Nutrition and Medical Science have a Massive Problem

What do we do when researchers contradict themselves?

I recently engaged in a conversation with Dr. James DiNicolantonio, a cardiovascular research scientist and Doctor of Pharmacy. His resume includes publishing 9 bestselling books on nutrition, serving as editor of the British Medical Journal, and authoring over 300 publications in medical literature. I respect and agree with much of what Dr. DiNicolantonio says, however, this conversation highlights a disastrous problem ubiquitous across the realms of nutrition and medical science.

We were discussing a fascinating new paper proposing a groundbreaking theory that muscle glycogen (sugar stored in muscles, the reason my swim team had pasta parties the night before every swim meet) is not the primary fuel limitation to athletic performance. This research, 5 years in the making, is especially intriguing to me because the conventional sports nutrition model says I shouldn’t have been able to hike the tallest peak in Colorado or bike 100 miles with 1.5 miles of elevation gain while fasting from dinner the prior evening and consuming zero carbs.

This new paper is highly controversial. It is suggesting the last 50 years of sports nutrition is founded on a flawed understanding of biological mechanisms. An accusation like that requires substantial proof. This paper presents compelling evidence and I am but one real world case study. The sports world should be abuzz, eager to seek answers to the waterfall of questions this paper elicits instead of the pure dismissals that it’s currently receiving.

I’m not entirely convinced of the theories this paper presents, and have been eagerly chatting with doctors and researchers that appear to be blatantly dismissing the paper – Dr. James included. Who better to pinpoint potential flaws than the people that disagree so vehemently that they won’t even bother reading the paper beyond a brief glance?

During our conversation, Dr. James presented another paper to support his argument that high carbohydrate intake before and during exercise is necessary for peak athletic performance. (Keep in mind, my point in writing this is not to say James is wrong, merely to highlight the flaws of nutrition science, subsequent dialog, and discounting of my personal experience.)

The authors of the paper that Dr. James presented, wrote their conclusion, “According to the systematic analyzes carried out in this work, most studies show that the use of carbohydrates before strength tests is favorable to increased performance.”

At first glance this seems very cut and dry. But if you zoom in to what the authors wrote in the Results section of the paper, the narrative shifts. "In total, 11 of the 19 acute studies found no significant effect of carbohydrate intake on strength training performance". How do the authors conclude most studies show a benefit from carbs when only 8 of 19 studies reviewed, less than half, show an effect? The authors continue, "However, none of the isocaloric comparisons found the higher carbohydrate condition had greater performance than the lower carbohydrate condition". And, "positive effects of carbohydrate intake were more prevalent when compared to fasts of four or more hours". In lay terms, even in the 8 studies reviewed that suggested carbohydrates do improve performance, there was no difference in performance when calories were equal across study groups. Performance improved only when comparing carbs versus fasting or calorie restriction.

Why am I telling you this?

• The authors’ conclusion is not even supported by what they themselves wrote in the discussion section of their review. In the most generous interpretation, their conclusion doesn’t state favorable performance compared to what – in which case it was extremely poorly written yet somehow passed peer review.

  
  

• Seemingly a majority of nutrition and medical studies I have read thoroughly contain blatant inconsistencies between the title, abstract, introduction, or conclusion, and the results and discussion sections. Oftentimes the title and the results are borderline opposite. That means that anybody scanning just the headlines has the exact opposite takeaway than what the data actually suggests.

  
  

• Doctor James presented this study to support his argument that carbohydrates improve performance. It is blatantly obvious he did not actually read the study. When I asked him if my interpretation was incorrect (I always leave open the possibility that I’m wrong), he ignored my question and redirected with a different study that’s behind a paywall, so I wasn’t able to read it.

  
  

• If Dr. James can’t be bothered to read a 4 page report that disagrees with his stance, before presenting it as support for his position, how are we supposed to think that practicing medical doctors have time to read 50-page studies to stay current with nutrition and medical advances? How many medical or nutrition experts read original research to understand it themselves? I know firsthand the time required to truly understand a study, and I don’t fault health professionals for not working overtime - for free - to read research papers. However, the result is that nearly zero health professionals ever set eyes on original data and information, merely updating their knowledge via the classic childhood game of telephone, whispering a phrase ear-to-ear until the final result is comically unrelated to the original thought.

My understanding is many doctors do regularly receive brief summaries of the latest medical research. They have access to the reports and the underlying data. But like how you and I skim news headlines, most doctors merely skim reports. They almost never click a link, much less read a full study. Even if they desired to, there just aren’t enough hours in the day.

If doctors don’t have time to understand the data, they have no option but to fall back on ‘Industry Standard of Care’. And the Standard of Care is built upon the headlines and conclusions that often conflict with the actual data and results of studies informing care. Is it any wonder then, that most of the population is struggling with chronic disease?

I am not intending to call Dr. James out. In fact, I happen to agree with most of his positions that are sometimes counter to the conventional medical position. This article is an indictment of the way that nutrition research is currently presented and discussed. When evidence isn’t thoroughly evaluated, the consequences ripple through our nutrition guidelines and into our long-term health. The structural challenges within nutrition and medical science are multifaceted. We’ve only begun scratching the surface.

I can't promise you I have all the science correct, and in fact I can promise you I don't - not a single person does. I can promise you I read scientific literature entirely top to bottom (plus supplementary material) and I engage with doctors and researchers with similar and differing viewpoints. I can promise you I will tell you when I learn something that changes my viewpoint. I can promise you that the way you eat is the most important factor in the quality of your health. And so many of the conventional recommendations don't actually lead to better health.

If you have been struggling with reaching your health and fitness goals, maybe it's not your motivation or your willpower that's the problem. Maybe it's the information you've been provided that's the issue. Have you been trying unsuccessfully to lose weight for the past 20 years? Are you struggling with pre-diabetes, IBS, anxiety or depression? We've helped countless people use real food to seemingly effortlessly lose fat and gain muscle. We've helped countless people improve their health and their confidence to work alongside their doctor and eliminate a range of medications that were ultimately harming their quality of life. Schedule a free consultation with us to chat about how we can help you reach your goals.

Embrace Nuance,

Alex