

In the summer of 2013 after a few social functions that served grilled hamburgers, grilled shrimp, and other summer party foods a paleo dieter might think would be okay, I went to the emergency room. I had a serious pain where my appendix should be. Sometimes the pain would get worse after eating, and I would often get diarrhea. I thought I had appendicitis, but the doctors found nothing wrong. They took regular X-rays and did blood tests, and came back and said they found nothing. I got really angry about that, so they ordered a CT scan. The CT scan also showed nothing. They told me I had IBS because they had gone through a list of other things it might be and eliminated all of them.

When I went to the emergency room, I also inadvertently took with me a large amount of sulfur. I had a couple of 90% Lindt bars with me. My chocolate intake had risen during that time, too. I had stuff to do, places to go — and an excuse to treat chocolate like a food group.

I was aware, from reading on the internet, of FODMAPs, which are osmotic carbohydrates that draw water into the gut, causing gas, bloating, cramping and diarrhea. They seemed a likely culprit because these were the symptoms I experienced. Following a low FODMAP diet seemed to help, but not perfectly so.

There is some overlap between the two lists of foods to avoid (high sulfur and high FODMAP), so avoiding FODMAPs might have helped because it made me avoid sulfur. It also made it possible for me to have days where I didn’t eat any FODMAP foods but I would eat something like shrimp and then I’d have symptoms despite not eating any FODMAPs. So, looking back on it, I think of attending a wedding, eating nothing but shrimp, and drinking a little bit of red wine, and then having IBS problems and not understanding why because it doesn’t fit in well with the FODMAP story. I think FODMAPs are problematic in a gut that has already been compromised, but FODMAPs are not evolutionarily novel, and thus are unlikely to be the original cause of the problem.

Since it was summer and I just gotten through that ER experience, I stopped eating a lot of fruits, chocolate, wine, etc. One of the things that figures largely for me as a source of sulfur during this time though is shrimp. I kept thinking it was a safe food to eat, and didn’t realize until later it was a source of sulfur. Additionally, I was taking several supplements that contained sulfur: gelatin, biotin, glutathione, NAC, ALA, MSM. I had gotten into the habit of trying different supplements since 2010 because of a neuralgia that neither doctors nor dentists could explain. Though I was not taking all of them at once, I did supplement enough to assume I kept my sulfur level high throughout this time period.

I noticed the thread Red Ringlets posted at 23&me in August of 2013. In October I asked whether or not sulfur could cause a dehydrating effect. I asked this because I’ve noticed wine can take more water out of me than other drinks containing alcohol do. I didn’t get an answer to that question, but I began to explore some of the links people had put into the thread. I read through this site: www.learningtarget.com. I found the following page particularly helpful because it mentioned that molybdenum is a vital part of the sulfite oxidase enzyme: Vitamins and Supplements for Sulfite Problems.

I still had not made a connection between sulfur and irritable bowel syndrome, but I decided to supplement with fucoidan, which is a sulfated polysaccharide found in some seaweeds. I thought it would help my gut, but it caused diarrhea. It was as if I had decided to supplement with cholera. The effect was large and obvious enough for me to realize it was probably the supplement I had just taken. Once I accepted that, I put together what I had learned from the 23&me thread.

Now, in retrospect, I think fucoidan may have caused diarrhea for completely different reasons. I learned in my 23&me health report that I am norovirus resistant, and I have subsequently read that this has something to do with my ability (or inability) to make fucose. I can’t remember where I read this, but it made me think fucoidan could have destabilized my gut flora for reasons unrelated to its sulfur content.

Whatever the reason for the extreme reaction to fucoidan, I decided the beneficial reaction to molybdenum meant that I had a genetically limited capacity to deal with all the extra sulfur in my food and supplements. I threw out my high sulfur supplements and tried to stick to low sulfur foods. Within about two weeks I started having normal bowel movements. This was better than what I was achieving before the entire fucoidan fiasco. I had migrated to a diet of rice and fish which helped me approximate normalcy, but any time I tried to have any variety in my diet, I would run into problems. By avoiding sulfur, I was able to eat a larger variety of foods without incident.

Eventually I found if I was very careful, I could eat small amounts of high sulfur foods, but this is hit or miss because I can’t reliably gauge what the potential dose is, nor is it always clear whether a food has sulfur in it. I still supplement with molybdenum but I think the long term strategy here is both molybdenum and at least avoiding high sulfite foods because my genetics suggest it is doubtful I am going to be able to process as many sulfites as other people do regardless of how much molybdenum I have.

