RCT or Observational Study or Anecdote -- Define Paleo first!
Well, I might as well weigh in on the post of Robb's that got to me on several levels.
Evidence Based Medicine: Fraud, Double Standards And Ignorance
Evidence Based Medicine: Fraud, Double Standards And Ignorance
Robb seems upset that some unnamed Twitter adversary who probably got him riled up linking to a piece on Marlene Zuk's Paleo Fantasies book. The response to this book has been interesting to watch but boils down to "she's all wrong, it's not about re-enactment". Well blow me down isn't that exactly what the whole Grok thing is? I Caveman? Some in paleo definitely take that schtick to a greater degree. But what of the diet?
Can I ask yet again for a definition of what a paleo diet is? The Paleo Diet (TM Cordain) used to include canola oil .... Near as I can tell, paleo = grain free. All else is negotiable. Dairy? Grok could have killed a lactating beast so ... Eat meat morning, noon and night, or just night and by all means eat a lot of fat ... just make sure it's from a grass fed cow. I mean come on, if there is stereotyping about what the paleo diet is, the paleo peeps have only themselves to blame. And if there's laughing at their expense, it's only because it is utterly ridiculous to make paleo ice cream and consider putting a stick of butter in your coffee to enjoy with a brick of dark chocolate somehow righteous and evolutionary and really that much different than a home baked chocolate cake or, non-God forbid, a Twinkie.
|Click to enlarge|
Macro and caloric content of
three paleo diet studies
But what gets me the most here, is that in the article Robb complains about how people just don't know there are scientific studies on the paleo diet. Read his book! I don't know who this guy on Twitter was, but I think one would be hard pressed not to have heard of that paleo vs. Med trial, whether or not the person knows that as the Lindeberg study: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. What most who cite that study don't know, is that it was a low calorie (under 1500/day) low fat (28%) and under 10% saturated fat. It was not, as Nora Gedgaudas -- one of the world's self-proclaimed leading experts on paleo nutrition -- claims, a VLC diet (almost 40% carb!).
After discussing a study on gun shot wounds and describing it as an observational study, Robb writes:
Should this be dismissed as flippantly as Lindeberg’s Paleo vs. Mediterranean diet in Humans trial frequently is amongst the EBM crowd? How about just holding the same standards to all of this material instead of using one’s biases ?
Would this be anything like the low fat challenge from Larry Istrail? I have certainly not been flippant about this study, I just don't find it supportive of the sort of paleo diet all of these bloggers are eating and selling. So Robb's Twitter friend wrote
“This is why I do not advocate Paleo, there is not science to back it up. Show me the science”
Personally, I'd like to see some science -- science, as in evolutionary biologists' takes on what paleolithic humans ate and whether or not they think we should be even attempting to mimic that. Eh? Were we ketotic carnivores? This is what Nora tells us. If we're talking double standards, have you read her book Robb? Sisson's? Where's the science behind the Primal Carbohydrate Curve? Heck, can you please tell me how you and Chris Kresser settled on dried seaweed and kale and acai berry for your "paleo blend" .
Normally I’d simply shoot the guy the Lindeberg paper, a Frasetto paper etc and theye MIGHT be surprised (as these people have never bothered to even look in pubmed for this material) but they will consistently default to the following positions:
-This is a small study, we cannot draw conclusions.-It is largely observational
And on, and on.
Umm ... Yeah, it is a small study, Gary Taubes calls that "bad science" ... But please tell me who has dissed it because it is observational? Robb seems confused that studies only come in two varieties: RCT or Observational. But what of Frasetto? I blogged on that study here. Frasetto is even less like the paleo diet we here so much about. Her trial was not lower carb than baseline, quite high carb in fact, lower in fat than Lindeberg and relatively high sugar. Oh, and very high protein. Let us hope Diane Sanfilippo of 21 Day Sugar Detox fame hasn't ever referenced that one!
