bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Parasites for gluten!

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A friend alerted me to this article last week. Before we look at the actual research study, I need to say this is terrible reporting. The headline proclaims: Gluten allergies may be reduced using hookworms. No. Well, maybe. But probably not, and that’s certainly not what the study was looking at. No wonder people are confused about gluten. The study looked at the effect of hookworms on gluten tolerance in individuals with celiac disease. Which, we know, is not an allergy. Celiac disease is an autoimmune disease in which consumption of gluten results in the destruction of microvilli in the small intestine in sufferers. Gluten allergy is a hypersensitivity of the immune system to the gluten (or one of its component proteins) protein. So… if you are allergic to gluten, don’t go infect yourself with hookworms and eat a sandwich. I wouldn’t recommend doing this if you have celiac disease either.

Looking at the actual study… It was very small (12 people, two of whom withdrew from the study before completion). When a study is so small, it’s impossible to say if the results would extend to the majority of those with celiac disease. Setting aside the fact that I’m doubtful that the majority of celiac disease sufferers would willingly ingest hookworms in order to be able to consume gluten again. That being said, it’s quite interesting that the study participants were able to gradually increase their gluten intake to 3 g of spaghetti a day without experiencing any overt, nor covert (i.e. intestinal damage) symptoms of celiac disease. Of course, that’s not a lot of gluten (about one cup of pasta a day) and the study took place over 12 weeks, with the largest quantity of pasta being consumed over the final two weeks. It would be interesting to see if intestinal damage was visible after an extended period of time or if greater quantities of gluten could be consumed.

Something else that I wondered about when reading the article was any potential complications from the use of hookworms. According to the Centre for Disease Control, most people with hookworms experience no symptoms. However, some many experience gastrointestinal distress and the most serious complication is blood loss leading to anemia, and protein loss.

Essentially, celiac disease leads to nutritional deficiencies when gluten is consumed. Introducing hookworms may allow celiac disease sufferers to consume gluten but may also lead to nutrient deficiencies. Alternatively, celiac disease sufferers can follow a nutritious gluten-free diet.


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Follow Friday: All of the low-carb diet blogs

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When the news about the new “low-carb diet is the best long-term weight loss diet” came out I fleetingly considered writing about it. In the moment that I took to think about it, pretty much everyone else had covered it. So… Rather than reinvent the wheel. Here are some links to posts that say pretty much everything I would have said (and then some):

James Fell on Six Pack Abs: New Study: What is low carb good for

Karmal Patel on Examine.com: Is low-carb really the best weight loss diet?

Yoni Freedhoff on Weighty Matters: What I actually learned by reading that low-carb is best study

Julia Belluz on Vox: The one thing you need to know about weight loss and diet studies

There’s more, but that’s probably more than enough reading for now. I’m off to The Canteen for a sandwich. See you Monday!

 


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Book review: Gluten Freedom

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After I wrote my post on Grain Brain I was contacted by the publisher of a new book about gluten Gluten Freedom. They offered to send me an advance reading copy with the hope that I would love it and share my love of it with others. Or, most likely, at the very least, not write a scathing review. Fortunately for them, I quite liked it.

Unlike other books about gluten *ahem* Wheat Belly, Grain Brain, this book isn’t about vilifying gluten or wheat. Dr Fasano even states that for anyone who doesn’t have celiac disease, a wheat or gluten allergy, or gluten sensitivity, there’s no reason to avoid gluten. This book is not about eliminating gluten to cure all ailments. It’s about how to deal with specific gluten disorders (primarily celiac disease).

I respect the fact that Dr Fasano is a researcher and not just a doctor aiming to prey on people who are desperate to lose weight. He actually conducts research experiments to examine celiac disease and the effects of gluten on other conditions. Gluten Freedom is not about fear mongering. It’s about how people with gluten-related disorders can live normal healthy lives.

This book isn’t for everyone. It’s more of a handbook to help people suffering from celiac disease (and their families) develop ways to live without gluten. There’s great information about addressing situations at school and for seniors. There’s also a couple of interesting chapters at the end discussing new preventions and treatments for celiac disease. In addition to being a handbook it’s also an informative read for health care practitioners and for an antidote for devotees of Davis and Perlmutter.


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Revisiting Dr Esselstyn

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A reader recently commented on a blog post from over a year ago: <a Something's Greasy About Dr Esselstyn's Diet. He suggested that I take a look at some recently published research supporting the diet (and, I think, revise my previously stated opinion).

One of the links was to a series of case studies presented by Dr Esselstyn. As we know, case studies can be interesting, especially in cases of rare conditions, but are not readily generalized. As coronary artery disease (CAD) is a fairly common condition, I feel that it’s more prudent to focus on larger research studies when developing recommendations for the public.

The other link was to a study conducted by, you guessed it, Dr Esselstyn. The study followed 198 CAD patients who were counselled in plant-based nutrition for approximately 44 months. Upon follow-up it was found that 21 were non-compliant (what ever that means… more on this to follow). The remaining participants all showed significant improvement, and only one experienced a related medical incident (i.e. stroke) during those 44 months.

