Author Topic: <THIS!!> When Evidence Says No, But Doctors Say Yes  (Read 3094 times)

rcjordan

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<THIS!!> When Evidence Says No, But Doctors Say Yes
« on: February 22, 2017, 01:33:48 PM »
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Striking the right balance between innovation and regulation is incredibly difficult, but once remedies are in use—even in the face of contrary evidence—they tend to persist. A 2007 Journal of the American Medical Association paper coauthored by John Ioannidis—a Stanford University medical researcher and statistician who rose to prominence exposing poor-quality medical science—found that it took 10 years for large swaths of the medical community to stop referencing popular practices after their efficacy was unequivocally vanquished by science.

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

10 yrs is conservative. I suspect, for instance, that the drive for 'real' fruit & vegetables (versus vitamins & legit supplements) in a modern diet is largely driven by deep-seated, long obsolete knowledge related to nutritional maladies such as scurvy.

JasonD

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #1 on: February 22, 2017, 05:05:20 PM »
Hear hear!!


>fruit and veg

fibre has a lot to do with it too, but that can be added via supplements too.

Travoli

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #2 on: February 22, 2017, 05:09:46 PM »
>10 yrs is conservative.

This is especially true with the evolution of government-recommended dietary guidelines.

grnidone

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #3 on: February 22, 2017, 05:20:24 PM »
I don't disagree with this, but ... are you trying to say that fruits and veggies can be replaced?  I guess technically they *could.* but...life is so crummy without good food!~

grnidone

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #4 on: February 22, 2017, 05:21:31 PM »
"If you close your eyes, it's almost like you're eating runny eggs."

https://www.youtube.com/watch?v=2oEnJfZ9joY


rcjordan

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #5 on: February 22, 2017, 05:41:11 PM »
I've largely replaced them for years with the low-carb diet. I love 'em -and occasionally slip them in- but they are problematic.

But the problem with doctors (or professionals of any kind, really) is that once they start servicing their clients they have less-and-less time to keep up with their profession.  Here in the US, a pharm rep told me that the average physician has to turn 100-150 patients/day in order to make a good income. Let's just say they average 5 minutes per patient. That doesn't leave much time for current studies, does it?  From this perspective, it's easy to see why they fall back on their (increasingly aging) staples of the trade.

littleman

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #6 on: February 22, 2017, 06:09:51 PM »
I agree with the premise and I think Travoli brought up a very good example with the food pyramid.  Going off topic a bit and more into nutrition, it is entirely possible to eat very low carb and have huge helpings of non-starchy vegetables.  Recent findings have found that fiber is fermented in the gut and that process makes short chain fatty acids.  So, high fiber veggies actually fuel you as fat!

Just in case you are thinking I am making this sh## up!

rcjordan

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #7 on: February 23, 2017, 03:41:08 PM »
Advice to eat 10 fruit and veg a day sends Brits into meltdown on Twitter

http://mashable.com/2017/02/23/10-a-day-fruit-vegetables/

grnidone

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #8 on: February 23, 2017, 04:44:53 PM »
>once they start servicing their clients they have less-and-less time to keep up with their profession.

I've been told that you should try to go to Doctors just out of med school because they have newer (better) information.

>So, high fiber veggies actually fuel you as fat!

Perhaps.  But I like that fact that they help me poop. 

rcjordan

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #9 on: August 29, 2017, 01:58:02 PM »
I'm going to have fun taunting doctors and other low-fat nuts with this one:

Low-fat diet could kill you, major study shows

http://www.telegraph.co.uk/news/2017/08/29/low-fat-diet-linked-higher-death-rates-major-lancet-study-finds/

rcjordan

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #10 on: August 29, 2017, 02:08:17 PM »
<added>
Better taunting quotes here:

