Should we believe anything we read about food?

Should we believe anything we read about food?

This might seem like a strange question, but perhaps, when we look deeper into Nutritional Science, it may not be so strange.
A growing number of scientists are saying that nutrition science is flawed to such an extent that we can't even trust many widely accepted conventional pillars of health advice such as eating plenty of vegetables and avoiding saturated fats.
Many now say that, within certain common sense boundaries, "it doesn't matter what we eat". But could this view really be true?

Diet has been studied very extensively the world over, and there are things that we know with a good degree of certainty, for example there is much convincing evidence that diets rich in fresh fruit and vegetables, with natural sources of dietary fibre, avoiding obesity by practising Healthy fad-free eating regimes, and appropriate physical exercise, are protective against illnesses caused by such as cancer and heart disease.

Sensationalist Media Headlines

Most people are attracted to 'sensationalist' headlines in the media, be it newspapers, television, internet or advertising, that is what it is strategically designed to achieve.

Take the following statement that has been widely touted throughout the media:

EATING CHEESE COULD BE THE SECRET TO A LONG LIFE

Well, as much as we would like to believe that this headline is true, it is clear to see that it makes a rather vague and broad statement. It suggests that cheese could have the much longed for miraculous effect of prolonging life. The problem with this headline is that the claim it makes is almost impossible to disprove, by that I mean how long is a 'long life', 60yrs, 80yrs, 100yrs?

The title of the research that spawned this headline is given as 'Dairy consumption linked to lower rates of cardiovascular disease and mortality'. Not the most eye catching title.

"Our findings support that consumption of dairy products might be beneficial for mortality and cardiovascular disease, especially in low-income and middle-income countries where dairy consumption is much lower than in North America or Europe," said Mahshid Dehghan, lead author of the study and an investigator at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

Read the full article here

So, as can be seen from the example, it is plainly obvious that the attention grabbing headline will be more attractive to, in this case, cheese-lovers, but is a quantum leap from the actual findings of the research.

Whilst misleading media sensationalist headlining of, often just a small assertion in research, is part of the problem, Nutritional Science's flaws run much deeper. There is a huge amount of research on food and diet published every year, much of it funded by Governments concerned about rising levels of ill-health in their populations, such as obesity and diabetes.

But, even in the pages of respected science journals, we find conflicting research results relating to much of what we eat and drink, including dairy products, bacon, fruit juice, alcohol, even water. And this isn't just conflicting views over minor details; there exists a major dividing line fracturing the Nutritional Science field over, for example, whether we should eat foods that are low in fat or low in carbohydrates.

As I have said, there is a mass of research relating to food and nutrition, however, as with all scientific research, a lot of it is subject to the same problems of 'bad research' found in other areas of scientific research. Some of these problems are:

• Sensationalised headlines: headlines about articles are commonly designed to entice viewers into reading the article. At best they over simplify the findings of research, at worst they sensationalise and misrepresent them.
• Misinterpreted results: News article sometimes distort or misrepresent the results of research for the sake of a good story intentionally or otherwise.
• Conflict of interests: Many companies, including those in the food industries, employ scientists to carry out and publish research on their behalf.
• Correlation and Causation: Be wary of correlation and causation because correlation between two variables does not automatically mean one causes the other.
• Speculative Language: Speculations from research are, at best, just that. Beware of headlines of articles that use words such as 'may', 'could', 'might' and suchlike as it is unlikely that the research provides hard evidence for the speculative conclusions reached.
• Sample size too small: In research trials, the smaller the sample size the lower the confidence in the results. It may be cause for suspicion if a large sample was possible but avoided.
• Unrepresentative sample: In human trials researchers will try to select individuals that are representative of the population as a whole. If the sample is different from the population as a whole then the results may be different.
• No control group used: In clinical trials results from test subjects should be compared to a control group not given the substance being tested. Groups should also be allocated randomly. In general experiments, a control test should be used where all variables are controlled.
• No blind testing used: To prevent any bias, subjects should not know if they are in the test or the control group. In double-blind tests even the researchers will not know which group subjects are in until after the testing. Note: Blind testing isn't always feasible or ethical.
• 'cherry picked' results: This includes selecting data from, for example experiments and surveys, that supports the research while ignoring those that don't. If a research paper draws its conclusions from a selection of its results, and not all, it may be cherry picking.
• Unreplicable results: Results should be replicable by independent research and tested over as wide a range of conditions as possible to ensure they are generalisable. Extraordinary claims require extraordinary evidence.
• Journals and citations: Research published to major Journals will have undergone a review process but can still be flawed. A large number of citations for an article, or series of articles, does not mean that the research is highly regarded.

