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Introduction

The diet industry is huge. And mostly it doesn’t work. Why is this? Well, it’s actually quite straightforward. People are set up for failure by an industry that thrives on people failing and coming back. They don’t really care whether their clients succeed or not, so long as they can profit from their efforts. I have a huge ethical problem with this, and I think any service should be covered by a guarantee. Instead, people blame themselves for the failure of commercial weight-loss programs, and the industry doesn’t take responsibility for their failures. In this entry what we’re going to look at is the peer-review published evidence for the Flexi diet, and I’ll go over whether or not it is sufficient to guide clinical practise.

The first thing I wish to ask is – how would you define success? Is yo-yo dieting/weight-gain a success? Is short term weight loss a success? Take a moment to consider these questions, they’ll be addressed as we proceed.

What is the “Flexi diet”?

The Flexi diet is “backed by CSIRO research” (CSIRO, 2016). When I first heard about this, I thought the CSIRO had designed and published a diet in the form of a book… I think I first heard it on the radio, and the media was reporting that the CSIRO launched an intermittent fasting diet for weight loss (Connery, 2017; Powley, 2017; SBS, 2017). In fact the CSIRO website also makes this claim. In reality they “co-developed” it, but it’s questionable as to exactly what they “developed” and wish to take credit for.

Despite repeated claims of this on the Impromy website they do not provide the citation to the paper itself. Even more bizarrely, neither do the CSIRO on most of their pages on Flexi including their blog announcement! I’ll refer to the research paper as the “CSIRO paper”, here is the paper’s citation,with a link to it so you can read in full if you want:

Brindal, E., Hendrie, G. A., Taylor, P., Freyne, J., & Noakes, M. (2016). Cohort analysis of a 24-week randomized controlled trial to assess the efficacy of a novel, partial meal replacement program targeting weight loss and risk factor reduction in overweight/obese adults. Nutrients, 8(5), 265. doi:10.3390/nu8050265

In a nutshell, the Flexi diet is a ~30% energy deficient diet that uses commercial meal replacement (MR) shakes and one high-protein meal six days a week. One day a week is a free day. The so-called “fasting days” are simply further energy restricted compared to the other energy restricted days. A more detailed description of the diet is in the following sections.

Description of the study

The study took place over a period of 24 weeks, and predominantly considered whether a program incorporating commercial meal replacement shakes, controlled diet, iPhone app, and ongoing dietary support would support weight loss for participants. In other words they studied a proposed commercial product, which eventually became known as the Flexi diet by Impromy.

The paper begins by informing the reader that lab data and real-world data are often very different, citing that meal replacement and other weight management strategies have been promising in trials, but that their efficiency in the real-world drops significantly. As noted in the paper, in just about all programs available through pharmacies weight-loss become negligible after the first 12 months. These issues will be discussed later in this essay.

The CSIRO study involved observing two intervention groups. All their participants were randomly assigned to one of two intervention groups, with both receiving the same intervention with the exception that one group was given a more basic iPhone app than the other. There was no control group. The study environment was a CSIRO lab and not a pharmacy. In total there were 146 participants, 104 females and 42 males. 27 participants were overweight, the remainder were obese (BMI 30+). The intervention period was 24 weeks, with 12 weeks of “active intervention”. “Active intervention” involved face-to-face meetings with non-nutrition trained consultants who had been given program-specific training from dieticians involved in designing the program. Participant-reported data was relied on primarily for care, and their weight was measured regularly by the consultants. They were also asked to provide feedback on their satisfaction of the meal replacement shakes throughout the program, as well as questions from the consultants that included “what has been the most helpful aspect of the program” (which was asked in week 12). Many of the feedback questions were targeted towards improving the prototype program rather than studying the program objectively per se. Meal replacement sachets were free for the first 4 weeks, and then provided at a nominal cost of $1 each for the remainder of the study.

The findings of the study were modest. 84 participants (58%) completed the study. Of those who completed, 72 offered 94 comments on the meal replacement shake, of those 57 were identified as positive comments, and 16 as negative. 33.5% of all participants lost weight over the study period. All significant weight loss occurred by week 12, with no significant change in weight between weeks 12 and 24.

The CSIRO paper cites Gordon et al. (2011) a systematic literature review which found that pharmacy based weight-loss intervention programs only achieve modest results. The Gordon paper found such methods only achieved an average weight-loss of 0.6-5.3 kg in the first 3 months, 0.5-5.6 in the first 6 months, and just 1.1-4.1 kg over the first 12 months. It’s important to mention to you the design of their study as it is not addressed in the CSIRO paper: this is not a review of all pharmacy weight loss products, rather it is a review of peer-review published “studies” of such products. Only 10 studies met inclusion criteria for a systematic review, and the paper’s authors report that this likely represents a strong bias towards meaningful results. That is many other programs that were available were either: not studied at all, studies undertaken went unpublished, published studies did not meet the inclusion criteria (eg did not take place in a pharmacy setting was the main reason for published papers not being included), or the focus of the study wasn’t weight loss. All 10 of the studies included were multi-factor interventions that included dietary and physical activity components. Finally, the authors noted there was a strong risk of bias in all of the studies which the CSIRO does not mention in its citation of this paper.

Discussion

The paper’s premise that pharmacy-delivered weight loss intervention programs are advantageous, is highly questionable to say the least. Any positive findings from the cited Gordon paper are not relevant to this study for several reasons including that: all trials reviewed in it included a physical activity component, and all trials were conducted in actual pharmacies and not research labs. Literature consistently shows that interventions that combine diet and exercise provide patients greater weight loss (Franz et al., 2007; Johns et al., 2014). Furthermore it represents but a small fraction of the weight management programs available in pharmacies, many of which are quackery! The Gordon paper is their best evidence from the literature for delivering weight-loss programs through the pharmacy, yet read below what the paper actually says in its conclusion:

“This systematic review identified few high-quality studies on weight management in community pharmacy. Currently, there is insufficient evidence for the effectiveness and cost-effectiveness of community pharmacy-based weight management initiatives to support investment in their provision.” (Gordon et al., 2011).

CSIRO authors correctly point out that successful lab studies generally provide participants with ongoing multidisciplinary professional support at no cost for the duration of their clinical trials. This should not surprise us! In fact, it completely discredits their hypothesis that any commercial program will succeed. Finding effective low-cost long-term solutions continues to be evasive. People who wish to lose weight will be far more successful by working directly with a dietician or a registered nutritionist on a tailored program: no commercial program has been shown to even approach an equal degree of success. In fact, most of the commercial programs are not designed and targeted for people who are obese, but rather people who are only slightly overweight. Cost is a big factor: clinical trials as mentioned are generally free to participate in. Commercial programs are expensive and need to fit into people’s budgets. Working directly with a registered nutritionist or a dietician is also expensive, however they can provide their clients suitable and realistic diet plans instead of generic plans produced for mass-consumption that don’t fit most overweight or obese clients. This begs the question: why is the premise of the CSIRO study to deliver a program through pharmacies instead of through dieticians?

