Tag: Diet

What is the Blue Zones Project?

I first heard about the Blue Zones project when I learned that some “moms” (their term) in Wilton were suggesting that we become a Blue Zones town, and I started to read up on it.

The term “blue zone” was coined by Belgian demographer Michel Poulain when studying the characteristics of centenarians in Sardinia, where he and his coworkers realized there was an unusual cluster of very old people in this region, and they drew a circle around the cluster using a blue marker. Imagine the controversy if he had used a red marker!

Soon journalist Dan Buettner had jumped into this study, travelling to this and several other regions to report on the clusters of centenarians in and discuss common characteristics among them. This led to an article he wrote for National Geographic and to a 2008 book, revised in 2012: Blue Zones, 9 lessons fir living longer from people who lived the longest. Note that while Buettner is a very polished writer, he is not a scientist and has no scientific training nor an advanced research degree. He could just as well have interviewed centenarians near where he lives, and this might had been equally interesting, and would have eliminated some of the cultural differences among the groups he wrote about.

He boiled down his findings to nine basic points (trademarked as The Power of Nine), some obvious and some rather unusual, but never tested his findings using any sort of control groups. Boiled down, these are

Move naturally (avoid mechanical aids)
Find a sense of purpose
Find time to relax and downshift
Eat until “80% full,” exclaiming Hara bachi bu, (or maybe Hakuna matata, or perhaps Ai ai Cthulu!)
Eat more vegetables
Drink wine at 5
Belong to a religious group
Put your family first
Choose a support social circle.

Being a scientist myself, I was surprised to discover that Buettner never published any of his findings in actual peer-reviewed scientific journals, but only in his popular book and magazine articles, so his conclusions have never been subjected to scientific scrutiny or peer review. Instead, Buettner formed a Blue Zones organization to try out his recommendations in a few communities. He then licensed the Blue Zones brand to Healthways of Tennessee who is involved in promoting these findings as a commercial enterprise.

Further, Buettner seems to have committed correlation without causation. Or as one of my colleagues called it, the Texas Sharpshooter Fallacy, where the target shooter shoots bullets at the side of a barn, and then draws a target around the bullet holes! To put it more clearly, he has not proven that any of these common findings cause longevity. He has not set up any kind of control group or test to prove their efficacy.

Academics respond

I contacted a couple of researchers who have written scientific articles about centenarians, and both responded to me.

Professor Jeremy Yorgason at Brigham Young University said, in part,

“…My understanding is that the “Blue Zones” work is aimed at replicating diet and other trends found in such areas. I agree with the principles put forth by those that encourage blue zone trends among seniors, however I’m not a fan of the commercialism they have introduced. Nutritious diet, exercise, and genetics will all influence our longevity. Environment likely also plays a role. People have some control over some of these factors, and I encourage us to do what we can to live healthy into our later years. I hope this helps.”

Professor Stuart Jay Olshansky at the University of Illinois, Chicago, said:

“I reviewed their proposal for National Geographic when it was first thought of, and I rejected the Blue Zone idea because Dan was not going to verify the ages of the alleged centenarians — he didn’t know this was important. So, he connected with someone who can do this reliably. That part of the science is now sound. He exaggerates the importance of diet as genetics is critical in these folks, and I was not happy early on that they were selling items from the various locations as longevity boosters, which supposedly they stopped doing. However, there are also some strong elements to what they do. I think there’s little doubt that pockets of exceptional longevity exist. Does that help?”

Professor Eric D. Carter

Perhaps the most wide-ranging criticism of the project came from Professor Eric Carter of Macalester College, published in the journal Social Science and Medicine, titled Making Blue Zones: Neoliberalism and nudges in public health promotion.

Carter notes that the Blue Zones Project (BZP) is a “place-based, community centered and commercial health promotion enterprise, and that it advocates a kind of “deep neoliberalism—neoliberal govermentality.” In social science jargon, “neoliberalism” refers to programs where the individual has to take responsibility for his own health, rather than being provided by a government entity. He calls this “libertarian paternalism” whose purpose is to “nudge” people towards healthy behaviors.

