Thanks to Carl Willat, Peter McDonnell, Stephen Marsh, and someone else whose name I cannot find.
The effect is so large, so easy to notice, it is enshrined in the word cold. We get far more colds and flu in the winter (“flu season”) than in the summer. In this excellent interview, epidemiologist Thomas Jefferson asks:
Why, for example, do we not get influenza in the summertime?
All of the possible explanations listed in this Wikipedia article assume that it is cold weather that makes flu more common in winter. However, an impressive 1981 study found that flu peaked during the light minimum, not the temperature minimum, contradicting all of these explanations.
My proposed explanation is that flu is less common in the summer because people sleep better during the summer. They sleep better in the summer because they get more morning light. More morning light causes your circadian system to have a greater amplitude, which means you sleep more deeply. Better sleep –> better immune function. When I started to sleep much better, I stopped getting noticeable colds and flu.
When I wrote my paper it was essentially impossible to test my idea. You need to measure a lot of sleep — and sleep scientists, intent on making it hard to do what they do, have made this nearly impossible. Perhaps it will soon be easier. To begin with, to test my idea you’d need to improve sleep somehow. To get more light exposure during winter is easy enough with a light box but measuring quality of sleep is much harder. Maybe FitBit (which will start shipping in a few months) will make this possible. I tried using SleepTracker to measure my sleep but after a few months I gave up. There were four big problems: 1. The interface didn’t work very well. It was often hard to get the data from the device into my computer. 2. The whole thing wasn’t designed to measure sleep, it was designed to wake you at a better time than you would wake up without it. 3. The way it measured sleep was a secret. 4. The output — the measure of sleep — was binary. All you were told was whether movement was above or below some threshold. And I had no idea how that threshold was determined.
Via Proinvests.com, Nassim Taleb said this:
I was in Korea last week with a collection of suit-wearing hotshots. On a panel sat Takatoshi Kato, IMF Deputy Managing Director. Before the discussion he gave us a powerpoint lecture showing the IMF projections for 2010, 2011, …, 2014. I could not control myself and got into a state of rage. I told the audience that the next time someone from the IMF shows you projections for some dates in the future, to show us what they PROJECTED for 2008 and 2009 in 2004, 2005, …, and 2007. They would then verify that Mr. Takatoshi and his colleagues provide a prime illustration to the “expert problem”: they serve as experts while offering the scientific reliability of astrologers. Anyone relying on them is a turkey.
This allowed me to show the urgency of my idea of robustness. We cannot get rid of charlatans. My point is that we need to build a society robust to charlatanism and expert-error [emphasis added], one in which Mr. Takatoshi and his staff can be as incompetent as they want without endangering the general public. We need less reliance on these people and the Obama administration has been making us more dependent on the “expert problem.”
I completely agree. This highlights two hidden strengths of self-experimentation.
First, the more you can rely on data about yourself, the less you need to rely on data from other people, which until recently — internet forums, CureTogether.org, PatientsLikeMe.com — almost always came to you through experts (usually doctors), who filtered it to suit their purposes. When I was a grad student, I had acne. My dermatologist prescribed tetracycline, a powerful and dangerous antibiotic. Studying myself, I quickly figured out tetracycline didn’t work. My dermatologist had failed to figure that out — that it didn’t work in at least some cases. In his practice, he must have encountered examples of this, but he ignored them. It served his purposes to think it worked. That’s one sort of filtering: Ignoring inconvenient data. Self-experimentation made me less reliant on my dermatologist.
Second, self-experimentation allows researchers such as myself to do innovative research in some area without getting permission from experts in that area. Self-experimentation is very cheap; no grant is required. A self-experimenter can be as heretical as he cares to be. My research on weight control has been breezily dismissed by nutrition professors, for example. Obviously they wouldn’t fund it. The Animal Care and Use Committee at UC Berkeley turned down my application to do rat research about it — my ideas couldn’t possibly be true, they said. My research on mood isn’t just utterly different than what clinical psychologists and psychiatrists say to each other in meetings and papers; it also, at first glance, sounds absurd. Self-experimentation allowed me to do it. That’s another sort of filtering: control of what research gets done.
