Evidence Based Medicine: Fraud, Double Standards and Ignorance

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Ok, as a caveat up front, I am NOT saying there is no credible Evidence Based Medicine (EBM). I am not Anti-Science. I know a few nut-swingers will say this. If you fall into this trap you clearly have poor reading comprehension and your mama dresses you funny.

What I AM, is skeptical of the skeptics, the folks who live and die by what is (or is not) in PubMed. Mainstream medicine got itself into a bit of a pickle a few years ago when holding “complementary and alternative medicine” to some pretty high standards of research validation. I forget the exact number, but 70-80% of what is practiced in your standard hospital or medical office has NO randomized controlled trial (RCT) establishing efficacy. I cannot tell you how many people I’ve run across who will dismiss things like Ancestral Health or gluten free eating due to a paucity of RCT’s , the “gold standard” in medicine… (although even these frequently have huge methodological problems like not keeping people in a metabolic ward for the duration of the study…). These same people think nothing of using methodology which lacks RCT backing (most of standard medical care), yet shoot down new therapy using the same criteria. What they are relying on is, GASP! Observation! That dirty, dirty word to the EBM crowd, yet the very thing which forms a remarkable chunk of the foundation of their practice. I’d call this a double standard but usually that term implies some degree of awareness on the part of the perpetrator. In this situation, there is NO awareness, just an assumption that what makes up current medical practice has been “rigorously studied” when in fact most of medicine has simply been observed to “work” and that was the end of that.

Some of this lack of RCT’s is for ethical reasons. I remember a study looking at survivability of gunshot wounds to the chest in folks who were given aggressive IV fluids. The thinking was that people would do better with a large amount of fluid administration, as an individual with decreasing blood volume easily develops cardiac output problems (and a host of other issues). Interestingly however, somewhat less aggressive therapy seemed to produce better survival rates, possibly due to the ability of the body to better form clots. We don’t know precisely why this is as it’s never been studied and is not likely to be studied for reasons I’ll get to in a moment. The point being, this is NOT a RCT. The study is OBSERVATIONAL. For the EBM crowd this should be jettisoned and largely ignored if they are to be consistent in their treatment of study material.  It’d be tough to get a bioethics committee to sign off on a RCT that would really put these questions to rest (we’d need to shoot similar people, in similar ways, apply varying therapy, kill people at various stages of the treatment to track different parameters to verify mechanisms…I guess you could do animal models on this but even that starts getting pretty gnarly). 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 ?

A few days ago I had some back and forth with a nice enough guy on Twitter who looked at this recent Slate piece (More on that later)  and declared “This is why I do not advocate Paleo, there is not science to back it up. Show me the science”

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.

So, I thought about things for a moment and the conversation went something like this:

Me: There are virtually no “good” studies in nutrition. “Good” being defined as a blinded, crossover, metabolic ward trail. If it does not fit this standard it is guess-work and largely worthless.”

Him: “Wait a second! You can’t just throw out all of the observational material that has been generated, there is a lot of value in that!”

Me: “Hey, that is a fantastic point, but if you really buy that then you cannot selectively choose to IGNORE OR DISMISS an observational study just because it does not fit your preconceived notions. Assuming similar study design, ALL these studies have equal merit, right.”

Him: ”Ugh…yea, that makes sense.”

I then I shot him the Lindeberg piece and he commented “Wow, I’ve never read that.” (shocker) Then he followed up with “But, until there are more studies I just can’t follow this stuff.” Am I missing something, but is it not odd that the folks who claim there is “no science” behind any of this stuff, never seem to be up on what has actually been published? If I ask for a critique of the Fresetto work looking at kidney function I just get a blank stare. I mean…if you can come out and strongly proclaim a position on a topic, you might think you have actually READ something on the topic. I know the vegan literature better than the vegans do. The conversation wrapped up with:

Him: “Maybe I should read your book…”

Me: “That’s crazy talk! Reading a book on the topic one is discussing! Send me your mailing address and I’ll send you a book.”

This guy comes from an academic/research background. I’ll give him credit for acknowledging the literature which he has not read, that he has not even read a book on this topic…but I literally had to trap the guy to get this favorable response.

The impetus for this piece has two vectors. One is a recent critical piece on Paleo which was published in Slate the other was yet another in a long list of editorials looking at fraud in science, in this case at one of the premier research institutions, Johns-Hopkins University. Stuff like this started cropping up about 10 years ago, and it seems like it is either happening more often, or we are simply learning about it more frequently. It’s unclear how much fraud occurs in medical research, but it would appear to be “A lot.”

The fraud seems to occur on both sides of the process, the bench researcher “cooking the data”, as well as the review editors who apparently are not doing the job Peer Review is supposed to do (which is provide quality control and maintain standards). That system of peer review is several hundred years old. One can make an agreement that it served a vital role in helping science to crack out of the mysticism of the past, but it is clear this system provides a safe-haven for not only bad research, but also the perpetuation of broken ideas which need to be tossed. Open Source peer review appears to deliver not only integrity, but also is much faster and more accurate. This is a Market based approach to medicine, not dissimilar to the open source approach to many software platforms. This is an important point: Open Source projects tend to work well as the people involved are INTERESTED in the topic at hand. As in: I like to spend time contemplating this topic. They may or may not have financial ties to the topic, but they are not a bored hourly employee nor the director of a lab trying to maintain funding via the publish or perish system. Passion for a topic seems to produce both integrity AND better results. Again, shocker.

This fraud topic creates a rather large bone I have to pick with the EBM “Skeptic” crowd. It’s already annoying when you have folks like the guy above who say there is “no science to back up Ancestral Health”, yet they are completely ignorant and non-conversant on the literature that DOES exist. Add to this a bias which makes shoddy studies supporting the status quo “ok”, yet studies like Lindeberg’s are held in contempt. That’s all annoying, but then when we add the fact we can’t really trust the information coming out of academia. It makes me call “Caca-de-Toro” on much of the EBM scene. It appears we are to trust a system which produces people who dismiss a topic despite complete ignorance of said topic, these people impose double standards and somehow categorize certain material as “acceptable”, dismissing other material (despite equal rigor) and these people “hang their hats” on research that is riddled with fraud.

Again, for the people with reading comprehension issues, I’m not saying science and the scientific method are not valuable, what I AM saying is much of the data being cited is questionable. Double standards are the soup-du-jour, and “Skeptics” are compelled to comment on topics with which they are clearly ignorant. I don’t know about you, but I find all of that “somewhat problematic.”

So, what do we do?

Medicine has done a fantastic job in dealing with infectious disease (antibiotics, vaccinations, public health), and with trauma. Unless your Crown Chakra is so misaligned as to cause brain damage, the strides that have been made in these areas are nothing short of miraculous. Unfortunately however, the “one disease, one cure” efficacy of antibiotics has blinded medicine into thinking a “magic bullet” awaits every disease and condition. Looking at our success with degenerative disease like diabetes, autoimmunity, cancer, neuro-degeneration, and cardiovascular disease paints a bleak picture. We dump massive amounts of resources into these conditions, but with little in the way of return. These “Diseases of Affluence” are complex and largely reflect a gen-environment mismatch that does not lend itself to simple pharmacological solutions. If you disagree with this, please show me how we are treating these issues in fast, cost effective ways. What is missing in medicine is an over-arching theory to both drive hypothesis generation, and allow for better data interpretation. Fortunately, just such a theory exists, and it’s called Evolution via Natural Selection. This is a piece from the Protein Debate we sponsored via the Performance Menu between Prof. T. Colin Campbell (Author of the China Study) and Prof Loren Cordain, discussing the role of protein and human health. This is part of the introduction written by Prof. Cordain:

Although humanity has been interested in diet and health for thousands of years, the organized, scientific study of nutrition has a relatively recent past. For instance, the world’s first scientific journal devoted entirely to diet and nutrition, The Journal of Nutrition only began publication in 1928. Other well known nutrition journals have a more recent history still: The British Journal of Nutrition (1947), The American Journal of Clinical Nutrition (1954), and The European Journal of Clinical Nutrition (1988). The first vitamin was “discovered” in 1912 and the last vitamin (B12) was identified in 1948 (1). The scientific notion that omega 3 fatty acids have beneficial health effects dates back only to the late 1970’s (2), and the characterization of the glycemic index of foods only began in 1981 (3). 

Nutritional science is not only a newly established discipline, but it is also a highly fractionated, contentious field with constantly changing viewpoints on both major and minor issues that impact public health. For example, in 1996 a task force of experts from the American Society for Clinical Nutrition (ASCN) and the American Institute of Nutrition (AIN) came out with an official position paper on trans fatty acids stating, 
“We cannot conclude that the intake of trans fatty acids is a risk factor for coronary heart disease” (4). 
Fast forward 6 short years to 2002 and the National Academy of Sciences, Institute of Medicine’s report on trans fatty acids (5) stating, 
“Because there is a positive linear trend between trans fatty acid intake and total and LDL (“bad”) cholesterol concentration, and therefore increased risk of cardiovascular heart disease, the Food and Nutrition Board recommends that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet”. 
These kinds of complete turnabouts and divergence of opinion regarding diet and health are commonplace in the scientific, governmental and medical communities. The official U.S. governmental recommendations for healthy eating are outlined in the “My Pyramid” program (6) which recently replaced the “Food Pyramid”, both of which have been loudly condemned for nutritional shortcomings by scientists from the Harvard School of Public Health (7). Dietary advice by the American Heart Association (AHA) to reduce the risk of coronary heart disease (CHD) is to limit total fat intake to 30% of total energy, to limit saturated fat to <10% of energy and cholesterol to <300 mg/day while eating at least 2 servings of fish per week (8). Although similar recommendations are proffered in the USDA “My Pyramid”, weekly fish consumption is not recommended because the authors of these guidelines feel there is only “limited” information regarding the role of omega 3 fatty acids in preventing cardiovascular disease (6). Surprisingly, the personnel makeup of both scientific advisory boards is almost identical. At least 30 million Americans have followed Dr. Atkins advice to eat more fat and meat to lose weight (9). In utter contrast, Dean Ornish tells us fat and meat cause cancer, heart disease and obesity, and that we would all would be a lot healthier if we were strict vegetarians (10). Who’s right and who’s wrong? How in the world can anyone make any sense out of this apparent disarray of conflicting facts, opinions and ideas? 
In mature and well-developed scientific disciplines there are universal paradigms that guide scientists to fruitful end points as they design their experiments and hypotheses. For instance, in cosmology (the study of the universe) the guiding paradigm is the “Big Bang” concept showing that the universe began with an enormous explosion and has been expanding ever since. In geology, the “Continental Drift” model established that all of the current continents at one time formed a continuous landmass that eventually drifted apart to form the present-day continents. These central concepts are not theories for each discipline, but rather are indisputable facts that serve as orientation points for all other inquiry within each discipline. Scientists do not know everything about the nature of the universe, but it is absolutely unquestionable that it has been and is expanding. This central knowledge then serves as a guiding template that allows scientists to make much more accurate and informed hypotheses about factors yet to be discovered. 
The study of human nutrition remains an immature science because it lacks a universally acknowledged unifying paradigm (11). Without an overarching and guiding template, it is not surprising that there is such seeming chaos, disagreement and confusion in the discipline. The renowned Russian geneticist Theodosius Dobzhansky (1900-1975) said, “Nothing in biology makes sense except in the light of evolution” (12). Indeed, nothing in nutrition seems to make sense because most nutritionists have little or no formal training in evolutionary theory, much less human evolution. Nutritionists face the same problem as anyone who is not using an evolutionary model to evaluate biology: fragmented information and no coherent way to interpret the data. 
All human nutritional requirements like those of all living organisms are ultimately genetically determined. Most nutritionists are aware of this basic concept; what they have little appreciation for is the process (natural selection) which uniquely shaped our species’ nutritional requirements. By carefully examining the ancient environment under which our genome arose, it is possible to gain insight into our present day nutritional requirements and the range of foods and diets to which we are genetically adapted via natural selection (13-16). This insight can then be employed as a template to organize and make sense out of experimental and epidemiological studies of human biology and nutrition (11).

