I first read Ioannidis’ paper several months ago and enjoyed it immensely. The Atlantic article is also good and I hope that it gets some much-needed conversation energized.
A couple of remarks.
I do not like the title. Ioannidis has shown that most published medical research is wrong and the title of his paper why most published research findings are false is misleading to me. Many of the pitfalls which he describes are specific to the limits of experimenting on human subjects which is not transferable across the entire universe of experimental science. Some of the pitfalls are general and all scientists should pay attention to them; it would have been a smoother rhetorical move to reflect this in his title.
The biggest issues amongst my friends and co-workers are diet and neurological nutritional supplements. My experience is that both of these areas are currently a quicksand swamp where it seems like a study of some sort can be found to support many positions that are in contradiction; the most obvious example is the thing with low fat diets, Atkins diets, paleo diets, and the list is far too long to include them all. I have a book Sports Nutrition published by The American Dietetic Association, which is a compilation from Track people, Football people, Swimming people, &c—there are fifty separate articles. The advice is all over the map. The most interesting thing in that book was the people who said that protein powders are useless. I have my own ideas on diet but I find my social life is less complicated if I keep them to myself.
There is some interesting information and (some complete nonsense) in the book by Doctor Daniel Amen Making a good brain great. It may just be blowback to his enterprising attitude, but Amen attracted enough detractor attention to get himself an entry on the quackwatch web page. He supplies medical journal citations for nearly all the claims in his book. Some of his recommended supplements I had heard of before, such as ginko biloba. Some of his recommended supplements I had never heard of, such as coenzyme Q. Amen takes twenty-five brain supplements daily. It was reading his book, and seeing his claims, and seeing his citations, which convinced me of the Ioannidis claim long before I read the Ioannidis paper. It seems impossible that all of the Amen claims and citations could be valid; it seems far more likely that most of the Amen claims and citations are false.
There is one fascinating item in Amen’s book which I will share as an aside. He is big on brain scanning (SPECT is his favorite protocol). He reported one research project where they were going to scan a large random sample of normal people. They preselected with a questionnaire to reject addicts, diagnosed mentally-ill, people with family history of Alzheimer’s and Parkinson’s, people with a memory of severe concussion, &c. Then they winnowed their population again with a preliminary brain scan. Of the first selected set, only ten percent of the people measured normal on their first brain scans and were kept in the study group!
This is an anecdotal data point for the contention that “normal” may be a dubious concept. This may be the single biggest flaw in medical research. People vary widely and they will necessarily vary widely in how they behave under experimental study. The normal distribution may be highly unusual for many practical applications.
If it won’t complicate your social life too much here, I’m quite curious about your ideas on diet—and if you don’t want to make them public to LW, could you PM me?
I saw that chart a long time ago in an article in a vegetarian magazine. The article said that about 10% of the people who try vegetarianism don’t thrive on it. It also said that no one needs more than 4 oz. of meat per day to be healthy.l
A little more about variation—I’ve talked with a man who keeps records of his blood tests based on the hope that rejuvenation may be possible, and the theory that if it is, it will be very useful to know what blood chemistry details should be used as a target—some blood factors (sorry, I didn’t ask which ones) vary by a factor of ten among healthy people.
I find the paleo argument pretty compelling by virtue of the logic of the argument—i.e. homo sapiens evolved in an environment which did not have agriculture and grains. Also there is an M.D. blogger whose name escapes me who strongly advises people to avoid all processed grains because they pulse the glucose-insulin cycle in the blood. In March I overhauled my diet. I was eating a croissant every morning, two slices of bread every noon, and two to four cookies every evening. My grain consumption is now less than three slices of bread every four days. I eat cheese and yogurt. So I am not paleo. I do eat a serving of fruit and a serving of raw nuts at every meal.
I may be the most paleo person I know.
The other overhaul I did to my diet is the largest mass of food I am now taking in daily is a big plate of frozen vegetables at noon. I buy the two pound sacks of: 1) peas; 2) corn; 3) string beans; 4) broccoli and cauliflower mix; 5) peas and corn and carrots and string beans and lima beans mix. Choosing which of the sacks to pour from at noon is one of the high points in my typical day. My weight is down; my body mass index is down; my workouts have more pep. I am going to be hanging with this diet for a while.
