Is The Mediterranean Diet Really Healthful?

I was thinking about the big Mediterranean diet study that often gets cited to defend that way of eating. It’s nicknamed PREDIMED, short for “Prevención con Dieta Mediterránea.”

Here it is:

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, New England Journal of Medicine, 25 February 2013

Just a refresher … there were 3 groups, about 2500 people in each group. One Mediterranean diet group ate a liter of olive oil a week, one Med. group ate 30 grams of nuts a day, and one group was a control.

The thing I was thinking… 179 people assigned to eat the Mediterranean diet (96 in oil group, 83 in nut group) experienced a “major cardiovascular event” in the ~4.8 years of the study. According to the authors, all 179 had “no cardiovascular disease at enrollment.”

Imagine having no cardiovascular disease, being put on a special diet that was designed expressly to prevent heart attack, and experiencing a heart attack less than 4.8 years later? Dr. Esselstyn took people with advanced coronary artery disease, put them on a low-fat, plant-based diet, and 12 years later they had no more cardiac events! Why isn’t a low-fat, plant-based diet the preferred diet?

Also, there was no difference among the groups for “death from any cause.” (There were 118 in the oil group, 116 in the nut group, and 114 in the control group who died “from any cause.”) The Mediterranean diet didn’t keep people from dying any more than the control group.

I do not believe in the Mediterranean diet. I don’t even know what it is. By the way, PREDIMED was sponsored by oil and nut groups.

Stay Away From These Exercises

This is a continuation of my post on Callanetics, a popular exercise program from the 1980s. …

You wouldn’t think, to see her contort her body in her exercise videos, that Callan Pinckney had a bad back. She did. From birth:

She was born with spinal curvatures, one hip higher than the other and severely turned-in feet. She was forced to wear leg braces for seven years.

When she wrote Callanetics For Your Back, she was consulting not just research (at a time before the internet) but personal experience. She knew what could cause injuries, spasms, and chronic pain.

These could:

Hamstring stretches. Pinckney says, “many people – even those who are classified as fit – have tight hamstring muscles.” This stretches can injure those muscles as well as the lower back, especially if done with locked knees, as below, or bouncing:

Splits, lunges, deep knee bends. Can injure knees and groin.

Back bends, the cobra position in yoga, and this one, the “swimmer.” Any arching or hyperextending the back can cause injuries:

Shoulder stands, bicycling with legs in air, plough in yoga. Can you guess what you’re injuring here? (“The position crunches the more fragile vertebrae of the neck.”) Even neck rolls, when you drop the head back, can do this.

Waist circles and waist bends. Can injure lower back. A safer way to do this is to support your back by placing that lower arm on your hip, and by tipping the pelvis up, i.e. the pelvic wave.

Sit-ups. Very bad for lower back. See Callan’s video in my previous post for how to do this safely. (Lower back should be on the ground.)

Leg lifts, done lying on back or side, even seated. Injures lower back. Note her arched back in this diagram:

Leg thrusts, to back or side. Injures lower back. Again, note her arched back in this diagram. Callan’s “exercises for the hips and behind” are a LOT more effective, I can attest.

These “stay away” positions can damage muscles, nerves, discs, tendons, and ligaments. Some damage can be life-long, especially if you keep reinjuring yourself.

Something else she talks about is losing your balance. I don’t hear this much. Tilting your head back or bending over or swinging your arms and legs vigorously can increase the risk of a fall. If there’s one thing you don’t want to do, it’s fall. No falling.

“Callanetics For Your Back” is a great book. Pinckney had a real passion for and commitment to her work. She was one-of-a-kind.

Callanetics

This is my photo. There are some diagrams inside that I hope to take photos of for a subsequent post.

A few weeks ago I picked up this book from our bookcase:

Callanetics For Your Back, Callan Pinckney, 1988

I wasn’t having back pain. I was just curious what she had to say. I’d done some of the back exercises over the years but not much more.

Callanetics was popular in the mid-1980s. It is a series of exercises that could, according to its developer Callan Pinckney, make you look “10 years younger in 10 hours.” This book of exercises for the back was published a few after her introductory book. It was a bestseller then and the exercises, based on the “pelvic wave,” continue to be recommended for back pain sufferers.

