Do I get the rant over with now?

Do I get the rant over with now?

Yes, I probably should.  Did I mention that I am a Registered Nutritionist?  I studied for 4 years and then worked in the field of evidence based nutrition for quite a long time (in Government Departments in the UK mainly) before going freelance.  There are a lot of people out there calling themselves nutritionists and a whole chunk of them are not regulated in any way, some believing wholeheartedly a load of stuff that quite frankly can in no way be healthy or fix, cure, detox anything.  Some make a lot of money out of following theories that are pure pseudoscience or some misrepresented science, some of which comes from practices of charlatans that really don’t care that their theories are flawed. As you may guess that can annoy me a bit.

Of course some nutritionists that are not registered can be excellent and some that are registered bad at their job – so I don’t want to offend people who take care about the advice they give, research thoroughly and understand the responsibility they have giving people advice that could affect their health.

I like this graph – it shows how someone with a little knowledge can be the person most easy to listen to because they have a confidence that far outweighs their knowledge.

Image result for dunning kruger effect graph

The experienced nutritionist will often answer the question with ‘it depends’ or ‘for most people it is this way but for some…’ – there is rarely complete black or white.  But for someone who has not learnt the complexity of human biology and science generally, it is very easy to be very sure and give simple absolute messages.  Some of which are really not balanced or healthy.  But at the same time very appealing.

To read some examples of the dunning-kruger effect in the nutrition world being torn down then have a read of The Angry Chef blog – out to challenge pseudoscience in the world of food.  He also demonstrates the other known phenomenon he refers to as

Brandolini’s Law, stating that –

‘The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.’

If you don’t mind a bit of swearing then Angry Chef is a great read – he rants well.  I share a lot of his frustrations.

My shared frustration becomes greater when pseudoscience is aimed at people with long term health conditions.  And here begins my rant proper.

I have no problem with sharing your own experiences with a view to help others.  Isn’t that what I am doing right here!!  And no, I don’t want to be all smug and self-righteous that I am a proper scientist so clearly I am superior.  IC is a condition that science really hasn’t got fully to grips with, there are still big questions about what causes it, everyone seems to respond differently to treatments and diets.  So there is scope for people to say that they did things and it made a difference for them – science or no science.  Some complementary therapies are going to help and we won’t know why – and as long as there is no risk of harm who cares if the person is feeling benefits.  But – oh yes there is always a but…..

My anger started with extreme exclusions diets. They made me angry.  There was just no way people could really have a balanced diet on some of these diets.  This is not exclusive to IC but also for MS and cancer to name just two.  People could really feel unwell on some of these diets followed to the letter, cancer patients have died when they needn’t have.  Not to mention having the joy of eating and socialising around food stripped away.

An honest blog about someone trying something and feeling better is one thing, suggesting it might help someone else. I struggle with the ‘I did this and my x is cured, so now I am an expert, buy my book/supplements/products/therapy sessions – this will work for you’.  These theories should be tested and assessed in a scientific way, if they are so miraculous then let us explore the hows and whys, refine the theory make it better. Assess the downsides and minimise them.

We would be told there is no need – this doesn’t work in conventional science, people are following the regimes and they are happy, it is working for them, their testimonials are evidence enough surely? Or naively – look at me as the proof.  Sorry but a sample size of one, with no control group or any control of other important factors cannot be evidence.  That is anecdote, not evidence.  Who is following the people who tried the regime with no benefit?  And often someone is making money, so why would they want to question it.

It is the usual suspects getting bandied about – the leaky gut, candida overgrowth, the evil that is gluten, sugar and dairy, we are being poisoned by chemicals, GAPS diets cures everything, the nightshade family of vegetables, paleo diet is also miraculous etc.  There are scientific reasons to question the plausibility of these theories and there is reliable reasons why some of the resulting diets could have detrimental effects on health and well being, particularly in the long term.

