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Carbohydrates- part 1

April 11, 2014

I´m a big fan of carbs and I usually eat quite a lot of them. From bread to pasta, to rice, I love them. Although lately they have been getting a bad rap and most people when losing weight are trying to take them out. Even though different studies have shown that the most important factor in these types of diets is the percentage of proteins you eat. In other words, it really doesn´t matter if you go on a low fat diet or a low carb diet, both of them will be more or less effective if you keep your protein intake high (1-3). But anyway, let´s try to explain carbs in simple way.

Carbs are your body´s preferred and most efficient energy source for intense training. Carbs can be stored in the muscle and in the liver as glycogen. Carbs can be divided into two groups more or less, SIMPLE CARBS AND COMPLEX CARBS:

Simple Carbs: consists of a single sugar molecule (monosaccharide) or two molecules linked together (disaccharide)

Monosaccharides: Include fructose, glucose and galactose.
Disaccharide: Which is formed by a combination of two monosaccharide molecules. So for example sucrose (which is table sugar) is formed by the combination of fructose and glucose. And lactose (dairy sugar) is composed of lactose and glucose.

*Simple Carbs are digested quickly and cause a rapid rise in blood sugar, but they also cause a rapid fall after. Meaning you eat these and after a while you are again hungry! That is why you should be careful with simple carbs, especially if they are not natural. Now this doesn´t mean you shouldn´t be eating fruits. Fruits have a lot of fiber and this cause that the rise in blood sugar to go more slowly and on top of that fruits have a lot of phytochemicals (lots of healthy things ;).

Complex Carbs: Also know as polysaccharides. Most complex carbs contain fibre and they provide sustained energy without the highs and lows you get after eating simple carbs. You can divide the complex carbs into two groups.

Starchy Carbs : Which include potatoes, yams, oats, beans, brown rice, lentils, green peas, corn, pumpkin, whole wheat.
Fibrous Carbs: Which include broccoli, spinach, asparagus, cucumber, tomatoes, cauliflower, brussels sprouts, onions, peppers, mushroom, aubergine, lettuce .

We should try to eat more fibrous carbs because of the fibre. Like I said before, fibrous foods take more time to chew and swallow and they have a low calorie density!!

So to summarize, carbs are not that bad and we SHOULD be eating them. The only thing to watch out for is make sure these carbs are ¨NATURAL¨ and not processed, and when eating carbs remember the word ¨dark¨, meaning, you should be eating ¨dark¨ bread, ¨dark¨ pasta and ¨dark¨ rice. And if you want to lose weight try to switch from starchy carbs to fibrous carbs!!

Hoped you enjoyed it!!

References

Hu T, Mills K, Demanelis K, Eloustaz M, Yancy W, Kelly N T, He J, Bazzano L. Effects of Low carbohydrated diets versys Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials. Am J Epidemiol. 2012 October 1; 176: S44-S54
Loria-Kohen V, Gomez-Candela C, Fernández-Fernández C, Pérez-Torres A, Garcia-Puig J, Bermejo LM. Evaluation of uselfulness of a low calorie diet with or without bread in the treatment of overweight /obesity. Clin Nutr.2012 Aug;31 (4): 455-61.
Soenen S, Bonomi AG, Lemmens SG, Scholte J, Thisjssen MA, van Berkum F, Westerterp-Plantenga MS. Relatively high-protein or ¨low-carb¨energy-restricted diets for body weight loss and body weight maintenance. Physiol Behav 2012 Oct 10;107(3):374-80.

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Fats- What are they and how do we classify them?

April 7, 2014

We always talk about fats, protein and carbohydrates but a lot of people really don´t know what they are. So, if they don´t know what they are, how are they going to understand what we are talking about? So in my next blogs I will just try to give a brief description of each macronutrient and some vital information that most people should know. Today we will start with FATS.

We should all know that 1 gram of fat contains 9 calories, this is more than 1 gram of carbohydrates (which contains 4 calories), and 1 gram of proteins (which also contains 4 calories).

Fats can basically be divided into:

Saturated fats (read more here)
Unsaturated fats.

