First, a headline relevancy rant: the headline here is both vague and misleading. "Researcher: 1970s Inuit heart disease fish oil study flawed" maintains the word count of CBC's article while conveying far more information. The headline as chosen is akin to a headline in a Poughkeepsie, NY, newspaper headline "3 killed in house fire" ... where the fire in question turns out to have been in Osaka, Japan. A human tragedy, yes. Likely highly relevant to most in Poughkeepsie? No. Would those with friends or relatives in Osaka be better served by the more accurate headline? Yes. As given the headline is linkbait -- it fails to provide sufficient context to determine whether or not the article is worth reading.
Fish oil has been tied to multiple benefits, not just heart disease. Claiming a blanket lack of efficacy for fish oil supplementation presumes that 1) there is no heart disease benefit (all we know is that there are methodological errors in the Inuit study) and that there are no other health reasons for supplementing with fish oil. From the Wikipedia article, identified (all specifically tied to studies).
But there is a new study ... and the new study is the important part of the article. This new study found more or less the opposite result of the old study.
A study or even a few does not prove anything. There are just too many ways to get it wrong. You need multiple high quality studies that all agree before you can be sure. And even then a small chance will remain that it is a statistical mirage that will be disproven by a future high quality study. Sorry to let you down but that is the nature of medical research.
My point isn't that the claims are all proven. I was pointing out that the Wikipedia claims are sourced to actual research papers, rather than some random blog (or worse: some random supplement sales site).
What this addresses is TFA's claim that fish oil has no benefits based on an analysis of one study concerning one claimed benefit. That claim is just as unsubstantiated as it claims the Inuit study benefits are.
the article focuses on the cardiovascular benefits... which appear to have been self-propagated by some adhoc "because x study says it helps!" without anyone doing critical thinking on their own part.
Unfortunately it isn't apparent that that is the the focus until you look at where the article is hosted. So I'll vehemently agree with your initial observation that the original title is link-bait at best.
There are many studied and documented benefits of fish oil. This hardly "puts a nail in the coffin" for the supplement but hopefully it gets people thinking and some more studies funded so we can get a better picture.
Of course if our food just had a better omega-3 :omega-6 ratio we'd be in a situation where the supplement wouldn't be the necessary...
There is a 20,000 person 2x2 randomized controlled trial underway right now looking at how useful fish oil is in preventing disease: http://www.vitalstudy.org Results will be out around 2017-2020.
An observational study from the 1970s and a critique of an observational study from the 1970s will carry little merit compared to a 20k RCT.
Knowing that we'll have better data in 5 years, the comment by the researcher is nauseating: "They simply don't do anything for you. The people should know that it doesn't help to prevent heart disease." Since we haven't quite reached an apex in research in fish oil, the comment is short-sighted and is overstating what we know about fish oil to date.
Just because we might have better data sometime down the road does not make the researcher's comment false. Assuming that the original study was flawed as claimed, then we're left to conclude that fish oil is in fact snake oil until we have evidence to the contrary.
The researcher's comment IS false based on the information we have available to date. We do not know if fish oil is worthless or not. The researcher implicitly states that he knows fish oil is worthless based on the evidence to date, when the evidence to date is much more mixed.
The NEJM article in this thread is much better evidence -- a 13k RCT that found no statistically significant benefit in 1g/day of omega 3s. On the other hand, there was a large 11k trial in the 90s that did find benefit 1g/day of omega 3s:
http://www.ncbi.nlm.nih.gov/pubmed/10465168
The VITAL study underway will be interesting. It's the largest trial to date on fish oil and is looking at a healthy normal population, as opposed to those with CVD or high-risk of CVD.
There is a more recent popular fish oil study - a randomized, placebo-controlled trial - showing that fish oil has no effect on CV mortality or morbidity. It's in the New England Journal, no less. http://www.nejm.org/doi/full/10.1056/NEJMoa1205409
Makes me think about people, science and the church. There is large decline in the church and it's as though a "faith" in everything "science" has replaced it.
Of course there's faith in science, the no-quotes kind. First, you have to believe in the scientific method. Second, you have to believe that the process as it's currently carried out in academia and elsewhere leads to valid, relatively unbiased results.
The first is more of a metaphysical question. But there are huge doubts about the second in every discipline, maybe except physics. There are publishing biases, observational studies everywhere, replication problems, sample biases (19 year old college students), even straight up fraud that goes uncorrected for years. And that's just the cases we know about.
There are people who state things like "American scientists have found that #fact" and then get angry when one proceeds to question them on details (to find out why the belief might be justified). Apparently they feel personally attacked if one does that. I've even heard "Why can't you just believe it?!' as answer..
I find this behaviour weird, but it seems to be quite common.
