Personal Health and Nutrition
Do statins make you live longer? Only if you take them daily. Statins (cholesterol-lowering drugs) are some of the most studied drugs in history. We know from many many studies that they prolong life. Statins are cheap, have few side effects, and extend life. They aren’t for everyone — there are risk factors and side effects. Dr Rob Siegel (yes relation) says: “For patients who tolerate them, statins lower LDL and lead to health benefits that exceed what we would expect from LDL lowering alone.”
What about supplements and nutraceuticals? The worldwide market for supplements (vitamins, botanicals, minerals, amino acids, enzymes, etc) is already at $240 billion and growing fast. Believe it or not, a few of them actually work. Saw Palmetto has been shown to reduce symptoms of enlarged prostate. St. John’s wort is better than placebo (but not necessarily drugs) for treating mild depression, BUT St. John’s wort interacts negatively with many prescription medications. Green tea shows maybe some benefit, but even if the tea is strong, the evidence is weak. A few other supplements may turn out to be helpful and safe.* Most of the rest do nothing but help the companies that sell the products. Echinacea hasn’t been shown to prevent or reduce cold symptoms. Unfortunately, more than half of pharmacists recommend nutraceuticals. Most supplements do nothing, some cause real harm, a few work, and a surprising number are tainted with actual prescription drugs. Should this industry be regulated? What do you think?
What about cannabinoids? Medical marijuana and cannabinoids do have some effects. However, there is much more enthusiasm for sales than for double-blind, placebo-controlled data. For epilepsy, researchers have found significant benefit, but for relief of anxiety, pain, nausea, and other symptoms, they haven’t seen any real signals yet. Steve Novella has a good summary, showing that we are just at the beginning to understand what the benefits and harms may be.
Are some people gluten intolerant? The market for gluten-free foods is over $4 billion, yet there is almost no real evidence for non-celiac gluten sensitivity.* It’s likely that most people who believe they are gluten intolerant aren’t, and a few are potentially pre-celiac or somehow have mild symptoms of celiac disease. If you believe you are gluten sensitive, then either you have some degree of celiac disease or you have something else you are not treating, and that could be dangerous. I have thought about how to make a home-test kit, but I’m not sure the market exists — people are willing to spend on gluten-free food but not on a test.
What do we know about nutrition? There are thousands of people with nutrition PhDs. Almost all of them are based on very poor research, bad statistical analysis, conclusions that contradict each other, and rigorous nonsense. The common idea that your weight equals calories in minus calories out may not be as true as we once thought,* and it hasn’t proven very useful as a regime for helping people lose weight. If it did, diets would mostly work, and they mostly don’t. What is driving the obesity epidemic? Is it sugar? Carbohydrates? Fat?Portions? Lack of sleep? Fast food? Depression? Genetics? In reality, we simply don’t know. (I’d write a book called What we Don’t Know about Nutrition, but a) it would be huge, and b) no one would buy it.) Most people believe they have a nutritional mental model that fits reality, but it is based on stories not evidence.
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