Evaluating the Pinnertest: The Importance of Scientific Evidence

by Erin Child

So, you think you have a food intolerance? What do you do? You could call your doctor and set-up an appointment that is inevitably months away. Then you have a 10-minute meeting in which they only look at their computer and refer you to a specialist, THEN go through more testing, and finally (hopefully!) get some answers. Or, you could order an at-home kit that takes 10 minutes to complete and promises results that will get you feeling better, sooner. Which one do you choose? Read on and decide.

In our current world of food intolerances and hypersensitivities in which the best path to treatment is often a conundrum, the Pinnertest promises an easy solution to any dietary woes.  A few months ago, I started noticing ads for this new test popping up on social media. The Pinnertest is an over-the-counter food intolerance testing kit that uses microarray technology to test for IgG (Immunoglobulin G) mediated sensitivities for 200 common foods.

The classic manifestations of true food allergies (hives, oral discomfort, trouble breathing, anaphylaxis, etc) are mediated by overproduction of IgE antibodies. Like IgE, IgG is a type of antibody. And IgG is the most common antibody in the human body. (The immune system releases five types of antibodies: IgA, IgE, IgG, IgD, and IgM.) Instead of testing IgE mediated allergies, the Pinnertest producers claim that the microarray technology allows them to test for IgG mediated intolerances to 200 different foods—including lettuce, quail, and baking powder—using only a few drops of blood. It sounds scientific, but also seemed too good to be true. Was it?

I started my research by reaching out to the Pinnertest folks directly. My goal? To score a pro-bono test to try it out myself and see the results first hand. I was thrilled when a friendly representative at Pinner immediately reached out to set up a phone interview (calendar evite and everything). When the day came, I called—and was sent to voicemail. Twenty minutes and five tries later, I knew I had been ghosted. My subsequent emails were ignored, and my quest to learn first-hand about the scientific evidence backing their product was squashed.

So, I began researching on my own. The Pinnertest website sports a cluttered page of medical study citations that cover work on food allergies, intolerances and Celiac Disease—but none of which provide any evidence of using IgG testing for food intolerances.  My own PubMed search [IgG + food intolerance; Immunoglobulin G + food intolerance] yielded little, but did include one recently retracted 2016 article linking IgG testing to food allergies. The rest of the Pinnertest website leads you down a rabbit-hole of B-list celebrity endorsements and every Friedman student’s favorite—Dr. Oz videos! Interestingly, nowhere on the site does it tell you the cost of the test. To find out pricing, you must first enter your information (“Hi, my name is Newt Trition”) before you discover that the test will run you a whopping $490.

To further explore if this test has any scientific merit, and is worth the hefty price tag, I reached out the Boston Food Allergy Center (BFAC). Dr. John Leung, MD, the founder and CEO of the BFAC, and the Director of the Food Allergy Center at Tufts Medical Center and Co-Director of the Food Allergy Center at Floating Hospital for Children, took some time out of his day to answer my questions. Dr. Leung said, “We have patients coming into our office on a weekly basis with that kind of report [IgG], who pay out of pocket no matter what insurance they have. [Insurance doesn’t cover the test] because there is a statement from both the American and European Societies for Allergy saying that this test has no clinical significance.”

This is something to consider in any area of medicine—if a test is not covered by insurance, it may be the first sign that clinical significance could be lacking.

My conversation with Dr. Leung was brisk, informative, and confirmed my gut reaction that this test was too good to be true. Furthermore, there is a body of literature providing evidence that IgG mediated reactions are a sign that a food intolerance does not exist, not the other way around. In a 2008 European Academy of Allergy and Clinical (EAACI) Task Force Report, the authors wrote, “food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components.” Simply put, IgG evidence can show that you’ve been eating that food, not that you are intolerant to it. The EAACI has been joined by their Canadian, American, and South African counterparts in clear statements that research does not support the use of IgG mediated testing for food intolerances at this time.

Having shadowed Dr. Leung at the BFAC, I know that he takes patients’ claims of food intolerances seriously, and is invested in using the best clinical practices and scientific evidence available to make the diagnosis. Concerning IgG mediated testing, he stated, “There is so little research, so from a clinical view it is not very useful, it doesn’t mean much. It is not diagnostic.” And yet, the Pinnertest website claims that the“Pinnertest is a common procedure in most European countries. In many cases, dietitians and nutritionists will ask for their client’s Pinnertest results before creating any kind of diet plan.” Since this approach directly contradicts the current EAACI recommendation, that’s highly unlikely.

I also had the opportunity to speak with Rachel Wilkinson, MS, RD, LDN, and Practice Manager of the BFAC. Rachel explained, “If patients come in concerned about food intolerances, we can do the hydrogen breath test for lactose, fructose or fructan [found in some vegetables, fruits and grains]. These are the three main ones [food intolerances] we can test for, because we actually have tests for those.” She went on to state, “What was interesting to me about the Pinnertest, was how they say they can specify one specific food–so not just a category. I honestly don’t understand how they would pinpoint a specific food. It makes more sense to me to listen to patient’s histories and to look at how their intestines are able to break down that particular group of sugars. So, I really would love to know how they [Pinnertest] are coming up with this.”

