Short response: Check out the Cochrane Library on mental health. (Browse by Topics in the left-hand side, Expand, then click on Mental Health—as of just now there are 406 entries.)
Evaluating healthcare interventions is hard. The gold standard is a randomised controlled trial (RCT), published in a peer reviewed journal. But there are all sorts of problems with single trials, some of which you allude to here. It’s a really great idea to do a systematic review of all published trials and combine the good ones to get the best evidence available.
Doing this well is really hard—you need specialist expertise in the specific area to correctly interpret the primary literature (the RCTs), and specialist skills in systematic reviewing (as with RCTs themselves, there are many obvious and subtle issues about how to do them well). And it takes ages.
Luckily, there’s an international collaboration of people, called the Cochrane Collaboration who get together to do this sort of thing, and have been beavering away for 20 years.
Unless you have significant resources, you are unlikely to do better on any topic than the latest available Cochrane Review. And if you do have significant resources, you’re likely to do well to start with it.
When a health issue pops up for me or someone I care about, I jump straight for the Cochrane review (and also any relevant guidelines and protocols, but that’s a tier down the evidence quality pyramid), and it’s like I’m getting a well thought-through briefing from the world’s experts on what we currently know about what works and what doesn’t.
I love it.
As a postscript, there is a whole field of healthcare informatics that looks at how to find good academic papers on a particular issue—I once ran a whole course on the topic (and related ones). The shortcut answer is ‘use Cochrane’; the long spadework answer is ‘search Medline’.
I forgot to mention: if you have money rather than time available, there’s MetaMed, which has personnel overlaps with LW, and does the looking-up job for you for a fee. See the write-up/pitch for it by Eliezer.
He takes individual variation very seriously. Blood and saliva tests are a good idea before supplements because needs and reactions for supplements vary a lot.
He believes that the human body has evolved to be good at living, and it’s better to support it and find out what’s getting in its way rather than just trying to prevent symptoms.
At the same time, he also comes up with a scoring system for a person’s symptoms—efforts at treatment should either improve the score or be discontinued.
Possibly important for LW: He believes that very low carb diets + hard exercise with insufficient recovery + fasting all increase stress hormones, and can lead to exhaustion that takes a lot of time and work to cure, and that people don’t necessarily get a lot of warning before they’re in trouble.
Possibly important for LW: He believes that very low carb diets + hard exercise with insufficient recovery + fasting all increase stress hormones, and can lead to exhaustion that takes a lot of time and work to cure, and that people don’t necessarily get a lot of warning before they’re in trouble.
In general this seems accurate but I request clarification regarding the ‘hard exercise’ claim. The word ‘hard’ in that context sets off warning bells. While either suitably extreme instantiation of ‘hard’ or a tautological instantiation of ‘insufficient recovery’ could make this claim denotatively true the connotations are something to be wary of. In particular I would like to assert the following claims and in so doing invite disagreement if the advice from your source happens to contradict them:
High intensity exercise is better than low intensity exercise in terms of effect on stress hormones. For a given degree of physiological distress and fatigue induced better stress hormone results come from high intensity exercise than low intensity exercise.
For the prevention of overtraining—the state where recovery is insufficient to the demands of exercise—an often effective solution is to reduce the amount of low intensity exercise and replace it with high intensity exercise. Obviously there will be less exercise as measured by time but more by measures of physical adaptation.
Except in extreme cases the effect of high intensity exercise on stress hormones is decidedly positive. Not only does such exertion reduce the level of stress hormones (and stress) in the body on average it also makes the body better able to resist the effects of stress. In particular the new neurons produced due to high intensity exercise are less vulnerable to destruction via chronic or acute stress. Many rats died in the discovery of this phenomenon.
I don’t wish to criticise or reject your source. Pardon me if I am excessively wary of the wording. Unless his advice contradicts the above claims, what you have conveyed of his lessons thus far indicates that he is worth listening to. I’ll add that his observation about fasting matches my research on the subject. Those that eat irregularly can in general improve their cortisol levels by consuming protein in the morning—that seems to be a fairly consistent finding.
From memory, since I don’t want to hack through the podcast again: He came up with an extreme example (something like Crossfit + an hour of cardio a day) and then clarified by saying that Crossfit can be very good, but it’s important to have a coach rather than do it on your own, and also something to the effect while it’s better to get blood tests and such, you have a clue that you’re pushing yourself too hard if you’re developing sleep problems.
From a different source: Serious problems with “Strong is the new skinny”—take a took at the number of comments from coaches who say they have to restrain their clients from over-training. I think there’s a cultural problem.
The more I learn about human metabolism, the more I realize how complex it is. And because of that, I am more skeptical of simple, broad claims, that aren’t backed up by solid research.
I wasn’t familiar with Cochrane; that looks like an excellent resource. Unfortunately, it looks like a lot of summaries haven’t been updated in a decade—is this something to be worried about, and if so, is there another resource someone can recommend other than simply reading PubMed and doing your own meta-analysis?
Short response: Check out the Cochrane Library on mental health. (Browse by Topics in the left-hand side, Expand, then click on Mental Health—as of just now there are 406 entries.)