Thank you for the interesting read. My first thoughts are of the Placebo itself (as it's coming up in the first part). A bit off-topic, but the placebo is often called sugar-pil but its exact content is often not revealed. It can be full of harmful stuff and this causes the examined group to look much better. "The control group experienced equal amounts of stomach aches" when the placebo was laced with stomach ache inducing stuff!
About parapsychology as mentioned in your link: Personally, that stuff scears the crap out of me. I just like to think there is more between heaven and earth than we know...
> "The fish oil capsules I don't think will stand up to a critical review. They simply don't do anything for you," he said. "The people should know that it doesn't help to prevent heart disease."
This struck me. For example examine.com has[0] quite good coverage when it comes to supplements like fish oil, and not surprisingly their round-up shows multitude of benefits from fish oil.
Okay, perhaps the phrasing was altered to provoke and mislead the reader, but still.
You might want to look at the examine.com page more carefully. The only result that is both significant (i.e. large effect) and robust (i.e. agreement in lots of double blind studies) is a reduction of triglycerides. And that is an indirect impact on health outcomes at best. The rest of the studies were either for sub-groups (depressed people) or were insignificant, mixed direction and/or not robust.
I've been downvoted into oblivion in this thread, so the forum system might hide this post from you. But, I was just going to chime in that I agree with you.
Also, I think more people need to look at what the prestigious Mayo clinic has to say about the positive benefits of fish oil as well:
N-3 fatty acids interfere with oxidative metabolism and promote cancer. In the short term N-3 oils can appear to help various problems like inflammation because they suppress the immune system. In the long term that's obviously bad.
No surprise. Most "scientific" studies in the realm of medicine are bullshit. Even many of the ones trying hard not to be bullshit still end up in that bin. For a clear understanding of why, read this:
Do you think this attitude explains some of the epistemological issues behind the anti-vaccine movement? I'm pro-vaccination, but I find it weird when people mock others for not believing vaccines are safe and then go on to criticize GMOs and the validity of nutritional studies. (Not saying you're doing this at all, this is just a tangent.)
Of course, vaccine studies are probably way more rigorous and easier to control than figuring out the complexities of nutrition, but it is a little unsettling how easily doubt can metastasize. There's really no solution here other than trying to spread scientific literacy and helping people understand the rigorous testing of modern medicine, while also encouraging them to think twice about the sensationalized studies they read.
As far as I can tell, the epistemological origin of the antivax movement is the human drive to find a reason for things that happen. There was never a scientific basis. They latched onto one study that suggested a link between vaccines and autism, but it's not like they had some sophisticated meta-analysis that led them to believe that study was more reliable than others. It just provided a narrative that gave them the answer they were seeking, while the alternative did not.
There could hypothetically have been a basis like the one you're talking about, but it seems evident from the movement itself that this didn't happen in our version of reality.
That's the point: that we have trained people to distrust science because most of the "results" people are exposed to are bad popular articles reporting on sketchy studies from Psychology and Medicine that tend to be "overthrown" every few years: it is difficult to go to people and say "no, seriously: vaccines work" when they can retort "that's what you said about red wine, and just today I read an article about how that was all bunk... in another few years everyone is going to be sorry they listened to you guys about these vaccine things you all love so much". :(
> That's the point: that we have trained people to distrust science
I am not sure science is an article of faith to be trusted or not. Science is a continuous process of reviewing evidence and making hypothesis based on that evidence. It is not a mathematical proof.
Sure, there are "bad popular articles" that describe causal relations enthusiastically. However, the pipeline of bullshit flows backwards too. There are enough research papers out there where results may not be fudged but over enthusiastic language may be used that can to the layman's eye look like magic.
Science is one part process and one part people: you first have to trust the process to provide useful evidence, and you second have to trust the people to tell you what they did honestly. Psychology and Medicine are "problem fields" in both areas: the process itself runs into ethical challenges that result in very few real "experiments" (leading to lots of correlations with difficult hidden variables, nothing at all like "causal relations"), and the people involved in the reporting process are also much more likely to blow things out of proportion as these are areas of extremely broad interest.
The result is that when Geophysics says something important the general populace doesn't believe them (hence why "trust" is the right word to be using here) because their mental model of Science is built out of "scientists" making lots of firm contradictory statements, and especially many situations they remember where what was said just a few years ago was entirely "overthrown" by the new research of the week. If you actually listen to the people who refuse to believe in things like vaccines or climate change, they seem to just think scientists are silly people who think they know more than they actually do :(.
> Science is one part process and one part people: you first have to trust the process to provide useful evidence, and you second have to trust the people to tell you what they did honestly.
I spent a few years in a heavy math PhD program before dropping out. The only two things I learnt.
