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Comment by seltzered_ | Hacker News Reader

I recall seeing this article from 2014 referring to suicides in Utah ('utah paradox') and how neuroscientist Perry Renshaw was trying to link it to altitude: http://mic.com/articles/104096/there-s-a-suicide-epidemic-in... which links to another study from 2011: http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.201...

"Together, the stray statistics and stories about life out west tipped off Renshaw to a common culprit: altitude-induced oxygen depletion. [...] Renshaw believes that oxygen-poor air tampers with brain chemistry, leading to a drop in serotonin and an uptick in dopamine."

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For that to be true, you'd need to establish that blood oxygen levels differ significantly across altitude adapted individuals, and I don't believe that this is the case.

Also, when I first moved from Philadelphia to a village in New Mexico at 6000', I remember reading that I should plan on a 3 phase adapative process that would take as much as 9 months to complete. This makes me give less weight to things like the 2005 Marines study that Renshaw cites, which only continued for 90 days.

I should stress that I'm not doubting the statistics, just the proposed mechanism ("low oxygen air"). On the other hand, "varying ability to fully adapt to lower oxygen levels" seems more plausible.

I agree. Low oxygen just doesn't make sense. It's more likely the higher cosmic rays and other space weather, which are already known to cause suicidal thoughts, as well as other mental health problems.

I think that warrants a citation

This makes me think. What if there was a database of conjectures. Each has an id number. The database could link to all sorts of media, scientific studies, etc. supporting or disputing each conjecture. Then you could just give the id number and folks would also get all the pro and con material they might like. Even things like "the earth is a sphere" could link to educational videos and whatnot. And even things like "political leaders who I disapprove of are in fact lizard aliens" could link to whatever material supports or disproves it. It'd be nice too if we could categorize these things: disputed, hypothetical, scientifically studied but not independently verified, multiple independent validations, technologies rely on the fact that this works, etc. I dunno why your point made me think of that.

Its called reddit

Sounds like Snopes.com

It's not particularly good, but you could look at procon.org

I think there are a few other similar sites.

In the age of the internet, lack of knowledge about something is a choice. People who believe Obama is a lizard alien don't do so because they haven't seen the appropriate "educational" video, but because that's what confirms what they want to believe.

What about people who do (or do not) believe that socialism is the future of America?

In a way, what you’ve described sounds an awful lot like the transformer architecture…

https://biomedres.us/pdfs/BJSTR.MS.ID.003709.pdf

Did you ever fully acclimate? After 3 years at 6000 ft I still had lower blood oxygen than at sea level. (per apple watch, so take that with a grain of salt)

I haven't measured my blood oxygen, alas.

I've been here 4+ years now, and other than being 4 years older and just coming out of a sedentary 3 year period, I notice zero effects of living (and running, cycling, swimming, hiking) at altitude. Can't say any more than that really.

Hmmm, given that...it does seem to me the initial claim is likely to be true.

I know you said that it has to vary between multiple individuals at altitude, but it's unclear to me why.

Don't we just have to show some individuals don't ever get back up to the same blood oxygen levels?

Well, another comment here from a guy of Sammi ancestry notes potential polymorphism in GHC1 as possible (and likely) partial explanation.

I would imagine that there are a variety of potential genetic differences that could generate a wide range of altitude-adaptation differences.

Isn’t Apple Watch and other blood oxygenation just measuring saturation (a relative measure)?

Among other things, Acclimatization involves producing more blood-oxygen carrying capacity (or less if you go back to sea level), which is an absolute measure, not a relative one that the oximeters would pick up.

Yea, we would only need a small percentage of folks unable to acclimate to create a significant correlation.

I can only speak anecdotally about my experience when I was young and now that I am much older. When I was young I went from about 69' MSL to about 6780' MSL when doing a job at the Air Force Academy and we dared each other to run up some stairs. We made it about half way up and fell over laughing and gasping for air. Our team chief that smoked about a half a carton of cigarettes a day walked right past us shaking his head. For about a week or so I had some pressure in my leg near the hip but it cleared up.

I am much older now and a couple years ago I retired/moved from about 600' MSL to 6300' MSL and it took about a half of a year for my body to adjust including some pain in my legs with some associated popping and other weird pressure like feeling similar to what I had when younger but it took longer to go away. Probably too many decades behind a computer and not enough walking. I've had no feelings of self defenestration.

Why would you need to show that? I don't see anything that requires blood oxygen levels to be significantly different to get from "people at high elevation have access to less oxygen" to "living in lower-oxygen environments creates the right conditions to see serotonin go down and dopamine go up". Even if oxygen levels are identical once you get to the blood stream, it can cause many changes further up the process.