Quote
An enormous prospective study of food intake in adults, reported here, challenges several staunchly held beliefs about dietary components and their association with health risks: finding, for example that diets rich in fats, including saturated fats, don't increase mortality risk, but high-carbohydrate diets do.
And the study, called PURE (Prospective Urban Rural Epidemiology), also found that the benefits of fruits, vegetables, and legumes top out at just three to four total servings per day.
In sum, the results suggest that nutritional guidelines and conventional wisdom regarding these basic dietary elements may be seriously mistaken.

https://www.medpagetoday.com/meetingcoverage/esc/67566

Front page of Gnews.  Break out the popcorn, this is going to be good.

ergophobe

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #11 on: August 29, 2017, 03:48:58 PM »
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I suspect, for instance, that the drive for 'real' fruit & vegetables (versus vitamins & legit supplements) in a modern diet is largely driven by deep-seated, long obsolete knowledge related to nutritional maladies such as scurvy

Actually, I see this exactly the opposite. More and more studies point to the limited efficacy of supplements when removed from food. Supplements are often successful medicine for treating illness, like scurvy, but seem to have limited impact in promoting health.

Every *recent* study I've seen says that all-cause mortality among people who take a daily vitamin, for example, is higher than among those who don't.

To me, popping vitamins is mostly a legacy of 20th-century optimism that they were cracking the Rosetta Stone of health and that solutions were simple - they boiled down to a few macro nutrients (avoid saturated fat!!!!) and a slightly larger group of micro nutrients (get your vitamin C!!!).

I think that's mostly outdated thinking and if I were a true rationalist, I would quit taking vitamins. I continue to take a daily (though only a few times a week) on the "cheap insurance" argument... but studies I've seen in the last few years have all said I'm wrong.

So at the end of the day, I take a daily vitamin for the same reason I knock on wood. It makes me feel better psychologically, despite lack of *strong* evidence. I have, however, much anecdotal evidence supporting the value of knocking on wood.

rcjordan

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #12 on: August 29, 2017, 04:02:47 PM »
>vitamins

Vitamin B6 and B12 Supplements Appear to Cause Cancer in Men

https://www.theatlantic.com/health/archive/2017/08/b12-energy/537654/

Look at B12 on popular, oft-recommended vitamins such as Costco's Kirkland and you'll see dosage of B12 hitting 400+ percent of RDA.  I'd already quit everything based largely on the sentiment expressed in this thread but was considering adding vitamins back in to avoid *severe* nocturnal leg cramps.  Screw it, I'm lazy anyway.

ergophobe

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #13 on: August 29, 2017, 04:22:20 PM »
A good balanced article that says "maybe this or maybe that" (i.e. the URL looks like it supports one point of view, but that's because stop words are removed). It covers the question of whether multivitamin supplementation increases mortality.

http://blogs.plos.org/publichealth/2014/08/21/multivitamin-supplements-increase-mortality-risk/

And decidedly on the other side
http://www.nutraingredients-usa.com/Research/Multivitamins-don-t-increase-mortality-risk-New-meta-analysis

But notice that the discussion is primarily, these days, about whether or not multivitamin supplementation *increases* mortality or has no effect.

Quote
Supplementation studies provide mixed evidence concerning a beneficial effect of vitamin D on disease prevention or reduction in mortality.
  -- http://www.medscape.com/viewarticle/748744_4
Also highlights the problem with these studies - the study period was four years, which is a short time to study all-cause mortality


Anti-oxidants and multis....

The anti-oxidant question came up somewhere else recently in The Core.  The thing about anti-oxidants is that if you have too many free radicals and not enough anti-oxidants, then AOs are likely to help, but if you take in a lot of AOs and don't have many FRs, then it's likely harmful. It's like saying "negative ions will balance Ph" - that's only true if you have too many negative ions. My vague memory is that AOs are similar to that - beyond a certain level, they're harmful.

In any case, the majority of studies showed no benefits to taking AOs

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A re-analysis of this meta-analysis by a group of well-respected antioxidant experts led by Prof Hans Biesalski from the University of Hohenheim found that 36% of the trials showed a positive outcome or that the antioxidant supplements were beneficial, 60% had a null outcome, while only 4% found negative outcome (<i>Nutrients</i>, 2010, Vol. 2, pp. 929-949).