 

The Paleo Diet/Ancestral Health concepts were born of observation, an observation that pre-industrial societies show a remarkable absence of the degenerative diseases which plague the developed world. From this observation, various theories have sprung forth (immunologically reactive plant proteins causing Leptin resistance, changes in activity levels altering gene activity, maladaptive sleep patterns,  gut dysbiosis and insulin sensitivity, etc.). We are now in the beginning stages of investigating some of these big picture hypotheses, and using the findings to refine our understanding of human health. It is humorous when I hear people dismiss “observational findings”, as these are the seed-crystal of ALL of science. We observe phenomena 1st, endeavor to construct predictive models 2nd.

 

Modern physics was born a little over a century ago when phenomena were observed that had no model of prediction or explanation. Shallow thinkers with names like Bohr, Einstein, De Broglei, Planck, and Schrodinger hashed out what would become the modern field (no pun intended) of quantum mechanics. It is worthwhile to do a little reading about this time, and the interpersonal conflicts that arose in the physics research community. It was a blood-bath. Personal attack’s, attempts at subterfuge.  Substitute “quantum mechanics” for “paleo diet” or “evolutionary medicine” and we can largely transfer these stories of a century ago to our modern equivalent of the emerging science of Darwinian Medicine. The Slate piece I linked to above is a nice illustration, as the author completely dismisses the whole Ancestral Health concept based on the early assumption that our genome has been largely static since the transition from the hunter-gatherer life way to agriculture, and now modern post-industrial living. This original idea was based on this wacky stuff called “The best data we had at the time.” Recent genetic research has shown we’ve seen a remarkable increase in evolutionary pressures as evidenced by a dizzying array of polymorphisms after the advent of agriculture. So, strictly speaking, we are not “hunter gatherers in Pin-Striped suits” but as Stephan Guyenet points out in his series looking at the genetics of the ice mummy, Otzi, the distinction is largely moot from a clinical standpoint. The genetic changes are at best in a middle ground attempting to mitigate the challenges of an agricultural life way, and observationally we still see huge benefit from the Ancestral Health model. Something worth mentioning here is that when we see rapid genetic changes, it is due to a significant selection pressure. A selection pressure is some activity, be it dietary, environmental, or what have you, that causes a large number of the population to die. Or we might have a genetic change that confers a remarkable survival advantage, and this rapidly makes it’s way through a population, or some combination of both. But the implication here is that agriculture was not a benign force to our ancestors, but rather a powerful challenge necessitating rapid evolution to deal with the problem.

So, yes, some early assumptions in the Paleo/Ancestral Health scene ended up not passing the scrutiny of subsequent findings. That’s what science is about, and I’m not sure what field we could look at that the folks who founded it got everything right the first time. Einstein refused to believe we live in a random universe (God does not play dice), and he spent the last decades of his life trying to make the data fit his religious views. Interestingly however, no one calls to invalidate General Relativity due to this gaffe, so again, how about the same standards we apply to other areas of investigation could be applied to the nascent field of Darwinian Medicine?

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.

Happy belated Pi day, and Einstein’s B-day.

birthday_einstein_pi

 

 

 

 

 

 

 

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  1. zack
    March 15, 2013 at 10:47 am

    I see a lot of dismissal of the paleo/primal diets that look something like this, “all you have are success stories. That’s only observational. It’s not scientific”. But if the china study, et al, are all technically observational, doesn’t the growing number of success stories warrant some sort of acknowledgement? I mean… here’s a test that’s repeatable and results are being observed and recorded. Isn’t that the essence of testing a hypothesis, i.e. science?

  2. Tom
    March 15, 2013 at 11:00 am

    I guess I’m lucky that I don’t debate academics about this kind of thing. From my personal experience, the rank and file person is far more open to the science that has been done than more ardent academics seem to be.

    Maybe I’m just lucky in general?

  3. Sabine
    March 15, 2013 at 11:02 am

    Thank you for discussing this topic, I could not agree more.
    This is why I value my own observations (in myself and others I know) more than many studies.
    There are too much bias, too little knowledge, not enough incentive, and too much junk science. We are being drowned in lies, misinformation, and ignorance.

    You are so right! I am thankful for the few intelligent people left, who can see beyond all of this.

  4. Danny Lennon
    March 15, 2013 at 11:23 am

    Very nice piece Robb.

    I’ve often wondered about how much quality-control the peer-review system is actually providing to the literature. The more I have looked into this over the duration of my masters studies the more I am inclined to think that open-access is the way forward. I really hope it takes off as much as it potentially could, for the good of science.

  5. Alberto De Armas
    March 15, 2013 at 11:23 am

    You hit the nail on the head here. I’ve come across as crude and inhuman for simply mentioning Natural Selection as the cause to certain misfortunes. Truth is we choose to ignore it and romanticize it. I guess we are paying for it now. Great article.

  6. Ryan
    March 15, 2013 at 11:25 am

    As an undergraduate chemistry major seeking to delve into the evolutionary health/functional medicine field, what do you think is the best way to go about it? Change the mainstream medical establishment from the inside out (MD/DO) or pursue an alternative healthcare profession that may lend an easier time towards getting into this niche? (DC, certified holistic nutritionist, etc).

    Thanks to anyone who will chime in with some advice.

    • Robb Wolf
      March 15, 2013 at 1:33 pm

      If you have the nerve for it, MD/DO.

    • Catherine
      March 17, 2013 at 5:02 pm

      I’m in the same boat. Planning to apply to medical school (MD) next year. Getting ready for the bumpy ride! Thanks, Robb, for your confirmation to attempt this seemingly insane endeavor.

      • Robb Wolf
        March 17, 2013 at 5:13 pm

        You’ll do great. Sleep as best you can, get as much sun as you can and get some activity daily. it’s a kick to the groin, but it’ll be worth it. We need GOOD doctors desperately.

  7. Becky
    March 15, 2013 at 12:02 pm

    Hey, Robb! Great, great points. I’m trained in the field of Speech-Language Pathology. We’re clinician-scientist hybrids. Our field is young, so we have limited research to back up our practice. We’re working hard to fix that, but in the mean time, we just have to be critical thinkers. We’re taught to use Evidence Based Practice, a triangle that consists of Research, Clinician Experience, and Client Values. Each point in the triangle provides a check/balance for the others. One big point to make is that the Research point is not limited to RCTs. We are encouraged to look at all levels of research (systematic reviews, RCTs, cohorts, case-control, case reports, etc.) and consider them accordingly. Just because a study isn’t a RCT, doesn’t mean it’s shit. And like you said, just because it IS a RCT, doesn’t mean it’s perfect. We also place high value on the previous clinical experiences and observations (oh my!) of the clinician who is trying to make the decision regarding client care. We ask around, too. Other clinicians with greater knowledge, skills, and experience with a given issue can provide awesome insight and integration of facts for solid decisions in a given case. Oh, you’ve targeted this type of deficit many times before? What has worked? What hasn’t? What patterns do you see? Finally, no matter what the research and your previous experience say, you must also put consideration into the values of your client/patient. You’re a team, you and your patient.

  8. Cee
    March 15, 2013 at 1:17 pm

    Robb,
    Just wondering and curious, do you ever doubt Paleo?

    • Robb Wolf
      March 15, 2013 at 1:31 pm

      Not sure what you mean…I don’t doubt evolution, there is a spectrum of what people are and are not able to tolerate/thrive on…based on this we tinke rand ifnd what works for the individual, using this “paleo template” as a starting point.

      Here is a question for you: When considering elements of health/disease…where is a “good” place to build a framework?

  9. zack
    March 15, 2013 at 1:39 pm

    I’m always shocked at the backlash as though cutting out refined sugars and processed food is a silly idea for losing weight. “Oh please, the paleo diet? That fad? Ha! Like you can really lose weight and be healthy by eating healthy foods and not garbage. So Dumb”

    This makes even less sense with gluten-free. There was a recent article that nearly 1/3 of Americans are going gluten free while only 1% are Celiac. I see comments like “people who go gluten free and aren’t Celiac are dumb fad dieters”. Except that there is literally zero harm in going gluten-free unless I’m mistaken and I have been avoiding my life-sustaining daily recommendations of wheat gluten?

    The anti crowd are anti for literally no good reason.

    • Robb Wolf
      March 15, 2013 at 3:03 pm

      Indeed. I’m still trying to figure out what one is missing by eating fruits, veggies and tubers instead of bread. The dietitians always say “fiber” then when you compare the two diets side by side you can’t seem to get a follow-up on that.

