Even though it doesn’t appear on any calendar, May 2014 will go down in history as “gluten sensitivity month.” After RealClearScience picked up on a 2013 paper that brought into question the existence of non-celiac gluten sensitivity (NCGS), news sites were obliged to post their own analysis of the article, and the blogosphere was alight with pro- and anti-gluten posts. One of the authors of the paper in question, Dr. Peter Gibson of Monash University, was even mentioned on the People magazine website, which gives him the distinction of being the only researcher to be published alongside the Kardashians.
The Monash paper,1 which was previously discussed on SBM, suggested that it might be the fructans in wheat and not gluten that is responsible for symptoms in IBS sufferers who feel better on a gluten-free diet. Fructans belong to a group of short-chain carbohydrates known as FODMAPs that are readily fermented by bacteria in the intestine. If fructans were really to blame for wheat-induced gastrointestinal symptoms, this would be good news for IBS sufferers currently on a gluten-free diet — for some, a diet low in FODMAPs would be less restrictive than one without gluten, making it less prone to nutritional deficiencies.
As it stands, the existence of NCGS has neither been proven nor disproven by anyone. But gluten sensitivity sits at the intersection of several dilemmas in medicine today and, unlike how it’s portrayed in the media, is hardly an all-or-nothing affair. Proving it wrong will not instantly heal the people who have prescribed themselves a gluten-free diet. Proving it wrong will not produce a cure for IBS, a shorter time to a celiac diagnosis, or the correct way to handle potential celiac disease. Neither will proving it right. In the eyes of one gluten avoider, “Modern medicine is really good at crisis intervention…[but] they don’t do well with chronic issues”.2
With these issues in mind, it’s time to move past the media debates and fad dieters and take a balanced look at NCGS. This overview will use four recent articles by the Monash group1, 3, 4, 5 as a framework to uncover some of the factors contributing to the gluten sensitivity phenomenon. Even though it has been gone over many times, a discussion of the FODMAPs study is still in order — in fact, essential — to appreciate the central importance of the elimination diet in diagnosing a food sensitivity. Along the way, we’ll get an idea of who the gluten sensitive might be, how successful gluten-free diets really are, and how challenging it is to pursue a celiac diagnosis. (more…)
What’s in a name? Will sugar by any other name taste as sweet? Well, yes, but calling sugar “evaporated cane juice” in an ingredient list may get food manufacturers into trouble. Consumers in several class action suits allege that companies are trying to disguise the amount of sugar in their products by calling it something else.
Robin Reese filed a class action suit against Odwalla, a subsidiary of Coca-Cola, saying use of the term “evaporated cane juice” instead of sugar fooled her into thinking she was getting a healthier product when she purchased Odwalla juice. Odwalla told the judge the suit should be dismissed because it’s up to the FDA to decide the issue. The FDA issued draft guidelines, in 2009, taking the position that the term “evaporated cane juice” should not be used because it’s not a “juice” as defined in the Federal Regulations. For unknown reasons, no final guidelines were issued and food companies seem to be honoring the draft guidance more in the breach. The FDA reopened the draft guidelines for comment in March of this year, for 3 months, but still hasn’t decided. Meanwhile, similar class actions against other companies were dismissed or stayed pending the FDA’s making up its mind. (more…)
A new Cornell University study examines the origins of food fears, and possible remedies. It’s a survey of 1,008 mothers asking about foods they avoid and why.
Food fears are a common topic on SBM, likely for several reasons. Humans have an inherent emotion of disgust, which is likely an adaptation to help avoid contaminated or spoiled food. In our modern society this reflex can be tricky, because we do not always have control over the chain of events that leads to food on our plates. Other people grow the food, transport it, process it, and perhaps even cook it.
Modern food technology can also involve many scary sounding substances and unusual processes. As the saying goes, you may not want to know how the sausage is made, as long as the end result is wholesome.
This leads to a second reason for modern food fears – we are living in an age of increasing transparency, partly brought about by the dramatic increase in access to information on the internet. I think ultimately this is a good thing – people are seeing how the sausage is made, which makes it more difficult to hide shady practices. This introduces a new problem, however. If you’re going to inspect the process of making sausage, then you need to know something about sausage-making. (more…)
As regular readers of this blog know, Dr. Mehmet Oz had a very, very bad day last week, in which he received a major tongue lashing from Senator Claire McCaskill (D-MO) for the scientifically unsupported and irresponsible hyperbole he dishes out day after day on his syndicated daytime television show. Personally, I was tempted to pile on myself, but had to content myself with enjoying a couple of posts from a super secret blog in the run-up to the hearing (inviting Dr. Oz to testify is “like asking Al Capone to testify about U.S. tax policy or Stanislaw Burzynski about clinical trial design and ethics”), right after the hearing, and looking at the fallout from the hearing. I had even thought of asking my “friend” to combine the last two into an SBM-worthy post, but by the time that thought had occurred to me, the moment had passed.
