A conversation about the merits of stretching

A life-long runner, I have spent my fair share of time in physical therapists’ offices seeking treatment for fitness-related injuries. Often during these visits, health-care providers assess my flexibility, deem it unsatisfactory and recommend a variety of stretches to further protect my muscles, tendons and joints from harm. But over the years, several studies have suggested that stretching may not actually help prevent injuries and the contradictory findings have left me with a lot of questions.

To get some answers I turned to Michael Fredericson, MD, who has served as the head team physician with the Stanford Sports Medicine Program since 1992. In this two-part Q&A, Fredericson discusses the role of flexibility in injury prevention and fitness performance and what the scientific evidence indicates about the effectiveness of stretching.

From a biomechanics point of view, how does flexibility influence athletic performance and help reduce the potential for injury?

It is difficult to make a vast generalization about the impact of flexibility because of the broad scope of biomechanical stresses and physical requirements throughout various athletic endeavors. For example, functional flexibility for a hurdler requires greater lengthening of the hamstring and a greater range of motion than for distance running. But in general the concern is when stretching increases a person’s flexibility beyond what is required for a specific motion.

Excessive flexibility may impair performance in sports where a high degree of flexibility is not required. For example, runners with less flexibility are actually more efficient at running. One example in a study involving 100 people, researchers evaluated participants’ flexibility with 11 different tests and then measured their efficiency while walking and running. Results showed, participants who were the most flexible expended 10 to 12 percent more energy to move at the same speed as compared with those that were the least flexible.

In everyday life, individuals maintain flexibility in a specific joint by using it. As we age, decreased activity and lack of use of a joint leads to reduced flexibility. The same is true for athletes. Participating in the sport itself provides the stimulus required to maintain their necessary range of motion. So, in many sports it is more desirable to achieve the required range of motion through specific actions that simulate the movements of the sport, rather than with prolonged stretching. Intense stretching could result in the range of motion exceeding what is needed for athletes to compete and consequently diminishing their performance.

There is an ongoing debate on if static stretching, where you hold a position for 20-30 seconds, is beneficial. How effective is this style of stretching?

Static stretching can increase muscle length but this doesn’t necessarily benefit all athletes equally. While some athletes such as gymnasts and swimmers may need to gain flexibility, being excessively flexible doesn’t benefit distance runners. Consider the standard hamstring stretch. Stretching your hamstring teaches the muscle to relax when the knee is fully extended. However, this doesn’t benefit runners. Instead, runners need to have their hamstrings stiff and activated when the knees are extended. Additionally, studies such as a recent USA Track and Field study (.pdf), have found that static stretching seems to have little benefit in terms of injury prevention, particularly against the overuse injuries common in running.

Another thing to keep in mind is that prolonged stretching, greater than 60 seconds, prior to athletic activity can reduce maximum force production with the loss of voluntary strength and muscular power. This effect can last up to one hour after stretching. For this reason, intense stretching is not typically recommended prior to competition. However many athletes, especially dancers and others participating in activities that require more than average flexibility, may still find shorter bouts of static stretching beneficial.

Salar Deldar, a third-year medical resident at Stanford, contributed information to this entry. The Q&A continues tomorrow with a discussion about the effectiveness of stretching before a workout vs. afterwards and the role of genetics in flexibility.

Photo by lululemon athletica

[Original Article on November 7, 2011

 

United States: Homeopathic Medicines Will Carry Labels Saying They’re Unscientific

But for the people buying them, this will make them even more attractive.

Homeopathic remedies are seen at Ainsworths Pharmacy on August 26, 2005 in London.
These remedies sure look scientific.

Peter Macdiarmid/Getty Images

 

The Federal Trade Commission just cracked down on an unusual product that has long enjoyed exemption from regulation: homeopathic drugs. Available everywhere from Whole Foods to CVS, homeopathic products are advertised as an effective way to treat a wide range of conditions. Just the “H” section of CVS’ online homeopathic medicine webpage mentions hay fever, head injury, hemorrhoids, high blood pressure, HIV support, and hypertension. According to 2007 government data, Americans spend over $3 billion a year on homeopathy, and the market appears to be growing steadily.

Despite their popularity companies selling these products have never been required to show they are effective at doing what they claim. So yesterday, when the FTC announced its “enforcement policy statement” about homeopathic product labeling, it was a welcome move. Unfortunately, the recommendations are pretty minimal: After soliciting comments, commissioning studies, and convening a one-day public workshop, the agency produced a 24 page report that concluded customers were likely to be deceived by labels that did not carry the appropriate disclaimers, and therefore disclaimers stating that these products are untested will now be required. The requirement is not technically a law like, say, the Food and Drug Administration regulations that govern prescription drug labels. Instead, A. Wes Siegner, an attorney who specializes in FTC and FDA regulation, told me “it’s an official heads up that if you want to avoid litigation you need to play by the rules.”

The rules require packaging to effectively communicate two key disclaimers:

  1. “There is no scientific evidence that the product works.”
  2. “The product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.”