1. Be skeptical of all statistics out there that you cannot personally replicate.
2. See 1.
The pressure to publish is real. The pressure to do something for the sake of novelty is real. The process becomes shakier and shakier as we go down the chain from Pure Math to Engineering and so on.
If there are Numerical Analysis papers with over 100 citations with basic linear algebra errors (that was a fun fucking two weeks of head scratching), why on earth would I trust the process somewhere downstream written by people who took a few grad courses in statistics?
Note that I am not taking sides here. I have no interest in one or the other part of the vaccine lobby. I just find it weird when people use terms best left to religion like 'faith' when it comes to scientific research.
> If you actually listen to the people who refuse to believe in things like vaccines or climate change, they seem to just think scientists are silly people who think they know more than they actually do
I think the problem comes from misconceptions in the fundamental nature of science. Scientists are not Gods who are bringing you truth from some mystical truth well. It is a continuous process prone with errors that eventually evolves into getting us closer to understanding processes. If people take that as a sign that everything is junk instead of having a healthy skepticism and reasoning for themselves, they have themselves to blame. Can't argue with stupid.
> It is a continuous process prone with errors that eventually evolves into getting us closer to understanding processes. If people take that as a sign that everything is junk instead of having a healthy skepticism and reasoning for themselves, they have themselves to blame. Can't argue with stupid.
A couple points:
1) The average person probably lacks the necessary background (knowledge of statistics, methodological concerns, etc.) to independently evaluate scientific research. So blaming them for not going and evaluating the research themselves is a bit unreasonable.
2) You also have to realize that this is not an abstract question for new mothers. When you're injecting something into the precious bundle of joy they carried in their bodies for 9 months, asking them to trust the current conclusions of a "continuous process prone with errors" is not going to be the easiest thing. Accepting the scientific consensus, one which you yourself admit is no magical source of truth, is a leap of faith for these parents; they're committing their child to a medical procedure based on that consensus.
And they should take that leap of faith, in my opinion. But let's not pretend like faith doesn't enter into the equation just because it's science.
You make some fair points. I am not sure what the right answer then is. I agree that the average lay person is probably not going to know how to reason on these matters. However, if we are building faith as an abstraction, how do we deal with the fact that the abstraction is leaky. There will be errors. How do we communicate that the errors don't necessarily mean that the system as a whole is broken but that it is the nature of the system, whilst maintaing this abstraction of faith?
It's definitely complex and may never be completely solved. The biggest thing in my mind is learning how to talk to these people; if someone is trying to make sense of competing opinions with no good standard to judge them by, going up to them and saying "Fuck you idiot, clearly we're right and you're stupid for thinking otherwise" is not productive (granted, this is a straw-man, but some of the vitriol I've seen comes pretty close). You run the risk of creating a serious blowback effect, where your condescension drives them further away from accepting what you're trying to tell them.
It's like a Chinese finger trap: if you want to convince an anti-vaxer, you can't treat them like they're crazy, even if you have an impulse to judge. You have to be able to meet them halfway, and from that point get them to understand the safety profile of vaccines. You don't have to throw numbers in their face, but there has to be some way of speaking to them as a fellow human being: "I know you're scared and you don't know if this is safe, but we don't want your child being hurt either. We've done an incredible amount of testing to make sure vaccines are safe, and we firmly believe they will keep your child as healthy as possible, as well as improving the overall health of the community."
Of course, this is just my opinion. But I really think that empathy will make it much easier to mend these kinds of fissures in our beliefs.
> if you want to convince an anti-vaxer, you can't treat them like they're crazy, even if you have an impulse to judge.
> You run the risk of creating a serious blowback effect, where your condescension drives them further away from accepting what you're trying to tell them.
This is exactly what I am coming from too. In my few years in the programming community, one thing I have noticed is a large population of people who pursue science as a religion. (I mentally tag them the r/atheism crowd.) When you treat something as canon and go up on people's faces as to why they are stupid and wrong, you are not creating a productive discussion.
I never used the word "faith": not once. You kept using the word "faith": I insisted upon using the word "trust". These terms are related, but are quite different. I guess a really important question becomes: how can one ever remove "trust"? You seem to believe that it is possible to have something that doesn't at some level rely on trust: as far as I can tell that only works if every single person ignores everything everyone else ever says and instead learns everything from scratch via first-hand experimentation (and even then I would maintain that one must trust your equipment, though maybe one could build their own equipment as well). Even if every single person in the world is an expert in statistics: you still have to trust that the things you read and are "verifying" were reported accurately. :/
There is a distinction between trusting a mathematical process and trusting random user "saurik" for example. I don't know you from hell, I would trust you to sell me lemonade. On the other hand, if you gave me a recipe for lemonade, that I could have the people I trust replicate for me. I might buy that recipe from you.
