Category Archives: Evidence-based living

Do we really need broccoli pills?

Whenever scientists find evidence that some new plant molecule (or phytochemical) is healthy, a ‘superfood’, that it prevents cancer, or helps you lose weight, what’s the first thing we do? We make a pill out of it.

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Red wine might prevent heart disease? Resveratrol pills! Fatty fish prevents cancer? Fish oil pills! Green tea? Catechin pills! Turmeric? Curcumin pills! And on, and on, and on.

Broccoli is one of the most recent foods to receive this treatment. Researchers found that a sulfur compound in broccoli, sulforaphane, has anti-microbial properties and kills cancer stem cells. It also increases liver enzymes that are known to be helpful against cancer.

So, what happens? A pharmaceutical company makes a pill, called Sulforadex, chalk full of sulforaphane. Perhaps unsurprisingly, it’s not even the first ‘broccoli pill’ on the market.

Now you might say, so what? My grandma told me to eat my broccoli when I was five years old. She knew this, why do we even need this research? Well, as people of science, we know that data are better than anecdotes. We also know that although our ancestors’ oral traditions often contain a great deal of wisdom, other times they are nonsense. So, I think it’s great that this research is being done.

The part that bugs me is that compounds that appear curative from research that is often funded by taxpayers must immediately be broken down into pill form and monetized. Many times in the past such pills have failed to fulfill the incredible promises made by their creators. Whether this was because the compound easily oxidized outside the plant (for example, catechins in green tea) or because it required a combination of other micronutrients present in the actual plant is interesting, but not super relevant. So, why does this keep happening? The answer is basically this: broccoli does not have lobbyists, red wine cannot be patented, whole blueberries can’t be crammed into a massively overpriced pill that everyone will buy and nobody will take.

I’m not saying the pills are bad for you. Some of them are smoke and mirrors, but some are likely effective supplements. But I know people taking a number of different supplements made from plant compounds like catechins, anthocyanins, curcumin, fiber, and many others. So, if you find yourself taking more than one pill that cost you a lot of money at GNC, and cost the company almost nothing to make, why aren’t you just eating vegetables? I get it, it’s hard, it’s expensive. But is it really harder than driving to a totally different store? Is it really more expensive than supplements at a specialized health food store, MANY of which are over 50 dollars for a month’s supply for one pill? And are you even considering the fact that there are likely thousands of other phytochemicals in the vegetables that might be healthy too?

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In other words, if there are enough healthy compounds in broccoli to make multiple different supplement pills, maybe even hundreds, why not just listen to your grandmother? Or if your grandmother didn’t tell you to eat your vegetables you can listen to mine.

Remember to eat your broccoli!

 

References

  1. Kim, BG, Fujita, T, Stankovic, KM, et al. 2016. Sulforaphane, a natural component of broccoli, inhibits vestibular schwannoma growth in vitroand in vivo. Scientific Reports doi:10.1038/srep36215
  2. Mahn, A., Reyes, A. 2012. An overview of health-promoting compounds of broccoli (Brassica oleracea) and the effects of processing. Food Science and Technology International 18 (6).
  3. Doss, JF, Jonassaint, JC, Garrett, ME, et al. 2016. Phase 1 Study of a Sulforaphane-Containing Broccoli Sprout Homogenate for Sickle Cell Disease. PLoS ONE 11(4): e0152895. https://doi.org/10.1371/journal.pone.0152895.

 

 

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Chocolate causes you to lose weight. Or does it?

So, this person who made a bunch of open access journals look like the fools they are a while back (turns out most don’t actually do peer review – whoops!) just posted about a more recent sting, this time on the science media.

Basically, they carried out a study that showed chocolate helps you lose weight, and reported it as such.

It was then spread far and wide for obvious reasons.

Mainly because chocolate is delicious and most of us want to keep eating it without gaining the weight it seems to drag along with it.

Turns out it was a crappy study, on purpose.

The authors say they purposely engaged in a practice called p-hacking, which is pretty common in science unfortunately. Basically, the researchers measured a whole bunch of other variables too, so by random chance you might expect some of them to LOOK like chocolate affects them.

I read as their main point that science media sensationalizes everything scientists find without really asking how much support there is for the conclusion they are spreading around the world.

The only problem is I keep coming back to their study. They DID find that chocolate helps you lose weight. Their ‘extra’ variables were things like blood protein, sodium, etc., which in my opinion are things that I wouldn’t expect chocolate to affect anyways.

