Diet and Exercise

Junk Science: Vitamin Mania

vitamins

vitamins

538, the new platform for stats-oriented analysis from Nate Silver at ESPN, has this good story by Emily Oster about the junky science of vitamins: “Don’t Take Your Vitamins.”

Many medical studies show positive health effects from higher vitamin levels. The only problem? These studies often can’t tease out the effect of the vitamins from the effect of other factors, such as generally healthy living. Studies that attempt to do this typically show no impact from vitamin use — or only a very tiny one on a small subset of people. The truth is that for most people, vitamin supplementation is simply a waste of time.

To get a little more concrete — and to understand how we got to that endless row of vitamins at CVS — it’s useful to look at a couple of examples: vitamin D and vitamin E. These are among the most popular vitamin supplements: In the 2009-2010 NHANES, 34 percent of adults reported taking vitamin D supplements and 30 percent reported taking vitamin E.

One can find plenty of support for this supplementation behavior in the medical literature. A recent review identified 290 observational studies on vitamin D. For the most part, these studies measure the amount of 25-hydroxy vitamin D — the marker of vitamin D concentration — in participants’ blood and analyze the relationship between that concentration and various measures of health.

Using this approach, researchers have found that higher concentrations of vitamin D are linked to less cardiovascular disease, lower overall mortality, less weight gain, less diabetes, less likelihood of getting infectious diseases, less multiple sclerosis, fewer mood disorders, better cognitive function — basically, every outcome under the sun. Based on these studies, vitamin D is pretty much the philosopher’s stone.

A bit less magical, vitamin E has also been credited (again, in observational studies) with everything from better pregnancy outcomes to lower mortality. In the most striking result, a large study published in the early 1990s found a 40 percent reduction in mortality risk from taking vitamin E supplements for two years. This effect is enormous.

But as striking as these results on both vitamin D and vitamin E are, they fall short of the standard for causality. These studies were not randomized controlled trials, which means other factors could have influenced their outcomes. The authors did try to adjust for some variables — age and whether the subjects smoke, for example — but these may not be sufficient. Yet people believe the results: 25 percent of adults reported taking vitamin E in 1989, and the share rose to almost 40 percent by 2003.

As is often the case, striking observational results like these were followed by large randomized controlled trials — many of them. A study run through the National Institutes of Health called the Women’s Health Initiative analyzed the impact of vitamin D and calcium supplementation in 36,000 post-menopausal women. Another large trial out of Harvard — the Physician’s Health Study — looked into vitamin E supplementation among 14,000 male physicians.

In these trials, participants were randomly assigned to take supplements. Because the assignment was random — and the trials were big — the demographic and health characteristics of the supplement group and the non-supplement group were similar before the study started. When researchers looked at participants’ health over the long term, they could therefore be confident that any differences they saw across groups were due to the supplements, and not some other factor.

When the results of these studies came out, they largely refuted the idea that these supplements offered benefits. Vitamin E appears to have no impact on cancer or heart disease. Results from the Women’s Health Study, released in 2005, showed no relationship between vitamin E supplementation and overall mortality. Later results from the men in the Physicians’ Health Study showed the same: no relationship.

For vitamin D, the randomized trials (nicely summarized here) refuted virtually all of the purported benefits to diabetes, weight loss and cancer. For elderly women, there is some evidence of a small reduction in mortality with supplementation, but well below what was seen in observational data and only marginally statistically significant.

Randomized controlled trials are not actually required to draw some conclusions in some cases; the problem is that it is easy and cheap to study correlations, as in those studies that show correlations between blood levels of vitamins and some health benefit. Taking vitamins is part of a constellation of habits of organized, health-conscious people, so naturally people who take vitamins tend to have many other healthy habits and so their vitamin levels often correlate with good outcomes. Researchers do the easy studies first, then get funding for the much more expensive studies to look for causation; in this case, very little causation is turned up. So don’t feel bad about taking vitamins — you can make a case for the multivitamin as insurance against deficiencies you may not be aware of. There is little downside to moderate doses of vitamins. But a good diet with diverse foods generally provides all of the vitamins most people need.

Vitamin D levels in blood correlate with low rates of dementia, for example, but that may well be because people who eat oily coldwater fish regularly are being protected by the fish oils and not the vitamin D they contain.

The “junk science” here is not the correlation studies, but the conclusion that they prove anything that should be acted on.

