5 Reasons You Can't Trust Nutrition Research

Both medical and nutritional research cannot always be trusted, but for different reasons.

If I had a nickel for every time a patient had told me that they  cannot have certain foods, because of an article they saw or their MD told them, I would be a rich man.

A case in point is salt. For years, I have been telling my patients with high blood pressure that salt is the least of their concerns, particularly when they have been scared off of it from their MD. I’ve had patients eating foods that were terrible for their hearts, because their cardiologist had put them on a salt-free diet, and as a result, worsening their condition instead of improving it.

Just last week, “new” research has been reported on which now shows that salt is not an important risk factor for high blood pressure.

The fact of the matter is that physicians such as myself who specialize in nutrition have known for years that only a very small part of the population with high blood pressure is sensitive to dietary salt. That research was done a long time ago.

But the news really never caught on with the popular press, and it clearly didn’t reach the ears of most medical doctors, who have been pressing the no-salt diet for years.

As I read the news online last week, I noted in the comments that several other readers were saying that the research on nutrition is so flighty that they no longer trust any of it, and will just eat whatever they want to.

As I have noted before, much of the mainstream medical research cannot be trusted. The majority of it has been tainted by big money from the pharmaceutical industry which has the money to hire its own research organizations and produce “scientific research” that, unsurprisingly, perfectly supports drug marketing plans.

Nutritional research becomes similarly warped, although on a smaller scale and for slightly different reasons.

One of the key problems with nutritional research is funding. Unlike drugs, which have a phenomenal return on investment, herbs and nutrients cannot be patented. So nobody is likely to get rich from, say, a paper which demonstrates that Vitamin C effectively combats the common cold. The return on investment on non-patentable health solutions is pretty low, so research investors are few and far between.

Nonetheless, the research is influenced by greed in a different way. While it is hard to find the money to prove a nutritional intervention is positively therapeutic, there is a tremendous amount of money available for research which will demonstrate that certain nutritional interventions are useless and/or dangerous.

And there is also a tremendous amount of political pressure which can be brought to bear on nutritional therapies, if they are thought to be a threat to pharmaceuticals.

Not but not least in the financial parade are the people which can make money directly by distorting the research. This is the group I am the most familiar with, so they get to be number one in our list:

1. The media: Not getting it right on a daily basis.

It is a poorly-kept secret that, prior to becoming a physician, I was a journalist. In fact, I was a science and technical journalist. My background in the sciences gave me the ability to explain complex technical topics in easily-accessible ways to non-geeks. So I’m familiar with the ways in which reporters, editors and publishers will, both consciously and unconsciously, bend their coverage to suit their needs.

The major problem with the reporting of nutritional research is that the findings of any study are sensationalized to increase the page hits. A relatively minor study of salt and hypertension, for example, becomes the health section’s page 1 news — and then, for the next 25 years, both diet and medical recommendations are misdirected.

Another problem with nutritional research reporting stems from the reporter’s inability to understand the science itself, or unfamiliarity with the field. It can be difficult to explain scientific-y stuff to a general audience, and to do so well, you must thoroughly understand the science yourself. Too few reporters have more than a basic grasp of the life sciences, much less a basic understanding of nutritional physiology, and fundamentally important data in a study gets flattened, misreported or simply ignored because of the reporter’s ignorance.

Finally, there are a few reporters who have been reported to consciously misconstrue the results of studies on alternative medicine in general.

New York Times health and medicine reporter Gina Kolata is a case in point. The author of hundreds of articles for the Times, Kolata has been uncovered by The Nation and others as using her articles to press her own agenda — a profitable one, at that. On one occasion, Kolata published an article which strongly hyped a couple of cancer drugs (an article which turned out to be erroneous, to boot) and within hours was floating a book proposal based on buzz generated by her own hype. While this is an ingenious feedback loop for a reporter hungry for a book contract, it is hardly impartial reporting.

Imagine how nutritional research is reported by a writer with the reputation of Kolata, with one hand on the keyboard and the other reaching for the pocket of the pharmacuetical company. It won’t be the unbiased story that many would imagine it to be.

2. Oops, we used the wrong vitamin.

For some reason I’ve never been able to fathom, the world of mainstream medicine has always been very faddish about vitamins and minerals. One vitamin or another is always “hot” with MDs. When I started practice a couple of decades ago, Vitamin C was the one being recommended by every MD and his brother. I suspect this was based largely on the later work of Linus Pauling, who already had accredited status with the mainstream medical community for his groundbreaking work in molecular biology.

