Category Archives: Science

Evidence-based diet, Evidence-based health, Evidence-based living, Science

Do we really need broccoli pills?

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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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Evidence-based medicine, Science

Got chronic pain? Maybe try a placebo

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If you have chronic pain and want to avoid pain meds, or even popping too many ibuprofen, maybe you should try a placebo!

The placebo effect is what we call improvement from a treatment when that treatment doesn’t do anything that should help the condition, usually in the context of clinical research. The placebo effect can actually be pretty powerful, and is one of the reasons why doing controlled experiments is so important. In an age where scientists often fail to replicate research, placebos are seen by some scientists and doctors as a promising treatment for some conditions. Leaving aside a number of technical discussions about what the ‘placebo effect’ really is, placebos are cheap, don’t have negative side effects, and the beneficial effects are well documented for some conditions.

‘But doctors can’t prescribe placebos!’ you say. ‘That would be unethical!’ Well, it turns out that placebos can help people even when they KNOW it’s a placebo. Check this out.

Lower back pain is a huge problem all over the world (seriously, it leads to tons of disability cases everywhere). So, in this study Carvalho and colleagues (2016) took adults with persistent lower back pain who were fine taking pills and didn’t take opioid drugs. They also didn’t include people who had pain from a bunch of different causes, like cancer, broken bones, surgeries, and trauma. Instead they were just trying to look at people with lower back pain without any obvious cause. They split everyone up into two groups of people: what they called ‘treatment-as-usual’ or TAU, and an ‘open-label placebo’ group (OLP). So, they actually TOLD the people getting the placebo that they were getting a placebo. All participants had the placebo effect explained to them in a ‘positive’ way. ‘Positive way’ just means they were told that placebos can help people if they are taken consistently, even if there’s nothing in them. 83 people were included in this study.

So what happened? Well, not only did the placebo (OLP) group see improvement in their pain symptoms, but their degree of disability from their lower back problems was actually substantially reduced! Kind of crazy.

How does this work? The idea is basically that the patient’s belief the placebos might help are actually leading to the improvements. Maybe they are just helping patients not notice the pain, or not care as much about the pain. An alternative hypothesis is that simply by seizing some agency, or in other words, by ‘doing something’ about their pain and feeling in control of their situation, the pain can be reduced.

Is this a real effect? Well, yeah. I mean, pain was a problem for the people in this study, and the placebo reduced their pain. A placebo can’t make a limb regrow, won’t kill parasites, won’t cure cancer or mental health problems, and you should probably run away from people saying otherwise. If you have a condition that could be dangerous, placebo treatment instead of conventional treatment is a BAD idea. But for issues like chronic pain, it could provide cheap and easy relief with no negative side effects for many people.

There are certainly some ethical considerations with doctors prescribing placebos (although it’s apparently commonly done in Europe with patients who are drug seeking or who doctors think are hypochondriacs). Most of these considerations are vastly reduced however when patients are TOLD they are being given a placebo, and simply told the truth that the placebo effect is real, and can be powerful. Pretty cool!

 

References:

  1. Rutherford BR, Mori S, Sneed JR, Pimontel MA, Roose SP. (2012) Contribution of spontaneous improvement to placebo response in depression: a meta-analytic review. J Psychatric Res 2012; 46: 697-702
  2. Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine 2014;39:556–63
  3. Open Science Collaboration (2015). Estimating the reproducibility of psychological science. Science, 349
  4. Carvalho C, Caetano JM, Cunha, L, Rebouta, P, Kaptchuk TJ, Kirsch I (2016) Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain doi: http://dx.doi.org/10.1097/j.pain.0000000000000700

 

Science

Why does science so often seem to disagree with itself?? Thoughts for new scientists or non-scientists.