    • Mike H
      March 15, 2013 at 6:59 pm

      The backlash seems to follow this reasoning:

      1. Eliminating refined sugar (“a whole food group”) is obsessive and unnecessary if calorie intake is managed
      2. Whole grains are healthy. Again, eliminating a whole food group is weird. You Hippy.
      3. A Paleo diet lacks carbs. You won’t have any energy and will struggle mentally
      4. “All that meat” is bad for you
      5. Too much fat is bad for you. Saturated fat is gives you heart disease. (On the flip side cooking with seed oils is good, avoids that saturated fat!)
      6. Gluten Free? Sounds like new-age paranoia. Billions eat gluten daily and haven’t died once yet. Obviously there’s no problem with it!
      7. Paleo eating sounds like it romanticizes the past, when infant mortality was heaps higher. Nice one you baby killer.
      etc…

      So much is based on perceptions, biases & politics. I don’t see that changing.

      • Robb Wolf
        March 16, 2013 at 5:44 pm

        Well…I can say we have “job security” for the moment! But where 10 years ago there were perhaps a few thousand people thinking about this stuff, today there are millions. Wednesday I will have a blog post that paints a pretty nice picture of Hope.

      • FrankG
        March 17, 2013 at 3:54 am

        I laugh at the one about “eliminating an whole food group”… where were these people for all the recent decades when we have been (still ARE) admonished to avoid fat! At least there *are* essential fatty acids, while apparently there are NO essential carbohydrates.

        Also low carb is not NO carb

        And high fat is simply a measure of relative energy… for an average adult the simple substitution of 43g of fat instead of 100g of carbs can tip a diet from being high-carb to high-fat — yes, while eating LESS food :-)

        Thanks for the post Robb… a much needed does of sanity.

        I figured out that Evil-Lyn was toxic when I first tried to have a discussion with her in comments following her podcast on Jimmy’s LLVLC — can you believe I listened to the whole thing twice; as she was so faltering and I wanted to give her a fair airing..! I am just amazed at how many people still seem to admire her “debunking of the gurus”… I see it like the tabloid newspapers, or a train wreck; appealing to the lowest common-denominators in society. Yes we may all have a base nature but I like to think that as a species, we should be able to raise ourselves above it.

        • Robb Wolf
          March 17, 2013 at 7:30 am

          Frank- it’s always nice to ask the “don’t delete a food group” folks what they feel about vegetarianism. All these people know are double-standards and contradictions.

          The crowd Evelyn has attracted is telling. That’s about the nicest thing I can say on that.

          • Joseph Fetz
            March 17, 2013 at 6:05 pm

            Ha, that’s exactly what I ask those who question my eschewing of grains. Even funnier, most of the people who bring up this whole “you cannot give up whole food groups” question, almost all of them are vegetarian or vegan. Hmm?

      • Paul N
        March 17, 2013 at 9:34 am

        “Whole grains are healthy.”
        The funny thing here, is that there is some evidence to show that “whole* grains can be healthy, it’s just that, with the exception of rice, we never eat whole grains, just “whole grain flour”, which is something quite different.
        In the 30′s Weston Price did some “experiments” with feeding whole grains to malnourished kids. Bread that was made out of *freshly ground* whole grains, and sourdoughed, improved health, but bread made from aged/stored industrial flour, whole grain or no, did not.

        Same with the old “mediterranean” diet, when they ate “whole grains” they were doing the same thing – freshly ground wheat for making their own pasta, whole or freshly ground oats, etc.

        None of this is to say we should continue to eat gluten grains.
        the point being it is the industrial processing/refining, transport and storing of our foods that is the problem.

        WP’s worldwide “observational study” (Nutrition and Physical Degeneration, 1940) showed in painful detail the impact of the “displacing foods of modern commerce”, and that was before we even had soy oil and soy fed chicken.

        There has been a nationwide (or even worldwide) “randomised trial” going on for the last 60yrs, and the results – increasing rates of degenerative disease – are not good – what more evidence do we need?

        • Robb Wolf
          March 17, 2013 at 10:12 am

          Zactly, well said.

        • Victor Venema
          March 17, 2013 at 4:14 pm

          I was wondering whether there are randomized blind trials changing the freshness of food.

          Normally it is difficult to do blind trails in nutrition, as people see what they eat, but you do not see whether the pasta or bread if from freshly ground and harvested wheat or from stuff that is one year old. Similarly you can change the freshness of many whole foods.

          And the freshness of foods is also a factor that has changed considerably the last few decades and might thus be responsible in part of more chronic decease.

      • Libby
        March 19, 2013 at 9:37 am

        Thanks for making me laugh, Mike! I just don’t get the whole Paleo backlash. Why don’t they go pick on Jenny Craig or something?

    • Greg Venning
      March 16, 2013 at 12:18 am

      Here’s an RCT that suggests that gluten does cause problems in non-celiac individuals
      http://www.ncbi.nlm.nih.gov/pubmed/21224837

  10. Tressa Pinkleton
    March 15, 2013 at 1:52 pm

    Robb, can you give the reference for “…70-80% of what is practiced in your standard hospital or medical office has NO randomized controlled trial (RCT) establishing efficacy”? I’ve heard that thrown around a lot and would like to know how it was determined.

    • Robb Wolf
      March 15, 2013 at 3:01 pm

      Tressa-
      This is not the exact thing I was looking for, but it paints the picture well:
      http://www.cochrane.org/faq/it-estimated-only-10-35-medical-care-based-rcts-what-information-based

      the piece I was referring to was actually a criticism of how the research validating “complimentary and alternative medicine” was being held to a MUCH higher standard than what passed muster within mainstream medicine AND that most of the clinically practiced medicine had not really ever been validated, just “observed” to “work.” See the double standard? The AMA can “grandfather in” Tx that are “observed” to work yet methodology from outside the orthodoxy is not given the same benefit.

      • Tressa Pinkleton
        March 15, 2013 at 3:23 pm

        Thanks for the link, I will look into it. I completely agree with you, too! I’m a student studying naturopathic medicine and have come up against individuals arguing against what I’m learning due to a lack of RCTs. I’ve wanted to use “80% of what’s practiced…” to counter but haven’t felt comfortable since I didn’t know where the stat came from (lest I hear “prove it,” and can’t).

        • Hilary
          March 18, 2013 at 12:50 am

          Reference
          Richard Smith. Where is the wisdom…? The poverty of medical evidence. BMJ 1991: 303 ;798-799

          This is an editorial. “Yet only about 15% of medical interventions are supported by solid scientific evidence, David Eddy, professor of health policy and management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all.”

          I’ve never found another paper that discusses this further in a mainstream medical journal. Any further help anyone?

      • Mike F
        March 29, 2013 at 1:25 pm

        Here is an excellent article from a few years ago titled “Lies, Damned Lies, and Medical Science”

        http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/2/?single_page=true

        You might be referring to this paragraph Robb:

        “That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed.”

  11. Rachel
    March 15, 2013 at 2:03 pm

    Nice post. I’ve always thought that the research we have at this point on Paleo or related eating was relatively strong. If not enough to conquer, certainly enough to compete. I’m surprised that you get a lot of people objecting on those grounds. I guess I’m naive.

  12. Tyler Haas
    March 15, 2013 at 2:23 pm

    Great article. Let me start off by giving the disclaimer that I am a lowly medical student so though I’ve had to read a lot of articles and EBM stuff for me, I’m still relatively new to it. I think the deal is that the people you are talking about (which happens to be a large portion of the medical field) aren’t actually doing EBM right. The way we learned EBM is that the meta-analysis of RCTs and RCTs are the bees knees, BUT when you can’t find that you down the line looking for the “next best evidence”. It isn’t RCT-Based Medicine but EVIDENCE-Based Medicine after all. Because, as you say, there isn’t a lot of good RCT nutritional evidence out there, suddenly your aforementioned Paleo-oriented studies start steadily moving up the list of possible “next best evidence” candidates. That’s why I disagree with the surface of your argument but I think agree at the heart of your point. I would argue that maybe EBM isn’t the issue but that the way people improperly use EBM IS (much in the same way you can’t really call a bunless McD’s burger “Paleo”-approved). I may have just restated your argument because I’m a genius like that, in which look how smart I am! Anywho, my nose is feeling lonely without a book attached to it.

    • Robb Wolf
      March 15, 2013 at 2:55 pm

      HA! I think you made a fantastic point, AND it was well stated. Where you doing Med School?

      • Tyler Haas
        March 16, 2013 at 7:58 pm

        Thanks! Attending medical school at the University of Oklahoma. On the Community Medicine track. I’m finishing year 2 now and they haven’t kicked me out yet….Oh and thanks for an awesome book. Paleo hugely helped me maintain energy levels for ridiculous study sessions.

        • Robb Wolf
          March 16, 2013 at 9:07 pm

          Right on man!! Sign up for the Paleo Physicians Network when you are done.

          • Tyler Haas
            April 1, 2013 at 9:03 am

            I get through this and you got a deal! I’m hoping to dive more into the research once this hopefully lets up post-Step 1 and Step 2. Thanks for being my intro to this. It’s helped me a lot!

  13. Stephanie
    March 15, 2013 at 2:57 pm

    Bravo. This was absolutely superbly said.

  14. Roland Denzel
    March 15, 2013 at 3:56 pm

    This is a great post, Robb.

    I’m lucky in that my brother is a cardiologist who sees almost eye to eye with me on this stuff, and a I have good friend who’s a spankin’ new RD who believed this even before we met.

    On the other hand, I have several personal friends who are well known, famous, and/or infamous in the nutrition and fitness world who tend to fight this stuff as if it’s a ‘win for the people’ when they take down one of my statements.

    We still have meals and coffee together, but certain elements of nutrition are now added to that list of topics not discuss over dinner, right above religion and politics.

  15. sonny
    March 15, 2013 at 6:41 pm

    In the physics battle (classic vs quantum) egos and reputations were involved. In nutrition, it is that plus billions (or trillions?) of dollars involved as well.

  16. George @ the High Fat Hep C Diet
    March 15, 2013 at 8:50 pm

    If we did really have EBM, everyone who has surgery for fractures of the wrist or ankle would be receiving vitamin C.
    http://www.ncbi.nlm.nih.gov/pubmed/22985495

    A 0.22 relative risk of complex regional pain syndrome is a whopping improvement in the incidence of a seriously debilitating complication for a minimal risk intervention.