Journalist Clare Wilson writing in the South China Morning Post tells us that a particular source of error in research is known as publication bias. Wilson writes, 'studies of published research show interesting results are more likely to be published than those that do not. So, for example, if two studies look at red meat and cancer and only one shows a link that one is more likely to be published.

This bias is present at nearly every stage of the long process from the initial research to publication in a scientific journal and ultimately to news stories, if journalists like me write about it. "What you see published in the nightly news is the end result of a system where everyone is incentivised to come up with a positive result." says Vinay Prasad at Oregon Health and Science University.

Prasad is an oncologist who has highlighted the lack of evidence behind certain cancer medicines. But, he says, nutrition research is in a worse state than his own field. "And they don't seem to want to improve themselves."

"It is impossible to quantify exactly how much confounders and publication bias are distorting the field. But they are enough of a problem that we should be sceptical of all dietary advice", says data scientist John Ioannidis at Stanford University, in California.

"Out of the roughly 1 million papers that have been published on nutrition, only a tiny fraction, perhaps a few hundred, are large, good-quality randomised trials", says Ioannidis. "The rest are mainly observational studies, small or poorly designed trials, opinion pieces, or reviews that summarise the results of other papers, with all their potential flaws. Even national dietary guidelines are based on this kind of work."

"And what do the few hundred decent-sized, randomised trials find? Here is the clincher: when the trials test the dietary recommendations based on observational studies, the strategies almost never succeed in extending lifespan. The studies either find no effect, or one that is much smaller than predicted by observational studies so small as to be practically meaningless."

Usually, any change isn't in rates of deaths, cancer or heart attacks, but in 'biomarkers'; these are generally substances in the blood, such as cholesterol, that are thought to affect health outcomes, but the evidence isn't clear-cut. "There is almost nothing that finds you can live longer," says Ioannidis.

Take for example the much promoted idea of vitamin pills for the healthy general population. Many observational studies suggested that taking various vitamin supplements kept people healthier. But when these ideas were tested in trials, the pills either had no effect or actually made people die sooner.

Conflicting research study results

Health study results, relating to the consumption of foods, are published only to have conflicting study results published - sometimes within weeks or months. A case in point is the debate over red meat and cancer risk. In October 2015, 22 scientists from 10 countries met at the International Agency for Research on Cancer (IARC) to review current evidence linking red and processed meat with risk of bowel and other cancers.

The summary, published in Lancet Oncology (DOI:https://doi.org/10.1016/S1470-2045(15)00444-1), states that this expert committee, which based its findings on the relationship between meat and colorectal cancer risk, classified consumption of processed meat as "carcinogenic to humans" and consumption of red meat as "probably carcinogenic to humans" as evidence is limited.

However, a new set of reviews published in October 2019 suggests that there is no need for adults who eat red or processed meat to cut down. The guidelines, published in the Annals of Internal Medicine are authored by the Nutritional Recommendations NutriRECS) consortium in the U.S. and the reviews have been conducted using a methodology set out by the consortium. This includes performing a systematic review and using GRADE* criteria to rate the certainty of evidence.

*Grading of Recommendations, Assessment, Development and Evaluation: see http://www.gradeworkinggroup.org/

On the back of this state of confusion over what to eat, what not to eat, what food is 'good' and what is 'bad' has arisen a growing cohort of people coming together under the banner 'Nutritionists'.

Who are Nutritionists?

Many 'nutritionists' are highly qualified accredited and respected health professionals providing much science evidence based information on food and diets that is reliable and trustworthy. These professionals will have had many years of training and will be registered with government approved institutes or healthcare organisations as dieticians.

There are, however, many 'sham' nutritionists whose only intent, it seems, is to revel in their own financial gain or fame.
Many of them purport to be an accredited scientist, even an accredited medical professional but who are not, and never have been, scientifically or medically trained and yet give out much, often doubtful and sometimes dangerous, or just plain wrong, advice on diet, foods, and lifestyle often through mainstream media outlets such as TV, newspapers and book publication.

A quick search through the internet will turn up many cases of self-styled 'health gurus' who have been exposed as having fake or dubious qualifications purchased on-line through non-accredited or even, in some cases, non-existent institutions.

One notable UK 'nutritionist' who, by the way, had no formal recognised scientific or medical qualifications, publicly promoted the use of wild blue-green algae - properly called cyanobacteria.
Jan Krokowski of the Scottish Environment Protection Agency wrote a letter to New Scientist, as a private individual, 'This algae is able to produce a range of very powerful toxins, which pose health hazards to humans and animals, and can result in illness and death.'

