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The deceptive rebranding of aspects of science-based medicine as “alternative” by naturopaths continues apace

That naturopathy is a veritable cornucopia of quackery mixed with the odd sensible, science-based suggestion here and there is not in doubt, at least not to supporters of science-based medicine (SBM). However, what naturopaths are very good at doing is representing their pseudoscience as somehow being scientific and thus on par with conventional SBM. So how do they accomplish this? Certainly, it’s not through the validation of any of the cornucopia of pseudoscience and quackery that naturopaths apply to their patients as though picking “one from column A and one from column B” from a proverbial Chinese menu of woo. Naturopaths’ favored modalities include homeopathy (which remains to this day an integral part of naturopathy that all naturopaths are taught), acupuncture and traditional Chinese medicine (TCM), “detoxification” practices (a key precept of a lot of naturopathy) such as juicing, enemas, and chelation therapy, and the various other quack modalities that make up the practice of naturopathy. Treatments like these (especially homeopathy, whose precepts would require a massive rewriting of the laws of physics and chemistry for it to work) have not been and almost certainly cannot ever be scientifically validated with an evidence base of the quality and quantity supporting SBM.

So, instead naturopaths play a very clever game. In all fairness, naturopaths are not the only practitioners of so-called “complementary and alternative medicine” (CAM) or “integrative medicine” who play this game, but from my observations they appear to be the most talented at it. Their skill at obfuscating the line between SBM and naturopathy is evidenced by the success they have had in state legislatures in expanding their scope of practice, most recently in Colorado, where, if there is not a groundswell of support urging the Governor to veto SB-215 (or, as Jann Bellamy aptly called it, the quack full employment act), consumer protections against quackery in Colorado will be laid waste. At the same time, there is a naturopath licensing act (HB-1111) sitting on the Governor’s desk as well that would license naturopaths and give them the path to mandatory reimbursement from insurance companies. Instructions to write to the Governor opposing both bills can be found here and here; they would be disastrous for efforts to keep full vaccination in Colorado. A direct link to write the Governor can be found here.
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Posted in: Clinical Trials, Homeopathy, Naturopathy, Nutrition, Science and the Media

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GAPS Diet

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…)

Posted in: Neuroscience/Mental Health, Nutrition, Vaccines

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It’s a part of my paleo fantasy, it’s a part of my paleo dream

There are many fallacies that undergird alternative medicine, which evolved into “complementary and alternative medicine” (CAM), and for which the preferred term among its advocates is now “integrative medicine,” meant to imply the “best of both worlds.” If I had to pick one fallacy that rules above all among proponents of CAM/IM, it would have to be either the naturalistic fallacy (i.e., that if it’s natural—whatever that means—it must be better) or the fallacy of antiquity (i.e., that if it’s really old, it must be better). Of course, the two fallacies are not unrelated. In the minds of CAM proponents, old is more likely to have been based on nature, and the naturalistic fallacy often correlates with the fallacy of antiquity. Basically, it’s a rejection of modernity, and from it flow the interest in herbalism, various religious practices rebranded as treatments (thousands of years ago, medicine was religion and religion was medicine—the two were more or less one and physicians were often priests as well), and the all-consuming fear of “toxins,” in which it is thought that the products of modernity are poisoning us.

Yes, there is a definite belief underlying much of CAM that technology and pharmaceuticals are automatically bad and that “natural” must be better. Flowing from that belief is the belief that people were happier and much healthier in the preindustrial, preagricultural past, that cardiovascular disease was rare or nonexistent, and that cancer was seldom heard of. Of course, it’s hard not to note that cancer and heart disease are primarily diseases of aging, and life expectancy was so much lower back in the day that a much smaller percentage of the population lived to advanced ages than is the case today. Even so, an implicit assumption among many CAM advocates is that cardiovascular disease is largely a disease of modern lifestyle and diet and that, if modern humans could somehow mimic preindustrial or, according to some, even preagricultural, lifestyles, that cardiovascular disease could be avoided. Not infrequently, evolutionary and genomic arguments are invoked, claiming that the estimated 10,000 years since the dawn of human agriculture is not a sufficiently long period of time for us to have evolved to handle diets rich in grains and meats and that we are “genetically wired” to exist on a diet like those of our paleolithic hunter-gatherer ancestors. For instance, in 2004, James H. O’Keefe Jr, MD and Loren Cordain, PhD wrote an article in the Mayo Proceedings entitled Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer that asserted in essence, just that. Over the last decade, Cordain has become the most prominent promoter of the so-called “Paleo diet,” having written The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat and multiple other books advocating a paleolithic-mimetic diet as the cure for what ails modern humans. Meanwhile, diets thought to reflect what our hunter-gatherer ancestors ate, such as the Paleo Diet consisting largely of animal and fish that can be hunted and fruits and vegetables that can be foraged for in the wild, have been promoted as a near-panacea for the chronic diseases of aging, such as cardiovascular disease and cancer.

