UPFs, or ultra-processed foods—like packaged snacks, sugary drinks, instant meals and fast food—are often renowned for their convenience, low cost and pleasant taste, but they could be taking a major toll on our health, even more than we once thought. Today, we are sharing an interesting study we came across, supported by the Intramural Research Program of the National Institutes of Health, National Institute of Diabetes & Digestive & Kidney Diseases, which demonstrated the negative effects of UPFs on our health.

We were particularly intrigued when this nutrition-based RCT (randomized controlled trial) surfaced within the current discussion around UPFs. Nutrition research is rarely conducted as an RCT, resulting in a mountain of conflicting observational studies where associations between variables are identified but causation cannot be drawn. The lack of RCT makes nutrition research particularly confusing and is often compounded by publication bias, media interpretation, reductionist thinking and self-interest. 

Note that the generalizability of this study is limited due to the lack of consumer choice and the in-patient nature of the study design. Further, the sample size was small, the time in each study group was short and a washout period between groups was absent. But the implications remain interesting and something to consider when we make choices about what we’re consuming.


Let’s take a close look at this 2019 study and the findings:

THE VARIABLES:
The study examined 20 weight-stable participants: 10 males and 10 females aged 18-50, all who were admitted to the NIH Clinical Center for a continuous 28-day period. For a two-week period, participants were randomly assigned a UPF diet (as defined by NOVA) or an unprocessed diet. After two weeks, without a washout period, they switched diets. All 20 participants completed the study. 

Each participant was provided with three meals a day. The weekly per-person costs of these diets were estimated to be $106 for the UPF diet and $151 for the unprocessed diet. The foods presented among the two diet groups were matched for calories from sugar, fat, sodium, fiber and macronutrients. Participants were instructed to eat as much as they wanted within a one-hour window for each meal. Snacks were also made available for each diet group.

MEASURING THE VARIABLES:
Participants wore continuous glucose monitors (CGMs) to track glucose, accelerometers to track energy expenditure (calculated as METs), and spent one day a week in a respiratory chamber to track energy components. Fasting blood was drawn at baseline and on the final days in each diet group.

Participants also responded to surveys assessing appetites, sensory experience and palatability.

To offset deconditioning from sedentary behavior, participants performed three, 20-minute cycle sessions at a controlled intensity.

THE OUTCOMES:
While on the UPF diet, participants consumed 500 more daily calories per day than when on the unprocessed diet, which correlated with an increase in calories consumed per minute in the UPF diet group. The extra calories consumed were from carbohydrates and fat (notably, not from protein).

Not surprisingly, participants showed increases in weight and body fat mass when on the UPF diet and reductions in weight and body fat mass when on the unprocessed diet. While on the UPF diet, fat oxidation was reduced, while insulin secretion and blood glucose increased.

While on the unprocessed diet, appetite-suppressing hormone PYY levels increased, along with free fatty acids and free T4, while hunger hormone ghrelin, adiponectin, total cholesterol, hsCRP and Total T3 levels decreased. 

UPFs AND BRAIN HEALTH
Last month, in Concierge Choice Physicians members’ only wellness program, Motivated Mondays, CCP closely examined the role of UPFs on cognitive health. UPFs have been associated with a number of health concerns, including cardiovascular disease, diabetes, and mental health disorders. In this study, a well-controlled RCT, we see it corresponding in a linear, stepwise fashion with weight gain via increased calorie consumption. In addition, even in the short term, the biomarkers hint at the potential for additional inflammatory and metabolic health concerns.

WHAT ALL OF THIS MEANS FOR US:
With all this in mind, strongly we encourage you to eat and identify real, unprocessed food.

To help, you can ask yourself the following three questions we should ask ourselves before adding a food item to our grocery baskets:

1) Did my grandmother eat this food?
2) Could I recreate this food at home in my kitchen?
3) Are the ingredients on this label available right here in the grocery store?

If your answer is no to any of the above questions, try to avoid it. 

