Tag: luckbasedmedicine

Inositol Non-Results

Three months ago I suggested people consider inositol for treating combined vague mood issues and vague stomach issues. I knew a few people who’d really benefited from it, and when one talked about it on his popular Twitter account several more people popped up thanking him for the suggestion, because it fixed their lives too. But those reports didn’t come with a denominator, which made it hard to estimate the success rate; I was hoping mentioning it on my blog and doing a formal follow-up to capture the non-responders would give a more accurate number.

Unfortunately, I didn’t get enough people to do anything useful. I received 7 responses, of which 3 didn’t have digestive issues and thus weren’t really the target. The low response rate might be a consequence of giving the wrong link in the original follow-up post, or maybe it just wasn’t that interesting. I’m reporting the results anyway out of a sense of civic virtue. 

Of those 4 remaining responses:

  • 2 rated it exactly 5 out of 10 (neutral)
  • 1 rated it as 6, which was not strong enough for them to try it a third time.
  • 1 rated it as 3- not bad enough that they spontaneously noticed a problem, but they did detailed mood tracking and the linear regression was clearly bad. 

That response rate isn’t really low enough to prove anything except that anything with a real effect can hurt you, and the value of detailed data. So for now we just have David’s estimate that 5% of people he inspired to take inositol benefited from it. 

Follow-up survey: inositol

Two months ago I wrote about inositol as a treatment that occasionally works for anxiety and depression, especially when the user also has weird digestive issues (not medical advice, I am not a doctor). If that inspired you to try inositol I would love if you would fill out this 5-7 question survey about your experience. This follow-up data helps other people considering inositol, and is broadly helpful to me in figuring out what luck based medicine looks like. 

And to the four people who already filled this out: gold star for epistemic virtue. 

The survey doesn’t allow for a lot of detail, which I know is painful for some people (it’s me. I’m people). If you would like to share more, feel free to write up as much as you’d like in a comment here, or share a link detailing your experience.

Elsewhere in luck based medicine: it was a dude in my survey, but I met a few more people who really love the Apollo Neuro. They are all the kind of people who already know what “somatically aware” or “embodiment” mean, so this is some support for my theory that that’s a prerequisite. It’s still an open question if you need that background for the Neuro to be beneficial, to notice it’s beneficial, or to stick with it long enough that it has time to be beneficial. 

The Apollo app has gotten even worse since last time I wrote. Every time I open it it bugs me to enable notifications, a permission it absolutely does not need. 

Luck based medicine: inositol

Summary: Do you have weird digestive symptoms and anxiety or depression? Consider trying inositol (affiliate link), especially if the symptoms started after antibiotics.

Epistemic status: I did some research on this 10 years ago and didn’t write it down. In the last nine months I recommended it to a few people who (probably) really benefited from it. My track record on this kind of suggestion is mixed; the Apollo Neuro was mostly a dud but iron testing caught a lot of issues. 

Background

Inositol is a form of sugar. It’s used in messaging between cells in your body, which means it could in theory do basically anything. In practice, supplementation has been found maybe-useful in many metabolic and psychiatric issues, although far from conclusively. 

There are a few sources of inositol: it’s in some foods, especially fruit. Your body naturally manufactures some. And some gut bacteria produce it. If your gut bacteria are disrupted, you may experience a sudden drop in available inositol, which can lead to a variety of symptoms including anxiety and depression.

Anecdata

Inositol deficiency (probably) hit me hard 9 years ago, when I went on a multi-month course of some very hardcore antibiotics to clear out a suspected SIBO infection.

Some background: My resistance to Seasonal Affective Disorder has been thoroughly tested and found triumphant.  At the time I took those antibiotics I lived in Seattle, which gets 70 sunny days per year, concentrated in the summer. This was a step up from my hometown, which got 60 sunny days per year. I briefly experimented with sunshine in college, where I saw 155 sunny days per year, a full 75% of the US average. The overcast skies never bothered me, and I actively liked Seattle’s rain. So when I say I do not get Seasonal Affective Disorder or light-sensitive depression, I want you to understand my full meaning. Darkness has no power over me. 

That is, until I took those antibiotics. I was fine during the day, but as soon as sun set (which was ~5PM, it was Seattle in January) I experienced crushing despair. I don’t know if it was the worst depression in my life, or just the most obvious because it went from 0 to doom 15 minutes. 

Then I started taking inositol and the despair went away, even though I was on the antibiotics for at least another month. After the course finished I took some probiotics, weaned off the inositol, and was fine. 

About six months ago, my friend David MacIver mentioned a combination of mood and digestive issues, and I suggested inositol. It worked wonders.

He’s no longer quite so deliriously happy as described in the tweet, but still describes it as “everything feels easier”, and every time he lowers his dose things get worse. So seems likely this is a real and important effect

He’s also tried probiotics. It took several false starts, but after switching brands and taking them very consistently he was able to lower his dosage of inositol, and the effects of going off it are less dramatic (although still present).

He has a fairly large twitter following, so when he tweeted about inositol he inspired a fair number of people to try it. He estimates maybe 50 people tried it, and 2-5 reported big benefits. So ballpark 4-10% response rate (of people who read the tweet and thought it looked applicable). And most people respond noticeably to the first dose (not me, I think it took me a few days, but most people), so it’s very easy to test. 

A second friend also got very good results, although they have more problems and haven’t tested themselves as rigorously as David, so causality is more questionable. 

Fun fact: because inositol is a cheap, white, water soluble powder it’s used as a cutting agent for multiple street drugs. It’s also the go-to substitute for cocaine in movies. So if cocaine, heroin, or meth have weirdly positive effects on you, might be worth checking out.

Practicalities

Anything with a real effect can hurt you. Even that totally safe magic bracelet I recommended maybe gave someone nightmares. But as these things go, inositol is on the safer end to experiment with. The fact that it’s both a natural food product and produced endogenously gives you good odds, especially compared to cocaine. OTOH the fact that it has a lot of sources makes it harder to dose – after a few months David found that his initial dose was too high and induced brain fog, and he needed to lower it. 

