From the Editor
Have you ever seen the movie “Amélie”? If you haven’t, you should.
It’s my favorite movie, and not just because I’m a sucker for romantic comedies. Surprisingly, the (admittedly sanitized) version of Paris portrayed in the movie is full of nutrition-and-health related points. Let’s break it down.
SCENE 1: Raspberries
Food is central to French culture. Even before the movie begins, we see our heroine as a child, eating raspberries one by one, as they are attached to each of her fingers. Across the Atlantic, this scene is less likely. Children in the U.S. tend to have diets that are nutrient focused, rather than food focused. A sugary cereal fortified with vitamins and minerals is still a glorified sugar-to-mouth delivery vehicle.
Raspberries are sweet, tart, and delicious. But they’re not as efficient or easy of a sugar-to-mouth delivery vehicle as sugary cereal. You can’t advertise that raspberries have “100% of the RDA for 12 vitamins and minerals!” because they don’t (and they don’t need to). Cereal has the upper hand in many logistical areas: it doesn’t go bad after a few days, it’s super cheap per calorie, and there are dozens of cereal types, but not many raspberry varieties.
Don’t weep for the raspberry, weep for the monstrous U.S. food system that skews food costs along with our taste preferences.
SCENE 2: Introducing Lucien
Amélie is a fan of the very-slightly-developmentally-disabled worker at the local produce stand. "She likes the way he handles each endive like a precious object, to be treated with care. It's his way of showing his love of good work."
First off, why can’t we have local produce stands with fresh endives?? It bears repeating: darn you, US food system. Second, food just takes way more time in France than in the U.S. At restaurants, waiters rarely rush. People often go to two or more places to get groceries on a regular basis, and small specialty shops abound. This has been changing over the past few years, unfortunately. But for now, France still treats food with care, whereas the U.S. commoditized and markets the hell out of it.
SCENE 3: Amélie’s famous plum cake
Spoiler alert: skip over this paragraph if, for some weird reason, you haven’t seen the movie.
The movie ends with a touching scene. After an entire film’s worth of schemes to meet her probable one true love, Amélie’s inner shyness prevails and she wimps out. She relegates herself to imagining what could have been, in a daydream where she’s making her famous plum cake, and then hears her beau sneaking up behind to surprise her. Alas ... it’s just her cat (not a bad consolation prize, though) and Amelie starts to weep.
What ties these three scenes together? Delicious, real food, often prepared and consumed with care. Nutrient micromanagement isn’t likely to make a cameo appearance.
European eating practices tend to align more closely to the Slow Food movement than the Low Carb movement, Sugar Detox movement, or If It Fits Your Macros movement. If you’re looking to change something this New Year, try this: slow your roll, savor your food, reap the rewards.
Editor-in-chief, Nutrition Examination Research Digest
Out of all the things I find annoying about health research studies, this one comes up the least often in discussion:
Treatments are often compared to placebo controls, but rarely to other treatments. Which is not surprising, given that the aim of studies is to ascertain a treatment’s effect. There is no obligation beyond that.
Why is this issue important? Here are some ways in which placebo comparison can be misleading:
It stacks the deck
If you test MusclePump 5000 against placebo, it might show pretty serious benefits for muscle growth (Note that while MusclePump 5000 isn’t currently a product, there’s a decent chance it will be in the future. The pool of muscle-y product names is growing dry.).
The problem is that MusclePump 5000 has both protein and carbs in it, which have already shown benefit for muscle growth. What if they had tested the product against an equivalent amount of non-proprietary-blend carbs and protein? That would probably drastically lower the appearance of benefit.
Placebos are rarely the standard of care
In some cases, researchers only care if something works. In other words, is it better than nothing / placebo / some other control? But, sometimes there is already a commonly-used treatment.
There are occasional examples of supplements being tested against pharmaceuticals. One is St. John’s Wort for depression – since it has a similar mechanism as some existing drugs, the comparison is natural. But these examples are few and far between. Prescription fish oil isn’t tested against over-the-counter fish oil, despite over one billion dollars spent on the prescription product every year. How much of this extra cost is actually necessary?
It makes statistical comparison nearly impossible
If you read a group of studies that say beet juice helps blood pressure, and a group of studies saying that kale juice helps blood pressure, what do you do as an individual? Well … a decent chunk of people would end up using both beet juice and kale juice. After all, the studies aren’t directly comparable (different doses, study populations, etc.), so might as well get the best of both worlds and take everything at once.
There is a statistical technique that’s very occasionally used to make indirect comparisons between treatments, called “network meta-analysis,” but it’s a bit complex and not always appropriate. In absence of that, we have thousands of studies but no great way to compare them.
All that being said, it’s not really possible to include multiple treatments in most studies. Getting funding for a trial is hard enough, so getting even MORE funding to add a study arm that might diminish your main findings? Not happening. But if there were just a few more major comparative studies done, it would make patients’ lives easier, and my job translating evidence a bit easier as well.
Editor-in-chief, Nutrition Examination Research Digest