Some of the claims in the paper are dubious to say the least:

“For longer term success on a program such as this, providing individuals with the flexibility to transition through to fewer meal replacements as their weight loss progresses or as fatigue with the shakes sets in becomes an important element for success. Pharmacy staff are ideally placed to assist the community with weight loss as they are readily accessible and can be available to consultant with individual’s on an as needs basis, potentially quicker that seeking advice from other health professionals. However, appropriate training and tools are required to ensure pharmacy staff delivering the program (not qualified in nutrition) have adequate support to facilitate such a transition through a weight loss program.” (Brindal et al., 2016)

These findings in particular are concerning as they did not recruit pharmacy staff. Nor did they do any research into determining whether people would actually approach pharmacists for dietary advice and assistance with weight management. Nor did they attempt to find out if this is something pharmacists would do instead of say directing a client to a registered nutritionist. Why should pharmacists who are health professionals administer a commercial weight loss program that is not supported by evidence? Even Impromy’s own forum shows the flaw in this logic: “Just opened up the program. … I’m thinking this appears to be more a money making venture, rather than a supported diet. … The Pharmacy wasn’t much help at all.” (C. Kendall, Impromy discussion forum). The last question from that participant on the online forum has gone unanswered for two straight weeks! I don’t imagine the pharmacy will help either – is this really the realistic supportive environment envisioned in the study?

I’m going to show you something the diet industry doesn’t want you to see:

weight-loss-interventions

Figure: Franz et al. 2007.

The figure is from a high quality literature review. As you can see, none of these interventions can be shown to work long-term except for maintaining some of the weight loss experienced in the first 3-6 months. The only thing in that review that kept going was an appetite suppressant (Sibutramine) that’s since been banned by the TGA (also the FDA in the US) in 2010 due to serious adverse side effects. This is why the diet industry is so big – nothing works long-term. Weight-loss doesn’t continue beyond 6 months. Only half the weight lost is maintained to two years, and often all the weight is regained over 5 years. I guess that’s fine if you just want to lose 8kg in 6 months and don’t mind putting back on 4kg. But – keep in mind that most participants at least in this study are obese. A person who is 5′ and slightly obese needs to loose a minimum of 12kg to get to a healthy weight. A person who is 6′ needs to lose 18kg. And have you ever noticed how there are dozens of “12 week” weight-loss products? Now you know why. It’s not because they’re great products, it’s because people won’t notice they don’t work if they stop after 12 weeks!

There are several problems with the CSIRO study. Firstly it’s far too small to generalise data from, and it doesn’t have any follow-up data after six months. There was no control group – therefore this is not an RCT but just an observational study. It’s not in the commercial interests of Impromy to commission an RCT (randomised control trial) as it would likely show their intervention to be ineffective as is the case with the Ahrens paper reviewed by Gordon et al 2011 (and the only RCT in their review). An academic description of it reveals there was no statistically significant difference in the weight loss outcomes compared to the control group that were given a traditional energy-restricted diet (Academy of Nutrition and Dietetics, 2006). The CSIRO study environment was not a pharmacy, and the trial was not delivered by pharmacists. Participant-reported data was relied on, when we know that is problematic. And the “satisfaction feedback” is unlikely to have produced meaningful feedback: people participating in studies are often willing to say more positive things about their experience then real-world clients or customers would.

Conclusions

Overall this is a low quality study that is not suitable to guide clinical practise. And that’s putting it as nicely as I can. As mentioned there are many problems with this study, it is low quality by design. It’s not really designed to find best practise, it’s just designed to produce a result. They lack a control group which is absolutely necessary to make any clinical guidelines from. There is no doubt at all that expecting participants to get ongoing support from pharmacies is wholly unrealistic.

The program produces mediocre results. Some media incorrectly reported that participants lost an average of 11kg (I have no idea why, perhaps they extrapolated the finds from 24 weeks to 12 months or something), but in reality the amount of weight lost was nothing special and well below the amount required to make the participants healthy. In other words, they’re selling a diet that fails to achieve a healthy weight even for participants that were only slightly obese. A successful program should at the very least reduce the weight of obese category one clients (BMI 30-35) to a healthy weight. There is no suggestion in the paper that any of their 117 obese clients achieved a healthy weight. Which is not surprising of course in only a 24-week period, but nor is there any indication that their clients were on track to do so: in fact the paper states that weight-loss ceased after the first 12 weeks!

The CSIRO are doing themselves no favours by promoting this “weight-loss diet”.

Recommendations

What should you do if you wish to lose weight? My suggested starting point is to learn the Consumer Healthy Eating Guidelines (that’s the AGTHE in Australia, MyPlate in the US, etc). Those guidelines are freely available and evidence-based, and you can read the literature behind them. Unfortunately most consumers ignore them. If you’re OK with a more restrictive diet you can also consider using DASH or the Mediterranean diet guidelines. None of those are weight-loss diets of course, but they are all health-promoting and provide a solid foundation for learning portion sizes and the right balance between the food groups. Meal replacement diets suffer the problem that they don’t re-educate people into healthy eating, and people often find themselves lost when working out how to eat once the MRs are gone.

A good starting point would be elimination of “discretionary foods”, and a strong focus on eating enough fresh fruit and vegetables (most people don’t eat enough veggies). If you can work that out, then weight-loss is as simple as creating a moderate energy deficiency with of course a long-term commitment to substantially altering one’s lifestyle.

Physical activity also needs to play an important role. When it comes to this there are many options available to people – sports, gyms, swimming, cycling, jogging, walking, altering the workplace environment, dancing, martial arts classes, etc. People should seek solutions that work for them.

References:

(Academic)

Academy of Nutrition and Dietetics. 2006. AWM: Meal Replacements (2006). Evidence Analysis Library (if page doesn’t load clear cookies)

Brindal, E., Hendrie, G. A., Taylor, P., Freyne, J., & Noakes, M. (2016). Cohort analysis of a 24-week randomized controlled trial to assess the efficacy of a novel, partial meal replacement program targeting weight loss and risk factor reduction in overweight/obese adults. Nutrients, 8(5), 265. doi:10.3390/nu8050265

Franz, M. J., VanWormer, J. J., Crain, A. L., Boucher, J. L., Histon, T., Caplan, W., … & Pronk, N. P. (2007). Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Journal of the American Dietetic Association, 107(10), 1755-1767. doi:10.1016/j.jada.2007.07.017

Gordon, J., Watson, M., & Avenell, A. (2011). Lightening the load? A systematic review of community pharmacy‐based weight management interventions. Obesity reviews, 12(11), 897-911. doi:10.1111/j.1467-789X.2011.00913.x

Johns, D. J., Hartmann-Boyce, J., Jebb, S. A., Aveyard, P., & Group, B. W. M. R. (2014). Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics, 114(10), 1557-1568. doi:10.1016/j.jand.2014.07.005

(Non-Academic)

Connery, G. (2017). CSIRO backs fasting and meal replacement shakes in new ‘Flexi’ Diet. Fairfax News

CSIRO. (2016). Impromy™ Health and Weight Management Program. CSIRO website

Powley, K. (2017). How does the CSIRO’s new flexi diet rate? News Corp (subscription) / Mirror

SBS. (2017). Researchers examine time-restricted eating. SBS News

Tufvesson, A. (2012). The CSIRO’s Flexi diet weighs in as the fast way to avoid fasting. The New Daily


1

RIP Carrie! 21-10-1956 – 27-12-2016.