I have a vague impression that quality isn’t an issue with inositol the way it is with some vitamins, so I just linked to the cheapest ones. 

In terms of dose: standard dosage is 0.5- 2g/day. David started at high end of that but is now down to 0.5-1g. I can’t remember what I did. If you try it, start small and experiment. 

If you do try it, I’d love if you filled out this form letting me know how it went.

Thanks to David Maciver for sharing his data. 

Luck based medicine: angry eldritch sugar gods edition

Introduction

Epistemic status: everything is stupid. I’m pretty sure I’m directionally right but this post is in large part correcting previous statements of mine, and there’s no reason to believe this is the last correction. Even if I am right, metabolism is highly individual and who knows how much of this applies to anyone else.

This is going to get really in the weeds, so let me give you some highlights

  • 1-2 pounds of watermelon/day kills my desire for processed desserts, but it takes several weeks to kick in.
    • It is probably a microbiome thing. I have no idea if this works for other people. If you test it let me know.
    • I still eating a fair amount of sugar, including processed sugar in savory food. The effect is only obvious and total with desserts. 
  • This leads to weight loss, although maybe that also requires potatoes? Or the potatoes are a red herring, it just takes a while to kick in? 
  • Boswellia is probably necessary for this to work in me, but that’s probably correcting an uncommon underlying defect so this is unlikely to apply widely. 
  • Stevia-sweetened soda creates desire for sugar in me, even though it doesn’t affect my blood sugar. This overrides the watermelon effect, even when I’m careful to only drink the soda with food.
  • My protein shakes + bars also have zero-calorie sweeteners and the watermelon effect survives them. Unclear if it’s about the kind of sweetener, amount, or something else.
  • Covid also makes me crave sugar and this definitely has a physiological basis.
  • Metabolism is a terrifying eldritch god we can barely hope to appease, much less understand. 

Why do I believe these things? *Deep breath* this is going to take a while. I’ve separated sections by conclusion for comprehensibility, but the discovery was messy and interconnected and I couldn’t abstract that out. 

Boswellia

Last October I told my story of luck based medicine, in which a single pill, taken almost at random, radically fixed lifelong digestion issues. Now’s as good a time as any to give an update on that. 

The two biggest effects last year were doubling my protein consumption, and cratering sugar consumption. I’m still confident Boswelia is necessary for protein digestion, because if I go off it food slowly starts to feel gross and I become unable to digest protein. I’m confident this isn’t a placebo because I didn’t know Boswelia was the cause at the time, so going off it shouldn’t have triggered a change. 

As I’ll discuss in a later section, Boswelia is not sufficient to cause a decrease in sugar consumption; that primarily comes from consuming heroic amounts of watermelon. The Boswellia might be necessary to enable that much watermelon consumption, by increasing my ability to digest fiber. I haven’t had to go off Boswellia since I figured out how it helps me, so I haven’t tested its interaction with watermelon. 

How does Boswellia affect micronutrient digestion? I have always scored poorly on micronutrient tests. I had a baseline test from June 2022 (shortly after starting Boswellia + watermelon), and saw a huge improvement in October testing (my previous tests are alas too old to be accessible). Unfortunately this did not hold up – my March and June 2023 tests were almost as bad as June 2022. My leading hypotheses are “the tests suck” and “the November tests are the only ones taken after a really long no-processed-dessert period, and sugar is the sin chemical after all”. I hate both of these options. 

If we use fuzzier standards like energy level, illness, and injury healing, I’m obviously doing much better. Causality is always hard when tracking effects that accumulate over a year. In that time there’s been at least one other major intervention that contributed to energy levels and mood, and who knows what minor stuff happened without me noticing. But I’d be shocked if improved nutrition wasn’t a major contributor to this. 

Illness-wise; I caught covid for the second time in late November 2022, and it was a shorter illness with easier recovery  than in April (before any of these interventions started). But that could be explained by higher antibody levels alone. I haven’t gotten sick since then (9 months), which would have been an amazing run for me pre-2022.

My protein consumption (previously 30-40g/day) spiked after I started Boswellia in May 2022 (~100g/day) and then slowly came down. Before November covid I was at ~70g/day. My explanation at the time was that my body had some repairs it had been putting off until the protein was available, and once those were done it didn’t need so much. It spiked again after November covid and only partially came down, I’m still averaging ~100g/day. I’m not sure if I still need that for some reason, or if I’m just craving more calories and satisfying that partially with protein. 

Watermelon

The cure to all my dieting woes?

In spring 2022 I started eating 1-2 pounds of watermelon per day. This wasn’t a goal-oriented diet or anything, I just really like watermelon and finally realized the only limitations were in my mind. I started eating watermelon when it came into season, before I got covid in April 2022, but didn’t start the serious habit until the later half of my very long covid case. As previously discussed, that May my doctor prescribed me Boswellia in part to aid covid recovery, and a bunch of good things followed (including a disinterest in processed sugar), all of which I attributed to the Boswelia. 

The loss of interest in sugar was profound. It wasn’t just that I gained the ability to resist temptation; I mostly didn’t enjoy sugar when I had it. I went from a bad stress eating habit to just… not thinking of sugar as an option when stressed. 

My interpretation at the time was “sugar cravings were a pica for real nutrition, as soon as I could digest enough food they naturally went away, fuck you doctors”. It never occured to me the watermelon might be involved because in my mind it was categorized as “indulgence” not “intervention”.  Even if it had occured to me to test it, I know now the effect takes at least six weeks to kick in, and I wouldn’t have waited that long. Lucky for science, reality was going to force my hand. 

Around October I started wanting sugar again, although not as much as before. I put this down to stress, but that never really made sense: August saw me break my wrist and have a very stressful interpersonal issue without any return in cravings. Then in November I got covid again, and it again created intense sugar cravings, which improved some but never really went away. I thought maybe covid had permanently broken my metabolism. I played with the Boswellia dosing for a while but it didn’t seem to make a difference. Plus my protein digestion stayed the same the whole time, so it seemed unlikely Boswellia had just stopped working. 