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An undergraduate student of mine recently showed me a scientific journal article he had been reading that confused him. Specifically, one result of the paper was that people who ate a vegetarian diet had higher cancer rates than those who ate meat [1]. He was confused by this because he said he had read other papers that suggested the exact opposite [for example 2, 3]. The point of this post is not to get into any discussions about the health effects of meat, but rather to briefly discuss the implications of contradictory results from the scientific literature. There are three issues that are immediately relevant and fairly straightforward for a growing scientist or a non-scientist: variation in how studies are carried out, the ‘random sample’-based idea of science, and reproduction of research.

Perhaps the simplest of these is the idea that if you ask the same question in different ways, you might find different results. I would personally explain this by pointing out that how you ask the question actually changes the question itself, just a little bit. To illustrate this, start with the question, “Does eating meat increase your risk of cancer?” To test this, one might start with a group of people who eat the average omnivorous American diet, remove all meat from their diets, and compare their cancer rates to the control (meat-eating) group five years later. This study has in fact modified the question slightly and asked, “How does removing meat from an omnivorous diet affect cancer risk?” Alternatively, if you compare cancer rates in the general population between vegetarians and omnivores, you are asking, “How do cancer rates compare among people who eat vegetarian diets compared to those who eat omnivorous?” At first glance, this may seem a pedantic distinction, but in practice this difference can be major. Can you think of any reasons people might not eat meat that could affect their health in other ways? What about people who have a major family history of cancer? They might be very careful about what they eat, but might also have an elevated risk of cancer even if they take special care.

The second issue here is the ‘random sample’-based idea of science. In essence, scientists are trying to make general conclusions that are generalizable to all people, not just those in their current study. In order to do that, they often try to collect a sample of people that is representative of the entire population. If they fail to do that, it’s not strictly a flaw in study, but it becomes important to be clear about which populations the results can be generalized to. For example, imagine the only vegetarians I can find for a research study are part of specific religions such as Buddhists or Seventh-day Adventists, along with a smattering of upper-middle class white Lutherans, pretty common in my part of the country. Well, in the end, that’s a pretty limited sample of people. What else might those populations do differently than the general population?

Finally, science is based upon the idea of repeating the same study many times. Both due to the random sample idea, but also the way we do statistics to come to conclusions, there is a certain possibility of error to every study. A well-designed and well-conducted study with a fairly large sample size, carried out by objective researchers who have no financial stake in the outcome, should have a low possibility of simply being ‘wrong.’ Unfortunately, every individual study does have this possibility. Studies in which the researchers have a heavily vested interest, or that are carried out by people who are not careful and objective, may have a higher likelihood of making errors. Now, this may seem depressing: “Why should we even believe science?” Nevertheless, the true power of science arises in reproducibility. If ten different researchers have conducted the exact same research, and nine reach the same conclusions, you can be pretty confident in the results of the nine. To, be clear, the contradictory study may be of very high quality as well, and may simply have found a different result due to random chance.

So, when you read a study, and you find the results confusing, or contradictory to your prior beliefs, here is my suggestion. First, keep an open mind. Maybe your prior beliefs were wrong! Approach every new idea considering the possibility that it might be right. Second, think critically about the study. The authors have probably stated a research question or hypothesis. But ask yourself, is their stated question really the question they asked with their research? What population do they say they studied? Did they really? Finally, look for more. Do they cite other related research? What did that prior research conclude? Has any new research cited the paper in question? Try using Google Scholar, or any number of other search tools to find other research on the same topic. Look for a review! Some articles are actually just summaries of many other research articles, and can be enormously helpful in this situation. Maybe yours is the only relevant research, but maybe there is a large body of science either supporting it, or failing to. Happy sciencing!

 

References

  1. Burkert, N.T., et al., Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study. PLoS ONE, 2014. 9(2): p. e88278.
  2. Tantamango-Bartley, Y., et al., Vegetarian Diets and the Incidence of Cancer in a Low-risk Population. Cancer Epidemiology Biomarkers & Prevention, 2013. 22(2): p. 286-294.
  3. Key, T.J., et al., Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). The American Journal of Clinical Nutrition, 2009. 89(5): p. 1620S-1626S.