Busting Myths: Does Dr. Oz Have A Monopoly?

Yesterday, I wrote about Dr. Oz's suggestion to snack with up to 200 calories two hours before eating your dinner in order to lose weight. There seemed to be no good logic to doing so. Imagine my surprise when today I get an email from RealAge.com, which is at least partially owned by Dr. Oz (see http://www.realage.com/press-release-sharecare) with the headline, "3 New Weight Loss Myths Busted."

Here is my favorite myth the article clams to bust.

"Myth 1: Eat five mini meals throughout the day.
The initial idea was to eat small, healthy amounts of food every couple of hours to keep blood sugar levels steady and energy high. The trouble is, many people end up eating what amounts to five full meals. "I find that people do much better when they sit down and have three balanced meals a day with two small snacks in between," says nutrition counselor Katherine Tallmadge, MA, RD. "Real meals stave off hunger. If you eat tiny bits throughout the day, you're hungry all the time."

This is diametrically opposed and mutually exclusive to Dr. Oz's concept of eating a small meal, which he calls a 200 calorie snack, two hours before dinner. Which is it? He probably doesn't even know, but busting myths seems to be one of his favorite concepts on his show. It's as if he has a monopoly on doing so. However, I never thought that in the span of one week, I would see him connected to both creating and busting a myth.

Here is another myth supposedly debunked by the article.

Myth 2: Eat less by using small plates. Studies have shown that large plates lead to more eating because they make portions look smaller, but the small-plates idea only works if there's a limited amount of food to put on the plate. In a recent diet study at Texas Christian University in Fort Worth, Texas, 10 overweight and 10 normal-weight women were randomly assigned a large or small plate for eating lunch on two different days, then allowed to serve themselves. The result? The ladies ate until they were full, regardless of plate size. "Make what you need, or measure the amount before putting it on a plate, then put things away," recommends Tallmadge, who was not involved in the study. "It's having easy access to food that keeps you eating more."

Contrary to what RealAge would have you believe, there is actually science that confirms the small plate approach to weight loss. See http://smallplatemovement.org/doc/big_portions.pdf for a review of the science. Brain Wainsink of Cornell University is one of the leading food investigators in the U.S. After reading his book, Mindless Eating, I am more inclined to trust his studies over the new study. I also know it works because it worked for me. I switched from a larger to a smaller bowl for my breakfast and never missed a beat on my way to a 20+ pound weight loss. Either way, with the conflicting study results, I hope you agree that this does not fall into the myth-busting category; however, it should fall into the sensationalistic headline one.

Here's a quote from Dr. Oz's website under the title "5 Diet Myths Making You Gain Weight" about the small plate issue:

"Dieters have been advised to eat from smaller plates in order to limit the amount they eat. Why? Because smaller plates make regular portions look larger. However, new research published in the Journal of Human Nutrition and Dietetics found that plate size had no impact on the calorie consumption of either normal weight or obese individuals. Despite these findings, Dr. Oz still recommends using small plates to help guide you in terms of how much you eat. But use them the right way – a small plate is not an excuse to pile on food vertically or go back for seconds."

So what are we expected to trust? The Dr. Oz Show or a website Dr. Oz has ownership in?


The third myth the article purports to bust is "it doesn't matter what meal plan you're on because you'll lose weight as long as you stick to it." Really, any food you eat as long as you stick to it will help you lose weight? The study the article referenced used 5 specific plans. There is definitely more than one way to lose weight, but the meal plan (and total number of calories) will always matter.

It is because of articles such as this one and the Dr. Oz Show that there is so much confusion out there that allows anyone to claim he or she is busting a myth. Besides, I caution trusting anyone that constantly claims they are a myth-buster. Wouldn't it be better if shows and websites just presented the science in layperson's terms and let intelligent people make the decision on their own. I think so. Do you agree?

Ignore Dr. Oz on Sage Leaf Tea and Alpha Lipoic Acid

Contrary to what some may think, I don’t enjoy blogging about Dr. Oz.  Why? It requires a lot of effort to identify the facts and if I don’t exert the effort, I am ultimately no better than him with his inaccurate proclamations.  Having written about the good doctor ad nauseum, I had planned to ignore his most recent show called "Snack Attack: Eat More and Weigh Less" this past Friday that originally aired February 17, 2012.   