Vitamin C has since cooled considerably since its days as the go-to vitamin for almost everything. Today, that role is fulfilled by Vitamin D. which is currently being touted by the medical community as a second-class cure-all for everything from fatigue to fibromyalgia to heart disease to depression to joint pain (it remains a second-class cure because in mainstream medicine, nothing is better than a pharmaceutical, natch).

Interestingly enough, 10 years ago, before D got big, it was being maligned on many fronts as being a near-useless nutrient which was only being touted by quacks as a remedy for fatigue and fibromyalgia and depression…you get the idea.

Many of these studies suffered from one very significant, very undisclosed flaw: The researchers were using the wrong form of Vitamin D.

The legal definition of Vitamin D includes 2 forms: Vitamin D2 and Vitamin D3. Both are equally useful in preventing rickets in children, which is what all Vitamin D was once thought to be good for. However, when it comes to its effects on the cardiovascular, immune and other systems, the D3 form is much more potent than D2, which often has little to no effect at all in these systems.

However, researchers investigating Vitamin D often neglected to note the difference. Thus, studies would report that Vitamin D was ineffective at treating a certain disorder — when actually, it was the ineffectual form of Vitamin D that was being used.

A variation on the “wrong vitamin” error is the “lousy vitamin” error. As most people know, there is a great deal of variability among vitamin products. Much of that variability results from how the vitamin is packaged in the tablet — particularly how well that tablet survives the gastrointestinal tract to dissolve at the right time. Many vitamins just are not digested well, and I have seen on x-rays, vitamin tablets residing unmolested in the large intestine, waiting to be moved out of the body without having given up the slightest amount of the nutrient they were supposed to disseminate. “Pharmaceutical-grade” nutrients tend to be no better in this regard than what you may pick up over the counter at a chain pharmacy store.

So if you are testing the efficacy of a certain nutrient, and not monitoring whether that nutrient is actually getting into the patient’s bloodstream, your results are going to reflect more the failure of the nutrient packaging than of the nutrient itself. It has happened more often than you would like to believe.

Coming up in Part II: Dodgy Dosages and Dietary Dilutions.

5 Reasons You Can't Trust Nutrition Research

It's time for cycling in America to grow up.

A mature cycling culture looks like this. (Courtesy Mikael Colville-Anderson)

For decades, cycling in America has struggled to roll beyond the pitifully small number of cyclists who ride on a regular basis. Despite the facts that regular riding can slash your transportation costs, improve your health and longevity (cyclists live 2-5 years longer than non-cyclists) and reduce infrastructure expenses for cities and towns, cycling remains a backseat activity for most people.

There are many reasons cyclists want to see more of us on the road. Some for perceived safety reasons — citing studies showing that the more cyclists there are on the road, the safer it becomes for all cyclists. Some because a larger cycling population means that more funding will be allocated to cycling-specific structure. Some wish to see cycling increase because of its undeniable environmental, economic, and health benefits.

Certainly, there are pockets of cycling growth. New York, San Francisco, Portland, Denver and a few other cities have seen a rather dramatic upsurge in the use of bicycles on a daily basis for commuting and running errands. But outside of the urban environment’s hip pocket, there’s not a lot happening.

Take Litchfield, for example. I can count on one hand the number of people I’ve seen in Litchfield using their bicycle as anything more than a recreational device. There are maybe 2-3 people, in a town of 8,000 who commute by bike, and I have never, ever seen another bicycle parked in front of Stop and Shop, CVS, or along West Street.

Is it unfeasible to use a bicycle for transportation in  Litchfield’s suburban/rural environment? Certainly not. If you live in much of Litchfield, you are, by definition, within only a few miles of the town’s center. The town’s facilities and shops are also within easy cycling distance of  parts of Bantam. I am quite willing to concede that cycling from Northfield, however, may be an uphill slog that fewer are willing to do.

Geography is not the problem. So what is?

There’s certainly interest in the state of cycling in Litchfield. There is an active group shepherding a recalcitrant multi-use path into existence. Once completed, this path would connect the center of Litchfield with Bantam, allowing cyclists to avoid Route 202 .

And I confess to being both surprised and dismayed at a few bicycle advocacy meetings I attended in the past couple of years. I was surprised in that the turnout for both meetings, to discuss ways to improve the state of cycling in Litchfield, was significantly higher than I thought it would be . My dismay stemmed from the fact in that I was the only attendee who actually rode a bicycle to the meetings.

