Why Your Weird Friend is in Great Shape (and you aren’t)

Every urbanite has a wacky friend whose dog is gluten sensitive (obviously right?), swears by the detox effects of hot yoga, goes through phases of reiki, chiropractic, rolfing, and rotates between a cornucopia of weird and seemingly extreme diet systems like Paleo, Ketogenic, and intermittent fasting. Her skincare regimen? You’d need to be a beautician to even understand what she’s saying. I roll my eyes at her too, but despite all the myth busting of the medical establishment, who could possibly argue with her washboard abs and glowing skin?

At DermLetter we occasionally write pieces that debunk extraordinary claims about skincare, diets, or other psuedo-science. You might also love to poke fun at pseudo-science, but do you notice that quite often, the believers actually do seem healthy and to do well, controlled trials and the scientific method be damned? Besides, science can be a bit of a downer to at times. Exercise? Not all that effective for weight loss1. Hot yoga? Actually quite good, at nearly 500 calories/hour, but a lot of lost weight is water through sweat--no there is no detox effect2. Under sufficient scrutiny (double-blind tests, sufficiently controlled clinical trials), most extraordinary claims fail, as would be expected. Being critical and asking for evidence can make life seem lame at times.

Anecdotally, outside the lab, many real people swear by the magic of almost every practice, scientific or not, whether it’s a special diet, exercise regimen, healing, rolfing, acupuncture, or other modality that isn’t quite recognized as medicine. You name it; there will be ardent followers. Your New Age friend isn’t making money selling whatever she’s into. She’s certainly fit, healthy, and sincerely has your best interest in mind. The optimism of people who follow (insert favorite practice or diet), love it, and have nothing to gain from promoting it vastly outnumber those who have self-interest and self-promotion in mind. So, keeping an open mind, you decide to join her to that hot yoga class, and you can’t help but notice that almost everyone in class seems to be in great shape. Maybe WebMD is wrong, and yogic meditation is the magical cure? Which makes you think for a second--is it possible that the conspiracy theorists were right, and it is Big Pharma and the evil medical establishment that is engaged in science denial to shut out naturopathy and alternate or competing modalities? Not quite.

Selection Bias Makes the World go Round

  • People on Dating Site X are 4 times as likely to find a relationship as those who aren’t using it!
  • Most people really love or really hate this restaurant on yelp.com!
  • Gamblers will tell you that beginners are always lucky.
  • Hot yoga will make you look shredded!
  • People who use this 10 step skincare regimen every day will have radiant skin!

We’ve all seen and perhaps even tempted by ads or claims like these that bombard our post-internet lives. These claims may in fact, be true, but not necessarily for the reasons that you think. People who are actively looking for a relationship by joining a dating site are obviously more likely to find a relationship than those who are not (The comparison needs to be with people that join *other* dating sites). The people that bother to write an online review tend to have strong opinions good or bad. Beginner’s luck is true in the sense that gamblers who immediately lose a bunch generally take up other hobbies and get removed from the sample. Many hot yoga practices are demanding, generally attracting only those that are already quite fit or have sufficient determination to continue. People who are willing to purchase and go through complicated skincare regimens care a lot about their skin, and take care of themselves in many other ways as well. Very often, the people that are attracted to a website, or a claim, are not representative samples of a general population; they are already exhibiting select characteristics, and this is why, under the scrutiny of controlled clinical trials, where you isolate away these other factors, over the top panacea claims get debunked rather quickly whether it’s acupuncture, chiropractic, multi-vitamins, hot yoga, or the Atkins diet as are the more miraculous claims of various “superfoods.” Even the effect of exercise (the general benefits of which nobody disputes) on weight loss is often disappointingly marginal when you isolate the other factors away. If you have time, you can search up any number of studies on any topic from the Public Library of Science, but I can practically guarantee you this: The effect of any individual non-medical modality is marginal when the factor is isolated, and scrutinized by cold evidence alone.

Then why do so many people swear by weird and often demanding regimens? It’s the same reason that the more “hard-core” communes and churches often survive and thrive better than the more liberal ones that impose less inconvenience or cost on its members. The friend of yours that picks up every latest pseudo-science fad is already unusually dedicated to keeping fit. She might attribute her success to a specific and eye-roll inducing fad, but her baseline lifestyle is already anomalous. It’s the same reason that the $5000 elite workout regimen is actually effective; anyone paying that much is likely to have a high baseline fitness, and is highly committed to ANY regimen (and probably has a very high income to boot). External barriers like high prices, severe restrictions, or insanely demanding routines and regimens automatically select out all but the most committed, capable, and dedicated people. Survivorship bias can cloud our perception on the effectiveness of treatments, regimens, diets, or other modalities.

