Cortisol Manager for Sleep

I wanted to do a whole rigorous review of all of the individual ingredients, but my new role at work is sucking up all my time and every time I mention “I found a supplement that cured my sleep problem” people demand to know what it is, so screw it, here’s the unscientific version.

Cortisol is the long term stress hormone. High cortisol at night can prevent you from falling asleep, or cause you to wake up in the middle of the night. I had this problem a lot, usually at 3 AM.  I started taking Cortisol Manager and started sleeping through the night, which, wow, is everything I dreamed it would be. It is not the only reason I went from working 60 hours/week to working 90, but it was a contributor.

[Note: “work” means “consciously chose to do a thing, of any kind, as opposed to looking up and realizing I’d just spent 40 minutes on Reddit.”, although my actual job-work hours did go up too]

Cortisol Manager has a number of ingredients, two of which I know anything about:

  • Ashwaganda, which is an “adaptogen”, raising or lowering cortisol as you need it. This is good, because cortisol is extremely important for getting out of bed in the morning. Taking ashwaganda alone does not seem to help me
  • Theanine, an amino acid that lowers anxiety. Theanine alone leads to higher quality sleep for me, and helps my anxiety enough to be used for dental visits before I got a prescription for something stronger.

 

I’ve been on and off CM in the past. At points it depressed on cortisol too much (although right now I need two tabs/night), other times it just didn’t feel necessary. But it is extremely necessary for me right now, and at least one friend has benefited tremendously from e sharing the recommendation.

Epistemic Spot Check: The Dorito Effect (Mark Schatzker)

Epistemic Spot Checks is a series in which I fact check claims a book makes, to determine its trustworthiness. It is not a book review or a check on every claim the book makes, merely a spot check of what I find particularly interesting or important (or already know).

Today’s subject is The Dorito Effect, which claims that Americans are getting fat because food is simultaneously getting blander and less nutritious, and then more intensely flavored through artificial means. This is leaving people fat and yet malnourished.

Claims

Claim: Humans did not get fatter over the last 100 years due to changes in genetics.
True. People are fatter than their ancestors, indicating it’s not a change in genetics (although genetics still plays a role in an individual’s weight).

Claim: Casimir Funk discovered that an extract of brown rice could cure beriberi in chickens.
True.

Claim: In 1932, the average farm produced 63 sacks of potatoes/acre. By the mid 1960s, it was 200 sacks/acre.
True.

KCalGraph.png
(source).

Claim: Everything is getting blander and more seasoned.
More seasoned.
Blander food.
Note that both sources were provided by the book itself.

Claim: “We eat for one reason: because we love the way food tastes. Flavor is the original craving”.
This doesn’t jive with my personal experience. I definitely crave nutrients and am satisfied by them even without tasting them.

Claim: “In 1946 and 1947, regional Chicken Of Tomorrow contests were held.”
True.

Claim: Over time the Chicken Of Tomorrow winners consistently weighed more, with less feed and less time to maturity.
True.

Claim: Produce is getting less nutritious over time.
True (source provided by author).

Conclusions

Extremely trustworthy, and therefore worrisome, given the implication that food is becoming inexorably worse. Dorito Effect is unfortunately light on solutions, so you might just freak yourself out to no purpose. On the other hand, if you’re looking for a kick to start eating better, this could easily be it.

Meditation Ramblings

For a few weeks in a row, I was meditating by focusing on my breath, mostly around my diaphragm. Inevitably after some time (exact amount hard to determine because, meditating), my attention would be drawn to some patches of skin around my neck.  If I focused on them, something good happened, although it’s been long enough since I did this that I don’t remember what. Probably I relaxed.

Several times I tried to get ahead of the system by focusing on those neck patches from the beginning. It was always the same patches, so the problem was not that I was focused on the wrong area. This never worked. Something necessary was happening during the focus on diaphragm.

“Skipping ahead to the neck” feels like a pretty good metaphor for my failure mode in meditation and introspection in general. I identify the thing that happened most directly before something good, and try to replicate that, then am disappointed when I get the same results. I have a lot of resistance to going through the longer process.

Some of that is Drive For Efficiency, but I think a lot of times I genuinely don’t know what the whole process was, only the last step or two. I spent a week in July drawing body map after body map and hit the most enlightened I’ve ever been, by which I mean I was getting the promised benefits of meditation. Even very negative emotions didn’t bother me, they were just another kind of sensation. I was able to see a lot of things I’d previously labeled as emotions were better considered reactions to emotions, or attempts to mitigate them.