One of the best takes I’ve seen on the whole “Oz-fest” last week comes from John Oliver on his HBO show Last Week Tonight With John Oliver. It’s a really long segment that takes up the last half of his show and features—don’t ask why—George R. R. Martin and a tap dancing Steve Buscemi. It’s hilariously spot on:
Most SBM readers will enjoy it. I promise. Oliver even correctly identifies Sen. Orrin Hatch (R-UT) and Tom Harkin (D-IA) as tools of the supplement industry and explains why dietary supplements in the U.S. are largely unregulated and the FDA and FTC have such limited powers to do anything about them preemptively.
One of the difficult things about science-based medicine is determining what is and isn’t quackery. While it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark’s “zapper,” the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other “energy healing” therapy) are the rankest quackery, there are lots of treatments that are harder to classify. Much of the time, these treatments that seemingly fall into a “gray area” are treatments that have shown promise in animals but have never been tested rigorously in humans or are based on scientific principles that sound reasonable but, again, have never been tested rigorously in humans. (Are you sensing a pattern here yet?) Often these therapies are promoted by true believers whose enthusiasm greatly outstrips the evidence base for their preferred treatment. Lately, I’ve been seeing just such a therapy being promoted around the usual social media sources, such as Facebook, Twitter, and the like. I’ve been meaning to write about it for a bit, but, as is so often the case with my Dug the Dog nature—squirrel!—other topics caught my attention.
I’m referring to a diet called the ketogenic diet, and an article that’s been making the rounds since last week entitled “Ketogenic diet beats chemo for almost all cancers, says Dr. Thomas Seyfried.” Of course, when I see a claim such as that, my first reaction is, “Show me the evidence.” My second reaction is, “Who is this guy?” Well, Dr. Seyfried is a professor of biology at Boston College, who’s pretty well published. He’s also working in a field that has gained new respectability over the last five to ten years, namely cancer metabolism, mainly thanks to a rediscovery of what Otto Warburg discovered over 80 years ago. What Warburg discovered was that many tumors rely on glycolysis for their energy even in environments with adequate oxygen for oxidative phosphorylation, which generates the bulk of the chemical energy used by cells. I described this phenomenon in more detail in a post I did four years ago about a drug that looks as though its anticancer properties come from its ability to reverse the Warburg effect. (more…)
NOTE ADDENDUM – Ed.
I’ll admit it: I’m a bit of a beer snob. I make no bones about it, I like my beer, but I also like it to be good beer, and, let’s face it, beer brewed by large industrial breweries seldom fits the bill. To me, most of the beer out being sold in the U.S., particularly beer made by Anheuser-Busch and MillerCoors can easily be likened to cold piss from horses with kidney disease (you need protein to get beer foam, you know), only without the taste. I have to be mighty desperate and thirsty before I will partake of such swill. I will admit that there is one exception, namely Blue Moon, which is manufactured by a division of MillerCoors, but that’s the only exception I can think of. Ever since I discovered Bell’s Oberon, a nice local (well, statewide, anyway) wheat ale, I can do without Blue Moon. Sadly, Oberon is only brewed during the spring and summer months; so when I want a similar bit of brew during the winter months sometimes I’m tempted by Blue Moon. Otherwise, I’m generally happy with one of the many craft and microbrews made by local brewers such as Short’s Brewing Company (whose brewpub I had the pleasure of visiting about a month ago) and Bells Brewery.
Despite my general hostility to Anheuser-Busch and MillerCoors products as examples of everything that is wrong with American beer, I have to say that I almost feel sorry for the people running those corporations right now. Unfortunately, they’ve fallen victim to the latest quack making a name for herself on the Internet by peddling pseudoscience. As is my wont, I’ll go into my usual excruciating detail shortly. But first, to whom am I referring?
