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Issue #50 (December 2018)

From the Editor

Volume 1

We cover a lot of research in the NERD that looks at the possible benefits (or lack thereof) of nutritional and supplemental interventions. We don’t spend quite as much time covering the harms, though. In this volume of the NERD, we rectify that, at least a little bit, by covering two different studies focusing on the dark side of supplementation — one in a full NERD review, and one in an NERD Mini.

There are a couple of reasons why we don’t focus on research covering the harms of nutritional interventions. The first is that there just isn’t as much published on the topic. The second is that what is published tends to be weaker evidence, such as observational studies, secondary analyses of trials, or animal studies, as opposed to randomized controlled trials. There’s an excellent reason for this: it’d be pretty unethical to design trials whose main outcome is harm! So, it’s the nature of the beast that we usually have to use weaker evidence when it comes to safety.

The level of evidence we’re talking about may be apparent to you when you read the two reviews. One of them covers a secondary analysis and follow-up to a clinical trial involving vitamin B12 and folate supplementation. The other is an observational study of serious adverse event reporting. What sets these two studies apart is that they deal with big negative effects — the former looks at cancer incidence, and the latter looks at serious problems in general. Given that these are really bad outcomes to get from taking a supplement, it’s okay to not demand absolute certainty or even really strong evidence before raising an eyebrow.

Of these two, I put a little more faith in the results of the B12 and folate study looking at cancer incidence since it’s a follow-up to a randomized controlled trial. Even though it’s a secondary analysis, the randomization to treatment or placebo done at enrollment still helps us infer a stronger causal link than if this were an observational study. Mechanistic considerations and previous research relevant to the topic also help.

The results of the adverse event reporting study we cover in the NERD Mini should probably be taken with a bigger grain of salt in terms of causality, although I still think it paints a plausible picture of the leading supplemental culprits when it comes to serious adverse effects. It’s far from surprising to me that fat burning and weight loss supplements lead the pack, again based on previous research and thinking about mechanism.

Evidence is rarely airtight — instead, it comes in shades of grey. It can either speak for or against a hypothesis, and can be strong or weak. While the evidence we present here concerning the possible harms of taking certain supplements isn’t very strong, I still think it’s worth bringing to your attention, since avoiding harm is just as important as getting benefits from supplementation, if not more so.

Gregory Lopez, MA, PharmD
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

It’s the end of another year at Examine.com and, presuming you’re following the Gregorian calendar along with us, for you, too! Kamal, our former NERD editor-in-chief and current Examine.com director, recently e-mailed out his end-of-year thoughts concerning Examine.com as a whole, so I thought I’d do the same for the ERD-verse.

At this point, the NERD is just over four years old: the first issue came out in November of 2014. Over that time, a lot of things have remained the same. For instance, the NERD still focuses on high-quality, in-depth dives into recent research. Also, our very first issue covered research on fish oil, a supplement we also cover in this volume. This shouldn’t be much of a surprise, since there’s a lot of research on fish oil, as anyone who’s ever scrolled through our fish oil page on Examine.com can attest to!

While some things have stayed the same since the NERD launched, other things have changed. For instance, we split the NERD into two volumes versus the single larger monthly volume that we started out with. A more recent change is the introduction of a new article format this year: the NERD Mini. In the past, we normally had interviews alongside our deep dive reviews, which made for the bulk of the NERD. This year, we mixed things up a bit by replacing some interviews with this new format. The goal of an NERD Mini is to give you a quick rundown of recent guidelines, consensus statements, or studies that may have some interesting points that are worth laying out for you as quick take-homes, but that aren’t necessarily a good fit for a deep dive. We’re still experimenting with the format a bit to see what works best.

We’re also working on some possible changes for next year. Much of the Examine.com team has been hard at work over the past several months surveying and interviewing current and past NERD subscribers to see what you get out of the NERD, what you like about it, what you don’t like, and what you’d like to see changed. In 2019, we’ll analyze this info in order to make the NERD meet your needs even better.

Some of you have already shared your thoughts about the NERD with us. For those of you who haven’t (or if more’s popped into your mind since you chatted with us), I’d like to ask for your input and impressions of the NERD. What would you like to see from us in 2019? What aspects of the NERD are must-haves? What would you like to see changed? Feel free to let us know through our contact form or to chat about it in the NERD Facebook forum. After all, you’re the ones we’re doing this for, so if you have some ideas of how to make the NERD suit your needs more, we’re all ears!

Gregory Lopez, MA, PharmD
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #50 (December 2018) of Study Deep Dives.