This went away after a few days. I tried desperately to get it back by drawing more body maps, but nope. That has never worked again. Either I solved all the problems body mapping can solve (unlikely), or there was some precursor I haven’t identified. Actually I generated a new guess writing this out. Thanks guys.

For a few weeks I was very frustrated by my inability to recreate the feelings at all. Then someone told me to stop striving (duh), and I got back maybe 40%, which is not bad at all.

Literature Review: MDMA

Introduction

MDMA (popularly known as Ecstasy) is a chemical with powerful neurological effects. Some of these are positive- the Multidisciplinary Association for Psychedelic Studies (MAPS) has shown very promising preliminary results using MDMA-assisted therapy to cure treatment-resistant PTSD. It is also, according to reports, quite fun. But there is also concern that MDMA can cause serious brain damage. I set out to find if that was true, in the hope that it wasn’t, because it sounds awesome.

Unfortunately the evidence is very strongly on the side of “dangerous”. Retrospective studies of long term users show cognitive deficits not found in other drug users, while animal studies show brain damage and inconsistent cognitive deficits. The one bright spot is the MAPS study, which reported no drop in cognitive function after a therapeutic dose of MDMA, but we’ll talk about the problems with that later. There was a single study showing mitigations may be effective.

I was a little inconsistent with citing my sources in this post when I was relying on a number of studies to inform a general point. If you want to follow up or check my work, you can see my notes here.

Background

MDMA’s primary effect is to release massive amounts of serotonin at once. In particular it works on the 5-HT(2B) receptor, which affects the brain, appetite, gut motility and, in a nice bit of poetics, the heart.

MDMA also has significant hormonal effects, causing an increase in DHEA (a cortisol precursor), cortisol (the long-term stress hormone) and prolactin (best known for inducing lactation, but also a counter to dopamine and sex hormones). Curiously, higher cortisol correlates with higher enjoyment of MDMA. At first this surprised me because cortisol is thought of as indicating stress, but then I remembered that the only thing worse than cortisol is needing it and not having it (which may be the chemical underpinnings of burn out). It may be that cortisol contributes to an “energized” feeling, which is interpreted positively due to the flood of serotonin and dopamine.

The Damage

Retrospective Studies

Studies looking at the brains and behavior of long term recreational users are the least trustworthy to me, because it’s so hard to distinguish what else the subject might have taken, deliberately or mixed with their supposed MDMA. If you did want to listen to those studies, the news is awful, with participants showing problems with:

[Note that some of those links are to the same study and should not be taken as independent confirmation]

In some cases, MDMA-users were compared to users of other street drugs and performed worse, providing something of a control. In other cases, only a combination of MDMA and alcohol inhibited performance.

Controlled Animal Experiments

It’s abundantly clear in autopsies that MDMA changes neurochemistry and damages nerves. But only some studies showed this to translate to any actual cognitive deficit. My best guess is this is either because some studies give their rats way more drug than is reasonable, or because the brain is able to work around deficients. I worry that these work arounds are temporary, and as age does its work it will reveal damage done long ago.

Most of the animal studies used very high doses of MDMA, or many repetitions in a short period. I think this is a reasonable shortcut to determining the effects of long term use, but it does leave the possibility the brain is able to heal from damage, if given enough time.

Controlled Human Experiments

These are thin on the ground, and the ones I did find often didn’t do cognitive tests, focusing instead on things like serum levels and temperature (which MDMA raises). The one exception was a study by MAPS, which reported no “significant” cognitive deficits, but declined to share the actual scores on the RBANS test they used. This makes me extremely suspicious.

Is it worth it? This meta-analysis found only ⅓ of MDMA-for-PTSD studies demonstrated statistically significant improvements. This study didn’t even find an improvement in mood. I was going to make fun of this study for specifying that “subjects liked MDMA”, but actually very few studies bothered to note the subjective enjoyment effects, so good on them for getting it on the record.

Mitigations

Folk wisdom has a number of remedies for the post-MDMA crash, including 5-HTP, tryptophan, and SSRIs. These are all aimed at the depletion of of serotonin that occurs after MDMA wears off; if that depletion is the primary cause of brain damage, they might reasonably intervene. If on the other hand the damage is primarily caused by the initial flood of serotonin I would expect them to have no effect.

