Summer feels like it’s finally here in Canada (well, Toronto at least). Here’s what I’ve been reading.Diet and Nutrition
I’ve written about Paul Offitt before. He’s an infectious disease specialist at the Children’s Hospital of Philadelphia. If you haven’t read his book, Autism’s False Prophets, I strongly recommend it. Paul has a new book with a broader focus, entitled, “Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine.” Here’s an excerpt from today’s New York Times:
Derived from “vita,” meaning life in Latin, vitamins are necessary to convert food into energy. When people don’t get enough vitamins, they suffer diseases like scurvy and rickets. The question isn’t whether people need vitamins. They do. The questions are how much do they need, and do they get enough in foods?
Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better. Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.
There was also a much longer and more detailed excerpt in The Guardian, yesterday:
The vitamin and supplement industry has successfully created a false dichotomy. On one side are natural products: vitamins, minerals, dietary supplements, plants and herbs. Because they’re natural, they’re safe. On the other side are drugs. Because drugs are man-made, they’re supposedly more dangerous. However, many drugs, including antibiotics, are derived from nature. Furthermore, the notion that natural products aren’t dangerous is fanciful.
The possibility of harm caused by natural products sold in health food stores isn’t theoretical. Blue cohosh can cause heart failure; nutmeg can cause hallucinations; comfrey, kava, chaparral, crotalaria, senecio, jin bu huan, usnea lichen and valerian can cause hepatitis; monkshood and plantain can cause heart arrhythmias; wormwood can cause seizures; stevia leaves can decrease fertility; concentrated green tea extracts can damage the liver; milkweed seed oil and bitter orange (Citrus aurantium) can cause heart damage; thujone can cause neurological damage; and concentrated garlic can cause internal bleeding. Indeed, one of the worst dietary supplement disasters in history occurred in 1992, when about 100 people developed kidney failure from a “slimming” mixture found to contain the plant aristolochia; at least 70 patients required kidney transplants or dialysis, and many later developed bladder cancers. In 2008, more than 200 people – including a four-year-old – were poisoned by massive doses of selenium contained in Total Body Formula and Total Body Mega. The products were supposed to contain 200 micrograms of selenium per serving; instead they contained 40,800 micrograms.
Herbal remedies can also cause harm: two infants died from a tea containing pennyroyal and another from a decongestant containing capsaicin. Because the dietary supplement industry is unregulated, only 170 (0.3%) of the 51,000 new products brought to market since the 1994 Supplement Act have documented safety tests.
So much for the routine claim from advocates that “natural supplements have never hurt anyone.” Offit’s book looks excellent. I have written before that there is little evidence for the routine consumption of vitamin supplements in the absence of a clear medical need. It will be interesting to see the response from the pharmacy profession. Any predictions?
How to Really Eat Like a Hunter-Gatherer: Why the Paleo Diet Is Half-Baked. Another excellent column on this diet fad that’s probably health, but based on a faulty premise:
The Paleo diet not only misunderstands how our own species, the organisms inside our bodies and the animals and plants we eat have evolved over the last 10,000 years, it also ignores much of the evidence about our ancestors’ health during their—often brief—individual life spans (even if a minority of our Paleo ancestors made it into their 40s or beyond, many children likely died before age 15). In contrast to Grok, neither Paleo hunter–gatherers nor our more recent predecessors were sculpted Adonises immune to all disease. A recent study in The Lancet looked for signs of atherosclerosis—arteries clogged with cholesterol and fats—in more than one hundred ancient mummies from societies of farmers, foragers and hunter–gatherers around the world, including Egypt, Peru, the southwestern U.S and the Aleutian Islands. “A common assumption is that atherosclerosis is predominately lifestyle-related, and that if modern human beings could emulate preindustrial or even preagricultural lifestyles, that atherosclerosis, or least its clinical manifestations, would be avoided,” the researchers wrote. But they found evidence of probable or definite atherosclerosis in 47 of 137 mummies from each of the different geographical regions. And even if heart disease, cancer, obesity and diabetes were not as common among our predecessors, they still faced numerous threats to their health that modern sanitation and medicine have rendered negligible for people in industrialized nations, such as infestations of parasites and certain lethal bacterial and viral infections.
The science-approved diet method. Fad diets seem to work, but a gluten-free-organic-locally-grown-free-range-vegan calorie is still a calorie. From the excellent Tim Caulfield, tireless defender of science and debunker of quackery:
Even diets that have a veneer of scientific legitimacy have little real research to support claims of long-term weight loss. A recent survey found that going gluten free is now Canada’s most popular diet. People often assume there is science behind the idea. And, no surprise, the market has jumped on the trend: Gluten-free products are everywhere.
But, in fact, there is absolutely no evidence to support the idea that the consumption of wheat is the cause of the current obesity problem. There is nothing magical, from a weight loss perspective, to avoiding wheat. Indeed, some studies have shown that going gluten free can — again, over the long term — lead to an increase in weight. This happens for a number of reasons, including the fact that many gluten-free foods are high in calories (and, incidentally, low in nutritional value).
