For a brief moment, on Instagram and TikTok, there was a baby-eating-butter trend. Specifically, a set of influencers were making the claim that giving your baby two spoonfuls of butter (grass-fed, preferably) before bed would make them sleep through the night. In one case, which I really appreciated, the person said she had experimented with her child (butter nights versus no-butter nights) and proved it worked.
There is no evidence that butter increases nighttime sleep. Not only is there no data, but there is also no reason to think this would be true — no mechanism, no data from rats, nothing.
This online claim is, therefore, not evidence-based. And many people, myself included, got on social media to point out that, no, this is not an evidence-based approach to more sleep. I wish it were that easy, but it’s not; sorry.
This episode is just one example of a much broader issue that extends into discussions around fertility, pregnancy, parenting, and menopause. In fact, Dr. Richard Paulson wrote a wonderful piece on the same topic, focused on infertility. He makes the point that the infertility space is ripe for therapies that do not work because the stakes feel so high to these patients. His particular focus is on supplements (his characterization: “quackery”), which are everywhere in infertility influencing, in chat rooms, even in doctor’s offices. For the most part, there is no evidence that these work.
There is an obvious pushback, though. Even if these treatments don’t work, what’s the harm? As long as the baby is old enough to have butter safely, what’s the big deal if some people feed it to their kid, even if it almost certainly doesn’t work? Even if supplements are not helping fertility, does it really hurt to take more DHEA? Moreover, this argument goes, the placebo effect is powerful. Maybe these treatments will help if people think they are helping, and they might give some hope or be good for their mental health. Also, maybe we just do not know if something works – it could have a tiny effect, or a tiny effect on some people, and we do not have enough data to see that yet.
These are reasonable arguments, but we must recognize that, in at least some cases, seemingly “harmless” treatments can cause harm. Paulson makes several points about supplements in his piece — they are expensive, they may interfere with other medications — and argues that harmless therapies are not obviously harmless. The same argument is true in many other cases.
The challenge, both for those of us who communicate about health behaviors and for consumers, is to figure out when a not-evidence-based treatment really is harmless and when it is not. Here: four things to look for, and why this matters (and to whom).
When is a harmless treatment not harmless?
1. When a harmless treatment gets in the way of a treatment that works
Let’s go back to the baby eating butter. Many parents and families struggle with sleep. A child who isn’t sleeping well can contribute to parental depression, loss in marital satisfaction, problems at work, etc. There are evidence-based approaches to improve child sleep hygiene. These range from the recommendation to have a standard bedtime routine to sleep training, either with or without crying. The bottom line is that this is a problem that does have real solutions, albeit ones that take some investment.
When we suggest to people that the solution to their sleep problem is so simple — just a couple of spoonfuls of butter — of course that is appealing. And of course you want to try it. What parent would prefer sleep training their child to feeding them butter? The problem is that while parents are going down this rabbit hole of butter feeding and all these other “quick tricks” from the internet, they are losing sleep. That’s a harm.
The same can be true of some of the supplements or lifestyle changes that people are sold as a solution to infertility. When people spend time changing their makeup routine and drinking special smoothies rather than moving more quickly to discussing fertility treatments with a doctor, they lose time that may impact their options in the long run.
2. When a harmless treatment is expensive
I have written before about prenatal vitamins. The bottom line is that there are a few core elements of prenatal vitamins that people need, and these are present even in very inexpensive options. Pregnant people are often pitched on very expensive prenatal vitamins with fancy ingredients that seem great but actually are no better than the cheaper option.
The problem with this is that most of us are not infinitely wealthy, and if we spend four times as much on prenatal vitamins as we need to, that’s money that doesn’t go to something else that may well help us more.
So much of what is being pitched on the internet and social media is expensive, and the pitches can be predatory. People trying to conceive, pregnant people, new parents — all are disproportionately susceptible to scare tactics and overstated claims. That makes us easy marks for spending money we simply do not need to spend.
3. When a harmless treatment makes your life less fun
When people are attempting to get pregnant, they sometimes hear the recommendation not to have sex during the “two-week wait,” presumably because of the concern that it will make conception less likely. This is especially common when individuals are going through IVF. This recommendation is not supported by evidence, and, in fact, there is evidence to suggest it doesn’t matter.
It is nevertheless common to hear it said, “Well, it won’t hurt to avoid sex, so you might consider it.” What this misses is that … sex is something people enjoy. Especially during a stressful period, sex may be part of how people engage in self-care or how they connect to their partner. While it’s true that it will not hurt your physical health not to have sex, it could very well make life less good. And that’s a harm.
This same argument applies to a lot of lifestyle choices that we suggest to people without much evidence for them. Never consume alcohol, for example — this claim isn’t supported by data, and it’s not harmless because it ignores the enjoyment that people get from alcohol consumption (in moderation).