Just because some idea has started with some logical premise doesn’t mean that it would stand up in the face of decent scientific testing.  Just because a few people believe that this thing they have done worked for them (this thing that no-one has objectively investigated to see if the thing that was changed was really the cause of their improvement) doesn’t automatically mean that it will work for everyone.  And some of these blogs can be so sure of themselves, so absolute that the person who hangs their hopes on this regime but for whom it doesn’t work is left feeling worse for having tried, more depressed with their condition, feeling inadequate that maybe they were just not sacrificing enough.

And this is the thing.  I am a sufferer of IC.  I am that vulnerable person.  I want that cure.  I want to be symptom free.  I want to believe that if I did this thing or ate that food or took that supplement I would get the bladder of my dreams back.  I question whether I am just too lazy to give these regimes a go and that if I sacrificed enough then maybe I could be fixed.  If you are in pain, if your day to day life is pulled apart because of the effects of a condition, you are in danger of being tempted into doing all sorts of things that a rational, well individual would not.  Pay silly sums of money. Take herbal supplements that are not required to pass rigorous tests in the same way as drugs because they are considered to be food.  Follow crazy diet regimes that are no way healthy in the long term not to mention impossible to enjoy.

But I have my head rooted in evidence based science.  It is impossible to set that aside.  I sometimes read these blogs or diets or adverts for a supplement and I am tempted.  Then I run my test.  Does it sound too good to be true?  Is someone making money out of this advice, is there a conflict of interests here?  Is there a risk of harm or any negative effects with no certainty of benefit?  Is there any evidence at all that might sway me?  Generally, the answers to those questions lead me to ‘not trying that then!!’

Angry Chef – could I borrow Captain Science and Evidence Warrior to help me out here!!  I need them.  You and your team could widen your net to pseudoscience aimed at us poor souls with weird rare conditions that no-one has heard of!!

IC limits your diet naturally – there are foods that aggravate the symptoms without a doubt.  There are foods that seem to affect most IC people and others that seem to be a problem only for some.  But more on diet later.  I think it is also important to remember that the symptoms are influenced by things other than diet which makes identifying problem foods hard and why diet alone, for most people, will not fix IC entirely.  Of course there will be some people who feel that diet alone works for them but there is no guarantee that following a diet will work for you just because someone said that it worked for them.

I don’t want to sound a killjoy – that there is no hope. Of course there is and I know things work even though there is no evidence.  If something works for you and does you no harm then go on and do it.   Enjoy that it works, share what works but don’t give the impression that it is a miracle cure that will work for everyone. Don’t peddle false hope. It may be your miracle but it might be someone else’s pipe dream that leaves them disheartened.

But be responsible on how you share what works for you with the world.  Don’t try to explain it with pseudoscience and make it sound all legitimate if there is no evidence. Be honest. I think there needs to be a lot more responsibility and care by bloggers in this field. I think the backlash on clean eating and the effect that this style of wellness blogging could have on those with a susceptibility to disordered eating should be widened.  Wellness blogging to other vulnerable groups has to be responsible too – in some ways it is even more important.

The real distrust in science is not good but there seems to be a move to challenge that and regain public trust in what good science tells us and also how science is communicated.  That is so important.  Scientists connecting with the public explaining why good science is important and what it looks like when science is done properly. How to differentiate good, sound information from bullshit.

I know there is a lot of debate about how to interpret data. Opinion can change, science can be flawed, it can take a long time to get to a concensus, sometimes scientists can be biased or worse still encouraged to show findings in a particular manner depending on where the money comes from (or the funders present the findings in a particular light).  But scientists are generally seeking the truth and follow the methods that aim to control for bias.  High quality science will expect scientists to highlight where there may be a conflict of interests.  And then of course, pooling evidence together in large meta-analysis to get a stronger, more powerful sense of what is truly happening and iron out any blips in the data.  Science is more reliable than bullshit. Fact.

Unfortunately, bullshit, with its absolutes and its simple messages often wins the battle of hearts and minds. And remember, ‘the amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.’