Category: health care

Journal of Personal Science: Omega-3 and ADHD (Part 2 of 2)

Seth Roberts13 Comments

by Allan Folz

My story of omega 3 and self-experimentation did not end with my wife and her pregnancy. As I mentioned, I discovered the paleo diet, Vitamin D, and fish oil all about the same time. Mostly for reasons of general good health we began supplementing with vitamin D and fish oil (Mega-EPA Omega-3 supplement). I ordered some of each from the same place online and we began supplementing both at the same time, around January-February of 2010.

At the time my son was in kindergarten and having problems socializing at school. He had them at home too, but we’d all adjusted to them at home. He exhibited a lot of what would be called typical spectrum issues, though I was certain he didn’t have anything approaching Asperger’s. Things that interested him, such as building with Legos playing outside with or without friends, he did quite well. It struck me that he was a high-energy boy who didn’t appreciate receiving directions, desk work, or anything requiring moderation and self-reflection. I like to joke that Tom Sawyer is hardly a modern archetype.

Nonetheless, he was having problems. The Vitamin D Council web site had a number of very persuasive anecdotes from parents about autistic children cured by Vitamin D. Our son wasn’t autistic, but autism involves several behaviors, and he had a few of them. He didn’t make good eye contact when talking or being talked to. He wouldn’t follow directions if he didn’t feel an intrinsic motivation to follow them. He could not fall asleep and would often lay in bed restless for an hour or more at night. The Vitamin D Council recommended 2000 IU per 50 lb/day, so that’s what we all took. We also took one fish oil capsule a week. At the time I thought of omega-3 only being for heart health. This made me a little skeptical about how much was really required. We seemed a healthy family, so I figured our needs were modest. One capsule a week seemed well beyond the norm so we should be good.

Almost immediately after beginning the supplements my son’s behavior improved. I was pleasantly surprised and attributed it to the Vitamin D based on what I’d read on the Vitamin D Council web site. It wasn’t a cure by any means, but it was a very noticeable improvement. He would still have bad days, and I was a little bummed that after the initial improvement the Vitamin D didn’t seem to be helping any further. However, I figured such is real-life outside of attention-grabbing headlines.

Two years later, January and February of 2012, second grade for him, and about a year and a half after the self-experiment with my wife during her third pregnancy, my son’s behavior dramatically worsened. We were all still taking D, but at that point it was obviously not showing any benefit for my son. He was in a worse place than when he was in kindergarten. I resigned myself to Vitamin D not being his problem, and at his teacher’s demand signed him up for outside testing.

I didn’t notice at the time, but we had run out of the “fish oil” over Christmas break. The second week of January we visited family in the Midwest. When we returned, school was a nightmare for him and us. My wife and I attributed it to too much TV, bad diet, and not enough sleep while we were visiting family. However, even two and three weeks after our return his problems were worsening. Around the beginning of February, I finally got around to ordering another bottle of the omega-3. I thought of it as mostly being for my wife, who was doing fine, so I didn’t feel any immediacy. When it finally arrived, we all started taking it again. Immediately his behavior improved. It was such a night and day difference the connection was impossible to miss. It was like kindergarten when he first started taking Vitamin D, only far more so. For the first time in two weeks he wasn’t angry and crying at the end of the day. That’s when it occurred to me that in kindergarten he started taking fish oil at the same time as Vitamin D. For the last two years I had been attributing to Vitamin D what was due to the omega-3 supplement. I felt like an idiot.

After that, I did some research on omega-3, fish oil, and ADHD. When I knew what to look for, I found that there were, in fact, a few studies about using omega-3 for ADHD treatment. It seemed that EPA was effectie while DHA was not, or at best, less effective than EPA. When I took a closer look at our “fish oil,” I remember thinking to myself, “Oh wow, this stuff is Mega-EPA. How lucky is that.” I had chosen it almost at random. It had the best per-dose price and was listed as a top seller.

In retrospect, were it not for the pain and difficulty experienced by my son, it would be funny how the answer was under my nose the whole time. I was slow to appreciate it because of my own prejudice and not treating the problem as something to scientifically test. I thought of omega-3 as being for heart health. I’d never seen it mentioned in relation to emotional health or brain development, outside of the usual bromides about eating walnuts and so forth. Plus the recommendations are always couched in generalities without specific dosage guidelines. Even after I discovered it made a difference for my pregnant wife, it didn’t occur to me to test it seriously on my son. Their symptoms and nutritional needs seemed unrelated.