Ben Goldacre in a 2007 article from The Guardian newspaper in the UK writes, "But these sham nutritionists don't stop there, because they can't: they have to manufacture complication, to justify the existence of their profession. And what an extraordinary new profession it is. They've appeared out of nowhere, with a strong new-age bent, dressing themselves up in the cloak of scientific authority. Because there is, of course, a genuine body of research about nutrition and health, to which these new "nutritionists" are spectacularly unreliable witnesses. You don't get sober professors from the Medical Research Council's Human Nutrition Research Unit on prime time TV talking about the evidence on food and health; you get the 'media nutritionists'. It's like the difference between astrology and astronomy."

Many have become very wealthy and, even when exposed as fakes and frauds, continue to dupe many people with their spurious, dubious or dangerous advice and products.

Goldacre continues, "These new nutritionists have a major commercial problem with evidence. There's nothing very professional or proprietary about "eat your greens", so they have had to push things further; but unfortunately for the nutritionists, the technical, confusing, overcomplicated, tinkering interventions that they promote are very frequently not supported by convincing evidence.

And that's not for lack of looking. This is not about the medical hegemony neglecting to address the holistic needs of the people. In many cases, the research has been done, and we know that the more specific claims of nutritionists are actively wrong."

As the law stands, in most countries anyone can practise as a nutritionist as the title is not protected. And, for better or worse for us, they do. While some will have spent years studying the science at university, others will have simply signed up to a short online course for a small fee, ticked a few boxes, then adopted the job title.
The problem? The short course, tick box school of 'nutrition' is unregulated, meaning the advice given can often be unfounded, unscientific and potentially dangerous.

The role of the media

Mainstream media

The mainstream media must shoulder some of the blame for the rise of misinformation and those who promote it. Many instances of the media 'flip-flopping' occur in the media, Unite For Sight in an article titled The Challenges and Failures of Nutritional Studies writes, 'The media will often declare that a certain food or supplement is great for you, just to refute it a short time afterwards.'

Social Media

The meteoric rise of the Internet, and its ability to give all the information we can possibly wish for, almost instantaneously, has undoubtedly transformed all of our lives - some would argue for the better, others not so much. Like it or loathe it, the internet is here to stay.

There is a fantastic, almost limitless, wealth of good, truthful, reliable, honest information on the world wide web, however, the thing that worries people the most about the internet is the content and quality of information available, that ranges from the best to the dangerous, and from truth to outright lies. Alongside and inextricably linked to the quality of the information are those that use the internet as a tool to lie, deceive, exploit and cheat other people with a view, and desire, to gain fame and wealth, or both.

Most people during their life will have some health issues, and many will turn to the internet to gain information; this fact is well understood by the bogus self-styled health gurus, quacks, charlatans, cheats, liars and thieves. They will post untruths about health issues, including life threatening illnesses and diseases in order to encourage people to buy their lies, and their products.

Into this melting pot come the bogus nutritionists who also see a way of making easy money by exploiting people's fears, hopes, dreams and, in some cases, vanity.

"There's lots of false information on the internet because there are people who want to believe things to be true, have incentive to believe that they're true, are trying to sell you something or convince you not to buy something. You have to sift through all of that," explained Dr. Ivan Oransky, president of the board of directors of the Association of Health Care Journalists.

Big Business and Nutrition Science

Big business names in the food industry understand two things, 1) That every single person needs food, 2) That Brand marketing and research is key to making people buy their products.

Much of the World's food supplies, especially in the developed industrialised areas, are dominated by a handful of monolithic companies, for example, Nestlé, a Swiss company. The Nestlé Group's net profit rose from about 7 billion in 2017 to roughly 13.7 billion Swiss Francs (14.17 billion US Dollars) in 2019. Nestlé is one of the world's largest food and beverage companies, accounting for over 2000 brands in over 180 countries.

It is undoubtedly safe to say that Nestlé, along with the other major food manufacturers such as Kraft Heinz co., Coca-Cola, Mondelez International, Inc., Archer Daniels Midland Co. for example, abides by an ethical code of conduct for food production and research.

However, they didn't get to where they are by being shy and retiring. Nestlé, in their words from its website:

Innovation has been at the heart of our company since its beginning. Ever since Henri Nestlé invented Farine Lacté to alleviate infant mortality, we have been dedicated to enhance people's lives.

Nestlé are closely allied to the Nestlé Nutrition Institute with the goal, in their words from their web site, of:

"The Nestlé Nutrition Institute is a not-for-profit association established in 1981 with the goal to advance the science of nutrition.