In February 2023 I talked about this with David MacIver of Overthinking Everything, and noticed that the sugar cravings had returned a few weeks after watermelon had gone out of season. I created a graph from my food diary, and it became really obvious watermelon was the culprit.

The effect is even stronger than it looks, because watermelon has sucrose in it. Over summer my sucrose intake is 90% from fruit; over winter it’s dominated by junk. 

I figured this out in February 2023. Because I live in a port city in a miracle world, that was late enough in the season to get mediocre watermelon. It took a while to work, but that was true the first time as well (somewhere between 6 weeks and 12, depending on how you count covid time). And you can indeed see where this started on the graph. But five months later it is still replicating the previous year’s success. Sugar cravings were weaker but still present, and certainly came back when I was stressed. The weight loss was slow and stuttering where it had previously been easy.  That brings me to my next point.

Stevia-sweetened Soda

In January 2023 my doctor gave me a continuous glucose monitor to play around with. The thought process here was…exploratory.  Boswellia is known to lower blood sugar, and helped with (I thought) sugar cravings and many other issues. Covid causes sugar cravings in me, is known to hurt diabetics more, and causes lots of other problems, so maybe that points to blood sugar issues in me? Also I was kind of hoping the immediate feedback would nudge me to eat less sugar.

One of the foods I was most excited to test was 0-calorie soda. I’d always avoided diet soda on the belief that no-calorie sweeteners spiked your insulin and this led to sugar cravings that left you worse off. But when I tried stevia-sweeted Zevia with the GCM my blood glucose levels didn’t move at all, and I didn’t feel any additional drive to eat sugar (compared to my then-high baseline desire – remember this was while I was off watermelon and dessert was amazing). 

I was extremely excited about this discovery. I’d given up cola about 18 months before and missed it dearly. Now I had chemical and mathematical proof that no-cal soda was fine. When I had the cola again it made me so happy I was amazed I’d ever managed to give it up before. I began a 2-3 cans/day caffeine-free Zevia cola habit. 

This would have been 4-6 weeks before I restarted on watermelon. When the watermelon failed to repeat its miracle I suspected Zevia fairly quickly, but I really, really didn’t want it to be true so I tested some other things first. Finally I had ruled out too many other things, and had a particularly clarifying experience of sudden, strong cravings with nothing else to blame.  I gave up Zevia, and immediately lost all desire for sugar. In retrospect the low-sugar-desire days of the previous months were probably not random, but days I happened to not drink Zevia. 

Unfortunately this doesn’t obviously show up on the fructose vs sucrose graph and I don’t care enough to export the data and do real statistics. It also doesn’t show up cleanly on my weight graph, because weight is noisy and the effect operates at a substantial delay. But I’ve given it 7 weeks, and I’m definitely losing weight. The current streak is faster than anything I had last year, although it’s too soon to say if that will hold up. . . 

Zevia is sweeted with stevia, which seems like it should make stevia an enemy. But my protein shake is also sweetened with stevia (plus something else), and I had at least a bottle/day during the weight loss last year (this is one excuse I gave for testing other potential culprits before Zevia). Maybe the issue is the amount in Zevia, maybe drinking stevia with a lot of protein is better than separately, even when it’s with a meal. Maybe Mercury was in retrograde I give up. 

Potatoes and Weight Loss

The no-sugar effect had kicked in in earnest by late May 2022 (I didn’t start a food diary until late June that year, but confirmed the May date by looking at my grocery orders). In July 2022 I went on minimum viable potato diet, in which I ate a handful of baby potatoes every day and demanded nothing else of myself. Within a few days my caloric intake dropped dramatically, and I started to lose weight. This continued late fall, when watermelon went out of season. 

The post-potato weight loss was weird, and seemed much too large to be produced by a handful of potatoes. But it was such a strong effect that started so quickly after potatoes that it seemed impossible to be a coincidence. 

I mentioned before that the watermelon works on a delay. So maybe I just happened to start eating potatoes the day the watermelon effect kicked in (I don’t have exact timing for this – the first run is complicated by covid and the second by stevia soda and work stress). Maybe I need watermelon and potatoes for some stupid reason. Maybe that 100g of produce was a tipping point, but 100g of anything would have worked. Or maybe that’s just when the summer heat kicked in, since I’ve always eaten less when it was hot out. Maybe it’s not a coincidence the current weight loss kicked in shortly after finishing a stressful, air conditioned gig… 

Questions

What is happening with sugar?

The stevia effect appears to be same-day, often kicking in within a few hours and wearing off by the next day, so I assume that’s a metabolic issue. But not one reflected in blood sugar, according to the CGM. Unless the effect kicks in slowly (while also stopping the day I stop drinking it). 

The no-sugar effect watermelon takes 4-8 weeks to kick in, and another 4+ to cause weight loss. But between those milestones… I don’t want to brag, but it’s relevant so I think I have to. ~10 weeks after 1-2lbs of watermelon/day my feces become amazing. So amazing they look fake, like they were crafted for an ad for a fiber pill. Enormous without being at all painful because of their perfect consistency. Other bowel movements resent mine for setting unrealistic beauty standards, but they can’t help it, that’s just how they naturally look. 

Between the delay and the gold-ribbon poops, I’m pretty sure the watermelon effect works through microbiome changes. Maybe fiber, maybe feeding different bacteria, maybe changing the metabolism of the existing bacteria?

Are you one of those idiots who thinks processed sugar is different than natural sugar?

I regret that I have to answer this with “maybe”.  Processed is not well defined here, but it sure seems like a Calorie from watermelon hits me differently than a Calorie from marshmallows; even if they fuel the same amount of metabolism. My guesses for what actually matters are fiber, fructose vs sucrose, water content, and “fuck if I know”. If anyone tries a sugar water + fiber pills diet, please do let me know. 