This very small study (treatment groups of size 8) nonetheless found that single treatments of 5-HTP and tryptophan prevented large drops in serotonin and its metabolite 5-HIAA, and large drops in the number of binding sites. 5-HTP and tryptophan actually increased serotonin or sensitivity in certain brain areas. This is a smaller study than I want to trust my brain to, but nonetheless very interesting.

Conclusion

These studies are likely heavily biased by the US government’s hatred of fun. They’re often quite small, so it would be easy for publication bias to sweep positive reports under the rug. To really answer this question I’d need to do similar literature reviews for other substances and see how they compared. I don’t have that kind of time (if you would like to buy the time for me, contact me at elizabeth at this domain name), but I did find MDMA’s wikipedia page much scarier than LSD’s or marijuana’s. On the other hand, all of the evidence points in one direction, and it would not be shocking if a sudden massive release of neurotransmitters, followed by a prolonged deficit, was damaging.

MDMA is risky, and you probably shouldn’t use it, although a handful of times with the right therapeutic environment might be worth it if your problems are bad enough. There are promising but unproven mitigations. If you do decide that MDMA is worth the risk to you, at least be careful to hydrate properly, in a cool environment to prevent overheating, and definitely don’t mix it with anything else. In other words: a rave is the last place you should be doing E.

 

This post supported by Patreon. Thanks to Justis Mills for copyediting.

 

Water Pick Experimental Results

Since my last dental appointment (3 months ago), I’ve cleaned one half of my mouth with a water pick (in addition to brushing on both sides), with the goal of determining if it actually did anything useful. I was inspired by my dentist’s insistence that I Do Something despite not noticing when I consistently used the pick. I pre-registered on Facebook that if the hygienist spontaneously commented that one side looked better, or some objective measure like # of cavities was different, I would consider it evidence in favor of the water pick. Today was the appointment.

Final results:

  • Hygienist didn’t comment either way.
  • No new cavities on either side
  • Gum pocket measurements were worse on the water picked side.

Obviously one trial isn’t conclusive, but I’m giving up on the water pick. Next step: test flossing.

Bullshit Job Notes

Scott talks about a bit of medical theater, in which companies demand doctors notes to allow people to bring in their own chairs to work; he is often the person in best position to provide that note, despite being a psychiatrist who usually works remotely. He’s knows little about back pain and nothing about chairs. His compromise has been to write out a note saying “[Patient] reports back pain that would be improved by a chair they have chosen.” This shouldn’t work because he’s not adding any additional information to the patient’s complaint, but it does.

I had my own experience with this in my first real-world programming jobs. The overhead lights in my office gave me a headache, so I turned them off. Someone noticed and didn’t think it was fair my roommate be forced to work in the dark (although he told me it was fine). I indeed had to go to the doctor, who dutifully wrote out “Elizabeth says the lights give her headaches…”. Luckily I had fabulous health care insurance and flexible hours at my job, so this was a minor annoyance.

I really disliked the way the company handled it though. Their solution was a lamp, which was fine, but there was a lot of pressure to say either “yes, the problem is entirely solved” or “no, it is definitely not solved.” “Can I take a week to see if I develop a headache?” was not an option. I don’t think I even got to pick out my own lamp.

Several years later I had a similar problem at a different large tech company you have definitely heard of, one known for being an amazing place to work. I hated working in an open office and tried to leverage my post-dental-surgery fragility into a private office or the right to work from home. In retrospect, this was not a reasonable accommodation: despite having offices in 50 countries and running much of the world’s telework infrastructure, that company’s workflow was set up for in person communication. But they couldn’t just say that, so they tried to find ways to meet the letter of my doctor’s note without actually giving anything up. This was a problem because what I really wanted was control over my environment, and that was the exact thing they didn’t want to give me.

I think a thing that’s going on with the notes is that gatekeeping makes sense in some circumstances (substantial changes in job duties), and it was no skin off the decision-maker’s nose to make that a universal rule. “Protection from lawsuits” factors in, but if companies were paying the cost of the note they would draw the line in a different place. As it stands, it’s worth infinite amounts of your time and money to avoid risk of a lawsuit that might cost them either.