Response of an M.D. / PhD to the China Study debate

Are you sick of debate on the China Study?

Remember how Mercola said his D.O. experience is more valuable than a PhD nutrition researcher’s?

If you’re not too sick of reading opinions, here’s a comment by a reader  that was buried deep in the comments on my blog, by an M.D. who also has a PhD. I think it’s important to note that while Mercola’s reported experience eating fruit for breakfast, and his triglycerides increasing (he implies these things are linked), is rather isolated.

(With anything that falls in the “case study” category, at best, I have this reaction: “Hm, interesting–but I’m putting no stock in that without more compelling evidence.)

Dear Robyn,

I want to respond to your message here as relates to The China Study and Dr. Mercola. Generally, Dr. Mercola is well respected in the health food industry; however, I think his analysis here is flawed. He is correct that The China Study is an observational study, but so are many studies. It is a very extensive, well designed study done by a top notch team of researchers

over many years.

They studied 6,500 people over diverse parts of China and came up with over 8,000 statistically significant associations between lifestyle, diet and disease.

I do think he may have generalized a little far from the associations found with casein, the major milk protein, and all protein. Nevertheless, it is hard to ignore the results of this study and the associations between high protein diet and diseases ranging from cancers to a wide range of autoimmune diseases.

I also found Dr. Mercola’s experience of moving some fruit into his breakfast and supposedly that causing him to have triglyceride levels of 3000 a little hard to believe. I have done hundreds of lipid panels and have never seen a triglyceride level even remotely close to that, not that it couldn’t happen.

There may be familial illness in his case but even those people generally don’t have levels approaching that. Another point is that high-protein, meat-based diets have for the most part been shown to be often quite harmful. Even the American Heart Association agrees with that. Dr. Atkins would probably also agree if he were still alive.

I do agree that one needs to listen to one’s body, but people are often fooled due to the very strong addictive qualities of our modern food industry. A great resource for that is Dr. Kessler’s book, “The End of Overeating”. People are very fooled into what they think they need and want, food-wise.

Dr. Mercola’s Nutritional Typing test asks a series of food preferences and how people feel with various food selections. How can one answer those questions realistically if they have no concept what true organic food is and how it operates in the body? Of course, more people are

going to associate with the higher protein diets, that is what they have been eating all their lives and that is what they think they need and feel best on. They have never been detoxified from those foods and been in touch with what they could feel like if they only knew.

Keep up your good work Robyn!

Sincerely,

Tim M., M.D., Ph.D.

Robyn’s response:

One thing I agree with in Minger’s critique (and what you say here) is that it’s a stretch to assume that because casein (milk protein) caused havoc in the laboratory, that all animal protein causes the same problems. I found Campbell to be honest about this, however, when I attended his lecture.

And he spoke, I spoke to him in person about whether any of his research could indicate whether kefir or yogurt–enzyme- and probiotic-rich raw milks with proteins broken down by fermentation–are a problem. He said, “I don’t know. We didn’t study that. It’s possible.”

this is Dr. Campbell’s response

Tomorrow, on to other topics. Today, here is T. Colin Campbell’s response to Mercola’s missive:

Dr. Mercola raises so many questions that it would take me at least several weeks if not months to answer. He invents clever sayings and makes serious innuendos that are total nonsense–indeed slanderous. His questions are rhetorical, with meaning, and no matter what I say, the questions will always remain–without my answers.

But here are a few general comments that strike me as main points:

1. Dr. Mercola’s main mantra (business model) is Nutritional Typing. In some way (maybe with paid phone assistance from his staff), we are supposed to listen to our body to determine which of three dietary types best suit us. He then becomes more specific as to the importance of eating foods in the right order and of the right type. These recommendations, he claims, are science based.

This is a clever strategy for positioning his company in the marketplace. He casts a broad net to capture as many customers as possible for his many products that he sells. According to him, we fit within one of these three diet groups, ranging from 1) the high carb-low fat types vs. 2) the low carb-high fat types vs. (3) those in-between, thus capturing for his company a much larger customer base.

I deeply respect our personal freedoms to do as we wish (as long as it doesn’t harm others). But given the complex environment within which we choose foods, I cannot understand how we can reliably determine what dietary patterns and order of eating foods is best for our long-term health. I know that some people can recognize specific food allergies, but I also know that we tend to choose food for all sorts of reasons, not the least of which is convenience, avoidance of pain and sense of ‘pleasure’ or gratification (read the little gem of a book, The Pleasure Trap, by Lisle and Goldhamer to see how so many of us continually choose foods not in our best interests). His method defies common sense. He says that this is based on science but, if so, I want to see the evidence. I see none. To say that we can determine, with any certainty, which nutritional type, based on our personal but very nebulous assessment of our metabolism is hocus pocus.

On his claims about science, Mercola is out of his element–way out. He excuses his failure to document his professional experiences in the scientific literature because he (and his compatriots like Dr. Eades) don’t have time in their busy practice of medicine, as if public documentation of evidence is a bit of a luxury that is not really that important. This is an extremely lame excuse, exposing his fundamental misunderstanding of what scientific validity really means. Scientific evidence, as accepted by virtually everyone, is that which represents proper scientific experimental design and subsequent publication in the peer-reviewed literature.