In fact, the BZP is “thoroughly desocialized” and more or less ignores health problems associated with poverty, unemployment, race, ethnicity, education or other social determinants. He cautions about the role of “lifestyle” or “wellness” industry professionals in framing the discussion about healthy places.

Carter notes that some of Buettner’s points, such as “sense of purpose” and “belong to a faith-based community” are unlikely to be cited by health professionals, and while Buettner claims that these can add up to 7 years to your life expectancy, this individualizes findings that are aggregate and probabilistic in nature.

Further, I suggest that the idea that communing with an imaginary Sky-Daddy having an effect on health is probably much too narrow. You might achieve the same group comfort from singing in a community chorus or playing Bingo weekly.

The original demonstration community, Albert Lea, MN adopted Buettner’s recommendations for a 10 month trial run, building more sidewalks (but only in the downtown area) and residents agreed to “deconvenience” their lives, walking more and putting aside snowblowers for snow shovels, a recommendation that cardiologists might dispute. At the end of this period using an on-line “Vitality Calculator,” they claimed residents had added 3.1 years to their life expectancy. However, their simple diet and exercise questions have not actually been validated.

And, the BZP has almost nothing to say about the health care sector: doctors, clinics, and hospitals. It concentrates on health-promotion and lifestyle management. Not having medical buy-in to this project seems short-sighted.

It also has nothing to say about diseases, other than making the preposterous claim that one Greek man living in the U.S., Stamatis Moriatis, had developed “terminal lung cancer,” but on return to his home in Ikaria, the disease eventually vanished, as if the healthy village lifestyle somehow cured his cancer. Spontaneous remission in cancers do happen, but outlandish claims like this one border on magical thinking. Buettner has spread articles about Moriatis all over the Internet, but that does not make them true. And he presents no medical evidence.

The Iowa Project

Carter notes that the BZP cooperated with Iowa Governor Terry Branstad to set up four demonstration sites, and after a competition among Iowa cities, four northern locations were chosen: Cedar Falls, Waterloo, Mason City (home of The Music Man’s con game) and Spencer. Financing for these 4 projects was provided by Iowa’s Wellmark Blue Cross, who paid Healthways $25 million for the five year demonstration. This also means that all Iowans did not have equal access to the potential benefits: another trait of such neoliberal projects.

In Iowa’s case, Branstad wanted to use the BZP to avoid expanding Medicaid for the Affordable Care Act, giving the BZP a political tinge as well.

Iowa outcomes

Recently, we learned that Cedar Rapids and Marion, IA were dropping the Blue Zones project. At the end of the demonstration period, towns had to pay to continue, and

“Cost was a factor as we would have to pay to continue to use the brand and tap into their Blue Zones network,” said Geoff Fruin, Iowa City manager.”

Cedar Rapids was selected as a Blue Zones demonstration site in 2013 and certified in 2016.

Cedar Rapids contributed up to $25,000 a year matched by $30,000 over three years from Linn County, and about $50,000 total in private contributions to pay for four full time staff members and office space, said Assistant City Manager Sandi Fowler.

She said the fee to renew with Blue Zones is considered proprietary information, and therefore was confidential.

Discussion

The BZP, according to Carter, is classic neoliberal governmentality: a commercial venture with a public-private partnership that asks people to take responsibility for and govern themselves. Such a system can only work in a homogeneous community and has no remedy for “persistent structural causes of health inequality.”

The BZP requires community buy-in to such things as “walkability and bike-ability,” that may require substantial investment to achieve. Wilton is a rural New England community, and outside of the diminutive downtown area of a couple of dozen stores, there are basically no sidewalks or bike paths. The town is built on rocky hills, and such construction could run into millions of dollars. It is instructive to note that most of the demonstration communities are in the Midwest, where there are few hills, while towns like Wilton are nearly all hills, making walkability and bike-ability that much harder to achieve.

Much of what BZP proposes amounts to changes in eating habits, which they then proudly trumpet in aggregate weight loss statistics. This is essentially a diet, and research has continually shown that diets do not work. People tend to regress to the mean about the time the demonstration period ends.