I try to be careful to say I haven’t given up processed sugar, just processed desserts. Lots of savory dishes have a fair amount of sugar (not just carbs) in them. My guess is that if easy, sugar-free prepared food was available I wouldn’t miss the sugar, but in the real world it is too much work to cut it out and I seem to be doing okay as-is 

Does it have to be watermelon?

If I’m right about the fructose, fiber, and/or water, no, but I haven’t tested it. Watermelon does have a pretty favorable mix of those (grapes have way more sugar per gram), but its primary virtue is that it is obviously the best fruit and I’d struggle to eat that much of anything else on purpose, much less do so accidentally for months straight. In fact I did try to replace watermelon that winter, but couldn’t find anything I’d eat that much of.  

However someone on twitter pointed out that watermelon is unusually high in citrulline (which is used to produce arginine, which is metabolically important). There’s no way I could detect this trend against my overall increase in protein uptake, so I can’t do more than pass this on. If California fails to deliver truly year round watermelon my plan is carrots + citruilline pills, so maybe we’ll find out then.  

Why does Boswellia help protein digestion?

I don’t know. Digestion isn’t even included on the list of common effects of Boswellia. All any doctor will tell me is “something something inflammation”, as if I haven’t taken dozens of things with equally strong claims to reducing inflammation.

Last year a reader connected me with a friend who had some very interesting ideas about mast cell issues, and I swear I’m going to look into those any day now… 

Conclusion

Everything is stupid, nothing makes sense. If hadn’t lucked into a situation where I was using Boswellia, eating stupid amounts of watermelon, and consuming no Zevia I might never have found out this no-sugar-desire state and would be at least 30 pounds heavier. 

PS

If you find yourself thinking “this is great, I’m so sad Elizabeth only publishes a few extremely long posts per year about metabolism that prove nothing”, I have good news! The Experimental Fat Loss substack features multiple posts per month in exactly that genre. It mostly follows the author’s fairly rigorous dietary experiments, but lately he’s been taking case studies from other people as well. 

Apollo Neuro Results

Introduction

Two months ago I recommended the Apollo Neuro for sleep/anxiety/emotional regulation. A number of people purchased it based on my recommendation- at least 25, according to my referral bonuses. Last week I asked people to fill out a form on their experience.

Take-home messages:

  • If you are similar to people who responded to my first post on the Apollo, there’s a ~4% chance you end up getting a solid benefit from the Apollo.
  • The chance of success goes up if you use it multiple hours per day for 4 weeks without seeing evidence of it working, but unless you’re very motivated you’re not going to do that.
  • The long tail of upside is very, very high; I value the Apollo Neuro more than my antidepressant. But you probably won’t. 
  • There’s a ~10% chance the Apollo is actively unpleasant for you; however no one reported cumulative bad effects, only one-time unpleasantness that stopped as soon as they stopped using it. 

With Numbers

The following graphs include only people who found the Apollo and the form via my recommendation post. It does not include myself or the superresponders who recommended it to me. 

Forms response chart. Question title: What was the outcome of trying the Apollo?. Number of responses: 18 responses.

(that’s one person reporting it definitely helped)

An additional six people filled out an earlier version of the form, none of whom found it helpful, bringing the total to 24 people.

Obviously I was hoping for a higher success rate. OTOH, the effects are supposed to be cumulative and most people gave up quickly (I base this on conversations with a few people, there wasn’t a question for it on the form). Some of that is because using the Apollo wasn’t rewarding, and I’ll bet a lot of the problem stems from the already pretty mediocre app getting an update to be actively antagonistic. It probably is just too much work to use it long enough to see results, unless you are desperate or a super responder. 

Of people who weren’t using it regularly: 55% returned it, 20% failed to return it, and the remaining 35% chose to keep it. I think that last group is probably making a mistake; the costs of luck-based medicine add up, so if you’re going to be a serious practitioner you need to get good at cutting your losses. It’s not just about the money, but the space and mental attention. 

Forms response chart. Question title: If you didn't like it- what was your experience?. Number of responses: 13 responses.

Of 6 people in the earlier version of the form, 1-2 found it actively unpleasant. 

The downside turned out to be worse than I pictured. I’m fond of saying “anything with a real effect can hurt you”, but I really couldn’t imagine how that would happen in this case. The answer is: nightmares and disrupted sleep. In both cases I know of they only experienced this once and declined to test it again, so it could be bad luck, but I can’t blame them for not collecting more data. No one reported any ill effects after they stopped using it. 

I would also like to retract my previous description of the Apollo return policy as “good”. You do get most of your money back, but a 30-day window for a device you’re supposed to test for 28 days before passing judgment is brutal. 

It’s surprisingly hard for me to find referral numbers, but I know I spurred at least 25 purchases, and almost certainly less than 30. That implies an 80% response rate to my survey, which is phenomenal. It would still be phenomenal even if I’d missed half the purchasers and it was only a 40% response rate. Thanks guys. 

Life as a superresponder

Meanwhile, the Apollo has only gotten better for me. I’ve basically stopped needing naps unless something obvious goes wrong, my happiness has gone up 2 points on a 10 point scale (probably because of the higher quality sleep)1, sometimes my body just feels good in a way it never has before. I stress-tested the Apollo recently with a very grueling temp gig (the first time in 9 years I’ve regularly used a morning alarm. And longer hours than I’ve maybe ever worked), and what would have previously been flat out impossible was merely pretty costly. Even when things got quite hard I was able to stay present and have enough energy to notice problems and work to correct them. The Apollo wasn’t the only contributor to this, but it definitely deserves a plurality of the credit, maybe even a majority.

When I look at the people I know who got a lot out of the Apollo (none of whom were in the sample set because they didn’t hear about it from my blog), the common thread is that they’re fairly somatically aware, but didn’t start that way. I’m not sure how important that second part is: I don’t know anyone who is just naturally embodied. It seems possible that somatic awareness is either necessary to benefit from the Apollo, or necessary to notice the effects before your motivation to fight the terrible app wears off. 

