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Dr. Oz Doubles Down on Green Coffee Bean with a Made-for-TV Clinical Trial

“One of the most important discoveries I believe we’ve made that will help you burn fat – green coffee bean extract” – Dr. Oz, September 10, 2012, Episode “The Fat Burner that Works”

Dr. Mehmet Oz may be biggest purveyor of health pseudoscience on television today. How he came to earn this title is a bit baffling, if you look at his history. Oz is a bona fide heart surgeon,  (still operating 100 times per year), an academic, and a research scientist, with 300+ or 400+ (depending on the source) publications to his name. It’s an impressive CV, even before the television fame. He gained widespread recognition as the resident “health expert” on Oprah, and went on to launch his own show in 2009. Today “The Dr. Oz Show” is a worldwide hit, with distribution in 118 countries, a massive pulpit from which he offers daily health advice to over 3 million viewers in the USA alone. For proof of his power to motivate, just look at the “Transformation Nation Million Dollar You” program he launched in 2011, enrolling an amazing 1.25 million participants. Regrettably, what Oz chooses to do with this platform is often disappointing.  While he can offer some sensible, pragmatic health advice, his show’s content seems more focused on TV ratings than medical accuracy, and it’s a regular venue for questionable health advice (his own, or provided by guests) and poorly substantiated “quick fixes” for health issues. (And I won’t even touch Oz’s guests like psychic mediums.) One need only look at the number of times the term “miracle” is used on the show as a marker of the undeserved hyperbole. Just this week, Julia Belluz and Stephen J Hoffman, writing in Slate, itemized some of the dubious advice that Oz has offered on his show, with a reality check against what the scientific evidence says. It’s not pretty.

I know I’m not alone in my dismay with the Dr. Oz show – As a health professional, Oz should know better than this. He has the education and training that should allow him see through the pseudoscience that he now embraces on a regular basis. I took a close look at Dr. Oz’s show on green coffee beans a few months ago as a case study in pseudoscience, after being inundated with questions about it.  In short, green coffee bean extract is derived from unroasted coffee beans and is touted as a source of chlorogenic acid, purported to be the active ingredient in what Dr. Oz called a “miracle” and a “fat burner”. All the clinical trials done on green coffee beans have been small and inconclusive, and a recent meta-analysis noted these limitations, and called for better conducted studies. On his show, Dr. Oz introduced a naturopath touting the product (who also happens to sell his own line of green coffee bean extract, but never disclosed his conflict of interest.) The naturopath and Dr. Oz discussed a small clinical trial by Joe A. Vinson that studied just 16 patients in India. Even from a cursory review of the study, the trial design and reporting was so poor that there was no way to make any definitive conclusions about its efficacy.

Instead of describing the problems with the trial, and cautioning the audience not to get suckered in by cures that look too good to be true, Oz did the exact opposite. He did a case study. He asked two members of his audience to take the supplement for five days. One reported a 2 pound loss, the other, a six pound loss. A five day, unblinded evaluation of a supplement in women who are about to be profiled on television is quite possibly the worst possible way to evaluate a treatment for obesity. But it was good enough for Dr. Oz.

“It’s important for everyone to understand what green coffee bean is, and why I think it’s so important for weight loss.” – Dr. Oz, September, 2012

Perhaps stinging from the well-deserved criticism he endured with his first show and his laughable case study, Dr. Oz recently dedicated another show to green coffee bean. He called it The Green Coffee Bean Project:

To test the effects of the green coffee bean extract for The Dr. Oz Show, the show’s Medical Unit conducted a project under the guidance of experts including Dr. Caroline Apovian and registered dietician Kristin Kirkpatrick. It is the largest project the show has ever done.

So what was the “project”? The website describes the undertaking:

The show’s Medical Unit enlisted 100 women between the ages of 35 and 49 who were overweight with BMIs between 25 and 45. The women were not pregnant or breastfeeding and didn’t have any major medical problems including diabetes, or history of heart attack or stroke. These women received either the green coffee bean extract or a placebo, and were instructed to take 400mg capsules, three times a day – 30 minutes before each meal. No participant knew which pill they were given. Furthermore, the participants were instructed to not change their diet, and to keep a food journal that would help The Dr. Oz Show learn what these women were eating. After two weeks, the study participants were weighed.