Further, the BZP has frequently suggested things like small bowls as glasses in restaurants to keep people from overeating. Unfortunately this is all based on Brian Wansink’s work at Cornell, nearly all of which has been retracted and Wansink dismissed from Cornell for essentially faking his data!

Improving physical activity and eating more vegetables are laudable goals and based on solid science, but Buettner’s insistence on including religion and “sense of purpose” are not. While there is no question that the Wilton organizers have their hearts in the right place, the BZP is not a science project, but a profit-making entity who plays its cards rather close to the vest. If they were a non-profit, I might consider their proposal, but a profit-making business who won’t disclose their fees does not impress me.

It probably is one we should not get involved in.

Fort Worth

We just learned that in Fort Worth , the project has had little success. After 2 years, reported BMIs are still rising, and given Texan’s steak and pick-up truck habits, this will probably take a very long time. Meanwhile the original Blue Zones are fading away, and demographer Michel Poulain has noted that the eating habits of Okinawa are much like anywhere else, and the obesity much the same. Similar findings are reported for Ikaria.

Oh, and to top it all off, it’s recommend by Doctor Oz!

Worried about diet soda? Strokes are not likely.

diet coke Late last week, the popular press began touting a paper by Matthew Pase and coworkers in the journal Stroke on the newfound risks of diet sodas, (artificially sweetened beverages, ASBs) as compared to sugar sweetened beverages (SSBs). Most of the articles have been pretty accurate, NBC, CNN and Arstechnica got it pretty much right. Only Meredith Bland, writing as Scary Mommy went a bit off the deep end. If you´re done drinking all of these sugary drinks, then here are some Healthy Drinks Tips.

What the researchers did was examine data on 2888 participants from the Framingham Heart Study Offspring Cohort, looking at their reported consumption of ASBs and SSBs, and the results of their regular examinations, which ended in 2001. Surveillance continued for 10 years, ending in 2011.

They found that “higher recent and cumulative consumption of ASBs were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.” Specifically, they found that stroke was 2.96 times as likely and dementia about 2.89 times as likely.

This sounds really worrisome, but bear in mind that this is a single study, and that they found a correlation, not any actual cause. In fact, they didn’t propose any cause, because these results are very difficult to explain medically. They do, of course, note that “future research is needed to replicate our findings and investigate the mechanisms…”

What many writers did not specifically mention, is that there is an accompanying editorial in this same journal by Wersching, Gardener and Sacco, that is quite critical of Pase’s paper. In addition to pointing out that they show correlation and not causation, the editorial notes that while Pase reported that those consuming SSBs did not seem to have strokes or dementia, they suggested that this could be because of selection bias because those consuming sugary beverages may have died earlier. They note that previous studies have indeed found negative outcomes from those consuming SSBs.

As regards those consuming diet beverages (ASBs), the editorial suggests that “reverse causation” cannot be ruled out. What they mean is that those who know they are at risk may have chosen to switch to diet beverages and thus their strokes and dementia were incorrectly being correlated with the diet beverages instead of their already existing risk. They specifically point out that “disentangling these effects” is “challenging” in such studies.

Finally, they note that there is no obvious biological pathway to explain these cardiovascular events in those consuming diet beverages. They suggest that the current body of research, including this paper, is inconclusive and that carefully designed studies, following subjects from childhood would be necessary to establish these effects for certain.

So, for the moment, it would seem that nothing has really been established concerning diet beverages, and you can go ahead and sip yours without new worries.

Is coconut oil healthy or just a fad? We check with Doctor Oz.

Recently we were discussing approaches to weight loss with a group of friends in Wilton, and one pointed out that Dr Oz had said that coconut oil was good for weight loss. This seemed surprising since it is an oil made of saturated fats, so we looked into it. You can buy coconut oil almost everywhere now and from quacks like Dr Mercola.

Dr Oz did indeed endorse coconut oil on a recent show, claiming that unspecified “recent research” said it was good for weight loss, skin conditions and treating ulcers. He didn’t claim it would walk your dog or fold your laundry, but that might be in the next segment.

Dr Oz trained as a medical doctor, and some of his straightforward medical advice can be pretty helpful, but he increasingly has moved to endorse alternative medicine, pseudo-science and even faith healing. Many scientists and physicians feel he has gone completely “over to the dark side,” eschewing science-based medicine for a lot of hokum.