That, to this day, a health care product deemed by the FTC to have “no scientific evidence” has avoided substantive regulation is due entirely to the peculiar nature of homeopathy. Developed in the late 18th century by a German physician named Samuel Hahnemann, the novel approach to healing blended scientific, religious, and downright strange concepts, like so from Hahnemann’s book The Organon of the Healing Art: “It is only by means of the spiritual influence of a morbific agent, that our spiritual vital power can be diseased; and in like manner, only by the spiritual (dynamic) operation of medicine, that health can be restored.”

There is near-unanimous mainstream scientific consensus that homeopathy’s purported mechanism of action—using ultra-highly diluted substances to allow “like to cure like”—runs counter to basic principles of chemistry, biology, and physics. As health policy expert Timothy Caulfield recently said, “to believe homeopathy works … is to believe in magic.” Detractors like him suggest the most likely explanation for homeopathy’s perceived efficacy is a combination of wishful thinking and placebo effect. This view of homeopathy has been popular for nearly two centuries: “The homeopathic method,” wrote physician Jacob Bigelow in 1835, “consists in leaving the case to nature, while the patient is amused with nominal and nugatory remedies.”

Nevertheless, practitioners and patients alike have successfully championed homeopathy into the present day. Unmoored as it is from the rest of conventional scientific thinking, regulators have had no idea how to classify homeopathic products. Most products are engineered to contain only infinitesimally small amounts of the active substance, which means they are almost always harmless. Consequently, until now, the FDA and the FTC found it easier to take a hands-off approach, which means that homeopathic medicine packaging has been basically governed by practitioner-authored guidelines and the FTC’s general injunction to be truthful and not deceptive.

That the FTC decided to regulate homeopathic medicine may seem like a step in the right direction. But the mandate they’ve come up with—to require disclaimers on these products—is nearly as lacking in scientific evidence as the products themselves. Requiring disclosures will probably do nothing to help people realize the true nature of what they’re buying.

Time and time again, studies have shown that with few exceptions, “This claim has not been approved by the FDA”–style disclaimers do little to inform consumers or change their purchasing habits. As I reported for Slate in 2014, the FDA’s own studies show this, with most disclaimers making no difference and some actually making heath claims appear persuasive! The FTC’s more recent studies on homeopathic medicine disclaimers are not encouraging, with 25-45 percent of consumers reporting that homeopathic products are FDA approved—after looking at a package with a disclaimer that says they aren’t.

The problem is bigger than inadequate packaging disclaimers. “I’m not confident that a disclaimer could ever effectively communicate ‘there’s really no evidence this product works,’ ” said Georgetown Law professor Rebecca Tushnet.* “Many consumers expect ‘they couldn’t say it if it wasn’t true’ and disclaimers are probably not good enough to combat a belief that basic.”

hyland label.

Screenshot via Amazon

 

Homeopathy compounds the problem. (That’s a homeopathy pun.) The labels on these drugs look incredibly scientific. They’ve got weird units (12X HPUS), and technical-sounding ingredients (Cuprum Metallicum), and even name-drop “the official Homeopathic Pharmacopeia of the United States.” The whole thing evokes a standardized, highly refined system, and for reasonable people unfamiliar with homeopathy it’s understandably hard to believe that products based on such a system that make health claims and are sold in CVS could actually be nothing more than placebos.

What’s worse, the second point required by the FTC’s new labeling standards may reinforce some consumers’ beliefs in the efficacy of the product. Prior beliefs and confirmation bias have a strong effect on how we process information. Those drawn to homeopathic medicine are more likely to be skeptical of mainstream medicine, a preference that homeopathic advertising plays to with its emphasis on descriptors like “natural.” To read that most modern medical experts don’t accept homeopathy highlights the anti-establishment allure of the product. Similarly, the appeal to antiquity means that mentioning homeopathy’s ancient origin will actually serve to bolster its plausibility. After all, goes the fallacious thinking, if it weren’t true and didn’t work how could it have stuck around for over two centuries?

This is not to rail on the FTC, which should be applauded for its strongly worded and scientifically accurate statement, especially given how difficult it is to mandate disclaimers without violating consumers’ rights. It did the best it could given the limitations it faces. But we cannot, as a society, let such statements breed complacency when it comes to addressing the problem of pseudoscience and deceptive marketing. In truth, what’s necessary is recognition that our education system is badly misallocating resources and leaving us susceptible to such claims. We learn a great number of scientific facts in middle school and high school, but spend virtually no time on the philosophy of science. This is a shame. Without understanding the process by which our culture decides on what counts as scientific knowledge, people are left to judge the reliability of a claim with little more than “Was it made by someone with letters after their name?” and “Does it sound like the science I did in school?”

When these questions are the only tools in the public’s epistemic toolkit, the gates are open to all sorts of pseudoscientific nonsense, from quantum healing to a lot of what has passed as macroeconomics. Confronted with an epidemic of inadequate education, I can see how it would be tempting to administer it on packages in an ultra-highly diluted form. Doing so, combined with anecdotal evidence of success, might even make us feel better about the problem. But that feeling isn’t based on actual improvement. It’s just wishful thinking and the placebo effect. And while placebos are often useful, in certain cases they can be dangerous, allowing the patient to ignore an illness until it’s gone too far. We wouldn’t want that to happen to someone taking homeopathic remedies for a serious disease. Let’s not let it happen with disclaimers and public scientific literacy.

