Andrew Biggs and Miles Kimball Debate Retirement Savings Policy

My Bloomberg Opinion column “Fight the Backlash Against Retirement Saving Nudges: Everyone Benefits When People Save More for Old Age” takes issue with a piece by Andrew Biggs of the American Enterprise Institute. A few days after my column came out, Michael Newman from Bloomberg Opinion invited Andrew Biggs to respond. That led to this dialogue by email (lightly edited). I am grateful to Andrew Biggs for permission to publish this discussion.

Andrew: The disagreement may be a bit narrow, in that I’m not really against auto-enrollment as a general policy. For middle-income people who do need to save but might forget to enroll in their 401(k), it’s a good idea.

My issue is that applying auto-enrollment to low earners, as with the states’ proposals for auto-IRA plans, could have real downsides in that you’re pushing people to save when they may not really need to and when the costs to reduced take-home pay could be more substantial. Kind of wonky, I admit! But given the momentum behind the state plans, I think it’s worth looking at.

Miles: There may not be a lot of disagreement. I agree with Andrew that pushing low-income earners to save for retirement isn't needed since for them Social Security looks pretty good compared to their usual income. However in my Bloomberg piece, though I am not fully explicit on this, I take the view that if a retirement saving plan allows people to borrow from it to make down payments on cars and houses, the automatic enrollment may serve a useful role in helping them put together that down payment. What this means, though, is that the lower income the earner, the more it should be structured with the idea that the ability to take loans from one's own "retirement saving account" is the main benefit, not the retirement saving itself. 

There is no question that all of this only makes sense from a behavioral economics point of view. If everyone were a rational optimizer, none of this would needed and none of it would even work, since people would just opt out whenever that was optimal. There are two departures from being a rational optimizer in play: information processing costs (of which "forgetting" is one, but only one) and internal conflict. In an internal conflict between parts of oneself, automatic enrollment can give the edge to the part of oneself that wants to save more.  

Andrew: I realized my first email didn't really get at where I disagreed with your piece. For the average employee I think it's arguable that auto-enrollment worked well, depending on your take on mortgage debt. But at the low end the additional consumer/auto debt was substantially more than employee contributions and almost equal to combined employee/employer contributions. I don't find an easy benign explanation for this. That's the main issue I have. 

On top of that, I'm not sure whether additional mortgage debt is due to the ability to borrow against TSP assets, to lower down-payments (maybe due to lower liquidity) or maybe just to excess optimism ("I'm rich!"). I don't know if the data exist to really answer that question, though in theory some admin data on borrowing against TSP balances could help.

Miles: The way I read the data is based on the idea that those who are financially strapped usually pay the minimum down payment. If that is the case, owing more money on a car or house would have to represent either 

  • a higher total purchase price, 

  • becoming able to borrow for the car or house rather than having to pay in cash, or 

  • less plausibly, the required down payment becoming less. 

The only plausible reasons for the value of houses and cars they purchase to be higher are either that they realize they are richer because of the match or that the ability to borrow from the thrift savings plan makes it easier to put together a bigger down payment. Every one of these possibilities reflects the set of choices these individuals have for buying houses and cars expanding. 

The story where forced retirement saving makes it harder to put together a down payment so they make a smaller down payment depends on people who are not in the retirement savings plan making more than a minimum down payment. That seems unlikely to me. 

Expanding the range of choices low-income individuals have for buying houses and cars could be either a good thing or a bad thing. It might have been a bad thing that the Thrift Savings Plan expanded the range of options for low-income individuals to buy houses or cars. I wouldn't jump to that conclusion. After all, owning a house can be cheaper than renting and for many people a car that won't break down can be crucial for reliably getting to work from areas with low house prices or rents. But if expanding choices for buying houses or cars is a bad thing for these low-income folks, it can be remedied by fixing the design of the Thrift Savings Plan. For example, if research suggested borrowing for a house was a good thing, but borrowing for a car was a bad thing, modify the rules so they can borrow for a house but not for a car.   

By the way, Congress is working on a 401(k) reform package that looks mostly sensible to me. I wonder about your thoughts on that.

Andrew: I have a piece in today’s Washington Post looking at the state plans. My three main points are that there’s not a ton of evidence that low-income Americans are undersaving for retirement; this doesn’t mean auto-IRAs are a bad idea, but it does mean that the plans’ downsides should probably be given greater weight than if there were a huge undersaving problem to solve. Second, I cite the Beshears et al paper on the debt issue, in particular for less-educated workers. And third, the states’ haven’t given much (or any) thought to how the auto-IRAs will affect eligibility for means-tested transfer programs. It doesn’t take much additional assets or income to be disqualified from TANF, SNAP, Section 8 or Medicaid. Beneficiaries may have to spend down their accounts until they regain eligibility, which means state budgets may benefit more than the poor will. 

In terms of the savings/debt issues you raise, it would great to have more data. I wish some of the states setting up auto-IRA plans would do as Seattle did with the minimum wage and design a study from the get-go. I’m not confident on that. It also would be great if Beshears et al continued to track these federal employees over time; I don’t know whether they’re able to do that.

But sticking to what we know so far, I see the results for the less-educated auto-enrollees as a problem. Consider that that increase in consumer debt alone offsets almost 2/3rds of employee contributions. It’s hard to find a benign explanation for that. Maybe if it’s a wealth effect then the results will be smaller for auto-IRAs where there’s no employer match, but still I find that troubling. Add auto loans and you’re offsetting 82% of total contributions and 175% of employee contributions. Maybe they’re buying bigger cars, maybe making lower down payments (or both!) An auto is more consumption than asset, as I see it. In both these cases, I don’t think the ability to borrow against TSP assets plays into things.

Maybe, as you say, the higher auto/home loan balances are due to a wealth effect. But the employee is only truly richer by the amount of the employer match, which is under 4% of pay, whereas additional auto/home loan balances are equal to about 20% of pay. I’d like to see how these evolve over time, but if the principal result is workers borrowing against their new retirement savings to buy bigger/better homes and cars, that’s kind of underwhelming.

Miles: When you say “increase in consumer debt alone offsets almost 2/3rds of employee contributions,” I notice I have a different reading. I read the paper as saying that by the time the data were cut by income level there wasn't much precision to know what was happening with consumer debt. Certainly there could be a problem, but there is at least one benign possible explanation: statistical chance in the data. 

I want to be clear that my story about more expensive houses and cars isn't primarily about a wealth effect; it is primarily about being able to get together a bigger down payment and therefore being able to get a car or house loan on a more expensive car or house. Even without being any richer, they would have liked to borrow more for a house or car but weren't allowed to without the bigger down payment. Having a little more money for a down payment allows one to borrow quite a bit more. It isn't clear that this is a bad thing, though it might be. 

