Tag: cholesterol

Standards in science journalism – #LCHF, #Banting and @BiznewsCOM

If you only get your news from people and places that agree with your pre-existing view, then you are living in a filter-bubble. This is not a good thing, as it means that you’re (relatively) impervious to discovering any errors in your beliefs, while simultaneously getting constant affirmation that you’re “right”.

That’s true for individuals as consumers of news, but also presents an opportunity for producers of news to reflect on their responsibilities. If you purport to be an objective – or at least balanced, seeing as objectivity is impossible – purveyor of news, then you need to take care to publish fair representations of the current state of knowledge.

One South African site that constantly abrogates its responsibility to present a balanced view is Biznews.com, and the headlong rush towards partisan propaganda is led by Marika Sboros, who seems to have taken on the position of journalistic praise-singer for the low-carb, high-fat diet, and for Professor Tim Noakes in particular.

To be clear, I don’t have a problem with self-confessed fans – rather than people who present themselves as journalists – doing praise-singing. Whether they are right or wrong about the facts, individuals have no responsibility to be fair with regard to the totality of evidence, and/or how it’s interpreted, on their personal websites or Twitter feeds.

This doesn’t mean I’d encourage that sort of epistemic irresponsibility, in the least. As I say, they have no responsibility to us to be fair – I’d say that have that responsibility to themselves, but that’s not what’s at issue here. In this case, we’re talking about a news website that isn’t set up as a promotional vehicle for LCHF, and a “journalist” who presents herself as objective.

Sboros’ most recent piece of misrepresentation arises as a result of the USA’s Dietary Guidelines Advisory Committee announcing that they are set to reverse their cautionary stance on dietary cholesterol (so, the cautions against the cholesterol content of food, rather than the cholesterol content of your blood).

A second piece of new research is also described in the link above, namely a meta-analysis by Harcombe et. al. arguing that the dietary fat guidelines in 1977 and 1983 (cautioning against fat) were never justified by evidence from randomised controlled trials (RCTs).

The piece begins with nonsense, where Sboros’ italicised introductory text includes “In 2013, Sweden became the first country to ditch low-fat dietary guidelines, restoring cholesterol in eggs and bacon to its former glory”. That’s literally false, in that a Swedish advisory body, rather than “Sweden”, made certain recommendations. Second, that’s a gross misrepresentation of the recommendations they made, as even the advisory body themselves have noted.

Let’s take them one at a time, starting with the case of the USA. First, the headline Sboros chooses is “Science says Tim Noakes is right on cholesterol”. “Science” is rarely, if ever, dogmatic – pseudoscience is. Science – meaning what the totality of evidence suggests – points in one direction or another, and sometimes by very fine margins.

What I mean is, evidence in support of one particular point of view (Noakes’, for example) tips the scales in favour of their point of view, rather than “proving someone right”. And in this case, the misrepresentation is particularly bad, in that the only support for Noakes in these guidelines is for one leg of his argument, namely that cholesterol consumed has little impact on cholesterol in the blood.

As the Washington Post write-up makes clear,

The greater danger in this regard, these experts believe, lies not in products such as eggs, shrimp or lobster, which are high in cholesterol, but in too many servings of foods heavy with saturated fats, such as fatty meats, whole milk, and butter.

The new view on cholesterol in food does not reverse warnings about high levels of “bad” cholesterol in the blood, which have been linked to heart disease. Moreover, some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.

So, we see continued warnings about saturated fat, and continued warnings about blood cholesterol. Noakes says that saturated fat is fine, and that statins (to lower blood cholesterol) are bad, even toxic – he even uses the perjorative “statinators” for those who prescribe or recommend them. In other words, two key pegs of the Noakes argument are directly contradicted by this research.

Sboros, meanwhile, Tweeted a link to that same Washington Post piece, saying:

Well – if those doctors or dietitians actually read the linked piece, you’d imagine that they would carry on prescribing the statins, seeing as nothing in it recommends that they stop doing so.

Another interesting thing to note is that these guidelines seem to have been developed with the support of the Egg Nutrition Center and American Egg Board. Now, I don’t think that this automatically taints the research – as I’ve said before, “the fact that something is funded by a pharmaceutical company doesn’t guarantee bias. There’s a difference between being cognisant of potential biases, and writing something off in advance, just because of whence it came.”

I note it just to make the point that Sboros, Noakes and other LCHF supporters constantly use alleged taint via funding to dismiss research they don’t like – but then somehow seem to forget that principle when the research says things that they happen to agree with. For example:

Before moving on, read especially that second link for a contrasting view on what the revised guidelines mean, and on how they should be interpreted according to the holistic framework of knowledge related to diet. My concern here is about misrepresentation, rather than the science itself.

