In a former life, when I was an Air Force doctor, one of my duties was to give “Healthy Heart” briefings with a script furnished by Air Force experts. It covered the scientific consensus of the time (the early 80s) about diet. It recommended a low fat diet, restricted cholesterol and saturated fat, and demonized tropical oils like palm oil and coconut oil. (Trans fats weren’t yet on the agenda.)
Times have changed. Today we are more lenient about cholesterol in the diet, less concerned about total fat and saturated fat, and more concerned about trans fats. While many major health organizations still discourage its use, coconut oil has not only been rehabilitated in the public mind, but all kinds of health benefits are being claimed for it.
The fats in coconut oil
Coconut oil is high in saturated fats; it contains more saturated fatty acids than any other non-hydrogenated oil. It is stable and has a long shelf life. It is used in movie theaters to pop popcorn and in South Asian cuisine for dishes like curries. A hydrogenated version of coconut oil is an ingredient in non-dairy creamers. Much of the research done on coconut oil studied hydrogenated or partially hydrogenated forms. According to an article in the New York Times:
Partial hydrogenation creates dreaded trans fats. It also destroys many of the good essential fatty acids, antioxidants and other positive components present in virgin coconut oil. And while it’s true that most of the fats in virgin coconut oil are saturated, opinions are changing on whether saturated fats are the arterial villains they were made out to be. “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong,” Dr. Brenna said.
Coconut oil contains lauric acid, which raises both HDL and LDL cholesterol levels. This may improve the cholesterol profile, although there are concerns that it may promote atherosclerosis by other means. Virgin coconut oil contains medium-chain triglycerides, which are not as risky as some other saturated fats.
Low back pain is a particularly frustrating condition that is common, poorly understood, and difficult to treat. Could a long course of antibiotics be the answer for some patients? A recent study from Denmark suggests that it might be: “Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy” by Albert, Sorensen, Christensen and Manniche. Is this a crazy idea like long-term antibiotics for “chronic Lyme disease” or will it pan out like antibiotic eradication of H. pylori in patients with ulcers? Time will tell. This was a rigorous, well-done study, but we can never rely on the results of a single study until it is replicated or confirmed elsewhere.
I’ll be speaking in Portland, Oregon on May 17th. Details here.
A correspondent asked me to look into the GAPS diet. I did. I was sorry: it was a painful experience. What a mishmash of half-truths, pseudoscience, imagination, and untested claims!
GAPS stands for Gut and Psychology Syndrome. It is the invention of Dr. Natasha Campbell-McBride. According to her, a wide variety of health problems can be traced to a single cause: an imbalance of gut microbes. She cites ancient wisdom: Hippocrates said all diseases begin in the gut. She says science confirmed that wisdom when it discovered that 90% of all cells and all genetic material in the human body belongs to the gut flora. She says the modern world poses many dangers for the gut flora, and once it is damaged, the health of the whole body enters a downward slide towards disease. She claims that autism and ADD, OCD, schizophrenia, epilepsy, depression, and numerous other ailments are all digestive disorders. (more…)
In his first book, On Being Certain: Believing You Are Right Even When You’re Wrong, neurologist Robert Burton showed that our certainty that we are right has nothing to do with how right we are. He explained how brain mechanisms can make us feel even more confident about false beliefs than about true ones. Now, in a new book, A Skeptic’s Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves, he investigates the larger question of how a brain creates a mind. There is no alternative to the scientific method for studying the physical world, but Burton thinks there are essential limitations to science’s ability to investigate conundrums like consciousness and free will. Brain scientists fall into error because:
…our brains possess involuntary mechanisms that make unbiased thought impossible yet create the illusion that we are rational creatures capable of fully understanding the mind created by these same mechanisms.
