Yeah, posts

Good intentions, but life and all that.

Plans for the next few posts.

Breakdown of bacon being a tasty tasty killer.

New Zealand Eating and Activity guidelines.

The play by play lol-fest of people harassing epidemiology, and their fight back.

Safe drinking limits

What constitutes an amount of alcohol that is matched with long term health?

Well, frankly, who knows? especially when we rely on a never ending run of poor quality epidemiology.

I found this while reading another blog on alcohol and health, with the ever popular public health way of "well, we have to make a recommendation, so lets just pick this"

I also found this article the other week on the world leading Nutrition journal, the American Journal of Clinical Nutrition.

The entertainment is in the conclusion

Higher usual alcohol consumption is associated with lower CAD mortality risk, independent of germline and early life environment and adulthood experience shared among twins, supporting a possible causal role of alcohol consumption in lowering CAD death risk.

10% reduction in cardiovascular disease for higher alcohol consumption compared to a lower consuming twin.  Now, more epidemiology, but the twins helps take some of the genetics out of it (always potential for epigenetic differences), but when do you think we will see anyhting above 0 consumption seen as potentially beneficial?

Crickets?

Do I hear chirping?

Productivity

Well, I was meant to start this and make lots of lovely posts, improve my knowledge and improve the ability of telling a story about data, and information, but got side tracked into that thing called life, family, work and international travel.  Hopefully back on deck for a tad longer now.

Artificial sweeteners and fatness

Another week, another observational trial showing the evils of artificial sweeteners.

The press releases and general lay public information from this trial are awful.  I know universities communication teams love controversial topics as they increase the hit count.  But this is garbage.

Observational trials are insensitive to pick up these effects, but they create a nice easy story.  You know, the "requires further investigation" type claims at the end of the paper.  Sure.  It also requires further investigation with examinations that are not just dataset milking piles of junk.

More to the point, this finding is nothing new.  Its most likely due to the fact that people know they are fat, therefore consume diet beverages - then treat it as permissive - I've been good and now i get to eat whatever.  Much like the gym goers who think because they did 20 minutes of cycling they deserve a triple fat mocha latte with a cookie.   Or like the previous research on telling people the product is low fat resulted in increased consumption.

Now, last year in the American Journal of Clinical Nutrition, there was an interesting meta-analysis published looking into this.  It was unique, in that it performed a meta-analysis on observational cohorts and also experimental trials.'

This paper can be found here.

It found that observationally, artificial sweetener consumption was associated with no real differences other than a significantly higher BMI (or significantly associated with a slightly higher BMI - as the authors say).

The meta-analysis of the experimental trials showed decreased bodyweight, decreased BMI, decreased fat mass and decreased waist hip ratio.

Why the difference?  Because observational trials are inadequate to decipher most of which they are asked to do.  But also, data mining of observational data sets (cough, Willett et al) will find enormous quantities of spurious associations that have nothing to do with anything.   Nothing like performing 5000 statistical tests on the same dataset to throw up some pointless garbage.

Just because fat people drink diet beverages doesn't mean that diet beverages caused the fatness.

Also, quit hyping your latest and greatest observational claptrap just because you want to advertise your University or Department.  Have some ethics.

Paper comment: Whey protein supplementation does not affect exercise training-induced changes in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults.

I was going to post something else, but thought I would throw this up instead.

So, from the title you can see "Whey protein does not affect exercise training-induced changes in body composition"

Silly supplement companies, selling their whey protein for NO EFFECT.

Large study.  Lots more subjects than normally find in protein trials.  Middle aged, inactive people.  They should get some benefit from actually doing something, so whey sucks at doses ranging from 0, 20, 40 or 60g per day.

Man, they took all this protein and achieved nothing.

But, try and find the information that you would be interested in, and they hide it.  When it first came out I had to wait for the 'supplemental' information that was not available when it first came out.

The body composition changes.

 

So... nine months of exercise, with or without protein, and the fat inactive middle aged adults didn't really change body weight, lean body mass or fat mass.  Well, they lost a (significant) tiny bit of fat mass and gained an equally small amount of muscle.   NINE MONTHS!
But hey, they gained a minuscule bit of strength, which is within the range seen from learning how to perform an exercise.

These lovely folk got to use somebody elses money (Supported by the U.S. Whey Protein Research Consortium and NIH T32AG025671 and UL1RR025761), mess around with subjects for nine months, and even their training program is so modest that the people went away with little to no difference. Plus they get published in one of the leading nutrition journals.

Hard life for some.

Evidence based medicine meets nutrition

As mentioned in my opening post, I have planned to warble on about evidence based nutrition (EBN).  I am trying to keep posts relatively brisk and to the point – as I can have a habit of heading down the rabbit hole for everything and this one is no exception.

But...

I am lucky with my place in life as a nutritionist.  I have no requirement to provide public recommendations for health unless I really feel like doing it.  I can have a complete independence form public health and having to provide something.  I can sit on my high horse and ask for the best quality data, be critical of everything, and decry all public health campaigns as much as I feel like.  

