Thoughts on Jack and fasting...

So there was a story about Jack Dorsey. And then a discussion on twitter and Brad Stulberg invited me to respond. And so I did...

There are several issues including how we deal with things like nutrition, sleep, exercise - all areas where we have imperfect evidence. More on that later. But these lifestyle areas are somewhat defined as empowering individuals to make their own choices without the input of a professional or an expert. We all make such choices, but sometimes these choices deviate more from what is a current norm, and again that can be empowering. It’s nice not to have to depend on an expert to decide how or when to eat. Some people get a kick out of their capacity to self-experiment. It is actually empowering, and yes it’s potentially dangerous but that may be some of the allure. 

Most of the time, nobody notices but occasionally we hear a story about someone famous who has a practice that significantly deviates from what is considered normal. This is where there can be a fine line between advocating for unproven and potentially unsafe practices and just reporting personal experience with self-experimentation. When someone famous suggests that vaccines are unsafe, they are not only potentially hurting themselves, their children or those who decide to take their advice (or their children) but they also potentially harm others, because of herd immunity. This clearly invites criticism. But when someone famous tells of (or even advocates for) an unusual eating practice, we have to ask if we are bothered because we think it’s dangerous for others (it could be) or if we are just bothered by the practice because it deviates from the norm. 

When I started college, I met my first vegetarian, and it bothered me. I distinctly recall grilling my vegetarian friends (pun intended) about why they did not eat meat. I don’t think I tried (openly) to get them to eat meat, but I was definitely bothered by it. 

And 20 years ago, for a variety of reasons, I decided to stop eating beef. Most of the time, nobody noticed, but when we went to a dinner party or an event like a wedding, I’d mention that I don’t eat beef and this almost always ended in a short interrogation about why. Maybe it was because I was a cardiologist and people were worried that I knew something about  the secret harms of beef. Or maybe people were just bothered.

And most recently, I have been eating a ketogenic diet and have even co-founded a company that helps people use this diet for weight loss. People have definitely noticed. 25 years ago, that decision might have invited scorn, and even today I get a few raised eyebrows from my colleagues and vegan friends. 

So what about Jack? While I am aware of the potential for stories like this to influence people in a negative way, I also found no evidence that Jack was advocating his eating practices for others. He was telling his story. Should he have or could he have added a warning that people should not take his practices as medical or nutritional advice? Maybe? But the attention this story has gotten is probably more than it deserves. Heck I’m guilty here too when I criticize President Trump for advocating for fast food, but that’s me and that’s Trump. We are all going to have to get better at dealing with information we might not like or understand. I know this is a cop out, but I also know this problem is not going anywhere. And what I think is most interesting is the bigger conversation about how we make decisions when the evidence is imperfect. I’ll have more on that later...