SW The Force Awakens Crawl

What a difference a year makes! Feel free to read my original review first, this is more of a supplement to that post than anything else. As usual, some spoilers are ahead.

Why is the film bad?

I’ve had a lot of discussions with people over the past year, many of whom feel I was too tough with my assessment of the movie. In some ways though I was not tough enough. Yes there are no end to people on the internet who see themselves as film critics and they often have different criteria to what I do when I evaluate at a film. Another thing that people have done is to dismiss my evaluation because “it has great reviews by others”. That may be true, but often these “others” are reviewers for newspapers that are no more qualified than I am to review films – and many of them do it because they get early access to cinema films, and free review discs of movies. I have even seen reviewers in the past give the same film different reviews each time it re-airs on television!

So let’s first discuss what TFA is and isn’t. TFA is a direct sequel to Return of the Jedi. What it isn’t is a remake of Star Wars (aka “A New Hope”). Star Wars movies combine Action, Adventure, Drama, and finally Sci-Fi. A lot of people make the mistake of thinking of movie genres as singular, when in fact a good movie often draws from a variety of genre-specific motifs. George Lucas usually describes the SW films as “space dramas” or “space soap operas”. As a film it should slot into the Star Wars universe in a way that incorporates it well into the existing film canon, and also works well as its own film.

TFA does work well as its own movie. But how many other wholly derivative sequels could we say the same for? How many remakes are good but inferior to their predecessor? Some examples here may help. The Empire Strikes back is one of the greatest movie sequels ever made, it brings a fresh and entertaining story that expands upon the film’s universe, and it has its own style flair and creativity. Let Me In is a fantastic example of a remake that is better than the original. It also shows how less is more: by throwing out the subplot involving the adults, and focusing the film’s attention squarely on the main plot. But it’s rare, most remakes fall well short of their potential: Robocop, Red Drragon, King Kong, The Hills Have Eyes, Halloween, The Texas Chain Saw Massacre, and The Three Musketeers just to name a few. If we evaluated TFA as a remake then it would fare better than as a sequel to ROTJ, but it still wouldn’t be a great movie either as it overcomplicates the plot with sub-plots that go nowhere, and never develops the story as well as Star Wars.

In the original Star Wars Trilogy, most people would agree that Return of the Jedi is the weakest of the films. One of the reasons why is recycling the Death Star sub-plot. The film’s main story is about defeating the Empire and reconciling Anakin and Luke. And on this part it does really well. TFA on the other hand is a direct sequel to ROTJ and recycles the Death Star sub-plot yet again! The main plot of TFA is to find Luke, and when they do the film ends.

In summary, the film is bad because it is a sequel to ROTJ that repeats the same sub-plot wholesale, as well as repeating the main plot of Star Wars wholesale as well. It doesn’t have its own creative flair, it doesn’t bring us new and beautifully designed planets such as Naboo, and it doesn’t understand the Star Wars genre as will be discussed in the next section.

What is Star Wars?

Star Wars is a 1977 film. Most kids today haven’t even seen the original film, in no small part due to the fact that only the revised 1997 Special Edition has been available on home video. But in addition to this, Star Wars in an Epic. It’s an original story from which other stories can be spawned. Each of the OT and PT are standard three-act movies. And they have their own genre in a way that combines the aforementioned genres of Action, Adventure, Drama, and Sci-Fi.

I don’t think a Star Wars movie needs to be a three act film, that’s more a description of the way they conform more than anything else. Most people today do not understand the three act film structure anyway, and can’t recognise when it does and doesn’t exist in a film. Many of the philosophies adhered to in the three act structure though still apply to all films. For example, your characters should experience luck or coincidences early in the movie, not later in the movie. You should make sure your audience is engaged and interested in the film’s plot early on. You need to define your reality, especially in a Sci-Fi film, early because to do it later leads to breaking the suspension of disbelief. For example, in TFA we see that Kylo Ren can stop a blaster bolt with the force – something we certainly wouldn’t accept late in the movie.

Problems with physics?

If we think of it just purely in these clinical terms we can also spot problems. The Starkiller base is not revealed to us until the second act of the movie. Now true, in the original film we don’t see the Death Star in all its glory until the second act either, but we are exposed to ever increasingly large space crafts as it is. In TFA we are instantly supposed to believe that a small group calling themselves the first order has gouged out a giant gash more than visible from space to construct their weapon? I think that’s where we loose the suspension of disbelief in this movie. With Coruscant we can at least believe that urbanisation expanded over time to cover the entire planet, but with Starkiller we have a purpose-built facility that can literally fit about six Death Stars into its gauge like marbles.

Another issues is when we see it suck in the mass of a nearby star with people still on-board the planet! Not to mention just look how fucking close they are to the star:

Starkiller

This is the case with a lot of sci-fi movies. I get to this point where I say “enough, this is fucking bullshit”. Note that just one scene earlier the sun appeared to be “normal” in the sky, yet if they were this close to it, besides the fact the planet would be engulfed anyway, it would fill nearly the whole god-damned sky! And this occurs way too late into the movie to suspend disbelief. To put it in perspective for you, if our Sun was the same size as the sun in the image above, the distance between us and the sun is about 130x longer than the distance shown. And the earth would be just two pixels across! And besides, the sun and stars are white, not yellow.

Yes Star Wars breaks some laws of physics, but they have to engage the audience first. Not doing it that way leads to the suspension of disbelief being broken. Holograms, Star Destroyers, Artificial Gravity, Landspeeders, Lightsabers and the Force are all introduced in the first act of Star Wars.

Conclusion

The movie is terrible. Yes people will enjoy it, especially if they never saw the originals and are unfamiliar with their story. But as a sequel and a Star Wars movie it fails dismally. In other Star Wars films, planets have their own distinct character – but in this film they do not. I thought we were on Tatooine when I saw the movie until I heard them say “Jakku”! That’s inexcusable when we’re put on a desert planet with Tatooine’s distinctive moisture vapourators.

So, before we begin here is a hopelessly low quality copy of the episode. As it is copyrighted, I will have to remove it if asked (and I will probably remove it anyway quite soon), however I am aware that this show is no longer being promoted or marketed, and there is no way to obtain a “legitimate viewing” at this time, and that is my fair-use rational for supplying it:


Video © Peteski Productions, 2016. Original US air-date: 18 Nov 2016.

What’s the problem?

Well, without reading other people’s comments on this, I see a number of huge ethical problems with this episode. Firstly – and this is not the only time this has happened on the Dr. Phil show – it seems very obvious that Ms Duvall has not given informed consent to be filmed, broadcast, and ogled at. Secondly, Phillip C. McGraw introduced her in a completely offensive and sexist way. His introduction was this:

“The former starlet famous for her quirky and waif-like appearance is unrecognizable.” -Phillip C McGraw, 2016.

That sounds an awful lot like body-shaming someone for their aging process to me. Yet later on in the episode he tells her she’s still beautiful. Make your goddamned mind up!