In two weeks, the group of women who took the green coffee bean extract lost, on average, two pounds. However, the group of women who took the placebo lost an average of one pound – possibly because they were more aware of their diet for that two weeks because of the required food journal.

There is a bit more detail  in the episode clips. All women started with an examination with extensive measurements, including blood pressure, weight, heart rate, and waist size. The bottles are shown on screen for a moment, and the label says “Green Coffee Bean Project”, “For investigational use only” and what looks like “There are no known side effects.”  Dr. Oz mentions that the placebo is “almost identical” in appearance. The study product (green coffee bean or placebo) was mailed to participants. All participants were also asked to complete a daily food diary, which appeared to be completed online. The study lasted two weeks.

Oz then moves to discuss the evaluation with the studio audience, which is made up entirely of the participants in the study. Overall, everyone (approximately 100 women, it’s not clear) is reported to have lost 123 lbs over the 2 weeks. Oz then notes that the group taking the green coffee bean extract group lost 81.5 pounds collectively, while the placebo group lost 42 pounds. Assuming 50 participants per group, that’s 1.6lbs in the green coffee bean group, and 0.84 pounds in the placebo group. No final numbers of participants are provided, so it’s not clear what the average weight loss really was.

Does 1.6 lbs versus 0.84 pounds sound convincing enough? There’s not a lot of detail here, but what is reported raises some serious questions about the approach and methodology.

Oz calls this a “project” but we should be clear on what this really was: a randomized clinical trial. He recruited participants, randomized them, gave them a treatment, and measured an outcome. Oz is presumably the principal investigator here, so my first question is if he obtained clearance to conduct this trial from an Institutional Review Board (IRB), either from Columbia University, or elsewhere. As staff at Columbia University, their requirements would presumably apply. Ensuring clinical trials are conducted in ethically sound ways is no trivial matter. Institutional review boards emerged in part as consequence of the horrific medical abuses of the second world war, to protect the right of research subjects. While IRB approval doesn’t guarantee a trial is credible and safe for participants, it does provide an external validity check of its overall approach and ethics. Now it could be the case that the show did obtain IRB approval from some organization who reviewed the protocol, consent forms, and overall methodology. I sincerely hope so, from a research ethics and patient protection perspective.

Another quality indicator is trial registration, a critical issue in research and a means of holding investigators more accountable for reporting their results in a transparent and unbiased manner. Public registration serves as international resource that catalogs human experiments, and allows for more systematic evaluations of treatments. Disappointingly, there are no clinical trials registered at clinicaltrials.gov that refer to green coffee bean. There are trials that are studying chlorogenic acids – but in coffee. Yes, despite what Dr. Oz said on his show, brewed coffee is also a source of chlorogenic acids.

Taking a closer look at the results that Oz reported, there’s even more missing data. No information is provided on how women were recruited, how they were randomized, and how comparable the two group were. The only condition for enrollment seems to have been BMI, which is not a good measure of obesity on an individual basis. There is no discussion of informed consent. Then we come to the blinding and the group allocation (placebo or active treatment). It’s noted that participants didn’t know which group they were in. Was this a”single-blind” trial where the staff collecting data knew of the allocation, raising the risk of bias? Again, it’s not clear. (One need only look at acupuncture trials to see how single-blinded studies generate misleading results.)

Now let’s look at the treatment itself. Two weeks is insufficient for a clinical trial of a drug for weight loss. Real obesity studies last months – not days. And multiple measures are collected before, during, and after the trial, including changes in figures like BMI, waist size, lipid levels, and weight.  Reporting only overall weight loss per group, as Oz has done, is both uninterpretable and suspicious. What about all of the other measurements collected? Even looking only at weight loss, we need both the average and the standard deviation.  We then need a statistical analysis of the results, to see if the results differ from random chance. None are reported, or even mentioned.

