Conflicts of Interest

Wikipedia says, "A conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other."  (Those are my italics for emphasis.)  A conflict of interest exists whether or not the organization is corrupted by a tie to a company; if the possibility is there, it is defined as a conflict of interest regardless.  This is definitely a touchy, convoluted topic.  One of my friends commented on an example of this in a comment to my previous post - physicians often receive compensation for recommending certain drugs to patients.  The potential for "possible corruption" here is huge.  Another example in biomedical engineering would be if a research institution is determining if a new company's implant performs just as well or better than an implant already on the market, if the institution is receiving extra funds from the company who manufactures the implant.  In the world of health food, conflicts of interest arise as well.  In Good Calories, Bad Calories, Taubes refers to an incident where Fred Stare, founder and chair of the department of nutrition at Harvard, announced to Congress the benefits of breakfast cereals, after which the Harvard School of Public Health received about $200,000 from Kellogg, Nabisco, and others.  Of course Harvard is going to want to continue to generate positive results about cereal grains!  This may influence their study design, statistical analysis, among other things.

These conflicts of interest with companies are probably not too surprising.  As a graduate student in biomedical engineering, I have the opportunity to present my research at conferences, where many share their work as a poster or at a podium presentation.  On the first day, everyone receives a booklet that contains the abstracts for every single research project at the conference.  In it, on the posters, and during the presentations, scientists are required to list any "disclosures," which would include conflicts of interest such as the ones I described above.  I always think of these as some type of disclaimer, and I hope that peer reviewers look at these studies more closely, especially how the data was collected and interpreted, to be sure that there isn't any bias before they are published and the results reach the general public.  Unfortunately, I'm not sure that's always the case...

Recently, a good friend shared this link: The NIH will not require universities to create websites detailing researchers' financial ties.  This is going to make it more difficult for the public to find out what conflicts of interest universities have.  Also, we won't be able to easily study how conflicts of interest can impact research results, an area that I think definitely needs massive attention.

The thing I don't understand is how funding from the government is not generally considered a conflict of interest.  The National Institute of Health (NIH) boasts to be the largest source of funding for medical research in the world.  To get funding from them, you have to submit grants that show extensive background research in the area, novel experimental methods, preliminary data (sometimes), and expected outcomes.  The thing is, the government clearly has an agenda, just as any hip implant or pharmaceutical company.  For instance, the government has taken a clear stance on spades of nutritional advice - limit total fat intake to 30% of calories, limit saturated fat to no more than 10% of total calories, choose vegetable spreads instead of butter, replace saturated fats with unsaturated fats whenever possible, eat whole grains instead of refined grains, eat egg white instead of the entire egg... I could go on and on.  Now, do you think they would have any chance funding a large study that tries to disprove any of the previous advice?  If a grant were submitted that outlined all of the research done that opposes these ideas, and even if they had a great study design that would hopefully reveal some interesting results, do you think they would receive funding?

I doubt it.  So much for the scientific method and unbiased research for the benefit of the people.

Our Diet Journey

Awhile back, my cousin asked me what my 3-5 top recommended diet changes were.  I ended up writing a novel for her, and it made me reflect upon how far we have come in improving our diet.  The now modified list is below:

1) Eliminate processed food

2) Reduce refined sugar and carbohydrate intake

3) Stop consuming vegetable/seed oils, including but not limited to: canola, sunflower, soy, corn, safflower, cottonseed, grapeseed (Good alternatives: butter, lard, and if you must, olive oil, coconut oil, palm oil)

4) Eat pasture-raised, organic, local beef, chicken, and eggs (if you eat animal products)

5) Increase food variety! Try all kinds of vegetables, organ meats, etc.

In addition to these, Alex and I eat organic, locally grown vegetables and unpasteurized,non-homogenized milk from a local farm.  We have salad and usually other vegetables every day.  We also limit our carbohydrate intake, but do still eat potatoes, sweet potatoes, and sometimes rice and Ezekiel bread made from sprouted grains.  Alex notices that without carbohydrates, it's hard for him to get enough to eat, so I think he may eat slightly more than I do.  Furthermore, we aren't afraid of saturated fat and cholesterol.  Our typical Saturday breakfast is bacon and eggs from the farmer's market, with some Ezekiel toast.  Saturated fat and cholesterol actually keep us fuller, requiring us to eat less over time as we get used to it.  It's a great feeling to look in my pantry, and not see ANY cookies, crackers, potato chips, corn chips, cereal, boxed mac & cheese, triscuits, salad dressing with vegetable oils, sugary candies, granola, protein bars...

Roasted vegetables from last week:

However, it can be quite a challenge, and making these changes was a gradual process.  To make all these changes at once would be ridiculously overwhelming.  This kind of diet does require more preparation and planning since you are using whole foods, but the investment is worth it.  There are ways to lighten the burden, too.  At the beginning of the week, I cut up enough vegetables for 7 days of salads, for example.  Also, I cook in bulk and we have no problem eating leftovers.  That being said, there are tons of improvements to make, and we still do indulge!  We will buy some dark chocolate when I'm craving it, and I just cannot stop baking homemade desserts entirely.  Also, last week we ordered pizza even though we looked up Papa John's ingredients and saw that there was vegetable oil...  