It is important to note that the Pinnertest is not just marketing itself as a food intolerance test. It is also presenting itself as a weight loss tool. Current Frances Stern Dietetic Intern and Masters Candidate Jocelyn Brault, interning at BFAC, indicated her concern: “I think this is also being marketed for weight loss, which you can see throughout their website. This is usually a good sign that we should dig deeper. Is this a proven weight loss method? This claim seemed out of nowhere to me.” Indeed, directly on the Pinnertest box it reads, “Discover which foods are making you sick or overweight.” If taken seriously, this test will result in unnecessary diet restrictions, and potential malnutrition if too many foods are unnecessarily eliminated. Rachel Wilkinson, RD noted, “if you’re going to be avoiding certain types of foods, you need to make sure your diet is still adequate. We do not want to see people over-restricting foods for no reason.”

Over the course of my research and conversations with Dr. Leung, Rachel, and Jocelyn, I confirmed that my initial gut reaction was correct: too good to be true. And here’s the kicker, so does The Pinnertest. In a tiny disclaimer at the bottom of their website, they write: “Quantification of specific IgE antibodies to foods and inhalants is an FDA-accepted diagnostic procedure for the assessment of allergies. However, the assessment of human IgG antibodies specific for individual food and inhalant antigens is not an FDA-recognized diagnostic indicator of allergy.”

It is a noble task to try to design an allergy test that does not require you to doctor hop, or wait months for an appointment, but the scientific evidence needed to back up the Pinnertest is lacking. Perhaps one day this will shift, and the body of evidence will improve. In the meantime, however, anyone who thinks they might have a food intolerance (or food allergy) is best served by going to their clinician (and then a dietitian). This at-home kit promises a quick fix, but is really just an expensive, dangerous distraction.

Erin Child is a second-semester NICBC student in the dual MS-DPD program. She is fascinated by the science of food allergy and intolerances, and will probably keep writing about them until someone tells her to stop.  With two weeks left in the semester, she would really like a nap. Like right now.

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The Dr. Oz Effect

by Julia Sementelli

With the beginning of the new year inevitably comes an onslaught of promotions and advertisements for miracle diets, detoxes, and supplements that vow to help you shed pounds, live longer, etc. And when you think of diets and supplements, most likely two words come to mind: “Dr. Oz.”  He is a doctor, but he is also a registered dietitian’s worst nightmare. While dietitians are out there teaching patients and clients that weight loss cannot be healthfully achieved in a pill or in a 2 week “cleanse,” Dr. Oz is preaching the opposite. Read on for the inside scoop of how Dr. Oz further complicates the already messy, ever-changing world of nutrition and health, including an interview with the man himself.

A recent client of mine, Mark (name changed for privacy), eats a fairly healthy diet: Greek yogurt and berries for breakfast, a salad with lean protein for lunch, and something from the Whole Foods salad bar for dinner (he doesn’t like to cook).  He says that his major downfalls are cookies and beer. Mark’s goal is to lose 30 pounds and improve his overall health given his family history of heart disease. “Give me a meal plan and I will follow it,” says Mark. I can work with that. He is actually a dietitian’s dream—someone who already doesn’t mind eating well and is motivated to lose weight. I thought his meal plan would be a breeze, until he said “Oh—I should tell you about my supplements.” I had expected a multivitamin and some daily vitamin D, but my hopes were dashed as Mark rattled off more than 15 supplements that he is currently taking, only one of them being a multivitamin. Among these supplements were resveratrol, an antioxidant found in red grape skins that he claims sheds years off of your life, and Conjugated Linoleic Acid (CLA), which apparently melts body fat. When I asked Mark where he learned about all of these supplements, he said “Dr. Oz.”

No two words can send angry chills up a dietitian’s spine quicker than Dr. Oz. While I am a fairly green registered dietitian, I have interacted with enough patients to see firsthand the power of Dr. Oz. Dr. Mehmet Oz started out as the resident expert on “The Oprah Winfrey Show” for five years before he was given his own spotlight, “The Dr. Oz Show.” He holds three degrees: a B.S. in biology from Harvard and an M.D. and M.B.A. from the University of Pennsylvania. He is vice-chairman of the department of surgery at the Columbia University College of Physicians and Surgeons in New York. He is also likeable. Consequently, he has become one of the most trusted doctors in the world and yet he uses words like “magical” and “miraculous” to promote supplements that promise to burn fat or prevent cancer. However, what the public may not understand is that a pill is not a miracle cure for anything. According to Stephanie Clarke, registered dietitian and co-owner of C&J Nutrition in New York City: “Most MDs get very little (or zero) nutrition education and background—so it’s a frustrating when they dole out nutrition advice or research without enough details or without thinking about how their messages will be interpreted by the public and related to real life eating.” But Americans continue to believe in the power of nutritional supplements recommended by a doctor that (most likely) has had minimal nutrition education and, more surprisingly, continue to buy them.  In fact, Americans spent more than $21 billion on vitamins and herbal supplements in 2015.  According to analyses, just the mention of a product on the Dr. Oz Show causes a surge in sales.

This phenomenon has been coined as “The Dr. Oz Effect.” Combine charismatic with a few letters after his name and you have someone who is more believable than the thousands of nutrition professionals that use science, not pseudoscience, to back up their recommendations. Even my own father, who has type 2 diabetes, an affinity for soy sauce (read: sodium), and meets my attempts to improve his diet with stubbornness, listens to Dr. Oz. Meanwhile, I have gone through four years of undergraduate education in nutrition, applying for competitive dietetic internships (50% acceptance rate), a one year unpaid dietetic internship, studying for and passing a comprehensive exam, and an additional two years of graduate work to get to where I am. And yet I still don’t have the influence that Dr. Oz does to change my father’s food behaviors.