We used to think that saturated fats were really bad for us (and I did 2 blogs on it), but now we know they are not that bad and should be included in our diet once in a while. You can find saturated fats in these foods: butter, cheese, dairy fat, chocolate, egg yolk, meat fat….with the exception of the tropical oils, saturated fats are primarily animal fats. Saturated fats lack the essential fatty acids you need, so you must balance them with the unsaturated fats.

Unsaturated fats can be divided into:

Monounsaturated fats

Polyunsaturated fats. These contain the healthy essential fatty acids.

Essential Fatty Acids- are those that your body can´t make on its own, so they must be supplied through your diet. The two primary essential fatty acids are omega 6 and omega 3. The modern Western diet today is very high in omega 6 fatty acids as compared to omega 3- with a ratio of 20-1. The optimal should be 2:1 (click here for more information).

One of the reasons for this imbalance is our increased consumption of refined grains and decreased consumption of omega 3 rich fish. As well as the industrial production of animal feeds containing grains high in omega 6 fatty acids. Since animals are what they eat, their meat becomes high in omega 6, unlike the leaner and higher omega 3 wild game that our ancestors once ate. As we consume high-omega 6 meats and refined grains, we lose the natural balance we once thrived on and begin to suffer from inflammatory and cardiovascular disease that were once unheard of. Many of the current diseases develop and exist as consequence of chronic inflammation, such as cancer, heart disease, hypertension, osteoarthritis, diabetes, osteoporosis, etc. (1-4)

FATS TO AVOID: HYDROGENATED AND TRANS-FATTY ACIDS- We could say these are the ¨processed fats¨. Hydrogenated oils contain large amounts of chemically altered fats know as trans-fatty acids and these are one of the unhealthiest foods you can eat. You find these fats in food like: MARGARINE, CRACKERS, DOUGHNUTS, PIES, BISCUITS, FRIED FOOD. Epidemiologic evidence has linked trans fatty acids (TFAs) in the diet to coronary heart disease in human populations. It has been estimated that dietary TFAs from partially hydrogenated oils may be responsible for between 30,000 and 100,000 premature coronary deaths per year in the United States. (5).

So in conclusion: Saturated Fats are not that bad and once in a while you can eat them. Unsaturated fats are called the ¨healthy fats¨ and again we should be eating them in our diet. On the other hand, we should really try to stay away from the hydrogenated and trans fats!

Hoped you liked it.

References

Balkwill F, Mantovani A. Inflammation and cancer back to Virchow? Lancert.2001;357:539-45.Ban WA, Man SF, Senthilselvan A, Sinn DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and meta-analysis. Thorax 2004;59:574-80.
Fernandez-Real JM, Ricart W. Insulin resitance and chronic cardiovascular inflammatory syndrome. Endo Rev 2003;24:278-301.
Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340:115-26.
Seaman DR. THe diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physio Ther 2002;25:168-79.
Zaloga GP1, Harvey KA, Stillwell W, Siddiqui R. Trans fatty acids and coronary heart disease. Nutr Clin Pract.2006 Oct;21(5): 505-12

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Clinical Trials- The importance of them; Ensayos clínicos

March 31, 2014

A lot of people sometimes base their claims on scientific studies, but the funny thing is they don´t even know how to understand that scientific study and, just because a scientific study comes out, it doesn´t really prove anything, especially if the scientific trial is not done correctly. So, I just want to highlight some interesting points that most people should know. Below I have also translated it into spanish.

The scientific study should be RANDOMIZED: This means that when we do a study, we should assign patients to each group ¨alternatively¨ and ¨indiscriminately¨. Let´s use an example: I´m testing this new pill for a headache. I have 2 groups, the group that is receiving a pill and the group that is not receiving anything. Imagine in one group I put young people, who exercise, eat properly and have no history of headaches, and in the other group I put obese people, who don´t do any sports and have a history of migraines. This would affect my results. But if the patients are randomly assigned to groups, then it can be assumed that both groups will be broadly similar in terms of any factor, such as age, income, gender.

The number: The more patients in a study, the better.

Sometimes it is not possibile to do a randomized scientific study so they do a ¨prospective cohort study¨ or an ¨observational study¨. This is a step down from a randomized trial but, if done properly, you can still come to decent conclusions. This studies are usually done for long term health issues. For example they did this kind of test in the 50´s to see if smoking was bad. What they did in this study was:

The participants had to be established smokers or really Non-smokers, meaning they had never smoked in their life.
The participants had to be reliable and dedicated.
In order to control for other factors, it would help if all the participants were similar in terms of their backgrounds, income, working conditions.