I don’t think conventional research in nutrition, clinical psychology, or psychiatry is worthless — far from it. I think it is very valuable. (For one thing, it helped me see that my self-experimental conclusions, as unorthodox as they were, had plenty of empirical support.) What is hard for outsiders to grasp is how what they see — what they read in magazines and newspapers and even books — is heavily filtered to conform to a party line. Plenty of research supports the Shangri-La Diet, for example (such as research about the set point theory of weight control), but you are unlikely to read about it in, say, The New Yorker because it doesn’t fit conventional ideas. Plenty of conventional research supports my ideas about mood, but you are unlikely to read about that research because it doesn’t support the party line of “dopamine imbalance” causing depression or whatever. This is what Leonard Syme taught his public-health students — that the party line was a lot more questionable than an outsider would ever guess. They hadn’t heard that before. (And it was unpleasant: Uncertainty is unpleasant.) This is a third sort of filtering: What data reaches outsiders.
I never had a teacher like Leonard Syme — I’ve never even heard of someone else doing what he did — but self-experimentation taught me the same thing. I came to see the fragility of mainstream claims about all sorts of things related to health. As Taleb says, we are used to thinking the charlatans are on the fringes. But they’re not — there’s plenty of them at the centers of power.
Thanks to Dave Lull. Frontline’s recent show “The Warning” makes the same point as Taleb, that there is great incompetence at the highest levels of power.
A friend writes:
As of today I’m getting over my fourth cold since I began eating lots of yogurt (maybe 1-2 cups a day, homemade), which was roughly in March of this year. So that would be a rate of about a cold every two months. On the one hand that sounds pretty terrible. On the other hand, a couple of things to think about:
1. I used to always get colds and other sicknesses as well. They just seem to be attracted to me. By my intuition, the current rate doesn’t seem particularly unusual, although I never kept track before. If anyone had a cold anywhere around me, invariably I got it. It’s been that way as long as I can remember, especially when I was traveling, as I have been during these last few months.
2. Each of the colds I have had in this last eight month period has been remarkably short. Really remarkable, so I will remark, by way of example, that this cold came out of the blue yesterday evening with a fit of sneezing. I hadn’t felt bad at all earlier in the day although in retrospect it’s possible I was a bit worn down (or maybe not: I took a half-hour swim in the late afternoon and felt pretty good). So I sneezed my way through an evening, nose dripping like a faucet. Before going to sleep I took some sort of medicine for cold symptoms (maybe something made by Bufferin maybe? Night/day something…), and in the morning I took the same thing (day version). During that whole time I was still pretty symptomatic: sneezing, nose dripping etc., but I guess the medicine might have been somewhat useful. Now here it is 2:30 in the afternoon and all of a sudden I realize my nose is dry and I haven’t sneezed for hours. I reckon this is about the end of the cold: less than 24 hours. The other three were like that as well: very quick onset, then disappearing almost before I could have time to realize I had a cold. For me this is particularly noteworthy because in years past I always seemed to get the worst of the colds, going on for days and often progressing into a hacking cough that would linger for weeks.
I suspect if my friend improved his sleep he would get see further improvement of these measures of illness. In this study, the frequency of sickness episodes went down for workers given a probiotic but their duration, when they happened, didn’t change — perhaps because it was nice to be away from work.
After I copy-and-pasted that, I got sick. It wasn’t sickness as most people know it. After an afternoon walk (1 hour) I felt tired; that was the first sign. After dinner, I felt really tired. That was an unmistakable sign. I went to bed early, slept about 8 hours (1-2 hours more than usual) and woke up rested. But an hour later I fell back asleep for 15 minutes. At that point I was sure something was wrong. I had a class that morning starting at 10 am. Should I cancel it? I got much more tired and, about two hours before class, was too tired to get out of bed to turn off the beeping yogurt maker. Okay, I’ll cancel class. I phoned the TA to cancel the class but he couldn’t — he had a bad cold. I phoned a student and she phoned the other students.