As a dietitian, I strongly believe in balance. It is my goal to reduce the all-or-nothing thinking that surrounds eating and exercise. The media and people like Dr. Oz perpetuate this mindset, capitalizing on the public’s obsession with weight loss and diets by highlighting drastic regimens and alleged cure-all supplements. Diets do not work because they typically deprive a person of entire food groups, fats or carbohydrates, for example, and eventually the individual gives in and eats those food groups in excess since they have been denying themselves of them for so long.

The demonization of food, another spawn of the media, is the belief that particular foods are good or bad. It has resulted in mass confusion and further damage to peoples’ relationship with food. One of the most infuriating examples of this demonization is fruit. Yes, fruit. “I heard that the sugar in fruit is bad for you” or “I was told not to eat pineapple because it is high in sugar” are actual quotes that I have heard from clients. And not surprisingly, both clients attributed their beliefs to Dr. Oz. After some research, I discovered that, lo and behold, Dr. Oz did a segment titled “Can the Sugar in Fruit Make You Fat?” that most likely influenced these beliefs. Aside from vegetables, fruit is one of the most wholesome food groups, packed with fiber, antioxidants, vitamins, and minerals. Yet fruit cannot even avoid falling victim to the war on food. Conundrums like this exist for nearly every food: eggs, fish, coffee, potatoes…the list goes on. The only way to try to reverse the damage is to tell people that no food is off limits and remind them that there is no replacement for good eating and regular exercise. The only way that I have seen weight loss occur is with gradual and sustainable changes over time. And anyone that promises anything different is lying or worse, using pseudoscience to make outrageous claims.

Pseudoscience, the basis upon which Dr. Oz has constructed his lucrative empire, involves exaggerated and often contradictory claims that are not supported by reputable research. The media is also a culprit of using pseudoscience, composing articles and news stories from press releases of studies with small sample sizes or that use mice as their subjects. Just because it is effective or safe for mice, does not mean it will be safe for humans. Many writers for tabloids and mainstream magazines are stretched for time and are more concerned with quantity rather than quality given that their main goal is to make headlines that sell papers and magazines. Unfortunately, such writers and apparent health experts like Dr. Oz produce the majority of what the general public sees and uses to shape its food choices. However, according to a study published in the BMJ in 2014: “Consumers should be skeptical about any recommendations provided on television medical talk shows, as details are limited and only a third to one half of recommendations are based on believable or somewhat believable evidence.” That’s right—more than half of what Dr. Oz claims on his show regarding nutrition is not based on science. While the show has seen a dip in ratings, currently 1.8 million still tune into the Dr. Oz Show and are consequently exposed to information that is incorrect 50-67% of the time according to the 2014 study in the BMJ.

Dr. Oz has been criticized by a slew of medical professionals for his scam marketing, most notably in 2015 when ten physicians wrote a letter to the dean of health sciences at Columbia University requesting that Dr. Oz be removed as a faculty member due to his “egregious lack of integrity” on his TV show. Dr. Oz defends what he tells the public by claiming that “it’s not a medical show,” despite the fact that the show is titled The Dr. Oz show. Dr. Oz says that freedom of speech gives him the right to say what he wants to. But it is difficult to respect this freedom when he is a faculty member at a prestigious university that makes false claims on TV.

I reached out to the Dr. Oz team and received a response from Oz himself. When asked where he finds his nutrition information he said, “We obtain nutrition information from a wide variety of sources. We rely heavily on literature published in scientific journals as well as textbooks. In addition we consult a wide variety of experts including medical doctors and nutritionists. Our research staff is made up of myself a physician trained in preventive medicine as well as 3 medical students who take a year off to work with us. We evaluate all of the content on our show to ensure that viewers are getting accurate information. One of our researchers this year has a master’s degree in nutrition as well.” I am not sure which scientific journals Dr. Oz and his team are using, but when I researched “curcumin” and “oil of oregano,” two of the supplements that Dr. Oz has promoted on his show and that Mark, my client, is currently taking, the conclusion was that “the existing scientific evidence is insufficient to recommend their safe use.” In our interview, Dr. Oz said: “We also reach out to the Friedman school when we have difficult questions. I spent a day up at the school this summer meeting with a number of your faculty. Most recently I have spoken to an expert about fiber fortified foods and to your Dean about the current opinions on dietary fats.” He included a note that says that he and his team welcome interns to join them every month from September to June and students from Friedman are welcome to apply. *Insert eye roll*

When I asked about Dr. Oz and his team’s stance on nutritional supplements, he replied: “In general we believe that many have a place in people’s life to enhance nutrition. We always love to see more and better studies conducted on the utility of supplements in promoting health.” This is a nice response but when I begrudgingly watched a clip from the Dr. Oz show in which he says that Conjugated Linoleic Acid (CLA) can help to burn body fat, even without diet and exercise, I realized that what he says and what he does do not match. And aside from empty promises and putting people at risk with questionable pills, he is encouraging people to waste their money. This is what I told Mark in an effort curb his daily supplement cocktail. If the risk of taking his favorite “fat-melting” supplement won’t stop him, maybe the opportunity to save money will.

