Feb 172016
 

MyPlate

You would imagine from its title that the US Department of Agriculture’s Nutrition Evidence Library would be a comprehensive database of all scientific research on nutrition.

Unfortunately, it isn’t. Here is its methodology:

  • Step 1: Develop systematic review questions and analytic frameworks
  • Step 2: Search, screen, and select studies to review
  • Step 3: Extract data and assess the risk of bias of the research
  • Step 4: Describe and synthesize the evidence
  • Step 5: Develop conclusion statements and grade the evidence
  • Step 6: Identify research recommendations.

All this seems very thorough doesn’t it? Well, when our friend Nina Teicholz, author of The Big Fat Surprise started looking for some of the recent nutrition trials, she noticed something strange.

“What I’ve found is that the Nutrition Evidence Library omits all the major Randomised Controlled Trials (RCTs) on saturated fats, nearly all the major RCTs testing the diet-heart hypothesis and its offspring, the low-fat diet, and nearly all the low-carb studies. That would be, in sum, pretty much all the research on nutrition, most of it NIH funded, since the birth of the diet-heart hypothesis.”

Or in other words, the selective inclusion of studies in steps 1 and 2 just happens to exclude the major trials and focuses instead on epidemiological studies, which are a weaker kind of evidence that cannot demonstrate cause and effect.

Why does this matter? Well, the US Dietary Guidelines for Americans are the most influential nutrition policy in the world. They are followed by governments all over the world.

These guidelines are underpinned by an expert report, which draws its evidence from the (incomplete) Nutrition Evidence Library. Can it be a surprise that the dietary guidance hasn’t changed for decades?

Nina is giving testimony on Friday (19 February) to the US Department of Agriculture, which publishes the US Dietary Guidelines. It is holding “listening sessions” because the US Congress mandated a review of the Guidelines by the National Academy of Medicine to find out what’s gone wrong.

She has started to compile a list of the nutrition research missing from the Nutrition Evidence Library which she would like to present on Friday. Could you help to complete the list? … in the next 24 hours!?

What to do to help complete the list:

  • find a nutrition study (clinical trial, observational study or review paper) on the low-fat diet, saturated fats or the low carbohydrate diet
  • check that it isn’t already in the list
  • enter the surname of the first author in the search on the top right of the Nutrition Evidence Library home page
  • if the study does not appear in the search results, add it to the list in the appropriate group in chronological order

UPDATE: 12 HOURS TO GO!!

Thanks to everyone who has helped to expand the list considerably so far. Here is the list as it stands now.

As you may realise from the list, most of the recent trials are missing from it. Of course, it could be a complete coincidence that the missing trials seem to be the ones which concluded positively about a low carbohydrate diet.

On the other hand, … take a look at the pages on Carbohydrates on the NEL website:

– Systematic review questions listed under the 2015 Methodology: http://www.nel.gov/topic.cfm?cat=3295 (all questions and answers appear to be from the 2010 dietary guidelines)

– the Carbohydrates section from the DGAC 2010 methodology: http://www.nel.gov/topic.cfm?cat=2854

All study designs were originally included in the searches, but cross-sectional studies were later excluded from the review if there was sufficient evidence from studies with stronger study designs. The Committee excluded studies that only included participants diagnosed with chronic disease, hyperlipidemia, hypertension (HTN) and related health conditions.”

“… The Committee only considered studies that directly assessed the relationship between the intake of food groups and health outcomes; studies examining the intake of food groups as a part of a larger dietary pattern were not considered in the review. “

For the topics considered by the 2005 DGAC, the Conclusions expressed in the 2010 DGAC report are informed by the evidence compiled for the 2005 DGAC report, but are based primarily on the NEL evidence gathered and reviewed since 2004. As discussed in the associated review, for some questions, the search was extended back further to capture a larger body of evidence. Studies of carbohydrates and health outcomes on a macronutrient level are often inconsistent or ambiguous due to inaccurate measures and varying food categorizations and definitions. The science cannot progress without further advances in both methodology and theory.”

Perhaps that last sentence should have said that the dietary guidelines cannot progress without further advances in both methodology and theory of reading the available scientific research?

Dec 212014
 
Poster image for You must be nuts!

It has taken much longer to complete the film than we had intended when we published the 3-minute prequel on New Year’s Day 2014!

The prequel shows the puppets Alph and Chah-Lee in bed on a Saturday evening – the eve of the start of the film.

Now (at last!) everyone has the chance to see what Alph shows Chah-Lee ‘the next day’. After making a few technical adjustments following its unlisted test publication on Vimeo in November, the film is now on YouTube.

Many thanks to everyone for the very positive feedback so far. We have started to add closed captions to the film in English so that the film will be subtitled automatically in the 163 languages now supported by YouTube. If you want to help refine the subtitles in any language, please let us know via the comments to this post.

Even though it was unlisted on Vimeo, over 700 people have watched the film so far in 37 countries. Thanks particularly to Deborah Walker and the Natural Health Radio team for helping to promote the film to their listeners. Deborah interviewed Obhi about how he has been applying his research to treat his father’s dementia and about the film. You can catch up with the interview here.

If you are looking for more details about the treatment given to Obhi’s father, Obhi wrote a guest post on the HealthInsightUK blog about it in August. The film’s Twitter feed (@youmustbenuts) highlights the latest developments on dementia, and the food, drugs and chemicals which may cause it.

Jul 212014
 
The Trouble with Medical Journals by Dr Richard Smith
The Trouble with Medical Journals by Dr Richard Smith

The Trouble with Medical Journals by Dr Richard Smith

In recent posts, we have seen that Dr Stephanie Seneff, Senior Research Scientist at MIT, was unable to get her paper published about whether the low fat diet and statins could cause Alzheimer’s until she deleted all references to statins. We have also seen that the financial reliance of medical journals on pharmaceutical companies exposes them to a potential conflict of interest – as revealed by Dr Richard Smith, former editor of the British Medical Journal, in his book The Trouble with Medical Journals.