More on Diet:

Getting to Less Than 10% Body Fat Like the Models – Ask Me How!
Starbucks, Jamba Juice Make You Fat
Fat Doesn’t Make You Fat. Government Guidelines Did!
‘Fed Up’ Asks, Are All Calories Equal?
Fructose: The True Villain?
More on “Fed Up”, Sugar Subsidies, and Obesity
Another Study on Diet Drinks
LeBron James Cut Carbs for Lean Look
Why We’re Fat: In-Depth Studies Under Way
Almonds: Superfood, Eat Them Daily for Heart Health
Fish Oil Supplements Ward Off Dementia
More on Diet Drinks: Best Studies Show They Aid Weight Loss
Vani Hari: “Food Babe” and Quack
Cleanses and Detox Diets: Quackery
Sugared Soft Drinks: Health Risk? (and What About Diet Soda?)
Gluten-Free Diets: The Nocebo Effect
Acidic Soft Drinks and Sodas: Demineralization Damages Teeth
Fish and Fish Oil for Better Brain Health
Salt: New Research Says Too Little May Be Unhealthy
Bulletproof Coffee: Coffee, Oil, and Butter for Breakfast?

More on Pseudoscience and Quackery:

Vani Hari: “Food Babe” and Quack
Vani Hari, “Food Babe” and Quack: Where the Money Comes From
Vandana Shiva: Quack
More on Quacks: “Dr. Oz” Testifies He’s a Victim!
“Parallel Science Propaganda Machine”
Mike Adams: Quack Suggests Murdering Monsanto-supporting Scientists
Cleanses and Detox Diets: Quackery
Robert F. Kennedy, Jr.: Quack
Progressive Neighborhoods: Low Vaccine Rates Create Epidemics

Green Coffee Extract for Weight Loss: “Dr. Oz” Hypesters Fined

Green Coffee Extract - Dr. Oz

Green Coffee Extract – Dr. Oz

The FTC has settled with Applied Food Sciences, whose “miracle weight loss” claims for green coffee extract were supported by the quack Dr. Oz but no real scientific studies. The Consumerist has a concise story:

According to the FTC’s complaint [PDF] against Applied Food Sciences, the company sponsored and subsequently relied on the same flawed study that TV’s Dr. Oz used when he touted green coffee extract as “the magic weight-loss solution for every body type” to the millions of viewers of his show.

Among the problems with the AFS-sponsored clinical trials of green coffee extract, the FTC alleges that the principal researcher altered the weights and other key measurements of the subjects, changed the length of the trial, confused which subjects took either the placebo or green coffee extract at various points during the trial.

“When the principal investigator failed to find a publisher for his summary of the purported trial, AFS hired ghost-writers, who – like AFS – themselves received numerous, conflicting data sets from the principal investigator, but accepted the final version as correct,” reads the complaint. “The published study does not refer to these inconsistencies. Moreover, the published study fails to explain why most of the reported weight loss occurred when subjects were taking neither GCA nor a placebo; and fails to disclose that subjects were exercising and/or dieting during portions of the trial.”

And yet AFS repeatedly use this highly flawed research to tout its product to resellers, and even brought along one of the researchers to industry events to talk about his team’s supposed conclusions.

The company’s marketing claimed that its product caused consumers to lose 17.7 pounds, 10.5% of body weight, and 16% of body fat with or without diet and exercise (even though participants in the study were instructed to watch their food intake and exercise more frequently), in 22 weeks….

As part of the deal, AFS has agreed to pay $3.5 million and it can not make any weight loss claims about its products in the future without including at least two adequate and well-controlled human clinical tests….

Dr. Oz’s gushing over green coffee extract, along with some other hyperbolic statements about supposed miracle weight loss drugs, landed him before a U.S. Senate panel in June, where he admitted that his enthusiasm for a product can lead to exploitation by unethical marketers.

“I do think I’ve made it more difficult for the FTC,” the TV personality admitted to the panel. “In the intent to engage viewers, I use flowery language. I used language that was very passionate that ended up being not very helpful but incendiary and it provided fodder for unscrupulous advertisers.”

Much like Vani Hari, the “Food Babe,” he claims his “passion” and concern for his fans excuses hype, lies, bad science, and ripoff products.

This is an excellent example of a fraudulent study to claim scientific proof for a fraudulent product, as discussed in “Parallel Science Propaganda Machine.”