Dr. Oz is frustrating for many reasons, but for nutrition professionals it is the fact he uses his credentials as a physician to get away with promoting pseudoscience. Being a dietitian no longer involves simply telling people what to eat. It is trying to untangle the web of misinformation surrounding nutrition that clients have woven over the course of their lives and re-teach them what a healthy relationship with food should look like. While turning to supplements can seem like an easy fix, science shows that eating a diet based on whole foods like fruits, vegetables, whole grains, lean protein, and healthy fats, is the ideal diet. Science does not show that a pill is the secret to losing those last five pounds that keep hanging on. If scientists really found a cure for obesity, we would not be hearing about it at 4pm on a Tuesday afternoon. And unfortunately, the supplement industry is not going anywhere. The FDA and FTC regulate the supplement industry, but not very well. So it is up to trained and licensed nutritional professionals (i.e. registered dietitians) to educate the public about the dangers of supplements and listening to people who are simply “health experts.”

Julia Sementelli is a second-year Nutrition Communication & Behavior Change student and Boston-based registered dietitian who works in a local hospital and also counsels private clients.  You can find her on Instagram (@julia.the.rd.eats- Follow her!) where she strives to intercept confusing nutrition messages from self-proclaimed health experts with expert nutrition advice and tips (as well as some beautiful food photos if she does say so herself!).

 

 

Visions for a Just and Equitable Nutrition School

by The Friedman Justice League

This is an exciting time in the history of the Friedman School. Dean Mozaffarian has undertaken a school-wide strategic planning process, open to all levels of the school body. Albeit executed under a tight time frame, staff, faculty, and students are being given the unique opportunity to consider in-depth what makes Friedman great and how we can continue to make it even better.

Stirred by our school’s time of reflection and planning, the Friedman Justice League (FJL) has crafted a vision for justice at the Friedman School. As detailed in our mission statement, we are a student organization that seeks to make our community more diverse and inclusive, and to find ways for the Friedman community to better address issues of discrimination and oppression in its teachings, research, and programs. We convened in November to build a shared vision of a nutrition school that embodies these principles.

Discrimination and oppression are at the root of many food system challenges, domestically and globally. The Friedman School must understand these vital issues and provide leadership as they pertain to nutrition and food systems. Methodical action will help Friedman progress as an institution at the cutting edge of research and in the training of future leaders. To this aim, justice, equity, diversity, and cultural appreciation should be central to the school’s strategic planning process. In addition, long-term growth will require personal reflection, open dialogue, sustained action, and inclusive community building. We are pleased to present the results of our conversation and look forward to working together with the entire Friedman community to advance this vision.

Investment in and commitment to justice. Real change requires investment and commitment from all levels of leadership. Progress will rely on transparent and open dialogue that encourages all voices to be heard. Financial investment will also be integral to support these goals, including prioritizing equity and diversity education and training, accessing resources for effective diverse recruitment, and building community partnerships.

Cultural humility and openness. We seek more welcoming social spaces to promote dialogue and community. Recent events at the University of Missouri, Harvard University, Yale University, and others illustrate that racism is still present in higher education. We implore our own institution to take an active role in being anti-racist, starting with the humble acknowledgement that there is still work to be done. To build an open and inclusive environment within the Friedman campus, all students, faculty, and administrators must be trained in cultural competency, cultural humility, and social equity. Proper training will position us as better practitioners and representatives of the field of nutrition in our current and future work.

A diverse student body, faculty, and administration. Our working definition of diversity encompasses race, ethnicity, socioeconomic status, ability, gender, sexual orientation, age, religious beliefs, and country of origin. To continue being a leader in our field, the Friedman School must be representative of the society we are a part of and work within, both domestically and globally. Institutions across the country are making bold promises around diversity and inclusion, serving as appropriate models from which to learn. For example, Brown University made the commitment to double its proportion of underrepresented minority faculty by 2025 through creation of a new postdoctoral fellowship program and a new young scholars program. It is our expectation that the Friedman School will make a similar commitment to the diversification of our student body, faculty, and administration.

Build justice into our curriculum. We see a gap in the course offerings that are centered on social justice frameworks and diverse cultural perspectives. The FJL diversity sub-committee is working with faculty to enhance teachings on justice in the classroom. We applaud those professors who already address these topics in their courses. We also recognize that this is an ongoing process, through which we hope to see more diverse guest lecturers, additional teaching modules to syllabi on key justice topics, and the inclusion of culture and diversity-related examples or readings to coursework. Changes can take many shapes and forms, but may include:

  • More nuanced race and class analyses
  • Emphasis on food justice and environmental justice
  • Stronger focus on human rights at all levels of the food system
  • More coverage of animal rights and cruelty
  • Emphasis on cultural influences of food and nutrition
  • Greater understanding and acknowledgement of structural racism in the U.S. food system

External partnerships that are diverse, inclusive, and community-oriented. As students and future professionals, we seek more exposure to community-based participatory research methods and projects that involve community interaction. Increased local partnerships would allow us to leverage our institutional strength and work with communities our school directly affects, such as Boston’s Chinatown. For example, Jumbo’s Kitchen partners with the Boston Chinatown Neighborhood Center, Inc. to educate students at Josiah Quincy Elementary School about basic cooking, nutrition, and health. We look forward to more opportunities to learn from individuals and communities directly so that we may apply our classroom knowledge.

Additional external partnerships could assist with the recruitment of a more diverse student body, staff, and faculty. For example, establishing formal and informal collaborations with state-based undergraduate institutions and strengthening relationships with colleges and universities serving underrepresented minority groups (e.g., Historically Black Colleges and Universities) would assist with these efforts. Fostering relationships with local graduate schools that have well-established enrichment programs with Boston’s middle and high schools (e.g., Harvard School of Medicine’s Office of Diversity and Inclusion) would also be a worthwhile strategy to include underrepresented students in allied health professions such as those within the nutrition field.