I like Pollan’s formula: eat food, not too much, mostly plants. If somebody put that in the rationality quote thread I would upvote it. Beyond his formula, I do not like Pollan at all. He is not a nutritionist; he is a journalist. When I try and read any of his writing at length my eyes roll.
The best partisan of the paleo philosophy in my mind is the anthropologist David Abram who is part of the “re-wilding movement”. I am not anywhere close to a re-wilding movement partisan, but his discussions of forager cultures and what those folks may have to teach us makes Michael Pollan and most of the other more popular figures look like they are serving up extremely thin gruel.
Normal testosterone in males varies by a factor of almost 4:241-827 ng/dL. This sticks in my memory because the last time my doctor did my blood I was at the top of the normal range and I asked him how come I don’t look like a gorilla. (The 241-827 does not stick in my memory—I looked it up.) I think my doctor is awesome but his answer to that question was not.
Your textbook stomach link is truly a picture worth a thousand words.
I find the paleo argument pretty compelling by virtue of the logic of the argument—i.e. homo sapiens evolved in an environment which did not have agriculture and grains.
The thing is, though, we have things like milk and alcohol that are not significantly older than grain consumption but we’ve seen evolutionary effects from them.
It is a point of scholarly contention whether people who retain their lactose tolerance with age were able to displace other people through their superior protein income, or taught milk cultivation to other people, who then had increased prevalence of the lactose toleration gene from that selection pressure. I have no more knowledge than the scholars, but consider the existence of a scholarly controversy evidence for the belief I am disposed against.
There’s also significant selection pressure against alcoholism genes among people that have access to alcohol (or just for ‘alcohol tolerance,’ but the first seems a more robust way to put things) and unsanitary drinking water: the result is that European Americans have dramatically lower rates of alcoholism than Native Americans. (The numbers I’ve seen compare alcoholism rates, not genes linked to alcoholism; so I suspect this is relevant but am not sure.)
So, it seems likely to me that people with European ancestry, at least, are likely to have spent the last hundred generations or so with a high percentage of grain in their diet, and we’ve seen that can make adjustments to patterns adopted for the previous thousand generations.
As for paleo? My friends that have tried it have all reported positive effects. My guess is that the main effects are better food and better food discipline. Whenever you make a serious attempt to plan your diet, some things disappear which you did not consider before- and my guess is that makes a huge difference. Extensive research shows that a lot of staples of industrial food- like sucrose, or massive levels of corn- are pretty bad for you. Simply preparing things yourself over having them prepared commercially has shown to dramatically reduce calorie intake; it’s easy to go to a restaurant and eat the food that tastes great when you didn’t see the two sticks of butter go into the pan. Beyond that, sticking to any sort of plan with food will decrease bad snacking and increase general good habits.
So, my advice is, “don’t pick a clearly deficient diet, and don’t not pick (i.e. default diet)”- beyond that, it doesn’t seem like you can do much besides match to your individual tastes. I think it would take a health benefit of 10 extra years for me to give up bread, since I really like bread. (And I’m expecting to live ~100 more years anyway, and so the duration effect has to be pretty massive to counterbalance the quality of life effect.)
That said, I suspect at some point in the next few years I’ll buy a blood glucose monitor and see what sort of effects my diet is having, and if I need to make any changes to prevent diabetes.
So, my advice is, “don’t pick a clearly deficient diet, and don’t not pick (i.e. default diet)”- beyond that, it doesn’t seem like you can do much besides match to your individual tastes. I think it would take a health benefit of 10 extra years for me to give up bread, since I really like bread.
I hear you. Paleo = NO bread. I am not choosing to go that far. Seven months ago I had grains at the base of the food pyramid at ~ 40% of my daily calorie intake. Now it is less than 5% and the idea of eating a foot long subway is not appetizing to me at all right now. I am genetically European and I eat dairy and I consume alcohol; it is interesting and disturbing to observe at first hand people who dairy and alcohol make physically ill because they have some different G-A-T-C sequences deep in the works of the organism.
It is a mystery at this point. I have the latest American Dietetic Association Complete Food and Nutrition Guide. They have the food pyramid with grains at the base just like they showed us all in elementary school. My recent experience is that for my bio makeup that pyramid is not the best guide.