He has a bone to pick with neuroscientists. They are discovering fascinating information, but their interpretations often go beyond what the data can really tell us. They often draw questionable conclusions from imaging studies that could have other explanations. (more…)
Some people would like to manage their own health care without having to depend on a doctor. They consult Google, diagnose themselves, and treat themselves. The Do-It-Yourself trend in lab tests continues apace. Without a doctor’s order, patients can get legitimate and/or questionable lab tests directly from various companies such as Any Lab Test Now and Doctor’s Data (which has sued Stephen Barrett for exposing their fraudulent “urine toxic metals” test on Quackwatch). Now a new company, Talking20, has jumped on the self-testing bandwagon with an innovative product that allows people to prick their finger, put a drop of blood on a card, and mail it in from anywhere in the world. Multiple tests are done on a single drop of blood. Results will be available online within a week or even sooner.
In the past I have criticized evolutionary medicine for its tendency to rely on unverifiable “Just-So Stories,” but a new book has helped me appreciate what the best kind of evolutionary thinking can contribute to our understanding of medicine. Doves, Diplomats, and Diabetes: A Darwinian Interpretation of Type 2 Diabetes and Related Disorders by Milind Watve investigates diabetes from an evolutionary perspective, suggesting how it might have originated, why it persisted, and how it is related to survival advantages. Watve develops well-reasoned hypotheses that can be tested by examining their expected consequences. He believes it is impossible to understand metabolism without understanding behavioral ecology, and he makes a good case.
A reassessment of the evidence concerning Type II diabetes (T2D) reveals a number of paradoxes. Elevated blood glucose is the defining feature of T2D but controlling it doesn’t prevent all the complications of diabetes, and it doesn’t appear that elevated blood sugar could produce all the pathological changes of diabetes. Insulin resistance is believed to be central to a cluster of deadly diseases in humans, but in other animals it has no adverse effects on health and even increases lifespan. Studying diabetes from an evolutionary perspective can shed light on such paradoxes. (more…)
I write about a lot of depressing subjects, and sometimes a change of pace is welcome. Mary Roach, billed as “America’s funniest science writer,” has followed up on her earlier explorations of cadavers (Stiff), sex (Bonk), the afterlife (Spook), and survival on spaceships (Packing for Mars) with a new book entitled Gulp: Adventures on the Alimentary Canal.
Forget all that mythology about diet, detoxification, and 10-year-old hamburger accretions in the bowel. The reality of human digestive physiology is far more interesting and has the extra-added attraction of being true. And in Roach’s hands, often howlingly funny. She is a hands-on investigative reporter who is ready to try anything; among other adventures she inserts her entire arm in a cow’s stomach. Her highly entertaining odyssey takes her to Igloolik to eat narwhal skin, to a dog food tasting lab in Missouri, to Minnesota to observe a fecal transplant, and to strange and exotic outposts at the cutting edge of science, populated by colorful characters. (more…)
For many years I have been using Continuing Medical Education (CME) programs offered by the American Academy of Family Physicians (AAFP). The FP Essentials program consists of a monthly monograph with a post-test that can be submitted electronically for 5 hours of CME credit. Over a 9-year cycle, a complete family medicine curriculum is covered to prepare participants for the re-certification board exams. Some examples of typical subjects are skin cancer, hand and wrist injuries, valvular heart disease, and care of the newborn. I rely on these programs to learn, review, and keep up-to-date in my specialty. Imagine my dismay when I opened the latest package to find a monograph on Integrative Medicine.
First it was called various names like folk medicine, quackery, and unproven/untested treatments, then all of those (the less rational right along with the more rational) were lumped together under the umbrella term “Alternative Medicine,” then it became “Complementary and Alternative Medicine” (CAM), and now it has been re-branded as “Integrative Medicine.” The term is designed to make unscientific treatments seem more acceptable to science-based doctors. “Integrative Medicine” is a marketing term, not a meaningful scientific category. It is a euphemism for combining Complementary and Alternative Medicine (CAM) with mainstream medical practice, unproven with proven, magic with science. It has been critiqued many times on this blog. We have stressed that there is only one medicine, and that when a treatment is proven to work by good evidence, it is just “medicine.” When the evidence for a CAM treatment is not good, it essentially amounts to experimental treatments and/or comfort measures. Worse, sometimes CAM even persists in using treatments that have been proven not to work or that are totally implausible, like therapeutic touch or homeopathy. (more…)