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Posted in: Evolution, History, Nutrition

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Calcium supplements and heart attacks: More data, more questions

Why take a drug, herb or any other supplement? It’s usually because we believe the substance will do something desirable, and that we’re doing more good than harm. To be truly rational we’d carefully evaluate the expected risks and benefits, estimate the overall odds of a good outcome, and then make a decision that would weigh these factors against any costs (if relevant) to make a conclusion about value for money. But having the best available information at the time we make a decision can still mean decisions turn out to be bad ones: It can be that all relevant data isn’t made available, or it can be that new, unexpected information emerges later to change our evaluation. (Donald Rumsfeld might call them “known unknowns.”)

As unknowns become knowns, risk and benefit perspectives change. Clinical trials give a hint, but don’t tell the full safety and efficacy story. Over time, and with wider use, the true risk-benefit perspective becomes more clear, especially when large databases can be used to study effects in large populations. Epidemiology can be a powerful tool for finding unexpected consequences of treatments. But epidemiologic studies can also frustrate because they rarely determine causal relationships. That’s why I’ve been following the evolving evidence about calcium supplements with interest. Calcium supplements are taken by almost 1 in 5 women, second only to multivitamins as the most popular supplement. When you look at all supplements that contain calcium, a remarkable 43% of the (U.S.) population consumes a supplement with calcium as an ingredient. As a single-ingredient supplement, calcium is almost always taken for bone health, based on continued public health messages that our dietary intake is likely insufficient, putting women (rarely men) at risk of osteoporosis and subsequent fractures. This messaging is backed by a number of studies that have concluded that calcium supplements can reduce bone loss and the risk of fractures. Calcium has an impressive health halo, and supplement marketers and pharmaceutical companies have responded. There are pills, liquids, and even tasty chewy caramel squares embedded with calcium. It’s also fortified in foods like orange juice. Supplements are often taken as “insurance” against perceived or real dietary shortfalls, and it’s easy and convenient to take a calcium supplement daily, often driven by the perception that more is better. Few may think that there is any risk to calcium supplements. But there are now multiple safety signals that these products do have risks. And that’s cause for concern. (more…)

Posted in: Herbs & Supplements, Nutrition

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Who takes dietary supplements, and why?

If you’re a regular reader of this blog, I’ll bet you’re not a regular consumer of vitamins or supplements. I’m in that group. Aside from sporadic vitamin D in winter, I don’t take any vitamins or supplements routinely, nor do I give any to my children. Your reasons may be close to mine: There is little to no evidence suggesting that dietary deficiencies are widespread, nor is there good evidence to suggest that vitamin supplements are beneficial in the absence of deficiency. I don’t have any need for an other supplements, nor am I confident in the scientific evidence for many of them.This position of “no supplements” is a cautious and conservative one, but is based on a consideration of the scientific evidence. I view decisions about healthcare as evaluations of risk and benefit, and then cost if necessary. Given supplementation (with some exceptions) has no demonstrable benefits and, in some cases, a little risk, the odds favour not supplementing in most cases. Add in costs, and it’s even less attractive as a routine health strategy.

Yet a decision not to take vitamins or supplements regularly is becoming a minority position. Supplement use has grown over the past 40 years among Americans, with the National Health and Nutrition Examination Survey (NHANES) showing steadily increasing utilization among younger and older adults:
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Posted in: Herbs & Supplements, Nutrition, Science and Medicine

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Death as a Foodborne Illness Curable by Veganism

Most reputable sources of nutrition information recommend a diet high in fruits and vegetables and low in red meat. Vegans go much further. Strict vegans reject all animal products including fish, eggs, and milk. Some vegans come across like religious zealots. Here are some comments recently posted by vegans on Facebook:

  • Right now the biggest social issue facing the world is the violence and suffering of animals.
  • The dairy industry is the number one feminist issue facing our modern society.
  • I expect within a generation that milk will be viewed as the most unhealthy habit after cigarettes. I bet it is responsible for more disease than anything else in the US. Dairy products promote all stages of cancer. [In fact, low fat dairy can be protective against some types of cancer]
  • Milk contains blood and puss[sic]
  • Humans are not omnivores; they are herbivores. [Most biologists would disagree.]