As your concierge physicians, we are always available to you, especially when it comes to helping you make healthier choices. Feel free to reach out with your individual questions. 

​Each year, we spring forward into Daylight Saving Time (DST) the second Sunday in March and we fall back to Standard Time the first Sunday in November. The intention of the extra hour of daylight is to conserve energy, but it has a number of adverse health effects.
 
Beyond a sleep deprived society losing yet another hour of sleep when we spring forward, what is the reason DST is so disruptive to our internal clocks?
 
In essence, every cell in your body has an internal clock that controls your biology on a 24-hour schedule. This is known as the circadian rhythm (CR). The primary driver of the CR is our exposure to lightness and darkness. For optimal functioning, our CR requires exposure to bright light during the day, which keeps us alert and gives us energy during the day, and reduced amounts of light in the evening, which induces drowsiness to get a good night’s rest. However, the opposite happens after DST when it is darker in the morning and lighter in the evening. Your body’s natural CR becomes mismatched with the clock. A misaligned CR will leave you groggy in the morning hours and alert before bed, much like jet lag if you travel west to east.
 
A misaligned CR will not only interfere with your sleep patterns, but also disrupt the appropriate timing of the release of hormones which impact hunger/satiety, mood, immunity, and metabolism.


Many agree we should skip the bi-annual time change, and just change the clocks once per year. There are several national petitions circulating to stop “falling back” but most scientists agree eliminating “spring forward” would make more sense, because Standard Time is more closely aligned with our CR.
 
As of now, no changes have been made so we will be switching to DST next weekend, so how can we prepare for Daylight Saving Time?
 

• Starting Tuesday night, March 4th, go to bed 15 minutes earlier each evening than the night before until the change happens. This will make that initial hour-long loss of sleep less challenging.
  
  
• Consider a lighter schedule on Sunday, March 9th  and Monday, March 10th  to allow your body to adjust.
  
  
• On Sunday and Monday limit naps to 20 minutes in duration. This will help to avoid a bad cycle of not sleeping and trying to catch up on sleep and then again not sleeping,
  
  
• From the time you rise until just after dinner, get as much exposure to daylight as possible.
  
  
• Monitor caffeine consumption. How quickly you metabolize caffeine is genetic, so you know best if it stimulates you and keeps you awake at night. If it does, make your last dose of caffeine 8 hours from your planned bedtime, as half of it should be metabolized by then. Did you know? There is little actual caffeine in chocolate. If you find chocolate stimulating, it is likely the effect of theobromine, a component of the cacao bean and in highest concentration in dark chocolate.
  
  
• Avoid alcohol at night. It may help you to fall asleep faster, but you likely won’t stay asleep through the night, interfering with the deep restorative stages of sleep.
  
  
• Exercise! Just avoid it close to bedtime when it might interfere with sleep.
  
  
• In conjunction with your concierge physician, consider eating within a restricted window of 8 hours a day (optimized if those 8 hours are during daylight hours).
  
  
• Lastly, as the night draws to a close, start to dim the artificial lights. This means dimming the overhead lights, reducing screen time/adjusting brightness and logging off 1-2 hours before bedtime, and ditching the TV. Consider a paperback book or a journal for entertainment before bed instead.

 
With these tips and tools, you can adjust your circadian rhythm and conquer the fog and grog of Daylight Savings.
 

​We’ve made it halfway through what has been a demanding decade! Having survived some challenging times, many of my patients report a resurgence of habits which are comforting, but unhealthy.  January 1st is a great opportunity to set your new course promoting health and wellness.
 
Rather than revisiting the worn concepts of years past, let’s start with a substantive foundation and then discuss unique approaches designed to promote success in reaching your resolutions. First, having the right perspective is the first step in creating a practical plan.  So here are the facts!
 
Resolution Stats

• Those that make resolutions are ten times more likely to change their behavior than people who do not—so make one!
  