Just so that it doesn’t slide by, let me repeat that: I was the only person to ride a bicycle to attend two bicycle advocacy meetings.

There’s something so dismally wrong with that fact that I have been a little bit afraid to do anything but squint at it sideways for fear of what I might find. At least I was, until I realized that this problem isn’t a local one. It’s a national one. It’s a problem that has infected every cycling advocacy program in the U.S., and it has remained largely ignored:

The problem with cycle advocacy lies at the feet of cyclists themselves and the cycling industry in North America.

The problem is that cyclists need to grow up.

I have been involved deeply in cycling since my teens, when I build my first “10-speed” from junked parts at age 17, to my twenties, when I discovered the joys of recumbent bicycles, to today, as one of the League of American Bicyclist’s 3,000+ certified cycling instructors.

But while I have grown up with cycling culture, the cycling culture hasn’t grown up with me.

Looking back to the cycling renaissance of the 70s, even though it was stirred by gasoline shortages and skyrocketing prices, the appearance and culture of cycling was completely built around the sport of cycling. Movies such as Breaking Away personified the cycling zeitgeist of the 70s.

Fast forward with me through the next 25 years. The next current that dragged cycling again into the public eye was a man by the name of Lance Armstrong. America loves a winner, particularly a winner in a sport dominated by Europeans, who even after 200+ years of independence from the UK, still make us insecure. Armstrong’s winning streak, it was thought by many in the cycling community, would bring a flood of riders onto the road. This, of course, was long before we discovered that Armstrong was drugged to the gills and winning more by pharmaceutical fiat than by true talent.

Regardless, the projected jump in numbers never materialized. Sure, there were a few more cyclists on the road than there were before, but hardly enough to make a statistical difference.

Jump to today, and once again, economic conditions have conspired to make cycling a potentially valuable mode of transportation. In fact, it just makes raw common sense to hop on a bike instead of in a car. Without even trying, I saved $3,000 last year by riding a bike a lot of places instead of taking an automobile. Do you have enough spare change to throw away a cool three grand for no reason? I don’t. And it’s not like I’m some sort of athlete. I’m just a guy on a bike going to work or the store.

And while a few isolated parts of the country have seen a substantial uptick, the seeds of cycling elsewhere in the country have not only failed to blossom, they haven’t even taken root (e.g., Litchfield). In many countries of Europe, everyday cycling is becoming a reality as it did long ago for the citizens of the Netherlands, where 86% of the residents hop on their bikes daily to run errands or go to work.

The difference between there and here, and then and now, is the behaviour of the cyclists themselves. Watch, for a few seconds, the cyclists of Copenhagen:

What do you see? The first thing I’ll bet most people saw was the lack of helmets. Then there is the clothing — everybody seems to be wearing everyday work or casual clothing. Then there is the behavior, on the part of both motorists and cyclists. The bikes look comfortable, and nobody is bent double in an uncomfortable, pseudo-aerodynamic position. Racks for groceries, briefcases, kids. Everything in that video speaks to what it is like to cycle in a mature cycling culture. Safe. Family-friendly. Gentle.

Compare that to what you’ve seen of cyclists in the U.S.: Cycling helmets, hi-viz gear, running red lights, running stop signs, making left turns from the right-hand side of the road, riding on sidewalks. Crouched down on uncomfortable-looking bikes stripped down to virtually nothing. Pounding their way to the next stop light. Cycling in the U.S. is almost the converse of cycling in a bicycle-rich environment.

In a cycling-rich environment, the cyclists behave as if cycling is a normal activity. They wear normal clothes. They don’t bother with unnecessary safety gear, like hi-viz jackets or helmets. They don’t ride like they are pretending to be racing. They ride like — well, they ride like normal people on a bike. Cycling is the normal way of life.

American cycling, unfortunately, is stuck in the unprofitable, dead-end rut of promoting cycling only as a sport, not as a lifestyle.  From manufacturers to advocacy groups, the vision of cycling in the U.S. is still built around the young, macho cyclist forging his way through danger and adversity.

But if you really want cycling to grow, you have to abandon that shrinking demographic. You have to attract different people to the activity, and in particular, you need to make it appealing to women. The percentage of female cyclists is closely correlated with the growth of cycling in a number of countries, to the extent where women cyclists are considered the canaries in the coal mine. When their numbers drop, cycling dies.