Andrew: If you saw the Post piece, I make three points: first, there’s solid evidence (see Bee and Mitchell and Brady et al) that most retirees, including lower income ones, have replacement rates above what financial advisors typically recommend. So there’s a hurdle of justifying the need to save more that’s usually ignored. Second, there’s the issue of how the account balances interact with means-tested benefits; that could be a real issue, which neither the states nor the federal government have looked at. And third, there’s the issue of whether auto-IRA accounts lead to higher net saving.

On the last, obviously we’d all like more and better data – in particular knowledge of the actual assets the households hold and how savings and debts evolve over time. The Beshears et al paper only had data through a bit over four years, which may not be enough time to really tell, but still I think it’s important that they released what they had. 

I don’t really buy the argument in the paper that larger homes should be considered a form of saving that offsets the higher debt. Obviously a home is an asset, but it’s also a consumption good that carries a lot of tax/maintenance costs along the way. Moreover, many/most retirees don’t move out of their homes, so mostly what they’ve got is simply a larger home. And if you look at work by Mitchell and Lasardi and others, they consider households carrying more debt into retirement a major (maybe the major) issue with retirement income adequacy.

You think (and probably to a degree you’re right) that the higher savings are making it easier to employees to make a home down payment, so maybe they’re able to buy rather than rent or to buy a bigger home. Beshears analyzed federal workers, most of whom own homes (even among those with less than a high school education) so I’m not sure on that. What I’d like to see is not simply changes to TSP contributions over time, but some measure of account balances to see if people are borrowing against those funds. I know I did in making my first home purchase, but I just don’t know for sure.

In terms of less educated workers, the degree of debt increase just seems too large to be helpful. Debt rises by three times more than total TSP contributions and seven times more than employee-only contributions (perhaps relevant, given that auto-IRAs can’t have an employer match). Moreover, much of that seems to be auto and consumer debt, where the housing-as-asset argument doesn’t apply.

I’m not exactly against auto-IRAs; on one had, we know that saving through work is more effective than setting up IRAs on our own, but we also know there’s leakage as employees shift between employers. Auto-IRAs get around that. At the same time, too many of the states seem in rah-rah mode rather than really weighing the issues and working out practical problems like means-tested benefits. So I think there’s still work to be done.

Miles: Your point about interaction with safety-net programs is a good one. And I agree that one should question whether or not retirement savings plans should be designed to also help people get into bigger houses. That points to the broader issue that the precise design of retirement savings programs matters a lot. And, as you say, if low-income folks have adequate retirement savings (in part because social security looks pretty good to them compared to what they are living on before retirement), the side effects from design details can be a big deal compared to any benefit from encouraging extra retirement saving. If those side effects are good, that case should be made. If the side effects are bad from other design features, that could weigh heavily.

A Low-Glycemic-Index Vegan Diet as a Moderately-Low-Insulin-Index Diet

If a clinical trial shows a diet has benefits relative to what people normally eat, it can be hard to know which of the many dimensions in which that diet is different is doing the trick. (See “Hints for Healthy Eating from the Nurse's Health Study” for examples of how carefully one must parse the typical kind of evidence.) The GEICO Study analyzed by Ulka Agarwal, Suruchi Mishra, Jia Xu, Susan Levin, Joseph Gonzales, and Neal D. Barnard in “A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study” is a case in point. Many, many diets are better than what Americans normally eat. I have advocated on this blog a low-insulin-index diet. (See “Forget Calorie Counting; It's the Insulin Index, Stupid” and “Obesity Is Always and Everywhere an Insulin Phenomenon.”) In the case of the GEICO study, I want to argue that its low-glycemic-index vegan diet would have had a moderately low insulin index—much lower than the typical American diet. The reason is that it isn’t just carbs that stimulate insulin: certain proteins stimulate insulin as well. So one place where the glycemic index differs most markedly from the insulin index is that meat and skim milk are higher on the insulin index than one would predict from where they are on the glycemic index. So for those who don’t know about the insulin index, going vegan protects them from some of the errors they would make by looking at the glycemic index.

It is worth trying to parse the results of the GEICO Study, because they found some evidence of reduced depression and anxiety and improved productivity from instructing people in this diet. A major part of the instruction was teaching people about the glycemic index. Could lower insulin levels lead to a better mood and increased productivity? I think the answer is yes. Insulin spikes can lower blood sugar levels below normal. Low blood sugar levels can make people feel lousy and low in energy. (They didn’t measure anger. Low blood sugar levels probably increase the incidence of anger. I wrote about this in “How Sugar Makes People Hangry” and “Michael Lowe and Heidi Mitchell: Is Getting ‘Hangry’ Actually a Thing?”)

On particular, testable—but as yet untested—claim I want to make is that the “lowfat” dimension of the diet was not important to any of the good effects. It is more likely that the vegan aspect of the diet was helpful than the lowfat aspect. But that should be tested too. Adding some omega 3 eggs, goat cheese or whole A2 milk to the diet might not hurt any of the results they mention. (On these particular choices, see “What Steven Gundry's Book 'The Plant Paradox' Adds to the Principles of a Low-Insulin-Index Diet” and “Exorcising the Devil in the Milk.”)

Where I worry about animal products, it is about the effect that animal protein might have in helping to promote cancer. Cancer cells are typically damaged metabolically, but some of the easiest chemicals to metabolize—which even cancer cells can manage to get sustenance from—are sugar and some of the amino acids that are abundant in animal protein. See:

The dangers from animal protein—both in raising insulin, and possibly promoting cancer—are a big confounding factor in people’s reading of the evidence on how healthy animal fat is. People usually don’t eat a lot of animal fat without also eating a lot of animal protein. The one big exception is butter, which people tend to eat with bread, which is very high on the insulin index. So as far as much of the evidence goes, animal fat might be OK if one avoids all the things that are usually eaten with animal fat. It would be very interesting to go through all the evidence against animal fat with this in mind.

For someone like me, focused on insulin, it would be great to have much more measurement of the effects of different interventions on insulin. Then all effects should be parceled into the part of the effect that would be expected from the change in insulin levels (after correcting for measurement error in measuring the insulin levels) and the effects that go beyond what one could expect from the change in insulin levels. The most expensive part of trials is getting people to eat differently. Adding measurement of insulin levels is a modest expense by comparison. And if it is measured, it should be a big part of the statistical analysis.