On the second issue (the Harcombe study), a key thing to note is that, as ever in the case of this “journalist”, only one view is being presented. The Harcombe study has already been subjected to a fair amount of criticism, some of which seems rather compelling. You might fall on either end of the contrasting views, or somewhere in the middle, but a piece of journalism, rather than praise-singing, would include relevant and plausible dissenting views at the same time.

To conclude, another recent Sboros post is worth highlighting, titled “Are you a vaccine zombie? Risks versus benefits of jabs debate goes on“. The piece expresses anti-vaccine fears, primarily the standard one amongst cranks, namely the risk of autism. The debate does not “go on”, except to the extent that those who hold fringe views pretend that it does – the scientific consensus on vaccines is clear, and long-settled.

This post embeds a video from (quoting Sboros) “one of my favourite sources of health information: Mike Adams, AKA the Health Ranger”. Mike Adams is the man behind “Natural News”, the site that argues that Microsoft are developing eugenics vaccines. And that HIV doesn’t cause Aids. It also publishes David Icke, the man who thinks the world is controlled by reptiles from outer space, who live in underground tunnels and take on human form.

This is a health journalist’s favourite source of health information?

To quote Ben Goldacre, speaking of Zoe Harcombe but with words that might apply equally well here, “you may disagree, but in a busy world, I’m not sure I see the point of a Zoe Harcombe”.

On causes, Noakes, and making prudent claims related to diet

Three pieces related to diet and the low-carb high-fat fad are worthy of highlighting this week, because all of them are a counterpoint to the “sugar is addictive and you’re a victim of a conspiracy” seam that continues to be mined by the likes of Professor Tim Noakes. The first is by Gary Taubes, who Noakes cites as being responsible for removing the scales from his own eyes, and the second is a response to Taubes by Dr David Katz, who says that Taubes is asking the wrong questions.

You can read those pieces yourself – the only aspect I want to highlight here is how moderate Taubes’ tone is. He acknowledges that the science isn’t settled, but that he’s biased in favour of “sugars and refined grains” being the problem. He even includes the rider that “we all have our biases”. Indeed we do. But on that minimal (and yes, selective) quote, Taubes could be saying the same thing that mainstream nutrition science is – which is at a significant remove from the claims made by Noakes, who speaks as if there’s no doubt that carbohydrates are the cause of most of our ills, and that most of our ills can be eliminated (or at least managed) by eliminating the majority of carbs from our diets.

In other words, Taubes at least speaks as if he acknowledges the possibility of being wrong. Noakes, by contrast, leaps straight to rather humorous epithets when people disagree with him, calling them victims of “Group Think”, “statinators”, or “The Anointed”. Alternatively, he’ll poison the well by making very generalised aspersions about funding, as if to pre-emptively taint any claims that are being made. It’s tinfoil-hat territory, and in short, in no way confidence-inspiring, at least not for those of us who want to resist signing up to a cult.

And it’s the third piece that merits your careful attention, if you care for holding science and scientists up to rigorous and principled scrutiny. Not because it says anything new, but because it quite clearly articulates a very essential, and simple, principle of scientific reasoning. Namely: what question is being asked, and what sort of an answer will we be willing to accept as legitimate? The key passage for me – at least in terms of highlighting how Noakes is compromising critical thinking – is this one:

It seems likely that we were seduced by the early successes of epidemiology with point-causes with large effects — infectious diseases — and we were similarly seduced by Mendel’s carefully engineered successes with similar point causes — single genes — for carefully chosen traits, but these are paradigms that don’t fit the complex world we’re now in. What Mendel showed was that causal elements were inherited with some specifiable probability, and he did that in a well-posed setting (selective choice of traits and highly systematized breeding experiments). But Mendel’s ideas rested on the notion that while the causal elements (we now call them alleles) were transmitted in a probabilistic way, once inherited they acted deterministically. Every pea plant with the same genotype had the same color peas, etc. We now know that that’s an approximation for some simple situations, but not really applicable generally.

This passage reminds me of the dispute between Humean accounts of causation and what I’ll call the “causal powers” account, described very usefully in Harre and Madden’s 1975 book, Causal Powers: A Theory of Natural Necessity. In short, the distinction could be captured in discriminating between the fact that high carbs typically mean high quantities of refined foods, sugars, a sedentary lifestyle etc. and the fact that neither does it need to mean that, nor that those causal factors exist in isolation.

By way of example: To say that aspirins relieve headaches is to say that, because of its nature, an aspirin can relieve a headache while a laxative cannot. The means by which it achieves this are neither occult nor unfathomable – it does not have this power in spite of its nature; it is rather because of its nature that this is possible.