As fate would have it, one of my guests at Friday night dinner asked me about the show and specifically about the Sage Tea he recommended to lose weight.  My short respite from analyzing the products Dr. Oz recommends was over.

So here we go again. The episode started with Dr. Oz claiming that “recent studies prove that snacking on the right foods at the right time can turn your body into a fat-burning machine.” He then went on to present that eating certain snacks of 200 calories or less two hours before dinner will result in less food consumed at dinner. One of those snacks he presented included prosciutto, a cured ham, which he recommended wrapping around 2% mozzarella cheese, and adding 2 olives, 1 cup zucchini, and 1/4 cup chickpeas.

I’d like to see a study that showed that eating prosciutto and mozzarella cheese two hours before dinner helps you lose weight. I highly doubt it. What do you think? He also states on his website in reference to this episode that “Get your metabolism going with a pre-dinner snack, 1-2 hours before your main meal. Doing so will help you stop eating once you're full, which is sometimes hard to do.” Why would snacking help you stop eating when you are full if eating non-snack food often doesn’t do that?  Enough said.

Of course, he also recommended a product—in this case a cup of Sage Leaf Tea--as a way to lose weight. After a few hours of research, including pubmed.com, Cochrane.org, naturalstandard.com, and infopoems.com, I could only find one reference to the use of Sage Tea for anything whatsoever related to weight.

It was a study titled “Antihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial.” This single study involving a whole 67 people showed that Sage Leaf may be useful in decreasing lipids. Mind you, that doesn’t mean losing weight. 

By the way, where do you think the study was done. Wait for it, here it comes—Iran.  Yes, that’s right--The People’s Republic of Iran, that bastion of scientific integrity known for its war-mongering, terrorist-supporting, Holocaust-denying oppressive government. Now that’s a source of a study I’m not sure anyone should rely upon.  There was not a single additional scientific reference to the use of Sage Leaf tea for weight loss, metabolism booster, etc. that I could find.

But Dr. Oz wasn’t done for the day pushing pills.  He then recommended 200 mg. Alpha-Lipoic Acid (ALA) as another weight loss aid.  Now here’s where it gets good. 

Like with Sage Leaf, I began an intensive search and here’s what I found--a South Korean study titled, “Effects of Alpha-Lipoic Acid on Body Weight in Obese Subjects” published in early 2011, that stated to the authors’ knowledge, “this is the first study to show that alphalipoic acid treatment led to a significant weight reduction in obese human subjects.” There appears to be no published study since, so this seems to be the first and only study of its kind. 

Second, the study initially involved 360 obese subjects (of which about 1/3 dropped out for different reasons including adverse side effects) consuming 1,800 mg (9 times the dose recommended by Dr. Oz).  

After 20 weeks of treatment with 1800 mg per day of alpha-lipoic acid, the results showed “modest but statistically significant reductions in body weight and BMI.” How much weight did they lose after 20 weeks of 9 times the dose recommended by Dr. Oz? They lost 1.8% of their weight. In a two hundred pound person that would be 3.6 pounds.  At 1,200 mg (or six times the Dr. Oz’s recommended dose) the weight loss was even less at about 2 pounds for a 200 pound person.

For full disclosure, there was another study, published in 2010, for which I could only access the abstract titled, “Alpha-lipoic acid supplementation: a tool for obesity therapy?” The conclusion of this Italian study according to the authors was “Our study indicated that LA is an ideal antioxidant candidate for the therapy of obesity related diseases. Further clinical studies should be considered to highlight the role and efficacy of LA treatment.” However, this was not a double-blind randomized controlled study and no data on caloric intake was given. By the way, they consumed 800 mg, or 4 times the dose recommended by Dr. Oz. Apparently, the South Koreans discounted this study as well based on their statement that they had performed the first study on the effects of ALA on weight loss.

Need I say more? Dr. Oz has little scientific basis (and for that matter, no business) recommending such a product at a dose that has no valid and conclusive scientific evidence to support his recommendations.