Evidence based medicine (EBM) fits me quite nicely.  I had mentioned that EBM came out of Canada, and while many may be distrustful of Canadian exports thanks to Celine, but EMB is an especially good advancement in the area of medicine.  The basic background and information of EBM is covered reasonable well in the bastion of all good referencing wikipedia.

I may be building my own strawman here, but EBM is a relatively simple idea, where the practice of medicine is guided from an evidence base built off a range of evidence.  This evidence is then ranked based upon it’s ability to answer the question.  A hierarchy of evidence.  This evidence ranges from the anecdotes of patients, or clinicians (like a case report), right through case control, ecological, cohorts, uncontrolled trials, randomised clinical trials and more recently, systematic reviews and meta-analyses of clinical trials.  Not accounted for in this is the basic art of interaction with the variable of the ‘sick’ human – which interplays the evidence base with the knowledge and creativity of the practitioner.

Now the nutrition world took this concept, but discovered that its not quite perfect mainly because of the differences between pharmacological/medical interventions and what we are capable of in nutritional interventions.  Which in reality, isn’t much. 

Blumberg (Blumberg et al, 2010) provided a nicer coverage on why EBM doesn't quite work in the context of nutrition.  The same year, Jim Mann (Mann, JI, 2010) also presented a commentary , while unfortunately starting with bible quotes, highlights the World Cancer Research Fund (WCRF) approach, which is less randomised clinical trial (RCT) centric and provides more focus on the observational evidence.  The WCRF report (World Cancer Research Fund, 2007) has a chapter on Evaluating the Evidence (Chapter 3) – in which they identify that they are so reliant on epidemiology -  they spend quite some time explaining epidemiological style trials and a short time on RCT – mainly spending their time downplaying the value.  That is because there is extremely few clinical trials on food and cancer outcomes, so they have nothing else to back it up on.  So they highlight the value of the data they have available.  

Following Blumbergs commentary, Fenton and Fenton (2010) wrote a letter to the editor, which in its title states the its entire intent “Nutrition Science mustn’t accept a lower level of evidence”.  Basically, we cant just accept epidemiology, just because RCT’s are difficult.

To which Heaney and Blumberg (2010) replied

“Across its full range, from micronutrients to protein, nutrition does not have the kind of evidence the Fentons advocate.  This is not an indictment of nutrition as a science; it is simply recognition of the following facts: 1) we cannot get RCT-level evidence for many, and perhaps most, nutritional questions, and 2) we have to make some recommendation.”

I understand why he is stating this, but I also say “bolderdash”.

Nutrition scientists have to stop making hard claims on soft epidemiology.  Nutrition scientists, public health officials, academics, epidemiologists, non-governmental organisations, government health authorities, everyone – have to stop overselling their data.  They have to stop saying the science is “settled” when it is largely based upon correlation.  In the same breath, we need to stop taking pharma-risk factor/disease modification trials and whole heatedly assume that nutrition influencing these risk factors will have the same effect on disease.

If we do not have the data, we do not have to and should not make recommendations.  

The public that funds an enormous amount of nutrition science deserves better.

References

Blumberg, J., Heaney, R. P., Huncharek, M., Scholl, T., Stampfer, M., Vieth, R., … Zeisel, S. H. (2010). Evidence-based criteria in the nutritional context. Nutrition Reviews, 68(8), 478–84. 

Mann, J. I. (2010). Evidence-based nutrition: Does it differ from evidence-based medicine? Annals of Medicine, 42(7), 475–86.

World Cancer Research Fund, & American Institute for Cancer Research. (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. (pp. 1–537). Washington DC: AICR.

Fenton, T. R., & Fenton, C. J. (2011). Nutrition science mustn’t accept a lower level of evidence. Nutrition Reviews, 69(7), 413–4; author reply 415–6. 

Heaney, R. P., & Blumberg, J. (2011). Author reply: Nutrition science mustn’t accept a lower level of evidence. Nutrition Reviews, 69(7), 415–416.

Building a base

I have been involved in Nutrition for a number of years now.  From early days of lifting weights and gaining an interest in optimised nutrition, to formalising this with academic education through to Masters of Science in Human Nutrition.  Finally, 10+ years of practicing nutrition in the commercial setting.  I work in the food industry as a researcher, and while some would think this can impair the impartiality of my thoughts, I say.  Bollocks.  I don't care for nutrition dogma, I don't care for status quo, I don't care most of the claptrap that excretes from the public health bodies.  I enjoy the data.  I have a modest dislike for epidemiology.  I also like pizza, coffee, eggs benedict and good beer.  Some of my personal bias comes from these likes.

This is an outlet.  A way to develop my line of thinking in some areas.  Solidify and enriched by brain dumping rants on various topics.

Hopefully my first commentary will be on Evidence Based Nutrition.  Which is similar to Evidence Based Medicine - a concept born from McMaster University, a lovely little place in Hamilton, Ontario.