If you truly don't trust me in your example, you would be a fool to buy my recipe: you may have people you trust to replicate it, but it turns out that my recipe tastes horrible. You fundamentally cannot get away from having to trust the people whose first-hand accounts you are verifying.
> That's the point: that we have trained people to distrust science because most of the "results" people are exposed to are bad popular articles
IOW, our educational system has failed to train people to distrust -- or even to simply critically evaluate -- popular articles on science, leaving them vulnerable to sloppy misrepresentations of science by outlets that usually have neither the skill nor the interest to properly report on it.
Of course, but a lack of trust in the medical establishment is probably an enabling factor. If they trusted their doctors to make the right decisions for their children, they probably wouldn't be buying into Wakefield's study or quoting Jenny McCarthy. Clearly there is fear and a human desire for easy answers, but I think lack of trust is also a big part of it.
Dayum, that's one of the best articles I've read in a really long time. I think we are still decades away from really understanding experimenter effect, and till then, I take all medical studies with a fucten of salt.
Example: I used to be really into reading large meta-analysis dietary supplement efficacy, but lately I've stopped taking all supps. They changed consensus on plenty of them in front my very eyes, and I kinda lost faith in the field.
Popular and consensus opinions in nutrition (including those ostensibly backed by science) are overturned all the time. Just look at historical views on saturated fat, GI, cholesterol, etc. etc. That's why the seemingly anti-intellectual advice of "eat a variety of foods in moderation" is actually quite good advice.
I think a lot of the heart disease confusion stemmed from preventing it is very different than what should be done once you have it. I still see a lot of confusion on this in literature. The layman seems to be unaware of it altogether. That makes even legitimate research look very contradictory.
> That's why the seemingly anti-intellectual advice of "eat a variety of foods in moderation" is actually quite good advice.
That is because it is vague, imprecise and can be defined whichever way you want.
For example, how much protein should a person intake? 56 gms per day as per the CDC. Other variant figures in the body building community include like 0.68 gms per kg to 2.5 gms per kg. So which figure does one use to establish the definition of moderation? Genetic and cultural differences also come into play. I have lived in cultures (Africa/Asia) where protein is expensive, eaten less. If I went with that sociological perspective of moderation, I could very easily eat less than the 56 gms of the CDC requirement. If I went with the American concept of protein, which sub population do I go with? Do I go with the traditional American eat a Burger + Mashed Potatoes erry day deal or go all Keto and eat Bacon every day?
Personally, I believe that one should gradually evolve towards a lifestyle that is suited to one's own needs.
It's true that the concept of moderation doesn't prescribe specific targets. It only excludes extreme targets.
The two rules that you really can bank on are that calorie intake is directly linked to weight loss/gain, and you need a certain amount of protein and fat to maintain or build muscle. That being said, protein needed for survival is minimal. Other dietary parameters will affect long-term health, but laypersons are so inundated with misinformation that it's better to eat a variety of foods in moderation than to adopt extreme diets or novel nutritional theories.
Why are those "one weird trick" ads so profitable?
I have a hypothesis that people focus on magic pills (like fish oil) and conspiracy theories (like sugar toxicity) because it is a welcome distraction from an ugly truth: that in order to achieve their ideal body composition, they just need to be extremely disciplined and hardworking in their dietary and exercise habits, and for the sake of long-term health, they should lay off the junk food. There's no "trick". People already generally know what they have to do, but they pretend to themselves that they don't, because if they know what they have to do and fail to do it, that's indicative of personal weakness. It's cognitive dissonance.
> Personally, I believe that one should gradually evolve towards a lifestyle that is suited to one's own needs.
Learning to live your own life really is a lot of work. Everyone's body is different and has its own set of quirks. I wonder when in the future medicine will be tailored to each individual. I would not be surprised if a diet/lifestyle that is healthy for one person is terrible for another. This is obviously the case for some people with well known disorders, but it might be true across the entire population.
For example, if I follow a diet where most of my calories come from carbohydrates, I tend to get very hungry in between meals. And even worse, if I miss a meal I feel very faint. However, if I get most of my calories from fat and protein, I do not get hungry between meals and if I miss a meal I don't feel like I'm going to die.
The deeply flawed study that linked less heart disease to fish oil relied on public health records and hearsay. That doesn't seem like such a deep flaw, at least not for fish oil, in light of thousands of other studies that may confirm the hearsay was right or right about something other than heart disease.
It's a pretty deep flaw given that Inuits apparently didn't have the same level of access to doctors as the groups they were comparing them to and therefore heart disease amongst them simply wasn't being reported in public health records, despite no actual underlying difference in the rate of heart disease.