Sometimes people ask me what I typically eat in a day.  For this month, we are keeping food diaries in a shared Google document, so here is what I ate yesterday:

Breakfast:

yogurt from raw milk, 1/2 cup

cocoa almonds

Lunch:

taco meat made from grass-fed, pasture-raised, local ground beef

liver from grass-fed, pasture-raised, local farm

cheddar cheese

hot salsa

peach

Snack:

10 carrots

1 pickle

9 dark hershey kisses

Dinner:

BIG salad with 2 kinds of lettuce, 2 hard-boiled eggs, 3-bean salad, red peppers, carrots, green peppers, tomatoes, and a homemade salad dressing of olive oil, vinegar, and some spices

one potato, sliced thinly and cooked with butter and cajun seasoning

raw milk, 1.5 cups

some steamed beet greens

Dessert:

1 cup of homemade chocolate peanut butter ice cream (made with raw milk and half the sugar it recommended)

Yes, so I definitely have a snacking weakness, especially where chocolate and ice cream are concerned.  I'm hoping that keeping the food diary will help with this, as I will be accountable for every piece of food that goes into my mouth.

I'm also excited because recently I had blood work done for a life insurance policy.  Here are some of the results:

Glucose: 82

Cholesterol: 182

HDL: 82

LDL: 91

LDL/HDL ratio: 1.11  <--- awesome!!

Triglycerides: 44

Exciting!  I'm glad to know that my diet in my life up until now hasn't been too detrimental.  I have my mother to thank, who breast-fed exclusively for months and months when we were babies, who always cooked hearty dinners of meat, potatoes, and vegetables, who limited our sugar intake, and didn't let us just snack until our hearts' content, and who made us drink milk instead of giving in to soda.  My blood was drawn back in March, I think, and so I'm really looking forward to see if the numbers change over time as we continue to improve our diet.

Good Calories, Bad Calories

I have begun reading Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health by Gary Taubes.  I've only read about 90 pages or so, but I have to say, it is a must read and my favorite book on the history of the diet-heart hypothesis, animal vs. plant foods, carbohydrates, etc. so far.  I am a little disappointed in the references, however.  Don't misunderstand - there are about a million of them, but they aren't in the text, making it difficult to find the exact reference he is using to back up a sentence or paragraph.  This makes my job a little more time-consuming, but oh well.  The amount of information is overwhelming and addicting!  Such a meaty book.

One of the most interesting things I've read so far is how difficult it is to design a diet clinical trial.  Many studies in the past have tried to prove that diets high in saturated fat increase cholesterol levels and increase the risk of heart disease.  At first glance, it seems pretty easy - feed one group of people some normal diet, and feed another group of people the same diet but with added saturated fat and see what happens.  The problem with this is that we don't know whether any effects we see will be from the extra saturated fat, the extra calories, or some ratio of fat to carbs, omega-3 to omega-6, etc, etc. If instead we choose to keep total calories the same, then the group who is not eating lots of saturated fat has to have something to fill its place - complex carbohydrates, polyunsaturated fats, and so on.  Taubes argues that it is almost impossible to conduct a double-blinded, placebo trial for food.  It's interesting, makes perfect sense, but it's not something I had ever thought about before.

Another big problem with large clinical trials, and really much science for that matter, is that scientists tend to ignore negative results, and run statistical analyses with an intended outcome in mind.  This is how results become skewed, and it goes entirely against the scientific method.  For example, Taubes discusses the Nurses Health Study by Willett, published in 1987 in the New England Journal of Medicine.  This study was trying to prove that increased fat consumption increased breast cancer risk.  However, the study showed no evidence of that.  When the nurses were followed up in 1992, then in 1999, it was shown that those who actually ate MORE saturated fat had a LOWER risk of breast cancer.  "For every 5 percent of saturated fat calories that replaced carbohydrates in the diet, the risk of breast cancer decreased by 9 percent."  However, this study went rather unnoticed, as most studies that reveal results opposite common dogma.  People will keep running studies until they get the results they want, and anything contrary is brushed aside as misleading, or lacking something.  And doctors will still recommend that women eat less saturated fat, even though breast cancer rates are rising ridiculously AND the fact that none of the clinical trials studying the saturated fat-heart disease link had women subjects before this diet started being recommended for women.

Lastly, for my little tidbit.  As everyone knows, not all fat is created equal: there are saturated, monounsaturated, and polyunsaturated fats, which can be broken down into more categories.  The same is true for carbohydrates: a potato, a slice of white bread, and triscuits from a box are not all the same.  I don't understand why the food pyramid and health specialists ever started to look at food in terms of servings, as if eating 3 apples every day would satisfy your "fruit requirement" and that it was the same as eating a variety of fruits all the time.  I get so angry when I hear commercials about fruit juices that have "two servings of fruit and a full serving of vegetables in each glass."  What does that even MEAN??  Food is much more complicated than just calories from fat, cabohydrates, and protein.  Our bodies are so much more complex, requiring hundreds of minerals, vitamins, co-factors...  many of which can disrupted or completely removed during harsh food processing.  I'm convinced that eating a wide variety of foods closets to their natural states is the best way to ensure that you are actually ingesting everything your body needs.  I think people are slowly starting to realize this, as we kind of re-discover the amazing potential and contents of "super foods."