Doing and reporting on peer reviewed research may not be a perfect solution for establishing truths (nothing is) but it is far better than listening to someone only telling us what he/she does or believes while giving us no way to evaluate such claims. Peer-review, the main engine of scientific validity, means that our research findings are subjected to the critique of professional colleagues before it is published in the professional literature. Even more to the point, in order for us to get the funding to do the research, especially from institutions like the National Institutes of Health (NIH) or the National Science Foundation (NSF), we are required to undergo a most serious and somewhat protracted exercise of defending our hypotheses before committees of professional peers that may include as many as 15 members (I know this, having been on several of these panels). The chances of successfully obtaining funding is, on average, only one in six. In short, peer review is rigorous both in getting the funding and in publishing the results. Anyone, like Mercola, who claims scientific validity for his personal/professional observations is really at liberty to say whatever pleases them–and their wallets. This opens doors wide for snake oil ‘science’.

2. He relies on the bogus idea that it is our individual differences in “metabolism” that makes it possible for us to determine which foods please our metabolism and guard us against future ailments.  He has no idea what is metabolism. It changes and responds continuously and it is an enormously complex system of digestion, absorption, transport, enzymatic synthesis and breakdown of intermediates and distribution, excretion and storage of metabolites, all in an effort to maintain homeostasis. Reducing this concept to a simple phenomenon of energy use, which we can assess for ourselves is more superficial than adjectives can describe.

Read the rest of this report here.

“the plural of anecdote is not data” . . . part 4 of 4

Third, is the study reliable?   This is the second basic research standard, and it means is the research repeatable with consistent results? Reliability is one of the best things about Colin Campbell’s The China Study, the largest nutrition study in history, which will be referenced throughout this book.   Dr. Campbell’s animal research showing the benefits of a low-animal-protein diet were duplicated by other researchers, using various animals, all over the world.   The results were very consistent.

 

Finally, have a basic understanding of and consider carefully a few other things before placing much stock in what you read.   Is the study longitudinal (covering a long period of time)?   If none of 500 subjects got cancer in three years, that’s much less compelling than if none of them got cancer in 30 years, like in the Framingham study, the Harvard Nurses’ study,  or the Oxford-Cornell (China Study) Project.

 

Was the study double-blinded, which means that neither the researcher nor the subject knew which of multiple therapies the person was receiving?   Was it placebo-controlled, meaning that some subjects received a placebo (sugar tablet) instead of the supplement or drug?   Was the research published in peer-reviewed journals (often but not always ensuring more scientific analysis)?   How big was the sample size?   Bigger is better, and although case studies (with only a few subjects) are interesting, without further research, you shouldn’t bet the farm on findings of those kinds.

The more you read and study, the more confidence you can have that the very important decisions you make about how to fuel your body are sound.   12 Steps to Whole Foods undertakes to synthesize the research and best practices from around the world, leading to dietary practice that is simple and achievable and customizable for your personal dietary needs–a direct route to optimal health.

“the plural of anecdote is not data” . . . part 3 of 4

This is an excerpt from the intro of 12 Steps to Whole Foods.

 

Advances in the field of nutrition are taking place faster than ever in history.   For example, just this decade, the “master hormone” leptin has been discovered, which governs the other hormones.   New data calls into question the popular counsel of the past decade to eat 4-6 small meals daily: leptin research suggests that we should eat three meals daily and allow our bodies much rest from digestion.   In just 2004, a class of glyconutrients (sugars) have been found to have powerful healing properties, which disputes a decade of anti-carb “experts.”   Many people become frustrated by all the new information and competing voices telling us what to eat, what not to eat, and why.   So that you don’t give up and “throw the baby out with the bathwater,” I have a bit of common-sense advice that super-simplifies the essence of a statistics class.

 

The main way to push through the inevitable cognitive dissonance is to read and learn all you can:  12 Steps to Whole Foods  is a good start, and you may also consider the reading list on www.greensmoothiegirl.com (I am adding to it shortly). When you encounter contradictions, consider several things.

 

First, what is the funding behind the research?   You don’t have to become paranoid to examine whether research was undertaken to objectively examine an issue, or to promote an agenda.   It’s simply a part of being a savvy consumer of information in an age when we are all bombarded with thousands of voices.

 

For instance, if a study tells you that drinking wine daily prevents heart disease, use your critical thinking skills.   Why did researchers study wine instead of grape juice–or better yet, grapes?   Before you go out and stock up on a year’s supply of wine, ascertain if you can who paid for the study.   Was it the wine growers of Sonoma Valley?   Often studies in the modern age are funded, second-level, by an industry wanting to promote a product (often one that is under fire), even if the legitimate-sounding researchers named in the media, such as a university, are not directly linked to a motive.   When that is the case, researchers know they are to publish whatever they can that is favorable to a product or industry, and publish nothing they find that is unfavorable.

 

Second, is the study valid?   This is the highest standard in statistics and research, and it means does the study measure what it purports to measure?   This seems simple enough, but it is in fact a difficult thing for researchers to achieve.   If wine drinkers have much less cancer than beer drinkers, wine must be preventing cancer, right?   Not necessarily.   Maybe wine drinkers are a higher socioeconomic class than beer drinkers, in the aggregate, and beer drinkers also eat more fast food and smoke at higher rates.

 

Third, in tomorrow’s post.