*Correction, Nov. 16, 2016: Due to an editing error, an earlier version of this article misspelled Rebecca Tushnet’s last name. (Return.)

 

Cold therapy? Maybe better to save your money

My friends know they are going to get an evidence-based read on medical practices when they turn to me for advice. Not all of them enjoy the eye rolls that involuntarily occur when I hear what they are considering, like when a friend asked me about the benefits of whole body cryotherapy.

Cryotherapy is the practice of subjecting tissue or lesions in tissue to very cold temperatures in an effort to kill something that is considered unhealthy. It can also mean the application of ice packs to reduce swelling or pain on a part of the body.

Icing an injury: There’s little good evidence for it. Photo: iStock
But whole body cryotherapy exposes the body for a couple of minutes to vapor that has been supercooled to somewhere between minus 94 and minus 148 degrees Celcius. It was once confined mostly to elite athletes, but now centres have cropped up across the country asserting that the practice can lead to any number of health benefits.

There is not much evidence, however, to back this up. A 2015 Cochrane systematic review looked at studies assessing the benefits and harms of whole body cryotherapy in preventing and treating exercise-induced muscle soreness in adults. The authors found four laboratory-based randomised controlled trials that included 64 young adults (average age 23), 60 of whom were male. All of the studies were judged to have some problems with design features, and overall, they found insufficient evidence to support the use of whole body cryotherapy for muscle soreness. Moreover, there was almost no evidence supporting its use for women or for the middle-aged and older people.

When we get into specific treatments, the evidence is even more scant. A recent two-week study (which doesn’t appear to have been randomised or blinded) found whole body cryotherapy to be similar to traditional rehabilitation in improving outcomes for 44 patients with rheumatoid arthritis. A case control study of 24 patients with multiple sclerosis found that those who received whole body cryotherapy had improved functional status and reduced feelings of fatigue. In a small randomised controlled trial lasting eight weeks, 12 patients with restless leg syndrome seemed to see improvements in symptoms and quality of life.

These were all small studies, involving few patients, over short periods of time, with minimal overall changes. Given the likelihood of publication bias here (positive results are more likely to be published than negative ones), it’s hard to make sweeping recommendations based on these findings.

Because so little data is available, the Food and Drug Administration has not certified cryotherapy chambers to treat anything, including muscle pain or inflammation. For this reason, they cannot be marketed to treat diseases.

That doesn’t stop all kinds of other assertions from centres that offer whole body cryotherapy. Some say it can help people lose weight. Others argue that it can help slow ageing and make you look younger. There are even those who maintain that it can make a difference in your mental health. None of these claims have been the subject of well-designed studies.

Most of the research on whole body cryotherapy doesn’t focus on disability or disease but on athletic performance. In 2013, a meta-analysis published on 21 randomised controlled trials showed no significant benefit to endurance, strength or the ability to jump. There was some benefit to sprint performance, but even this seems to be the result of one outlying study.

This hasn’t stopped these athletes from continuing to use cryotherapy. But as I’ve discussed before, many athletes are willing to spend money and try therapies with little proof of potential gain.

The bad news is that even the use of ice to take care of localised injuries isn’t nearly as well supported as you might imagine. A systematic review published in The Journal of Athletic Training in 2012 gathered evidence from studies testing “rest, ice, compression and elevation” therapies. They found limited evidence to support the use of ice in the treatment of ankle sprains.

A 2004 systematic review looking at the use of ice for a variety of soft-tissue injuries found that “many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.”

Of course, applying an ice pack has few potential harms and almost no cost. If people find benefit from that, I’m not going to argue that they should stop. The potential downsides of whole body cryotherapy are much more significant.

Whole body cryotherapy is also inherently dangerous, which is why it should never be done alone. In 2015, an employee using a cryotherapy chamber after hours unaccompanied was found dead inside. Freezing your body can also result in hypothermia or frostbite, adding to the necessity that the procedure be monitored closely.

Whole body cryotherapy isn’t cheap, either. Sessions can run between $50 and $100, and no insurance plans I know of will help you cover those bills. Given all of this, and the utter lack of proven benefits, when my friend asked about it, an eye roll was probably the appropriate response.

New York Times

[Original Article] AARON E. CARROLL

The Vitamin Myth: Why We Think We Need Supplements

[Original Article]

Nutrition experts contend that all we need is what’s typically found in a routine diet. Industry representatives, backed by a fascinating history, argue that foods don’t contain enough, and we need supplements. Fortunately, many excellent studies have now resolved the issue.

vitamingc
slipah/Flickr

On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. “It’s been a tough week for vitamins,” said Carrie Gann of ABC News.

These findings weren’t new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements. What few people realize, however, is that their fascination with vitamins can be traced back to one man. A man who was so spectacularly right that he won two Nobel Prizes and so spectacularly wrong that he was arguably the world’s greatest quack.

In 1931, Linus Pauling published a paper in the Journal of the American Chemical Society titled “The Nature of the Chemical Bond.” Before publication, chemists knew of two types of chemical bonds: ionic, where one atom gives up an electron to another; and covalent, where atoms share electrons. Pauling argued that it wasn’t that simple — electron sharing was somewhere between ionic and covalent. Pauling’s idea revolutionized the field, marrying quantum physics with chemistry. His concept was so revolutionary in fact that when the journal editor received the manuscript, he couldn’t find anyone qualified to review it. When Albert Einstein was asked what he thought of Pauling’s work, he shrugged his shoulders. “It was too complicated for me,” he said.