Of course, that never seems to stop him and it didn’t here.

Pressure Rising But Not As Fast As Costs

Trying to learn all I can about evaluating clinical studies, I recently completed a book aptly titled, "Evaluating Clinical Research, All That Glitters Is Not Gold," by Bengt Furberg and Curt Furberg.  

Suffice it to say that I learned a lot from this book about what to look for in a study to determine if it offers valuable and practical data. One of the examples repeatedly used in the book to show how data can be manipulated refers to studies of blood pressure medications. The book reveals numerous examples of how many of the new hypertensives have shown little benefit over the long used, inexpensive diuretics as a first line therapy for high blood pressure. Diuretics reduce your body's fluid volume, which often reduces blood pressure. I didn't think much about these examples because I haven't look at the full body of research on blood pressure control medication so I read about them with a passing fancy.


So when I came across an interesting article yesterday titled, "Rethink Pills for Hypertension," on a Canadian website, it caught my attention.

Here's the article: http://www.thestarphoenix.com/health/Rethink+pills+hypertension/6885891/story.html#ixzz1zqEgqhvd


The gist of the article is that while new medications have substantially raised the cost of treating hypertension, hypertension continues to increase across the Canadian population. Of course, there can be many reasons for more hypertension including increasing heart disease, diabetes, obesity, etc.

Nevertheless, the article reports, "In a study published in the Canadian Medical Association Journal, the authors documented that the cost for these medications rose to $5.3 billion in 2006 from $1.7 billion in 1996. The cost per 100,000 population rose to $17.5 million from $5.8 million during that 10-year period. The authors observed no plateau in spending and concluded that the rapid escalation in costs threatens the sustainability of public drug insurance programs."

So what's the problem? According to the article, "Of the 88 new patented drugs used during the study period, only 20 per cent offered a new active substance, let alone an actual clinical improvement...The first issue is that cheaper diuretics actually are superior to anti-hypertensive medications in treating high blood pressure. "

The article also shared the following study results, some of which were also discussed in my book; please note that I have not independently verified these studies.

"The Cochrane Collaboration performed a meta-analysis and found that no other drug class improved health outcomes better than diuretics. An interesting part of this analysis was that low doses of diuretics prevented coronary heart disease by 28 per cent and mortality by 11 per cent, while higher doses of diuretics did not. This same review also found that more expensive beta blockers and calcium channel blockers were not effective in reducing coronary heart disease and mortality. There were 14.8 million prescriptions filled in 2006 alone for beta blockers. The authors of the review concluded that low dose diuretics should be the first choice of drugs for patients with high blood pressure, and that it is fortunate that diuretics also are very inexpensive."

Furthermore, the article reports that "The Cochrane Collaboration published four meta-analyses on the effectiveness of anti hypertensives in reducing blood pressure. ACE inhibitors, alpha blockers, ARBs and beta blockers all reduce systolic blood pressure by a range of seven to eight points, and diastolic blood pressure by a range of five to six points. However, in these systematic literature reviews, the average blood pressure prior to treatment was 157/101 mmHg. As such, these medications reduced blood pressure to only 149/96 - well above the target of 120/80." That's not much of an improvement and leaves blood pressure too high for comfort.

The conclusions of the article are essentially that instead of using new (actually, not always new chemicals) expensive, patented blood pressure lowering drugs, doctors as a first-line therapy should stick with the tried and true, and very inexpensive, diuretics because they work as well if not better.

According to Mark Lenstra, the author of the article, if the new drugs showed limited benefit in a carefully controlled study where complianace is high and you expect the best results, what can you expect in the real world where there is less compliance. I don't share that concern because I believe that a drug should be evaluated based on when it is actually taken and not on what happens when someone doesn't take it.

Nevertheless, I have to agree with Mark's original premise that it may be time to reconsider leapfrogging over diuretics as a first line therapy to more expensive, but no more effective, patented drugs. Combining the data from the book I just finished and these studies, that would seem to be the logical conclusion.