  
• Resolutions that incorporate a new behavior are more likely to succeed than those which avoid an old behavior.
  
  
• People who choose one resolution are more likely to succeed than those who set multiple goals.
  
  
• Those who anticipate and plan for obstacles are more likely to succeed than those who do not.

 
Approaches

• For built-in motivation, align your resolutions with your values. For example, if your resolution is to sleep more, tie your resolution to the pitfalls of excessive social media consumption or TV use. If you watch less TV and spend less time scrolling at night, you are more likely to hit the hay earlier.
  
  
• There is no reason to swallow the elephant whole. Take smaller bites! In other words, break the resolution down into smaller resolutions. For example, one study found that those who resolved to volunteer 200 hours a year were more likely to reach and even exceed that goal if they broke down that resolution into volunteering 4 hours a week, instead.
  
  
• Tie the resolution to a reward!  The adage of “no pain, no gain” is a falsehood.  Human nature dictates that we are more likely to do something that brings us joy than sorrow. So pair a less favored activity with something that brings a smile.  For example, if you resolve to hit the gym 5 days a week, plan a small donation to your favorite charity WHEN (not if)  you successfully hit your goal.
  
  
• On the flip side, tie a “punishment” to a backslide, so it’s associated with pain. Using the example above, if you miss your weekly gym goal, make a donation to a charity not aligned with your belief system—ouch!
  
  
• Hold yourself accountable by building your support network!  Make resolution setting a group activity with one friend or many (can be virtual). You will be less likely to backslide if you know you are there to support others. Camaraderie is a great motivator!
  
  
• Think like a Marine – Improvise, Adapt and Overcome. Life rarely goes as planned, so pivot when challenged, as there is usually more than one path to victory. Using our gym example, what happens if your car is in the shop, and you cannot drive to the gym? Go walking for the time you would spend at the gym so that you’re still getting exercise, just in a different environment.
  
  
• Moreover, if you journal your progress, you will be able to reflect upon and learn from past successes or challenges.
  
  
• Seek professional guidance-there is no harm in hiring a coach! Consider the cost your financial accountability partner!

 
And, of course, I will use this opportunity to remind you of the Motivated Mondays program available to you via my partnership with Concierge Choice Physicians. If you were enrolled last year, you will be auto enrolled for 2025. If you are a new member or have not previously participated in Motivated Mondays, then you’ll soon receive an email inviting you to participate.
 
Good luck and, as always, feel free to comment below or reach out directly with any personal questions or concerns.

​With Thanksgiving approaching, our hearts are filled with immense gratitude and warmth. We want to take a moment to express just how thankful we are for each and every one of our concierge members. Your decision to join our concierge program and prioritize your health is something we deeply appreciate.
 
In an era where healthcare often feels like a series of rushed appointments and impersonal interactions, we knew we needed to forge a new approach to patient support and enhance the service we provide. Our concierge program became the solution, helping us build a more personalized patient environment and fostering a mutual dedication to improving health outcomes.
 
This journey has been incredibly rewarding for us, not just as healthcare providers, but as partners in your health. We’ve seen firsthand the positive changes and improvements that come from a more engaged and proactive approach to healthcare. It’s been inspiring to witness your progress and to work with you to maintain and improve your health over time, with greater continuity and understanding.
 
Together, we are not just managing health. We are thriving.
 
The opportunity to make a real difference in people’s lives is truly fulfilling, and we thank you for making that possible.
 
Practicing Gratitude for Your Health
 
“The heart that gives thanks is a happy one, for we cannot feel thankful and unhappy at the same time.” -Douglas Wood
 
In the spirit of Thanksgiving, we encourage you to identify all that you are thankful for and to develop a regular practice of gratitude. Gratitude is like a personal trainer for your mindset—just a few reps a day can boost your mood and strengthen your outlook!
 
Your practice doesn’t have to be hokey or complicated. It can be as simple as writing one line in a journal each day or keeping a note in your phone to share something that happened that day for which you are grateful.
 