Thirdly, Phillip C McGraw is not a psychologist, and his show is the worst level of trash on TV that there is. Now you might say “well everyone knows he isn’t a psychologist” – um, no they don’t. I have to tell fans this, and half the time they don’t believe me. It was only about a year ago that I told this to someone who simply didn’t believe me. She would have done better to go on the Jerry Springer Show than to appear on this one, at least Springer doesn’t bullshit his guests.

Fourthly, Phillip C McGraw offers her “professional assistance as a gift”. Hmm, really? What he doesn’t tell you is that he has specifically decided what professional assistance she’s going to need – despite the fact that he is unqualified to do so. For people who have mental or behavioural disorders there are a number of different ways to approach treatment. McGraw’s preferred method is to send her off to some unfamiliar place for treatment. Whereas she could have received treatment in her home, or even by telephone. There was no evidence that anyone professional evaluated how best to approach treatment from the best interests of Ms Duvall.

But McGraw does treat Ms Duvall with respect, right?

I feel genuinely annoyed at the fact that McGraw is so good at pulling the wool over his viewer’s eyes. Let’s be honest here, the kind of people that are interested in this show are generally pretty naive about current psychological thought. That’s not to be disparaging, it’s just that the show would lose its interest if a person has a strong knowledge of current psychological theories. The show is after all based on the audience being shocked by the guests.

Right, so I actually haven’t finished listing the problems with just this one episode yet, but I wanted to give you the opportunity to pause for a moment and think about whether you think McGraw is genuinely respectful to his guests? Well I think he’s not an the reason is…

Fifthly, McGraw’s show thrives on provoking and perpetuating the social stigmas attached to mental and behavioural disorders.

“The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioural disorders.” –World Health Organization, 2001.

Now I can’t possibly go over social stigma in just this one post – if you want to know more you’re going to have to do some reading, or watch some videos, starting with my own here:


Baxter, D. 2016. Video released under Creative Commons Attribution 3.0 Licence (Aus). Originally published at: https://youtu.be/HMdl-VDRg9I

For many people stigma is worse than the disease itself. To hear people say that for yourself see this video featuring HIV+ people.

Generally speaking, from what I’ve seen of the show in the past, McGraw is very often interested in blaming people who likely have mental or behavioural disorders for their anti-social behaviours. This of course is called victim-blaming. Now he does sprinkle in a bit of “it’s not your fault” here and there, but I think one of the things that made this episode in particular so heinous is the fact that Ms Duvall clearly does not understand what’s going on around her, and McGraw & producers still think it’s appropriate to publish and profit from her “interview” anyway.

And by the way he does use victim-blaming language, even in this episode. For example, towards the end of the episode you hear him say that Ms Duvall “refused medication”. The way that he phrased it implied that she should have accepted medication it’s for her own good; however the episode itself made it clear Ms Duvall is fearful of doctors. So really this response is exactly what you would have expected from someone in her circumstance. We don’t even know what her diagnosis is and whether it can be managed with medication or not, so that statement was quite inappropriate and disrespectful to say the least.

Sixthly, I would have to assume that Ms Duvall was lured onto the show under false pretences. She doesn’t appear to understand that she’s being filmed, as previously mentioned.

Do these opinions matter?

Well it’s not just that there are ethical problems with the show, but the fact that it also a clear breach of professional standards by anyone’s measure. For reasons I’ve already listed. Now what’s interesting is that even the producers of the show have realised they fucked up big time by producing and then publishing this episode – and if you want proof of that go here. You will find that all the pages on the DrPhil website with mention of the episode have been removed. As of writing this though you can see what was there by viewing the Google-cached versions. Note that despite the fact that this action proves they’ve acknowledged their fuck-up that there’s no official explanation given.

Ms Duvall deserves to be treated with dignity and respect. I fear that what McGraw has done can only cause her undue damage and harm. Ms Duvall doesn’t deserve to be stigmatised in this way, and the greatest tragedy of all is that the show didn’t even try to balance the negativity by showing her at her best. She might have plenty of other great hobbies and interests that fill her time in a valuable and fulfilling way, but the show paid no attention to that area of her life at all.

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There is a section at the end of this blog post about their recent Tumblr drama, but the focus on this blog post is on the question health advice, as well as mental health. Okay, so let’s get right into this. They both have a superiority complex – and I have one as well. I don’t think that is a bad thing – in fact for me it’s been most helpful over the years. I’ll explain why in a moment, but let’s start with the premise that health is not just about physical health, but also psychological well-being, as well as spiritual well-being, and even community well-being. Earlier this week, new parliamentarian Julian Leeser devoted his maiden speech to talking about depression. Most people know what it is like to go through depression at some point, but it can affect people in disproportionate ways. And it can be very difficult to seek help for. When I went through a period of this myself as a young adult, I tackled it completely alone. And so one day I decided that I needed to help myself – if I’m not going to reach out for help, then I need to step up and provide a solution. And that’s what I did, and it was very successful for me. What I decided was that I didn’t give a fuck what anyone else thought about me, I would love myself unconditionally. So that’s why I have a superiority complex.

What I don’t allow it to do is guide my belief-set. It has taken a very long time to free myself from preconceived beliefs. And I believe the reason I have been successful with this is because I am quite receptive to receiving and considering information, even when it gets overwhelming. Health, unfortunately, is one of these areas where people have a lot of preconceived ideas, and everyone thinks they’re an expert. Not only that, but then they join the “evil” diet industry and are oblivious to the fact they’re a part of it. It wouldn’t bother me so much if when we showed people like this evidence they looked at it and said “that’s interesting, let me have a very good look at this and come to a fresh conclusion”. Diet is a very fast growing area of study, and things we used to believe about cholesterol and saturated fats have turned out to be wrong. If you don’t know exactly what I mean by this do not worry I will explain it in the future.

Much of the stuff that Leanne “Freelee” Ratcliffe and Harley “Durianrider” Johnstone have said regarding health is based on incorrect assumptions, and knowledge drawn from questionable sources. For example in 2014 Leanne said that Chemotherapy “killed” 13-year old cancer patient Talia Joy. Now it’s certainly true that chemotherapy is dangerous, and can result in patient death. This actually happened to someone I know recently. However, doctors do not prescribe the treatment unless the potential benefit outweighs the risk. That is to say, if you have a terminal illness like cancer then the prospect of dying a little sooner due to a negative reaction to treatment is outweighed by the potential to go on and live a long healthy life if the treatment is successful. So it’s not accurate to say that chemo killed the patient, when in fact it was cancer that was the main culprit.

In the video Leanne made, she claims that a raw vegan diet could have cured the girl’s cancer. As evidence she uses a testimonial from a man claiming that he overcame colon cancer by switching his diet. But Belle Gibson made the same claim and we now know it was a complete fraud. But even if the anecdotal case is true, it is still just evidence of a correlation and not causation. And that is a very important distinction to make. She also incorrectly claims that the health industry has a monopoly – the truth is that it is very difficult to research alternative cancer treatments because you cannot prevent patients from having surgery and/or chemotherapy as a part of the treatment for the purpose of research. What you can do is anything that will not prevent them from having those treatments, so if you wanted to do a large randomised controlled trial where people were given different diets – let’s say DASH, and Vegan, and Control – you could do that, you would get ethics approval. In her criticisms of chemo she does not cite anything peer-review or even from respected experts in the field.