FJL is thrilled that the Friedman School is undertaking a school-wide strategic planning process, and several of our members are currently serving on Investigative Working Groups (IWGs) to support this process. We hope that our working vision for justice at Friedman can supplement the school-wide process that continues to make Friedman great. FJL shares many similar goals with the IWGs, such as building upon our external partnerships, improving work-life balance and diversity, increasing the public impact of research from cell to society, improving the educational experience of students, and ultimately creating a cultural shift and transformational change within the Friedman community. We believe FJL adds value to the conversation by ensuring that a justice framework and issues of diversity and inclusion are considered fully. The Friedman School’s progress and continued public impact on nutrition and food in our increasingly diverse nation and globalized world depends on it.

Signed,

Sarah Andrus, MS, FPAN 2016

Madeline Bennett, MS, FPAN 2017

Stacy Blondin, PhD, FPAN 2016

Rebecca Boehm, PhD, AFE 2016

Alison Brown, PhD, FPAN 2017

Sarah Chang, MS/MPH, AFE 2016

Rebecca Harnik, MS, AFE 2016

Sam Hoeffler, MS, AFE 2017

Mehreen Ismail, PhD, FPAN

Caitlin Joseph, MS, AFE 2017

Micaela Karlsen, PhD, NEPI 2017

Kathleen Nay, MS/MA, AFE/UEP 2018

Megan Lehnerd, PhD, AFE

Caitlin Matthews, MS/MA, AFE/UEP 2017

Danielle Ngo, MS/MA, AFE/UEP 2017

Nathaniel Rosenblum MS/MALD, AFE 2016

Rebecca Rottapel, MS/MPH, AFE 2016

John VanderHeide, MS/MA, AFE/UEP 2018

The Friedman Justice League encourages this conversation to continue among the broader Friedman community. We are compiling signatures for this vision, which will be used to contribute to the Friedman School’s strategic planning process. Please add your name if you believe this vision adequately reflects your views and would like to share your support, by December 11: http://tinyurl.com/fjlvisions2015.

Good Sense and Humor

By Katherine Pett

Why Someone Should Give James Hamblin, MD, a TV Show

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Dr. James Hamblin poses with students at the 2015 Gershoff Symposium

“The formula is simple, to write a bestselling diet book.  I’ll tell you…if you promise not to do it.”

James Hamblin, MD, Senior Health Editor at The Atlantic, paces in front of a giant projection of a man’s head.  Dr. Hamblin is tall, slight, and—as is often noted in profiles of the doc—looks young.  The projected head is slightly orange, suggestive of a spray tan, and belongs to Dr. David Perlmutter, neurologist and bestselling author of the book, Grain Brain, which blames gluten for all chronic diseases.

Hamblin is giving a talk at Tufts’ Friedman School of Nutrition as part of the annual Gershoff Symposium.  This year’s theme is “Nutrition Messages in the Media: Making Sense of the Chaos.” Despite the serious title of his talk, “Evolving Strategies for Effectively Conveying Nutrition Information,” Hamblin keeps the mood light.

A sense of foreboding enters his voice as he describes the recipe for a bestseller.  Starting slowly, voice low, he starts an alarmist “trouble in River City” style rant of a stereotypical Fad Diet Doctor:

“We’re in Danger,” he starts.

“There’s a Serious Problem.

It is threatening us all.

It is going to give us all everything you could possibly be scared of:

People are going to hate you,

You are going to get dementia,

You are going to be fat and have cancer,

AND have hypertension,

And be socially ostracized and every single thing!

You’re going to default on your mortgage!

And it is not your fault! You know it’s not your fault.

It’s the corporations and the government! They have lied to you!”

But luckily Dr. Hamblin’s fake diet book has the solution: a single, simple dietary switch that will save and your family from harm:

“Cut the gluten… You’re gonna see a lifespan triple!  You’re gonna go home and you’re gonna find a new car in your garage!”

The audience is laughing, but the topic is a pressing one. How do doctors, scientists, and nutritionists defend against sweeping assertions made by health gurus with fewer scruples about bending the truth? A headline saying that Mediterranean diets may or may not improve risk factors for cardiovascular disease is a lot less catchy than “one weird trick” that promises effortless weight loss.

Doctors like James Hamblin and David Perlmutter trade on their MDs; their medical content knowledge informs their prominent careers in media. While Perlmutter has leveraged his MD into a massive brand, fad diet book, and YouTube channel around his name and tagline, “empowering neurology” (draw Dr. Oz comparison here), Hamblin has taken what one could call a more measured approach. And though he isn’t interested in writing the next diet bestseller, his long-term aspirations are not modest.

Leaving his unfulfilling residency in radiology after year three of five years, Hamblin joined The Atlantic when the staff created a health segment for the online magazine. In the more creative essay style of The Atlantic, Hamblin uses his writing talent and self-deprecating sense of humor to take objective, approachable stances on divisive health issues. His work often requires him to interview the creators of fad diets and purveyors of pseudoscience, such as Vani Hari (The Food Babe) and Dr. David Perlmutter, who likens eating gluten to pouring gasoline on oneself.

Dr. Hamblin stars in The Atlantic’s popular video series “If Our Bodies Could Talk,” where he sheds light on awkward health situations like how to get a friend to quit smoking, or how to empower women to ask their doctors about orgasms. He’s also purchased (legal) THC laced candy…for science.

Hamblin’s accessible comedic style in “If Our Bodies Could Talk” make it easy to see him as a potential John Oliver or Stephen Colbert of health and nutrition, and Hamblin feels he’s headed in that direction.