So they got DOCTORS, over 30,000 doctors, and they observed them during 5-10 years. That is how they proved that smoking is horrible to our health.

Ok, so now that we know that there are at least 2 types of scientific studies. And we also know that a randomized trial is usually better but it should follow certain rules:

We have to test for PLACEBO. A genuine medicine offers a benefit that is largely due to the medicine itself and partly due to the placebo effect, whereas a fake medicine offers a benefit that is entirely due to the placebo effect. So for example, in the example I used about the headaches, I would also need a group that is taking a ¨fake pill¨ which would be my control group. In other words, I would have one group who takes the real medicine, another group that takes nothing, and a third group who takes a fake pill. If this is done then it´s called a RANDOMIZED, PLACEBO CONTROLLED TRIAL
Blinding- meaning the patients don´t know what they are getting, the real or fake treatment. This is really important and can affect the outcome of the study!! But, it is also CRUCIAL that both the control group and the treatment group are treated in similar ways, because any variation can potentially affect the recovery of patients and bias the result. If this is done then it´s called a RANDOMIZED; PLACEBO CONTROLLED, BLIND CLINICAL TRIAL
Double blinding- Meaning whoever is administering the treatment or placebo should also be ¨blind¨. This is because a doctor´s demeanour, enthusiasm and tone of voice can all be affected by knowing that he or she is administering a placebo, which means that the doctor might unconsciously give hints to the patients that the medicine is merely a placebo. If this is done then it´s called a RANDOMIZED, PLACEBO CONTROLLED; DOUBLE-BLIND CLINICAL TEST and this is the GOLD STANDARD of clinical trials!!

So next time you see a study, lets try to look for these things to see how serious the study really is.

Este va a ser uno de mis post más importantes y por eso he decidido traducirlo al castellano. Muchas veces nos basamos nuestras conclusiones en diferentes estudios que hemos visto o leido, pero lo gracioso es que muchas veces verdaderamente no entendemos esos estudios. Y solo porque veamos un estudio que llegue a una conclusión, no signifique que la conclusión sea verdadera, ya que el estudio puede haber tenido varios fallos. Entonces, ¿en que cosas nos tenemos que fijar para saber si un estudio es válido?
1) Que el estudio se ALEATORIO: Esto quiere decir que cuando se hace un estudio los pacientes de este estudio tienen que haber sido elegidos ¨alternativamente ¨ e ¨ indiscriminadamente. Por ejemplo: Imaginaros que estoy haciendo un ensayo clinico sobre una pastilla que supuestamente quita el dolor de cabeza. Tengo 2 grupos y en uno de esos 2 grupos pongo a gente que es deportista, come bien, poco estres, y joven. Y en el otro grupo pongo a gente mayor, obesa, depresiva, y no hace deporte. Lo más seguro que esto afectaria los resultados de mi estudio. En cambio, si los pacientes son asignados al azar a los diferentes grupos, se puede suponer que ambos grupos serán muy similares en términos de cualquier factor, como la edad, el ingreso, el género y salud.
2) El número: Fijaros en el número de pacientes que tiene ese estudio. Si ese estudio se ha hecho en una persona o en pocas personas los resultados no se pueden extrapolar. En cambio, si el estudio tiene a 500 pacientes pues las conclusiones seran más validas e fiables. Entonces, cuantas más gente en un estudio mejor.

*A veces no se puede hacer un estudio científico aleatorizado así que se hacen otros estudios, cono un estudio de ¨cohorte prospectivo ¨ o ¨un estudio de observación ¨. Estos estudios no son tan fiables como los ensayo aleatorios, pero si se hace correctamente se puede todavía llegar a unas conclusiones dignas. Estos estudios se realizan cuando el estudio va a durar mucho años. Por ejemplo , un estudio muy famoso de este tipo fue el que se hizo en los años 50 para ver si tabaco era perjudicial para la salud. Lo que hicieron en este estudio fue:
•Los participantes tenian que ser fumadores ¨establecidos¨o no fumadores, es decir que NUNCA habian fumado
•Los participantes tenian que ser gente en la que se pueda confiar y dedicados
•Y para controlar otros variables, intentarón elegir a participantes con el mismo estilo de vida en lo que se refiere a, educación, dinero, condiciones de trabajo.