My heart sank when I saw the video Leanne made about Eugenia Cooney. Eugenia suffers from some form of eating disorder, and is clearly quite underweight. I used to think that Freelee’s advice was based on a misunderstanding about nutrition, but I now can confirm it’s based on a lie. Eugenia suffers from a mental disease, not a diet-related-illness. Her poor diet is a symptom, not the cause, of her illness. Leanne’s video is completely misinformed about this, and in particular she makes comments about Eugenia’s body which are counter-productive. When a person is suffering from an eating disorder it means they also suffer from body dysmorphia. Criticising her body will only reinforce the beliefs that Eugenia has about her body. Asking Eugenia to go vegan is very inappropriate because it’s the exact opposite of what her therapist would be trying to do, which is to let her know that foods are safe, and that she can be less obsessive about her diet without it adversely affecting her. Also, therapists will want to introduce foods the patient enjoys, and not limit their choice by imposing restrictive constraints on their choices.

Was Harley abused by Leanne?

Right, so as promised I do have an opinion about this. I do not know the full story, of course. When I first saw the video I thought “he looks like a wreck”! But then I realised that was a manipulative attempt by Harley to convince people he was telling the “100% truth”. You could say that I took my preconceived ideas about Leanne into this and I had to keep them in check.

In this instance I see a few things that concern me. Harley consistently hurls insults/accusations at Leanne. This was true by the fact that he was sending her text messages, and in the video he posted where he began by saying “Freelee’s been using botox since 2013, but I don’t judge people who use it…” If you watch the video from start to finish you’ll see it’s a consistent attack on the other person, first botox, then claiming she “changed”, then calling her out for cheating. Notice that he talks about how she used to be carefree but started using makeup as well. What I see are clear actions of a perpetrator trying to exert control over their victim. I’m not saying that Leanne is innocent in this, on that point I do not know, but from what I’ve seen from Harley’s side is clear evidence of a manipulative abuser. He talks about her punching him in the head, but in a later video he says it only happened twice. Which is of course not evidence of systemic abuse against him, but perhaps a desperate attempt by her to fight back. As I said that much is speculation, but it does appear Harley was abusive nevertheless. A victim of abuse is not going to be the one who is sending abuse towards their former partner by texts, those actions alone incriminate Harley.

With all that said I think he made one valid point, which is that Leanne has been using botox since 2013. I don’t think that’s a lie, and I don’t think that Leanne realises how much she has been lying over the years about her health. Yes she might be a raw-to-four vegan, however she also does an excessive amount of exercise and has made use of cosmetic surgeries including her breast reassignment surgery. One thing I’ve learned in nutrition is that the more active a person, the more so-called “crap” they can eat in their diet. She preaches the opposite which is that you need to be excessively active and eat only raw foods. Athletes actually do eat a lot of “junk food” purely for the extra energy they need, and the reason why they can do that is because of their lifestyles. Leanne seems to be completely oblivious to this, and that is why I would caution anyone from taking advice from people like these.

I don’t expect to change anyone’s mind, just please remember to be sceptical and to look at what the evidence says, and not what so-called “health gurus” say.

 

How bad are multivitamins?

First thing’s first. Most people do not need to take multivitamins. Sadly though people are stupid and tend to self-medicate with them anyway. So let’s start by considering who would need to take a multivitamin: the main groups of people who would need multivitamins are: People on restrictive diets (including people with eating disorders, people on low-kilojoule weight-loss diets, or people fasting), alcoholics, and perhaps the elderly. Do not take this as an invitation to self-medicate, if one of these three categories describes you then you should see a nutritionist or a dietician for dietary advice.

So what would happen if you need to take a multivitamin? Well as a starting point you’d need to know how much of the nutrients you need to get from a supplement, and how much you can get from your diet. In an ideal world a multivitamin+mineral supplement would contain 100% of all nutrients, and would be delivered across 5 or more tablets so that a person who needs say 20% of their nutrients from a multivitamin could take 1/5th the dosage easily.

Sadly though this is not the case. Almost all multivitamins contain way too much of the cheap water soluble B-group vitamins, way too much vitamin C, and low amounts of poor quality nutrients (cheap ingredients with low bioavailability) for everything else. Below I have made a table showing the Australian NRVs (Nutrient Reference Values) for men and women. I based it on the 31-50 age group, but most values are correct 19 through to 70 years. It shows these popular brands available at Woolies and Coles: Cenovis, Berocca Performance, Centrum Advance, and Swisse. I have also included the Life Extension Mix tables, which despite being much more expensive than supermarket brands is far worse.

Abbreviations: RDI – Recommended Daily Intake, AI – Adequate Intake (/day), UL – Upper Level of Intake, NP – Not possible to set, mg – milligram, µg – microgram.

Multivitamin - NRV Comparison

Breakdown

Well there are quite a few areas for concern here, and this is simply going by the state nutrient levels – some lab analyses have shown that nutrient levels are often misreported on the product labels. You will notice the Upper Level of Intake for Magnesium is actually lower than the RDI for men (which is why I’ve highlighted it). The Upper Level is actually specifically in reference to supplement use, as opposed to Magnesium found in food. Life Extension Mix is actually the worst multivitamin in my table here, for the fact that three nutrients contain well above the Upper Level of Intake (Niacin, B6, and Magnesium), as well as containing excessive amounts of Beta-carotene, Thiamin, Riboflavin, Pantothenic acid, B6, Botin, B12, Vitamin C, Vitamin D, and Zinc. This is particularly concerning, much more than the nutrients with low amounts. It contains one hundred times the recommended daily amount of Pantothenic acid, and also one hundred times the recommended daily amount of Biotin. The level of Vitamin C was also of particular concern.

Berocca Performance was the worst of the four supermarket brands I looked at. I chose it because it’s heavily advertised on TV. The first thing to note is that it misses a lot of key nutrients. Like most multivitamins, it is packed with the cheap and readily available shit that the company can pack into their tablet without spending money on balancing it out with the more expensive nutrients. Just about everything it contains it contains in excess of, with the exceptions of Magnesium and Folate. On the plus side, it doesn’t contain any Iron or Copper which are two metals worth leaving out of a multivitamin. Most concerning of all is that it contains above the upper level of intake for Niacin.

Swisse is only slightly better, but their nutrient compositions all over the place. Despite women needing less micro-nutrients than men (except for Iron, obviously), their Women’s formula contains more micro-nutrients for most nutrients. Like Berocca, it contains Niacin in amounts either close to the UL or in excess of it. In addition to containing excessive amounts of B-group vitamins, it contains low levels of Vitamin D, calcium, iodine, and anything else people might actually need, as well as an excessively high level of beta-carotene. At least it’s not Retinol.

Cenovis has just 1% of RDI of Calcium. I’m not sold on whether this multivitamin is better or worse than Swisse, but they’re both bad. Cenovis at least did not contain above the upper level of intake for any nutrients, but like Berocca and Swisse it is missing quite a few key nutrients. On the plus side, it contains decent amounts of Vitamin D and iodine.