“I want to entertain people, and I want it to be substantive; why don’t I do it about the thing I know and care about like health? John Oliver and Daily Show and Colbert, they set out primarily to entertain. And I really like that, I think that’s more my path.”

Blending health and comedy may be the ideal way to combat nonsense that floats around the Internet and daytime TV (Dr. Perlmutter has a 90-minute Grain Brain special that airs on PBS). And there’s no mistaking the powerful combination of common sense and jokes in YouTube clips that can easily be shared on Facebook, the major source of news for at least one third of Americans.

Perhaps getting people to laugh about the absurdity of gluten as the root of all evil, like a recent episode of South Park did, is the key to dispelling nutrition myths that can’t be combated through reasoning alone.

While Dr. James Hamblin doesn’t have any concrete plans yet, he’s open to the idea. As we spoke the day after his talk, he threw out the possibility.

“Yeah I’d love to have a TV show, and if you know anyone I could talk to…”

Katherine Pett is a first-year student in the Biochemical and Molecular Nutrition program at The Friedman School.  She can be reached at katherine.docimo@tufts.edu.

Bulletproof Coffee: the Breakfast of Champions?

by Ally Gallop, BSc, RD, CDE

Imagine waking up in the morning to a breakfast of butter, oil, and coffee. Better known as Bulletproof Coffee, it’s the new rage in the diet world. With proponents noting marked improvements in alertness, hunger suppression, and weight loss, bulletproof coffee and its creator are altering the morning routine. But navigating through these claims, the science doesn’t align.

After a trip to Tibet in 2004, Silicon Valley businessman Dave Asprey tasted Tibetan Yak Butter Tea: a concoction of brewed tea, salt, and yak butter. Upon returning to the U.S., Asprey devised his own version. Now marketed as bulletproof coffee (or BPC), it pairs well with his newly released book The Bulletproof Diet. Advocates for BPC include U.S. Olympic marathoner Ryan Hall, Divergent actor Shailene Woodley, and singer/songwriter Ed Sheeran. BPC is said to be creamier than a latte, prevent hunger before lunch, increase alertness, and be loaded with vitamins A, E, and K2 alongside omega-3 fatty acids. Yet the most enticing reason in opting for this drink is because it seemingly causes weight loss without having to exercise.

The recipe for BPC is simple. In a blender combine many of Asprey’s own products:629px-Bulletproof_Coffee_Starter_Kit

  • At least 2 tablespoons of unsalted grass-fed butter,
  • 1-2 tablespoons of Brain Octane™ Oil, and
  • Bulletproof® Upgraded™ brewed coffee beans.

Keep in mind, BPC is meant as a breakfast replacement. So let’s compare the BPC nutritional content to that of a typical breakfast: two scrambled eggs, an apple, black coffee, and a slice of whole grain toast with a tablespoon of peanut butter.

Typical Breakfast BPC *Unable to find specific nutrient data for grass-fed butter and omega-3 content.**The USDA Foods List only lists information for vitamin K1.
Calories (calories) 491 461
Total Fat (g) 23 51
Saturated Fat (g) 4 43
Omega-3 Fatty Acids (mg) < 1 n/a*
Total Carbohydrates (g) 48 0
Total Fiber (g) 10.4 0
Protein (g) 24 0
Vitamin A (IU) 803 400
Vitamin E (mg) 1.88 0.4
Vitamin K1 (μg) 9.5 0.8
Vitamin K2 (μg) n/a** n/a**
Caffeine (mg) 142 142

Starting the day off with a high-fat brew that shuns hunger and enhances alertness sounds like a great idea. Losing weight is easier when your stomach isn’t grumbling. High-fat BPC in the gut slows the rate of stomach emptying, suppresses ghrelin (the “eat more” hormone), and reduces the amount of calories consumed at subsequent snacks and meals. Since fat takes the longest to leave the stomach and be digested, even in its liquid form, Asprey’s claim makes some sense.

But Asprey’s claims regarding omega-3s and vitamins A, E, and K2 are cloudier. The amount of these nutrients in grass-fed versus conventionally grain-fed beef is higher. Yet only 60% of studies found a statistically significant difference. Further, no research exists on the amount of omega-3 fatty acids in butter- all the research comparing omega-3 contents is in types of beef, not dairy.

Recently, I contacted Kerrygold, a popular brand of grass-fed butter, and asked them to elaborate on the omega-3 content their product. They responded by saying that they have no research on omega-3’s present in butter. While grass-fed dairy may be a wiser nutritional source, there is currently no research that supports Asprey’s supposition that it has more omega-3s.

The caffeine content of BPC is likely the source of increased alertness drinkers report. It’s also possible that if the coffee truly does have a higher omega-3 content, those omega-3s could give the brain extra power.

Asprey’s line of Bulletproof® Upgraded™ coffee beans are touted as being free of mycotoxins (i.e., mold), which he claims are pervasive components of every other coffee on the market. However, coffee producers like Starbucks and Dunkin Donuts have long known about these mycotoxins. That’s why coffee beans are wet-processed, which means that the beans are washed to eliminate the mold. So the upgraded brew is no better than the rest.

But what really stands out about BPC? How about its fat content: the brew fulfills 23% of both your daily total caloric and fat intake. The Institute of Medicine (IOM) recommends 25-35% of daily total calories should come from fat. BPC fulfills that quota on its own. The Canadian Society of Intestinal Research also reminds us how fat is a stimulant for the intestines. Higher intakes may result in abdominal cramping, diarrhea, and floating stools. But that’s never advertised.