Finally let’s look at the safety. There’s little mention of side effects other than a question that Oz asks the audience. Were participants asked to report on side effects? Were there any differences at all? Again, it’s not reported. Two weeks is insufficient to evaluate safety, in any case. And if the bottle really says, “There are no known side effects,” should we really expect participants to report any negative effects? What still hasn’t been answered with green coffee bean is the long-term safety. Concerns have been raised about the potential for chlorogenic acid to raise levels of homocysteine. While the relationship between elevated homocysteine and cardiovascular disease isn’t clear, it does suggest that the safety profile should be confirmed, and not assumed.

“This stuff really seems to work” – Dr. Oz

This clinical trial makes a mockery of good research methodology. As a clinician scientist, Dr. Oz knows the evidence bar for good research. This made-for-TV trial doesn’t even come close. The idea of doing a clinical trial on green coffee bean extract is a good one. And the Dr. Oz show certainly has the resources to fund a proper evaluation. So why design it in a way that will guarantee meaningless results? If he truly believes that this was a fair and ethical test of green coffee bean extract, I invite the Dr. Oz show to prove it: Show us the IRB approval, show the consent forms, give us the pre- and post-test comparison of the two groups, describe the randomization, show all the collected data, and show us the statistical analysis that let to the conclusion that green coffee bean actually works as a weight loss product. And I’ll happily write up a follow-up post heralding the first non-prescription product ever to generate meaningful weight loss despite no changes in dietary consumption and exercise. I’m not going to hold my breath.

Despite the impression given by Oz, the laws of thermodynamics hold, even on daytime television. There is no magical product that allows you to eat whatever you want, hold your calorie expenditure constant, and still lose weight. Weight changes are driven by by overall calorie intake and expenditure, so weight loss is always a consequence of a negative balance.  In the case of the Dr. Oz study, weight loss in both groups was almost certainly due to food journaling of calories, and a heightened awareness of calorie intake simply from being in a clinical trial. In fact, Oz goes on to recommend the food diary as an acceptable alternative to those that don’t want to purchase green coffee bean extract, which may be the most sensible statement he makes in the entire episode.

Conclusion

A year ago green coffee been was a little known product showing some promising but unverified results in small clinical trials. Then came the Dr. Oz effect. Lots of publicity, lots of use of the term “miracle”, and then a made-for-TV clinical trial. Despite all this hype, the evidence base is no better today than it was one year ago.  Yet sales have skyrocketed, will millions likely trying green coffee bean, in the absence of good efficacy or safety data. Thanks to Dr. Oz, many consumers have the impression that green coffee bean has been evaluated, it’s safe, and it offers a meaningful benefit for weight loss. In short, it’s a panacea. Unfortunately, there are no panaceas for weight loss, and there are no short cuts when it comes to science. Of course, these uncomfortable realities don’t lend themselves well to daytime television.

Posted in: Clinical Trials, Herbs & Supplements, Medical Ethics

Leave a Comment (41) ↓

41 thoughts on “Dr. Oz Doubles Down on Green Coffee Bean with a Made-for-TV Clinical Trial

  1. David Gorski says:

    Holy crap! How can Oz get away with this? As a clinician-scientist, I’m appalled. This is clinical research, crappily done. As such, it’s highly unethical. No IRB would approve it.

  2. Jimmylegs says:

    This report from Oz is monstrous. The methodology of this “project” is horrible, even if he wasn’t attempting at real research. You would think he would gather a food log for some time before you start, double-blind it, then report back in a few months. Plus “about 100 women” how about we get a real number… was it 100? 95? 120? Who the hell knows.

    Of course Oz will turn this circus show into absolute fact that green coffee bean extract works for weight loss. Oz will never release any of the information you, and I’m sure many others, are demanding. Also this will never reach the eyes and ears of Oz viewers sadly (even if it did I’m sure it wouldn’t have any effect).