For example, you can start by writing a note that states, “Good things always happen to me.” Then, throughout the day, look for positive things that occur and write them down.
 
When we regularly acknowledge and appreciate the positive aspects of our lives, we shift our focus away from stress and negativity, which can help lower levels of the stress hormone, cortisol. This shift not only improves emotional resilience but also supports better mental health by reducing symptoms of depression and anxiety. Furthermore, gratitude can enhance physical health by encouraging healthier lifestyle choices, such as improved sleep quality and more consistent exercise, which contribute to a stronger immune system and better cardiovascular health.
 
A Final Note
 
Thank you once again for reminding us why we chose this profession, and for being major contributors to our gratitude practice each day.
 
As we move forward, we remain dedicated to ensuring your membership exceeds your expectations. Your feedback and experiences are invaluable, and we encourage you to share them with us so that we can continue to improve and adapt to better serve your needs.
 
We wish you and your loved ones a wonderful Thanksgiving.

As the primary fat in the Mediterranean Diet, olive oil has been studied extensively for its health-promoting benefits. Regular consumption, defined as 1.5 - 4 tablespoons a day, has been observed to reduce the risk of total and cause-specific mortality. But not all olive oils are created the same. Thus, a study comparing the health benefits of EVOO to OO recently caught our eye.
 
Extra virgin olive oil (EVOO) is distinguished from olive oil (OO) by the extraction process. OO is produced via chemical extraction and processing, whereas EVOO is produced by crushing the olive thereby retaining and preserving the phenol content of the fruit (yes, olives are classified as a fruit!). It is the phenol content of the EVOO which is thought to impart the health-promoting benefits, not the fatty acid content (aka MUFAs).
 
The study participants
 
In the study comparing the two, 12,161 participants were assessed for variables such as sociodemographic factors, self-reported health conditions and medications, and diet, specifically their adherence to the Mediterranean Diet and type of olive oil consumed each day. Participants were followed for a mean 10.7 years.
 
The findings
 
Researchers found the risk of all-cause mortality and cardiovascular mortality was lower in those with the highest reported daily EVOO consumption, and this association was not replicated in those reporting OO consumption.
 
When total daily olive oil consumption was combined (i.e. adding together both OO and EVOO consumption), the risk of mortality was also reduced—but not as low for those with higher daily EVOO consumption (not combined with OO).
 
Interestingly, deeper reductions in all-cause mortality were noted in those reporting both higher EVOO consumption and physical activity, indicating a synergistic effect between the two, the mechanism of action for which is not fully understood.
 
How do we interpret this study?
 
We can start by noting it is not a randomized clinical trial (RCT). Instead, this study is strictly observational, meaning we can observe the results, but we cannot draw conclusions. Had the researchers randomly assigned half the participants to EVOO consumption and half to OO, we would have more conclusive results. So, we dug a little more into the research in PubMed. A review article of 34 studies in which EVOO was compared to other fats found EVOO superior in a variety of biomarkers and health outcomes—this was again believed to be imparted by the phenol content.
 
Where does this leave us?
 
It would seem that EVOO might have benefits above and beyond that of other fats, including plain old olive oil. Specifically, a serving of 2 tablespoons of EVOO a day appears to be beneficial. It’s important to also remember the statistically observed synergy between EVOO and physical activity—so keep moving!
 
Buying EVOO
 
When purchasing, remember to read the label to make sure it says EXTRA VIRGIN olive oil and if you can find it unfiltered that’s even better! Check the expiration date, as phenol content wanes with time. Pesticide residue studies of European olive oils do not indicate contamination above threshold levels, thus if purchasing European olive oils, it may not be important to choose an organic version. And be sure to keep your EVOO away from heat (not next to or above the stove or oven) and away from light.
 
There exists both controversy and contradictory research results regarding the degradation of phenols with cooking. It seems prudent to save the pricey EVOO variety for salad dressings and for finishing/topping soups and vegetables for flavor and mouthfeel.
 