A few weeks later we saw the professional who had tested our son to go over the results. A few weeks had passed between the evaluation and when we met to discuss the results; it was during that time that I made the omega-3 discovery. I told the professional that our son was getting really good results from the omega-3 supplement. I said that after noticing his results I’d done some online searching and there were a few scientific studies supporting the use of omega-3 supplements for ADHD. The professional said he was aware of the studies, but the efficacy wasn’t as certain or as strong compared to the prescription drugs so most people choose the prescriptions. (He sent me the same Bloch & Qawasmi paper Seth linked to in his April 21 Assorted Links.) I wondered if most people were even made aware of the possibility of omega-3 deficiency — he certainly didn’t bring it up with us. I would not have found the research papers without first knowing what to look for. I knew what to look for only because of the discovery I made with my son.

The omega-3 supplement, while a huge improvement, was not an immediate cure. We started giving him two capsules daily which consisted of 800 mg EPA and 400 mg DHA. That seemed to me a lot of omega-3, relative to what one could consume through normal dietary intake.

I was not overly comfortable with that level of dose long-term despite it clearly working. So every couple months or so I’d have him skip a day or whole weekend. Without fail, his mood noticeably worsened. By the early evening he would be overwhelmed and frustrated to the point of tears by little things that weren’t going his way, things that were really just the usual complications of life in a household with two parents and two siblings.

A poignant instance of the effects of missing a dose happened in the Fall of the following school year, still 2012. My wife’s mother came for a visit. The break from routine caused my wife to forget to give our son his omega-3 supplement for three or four days in a row. He might have had them on Sunday, but not on any of the weekdays. By Thursday I had gotten a note and phone call from his teacher about his behavior at school. We had to go and meet with her the following week. At the meeting I shared that we had forgotten to give him the omega-3 capsules due to his grandmother visiting. I saw this as proof it was working. The teacher didn’t know we had forgotten, and yet his behavior had noticeably regressed. She did not share my awe, and tried to imply that he should be on a prescription. I said that kids can forget prescriptions just as easily and the side effects from a missed prescription are going to be far worse than three days off an omega-3 supplement.

Last month we again ran out of the omega-3 supplement. Except for the accidental occurrence when my wife’s mother was visiting, this is the first time he’s been off it for more than a few consecutive days in the two years and two months since I first discovered it helped him. I’m quite pleased that he seems to be doing OK. There’s been virtually no difference in his behavior since stopping. However, it’s not a true cold-turkey quit. We have some of the Green Pastures FCLO infused coconut oil, so he’s been taking that instead. The manufacturer is vague about its omega-3 content, but my rough estimate is that he’s taking, a third to a half of his previous dose with the Mega-EPA capsules. Then again, it’s in the triglyceride form which is supposed to be 50-70% better absorbed on a per-gram basis. Perhaps it’s a wash.

I’ve thought about having him try flax oil. There is considerable debate about the efficacy of flax oil and the body’s ability to synthesize EPA and DHA from ALA, the omega-3 in flax oil. It might be a little late to test efficacy now. The best time to test was one and two years ago when the Mega-EPA supplement was clearly working and had an “efficacy” half-life of 24 hours. The thought never occurred to me until recently when reading Seth’s blog.

I can’t end without sharing some of my frustrations with the state of health science. There is no doubt in my mind that omega-3 helped both my son and my wife deal with some severe and yet common mental health problems. I’m a pretty sharp, pretty well-read guy that’s always had an interest in biology and medicine. Outside of a few esoteric corners of the web where you have to know what you’re looking for in order to find it, omega-3 is something you take for heart health.

I think the comparison with statins is apt. When “heart-healthy whole-grains” don’t fix one’s blood makers, and why would they, it’s very quickly on to prescription drugs (statins). When “use your words” doesn’t fix a young boy’s interactions with classmates and teachers, and why would it, it’s on to prescription drugs. Boys especially are put on incredibly strong pharmaceuticals with well-established risk factors that include stunted growth and suicide. Pharmaceuticals should be tried last, but they are clearly being tried first by frustrated parents and suspect practitioners. It’s a national shame and a personal outrage.

Part 1, about using omega-3 to treat postpartum depression, appeared yesterday. Allan Folz is a software developer in Portland, Oregon. He recently co-founded Edison Gauss Publishing, a software house that makes academically rigorous educational apps for children in grades K-8. Their apps are suitable both classroom and home use, and have proven to be particularly popular among homeschoolers that appreciate a traditional approach to practicing math.

Assorted Links

Seth Roberts8 Comments

Thanks to Tyler Cowen.

