Here on SBM we have frequently had cause to criticize the media for poor science reporting and for spreading misinformation. Among many other individual offenders, we have criticized Dr. Oz for promoting alternative medicine on his TV show and gullibly promoting guests who pretend to talk to the dead and pretend to heal people with carnival sideshow tricks. We tend to be negative and critical because somebody has to do it, but it’s not pleasant. For once, I have some good things to say.
The September 12 issue of TIME magazine was a Special Nutrition Issue. The cover featured pictures of food and the title “What to Eat Now: Uncovering the Myths about Food by Dr. Oz.” It devotes 7 pages to an article by him entitled “The Oz Diet: No more myths. No more fads. What you should eat — and why.” This is followed by a 5 page article by John Cloud “Nutrition in a Pill? I took 3000 supplements over five months. Here’s what happened.” Both articles have a rational, science-based perspective without any intrusions of woo-woo.
Oz on What to Eat
Oz acknowledges that the science of nutrition is not simple and that much of what we once believed has been discarded in the face of new knowledge. He debunks a number of popular misconceptions about diet. Most of what he says is consistent with scientific evidence and with mainstream diet advice.
- It’s not necessary to restrict ourselves to low-fat foods.
- It’s OK to eat eggs, whole milk, salt, fat, nuts, wine, chocolate and coffee — as long as we don’t overindulge.
- The only fat accepted as “bad” is trans-fat, and that has been stripped out of most foods.
- Dietary cholesterol is less important than we used to think and is irrelevant to some people who have good genes.
- Excess salt is dangerous mainly for the minority of people with salt-sensitive high blood pressure.
- Foods labeled “fat free” don’t taste as good, so manufacturers add more salt, sugar, and thickeners, and people tend to eat more calories.
- Fad diets work by restricting food choices: they result in fluid loss and decreased calorie intake, and the weight lost comes right back when people stop the diet.
- The low carb diets change nutritional balance in ways that may not be desirable.
- The paleo diet? Maybe not ideal: cavemen were shorter than modern people and died earlier.
- Individualized nutrition? Blanket recommendations don’t fit all individuals, but nutrigenomic studies do not yet have clinical applications.
- Weight loss is hard. To maintain a healthy weight, calories consumed must equal calories burned.
- High fiber foods augment satiety.
- One study showed that the foods most associated with weight gain are French fries, potato chips, sugary drinks, meat, sweets and refined grains and the foods most associated with successful weight loss are yogurt, nuts, whole grains, fruits and vegetables.
- There are no elusive “superfoods.”
- Exercise is important, but we mustn’t over-estimate its caloric benefit.
He mentions that coffee is the number one source of antioxidants in the Western world. I knew there was a reason I like coffee so much! Isn’t it refreshing to read an article about diet that doesn’t tell you to give up any of the foods you love? Isn’t science wonderful?
He doesn’t recommend vegetarianism, saying we are omnivores and there are multiple food groups for a reason. He concludes with the advice to
- Eat in moderation
- Choose foods that look like they did when they came out of the ground (minus the dirt, I hope!)
- Be an omnivore
- And get some exercise.
This is entirely consistent with what we have been hearing from other sources, from Mom to the American Dietetic Association, and with Michael Pollan’s advice to “Eat food. Not too much. Mainly plants.”
Going Beyond the Evidence
He does say a few things that I would argue with because I think he goes beyond the (good) evidence:
- Since red wine is good for you, you should drink some every day and also take resveratrol supplements.
- When you take all the fat out of milk, you’re left with too high a concentration of natural sugars, which interacts like candy with your hormones.
- Berries have a profound impact against age-related diseases
- Broccoli is good for the liver and strengthens the body’s natural detoxification systems.
- You should take a multivitamin.
Some of these are open to discussion and I can’t object strongly to any of them. On the whole, his advice is moderate and mainstream, without a hint of the kind of woo-woo he promotes on TV. Maybe writing for TIME has a restraining influence on him.
Nutrition in a Pill?
John Cloud experimented on himself. He consulted a supplement company and followed a plan custom-designed just for him. It involved 22 pills a day plus protein bars, powder drinks and psyllium fiber. He followed the plan for 5 months. It cost $1200 but TIME paid the bill. He had a panel of blood tests done before and after, and found that the supplements made no difference. Only two measurements changed significantly: his vitamin D level (which he could have raised much more cheaply with a generic vitamin D tablet) and his HDL level (which was unexplained by the supplements). He felt better on the supplements, but he attributed that to placebo effect.
He had one unfortunate side effect: he gained 10 pounds over 2 months. He attributes that to “the licensing effect.” He felt virtuous. He knew he was getting his nutrition in the pills, so he felt licensed to eat a less healthy diet with more calories. He managed to lose the weight, but it took him 3 months. When the experiment was over, he threw the rest of the supplements away. He discusses the history of vitamins and the inconclusive science behind supplement recommendations. He provides insight into the way nutraceuticals are marketed. He interviews skeptical scientists including one who calls the vitamin business “the damnedest racket ever perpetrated upon the public.”
His conclusion makes a lot of sense to me:
On nutraceuticals, I had come to believe that health could be a set of tablets to take rather than a series of responsibilities to meet — water instead of soda, an apple instead of chips, real fish instead of giant fish-oil capsule. You can take vitamins on the faith that they will make you better and if you have a real vitamin deficiency, they will. But there’s more science behind another way of getting your vitamins: eating right.
Both of these articles are informative and reasonable, well written and entertaining, and are examples of good science journalism. TIME is no Science-Based Medicine, but it does a pretty good job for a popular publication. All too often, the media get science wrong; but sometimes they get it right. And when they do, we should say so. Good job, TIME!
*This blog post was originally published at Science-Based Medicine*