I think they change the ratio of LDL / HDL , i.e. they increase the HDL level which is good since, there is less cholesterol in periphery arteries to clog them. i also remember them having an effect on triglycerides (overall decrease), so i still don't think that omega 3 effects on cvd is BS since those are some of the key factors of the genesis of arteriosclerosis, so it might not help the Heart itself directly , but i am pretty sure there are huge vascular advantages and that's mostly anyway what's messing up the heart in the ende.
Almost all the studies used in the first meta-analysis, and all the studies in the second, were investigating the secondary preventative effects of Ω-3 supplementation on CVD. That means the people being studied already had heart disease. Supplementation didn't demonstrate a definitive impact on all-cause mortality, or cardiovascular events (though in both cases, there appears to have been a slight reduction in cardiovascular deaths) in that population. That's hardly surprising, and proves nothing at all, except perhaps something we already knew: people with heart disease have heart attacks and die.
"Proves" is a complicated word. What they did was provide evidence supporting the hypothesis that Omega-3 supplementation does not make a significant difference for people who already have heart disease.
While not ground-breaking, it's something. And if you gather enough meta-studies showing "Supplementation of x in y circumstance had no significant effect", then it starts to become reasonable to claim supplementing x in general is not worthwhile. (I'm not saying they have done that, but I'm pointing out that this is part of the corpus of data we need to test a supplement in general.)
And if you gather enough meta-studies showing "Supplementation of x in y circumstance had no significant effect", then it starts to become reasonable to claim supplementing x in general is not worthwhile
Woah, that's a horrible way to approach things.
As far as I know vitamin C only prevents exactly one ailment, scurvy. By that token, you could test against a hundred other random conditions and claim you'd proved it was worthless. Of course, you test substances for ailments you have a reason to think they will prove effective against and any other tests are beside the point.
Also, whatever the merit of the study mentioned, for its purse, the GP citing here is kind of misleading or irrelevant. People don't take fish oil to cure their existing heart disease, they take supplements to prevent heart disease (which it may or may not do regardless of whether or not it does other things).
There is no evidence that vitamin C supplementation has any benefit. I have seen studies on this, and they don't show any benefit.
Please note the difference between supplementation and deficiency. I am using "supplementation" in the same way that I understand the medical community uses it: for strictly when you are supplementing a normal diet, and you are not already deficient in that vitamin or compound. If you are deficient in vitamin C because you are forced to eat foods without it for a long period, then you should take vitamin C pills to prevent scurvy. But if you are not deficient in vitamin C, and you do get it from your normal diet, then no one has established any benefit to its supplementation.
In that context, I think that the meta-study is relevant. People supplemented their normal diet with omega-3s, and it didn't help. Yes, there are other circumstances we have to test. We have not "proved" that omega-3 supplementation is not beneficial. But we need to amass a large corpus of evidence to address the question, and that is part of it.
Well, most of those studies deal specifically with people recovering from a heart attack, not the general population. Those are two very different groups.
The largest study there (MARGARIN) showed pretty much no benifit for ordinary people with no history of MI. There are many mixed results in that summary as well...
Several randomized trials of fish oil were conducted over the past 10 years to test the hypothesis that omega-3 fatty acids could prevent restenosis after percutaneous transluminal coronary angioplasty. Although a meta-analysis of seven early trials concluded that supplementation was beneficial,49 more recent trials (with large study populations given 5 to 7 g/d of omega-3 fatty acids) have not supported this conclusion.50,51 Most investigators have concluded that further trials are not warranted.
The first study to explore the effects of omega-3 fatty acids on angiographic progression rates provided 59 patients either 6 g/d of omega-3 fatty acids or olive oil for 2 years.46 No benefit was observed.
In contrast to the growing body of evidence supporting a protective effect of omega-3 fatty acids in secondary prevention, a recent study reported no effect of 3.5 g/d of DHA+EPA versus corn oil on cardiac events in post-MI patients (n=300) after 1.5 years of intervention.
I take 1800mg of DHA a day and on those days my joins don't hurt. I do martial arts and that takes a toll on my knees but when i take fish oil they feel better.
> Placebos work in general as long as the problems are psychological.
There was a study [0] about the placebo effect in heart failure patients: "In a 1999 Swedish Study, doctors implanted an active pacemaker into 40 heart failure patients. Another 40 patients underwent the same surgery, believing they were receiving active pacemakers. But their pacemakers were never turned on: they were, in essence, placebo pacemakers." - [1]
Now as a disclaimer, I did not complete read or understand this study nor do I know if there are counter studies, but it's my favorite bit of information about the placebo effect.
Be cautious with the phrase "psychological problems". Placebo seems to work well for pain, and peoe will get very angry if you describe the pain they feel as a psychological problem.