As I mentioned before, I think once the gut is compromised, many things become irritants. Removing excess sulfur has increased my health a lot, but I suspect I need to improve gut flora, and possibly heal some tissue damage. The doctors may not be able to see it, but I still have residual pain in the region where my appendix is.

• Oncology researchers make too much of very little.
• deadly delays in newborn blood testing. Do hospital employees = government employees?
• University of Western Australia refuses request for data because requester “made inflammatory statements on [his] weblog . . . including attacks on the character and professionalism of University staff.”
• Benefits of fermented food. “Once all the grains in her diet were fermented, she began to feel normal — for the first time in years.”

I haven’t been interested in the work of John Ioannidis because it seems unrelated to discovery. Ioannidis says too many papers are “wrong”. I don’t know how the fraction of “wrong” papers is related to the rate of discovery. For example, what percentage of “wrong” papers produces the most discovery? Ioannidis doesn’t seem to think about this. Yet that is the goal of science — better understanding. Not “right” papers.

Almost all important health discoveries are discoveries of new cause-effect relationships. If you do X, Y happens. My view of the problem with modern health science is nothing like what Ioannidis and other critics (such as the “couldn’t replicate Finding X” critics) say. It is lack of progress on major health questions (e.g., what causes depression?), emphasized every year by awarding of the Nobel Prize in Medicine to research of little or no practical value. Almost every year, the Nobel Prize press office says the honored research will be useful in the future. The lack of progress shows no sign of ending.

The best that can be said about recent critics of science, such as Ioannidis and Danny Kahneman, my former colleague, is they see there’s a problem. The worst that can be said about them is they fail to understand the cause of the problem. This is why their proposed solutions could easily make the problem worse.

Whenever you do an experiment — psychology and the health sciences are almost all experimental — you “use up” the effect you are studying (X causes Y). You can do an experiment to learn if X causes Y only so many times. After that, you know the answer and a new experiment is pointless. Professional scientists are only able to test ideas (cause-effect statements) that are fairly plausible. With such ideas, a publishable outcome is likely enough to be worth the cost of testing. They are unable to test implausible ideas, because such experiments are not likely enough to produce a publishable outcome. With limited resources, they must generate a certain number of published papers per year, at least if they want a career.

To have a viable system, you need to generate new plausible ideas at at least the same rate you are using them up. Otherwise you will run out. You must design your experiments so that they accomplish this. Not necessarily every experiment, but your experiments in aggregate. It isn’t easy to find new plausible ideas. If you think I’ll just get on with my career, generating papers as fast as possible and leave it to someone else to come up with new ideas worth testing, then your field will run downhill as plausible ideas are used up and not replaced. This is what has happened in several fields, including mine (animal learning). In psychology much greater concern about both fraud and lack of replicability have started at about the same time. I believe both (more fraud, more lack of replicability) stem from the increasing difficulty of honest (or more honest) research.

A friend who is a psychology professor agreed with me that psychologists — at least him — didn’t know how to generate new ideas worth testing. “Do you?” he asked. I said I did:

1. They [= psychologists] should modify their data collection. In my experience, new ideas almost always come from carefully collected data. They don’t come from introspection, talking to friends, reading the newspaper, watching TV, going to talks, etc.

2. Finding new ideas worth testing means finding new ideas that are plausible enough to be worth the cost of testing. To find new ideas with sufficient plausibility to test you need to test implausible ideas. A small fraction will pass the test, gaining plausibility. They will become sufficiently plausible to be worth testing.

3. To test implausible ideas in a career-consistent manner, you need to be able to test them very cheaply. Few if any psychologists have thought about this. They don’t realize how important it is.

 

When you have very cheap tests, you can test far more ideas than you can if you only have expensive tests. You need a “test set”: very cheap tests, cheap tests, almost-cheap tests, and so on. Ideas that pass a very cheap test become worth testing with a cheap test, those that pass a cheap test become worth testing with an almost cheap test, and so on. With current methods (all tests are expensive), perhaps social psychology professors who want to publish have a set of 50 ideas that are plausible enough to be worth the cost of testing. Those ideas get tested over and over, using them up. Were cheap tests available, perhaps the same professors could choose from a set of 1000 ideas those they want to test. Of those 1000 ideas, 950 were too implausible to test with expensive tests. Among those 950, I believe, would be some ideas that when tested seemed to be true.