    So do we have EBM? Is this the practice where you live?

  17. Richard Nikoley
    March 15, 2013 at 11:39 pm

    Perhaps my favorite Robb post ever. Indeed, everything begins and ends through the human evolutionary lens or framework. That evolutionary lens regards the human animal as an integrated whole that inhabited various environments in which various real foods were available.

    Health, nutrition and medical science is often plain unbridled deconstruction. Such deconstruction is perfectly valid in trama settings, for example (yea, this drug might damage his liver but we need X to happen right now or he’ll die), antibiotics, etc.

    Anecdote is the basis of scientific inquiry. It simply needs to be carefully evaluated and controlled.

    Great job Robb. Now I have even more material to quote for my post on the strawman fantasy of the “Paleofantasy.”

  18. Vetti
    March 15, 2013 at 11:51 pm

    It is also important to be aware that not all research data is made available:
    http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

    • Robb Wolf
      March 16, 2013 at 5:42 pm

      I was going to include that but the post was already pretty long, thanks for throwing that in. ALL outcomes should be reported. We should make the drug screening process much faster, much cheaper and remove many of the class action suits that make drug companies gamble with being unethical with this type of information.

  19. Greg Venning
    March 16, 2013 at 12:17 am

    Couldn’t agree more Robb. For those who worship at the altar of the RCT, here is a good read http://www.bmj.com/content/327/7429/1459. It proposes that we do RCTs on how well parachutes work. Think about it…

    I’m a DC who routinely faces argument that starts with, “There is no evidence that proves…” and they either go on to slate the Ancestral Health issue (which I obviously advocate) or my chosen profession. Once they’ve said that you know you can get them on two points: 1) There is SOME evidence to suggest what they’re trying to refute and 2) Evidence can’t PROVE anything, saying that it can shows their lack of understanding of the scientific process.

    Here’s a piece that shows that of common medical practices with RCTs, 50% have unknown effectiveness: http://theincidentaleconomist.com/wordpress/half-of-medical-treatments-of-unknown-effectiveness/

    David Eddy was the one who stated that only 15% of medical procedures had evidence to back them up. (BMJ 1991 303:798)

    That was in 1991, here’s a link to an unreferenced updated figure in 2006 of 20-25% – http://www.businessweek.com/stories/2006-05-28/medical-guesswork

    So if we put those two together we have RCTs for only 30% (I’m being generous) of medical interventions and of those, we don’t know how well half of them work. I know that’s not completely accurate but it works in an informal discussion to make the point.

    Double standards abound, thanks for putting this out there Robb.

    • Robb Wolf
      March 16, 2013 at 5:40 pm

      Thank You doc! A number of folks were looking for just those references.

    • Zach Bush
      March 21, 2013 at 9:42 am

      Greg and Robb,

      This is very refreshing to hear. People seem to be infected with the belief that facts = science or that facts prove theories. Ironically my experience has been that the highly “educated” population seems to have the highest infection rate.

      May I suggest to you both the following books by the economist Ludwig von Mises:

      Theory & History
      Epistemological Problems of Economics

      Both are available for free download at Mises.org.

      Mises was dealing with the problem with economic science specifically, but his insight applies to all fields.

      • Robb Wolf
        March 21, 2013 at 10:42 am

        LOVE Mises. I wish more of the nutrition oriented readers were more open to the possibility there is much to be learned from the Austrian Econ school.

  20. Jess McClure (@YogaAndBirth)
    March 16, 2013 at 3:25 am

    As a student midwife, I hear birth professionals use the term “evidence based medicine” a lot, mostly to separate them from those who perform medical interventions during birth that are contrary to evidence. Is there another term to describe someone who uses both evidence and observation, also looking from an evolutionary model, but that would distinguish them from the practitioners who seem to practice contrary to evidence? Or perhaps it is like Tyler Haas, the med student who commented above, pointed out: Our observation is also evidence, and so it thousands of years of successful non-medical childbirth, so we may still embrace the term.

    • Robb Wolf
      March 16, 2013 at 5:39 pm

      Jess-
      I think you answered your own question here. My point in this post is the establishment uses EBM in a way fraught with double standards. THAT is the real take-away. OB’s are no longer trained how to turn a baby during delivery. The baby either comes out “easy” or we go to a C-section. To some degree we have done this to ourselves with medical litigation…everything need to be quantifiable, and it’s easier to quantify the process of a C-section than the skills of a skiled midwife/OB who can perform turn, move limbs etc during the birth process. I forgot the need for reform in the medical litigation scene…We need our HC practitioner to THINK and we need to not sue them when things take an unfortunate turn, in which no one is at fault.

      • DoctorSH
        March 30, 2013 at 7:13 am

        Robb

        EBM is actually being used in healthcare more as a means of govt and third party insurers to control the actions of physicians and other healthcare professionals, all to save money.

        What they don’t realize is that EBM rarely works, we are individuals not communities, and that EBM actually costs more and does not improve health.

        EBM is just another political-media stunt by the govt to bring health professionals in line.

        But their line is not straight, more screwy!!

  21. Danny Albers
    March 16, 2013 at 3:44 am

    We have a bigger problem at the root of the matter and that it is human nature to beleive what they want to beleive and find the evidence after the fact. Confirmation bias.

    Someone determined to find fault with paleo will find TONNES of fault. Someone determined low carb is bad will find TONNES of fault. So too with veganism, etc…

    And that I think is really what your article is getting to.

    If one truly stepped back, and I mean wayyyy back, and grouped all “observational evidence” for all disciplines into one, I think the only conclusion you could truly make is that observational data points to a theory, that theory is almost always later proven wrong or woefully inadequate.

    Another thought I had.

    “You guys don’t practice gold level science so do not expect me to” also seems like a losing view of things on all sides. In this scenario NOBODY practices good science, and everybody accepts “whatever is available”.

    This is not an ideal way for a population to move forward.

    • Robb Wolf
      March 16, 2013 at 5:36 pm

      Danny-
      If we start with the Evolutionary template, all this discussion goes out the window.

  22. Vin Miller
    March 16, 2013 at 5:34 am

    I’ve taken two graduate courses on evidence-based medicine and have done a fair amount of reading on it. In nearly all the resources I’ve been exposed to, it is said that EBM is not intended to be a rigid process and that there is room for intuition. Based on this, I agree with Tyler that the problem is not the concept of EBM itself, but rather how some people are putting it to use, similar to how the concept of paleo has been tarnished by the “low carb jihadists” who make it seem more like a fad diet than an evolution based set of principles.

    I really do think that people who charge money for health advice are obligated to have a fairly strong understanding of the available evidence. I don’t mean to say the evidence should be blindly followed, but that it should be a factor in most decisions and recommendations when possible. One of the reasons why I really enjoy your podcasts, Rob, is because you do such a great job of finding a logical compromise between science, common sense, and practicality. Without your familiarity with research and science, I don’t think you’d be able to do that!

    Fraud in research, however, is very disconcerting. If we can’t trust scientists (seekers of truth) to have integrity, who can we trust? Despite this, I think we can trust that there are enough good researchers out there for the fraudulent science to eventually be flushed out. In other words, I don’t think we need to throw out the baby with the bath water. I don’t think you’re suggesting that, but I think there’s still a lot of value to be gained from the principles of evidence-based practice, as long as they are followed with integrity … and some common sense!

  23. R. Brain
    March 16, 2013 at 11:13 am

    Here’s a stunning example of an underestablished medical procedure: coronary bypass grafts and angioplasty: http://harvardmagazine.com/2013/03/a-cardiac-conundrum

    • Robb Wolf
      March 16, 2013 at 5:35 pm

      I think i did a piece on CABG a few years ago…it is a farce, par-excel-lance. Insurance is all to willing to pay for a proceedure with remarkably high risk, that does nothing to extend life.

      • Sean Grady
        March 31, 2013 at 7:19 am

        Well, that’s just great! I’ve been Paleo for the last year and doing Crossfit (I am a runner also). I developed angina last November which worsened over the winter. At the end of January the doctors stepped in and I lost all control. Next thing I knew they cracked me open and did a triple bypass. I’m still trying to feel as good as I did before the surgery that was supposed to make EVERYTHING better. A week before the surgery I was doing Sumo Back Squats with several hundred pounds on my shoulders. Now I work to get out of a chair. My life was turned upside down and now I find out there is no science to back it up. I hope paleo and Crossfit will keep me going.

  24. CarbInsanity
    March 16, 2013 at 1:29 pm

    Evelyn deserves an apology, Robb. And while you’re at it, the general public also deserves to know what in GOD’S NAME possessed you to agree to attend the Low Carb Cruise. Jimmy Moore has been exposed – yes, by Evelyn and many others – a thousand times over. Shame.

    • Robb Wolf
      March 16, 2013 at 5:34 pm

      I told Evelyn why I chose to do the LC cruise. She has self-servingly sat on that information (shocker). In 2010 Jimmy asked me to do LCC 2011. I agreed, seemed like a potentially fun time to hang with some cool people, get a tan and talk about stuff I enjoy. Then, we got pregnant, the due date was April 28th, the LCC was May 5th. I waffled and hemed and hawed about giving the thing a go, but non-carbsanity prevailed and I backed out of the gig rather late in the game, apologizing to Jimmy who completely understood the whole thing. I PROMISED him I’d do the following year, this year for the reading impaired! Zoe arrived May 3rd, so had I gone on the LCC that would have sucked missing the first few days of my daughters life. As it was, Evelyn managed to get me drug into the whole Jack Kruse debacle , which I tried to keep that brush fire from turning into a full scale meltdown.

