I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However, after being approached by the authors’ PR agency with the promise of a book that contains science-based nutrition information I decided to agree to the review. This is how the book was described to me in an email:
In their provocative new book, Eat to Save Your Life, best-selling authors Dr. Jerre Paquette and Gloria Askew, RRN, sort through the piles of information and misinformation about nutrition to reveal the true connection between food and health. Fed up with the advertising hype and conflicting nutritional advice, the duo provides common sense explanations for consumers everywhere who are looking to make smart nutritional choices.
Unfortunately, I was sold (quite predictably) a bill of goods. And rather than ignore the book and simply not do a review, I figured that maybe a negative review would reduce the number of incoming PR requests for future tomes of pseudoscience. In the end, I’ll probably just become the focus of personal attacks by dedicated proponents of various snake oils.
That being said, I thought it might be somewhat instructive to remind Better Health readers of certain basic “warning signs of pseudoscience” that I accidentally overlooked in agreeing to review the book. For a more complete review of similar “signs” I highly recommend Dr. David Gorski’s 2007 classic, humorous take on predictable arguments and behaviors of alternative medicine proponents (written in the style of comedian Jeff Foxworthy). As for me, I tend to think of much of the world of integrative medicine as a militant group of bakers eager to add odd, inert and occasionally toxic substances to cake recipes.
And so, without further ado, here is a small sample of what authors Askew and Paquette have added to their half-true diet book recipe:
- The “one true cause” fallacy: The book opens with an interesting review of vitamin C deficiency, noting that it (apparently) took the British Royal Navy 40 years before they accepted that the treatment for scurvy was citrus extract (rather than flogging). Citing this incident as an example of nutritional deficiency leading to life-threatening illness, it’s a short ride to the “one true cause” fallacy whereby the authors postulate that there are untold numbers of modern diseases caused by unrecognized nutritional deficiency syndromes. Nutritional deficiency may be the one true cause of most diseases, you see.
- The appeal to research without references. Countless appeals are made to “mounting evidence” of this and that (arthritis being caused primarily by food-related inflammation for example), either without reference footnotes, or with mentions of sources of dubious credibility (such as the Canadian Association of Naturopathic Doctors).
- The appeal to supplements in lieu of vaccines. No diet advice would be complete without a gratuitous attack on vaccines, right? The authors suggest that flu vaccines (for example) only provide immunity for 2 months “and only for certain individuals.” Meanwhile, they assert that a combination of Echinacea, garlic, and vitamin C support the immune system to successfully fight of viruses. These claims are simply unproven and multiple studies have already found no benefit (over placebo) of these supplements at preventing and treating the common cold.
- Over-diagnosis. If you think that the world of medicine is predisposed to seeing disease where there is none, try the alternative medicine world. The authors assert that everything from zits, to rashes, to “brain fog” are potential signs of grave underlying immune compromise – caused by, you guessed it, dietary deficiencies.
- Over-supplementation. The authors argue that “supplementation is a necessity in our nutrient-robbed world.” However, new evidence doesn’t support supplementation for the general population, though it had beentraditionally felt that multi-vitamins might be valuable. In addition, new studies are finding that food sources are preferable to supplements for daily nutritional requirements (such as calcium) and that anti-oxidants such as vitamin E may do more harm than good.
- The “organic is more nutritious” argument. Although a recent systematic review of the scientific literature found no support for the notion that organic foods contain more nutrients than those grown with traditional methods, the authors attribute Americans’ supposed vitamin deficiencies to poor soil quality caused by non-organic farming methods.
- Nutrigenomics and DNA hype. The authors do not take a sufficiently skeptical view of the emerging field of nutrigenomics (whereby certain foods and supplements are recommended to individuals based on their genetic profiles). They even suggest that nutrigenomic testing is so much fun, it’s “almost like being part of a CSI television show.” Who cares if it’s no more accurate than fortune telling?
So what’s the half true part? Well, obesity is certainly a driver of many modern illnesses, and obesity is caused by (in no small part) nutritional choices. The authors cite statistics on the ravages of heart disease, high blood pressure, and diabetes on the U.S. population which are all quite true. (How this supports the “deficiency” argument is somewhat lost on me – because it would seem more logical that a possible excess of nutrients could be the “one true cause” of a lot of these diseases, but I digress).