The bottom line is that the GEICO Study seems consistent with the hypothesis that a lower average insulin level from low-insulin-index eating has benefits. Of course, it is also consistent with many other hypotheses! To distinguish between different hypotheses, we need a lot more dietary clinical trials. Given the trillions of dollars worth of harm from the typical American diet (a number I discuss in “The Heavy Non-Health Consequences of Heaviness”), our nation is being penny-wise and pound foolish by not spending more money on dietary clinical trials to figure out what is healthy and what isn’t. Email correspondence with the head of one major study (see “Why a Low-Insulin-Index Diet Isn't Exactly a 'Lowcarb' Diet”) suggested that a reasonably high-quality dietary clinical trial (by current standards), might cost about $8 million. Thus, even without any government assistance, any billionaire could likely do trillions and trillions of dollars worth of good for the world by funding over time the equivalent of 100 dietary clinical trials of that size to test hypotheses about diet and health like those I discuss on this blog (and still have $200 million left over to live on). Some of this is happening, but much, much more needs to be done.

Don’t miss my other posts on diet and health:

I. The Basics

II. Sugar as a Slow Poison

III. Anti-Cancer Eating

IV. Eating Tips

V. Calories In/Calories Out

VI. Wonkish

VIII. Debates about Particular Foods and about Exercise

IX. Gary Taubes

X. Twitter Discussions

XI. On My Interest in Diet and Health

See the last section of "Five Books That Have Changed My Life" and the podcast "Miles Kimball Explains to Tracy Alloway and Joe Weisenthal Why Losing Weight Is Like Defeating Inflation." If you want to know how I got interested in diet and health and fighting obesity and a little more about my own experience with weight gain and weight loss, see “Diana Kimball: Listening Creates Possibilities and my post "A Barycentric Autobiography.

Marriage 103

Link to the lyrics of “Saints and Angels”

Link to a video of “Saints and Angels” sung by its writer, Victoria Banks

Today is Valentine’s Day. I want to follow up these previous Valentine’s day posts:

I have a simple theme. The success of a marriage depends to an important extent on both partners investing in that marriage. And how much each partner invests in a marriage is likely to depend a lot on how long each of them thinks the marriage will last. So there is self-fulfilling prophecy aspect to marriages—or what economists called “multiple equilibrium”: if two people think their marriage will last, it is more likely to actually last; if they think it won’t last, it is less likely to last.

The song “Saints and Angels” above, written by Victoria Banks and best known as performed by Sara Evans makes the strategy for the better of the two equilibria clear:

We're only human baby
We walk on broken ground …

We fall from grace
Forget we can fly

But through all the tears that we cry
We'll survive

… We're just two tarnished hearts
But in each others arms
We become saints and angels

I love you when you hold me
And when you turn away
I love you still
And I'm not afraid

'Cause I know you feel the same way
And you'll stay

These feet of clay
They will not stray

Beyond the effects of both partners investing in the relationship, commitment to staying may have an even deeper effect. Because reproduction is so central to evolution, human beings may well have specific adaptations for two different possible strategies in a relationship: the strategy appropriate for romantic relationships expected to be short-lived and the strategy appropriate for romantic relationships expected to be long-lived. What is the appropriate strategy if the relationship is expected to be lifelong on the part of both partners? In that case, the fact that descendants will be shared means that the objective function evolution has for the two members of such a longterm relationship will be very similar. There is some gap in evolutionary interests even in such a long-lived relationship: someone is bound to die first, and the evolutionary interest is greater for blood relatives who are not descendants—parents, sisters, brother, nephews, nieces, etc.—than for in-laws. But the high degree of concordance of evolutionary interests for a pair that both expect a lifelong relationship should mean that fully expecting a lifelong relationship should help kick highly cooperative adaptations into gear. If these highly cooperative adaptations can be kicked into gear, living and striving side by side with someone who is pulling in the same direction is a very rewarding experience!

Of course, things aren’t quite that simple, but where interests continue to differ, reciprocity, love and empathetic understanding can help make up the difference.

Economists use the unromantic sounding term “relationship-specific capital” for what one gets from investing in a relationship. Besides shared experiences and shared loved ones beyond the couple, one important type of relationship-specific capital is learning which battles to fight and which battles to avoid. Some of the content of what one can predict about what one’s partner will do or how one’s partner will react in any given situation can be frustrating. But being able to predict it is a lot better than having it come as a surprise! There is often a path to avoiding bad interactions and a path to seeking out good interactions. Many times early on in my marriage, I wished I could rewind time ten seconds and try a different tack. I couldn’t do that then, but in our 34+ years of marriage, a similar situation has often come up later on, in which I could indeed take a different tack.

Here is the bottom line: there are indeed marriages so damaging to at least one of the partners that the marriage should be broken apart. But assuming the partners begin the relationship by marrying someone of a gender they are attracted to, it is good to set expectations for the two in the relationship that both will be very, very slow to break apart the marriage for anything less heavy, say, than adultery by the other partner, physical abuse, felonies, or prolonged verbal and emotional abuse. As long as there is still good will and good intent on both sides, even big hairy arguments can often be worked through, and reruns of those arguments moderated.

For me, it is not a hard judgment to make that the most recent year in our marriage has been the best. I hope that continues to be true for the rest of our life together!

Biohacking: Nutrition as Technology

Many of the ideas on diet and health that I have written about here on this blog have attracted the attention of Silicon Valley companies. (That is cousin causality, not any causal influence flowing from my blog!) I wanted to give my reactions to various things Amanda Mull reports are on the market in her October 30, 2018 Atlantic article “The Harder, Better, Faster, Stronger Language of Dieting.”

Let me begin by saying that I find it a very congenial perspective to think of what I eat as a practical question without any big moral dimension beyond the idea that extending one’s life and improving one’s health might have some positive spillovers on other people. (By contrast, getting accurate information and useful perspectives to people about how they might extend their own lives and improve their health has a strong moral dimension. And intentionally obfuscating evidence about diet and health—say, in order to uphold sales of a product—is reprehensible to the highest degree.) So I find this that Amanda describes a positive development:

Dieting is no longer a necessary problem of vanity, as it has been historically termed, but a problem of knowledge and efficiency—a rhetorical shift with broad implications for how people think of themselves. Where bodies might have previously been idealized as personal temples, they’re now just another device to be managed, and one whose use people are expected to master. We’re optimizing our performances instead of watching our figure, biohacking our personal ecosystem instead of eating salads.

Amanda makes the point that this way of looking at things is especially important to men, but it seems to me likely to be helpful to women as well. If not, I would like someone to help me understand why not. The way dieting has been sold to women sounds pretty alienating to me, even if it has been successful in manipulating many women. As Amanda writes:

The diet industry’s modern history in America is feminized, which until recently left men as a relatively untapped potential market. “Gender contamination,” as the Harvard researcher Jill Avery coined it, is when a product or idea becomes so female-coded that men are no longer willing to engage with it. The classic example of this phenomenon is diet soda, and it’s no coincidence that gender contamination shows up most recognizably in the things people eat: The diet industry has always found its easiest prey among women, who are culturally primed to hone their appearance toward impossible ideals to demonstrate their social worth.