More on Pseudoscience and Quackery:

Vani Hari: “Food Babe” and Quack
Vani Hari, “Food Babe” and Quack: Where the Money Comes From
Vandana Shiva: Quack
More on Quacks: “Dr. Oz” Testifies He’s a Victim!
Mike Adams: Quack Suggests Murdering Monsanto-supporting Scientists
Cleanses and Detox Diets: Quackery
Robert F. Kennedy, Jr.: Quack
Progressive Neighborhoods: Low Vaccine Rates Create Epidemics

“The Dark Side of Almond Use” – Really?

almonds

The online Atlantic is funding some excellent journalism on California water use — this story is in-depth and worth the time to read, for example.

On the other hand, it is also publishing some of the silliest alarmism on the topic I have seen. First we have “Why Bottled Water Comes From California, Which Can’t Spare Much,” a concern troll of story — bottled water, which uses about 0.01% of California’s water supply (and most of that replacing tap water which would also come from the same sources), is decried as if the water is shipped to places where it is bountiful (most isn’t.) Failure to do math or have any understanding of true problems (like using water for irrigating crops that a very water-thirsty, like rice, in a dry state.)

This week The Atlantic gave us this concern troll: “The Dark Side of Almond Use,” by James Hamblin, (a very young) M.D. and editor there. Clickbait, even high-minded clickbait, is deadly to true understanding — our journalist wants us to feel guilty about eating almonds, a (not especially thirsty) irrigated crop in California’s central valley which supplies much of the world with almond-y goodness. He doesn’t present much evidence of how much water is used to irrigate almond crops or compare the value of that crop with the value of the water used to give us a sense of whether this irrigation is a consequence of the ultra-low rates irrigation users pay for their water, or if it is a reasonable use for the value of the crop:

This week another large study added to the body of known cardiovascular benefits of eating almonds. Every ounce eaten daily was associated with a 3.5 percent decreased risk of heart disease ten years later. Almonds are already known to help with weight loss and satiety, help prevent diabetes, and potentially ameliorate arthritis, inhibit cancer-cell growth, and decrease Alzheimer’s risk. A strong case could be made that almonds are, nutritionally, the best single food a person could eat….

This follows a massive study released last fall from Harvard that found eating nuts decreased mortality rates by 20 percent, and it builds on Jenkins’ work done more than 10 years ago which suggested, in the American Heart Association’s journal Circulation, “Almonds used as snacks in the diets of hyperlipidemic subjects significantly reduce coronary heart disease risk factors.”

That’s all wonderful, but coverage of almond-nutrition research necessarily affords a narrow vantage on health. It seems like every day someone asks me to dichotomize a health trend: good or bad. Almonds are a great example of why I’m terrible at doing that…. [Ed. note: indeed!]

The only state that produces almonds commercially is California, where cool winter and mild springs let almond trees bloom. Eighty-two percent of the world’s almonds come from California. The U.S. is the leading consumer of almonds by far. California so controls the almond market that the Almond Board of California’s website is almonds.com. Its twitter handle is @almonds. (Almost everything it tweets is about almonds.)

California’s almonds constitute a lucrative multibillion dollar industry in a fiscally tenuous state that is also, as you know, in the middle of the worst drought in recent history. The drought is so dire that experts are considering adding a fifth level to the four-tiered drought scale. That’s right: D5. But each almond requires 1.1 gallons of water to produce, as Alex Park and Julia Lurie at Mother Jones reported earlier this year, and 44 percent more land in California is being used to farm almonds than was 10 years ago.

That raises ecological concerns like, as NPR’s Alastair Bland reported last weekend, that thousands of endangered king salmon in northern California’s Klamath River are threatened by low water levels because water is being diverted to almond farms. Despite the severe drought, as of June 30, California’s Department of Agriculture projected that almond farmers will have their largest harvest to date. If more water is not released into the river soon, Bland reported, the salmon will be seriously threatened by a disease called gill rot. If there’s one disease I never want to get, it’s gill rot…. [Ed note: he places water use for almonds in opposition to water used to preserve salmon runs, as if there are no other uses, like for animal feed, corn, rice, etc., much lower value crops.]