Science and Politics, and GMOs
Keith Kloor is one of my favourite bloggers. He’s always insightful and a great writer on science and technology. In a post this week he pointed out that so called “progressives” can be as anti-scientific as conservatives that they like to mock for their anti-science views:
It’s downright hypocritical of progressives and enviros to call out others for “anti-science” behavior–be it denial of climate change or evolution–when they are the ones leading the crusade against biotech research and GMOs.
It’s like Newt Gingrich preaching family values. If progressives want to remain a credible voice on science, they’re going to have marginalize the growing forces in their midst that have strayed into the world of biotech pseudoscience and fear-mongering.
Here’s an experiment to try. Speak to one of your progressive friends (or make a post on Facebook) about GMOs. Wait to see the response. How many comments before someone mentions Monsanto?
What is at the root of denial? A Must Read from Chris Mooney in Mother Jones Excellent review, via Denialism Blog:
Scientific reasoning and pragmatism is fundamentally unnatural and extremely difficult. Even scientists, when engaged in a particular nasty internal ideological conflict, have been known to deny the science. This is because when one’s ideology is challenged by the facts you are in essence creating an existential crisis. The facts become an assault on the person themselves, their deepest beliefs, and how they perceive and understand the world. What is done in this situation? Does the typical individual suck it up, and change, fundamentally, who they are as a person? Of course not! They invent a conspiracy theory as to why the facts have to be wrong. They cherry pick the evidence that supports them, believe any fake expert that espouses the same nonsense and will always demand more and more evidence, never being satisfied that their core beliefs might be wrong. This is where “motivated reasoning” comes from. It’s a defense of self from the onslaught of uncomfortable facts.
Robert F. Kennedy Jr.: Anti-Vaxxer from Phil Plait:
RFK Jr. has a long history of adhering to crackpot ideas about vaccines, mostly in the form of the now thoroughly disproven link to autism. He’s been hammering this issue for a decade now, and his claims appear to be no better and no more accurate now than they were when he first started making them.RFK Jr. has a long history of adhering to crackpot ideas about vaccines, mostly in the form of the now thoroughly disproven link to autism. He’s been hammering this issue for a decade now, and his claims appear to be no better and no more accurate now than they were when he first started making them.
Drug Use and Drug Safety
This is a call to arms to my fellow providers to protect our patients from themselves and our willingness to comply with their requests. We live and practice in a society filled with fear of medications and their side effects. People will not take blood pressure, cholesterol, or diabetic medication because of the side effects they have heard or read about.
However, these same patients will take antibiotics every day of the week for a sniffle or a scratchy throat that started this morning. Are we facing an epidemic of patients actually addicted to the use of antibiotics? Where does this laxity in taking antibiotics come from? Why do the majority of patients believe that antibiotics are harmless, yet pills to prevent stroke are dangerous?
More adulterated supplements for sale in Canada. Yet another consequence of a regulatory structure that seems to prioritize industry interests ahead of consumer rights to safe and effective products.
Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis. Expect a more thorough analysis in the future. Not that the results of this review are for hospitalized patients, not ambulatory patients. Their conclusion:
Our findings illuminate the benefits of probiotics in preventing both AAD [antibiotic-associated diarrhea] and CDI [Clostridium difficile infection] in the specific patient population of adult inpatients requiring antibiotics. On the basis of the current review, probiotics can be recommended for such patients in the absence of contraindications; however, the prevalence of AAD and CDI should be taken into consideration before guidelines are developed. The literature does not clearly indicate a favoured choice of probiotic, although there is stronger evidence for Lactobacillus-based formulations.
The journal Focus on Alternative and Complementary Therapies has an entire issue dedicated to CAM (complementary and alternative medicine) for pharmacists. It’s behind a paywall but the entire issue looks excellent. I hope to review some of these articles in the future:
- Commentary: the law, unproven CAM and the two-hats fallacy
- Homeopathy for insomnia and sleep-related disorders: a systematic review of randomised controlled trials
- Why homeopatohy is unethical
- The ethics of using homeopathy in clinical practice
- Is evidence-based complementary and alternative medicine a contradiction in terms? ‘Yes’
- Is evidence-based complementary and alternative medicine a contradiction in terms? ‘No’
- Efficacy of herbal supplements containing Citrus aurantium and synephrine alkaloids for the management of overweight and obesity: a systematic review
- Why pharmacists should not sell homeopathic products
- Factors affecting the pharmacokinetics of herbal preparations and their impact on the outcome of clinical trials
FDA Urged to Prohibit Sale of Ginkgo in Wake of Cancer Study. My take on Ginkgo is that the product is ineffective and therefore should not be consumed.
Drowning doesn’t look like drowning: A must-read for parents. Everyone, really.
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