Note that the diet soda men shun probably hasn’t done much good for women either. There is little evidence that people’s weight goes down when they drink diet sodas. For some of why this might be, see “Which Nonsugar Sweeteners are OK? An Insulin-Index Perspective.”

Having discussed the new rhetorical angle for nutrition as technology, let’s talk about some specific things out there. Let me chop up one of Amanda’s paragraphs into bullet points and comment:

I attend social science genetics conferences where the latest developments in human genetics in general are also talked about. There are some long-known disorders that depend only on a few genes, but aside from those, I don’t believe anyone who claims there is currently a measure based on tiny effects from many, many genes for people that could generate replicable results for diet and health. Basically, to get a reliable measure that would generate replicable results for a highly polygenic measure (based on many genes, each with a tiny effect), one would need very large samples of people with very good data on their diets. The best existing data sets are still not good enough. On the other hand, if you want the illusion of a result, a small sample is good for p-hacking. And with p-hacking, you could glom onto false positives of supposedly big effects of a few genes. My guess is that the services being sold are based on p-hacked science. But I would be glad to be told convincingly otherwise.

In a phrase that predates any tradename, “bulletproof coffee” is coffee with butter melted in it. For coffee drinkers, bulletproof coffee is a great way to deal with a desire for something foodlike while still keeping one’s insulin levels low. (See “Obesity Is Always and Everywhere an Insulin Phenomenon” and “Forget Calorie Counting; It's the Insulin Index, Stupid.”) But you don’t have to pay someone extra to put the coffee and the butter together for you! And indeed, if you do it yourself, you can make it a bit healthier by using goat butter rather than cow butter. (See “Exorcising the Devil in the Milk.”)

“Studying your biomarkers” means looking at a saliva sample and three blood samples taken after drinking a nutrition shake. I don’t know exactly what Habit does, but in principle, it could be very much like what some doctors do. It is a matter of what level of quality they are actually delivering, which I don’t know.

This is an attempt to mimic what happens during an extended fast. It may have some fraction of the benefits of actually fasting, but I doubt it has all of the benefits.

This one I have to laugh at. Fasting doesn’t need any particular pattern. The environment of evolutionary adaptation for humans likely had a lot of random involuntary fasting. So we are likely to be designed for patternless fasting. The main thing is to (a) do enough total fasting and (b) fast for some reasonably long chunks of time, and (c) work up slowly to anything more than 24 hours so that you know your tolerance for fasting. That’s it. No particular pattern needed. Do a water-only fast (or allow unsweetened coffee and tea) when it is most convenient, which might be either when you are especially busy or when you have many distractions to keep your mind off of food (which could happen at the same time).

Let me do one more from Amanda’s first paragraph:

  • Late last year, the health-care start-up Viome raised $15 million in venture-capital funding for at-home fecal test kits. You send in a very small package of your own poop, and the company tells you what’s happening in your gut so that you can recalibrate your diet to, among other things, lose weight and keep it off. In the company’s words, subscribers get the opportunity to explore and improve their own microbiome: Viome “uses state-of-the-art proprietary technology” to create “unique molecular profiles” for those who purchase and submit a kit.

A lot of science is documenting that the gut microbiome is very important for health. And what you eat can have a big effect on your gut microbiome. So it would be good if we all knew more about our gut microbiomes. There is a cost here in money, trouble and disgust, but I think those willing to pay that cost will gain some benefit. (I am not yet ready to go for it, personally.)

Amanda uses the word “biohacking” several times. I consider the approach I take in my diet and health posts to be a “biohacking” approach. (Note: biohacking good; p-hacking bad.) I hope you find the biohacking approach in this blog helpful. One thing you should be reassured by is that I am currently making no effort to monetize any of what I am saying about diet and health. And what fantasies I have about monetization are about books and advice-giving rather than about selling products. (When I think about inventing new products, it is so I can eat them! I would love to see a commercial ice cream invented and marketed that was designed to have as low an insulin index as possible for a reasonable level of deliciousness. Halo Top is not terrible, but it is too focused on getting the calorie count down. With healthy dietary fats bringing the insulin index down, the healthiest ice cream would be a very rich, high-fat ice cream.)

Don’t miss my other posts on diet and health:

I. The Basics

II. Sugar as a Slow Poison

III. Anti-Cancer Eating

IV. Eating Tips

V. Calories In/Calories Out

VI. Wonkish

VIII. Debates about Particular Foods and about Exercise

IX. Gary Taubes

X. Twitter Discussions

XI. On My Interest in Diet and Health

See the last section of "Five Books That Have Changed My Life" and the podcast "Miles Kimball Explains to Tracy Alloway and Joe Weisenthal Why Losing Weight Is Like Defeating Inflation." If you want to know how I got interested in diet and health and fighting obesity and a little more about my own experience with weight gain and weight loss, see “Diana Kimball: Listening Creates Possibilities and my post "A Barycentric Autobiography.

John Locke on the Supremacy of the People, the Supremacy of the Legislature over the Executive, and the Power of the Executive to Deal with Rotten Boroughs

In Chapter XIII, “Of the Subordination of the Powers of the Commonwealth,” of his 2d Treatise on Government: Of Civil Government, John Locke argues for the supremacy of the people over the legislature, and for the supremacy of the legislature over the executive. But he looks to the executive to act on behalf of the people in dealing with rotten boroughs.

First, on the supremacy of the people over the legislatures, John Locke writes:

§. 149. THOUGH in a constituted commonwealth, standing upon its own basis, and acting according to its own nature, that is, acting for the preservation of the community, there can be but one supreme power, which is the legislative, to which all the rest are and must be subordinate, yet the legislative being only a fiduciary power to act for certain ends, there remains still in the people a supreme power to remove or alter the legislative, when they find the legislative act contrary to the trust reposed in them: for all power given with trust for the attaining an end, being limited by that end, whenever that end is manifestly neglected, or opposed, the trust must necessarily be forfeited, and the power devolve into the hands of those that gave it, who may place it anew where they shall think best for their safety and security. And thus the community perpetually retains a supreme power of saving themselves from the attempts and designs of any body, even of their legislators, whenever they shall be so foolish, or so wicked, as to lay and carry on designs against the liberties and properties of the subject: for no man or society of men, having a power to deliver up their preservation, or consequently the means of it, to the absolute will and arbitrary dominion of another; whenever any one shall go about to bring them into such a slavish condition, they will always have a right to preserve what they have not a power to part with: and to rid themselves of those who invade this fundamental, sacred, and unalterable law of self-preservation, for which they entered into society. And thus the community may be said in this respect to be always the supreme power, but not as considered under any form of government, because this power of the people can never take place till the government be dissolved. 