Pues para cumplir estos requisitos eligierón a MEDICOS. En total unos 30.000 médicos. El estudio tenia que durar 30 años pero al cabo de 5 años lo pararon porque ya tenian suficiente información para concluir que el tabaco era perjudicial para la salud humana.
Ok, así, que ahora sabemos que hay por lo menos 2 tipos de estudios científicos.También sabemos que un ensaño aleatorio suele ser mejor, pero para que esto sea cierto el estudio tiene que cumplir ciertas reglas .
1.
Tenemos que contralar contra el efecto placebo. Un medicamento real ofrece un beneficio que es en gran parte debido a la propia medicina y en otra parte debido al efecto placebo, mientras que un medicamento falso ofrece un beneficio que es enteramente debido al efecto placebo. Así que por ejemplo, si estoy probando si un medicamento es efectivo contra el dolor de cabeza,tendre que tener un grupo ¨controlado¨. Es decir, un grupo que toma la medicación falsa sin que ellos sepan que el medicamento es falso. Si en el estudio se ha controlado contra el efecto placebo, al estudio se le llama ESTUDIO ALEATORIO, AL AZAR, Y PLACEBO CONTROLADO

2.
E lciego- los pacientes no saben si están recibiendo el tratamiento real o falso. Esto es muy importante y puede influir en el resultado del estudio! Pero, también es fundamental que tanto el grupo control y el grupo de tratamiento son tratados de manera similar, ya que cualquier variación puede afectar potencialmente la recuperación de los pacientes y el sesgo de los resultados. Si esto se hace el estudia se le llama ESTUDIO ALEATORIO, CIEGO Y CONTROLADO CON PLACEBO .

3.
El doble ciego-que significa que el que está administrando el tratamiento en el estudio no sabe si esta dando la pastilla verdadera o el placebo. Esto se debe a que la conducta de un médico puede influir en el resultado de un estudio. Inconscientemente puede dar pistas ( el entusiasmo, tono de voz) a los pacientes que el medicamento es un mero placebo o que es verdaderamente el real. Si se hace esto, entonces el estudio se le llama ESTUDIO ALEATORIO, DOBLE CIEGO Y CONTROLADO CON PLACEBO y este es el estándar de oro de los ensayos clínicos!

Normalmente los estudios de calidad han demostrado que la ¨medicina alternativa¨no tiene ningún efecto más que el placebo.

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Placebo! How powerful can it be? part 2

March 21, 2014

So in the first part I gave some examples of what placebo is and how effective it can be. In this second part I will give one more example so that people really understand and see the power and the ¨magic¨ behind placebo.

I´ll start by mentioning a study that Dr. Tor Wager in Bolder Colorado did. He wanted to see if ¨placebo¨ can influence the feeling of pain. I´ve already mentioned a couple of times that pain is a subjective feeling and it can vary depending and a lot of factors, like stress, anxiety, beliefs, and a thousand other things (pain part 1). Anyway, what he did that was new was that he scanned people as they were getting their placebo to see what the brain was doing, and the results were amazing. First, let me explain how the study went. He got some volunteers, and on one part of their arm he put a moisturizing cream and told them what it was, this would be the ¨control group¨. In another spot on their arm he put a local anesthetic and also told them what it was. Then on a different part of the arm he put the same moisturizing cream as before but told patients that this was also a local anesthetic. After this was done he put them under a scan and did a thermo pain test on them. The results, as you can imagine, were that the placebo cream was as effective (sometimes even more) than the local anesthetic. But what was really amazing is that the brain (they saw this on the scan), was releasing endogenous opioid in the placebo group, meaning it was releasing its own morphine!! Thanks to this study we can now begin to understand how a placebo works….. it works because placebo relies on chemicals, but those chemicals, unlike ¨real medicine¨, are being produced in the brain!!

