Friday, February 18, 2011

Healthy Skepticism

Among the papers from the last post fell out this letter in Science, The Potential of Nutritional Therapy. (unfortunately, limited access).  However, the letter speaks to many of the shortcomings in investigating the science of nutritional cures, and has a number of important points.  Conventional adherents might find this odd, but these shortcomings are, in part, why I hold fast to a "paleolithic-style" approach (with forays into dairy fat, white rice, and neolithic vegetables that I believe are scientifically sound.)   I think the paleo fall-back is the safety zone.  Forays into modern industrial food requires a bit more careful study before we recommend it for the masses (sorry, USDA.  Grains and copious vegetable oil for my little ones?  I don't think so.)

The problem with the studies if nutritional therapies?  Often they have been poorly done, or investigated one nutrient at a time.  A "paleolithic" focus requires cutting out grains, balancing the omega 3/6 ratio, and drastically reducing fructose and eliminating processed food.  There are absolutely no randomized controlled trials for mental disorders with these criteria (unless you count the recent ADHD trial with the limited wheat and unlimited rice - which is why I post so much about the ketogenic diet trials, some omega 3 supplement trials, and the ADHD elimination diet trials - they are ALL I HAVE to truly hang my hat on.  Everything else is just vague supporting evidence and a flair for spinning a tale, and don't think I don't know that.)

The letter in Science mentions the issue with mitochondrial dysfunction that often accompanies mental issues (see Brain Efficiency and Brain Efficiency, Pediatric Edition), and notes that nutritional problems may induce mitochondrial inefficiency. 

And bless Science magazine - they discuss the problem of nutritional journalism, with the crappy headlines shadowing the misleading abstracts redoubling the worth of the Denise Mingers out there with every stupid headline:

"Medical journalism may be one important agent for spreading
information about legitimate research on nutrition and mental health,
especially in the face of the lack of profit-generated funding. This also
implies a special responsibility for medical journalists, since the dan-
ger of “pseudoscience” is close at hand."

Doctors cannot recommend therapies without evidence.  And I shake my head at (for the most part) perfectly reasonable skeptic alternative health practitioners who eschew traditional prescriptions for traditional herbals which have no more evidence (and more than likely less regulation of the actual content of the herbal formulation) than any prescription product.

"Show me the evidence" should be the rallying call of the health-conscious consumer these days.  Otherwise, I'll stick with eating nose-to-tail and seeking out seafood and going for the seasonal fruits, starchy vegetables, green leafy vegetables, and rendered fats and oils that my ancestors did. 

3 comments:

  1. I remember 1st year Med school when they started going on and on about 'Evidence Based Medicine'. I was shocked... is there another way? I very quickly learned that much of what we do (and think) is NOT evidence based. I'm frequently surprised by the credence alternative medicine gets around campus and how all the CAM presentations are so well attended. A fellow MudPhud writes for 'Science Based Medicine' http://www.sciencebasedmedicine.org/ where they frequently take these things to task, though he got in quite a bit of hot water after writing a piece on a naturopath that spoke at our school.

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  2. Most alternative medicine is neither. It's not medicine and it's only an alternative if you want something outside allopathic medicine that also does not work, but is sometimes cheaper.

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  3. Hippocrates said, "food is medicine." How can you say that alternative medicine is not medicine when they use food/diet to help heal illness? The father of medicine thought so...

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