Hmm. So, clearly, science media sensationalize everything without regard to the quality of the research.

But I keep coming back to the important question – can chocolate help me lose weight? (Or rather, can I keep eating lots of chocolate but do something about my ever-growing midsection?)

I’m going to conclude that the authors set up a bunch of ‘straw man’ hypotheses they didn’t really believe in to prove a point, and that they in fact were NOT engaging in p-hacking. Maybe I’m being nitpicky, but I don’t see chocolate affecting sodium as that good of a hypothesis.

BUT on the other hand the main points they made were really good! I keep going around in circles on this…

Whatever. I don’t think I’ll be able to solve this tonight.

I’m gonna go eat some chocolate.

What ACTUALLY causes autism? Here are 7 possibilities.

Fresh from listening to some of my Facebook friends argue about vaccines, a question occurred to me. What DOES cause autism? Not the MMR (measles-mumps-rubella) vaccine (see for example, Jain et al. 2015. Also, the weight of a huge amount of scientific evidence vs. one tiny, discredited study. I will fight you). But SOMETHING causes autism, so what is it? Much of the following is a summary of “Environmental factors in autism” by Andreas Grabrucker (2013).

So, t1024x1024 Wallpaper rain man, tom cruise, dustin hoffmano start, what actually IS autism?

Autism is a developmental brain disorder, generally classified on a spectrum (autism spectrum disorder or ASD), meaning it can vary in severity and symptoms among people. Interestingly, although most people with autism can’t count toothpicks really fast like Dustin Hoffman in Rain Man, his character was actually based on a real person. Among the most common symptoms of ASD are impaired social behavior and repetitive behaviors.

Some autism advocates believe terms like ‘disorder’ and ‘impairment’ are loaded, and don’t like them. I use them here for consistency with medical and research terminology, but it is a good thing to be aware of.

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Autism has a genetic component, meaning it can run in families (Abrahams and Geschwind 2010). However, autism risk is strongly affected by the developmental environment as well. Here are the environmental factors most strongly linked to autism. Note that although some of these are likely causal, others may just co-occur with autism often.

Risk factors during pregnancy

1. Prenatal virus, allergy, or auto-immune disease – thought to alter immune function in the placenta or fetus

2. Zinc deficiency – very common in autistic children, may represent a physiological mechanism, may relate to infections

3. Abnormal melatonin synthesis – melatonin is an important hormone, abnormalities may relate to light pollution or zinc

4. Maternal diabetes – linked to a two-fold increase in autism risk, mechanism here is unclear

5. Stress and trauma during pregnancy and birth – may be related to immune function, can cause similar behaviors in other animals

6. Some chemicals that negatively affect humans (‘toxins’) – for example, pesticides, valproic acid, and thalidomide

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7. Advanced age in either parent – may be due to increased mutation risk or increased risk of pregnancy complications

Postnatal risk factors

There are not currently well-supported risk factors for autism that occur after birth. This may change, as some are being investigated, but none are strongly supported at this point.

In conclusion, risk factors for autism may be most important during pregnancy, and certainly seem to be linked to immune function, stress, certain toxic chemicals, and pregnancy complications. What we are still missing is a unifying physiological hypothesis tying these together in a meaningful way that incorporates the genetic risk.

References

1. Jain, A., Marshall, J., Buikema, A, Bancroft, T., Kelly, J.P., Newschaffer, C.J. (2015). Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. Journal of the American Medical Association. 313 (15): 1534-1540.

2. Grabrucker, A.M. (2013) Environmental factors in autism. Frontiers in Psychiatry 3 (118).

3. Abrahams, B.S., Geschwind, D.H. (2010) Connecting genes to brain in the autism spectrum disorders. Arch. Neurol. 67, 395-299.

Marijuana improves effectiveness of radiation in treating some forms of cancer

Short post today about a paper that came out at the end of 2014 on how some of the compounds in marijuana might play a role in cancer treatment.

This is marijuana.

Medicinal marijuana is thought to help seizures and pain, but is generally used more to treat symptoms than to treat diseases directly.

Nevertheless, there is growing evidence that marijuana may actually be helpful in the treatment of some diseases directly.

