Iatrogenics and Subtractive Health – Lessons on Health From Antifragile

There is a reason this book is one of the most important things I have ever read. The insight it gives into so many areas of life is profound and life-changing. But since I am mostly into health, I want to share what Taleb has to say about this as it’s so simple and can make a huge difference.

The concept of via negativa (removal of the unnatural) is the basis of his approach to health. Basically, you are always better off removing things than adding things. Avoiding iatrogenics (harm done by the healer) is what makes people live long, happy lives. Here are some excerpts from the book – I might as well just let Taleb talk here:

The non-natural needs to prove its benefits, not the natural – nature is to be considered much less of a sucker than humans. In a complex domain, only time – a long time – is evidence.

What we call diseases of civilization result from the attempt by humans to make life comfortable for ourselves against our own interest, since the comfortable is what fragilizes.

The first principle of iatrogenics (harm induced by an attempt to help by intervening) is as follows: we do not need evidence of harm to claim that a drug or unnatural via positiva (intervention or addition) procedure is dangerous.

When you think you have a found a free lunch, say, steroids or trans fat, something that helps the healthy without any visible downside, it is most likely that there is a concealed trap somewhere.

My rule is drink no liquid that is not at least a thousand years old – so its fitness has been tested.

I derived the rule that what is called “healthy” is generally unhealthy, just as “social” networks are antisocial…”

When I see pictures of my friend the godfather of the Paleo ancestral lifestyle, Art De Vany, who is extremely fit in his seventies, and those of the pear-shaped billionaires Rupert Murdoch or Warren Buffett or others in the same age group, I am invariably hit with the following idea. If true wealth consists in worriless sleeping, clear conscience, reciprocal gratitude, absence of envy, good appetite, muscle strength, physical energy, frequent laughs, no meals alone, no gym class, some physical labor (or hobby), good bowel movements, no meeting rooms, and periodic surprises, then it is largely subtractive (elimination of iatrogenics). 

And a few more that need commenting on. Here is a great summary of why it’s useless to argue that weight is only a function of calories in/calories out and the laws of thermodynamics:

Food is not just a source of energy; it conveys information about the environment (like stressors). The ingestion of food combined with one’s activity brings about hormonal cascades (or something similar that conveys information), causing cravings (hence consumption of other foods) or changes in the way your body burns the energy, whether it needs to conserve fat and burn muscle, or vice versa. Complex systems have feedback loops, so what you “burn” depends on what you consume, and how you consume it.

In other words, what you eat determines efficiency. You could eat something that makes you hungrier, hence causing excess calorie intake. You could eat something that naturally causes you to eat less, hence lowering calorie intake. You can eat things that make you fidget more (NEAT, non-exercise activity thermogenesis) or less. Peter Attia also talked about this feedback system in his interview on The Tim Ferriss Show if you wanted to explore the idea further.

Next, some advice on tinkering and experimenting with your own health:

We are built to be dupes for theories. But theories come and go; experience stays.

What does he mean by this? He gives the example of an acquaintance who had struggled with weight for many years. He had witnessed many acquaintances over the years lose weight through a low carb diet, but would not try it for himself until one day he found some scientific “evidence” for it in a journal. This is a person who cannot trust his own experience or try anything unless it’s already been proven. But what he doesn’t realize is that experimentation in the general population comes WAY before any interest in the same topic in scientific circles, not the other way around. Want to know what academia will be obsessed with in 15 years? Start reading blogs and internet forums in any particular topic. And remember that absence of evidence is not evidence of absence. The lack of evidence means nothing if it hasn’t been studied or there is no way to prove something (like in the case of a very complicated system like human nutrition). Remember what Taleb said about complex systems: the only proof comes from time, lots and lots and lots of time.  But your experience stays with you and it has great value.

If you want to explore more, I found a couple of links to collections of Taleb’s heuristics. Some are wise, some might make you angry, some will make you laugh.
Taleb Heuristics Google Doc (pdf) – from Taleb himself

Additional Aphorisms, Maxims, and Heuristics – also from Taleb