An hour later, however, I felt much better. By class time I felt well enough to go to class, although I walked rather than ride my bike. (The student did her best to uncancel the class.) In the afternoon I took a long nap (1.5 hours). The next day I was just barely more tired than usual. Today I feel completely well.
I was sick, yes, but without chills, runny nose, sneezing, sore throat — without any discomfort at all unless feeling tired counts as discomfort. And I felt distinctly more tired than usual for only about a day. I think this is what happens when your immune system works properly. You fight stuff off much faster than the five days or so many people take to get better. Before I figured out how to improve my sleep, I got the usual 4-6 colds per year. After I started to sleep much better, I never got sick in the usual runny-nose way so long as my sleep was good. The current episode is striking to me because I was more sick — that is, more tired — than usual. I do only two things to make my immune system work better: (a) improve my sleep in several ways (eat animal fat, get plenty of morning light, stand on one foot); and (b) eat plenty of fermented foods (mostly yogurt, but also miso, kimchi, natto, and kombucha).
After the striking correlation I described earlier — I ate lot more animal fat than usual and slept longer and had more energy the next day — I started eating much more of what had produced the correlation: pork belly (which is used to make bacon). I couldn’t get uncured pork belly, so I ate bacon. I usually ate it raw. I tried several brands; the only one I liked was from Fatted Calf ($10/pound).
In Beijing I discovered pork belly for sale in every meat department. It is used to make a dish said to be Chairman Mao’s favorite. I bought a soup cooker, an appliance I haven’t seen in America, which made it easy to cook the pork belly. I seemed to sleep better when I had it for lunch.
Finally I did an experiment. I ate pork belly for lunch some days but not others. I ate the pork belly in miso soup, with vegetables. I always ate a whole package of pork belly, which was about 0.7 lb and perhaps 80% fat, 20% meat. On baseline days I ate my usual diet, which was already high-fat by people’s standards. (For example, I ate a lot of whole milk yogurt, a fair amount of nuts, and ordinary amounts of meat.) I tried to alternate baseline and pork-belly days but this wasn’t always possible.
Here are the results on ratings of how rested I felt when I awoke (100% = completely rested = the most rested I have ever felt, 0% = not rested at all).
The lines were fit separately to each set of points (red line to the red points, etc.). The difference is is very consistent (t = 5). Differences in how long I slept were much less clear. I will discuss them in a separate post.
The fascinating thing about this effect isn’t just how clear it is; it’s also how fast it goes on and off (within a day). With most nutrients you’d never see an effect like this. For example, scurvy takes months to develop and a few weeks to recover from. The omega-3 effects I’ve studied have a fast onset but take days to go away.
Sleep is controlled by the brain, of course. The brain is more than half fat, but determinations of how much fat the brain has have measured structural fat. This effect is so fast, both on and especially off, that it must involve circulating fat. Apparently my brain works better when there is a certain amount of animal fat in my blood. This supports Chairman Mao’s idea that pork belly is “brain food” but is a new idea for American intelligentsia. I think the chance that a nutrient that is good for one part of the body is bad for another part is zero — the same as the chance that the electrical appliances you own work best with widely-different currents. The obvious conclusion suggested by this data is that we need plenty of animal fat to be healthy. The only novel element of these lunches was the animal fat. Miso soup with ordinary meat has no effect on my sleep, as far as I know.
I think the science of nutrition proceeds in four steps, repeated over and over for each necessary nutrient: 1. Figure out that we need it. 2. Determine a way to measure how much of it we need. 3. Figure out the optimal amount. 4. Check your answer. With animal fat, conventional nutrition science hasn’t quite reached Step 1. Before this data, I’d say the clearest evidence that we need animal fat is that fat tastes good and long ago we had very little plant fat so it must have been the benefits of animal fat that produced the fat-tastes-good linkage. But conventional nutrition scientists never think this way — never take what we want to eat as meaning anything. And the mere fact that fat tastes good is no help figuring out how much is best.