I was even told that that anyone who really cares about the welfare of others must promote veganism. It seems I am an evil, uncaring person if I waste my time writing about any other subject.

Vegans offer some good arguments based on ethics, environmental protection, cruelty to animals, and sustainability.  I won’t get into those issues here. I’ll only address the scientific evidence behind the health claims. How does this description of a video strike you?:

Death in America is largely a foodborne illness. Focusing on studies published just over the last year in peer-reviewed scientific medical journals, [Hardly any of the studies he cites were published over the last year.] Michael Greger, M.D., offers practical advice on how best to feed ourselves and our families to prevent, treat, and even reverse many of the top 15 killers in the United States.[emphasis added] (more…)

Posted in: Nutrition

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Should you be “Eating Clean”?

Like many of you I’m interested in the science of good nutrition. In general, I’ve come to be pretty skeptical of the nutritional literature, as so many studies seem to follow the same trajectory that we see with drug studies: Trivial changes in non-relevant outcomes, a failure to consider the results in the context of the accumulated scientific evidence and often, significant conflicts of interest. What’s worse, “real world” nutritional studies aren’t blinded and they’re rarely prospective. So we’re left to dig through observational studies and try to sort out correlation from causation. It’s little wonder that so many consumers are confused about the basics of healthy eating. Many believe that vitamins supplements are both beneficial and routinely necessary (they are not) and that the latest “superfood” is all that’s standing between themselves and immortality. But nutritional science is important, and I’m always pleased when patients initiate discussions about weight loss, or just improving their dietary habits. After all, obesity is a significant risk factor for an array of chronic illnesses. Improving our dietary patterns should pay off with improved health.. A regular challenge I face is that my patient that has already decided to use a highly restrictive weight loss plan in order to achieve a specific weight loss goal. I always caution them to take a long-term view. Weight loss is easy. Maintaining that loss is the challenge. Most “diets” fail. So I’m critical of useless interventions (like food intolerance blood tests) or faddy diets (like going gluten-free) with the hope of easy weight loss. At its core, weight loss and weight maintenance comes down to caloric balance. Permanent weight loss requires permanent dietary changes. And how we spend our “calories” matters.

Over the past few months I’ve seen a few friends and colleagues announce that they’ve decided to transform their diet, lose weight, and “eat clean”. When I asked what was “clean” food, no-one seems to have a consistent answer. The most common response was that “eating clean” meant cutting out processed foods. But to others, eating clean meant avoiding meat, anything with GMOs, wheat and sometimes milk. It seemed to mean something different to everyone. It reminds me a bit of Humpty Dumpty in Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Is “eating clean” just a faddish buzzword? There are a number of personalities competing in the “eating clean” dietary space. The pioneer seems to be Tosca Reno, who has the Eat-Clean Diet and about a dozen related books based on the same idea. But  she’s not alone, as there are several other books with related names, including Terry Walters with her “Clean Food” books. Success breeds competition, it seems. Given Reno’s book appears to be the most popular, I’ll take her plan as the template. She outlines the principles of how she defines eating clean in her 2007 book. I’ve added my comments after each principle. (more…)

Posted in: Nutrition

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The Shred Diet: A Minimally Kooky Way To Lose Weight

book-cover-shred

With New Years’ weight loss resolutions freshly made, let’s take a science-based look at another of the latest diet books being promoted by various public relations agencies. In my last post we explored the claims made by the hysterical Eat To Save Your Life authors in their book featuring a demonic cheeseburger on its cover jacket. Today I will review, Shred: The Revolutionary Diet ‚ 6 Weeks, 4 Inches, 2 Sizes, by Ian K. Smith, M.D.

I’m not sure what images the word “shred” conjures up for you, but if they have anything to do with muscle-bound, uber-lean bodybuilders on steroids you will be pleased to note that this book has nothing to do with them. In fact, what you’ll find in this book is a rather practical and healthy eating and exercise prescription with recipes and careful calorie counting. You’ll also find one fairly harmless chapter of liver detox pseudoscience, and an odd command to stare at yourself in the mirror at the beginning of week six.

Quietly stand in front of the mirror, and look deeply into your eyes as if you’re trying to see all the way into the depths of your soul… [p. 167]

The purpose of this visual exercise is never explained.

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Posted in: Nutrition, Science and Medicine

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The Dr. Oz Red Palm Oil (non-) Miracle

Red Palm Oil Dr. Oz

If there is an antithesis to the principles of science-based medicine, it’s probably the Dr. Oz show. In this daytime television parallel universe, anecdotes are evidence. There are no incremental advances in knowledge — only medical miracles. And every episode neatly offers up three or four takeaway health nuggets that, more often than not, seem to leave the audience more ill-informed about health and medicine than they were 30 minutes earlier.