Look, I've tried to get Robb's take on what a paleo diet is, or what the diet is that is being studied. I read his study on paleo in Reno PD and he basically said there are very general guidelines, that their diet was LC and he's trying to push it more Lindeberg. But I learned something new from the byline: Robb Wolf, Writer, The Performance Menu, and Editor The Journal of Nutrition and Metabolism, Reno, Nevada. What? Editor of the Journal of Nutrition & Metabolism? He was a review editor apparently, though he's not listed now. But speaking of journals, Robb's post goes on to trash peer review and extol the virtues of PLoS. What does that say of his work with JN&M? Oh ... and science is rife with fraud. All but those paleo studies I suppose? And by the way, Paleologix are touted as "clinically proven" -- where's that science? Is it observational? ;-)
Look, if there are double standards about the science here, the paleo and low carb communities are the ones demonstrating in spades. Any observational study on sugar or carbs and diabetes, however remote, makes the rounds ... but one on meat or fat? Repeat after me: correlation is not causation, someone should tell these idiots that. Somehow the flat out misrepresentation of scientific studies within his flock doesn't seem to bother Robb much.
Now I'm not sure, but it seems like Robb is equating himself with Einstein because criticism of "Ancestral Health" is like criticizing "shallow thinkers" like Einstein. Huh? First, I realize paleo poses problems, but "ancestral health" is more than paleo or primal or whatever. We have neolithic ancestors!! Robb kept conflating the two. And he threw in more knocks at modern medicine -- we've made great strides with antibiotics, but in treating diabetes and cancer, not so much. The problem as Robb sees it is apparently that scientists do not view everything through a Darwinian monacle.
In closing I’d like to issue a statement and a challenge to the Evidence Based Medicine crowd: If you are conducting research in the biological sciences (medicine is a sub-discipline of biology), and your research does not consider the implications of Evolution via Natural Selection, you are not yet practicing science. You are earnestly data collecting, but you have no overarching framework to know if your questions or interpretations have any merit. If you want to move the field of medicine towards an epistemology with the predictive power of Quantum Mechanics, you must conduct every bit of research, hypothesis generation, and data interpretation with the background music of “what are the evolutionary implications?” This transition will eventually happen; it’s just a question of if it will take a decade or a century.
What? If scientists did what Robb proposes, it would set us back decades if not centuries. This, frankly, is one of the more ridiculous things I've read coming from the IHC, and that's a pretty high bar. Is this "What Would Darwin Think?" C'mon! What does natural selection have to do with anything if, as the paleo crowd claims, we haven't evolved. How are diseases cured by applying Darwinism in the operating room? I mean what do you even make of that paragraph?
Here's what I'd like to see. How about YOU and the rest of the paleos get together and have a summit and decide what this paleolithic diet is. Begin with doing studies to look at the efficacy of THAT diet. How about correct the record when science proves you wrong? Concerned about fraud? Look around you and tell me it is the scientific community that is the biggest problem in paleo. Need I remind the audience that Robb Wolf will be headlining Jimmy Moore's LC Cruise this year, and he is fully apprised of that situation. He is now selling supplements with the claim that they are clinically proven. Show us the proof.
In my last post I got a lot of "he's doing great things", kiss and make up and let's all sing kumbaya. What great works? He's trashing the modern medicines that are being used in his own Reno Law Enforcement "paleo" study, while apparently paleo is getting all the credit for the results. This he is apparently doing for free. Kudos. Doesn't give him a pass on the rest of what he does which is done to earn his living (nothing wrong with that!). In my experience, folks who routinely remind you of how much they do to help people with their free stuff are doing so to convince themselves. He left science long ago, opened up a gym and wrote a diet book. Oh ... and he had a hand in "bringing us" Jack Kruse and pointing fingers of blame. I imagine he's still pissed at me for pointing out that he was linking to yet another quack with an interest in neuroscience a week or so ago. (Still debating publishing up a post on that episode). Rather than accuse people of having reading comprehension problems, how about you take little responsibility, Robb, for the reading material you are suggesting to them. Is that really too much to ask?