      So, I agreed to go, gave Jimmy my WORD and intended to see things through. Then the whole David Duke, KKK gig hit. I’ll be honest, I was pretty stunned and none to happy with Jimmy. Someone on this site commented “Hey, what do you think of JM on the David Duke show?” I responded “The White Supremacist!? surely this is a different person!” Unfortunately, no, it was not. I was pretty bummed with Jimmy and was thinking hard about seeing through on my word vs. getting involved with this stuff. I had actually decided to PULL OUT (again, for the reading impaired, that mean “to not go on the Low Carb Cruise…I want to make sure people understand the context of “pull-out” after all). Then Evelyn decides it is her DUTY to ride me on this topic. I do NOT like being pestered. I still waffled some more but then decided I was not going to be bullied into doing something Evelyn wanted, just for the sake of her desires on this topic. AND I was not going to go back on my WORD just because it was going to bring some heat to myself. People are spineless coward these days and I was not going to cave just to make my own life easier. And trust me, bailing on the LCC would make my life much easier and it has nothing to do with Evelyn. I am scheduled to do a military gig right before the LCC and will be traveling for 10+ days, I get home for 4 days, then I’m back across the country for the LCC. Now, I know Evelyn’s minions have conjectured about “how much money Robb is making on that thing!” I make “nothing”. In fact I pay my airfare, my cruise ticket and miss work for this. So, it’d actually be pretty nice to bail on the gig for my own, selfish reasons, but as I mentioned above (and to Evelyn in an email, which again she has selectively not shared with her readers) I’m seeing this through so I can look myself in the mirror and have some notion that I am a “Person of My Word.” Since you posted with a dummy email adress and no name I know that stuff is meaningless to you, but perhaps you can play make-believe and try to see this form my shoes. I doubt it, but who knows.

      So, to re-cap:
      1-I am going, as I gave Jimmy my WORD.
      2-I am not happy about the David Duke gig, nor the fact I’ll be gone from my family for too damn long.
      3- This whole thing comes out of my pocket and has been a pain in the ass for going on two fucking years.

      If you would like further clarifications on things like this, why I wipe myself form front to back, hold my steering wheel at “ten and two”, please don’t hesitate to ask.

      As to an apology to Evelyn: that would imply I, in some remote way desire a relationship or ongoing interaction with Evelyn. I do not. She is a toxic person.

      Finally: If you guys continue to push this or similar topics I’ll tell you what I’ll do. I will put Jimmy’s site front and center on mine, I’ll sit down with him and figure out how to make LCC 2014 an actual financial success, and I will spare NO EXPENSE in ensuring that come to be. Bully, threaten and stalk me and see what you get. This will damage my credibility and income not in the least. I could close this site, disappear from the interwebz and I will still have 5 lifetimes of work with the police, military and fire contracts I have. CrossFit HQ thought I’d back down to them too for fear of a fight or losing my job. They were wrong and the break-up put another zero at the end of my yearly income.

      • Sara
        March 17, 2013 at 9:45 am

        Great comment, Robb, and great post as well. Why am I not surprised that Evelyn is pretending not to know the truth about the low-carb cruise?

        And I’ve seen that “Evelyn deserves an apology” idea posted many places by her followers. What she deserves is to be told to go fuck herself.

        Guess we can check that off the list. :-)

        Bullies suck.

        BTW, think you’ll get a kick out of this:
        http://itsthewooo.blogspot.com/2013/03/ill-decode-this-latest-dramarama-for-my.html

      • Melissa
        March 17, 2013 at 11:53 am

        Robb, you know for a fact that the Kruse thing was festering long before the cruise fiasco. There is a long long thread in my inbox about Kruse’s mendacity that is three months before the cruise fiasco. But no one would publicly take a stand on him except a few rather minor hobbyist female bloggers like me until them. After not just Carbsane, but me and Emily Deans were dragged through the mud by him and his cronies and it became a full-scale police incident, you gave a statement on Paleohacks that was rather half-hearted to be honest. I still think you somehow thought we were behind it. It was the thing that forced me to realize that people don’t really care about science in the paleo community, they will only take a stand if their reputation is at stake.

        Now that it’s a war between you and Carbsane you won’t take that because you think people will interpret you not going on the cruise to letting her win or something. You are willing to spend less time with your family and wade into the sunk cost fallacy on that account. It’s too bad. I honestly do believe you care about the core of the paleo principles that help people and I was happy to see you take a stand for evolutionary medicine in this post, but then you are going on a cruise run by the man who has essentially eviscerated paleo of that very thing. Read your last blog posts and think about whether they are congruent at all with what Jimmy promotes, which is lately a borderline-eating disorder (https://www.facebook.com/LLVLC/posts/504832729573313). I think you know this really and that is why you are so sensitive to Carbsane’s quips.

        • Robb Wolf
          March 17, 2013 at 4:44 pm

          NO, it was agreed upon by most of the people on an email thread that we’d NOT engage Kruse publicly, and instead let him hang himself with his own neurosis, which he did. Are you forgetting the mental health expert who counseled THAT course if action?

          That you and Evelyn took it upon yourselves to do what you did is telling. You two love drama, love an opportunity to be a bully. It just turned out in the Kruse case that we had a legitimately unstable personality to deal with, so that somehow translates into a License to Annoy by you two.

        • Robb Wolf
          March 17, 2013 at 4:45 pm

          AND I have no fucking idea what Jimmy is up to. I have a few things occupying my time these days. You have an amazing capacity to twist things to suit your agenda.

        • Robb Wolf
          March 17, 2013 at 4:48 pm

          Jimmy is doing a water fast for a week, and this is cause for alarm? And THIS is Justification for me being “sensitive” to Evelyn? Not the fact she has been bugging me for almost two years, and about hit I can care less about? THIS is really your logical position on this?

        • Robb Wolf
          March 17, 2013 at 5:07 pm

          Before the David Duke gig had had yet occurred Evelyn was ll over me for going on this thing. I told her tow things:
          1-I gave the guy my word I’d go.
          2-My WHOLE talk was going to be about Evolutionary Medicine. And i said to Evelyn: “Can you think of a group of people who NEED to hear this more?” Which had ZERO effect on her other than waiting for another opportunity to bug me abut this stuff.

          what is perhaps most vexing is she never pinged me a cordial email with some kind of a tone like “Hey Robb…have you considered the big picture ramifications of all this…” instead it was the wall of arrogance and condescention that I STILL tried to wade through to see if I was making some bad decisions. Even trying to be logical about this though, at some point, when you have someone nipping at your heels and trying to bully you, the option of doing what they DO NOT want you do do become appealing, even if it is at significant inconvenience to me. Not everyone responds favorably when you are approached with the equivalent of an Asberger’s type of assault.

          Melissa, you have never ben at the ground floor of seeing a charismatic person start making a march on the world. I have. In the Kruse case you can create a convenient “us vs them” world which seems to legitimize the cult leader. THAT is what was agreed upon in the emails that were exchanged between a NUMBER of people. Again, you and Evelyn decided to take an entirely different approach. Then, anyone who was not championing your way of handling this were idiots, cowards or worse. I’ve reached a point where I’m not going to expend energy to try to keep the whole thing under one rough umbrella. there is no need to, we can drag all this past the lazy academics, neurotic religious kooks and bring Evolutionary Medicine into the proper place it should take. it’d be nice if we could put effort into that in a congruent way, but That’s largely up to you at this point.

          • ItsTheWooo
            March 19, 2013 at 6:28 am

            +1 to Robb
            Clearly teh winnar in this fisticuffs. Everyone can go home now, a clear winnar stands here. I know this because am the moderator of the “GFY debacle” debate panel

          • Robb Wolf
            March 19, 2013 at 8:15 am

            Will this be a Union conflict with the Hall Monitor of the Internets?

      • Lea
        March 17, 2013 at 5:27 pm

        Robb, I hope the statement above (specifically, the part where you vow to spare no expense promoting Jimmy Moore’s business if Evelyn continues to bug you) was written out of frustration and doesn’t reflect your actual beliefs or decision-making process. You’re saying that you’ll do your best to promote Jimmy Moore purely out of spite (i.e., to piss off Evelyn and Melissa). If you think a move like that isn’t going to cost you some credibility, I’d say you’re sorely mistaken. And your promise to avenge your critics is sounding a little Kruse-ian at this point.

        • Robb Wolf
          March 18, 2013 at 2:17 pm

          Lea, it’s not Avenge my critics, it’d be “take vengeance upon”. Did you miss the point of me having too much work to do as it is? that If i close the site ENTIRELY , I have plenty to do?

          I never followed any of Jack’s work, so I’ll have to take your word on the Kruse-ian nature of the comment.

      • Galina L.
        March 18, 2013 at 2:37 pm

        Unfortunately, there is no warranty on friends that they would never ever do something foolish. I think that the associating with David Duke was just a gross misjudgement on Jimmy’s part.

    • Dana Michelle of Eclectic Kitchen Evolved
      March 16, 2013 at 8:39 pm

      Exactly why does Robb have to answer to anyone about why he chooses to go speak to the public about the Paleo diet? Regardless of whether it is on the Low Carb Cruise, at AHS, a random Crossfit box or at Paleo FX? He’s furthering the movement and the cause. I think that is what’s relevant. Now you don’t have to buy tickets to any of these events if you don’t want to, that is YOUR choice but it is not your CHOICE or YOUR decision whether or not Robb chooses to speak at them and I don’t think he has to tell anyone why he chooses to speak at any of them. We are all very fortunate he still does. What everyone needs to remember is, this movement isn’t mainstream and the longer we allow people to continue with their negative impact, toxic influences and with counter-productive acts in this manner, we won’t ever get there. We’ll self-implode. All those that help perpetuate the drama, the negativity and toxic nature that does not serve to help the cause but instead harms it, are clearly not concerned about the best interest of this movement but far more interested in drawing attention to themselves and wreaking havoc. Do something productive and positive for a change, instead of always seeking the negative and looking for the worst in everyone so you can feel better about yourself. Get therapy.

      • Robb Wolf
        March 16, 2013 at 9:09 pm

        Well said!

      • Melissa
        March 18, 2013 at 8:08 am

        ROTFL laughing at the woman responsible for bringing so many toxic people into the movement and promoting them. Kevin Cottrell? Jack Kruse? AHS should be ashamed to be associated with the PaleoFX circus.

        • Robb Wolf
          March 18, 2013 at 2:10 pm

          Melissa-
          Beat it. You already opted OUT of the AH movement. You got a pair of poopy pants because we did not take up your Lothor of the Hill People schtick.

          • Joe
            March 20, 2013 at 9:51 am

            Ultimately, what the whole brouhaha is all about is that Evelyn and Melissa want to be stars but never did the work required to get the credentials or knowledge necessary to be credible.

          • Robb Wolf
            March 20, 2013 at 11:19 am

            If they had focussed on helping people instead of being jerks they could be huge assets. not to be apparently.