I see this as saying that one cannot expect people to give up their self-interest. And if the self-interest of the vast majority of people in a nation is being trampled on by the government, then they have the right to abolish that government. Of course, in some cases the cost of abolishing the government may be so high that they don’t do it, but they have the right to.

On the supremacy of the legislature over the executive, John Locke is careful to distinguish between (a) the ceremonial role of the executive as a symbol of the will of the legislature (and behind that, the will of the people), (b) the executive as someone with the fiduciary duty to realize the will of the legislature (and behind that the will of the people) and (c) the executive as a particular person with whims of his or her own. As long as the executive isn’t also the sole legislator, these distinctions hold even when the executive has a role in legislation (such as veto power).

§. 150. In all cases, whilst the government subsists, the legislative is the supreme power: for what can give laws to another, must needs be superior to him; and since the legislative is no otherwise legislative of the society, but by the right it has to make laws for all the parts, and for every member of the society, prescribing rules to their actions, and giving power of execution, where they are transgressed, the legislative must needs be the supreme, and all other powers, in any members or parts of the society, derived from and subordinate to it.  

§. 151. In some commonwealths, where the legislative is not always in being, and the executive is vested in a single person, who has also a share in the legislative; there that single person in a very tolerable sense may also be called supreme: not that he has in himself all the supreme power, which is that of law-making; but because he has in him the supreme execution, from whom all inferior magistrates derive all their several subordinate powers, or at least the greatest part of them: having also no legislative superior to him, there being no law to be made without his consent, which cannot be expected should ever subject him to the other part of the legislative, he is properly enough in this sense supreme. But yet it is to be observed that though oaths of allegiance and fealty are taken to him, it is not to him as supreme legislator, but as supreme executor of the law, made by a joint power of him with others; allegiance being nothing but an obedience according to law, which when he violates, he has no right to obedience, nor can claim it otherwise than as the public person vested with the power of the law, and so is to be considered as the image, phantom, or representative of the commonwealth, acted by the will of the society, declared in its laws; and thus he has no will, no power, but that of the law. But when he quits this representation, this public will, and acts by his own private will, he degrades himself, and is but a single private person without power, and without will, that has any right to obedience; the members owing no obedience but to the public will of the society.

John Locke points out that sometime the subordination of the executive to the legislature is clear—as it would be in a city-state where the city council hired a city manager—but other times one must be careful to see the subordination of the executive to the legislature despite the executive having a large share of legislative power:

§. 152. The executive power, placed anywhere but in a person that has also a share in the legislative, is visibly subordinate and accountable to it, and may be at pleasure changed and displaced; so that it is not the supreme executive power, that is exempt from subordination, but the supreme executive power vested in one, who having a share in the legislative, has no distinct superior legislative to be subordinate and accountable to, farther than he himself shall join and consent; so that he is no more subordinate than he himself shall think fit, which one may certainly conclude will be but very little.

Immediately following that, in Section 152, he asserts the ultimate subordination of all other arms of the government to the legislature, and under that to the chief executive:

Of other ministerial and subordinate powers in a commonwealth, we need not speak, they being so multiplied with infinite variety, in the different customs and constitutions of distinct commonwealths, that it is impossible to give a particular account of them all. Only thus much, which is necessary to our present purpose, we may take notice of concerning them, that they have no manner of authority, any of them, beyond what is by positive grant and commission delegated to them, and are all of them accountable to some other power in the commonwealth. 

With the rise in the power of independent agencies in the US and other countries, this is a meaningful stipulation.

After asserting this hierarchy, John Locke turns to two possible abuses: one of the executive, one of the legislature: the executive might try to avoid calling the legislature into session, while the legislature might not fix rotten boroughs because the rotten boroughs help incumbents.

In general, John Locke likes the idea of the executive choosing when the legislature should meet, because otherwise the legislature might meet too often and make too many needless laws. But if the executive doesn’t call the legislature when it should be called (because of business arising)—or worse, tried to actively prevent the legislature from meeting—that would violate the supremacy of the legislature, and put the executive at war with the people as well:

§. 153. It is not necessary, no, nor so much as convenient, that the legislative should be always in being; but absolutely necessary that the executive power should, because there is not always need of new laws to be made, but always need of execution of the laws that are made. When the legislative hath put the execution of the laws, they make, into other hands, they have a power still to resume it out of those hands, when they find cause, and to punish for any mal-administration against the laws. The same holds also in regard of the federative power, that and the executive being both ministerial and subordinate to the legislative, which, as has been shewed, in a constituted commonwealth is the supreme. The legislative also in this case being supposed to consist of several persons, (for if it be a single person, it cannot but be always in being, and so will, as supreme, naturally have the supreme executive power, together with the legislative) may assemble, and exercise their legislature, at the times that either their original constitution, or their own adjournment, appoints, or when they please; if neither of these hath appointed any time, or there be no other way prescribed to convoke them: for the supreme power being placed in them by the people, it is always in them, and they may exercise it when they please, unless by their original constitution, they are limited to certain seasons, or by an act of their supreme power they have adjourned to a certain time; and when that time comes, they have a right to assemble and act again.  

§. 154. If the legislative, or any part of it, be made up of representatives chosen for that time by the people, which afterwards return into the ordinary state of subjects, and have no share in the legislature but upon a new choice, this power of chusing must also be exercised by the people, either at certain appointed seasons, or else when they are summoned to it; and in this latter case, the power of convoking the legislative is ordinarily placed in the executive, and has one of these two limitations in respect of time: that either the original constitution requires their assembling and acting at certain intervals, and then the executive power does nothing but ministerially issue directions for their electing and assembling, according to due forms; or else it is left to his prudence to call them by new elections, when the occasions or exigencies of the public require the amendment of old, or making of new laws, or the redress or prevention of any inconveniences, that lie on, or threaten the people.  

§. 155. It may be demanded here, What if the executive power, being possessed of the force of the commonwealth, shall make use of that force to hinder the meeting and acting of the legislative, when the original constitution, or the public exigencies require it? I say, using force upon the people without authority, and contrary to the trust put in him that does so, is a state of war with the people, who have a right to reinstate their legislative in the exercise of their power: for having erected a legislative, with an intent they should exercise the power of making laws, either at certain set times, or when there is need of it, when they are hindered by any force from what is so necessary to the society, and wherein the safety and preservation of the people consists, the people have a right to remove it by force. In all states and conditions, the true remedy of force without authority, is to oppose force to it. The use of force without authority, always puts him that uses it into a state of war, as the aggressor, and renders him liable to be treated accordingly.  