But wishful thinking is a powerful influence, it triggers all sorts of internal processes which may indeed be more powerful and beneficial than medicine. Similarly, religion is nothing more than placebo, but that has influenced (and perhaps benefited) mankind since forever.
Eating fish is much more robustly tied to health outcomes. This is all the result of people absolutely refusing to follow health advice more complex than popping a pill.
The original snake oil -- from the Chinese water snake -- may in fact have been effective, in part due to its high Omega-3 oil content. The pejorative sense came from a mix of hucksterism and cargo-culting: concoctions from other sources (including other animal oils or petroleum-based oils) which lacked the specific constituents of the Chinese remedy:
Well, hucksters that sold patent or proprietary medicine caught wind of the miraculous muscle-soothing powers of snake oil. Naturally, they decided to sell their own versions of snake oil—but it was just much easier to forgo using actual snakes.
I do not think this comment was very beneficial to the community here at HN. It seems this same sentiment can be found in other comments on this story. Furthermore, regardless of the novelty of the idea expressed, these slapstick humor, childish one liners do not invite debate or lead to lively discussions. What was the point of your comment?
Though I agree it was slapstick humor, in my eyes it was the fastest way to convey the simple idea that science research findings often alternate from saying something is good for you, to something is bad for you. You really are never sure of anything.
Are the newer studies factoring in perhaps that their diets may have changed since the older studies? Do they eat less fish, etc. nowadays and eat more junk food? Consume more alcohol? Other drugs? More sedentary? If that's the case, the new study is deeply flawed.
Those are just a tiny fraction of the reasons why medical research is so difficult. Others include statistical issues, genetic variation, high costs, long timeframes, ethical constraints, publishing bias, bias of researchers, various kinds of fraud.
More evidence that vitamins and supplements are bullshit. While people with specific conditions may benefit AFAIK there is no pill you can take that has actually been proven to improve the health outcomes on otherwise healthy people.
All this confusion is the natural result of the combination of profit seeking and the difficulty of medical research. Maybe someday they will find that magic pill just not yet.
NY Times had a bunch of good article on the subject at the end of last year such as this one:
The problem with your comment IMO is that, while there's a fair bit of foundation to both questions of efficacy of vitamin supplements in general (it's a very incestuous industry with a history of collusion and abuse), and to megadosing in particular (most micronutrients are generally considered to be limiting only when lacking from a diet -- consuming more than limiting factors tends not to be associated with benefits and can be associated with harm, such as where overconsumption of one nutrient blocks uptake of another, or has toxic effects of its own).
But to claim that all supplements, and vitamins, are bullshit, without substantiation, is simply not justified. There are in fact clear cases where supplementation has proven beneficial where a deficiency exists (vitamins C, D, and B-complex vitamins in particular).
And it seems HN are calling you on that.
I do generally agree that eating a balanced and nutritious diet is your best insurance.
Yes - if you have a known vitaamin deficiency, you should (and your doctor would recommend) be taking vitamins to correct it. I hope this is not controversial.
However if you are healthy (i.e. have no known condition requiring treatment with vitamins), then there is no solid evidence that vitamins or supplements improve health outcome. If you disagree the burden of proof is on you: Point to multiple double blind studies by reputable researchers showing consistent and significant (practically not statistically) positive results. This may happen but AFAIK has not happened to date.
About 77% of the population is deficient in vitamin D.[0] You can't say "vitamins are bullshit" because only deficient people need them when a huge majority of the population IS deficient.
Sensible theory so then you need to run experiments to see if supplementing Vitamin D in "healthy" people actually improves their health outcomes. There are many reasons the theory might be wrong (ex. Natural variation of "normal" vitamin D levels). Unfortunately so far these studies have been mixed - even some negative outcomes.
From what I understand, the paper did a survey of Vitamin D related statistical studies. Then, went ahead and said that there existed a reverse causal link (Depression -> Stay Inside -> Low Vitamin D) as to why certain correlations existed. I am not going to make any judgements as to the causal conclusions they make. However, can you please clarify where you got the "negative outcomes"? There is no such thing mentioned in the NYT article, neither in the abstract of the Lancet paper.
The negative outcomes are not in those short summaries but the are easy to find. However just as a few positve studies don't prove Vitamin D is good for you a few negative studies don't prove it is bad. However negative studies do add to balance of evidence against use.
There is also the risk of overdose in any widely used supplement. Thankfully few of the 60,000 cases of vitamin toxicity in the US annually are Vitamin D (Iron is the riskyist).
A short walk in the sunlight is the best source of Vitamin D because your body naturally regulates it's production to near the optimum amount! I often wonder if the extreme avoidance of sunlight by some people is actually unhealthy...