This doesn´t mean that placebo works for everything, it sure won´t fix a broken leg or help to reduce a tumor, but in the area where it seems effective scientists are trying to figure out how to make the most of it. And what they have seen is that for a placebo to work we usually need to belief it´s real. In other words, it´s about expectations. That is why the size and shape of a pill can influence how a placebo works. It´s also why a capsule is more effective than a tablet, why a large capsule is more effective than a small tablet, why expensive medication is more effective than cheap medication, why color makes a difference; red pills are more effective for treating pain and blue pills are more effective for treating anxiety, unless of course you are a male italian (blue is the color of the national football team, and a symbol of immense excitement, passion and heart ache) (2-5).

So does this mean that if something is as good as placebo it should be allowed to be used as medicine? Well, in my opinion not really. In my opinion we should use medicine that has been proven to be more effective than placebo in clinical control studies. Meaning medication that no matter what the expectation of the patient is will work. But I do believe that once this medication has been proven to be effective, we should try to make use of the placebo effect, as it will help the real medication even more.

One last thing quick thing that a lot of people might not know. Any medication that comes out onto the market must have been proven to be more effective than placebo. If it is not more effective than placebo then that medication (pill, capsule), is not allowed to go onto the market.

Hoped you enjoyed!! Till next time

References

http://wagerlab.colorado.edu/files/papers/Wager_Fields_Textbookofpain_toshare.pdf
McRae C, Cherin E, Yamazaki TG, Diem G, Vo AH, Russell D, Ellgring JH, Fahn S, Greene P, Dillon S, Winfield H, Bjugstad KB, Freed CR (2004). “Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial”. Arch Gen Psychiatry 61 (4): 412–20.
de Craen AJ, Roos PJ, Leonard de Vries A, Kleijnen J (1996). “Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. BMJ 313 (7072): 1624–6. .
Buckalew LW, Ross S (1981). “Relationship of perceptual characteristics to efficacy of placebos”. Psychol. Rep. 49 (3): 955–61. doi:10.2466/pr0.1981.49.3.955. PMID 7330154.
Dolinska B (1999). “Empirical investigation into placebo effectiveness”. Ir J Psych Med 16 (2): 57–58.
Blackwell B, Bloomfield SS, Buncher CR (1972). “Demonstration to medical students of placebo responses and non-drug factors”. Lancet 1 (7763): 1279–82. PMID 4113531.
Branthwaite A, Cooper P (1981). “Analgesic effects of branding in treatment of headaches”. Br Med J (Clin Res Ed) 282 (6276): 1576–8. doi:10.1136/bmj.282.6276.1576. PMC 1505530. PMID 6786566.

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Placebo!! How can it be so powerful?

March 10, 2014

They are the miracle pills that shouldn’t really work at all. Placebos come in all shapes and sizes, but they contain no active ingredient. Now they are being shown to help treat pain, depression and even alleviate some of the symptoms of Parkinson’s disease. How is this possible?

Well, it all lies inside the brain and scientists are trying to figure out why, but I want to give you a couple of examples to show you how powerful a placebo can be.

In one test they had professional bicycle riders do a time trial around a track as fast as they could. After that was done, they gave each cyclist a placebo pill. Now, the cyclist thought they were getting this ¨legal¨ caffeine pill that would improve their results but in reality there was NOTHING in the pill. The normal thing would be that the second time trial they would go slower because they were already tired from the first. But all cyclist performed better and some even register their best record ever!! So how can a pill with nothing inside help someone cycle faster than ever before??

But a placebo doesn´t even have to be a pill, for instance lately there have been different studies where they have done ¨fake operations¨ and have gotten the same results as real operations (1). In one these ¨fake operations¨, patients thought they were getting a vertebroplasty. This means that ¨cement¨ is injected into a fracture spinal bone to provide extra strength to it. So what they did is they had thirty-six patients believing they were undergoing this procedure (while another group was actually getting the real surgery). To mimic the effect of the operation, surgeons just tapped against the spine making the patients believe the needle containing medical cement was being inserted into the spinal bone. To make it even more authentic, they also made sure that the odour of the cement was present in the operating room. The results were that the patients who had the sham surgery reported that they experienced the same relief of pain as those who had the real operation (2)!!! This is not an isolated finding as they have done the same thing with knee arthroscopic surgery and found the same results!!! Incredible or what?