Conclusion

The Apollo doesn’t work for most people, you probably shouldn’t buy it unless you’re somatically aware or have severe enough issues with sleep or anxiety that you can push through the warm-up period. 

  1. I don’t use a formal mood tracker. But I did have a friend I ask to send me pictures of their baby when I’m stressed or sad. I stopped doing that shortly after getting the Apollo (although due to message retention issues I can’t check how long that took to kick in). ↩︎

Product Endorsement: Apollo Neuro

Short version: This $310 vibrating bracelet dramatically improved my sleep and moderately improved my emotional regulation. The return policy is pretty liberal so if this seems at all appealing I recommend trying it, or one of the cheaper alternatives I haven’t investigated. Between now and Mothers’ Day they are $300. 

[note: the link I use here is an affiliate link that gives you a $40 discount and me a $50 Amazon gift card] 

EDIT 2023-06-07: they recently updated the Android app and it’s quite bad now. It stalls while loading, or connecting to the device, and I swear it’s sometimes playing the wrong program. It’s still easily worth it for me, but if you’re on the fence I would wait until the new app is polished.

Backstory

As a strong believer in luck-based medicine, I have a pretty liberal threshold for trying shit Facebook advertises to me. Most of it is crap, but every once in a while there is something amazing that justifies all the work and return fees. Previous purchases include resistance band clips that measure force applied, sleep-safe headphones that claimed to measure your HRV, and an infrared heat massage. But when I first looked at the Apollo Neuro’s website, it was too dumb even for me. The explanation for how it worked was a mix of absent and stupid, and the rush to provide scientific evidence was somehow worse than nothing. I only tried it because a friend raved about it. He had also thought it sounded deeply stupid and only bought it because his friend raved about it, and I can only assume she also thought it was stupid until someone raved about it to her, in a great circle of life. Now it is your turn to be told it sounds stupid but it works.

[For some people. My sample size is only three people.]

Benefits to me

My sleep improved a lot. I don’t have precise metrics for this because fitbit is stupid, but 1-3 times a week I wake up feeling drugged (positive valence) because my muscles are so relaxed. This never happened before the neuro unless I took actual drugs*. I also estimate my number of remembered wake-ups has been ~halved. 

The Neuro has about 8 hours of battery. When I started using it I always woke up with the battery drained, meaning I’d activated it repeatedly. I now wake up with it at 70-90% charge, partially because I wake up less and thus am not turning it back on, and partially because I use less intense vibration.

[*TBF I regularly take supplements for sleep, so what I really mean here is “unless I took more drugs than baseline”]

My emotional regulation improved as well. There were a number of stressful things I handled better than my baseline. Some of this is subjective, but there are a few things with obvious before-pictures. Most notably:

I have pretty bad medical anxiety, due most notably to dental malpratice leaving me with painful nerve damage, but also some other stuff. Last fall I had a doctor’s appointment on Friday, followed by friend’s child’s medical emergency on Saturday that, due to their newness to the country, I needed to be in charge for. I did it, but I was wrecked for at least a day afterwards, possibly more, and my partner had to put in a lot of emotional energy helping me recover. ~4 weeks into using the Apollo Neuro I had a dentist appointment in the afternoon, followed 8 hours later by a friend’s medical emergency requiring my attention and eventually a 3AM field trip to the ER for which I was the only available driver. I did have a little freak out once I was home, but I recovered to normal faster than I did from the incident in the fall despite that having been a less intense day with more help. 

I also found myself more decisively liking and disliking things, and noticing when things shifted. At parties the transition from “I’m enjoying this” to “I’m done” is clearer, without a lot of “maybe I should hold out and it will get better”. 

Mechanics

The website is stupid, so let me tell you how it really works. The Neuro is shaped like a watch with a large rectangular face. You can wear it around your wrist or ankle with a band, or clip it to clothes. When activated, it vibrates with oscillating intensity. There are 7 programs with varying oscillation patterns and durations: the wake-up program lasts five minutes with a short peak and shifts between off and on quickly, sleep spends longer in both phases and shifts between them much more slowly. Sleep is the longest program but also lowers intensity over time. You can configure the peak intensity but not duration or pattern, which I feel very oppressed by. 

You can change intensity, and pause and restart the last program from the watch, but to choose a program you need the smartphone app. It is impossible to use the watch without a smartphone, which is a serious quality of life issue for those of us with insomniac older relatives. 

The website talks about cumulative effects a lot, and is clearly pushing you to try for several weeks before judging it. There’s even some gamification for the first N hours. This felt to me exactly as necessary as a punch card from a heroin dealer. I loved it from the moment I put it on and found the little badges cheapening of my relationship with my device. But the cumulative effects part was true: as previously mentioned I needed less and less work from the Neuro to sleep, and lowered the intensity setting over time. When I first started most of the programs besides sleep and wake-up ran together, but at 6 weeks in I started really distinguishing the other programs and having strong preferences about which program, which changed over time. 

The website also advertises the Apollo for concentration problems, but I don’t know anyone who’s really tested that.

One thing I want to give the Apollo is that there is no subscription fee. You give them money and they give you the whole product and app. That should be standard but very much isn’t in the as-seen-on-FB crowd.

Cheaper Alternatives?

The Neuro is very expensive and seems like it can’t possibly cost that much to manufacture. For me paying them for the R+D was worth it. It would even have been worth a second one at the same inflated price, had my sleep not improved to the point I didn’t need it. 

Back when I thought I would need a second one to cover a full night of sleep I looked around for cheaper alternatives. None of them quite worked and I gave up when I no longer personally needed it, but if you’re motivated some might be worth checking out. 

The Senate works on a similar principle, but is no cheaper. Its programs are only 10 minutes, which is much too short for me. 