  3. BobbyG says:

    “Also this will never reach the eyes and ears of Oz viewers sadly”

    I wouldn’t give up that easily. I just tweeted him, with relevant hashtags. He has almost 2.5 million Twitter followers. This will get SOMEONE’S attention. I exhort everyone to do likewise.
    __

    @DrOz SBM takes issue with you here. http://www.sciencebasedmedicine.org/index.php/dr-oz-doubles-down-on-green-coffee-bean-with-a-made-for-tv-clinical-trial/ #OzTip #TheDrOzShow #OzResolution #OzQuestion I will cite this on my REC blog.
    __

    I also posted it on his Facebook page: https://www.facebook.com/droz

    It’s not about attacking HIM, it’s about defending the scientific method.

  4. cervantes says:

    Oz is a con artist and a traitor to science. Columbia should fire him.

  5. windriven says:

    Mehmet Oz is a prostitute first and a physician second. The Lizard of Oz has sufficient education and training to understand that he is dishing up brimming bowls of bullsh|t for hard cold cash. It is morally and ethically reprehensible. One might make allowances for some store front charlatan with a high school education peddling woo to the credulous; he might actually believe it himself. For a scientist and physician to do this betrays utter contempt for his audience, for his oath and for the principles for which he pretends to stand.

  6. Khym Chanur says:

    So, why chlorogenic acid? Did in vitro studies show something interesting about it?

  7. OkieBlue says:

    Apparently you’re already behind the curve. In a form of the Gish Gallop Oz is already promoting a new diet. He now maintains that eating different foods each day tricks your metabolism and causes you to lose weight. For instance, if you eat the same thing every morning your body gets used to it and somehow magically causes you to gain weight. A variety of foods tricks your metabolism and causes you to lose weight. Or something. I would like to see an index of all the different diets that he has promoted over the years. It would be truly amazing.

    I have noticed that Oz moves between miracle cures on an almost daily basis. The “cures” that he promoted last week are quickly forgotten and just as quickly replaced with new “cures” the following week. He is very successfully executing the Gish Gallop on his TV show by moving so fast from one quack claim to the next it is impossible to keep up, especially if you take the time to scientifically debunk each one of them.

  8. BobbyG says:

    Interesting. The Dr. Oz people deleted my post on his Facebook wall in which I cited this SBM post.

    Captured it.

    http://www.bgladd.com/DrOz010313.png

  9. Quill says:

    It’s a funny thing about “hard cold cash” — the more if it you have the more of it you want. It never gets to be enough. Add that to the crack-like high of fame and the feeling of omnipotence when you see your influence go out in the world and you have the recipe for more and more of this stuff from Dr. Oz. These beans are only the beginning of what promises to be more of these bad “clinical trials” and unless he has very wise personal counsel to reign in his expanding ambitions, it will all just get worse and worse.

    At some point the tension between his legitimate medicine at Columbia and his burgeoning Empire of Weekly Miracles will snap and I bet he’ll gracefully retire from Columbia and start up his own foundation, place or specialty clinic.

  10. Quill says:

    Oh, and since people enjoy calling Dr. Oz names, why not get Crislipian and add some Shakespeare?

    Ah, that Oz! That measureless liar, false hound, basest thing, whoreson dog, most credulous fool, implorator of unholy suits, fleering tell-tale, dissentious rogue, counterfeit module, double-meaning prophesier, common gamester, monstrous malefactor and injurious thief! He is becoming a periwig-pated fellow, a minion of the moon; in science he is king of shreds and patches, a frost-spirited rogue and a lack-brain; in his speech a fellow of infinite tongue and a bolting hutch of beastliness. His mind? Pure tickle-brain and a pintpot, a stuffed cloakbag of soused gurnet making him a shallow jester, a nimble-footed madcap. Oh woe our age when such a foul offender takes valiant fleas and sets them upon thrones. May this foolish vane blown with all winds, this puffed man full of old, cold, withered and intolerable entrails follow his function and go and batten on cold bits.

  11. The Dave says:

    Wow. Have you looked at his fb page? click on the filter and see what fans are posting on his wall. Here’s a good one:

    “Today’s show was so important in renewing my faith in your advice. I had tried a scam Green Coffee Bean and was not only upset with it but with you. Thank you for letting us know what has been happening concerning the illegal use of your name and image and I’ll keep an eye out. Thanks for doing us all a great service with your show.”