So here are the steps cyclists need to take to ensure the growth of the activity.

1. Stop selling fear. Selling an activity as risky and adventurous works very well on the 14-28 male demographic. It doesn’t work so well with women, whose number one reason for not cycling more is that they feel it is unsafe. And why wouldn’t they? All of this special safety gear that you allegedly need to ride a bike practically screams DANGER!

The fact of the matter is, cycling is one of the safest activities you can engage in. Injuries requiring medical intervention are relatively rare for cyclists, and those who do suffer injury are not infrequently riding unsafely. The alleged danger of cycling has been highlighted by the focus on racing and exaggerated by an industry focused on selling to their slender demographic.

So, for crying out loud, quit preaching helmets. They aren’t necessary and you won’t die riding without one. Anyone who has thoroughly examined the literature will reach the conclusion that helmets can do little to protect you against serious injury. So if you want to wear one, wear one. If you don’t, don’t.

On virtually any ride that I encounter a large number of other cyclists, I am bound to get at least one comment about my lack of helmet. And, invariably — I know, because I have made it a point to track them — the people who castigate my bareheadedness proceed to run the next red light or blow through the next stop sign. Which brings me to point number 2:

2. Start riding like adults. Motorists don’t respect cyclists, in part, because most cyclists ride like children. The majority of cyclists treat the rules of the road as if compliance was voluntary, not mandatory. It ends up making cyclists look like self-absorbed children, and who wants to be like that? If cyclists start to behave in a manner that makes them look like adults, then it is much more likely that other adults will find the activity interesting. And while we’re talking about looks…

3. Save the spandex for when you need it. I agree that when I’m on a long ride on a hot day, cycling-specific clothing makes cycling more pleasurable. But that same apparel drives potential cyclists away in droves. There is nobody on the planet Earth who has not looked at a pair of Lycra shorts and said to themselves “There’s no way in hell I’m gonna look good in that.”

Trust me, I don’t. So, unless it’s a longer ride or the weather forces my hand, I don’t wear cycling-specific clothing. When I’m going to work in favorable weather, I’m in dress slacks, shirt and often my tie. To the grocery store? It’s shorts or jeans and a comfortable shirt and jacket. Remember those Copenhagen cyclists in the video? They’re looking pretty fly. In fact, there’s a whole website, called Copenhagen Chic, dedicated to the classy men and women cyclists of that city.

4. Be nice to others. In pursuit of the macho road warrior image, most cyclists speed down the road, looks of determination set on their faces, ignoring walkers and runners alike. You want more people to ride bikes? Say hi to the runner that you pass. Wave to the kid on the sidewalk. Slow down to just a few miles per hour when you’re on the path and passing pedestrians. It’s called being nice, and it works phenomenally well, if you want to encourage others to join you.

5. Tell industry leaders to embrace the reality of a mature, cycling rich culture. I’ve been a member of the League of American Bicyclists for years. As part of that membership, I receive a complimentary subscription to Bicycling magazine. It is the largest cycling magazine in the country. It is also one of the worst. It depicts cycling in all of the immature stereotypes that restrict its growth. Far better would be a complimentary subscription to a magazine like Bicycle Times, which is a far more adult publication.

Similarly, what few audio/video media outlets that cover cycling need to change their focus. Podcasts such as David Bernstein’s The Fredcast need to shift gears into a format less racing-centered and more about the cycling lifestyle. While I admire David and his revolving crew of participants on both The Fredcast and The Spokesmen, I began to lose interest when his coverage of Armstrong’s fall and its effect on cycling dominated episode after episode, while topics of real meaning to cyclists, such as funding, politics and other news was virtually ignored.

It all comes down to this. If we want cycling to grow beyond its small, homogenous niche, all of us cyclists need to change our behavior to reflect the cycling culture that we want to bring about. In other words, if you want an environment where most of the population rides a bike — then you should ride your bike as you would in that environment.

 

 

It's time for cycling in America to grow up.

5 shocking things you didn't know about chiropractors!

The truth about chiropractic.

Despite being the second largest whole body health profession in the country, chiropractic remains one of the most misunderstood of professions. Are we back doctors? Witch doctors? What kind of school do we go to? Isn’t it all quackery?