§. 156. The power of assembling and dismissing the legislative, placed in the executive, gives not the executive a superiority over it, but is a fiduciary trust placed in him, for the safety of the people, in a case where the uncertainty and variableness of human affairs could not bear a steady fixed rule: for it not being possible, that the first framers of the government should, by any foresight, be so much masters of future events, as to be able to prefix so just periods of return and duration to the assemblies of the legislative, in all times to come, that might exactly answer all the exigencies of the commonwealth; the best remedy could be found for this defect, was to trust this to the prudence of one who was always to be present, and whose business it was to watch over the public good. Constant frequent meetings of the legislative, and long continuations of their assemblies, without necessary occasion, could not but be burdensome to the people, and must necessarily in time produce more dangerous inconveniences, and yet the quick turn of affairs might be sometimes such as to need their present help: any delay of their convening might endanger the public; and sometimes too their business might be so great, that the limited time of their sitting might be too short for their work, and rob the public of that benefit which could be had only from their mature deliberation. What then could be done in this case to prevent the community from being exposed some time or other to eminent hazard, on one side or the other, by fixed intervals and periods, set to the meeting and acting of the legislative, but to intrust it to the prudence of some, who being present, and acquainted with the state of public affairs, might make use of this prerogative for the public good? and where else could this be so well placed as in his hands, who was intrusted with the execution of the laws for the same end? Thus supposing the regulation of times for the assembling and sitting of the legislative, not settled by the original constitution, it naturally fell into the hands of the executive, not as an arbitrary power depending on his good pleasure, but with this trust always to have it exercised only for the public weal, as the occurrences of times and change of affairs might require. Whether settled periods of their convening, or a liberty left to the prince for convoking the legislative, or perhaps a mixture of both, hath the least inconvenience attending it, it is not my business here to enquire, but only to shew, that though the executive power may have the prerogative of convoking and dissolving such conventions of the legislative, yet it is not thereby superior to it.  

The US Constitution lets Congress determine its own meeting times, with the stipulation that it meet at least once a year. Here is the relevant clause in Article I, Section 4 of the US Constitution:

The Congress shall assemble at least once in every Year, and such Meeting shall be on the first Monday in December, unless they shall by Law appoint a different Day.

Redistricting to deal with rotten boroughs that have a lower population than other districts is something for which John Locke trusts the executive more than the legislature:

§. 157. Things of this world are in so constant a flux, that nothing remains long in the same state. Thus people, riches, trade, power, change their stations, flourishing mighty cities come to ruin, and prove in time neglected desolate corners, whilst other unfrequented places grow into populous countries, filled with wealth and inhabitants. But things not always changing equally, and private interest often keeping up customs and privileges, when the reasons of them are ceased, it often comes to pass, that in governments, where part of the legislative consists of representatives chosen by the people, that in tract of time this representation becomes very unequal and disproportionate to the reasons it was at first established upon. To what gross absurdities the following of custom, when reason has left it, may lead, we may be satisfied, when we see the bare name of a town, of which there remains not so much as the ruins, where scarce so much housing as a sheepcote, or more inhabitants than a shepherd is to be found, sends as many representatives to the grand assembly of law-makers, as a whole county numerous in people, and powerful in riches. This strangers stand amazed at, and every one must confess needs a remedy; though most think it hard to find one, because the constitution of the legislative being the original and supreme act of the society, antecedent to all positive laws in it, and depending wholly on the people, no inferior power can alter it. And therefore the people, when the legislative is once constituted, having, in such a government as we have been speaking of, no power to act as long as the government stands; this inconvenience is thought incapable of a remedy.  

§. 158. Salus populi suprema lex, is certainly so just and fundamental a rule, that he, who sincerely follows it, cannot dangerously err. If therefore the executive, who has the power of convoking the legislative, observing rather the true proportion, than fashion of representation, regulates, not by old custom, but true reason, the number of members, in all places that have a right to be distinctly represented, which no part of the people however incorporated can pretend to, but in proportion to the assistance which it affords to the public, it cannot be judged to have set up a new legislative, but to have restored the old and true one, and to have rectified the disorders which succession of time had insensibly, as well as inevitably introduced: For it being the interest as well as intention of the people, to have a fair and equal representative; whoever brings it nearest to that, is an undoubted friend to, and establisher of the government, and cannot miss the consent and approbation of the community; prerogative being nothing but a power in the hands of the prince, to provide for the public good, in such cases, which depending upon unforeseen and uncertain occurrences, certain and unalterable laws could not safely direct; whatsoever shall be done manifestly for the good of the people, and the establishing the government upon its true foundations, is and always will be, just prerogative. The power of erecting new corporations, and therewith new representatives, carries with it a supposition, that in time the measures of representation might vary, and those places have a just right to be represented which before had none; and by the same reason, those cease to have a right, and be too inconsiderable for such a privilege, which before had it. ’Tis not a change from the present state, which perhaps corruption or decay has introduced, that makes an inroad upon the government, but the tendency of it to injure or oppress the people, and to set up one part or party, with a distinction from, and an unequal subjection of the rest. Whatsoever cannot but be acknowledged to be of advantage to the society, and people in general, upon just and lasting measures, will always, when done, justify itself; and whenever the people shall chuse their representatives upon just and undeniably equal measures, suitable to the original frame of the government, it cannot be doubted to be the will and act of the society, whoever permitted or caused them so to do.

In John Locke’s day, there was a real issue of whether redistricting to reflect population shifts would happen at all. The US Constitution worries about the problem or rotten boroughs, by requiring redistricting in accordance with a census ever 10 years in Article 1, Section 2:

The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct. The Number of Representatives shall not exceed one for every thirty Thousand, but each State shall have at Least one Representative;

In the US Constitutional system, redistricting happens, but is often done in a way that is both (a) partisan and (b) protective of incumbents. And nowadays, we don’t trust the executive to do impartial redistricting either; the movement for nonpartisan redistricting often puts the redistricting in the hands of a panel of retired judges, for example.

Both of the issues John Locke raises at the end of the chapter: the executive trying to keep the legislature from meeting and the problem of rotten boroughs John Locke address according to the principles that the people are superior to the legislature, which is superior to the executive. Those seem wise principles to me.

For links to other John Locke posts, see these John Locke aggregator posts: 

Don't Tar Fasting by those of Normal or High Weight with the Brush of Anorexia

Healthy Fasting. One of the challenges people face when they use fasting as a tool for weight loss and other health benefits is that people around them may think fasting is more dangerous than it really is. In “4 Propositions on Weight Loss,” Proposition 2 and its gloss are:

For healthy, nonpregnant, nonanorexic adults who find it relatively easy, fasting for up to 48 hours is not dangerous—as long as the dosage of any medication they are taking is adjusted for the fact that they are fasting. …

The best evidence that fasting is not dangerous comes from the experience of those in religious traditions that encourage fasting. For example, the Mormonism I grew up in not only instructed everyone who could to fast for 24 hours once a month, it also encouraged people to fast for longer periods of time for special spiritual purposes. Mormon fasts often involved not drinking as well as not eating. Given the body of experience indicating that even fasts that risked dehydration were usually not that dangerous, nonreligious fasting that encourages the drinking of water should not be dangerous for those in good health who are not pregnant or anorexic. The biggest worry I have about people fasting is that it could easily throw off the dosage of medication they are taking. So anyone taking prescription medication should consult their doctor about medication interactions before fasting. And anyone taking nonprescription medication should think hard about lowering the dose when they fast. 