Scott et al. (2014) showed that two compounds found in marijuana, tetrahydrocannabinol (THC) and cannabidiol (CBD), can increase the sensitivity of cancer cells to radiation therapy in the context of mice with glioma, a very aggressive cancer that has very poor long-term survival rates in humans. THC was best administered as a botanical drug substance, while CBD was best administered in a pure form.

These are mice.

There is a big hole in our knowledge of marijuana use in medical treatment. That will probably not change soon unless its current classification as a Schedule I drug is changed. Schedule I means that it’s extremely difficult for scientists to even do research on a substance. The current lack of support by the FDA is cited as due to a lack of high quality research on the topic, yet the classification means that it’s unlikely there will be much high quality research anytime soon. Kind of a silly catch-22, especially when highly-addictive narcotic-type drugs like hydromorphone, oxycodone, fentanyl are Schedule II and prescribed by doctors constantly.

For the record, I don’t have a strong opinion either way about legalization for recreational use, but I think that the government preventing scientific research on a potentially effective treatment is unfortunate.

References

Scott, KA, Dalgleish, AG, Liu, WM (2014) The combination of cannabidiol and d9 – tetrahydrocannabinol enhances the anticancer effects of radiation in an orthotopic murine glioma model. Mol. Cancer Ther. 13 (12): 2955-2967

Does education really pay?

Although most of my friends have, or are currently working on, graduate degrees of some kind, most people don’t achieve this level of education. Shocking, I know.

Following a discussion about why I think it’s important for people without high school educations to work on their GED or pre-GED even if they don’t think they’ll be able to finish the entirety of it, I looked for research on it, the way I do.

What I found generally supports my opinion, but not completely. At least according to David Card (1999) in the Handbook of Labor Economics (1), it looks like if you have a 8th grade education, it makes sense to try for a 9th, and from there a 10th, but after that, unless you actually get a high school degree, it might not be worth it to pursue more education (Figure 1).

Hourly wage and years of education
Mean log hourly wage as relating to mean years of education (modified from 1).

Interestingly, the trend continues with college. It’s worth it to go to college, even if you don’t even get an associate’s degree.

But an associate’s degree is even better, and a bachelor’s degree is better yet.

Lastly, I guess most people who do a Master’s of Arts degree take almost as long as a PhD, and both take longer than an MD or JD (lawyer degree).

So, perhaps not shockingly, neither a Master’s degree nor a PhD are really worth the years of enslavement relative to becoming a lawyer or a medical doctor.J-D-scrubs

But we do it because we value education for it’s own sake, right? And because not all of us can look this good in scrubs.

Just kidding, I look awesome in scrubs.

References and Further Reading:

1. Card, D. (1999) The Causal Effect of Education on Earnings. Chapter 30, Handbook of Labor Economics, Volume 3, Part 1. Page 1808.

… and now gluten intolerance may be a real thing.

There’s a new paper out in Clinical Gastroenterology and Hepatology (online; 1) that suggests that non-Celiac gluten sensitivity IS in fact a thing, despite other fairly recent research to the contrary.

I’ll save the contrary research for another post to keep this short, but in this new paper Di Sabatino et al. gave 59 subjects either 4.375 g/day of gluten or rice starch (the placebo) for 1 week, then switched the groups for the next week. 4.375 g of gluten is about the same amount as found in two slices of white bread, so you’d get that much from eating a sandwich.

Well, Di Sabatino et al. found that this approach resulted in measurable, statistically significant changes in overall symptoms (a measure combining all the individual symptoms they measured). Individual symptoms that were worsened by gluten included abdominal bloating, pain, foggy mind, depression, and aphthous stomatitis (canker sores).

Twenty-three out of 28 other symptoms did not worsen with gluten administration.

I’ll save forming a confident opinion for when more new research on the topic comes out, but at least this paper shows that we have not heard the last word on non-Celiac gluten sensitivity.

1 Di Sabatino, A., Volta, U., Salvatore, C., Biancheri, P., Caio, G., De Giorgio, R., Di Stefano, M., Corazza, G.R. (online 2015) Small amounts of gluten in subjects with suspected nonceliac gluten sensitivity: a randomized, double-blind, placebo-controlled, cross-over trial. doi: 10.1016/j.cgh.2015.01.029

Healthy eating for vegetarians and vegans: what about B-12?