For this single paper, Pauling received the Langmuir Prize as the most outstanding young chemist in the United States, became the youngest person elected to the National Academy of Sciences, was made a full professor at Caltech, and won the Nobel Prize in Chemistry. He was 30 years old.

In 1949, Pauling published a paper in Science titled “Sickle Cell Anemia, a Molecular Disease.” At the time, scientists knew that hemoglobin (the protein in blood that transports oxygen) crystallized in the veins of people with sickle-cell anemia, causing joint pain, blood clots, and death. But they didn’t know why. Pauling was the first to show that sickle hemoglobin had a slightly different electrical charge — a quality that dramatically affected how the hemoglobin reacted with oxygen. His finding gave birth to the field of molecular biology.

In 1951, Pauling published a paper in the Proceedings of the National Academy of Sciences titled “The Structure of Proteins.” Scientists knew that proteins were composed of a series of amino acids. Pauling proposed that proteins also had a secondary structure determined by how they folded upon themselves. He called one configuration the alpha helix — later used by James Watson and Francis Crick to explain the structure of DNA.

In 1961, Pauling collected blood from gorillas, chimpanzees, and monkeys at the San Diego Zoo. He wanted to see whether mutations in hemoglobin could be used as a kind of evolutionary clock. Pauling showed that humans had diverged from gorillas about 11 million years ago, much earlier than scientists had suspected. A colleague later remarked, “At one stroke he united the fields of paleontology, evolutionary biology, and molecular biology.”

Pauling’s accomplishments weren’t limited to science. Beginning in the 1950s — and for the next forty years — he was the world’s most recognized peace activist. Pauling opposed the internment of Japanese Americans during World War II, declined Robert Oppenheimer’s offer to work on the Manhattan Project, stood up to Senator Joseph McCarthy by refusing a loyalty oath, opposed nuclear proliferation, publicly debated nuclear-arms hawks like Edward Teller, forced the government to admit that nuclear explosions could damage human genes, convinced other Nobel Prize winners to oppose the Vietnam War, and wrote the best-selling book No More War! Pauling’s efforts led to the Nuclear Test Ban Treaty. In 1962, he won the Nobel Peace Prize — the first person ever to win two unshared Nobel Prizes.

In addition to his election to the National Academy of Sciences, two Nobel Prizes, the National Medal of Science, and the Medal for Merit (which was awarded by the president of the United States), Pauling received honorary degrees from Cambridge University, the University of London, and the University of Paris. In 1961, he appeared on the cover of Time magazine’s Men of the Year issue, hailed as one of the greatest scientists who had ever lived.

Then all the rigor, hard work, and hard thinking that had made Linus Pauling a legend disappeared. In the words of a colleague, his “fall was as great as any classic tragedy.”

The turning point came in March 1966, when Pauling was 65 years old. He had just received the Carl Neuberg Medal. “During a talk in New York City,” recalled Pauling, “I mentioned how much pleasure I took in reading about the discoveries made by scientists in their various investigations of the nature of the world, and stated that I hoped I could live another twenty-five years in order to continue to have this pleasure. On my return to California I received a letter from a biochemist, Irwin Stone, who had been at the talk. He wrote that if I followed his recommendation of taking 3,000 milligrams of vitamin C, I would live not only 25 years longer, but probably more.” Stone, who referred to himself as Dr. Stone, had spent two years studying chemistry in college. Later, he received an honorary degree from the Los Angeles College of Chiropractic and a “PhD” from Donsbach University, a non-accredited correspondence school in Southern California.

Pauling followed Stone’s advice. “I began to feel livelier and healthier,” he said. “In particular, the severe colds I had suffered several times a year all my life no longer occurred. After a few years, I increased my intake of vitamin C to ten times, then twenty times, and then three hundred times the RDA: now 18,000 milligrams per day.”

From that day forward, people would remember Linus Pauling for one thing: vitamin C.

In 1970, Pauling published Vitamin C and the Common Cold, urging the public to take 3,000 milligrams of vitamin C every day (about 50 times the recommended daily allowance). Pauling believed that the common cold would soon be a historical footnote. “It will take decades to eradicate the common cold completely,” he wrote, “but it can, I believe, be controlled entirely in the United States and some other countries within a few years. I look forward to witnessing this step toward a better world.” Pauling’s book became an instant best seller. Paperback versions were printed in 1971 and 1973, and an expanded edition titled Vitamin C, the Common Cold and the Flu, published three years later, promised to ward off a predicted swine flu pandemic. Sales of vitamin C doubled, tripled, and quadrupled. Drugstores couldn’t keep up with demand. By the mid-1970s, 50 million Americans were following Pauling’s advice. Vitamin manufacturers called it “the Linus Pauling effect.”