If you have questions about your specific EVOO recommendations in relation to your personal health, please reach out for a chat. You may also feel free to share this blog with your friends and family.
 
 
 

SOURCES:
 
Ambra R, Lucchetti S, Pastore G. A Review of the Effects of Olive Oil-Cooking on Phenolic Compounds. Molecules. 2022 Jan 20;27(3):661. doi: 10.3390/molecules27030661. PMID: 35163926; PMCID: PMC8838846.
 
Donat-Vargas, C., Lopez-Garcia, E., Banegas, J.R. et al. Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort. Eur J Clin Nutr 77, 226–234 (2023). https://doi.org/10.1038/s41430-022-01221-3
 
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866.
 
Flynn MM, Tierney A, Itsiopoulos C. Is Extra Virgin Olive Oil the Critical Ingredient Driving the Health Benefits of a Mediterranean Diet? A Narrative Review. Nutrients. 2023 Jun 27;15(13):2916. doi: 10.3390/nu15132916. PMID: 37447242; PMCID: PMC10346407.
 
Gaforio JJ, Visioli F, Alarcón-de-la-Lastra C, Castañer O, Delgado-Rodríguez M, Fitó M, Hernández AF, Huertas JR, Martínez-González MA, Menendez JA, Osada J, Papadaki A, Parrón T, Pereira JE, Rosillo MA, Sánchez-Quesada C, Schwingshackl L, Toledo E, Tsatsakis AM. Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients. 2019 Sep 1;11(9):2039. doi: 10.3390/nu11092039. PMID: 31480506; PMCID: PMC6770785.
 
Guasch-Ferré M, Li Y, Willett WC, Sun Q, Sampson L, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Hu FB. Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults. J Am Coll Cardiol. 2022 Jan 18;79(2):101-112. doi: 10.1016/j.jacc.2021.10.041. PMID: 35027106; PMCID: PMC8851878.
 
Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean die t, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004 Oct;80(4):1012-8. doi: 10.1093/ajcn/80.4.1012. Erratum in: Am J Clin Nutr. 2005 May;81(5):1181. PMID: 15447913.

Background
 
Over the past 20 years, medicine has made incredible advances, and those of us in practice can attest to the incredible ways in which we can extend the life of our patients, beyond what we could have ever anticipated in medical school. But with longer lives comes the spectrum of cognitive decline and neurodegenerative diseases, namely dementia—an umbrella term for a number of neurodegenerative diseases, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In early June, a rare, albeit small (n=51), randomized clinical trial was published in Alzheimer’s Research & Therapy that determined the effectiveness of lifestyle changes on the progression of MCI and AD, and I am inspired by the findings.
 
It is estimated that 40% of global dementia cases are related to 12 modifiable risk factors. (Many of which also impact heart disease. Remember, what affects the heart affects the brain!). Several previous, small studies have shown the effectiveness of intensive lifestyle changes on the progression of MCI and early AD, but none had a control group nor were they randomized. That is what sets this study apart.
 
What did the study address?
 
Over the course of 20 weeks, participants and their spouses or study partners adapted the following lifestyle changes:

• A diet of minimally processed, plant-based, whole foods (no Beyond Meat here—remember, some plant-based foods can still be highly processed!), low in added sugar, refined carbs and harmful fats. Calories were unrestricted.
  
  
• Taking select* supplements. *Please consult me before divesting yourself of hard-earned money prior to taking something that may not be appropriate for your biochemistry or that interacts with medications prescribed for you.
  
  
• Moderate daily exercise, such as 30 minutes of walking or other cardio exercise, and mild strength training three times per week. Specific exercise guidelines were based on age and fitness level.
  
  
• Stress management via an hour of meditation, gentle yoga or breathwork daily.
  
  
• Support groups for participants and their spouses or study partners, 3 days a week.