    So apparently not all Green Coffee Beans are created equal, she used one that (surprise) didn’t work, so obviously it was a scam one not promoted by The Oz-man.

    Another posted a picture of the bottle she bought, asking if it was the right one, so I commented, leaving the link to this post.

    I’m not sure how much more of his page I can endure. I better stop now.

  12. The Dave says:

    @BobbyG:

    It actually hasn’t been deleted. You have to click on the box that says “highlights” and change it to “Posts by others” and then scroll down to find it. You actually have done some good, based on the comment left:

    ” Thanks, Bobby. I WAS really considering but… Buying this. Think I’ll pass and save some money. :.)”

    SBM FTW!

  13. windriven says:

    @Quill

    Made me laugh out loud! Don’t know if you read Barthelme’s The Sotweed Factor but your Shakespearean rag put me in mind of a passage that goes on for about two pages wherein two tarts hurl increasingly obscure sexual insults at each other. :-)

  14. Lytrigian says:

    By coincidence, an ad for a brand of green coffee bean extract was on the radio on my way in to work today. “Contains no harsh stimulants!” the announcer proclaimed. I guess caffeine isn’t “harsh”?

  15. Robb says:

    “So, why chlorogenic acid? Did in vitro studies show something interesting about it?”

    It’s considered an antioxidant but the only thing vaguely related to weight/diet on it as an active ingredient I’ve found is this:
    http://ajcn.nutrition.org/content/78/4/728.full

    The roasting temperature of coffee is higher than the melting point of chlorogenic acid so it isn’t surprising that there’s some degradation and lesser amounts found in coffee than in the green bean:
    http://www.ncbi.nlm.nih.gov/pubmed/19530715

    This doesn’t mean I think it’s effective for weight loss, just that it makes sense that it contains more chlorogenic acid than roasted beans/coffee.

  16. fxh says:

    “Oz is a bona fide heart surgeon, (still operating 100 times per year), an academic, and a research scientist, with 300+ or 400+ (depending on the source) publications to his name. It’s an impressive CV,”

    In my experience surgeons are one of the hardest mob to get to look at evidence or science based practice. (At least compared to physicians, anaesthetists and GPs) A lot of surgery is still seen as solo heroic and mortality is often the only data that impacts.

    Long term follow up studies with controls aren’t as widespread as one would want. Nor do they seem to be pushed by the Colleges. Take routine back pain surgery as a f’rinsctance.

    Even though we are fortunate to have Stephen Bolsin of the infamous Bristol Deaths here locally in Australia – and lecturing – I’m afraid there is still a long way to go in getting the actual surgery, as opposed to the surrounds and supports, in to a rigorous risk, skill and improvement mentality conducted in a team environment.

  17. fxh says:

    I’m on my third cup of roasted coffee this morning – already feeling much healthier.

  18. fxh says:

    Oh and while I’m here and waiting for the next coffee to come up on the stovetop espresso – I automatically suspect scam whenever I see a Dr. on TV in scrubs or a white coat.

    In fact it must be 20 years or so since I last saw someone in a hospital or research institute in a white coat. If someone stood up at a conference, journal presentation or meeting in a white coat or scrubs they would be mocked unmercifully – at least here in urban Australia.

  19. OneThree Athlete says:

    “Despite the impression given by Oz, the laws of thermodynamics hold, even on daytime television. There is no magical product that allows you to eat whatever you want, hold your calorie expenditure constant, and still lose weight. Weight changes are driven by by overall calorie intake and expenditure, so weight loss is always a consequence of a negative balance.”