Lyme Disease and Bad Medicine

Seth Roberts2 Comments

I got Cure Unknown: Inside the Lyme Epidemic (2008) by Pamela Weintraub from the library and found something surprising: an angry foreword. Weintraub is a science journalist; the foreword is by Hillary Johnson, another science journalist and apparently a friend of Weintraub’s.

In her anger, Johnson says several things I say on this blog.

The more Weintraub investigated, the more virtually everyone with a shred of authority was losing their credibility. . . The so-called “objective” scientists were sending an entire disease down the river and over the cliff [meaning they ignored it] for reasons that seemed frequently to have more to do with mere opinion and crass external forces — cash, prestige, careerism — than with scientific erudition.

She rejected the science writer’s inbred habit of relying on the government official with the highest pay grade or the scientist with a job at Harvard as the final word on a topic. . . . I think of her, with enormous respect, as a “recovered” science journalist.

As one who also suffers from the disease I chronicled with kindred passion in Osler’s Web, I sometimes wonder if the only investigative writers who will possess the necessary temerity to remove the white gloves and tackle those putative experts to the ground will be those . . whose personal experience demands they follow the rocky trail that leads to the truth.

The last point is the most important, I think. You can curse the careerism of Harvard medical school professors and the servility of science writers but that does nothing, or not much, and what you are upset about (careerism and servility) is unsurprising. Less obvious, at least to me, is that there is a way to overcome the careerism and servility. It still surprises me that I was able to figure out interesting stuff about sleep, obesity, depression and so on that the experts in these fields hadn’t figured out — and that sometimes contradicted what they said. (For example, I found sugar isn’t fattening.) As Johnson says, one reason I was able to learn so much was that I wanted to sleep better, lose weight, be in a better mood, and so on. Unlike the experts in those fields, for whom research was a job.

High-Frequency Trading and Health Care

Seth Roberts19 Comments

High-frequency trading is a misnomer. It’s actually short-latency trading, a name that makes clearer why it is so unsavory. As Michael Lewis explains in Flash Boys, short-latency traders use a buy order on one exchange to quickly buy that stock on other exchanges before the original buy order reaches the other exchanges. Lewis writes:

The deep problem with the system was a kind of moral inertia. So long as it served the narrow self-interests of everyone inside it, no one on the inside would ever seek to change it, no matter how sinister or corrupt it became — though even to use words like “corrupt” and “sinister” made serious people uncomfortable.

I thought of health care. Our health care system — centered on treating symptoms with drugs you take for the rest of your life — serves the narrow self-interests of those inside it, such as doctors and medical school professors. That is surely one reason its predatory aspect is rarely mentioned.

But I also noticed how poorly Lewis, an excellent writer, describes the problem. “Moral inertia”? No, the problem is not that Person X or Person Y is slow to get outraged. “Corrupt”? No, no one is being paid off to look the other way or vote a certain way or introduce a certain bill. “Sinister”? It’s unclear what that means. Is Lewis just using a fancy synonym for “bad”?

Elsewhere Lewis uses the word predatory, which seems accurate. Short-latency traders preyed on those who sold stock, taking advantage of their ignorance. Of course, no one is forced to buy or sell stock and the loss on one trade is small. But everyone gets sick.

 

 

What Goes Unsaid: Self-Serving Health Research

Seth Roberts13 Comments

“The realization that the world is often quite different from what is presented in our leading newspapers and magazines is not an easy conclusion for most educated Americans to accept,” writes Ron Unz. He’s right. He provides several examples of the difference between reality and what we are told. In finance, there are Bernie Madoff and Enron. Huge frauds are supposed to be detected. In geopolitics, there is the Iraq War. Saddam Hussein’s Baathists and al-Quada were enemies. Invading Iraq because of 9/11 made as much sense as attacking “China in retaliation for Pearl Harbor” — a point rarely made before the war. In these cases, the national media wasn’t factually wrong. No one said Madoff wasn’t running a Ponzi scheme. The problem is that something important wasn’t said. No one said Madoff was running a Ponzi scheme.

This is how the best journalists (e.g., at The New Yorker and the New York Times) get it wrong — so wrong that “best” may be the wrong word. In the case of health, what is omitted from the usual coverage has great consequences. Health journalists fail to point out the self-serving nature of health research, the way it helps researchers at the expense of the rest of us.

The recent Health issue of the New York Times Magazine has an example. An article by Peggy Orenstein about breast cancer, meant to be critical of current practice, goes on and on about how screening has not had the promised payoff. As has been widely noted. What Orenstein fails to understand is that the total emphasis on screening was a terrible mistake to begin with. Before screening was tried, it was hard to know whether it would fail or succeed; it was worth trying, absolutely. But it was always entirely possible that it would fail — as it has. A better research program would have split the funds 50/50 between screening and lifestyle-focused prevention research.