In another test, Professor Fabrizio Benedetti (University of Turin) is using low oxygen levels at high altitudes to conduct his investigations, to test whether placebos can cause real changes in the body. Subjects strapped with fake oxygen canisters were requested to hike for 30 minutes whilst their brain activity, heart rate and neurotransmitters were all monitored. You see, when we come to high altitudes the low oxygen levels cause our blood levels to fall, this makes our PGE2 (a neurotransmitter) levels to go up, and that leads us to feel some of the familiar symptoms of altitude sickness like pain, but extra oxygen can ease the problem. Well guess what, the fake oxygen cause those PGE2 levels go down. A placebo, meaning nothing, has changed something physically in the body. How crazy is that?

I will leave it at that today so that you guys can digest all the information. But I will do a second part with more examples to try to explain a little more of what placebo is and how we can use it.

Hope you liked it!!

References:

1)J. Bruce Moseley, M.D., Kimberly O’Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H. A controlled trial of Arthroscopic Surgery for Osteoarthritis of the Knee.N Engl J Med 2002; 347:81-88

2)http://www.dailymail.co.uk/health/article-2558438/The-remarkable-power-PLACEBO-effect-Patients-FAKE-surgery-broken-recovered-just-documentary-reveals.html#sthash.6BeKXKul.dpuf

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POST HOC ERGO PROPTER HOC

March 3, 2014

¨After this, therefore because of this¨ – It´s a logical fallacy that we tend to make more often than we would like to admit. I already talked about this in one of my previous posts but I would like to explain it one more time by giving 2 examples.

A lot of people don´t know what a wonderful machine our body and mind is. It is by far the best thing you will own in your lifetime. For example, did you know that roughly 50% of all illnesses for which people seek medical help are ¨self limited¨, meaning they are cured by the body´s own healing processes without assistance from medical science. Let´s see a Porsche trying to fix a flat tire or a broken suspension……haven´t seen it yet. So the body, we can safely say, is a truly amazing machine with remarkable powers to set itself right.

With the body so effective in healing itself, many who seek medical assistance will experience a positive outcome even if the therapist or doctor does nothing. In other words, even a worthless treatment can appear effective, I mean we have a 50% change that our body will fix itself. So when an intervention is followed by improvement, the intervention is said to be ¨effective¨ according to the person´s experience. Now, don´t try to convince that person that maybe it may not have been the treatment that restored his health because he will not even listen to you, you have no chance. His ¨personal experience¨ tells him otherwise. But what about if he would have tried another treatment or even no treatment at all? Maybe he would have learned something else. This is a classic example of Post hoc ergo propter hoc.

Regression to the mean- Many diseases are cyclical, meaning they get worse or better temporarily, but always move back to an average severity(1). Back pain, arthritis, allergies, and multiple sclerosis are cyclical, meaning sometimes they get worse and sometimes they get better. Usually, we go to the therapist or doctor when we have the most pain, so it´s bound to get better no matter what the therapist does to you (2). So as you can see this would be another classic example of post hoc ergo propter hoc.

Things are sometimes not as clear as they appear and looking at things from a different perspective can give us a better idea of what´s really going on.

References

Streiner DL. Regression toward the mean: Its etiology, diagnosis, and treatment. Can J Psychiatry. 2001;46:72–76
Ernst E, Simon S. Trick or Treatment ? Alternative medicine on trial. Transworld Publishers.London,UK.2008
Gilovich Thomas. How we know what isn´t so.The free press. 1991

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Bread – Does it make you fat?

February 24, 2014

I will admit it, I love bread and I cannot eat without bread. You give me a plate of pasta and there is no bread and I won´t enjoy it. You give me the best steak in the world with fries and there is no bread and I will be disappointed. I will still eat the steak and the pasta but it´s not going to be the same. Bread for me is sacred, it´s one of the best things there is. And that is why I eat with a fork (spoon) in one hand and bread in the other and I love it. So when people tell me they are going on a diet and give up on ¨bread¨, I gasp and say two things, ¨you are crazy¨ and ¨how the hell can you get the pasta on your fork without the help of a piece of bread? ¨ 😉