When the number of recommendations about behavior creeps up and up and up, there is also a mental load that can start to take over everything. This is especially true in fertility. I have talked to people who are trying to conceive who changed their entire diet, their makeup routine, the water they were drinking, all in service of the possibility — not supported by data — that these might matter for success. That mental load is emotionally draining.
4. Most important: when it causes people to blame themselves for failure
The most subtle, but I think most pernicious, issue with harmless treatments is when they give us the illusion of control and then the feeling of fault.
There are many aspects of fertility, pregnancy, parenting, and health overall that are out of our control. Sometimes good things happen by chance, and sometimes bad things happen by chance. This is hard to accept, and as humans we are always looking for explanations, just as we are looking for solutions.
When we suggest solutions to people and those solutions do not work (because they are not evidence-based), we increase the chance that people feel like they have done something wrong. If we prescribe useless supplements and then pregnancy doesn’t come, patients are drawn to ask, Maybe it’s because I didn’t take the right supplements, or at the right time. What did I do that could have caused this?
It is very hard for people to hear that something they care a lot about is out of their control. But by accurately conveying that, we also convey a lack of fault. On the flip side, by implying there is something a patient can do to change the outcome, we convey a false sense of control that may seem helpful in the moment but can cause harm in the longer term.
Why does this matter? What should change?
My core argument here is that seemingly harmless treatments in some cases actually do have harm.
This doesn’t mean that every random health thing we do is harmful. A lot of people have been compelled by wellness influencers to drink lemon water first thing in the morning. There’s no evidence that does anything, but in my mind it passes the tests above. It doesn’t get in the way of other things, it’s not expensive, it’s not (that) unpleasant, and, importantly, since the proposed benefits are so vague, there is nothing to fail. Sure, it doesn’t do anything. But it probably is, basically, harmless.
But so much that seems harmless is not, for the reasons above. So here is what I think should change.
First: Doctors and other health communicators should recognize this. I would call out social media influencers, but I think the motivations there are different. For anyone who is a trusted source, though, it is crucial to carefully consider whether a “harmless” treatment is really harmless. And whether advice that we are giving — however well-meaning — is actually neutral.
This is a huge challenge, especially when the receiver on the other side of the message is looking for solutions. As I’ve heard from one infertility doctor, The best predictor of success is continuing to try. That message is both true and also not what patients want to hear. But similar to the adage “no option is completely safe,” no messaging option here is completely harmless.
And second, for consumers: The world is full of recommendations like this — butter, prenatal vitamins, sleep “solutions,” everything-for-fertility. It is easy to get sucked into activities that seem harmless. But before you do, please take a beat to think about the above guidelines. Is it really harmless, or are the harms just not obvious at first? Protect yourself a bit before you leap into something unproven.
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I understand your point here. However, as another commenter said, there absolutely must be a distinction between treatments that have been proven to be ineffective or harmful and those that simply don’t have any or enough evidence to determine one way or the other. Sometimes, no one has invested in the research needed to determine if something works and/or causes harm.
Case in point: Reproductive Immunology. It’s a very “underground” medical field that few in the medical profession are supportive of, because of the lack of scientific evidence and also because of the risks involved with the treatment. Some mainstream doctors refer to it as “voo doo” medicine or RI doctors as “quacks”. But there are hundreds or even thousands of women who have been able to have children because of RI treatment. Much of the evidence is anecdotal (yet extremely difficult to deny), simply because not enough scientists or doctors are devoting time and money towards conducting and publishing the formal research. RI treatment certainly isn’t needed for every women or even most, but it can be the missing piece for a subset of women who experience recurrent pregnancy loss or recurrent implantation failure.
Instead of touting the need for all medical treatments to be evidence-based, it really is imperative that scientists and medical professionals acknowledge that the lack of evidence doesn’t automatically mean that something doesn’t work. Nearly all of modern treatments were once unproven, until someone invested in researching them. There is real harm that is done to the psyche of women when they are forced by respectable professionals to defend themselves against the idea that they are being taken advantage of by money-hungry “quacks”.
I think there are a few things that could have been added in the realm of mental health especially for kids. For example, giving pregnant women depression screenings at every single visit. These ask them very detailed questions about hurting themselves or others and often can lead to rumination on the hard times since the last visit. You weren’t thinking about hurting yourself… but if someone puts that idea in your head enough times maybe you start thinking about it more or it could make symptoms worse. Along the same lines of expensive, less fun, and getting in the way of treatment that works, I would argue, is therapy. I’m not saying there’s no place for therapy as I’ve been to it and it has had a helpful place in my life. However if you’re going to therapy instead of building friendships and confiding in friends, which has been shown to be the most impactful for happiness and resilience in hard times, there’s a real harm there.