Evaluating healthcare interventions is hard. The gold standard is a randomised controlled trial (RCT), published in a peer reviewed journal. But there are all sorts of problems with single trials, some of which you allude to here. It’s a really great idea to do a systematic review of all published trials and combine the good ones to get the best evidence available.
Doing this well is really hard—you need specialist expertise in the specific area to correctly interpret the primary literature (the RCTs), and specialist skills in systematic reviewing (as with RCTs themselves, there are many obvious and subtle issues about how to do them well). And it takes ages.
Luckily, there’s an international collaboration of people, called the Cochrane Collaboration who get together to do this sort of thing, and have been beavering away for 20 years.
Unless you have significant resources, you are unlikely to do better on any topic than the latest available Cochrane Review. And if you do have significant resources, you’re likely to do well to start with it.
When a health issue pops up for me or someone I care about, I jump straight for the Cochrane review (and also any relevant guidelines and protocols, but that’s a tier down the evidence quality pyramid), and it’s like I’m getting a well thought-through briefing from the world’s experts on what we currently know about what works and what doesn’t.
I love it.
As a postscript, there is a whole field of healthcare informatics that looks at how to find good academic papers on a particular issue—I once ran a whole course on the topic (and related ones). The shortcut answer is ‘use Cochrane’; the long spadework answer is ‘search Medline’.
Good luck.
Wow, now I’m really glad I asked! This sounds like exactly what I was looking for. Thank you!
You’re welcome. Glad to help.
I forgot to mention: if you have money rather than time available, there’s MetaMed, which has personnel overlaps with LW, and does the looking-up job for you for a fee. See the write-up/pitch for it by Eliezer.
Not quite enough of it for MetaMed, but thank you for the suggestion.
This health coach seems sensible, and might be cheaper than Metamed.
Nancy, what made you think that coach was sensible?
He takes individual variation very seriously. Blood and saliva tests are a good idea before supplements because needs and reactions for supplements vary a lot.
He believes that the human body has evolved to be good at living, and it’s better to support it and find out what’s getting in its way rather than just trying to prevent symptoms.
At the same time, he also comes up with a scoring system for a person’s symptoms—efforts at treatment should either improve the score or be discontinued.
Possibly important for LW: He believes that very low carb diets + hard exercise with insufficient recovery + fasting all increase stress hormones, and can lead to exhaustion that takes a lot of time and work to cure, and that people don’t necessarily get a lot of warning before they’re in trouble.
In general this seems accurate but I request clarification regarding the ‘hard exercise’ claim. The word ‘hard’ in that context sets off warning bells. While either suitably extreme instantiation of ‘hard’ or a tautological instantiation of ‘insufficient recovery’ could make this claim denotatively true the connotations are something to be wary of. In particular I would like to assert the following claims and in so doing invite disagreement if the advice from your source happens to contradict them:
High intensity exercise is better than low intensity exercise in terms of effect on stress hormones. For a given degree of physiological distress and fatigue induced better stress hormone results come from high intensity exercise than low intensity exercise.
For the prevention of overtraining—the state where recovery is insufficient to the demands of exercise—an often effective solution is to reduce the amount of low intensity exercise and replace it with high intensity exercise. Obviously there will be less exercise as measured by time but more by measures of physical adaptation.
Except in extreme cases the effect of high intensity exercise on stress hormones is decidedly positive. Not only does such exertion reduce the level of stress hormones (and stress) in the body on average it also makes the body better able to resist the effects of stress. In particular the new neurons produced due to high intensity exercise are less vulnerable to destruction via chronic or acute stress. Many rats died in the discovery of this phenomenon.
I don’t wish to criticise or reject your source. Pardon me if I am excessively wary of the wording. Unless his advice contradicts the above claims, what you have conveyed of his lessons thus far indicates that he is worth listening to. I’ll add that his observation about fasting matches my research on the subject. Those that eat irregularly can in general improve their cortisol levels by consuming protein in the morning—that seems to be a fairly consistent finding.
From memory, since I don’t want to hack through the podcast again: He came up with an extreme example (something like Crossfit + an hour of cardio a day) and then clarified by saying that Crossfit can be very good, but it’s important to have a coach rather than do it on your own, and also something to the effect while it’s better to get blood tests and such, you have a clue that you’re pushing yourself too hard if you’re developing sleep problems.
From his blog: On combining fasting and exercise.
From a different source: Serious problems with “Strong is the new skinny”—take a took at the number of comments from coaches who say they have to restrain their clients from over-training. I think there’s a cultural problem.
Fasting can be bad for people with disregulated cortisol.
Thanks NancyLebovitz.
The more I learn about human metabolism, the more I realize how complex it is. And because of that, I am more skeptical of simple, broad claims, that aren’t backed up by solid research.
I wasn’t familiar with Cochrane; that looks like an excellent resource. Unfortunately, it looks like a lot of summaries haven’t been updated in a decade—is this something to be worried about, and if so, is there another resource someone can recommend other than simply reading PubMed and doing your own meta-analysis?