This data pushes our knowledge toward Step 2. It doesn’t just suggest we need plenty of animal fat for best health, it also makes two methodological points: 1. Animal fat improves brain function. There may be better measures of the improvement than sleep quality. 2. The timing of the improvement — which as far as I know is unprecedented in the study of nutrition — makes it easy to measure.
Yesterday at a Carrefour I watched a pig being cut up. The butcher cut off the skin (with a thick layer of fat) and tossed it into a section of the display of pork for sale. I could buy the part of the pig I valued most for an incredibly low price (about 25 cents/pound). All other pork cost more. That’s how much Chinese shoppers wanted it. No one rushed to buy the newly-cut piece of skin. It reminded me of New York where I tried to buy food past its expiration date, ordinarily considered worthless.
An example of “too big to fail” never mentioned in discussions of the financial crisis are big public-works projects: In spite of staggering cost overruns, which occur in practically every project, they are never stopped. The latest example is London’s Crossrail, a new train crossing London. Original estimated cost: 3 billion pounds. Current estimated cost: 16 billion pounds. And construction hasn’t started!
I heard a talk about why this happens. I think the speaker said there was no motivation to be honest. The companies that underbid dishonestly pay no penalty; the politicians that approve their dishonest bids risk nothing. Curiously, in notoriously corrupt China, this sort of thing doesn’t seem to happen (although my Chinese isn’t good enough to be sure). Maybe Dubner and Levitt will write about this in Superduper Freakonomics.
At a talk by Laurie Garrett at the UC Berkeley School of Journalism, I made this point about science journalism: There is no motivation to be honest. The scientists dishonestly inflate the importance of their work, and pay no penalty for doing so; the reporters dutifully write down their lies, and benefit by doing so (because it makes the story seem more important). No, no, this doesn’t happen, said Garrett. Of course it does. The most visible examples are the press releases that accompany the Nobel Prize in Medicine and Physiology, the most prestigious prize in all biology: the whole field should be embarrassed by the claims about the practical importance of teleomere research, which Nicholas Wade dutifully repeated in the New York Times.
There should be some term for these screw-the-public-they’re-too-stupid-to-realize-it situations.
Here is what Brent Pottenger was asked during a recent interview at USC medical school:
Here is a long list of reasons, by Steve Dworman, who makes them for a living, why infomercials are the way they are. One big reason is data: you can easily do an experiment that compares two different versions of the same commercial. It is much harder to measure the effectiveness of other forms of advertising. (The lack of data involved in most advertising choices is easy to see on Mad Men.) Self-experimentation has the same advantage: It’s so much easier to test an idea.
One of his points is about the use of celebrities: It must work, or else they wouldn’t do it. (Because there is data behind how things are done.) I think this points to something hard-wired: We want to learn from other people. That’s the default. If we have a question, we search for someone who will answer it. Learning from our own experience — such as self-experimentation — is a last resort. It feels wrong, we don’t like it. I remember feeling this way when I bought a camera. Sure, I could do extensive research about which camera is best. But that would be hard. Better to ask a friend. And then the purchase would be a link between us.
A brief summary of my previous post is all I needed to do to cure/prevent a skin infection was buy more socks. Instead of buying 5 pairs every 6 months, buy 20 pairs every two years. That’s all. Costs nothing. No drugs. No special treatment of the socks. No special cycle on the washing machine. No following a hundred (or ten) instructions about how to avoid infection. Like my depressed friend, I had the reaction: Why didn’t my doctor tell me this? He didn’t tell me because he didn’t know, I realize. Why he didn’t know . . . is a harder question.
The whole practice of health care is called medicine, so focused is it on cure rather than prevention. There are medical schools, which turn out doctors. Schools of public health are the closest thing we have to schools based on prevention but they don’t even train nutritionists. Nor do they do experiments, in most cases. (They do little data collection besides epidemiology.) And they get much less money than medical schools. Scurvy and Vitamin C are the first examples of the new way of dealing with illness I’m talking about — finding the environmental deficiency and fixing that, which is inevitably extremely safe and extremely cheap. After the discovery of Vitamin C, similar examples were discovered and the broader term vitamin was coined. But I think there is a need for a similar term that includes non-vitamins. It would mean aspects of everyday life, food and non-food, that we need to be healthy.
