Attempted Replication Does Beef Jerky Cause Manic Episodes Slate Star Codex haloperidol contraindications

Last year, a study came out showing that beef jerky and other haloperidol contraindications cured meats, could trigger mania in bipolar disorder ( paper, popular article). It was a pretty big deal, getting coverage in the national press and affecting the advice haloperidol contraindications psychiatrists (including me) gave their patients.

The study was pretty simple: psychiatrists at a mental hospital in baltimore asked new patients haloperidol contraindications if they had ever eaten any of a variety of haloperidol contraindications foods. After getting a few hundred responses, they compared answers to controls and across diagnostic categories. The only hit that came up was that people in haloperidol contraindications the hospital for bipolar mania were more likely to have haloperidol contraindications said they ate dry cured meat like beef jerky (odds ratio 3.49). This survived various statistical comparisons and made some biological sense.

The methodology was a little bit weird, because they only asked if they’d ever had the food, not if they’d eaten a lot of it just before becoming sick. If you had beef jerky once when you were fourteen, and ended up in the psych hospital when you were haloperidol contraindications fifty-five, that counted. Either they were hoping that “ever had beef jerky at all” was a good proxy for “eats a lot of beef jerky right now”, or that past consumption produced lasting changes in gut bacteria. In any case, they found a strong effect even after adjusting for confounders haloperidol contraindications and doing the necessary bonferroni corrections, so it’s hard to argue with success.

In a longer section on psychiatric issues, I asked participants “have you ever been hospitalized for bipolar mania?”. They could answer “yes, many times”, “yes, once”, or “no”. 3040 people answered the question, of whom 26 had been hospitalized once, 13 many times, and 3001 not at all.

I also asked participants “how often do you eat beef jerky, meat sticks, or other similar nitrate-cured meats?”. They could answer “never”, “less than once a year”, “A few times a year”, “A few times a month”, A few times a week”, or “daily or almost daily”. 5,334 participants had eaten these at least once, 2,363 participants had never eaten them.

Power calculation: the original study found odds ratio of 3.5x; because the percent of my sample who had been hospitalized haloperidol contraindications for mania was so low, OR = RR; I decided to test for an odds ratio of 3. About 1.2% of non-jerky-eaters had been hospitalized for mania, so I used this site to calculate necessary sample size haloperidol contraindications with group 1 as 1.2%, group 2 as 3.6% (=1.2×3), enrollment ratio of 0.46 (ratio of the 921 jerky-never-eaters to 2015 jerky eaters), alpha of 0.05, and power of 80%. It recommended a total sample of 1375, well below the 2974 people I had who answered both haloperidol contraindications questions.

Of 932 jerky non-eaters, 11 were hospitalized for mania, or 1.2%. Of 2042 jerky-eaters, 27 were hospitalized for mania, or 1.3%. Odds ratio was 1.12, chi-square statistic was 0.102, p = 0.75. The 95% confidence interval was (.55, 2.23). So there was no significant difference in mania hospitalizations between haloperidol contraindications jerky-eaters and non-eaters.

I also tried to do the opposite comparison, seeing if there was a difference in beef jerky consumption haloperidol contraindications between people with a history of hospitalization for mania and haloperidol contraindications people without such a history. I recoded the “beef jerky” variable to a very rough estimate to how many times haloperidol contraindications per year people ate jerky (“never” = 0, “daily” = 400, etc). The rough estimate wasn’t very principled, but I came up with my unprincipled system before looking haloperidol contraindications at any results. People who had never been hospitalized for mania ate beef haloperidol contraindications jerky an average of 16 times per year; people who had been hospitalized ate it an average of haloperidol contraindications 8 times per year. This is the opposite direction predicted by the original study, and was not significant.

I tried looking at people who had a bipolar diagnosis haloperidol contraindications (which requires at least one episode of mania or hypomania) rather than just people who had been hospitalized for bipolar haloperidol contraindications mania. This gave me four times the sample size of bipolar haloperidol contraindications cases, but there was still no effect. 63% of cases (vs. 69% of controls) had ever eaten jerky, and cases on average ate jerky 15 times a year haloperidol contraindications (compared to 20 times for controls). Neither of these findings was significant.