In Amanda Mull’s Atlantic piece “What Billionaires’ Fasting Diets Mean for the Rest of Us,” she unfairly suggests that a short eating window every day is extreme enough to be suspect:

Twitter’s CEO, Jack Dorsey, doesn’t eat for 22 hours of the day, and sometimes not at all. Over the weekend he tweeted that he’d been “playing with fasting for some time,” regularly eating all of his daily calories at dinner and occasionally going water-only for days on end. In many cases, severe and arbitrary food restriction might be called an eating disorder. And while researchers are hopeful that some types of fasts may be beneficial to people’s health, plenty of tech plutocrats have embraced extreme forms of the practice as a productivity hack.

I am in line with Jack Dorsey’s practice, except I try to do my eating window around lunchtime when I can, which is often, since I spend my most research-intensive days working at home. I view fasting for 20-22 hours a day and occasionally for 48 or 72 hours as quite healthy. And as I wrote in “My Annual Anti-Cancer Fast,” I try to fast for a week once a year with the idea that, however hard that might be on me, it will be harder on any cancer cells or precancerous cells I might have.

Given my view that fasting is healthy, I also don’t see anything amiss in timing when I fast to when I most need some extra time. During my teaching semester—four months out of the year—when I teaching Monday, Wednesday, Friday, I fast throughout Monday and Wednesday (making for close to a 44-hour fast when combined with my short eating window on surrounding days) and eat lunch with my colleagues on Friday. Last week, in order to help get a grant proposal done, I fasted an extra day when I wouldn’t have otherwise. During the rest of the year, in addition to the short eating window each day, I find I need to skip eating at least one day every two weeks to keep my weight steady. I wish it weren’t so, but it is what it is. On the other hand, part of that is compensating for vacation days or days when guests are visiting, when I have a longer eating window.

I have to emphasize that if I were fasting this much and it were hard, that would indicate some sort of psychological pathology. But as I have emphasized often in my diet and health posts, if one is eating very low on the insulin index when one does eat fasting can be surprisingly easy, at least for some people, among whom I am one. (See “Forget Calorie Counting; It's the Insulin Index, Stupid,” “Obesity Is Always and Everywhere an Insulin Phenomenon,” and “Why a Low-Insulin-Index Diet Isn't Exactly a 'Lowcarb' Diet.”) And I promise, I am still well within the normal weight range. Putting the lowest weigh I have seen on the scale lately and rounding up my height to the nearest inch, I still get a BMI of 23.1, which is far from any danger zone of being too thin!

In the following paragraph, Amanda Mull summarizes some of the health benefits of fasting, but then argues that fasting raises the risk of anorexia and bulimia:

Intermittent fasting, like most health-and-wellness behaviors, can exist anywhere on a spectrum that runs from very dangerous to potentially beneficial, depending on who’s doing it and how it’s implemented. Fasting in one form or another has been a part of human eating behavior for millennia, and although scientific research on it is still preliminary, early studies suggest it might help reduce the risk of heart disease, cancer, and diabetes. For people with eating issues, though, fasting can be a very risky trigger for anorexia or bulimia. For most people, exploring Dorsey’s lengthy, everyday fasts without oversight from a doctor or nutritionist is probably unwise.

Bulimia. Amanda’s link on “bulimia” is to a Journal of Abnormal Psychology article, “Fasting Increases Risk for Onset of Binge Eating and Bulimic Pathology: A 5-Year Prospective Study.” The authors of this study are more careful in distinguishing correlation from causation in their abstract than in their title. They write:

We tested the hypothesis that fasting (going without eating for 24-hours for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5-years. Results confirmed that only 23% of participants with elevated dietary restraint scores reporting fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting.

Wikipedia currently defines bulimia as “an eating disorder characterized by binge eating followed by purging.” One possibility, which I think the authors of this study would take seriously, is that girls who are likely to become bulimic later on in any case, also are prone to a variety of other behaviors. The other important possibility is that if one does fasting without eating low on the insulin index, it is quite dangerous for setting up a cycle of bad eating behavior because of the strong hunger that results. I do not recommend trying to do a lot of fasting without first moving to low insulin-index eating.

Those who are fasting in the way I do recommend should be careful to explain to others who see them fasting that the low-insulin-index eating is an important part of the practice. If people prone to anorexia could get fixated first on avoiding sugar, before they are tempted to do more than that, they would be less likely to do themselves harm.

Fasting is counted as one of the possible types of “purging” in bulimia. But the more common types of purging are vomiting and taking laxatives. Repeated vomiting can be quite dangerous. And laxative abuse is unlikely to be healthy. As far as these very dangerous behaviors go, for someone for whom fasting is easy because they are eating low on the insulin index, I don’t see why they would turn to vomiting or laxatives. And if they are eating low on the insulin index, they are less likely to do extreme binge eating because satiation kicks in fairly quickly if one is avoiding, say, sugar, rice, bread and potatoes and a few other high-insulin-index foods.

As near as I could make out from my online reading, those who induce vomiting or abuse laxatives who are underweight are called anorexics of the binge-purge subtype rather than being classed as bulimics. But clearly, the binge-purge subtype of anorexia shares a lot in common with bulimia. The National Association of Anorexia Nervosa and Associated Disorders gives a .9% lifetime risk for anorexia. Of this, from two studies I looked at on the fractions of each subtype in studies that were taking all the anorexics they could enroll, it appears that the binge-purge subtype is somewhat over half of anorexics, while the restrictive subtype is somewhat less than half.

It is possible that seeing other people fast might inspire someone prone to the restrictive subtype of anorexia to be very restrictive in eating. But it is also possible that if more people not prone to psychopathology were fasting regularly, that those prone to restrictive anorexia who were not fated to fall into anorexia no matter what could be better guided into helpful, rather than harmful patterns of fasting.