I tried a few sexual vibrators but even those with intermittent patterns transition from on to off much too quickly, which is how I figured out the gentle transition is so important. Presumably there are some that transition gently but I have no idea how to search for them. 

There are apps to vibrate your phone but they are mostly ad-ridden messes I couldn’t deal with. The one I managed to test had the same problem as the sexual vibrators. 

Products aimed at babies: these mostly run on external batteries, but they can be pretty cheap and many don’t require a smart phone. If you try any of these let me know because the alternative is teaching my elderly aunt to use a smart phone and I am not looking forward to it.

Conclusion

This product is very much in “immensely valuable to some people, price and quality of life issues limit its market for now”. If you have anxiety or sleep issues I seriously recommend trying it; the return fee looks to be about $20, although they’re less forthcoming than one might hope. If money is an issue or you’re just feeling curious you could also try the vibrating baby soothers. Amazon sells several and returns are usually free. 

If you do try the Apollo or any other product in the category I’d love to hear from you so I can share the information (please decide in your heart if you want to share your results before you try it, to avoid biasing the data). You can report your experience here. 

Thanks to my Patreon patrons for supporting this write up, and J for suggesting the Apollo to me in the first place.

Luck-based medicine: My resentful story of becoming a medical miracle

You know those health books with “miracle cure” in the subtitle? The ones that always start with a preface about a particular patient who was completely hopeless until they tried the supplement/meditation technique/healing crystal that the book is based on? These people always start broken and miserable, unable to work or enjoy life, perhaps even suicidal from the sheer hopelessness of getting their body to stop betraying them. They’ve spent decades trying everything and nothing has worked until their friend makes them see the book’s author, who prescribes the same thing they always prescribe, and the patient immediately stands up and starts dancing because their problem is entirely fixed (more conservative books will say it took two sessions). You know how those are completely unbelievable, because anything that worked that well would go mainstream, so basically the book is starting you off with a shit test to make sure you don’t challenge its bullshit later?

Well 5 months ago I became one of those miraculous stories, except worse, because my doctor didn’t even do it on purpose. This finalized some already fermenting changes in how I view medical interventions and research. Namely: sometimes knowledge doesn’t work and then you have to optimize for luck.

I assure you I’m at least as unhappy about this as you are. 

Preface to the Preface

I’ve had nonspecific digestive issues since before I have memories. In pre-school my family joked that I would die as a caveman because there were so few things I would eat, and they were mostly grains. This caused a bunch of subclinical malnutrition issues that took a lot of time to manage and never got completely better. And while I couldn’t articulate this until it went away, food felt gross all the time

It’s hard to convey just how bad this was for me, because it feels like it undermines everything I did to work around it. I’ve always been functional but decidedly less healthy than my friends. I got sick more often and it hit me harder. I was slower to heal from injuries and scrapes and that limited my interest in the more athletic sort of hobbies.  I couldn’t work the same hours, and working hours traded off really sharply against energetic hobbies. I had to spend a lot of time managing food where other people can just show up and eat, which was a constant source of social stress. My genetics say I was destined to have anxiety issues, but the low level malnutrition and justified feelings of food insecurity despite apparent abundance did not help anything.

Eventually in my late 20s. I saw a nutrition-focused psychiatrist who listened to my observations (I could only eat protein with soda), immediately formed a hypothesis (I produced insufficient stomach acid), asked questions to rule it out (which I no longer remember), suggested a test (take stomach acid pills and see if they gave me heartburn), and when it came back positive (no heartburn) suggested a course of action (keep taking stomach acid pills) that showed immediate benefits in practice (indigestion removed, but only when I took the pills). My protein and produce intake increased enormously, and I felt overall much better. 

This is exactly how I want medicine to work. I gathered good data and took it to an expert who immediately formed a model, definitively tested it, and prescribed a course of action that made mechanistic sense.  If you forget that it took almost 30 years and I took those exact same symptoms to other doctors beforehand, it’s a stunning success. 

But it was not a total success. My protein intake maxed out at 50 grams/day, and that was if I made consuming protein a hobby and nothing went wrong. I was doing much better than I had been, but my nutrient tests showed I still had a lot of issues. Eventually the stomach acid pills stopped working, although that seems to be “my stomach started producing more acid and a different problem became the bottleneck”  rather than the pills ceasing to contain acid. But the problem was not solved, and more of the existing treatment did not help.

Standard Preface

I worked with a number of doctors on fixing the remaining digestive, for ~another decade. I had a lot of conversations like the following:

Me (over 20 pages of medical history and 30 minutes of conversation): I can’t digest protein or fiber, when I try it feels like something died inside me. 

Them: Oh that’s no good, you need to eat so much protein and vitamins

Me: Yes! Exactly!. That’s why I made an appointment with you, an expensive doctor I had to drive very far to get to. I’m so excited you see the problem and for the solution you’re definitely about to propose.

Them: What if you took a slab of protein and chewed it and swallowed it. But like a lot of that.

Me: Then I’d feel like something died inside me, and would still fail to absorb the nutrients which is the actual thing we want me to get from food.

Them: I can’t help you if you’re not willing to help yourself.

Or sometimes…

Me (over 20 pages of medical history and 30 minutes of conversation): I can’t digest protein or fiber, when I try it feels like something died inside me. If I make it my top priority I can get maybe 50 grams of protein a day.

Them: Oh that’s no good, you need 70 minimum, and really more like 100. Also because I’m a naturopath I’m morally obligated to tell you to give up eggs, dairy, and wheat.

Me: That’s gonna be hard seeing as those three are 90% of my protein intake and by far the easiest forms of protein to digest.
Them: What if you ate pea protein?

Me: Well that’s harder so…worse.

Them: What about hemp?

Me: That is even harder than pea protein.

Them: If you’re not going to try why are you even here?

These exchanges were incredibly draining for me, so I didn’t have them that often. Every year or two I’d get my hopes up for a new doctor, pay a shitton of money (these doctors are never covered by insurance) for several emotionally draining appointments, and then get told they couldn’t help me and this was a failure on my part.