 
In the study, all interventions were supported via 4-hour Zoom sessions three times a week for the participant and spouse or study partner.
 
The study aimed to determine if:
 

• these specific multi-modal intensive lifestyle interventions could affect MCI or cognitive function in cases of early dementia
  
  
• there was a correlation between the degree in lifestyle changes and the change in cognitive function
  
  
• the degree in lifestyle change affected the degree of biomarkers

 
What did they find?
 

• There were significant differences between the study group and control with regard to all four cognition and function tests, either by improvement over the control group, or less deterioration than the control group.
  
  
• There was significant correlation between the degree of lifestyle change (how closely participants adhered to the protocol, i.e. a dose response) and clinically relevant biomarkers for AD/MCI and cognition and function tests.
  
  
• Only the study group experienced positive microbiome changes.

 
Interestingly, in one of the biomarkers, the degree of change was similar to that affected by the clinical trials for new intravenous medications!
 
My takeaway
 
This study provides yet another reason for us to eat real food, move more, breathe better and connect more—all of which have multiple benefits to our health and wellbeing.
 
Let’s continue to work together on the path toward better health and wellness. Don’t forget, my concierge members also have access to the Concierge Choice Physicians Motivated Mondays program which provides a year’s worth of mini-resolutions focused on the prevention of cognitive decline through lifestyle changes. To sign up for the weekly emails, please contact CCP’s Erica Rios: [email protected]
 
Click here to visit past editions of Motivated Mondays.
 
Study source:
Ornish, D., Madison, C., Kivipelto, M. et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122 (2024). https://doi.org/10.1186/s13195-024-01482-z

American dietary guidelines for cholesterol limits were established in the 1960s and, in the three decades that followed, an entire food industry was born as low-fat food products dominated grocery store shelves. Americans became fat-obsessed, eschewing nutrient-dense foods high in cholesterol, such as eggs, shrimp and cheese. Unfortunately, though, the daily cholesterol guidelines were not based on data but on consensus; and in 2015 dietary cholesterol guidelines were eliminated. But many people remain afraid of fatty foods with the idea that dietary cholesterol increases serum cholesterol (e.g. type of body fat or lipid, representing the amount of total cholesterol in our blood) and thus, they continue to avoid nutrient-rich, high cholesterol foods. Today, let’s settle this issue once and for all.
 
For most people, consuming foods high in cholesterol does not lead to an increase in serum cholesterol.
 
Why is this? Isn’t it intuitive to think that what is consumed would be reflected in a blood test? The human body is remarkable in its pursuit of homeostasis. Meaning, physiologically speaking, the body seeks to keep all variables in balance.
 
Cholesterol serves a great many functions in the body: it is the foundation for the production of steroid hormones and Vitamin D, it is a critical component of cell membranes (the outer shell) and it is involved in the creation of bile, which helps digest fat. You might be surprised to know your brain holds the greatest concentration of cholesterol in your body!
 
Plainly stated, the body needs cholesterol and uses an enzyme to make cholesterol—it isn’t purely sourced from the diet. When dietary cholesterol is high, this enzyme is suppressed, maintaining homeostasis. Like I said—the human body is remarkable!
 
The notable exceptions to this rule are diabetics and cholesterol hyper-responders—which make up an estimated 10-30% of the U.S. population. The information above does not apply to these individuals, who should continue to adhere to physician orders regarding dietary cholesterol.
 
We can further this discussion in the context of your specific health history at your next annual concierge exam. Please be sure to contact my office if your exam is not already on the schedule.

A reporter from MedCentral recently reached out to Dr. Anderson Halabuk to discuss why her practice transitioned to concierge medicine and how this style benefits both patients and physicians.

Some key quotes from the article:

“We decided to make the move to a concierge practice because we felt that we needed more time with patients in order to use our clinical skills and acumen to their full potential,” said Elizabeth Anderson Halabuk, MD, an internist with Paramount Care Physicians, a small group practice in Fairfax, VA.