Scientists weren’t as enthusiastic. On December 14, 1942, about thirty years before Pauling published his first book, Donald Cowan, Harold Diehl, and Abe Baker, from the University of Minnesota, published a paper in the Journal of the American Medical Association titled “Vitamins for the Prevention of Colds.” The authors concluded, “Under the conditions of this controlled study, in which 980 colds were treated . . . there is no indication that vitamin C alone, an antihistamine alone, or vitamin C plus an antihistamine have any important effect on the duration or severity of infections of the upper respiratory tract.”

Other studies followed. After Pauling’s pronouncement, researchers at the University of Maryland gave 3,000 milligrams of vitamin C every day for three weeks to eleven volunteers and a sugar pill (placebo) to ten others. Then they infected volunteers with a common cold virus. All developed cold symptoms of similar duration. At the University of Toronto, researchers administered vitamin C or placebo to 3,500 volunteers. Again, vitamin C didn’t prevent colds, even in those receiving as much as 2,000 milligrams a day. In 2002, researchers in the Netherlands administered multivitamins or placebo to more than 600 volunteers. Again, no difference. At least 15 studies have now shown that vitamin C doesn’t treat the common cold. As a consequence, neither the FDA, the American Academy of Pediatrics, the American Medical Association, the American Dietetic Association, the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, nor the Department of Health and Human Services recommend supplemental vitamin C for the prevention or treatment of colds.

Although study after study showed that he was wrong, Pauling refused to believe it, continuing to promote vitamin C in speeches, popular articles, and books. When he occasionally appeared before the media with obvious cold symptoms, he said he was suffering from allergies.

Then Linus Pauling upped the ante. He claimed that vitamin C not only prevented colds; it cured cancer.

In 1971, Pauling received a letter from Ewan Cameron, a Scottish surgeon from a tiny hospital outside Glasgow. Cameron wrote that cancer patients who were treated with ten grams of vitamin C every day had fared better than those who weren’t. Pauling was ecstatic. He decided to publish Cameron’s findings in the Proceedings of the National Academy of Sciences (PNAS). Pauling assumed that as a member of the academy he could publish a paper in PNAS whenever he wanted; only three papers submitted by academy members had been rejected in more than half a century. Pauling’s paper was rejected anyway, further tarnishing his reputation among scientists. Later, the paper was published in Oncology, a journal for cancer specialists. When researchers evaluated the data, the flaw became obvious: the cancer victims Cameron had treated with vitamin C were healthier at the start of therapy, so their outcomes were better. After that, scientists no longer took Pauling’s claims about vitamins seriously.

But Linus Pauling still had clout with the media. In 1971, he declared that vitamin C would cause a 10 percent decrease in deaths from cancer. In 1977, he went even further. “My present estimate is that a decrease of 75 percent can be achieved with vitamin C alone,” he wrote, “and a further decrease by use of other nutritional supplements.” With cancer in their rearview mirror, Pauling predicted, Americans would live longer, healthier lives. “Life expectancy will be 100 to 110 years,” he said, “and in the course of time, the maximum age might be 150 years.”

Cancer victims now had reason for hope. Wanting to participate in the Pauling miracle, they urged their doctors to give them massive doses of vitamin C. “For about seven or eight years, we were getting a lot of requests from our families to use high-dose vitamin C,” recalls John Maris, chief of oncology and director of the Center for Childhood Cancer Research at the Children’s Hospital of Philadelphia. “We struggled with that. They would say, ‘Doctor, do you have a Nobel Prize?’ ”

Blindsided, cancer researchers decided to test Pauling’s theory. Charles Moertel, of the Mayo Clinic, evaluated 150 cancer victims: half received ten grams of vitamin C a day and half didn’t. The vitamin C-treated group showed no difference in symptoms or mortality. Moertel concluded, “We were unable to show a therapeutic benefit of high-dose vitamin C.” Pauling was outraged. He wrote an angry letter to the New England Journal of Medicine, which had published the study, claiming that Moertel had missed the point. Of course vitamin C hadn’t worked: Moertel had treated patients who had already received chemotherapy. Pauling claimed that vitamin C worked only if cancer victims had received no prior chemotherapy.

Bullied, Moertel performed a second study; the results were the same. Moertel concluded, “Among patients with measurable disease, none had objective improvement. It can be concluded that high-dose vitamin C therapy is not effective against advanced malignant disease regardless of whether the patient had received any prior chemotherapy.” For most doctors, this was the end of it. But not for Linus Pauling. He was simply not to be contradicted. Cameron observed, “I have never seen him so upset. He regards the whole affair as a personal attack on his integrity.” Pauling thought Moertel’s study was a case of “fraud and deliberate misrepresentation.” He consulted lawyers about suing Moertel, but they talked him out of it.

Subsequent studies have consistently shown that vitamin C doesn’t treat cancer.

Pauling wasn’t finished. Next, he claimed that vitamin C, when taken with massive doses of vitamin A (25,000 international units) and vitamin E (400 to 1,600 IU), as well as selenium (a basic element) and beta-carotene (a precursor to vitamin A), could do more than just prevent colds and treat cancer; they could treat virtually every disease known to man. Pauling claimed that vitamins and supplements could cure heart disease, mental illness, pneumonia, hepatitis, polio, tuberculosis, measles, mumps, chickenpox, meningitis, shingles, fever blisters, cold sores, canker sores, warts, aging, allergies, asthma, arthritis, diabetes, retinal detachment, strokes, ulcers, shock, typhoid fever, tetanus, dysentery, whooping cough, leprosy, hay fever, burns, fractures, wounds, heat prostration, altitude sickness, radiation poisoning, glaucoma, kidney failure, influenza, bladder ailments, stress, rabies, and snakebites. When the AIDS virus entered the United States in the 1970s, Pauling claimed vitamins could treat that, too.