Being so high in calories, how can BPC help weight loss? If, like with any diet, fewer calories are consumed, then weight loss may occur. Asprey’s book recommends following a low-carbohydrate diet as to induce ketosis. And food restriction generally leads to weight loss.

In an interview with Runner’s World, University of California Davis’ director of sports nutrition Liz Applegate debunks Asprey’s idea behind Brain Octane™ oil, which is made of medium-chain triglycerides (MCTs). Asprey believes that the oil increases the body’s ability to burn calories because it is processed differently than other fats. Unlike long-chain triglycerides, MCTs pass directly from the gut into the bloodstream and are immediately available to be burned for energy. However, Applegate notes that there is no scientific evidence to support MCTs’ ability to increase metabolism and promote weight loss. If consumed in amounts that surpass the body’s immediate needs, MCTs will still be converted to and stored as fat.

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Breakfast of Champions?

Ultimately, this article wouldn’t be complete without attempting BPC myself. I found it odd watching butter dissolve into my morning cup. The oil slick on top was definitely unsettling. Using coconut oil and regular coffee in place of Asprey’s oil and beans, the concoction was creamy with a subtle hint of coconut. My hunger was suppressed the rest of the day, cravings for carbs were reduced, and I was able to forgo my mid-morning snack. In comparison to my normal routine of breakfast and a snack, I likely saved 120 calories. But due to an injury, I was unable to exercise. Would this daily pattern of high-fat BPC power me through morning exercise sessions?

Should YOU add BPC to your diet?

The typical breakfast provides protein and fiber, long having been touted as essentials for their hunger-suppressing properties. But choose BPC, and neither exist. The idea is you can’t have both food and BPC.

For those who already eat breakfast, replacing it with BPC on a short-term basis or intermittently could be all right. The BPC’s calories are appropriate for a morning meal. Caloric intake may even be less, depending on what one would normally eat. However, the habit of drinking coffee alongside breakfast may return, thereby increasing total calories consumed. In a recent article, Chris Gayomali, a journalist for Fast Company, tried BPC for two weeks. By the end, he was adding toast in addition to his BPC. After two weeks he ditched BPC completely because he missed eating solids.

Diet trends tend to fail due to deprivation. Given that all other meals and snacks consumed throughout the day remain constant, having BPC and food in the morning could lead to weight gain since it is so high in calories.

If you’re adamant about BPC, doing so every-other-day and ensuring intake of higher fiber and protein foods is advised. That way you can indulge while still limiting saturated fat intakes, promoting gut health with fiber, and sparing protein. Following the IOM guidelines, you wouldn’t require any additional fat on a BPC day. On those days opt for vegetable-dishes, lean protein, and unsaturated fats, like those from nuts, plant oils, and avocados.

For those who don’t typically eat breakfast, adding almost 500 calories of BPC in addition to your usual food consumption could lead to significant weight gain.

So what’s the final consensus?

When it comes to Bulletproof Coffee, the science is lacking. Egregious claims that the oil supplies “fast energy for the brain,” “reduces brain fog,” and is responsible for “rebalancing…yeast in the gut” are stated on Asprey’s website. Yet they lack any footnotes for supporting literature.

We also can’t look at foods in isolation. Rather, the whole diet matters. Asprey’s BPC argument focuses on the nutrients in two items: butter and oil. Humans are encouraged to seek variety in the foods we eat. The typical breakfast I detailed above already contains all of the nutrients advertised as part of BPC and more. If for an entire month one were to replace their breakfast with solely BPC they would be missing out on vital nutrients that variety would fulfill.

Like any other diet, BPC is supposedly “universal.” It’s meant to meet the needs of all of its followers. For me, I felt full. Others may be starving after just a couple hours.

And ultimately, Dave Asprey is a businessman. His empire includes a line of pricey oil and coffee beans in addition to travel mugs, T-shirts, and anti-aging skin creams. With a booming business plan, book, and BPC shops in the works, Asprey is raking it in when you drink his breakfast of champions.

Ally Gallop, BSc, RD is a Certified Diabetes Educator and is studying towards an MS/MPH focusing in health communication and epidemiology. She continues to drink black coffee alongside her high-fiber and scrambled egg breakfast.

The Basics of a Ketogenic Diet

by Mireille Najjar

The ketogenic diet remains one of the most extreme types of low carbohydrate diets, yet its potential role in tumor regression and pediatric epilepsy treatment has become an increasing topic of study among researchers and health professionals worldwide.

What is the Ketogenic Diet?

The ketogenic diet is a low-carbohydrate, moderate-protein, high-fat diet often used to control seizures in children with epilepsy. In such cases, the diet is usually recommended when two or more anti-seizure medications fail to control the seizures or result in harmful side effects. The diet requires careful monitoring by a medical support team, including a pediatrician, a neurologist and a dietitian. After two to three years, a normal diet is reintroduced gradually, depending on the progress of the child. A doctor may also slowly reduce the dosage of medications at this time.

High fat sources common in the ketogenic diet

High fat sources common in the ketogenic diet

Some individuals follow the diet to lose weight and have reported successful short-term weight loss after several months by eating low-carbohydrate, high-fat meals daily. Several studies have also reported unknown or beneficial long-term effects of the diet, particularly in obese patients with high cholesterol. While it can induce rapid weight loss, it is always important to consult a doctor or dietitian before beginning a ketogenic diet.

How Does the Diet Work?