Bread always gets a bad rap and whenever people want to lose weight, the first thing they take out is ¨bread¨. So, I wanted to find out if bread is really that bad and if it´s really the thing that is causing you to gain weight. And luckily they recently did a study on that. The study is called ¨the evaluation of the usefulness of a low-calorie diet with or without bread in the treatment of overweight/obesity¨. So, what they basically did in this study was divide 122 women into 2 groups. One group was called the intervention group (COULD EAT BREAD, N=61) and the other group was called the control group (NO BREAD, N=61). Both groups received a low-calorie diet of 1500 kcal, with a total caloric distribution of 55% carbohydrates, 21% proteins and 24% fat. The BREAD group was given a diet that included bread while the NO BREAD group was given other sources of carbohydrate, such as pasta, rice , potatoes and legumes. Both groups also received a Nutrition Education Programme and the same physical activity guidelines to be carried out at least three times a week, with 30 minutes of moderate to intense physical activity. And what they found out is that both groups of women significantly reduced their body weight, waist circumference , BMI and body fat percentage. But the intervention group (BREAD) had a better evolution of dietetic parameters and a GREATER compliance with the diet with fewer dropouts.

So what does all this mean? Well, that a calorie is a calorie, and if you are losing weight because you are not eating bread it is because you are consuming fewer calories, not because of the bread in itself. You could do the same thing if you just restricted another food. In fact, according to this study a low-calorie diet with bread is better than a low-calorie diet without bread. So, in conclusion, do whatever you want but please don´t mess with ¨the bread¨.

References

Kohen-L V, Candela-G C, Fernández-F C, Torres P A, Puig-G J, Bermerjo L. Evaluation of the usefulness of a low-calorie diet with or without bread in the treatment of overweight/obesity.Clin Nutri 2012. Aug,31(4):455-61.

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Alternative medicine part 3

February 18, 2014

My last post has created some controversy and some people were not happy with what I had written. I even got a couple of e-mails asking why I was so harsh with ¨alternative medicine¨. The senders said that, in their case, they had tried ¨alternative therapy¨ and it had worked for them, whereas ¨real medicine¨ had failed. And if their problem was one that had to do with pain or some other disease that is ¨subjective¨, I believe them. Yes, that´s right I believe them, but not for the reasons they think that the alternative therapy worked. I´ll use the example of pain and I will try to explain it.

In my last post (click here) I gave an example of an experiment which demonstrated that, subjectively, everything works. There wasn´t really any difference between any of the treatments, right? Well, pain is a very subjective feeling. We can´t measure pain. Some people have a small injury and lots of pain, while other people can have a huge injury and no pain. Pain is influenced by stress, anxiety, your beliefs, attitude, and a thousand other things. That is why pain is very complex, after all, pain is in the brain (click here). Your belief in a therapy can even influence pain, so if you belief something is going to help you with your pain then it probably will! And that may be the reason why sometimes alternative therapy helps these patients.

Now, when you have a disease that can be measured, for example diabetes, asthma, high blood pressure, etc. alternative therapy simply doesn´t work. Because different trials have shown that alternative therapy is no better than placebo. A pill is horrible and I wish doctors would stop prescribing so many of them. But a pill is only released onto the market when it has been proven that is has a BETTER effect than placebo, while with alternative therapy that doesn´t happen.

But not only this, if we look at the logic behind these alternative therapies we realize that there is no logic. For example, acupuncture bases itself on the principles that a ¨life force called qi flows through bodies along 12 channels or ¨meridians¨, and that illness and pain occur when qi cannot flow freely. Science cannot do a lot of things but it can measure energy, and ¨QI¨has never been found.

Homeopathy dilutes one drop of the original substance in a hundred, thirty times over, meaning that less than one part per million of the original solution is in the final product, but this doen´t matter because homoeopathist believe that ¨water has memory¨.

I will say, though, that most alternative therapists usually listen better to their clients, they create a greater bond than a doctor does with his client. If you are lucky the doctor will maybe give you 5 minutes and prescribes you something. I think this is horrible and something that should change. The best thing would be to combine both treatments, things that have been demonstrated to work in clinical studies, with the care and effort that alternative therapists treat their patients.

So in conclusion: I believe those patients 100% when they say that the alternative therapy worked for them… but it´s not for the reasons why they think it worked.