I came to these beliefs trying to understand why my self-experimentation did a good job of finding new ideas worth testing. I concluded that the secret was this: I was able to test implausible ideas very cheaply — thousands of times more cheaply than professional scientists. Self-tracking — keeping track of my sleep, for example, and looking for outliers — was a very cheap way of getting new ideas about what controls sleep. Self-experimentation was a slightly more expensive (but still very cheap) way to test ideas that self-tracking came up with.

Many people have complained about a lack of replicability problem in psychology, including my friend and co-author Hal Pashler. An obvious solution is to raise the bar for publication: require better (= stronger) evidence. Sure, this will improve the quality of testing, but how will it affect the rate of production of plausible new ideas? My cost-of-test proposal suggests it will reduce that rate of production. I am saying that cheap tests are all important. Raising the publication bar will make the only test you have more expensive. What if the replication problem is a response to lack of plausible new ideas? Then this solution to the problem would make the problem worse.

 

On Econtalk, Russ Roberts recently interviewed Jeffrey Sachs, author of The End of Poverty and head of the Millennium Village Project (MVP). I enjoyed it but thought Roberts was too easy on Sachs. Here’s what I wished he had asked:

Your book, The End of Poverty — did you get anything wrong?

What mistakes have you made with MVP?

You say Nina Munk [author of The Idealist] chose a non-representative village. [Sachs said that Munk spent her time in the only village in “a war zone.”] Did you tell her that? If not, why not?

Munk was on your side when she began reporting, but changed her mind. Why is that?

Why was the project set up in such a way that evaluation is difficult? Why not pick ten villages and randomly select five for treatment?

You say the MVP project is successful because people are copying it — but those people are government officials. Is it plausible they are copying it because they see it as a good way to make money for themselves or improve their career? You must know many worthless medical treatments have been widely copied. Is this your best evidence of success?

No doubt your employees have often told you what you wanted to hear rather than the truth. What’s an example? What have you done to get honest assessments of how things are going?

What did you learn from Nina Munk’s book?

Roberts says he didn’t ask Sachs certain questions because there wasn’t enough time.

In Vitamin D and Cholesterol: The Importance of the Sun (2009) by David Grimes, an excellent book, I came across a 1977 study of healthy middle-aged men. The researchers measured their diet and watched them from 1966 to 1976. The question: What diets were associated with better health? There turned out to be associations with cholesterol (lower better) and systolic blood pressure (lower better), but these were less interesting than two strong dietary associations. One was between energy intake and heart disease. Men in the lowest third of energy intake had 23 cases of heart disease; men in the highest third had 7 cases. That’s probably due to exercise: the more you exercise the more you eat. We already know exercise is good.

The other association was with cereal fiber. Men in the lowest third of consumption (2-7 g/day) had 25 cases of heart disease; men in the highest third (8-34 g/day) had 5 cases. (A Wasa cracker has about 2 g cereal fiber.) You might dismiss this as healthy-person bias: healthy people do many healthy things, such as eat fiber. However, there was no association of heart disease and fiber from fruit and nuts. They’re healthy too. “The advantage of a diet high in cereal fibre cannot be explained [by us],” said the authors.

Later studies have found the same thing. For example, a 2006 review reached a similar conclusion: “There is an increasing body of evidence, including that from prospective population studies and epidemiological observational studies, suggesting a strong inverse relationship between increased consumption of wholegrain foods and reduced risk of CVD.” A study of health-conscious people — to reduce healthy-person bias — found a similar association: “Persons who habitually ate wholemeal bread had a lower mortality from cerebrovascular disease.” A 2002 review and a 2013 review provide even more evidence for the association.

Shant Mesrobian has emphasized the importance of fiber for health. Whereas paleo gurus usually say grains are bad. Here, for example, are “10 reasons to avoid grains”.

Edward Edmonds is an histologist at the Albany Stratton VA Medical Center, Albany, New York. He has been an histologist since 2002. Previously he worked at the Landstuhl Regional Medical Center, Landstuhl, Germany, the Ehrling Bergquist Hospital Offutt AFB, Nebraska, and the Armed Forces Institute of Pathology (now Joint Pathology Center), Washington D.C.

