The response to my medical miracle post has been really gratifying. Before I published I was quite afraid to talk about my emotional response to the problem, and worried that people would strong arm in the comments. The former didn’t happen and the latter did but was overwhelmed by the number of people writing to share their stories, or how the post helped them, or just to tell me I was a good writer. Some of my friends hadn’t heard about the magic pills or realized what a big deal it was, so I got some very nice messages about how happy they were for me.

However, it also became clear I missed a few things in the original post.

Conditions to make luck-based medicine work

In trying to convey the concept of luck-based medicine at all, I lost sight of traits I have that made my slot machine pulls relatively safe. Here is a non-exhaustive list of traits I’ve since recognized are prerequisites for luck based medicine:

  • I can reliably identify which things carry noticeable risks and need to be assessed more carefully. I feel like I’m YOLOing supplements, but that’s because it’s a free action to me to avoid combining respiratory depressants, and I know to monitor CYP3A4 enzyme effects. A comment on LessWrong that casually suggested throwing activated charcoal into the toolkit reminded me that not everyone does this as a free action, and the failure modes of not doing so are very bad (activated charcoal is typically given to treat poison consumption. Evidence about its efficacy is surprisingly equivocal, but to the extent it works, it’s not capable of distinguishing poison, nutrients, and medications).
    • This suggests to me that an easy lever might be a guide to obvious failure modes of supplements and medications, to lower the barrier to supplement roulette. I am not likely to have the time to do a thorough job of this myself, but if you would like to collaborate please e-mail me (elizabeth@acesounderglass.com).
  • A functioning liver. A lot of substances that would otherwise be terribly dangerous are rendered harmless by the human liver. It is a marvel. But if your liver is impaired by alcohol abuse or medical issues, this stops being true. And even a healthy liver will get overwhelmed if you pile the load high enough, so you need to incorporate liver capacity into your plans.
  • A sufficiently friendly epistemic environment. If it becomes common and known that everyone will take anything once, the bar for what gets released will become very low. I’m not convinced this can get much worse than it already has, but it is nonetheless the major reason I don’t buy the random health crap facebook advertises to me. The expected value of whatever it is probably is high enough to justify the purchase price, but I don’t want to further corrupt the system. 
  • Ability to weather small bumps. I’m self-employed and have already arranged my work to trade money for flexibility so this is not a big concern for me, but a few days off your game can be a big deal if your life is inflexible enough. Somehow I feel obliged to say this even though I’ve lost work due to side effects exactly once from a supplement (not even one I picked out; a doctor prescribed it) and at least three times from prescription medications.
  • A system for recognizing when things are helping and hurting, and phasing treatments out if they don’t justify the mental load. It’s good to get in the habit of asking what benefits you should see when, and pinning your doctor down on when they will give a medication up as useless.
    • Although again, I’ve had a bigger problem with insidious side effects from doctor-initiated prescription meds than I ever have with self-chosen supplements.
    • Probably there are other things I do without realizing how critical they are, and you should keep that in mind when deciding how to relate to my advice. 

Feel free to add your own conditions in the comments and I’ll add my favorites to this list.

Ketone Esters

Multiple people have asked for details on the ketone esters thing, and I sure hope that’s because I convinced them to try stuff rather than somehow sold ketone esters in particular as good. Answers to the common questions:

  • I use KE4, but I haven’t tried any others. I think when I originally looked it was the only one available without caffeine, but I could be wrong, or that could have changed.
  • When I first started and was doing longer intermittent fasting I’d do 10-15ml at night, 5-10 in the morning, and 5-15 before workouts (all on an empty stomach). I currently only do 5ml, before bed, to smooth out blood sugar issues whle sleeping.
    • The change is partially because I’m recovering from an injury and that does not mix with intermittent fasting, and partially because KE seems to have caused durable changes so there’s less point. I went from 3-4 sodas a day to none a few days after starting KE4 and it’s never reverted. The only caffeine I’ve had is incidentally in chocolate, and after the Bospro I’ve barely even had that.

Minimal Potato Diet

Again I am not recommending this, but if you would like to know what I’m doing:

  1. I use small potatoes- ideally the really tiny ones, but half-a-fist size at most. And I aim for a variety of color potatoes. These are out of a not particularly verified belief that skin has more vitamins than the core and that color means vitamins, or at least antioxidants. I also prefer the way the small ones cook.
  2. I cook the potatoes as soon as I receive them. If that’s not possible they might spend a few days in the fridge. When I let them age enough to get eyes they upset my stomach.
    1. A lot of people on the potato diet had to skin their potatoes to prevent feeling ill. I am curious if that would have been required if they’d used very new potatoes.
  3. I cook the potatoes by throwing them onto a cookie sheet and roasting at 350F for 45 minutes. I do this because it’s really quick and I prefer the dry texture.
    1. I cook 3 pounds a time because that is both the size of the bag they come in and about what my cookie sheet can hold.
    2. I tried gnocchi, but the additional flavor made me get tired of it faster. Also maybe my weight loss slowed around then but the potato weight loss has been weirdly punctuated so I dunno.
    3. I wish I could share a graph of just how weird the weight loss has been – same weight for 1-2 weeks, then 3 pounds in 4 days. Unfortunately, I keep changing my creatine dosage which ruins the aesthetics with a lot of water weight changes.
  4. The cooked potatoes spend at least a day in the fridge before eating, and ideally several. This is out of a slightly verified belief that the post-cooking cold converts some of the starches from digestible to indigestible, which lowers calories while doing something vaguely good for my digestive tract. But since I’m cooking much less often than eating they inevitably log a lot of fridge time anyway.
  5. Originally I ate about 100g/day, mostly in the morning but if I woke up craving something I’d start with that. For a few days now I’ve been experimenting with eating smaller amounts of potato more times per day and that’s maybe driven calorie consumption further down, but far too early to say for certain, and it’s not totally clear that would be desirable.
    1. This is based on my hypothesis that potatoes reduce calorie consumption in me by being a relatively bland food with (small amounts of) lots of different micronutrients, plus some help from the fiber. 
    2. Slime Mold Time Mold thinks it’s potassium and is testing that now. 
  6. I originally described myself as making no other changes. That was 100% true in the beginning, I will admit I now check in with my food diary calorie total and adjust a bit (including upwards, although not sure about the relative frequency). The point of the food diary is micronutrient tracking but it’s hard to avoid reacting to the calorie number once it’s there. I’m not sure that’s actually affecting things much – on days I happen to have a high count I eat much less the next few days without thinking about it. 
  7. My food diary is very clear I am not reliably hitting the RDA for most vitamins. I think you can do it on my calorie count but it would be a lot of effort and planning and I’m on vitamins anyway. Hopefully I get nutrition test results in the next month, although that will be much more a referendum on the Bospro than the potatoes. 
average nutritional intake for the last two weeks

A male friend lost 4 pounds on a 50% potato diet and then plateaued (but that could be from an injury). A female friend tried my minimal potato diet and experienced no change.  I think if that worked reliably we would already know about it.

Bonus

Shout to reader George who connected me with an offline friend who had similar symptoms with the same cure, who has done a ton of research into mechanisms and suggested some follow-ups. They’re not guaranteed to work but this feels like a rich vein to me. Thanks George and offline friend!

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3 comments, sorted by Click to highlight new comments since: Today at 8:04 AM

A system for recognizing when things are helping and hurting, and phasing treatments out if they don’t justify the mental load. It’s good to get in the habit of asking what benefits you should see when, and pinning your doctor down on when they will give a medication up as useless.

It's worth noting here that human memory can be pretty bad. If you care about an issue enough to try multiple different solutions it's likely also worthwhile to have regular measurements for the issue, so that you are not relying on your memory. 

If you have an issue like pain in a body area, marking the location of the pain and then photographing it, is one way to have a good record.

One failure case is that there are a few treatments like colon cleansing, whose popularity partly relies on them producing surprising results for the person, that are medically useless. It's important to be able to say "This treatment does something surprising but it doesn't really solve the issue I'm having, so I shouldn't take the fact that it does something surprising as evidence that it's somehow working." 

"an easy lever might be a guide to obvious failure modes of supplements and medications"

I desire to see more things like this.. Especially if they're presented not as a list of "gotchas", but as specifics of a general moving-parts model of how naive models/strategies operate in a complex space. Should be lots of base rates being thrown around.

A system for recognizing when things are helping and hurting, and phasing treatments out if they don’t justify the mental load

This part has been a historical blocker to me using luck/exploration based medicine. If one is dissociated, alexythmic, or has an experience completely dominated by one sensation like pain or anxiety, then it's going to be pretty hard to notice fine gradations in how well they're doing. Not having precision really narrows the possible paths to success; effect has to be almost overdetermined before one actually updates on the evidence.

An extension of the noticeable risks and helping/hurting points I think is worth separating out: how to identify and avoid literal poisons. Not risky bets, per se, but things that are likely to directly harm the objective (health) and the other conditions necessary to make your strategy viable (kill your liver, mind, ability to move under your own power).I think it's a useful comparison point to know what it takes to figure out what is safe to eat in an unfamiliar environment. There's a protocol for slow steps of Graduated exposure and Waiting to see how well it's tolerated. Accumulated culture and the FDA are so very cheating technique. It's worth understanding how much work it otherwise takes to narrow down what world you are in without leaning on them.

A system for recognizing when things are helping and hurting

Do you have a particular way you recommend to measure and track mental effects? I have not been able to find something that is sufficiently sticky and sufficiently informative and sufficiently easy.

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