You'd need to show it because for O2 levels to matter, it would need to be the O2 levels experienced by cells that are different. But because of the body's adaptive mechanisms, it is possible for cellular O2 availability to remain (relatively) constant despite living in a depleted O2 environment.

Your cells cannot measure environmental O2 levels - only what is available from the bloodstream. Ergo, if sufficient adaptation has taken place - and it may not have - then as far as the body is concerned, there is no depleted O2 environment.

>Ergo, if sufficient adaptation has taken place - and it may not have

This tiny little caveat is the entire point of my comment. Happy to converse about other stuff, but it's a tangential topic at best.

>You'd need to show it because for O2 levels to matter, it would need to be the O2 levels experienced by cells that are different.

Right, and some of your body's cells are experiencing it differently. How... else would your body know to respond?

Suppose you had an internal combustion engine that functions well in 20.9% O2, but very poorly in 19.2% O2.

Then a mechanic shows up a lever you can pull that alters the way the engine intakes and processes O2. You move it a bit, and all of a sudden, the engine now functions just as well in 19.2% O2 as 20.9% O2.

Now imagine that the engine can measure its own performance, and can move the lever itself ...

This implies that it has some type of sensor which determines if it's at 20.9% or 19.2% in some manner. Those are analogous to whichever cells are experiencing the world differently, so that the lever knows to move.

> This tiny little caveat is the entire point of my comment. Happy to converse about other stuff, but it's a tangential topic at best.

Renshaw appears to be suggesting/hypothesizing that there is some universal "low O2" effect that leads to higher rates of suicide.

I'm saying that this seems unlikely, given that in fully adapted individuals, the cellular environment does not experience low O2.

Of course, in non-fully adapted individuals (either because they are still adapting, or because genetic/physiological factors prevent it), this would not be the case.

But that still says that there's no "general" low-O2 mechanism that is affecting anyone who lives at altitude. It only suggests that there maybe a low-O2 mechanism that affects some individuals. Whether there is a correlation between suicide rates and altitude adaptation doesn't appear to be easily established.

You are missing the fact that the human lungs are something like twice as effective and powerful as the "need" to be at sea level, and have plenty of room to handle less oxygen in the air. Second, the human body adapts quite well to living at higher altitudes, because it will compensate for the lower oxygen levels.

Same blood oxygen level as a sea level human means same quantity of oxygen getting to the brain.

>Even if oxygen levels are identical once you get to the blood stream, it can cause many changes further up the process.

What mechanism could possibly cause this? The brain is getting all the oxygen it needs.

>What mechanism could possibly cause this? The brain is getting all the oxygen it needs.

I have no idea, but I was unaware this could only be caused by oxygen failing to reach the brain.

> missing the fact that the human lungs are something like twice as effective and powerful as the "need" to be at sea level

on average, but you can get a population effect from "some small portion of the population has smaller or disease compromised lungs or just sleep apnea, and THOSE people commit suicide at a higher rate at high altitude".

The "our lungs are big enough" only works if you control for the cases where they aren't.

I'd hoped that things like genetic screening would uncover that some cases where studies showing that eating/avoiding Foo has a small positive or negative effect turns out to actually be an enormous effect in a small sub-population... but so far we don't appear to have identified too many of those.

its called scientific rigor

Is depression and suicide significantly positively correlated to asthma or other breathing disorders?

Preferably low-grade to rule out gross pathology.

This aligns with my similar theory (lack of O2 leads to depression) that was born from observations of yoga, meditation and walking all forced people to breath more air through breath work, exercises or going outside, lead to better mental health outcomes.

I am going to assume that in urban vs rural areas that is a similar effect from air pollution.

But all my doctors have been inclined to give me pills for depression, and aren't interesting in exploring the relationship with O2.

Your link from "yoga, meditation and walking" to oxygen availability is... to put it mildly, in need of extra support.

Yoga and walking are both exercise. Any form of aerobic exercise will increase oxygen availability.

Elite, and dedicated amateur, athletes will develop specific breathing routines to increase O2 availability in support of increasing their VO2 Max but even for sedentary (so, typical) adults practically any form of mindful breathing coupled with higher-than-typical physical exertion will increase oxygen availability.

Their breathing routines not coincidentally almost always mirror some kind of yogic breathing technique.

Yogic breathing in hypobaric environment: breathing exercising and its effect on hypobaric hypoxemia and heart rate at 3,650-m elevation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413908/

Effects of Slow Deep Breathing at High Altitude on Oxygen Saturation, Pulmonary and Systemic Hemodynamics

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495772/

When you meditate or do yoga asanas (poses) with a focus on your pranayama (breathing) as a matter of routine for long enough you subconsciously start performing yogic breathing all of the time.

Walking is just irrefutably, no-citation-needed, good for you.