I hope you don't take any prescription medicine, do not drink, do not sleep near electronic devices, sleep 8+ a night and eat only food that has none of the weird chemical preservatives which nobody knows the long term effects. How is the air pollution in your city? What about the weather? How much fluoride do you consume a day? Do you get stressed? Do you drink caffeine? Have you ever taken antibiotics?
> While people with specific conditions may benefit AFAIK there is no pill you can take that has actually been proven to improve the health outcomes on otherwise healthy people.
You're absolutely right. Taking supplements is about attempting to minimize the probability that one is deficient in something that's needed, which, if not addressed, can eventually affect one's health.
In the same sense, it's impossible for one to prove to themselves that they are perfectly healthy.
I'd recommend simply avoiding a bad diet (mostly just eat a diversity of foods) then you will already be getting all the vitamins/nutrients/etc you need while avoiding getting too much of anything that is bad for you. No need for pills unless something is wrong.
In the future this may change. For example genetic tests may be able to identify hidden long-terms problems with clear biochemical mechanisms that can be corrected with a pill. Much harder to find something that will make most people healthier but it could happen. Just not yet.
> I'd recommend simply avoiding a bad diet (mostly just eat a diversity of foods) then you will already be getting all the vitamins/nutrients/etc you need while avoiding getting too much of anything that is bad for you.
A diversity of foods doesn't mean much.
Fish oil is commonly recommended for good reasons. The amount of Omega 3 in the American diet is insanely low, mostly due to the lack of sea food in the average American diet (Seafood being one of the more plentiful sources of Omega 3).
In addition to that, the amount of Omega 6 in the average American's diet is sky high. There are potential problems when the Omega3/Omega6 ratio in a diet is too far in favor of Omega 6, these problems are what Fish Oil is theorized to help with.
On a more general note, many supplements can help with a variety of problems. While I'd say most supplements are worthless, there are quite a few that are not.
If you properly take melatonin, it will help with your sleep. (Don't take the huge doses most people do, 300mcg will suffice, overdosing will hurt your sleep after awhile!)
l-Theanine greatly reduces the side effects of caffeine and helps it work longer. Flat out, less anxiety, less jitters, and a large increase in focus.
Creatine flat out helps all around with physical performance, and may help out with some mental performance as well. There are dozens upon dozens of studies showing creatine's effectiveness.
Heck there are supplements out there that work as treatment for diabetes by controlling blood glucose levels, and by control, I mean "take this supplement, blood glucose levels drop".
The multi-vitamin sold at your local pharmacy? Yeah likely useless (or even worse), assuming it has any active ingredients in it at all.
But well researched supplements from reputable companies that have independent third party audits done on their production lines?
Heck there are supplements out there that work as treatment for diabetes by controlling blood glucose levels, and by control, I mean "take this supplement, blood glucose levels drop".
Cinnamon and Alpha-Lipoic Acid among others, are reputed to have this effect. Being diabetic, I was curious, and one time when I ran out of Metformin while traveling and not having a chance to get back to my doctor to get a new prescription, I decided to do a little (totally unscientific, not to be relied on) testing on myself.
I checked my blood sugar a couple of times, took 1 gram of ALA, and checked my blood sugar an hour later, and 90 minutes later.
I always saw a decrease. Now, this doesn't prove anything, as it could be that, by happenstance, the timing worked out that way, in terms of when I last ate and the natural upswings and downswings in the levels. But I made it a point to try and do this several hours I'd last had anything to eat to minimize that aspect, and I saw marked (50-60 point) drops after taking the ALA.
I never bothered testing Cinnamon or ALA+Cinnamon, but I tend to believe the suggestion that ALA supplementation may be of value for diabetics.
> I always saw a decrease. Now, this doesn't prove anything, as it could be that, by happenstance, the timing worked out that way, in terms of when I last ate and the natural upswings and downswings in the levels. But I made it a point to try and do this several hours I'd last had anything to eat to minimize that aspect, and I saw marked (50-60 point) drops after taking the ALA.
What you want is stabilized R-ALA, it is much more expensive but the unstabilized form of ALA tends to degrade quickly so you have less guarantees over what you are getting.
If you are type 2 you can do a good job of maintaining it by supplements and dietary maintenance. A Ketogenic diet is great, since it just removes carbs all together. :)
Examine.com is your friend. Unfortunately they went through a site redesign recently that puts their most powerful organizational tools behind a paywall. Then again, they need to earn their $ and their services are well worth it.
>>I'd recommend simply avoiding a bad diet (mostly just eat a diversity of foods)
Define "bad diet". Define measuring method & desired degree of food diversity. Isn't that what we're all here trying to figure out? ;-)
I want to eat more fish but the whole mercury thing scares me away. Perhaps fish oil supplements grant me the benefits of eating fish without the mercury??? I have no idea, but that sounds like a reasonable conclusion I'd come to.... then a study like this comes out and then I'm like (╯°□°）╯︵ ┻━┻
As a vegetarian I am pleased to hear that those fish oil supplements are not all that they are cracked up to be.