The simple fact is that we just don’t know whether having healthy fasting be more common in our culture would make things worse for those prone to anorexia or better. To me, one possibly powerful effect in the direction of making things safer for those prone to anorexia is that if were common knowledge in our culture that weight could be lost by a combination of low-insulin-index eating and fasting whenever someone wanted to, then the total amount of angst about weight in our culture might go down. That might help. One of the biggest ways it might help is if the common knowledge that the combination of low-insulin-index eating and fasting could bring effective weight loss helped everyone to set a bright line that inducing vomiting or abusing laxatives for weight loss is bad and unjustified, no matter how disgusted one is with one’s weight.

Anorexia. Amanda’s link on “ anorexia” is the second article above, Rebecca Ruiz’s piece “Silicon Valley preaches the virtues of fasting, alarming eating disorder experts.” Rebecca Ruiz relies on Andrew Walen making the immediate judgment that fasting is “disordered eating,” which is exactly the question at issue. Actually, in context, Andrew Walen and the other expert Claire Misko are saying something more subtle: that people who think of weight loss and eating well as a big achievement might be getting into a weird and unhealthy headspace:

"The connection between achievements and food and eating is very alarming," says Claire Mysko, CEO of the National Eating Disorders Association. "Not everybody who gets into this is necessarily going to spiral into a eating disorder, but if you are at risk, this is a really triggering framing."

In other words, Claire is saying it is notion of “achievement” that could trigger disordered eating, not having people around who are calmly doing fasting in the background of their lives as no big deal. And that is exactly how I do fasting: it isn’t a nothing, but for the most part it fades into the background of my life. The reason it can fade into the background is because the combination of low-insulin-index eating and fasting is relatively easy. It is not easy for things that are difficult to fade into the background of one’s life!

Tradeoffs. As I noted above, we just don’t know if having healthy fasting become more common would tip some of those prone to restrictive anorexia—or perhaps even those prone to binge-purge anorexia or bulimia—into worse symptoms. This is not something we have causal evidence of. But even if there is a causal effect in this direction, it needs to be counterposed to the health benefits people get from healthy fasting, including reducing the incidence of all the diseases associated with obesity.

As quoted in Rebecca Ruiz’s article, Geoffrey Woo makes this point:

Geoffrey Woo, who created a private HVMN Facebook group devoted to answering questions about fasting, is sympathetic to such criticism but calls it a "stretch." 

He argues you could make a similar criticism of public health officials who promote hand-washing because some people, presumably who experience obsessive-compulsive disorder, might find such campaigns triggering. Woo knows it's not an equivalent analogy, but it speaks to his view of fasting as a public health intervention.  

"The inspiration of fasting does come from realizing two-thirds of Americans are overweight or obese," he says. 

Let me make another analogy. There is another behavior that is widespread in our society, whose main benefit is pleasure—with some believing that it might aid health based on evidence that is much weaker than the evidence for the health benefits of fasting. That behavior is moderate drinking of alcohol. I think people drinking some alcohol rather than none is much more likely to create a danger for those prone to alcoholism than people doing healthy fasting is to create a danger for those prone to anorexia. But how many of us wish that alcohol and similar drugs didn’t exist? I might, but I think I am in the minority.

The majority who are happy that alcohol exists have a responsibility to distinguish carefully between moderate drinking and excessive drinking. Just so, those who are happy that we have the powerful tool of fasting to aid health in numerous ways have a responsibility to distinguish carefully between healthy fasting and anorexic behavior. Let me try. First is the bright line that inducing vomiting and laxative abuse are bad. Second, I would say that those younger than 20 years old (or are pregnant) should definitely not be fasting more than 24 hours at a stretch, and should not be fasting more than 16 hours with any frequency. Third, it is a red flag if someone is doing a lot of fasting without also avoiding sugar. This could be conducive to a binge-purge pattern. Fourth, it is a red flag if someone is keeping their eating or purging patterns a secret. It can be annoying to have to defend what one is doing with fasting, but being open about what one is doing and defending it to other people—and sometimes recognizing that their worries are well-founded. is an important safeguard against doing something really stupid.

Doctors. What about the idea that one should only fast under a doctor’s supervision? Basically, this is impractical. Do we think every practicing Muslim should be under a doctor’s supervision throughout Ramadan every year, when they fast from sunup to sundown every day? Should every Mormon only do their once-a-month 24-hour fast only under a doctor’s supervision?

As another comparison, think of how many lives could be saved if we insisted that no one should eat sugar except under a doctor’s supervision!

There are certain things we should develop a common wisdom about so that we all know what is a sensible way to do them without always needing to use expensive doctors to supervise them. Let me try my hand at beginning to develop that common wisdom:

  • If your body-mass-index is below 18.5, quit fasting! Here is a link to a BMI calculator.

  • Definitely people should not do fasting for more than 48 hours without first reading Jason Fung’s two books The Obesity Code (see “Obesity Is Always and Everywhere an Insulin Phenomenon” and “Five Books That Have Changed My Life”) and The Complete Guide to Fasting.

  • Those under 20, pregnant or seriously ill should indeed consult a doctor before trying to do any big amount of fasting.

  • Those on medication need to consult their doctor before doing much fasting. My personal nightmare as someone recommending fasting is that a reader who is already under the care of a doctor who is prescribing medicine might fail to consult their doctor about adjusting the dosage of that medicine in view of the fasting they are doing. Please, please, please, if you want to try fasting and are on medication, you must tell your doctor. That may involve the burden of educating your doctor about fasting. But it could save your life from a medication overdose.

  • Those who find fasting extremely difficult should not do lengthy fasts.

  • But, quoting again from “4 Propositions on Weight Loss”: “For healthy, nonpregnant, nonanorexic adults who find it relatively easy, fasting for up to 48 hours is not dangerous—as long as the dosage of any medication they are taking is adjusted for the fact that they are fasting.”

The Limits of My Knowledge. I am painfully aware of how little I know about anorexia and bulimia. Please, do educate me in the comments section below. Anorexia and bulimia are terrible. Despite some superficial similarities with fasting, I am questioning how much they have to do with healthy fasting. And no one knows what effect an increase in the fraction of those doing healthy fasting would have on those prone to anorexia and bulimia. It might well depend on exactly how those into healthy fasting do it and how they explain what they are doing.

Don’t miss my other posts on diet and health:

I. The Basics

II. Sugar as a Slow Poison

III. Anti-Cancer Eating

IV. Eating Tips

V. Calories In/Calories Out

VI. Wonkish

VIII. Debates about Particular Foods and about Exercise

IX. Gary Taubes

X. Twitter Discussions

XI. On My Interest in Diet and Health

See the last section of "Five Books That Have Changed My Life" and the podcast "Miles Kimball Explains to Tracy Alloway and Joe Weisenthal Why Losing Weight Is Like Defeating Inflation." If you want to know how I got interested in diet and health and fighting obesity and a little more about my own experience with weight gain and weight loss, see “Diana Kimball: Listening Creates Possibilities and my post "A Barycentric Autobiography.