Paleo diets generally consider corn a grain so you might want to avoid that. Some paleo variants (like the one I’m currently following) are ok with cheese and yogurt in moderation (and butter).
I first read Ioannidis’ paper several months ago and enjoyed it immensely. The Atlantic article is also good and I hope that it gets some much-needed conversation energized.
A couple of remarks.
I do not like the title. Ioannidis has shown that most published medical research is wrong and the title of his paper why most published research findings are false is misleading to me. Many of the pitfalls which he describes are specific to the limits of experimenting on human subjects which is not transferable across the entire universe of experimental science. Some of the pitfalls are general and all scientists should pay attention to them; it would have been a smoother rhetorical move to reflect this in his title.
The biggest issues amongst my friends and co-workers are diet and neurological nutritional supplements. My experience is that both of these areas are currently a quicksand swamp where it seems like a study of some sort can be found to support many positions that are in contradiction; the most obvious example is the thing with low fat diets, Atkins diets, paleo diets, and the list is far too long to include them all. I have a book Sports Nutrition published by The American Dietetic Association, which is a compilation from Track people, Football people, Swimming people, &c—there are fifty separate articles. The advice is all over the map. The most interesting thing in that book was the people who said that protein powders are useless. I have my own ideas on diet but I find my social life is less complicated if I keep them to myself.
There is some interesting information and (some complete nonsense) in the book by Doctor Daniel Amen Making a good brain great. It may just be blowback to his enterprising attitude, but Amen attracted enough detractor attention to get himself an entry on the quackwatch web page. He supplies medical journal citations for nearly all the claims in his book. Some of his recommended supplements I had heard of before, such as ginko biloba. Some of his recommended supplements I had never heard of, such as coenzyme Q. Amen takes twenty-five brain supplements daily. It was reading his book, and seeing his claims, and seeing his citations, which convinced me of the Ioannidis claim long before I read the Ioannidis paper. It seems impossible that all of the Amen claims and citations could be valid; it seems far more likely that most of the Amen claims and citations are false.
There is one fascinating item in Amen’s book which I will share as an aside. He is big on brain scanning (SPECT is his favorite protocol). He reported one research project where they were going to scan a large random sample of normal people. They preselected with a questionnaire to reject addicts, diagnosed mentally-ill, people with family history of Alzheimer’s and Parkinson’s, people with a memory of severe concussion, &c. Then they winnowed their population again with a preliminary brain scan. Of the first selected set, only ten percent of the people measured normal on their first brain scans and were kept in the study group!
This is an anecdotal data point for the contention that “normal” may be a dubious concept. This may be the single biggest flaw in medical research. People vary widely and they will necessarily vary widely in how they behave under experimental study. The normal distribution may be highly unusual for many practical applications.
If it won’t complicate your social life too much here, I’m quite curious about your ideas on diet—and if you don’t want to make them public to LW, could you PM me?
The “textbook stomach” compared to the range of actual stomachs.
I saw that chart a long time ago in an article in a vegetarian magazine. The article said that about 10% of the people who try vegetarianism don’t thrive on it. It also said that no one needs more than 4 oz. of meat per day to be healthy.l
A little more about variation—I’ve talked with a man who keeps records of his blood tests based on the hope that rejuvenation may be possible, and the theory that if it is, it will be very useful to know what blood chemistry details should be used as a target—some blood factors (sorry, I didn’t ask which ones) vary by a factor of ten among healthy people.
I find the paleo argument pretty compelling by virtue of the logic of the argument—i.e. homo sapiens evolved in an environment which did not have agriculture and grains. Also there is an M.D. blogger whose name escapes me who strongly advises people to avoid all processed grains because they pulse the glucose-insulin cycle in the blood. In March I overhauled my diet. I was eating a croissant every morning, two slices of bread every noon, and two to four cookies every evening. My grain consumption is now less than three slices of bread every four days. I eat cheese and yogurt. So I am not paleo. I do eat a serving of fruit and a serving of raw nuts at every meal.
I may be the most paleo person I know.
The other overhaul I did to my diet is the largest mass of food I am now taking in daily is a big plate of frozen vegetables at noon. I buy the two pound sacks of: 1) peas; 2) corn; 3) string beans; 4) broccoli and cauliflower mix; 5) peas and corn and carrots and string beans and lima beans mix. Choosing which of the sacks to pour from at noon is one of the high points in my typical day. My weight is down; my body mass index is down; my workouts have more pep. I am going to be hanging with this diet for a while.