Centrim Advance was by far the best of the four brands I looked at. Do keep in mind though that it’s still badly formulated. On the positives: it contains both Retinol and beta-carotene, it contains good levels of Vitamin D3 and Iodine, the b-group vitamins are all above the RDI but not to the excesses of the other brands, and at least it includes Vitamin K. On the negatives, it contains both Iron and Copper, and only half the minerals are at decent levels with the rest at worryingly low or absent levels. This is especially so for calcium with Centrum choosing to use (no surprise) a dirt-cheap form of calcium with poor bioavailability. Look it appears to be somewhat more workable than the others I have looked at, but it still would not be an ideal choice for someone that needs the use of a multivitamin.

Further considerations

Just because a vitamin or mineral doesn’t have a UL does not mean it is safe to over-consume in supplement form. There is no UL for Vitamin C, but NHMRC notes that 1,000mg is a “prudent limit”. They all contain high levels of Folic Acid, which could also be a concern noting that all non-organic wheat-flour used for bread making is fortified with Folic Acid to reduce the risk of Neural Tube Defects at childbirth. Too much Folate in the diet can mask B12 deficiency, as well as make it worse. I did mention earlier that in an ideal world multivitamins would contain everything and be able to be taken in an easily measured dose – that is simply not the case for these products. Yes you could take half a tablet every two days to reduce the dosage by 1/4, however a well formulated option should come pre-packed to be taken at the required dose, and not require consumers to make extra effort to control their dosage.

I’m not sure a “good” multivitamin even exists. As I mentioned above, it would seem that a nutritionist would have to work with the “best available” options rather than an ideal option. Even then they have no guarantees that the tablets can be properly absorb anyway, or that the stated dosage is indeed correct. My advice would be to strongly distrust anything that is actively advertised anyway, and of what’s remaining to be very sceptical and to ask the advice of a professional before selecting a product.

Well this post will cement my return to tackling the far more controversial and “difficult” topics on my blog. I want to acknowledge that this post does not provide all the answers you may be seeking, but after doing 2 low-level psychology units at university I feel it is imperative to share with you some of the contradictory information that set off alarm bells in my head, by highlighting some of the large unanswered questions the discipline leaves us. But firstly consider this: I’m asking the question “is mental illness a sham”. A sham does not mean that it doesn’t exist, what it does mean is that at some level there is a misalignment of priorities, a miscommunication of fact versus theory, and at least some level of deception.

I want you to consider a peer-reviewed journal article titled Spirituality, religion and health: Evidence and research directions, by Williams & Sternthal (2007), you can read the text online here. It talks about the evidence that exists for the connection between religion and health. Overall the effect is positive, but there are some negative effects also. This is not controversial, this is something very well known. For all the bashing I did to Christianity in recent posts, note that I’ve never denied the evidence that does show conclusively that religion generally brings participants better health. Doesn’t matter if it’s ‘right’ or ‘wrong’.

There are two main responses that critically thinking people have to the above. The first (the point of view I subscribe to) is that community involvement in solving health problems and promoting positive health should be valued and nurtured. The World Health Organisation also shares this view, as does the National Aboriginal Community Controlled Health Organisation. Some benefits include that it is cheap and can break through barriers that prevent people from accessing other health services. I would further argue that strictly from an evolutionary point of view as it applies to human culture (game theory etc.) it predicts that behaviours and structures that benefit the whole should ultimately rise and prevail above those that don’t. To put it in a nutshell, religion and culture exists because the people who practised them outperformed the people who didn’t. Religion does create barriers as well, and that’s one of the negatives.

The other main point of view is that although religious beliefs have a positive correlation with health they do not benefit society overall. This point of view could suggest that religion has been a powerful force for good in the past, but that now its benefits do not have the merit that they once had. And it’s certainly true that people slip through the cracks when religion gets involved. At one time Christians believed that all illnesses were caused by daemons as per Acts 5:15-16. Later this belief was changed to daemons causing some illnesses but miasmas causing others. In Romans 1:26-27 Paul writes pretty clearly that homosexual desires are caused when people turn away from God and his truth. This type of primitive mythology for explaining so-called ‘deviant’ human behaviour is the seed from which discrimination and oppression are grown and has caused a great deal of suffering for different people. It creates barriers between people. But I would argue that although that is true, in every society there are marginalised and disadvantaged people. You can’t judge a society just because it has disadvantaged people, but you can judge it on their attitudes and whether they minimised the number of people who would be disadvantaged.

So how do we apply this information to modern medical thinking then? Well an effective medical treatment will either alleviate symptoms or cure an ailment. It should improve the quality of life, and reduce the burden of disease. But it does come with a similar expense to that of religious participation – medical treatments also have negative health effects. And as you will see, Psychology cannot always offer any improvement to existing techniques for treating certain mental illnesses.

If a person has been diagnosed with a mental illness, there are an array of theories behind how or why that illness has developed. Behavioural, Cognitive, Biological, Evolutionary, Genetic, Physiological, Psychodynamic, Naturalist. The only two theories that have absolute conclusive proof for causing a mental illness is physiology and genetics. We know for instances that brain damage can cause an irreversible impaired mental state. We know that roundworms in the small intestine can cause clinically significant depression. Impaired foetal development can also cause lasting mental illness. Autism and Alzheimer’s have strong genetic predispositions, but both are thought to be due to an autoimmune disease (i.e. triggered by an environmental factor such as an infection).

Now that’s all fine and well, but we also know that life events can contribute to or cause mental illnesses. There’s really not a debate that this happens – even the social gradient effect on the cognitive ability of children has been established – the question however is why it happens. So let’s take something like Gambling Disorder. How should it be treated do we think? With medication perhaps. What about interventional therapy? Okay, well the most researched forms of therapy are cognitive therapy (CT) and cognitive-behavioural therapy (CBT). But there’s also behavioural therapy (BT), motivational therapy (MT), and “minimal intervention” (MI), a striped down intervention that simply has a therapist deliver targeted advice to the patient just once for as little as 10-15 minutes or as long as an hour. There’s also the 12-step program that’s refused to change or update the 75 year-old method – Gambler’s Anonymous (GA). Surely CBT and CT based treatments did best, right? WRONG! CBT, CT, BT, MT and MI all performed essentially equally well according to Toneatto and Gunaratne (2009). Well there’d at least have to do much better than Gambler’s Anonymous anyway. WRONG AGAIN! Marceaux and Melville (2010) found that GA was just as effective as CBT after 6-months (their results are from a controlled study). Petry et al. (2009) conducted a study with one cohort receiving CBT in addition to MI, one receiving just the MI session, and a control group, and found that both of their groups that received the intervention showed improvement with no significant difference between the group that received the CBT and the one that didn’t!