[and now he drags in concern for honeybees, which are not natural but brought in by honeybee keepers]

California’s almond industry is also completely reliant on honeybees to pollinate its almond trees. The industry requires 1.4 million bee colonies, according to the USDA, most of which are brought to the state from across the country. Because of colony collapse disorder, honeybees are a commodity. The almond farmers’ requirements represent approximately 60 percent of the country’s managed colonies. This year many of the mercenary pollinating bees brought to California died due to exposure to pesticides.

Anyway, when I buy almonds, I don’t think about having a hand in killing bees or salmon, or getting someone’s truck stolen or collapsing a road. It’s just a jumble of what’s “good for me,” what I feel like eating, and how much things cost. Michael Specter’s feature on GMOs in last week’s New Yorker gets into how seven billion people on the planet will be 10 billion by the end of the century, and feeding that population might well be the greatest challenge to humanity ever. Thinking about going easy on almonds is sort of analogous to GMO dilemmas or buying organic, where the point isn’t really nutrition, it’s environmental consciousness and sustainability, which always come back to water. Thinking about that side of food makes it hard to write about nutrition in isolation. Anyway, almonds are good for our hearts.

[“I’m very confused but I wanted you to know the whirl of considerations I keep in my head when I’m choosing food. I have no idea how important each of them is proportionally, but my guilt and sensitivity over choosing what foods to eat makes me a good person.”]

For more on almonds and other good supplements for life-extension:

Almonds: Superfood, Eat Them Daily for Heart Health
Getting to Less Than 10% Body Fat Like the Models – Ask Me How!
Low-Dose Aspirin Reduces Pancreatic Cancer
Daily Aspirin Regimen Reduces Cancer Rates
Fish Oil Supplements Ward Off Dementia
Lower Back Pain: Acetaminophen (Tylenol, Paracetamol) Useless
Cleanses and Detox Diets: Quackery
Gluten-Free Diets: The Nocebo Effect
Scams: Multi-Level Marketing, Herbalife
Fish and Fish Oil for Better Brain Health
Vitamin D: Anti-Dementia?
Salt: New Research Says Too Little May Be Unhealthy

Why We’re Fat: In-Depth Studies Under Way

Sugar in Processed Foods

Sugar in Processed Foods – UCSF

Wired has a deep look into the more rigorous studies now being done to examine the connections between diet and obesity. The article by Sam Apple (“Why Are We So Fat? The Multimillion-Dollar Scientific Quest to Find Out”) is long and worth reading if you’re interested, but here’s a few takeaway bits:

In January of this year, the first subject checked into the metabolic ward at the National Institutes of Health in Bethesda, Maryland, to participate in one of the most rigorous dietary studies ever devised. For eight weeks, he was forbidden to leave. He spent two days of each week inside tiny airtight rooms known as metabolic chambers, where scientists determined precisely how many calories he was burning by measuring changes in oxygen and carbon dioxide in the air. He received meals through vacuum-sealed portholes so that the researchers’ breath wouldn’t interfere with their measurements. The food itself had been chemically analyzed to ensure an exact number of carbohydrate, protein, and fat calories.

The two-day stays in the chambers were only a small part of the testing, which was also being carried out on subjects at three other institutions around the US. Twice a month, the subjects were required to lie down for dual-energy x-ray absorpti­ometry scans, an accurate way to measure body fat. They offered up their veins again and again so that scientists could measure their lipids and hormone levels. They provided samples of their stools so the researchers could record the different colonies of bacteria residing in their guts…. [T]he studies are intended as steps toward an audacious goal: cutting the prevalence of obesity in the US by more than half—and the prevalence of diabetes by 75 percent—in less than 15 years….

But in recent years, competing theories have suggested other culprits. A growing number of doctors and advocates now see decades of increased consumption of table sugar and other refined carbohydrates as the most likely explanation for our current epidemics. Robert Lustig, a pediatric endocrinologist, rose to national fame after a 2009 lecture in which he called sugar “poison” went viral on YouTube. (Lustig had a chance to repeat his case against sugar in the 2014 Katie Couric-produced documentary Fed Up.)….

… Taubes eloquently argues, most of the existing knowledge gathered in the past five decades of research comes from studies marred by inadequate controls, faulty cause-and-effect reasoning, and animal studies that are not applicable to humans. The whole body of literature, Taubes wrote in a blog post announcing the launch of NuSI, “is based on science that was simply not adequate to the task of establishing reliable knowledge.”