Recently he left an interesting comment on this blog:

When I train students I always expect that they will do things a little differently or that they will have new ideas, so . . . my first question is always show me what you have learned or show me how you’d like to do this procedure. In other words they went through the same training I did maybe at a different facility but there are a lot of different ways to approach things we do in the lab, so I let them develop their own “style”. Then after they do it in their own way I show them how I do it my way and I explain step-by-step why I’m doing it this way . . . The entire thing is an enjoyable experience. We are learning, and laughing, and undoing the dogma learned from the academic setting. . . . All of my students end up being excellent troubleshooters and problem solvers.

I asked how he came to this way of teaching. He replied:

Through experience. People like to feel good about themselves, no matter their status. If that person feels they have some sort of insight or knowledge that other people don’t have — when that person is queried about their knowledge or has an opportunity to discuss it, they light up, becoming a teacher themselves (regardless of the quality of the information). There is a level of confidence there.

What if someone came along and challenged the quality of that information? Let’s say the person challenging the information was an arrogant prick who did have better information but nonetheless put the ignorant person in their place? The quality of the information might be good, but nothing was actually learned that was relevant to the subject. Instead what was learned was how that prick made the other person feel and the prick feeling unchallenged felt empowered. If there were witnesses to the exchange the information learned was not bidirectional it was omni directional, everybody in the setting learned more about each others’ behavior but nothing relevant was retained because the environment was authoritarian. That is an extreme example but it happens in degrees and often it is subtle.

Now that person who was challenged might go home and for spite try to find things to improve the quality of their information. But the learning is motivated not by genuine interest but by spite which has a tendency to cloud judgment (as we can witness in heated academic debates). Are they learning (understanding) in that state of mind? Probably not.

That is partly where my teaching style comes from. It comes from recognizing the “state” in which learning occurs and that someone that learns well who is “smart, motivated, and capable” is so, not because they have some inherent grasp on a subject, but because they have confidence in their ability to learn. In other words they are smart because they recognized as being “smart, motivated, and capable of learning”. I want to learn from the students just as much as they want to learn. That really is key.

He also explained the difference between histologists and pathologists:

The histologists/cytologists are the people who develop the microscope slides you often see in studies with different “stains” we have a background in chemistry, biology, and anatomy, we do grossing (dissecting specimens), and autopsy, immunohistochemistry, electron microscopy, etc. A pathologist is some one who makes the diagnosis on the specimens we prepare. We work very closely together and in some facilities our disciplines overlap. However, they are actual doctors. There are also pathology assistants, they typically just gross and do autopsy. So whenever you have surgery or a biopsy it comes to histology to be processed, we do that and then the pathologist makes a diagnosis and puts their signature on it.

My sister sent me a link to an article (“Butter is Back”) by Mark Bittman, the New York Times food columnist, about a recent review that found saturated fat didn’t cause heart disease. I told my sister I had clicked on the link but had forgotten to read the article.

My sister was incredulous. How could you not want to say “I told you so”? she wondered. (In a 2010 talk I questioned the danger of butter.)

Here is the relevant passage, according to my sister:

A meta-analysis published in the journal Annals of Internal Medicine found that there’s just no evidence to support the notion that saturated fat increases the risk of heart disease. (In fact, there’s some evidence that a lack of saturated fat may be damaging.) The researchers looked at 72 different studies.

I told you so. But this part interests me more:

No study is perfect and few are definitive. But the real villains in our diet — sugar and ultra-processed foods — are becoming increasingly apparent.

Uh-huh. The experts were staggeringly wrong about saturated fat…but they couldn’t possibly be wrong about “sugar and ultra-processed foods”. That makes no sense, but that’s what Bittman wrote (“increasingly apparent”). To me, what is increasingly apparent is that nutrition experts shouldn’t be trusted.

I don’t know what “ultra-processed foods” are but I am beginning to believe the experts are utterly wrong about sugar, too. As far as I can tell, sugar in the evening improves sleep — by a lot, if you get the details right — and nothing is more important than good sleep. If you have read The Shangri-La Diet, you already know that sugar alone cannot have caused the obesity epidemic. It is more complicated than that.