How can this be? If you don’t know what a mental illness is to begin with, then how could you possibly know how to treat it? The disciple of Natural Psychology argues that mental illnesses are non-existent:

The question is not, “What is the best definition of a mental disorder?” The question is not, “Is the DSM-5 definition of a mental disorder better than the DSM-IV definition of a mental disorder?” Those are absolutely not the right questions! The first and only question is, “Do mental disorders exist?” The phenomena certainly exist. The birds and bees exist; pain and suffering exist. But birds do not prove the existence of gods and pain does not prove the existence of mental disorders. Let us not play the game of debating the definitions of non-existent things. Let us move right on. (Eric R. Maisel Ph.D. on Psychology Today).

So if we don’t understand how mental illnesses occur, and we can’t clearly define it, and all of our wildly different treatment options performed equally well as each other, wouldn’t that tell you that something is seriously amiss? Now I want to acknowledge that I’m not saying I know either – but I do know that the risk can be reduced environmentally. That is through policies that provide better safeguards for people who are at risk of developing an addition, and ensuring early proactive intervention rather than reactive intervention.

Pharmaceutical companies are some of the most immoral in the world.

Certainly more immoral than tobacco companies – at least tobacco companies can’t advertise their products on TV, radio, newspapers, and magazines. And yes, the risks are stated on the label, supposedly, the label that you see AFTER you buy the medication. Many of the patients who are currently dependant on pharmaceuticals were never told that in the first place, because the development of dependency wasn’t known at the time. Over-medication, dependence, and people accessing the wrong medications for their health issues, as it is, creates a huge amount of pharma-waste. Pharmaceutical advertising encourages people to self-diagnose, and self-select the medications they think they need. This is a massive problem with non-mental medical disorders; so you can just imagine how big a problem it is with mental-health related diagnosed “disorders”.

If you see a psychiatrist here, in Australia, they will diagnose you according to the DSM-V. If you go to China, and see a psychologist they will diagnose you according to the CCMD-3. That’s right – there are two completely different diagnostic manuals, that define mental illness differently to each other, and designate a number of different illnesses. Each has illnesses that are unique to their manual as well – in other words there are illnesses that exist in CCMD and not in DSM (and vice versa)! Mental health illnesses are also defined in the ICD-10 (maintained by WHO) with some difference to DSM.

So then, is mental illness a sham?

Yes I believe so. Hypothesises are presented to clients as medical fact and that means it’s falsely presenting mental health issues as sure and certain factual illnesses. Now I just said before that there are some mental health issues that we know are illnesses like Autism and Dementia. But those are believed to be autoimmune diseases; they’re a physiological disorder that causes mental health problems. But the mental health problems that are purely mental health related with no known link to physiology or bacteria or viruses are not proven to be illnesses per se. They may masquerade themselves into a diagnosable condition; but that’s not an illness. Think about this: we still call gender dysphoria an illness because all conditions in the DSM are mental illnesses by definition (DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5); yet this is offensive to many people who suffer from the condition, and the French government actually declared that it is not to be considered a mental health condition whilst guaranteeing that people who suffered from the condition would still be able to receive subsidised healthcare.

So I personally welcome a clear delineation between illnesses and other states of mental health, and I look forward to the day that we stop using the word “disorder” to refer to people’s health problems that we don’t understand.

References

Check back they will be edited in. :)

The Aractus Creed (subject to review):

We believe in the prophet, our apostolic father, Charles Darwin;

Creator of wonder, evolutionary biology, and wonder;

We follow the teachings of the great holy book “Origin of Species”;

We follow the guidance of his disciplinary descendant, Richard Dawkins;

Towards truth, wisdom, discovery, and wonder;

Even though sometimes he can be a giant douche;

We believe in his ways of inductive reasoning and the holy scientific method;

We believe in his teachings written down in the academic journals of Science, Nature, and the Journal of Theoretical Biology;

We believe in the pursuit of Power, Wealth, Wisdom, Knowledge, Happiness, Health, Development, Advancement, and Progress;

We acknowledge the inspired work of secularists;

We strive each day to understand their teaching;

We believe that the Christian god isn’t really real;

And that when we die we don’t go anywhere we just rot in the ground.

You know time and time again I see Christians and atheists making exactly the same arguments against each other, oblivious to the fact that their argument is equally absurd as the one levelled at them from the other side. If you’re going to get into these discussions and debates you should observe a few simple principles:

  • Keep an open mind – they might have an excellent response or argument.
  • Keep a level playing field – you have to play by the same rules and keep them honest and consistent. For example don’t say they can’t make reference to their ancient texts because then neither can you.
  • Don’t make rushed arguments – either learn the material first and be sure your argument is valid, or don’t make it in the first place.

Now I’m specifically going to talk about sins of the atheists here, since they so often claim to be more informed all the while spurting ignorant, ill-informed bullshit based on their own biased blind-beliefs and not based on real tangible evidence.

Erhman and Hurtado

So let’s have some examples. There are a good few atheists who claim that the Bible isn’t evidence – well then neither is any historical document. There are 66 books in the Bible (73 in the Catholic Bible and more still in some Orthodox cannons) and some have a greater historical validity than others. You can’t simply dismiss the credibility of the books because they are in the Bible – just like Christians can’t discard the validity of other texts because they aren’t in the Bible. In fact a Christian would tell you that the reason why the books got bound into the Bible in the first place was because they were determined by the religious authorities of the time to be genuine. These two handsome fellows above are scholars – they’re New Testament era historians – and they both say there is hard evidence for the existence of Jesus as a historical figure – and so does just about every other scholar. This in-turn means they have determined that at least part of the New Testament constitutes (or contributes to providing) hard evidence for the existence of Jesus. Hurtado mentions it many times on his blog, and Ehrman says it in this youtube video (and probably also on his subscription blog). As Hurtado puts it you are not entitled to your own truth: you need to go to the experts to get the facts.

Often times atheists use poor quality material to get their “academic information” from. There are reliable sources out there – for example try the New Oxford Annotated Bible (4th.Ed 2010) instead of the Skeptic’s Annotated Bible. And in my view you should supplement the Oxford Bible with any decent Evangelical commentary since the Oxford text often leaves out both sides of the argument and fails to even acknowledge perfectly reasonable arguments from scholars that disagree with them. Any time you read a book ask yourself who the author is, what their credentials are, and most importantly what other academics/scholars say about this person. Too often atheists gravitate towards the quacks who make extreme arguments suck as Jesus Mythicism instead of constructing valid objections to the content of the Bible.

HerodotusEgyptian Slaves

Sometimes atheists say that because there are some clear inaccuracies that the Bible has no historical credibility. Herodotus had historians convinced for over 2,000 years that the Pyramids of Giza were built by slave workers. Yet it wasn’t his intention to deceive, and just because of that one monumental fuck-up historians don’t throw out everything else he wrote – they still treat him as a serious historian. In the New Testament one writer in particular talks extensively about contemporary issues – and that’s Paul. He has more to say about the present time than about the time that Jesus lived in. I find it incredibly naive of people that would claim that those writings are “not history”. Furthermore it is disingenuous to claim that scholars can’t learn anything of value from the Bible – it not only tells them quite a bit about the ministry of Jesus, it also tells them about what the early Christians believed when those books were written. When Matthew 14 says that Jesus walked on water; that tells you that the author of the gospel believed that Jesus had walked on water. And just because that may not be physically possible from the point of view of a sceptic doesn’t meant that Jesus didn’t deliver the Sermon on the Mount or come up with the parable of the Good Samaritan.

