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Tracking method

How do you tell a real trigger from a coincidence?

Ask one question: how often was the suspect present on days you did not flare? A real trigger is mostly absent from your calm days. A coincidence turns up on them just as often, and you never noticed because you were only ever looking at the flares.

In short

The answer

The short answer

Look at your calm days.

Almost everyone assesses a suspected trigger by asking "was it there when I flared?" That question cannot distinguish a cause from a coincidence, because plenty of things are there when you flare, including everything you do every single day.

The question that discriminates is the other one: on the days you did not flare, how often was it there too? If the answer is "about as often", you have found a habit, not a trigger.

Four numbers, not one

Any suspect has four possible days attached to it, and most people only ever count the first.

Grid of four day types: suspect present or absent, against flare or calm days Days you flared Days you did not Suspect present Suspect absent The one everyonecounts Worth counting Your baseline The one thatdecides it and nobody counts
Every suspect has four kinds of day attached to it. The top-left group generates the theory. The top-right group is the one that decides whether it is real, and it is the group almost nobody counts.

The first group is the one that generates the theory, and on its own it is close to meaningless. A food you eat four times a week will be present before most of your flares no matter what causes them.

You do not need any statistics to use this. Read your last two months, count the four groups roughly, and see whether the picture survives. Most suspects do not survive, and finding that out in ten minutes is a much better outcome than eliminating something for six months on a hunch.

Why we are so bad at this unaided

Three reasons, and knowing them helps.

We only investigate after something goes wrong. Nobody wakes up on a good day and asks what they ate yesterday. So the search itself only ever samples flare days, which guarantees the calm days stay uncounted.

Fluctuating conditions manufacture patterns. A condition that comes and goes on its own will, purely by chance, line up with some of your habits. This is not a flaw in your observation. That is what randomness looks like up close, and it is why a pattern needs to repeat more times than feels necessary.

Every extra variable multiplies the chances. If you track twenty things, some of them will match your flares by luck alone. Tracking more is not automatically better, which is the opposite of what most tracking advice implies.

The moment a pattern appears is the moment it is least reliable, and the moment you are most likely to stop looking.

When to act on a suspected trigger

Before you act on a suspected trigger, ask whether it clears all four of these:

That is a deliberately conservative bar. It is set there because the cost of a false trigger is not neutral. People give up foods they did not need to give up, spend money on products that were never the problem, and narrow their lives around a rule that a fortnight of ordinary data would have dismantled.

What to do when something clears the bar

Take it to a clinician, with the record in hand.

That is not a disclaimer bolted onto the end, it is the actual next step. A pattern in your own notes is a good question, not an answer. Co-occurrence is not causation, and the tests that can settle some of these questions properly, patch testing among them, exist for exactly this reason. Bringing two months of dated notes to that conversation makes it a substantially better one.

What you should not do is start removing things from your life on the strength of a pattern you found alone, particularly food, and particularly for a child.

Sources

Where this comes from

Questions

Questions people ask

How do I know if something is really a trigger?

Compare two things, not one. How often it was present when you flared, and how often it was present when you did not. If it shows up about as often on calm days, you have a coincidence, however convincing the flare days felt.

How many times does a pattern need to repeat?

As a working minimum, five or six separate episodes, and it should survive you actively hunting for counter-examples. Two or three matches is the point at which almost everyone becomes convinced, and it is far too early.

Why do I keep finding triggers that turn out not to be real?

Usually because only bad days are on record, so there is nothing to compare against. It is also normal: conditions that fluctuate on their own will produce apparent patterns by chance, and the more variables you track, the more of these you will find.

Can an app tell me what my trigger is?

No, and be wary of anything that claims to. Software can show you what tended to occur alongside what in your own notes. Whether something is genuinely causing your flares is a clinical question, and one that self-observation alone cannot settle.

About the author

Wiki is a UK medical doctor and the founder of Moya. She trained at King’s College London and Imperial College London, and has a long-term condition of her own. More about the author.

This guide is general information about self-tracking, not personal medical advice. It does not diagnose or treat any condition, and it is not a substitute for seeing a clinician. Never start, stop or change prescribed treatment based on something you read here. Moya is a wellness tool, not a medical device.

Next in the method: Why elimination diets usually fail to find skin triggers

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