The ketogenic diet works by shifting the body’s energy source from carbohydrates to fat. When the body is in a fasting state, it creates molecules called ketone bodies that build up as the body burns fat for energy—a process called ketosis. The exact reason is unknown, but researchers believe that the high production of ketone bodies improves seizure control in some epileptic children who show no signs of improvement with medication. Some studies, such as a 2010 case report in Nutrition & Metabolism, also show evidence of reduced tumor growth in cancer patients who receive chemotherapy and radiation along with the ketogenic diet.

Characteristics of the Diet

In general, the ratio of fat to carbohydrates and proteins is four to one (4:1) and must be tailored specifically for each individual. This is approximately 60 percent of calories from fat, 35 percent from protein, and 5 percent from carbohydrates. When starting out, it is recommended to limit net carbohydrate intake, which is the amount of carbohydrate in a food that the body is able to use for energy, to 20 grams per day to help the body enter ketosis. Afterwards, it should be limited to less than 50 grams per day. The amount of net carbohydrates per day is dependent on an individual’s own metabolism and activity level.

Many people—particularly adults—find the ketogenic diet difficult to follow since it is very limited in the types and variety of food it allows. The diet is based mostly on fat, protein and vegetables (specifically green leafy vegetables) that provide most of the carbohydrates you eat. Since the diet does not supply sufficient amounts of vitamins and minerals, people usually need to take vitamin and mineral supplements. They must also be completely committed to following the diet for it to work effectively.

Below are some tips on what you should and should not eat, as well as general tips, while on the ketogenic diet:

Foods to Eat

  • Eat plenty of green leafy vegetables like spinach, lettuce, cabbage, broccoli, cauliflower, celery and cucumbers. Limit vegetables like red and yellow peppers, onions and tomatoes, and avoid starchy vegetables like potatoes since they contain higher amounts of carbohydrates.
  • Consume peanut butter, cheese or boiled eggs as a snack. Nuts (with the exception of macadamias and walnuts) should be consumed in moderation since they are rich in inflammatory omega-6 fatty acids.
  • Meat, such as beef, pork and lamb, can be cut or prepared any way you like.
  • Leave the skin on poultry (chicken, turkey, quail, duck, etc.) to increase the fat content. It can also be prepared any way you like.
Beef stir fry, an easy-to-prepare ketogenic meal

Beef stir fry, an easy-to-prepare ketogenic meal

Foods to Avoid

  • Avoid low-fat foods. Since you are getting most of your calories and energy from fat, you need to make sure you are eating enough high-fat products, such as bacon, full-fat dairy (including raw and organic milk products, such as heavy whipping cream, sour cream, cottage cheese, cream cheese, hard and soft cheese, full-fat yogurt, etc.), mayonnaise, oil and butter.
  • If you choose to drink coffee, avoid extra sugar and milk. Instead of sugar, use a sweetener such as Stevia or EZ-Sweetz®. Replace milk with almond milk or heavy cream for a low-carbohydrate alternative.
  • Do not eat fresh, dried or frozen fruit since fruit is high in carbohydrates and fructose, the natural sugar found in fruit. If you choose to eat something sweet, you can eat one or two strawberries, but the fructose might prevent ketosis.
  • Avoid all grains and grain products, juices made from fruit and vegetables, beer, milk (1 percent and skim), beans and lentils, which are all high in carbohydrates.

Important Tips to Consider

  • Check the carbohydrate content of everything you eat. Some foods, such as processed sausages, cheeses, and sauces, contain hidden carbohydrates. For example, added honey and artificial sweeteners in regular low-carbohydrate mustard can increase its carbohydrate content. Be sure to check the carbohydrate content of mayonnaise and oil-based salad dressings, too.
  • Keep track of your daily food and carbohydrate intake. Keep a spreadsheet, use an online food intake tracker, or record the foods you eat in a journal. Write down how you felt each day and any changes you made. If you go off track, you can look back and see what was successful for you.
  • Always choose the lowest carbohydrate options to make sure you do not exceed your daily carbohydrate limit of 50 grams per day. Also, check food labels for net carbohydrates, which are the total carbohydrates minus the amount of fiber.
  • Take a daily multivitamin to replenish the nutrients lost while following the diet.

1-Day Sample Menu (4:1 ratio, approximately 1,884 calories)

Breakfast: Eggs (4 whole eggs, ½ avocado)

Total calories: 419
Fat: 31 g
Protein: 25 g
Net carbohydrates: 5 g

Lunch: Chipotle salad, no dressing (lettuce, chicken, mild salsa, cheese, sour cream and guacamole)

Total calories: 585
Fat: 38 g
Protein: 45 g
Net carbohydrates: 9 g

Snack: Large spinach salad (spinach, olive oil and vinegar dressing)

Total calories: 340
Fat: 32 g
Protein: 4 g
Net carbohydrates: 2 g

Dinner: Cheesy chicken (2 grilled chicken breasts, ½ cup cheese)

Total calories: 380
Fat: 15 g
Protein: 62 g
Net carbohydrates: 4 g

Snack: 24 almonds

Total calories: 160
Fat: 15 g
Protein: 6 g
Net carbohydrates: 3 g

Daily Totals:

Calories: 1,884
Fat: 131 g (63.7% of calories from fat)
Protein: 140 g (30.9% of calories from protein)
Net carbohydrates: 23 g (5.4% of calories from carbohydrates)

Mireille Najjar is a first-year Nutrition Communication student originally from Lebanon. She has a background in nutrition and dietetics and hopes to further strengthen her true passion—writing—here at Friedman.