There are real nutritional deficiencies that cause medical problems, such as iron-deficiency anemia, neural tube defects related to folic acid deficiency, vitamin D deficiency and rickets, and osteoporosis contributed to by low calcium levels. These conditions underscore the importance of healthy eating habits, but do not support the idea that the entire population is deficient in these nutrients. In fact, a large population study analyzed by the CDC, suggests that most Americans are not deficient in any major nutrient even with their current sub-optimal and obesogenic eating habits.
In general, fair-minded individuals will find Eat To Save Your Life to be yet another example of a half-true, hysteria-peddling, micro-nutrient-obsessed diet advice book. Ironically, the book’s title itself states the opposite of what we really need to be doing to reduce obesity-related diseases: stop eating (so much) to save our lives.
This book may be purchased (against my medical advice) at Amazon.com.
This post originally appeared at the Science Based Medicine blog.
Miracles are pretty rare events. Except on television’s “Dr. Oz Show,” where they appear with astonishing frequency. Oz of course doesn’t claim to raise the dead or part the Red Sea, but he does raise people’s hopes of parting with their flab. And he’s certainly not shy about flinging the word “miracle” about. But it seems miracles fade as quickly as they appear. Raspberry ketones, acai berries and African mango, once hyped as amazing “fat busters,” have already given way to newer wonders.
Granted, Dr. Oz, or more likely his producers, do not pull miracles out of an empty hat. They generally manage to toss in a smattering of stunted facts that they then nurture into some pretty tall tales. Like the ones about chlorogenic acid or Garcinia cambogia causing effortless weight loss. The former piqued the public’s interest when the great Oz introduced green coffee bean extract as the next diet sensation. Actually “chlorogenic acid” is not a single compound, but rather a family of closely related compounds found in green plants, which perhaps surprisingly, contain no chlorine atoms. The name derives from the Greek “chloro” for pale green and “genic” means “give rise to.” (The element chlorine is a pale green gas, hence its name.)
An “unprecedented” breakthrough, Dr, Oz curiously announced, apparently having forgotten all about his previous weight-control miracles. This time the “staggering” results originate from a study of green coffee bean extract by Dr. Joe Vinson, a respected chemist at the University of Scranton who has a long-standing interest in antioxidants, such as chlorogenic acid. Aware of the fact that chlorogenic acid had been shown to influence glucose and fat metabolism in mice, Vinson speculated that it might have some effect on humans as well. Since chlorogenic acid content is reduced by roasting, a green bean extracts was chosen for the study.
In cooperation with colleagues in India who had access to volunteers, Dr. Vinson designed a trial whereby overweight subjects were given, in random order, for periods of six weeks each, either a daily dose of 1,050 mg of green coffee bean extract, a lower dosage of 700 mg, or a placebo. Between each six-week phase there was a two-week “washout” period during which the participants took no supplements. There was no dietary intervention; the average daily calorie intake was about 2,400. Participants burned roughly 400 calories a day with exercise. On average there was a loss of about a third of a kilogram per week. Interesting, but hardly “staggering.” And there are caveats galore.
The study involved only eight men and eight women, which amounts to a statistically weak sample. Diet was self-reported, a notoriously unreliable method. The subjects were not really blinded since the high dose regimen involved three pills, the lower dose only two. A perusal of the results also shows some curious features. For example, in the group that took placebo for the first six weeks, there was an 8 kilogram weight loss during the placebo and washout phase, but almost no further loss during the high dose and low dose phases. By the time, though, that critics reacted to Oz’s glowing account, overweight people were already panting their way to the health food store to pick up some green coffee bean extract that might or might not contain the amount of chlorogenic acid declared on the label. As for Dr. Oz, he had already moved on to his next “revolutionary” product, Garcinia cambogia, unabashedly describing it as the “Holy Grail” of weight loss.
We were actually treated to the Grail in action. Sort of. Dr. Oz, with guest Dr. Julie Chen, performed a demonstration using a plastic contraption with a balloon inside that was supposed to represent the liver. A white liquid, supposedly a sugar solution, was poured in, causing the balloon, representing a fat cell, to swell. Then a valve was closed, and as more liquid was introduced, it went into a different chamber, marked “energy.” The message was that the valve represents Garcinia extract, which prevents the buildup of fat in fat cells. While playing with balloons and a plastic liver may make for entertaining television, it makes for pretty skimpy science.
