Published on June 25, 2013
Diet discussions in the social media –A dietician’s viewRegistered dietician, M.Sc, MBAReijo Laatikainenwww.pronutritionist.netwww.pronutritionistblog.comwww.twitter.com/pronutritionistPage 1
• Posted more than 500posts at different 4 blogs• Engaging in discussionsin Finland, US, UK andAustralia• Follow nutrition literature• Meet patients regularly2My view is based on participation
Why do discussions on diet heatup?5 reasons
These are my personal viewswww.pronutritionist.netPage 4
It’s easy to blame others, but weshould inspect our own nestsprimarily.Afterall, you can mainly impactyour own bevaviour. Not so muchothers.www.pronutritionist.netPage 5
6NutritionauthoritiesMediaIndividualismDieticians andnutritionistsInterest groups(low carb,vegans etc.)Dieticians are often absentor cautious. Stand up for thediscipline, as a profession!Selling news & huntingclicks is rife in somemedia.Too often black & white,sluggish to admit mistakes& overselling own studiesCherry picking, ridiculing &dismissing opposing dataas a chosen strategy“I’m the best expert onmy health”✔✔
I’ll only focus on two of these.Nutrition authorities and media
Public health messages cast bynutrition authorities are often toosimplistic, exaggerated or tooblack and white.8Shades of grey. It is risky to oversimplify science for the sake of a clearpublic-health message. Nature 2013:497; 410 (editorial)
Example 1Simplistic and exaggerated9
• Professor of Pediatrics in theDivision of Endocrinology atUniversity of California, SanFrancisco• Eagerly praised and followed bylow carb and paleo communities10How a single ecologic (correlation)study becomes the ultimate piece ofevidence
11Sugar usage was linked to incidence oftype 2 diabetes in an ecologic studyCorrelation of sugar availability and type 2 diabetes worldwideBasu S, Yoffe P, Hills N, Lustig RH. The Relationship of Sugar to Population-Level Diabetes Prevalence: An EconometricAnalysis of Repeated Cross-Sectional Data. PLoS ONE 2013; 8(2): e57873
New York Times(It’s sugar, Folks 02/28/2013)
14Mark Bittman, NY Times strechesLustig’s findings further…• ”The take-away: it isn’t simplyovereating that can make yousick; it’s overeating sugar.We finally have the proof weneed for a verdict: sugar istoxic.”• ”Obesity doesn’t causediabetes, sugar does”.
158 days later, a correction appears
But who reads the correctionanyway?Damage is done, and onedogmatic view is facilitated.
Simplistic and exaggeratedExample 2, read here(was not presented)
Next. This is how it often goes,when conclusions becomedistorted.
4 Opinion,comment,blog3 News2 Pressrelease1 Scientificpaper (article)A formation of distorted message is cascade of(small) failures. Media and academics do havea role and cannot short-sightedly accuse onlythe bad behaving in social mediaAuthorspresentresultsUniversitysells thestoryto mediaMediasells thestory topeopleSomeonefurtherexaggeratesand modifiesdata/context
Let’s face it (nutrition authoritiesand science journalists). There iscontradictory data in the field ofnutrition.It’s often not black and white.
Example 1Cancer and diet in cohort studies
Schoenfeld & Ionnidis. Is everything we eat associated with cancer ? A systematic cookbook review, Am J Clin Nutr December 2012ajcn.047142.Sometimes variety of results isvery broad in the field nutrition
Example 2read here (not presented)
We rarely talk on the value ofparticular research design.However, nutrition studies can beranked.There is a ranking tool forevidence. But few are activelyaware of and using it.24
1. Randomized mortality &morbidity trials2. Prospective cohorts3. Randomized riskmarker studies4. Cross-sectional andcase-control cohorts5 Ecological & animalstudiesStrengthofevidence Meta-analyses of 1,2 & 3Modified from: Micha & Mozaffarian.Lipids. 2010; 45(10): 893–905 andEvidence Analysis Manual.Academy of Nutrition and DieteticsJanuary 2012
Why don’t we see this rather simpleillustration more often in pressreleases, in scientific journals, inpresentations etc.?Design of the study or hierachy ofevidence are usually not wellarticulated, and therefore all kind ofstudies tend to get equal coverageand attention. Result: a mess26
Obviously, there is some mediawhich do not seem to carehonestly about the ”truth” butrather focuses on exploitingdebates within the field ofnutrition27
Some tabloid papers exploited thedispute on Low Carb Diet28Good Diet Bad Diet
My two hopes for both media andnutrition authorities.Less black and white statementsand less focus on selling.Page 29
One more hope. (Not presented)
Let’s stop accusing shortsightedlythe bad people across the border(low carb advocates, paleo people,vegans, super foodies, dietarysupplement advocates etc. )Let’s scrutinize also our own nest.www.pronutritionist.netPage 31
“Everything should be made as simple aspossible, but not simpler”www.pronutritionist.netPage 32
Recommended readings• Murad & Montori. Synthesizing Evidence. Shifting the FocusFrom Individual Studies to the Body of Evidence. JAMA2013;309:2217-8• Hughes V. The big fat truth. Nature 2013:497;428–430• Shades of grey. It is risky to oversimplify science for the sake ofa clear public-health message. Nature 2013:497; 410
Wellcome aboard!http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionisthttp://www.pronutritionist.netReijo Laatikainen, Authorized Nutritionist, MBAImages bought and licensed from BigStockPhoto. Snapshots from papers and sites refered to.Page 34
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