• difficulties of personalized risk assessment
• Drugs cause falls in old people. When drugs were stopped, falls went down — in one case, by two-thirds.
• University of Western Australia, in response to a complaint, allows researcher to “investigate” himself.
• Food and mental illness
• “ I have stage 3 melonoma. . . . I have the ability to speed read . . . I found one very promising study.”
• Translator strikes back
• Masha Gessen, one of my favorite writers, on Pussy Riot

Thanks to Alex Chernavsky.

dearime asks:

Why do people fuss so much about paleo life? The population has grown so much since that it’s easy to believe that we’ve evolved a long way from then.

Jared Diamond wrote a paper about rapid evolution on an isolated island. When modern (factory) food was introduced to the island (in the 1940s?), there was a very high rate of diabetes, presumably due to the new food. Since then, the rate of diabetes on the island has gone way down, although they still eat modern food. Diamond took this to be due to evolution (people with diabetes-resistant genes had more offspring), supporting dearime’s point of view.

After the first Ancestral Health Symposium, Melissa McEwen commented how unhealthy many of the top people looked. On the other hand, Tucker Max commented how healthy the attendees looked in general. I agree with both observations. A paradox.

When I was an assistant professor, and wanted to sleep better, I believed wondering about paleo life was unhelpful because (a) we knew so little about it and (b) it must have differed in thousands of ways from modern life. Should I spend an hour trying to find out about paleo life and/or what paleo gurus recommend for bad sleep? Or should I spend an hour trying to find out how ordinary people have improved their sleep? My answer was the latter. I ignored paleo life.

Looking into how ordinary people improved their sleep did help. I eventually reached a non-trivial conclusion: Eating breakfast made my sleep worse. No paleo guru had said that — I had been right to ignore them. Yet it made evolutionary sense. Cavemen did not eat breakfast, I was pretty sure. (No refrigerators.) After that I paid more attention to what evolutionary thinking would suggest. This led to several discoveries: the effect of faces in the morning on mood, the effect of standing on sleep, and the Shangri-La Diet. It is incredibly hard to discover big new experimental effects (such as the effect of morning faces), especially in fields you know little about (my specialty in psychology was animal learning, not mood, sleep or weight control). I was impressed.

The effect of bedtime honey (more generally sweets in the evening) on sleep emphasizes the paradox or puzzle or whatever you call it. I found out about the honey effect by paying attention to what works. No paleo involved. Stuart King told me it improved his sleep. Here are three reasons to look at ordinary experience and avoid paleo theorists: 1. It turned out to help. 2. It’s a huge effect and very easy. 3. Paleo theorists have said the opposite: avoid carbs, avoid sugar. If you followed their advice, you would do the opposite of what helped Stuart and me. On the other hand, I increased my belief in the effect because it made evolutionary sense: 1. It makes sense of why we like sweets. 2. It makes sense of why our liking for sweets goes down when we are hungry (surely due to an evolved mechanism). 3. It makes sense of why we eat sweets more in the evening (presumably due to an evolved mechanism that makes sweets taste better in the evening).

The short answer to dearime’s question is that, in my experience, it is incredibly hard to learn anything about health. There are so many possibilities and evolutionary thinking helps choose among them — decide which to take the trouble to test.

A Vancouver drug center has started an unusual program: alcoholics bottle homemade beer.

The Drug Users Resource Centre, the Downtown Eastside non-profit famous for housing Canada’s first crack pipe vending machine, is also behind what may well be North America’s first program teaching severe alcoholics how to brew their own beer and wine.

Now the alcoholics just do bottling but the people behind the program intend to expand it to include other parts of the beer-making process, such as fermentation.

What’s interesting is that they are not treating severe alcoholics as passive or disabled — as recipients of treatment. At least not entirely.

This program reminds me of several things. Geel, a town in Belgium, treats people with mental illness as valued caregivers. Zeynep Ton says low-level retail employees should be treated as people who can learn many jobs, give good advice to both customers and management, make good use of free time, and so on. I treat my students as people who want to learn — who do not need to be scared into learning by threat of a bad grade — and are capable of inventing their own assignments.

Is there a general lesson to be drawn from these examples? (All are complicated, in spite of brief descriptions.) Could it be a good idea — as a default — to treat those you deal with as smart, capable and motivated? It is no great leap to treat alcoholics as motivated to make beer but it is a slight leap to treat them as capable of making beer. Is the next step is to treat them as smart?

What if doctors, before they saw a patient, told them: Please search the Internet for possible remedies. Bring a list of the ones you want to consider to our meeting. Is that crazy? The slightly subtle point is this may make the doctor happier.