After I completed my post on Dr. Oz’s prolonged embrace of the “miracle” that is green coffee bean extract, a number of readers brought me up to speed. Green coffee beans are yesterday’s miracle. The new weight loss miracle for 2013 is red palm oil. This constant drive for miracles must keep the producers in a perpetual panic. They need at least five miracles per week. Having now watched a few episodes, I’m reminded of the classic “That Mitchell and Webb Look” skit where two nutritionists pick a new superfood. It could be just a matter of time until we see white veal profiled as a superfood in a future Dr. Oz episode.

If there is a common characteristic of complementary and alternative medicine (CAM) proponents who believe themselves to be scientific (and I include Dr. Oz in this group), it is that they extrapolate from weak clinical evidence to grandiose claims by cherry picking the most supportive strands of evidence to give the impression of being evidence-based. They have the belief, and then they look for the supporting evidence to bolster the claim. In short, to paraphrase a quote attributed to Hahns Kuhn, they use scientific evidence like a drunkard uses a light post: for support, not for illumination. As I noted with green coffee bean extract, Dr. Oz extrapolated from ambiguous, preliminary data to recommendations to consume green coffee bean extract as a weight loss strategy. Frankly, the evidence isn’t there, so I didn’t have high expectations with the latest miracle. All I knew going in about palm oil is that it’s used in most industrial food production and the demand for it is linked to massive destruction of tropical rainforests. But who doesn’t want longevity? So I sat down and watched another episode.

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Posted in: Nutrition

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Everything we eat causes cancer…sort of

Read meat causes cancer. No, processed meat causes cancer. OK, it’s both read meat and processed meat. Wait, genetically modified grain causes cancer (well, not really). No, aspartame causes cancer. No, this food coloring or that one causes cancer.

Clearly, everything you eat causes cancer!

That means you can avoid cancer by avoiding processed meats, red meat, GMO-associated food (no, probably not), aspartame, food colorings, or anything “unnatural.” Or so it would seem from reading the popular literature and sometimes even the scientific literature. As I like to say to my medical students, life is a sexually transmitted fatal disease that gets us all eventually, but most of us would like to delay the inevitable as long as possible and remain as healthy as possible for as long as possible. One of the most obvious ways to do accomplish these twin aims is through diet. While the parameters of what constitutes a reasonably healthy diet have been known for decades, diet still ranks high on the risk of concerns regarding actions we take on a daily basis that can increase our risk of various diseases. Since cancer is disease (or, I should say, cancers are diseases) that many, if not most, people consider to be the scariest, naturally we worry about whether certain foods or food ingredients increase our risk of cancer.

Thus was born the field of nutritional epidemiology, a prolific field with thousands of publications annually. Seemingly, each and every one of these thousands of publications gets a news story associated with it, because the media love a good “food X causes cancer” or “food Y causes heart disease” story, particularly before the holidays. As a consequence, consumers are bombarded with what I like to call the latest health risk of the week, in which, in turn, various foods, food ingredients, or environmental “toxins” are blamed and exonerated for a panoply of health problems, ranging from the minor to the big three, cardiovascular disease, diabetes, and cancer. It’s no wonder that consumers are confused, reacting either with serial alarm at each new “revelatory” study or with a shrug of the shoulders as each new alarm joins other alarms to produce a tinnitus-like background drone. Unfortunately, this cacophony of alarm also provides lots of ammunition to quacks, cranks, and crackpots to tout their many and varied diets that, they promise, will cut your risk of diseases like cancer and heart disease to near zero—but only if adhered to with monk-like determination and self-denial. (Yes, I’m talking about you, Dean Ornish, among others.)

All of this is why I really wanted to write about an article I saw popping up in the queue of articles published online ahead of print about a month ago. Somehow, other topics intervened, as did my vacation and then the holidays, and somehow I missed it last week, even though a link to the study sits in my folder named “Blog fodder.” Fortunately, it just saw print this week in its final version, giving me an excuse to make up for my oversight. It’s a study by one of our heroes (despite his occasional misstep) here on the SBM blog, John Ioannidis. It comes in the form of a study by Jonathan D. Schoenfeld and John Ioannidis in the American Journal of Clinical Nutrition entitled, brilliantly, Is everything we eat associated with cancer? A systematic cookbook review.
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Posted in: Cancer, Nutrition

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