Coconut oil may very well make a good skin treatment, as you often find it in suntan lotions and the like. But there really isn’t much peer-reviewed research to support Oz’s assertions. It has been linked to impaired memory performance in rats. But there are no studies linking coconut oil to the stomach ulcer bacteria h pylori. There are, however, a number of sites hawking coconut oil that make these claims, though.

There is one preliminary study on 20 obese Malaysian males that showed some reduction in waist circumference and another study showing increasing obesity upon ingestion of coconut oil and other saturated fats. Finally there is a study among Filipino women showing that coconut oil improved the lipid profile by increasing HDL (good cholesterol).

However, these are small and preliminary, and no definitive conclusions have been reached. On the web site sharecare.com, the Mt Sinai Medical Center answers a query about coconut oil, suggesting it is unlikely to be useful.

The bottom line, according to the Mayo Clinic and others is this: People on coconut oil diets showed higher arterial fat after just one meal, it can increase cholesterol and, if it is not reducing your caloric intake, coconut oil can actually lead to weight gain.

And the Mayo Clinic web site points out

Although eating coconut oil in moderation for a short-term diet probably won’t harm your health, it may not help you lose weight. At prodiets, you can assure to achieve what you want medically, you can compare both the programs if you want to. And keep in mind that coconut oil actually has more saturated fat than do butter and lard. For successful, long-term weight loss, stick to the basics — an overall healthy-eating plan and exercise.

There are some articles on Oz’s web site but mostly by blog contributors, many with only Naturopath training (which is not science based medicine) and even they come back to these same preliminary studies. There is also one by a board certified dermatologist touting essentially the same studies.

The only places strongly touting coconut oil are quack doctor Joe Mercola’s site and the even more suspect site at the Weston A Price Foundation. The paper Mercola appears to be referring to is also the 2009 Brazilian study where 2 groups of volunteers were fed either soybean oil or coconut oil over 12 weeks and instructed to walk 50 minutes a day and follow an otherwise balanced low calorie diet. Both groups lost weight, but HDL (good) cholesterol was higher in the coconut oil group.

In conclusion, there is a bit of preliminary evidence for some benefits, but since it seems counter-intuitive that eating a high saturated fat diet can help you lose weight, it is probably better to control your nicotine with an e-cig and follow the advice of the established experts such as WebMD and the American Heart Association who recommend against it.

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Gary Taubes says sugar is poison

Science writer Gary Taubes has been writing columns everywhere promoting his new book The Case Against Sugar. He has written columns in The Guardian, and The New York TImes among other places, and has been reviewed somewhat critically in The Guardian, Food Insight and The Atlantic.

Taubes’ central argument is that calories from sugar are not the only reason for obesity, but argues that sugar itself is uniquely toxic.

Taubes: “If the research community had been doing its job and not assuming since the 1920s that a calorie is a calorie, perhaps we would have found such evidence long ago.”

In a nutshell, the flaw in his argument is revealed in the above statement in the Times article. There must be more to sugar’s causing obesity than just calories, but researchers haven’t been doing their job!

And, in fact, despite Taubes’ persuasive writing, this is most of his argument. He cites no research in his articles (I have not read his actual book) or even mentions researchers who agree with him.

His thesis echoes that of Dr Robert Lustig, who makes much the same arguments in his book Fat Chance, and in the movie Fed Up but both Lustig’s and Taubes’ similar ideas have been debunked in articles, such as this one in Science Based Medicine. And Food Insight called this “blind fealty to correlation as causation.” Scientific American pointed out the fallacies in this argument in 2013.

In fact, while obesity continues to increase, sugar intake in the US actually decreased from 1999-2008, mainly because of decreased consumption of sugary soft drinks.

Taubes’ other somewhat distressing argument is that the sugar industry has been influencing research outcomes for years by sponsoring research. This suggests that not only that scientists are unethical but that the journal peer-review process itself is corrupt, and that is hard to swallow. The idea that research funding influences outcomes had been thoroughly debunked in this article by van Eenenaam, who notes that such corrupt research is a sure path to a short academic career.