On April 6, 1992, the cover of Time — rimmed with colorful pills and capsule — declared: “The Real Power of Vitamins: New research shows they may help fight cancer, heart disease, and the ravages of aging.” The article, written by Anastasia Toufexis, echoed Pauling’s ill-founded, disproved notions about the wonders of megavitamins. “More and more scientists are starting to suspect that traditional medical views of vitamins and minerals have been too limited,” wrote Toufexis. “Vitamins — often in doses much higher than those usually recommended — may protect against a host of ills ranging from birth defects and cataracts to heart disease and cancer. Even more provocative are glimmerings that vitamins can stave off the normal ravages of aging.” Toufexis enthused that the “pharmaceutical giant Hoffman-La Roche is so enamored with beta-carotene that it plans to open a Freeport, Texas, plant next year that will churn out 350 tons of the nutrient annually, or enough to supply a daily 6 milligram capsule to virtually every American adult.”

The National Nutritional Foods Association (NNFA), a lobbying group for vitamin manufacturers, couldn’t believe its good luck, calling the Time article “a watershed event for the industry.” As part of an effort to get the FDA off their backs, the NNFA distributed multiple copies of the magazine to every member of Congress. Speaking at an NNFA trade show later in 1992, Toufexis said, “In fifteen years at Time I have written many health covers. But I have never seen anything like the response to the vitamin cover. It whipped off the sales racks, and we were inundated with requests for copies. There are no more copies. ‘Vitamins’ is the number-one-selling issue so far this year.”

Although studies had failed to support him, Pauling believed that vitamins and supplements had one property that made them cure-alls, a property that continues to be hawked on everything from ketchup to pomegranate juice and that rivals words like natural and organic for sales impact: antioxidant.

Antioxidation vs. oxidation has been billed as a contest between good and evil. The battle takes place in cellular organelles called mitochondria, where the body converts food to energy, a process that requires oxygen and so is called oxidation. One consequence of oxidation is the generation of electron scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes, and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer, and heart disease. To neutralize free radicals, the body makes its own antioxidants (good). Antioxidants can also be found in fruits and vegetables — specifically, selenium, beta-carotene, and vitamins A, C, and E. Studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious: if fruits and vegetables contain antioxidants — and people who eat lots of fruits and vegetables are healthier — then people who take supplemental antioxidants should also be healthier.

In fact, they’re less healthy.

In 1994, the National Cancer Institute, in collaboration with Finland’s National Public Health Institute, studied 29,000 Finnish men, all long-term smokers more than fifty years old. This group was chosen because they were at high risk for cancer and heart disease. Subjects were given vitamin E, beta-carotene, both, or neither. The results were clear: those taking vitamins and supplements were morelikely to die from lung cancer or heart disease than those who didn’t take them — the opposite of what researchers had anticipated.

In 1996, investigators from the Fred Hutchinson Cancer Research Center, in Seattle, studied 18,000 people who, because they had been exposed to asbestos, were at increased risk of lung cancer. Again, subjects received vitamin A, beta-carotene, both, or neither. Investigators ended the study abruptly when they realized that those who took vitamins and supplements were dying from cancer and heart disease at rates 28 and 17 percent higher, respectively, than those who didn’t.

In 2004, researchers from the University of Copenhagen reviewed fourteen randomized trials involving more than 170,000 people who took vitamins A, C, E, and beta-carotene to see whether antioxidants could prevent intestinal cancers. Again, antioxidants didn’t live up to the hype. The authors concluded, “We could not find evidence that antioxidant supplements can prevent gastrointestinal cancers; on the contrary, they seem to increase overall mortality.” When these same researchers evaluated the seven best studies, they found that death rates were 6 percent higher in those taking vitamins.

In 2005, researchers from Johns Hopkins School of Medicine evaluated nineteen studies involving more than 136,000people and found an increased risk of death associated with supplemental vitamin E. Dr. Benjamin Caballero, director of the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, said, “This reaffirms what others have said. The evidence for supplementing with any vitamin, particularly vitamin E, is just not there. This idea that people have that [vitamins] will not hurt them may not be that simple.” That same year, a study published in the Journal of theAmerican Medical Association evaluated more than 9,000 people who took high-dose vitamin E to prevent cancer; those who took vitamin E were more likely to develop heart failure than those who didn’t.

In 2007, researchers from the National Cancer Institute examined 11,000 men who did or didn’t take multivitamins. Those who took multivitamins were twice as likely to die from advanced prostate cancer.

In 2008, a review of all existing studies involving more than 230,000 people who did or did not receive supplemental antioxidants found that vitamins increased the risk of cancer and heart disease.

On October 10, 2011, researchers from the University of Minnesota evaluated 39,000 older women and found that those who took supplemental multivitamins, magnesium, zinc, copper, and iron died at rates higher than those who didn’t. They concluded, “Based on existing evidence, we see little justification for the general and widespread use of dietary supplements.”