On Saturday, Kailash Chand, the deputy chair of the British Medical Association, described the guidance from UK National Institute for Health and Care Excellence (NICE) recommending that doctors “offer atorvastatin 20 mg for the primary prevention of [cardiovascular disease] to people who have a 10% or greater 10‑year risk of developing [cardiovascular disease].” as “a victory for vested interests over evidence“. The consequence of the NICE guidance would be that “millions more” would be given statin drugs.

Back in February, Zoë Harcombe had identified the potential conflicts of interests of the members of the NICE panel. In June, a group of doctors and academics wrote an open letter to NICE and to the UK Health Secretary about their concerns about the latest NICE draft guidance on statins. The Department of Health thought it was up to NICE to manage any conflicts of interest and NICE saw no problems with conflicts of interest in the guidance.

No doubt it’s entirely coincidental that the patents for statin drugs were due to expire in 2013, when similar new guidance vastly expanding the number of candidates for statin drugs was issued by the American College of Cardiology and the American Heart Association. After all, as the graph below shows, by 2013 even though some 64 million prescriptions for statin drugs were issued by UK doctors, the cost to the NHS (and hence the revenue of pharmaceutical companies) had dropped to just £150 million, compared to the peak of £740 million in 2004.

Statin use and cost in England 2002-2013

A similar issue of conflicts of interest has emerged with the publication of draft guidance from NICE recommending free bariatric surgery for diabetes patients.

As Dr Malcom McKendrick found, the tool to assess the risk of cardiovascular disease recommends statins for extremely healthy men over 58 and extremely healthy women over 63. This morning, cardiologist Dr Aseem Malhotra pointed out that, in 2008, an analysis of published statin trials had identified an increased risk of cancer caused by statin drugs for certain populations.

“Close inspection of statin trials reveal the specific populations at risk for the development of incident cancer with statin treatment. These include the elderly and people with a history of breast or prostate cancer. Furthermore, statin-treated individuals undergoing immunotherapy for cancer may be at increased risk for worsening cancer.”

Even the patient information leaflet for Lipitor, the bestselling statin drug, suggests that it may not be suitable “if you are older than 70”.

Meanwhile, as revealed by investigative journalist Nina Teicholz in her excellent, bestselling book The Big Fat Surprise, the dietary advice recommending a low fat diet since 1961 has been based on faulty science. The book traces the disaster trail of evidence against saturated fat, which it summarises as follows: “the early trials condemning saturated fat were unsound; the epidemiological data showed no negative association; saturated fat’s effect on LDL-cholesterol (when properly measured in subfractions) is neutral; and a significant body of clinical trials over the past decade has demonstrated the absence of any negative effect of saturated fat on heart disease, obesity or diabetes. … It seems now that what sustains it is not so much science as generations of bias and habit … .”

The same appears to be true of the medical recommendations of statins, whose rationale is based on the same faulty hypothesis as the low fat diet. Should we, as Dr Seneff suggests, look forward to millions of people suffering disabilities through long-term statin use? Even before the latest NICE guidance, the OECD concluded in December that the UK had become the ‘statin capital of Europe‘.

Instead of spreading enthusiasm for mass bariatric surgery to deal with diabetes, perhaps NICE ought to read this paper in Nutrition advocating “Dietary Carbohydrate restriction as the first approach in diabetes management“. That means recommending a low carbohydrate, high fat diet, which was also found to be the best for weight loss in one of the few clinical trials in this field. This is already the official dietary advice in Sweden.

More than ever before, public authorities offering medical and dietary guidance must be not only free of bias but also be seen to be free of bias. They must also base themselves on rigorous science, in full knowledge of any negative effects. At present, this does not seem to be the case. In particular, the data underpinning the NICE guidance is unavailable, due to an agreement with a manufacturer of statin drugs. A wider problem is that, according to Dr Ben Goldacre and All Trials, some 50% of trial results are never published.

In spite of the scientific evidence to the contrary, most official dietary advice continues to recommend avoiding saturated fats, pushing people towards genuinely unhealthy trans fats and their substitutes, and a high carbohydrate diet – all of which have negative effects on health. A similar approach for statins could turn out to be yet another “very large, human-scale, uncontrolled, unmonitored … experiment” on the entire population, with a similar negative, long-term impact on our health – particularly that of our older relatives. Some doctors even see a risk that people in Western nations are suffering from a culture of over-intervention and over-medication. But then, as we will see, statins are not the only medication prescribed routinely to older patients which have serious adverse effects, particularly on their brains.

Mar 152014
 
Justin Smith, producer/director of Statin Nation

Last week, the UK’s Daily Telegraph published the article Low fat foods stuffed with ‘harmful’ levels of sugar. It analysed the sugar content of a range of food and drinks marketed as ‘low fat’.

In the sixth part of his interview for You must be nuts!, Justin Smith, the Producer/Director of the documentary Statin Nation, considers whether a low fat diet could lead to a high carbohydrate diet. Apart from sugar, he talks about the effect on blood sugar levels of eating grains.

In September 2012, a study by the Mayo Clinic found that a high carbohydrate diet raised the risk of dementia in older people by a factor of almost 4, compared to a low carbohydrate, high fat diet. “When total fat and protein intake were taken into account, people with the highest carbohydrate intake were 3.6 times likelier to develop mild cognitive impairment.”

Neurologist Dr David Perlmutter’s bestselling book Grain Brain: the surprising truth about wheat, carbs and sugar – your brain’s silent killers highlights the connection between eating grains and dementia.