The United States has the highest breast cancer incidence (age-adjusted) rates in the world — about 120 per 100,000 women, in contrast to 20-30 per 100,000 women in poor countries. This implies that lifestyle changes can produce big improvements. Orenstein doesn’t say this. She fails to ask why the Komen Foundation has totally emphasized cure (“race for the cure”) over prevention due to lifestyle change. In a long piece, here is all she says about lifestyle-focused prevention:

Many [scientists and advocates] brought up the meager funding for work on prevention. In February, for instance, a Congressional panel made up of advocates, scientists and government officials called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities.

Nothing about how the “meager funding” was and is a huge mistake. Xeni Jardin of Boing Boing called Orenstein’s article “ a hell of a piece“. Fran Visco, the president of the National Breast Cancer Coalition, praised Orenstein’s piece and wrote about preventing breast research via a vaccine. Jardin and Visco, like Orenstein, failed to see the elephant in the room.

Almost all breast-cancer research money has gone to medical school professors (most of whom are men). They don’t do lifestyle research, which is low-tech. They do high-tech cure research. Breast cancer screening, which is high-tech, agrees with their overall focus. High-tech research wins Nobel Prizes, low-tech research does not. For example, those who discovered that smoking causes lung cancer never got a Nobel Prize. Health journalists, most of whom are women, apparently fail to see and definitely fail to write how they (and all women) are harmed by this allocation of research effort. The allocation helps the careers of the researchers (medical school professors); it hurts anyone who might get breast cancer.

Are Drug Companies Becoming Less Law-Abiding?

Seth Roberts6 Comments

Alex Chernavsky drew my attention to a report of the giant fines assessed drug companies for fraudulent marketing. For example,

Merck agreed to pay a fine of $950 million related to the illegal promotion of the painkiller Vioxx, which was withdrawn from the market in 2004 after studies found the drug increased the risk of heart attacks. The company pled guilty to having promoted Vioxx as a treatment for rheumatoid arthritis before it had been approved for that use. The settlement also resolved allegations that Merck made false or misleading statements about the drug’s heart safety to increase sales.

Fines, of course, are supposed to reduce bad behavior. Here are the fines by year:

  • 2009: 2 fines
  • 2010: 1 fine
  • 2011: 1 fine
  • 2012: 5 fines

This pattern does not suggest the fines are working. Drug companies, of course, are very big. I would like to see cross-industry comparisons: which industries pay the most in fines per dollar of revenue?

 

Assorted Links

Seth Roberts8 Comments
  • Open Source Malaria
  • Criticism of Malcolm Gladwell by The Korean, Gladwell’s persuasive rebuttal, more from The Korean, more from Gladwell. I thought the work under discussion (“ethnic theory of plane crashes”) was the best part of Outliers. Gladwell summarizes it: “That chapter in Outliers is about a series of extraordinary steps taken by Korean Air, in which an institution on the brink of collapse and disgrace turned themselves into one of the best airlines in the world. They did so by bravely confronting the fact that a legacy of their cultural heritage was frustrating open communication in the cockpit. That is not a slight on Korean culture, or any other high-power distance culture for that matter.”
  • More praise for the new TV show Naked and Afraid on the Discovery Channel. It really is riveting.
  • Ziploc omelette. Poor man’s sous vide.

Thanks to Nicole Harkin.

Assorted Links

Seth Roberts9 Comments

Thanks to Alex Chernavsky.

Assorted Links

Seth Roberts3 Comments

Thanks to Phil Alexander and Casey Manion.

“The $2.7 Trillion Medical Bill”

Seth Roberts12 Comments

The New York Times has started a series called Paying Till It Hurts about high medical costs. The first installment is called “The $2.7 Trillion Medical Bill” and is about the high cost of common procedures, such as colonoscopies, in the United States compared to other countries. (Which I blogged about quite recently.) The most extreme example is that a certain (unspecified) amount of lipitor costs $124 in the United States and $6 in New Zealand. Other treatments that cost much more in the United States include hip replacements and MRI scans.

This series might be a turning point, leading to government regulation of what health care providers can charge, which is how other countries control health care costs. To read the huge number of comments (already > 1000) is to see the suffering caused by these prices. One comment: “An acne medication was over $550 for a small tube of ointment. The [prescribing] Dr. had no idea it was that expensive.”

The high prices are the tip of the iceberg of American health care dysfunction. Less obvious is the poor research that sustains them. Acne is an example. It surely has environmental causes (probably diet). If we knew what those are, you wouldn’t have to pay anything to cure acne.