I like Pollan’s formula: eat food, not too much, mostly plants. If somebody put that in the rationality quote thread I would upvote it. Beyond his formula, I do not like Pollan at all. He is not a nutritionist; he is a journalist. When I try and read any of his writing at length my eyes roll.
The best partisan of the paleo philosophy in my mind is the anthropologist David Abram who is part of the “re-wilding movement”. I am not anywhere close to a re-wilding movement partisan, but his discussions of forager cultures and what those folks may have to teach us makes Michael Pollan and most of the other more popular figures look like they are serving up extremely thin gruel.
Normal testosterone in males varies by a factor of almost 4:241-827 ng/dL. This sticks in my memory because the last time my doctor did my blood I was at the top of the normal range and I asked him how come I don’t look like a gorilla. (The 241-827 does not stick in my memory—I looked it up.) I think my doctor is awesome but his answer to that question was not.
Your textbook stomach link is truly a picture worth a thousand words.
The thing is, though, we have things like milk and alcohol that are not significantly older than grain consumption but we’ve seen evolutionary effects from them.
It is a point of scholarly contention whether people who retain their lactose tolerance with age were able to displace other people through their superior protein income, or taught milk cultivation to other people, who then had increased prevalence of the lactose toleration gene from that selection pressure. I have no more knowledge than the scholars, but consider the existence of a scholarly controversy evidence for the belief I am disposed against.
There’s also significant selection pressure against alcoholism genes among people that have access to alcohol (or just for ‘alcohol tolerance,’ but the first seems a more robust way to put things) and unsanitary drinking water: the result is that European Americans have dramatically lower rates of alcoholism than Native Americans. (The numbers I’ve seen compare alcoholism rates, not genes linked to alcoholism; so I suspect this is relevant but am not sure.)
So, it seems likely to me that people with European ancestry, at least, are likely to have spent the last hundred generations or so with a high percentage of grain in their diet, and we’ve seen that can make adjustments to patterns adopted for the previous thousand generations.
As for paleo? My friends that have tried it have all reported positive effects. My guess is that the main effects are better food and better food discipline. Whenever you make a serious attempt to plan your diet, some things disappear which you did not consider before- and my guess is that makes a huge difference. Extensive research shows that a lot of staples of industrial food- like sucrose, or massive levels of corn- are pretty bad for you. Simply preparing things yourself over having them prepared commercially has shown to dramatically reduce calorie intake; it’s easy to go to a restaurant and eat the food that tastes great when you didn’t see the two sticks of butter go into the pan. Beyond that, sticking to any sort of plan with food will decrease bad snacking and increase general good habits.
So, my advice is, “don’t pick a clearly deficient diet, and don’t not pick (i.e. default diet)”- beyond that, it doesn’t seem like you can do much besides match to your individual tastes. I think it would take a health benefit of 10 extra years for me to give up bread, since I really like bread. (And I’m expecting to live ~100 more years anyway, and so the duration effect has to be pretty massive to counterbalance the quality of life effect.)
That said, I suspect at some point in the next few years I’ll buy a blood glucose monitor and see what sort of effects my diet is having, and if I need to make any changes to prevent diabetes.
I hear you. Paleo = NO bread. I am not choosing to go that far. Seven months ago I had grains at the base of the food pyramid at ~ 40% of my daily calorie intake. Now it is less than 5% and the idea of eating a foot long subway is not appetizing to me at all right now. I am genetically European and I eat dairy and I consume alcohol; it is interesting and disturbing to observe at first hand people who dairy and alcohol make physically ill because they have some different G-A-T-C sequences deep in the works of the organism.
It is a mystery at this point. I have the latest American Dietetic Association Complete Food and Nutrition Guide. They have the food pyramid with grains at the base just like they showed us all in elementary school. My recent experience is that for my bio makeup that pyramid is not the best guide.
At least some people who are into paleo think that 80% or 90% will give you almost all the benefits.
Paleo diets generally consider corn a grain so you might want to avoid that. Some paleo variants (like the one I’m currently following) are ok with cheese and yogurt in moderation (and butter).