Although diuretics are by no means perfect, I think I will give them a more careful consideration moving forward in initially treating a patient's high blood pressure.

Something To Laugh About and More On Vitamin D

It's often been said that laughter is the best medicine, and I couldn't agree more. Therefore, I dedicate today's blog to a funny video that a friend shared with me and my wife. I hope you enjoy it as much as we did.

http://www.youtube.com/watch?v=PypsMk_0QxY&feature=youtube_gdata_player

For those hungry for some science, here's a funny, not in terms of humor, but in terms of being a somewhat ridiculous study that was reported on a few days ago. I have no doubt that the results of the study are already being used to feed the recent hysteria about Vitamin D deficiencies.

Why? I'll get to that in a moment but let me first share what happened with an email I received from a service of the U.S. National Library of Medicine and National Institutes of Health that reported on this new study.

Last week, I took exception to material in another article from the same source that implied that calcium could only be obtained from dairy products, which is far from the truth. Here's a link to another government resource listing many other food sources, albeit not all healthy ones. And while dairy products dominate the list, there are other excellent sources as well. Cut and paste: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

When I wrote to the source of the email, the response was that they simply reported what they received from the newswires. I told them that such a response was a cop-out and that they had a responsibility as a government service to make sure that the information they were disseminating was accurate. We went back and forth in a few emails and the net result was that I received an email from the head librarian in which he essentially disavowed any responsibility for the information being forwarded. I found that quite disappointing.

Nevertheless, I knew that henceforth I have to be careful with anything I received from this source. With that in mind, let’s address the headline of the article in a recent email I received from the same source, which was titled, “Low Vitamin D Levels Linked To Weight Gain in Older Women.” Now any reasonable person would conclude based on this headline that women with Vitamin D deficiencies are generally gaining weight as a result of their deficiency. Well, that’s not what the studied showed.

Quoting from the email, “The researchers followed more than 4,600 women aged 65 and older over the course of nearly five years. The study found the women with low levels of vitamin D gained about two more pounds during that time than those with normal levels of the vitamin.” How about that? A whole two pounds more. Is that consistent with what you expected from the headline? Two whole pounds gained over 5 years? I’m sure we all expected that from the headline, right? That’s not all. Which women do you think gained the weight? It turns out to quote the article again, it was the “women [who] generally weighed several pounds more to begin with, the researchers noted.” So the heavier women gained more weight. Not a big surprise that an overweight person would gain more weight as is often the case.

But that’s not the funny part I referenced earlier.

Here’s the funny, or not so funny, part. The article goes on to say, “Although most of the women in the study were not trying to lose weight, over the course of the study 27 percent of the women lost more than 5 percent of their body weight and 12 percent gained more than 5 percent of their body weight, the researchers noted.”So despite the vitamin D deficiency or perhaps because of it, which apparently according to this study was present in 78% of the tested women, more women actually LOST weight than gained it.

Accordingly, why wasn’t the headline “Low Vitamin D Levels Linked To Weight Loss in Older Women” or even “Low Vitamin D Levels Linked To Weight Gain, Weight Loss, and No Weight Change in Older Women.” Now that would have been an accurate headline.

So was the article a total loss? No. Here’s the only semi-reasonable comment coming from the article and I quote, “"Our study only shows an association between insufficient levels of vitamin D and weight gain," study author Dr. Erin LeBlanc, an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Oregon said. "We would need to do more studies before recommending the supplements to keep people from gaining weight. Since there are so many conflicting recommendations about taking vitamin D for any reason, it's best if patients get advice from their own health care provider."

Finally, a little bit of sense although given the 27% of women actually lost weight it would be more logical to suggest that Vitamin D supplementation should NEVER be used as a weight loss tool.

So as I often recommend, please don’t trust headlines, even from government sources. You need to, at a minimum, read the entire article and ideally, look at the actual study if you want to even get close to the truth. Of course, even looking at the study is not a safe bet because so many studies are done by unreliable sources with an agenda, who manipulate the science, if it even is actual science, in their favor.

So what’s a person to do? Send the article or study it to me. I love to look at interesting studies and dissect them looking for the truth. Consider me your personal truth seeker.