Regarding multi-vitamins, data from the Iowa Women's Health Study, published in the <i>Archives of Internal Medicine</i> (2011, Vol. 171, pp.1625-1633), found that multivitamins increased the so-called absolute mortality risk by 2.4%.

-- http://www.nutraingredients-usa.com/Research/Multivitamins-don-t-increase-mortality-risk-New-meta-analysis


And from the respected Cochrane Reviews, considered perhaps the best source for such things....

- No evidence that B6 supplementation helps with mood
http://www.cochrane.org/CD004393/DEMENTIA_no-evidence-of-benefit-from-vitamin-b6-supplementation-on-mood-or-cognition-of-older-people-with-normal-vitamin-b6-status-or-with-vitamin-b6-deficiency

- same for B12, though often proposed to help dementia
http://www.cochrane.org/CD004394/DEMENTIA_no-evidence-of-the-efficacy-of-vitamin-b12-supplementation-for-cognitive-function

- vitamin supplementation has no effect on miscarriages, though a single small study did find it reduced number of stillborns
http://www.cochrane.org/CD008873/PREG_vitamin-d-supplementation-women-during-pregnancy

- hopefully everyone knows by now that Vitamin C has no effect on contracting or curing a cold
http://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold

And while on the subject of Vitamin C, was Linus Pauling vindicated as some recent headlines have said? Not really...
https://sciencebasedmedicine.org/high-dose-vitamin-c-and-cancer-has-linus-pauling-been-vindicated/

And Pauling was the great salesman of the anti-oxidant hypothesis
https://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/

It's a long article, so one long quote, which goes on to cite additional studies, but just to grab the first couple:

Quote
The logic is obvious: if fruits and vegetables contain antioxidants -- and people who eat lots of fruits and vegetables are healthier -- then people who take supplemental antioxidants should also be healthier.

In fact, they're less healthy.

In 1994, the National Cancer Institute, in collaboration with Finland's National Public Health Institute, studied 29,000 Finnish men, all long-term smokers more than fifty years old. This group was chosen because they were at high risk for cancer and heart disease. Subjects were given vitamin E, beta-carotene, both, or neither. The results were clear: those taking vitamins and supplements were more likely to die from lung cancer or heart disease than those who didn't take them -- the opposite of what researchers had anticipated.

In 1996, investigators from the Fred Hutchinson Cancer Research Center, in Seattle, studied 18,000 people who, because they had been exposed to asbestos, were at increased risk of lung cancer. Again, subjects received vitamin A, beta-carotene, both, or neither. Investigators ended the study abruptly when they realized that those who took vitamins and supplements were dying from cancer and heart disease at rates 28 and 17 percent higher, respectively, than those who didn't.

In 2004, researchers from the University of Copenhagen reviewed fourteen randomized trials involving more than 170,000 people who took vitamins A, C, E, and beta-carotene to see whether antioxidants could prevent intestinal cancers. Again, antioxidants didn't live up to the hype. The authors concluded, "We could not find evidence that antioxidant supplements can prevent gastrointestinal cancers; on the contrary, they seem to increase overall mortality." When these same researchers evaluated the seven best studies, they found that death rates were 6 percent higher in those taking vitamins.


ergophobe

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Re: <THIS!!> When Evidence Says No, But Doctors Say Yes
« Reply #14 on: August 29, 2017, 04:25:06 PM »
From that last article, one more tidbit that goes with my comment about getting the right amount of AOs, but not too many

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The most likely explanation is that free radicals aren't as evil as advertised. Although it's clear that free radicals can damage DNA and disrupt cell membranes, that's not always a bad thing. People need free radicals to kill bacteria and eliminate new cancer cells. But when people take large doses of antioxidants, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state in which the immune system is less able to kill harmful invaders. Researchers have called this "the antioxidant paradox."