Regarding kids, getting then a diagnosis if they’re just a tiny bit different from their peers. A sensory processing disorder or very mild autism (all of this is very separate from kids with very severe disease). This changes how they see themselves and how they think their patents see them. They now have something wrong with them and can use it to make their whole identity. They might not believe they can do something without accommodations instead of something about themselves that they can find ways to overcome. I see this is my gen Z brother who got himself an autism diagnosis. He was a fully functioning, albiet quirky, adult, but now uses it as an excuse for everything and is now unemployed and having a hard time making ends meet. His diagnosis is now the center of his identity. I think the diagnosis has been significantly more harmful than helpful.
I absolutely love this article! Having gone through years of infertility, I have definitely gone down rabbit holes of, “What else could I be doing?” or “What supplement can I take to help?” It’s an exhausting place to be in. So thank you for posting this!
The only issue I see here is what seems to be people using “not evidenced based” to mean both (1) reliable data show this is not true; and (2) there is currently no reliable data that show this is true. But those, of course, are two very different things. See, e.g., the issue with lack of rigorous data showing flossing to be effective at promoting oral health from a few years ago–that was (2) but not (1). That difference matters (at least to me).
Thank you. These are well-explained and I’ll save the article to share with others when they promote claims that are supposedly harmless but not evidence-based. I wonder if there might be a another potential harm. Are these solutions a gateway for other non-evidence-based activities? If you are willing to take a supplement “just in case it does work” or try a certain cleanse or other quick idea, are you more likely to try other activities that might end up not being harmless? Does it lead you down a path of ignoring medical advice?
Thank you for this. I’m in the SMBC community, so we all need some assistance despite unknown fertility… and the amount that people swear by It Starts With the Egg is incredibly frustrating. And even my RE recommended a random list of supplements with no guidance based specifically on me and my test results. I’m fine with paying for and taking supplements if it’s proven it’s going to be helpful, but I’ve spent a lot of money on supplements and am not pregnant. I know we’re all just looking for control in a situation we have little control over, but if one more person recommends some supplement im
not taking, acupuncture, wearing warm socks… im going to lose it 😂 people get pregnant without doing all these things all the time!
Thank you for this. Totally matches my experience, where I was told to take supplements, including DHEA, which would actually not be appropriate for someone with my reserve and general health profile. Fortunately I caught this and pointed it out to my doctor, but I did end up coughing up a large amount of money for CoQ10 and acai along w prenatals. I also stopped running (something I love to do) and cut back on coffee (another thing I love) per doctors. It was only after 4 years and 5 failed rounds of fertility treatment, when I gave up on all the supplements, started running, and drinking coffee, that I just…got pregnant.
I love this.
I would extend this analysis to screenings, though with a slightly different spin. With people getting cancers at younger and younger ages recently, there is a push to lower the age of screenings. This is a reasonable conversation, but ignores the time cost, money cost, stress, etc.
I understand the premise of this blog is to present evidence-based data though I found the approach to this article using the butter scenario to completely bypass the reasoning behind the suggestion. It cuts down the example without exploring the “why” or even the potential “hurt”, for that matter. The article does not mention the potential harm of this claim, much less exactly why the social media influencer thinks it will help. This feels like a hot take to prove a point based on assumption of agreement on the part of the reader.
Why not mention the potential benefit of slow-burning fats as good fuel before bed? The concept of “full feedings” from breast milk to assist with good sleep isn’t new.
Needless to say, of course there aren’t studies about using butter to assist with sleep… studies are missing on endless topics. However there are other resources — nutritional science research in this case? — that could be referenced at the least.
Thank you for articulating this so compellingly. I’ll be saving this to share when people ask “What’s your problem with supplements?”
Thanks for this – I was very curious about the butter concept, which DID make sense on some level (satisfaction after eating ice cream, for example). On another note – why say “pregnant people”? Have we really come to a point where saying “pregnant woman” is wrong or politically incorrect? When you work in women’s health, it seems an insult to all the women who are so intrinsically vested in the very female-ness of their bodies: periods, cramps, fibroids, fertility, ectopics, pregnancy, miscarriages, and birth, etc. For the tiny 0.001 percent of women who transitioned to men, then decided to become pregnant, that’s wonderful – but the rest of the biological women, going through womanly trials and triumphs, want to be referred to as “women” – which is not an offensive word.
Hi Jayne, one perspective from a pregnant woman – I have no problem being called a pregnant person. I am a pregnant person and it takes nothing away from me to called such. If using that language is kind or helpful to other pregnant people (even a very small number) who may or may not identify as women, then it sounds great to me.
But it’s not just this usage, it’s all around us – erasing “womanhood”. Did you know the timely classic “The Womanly Art of Breastfeeding” has also taken the word “woman” out of title? As though the WORD was somehow offensive? As a feminist, it is very concerning to make “women” disappear. It trivializes us, makes us just a “person” which actually doesn’t apply when you speak about female reproduction. We are people, but we are women specifically when we talk about things only we can do & agency over our own bodies. Not “people’s” bodies – women’s bodies.