The biggest issue with this study is that there was no control group. There is nothing to compare the participants with. It’s entirely possible that a group, provided with all the same medical treatments and advice, minus the nutritional counselling would have fared just as well. It does seem unlikely, but without the inclusion of such a group, there is no way to be certain that the nutrition counselling (and subsequent adherence) was the reason the participants fared so well. In addition, there was no control for any potential confounding factors. The authors didn’t control for anything. That means that the success could have been due to physical activity/exercise, sleep, stress reduction, socioeconomic status, etc.

There are a few other issues I have with this research. The article states that:

Initially the intervention avoided all added oils and processed
foods that contain oils, fish, meat, fowl, dairy
products, avocado, nuts, and excess salt. Patients were also asked to avoid sugary foods
(sucrose, fructose, and drinks containing
them, refined carbohydrates, fruit juices, syrups, and molasses). Subsequently, we also
excluded caffeine and fructose

However, “We considered participants adherent if they eliminated dairy, fish,
and meat, and added oil.”

My issue with the diet prescribed by Dr Esselstyn was the lack of healthy fats. I have no issue with a vegetarian diet (yes, I’m still not convinced that oil, fish, and dairy products are unhealthy, especially for those who do not suffer from CAD) which is what the adherent participants followed. This means that they could have added nuts, seeds, nut butters, sugar, coffee, avocado, and so on, to their diets and still been adherent. A far cry from the original Esselstyn diet. In turn, I also wonder what the non-adherent participants consumed. Did they eat some fish or meat? Drink some milk? Or were they chowing down on fast food and Hungry Man dinners on the regular? Without knowing these things we shouldn’t be too quick to jump to the conclusion that the Esselstyn diet is superior to all other diets when it comes to treating CAD.

Naturally, there’s also the issue that (despite stating that the authors had no known conflicts of interest) Dr Esselstyn is the author of a number of heart health and lifestyle books that would surely take a hit in sales were research contrary to his hypothesis to be published.

Sure, this study warrants further research into the benefits of plant-based diets (and Dr Esselstyn’s very low-fat plant-based diet) for CAD patients. I’d like to see some larger studies with control groups conducted. Until then, I’ll still be cooking with oils and enjoying my guacamole.

 

 


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Diet, cancer, and blame

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I read these articles backwards. Starting with Dr Joel Fuhrman’s The Nutrition and Cancer Myth? in the Huffington Post and then reading the article An Apple a Day, and Other Myths in the New York Times, which it was written in response to.

To summarize: the NYT article was covering the annual meeting of the American Association for Cancer Research. The article reports that nutrition research has proven to be much less cut-and-dry than had been hoped and that there has been little evidence to date to support any specific connections between diet and cancer prevention (or cause). The HP article suggests that the former article was biased and based on “mainstream” science. Fuhrman argues that there are connections between diet and cancer.

Let’s talk a little bit about bias. The free dictionary defines bias as: A preference or an inclination, especially one that inhibits impartial judgement. Fuhrman accuses George Johnson of bias in his article. Johnson is a writer and science journalist for the NYT. I’m not sure what leads Fuhrman to accuse him of bias other than the fact that his article threatens his book sales. As a journalist, impartiality is essential to Johnson’s writing. Fuhrman, on the other hand has a vested interest in having people believe that cancer can be prevented through diet as the author of books such as Super Immunity and Disease Proof Your Child and the creator of the “nutritarian” diet.

Maybe it’s just my interpretation, but I didn’t read Johnson’s article as telling us to eat whatever we please because it won’t have any impact on whether or not we develop cancer. To me, it said that we shouldn’t beat ourselves up too much for our dietary choices if we develop cancer because nutrition may not have a huge (or even a small) role in cancer development. Cancer has myriad causes and victim blaming does little to advance our knowledge. To his credit, Fuhrman does acknowledge that there are a number of causes of cancer, some of which are outside of our control. However, he continues to cling to the notion that diet can play a large role in cancer prevention and treatment. Understandably, he has a vested interest in people believing this assertion.

Fuhrman cites a number of observational epidemiological studies to support his claim that diet can affect cancer development/prevention. Obviously, we can’t determine causality from these types of studies and, in the comparisons of developed and developing countries there are many factors other than diet which may result in varying rates of breast cancer. Fuhrman uses a small study of the consumption of flax muffins by women with breast cancer as support for the assertion that diet can prevent cancer. Of course there were only 32 women in the study, they were all post-menopausal, and they all were diagnosed with breast cancer. So, really, while interesting that the women eating the flax muffins saw greater cancer cell death than the women eating the muffins without flax (of import is that both groups saw cell death) it’s not translatable to the general population and says nothing about diet and cancer prevention.

Diet may prove to play a role in cancer prevention. However, the evidence does not yet support this. Don’t let nutritionologists scare you into believing that you are in control of cancer prevention and you can only do so by buying their book(s) and ascribing to their diet.