        • Basil Gravanis
          March 18, 2013 at 11:09 pm

          We all make mistakes in our bids to be inclusive and you’ve just cited some whoppers in that pursuit. Some are easier to spot/vet than others… You and I both saw Kruse coming from about 10 miles off, as did a few others with similar instincts or sniff tests. I think the challenges regarding not ‘poisoning the well’ of the AH community, such that it is, would better be met with more constructive criticism (most of what Paleo Drama seems to be about, if misleadingly named) and a notch or two less snark & harassment (if that, in fact, happened). Then again, I am sort of a wuss with thin (Greek, emotional) skin and Robb isn’t… ;-)

        • Dana Michelle of Eclectic Kitchen Evolved
          March 19, 2013 at 12:18 am

          Melissa,
          I didn’t direct that comment at you…kind of telling that you took it that way, though. I am also not responsible for bringing Jack Kruse or Kevin Cottrell into the fold and YOU KNOW IT, since we have had private convos about this when you wanted and offered to invest in what you are now calling the PaleoFX circus. My, my how things change, huh Melissa? Kevin was not vetted by me or Keith, we trusted others that told us he was fine and we were burned very badly by him, which you were also aware of and why we didn’t accept your offer to invest in PaleoFX. It’s too bad that you have chosen the path of Paleo drama instead of sticking with the higher ground of intelligence I know you to have. I am disappointed, seriously. I had really looked forward to meeting you, your brilliance is being tarnished by your lack of judgement and it’s been sad to watch you choose this, the drama is so beneath you.

  25. Gail
    March 16, 2013 at 1:32 pm

    I got into Paleo after not getting answers from my doctor about why I felt so awful on Metformin. When I looked for answers on the ADA, AMA, and .gov websites, there was nothing except take your drugs, eat low-fat (which it what got me into this mess) and wait to die as a blind amputee. When I looked into other sources and discovered Paleo, I started seeing a lot of serious bio-chemistry, which I understood enough to find it convincing. So which is the evidence based medicine? I’ll go with Paleo.

  26. Jake d
    March 16, 2013 at 3:44 pm

    Using the big bang as an example is good science is an extremely poor choice :/

    • Robb Wolf
      March 16, 2013 at 4:58 pm

      Because the planet is 6,000 years old?

      • Dan
        March 17, 2013 at 7:05 pm

        Your argument operates on the assumption that the only two notions are that the “big bang” happened as described and that “god created the universe”. Given that you (rightly) complain about poor science in your field, it is unnerving to see you reject, out of hand, people who would make similar complaints about other fields. Please do some reading before you malign someone so dismissively.

        • Robb Wolf
          March 18, 2013 at 2:13 pm

          Dan-
          No, I
          ll malign fucking morons who perpetuate material on par with witch burning and built from the substance of imaginary friends.

          • Dan
            March 18, 2013 at 5:14 pm

            I still don’t understand why you think the options are: (1) big bang as described by the mainstream, and (2) god did it. The big bang could have mechanics other than those accepted in the mainstream, and this could have meaningful implications (e.g., was there an inflationary period?).

          • Robb Wolf
            March 18, 2013 at 6:35 pm

            Ahh!! Well, I’m going off the orthodoxy of cosmology. Def interested in alternate views on that. If you have some resources I’d be grateful.

      • Trent
        March 17, 2013 at 9:26 pm

        LOL, I think that post should be “naturally selected” off this thread…

      • Neil B. Feldman
        March 20, 2013 at 7:54 am

        There used to be two equally competing views on the origins of the universe – the “steady state” and the “big bang”. The Big Bang eventually became mainstream after 1965 first due to the discovery of the cosmic “background” radiation by Penzias & Wilson. However, there are still some who feel the jury is out. In particular, those who recognize that the big bang defies a basic “law” of science – the conservation of mass and energy – insofar as it says that you can “get something out of nothing”. There is a whole lot more to the argument, of course. You can start by reading Fred Hoyle, who first coined the term “big bang” satirically.

  27. Chris Chatzoglou
    March 16, 2013 at 4:01 pm

    Fantastic post!
    It amazes me how little knowledge those that pray to The Church of The RCT have about research methods. They seem unaware that there are different levels of research and that RCTs may not be appropriate for everything we want to study.
    For example, procedure-based interventions such as surgery, manual therapies etc. are difficult, and sometimes unethical, to blind. Anyone remember the knee surgery study where the placebo incision had a better outcome that the actual surgery? Case studies (n=1), followed by a case series and resulting observations are often more appropriate here.
    Also, its important to note that EBM, as defined by Sackett, is a synthesis of the best available research + the clinician’s experience/professional judgement + the individual needs of that one patient. Simply providing treatment based on RCTs is a cookie cutter approach to health care and in some cases (celebrex, avandia, vioxx) dangerous.
    So-called “skeptics” need to remember that while they may have read a few books or journal abstracts, there are professionals out there who are treating and councilling real patients everyday. In many cases, they are getting incredible results IN SPITE OF the best avilable research.

    Evidence based medicine: what it is and what it isnt’t. (Sackett) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349778/

  28. Carole AKA Carbsaner
    March 16, 2013 at 5:04 pm

    Great post, Robb. I hope you don’t mind, but I’ve just posted about the latest twitter ‘discussion’ on my CarbSaneR blog and have taken the liberty of using a pic of you!

  29. Martin
    March 16, 2013 at 10:54 pm

    Robb, you should invite Tim Noakes for a podcast about medicine, nutrition and science :-)

  30. mike
    March 17, 2013 at 5:19 am

    good website and very interesting points. really like the content on this. you are a very experienced person rob, keep up the good work.

  31. Geoff
    March 17, 2013 at 5:48 pm

    Have you no sense of decency left, Evelyn? At long last, have you left no sense of dignity?

  32. Marcus
    March 17, 2013 at 10:20 pm

    Hi Robb,
    One way to reach the hard of reading is to write your posts very slowly, that way the mislexically challenged may be able to keep up.

  33. Rachel B.
    March 18, 2013 at 4:17 am

    Hey, Rob. I wanted to leave you the name of a book that you might enjoy which is about this very topic: the whole business of medicine, “evidence-based” standards, and the ways in which medicine today is practiced in ways that are often really NOT based on evidence. It’s by a doctor, an oncologist named Otis Brawley. It’s called “How We Do Harm.” I guarantee you will be bug-eyed at some of the stuff you will find in this book! In case we needed any other motivation to stick to an anti-inflammatory foodway and stay out of hospitals. . .

  34. Jane
    March 18, 2013 at 5:01 am

    ‘..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. ..’

    Well, the scientists I know do just that, and it has got them into very serious trouble. They thought modern disease was due to genes and the Human Genome Project would find them. But mostly they haven’t found them. This is the problem of ‘missing heritability’. I’ve been to seminars where scientists say ‘we WILL find them, we know they’re there’, but it really isn’t convincing any more. It’s looking as if much of the heritability may lie in junk DNA, and that changes in junk DNA (and in genes, for that matter) could be the result of micronutrient deficiencies from eating refined carbs. DNA repair needs micronutrients.

    • Robb Wolf
      March 18, 2013 at 2:11 pm

      that’s becasue they forgot about epigenetics. Gene-environment INTERACTION.

  35. Kelley Folsom
    March 18, 2013 at 10:15 am

    I really loved your “crown chakra” comment. LOL

  36. pzo
    March 18, 2013 at 12:22 pm

    Thanks for observing, er, writing about what I’ve been thinking for the four years I’ve been interested in diet and health.

    I’m of the opinion that when a test subject has many variables – genetics, sex, lifestyle, on, and on – that it is almost impossible to find the accurate data. Because there isn’t any.

    OTOH, when many thousands of people from Mr. Banning in the 1860′s to this day (almost) consistently report health improvements by adhering to a low carb, or ancestral type diet, that is certainly valid science. When Dr. William Davis of Wheat Belly fame has watched his patients health turn on or off just based on wheat consumption, what? This is bad science?

    Random controlled studies are great when the target information is simple. I was a Polio Pioneer. I got the Salk vaccine about 1953, although the families did not know whether the vaccine or a placebo was received until later. Studies like this can come up with accurate results easily. The vaccine obviously worked.

    Here’s an observational study: Look at people in the grocery store line. Look at what is in their carts. Almost a perfect correlation with their weight and health.

  37. Galina L.
    March 18, 2013 at 2:45 pm

    Evidence-based medicine is a conflict-causing subject.
    The arguments based on evidence and personal experiences versus data obtained during different trails are at the base of the disagreement between LC zealots and people like Dr.SG.

  38. Amber Golshani
    March 18, 2013 at 3:58 pm

    Thanks Robb! Another great article. I’m sure you’ve seen this

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/

  39. Robert
    March 18, 2013 at 7:01 pm

    Rob,
    As a member of the health care community (I am a psychiatric NP) I can tell you that you should minimally invest yourself in arguing with the skeptics. The evidence for evolutionary medicine (and psychiatry) is overwhelming, particularly the nutritional aspects. Despite that there will always be nay-sayers. Much like politics and religion, the more you present your case to some individuals the more they will bury down and refuse to rationally analyze the facts, and rather re-interpret all evidence to support their pre-existing belief system. Don’t let them drag you down. Analyze and present your evidence, politely reply to them initially, then let them go on with their opinions. Some of those responding to you seem to be doing little more than itching for a fight. Those seem to be individuals who enjoy turmoil and chaos. Let them find it elsewhere, or they will just make you miserable and bring you down to their level.

  40. Alexandra
    March 19, 2013 at 3:13 am

    Robb,very nice post, possibly one of your best. I hope that you end up enjoying the Low Carb Cruise, I went last year and will be there again this year. (BTW, I had never even heard of that Jack Kruse guy before the cruise and still know almost nothing about him…too “fringy” for me.) What I didn’t find on the LCC was a bunch of followers or minion types or anyone that worshipped certain bloggers and podcasters. What I did find was a group of interesting individuals, (It is almost a requirement that you be the type of person willing to buck the system to go in the low carb and maybe even paleo direction and turn your back on crappy conventional weight loss/health advice and doctors) many of them astonishingly successful at losing weight and turning around some rather severe medical problems as well. I am pleased to see that many low carbers are moving in a more Paleo direction and skipping the artificial sweeteners and low carb processed products in favor of real foods. why would anyone be against that? I am 90+% Paleo and have successfully kept off nearly 130 lbs for 4 1/2 years by being careful with my carbs and skipping all but a minimum amount of starches. This works, I am healthy and I feel great. I am not sure about all those hate mongers out there and wish that they would try to add something to this movement instead of wasting time as they seem to. I am looking forward to metting you in May.