Today, I’m going to address some of the most common misconceptions I’ve encountered over the past 18 years:

1. Chiropractors aren’t “real” doctors, are they?

Although we don’t go to medical school, all chiropractors are “real” doctors. The degree on our diplomas say so, and, more importantly, so do state laws. In most states and under federal law, chiropractors are also regarded as physicians, with the only difference between us and medical doctors being that chiropractic doctors do not prescribe medications and medical doctors cannot safely adjust the spine. In some states, chiropractors can perform minor in-office surgery.

2. Speaking of prescriptions, if chiropractors are real doctors, why can’t you prescribe drugs?

It’s not so much a matter of “can’t” as it is “don’t want to.” Chiropractic was founded as an alternative to the dangerous drugs and procedures in use by the medical profession at the end of the 19th century. Back then, medical doctors were still dosing their patients with mercury. Today, most of us became chiropractic physicians because we aren’t very interested in the use of drugs, since we are adept at using several alternatives to pharmaceuticals.

That said, the times have changed, and the profession is changing with it. Chiropractic doctors in some states are readying their practice laws for changes which will incorporate chiropractic prescriptions of drugs. Most of us see drugs as a sometimes-necessary alternative to natural therapeutics, and it would be more convenient for our patients to simply provide the prescription at our offices.

If you have followed my blog, you know doubt have the impression that I am anti-drug, and to a certain extent I am. My problem with pharmaceuticals is mostly that they are used as an immediate, knee-jerk response to any problem a patient presents. And the overwhelming, suffocating marketing of drugs has hoodwinked the public into thinking that drugs are always the way to go. They aren’t. But sometimes they are necessary.

So I support the movement toward prescriptions by chiropractors because I think, in all likelihood, patients are safer when we are dispensing them than when anyone else is writing the prescription.

3. Do you have to go to school to become a chiropractor?

I’ll never forget one of the most painful moments in my life, when I was at a holiday dinner in Philadelphia with my fiance. I was in my first year of chiropractic school, studying like the devil to keep up with the classwork. While chatting with a young man at the table, I mentioned that I would be spending the next several years in school to become a chiropractor.

“Chiropractor?” he said incredulously. “That’s just a mail-order degree! You don’t have to go to school for that, do you?”

Yes, my new friend, yes indeed. You have to go to a real school for many years to become a chiropractor. I, in fact, have spent 10 years in school to get my degree, but granted, I took a bit of a detour as a science/technical journalist along the way.

The real fact is that chiropractic school is more extensive than medical school. Chiropractic students receive an average of 4,485 hours of education, compared to medical doctors, who receive only 4,248. We spend over twice as much time studying neurology and differential diagnosis, and significantly more time on anatomy and embryology.

And, yes. It’s a slog.

4. But chiropractors aren’t allowed to order tests, are they?

I order tests every day of the week, from laboratories across the country. I order TB tests, metabolic profiles, MRIs, CT scans, ultrasounds and dozens of more esoteric blood, stool and urine tests used only by those in my specialty.

Not only do I order tests, I perform them. We do EKG tests right in the office. And my office includes a CLIA-certified lab, which is cleared to perform multiple tests, from urinalyses to strep tetst to drug testing.

In fact, when I first began practicing, I kept body and soul together by performing physicals for life insurance companies, the major component of which was drawing several vials of blood to send off to their lab. I got pretty good with sticking needles, a foreshadowing of what was to come.

5. Well, that all sounds good. But the fact of the matter is, chiropractic is not scientifically-based. How do you explain that?

Chiropractic was indeed founded on principles that, today, look less than logical, and certainly aren’t supported by science. But, remember, at the same time chiropractic was founded, medical doctors were still bloodletting their patients and refusing to wash their hands between surgeries in the rather egomaniacal belief that no germs would dare exist on their august hands.

Like medicine, chiropractic has come a long way since then. There are many scientific journals dedicated to the investigation and further understanding of chiropractic’s unique power to improve health, and it is today based on sound scientific principles backed by the research.

In fact, I would be willing to bet that the therapeutics I provide on a daily basis have a better foundation in science than much of what is performed in a medical doctor’s office.

************************

Most of these misperceptions, by the way, come from nearly a century of lies and misinformation that was spread about chiropractic doctors by the AMA. It took a massive anti-trust lawsuit and a federal judge unaffected by AMA lobbying money to force a stop to the overt oppression of chiropractors.

And although I have seen the prevalence of some of these myths subside somewhat, it will probably take another generation until chiropractors gain their rightful place in American healthcare. I hope that I am still practicing when that day comes, not because of the victory it will mean for my profession, but because it will be a victory for my patients.

5 shocking things you didn't know about chiropractors!

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