After several years of that pattern I gave up and went back to my old PCP. She hadn’t solved the problem either, but she had solved other problems, had ideas to try for this one, and believed it was a physical rather than moral problem. Unfortunately she is very busy, and sometimes pawns me off on her assistant doctors, who are idiots. That second conversation was with one of those, although in the real conversation I was less witty, and was more like “*sob* no *sob* I told you *sob* I CAN’T”. 

I refused to see that doctor again, but this left me little leverage when they assigned me a different sub-doctor to handle a post-covid rash back in April. You know how naturopaths complain about western medicine being mechanical and reactive and not taking the time to reach a systemic understanding? Well this guy, who we will call Dr. Spray-n-pray, was determined to fight for equality by taking the same approach with unregulated supplements. He guessed I had an allergic reaction and threw 5 different antihistamines of varying legitimacy at me, with no mention of testing the hypothesis, monitoring my progress, expected changes, duration of treatment… 

And it worked.

Not on the rash; I eventually had to go to urgent care for that. But shortly after I started the pills, I found myself eating 50 grams of protein in a sitting and then going back for more the next meal. I also started chowing down on produce, and at some point realized I couldn’t remember the last time I’d had dessert. I had known I had some aversion issues with food but didn’t realize how gross I found it until the feeling went away and I could just eat without feeling contaminated. About here is when I started a food diary and found I was regularly hiting 100g of protein/day. When I crashed my scooter I ate 350 grams of protein over two days, suggesting I could do that any time I wanted but chose not to, suggesting my body was getting all the protein it felt it needed, all of the time.

I’m not sure I can convey what a big deal this is either. I would have paid several years’ salary for this cure without thinking. It is now possible for me to feel okay at an emotional level it wasn’t before. Plus, you know, I can actually get the nutrients I need to run my body and stuff.  My injuries after that scooter accident healed noticeably faster than past injuries. The fact that I haven’t caught an illness since April’s covid isn’t conclusive, since it’s summer and I haven’t done anything high risk, but it is interesting. 

[I do have covid antibody results from the December (8 months after my vaccine) and August (4 months after catching covid)  and my levels have gone way up, but that’s more likely due to the more recent and stronger immune stimulus.]

But that evidence came later. Back in May the timing of the miracle suggested that one of Dr. Spray-n-pray’s pills was responsible. This was more or less confirmed when I weaned off the various pills and the subtle grossness around food started to return. I could also feel growing sugar cravings. So it was important to figure out what the miracle pill was and get back on it immediately.

[If any of you are thinking “well it could have been a coincidence”: no it fucking couldn’t. I did not carry this around for 35 years and try everything to fix it only to have it suddenly go into remission for no reason. I’ll believe covid fixed it before I believe that.]

I had always assumed the reason doctors turned on me was that it was easier than accepting that they couldn’t solve my problem. But this one had fixed my problem! Not on purpose or anything, but I was fully prepared to pretend it was. Now we just had to figure out what had worked and why, in case it suggested any additional actions. I made a spreadsheet tracking the changes as best I could – when my diet changed (using grocery order data), when I’d started and stopped which pills. Surely my data plus his doctor ego would help us get to the bottom of this.

At the time of my follow-up appointment I had a strong guess which supplement had helped based on timing, but it didn’t make any sense. The active ingredient was Boswelia (specifically BosPro brand (affiliate link). I’m afraid to try another in case it breaks the spell). Boswelia is sometimes described by alt medicine websites as helping digestive issues, but in the same way they describe every supplement as helping digestive issues. “Helps anxiety, allergies, autoimmune disorders, inflammation, and digestion” should just be a stamp. This isn’t even necessarily illegitimate – the body is complicated and lots of things are entangled, especially with inflammation.

But I’ve tried a lot of these supplements at one point or another and there was absolutely no reason to predict this one would be different, even if I had researched it ahead of time. Examine.com is pretty positive on Boswelia but doesn’t list digestion as an issue it solves. Everything is connected to everything else in the body and it was still pretty hard for me to make a causal chain between Boswelia’s alleged mechanisms and improvements in my digestion. So I was extremely excited for Dr. Spray-n-pray to explain why it had worked.

All this was on my mind when I finally got to ask Dr. Spray-n-pray why his treatment had worked. He mumbled something about inflammation and moved on. He had zero interest in my spreadsheet or a more mechanistic understanding of what had changed. I confirmed the miracle was from BosPro when I resumed taking it and the digestive improvements returned (including the creeping feeling of grossness going away). It’s now 5 months since I started taking it and it still works but I have no idea why.

This is not how I want medicine to work, at all. A medic who clearly was not trying for a systemic understanding recommended a lot of stuff and one of them happened to fix a problem as unrelated as could be that I’d spent a decade+ searching for without success? Even knowing definitively that it works we have no idea why, and what would help or hinder it? And there’s ~0 evidence this would help other people with the same condition?

This is bullshit. But bullshit is working where logic feared to tread.

Other Evidence

This experience isn’t what got me on the path of luck-based medicine though. I was already at that point when the supplements were prescribed, which is why I took them instead of doing 5 hours of research and ignoring Dr. Spray-n-pray’s suggestions as the ravings of an idiot. There were a lot of contributors to my shift, but a few stand out.

A few years ago I ran a series of epistemic spot checks on various self-help books, and found that how helpful they were had no correlation with how rigorous or true their theoretical backing was.

Then last year I ran that ketone ester study. I and a handful of people I know get insane gains from using ketone esters – better than Ritalin with none of the side effects – but when I ran an RCT (n=8-12 depending on how you count) no one reported any benefits. 