I understood that rural air is significantly worse than urban due to all the pesticides.

Worse than urban air with auto pollution? I'd want to see a source for that...

Yeah, ppl on the ring road of Amsterdam live 10 years shorter afaik, for instance

Source? As a counter anecdote: Madrid, where most people live near traffic, has the highest life expectancy in the EU at 85.4 years.

maybe there are other factors at play here; who knows how long would they live if they didn't live near traffic.

What are they doing differently to get this average?

I had to look it up, i was indeed mistaken. It's 79 days on average. The road is called the A10, so I guess I mixed that up :)

Source, in dutch: https://www.hln.be/milieu/omwonenden-a10-snelweg-leven-79-da...

Poor people live next to highways?

Or when we build the highway, we don’t raze the homes of the elite/wealthy/well-connected to do it, we do it in “bad neighbourhoods”

Or indirect effects: factories move/build next to the new highway (ease of moving materials+density of employees+ease of commuting because of the highway), contaminating the neighbourhood.

Many rural areas do not have farming.

I live in a rural area and air here is significantly better than smog filled and ozone enriched air in the city I used to live in. Not to mention the lack of winter fog that can linger around for weeks at times.

And that's excluding the light and noise pollution that are inevitable in urban areas. Yeah, living in a rural area is pure hell.

What do you believe Ozone is?!?

Deeply toxic to human lungs.

Today I learned that ozone is typically found in the stratosphere (which I knew) but also at ground level due to chemical reactions.

And if you own an air purifier, likely in your room!

A fairly toxic allotrope of oxygen?

Urban/rural v suicide relationships are all over the place: https://www.sciencedirect.com/science/article/abs/pii/S01650... sees opposite relationship in China and Australia, e.g.

I have lived in multiple cities and multiple exurbs, at sea level and at a ski resort town (7000+ ft above sea level).

I would make these claims instead:

  - people at altitude spend more time indoors avoiding extreme weather caused by the altitude 
  - o2 levels to the brain are not significantly different for people whose bodies have adjusted to the altitude already
  - people who live at altitude are more likely to be more active
  - cities in modern western countries are largely clean of major sources of air pollution (one of the few things NIMBYs are good at)
  - cities in developing countries (eg. Pakistan, India, China) are incredibly different
  - rural areas are largely clean of air pollution except in hotspots (eg. factories and mines)
  - your doctor likely doesn’t do actual science (“explore relationships”), but rather just disseminates the evidence that others have already recorded
  - your doctor likely works in the USA where we pay fee for service. Maybe you should look at how single payer systems align healthy patient long term outcomes align with the single payer total costs.

Except that whole chemical imbalance theory was thoroughly debunked earlier this year as not being the cause of depression, just a marketing gimmick used to sell more anti depressants by pharma companies...

"The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants."

https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...

THIS needs to be spread around much more broadly.

[UPDATE]: Looks like I'm getting downvoted by people who cling to their meds. Try physical activity and adjusting your self-talk. Try having goals and making steady progress toward them. What you need doesn't come from a pill, it comes from living life.

>What you need doesn't come from a pill, it comes from living life.

Fuck off. Imagine telling someone with astigmatism that they don't need a physical modification and augmentation to their bodies, but rather "to live life", whatever that means.

Meanwhile, after decades of swearing I didn't need a pill, I didn't want a pill to "change" me, etc, I got on pills, and my life actually works. I rode a rollercoaster for the first time in decades the other day, zero butterflies in my stomach, zero panic or anxiety, zero inappropriate fear. I'm likely only alive today BECAUSE of medication.

The whole point behind how new medications are tested are that we often don't have a great understanding of HOW a medication works, but that doesn't matter, because it demonstrably works in some percentage of people, and for those that it doesn't work for, often another medication might.

So, with zero respect because you are actively harming people, Fuck right off.

Thanks for saying that.

Although I've resigned myself because I know that people will often not acknowledge and have empathy and understanding towards a condition if they haven't experienced it in their own skin.

It's depressing, but it seems to be part of the human condition.

1. A countervailing meta-analysis does not mean it's "debunked"

2. A theory being debunked does not mean it's "just a marketing gimmick"

3. The serotonin theory being debunked does not mean "chemical imbalance" is totally exonerated

Great article though, thank you for sharing. Here's the paper itself for anyone interested (AFAICT it is oddly not linked in the UCL article?): https://pubmed.ncbi.nlm.nih.gov/35854107/

Great points, but the word exonerated makes no sense in that context.

> to clear from accusation or blame

Serotonin theory being debunked does not mean “chemical imbalance” is totally cleared from blame

Seems clear enough to me, but noted for the future!

Too bad that the chemical theory of depression is pseudo-science.

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