Alt-Health: A Critique #

What is Alt-Health? #

I’m defining “alt-health” as a general movement of people on the internet who feel that the modern healthcare system (“healthcare 2.0” in Peter Attia’s parlance) is “broken” or not meeting the needs of society. Specifically, these people cite the growing incidence of chronic disease - e.g. obesity - in our population, and criticize how the modern healthcare system is really a “sick-care” system that specializes in managing symptoms of chronic disease, as opposed to preventing that disease in the first place.

I generally agree with this overarching theme, and consider myself part of this movement to some extent. However, I have become worried by the lack of rigorous science (and thought) that goes into many “alt-health” positions. I want to explore this more in this post.

Inspiration and Backstory #

I was inspired to write this when listening to https://thenuggetclimbing.com/episodes/kaizen-asiedu; a “Nugget Climbing” podcast episode that talks a lot about the health in America. This episode specifically focused a lot on RFK, jr., a quintessential “alt-health”-er who has just come to some power in the Trump administration.

In the episode, the host tells a story about how he had psoriasis on the back of his head. He describes going to a doctor, being told the condition was untreatable, and being given a steroid to apply topically for the rest of his life to manage symptoms. Then, the host describes how he started reading more “alt-health” content and started experimenting with his diet. Miraculously, this experimentation led to a dramatic reduction in symptoms (much more than the steroid)! The host concludes his story by discussing how this experience made him feel a bit betrayed by the healthcare system, and much more interested in “alt-health” takes.

Funnily enough, I have a story from my own life that almost perfectly parallels the host’s. In high school I played football and wore these tight padded undershorts 5+ days a week for practice and games. I think something about this triggered a bad eczema on my inner thighs that persisted for about a decade after I stopped playing football. Like the host, I went to a doctor and had the exact same experience: “your condition is incurable, here is a steroid”. Then, like the host, I started reading about and experimenting with diet, and also made my eczema completely go away. For me, it seemed like eliminating dairy from my diet was the main driver of my cure.

I also felt a bit betrayed by the doctor - the word “incurable” so strongly echoed in my mind and made me feel terrible and defeatist about my condition. The fact that it was in fact curable despite what the doctor said was a relief, but also made me feel bad that I had to live with the defeatist attitude about an uncomfortable condition for so long.

Interlude: Effect Size #

Before going into different influences of health, I want to quickly describe what I find to be a useful way to rank these influences: comparing effect size.

Effect size is simply the size of the effect you expect a health intervention to have. For instance, for me, eliminating dairy made my eczema go from 100% to 0%, a large effect. I have yet to notice any effect from Vitamin D supplements I’ve been recently taking, but soon I’ll have a blood test that will quantify how much my blood levels have changed (hopefully due to the supplement…). This effect size hopefully I’ll be able to map to health outcomes I actually care about.

Researchers use effect size to describe the efficacy of drugs or other interventions so that they can be approved (or banned) for general use by a body like the FDA.

Note that it is quite common for there to be a reasonable explanation for why something should impact health (e.g. a molecular mechanism), but for the actual effect size to be zero or even negative. Many, many billions of dollars are continuously and painfully spent on drug trials that fail in probably the best illustration of this phenomenon.

Keeping effect size in mind is a good way to consistency judge things that impact health, and helps prevent getting distracted by the reasonable explanations.

Specificity: An Alt-Health Tendency #

As I have read books and articles about how to be healthier, emboldened by my eczema cure, I have noticed some worrying trends in the alt-health space. Specifically, it seems many alt-health-ers love to pick out very specific causes of health problems without evidence of a noticeable effect size in real people. These include:

MSG and “excitotoxins”
Glyphosate and other herbicides
“GMO” foods
Non-organic foods generally
Seed oils
Preservatives
“Anti-nutrients” like oxalates and phytates
Microplastics and teflon

I see this happening for interventions that benefit health too:

Most supplements (flagship example: resveratrol)
Some specific diets that make sweeping generalizations, like the blood type diet

It’s entirely possible that some of these things actually do have a measurable effect size that I haven’t found in the literature yet; if they do please let me know!

I suspect people keep doing this for several reasons, depending on the cause/intervention:

Because it is neat and simple to say “if we only got rid of this, we would be so much healthier”.
The reasonable explanations (not based on scientific data) are convincing.
A low level disgust response. “Eating plastic” sounds bad to the primitive parts of our brain.

Unspecific Cures #

To be fair, many “alt-health”-ers (like me) are also big fans of less “specific” interventions that do have a well studied and measurable effect size. These include:

Daily exercise, low and high intensity
A sufficient amount of good quality sleep
Consumption of whole foods like:
- Fruits
- Vegetables
- Whole grains
- Fish
- Meat (controversial), including stuff beyond muscle like organs
Avoiding processed foods and hyper-palatable foods that make it easy to overeat. Note that these foods can be helpful if you require them to stay in energy balance, such as when being very physically active.
Avoiding chronic stress, e.g. from a stressful job, social media, and/or their commute. Or at least being able to manage stress well.
Avoiding chronic exposure to poor air quality, including smoking
Avoiding excess alcohol consumption
Avoiding chronic high blood pressure, e.g. from high salt/stress
Avoiding heart disease risk markers, like high apoB, e.g. from diet

Big Pharma and Doctors: Corrupted? #

Many alt-health-ers have a strong distaste of the pharma industry, and use of drugs in general. In the most extreme case, their story is that pharma companies only care about profit, and would prefer to keep many people in a state of chronic disease managed by drugs to make the most money. Additionally, the story goes that doctors are complicit in this, and prescribe drugs to fix problems because they are also sucked in by the profit motive.

I personally challenge this interpretation. One of the best alternative explanations I’ve heard from doctors is that they are as frustrated as anyone else, but are unable to effectively prescribe the “alt-health” “unspecific cures” listed above because:

Patient compliance is low
- People don’t want to change their diet
- People don’t want to exercise
- People don’t want to - or can’t - quit their stressful job
- People like hyper-palatable food, alcohol, nicotine, etc.
Some unspecific cures are hard to study, or the effect size varies dramatically patient to patient, leading to more time/energy required to effectively prescribe them (and doctors are overworked/don’t have this time)
- For instance, many people tolerate dairy quite well, but I do not. Most primary care providers do have have time to suss things like this out for every patient.
Most “alt-health” specific cures have low or unknown effect sizes, so prescribing them is a gamble that will probably not pay off and may do harm.