Or take Slime Mold Time Mold’s all-potatoes-all-the-time diet study (which happened after I started on the magic pills, but is too good an example to pass up). I have an extremely long list of complaints about their hypothesis and follow up study:

  • They failed to contextualize it as a monodiet and discuss the classic monodiet problems.
  • Potatoes aren’t nutritionally complete and don’t have enough protein for people to thrive. They gestured at some of the nutritional deficiencies but I think not hard enough, and believe potatoes have more protein than reported but have not pointed to any evidence to that effect.
  • They tracked weight loss over 28 days but will not be doing a follow-up for six months. Since the default after rapid weight loss caused by an unsustainable diet is immediate regain, this is unconscionable.
  • I haven’t had time to dig into the object-level facts in the argument between SMTM and a persistent critic, but with my monkey social brain it sure does look like SMTM is blowing off well-founded criticism (given in a super aggressive manner).
  • They treat weight loss as an unalloyed good no matter how fast or what the person’s starting weight was.
    • I have not looked into the popular “weight loss not safe above 2 pounds per week” claim and it wouldn’t shock me if it were made up, but if I had an intervention with double that impact I’d spend an hour investigating the claim.
    • Weight loss beyond a certain body fat percentage is bad. You need that stuff.
  • They did warn people about solanine poisoning but I think they should be more concerned about it.
  • Analysis featured a lot of stories along the lines of “Did X on Wednesday and lost 2 pounds on Thursday” and fat loss does not work like that. Two pounds overnight is either water weight or has a lookback period longer than 24 hours.
    • I’m deeply confused about that second part, I don’t understand why or how weight-loss-that-is-definitely-not-changes-in-water-retention comes in chunks. If you have an answer I’m quite curious.

That’s a lot of epistemic sins. OTOH, their potato diet results inspired me to try the minimal potato diet, which consists of eating some potatoes every day (I started with ~100g of baby potatoes), and I’ve lost 15 pounds in 3 months. That level of weight loss with zero sacrifices buys you a lot of epistemic forgiveness, especially when my miraculous dramatic dietary improvements did fuck all to the number on the scale.

[ People already writing their “potatoes can’t possibly be the cause it must be psychosomatic” comments in their head: I see you. Your hypothesis is perfectly reasonable; in your position it would be my first reaction too. But in this particular case you’re going to need to explain why potatoes caused that magic mental shift when giving up soda, a dramatic improvement in diet and removal of dessert entirely, complete emotional reorientation to food, a mild prescription stimulant, and varying levels of exercise did nothing, and ketone esters worked better than all of those but much worse than potatoes. Comments not attempting this will be deleted or mocked as I see fit.]

If you are thinking “ah, but clearly those all did contribute and the potatoes were just the last step”: I agree that’s likely. If I’d started minimal potato diet before BosPro it either wouldn’t have worked or would have been extremely bad for me. But since it seems to work for at least some other people who didn’t have all this baggage I think we need to update in that direction.]

Or take every person who got a second opinion on their cancer and was recommended diametrically opposing treatment plans. Doctors as a class are not as epistemically virtuous as I’d like, but that’s not (always) why they propose wildly divergent treatment plans. In most cases it’s because the answer isn’t obvious, or at best has only been obvious for a few years.

And then there’s the absolute shitshow that is nutrition research. No one knows what the average optimum nutrient level is and even if we did it wouldn’t be that helpful for figuring out the optimum level for a given individual, because humans are so unbelievably variable.

I could go on here, but if you’re reading my blog you’re probably already on board with shit being extremely complicated and I don’t want to belabor the point.

Moral of the story: when intellect fails, try luck guided by intuition

Some medicine is very deterministic. Antibiotics, most of the time. That daylong IV drip when I had norovirus that probably turned the infection from deadly to a kind of annoying 36 hours. We may not know the optimum level of a given nutrient but most severe deficiency diseases can be solved by giving you the thing you’re severely deficient in. My impression is statins work pretty reliably.

But a lot of medicine just seems to be kind of random. People go through 10 antidepressants and then somehow the 11th one works great. Ketone esters increase my energy level so much I gave up soda and caffeine entirely but do nothing for most people. All those books where the cure was a miracle for someone, and it can’t just be a placebo because there’s no reason for the 35th placebo to be the one that works but nothing else makes sense.

All of which leads me to conclude that once you have exhausted the reliable part of medicine without solving your problem, looking for a mechanistic understanding or even empirical validation of potential solutions is a waste of time. The best use of energy is to try shit until you get lucky.

Not at random or anything. My guess is the world contains metis and you do better-than-chance preferentially trying things that helped one guy on a message board for your condition (even though it was shown to make no difference in real studies) or going to alt-modality practitioners (even the one with proactively stupid justifications they insist on sharing). The latter is especially true if you can find a practitioner that accepts that their treatments don’t always work and have a system to notice that and change course, but I think maybe even the really gung-ho ones sometimes have good ideas (you just have to set up your own system for deciding when to quit). Just don’t get hung up on “do we understand why this works?” or “does this work for other people?”

Also please remember that side effects and drug interactions are a thing. Anything with a real effect can hurt you. I gave a very caveated suggestion of BosPro to someone on Twitter and it caused something akin to niacin flush in them. This is the same brand that does nothing to me but makes me better at digestion and uninterested in sugar.

So I guess the full and accurate statement of my beliefs is “Try solving problems with understanding first, but accept when you’ve hit diminishing returns and consider if your energy isn’t better spent increasing your surface area to luck”.

Parting shots

Fuck you every doctor who told me my digestive problems were in my head or my fault for being a bad patient and you couldn’t help me until I solved the problem that drove me to you. You were factually incorrect and you should feel terrible.

For potential clients in particular

People sometimes approach me for medical literature reviews aimed at their specific problem. There are forms of these I will do, but those forms do not include producing a mechanistic model and high-probability treatment for someone’s persistent, sub-clinical, amorphous problem that medicine has failed to solve. There are a few reasons accepting these commisions would be wasting the clients’ money, and one of them is that by the time they come to me they have found all the low hanging deterministic fruit. The best I can do is spend a ton of time generating lists of things that might work. Sometimes I do offer that, but people tend to prefer my other offer of a referral to a researcher that’s better at individualized treatment.