Two days later, on October 12, researchers from the Cleveland Clinic published the results of a study of 36,000 men who took vitamin E, selenium, both, or neither. They found that those receiving vitamin E had a 17 percent greater risk of prostate cancer. In response to the study, Steven Nissen, chairman of cardiology at the Cleveland Clinic, said, “The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage.” On October 25, a headline in the Wall Street Journal asked, “Is This the End of Popping Vitamins?” Studies haven’t hurt sales. In 2010, the vitamin industry grossed $28 billion, up 4.4 percent from the year before. “The thing to do with [these reports] is just ride them out,” said Joseph Fortunato, chief executive of General Nutrition Centers. “We see no impact on our business.”

How could this be? Given that free radicals clearly damage cells — and given that people who eat diets rich in substances that neutralize free radicals are healthier — why did studies of supplemental antioxidants show they were harmful? The most likely explanation is that free radicals aren’t as evil as advertised. Although it’s clear that free radicals can damage DNA and disrupt cell membranes, that’s not always a bad thing. People need free radicals to kill bacteria and eliminate new cancer cells. But when people take large doses of antioxidants, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state in which the immune system is less able to kill harmful invaders. Researchers have called this “the antioxidant paradox.” Whatever the reason, the data are clear: high doses of vitamins and supplements increase the risk of heart disease and cancer; for this reason, not a single national or international organization responsible for the public’s health recommends them.

In May 1980, during an interview at Oregon State University, Linus Pauling was asked, “Does vitamin C have any side effects on long-term use of, let’s say, gram quantities?” Pauling’s answer was quick and decisive. “No,” he replied.

Seven months later, his wife was dead of stomach cancer. In 1994, Linus Pauling died of prostate cancer.


This is an excerpt from Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.

11 Nutrition Myths That Cause Weight Gain

[Original Article]

July 29, 2013

Losing weight is a journey, a confusing one at that. End the confusion with these myth-busting tips from Shape!

1. Going vegan is a healthy way to lose weight.

“While various research shows that vegetarians and vegans, on average, consume fewer calories and less fat than omnivores (a 2009 Oxford study found that vegetarians weigh 3 to 20 percent less than their meat-eating counterparts, and a National Cancer Institute study found that subjects who consumed four ounces or more of red meat weekly were 30 percent more likely to die of any cause than those who ate less), these numbers may be misleading,” says Rania Batayneh, MPH, a certified nutritionist and owner of Essential Nutrition for You.

Going vegan solely for weight loss can backfire, big time. If you aren’t vigilant with a vegan diet, it’s easy to lack in vital nutrients, vitamins, and proteins, which give you energy and help keep your metabolism stoked. Many first-time vegans may also find themselves reaching for more processed foods like vegan cookies, chips, or even ‘ice cream’ more often with such a restricted diet, and many end up packing on the pounds instead.

If you do decide to adopt a vegan diet, be sure to keep the ‘treats’ to a minimum and plan balanced meals. “Aim to get about 10 to 20 percent of your calories from protein (or about 1 gram per kilogram of body weight), replacing animal protein with healthy plant proteins, like those found in beans, legumes, nuts, seeds, and soy products,” Batayneh says. “And, whether you are vegan or not, eating more green, leafy vegetables is great for your health and your waistline.”

2. Cut all carbs to shed pounds.
Your body needs ‘carbs’ for energy, and many carbohydrate foods are rich in essential vitamins, nutrients, and dietary fiber that help you stay full and fuel your workouts. “Eliminating carbohydrates not only reduces whole grains, B vitamins, and a good source of fiber, but it also reduces your body’s feel-good capacity (it’s no wonder that most comfort foods are carbohydrate based),” Batayneh says.

Plus, cutting out food groups may only make you crave them more, and you may find yourself finishing off an entire bag of chips in a moment of weakness. “Starches and carbs are actually an important tool in weight management,” Batayneh says. “They provide belly-filling fiber, complex carbohydrates to keep your engine running all day, and they stimulate the production of serotonin, the feel-good neurotransmitter that regulates mood.”

Stay healthy, full, and happy while dropping the lbs. by swapping out processed carbs for fiber- and nutrition-filled foods like vegetables, fruits, and whole grains.

3. Diet drinks are a good way to cut calories.
You may think you’re doing yourself a favor by sipping artificially sweetened drinks, but recent research says you may just be setting yourself up to crave sweets even more. ‘Fake’ sugar can trick our bodies, since we aren’t actually providing it with any calories to back up the sweetness, causing a vicious cycle of cravings. “Artificial sweeteners tend to trigger your appetite, making you want more and more sugar, but without actually satisfying a desire for sweets like normal sugar does,” Batayneh says. “Diet soda-drinkers may end up eating tons of sugary and fatty snacks in order to satisfy their cravings.”

Case in point: One University of Texas study found that people who drink diet soda regularly (more than two per day) had a 70 percent greater waist circumference than those that don’t. Not to mention, diet sodas are also often loaded with additives, including caramel coloring, which is made by reacting sugars with ammonia and sulfites, resulting in two compounds that have been found to cause lung, liver, and thyroid cancers in mice, Batayneh says.