Contrary to Dr. Oz’s introduction that “you are hearing it here first,” there is nothing new about Garcinia. There’s no breakthrough, no fresh research, no “revolutionary” discovery. In the weight control field, Garcinia cambogia is old hat. Extracts of the rind of this small pumpkin-shaped Asian fruit have long been used in “natural weight loss supplements” Why? Because in theory, they could have an effect.
The rind of the fruit, sometimes called a tamarind, is rich in hydroxycitric acid (HCA), a substance with biological activity that can be related to weight loss. Laboratory experiments indicate that HCA can interfere with an enzyme that plays a role in converting excess sugar into fat, as well as with enzymes that break down complex carbohydrates to simple sugars that are readily absorbed. Furthermore, there are suggestions that Garcinia extract stimulates serotonin release which can lead to appetite suppression.
Laboratory results that point toward possible weight loss don’t mean much until they are confirmed by proper human trials. And there have been some. Fifteen years ago a randomized trial involving 135 subjects who took either a placebo or a Garcinia extract equivalent to 1500 mg of HCA a day for three months, showed no difference in weight loss between the groups. A more recent trial involving 86 overweight people taking either two grams of extract or placebo for ten weeks echoed those results. In-between these two major studies there were several others, some of which did show a weight loss of about one kilogram over a couple of months, but these either had few subjects or lacked a control group. Basically, it is clear that if there is any weight loss attributed to Garcinia cambogia, it is virtually insignificant. But there may be something else attributed to the supplement, namely kidney problems. Although incidence is rare, even one is an excess when the chance of a benefit is so small. So Garcinia cambogia, like green coffee bean extract, can hardly be called a miracle. But it seems Dr. Oz puts his facts on a diet when it comes to fattening up his television ratings.
Joe Schwarcz is director of McGill University’s Office for Science & Society (mcgill.ca/oss). He hosts The Dr. Joe Show on CJAD Radio 800 AM every Sunday from 3 to 4 p.m.
Newsweek has a very provocative and yet incredibly too simplistic piece for the public and patients on its cover story – One Word Can Save Your Life: No! – New research shows how some common tests and procedures aren’t just expensive, but can do more harm than good.
The piece is actually well written and highlights facts that have been apparent for some time. More intervention and treatment isn’t necessarily better. Having a cardiac catheterization or open heart surgery for patients with stable heart disease and mild chest pain isn’t better than diet, exercise, and the prescription medication treatment. PSA, the blood test previously suggested by many professional organizations, isn’t helpful to screen for prostate cancer, even though the value of the test was questioned years ago. Antibiotics for sinus infection? Usually not helpful.
Certainly doctors do bear part of the blame. If patients are Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.
So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or opposing the guidelines. The researchers then asked women about their beliefs, concerns and attitudes about breast cancer and mammogram screening. Here’s what they found -
- Women overwhelmingly want annual mammograms – Close to 90% of women surveyed felt they should have annual mammograms, regardless of what their doctor might recommend.
- Women overestimate breast cancer risks – Eighty eight percent overestimated their lifetime risk for the disease, with the average estimate being 37%. (The correct lifetime risk for breast cancer is 12%). This is consistent with previous research on breast cancer beliefs.
- The media may not influence women’s opinions about screening guidelines – Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
I have said that the best tool for treating atrial fibrillation (AF) is education. I still strongly believe this, perhaps more then ever.
AF presents itself to people in so many different ways–from no symptoms to incapacitation. Likewise, the treatments for AF range from simple reassurance and lifestyle changes, to taking a medicine, and on to having a complex ablation[s].
Because knowledge is so important to patients with AF, I encourage them to do outside research. This surely means going on-line. The problem, of course, comes with assessing the quality of information. It reminds me of what an old professor used to profess, “no data is better than bad data.”
What’s more, the vast diversity of AF makes comparing notes with friends problematic. One person’s wonder drug may be another’s poison.
Last week, this provocative AF headline came through on one of my Google Alert emails:
“Flecainide Treatment Linked to Sudden Cardiac Death.” Read more »
*This blog post was originally published at Dr John M*