In cases like these, scientists are able to investigate the chemical composition of an aspirin, and then to figure out why it has the effect it has on the body, describable in terms of chemical reactions within the body. An aspirin’s power to relieve headaches is furthermore something which exists even when the tablet is not being used to relieve a headache. When we say that aspirins relieve headaches, we are saying that in a particular situation (essentially, a person having a headache), aspirins will be more effective than other things, because they by nature have the power to relieve headaches.

When we open the medicine cupboard, looking for something to relieve our headache, we choose aspirin over a laxative because we think or indeed know that it currently has such and such powers. The difference between a placebo and an aspirin is not that the aspirin will relieve the headache and the placebo will not, as there will be situations in which the aspirin is ineffective or the placebo effective, the difference is in the natures of the two substances, and that, by nature, aspirins generally behave in such a way as to exhibit the power to relieve headaches.

Harre and Madden go on to draw a distinction between enabling conditions and stimulus conditions, where enabling conditions are those that ensure that a thing is in a state of readiness to create a certain effect, and stimulus conditions which actually bring about an effect, assuming that the enabling conditions have been fulfilled. In other words, we’re talking about potential causal factors rather than absolute causes.

Enabling conditions for an aspirin would be that the aspirin is in a state whereby it could possibly alleviate pain – if an aspirin is consumed after its sell-by date, the possibility exists that certain changes have taken place in its chemical structure, resulting in that aspirin not being able to relieve pains. So, assuming that the aspirin is enabled in this way (this is not to say that this is the sole enabling condition), what are the stimulus conditions which actually bring about the response from the aspirin that causes the headache to be relieved?

To relate that to diet, what are the conditions under which carbohydrates cause obesity, or type 2 diabetes, or whatever? Noakes would respond to say that the conditions are quite clear – namely that they obtain when one is insulin-resistant. But he only mentions this qualification when challenged to do so. Page 22 of the Real Meal Revolution states quite plainly – without any qualifications – that “fat does not make you fat. Carbs do”.

The very next page introduced insulin, but without any suggestion that we might have variable insulin reactions to carbohydrates. And the page ends with a generalised warning of a “near-perpetual cycle of weight gain. Unless, of course, you break the addiction…”. Never mind, of course, that the word and concept of “addiction” is being used in a rather quackish sense here.

In other words, the qualification that this only applies to some is introduced grudgingly, under duress, whereas his generalised opposition to what he dubs the ‘prudent diet’ recommendations gives the clear signal that he’d prefer for dietary guidelines to suggest a low-carb high-fat approach, for everyone. As he says in an interview in early February 2014, he’s calling for a “return to your dietary roots, bringing you back to the way humans are meant to eat and returning your body and mind back to the trim, happy, energised state our ancestors experienced thousands of years ago. They didn’t get fat or suffer from obesity, diabetes or other lifestyle illnesses” – and as he’s pointed out in every talk I’ve heard and read, those dietary roots (allegedly) involved high fat diets and low carbohydrate intake.

Yes, he does allow for wiggle-room, with some of us allowed to eat “a maximum of 200 grams of carbohydrates a day, depending on your insulin resistance”. But he’s also claimed that 60% or more of us would benefit from the LCHF diet, so it seems clear that – unless you prove yourself carb-worthy by whatever standard he sets – the presumption is that you, like him, should avoid carbs.

Here’s the thing: dieticians already know that excessive consumption of carbs is a bad thing, especially when they come in super-refined forms, and especially in the form of sugar. If that were all Noakes were saying, nobody would care. He’s saying something more, which is that we don’t need to fear saturated fat, and that the proportions of proteins and saturated fat we consume should increase, at the expense of the proportions of carbs.

When making these sorts of claims, he cites sources like the Harvard School of Public Health, even though they include the (standard) cautions against saturated fats. Just as he and his followers have been claiming that Sweden has “officially” adopted LCHF, even though they’ve done no such thing. And when faced with challenge, the retort is that you’re indulging in “Group Think”, as though conspiracy theory isn’t a perfect example of exactly that.

Take the example of that tweet, pasted above. In Noakes-science, that’s evidence (or so it seems). For the rest of us, we might say a) that’s a post-hoc (ergo fallacious) argument; or b) that it seems fairly straightforward to intuit that high cholesterol is sometimes a potential causal factor, but never a necessary one, in causing heart attacks; and c) what about the other 50% – does their elevated cholesterol not mean anything, on this model?

As I’ve said before, I really hope he’s right (leaving aside the fact that non-human animals will be killed in even higher numbers if his diet takes off). But damn, I wish he could try sounding like a scientist for a change.