4. Fat-free snacks are better for your waistline.
“Reduced-fat versions of snacks typically have been stripped of one quarter of their original healthy monounsaturated fats, and to replace that flavor, the brand adds in fillings, additives, and sugar — all for the same amount of calories,” Batayneh says. “Picking reduced-fat products may even end up hurting your waistline: in one study, average-weight participants ate 22 percent more calories if the food was labeled ‘low fat’ and overweight participants ate up to 50 percent more.”

Your body needs fat to absorb vitamins, and it may also help you shed pounds — a recent Stanford University study found that people on a moderate-fat diet lost twice as much weight as subjects eating a low fat diet.

So skip the highly processed, fat-free snacks that are basically empty calories and fill up on healthy, whole foods that will help you stay satisfied on a lower-calorie diet such as avocados, nuts, and coconuts.

See seven more weight-loss tips after the break!

5. Fruit has too much sugar to be healthy for weight loss.
With all the sugar that is added to processed foods, the sugar in fruit is the least of your worries. Getting rid of fruit means you are losing out on valuable vitamins and nutrients that your body absorbs easily since they’re found in their natural, whole state.

“Eliminating fruit from your diet when trying to lose weight makes no sense,” Batayneh says. You’ll miss out on a whole lot of filling fiber, which studies have directly linked to long-term weight loss, and you may be more likely to reach for other processed, empty food items instead.

6. Protein shakes will help you lose weight.
Drinking protein shakes alone can’t help you lose weight, but replacing a meal with them could. The trouble is, many would-be dieters make the mistake of adding in a shake to their current daily intake, which can pack on the pounds (this is why bodybuilders trying to gain size use them often).

If you want to add protein shakes to your diet, look for a mix that is low in sugar and has a short ingredient list. Depending on the calorie count, and what you add to it (Batayneh recommends whey protein, milk, and fruit), you can substitute a shake for a snack or a meal to help move the scale down, not up.

7. A high-protein diet is the best way to shed fat.
While protein is important for weight loss, eliminating other food groups (like carbs) for the sake of eating more protein could be setting you up for a carbo-loading binge later. Plus, you may be missing out on the fiber, vitamins, and minerals found in unprocessed carbohydrates, and you run the risk of eating too much fat in your diet, which can lead to high cholesterol and triglycerides, Batayneh says.

Skip the yo-yo cycle and round out your meals with a healthy balance of protein, carbohydrates, and fat. “When you have all three macro-nutrients in your diet, you are less likely to feel deprived and may experience less cravings.”

8. Swear off all your favorite fattening foods to lose weight.
Anyone who has ever sworn off pizza, chocolate, or chips knows that as soon as you tell yourself you can’t have them, you start dreaming of swimming in gooey, cheesy pizza or rich, dark chocolate cake. “Moderation is key. We tend to be in ‘all or nothing’ mode when we diet. And while you can’t have pizza, french fries, and chocolate cake all in the same day, with careful planning, you can still enjoy them in moderation,” Batayneh says. Have your cake, and eat it too — just share it with a friend or save the other half for another day.

9. Eating after 8 p.m. makes you fat.
Eating after a certain hour won’t necessarily mean you’ll pack on pounds, just as staying out after midnight won’t turn you into a pumpkin. This Cinderella-esque fat fairy tale continues to exist, but the bottom line is that your metabolism doesn’t know what time it is, Batayneh says.
Skip the mad rush to consume as much food as you can before the clock strikes 8:00.

“Calories are calories, no matter when you eat them, but what does matter is what and how much of it you eat. Late-night snacking gets a bad rap because often the foods that are consumed late at night are calorie-dense foods (chips, ice cream, pizza, and other junk food) and may be in excess calories to your daily caloric needs, which translates to weight gain.”

10. You’ll burn more fat if you don’t eat before a workout.
Exercise normally burns away your glycogen (carbohydrate) reserves, and when you’re done burning those, you’ll start dipping into your fat stores for energy. It’s true that when you’re already running on empty, you burn fat right away, but you’ll likely run out of steam before your workout is over or end up ravenous and grabbing whatever food you can find in an attempt to refuel afterwards, Batayneh says.

“Energy comes from calories. A study from the University of Birmingham compared two groups of cyclists — some ate before their workout and the others fasted. While the group who fasted did end up burning more fat, the group who ate cycled at a much higher intensity than the fasting group, and burned more calories. A person needs fuel to run, just like a car, so find the foods that give you the energy to work out at your hardest.”

11. You can eat whatever you want on weekends.
If you do the math, eating ‘whatever you want’ Friday-Sunday adds up to 12 days, or almost half of a 30-day month! Not exactly the recipe for weight loss success. “When you throw caution to the wind on the weekends it can actually offset the consistency and success you had all week,” Batayneh says. Instead of taking a no-holds-barred approach to your weekends, Batayneh recommends trying to scale back the little things that really add up like the bread basket and having a few extra glasses of wine during dinners out, along with mindless munching out of boredom.

More on SHAPE:
7 Foods a Nutritionist Would Never Eat
Must-Know Hot-Weather Workout Tips
A Beginner’s Guide to the Paleo Diet

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