Good (and bad) Habits Add Up Outside the Lab

The point of clinical trials is to get an accurate measurement of how effective a treatment is. To do so, the trial patients need to have somewhat uniform characteristics. Isolating factors is important to ensure that it’s the diet or therapy that is working (or not) and not another factor, like simply exercising more, having a better overall lifestyle, or simply the result of the placebo effect. In the real world, however, isolation is not the norm. A much more typical narrative goes like this:

You go to the hot yoga class. It’s brutal, but you sleep a bit better that night and feel a bit more energy the next morning. The next day you make sure to drink a bit more water throughout the day so that you’re better prepared for next day’s class. You eat just a bit less than normal since you have more water and feel slightly more satiated than normal. The class is a bit easier, and you feel like you improved already (though that’s probably mostly in your head). A week later, you’re more conscious of the effect that diet has on your performance at the hot yoga class, so you make minor adjustments like staying hydrated, eating cleaner, and sleeping earlier. A few months in, you eat better, feel better, are 10 pounds lighter, have better skin, now go to the gym, get to bed earlier, generally feel better, and have a more positive outlook on life. You attribute all this to the practice of hot yoga, which seems to have triggered everything. In reality, despite attributing it to one factor, your entire lifestyle is very different from where you were at prior to yoga. This feedback loop is something that clinical trials factor out by design. Yoga (and almost everything else in isolation) might be marginal in the lab, and it might seem that nothing is worth doing at the outset, but in the real world, both positive and negative feedback loops can change entire lifestyles.

What the Rest of Us Can do

So you’re not a health-nut, and you’re not really into the whole “extreme regimens and extreme claims” which is most of us, but you are interested in being healthier, looking better, and feeling better this year. Here’s some practical do's and don’t tips to look more like your quirky friend without wildly abandoning reason.

Do:

  • Be more open-minded. Try out new things. Quite often it’s you, the skeptic that’s closing out opportunities. Your quirky friend might not be the best fact-checker, but she’s open-minded and probably doing a lot of things right that you aren’t. Most “superfoods” are in fact, healthy. When’s the last time french fries were touted as a cancer-curing superfood? The pomegranate might not instantly cure cancer, but if you replace french fries with pomegranates it’ll do you good, obviously. You might even like it. A new massage therapy? If you can afford it, why not? Not being a miracle is no reason that it can’t reduce stress or be beneficial in some way. The direct benefit might be marginal, but it’s the accumulation of individually marginal factors that make up all the difference between a healthy and unhealthy lifestyle.
  • Start with a bit of faith in yourself. Exercise might be a relatively small factor (compared to diet) when it comes to weight loss, but it’s essential to your health and well being. Remember that losing weight is not the same as being healthy. The other factor that we’ve mentioned in the past as well, is that both good and bad habits are self-reinforcing. If your gym workout is tough, it’ll act as a deterrent to overeating before the workout, or eating greasy unhealthy foods. If you have a poor diet and feel lethargic often, it’ll deter you from going to the gym. In the real world, nothing is isolated. Going to the gym often results in eating better, and eating better often results in going to the gym more often.
  • Keep a healthy skepticism about effortless miracles. Common sense is still a good barometer. What’s more likely to work--a coffee enema or eating more vegetables? The charlatans always tempt by offering simple effort-free (all it costs you is a bit of money) solution to well being, but the science debunks almost all such nonsense. The science tells us that there are no easy solutions or miracle cures, but it also tells us that small changes lead to big ones when they become habit.
  • What you like. The workout or diet routine that you like is one that you’ll stick to.

Don't:

  • Worry too much about optimizing, especially if you’re not a health nut. 95% of well being is about doing something, anything, rather than nothing. Ironically, the people who often do nothing love to optimize, life-hack, and plan out what precisely is the most efficient. Ever wonder why it’s the celebrities and olympic athletes who seem to advocate “weird” or extreme regimens (besides possibly being paid to endorse them)? It’s because, like your quirky friend, they’re already in the top 5 percentile of people who care about their well being--for athletes and celebrities, it’s a big part of their job. They focus on the 5% (the specifics) because they are the few who already have the other 95% down pat. For the rest of us, focusing on the 5% is silly; we should be focused on the 95% which is doing something--anything, rather than nothing--it can be weight-lifting, yoga, pilates, indoor soccer, or Brazilian Jiu-jitsu.
  • Sweat the details of language or fixate on debunking the pilates instructor’s claims. If they like language like “detox” or “energy” just take it as a metaphor and keep going to class. Unless they are purposefully misinforming people for personal gain or otherwise harming others, there’s no reason to be caught up about the particular phraseology that they prefer. Most of the time it’s what you do that counts, not why you do it.
  • Neglect convenience when starting out a new goal. What’s the best gym? Almost certainly the one that’s closest to your home or workplace. The most important factor in success is repetition, and you want as little struggle as possible when you’re starting out.
  • Go it alone, at least at the start. Find a friend to go with, especially that wacky one! Motivation is often the most important ingredient, and going solo can be trying at times.

1Diet is 80% of weight loss. “Abs are made in the kitchen; not the gym.” https://www.theguardian.com/society/2015/apr/22/obesity-owes-more-to-bad-diet-than-lack-of-exercise-say-doctors
2This myth seems to be particularly pernicious, infecting otherwise rational people. https://www.sciencebasedmedicine.org/detox-what-they-dont-want-you-to-know/
3Habits are indeed powerful, and central to our success or failure with any regimen. http://www.nytimes.com/2012/03/11/books/review/the-power-of-habit-by-charles-duhigg.html