“We wanted flexibility in scheduling that would allow us to meet the patients’ needs with things like home visits and extended office appointments,” Dr. Halabuk said. “We wanted practice autonomy different from today’s environment where physicians are more frequently viewed as expendable cogs in a corporate machine.”

Read the complete article in MedCentral by clicking here!

A Scary Look at Data Misrepresentation in Nutritional Science
 
As consumers of information, we are barraged daily with conflicting information, nowhere is this more evident than in nutrition research where the information seems to change from week to week. Why is this the case?
 
We can start with how people eat: are the people in the fake headline above just eating ice cream? Likely they are eating the usual ice cream companions like cones, sprinkles, whipped cream and hot fudge. People follow patterns of eating behavior. It is virtually impossible to take a reductionist view of what people eat and limit it to a single food or nutrient.
 
Then, we can look at how the data is collected. Most often, nutrition research asks people to recall what they ate over a given period of time in the past. Do you recall how much ice cream you ate last summer? Last month? Last week? Was it soft serve or hard? What flavor was it? Was it dairy or dairy-free? Did you add toppings? Was it served in a cup or a cone? What type of cone? …Just how accurate do you think the information collected is?
 
Next, we can examine the participants in the study. How many participants are needed before one can make the observation in our fake headline? 3? 30? 300? What were the demographics of the participants? Was it a diverse group of people (age, ethnicity, socioeconomic status, geographical location, etc.)? If all the participants in our fake headline were 80-year-old Caucasian females living in the Bronx, then it would be nonsensical to the extrapolate trends from this data to anyone other than 80-year-old Caucasian females living in the Bronx.
 
Then, ask yourself, is observation causation? The answer is no. That is a fundamental issue with study design. Much nutrition research is observational. We observe “associations” between variables, but we cannot control unforeseen variables. Let’s take our fake headline: What if the participants in the study ate their ice cream on a sugar cone? How do we know the shark bite wasn't due to the cone and not the ice cream at all? By not measuring the sugar cone as a variable we have made a false association between ice cream and shark attacks.
 
In addition, it is rare in nutrition research to see a “gold standard” randomized control trial (RCT) in nutrition whereby people are randomly assigned to an intervention and a control group. In our fake headline, one group would eat ice cream, one group would not (the control group) but they would both go swimming at the beach. Then we would be able to draw comparisons between the two groups about a shark attack.
 
Sometimes the research comes up flat and nothing of interest is found. These negative results are important! They add to the body of knowledge on a subject. However, negative results aren’t highly sought after and are rarely published. This is referred to as publication bias. What if 10 previous studies found no association between eating ice cream and shark attacks, but because this was a positive result it was the only one published? The body of knowledge suffers as does the information disseminated to the public.
 
It is sad but true, that much research is funded by industries. The nut industry funds much of the research on nuts. The cacao industry funds much of the research on chocolate, and so on. Again, positive findings are more likely to be published, negative findings are repressed. Unfortunately, these positive findings are then used by the government to make nutrition guidelines and recommendations.
 
Researchers are human, they have egos and pride. The careers of scientists are built on their hypotheses, and, like industries, they have a vested interest in positive findings. Disappointingly, research is replete with insidious behavior meant to protect and promote careers.
 
Finally, there is the media; their job is to promote ratings. They are not obligated to properly vet the research (study design, participants, funding, etc.). Additionally, the media fails to properly explain the implication behind the headline (i.e. what does this mean to you?)
 
Where does this leave us, the consumers of information who want to make smart nutrition choices? Do we throw the baby out with the bathwater? Throw our hands up and eat Oreos for breakfast? Pringles for lunch? Not exactly. However, we do have a responsibility to take a look behind the headlines before making dietary decisions that impact our health. Sometimes that may mean getting the original research and using the above to decide if the study is valid for us.
 
Feel free to email Concierge Choice Physicians ([email protected]) with your questions or even send a headline or study to us, and we will be happy to answer your questions.