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Issue #16 (February 2016)

From the Editor

Volume 1

Randomized trials are overrated. There, I said it.

On one hand, their importance is hit-you-over the head obvious. In fact, the editor-in-chief of this research digest (that would be me) was once involved in a project compiling the 100 most important randomized trials of all time, starting from the very first trial by James Lind in 1747 that randomized sailors to different groups (including a sulfuric acid group and a seawater group … ewww) and found vitamin C prevents scurvy.

On the other hand, RCTs are just one facet of evidence. And if there’s one thing most people aren’t great at, it’s evaluating complex research bases. Well, maybe that’s not the main thing most people aren’t great at, but you get what I’m saying. Randomized trials are known as the “gold standard” of evidence. That relegates everything else, from case-control studies to animal research, to something akin to evidentiary poop.

So, who cares? As long as the researchers know how to evaluate an array of evidence, everybody outside the ivory tower can relax. If only it were so easy.

First of all, researchers by and large don’t actually know how to evaluate different types of evidence. I’ve heard some deliciously weird quotes from academics, ranging from “That’s from a meta-analysis? I don’t follow that bullshit.” to “It kills mice? Who cares, we’re not mice!”

Most importantly, some of the most basic things in life cannot or will not be studied by randomized trials. The hospital I previously did research at, Tufts Medical Center in Boston, has a pediatric hospital called “The Floating Hospital for Children.” It’s called the Floating Hospital because it used to be an actual boat. Can you believe that?

The story goes like this: over a hundred years ago, one intrepid soul started taking sick children out on a boat, where they could get fresh air and sunlight, and also be seen by volunteer doctors and nurses. The children loved it! As would approximately 100% of non-children, plus the vast majority of modern hospital patients stuck in rooms smelling of chemicals.

Not to spin a conspiracy theory, but here goes … the sun and the wind are not patentable (I think?) so there’s no money to be made by studying their health effects. Randomized trials testing the sun’s benefit number in the dozens, compared to over a thousand trials of fish oil.

This phenomenon appears all around the health-o-sphere. For example, fecal transplants could be a huge boon for people with certain chronic diseases, but very, very few trials exist. Poop is tough to profit from. Light therapy has shown much promise for conditions ranging from depression to fibromyalgia, but you’re much more likely to get a quick prescription for an SSRI than an order to get 30 minutes of sun exposure each day.

Since 1747, the number of randomized trials has grown at a seemingly exponential rate. This is assuredly good news, but also bad news if we can’t escape the haze of randomized trial myopia.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

The protein research deity Stu Phillips penned the op-ed for this issue, and since protein is always on people’s minds, I figured I’d write a bit about protein here. But, not without rambling a bit first.

Have you ever heard of the “80/20” rule? Although it’s a classic economics rule-of-thumb, more recently it’s been (mis)applied to habit change. This rule, also called the Pareto Principle, after the original creator Vilfredo Pareto, says that 80% of outputs are driven by 20% of inputs. So a small chunk of what you do on a daily basis drives a BIG CHUNK of how your life goes.

The arguably main way that 80/20 is perceived nowadays is as a rule for how often to cheat. Like if you stick to a diet 80% of the time, it’s cool if you eat outside of the dietary rules 20% of the time.

While these concepts may seem a bit similar at first glance, they are actually somewhat opposite. The Pareto Principle says that there are some key moments that are very, very important. The 80/20 rule says that if you do what’s right most of the time, you can relax the rest of the time. In other words, one rule says to focus on the minority of your time/actions, and the other rule says it’s all okay as long as you stick with the program for the majority of your time/actions.

Now how does this apply to protein intake? Well, protein is not just a big deal in the supplement sales world, but it’s also the most popular topic on Examine.com. People eat up protein research like cookies and cream deluxe whey protein. And for good reason: getting enough protein is not just important for gaining and retaining muscle, but also for dampening hunger and supporting many physiological functions.

While all this focus on the details of protein intake is great for a competitive bodybuilder or even the intermediate-level gymrat, it can also be used as a crutch for the unhealthy masses who are looking for an understandable (often simplified) message. Do we need cereal bars fortified with protein? No. Does “protein doesn’t hurt your kidneys and liver” mean that you should eat massive amounts of protein each day? No. Should you focus on amino acid levels when your carb/fiber/fat quality isn’t high? No.

When it comes to hectic modern lives, with thousands of food choices and much opportunity to eat non-nutritious food, Pareto’s idea applies more than ever. It’s great to learn more about protein, but what impacts a typical person’s physique is much less likely to be protein intake (which gets a ton of attention) and more likely to be something as simple as that two hour period when you were browsing the web instead of going to bed. Poor sleep makes you feel crummy the next day, which then impacts your eating and the hormones that impact muscle growth.

And it turns out that two hours, out of a sixteen hour waking day, is equal to 12.5% of the day. You’ve just born witness to the new and highly unpopular 87.5%/12.5% rule.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #16 (February 2016) of Study Deep Dives.