    • Robb Wolf
      March 19, 2013 at 8:03 am

      Looking forward to meeting you!

    • tess
      March 29, 2013 at 10:41 am

      this will be my first time to join the LC cruisers, and i’m looking forward to meeting you both! Robb, i admire you for going ahead and speaking on this trip (in ADDITION to not caving in to the internet bullies), because you SAID YOU WOULD.

      the lower-carb branch of paleo is paleo nonetheless, even though we can’t tolerate many tubers and fruits anymore! a lot of us STARTED with Atkins but are doing much better with the refinements suggested by Mark and Robb — their inclusiveness and “quality” are what have earned our respect and esteem!

      • Robb Wolf
        March 31, 2013 at 7:56 pm

        Tess-
        Looking forward to meeting you. LC/paleo is a tool and very handy for the right person.

  41. Jane
    March 19, 2013 at 6:43 am

    About Lindeberg’s Paleo vs Mediterranean diet study. I emailed him to find out if the Mediterranean diet was a whole food diet like the Paleo diet was. It wasn’t. The subjects were eating refined oils, low-fat dairy and an unknown amount of refined carbs. They were told to ‘eat more whole grains’ but not to eliminate refined grains. Therefore the benefit of the Paleo diet could have been due to elimination of micronutrient-depleted foods. I asked him about this and he told me he was not sure what ‘whole food’ meant. I explained, but I did not hear from him again.

  42. CarbInsanity
    March 19, 2013 at 1:04 pm

    “Silly ass cruise”? Now it’s poor Jimmy Moore who deserves an apology, Robb – to say nothing of the actual cruise-goers themselves.

    • Robb Wolf
      March 19, 2013 at 2:21 pm

      Evelyn has apparently NOT considered everyone who emailed her was being conciliatory to HER, to keep the Harpie off their respective backs and try to placate her in a way that did not level her staker-cross-hairs on them. But thinking of that would require stepping outside herself and considering the motivations of others, even if just to be tactical. I’m not excited about the travel elements of the cruise, nor being gone from my family, but I’m going to do the best presentation I can AND I’m going to have as much fun as I can.

      Like I said elsewhere though, I’m enjoying the extra traffic!

      • Sara
        March 19, 2013 at 10:01 pm

        Suddenly the “CarbInsanity” troll feels for “poor Jimmy Moore”? HAHAHAHAHAAHAH

        Everyone but Evelyn realizes that, confronted with an enraged honey badger, you were simply trying to say “nice doggie” in a soothing voice while backing away vewwwwy slowwwwwly.

        And everyone but her realizes that she only makes herself look even crazier by publishing private correspondence.

      • raydawg
        March 21, 2013 at 9:02 am

        It’s amazing to what lengths and time frame the clinically insane will go to hold a grudge when they’ve been butthurt on the internet. I guess the 12 bowls of grains they’re consuming each day are rotting their brains. Oh well.

        Fight to good fight Robb, and don’t let the trolls get you down. The best revenge is living well and thriving, that just gets them even more upset, which gets their cortisol all chronic, and they crave more wheat. Muahahaha!

  43. charles grashow
    March 19, 2013 at 1:43 pm

    Robb

    http://robbwolf.com/2012/04/16/paleo-diet-risk-assessment/
    http://robbwolf.com/2012/05/16/paleo-diet-risk-assessment-update/

    How come you never mentioned that the police were taking drugs as part of the protocol??

    http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id=122012

    Case one. This case involves a highly motivated 33-year-old police officer who, over a four-month period, has had a spectacular reversal of insulin resistance. This was accomplished with a low-carbohydrate diet, exercise, a weight loss of 12 pounds, and medication—in this case, a generic statin costing $10 every three months.

    Case two. This case is a six-year follow-up on a 52-year-old police officer. He lost 40 pounds (including five inches from his waist) and corrected almost all of his numbers including four of the markers that diagnose him with metabolic syndrome. He went from having five out of five metabolic markers to one out of five. These results were achieved by the same basic approach that was used in case one but with more pharmaceuticals.

    SO – how much the result of the diet and how much was the result of the drugs??

    I also find it interesting that the article only talks about 2 out of appx 80 who took part in the program – is there any info available about the results of the rest of the participants??

    • Robb Wolf
      March 19, 2013 at 2:16 pm

      I have a follow-up post on this tomorrow, we have material in the publication pipeline. You’ll have to wait a bit until it’s all released to get more details.

      Jackie might be able to give you a bit of a breakdown on the relative contribution of diet vs pharmaceutical…that’s actually a nice angle to look at in this, which she may have done, but if not it is certainly worth doing. Please keep in mind though, this is a case by case basis, largely driven by what the clinicain feels is appropriate for EACH person. I can tell you this, they tried high carb, low fat, grain based diets in the beginning and people got worse. MUCH worse. You can ping a phone number to chris@robbwolf.com and I can put you in contact with Jackie, who does the data analysis portion of this program.

      • Sara
        March 19, 2013 at 9:55 pm

        What I want to know is how much of Charles’ comments are as a result of the drugs?

        • Robb Wolf
          March 20, 2013 at 6:36 am

          I was wondering that too! He felt compelled to ask essentially the same question twice. Evelyn is the only person who have ever asked a similar question, and is the only one to have “stalked” her way through all the material to ask originally “what was the EXACT “paleo diet” used. Similar to the other treatment, the nutrition is customized to the individual. Odd that “he” disappeared when the offer of a phone call was made.

          It was an interesting question though and it got me thinking on it, even if it was offer by a Trollop (female troll). But we’d need to do the nutrition therapy alone, then the glucophage, then the crestor, to get a sense of what the individual impacts are, but that is exactly opposite the integrated approach we are taking.

          Normal creator doses run in the 20mg range. 5 mg is considered to be “below the therapeutic threshold” yet this is the highest dose virtually everyone in the program receives. This is due most likely to the anti-inflammatory nature of the diet increasing the efficacy of the Crestor.

          It’s still an interesting question, but given that each individuals treatment is different, I don’t know that any type of averaging would tell us much beyond what we already know: some will only need diet, some diet + meds.

    • Robb Wolf
      March 19, 2013 at 2:08 pm

      I did, I mentioned it in the podcast, my AHS talk and several other locations as well.

    • Ty Fyter
      March 20, 2013 at 3:47 am

      i seem to recall him mentioning it *several* times upfront.

    • Robb Wolf
      March 20, 2013 at 1:58 pm

      Charlie!!

      Where did you go? You asked the same question twice, and not a bad question at that.
      Then no emails to Squatchy and no follow-up here? It’s so…odd. I mean, you spent so much time going through all that old back material, Only Evelyn, while on the stakler-path, has shown the tenacity to do that. She is also the ONLY person who has ever asked any questions about the Police chief piece!

      Charlie!!…c’mon, do you have something you want to share with us?

  44. Eboyette
    March 19, 2013 at 3:04 pm

    Wow is there that much money to be made in professional douchery, and naggery? I may have to jump on the bandwagon!

    1. Make Blog
    2. Make accusation “Robb Wolf hates women and his head is kinda funny shaped”
    3. Profit!!!!?

    • Robb Wolf
      March 19, 2013 at 3:44 pm

      I see a franchise opportunity.

      • Ty Fyter
        March 20, 2013 at 3:48 am

        LOL! ;-P
        wish i had thought of that first… ;-)

      • raydawg
        March 21, 2013 at 9:04 am

        That would make an excellent T-shirt!

  45. Erin
    March 20, 2013 at 3:06 am

    Me (pharmacist): “I eat paleo, no grains or dairy. It may help you with your joint pain…”
    Co-worker (pharmacist): “I’ve been around too long to believe anything like that without some randomised controlled trials.” (Shoves fiber one bar in face)

    Seriously??!! Are there RCT’s telling us packaged, scientifically manufactured fiber bars are good for us?

  46. Jane
    March 20, 2013 at 6:08 am

    ‘..I can tell you this, they tried high carb, low fat, grain based diets in the beginning and people got worse. MUCH worse. ..’

    Could I ask you please, were the grains refined or whole? If some of them were refined, and if ‘low fat’ means low-fat dairy, deficiencies would be expected for fat-soluble vitamins, B vitamins and various minerals including the all-important magnesium.

    I realise a lot of people think whole grains are just as bad as refined ones, but in 30 years of studying the biomedical literature I have not found evidence for this. All the so-called toxins in grains are only toxic under certain circumstances, and people who have never eaten refined grains do very well on a grain-based diet, as McCarrison found in northern India 100 years ago. In fact the people whose doctor he was for 7 years may have been the healthiest on the planet, and the rats he fed on their diet were astonishingly healthy too.
    http://www.soilandhealth.org/02/0203cat/020301wrench/02030100frame.html

    • Robb Wolf
      March 20, 2013 at 6:19 am

      So, pearled barley, soaked Oates? No, they did not eat that way.

  47. Robb Wolf
    March 20, 2013 at 2:09 pm

    I should let this go, but this is REALLY too good. From Evelyn’s comment above, attached to her FB page:

    CarbSane from The Carb-Sane-Asylum
    “Some of this lack of RCT’s is for ethical reasons. I remember a study looking at survivability of gunshot wounds to the chest in folks who were given aggressive IV fluids. The thinking was that people would do better with a large amount of fluid administration, as an individual with decreasing blood volume easily develops cardiac output problems (and a host of other issues). Interestingly however, somewhat less aggressive therapy seemed to produce better survival rates, possibly due to the ability of the body to better form clots. We don’t know precisely why this is as it’s never been studied and is not likely to be studied for reasons I’ll get to in a moment. The point being, this is NOT a RCT. The study is OBSERVATIONAL. For the EBM crowd this should be jettisoned and largely ignored if they are to be consistent in their treatment of study material.”
    Umm, no Robb. That is still an EXPERIMENT, not an observational study. Not randomized, probably with no control that makes sense, but experimental nonethelesst. A treatment was applied and the result measured, the very definition of an experiment whereas an observational study by definition involves observation only and no intervention. Presumably, based on the results of this study, standard medical treatment for gunshot wounds to the chest involves less aggressive fluids.
    You’ve erected a pretty big RCT strawman there. This may be the “gold standard” but it is not the only means by which “good science” is done.