Science research and the Food Industry

For many years Food Companies have used [and paid] scientists to undertake research into their products to make them more saleable, and always more desirable to consumers - in order to boost their profits - and to develop new products.

The food industry however, is not alone in using Scientific research, researchers, Clinicians, Medical Doctors, and others, including politicians and high profile celebrities to promote, endorse, popularise and, ultimately, sell their products.

Tobacco Industry research

In the middle to late 20th century the tobacco industry was coming under more and more intense scrutiny, together with tobacco related products, as more and more research uncovered and identified the link causal links between smoking and ill-health, leading smokers to early morbidity.

The response of the tobacco industry was to use [pay] scientists to undertake research that always cast doubt on research, and the researchers, that showed smoking was ultimately a killer.

Amazing claims for benefits of certain foods

'Chocolate is heart-healthy'. Yogurt helps prevent type 2 diabetes. Pomegranates help cheat death. We are constantly bombarded with such amazing claims; the Media report them as science, and influences what we eat. However, Marion Nestle tells us in her book Unsavory Truth, How Food Companies Skew the Science of What We Eat, these research studies are more about marketing than science; they are often paid for by companies that sell those foods. Whether it's a Coca-Cola backed study extolling light exercise as a calorie neutralizer, or blueberry growers sponsored investigators proclaiming that "this fruit prevents erectile dysfunction", every facet of the food industry knows how to turn conflicted research into big profit. As Nestle argues, it's time to put public health first. Unsavory Truth reveals how the food industry manipulates nutrition science, and suggests what we can do about it.

In 2017, the Journal of the American Heart Association published the results of a clinical trial concluding that 'incorporating dark chocolate and almonds in your diet may reduce your risk of coronary heart disease'. OK. But can you guess who paid for this study? The answer may come as no surprise to find that it was The Hershey Company and the Almond Board of California funded the research. They also reportedly paid seven of the nine authors for their participation in the research; the other two authors attributed to the research study were employees of the funders.

As Marion Nestle says in her book, "But what if the findings of such studies are true? If exercise, chocolate, and almonds are good for health, what is wrong with funding research to prove it?" She goes on to state, "This is a serious question that deserves a serious answer". "Let me state for the record that financial ties with food companies are not necessarily corrupting; it is quite possible to do industry-funded research and retain independence and integrity. But food-company funding often does exert undue influence, and it invariably appears to do so. Even a hint of industry funding is all it takes to reduce trust among some segments of the public. Nutrition professionals have long recognized the reputational hazards of accepting sponsorship from food companies but for the most part have considered the benefits - in money, resources, and contacts - to be well worth the risk. From the food industry's standpoint, 'capturing'nutrition scientists and practitioners is a well-established strategy for influencing dietary advice and public policy."

Nestle explains that food companies must believe they need such strategies to survive in what is a hugely competitive marketplace. The U.S. food industry provides about four thousand calories per day per head of population, adding up in total to roughly twice the average person's dietary need. However the financial sector expects publicly traded Corporations to do more than make profits; it expects them to increase shareholder value. Market competition forces the food companies to work ever harder to convince consumers to buy their products rather than those of their competitors. They encourage consumers to eat more, and to choose those products that are more profitable for them. It is a well documented fact that, by far, the most profitable products are highly processed 'junk' foods and beverages. These are often very high in calories but low in nutritional value. Engaging nutrition professionals, together with high profile celebrities and such like, to declare such products "harmless" makes sound business sense. So does engaging them in promoting healthier foods as 'superfoods', which Nestle calls "a marketing term with no nutritional significance".

Basic dietary advice is constant and simple, the food writer and lecturer Michael Pollan has it in seven words: "Eat food. Not too much. Mostly plants." The problem problem for the food industry with advice like this is, it doesn't sell food products. On the other hand influencing nutrition professionals to endorse products does.

Recommended reading:

Unsavory Truth, How Food Companies Skew the Science of What We Eat. By Marion Nestle, Ph.D., M.P.H. Published by Basic Books 2018. ISBN-13: 9781541617315

Natural Health's Comment

In this article we have attempted to explore the area of Nutritional Science in order to understand why there is so much contradictory 'evidence' relating to foods and diets.

We at NH believe that there is much good being done in the world of nutrition, but we also want to try and help people by showing that there is also much to be wary of; The collusion of the 'Big-Food' companies and vested scientific research, that is also inexorably intertwined with the media and marketing, makes for a complex puzzle for consumers.

As with most things in life, "If it sounds too good to be true, then it probably is".

In the following sections are some tips for helping you to make informed decisions and choices, we hope they are of value to you.