I know by now I shouldn’t be, but I am still amazed by how readily so many people buy into the seemingly endless array of bogus sCAM nostrums. Many are marketed and hawked for the treatment or prevention of diseases that are poorly managed by science-based medicine. There are countless examples of dietary supplements that are purported to effectively treat back and joint pains, depression, anxiety, autism, chronic pain, and chronic fatigue; the list goes on and on. The lure for these treatments is at least understandable and, although frustrated that scientific literacy and rational thought loses out, I empathize with the desire to believe in them. On the other end of the spectrum is the even more ethically corrupt substitution of safe and effective treatments with products that are not. I encountered what I find to be possibly the most frightening and dangerous example of this recently at my practice. A family new to the area called to schedule a routine health-maintenance visit for their 5-year-old daughter. When our nurse reviewed the medical records the mother had faxed over, she noted that the child was unimmunized and explained to her that she would need to begin catch-up vaccinations. The mother matter-of-factly stated that her daughter was actually fully vaccinated with a vaccine alternative. She had received a series of homeopathic vaccines from a naturopath. I am not going to discuss this egregious example of sCAM here, though it was addressed in previous SBM posts.1,2 Instead I’d like to focus on another part of the sCAM spectrum. Here lies a form of sCAM that, in some ways, is even more difficult for me to comprehend. These are products invented, marketed, and sold solely for the treatment or prevention of fictitious diseases or problems that exist only in the realm of fantasy. (more…)
PETA (People for the Ethical Treatment of Animals) has a history of (as the old saying goes) using science as a drunk uses a lamppost – for support rather than illumination. In that way they are typical of ideological groups. They have an agenda, they are very open about their beliefs, and they marshal whatever arguments they can in order to promote their point of view.
Favoring information that supports our current beliefs is a cognitive bias common to Homo sapiens, but ideology tends to take this simple bias to a new level. It can lead to the systematic distortion or denial of science, and render belief systems immune to logic and evidence.
PETA provides us with a nice example of how having an ideological agenda can motivate an individual or a group to embrace dubious science. In an article currently on their website, and making the rounds in social media (this is repeating a claim from at least 2008, but the current article is undated), the group warns: Got Autism? Learn About the Link Between Dairy Products and the Disease. They claim:
The reason why dairy foods may worsen or even cause autism is being debated. Some suspect that casein harms the brain, while others suggest that the gastrointestinal problems so often caused by dairy products cause distress and thus worsen behavior in autistic children.
Saying that “how” dairy harms the brain is being debated implies “that” dairy harms the brain is accepted and not being debated. This is misleading. It is not accepted that dairy harms the brain or is in any way linked to autism, and the evidence is largely against it. (more…)
Gary Taubes has written two books explaining why people get fat and why a low-carb diet is the solution to preventing and treating obesity. He didn’t like what I had to say about his books on this blog back in 2011. I was not the only one to criticize. Another reviewer accused him of “abandon[ing] journalistic and scientific integrity in place of observational data, straw men and logical fallacy.” He says he agrees with Taubes’ premises but that his “arguments made me cringe,” and he goes into considerable detail to explain why. His analysis is worth reading.
Rather than engaging in the Comments section, Taubes complained to me in a somewhat offensive personal e-mail, saying I had failed to understand what he wrote. Recently he e-mailed me again, condescendingly suggesting that I might understand his arguments better if I read an article he wrote last year for the British Medical Journal. I read it, and confirmed that I had understood perfectly well the first time around and that it was Gary Taubes who didn’t understand my criticisms. I pointed out some omissions and inconsistencies, but my major criticisms boiled down to two:
- The clinical evidence isn’t yet sufficient to convincingly prove his thesis. (He himself admitted this.)
- He strongly recommended that everyone adopt a low-carb diet, essentially insisting that we act on insufficient evidence. And this was after he had devoted whole chapters of his books to demonizing the low-fat diet advocates for doing exactly that: acting on insufficient evidence.
Science-based medicine is a concept that is larger than the analysis of any specific topic. It is, essentially, an approach to answering health and medical questions, one that involves careful and thorough analysis of scientific evidence within a framework of understanding of critical thinking, mechanisms of self-deception, and the process of science itself. We feel this creates the best opportunity to arrive at tentative conclusions that are most likely to be reliable.
We often address claims that are the result of a very different process. In fact there seems to be a thriving subculture on the internet that emphasizes the naturalistic fallacy, fear of anything technological (including irrational chemophobia), paranoia about the government, corporations, and mainstream medicine, and embracing anything perceived as being contrarian, exotic, or radical. To this subculture science is either the enemy, or it is used (as Andrew Lang famously quipped) like a drunk uses a lamppost, for support rather than illumination. This approach is simultaneously gullible and cynical.
It is no surprise that those who follow this fatally flawed approach consistently arrive at the wrong conclusion, especially on any controversial scientific topic. The two most prominent netizens following this approach, in my opinion, are Joseph Mercola and Mike Adams. I do believe, however, that there is another hoping to join their ranks – Vani Hari, who blogs under the name Food Babe. (Mark Crislip also blogged about her here.)