    Robb again:
    So, the hilarity here is I explained in the original piece that I had to trap the guy from twitter. I did this by setting up RCT’s as the “only real science” which led him to say “no man, all this other stuff is valuable too” which prevented him from dismissing the Lindeberg piece out of hand, as is typical. Now, I mentioned all this in the body of the post. I also led in admonishing people to NOT have poor reading comprehension.

    The punchline: Evelyn’s tweet to me about WFT I pester my readers about their READING COMPREHENSION!

    The irony is just too much.

  48. Vard
    March 20, 2013 at 3:37 pm

    Much like the Paleo diet is considered an “alternative” diet or worse by the mainstream, who Robb rightly points out dismiss it out of hand, there are alternative theories on cosmology as well. There never was a consensus going back to Einstein’s time. Many scientists of the era had differing takes on the observations that were being made. Many people like Kristian Birkland were ridiculed by academia, though his theories and predictions have since been proven correct. Halton Arp who was the protege of Edwin Hubble was blackballed after calling into question prevailing theories about the expansion of the universe due to real observational data. They kicked him off his telescope. Peer reviewed journals refused to publish his papers. Know that the status quo is not limited solely to the field of health. Much of the flimsy studies that Robb is calling into question concerning the health field/academia is occurring in even more glaring instances in other fields and especially cosmology. Alternative theories are out there.

    http://www.thunderbolts.info/wp/

  49. Jane
    March 21, 2013 at 4:32 am

    @Vard
    The Thunderbolts people are brilliant. Have you read ‘When astronomers fall into a black hole’?
    http://www.thunderbolts.info/webnews/112607fallintohole.htm

    As you say, alternative theories are out there. In nutrition, the alternative theories involve metals. According to the conventional view modern diets are deficient in iron and zinc, and not deficient in their respective partners manganese and copper. This idea is being turned on its head. Evidence is accumulating that diabetes is caused largely by a high ratio of iron to manganese, for instance. And heart disease is caused by a high ratio of zinc to copper, according to Leslie Klevay. His work has been ignored for 40 years.

    • Robb Wolf
      March 21, 2013 at 9:45 am

      The iron overload leading to inflammation and subsequent insulin resistance AND oxidative stress in the beta cells makes a ton of sense as a significant piece of the puzzle.

      The other stuff is out of my wheel house so I can’t comment on it, but very interesting nonetheless.

  50. Jane
    March 22, 2013 at 3:59 am

    Would you like some references? An important paper came out this year on manganese and diabetes.
    ‘Manganese supplementation protects against diet-induced diabetes in wild type mice by enhancing insulin secretion’
    http://www.ncbi.nlm.nih.gov/pubmed/23372018

    This one is also of great interest
    ‘Pathway to diabetes through attenuation of pancreatic beta cell glycosylation and glucose transport’
    http://www.nature.com/nm/journal/v17/n9/full/nm.2414.html
    …when you consider that glycosylation requires manganese.

    Equally interesting is that saturated fat promotes iron absorption and inhibits manganese absorption.
    http://www.ncbi.nlm.nih.gov/pubmed/11697763

  51. Tony Mach
    March 22, 2013 at 8:03 am

    I think regarding nutrition “our” confirmation bias in “Paleo land” (and neighboring territories) is (much) closer to reality of health and disease then the confirmation bias in “medical mainstream land” – but I dearly like to know much more what part of nutrition cause what health problems, for how many people, and by which mechanisms. That we lack this knowledge (knowledge we should actually have by all means available) is a failure of mainstream medicine. So while I agree with some/many of the things you have to say, I think saying “We might have a problem with science, but the others are not particularly science based as well!” is a tad bit weak argument. And when it comes to herbs, I think you are wrong with your observations (similarly wrong as “pharma” is with some/a few/many of their studies). You simply don’t know if some of the stuff does more harm than good. I did a lot of changes to my nutrition to track down the cause of my health problems, and sometimes I changed two or three things at a time. While it helped me to make faster changes (rule out or rule in a bunch of stuff at a time) it always made it blurred it always what the cause of the result was. I suspect that when you talk to people, you advise nutrition *and* herbs and then ascribe benefits from one to other – but which one?

    What I wrote as comment on the half-hearted SBM hit-piece is equally valid here: They have the duty to clean up their house, you have the duty to do the same for yours. While I think what you do is less dangerous than what the medical science does (and some as nutrition much better), I am however critical of some of the stuff you do. Sorry for this meandering comment, but either it is right or it is wrong what they do (or a mix somewhere in between), and it is either right or wrong what you do (or a mix) – saying “the others are wrong too” and crying “double standard!” won’t solve nothing. And just because the main stream is wrong in so many places does not mean being an heretic is always right.

    PS: I think such self proclaimed skeptics who blindingly follow their confirmation bias of “their side” are no skeptics, and a rather disgusting hypocrits as such.

  52. js
    March 23, 2013 at 1:58 pm

    Thank you so much for discussing this topic. I will be using your article as a reference to forward to other practitioners who will not accept anything that does not have several P< 0.05 randomized double blind studies associated with it. When I have tried to explain this topic they dismiss it as simply "my opinion". Thank you!

    • Robb Wolf
      March 25, 2013 at 9:02 am

      You bet. This post seems to have struck a chord, i have 3-4 follow-up posts in the works.

  53. Marcia
    March 29, 2013 at 10:11 am

    Damn, I could say the same for our politicians. You can’t trust any studies or any comments as it’s all based on spin or whatever is best for their agenda (and power money)…. which also means that it requires that we research everything… and there is no one who could except for a peer review.. and even then politics enters the realm.
    “Buyer be ware”is now unfortunately the norm in all aspects of life from most organizations well intended or not… What a world we live in!
    The only thing that we can do as individuals is be as aware as we are able and then somehow turn off the stress for our survival.
    Make good choices… and good luck with that. (sorry about the pessimism)

  54. Lauren
    March 29, 2013 at 3:31 pm

    Great post! I like evidence based guidelines as much as anyone, but the problem with many RDs (just from being in that field) is they dismiss this stuff as bullshit without looking at ANY research because of what we’re taught. I just had a conversation today with a few RDs who were talking about people they’ve met that are gluten-free (without celiac) and have “all those crazy ideas that wheat is the devil.” Maybe there isn’t tons of research backing every single thing, but if it makes someone feel better, then isn’t it worth a try? I posed that question that if gluten does make someone legitimately feel better, then why shouldn’t they eat that way? Their answer was (while eating healthy processed whole grain crackers) oh, it’s because they probably cut out other processed foods and feel better. I just want them to try out even cutting out gluten (as an experiment) and then have the conversation again.

  55. JR
    March 29, 2013 at 4:12 pm

    Fine post.
    Being a grammar nazi is pretty lame when the content is excellent but this is a big one: it’s “complementary”, not “complimentary”… and alternative medicine.
    Huge blow to credibility when you misspell the field you’re defending. Especially after calling people out for their reading proficiency just two sentences before.

    • Robb Wolf
      March 31, 2013 at 8:09 pm

      JR-
      “blow to credibility”. I love how lightly that term is used by folks. Y’all may end up wearing it out if you are not careful.

  56. Hemming
    March 30, 2013 at 11:14 am

    In Denmark rye bread is huge and whole grain is the big thing. So when people tell me how crazy I am for not eating it I usually say that something like butter (butter is one of the most hated foods in DK) has more vitamins, comparing it gram by gram. Then they will look at me in disbelief, emphasise even more how crazy I am and say that butter is just fat devoid of any nutrition.

    This argument could be made with a very long list of foods, I just choose butter because that’s the most controversial for people.

    Btw, Robb. Do you exclude any particular fruits or starches in your paleo ‘template’?

    Best regards,

    Hemming

  57. Melissa
    March 31, 2013 at 10:18 am

    Great work Robb! I trust in your science because I know you’re not getting government research dollars for your efforts. I question any research where the government is involved. After years of using canola oil, pulling skin off the chicken and eating whole grains I couldn’t help but wonder why I was gaining weight and not feeling well.

    People can criticize the science of paleo all day long, but the effects of the paleo diet proves to be correct. I’m no longer inflamed, or feeling sickly.
    As an older woman, (a layperson and not a scientist), I hope that you can discuss the nutritional aspects in layman’s terms for us older people, 60 and above, because I will not do the cross-fit training, nor can I walk very far. I was interested in the supplements I need to take as well.

    By the way, my son is in medical school, working on his MD, and is a huge advocate of the paleo way of eating as it has helped him tremendously. For now, he tells his peers to see their physician before starting paleo :)

  58. Ivey
    April 2, 2013 at 7:43 am

    This was a great post! We have been going back and forth with someone because there is no “science” in Paleo… ya know because there is so much “science” in the rest of the nutrition world. Grains are so good for you and by eliminating all these food groups you are missing out on nutrients… Um… Which ones? Well, you’re missing out on great sources of nutrients. Oh. Right. Grains. Great sources of…???? I’m sorry? What again? Grains are better than fruits and veggies how?
    Gah. Every damn day.
    “Nothing in Biology makes sense except in the light of evolution.” Has been on my quotes on FB for 6 years now.
    Wait. Have I been on FB for 6 years? Lame.

  59. S Andrei Ostric
    April 5, 2013 at 6:23 am

    Robb, I am a plastic surgeon, and that puts me in an interesting frame of mind regarding this matter. I agree with your points and have tried to articulate them in the past on my blog. There are three inside jokes in the field of plastic surgery I wanted to share which seem appropriate to the general message of your blogpost. (A) 90% of published articles are BS used for pr and they don’t work in reality. (B) there is only one field where you can’t BS your results. Plastic surgery because you can’t convince people micheal Jackson had a good nose job. Results matter despite you saying ‘you did the right thing’. When it doesn’t work either uncontrollable unseen factors played in or it was just a technical error (risk and uncertainty). (C) most of the the great advances of plastic surgery came through uncontrolled situation which requires imagination and innovation and were subsequently judged by results and the process was only delineated later through scientific empirical inquiry. That is, war necessitated doing something. Or a surgeon was just frustrated at what was happening or wanted to challenge the concept of ‘this can’t be done’ then just did it, and when it worked explained why later. This I think is what you are getting at in your blogpost.

  60. David
    June 13, 2013 at 4:01 pm

    Relevant to your interests (and to this topic):
    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/

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