Many people choose to eat little meat, only eat fish, not to eat meat at all (vegetarians), or not to consume animal products of any kind (vegans). Often these diets are eaten for moral, environmental, or health reasons, yet concerns are often aired that these diets lack important vitamins. Many vegans and vegetarians are very nutrition conscious, and with a few exceptions, careful food choice appears to generally make up for the lack of certain nutrients in an all- or mostly-plant diet.

With pregnancy comes new concerns: namely deficiencies in iron, calcium, folate, and other vitamins become more pronounced, and have greater consequences. Low birth weights, neural tube defects, and a variety of other problems can arise from vitamin deficiencies during pregnancy, especially at early stages during which pregnancy may not yet be detected. Vegetarians and vegans often suffer increased risk of a couple of these deficiencies, for example iron.

Some vitamin deficiencies are largely unique to vegans and vegetarians. B-12 deficiency in particular is common to anyone eating little meat, even non-vegetarians. Symptoms of B-12 deficiency generally appear in infants in their first year of life and can include lethargy, failure to thrive, and a loss of previously established developmental skills, among other possible problems. Severe neurological problems can also result. Folate, another B vitamin, is of common concern for pregnant women because folate deficiencies can lead to fundamental neural problems. Interestingly, folate is generally easy to get appropriate levels of for vegetarians and vegans eating a healthy diet, and high folate can mask B-12 deficiency. Because the problems associated with maternal B-12 deficiency don’t usually appear until the first year of life, this is an important, and potentially overlooked concern for vegan and vegetarian women who are considering children.

Supplementation is the first approach generally suggested, and indeed seems to be effective in many cases. However, there are many examples in which dietary supplements are not as effective as people would like to believe, and in some cases they may even be harmful. Therefore in cases in which the effectiveness of supplements has not been directly studied (and pregnant women are generally not experimented on for obvious reasons) it might be safer to actually include foods in the diet that have important nutrients, obviating the need for supplementation. Secondarily, many people who avoid animal products may also wish to avoid artificially ‘enhanced’ foods, such as vitamin-enriched cereal grains or genetically-modified plants that have B-12 producing genes inserted. So, it may be important to consider true whole-food sources of important nutrients in which specific diets are low.

Interestingly, some foods atypical in the western diet, such as dried purple laver (nori), and fermented foods such as
tempe, already eaten by many vegans, include high levels of B-12. Nori is generally wrapped around sushi rolls (avoid the fish rolls if pregnant due to heavy metal and probably parasite concerns), but can also be eaten in salads, on sandwiches, or for the other Midwesterners out there, in hotdish!

TL;DR vegans and vegetarians may have a few extra things to think about when choosing to become pregnant, but they can be solved through appropriate prenatal care with supplementation, and ideally very carefully chosen and potentially atypical dietary items such as nori

1) Bleys, J., Miller, E.R., Pastor-Barriuso, R., Appel, L.J., Guallar, E. (2006) Vitamin-mineral supplementation and the progression of atherosclerosis: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. 84 (4) 880-887

2) Chalouhi C., Faesch, S., Anthoine-Milhomme, M.C., Fulla, Y. Dulac, O. Cheron, G. (2008) Neurological consequences of vitamin B-12 deficiency and its treatment. Pediatric Emergency Care 24(8): 538:541.

3) Koebnick, C., Hoffmann, I., Dagnelie, P.C., Heins, U.A., Wickramasinghe, S.N., Ratnayaka, I.D., Gruendel, S., Lindemans, J., Leitzmann, C. (2004) Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women. Journal of Nutrition. 134: 3319-3326.

4) Kuhne, T., Bubl, R., Baumgartner, R. (1991) Maternal vegan diet causing a serious infantile neurological disorder due to vitamin B12 deficiency. European Journal of Pediatrics 150: 205-208.

5) Miller, E.R., Pastor-Barriuso, R., Dalal, D., Riemersma, R.A., Appel, L.J., Guallar, E. (2005) Meta-analysis: High-dosage vitamen E supplementation may increase all-cause mortality. 142 (1).

6) Stabler, S.P. (1999) B12 and nutrition, p. 343-365. In R. Banerjee (ed.),Chemistry and biochemistry of B12. John Wiley & Sons, Inc., New York, NY.

7) Watanabe, F., Yabuta, Y., Bito, T, and Teng, F. (2014) Vitamin B12-Containing Plant Food Sources for Vegetarians Nutrients 6(5) 1861-1873