For instance, much of what we think we know about nutrition is based on observational studies, a mainstay of major research initiatives like the Nurses’ Health Study, which followed more than 120,000 women across the US for three decades. Such studies look for associations between the foods that subjects claim to eat and the diseases they later develop. The problem, as Taubes sees it, is that observational studies may show a link between a food or nutrient and a disease but tell us nothing about whether the food or nutrient is actually causing the disease. It’s a classic blunder of confusing correlation with causation—and failing to test conclusions with controlled experiments.

… Taubes knew almost nothing about the topic. He would end up spending the next nine months interviewing 80 researchers, clinicians, and administrators. That research resulted in an August 1998 article headlined “The (Political) Science of Salt.” It was a sweeping takedown of everything scientists thought they had established about the link between salt consumption and blood pressure. The belief that too much salt was the cause of hypertension wasn’t based on careful experiments, Taubes wrote, but primarily on observations of the diets of populations with less hypertension. The scientists and health professionals railing against salt didn’t seem to notice or care that the diets of those populations might differ in a dozen ways from the diets of populations with more hypertension.

Taubes began to wonder if his critique applied beyond salt, to the rest of nutrition science. After all, one of the researchers Taubes interviewed had taken credit not only for getting Americans to eat less salt but also for getting them to eat less fat and eggs….
Under the cover line “What if Fat Doesn’t Make You Fat?” Taubes made the case that we get fat not because we ignore the advice of the medical establishment but because we follow it. He argued that carbohydrates, not fat, were more likely to be the cause of the obesity epidemic. The piece was a sensation. “Gary Taubes is ruining my life!” one NYU professor of nutrition, Marion Nestle, complained to Popular Science at the time. “I can’t go anywhere without someone asking about that damn article.” … The Times article led to a $700,000 deal for what would become Good Calories, Bad Calories, and Taubes spent the next five years plowing through late-19th- and 20th-century nutrition research. In doing so, he found himself drawn to an even more radical theory, the so-called alternative hypothesis, which holds that we get fat not because we eat too many calories but because specific kinds of calories trigger hormones that regulate how our fat cells behave. In particular, eating refined carbohydrates, and especially sugar, on a sustained basis leads to chronically elevated insulin levels. Among its many other crucial functions in the body, insulin tells fat cells to take up glucose, which is converted into fat, and then keeps fat from all sources locked inside. Therefore: Consume a bunch of sugar every day, as most Americans do, and you’ll get fat.

Of course, Taubes could only present the hypothesis. He couldn’t prove any of it. The right experiments had never been done….

At age 35, Attia weighed 205 pounds, 45 more than he did in high school. Alarmingly, his blood work suggested he was on the path to heart disease. Fearing for his future and out of conventional options, in late 2009 Attia began eliminating more and more carbs from his diet while adding more and more dietary fat. Over the next two years, his waist shrank from 36 to 31 inches. His triglycerides, an indicator of cardiovascular risk, dropped from 154 to 22. His HDL (the so-called good cholesterol) rose from 31 to 85 even as his LDL (the arguably bad cholesterol) dropped from 113 to 59.

This is also my story: despite years of long-distance running and weightlifting, I still was a bit pudgy. When I eliminated most carbs from my diet (cutting way back on bread, rice, and sugars) I reduced my body fat percentage to less than 10% and my triglycerides dropped into the heart-safe zone.

For more on science-based diet and fat loss:

Getting to Less Than 10% Body Fat Like the Models – Ask Me How!
Starbucks, Jamba Juice Make You Fat
Fat Doesn’t Make You Fat. Government Guidelines Did!
‘Fed Up’ Asks, Are All Calories Equal?
Fructose: The True Villain?
More on “Fed Up”, Sugar Subsidies, and Obesity
Another Study on Diet Drinks
LeBron James Cut Carbs for Lean Look
Almonds: Superfood, Eat Them Daily for Heart Health
Fish Oil Supplements Ward Off Dementia
More on Diet Drinks: Best Studies Show They Aid Weight Loss
Vani Hari: “Food Babe” and Quack
Cleanses and Detox Diets: Quackery
Sugared Soft Drinks: Health Risk? (and What About Diet Soda?)
Gluten-Free Diets: The Nocebo Effect
Acidic Soft Drinks and Sodas: Demineralization Damages Teeth
Fish and Fish Oil for Better Brain Health
Salt: New Research Says Too Little May Be Unhealthy
Bulletproof Coffee: Coffee, Oil, and Butter for Breakfast?