As a child I was made to feel that as a vegetarian, if I did not take these fish oil supplements, then I would probably die. No TV advert or doctor told me that, just ambient peer pressure from good, well-meaning friends and their mothers that indulged in these fish oil things. The fear of god is one thing, scientific evidence from the back of the packet is something else. Looking back it is a miracle that I did not give in to the peer pressure.
I am part of the self-selected control group of vegetarians. We exist so any normal people (i.e. in the meat-eating cult) can see if you really need fish, meat or some scientifically proven meat/fish dietary supplement thing. As it happens the vegetarian control group, even if some of them do wear leather shoes, tends to outlive those that are tied to their beliefs about things like eating their fish oils, getting tonnes of protein from beef, eating things because those vitamins can only be found in pigs not celery and so on.
Hence I can quietly keep my feelings of "told you so" to myself on this one, rather than go round my friend's mum's house and tell her how wrong she was to try and force feed me that fish oil stuff.
> Hence I can quietly keep my feelings of "told you so" to myself on this one
Yes, quietly post to an international forum of thousands of users how you're keeping those feelings to yourself.
As a vegetarian myself, I would suggest that you'll hold an audience longer by dialing the "smug" knob down a notch. People like their meat, and someone waiting since childhood to say "I told you so" isn't likely to change their mind.
On the other hand, calm and reasonable explanations aren't likely to change their minds, either. Because, damn, bacon sure tastes good.
In my experience, there are two types of vegeterian: those that just get on with it and the smug evangelising types who feel it necessary to preach at the flimsiest opportunity (e.g. what have leather shoes got to do with diet?). A balanced diet is necessary and in most Western societies this is easier to achieve for omnivores. Your friend's mum thought she was doing the best for you and all you can do in return is be self-righteous. Grow up, you'll probably stop being a hipster vegeterian when you do.
I respect your choice to be vegetarian. I am sure there are times where your friends/family members harassed you for your beliefs; I sympathize. However, there are others who are not necessarily vegetarians and you come across as a over compensating dick.
As it happens the vegetarian control group, even if some of them do wear leather shoes, tends to outlive those
I am sorry, but no such thing happens. There's a lot written on the subject why you can not directly compare "vegetarians" to "everyone else". For example, vegetarians not only do not eat meat, but also smoke and drink less, and exercise more than the general population and are in general more health conscious. So there are many confounding factors involved.
However, if you study people who are vegetarians not for health reasons, but, for example, religion - you suddenly find no health benefits, but rather quite a few increased risks.
Here's one of the articles on the topics, and plenty of scientific links inside for the curious.
The good news for the vegetarians is that their Lp-PLA2—a marker specifically for vascular inflammation—was lower than in the control group. But that’s where the good news ends. The researchers seemed pretty surprised to report that the vegetarians had higher levels of CRP (borderline significant at p=0.05) than the omnivores, along with higher homocysteine and triglycerides.
The surprising results? The vegetarians had significantly thicker arterial walls (p<0.0001), reduced flow-mediated dilation (a predictor of cardiovascular events) (p<0.0001), higher blood pressure (p<0.05), and higher triglycerides (p<0.05) than the omnivores. (According to the paper, the raised blood pressure might be related to some popular high-sodium vegetarian foods such as processed protein food substitutes, fake oyster sauce, and tomato paste.)
In the researchers’ multivariate statistical models, vegetarianism had the strongest association with both artery thickness and diminished flow-mediated dilation out of all the variables documented—including age, gender, and triglyceride levels.
As might be expected, the vegetarians also had lower B12 levels and higher homocysteine than the control group—but even after adjusting for these, vegetarianism remained strongly linked with less-healthy hearts. The researchers concluded with this:
In summary, contrary to common belief, vegetarians, at least in the Chinese, might have accelerated atherosclerosis and abnormal arterial endothelial function, compared with omnivore control subjects. The increased risk could only be partially explained by their higher blood pressure, triglyceride, homocysteine, and lower vitamin B12 concentrations.
Fish oil has been tied to multiple benefits, not just heart disease. Claiming a blanket lack of efficacy for fish oil supplementation presumes that 1) there is no heart disease benefit (all we know is that there are methodological errors in the Inuit study) and that there are no other health reasons for supplementing with fish oil. From the Wikipedia article, identified (all specifically tied to studies).
• Cancer
• Cardiovascular
• Hypertension
• Mental health
• Alzheimer's disease
• Lupus
• Psoriasis
• Pregnancy