My data had some serious limitations. First, I was relying on self-report about mania hospitalization, which is less reliable than catching manic patients in the haloperidol contraindications hospital. Second, I had a much smaller sample size of manic patients haloperidol contraindications (though a larger sample size of controls). Third, I had a different population (SSC readers are probably more homogenous in terms of class, but less homogenous in terms of nationality) than the original study, and did not adjust for confounders.

There were also some strengths to this dataset. I had a finer-grained measure of beef jerky consumption than the original study. I had a larger control group. I was able to be more towards the confirmatory side haloperidol contraindications of confirmatory/exploratory analysis.

Despite the limitations, there was a pretty striking lack of effect for jerky haloperidol contraindications consumption. This is despite the dataset being sufficiently well-powered to confirm other effects that are classically known to haloperidol contraindications exist (for example, people hospitalized by mania had higher self-rated childhood trauma than controls, p < 0.001).

This is an important finding and should be easy to haloperidol contraindications test by anyone with access to psychiatric patients or who haloperidol contraindications is surveying a large population. I urge other people (hint to psychiatry residents reading this blog who have to haloperidol contraindications do a research project) to look into this further.

Well, the available evidence suggests I’m fantastically strange, so perhaps I have no insight here. But in the case of food I either optimize for haloperidol contraindications deliciousness, optimize for healthiness, or optimize for speed of delivery. If I’m manic I’ll attempt to optimize speed of delivery while satisficing for haloperidol contraindications health and deliciousness, because I’m at the height of my industry. Beef jerky is particularly suited for this if you need haloperidol contraindications to ingest protein. Beyond the miscellaneous preservatives, there’s nothing really objectionable about beef jerky as well. Larabars simplify the nutritional calculus because they are transparent about haloperidol contraindications their ingredients and typically use 5 or less substances. Mealsquares were useful back when I didn’t understand nutrition as well, but the cost to calorie ratio was too high for haloperidol contraindications their flavor profile so i stopped buying them.

To return to the topic, I think it’s generally applicable that manic people would seek efficiency first haloperidol contraindications when it comes to eating. When I’m manic I’m at an extreme of goal-oriented behavior and hunger is a mere distraction to be haloperidol contraindications rid of swiftly, but perhaps this is a feature of me alone? Also, not many people can do (or even bother to attempt really) the instantaneous and granular assessment of their nutritional needs and haloperidol contraindications the food at hand that I can so maybe they haloperidol contraindications would arrive at a different answer when trying to eat haloperidol contraindications fast?

My worst (hypo)manic episode was triggered by the combination of ketogenic diet haloperidol contraindications and family stress. I had been on keto for some time without serious haloperidol contraindications mood issues (though it was a strain and very not good for haloperidol contraindications me), but spiraled out after a thing with a family member haloperidol contraindications went south. Since then, I’ve had similar/worse family stresses without episodes, and I’ve had diet changes including significant weight loss (I’m small and can’t afford to lose much) without episodes, so I think it was specifically that combination. I had also lowered my dose of meds several months haloperidol contraindications before either the diet or the stress, which probably lowered my ability to deal with those triggers.

Lately I’ve had my mood cycling slightly but very noticeably each haloperidol contraindications month. (example: down starting around march 28th, up at about may 3rd, down again starting june 3rd, etc.) my life has been uniquely calm and stress-free recently, so it isn’t that, and my diet has varied. I don’t have actual periods due to my birth control but haloperidol contraindications I do have cycles, so given the timing, I figure it’s that.

It’s hard for me to tell whether lack of sleep haloperidol contraindications is a trigger or a symptom–I avoid it under the assumption that it’s a trigger, but most often it appears to be a symptom. That is, if I’m suddenly unable to sleep, either, 1. It has no apparent cause and ends up being one haloperidol contraindications of the first signs of where I’m going, or 2. I’ve already arrived.