References

Singh S, Ernst E. Trick or Treatment? Alternative medicine on trial. Transworld Publishers.2009
Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoepathy and allopathy. Lancet.2005
Ernst E. Homeopathy: what does the ¨best¨evidence tell us? Med J Aust. 2010 Apr 19;192(8):458-60.
Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011:152:755-64.
Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet.2005
David Colquhoun (UCL) and Steven Novella (Yale). acupuncture is a theatrical placebo. Anesthesia & Analgesia, June 2013 116:1360-63
Asbjørn Hróbjartsson, M.D., and Peter C. Gøtzsche, M.D. Is the Placebo Powerless?-An analysis of clinical trials comparing Placebo with no Treatment.N Engl J Med 2001; 344:1594-1602.

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Alternative medicine part 2: subjectively – objectively

February 8, 2014

Anyone who has followed me knows that I am not a big fan of alternative medicine. Not because I have anything against it, it is just because it doesn´t really work. Study after study has found that alternative medicine is just NO good (1-4), and when they have found that something really works, well, it stopped being called alternative medicine and started being called MEDICINE.

The thing is, sometimes when you visit one of these ¨alternative therapists¨, you may come out feeling better and thinking ¨his medicine or therapy is working¨. Now, a couple of factors may come into play why ¨his therapy may be working¨, like the ones I mentioned in one of my previous blogs (click here). But, people sometimes don´t understand this quite well so I want to explain it with an example.

Three years ago they did a study on asthma (5). Now, I first want to mention that we know how to treat asthma. If you have asthma and take your medication you probably won´t have any problems and can live a normal life. However, if asthma is not treated properly it can lead to complications and even death. annually 250,000 people worldwide die due to asthma (6).

Ok, so the experiment went like this: There were 4 groups of people with asthma. Each group was treated with a different technique. One group was given the real medicine (albuterol), another group was given fake medicine (fake albuterol or fake inhaler), another group received sham acupuncture (there is really no difference between sham acupuncture and real acupuncture (7-12)), and the last group received nothing, they were only controlled.

SUBJECTIVELY all 4 groups improved a lot. A visual analogue scale was used to measure this (with 0 indicating no improvement and 10 indicating complete improvement). The results went as follows:

ALBUTEROL- 50% improvement
FAKE ALBUTEROL- 45% improvement
SHAM ACUPUNCTURE- 46% improvement
NO INTERVENTION CONTROL- 21% improvement

This is so important because there was really no difference between the fake treatments and the real treatments. After the experiment the patients felt quite good.

Now, OBJECTIVELY, meaning they can measure it (they measured the percent change in Maximum Forced Expiratory Volume in 1 Second), they all improved!! And here are the results:

ALBUTEROL- 20.1% improvement
FAKE ALBUTEROL- 7.5% improvement
SHAM ACUPUNCTURE- 7.1% improvement
No-INTERVENTION CONTROL- 7.1% improvement

The real medicine worked 3 TIMES BETTER than all the fake medicines, even though subjectively there was barely any difference. This is important because, like I said before, if asthma is not treated properly it can lead to a lot of complications and even death!! Subjectively you may go to an ALTERNATIVE THERAPIST and feel great, but objectively it probably isn´t helping you too much. Because alternative medicine is no better than Placebo (1-4).

Another thing to take into account from this study, is the power of the brain. Because even though the 3 ¨fake groups¨ are inefficient in treating asthma, they (objectively) improved the outcome of each patient. Even the group that was only being observed!!! This phenomenon is called Hawthorne effect and it means: Clinical improvement in a group of patients in a clinical trial that is attributable to the fact of being under study!!

Hoped you liked it

References

Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011:152:755-64.
Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet.2005
David Colquhoun (UCL) and Steven Novella (Yale). acupuncture is a theatrical placebo. Anesthesia & Analgesia, June 2013 116:1360-63
Asbjørn Hróbjartsson, M.D., and Peter C. Gøtzsche, M.D. Is the Placebo Powerless?-An analysis of clinical trials comparing Placebo with no Treatment.N Engl J Med 2001; 344:1594-1602.
Michael E. Wechsler, M.D., John M. Kelley, Ph.D., Ingrid O.E. Boyd, M.P.H., Stefanie Dutile, B.S., Gautham Marigowda, M.B., Irving Kirsch, Ph.D., Elliot Israel, M.D., and Ted J. Kaptchuk. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma.N Engl J Med 2011; 365:119-126
http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx
Linde K, Streng A, Jürgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293:2118–25
Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005;331:376–82
Haake M, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892–8
Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther HU, Melchart D, Willich SN. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366:136–43
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858–66
Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115

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