He cites this PLoS One paper which reviews papers for their findings, correlating them with the source of their support. The authors suggested that papers with no declared “conflict of interest” are more likely(83%) to find that sugar sweetened beverages could be a risk for weight gain, but for those “disclosing some financial conflict of interest” 83% found that there was no such correlation.

The trouble with that paper is that there are only a few such studies: there were only 12 in the first category and 6 in the second category, and only 10/12 and 5/6 supported the author’s conclusions.

There are other reviews of sugar consumption that we need to consider. For example, Weed et al. studied reviews of health outcomes from sugar sweetene beverage (SSB) consumption, and rated the review quality using the AMSTAR review rating scheme, and found that most of them received moderately low quality scores, regardless of the conclusions of the paper. This would mean that the conclusions of these reviews are probably not entirely convincing, and basing Taubes’ sugar conspiracy theory on such weak data is not fully substantiated.

Moreover, this recent paper by Keller et al. reviews papers on sugar sweetened beverage consumption among children and adolescents, reporting that 9 reviews found a correlation between obesity and SSB consumption, while 4 did not. But that the quality scores of the reviews was low to moderate and that the two papers with highest quality scores reported discrepant (inconclusive) results.

The most important conclusion we can draw from reading Taubes’ many opinion pieces is we eat too much sugar, but that studies so far have not shown that sugar is more to blame than calories from any other source. No such research seems yet to exist.

Cleansing diets: are they right for you?

bottles With the start of each New Year, there have been several surveys of diet plans, explaining which are most effective, easiest to follow and most heart healthy. US News recently published their recommendations based on their expert panelists. WebMD has a summary of dozens of such diet plans, and has a good summary of the highly successful (and free) DASH Diet Plan.

But you may also have friends who decide that what they really need to do is “cleanse their systems.” The idea behind this is that a lot of nasty processed foods and the like build up in your colon, and need to be “cleansed.” If this sounds like purging, it is.

Nevertheless you don’t have to go very far to find people peddling their highly profitable “juice cleanses” and other detox diets. For example, Westport’s Kaia Yoga Café offers a 3-day juice cleanse program for $195. And the quack-bound Darien Center for Integrative Medicine offers cleansing and detoxification programs. This is an alternative medicine group. But remember that

alternative medicine is made up of things we don’t know work and things we know don’t work.

The whole cleansing idea is not well regarded by the medical community. For example Dr Eric Yoshida, head of gastroenterology at the University of British Columbia says:

… this is all bunk. The body’s systems just don’t work the way the proponents of the cleanses claim they do. Once in the colon, nothing but water gets reabsorbed, he says. The liver detoxes our food very efficiently.

If you consult WebMD, it expresses similar concerns:

The Master Cleanse Diet is supposed to “release years of built-up waste in just 10 days, while your energy soars.” Yet, experts point out, the liver already detoxifies the body. Further, there is no medical evidence that fasting or “cleansing” diets actually rid the body of any toxins not otherwise discarded in bodily waste.

And the Mayo Clinic web site says much the same thing:

There’s little evidence that detox diets actually remove toxins from the body. Most ingested toxins are efficiently and effectively removed by the kidneys and liver and excreted in urine and stool.

Finally, Robert Lambert, MD noted that Body Detoxification is a Hoax

Your body is not “full of toxins.” When it is, your liver and kidneys are designed to handle those “toxins” and will do so far better than anything someone tries to sell you.
2. Diets only work when they restrict calories.
3. Your colon is fine and does not deserve to be regularly “cleansed.” Colonics have been around since the early 1900’s (maybe earlier) and the fact that they are still being used is only evidence of the gullibility of humans. Careful with certain exotic fruits claiming to cleanse also, make sure you read irvingia gabonensis side effects before consuming something you can’t pronounce. Just be smart.

You will find hundreds of web sites promoting these quack remedies, but they are snake oil: they are all out to take your money.

New Year’s is a great time to take stock of your weight and perhaps lose some holiday overage, but use one of the diets listed on the US News of WebMD sites above, and stay away from quackery.

This article was originally published in Examiner.com on January 9, 2012