    Great blog. First off, I’m not an Oz proponent. His approach to nutrition is status quo, and I wish he would stop giving advice in that area. And now that I read your blog post about his approach to weightloss, I wish he would stop advising people there as well.
    I’m in the business of weightloss and have clients who have that as their primary goal. The notion of weightloss or gain being dependent upon calories is untrue, at least to a certain extent. I also believe that there’s a misunderstanding of the way the 2nd law of thermodynamics is applied to calories consumed. It is true that the physical laws always hold, I’m not trying to say that I’ve found an exception to them. What I’m saying is that the body treats 1000 calories of fat, carbohydrates and protein differently. Furthermore, raising or reducing caloric intake by a few hundred calories doesn’t produce any weight change in most people. Because this is my business, my shoulders kinda sag and I have to sigh every time I come across an instance where weightloss or gain is overly simplified by saying it’s a matter of caloric/energy balance, a.k.a. “calories-in/calories-out”. I have to unwind these knots in my clients because they read this stuff, too. I think Richard David Feinman does a great job of addressing calories and the Laws of Thermodynamics in his blog post here: http://rdfeinman.wordpress.com/2011/06/06/metabolic-advantage-%E2%80%9Ca-calorie-is-a-calorie%E2%80%9D-and-why-the-first-law-of-thermodynamics-does-not-apply-2/

  20. Calli Arcale says:

    OneThree Athelete — part of the trouble there is that the whole idea of calories-in/calories-out is an oversimplification. Intentionally; it makes it easier to accept eating less and exercising more as a way of losing weight. And it is *broadly* true. But of course, what is defined as a calorie is itself an oversimplification, and you can tell just by observing different that their bodies are responding differently in some important way to the food they eat. Pinning down exactly why, and then working out a way of controlling it, is the elusive part. Right now, controlling how much you eat and how much you exercise seem to be the easiest ways (or at least the ones we can do the most about).

  21. OneThree Athlete says:

    @Harriet Hall

    I read the blog post by Steven Novella, but more importantly I read the research paper he based his post on. Did you read the research paper he cites?

  22. Harriet Hall says:

    @OneThree Athlete,

    Yes, I had read that research paper as soon as it was published (I subscribe to that journal), and I even mentioned it and its accompanying editorial in a blog post of my own http://www.sciencebasedmedicine.org/index.php/why-we-get-fat/ And I read a lot of other studies, some of which I cited in that post. What is your point?

  23. OneThree Athlete says:

    @ Harriet,

    Well, before I get too far into it, let me outline the study as I understand it. I might be wrong about some things.

    This study took 811 overweight/obese men and women and took initial measurements of weight, waist circumference (and some blood and urine stuff), current eating patterns and current exercise patterns. After this baseline was established, they were randomly assigned to four different diets. These diets differed in macro-nutrient ratios and were 750kcal less than what the individuals were currently used to eating. The study says meal plans were given (but doesn’t tell us what the meals were). At the end of the Supplementary Appendix there are two daily meal plans (they show one breakfast, one lunch, one dinner and one snack for one day), one for 2,000kcal and one for 1,400kcal, but there’s no explanation of what they mean or are in reference to.
    Also the participants were told to increase their physical activity to 90mins/week of moderate to intense activity throughout the study, but we don’t know if this was adhered to.
    The participants were given meal plans and food logs, but there was no way to know if these were followed. Food logs were given, but there’s no mention if they were used. Dietary intake was assessed in a random sample of 50% (~330 people) of the participants by 24-hour recall during a telephone interview at 6 months and at 2 years. (That’s twice in two years.) The study tells us that there were times when the food data was to be collected from the participants, but doesn’t say anything about adherence. In essence, we don’t know what the people in the study were eating. 645 people completed the study. 645 provided body weight at the end of 2yrs. 599 provided waist circumference after 2yrs. The daily intake of calories among the four groups ranged from 1,862 to 2,015 with a deviation of 505 to 599kcal (please think about that deviation one for a second).
    The results were that the participants lost between 6 and 15lbs over two years, with most of the weight loss coming in the first six months. Also, this study uses the intent-to-treat paradigm. I know this isn’t anything new these days, but making up data about the people who dropped out of the study and reporting it as part of the study is something I think everyone should be aware of.

    If we agree that what I’ve stated is factual, my point is that this study doesn’t give us any reliable numbers. We don’t know what they ate. We don’t know how close they stuck to the study. It’s useless. I wouldn’t know what type of conclusion I could draw from a study that has so many uncertainties. Which should be good news for Novella because that means calorie restriction (750 CALORIES RESTRICTED!!!) leads to a paltry 6-15lbs weight loss, and it takes six months to two years to accomplish. If that were true, it would be the worst way to lose weight ever.
    Also, I understand that this study was meant to compare different macronutrient diets, but not one of the diets could be considered low-carb or high-fat. Even when it comes to carbs and fats, there are differences among them that need to be discussed rather than broadly speaking of “carbs” and “fats”, so I know that’s a whole other discussion I’m sure we have both had many times.