Callanetics is unique:

It is a system of exercise involving frequent repetition of small muscular movements and squeezes, designed to improve muscle tone. The programme was developed by Pinckney from classical ballet exercises, to help ease a back problem that she was born with.

The theory of callanetics is that the surface muscles of the body are supported by deeper muscles, but popular exercise programmes often exercise only the surface muscles. According to callanetics, deeper muscles are best exercised using small but precise movements. Exercising the deeper muscles also leads to improved posture, which may result in the appearance of weight loss even if very little weight was lost.

She’s not kidding when she says “small movements.” For some exercises, she brings her thumb and forefinger almost together and says, “one sixteenth of an inch!”

Here’s Pinckney demonstrating her stomach exercise, which she is keen to say, “This is not a sit up!” Sit-up use (and abuse) the back. Notice here that the lower back is always on the floor, always in repose, not arched:

Why I’ve Come To Distrust Meta-Analyses, Especially Those Funded By Dairy/Egg/Meat Industries

I happened upon this little video on Twitter. It’s why I’ve come to distrust meta-analyses. It’s not just about cherry-picking studies to prove your point, although that’s part of it. It’s about publication bias and statistical analysis bias and design bias. There are so many ways that food industries are employing “science” to promote their products. They don’t have to find their products safe; all they have to do is instill doubt:

Doubt is their product.

Here’s an example of a meta-analysis that is suspect:

A giveaway that this is more advertisement than “science” … You can’t conclude from a study that a way of eating is “wrong.” You can only say that this study did not support that way of eating. Value judgements such as good vs. bad, and right vs. wrong are said purposely to manipulate:

Ian Givens, a professor of food chain nutrition at Reading University, who was one of the researchers, said: “There’s quite a widespread but mistaken belief among the public that dairy products in general can be bad for you, but that’s a misconception. While it is a widely held belief, our research shows that that’s wrong.

This Guardian article is strewn with manipulations. Givens (not just an expert but one of the study’s researchers) says that “drinking too little milk” leads to osteoporosis and brittle bones. It doesn’t, e.g. Milk Intake And Risk Of Mortality And Fractures In Women And Men: Cohort Studies, BMJ, 2014: “Conclusions High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women.”

And this … what a scare tactic!

Pregnant women who drank too little milk could be increasing the risk of their child having neuro-developmental difficulties, which could affect their cognitive abilities and stunt their growth, Givens added.

It’s a disgrace how food industries have co-opted science for their own greedy goals.

The Story Of Lola

This is a good story, a true story.

In the process of showing empathy, it shows, it has to show, human weakness and carelessness and greed and contempt. As I say, red is invisible against a red background … empathy and compassion only emerge against a background of their opposites.

Have economies always been erected upon the labor of an underclass? Is that how it works?

Placebos Work Even When You Know It’s A Placebo

Placebos, commonly thought of as fake treatments that people think are real, have been found to be helpful even when people know they’re fake.

A Placebo Can Work Even When You Know It’s A Placebo, Harvard Health, 7 July 2016

What if people were told, up-front, that they were getting a placebo and not an active medication? It stands to reason the placebo would have no effect. Right?

Wrong.

Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School, has been studying placebos for more than 20 years:

In one study, Kaptchuk looked at people with irritable bowel syndrome (IBS), a common condition that causes abdominal cramping and diarrhea or constipation that can be debilitating for many. Half of the study volunteers were told they were getting an “open-label” placebo and the others got nothing at all. He found that there was a dramatic and significant improvement in the placebo group’s IBS symptoms, even though they were explicitly told they were getting a “sugar pill” without any active medication.

Here’s that study:

Placebos Without Deception: A Randomized Controlled Trial In Irritable Bowel Syndrome, PLOS One, December 2010

Kaptchuk also found open label placebos were useful for back pain. This is from: Fake Pills Can Work, Even If Patients Know It, NPR, December 2010

And Kaptchuk and his colleagues found the same effect among people with garden-variety lower back pain.

All the participants were told that the placebo was an inactive substance containing no medication.

Then half the group was assigned to simply continue their usual treatment regimens, which included things like non-opioid painkillers, rest and alternative or complementary remedies. The other half were assigned to continue with their usual treatment, but to also take the placebo.