How to spot the fakes

To keep an open mind, but also remain clear-eyed about what you read, consider these tips:

Seek out reputable sources

Take cues from medical advisory organizations. What's the American Heart Association response about a new heart disease study? Has the American Cancer Society weighed in on that supposedly breakthrough cancer treatment everyone on Facebook is sharing? The information from organizations like these have been carefully written, reviewed and vetted by experts.

"In other words, it's credible medical information that has been scrutinized through rigorous review processes and can generally be trusted," Ramin said.

Look for more than one source of info

Can you find sustained information?” that is, a pattern, trend, or a number of studies which have all reached the same conclusion? "If something says, 'the first study to show', I wouldn't use that to make decisions," said Oransky. "You want to make a decision about your health based on a body of evidence, not a single study."

Get in touch with your inner skeptic

"Trust and verify," advised Oransky, noting the tried-and-true rule of journalists: "If your mother says she loves you, check it out."

"Just because a research study or claim from an expert sounds good, or appeals to what you're already doing, doesn't mean it's authentic. And beware of easy-peasy claims, for instance, Eat this super fruit once a day and you'll never get cancer."

If it's too good to be true, Oransky points out, it probably is.

Talk to your doctor

"Even the most credible information found online is useless in the absence of expert physician evaluation and diagnosis," said Dr. S. Adam Ramin, urologist and medical director of Urology Cancer Specialists in Los Angeles. Tell your doctor what you've read online. Email them the article that's captured your interest, or print it out and bring it to your next appointment. A good doctor will walk you through it," Ramin noted.

Get a second opinion

"I would be wrong if I said that every physician's assessment and recommendations are 100 percent perfect, all of the time," acknowledged Ramin. "Like you, we are human after all."

If you walk out of your doctor's office feeling like your questions were blown off, it may be time to look for another doctor.

"This isn't necessarily because the doctor is 'wrong.' It has more to do with how you feel about the interaction," said Ramin. "In fact, research has shown that patients are more likely to follow the course of treatment when it's recommended by a physician they trust. Internet research aside, it's important to go with your gut on this one."

How to protect yourself from misinformation

The Colorado State University Extension published the following advice on how to protect yourself from misinformation:

The best way to protect against questionable health products and services is to be an informed consumer. The following list of claims and themes are common with nutrition misinformation, and may help consumers evaluate questionable advertising and sales techniques:

• Does the seller promise immediate, effortless or guaranteed results?
• Does the advertisement contain words like 'break-through','miracle','special' or 'secret'? These are used to appeal to your emotions and are not scientific or medical words.
• Is the product or service a 'secret remedy' or a recent discovery that cannot be found anywhere else?
• Is the product recommended for stress, or being promoted as 'natural' claiming it will help 'detoxify', 'revitalize' and 'purify' your body?
• Does the manufacturer claim that the product is effective for a wide variety of ailments, or a 'cure all'? The broader the claims, the less likely they are to be true.
• Do the promoters offer testimonials or case histories of patients who have been 'cured'?
• Are vitamin and mineral dose recommendations greater than the Dietary Reference Intake (DRI)? Reliable sources will make only recommendations that are in line with the DRIs.
• Is the product being sold by a self-proclaimed 'health advisor'? Insist on identification and professional credentials that are nationally accredited and recognized, such as a registered dietician (RD).
• Does the sponsor claim to have a cure for a disease (like arthritis or cancer) which is not yet understood by medical sources?
• Do the promoters use guilt or fear to sell the product?
• Does the advertisement claim Food and Drug Administration (FDA) approval? It is illegal to suggest FDA approval as a part of any marketing claim. However, all medical products sold across state lines must be registered with the FDA. Ask for the FDA proof of product listing if in doubt.
• Do the producers claim that the product is available in limited quantities and recommend the consumer pay in advance?
• Is there promise of a 'money-back guarantee'?

Reference Links:

• scmp.com - South China Morning Post, magazine - Food science should we believe anything we read

• nutrition.org.uk - nutrition in the news; headlines

• theguardian.com, media, 2007, feb 12; 'What's wrong with Gillian McKeith'

• uniteforsight.org - Nutrition Study

• extension.colostate.edu - topic-areas; Nutrition misinformation, how to identify fraud and misleading claims, 9-350/

• healthline.com - health-news; How fake health news may be influencing you to make dangerous decisions. How to spot the fakes

• fhs.mcmaster.ca - news 2018; Dairy consumption linked to lower rates of cardiovascular disease and mortality

• dcscience.net - 2012/01/16; Which Magazine - High street nutritional therapists are a waste of money

• Sentient Media - Big Food

• webmd.com - 7 rules for eating

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