  24. Harriet Hall says:

    “We don’t know what they ate. We don’t know how close they stuck to the study.”

    But that’s equally true of all the groups, so we are controlling for those confounders. The study didn’t use the kind of low-carb or high-fat diets you would ideally like, but the fact remains that there is no good evidence that macronutrient content makes a real difference to success in weight loss.

  25. RUN says:

    @OneThree Athlete
    I am asking because I am curious (nothing more)… What are your credentials…MD? Maybe you have already mentioned it. You mentioned working in a weight loss facility… can you describe that more and what your clientele are like? My understanding is that there are not many medically supervised weight loss programs and I am curious what yours is like.

  26. OneThree Athlete says:

    @Harriet

    I’m just going back to the purpose of the citation. You and Mr. Novella would present this study as proof that macro ratios do not matter (which I mostly agree with), but this particular study doesn’t prove anything to someone who reads carefully how the people were monitered. Nothing serious can be taken from this study because it doesn’t come close to proving what the people ate. We don’t even know if they stuck to the maco ratios they were told to. I do understand that it’s not like we can hold 800 people prisoner and make sure they eat what the study needs them to. I think the people in this study did the best they could. Still, if I proposed it to you, you would’ve tore it to shreads, too.

    @Run

    I have some letters after my name, but nothing that carries the impression ‘MD” does. I own my own personal and group training business. About 40% of my clients want weightloss. My method is to review the foods they currently eat and go from there. The guiding principle is removing nutrient sparse foods from the diet and replacing them with nutrient dense, whole foods. This means grains and legumes must go (typical junk food like candy and soda are obvious). But (and this relates to the calories in/calories out idea) I make sure they don’t purposefully restrict calories. In other words, if they remove bread from their meals, I want them to replace it with something that’s nutrient dense (meat, including organs, seafood, eggs, veggies or fruit). The key is to not allow them to become hungry. The body will not allow itself to be starved, so the overal satiating quantity of food must be maintained if you want long lasting results. Sure, I have people fail because they can’t resist tasty, nutrient sparse foods, but they don’t fail because I’m restricting their food intake. It works like a dream. People lose weight without any powders, pills, shakes or crap like that. And it never comes back until they begin eating nutrient sparse foods again.

  27. Harriet Hall says:

    @OneThree,

    I understand that the study doesn’t prove what people ate, but I don’t understand why you think that would have invalidated the results. Do you have any reason to think subjects in one group were less compliant or honest than in the other groups?

    Note: Please don’t refer to Dr. Novella as “Mr. Novella.” It comes across as a mark of disrespect, whether or not you meant it as such.

  28. Harriet Hall says:

    @OneThree,
    “I make sure they don’t purposefully restrict calories.”

    Isn’t it nevertheless possible that your advice results in lower total calorie intake? Studies like this http://www.ncbi.nlm.nih.gov/pubmed/12684364 indicate that weight loss relates to calorie intake rather than to macronutrient content.

  29. OneThree Athlete says:

    @Harriet

    “…why you think that would have invalidated the results.”

    Because the results of the study are dependent upon what people ate. Imagine it. Imagine if I told you I had some results from a study where people were told to eat x, y & z. If you started asking me questions as to how sure I was about what they ate, I wouldn’t be able to answer with much confidence.
    You: Oh, well those are some interesting results, Mr. Libbie. What did they eat?
    Me: They ate x,y & z.
    You: How do you know that?
    Me: Well, we told them to.
    You: But how do you know they did what you told them to?
    Me: Well, I guess I don’t really know, ma’am. We asked them twice in two years (via phone call) to tell us what they ate in the previous 24hrs of us calling. And not all of them by the way, just 50% of them. I guess you could say it’s on the honor system. It’s the best we could do with the money we had.
    You: Okay, so it’s possible these people ate anything under the sun, right?