Participants rated their pain levels and their difficulty in performing daily activities, like getting dressed or climbing stairs, at the beginning and the end of the three-week study. And researchers found that people who received the placebo saw their scores for both usual and maximum pain levels drop by 30 percent, compared to 9 percent and 16 percent declines for the control group. The placebo group also reported a 29 percent reduction in their score for difficulty in performing daily activities, while the control group saw no change. (A higher score on that test indicated more difficulties.)

Here’s that study:
Open-Label Placebo Treatment In Chronic Low Back Pain: A Randomized Controlled Trial

So, in many cases, it’s definitely not the pill:

But there’s no question that people also benefit from the entire interaction with a physician. “It’s absolutely not the pill,” Kaptchuk says. “It’s what surrounds the pill,” he says. That includes a trusting relationship between the doctor and patient. In that situation, if you think the treatment might possibly work — even if you have been told the pill is inactive, as in the back pain study — the brain can fill in the picture and improve symptoms, he says.

Two things here:

    • How many drugs on the market (money-making drugs) do something more because of doctor-patient relationship than because of any effects of the pill?
    • If we suspect something might be helpful, even when another part of our brain says it can’t be, why not go with it?

Our Understanding Of How The Body Deals With Salt (Sodium) Is Changing

A refresher: When you burn a fuel, say wood, in the presence of oxygen, it gives off energy (in the form of heat and light), and it yields gas (e.g. carbon dioxide) and water.

In our body, that combustion process is called cellular respiration, the fuel can be fat or glucose. In the process of respiring, glucose and oxygen yield the same carbon dioxide and water. The reaction also gives off energy, some is trapped or stored in the bonds of a chemical called adenosine triphosphate (ATP), and some energy is given off as heat (which keeps our bodies warm).

Glucose + Oxygen → Carbon Dioxide + Water + ATP

So, our body can actually make water. We make it by burning a fuel.

With that background … Here’s the thing I just read about salt:

It reminds us of this, which I was taught, and always believed:

If you eat a lot of salt — sodium chloride — you will become thirsty and drink water, diluting your blood enough to maintain the proper concentration of sodium. Ultimately you will excrete much of the excess salt and water in urine.

But when researchers gave Russian cosmonauts a lot of salt:

Instead of drinking more, the crew were drinking less in the long run when getting more salt. So where was the excreted water coming from?

“There was only one way to explain this phenomenon,” Dr. Titze said. “The body most likely had generated or produced water when salt intake was high.”

So, the water that the body uses to flush out extra sodium doesn’t come only from what we drink, but also from what we make, either through respiration or water conservation (e.g. reabsorption in the kidney). These processes use energy, which might make people hungry?

Another puzzle: The crew complained that they were always hungry on the high-salt diet.

There was some discussion about how high-salt diets could lead to weight loss because they increased energy expenditure:

Experiments found that mice burned more calories when they got more salt, eating 25 percent more just to maintain their weight.

But trying to capitalize on this as a way to lose weight seems fraught. The hormones involved in water conservation can also lead to osteoporosis, muscle loss, and type 2 diabetes (according to study author and lead researcher Dr. Jens Titze). That’s a high cost.

Camels can live where water is scarce by breaking down fat in their humps.

All of this seems like a lot of trouble to go to just to find water in the body. But it would work if it happened that no water was coming in … which is one way animals like camels get fluids without actually drinking.

Here are the studies that this article was based on:

High Salt Intake Reprioritizes Osmolyte And Energy Metabolism For Body Fluid Conservation, The Journal of Clinical Investigation, Online 17 April 2017

Increased Salt Consumption Induces Body Water Conservation And Decreases Fluid Intake, The Journal of Clinical Investigation, Online 17 April 2017

Editorial: Salt And Water: Not So Simple, The Journal of Clinical Investigation, Online 17 April 2017

So, it’s not true that eating salt will make you thirsty. In fact, it does the opposite, it makes you less thirsty, because internal water-making kicks in. But it’s true that eating salt makes you hungry, for the same reason: water-making uses calories that you are primed to replace.

You know who will love these studies? Food manufacturers. Put a little extra salt in their products and it will have us coming back for more.