Like Vitamin C, my discovery that more socks eliminates skin infection points to a cure/prevention agent that is perfectly safe and extremely cheap. So do all my posts about fermented foods. It costs basically nothing to let food ferment. You lose nothing and gain a lot. Yet bacteria are not vitamins — and it isn’t all bacteria we need, just the 99.999% that are harmless. (And other foreign stuff, like bee venom, can substitute for bacteria.) I began thinking there are non-food vitamin-like things (things we need to be healthy) when I discovered the effects of standing on sleep and morning faces on mood. So we need several things to sleep well, including morning light, and at least one thing for proper mood regulation. Insomnia and depression are non-infectious problems, like scurvy. We think of vitamins as preventing/curing non-infectious problems, so the analogy was obvious. And these examples (sleep and mood) involved the brain. So there were vitamins for the brain, you could say. But the socks/foot infection example and the fermented foods/many illnesses example both do not involve the brain and do involve infectious diseases and auto-immune diseases (which, although non-infectious, are quite different from scurvy). So the idea that there are bunch of extremely cheap, perfectly safe things we need to be healthy expands to cover more of health.
Vast amounts of money are spent on health research, much much more on the consequences of poor health, and truly incalculable suffering comes about because we don’t know what these things are. (Depression alone causes vast suffering. Now add to that poor sleep, autoimmune problems, much infectious disease . . . ) Yet because studying these things (a) will make money for no one, (b) won’t produce a steady stream of published papers and (c) is useful (= low status), they are nearly impossible to study.
Several years ago, during a routine checkup, my primary-care doctor pointed to some white lines on my right foot. (Curiously only one foot had them.) Fungus, he said. I had a fungus infection. What should I do? I asked. He suggested over-the-counter anti-foot-fungus medications, sold in every drugstore.
I tried a few of them. They didn’t work. The problem persisted.
A month ago I noticed the problem had gotten much worse. Yikes. What had gone wrong? I realized that in the previous few weeks I had changed two things:
This suggested a theory: My skin infection was due to my socks. The infectious agents get on my socks and are not completely removed by the washing machine. They survive a few days on the shelf. To wear socks with the infectious agent already present gives the infection a boost. Maybe my new socks supported the infectious agent better than the socks they replaced.
Based on this theory, I did three things:
I saw improvement right away. (The morning after I wore new socks.) A month later, the infection, present for at least several years, is entirely gone. It took about a month for it to clear up completely.
The essence of my discovery is that the infectious agent could survive my socks being washed conventionally (in a washing machine) and live for a few days without contact with my feet. Whereas a few weeks away from my skin killed it. I have been unable to find this info anywhere else. A very minor discovery, but unlike the work that won the most recent Nobel Prize in Medicine, useful right now. Cost: zero. I would have had to buy new socks anyway.
In Cities and the Wealth of Nations, Jane Jacobs tells about a reporter interviewing someone in an oil-rich Middle East country (Iran?). During the interview the interviewee tries to cut an apple with a knife. The knife breaks. We can’t even make knives, the interviewee says. That’s how backward our economy is. To develop economically, MIT professors had advised his country’s government to build a dam, at great expense. The MIT advisors thought that building a dam would be good for economic development. They were wrong, it turned out. Jacobs thought it was telling that after all that money invested, the local economy still couldn’t make something as basic as a good knife. Many industrial processes require cutting tools.
This is the same thing. Preventing and eliminating infection is at the core of medicine, just as cutting is at the core of manufacturing. My discovery reveals that my doctor — and by implication, the whole health care establishment — failed to know something basic and simple about this. If they understood what I figured out, there would be no need for anti-foot-fungus medicine. A gazillion dollars a year is spent on medical research, medical schools and research institutes around the world are full of faculty doing research — and they haven’t figured out something as basic and simple as this.
Gatekeeper Drugs. How to Avoid Infection: Something I Didn’t Know.