    See what I mean? It’s just not solid. To take the results seriously, the input needs to be known.

    “Do you have any reason to think subjects in one group were less compliant or honest than in the other groups?”

    No. All of the groups could’ve followed the diets to the letter, or not at all. We don’t know. They weren’t monitored. The study says food logs were given and a computer system was offered to them, but there’s no mention of the data from those sources.

    “Isn’t it nevertheless possible that your advice results in lower total calorie intake?”

    Yes, it’s possible, but unlikely. I have my clients take pictures of each meal and send it to me via text. They follow my instructions of adding the approved foods in place of the proscribed foods, so that their not eating tiny, unsatisfying amounts of food. Furthermore, they usually add a fat back to their diet that they had stayed away from because of all the conventional wisdom. But I have thought about how maybe the overall calories go down; I’m not closed off to the idea, and am only interested in what works for my clients. I wondered that in my own situation, but it just seems sooooo unlikely. I eliminated grains and legumes from my diet a few years ago and began eating completely uncontrolled amounts of mono and saturated fats. I never measured things, but I can tell you without a doubt that the overall amount of calories I consumed had to have went up. It was a personal experiment and it astonished me. I though for sure it would lead to me getting bigger, but I actually leaned out by about 5lbs. I don’t pretend to know what’s going on. It could be that the body adjusts to the new calorie intake by not absorbing it all, something like the body fat set point idea by a guy who devotes his entire life the study of obesity http://wholehealthsource.blogspot.com/2009/12/body-fat-setpoint.html. I don’t really know. It defies all I was ever told. But the observed phenomenon is remains. Try it for yourself sometime. Add a tablespoon of coconut oil to your life daily. Just do a little N=1.

  30. The Dave says:

    ” Add a tablespoon of coconut oil to your life daily”

    I’ve been wondering about coconut oil for a while (ever since my wife really got caught up in listening to the advice of various “nutritionists”. Has anybody taken an SBM look at the various claims of cocunt oil? So many people swear by it for so many purposes, and then there are some that reject it on the soul basis that its a saturated fat (while the supporters say that its healthy because its a medium chain S.F. Does that matter?)

  31. The Dave says:

    ” Add a tablespoon of coconut oil to your life daily”

    I’ve been wondering about coconut oil for a while (ever since my wife really got caught up in listening to the advice of various “nutritionists”. Has anybody taken an SBM look at the various claims of coconut oil? So many people swear by it for so many purposes, and then there are some that reject it on the soul basis that its a saturated fat (while the supporters say that its healthy because its a medium chain S.F. Does that matter?)

  32. RUN says:

    I agree with ‘the Dave’. It would be nice to have SBM do a review on coconut oil. I hear a lot of claims, but my understanding is that there is very limited research on it…and many claims are not supported by research. At any rate, even if there is a small amount of supportive research, does it really override ALL the supportive research on olive, peanut, and fish oils?? I saw this article awhile back (its more for the lay person) and would appreciate experts feedback. http://rosieschwartz.com/2012/08/01/whats-the-verdict-on-coconut-oil/
    Also, unless criteria has changed, I thought high LDL’s were unhealthy:)

  33. The Dave says:

    Today’s post about Red Palm Oil kind of answers my questions. (Did I have a little pre-cognition? lol)

    One book that is a major proponent for coconut oil basically says it is the same as palm oil, health-claim wise.

  34. Mark Hanna says:

    I’ve seen a variation of this product advertised here in New Zealand as a “Miracle Weight Loss Combo” (when combined with mango extract). However, in New Zealand our advertising standards authority’s therapeutic products advertising code prohibits advertising therapeutic products as miraculous so I’ve put in a complaint.

    It’ll be interesting to see if this complaint can set a precedent, especially since claims endorsed by Dr Oz (as this one is, which is mentioned in the advertisement) are often called “miracles”.

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  36. gio says:

    Mmm,

    I feel so stupid I did not find this website earlier. I live in the Netherlands and all the negative feedback on the Dr.oz show has not reached us..I was blindly believing him..Quite stupid

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