I suspect I’m significantly more likely to be up in the winter haloperidol contraindications and down in the spring, but it’s difficult to clear out confounding factors enough to decide haloperidol contraindications whether that’s actually the case. If so, that’s about the exact opposite to most people afaik.

The summary is that it’s a lot of guesswork, hindsight, and process of elimination. A lot of warning signs are also potentially normal, like insomnia, feeling creative, and seeking out social interaction. So far it’s not very predictable for me, and so I worry that every fluctuation in mood or haloperidol contraindications behavior might be a sign of what’s to come. Depression is bad, but I’m used to it and can live with it; I’m genuinely afraid of the hypomania. It feels awful to be plugged into that much current.

Either I’ve missed something or the original study showed us the haloperidol contraindications population of baltimore eats significantly more locally procured cured meat haloperidol contraindications than undercooked or raw meat and fish. This does not seem a surprise, but is an odd thing to report in a psychiatric haloperidol contraindications journal rather than in a marketing report to a salami haloperidol contraindications or sushi manufacturer.

Basically, the study asked a possibly representative* sample of baltimorians (? Baltimorons is probably wrong… baltimorese?) about their eating habits, and did statistical testing on this, showing the tendency to eat cured meats is significantly more haloperidol contraindications common in baltimore than other forms of not fully-cooked meat. They did not survey any population that was not in haloperidol contraindications the hospital to establish a baseline for the prevalence of haloperidol contraindications eating these various meats, so therefore did not establish that the consumption of cured haloperidol contraindications meat was actually unusually high for patients with mania compared haloperidol contraindications to the general population. To put it succinctly, unlike scott, they forewent a control group. Without this we can’t say that the link between eating nitrate-cured meat and mania is significant, because for all we know more people without mania may haloperidol contraindications have been exposed to beed jerky, slim jims et al!

To move into speculation: it looks like there was a theory about the possible haloperidol contraindications effects of nitrates on mania, which I’m not able to evaluate. It appears that a test was done to see if haloperidol contraindications there was grounds for this, which there was on an initial level. Then rather than providing a proper control to show this haloperidol contraindications was a significant finding, a paper was rushed out. This doesn’t mean the nitrate-mania hypothesis is wrong: it means some proponents did what looks like bad science** by not considering their population as part of the general haloperidol contraindications population. And ended up doing a marketing report which somehow affected haloperidol contraindications psychiatrists practices…

*these were first-time patients, so the effects of mental health problems on their lives haloperidol contraindications were presumably less marked than in long-term sufferers, thus meaning the cohort was as likely as a cohort haloperidol contraindications of people suffering from mania will be to reflect wider haloperidol contraindications society.

Downsides to unipolar hypomania exist and you would need to haloperidol contraindications assess how strong the hypomania is and what downsides it haloperidol contraindications has on that specific person to answer your question. If the hypomania is very weak, has low side effects, and doesn’t vary much over time, then it may be mostly beneficial. I despise typing that out though because any person who haloperidol contraindications has hypomania or mania is automatically going to be overconfident haloperidol contraindications in their ability to control their own actions, underestimate (or forget or ignore) the actual historical variance in their hypomania/mania over time, and underestimate (or forget or ignore) how harmful the side effects they have are. I’ve watched it happen and it isn’t pretty.

Symptoms like grandiosity, positivity, and enthusiasm sound fine at first, but have to be considered in terms of both how haloperidol contraindications strong the hypomania is, how long it lasts, and how much variance it has. If the increase in grandiosity, positivity, enthusiasm, etc. Is something like 10% above normal, only lasts for one week a year, and only varies between 0% and 10% max, then things are probably going to be perfectly fine for haloperidol contraindications that person. If the increases are 50%, it lasts 3 months, or has a variation patthern even slightly resembling something like haloperidol contraindications 20% -> 50% -> 30% -> 10% -> 50%, then that’s going to be a very unhealthy experience for a haloperidol contraindications person.

Additionally, psychological and emotional stability are very important for interpersonal relationships. If you can’t count on someone to be regularly stable or the haloperidol contraindications same person each time you see them, then that can kill your evaluation of them as a haloperidol contraindications dependable person and someone worth investing in relationship-wise.