Israel FinkelsteinSometimes atheists make the claim that Jesus never really existed and he was a myth. Rubbish. I have yet to see a serious contemporary scholar that holds that view. Instead, atheists invoke crackpot wannabe historians like Kenneth Humphreys who are unqualified to offer a meaningful opinion in the first place. If you’re going to listen to unqualified people instead of the experts in the field, then you may as well get your archaeological information from Ron Wyatt and his crackpot fundamentalist young-earth science-denying creationist peers instead of real experts who are respected in their field like Israel Finkelstein (pictured). If you won’t accept respected NT scholars as a source of evidence then you can’t expect Christians to accept your respected scholars either. Cherry-picking unqualified people to get your information from is not valid. A NT scholar is a qualified historian who specialises in New Testament period history and can read Greek. And an expert would be someone that is involved in research and publishes evidence (eg peer-review material). An Old Testament scholar is a qualified historian who can read Hebrew, and who specialises in Old Testament history. Finkelstein is an OT Scholar, but he seldom calls himself that, instead he’s better known as an Israeli archaeologist because he focuses on the history of ancient Palestine (Israle/Judah) area. Because he researchers and publishes evidence, he’s also an expert. Not all scholars call themselves scholars, and many are simply students and not experts.

Papyrus 66

“We can never know what the bible originally said because it’s been copied and translated too many times”. This is an argument I’ve heard a few times recently. It’s completely uninformed. Yes the Bible has been translated into dozens of languages – however it also exists in its original form and there are 5800 ancient manuscripts of the New Testament in Greek, with an average length of 450 pages amounting to some 2.5 million leaves or so. Now why do I give you the other numbers where most people stop at the 5800 manuscript number? Because often atheists make the claim that the number is inflated because it counts fragments individually or because it counts individual books. Neither is true. A manuscript includes all fragments and leaves that belong to the same volume of work – and there are only a very few that contain just one fragment. Pictured above is Papyrus 66, it dates to c. 200 AD, is a manuscript containing only the gospel of John, and it’s near complete. It makes consistent use of the Nomina Sacra. Most manuscripts contain multiple NT texts however, and many contain all books plus the apocrypha plus the lxx. Furthermore because there are a number of different early manuscripts representing different textual traditions (i.e. copied from different sources going back generations) scholars have around 99.5% confidence of the near-enough exact wording of the NT. Of that remaining 0.5% most of the differences are not meaningful – but some are for instance if the Number of the Beast is 666 as in most manuscripts or 616 as in Papyrus 115. That’s a much higher degree of confidence in the original wording than any other ancient manuscript. It means they’ve been able to more reliably identify the areas which are additions to the text (such as Jesus saying “let he who is without sin throw the first stone” – sorry guys that sentence it not really in the Bible). Compare this with Antiquities of the Jews by Josephus – the number of ancient manuscripts in Greek is only 10 or 11 and the earliest is c. 10th century.

Religions

Many times I hear atheists denying that religious practise has health benefits. There is great danger in doing so. Firstly it doesn’t prove any religion right anyway because it doesn’t matter what the religion is – it could be Christianity or Hinduism or any religion. Secondly this denialism leads to denying people the access that they need to their religion, which in-turn will cause far greater harm than good. Religious and cultural/ethnic practise are important determinants of health. I find it incredible that so many atheists refuse to accept this, it’s widely discussed in peer-reviewed literature. Now of course it also has negatives, but for adherents the positives outweigh the negatives at a population level. Not from an individual level; some individuals certainly get the bad end of the stick. Homosexuals for instance. It’s not just religious practises it’s also ethnic and cultural practises. It’s one reason why there is a gap in life expectancy between Aboriginal and non-Aboriginal Australians. It’s important because it needs to be considered when forming healthcare policies in places such as hospitals, retirement homes, in-patient care, in-home care, etc. It’s not disputed in academic circles, it’s accepted fact: “the significant disruption in access to traditional foods, Country and traditional practices (such as their ability to undertake vital societal, legal and religious obligations) played heavily upon the First Peoples’ health and well-being.” (Best & Fredericks [Eds]. 2014. Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care. p. 11).

Many times I hear atheists try to claim that this is just a benefit from social activity and is not dependant on people practising their religious practises – this is wrong. A paper titled Social Participation and Depression in Old Age: A Fixed-Effects Analysis in 10 European Countries (2015) by Croezen, Avendano, Burdorf, and van Lenthe specifically looked at other social groups in a longitudinal study of older Europeans (over 50 years), and found that Religion was the only type of social activity that improved the health of people suffering depression. Participation in voluntary work/charities, education/training, sports/social clubs, or political/community organisations did not improve health. Yes it might have a confounder, but note that the authors did say the study was controlled for possible confounders, and that one has not yet been identified. To quote from the abstract: “Participation in religious organizations may offer mental health benefits beyond those offered by other forms of social participation.” If you’d like something open-access that you can read for yourself right now try the Williams & Sternthal (2007) paper, from which I shall quote and end on this point: “The potential for both positive and negative effects of spirituality on health, combined with the high levels of engagement with spirituality by the Australian population, suggests that this area is ripe for future sustained research. Moreover, Australian patients want their clinicians to incorporate spirituality into their treatment.4,55

Slightly updated (11/05/2015).

Prepare to be grossly disappointed.

Brief Intro

If you follow my blog you know this entry has been a long-time coming. And in fact this entry will signify the re-starting of this series, since I now have a lot more information that I did originally, I know a lot more about it, and therefore I have to set the record straight with my previous entries.

I was delayed in doing this entry partly because I submitted an academic essay for a public health unit at uni that talked about obesity policy here in Australia with a strong focus on the science. And I didn’t want to duplicate anything that was in it, lest I get done for plagiarising my blog! The tutor really liked my essay and I got 92% this is what he had to say about it: “It was really impressive – one of the few that took a critical perspective on policymaking. It was very well written, clear, well referenced and persuasive. You got a 46 out of 50 (one of the highest marks in the class).” I’ve uploaded the essay now here on my blog if you’d like to read it (click here). Again the essay is on the topic of public health policy in Australia and what I primarily critique is the decision not to class obesity as a disease and the direct mass-marketing campaigns that have been run since 2008. But I also talk about some of the science that was directly relevant to policy. Note though that I didn’t specifically talk about the important role that insulin plays – but that it does have a long-term effect on weight. Much as I would have liked to, I did not get to fully cover the science of obesity, which is what this blog post aims to do! I will do a blog post on obesity policy another time, but I suggest taking a look at my essay if you’re wanting to know about obesity policy in Australia.

I have now researched this topic thoroughly, and I’ve read a lot of peer review science. There is a lot of misinformation out there on diets, and weight maintenance, and almost none of it is based on actual science. And when I say a lot, I mean an awful lot. So although some of the things I have to say may seem implausible, they are 100% scientifically valid and reflect the general academic thinking by the experts on obesity. If you haven’t studied it, some of these facts will surprise you.

What is the cause of obesity?

Obesity is caused by homoeostatic imbalance of the hunger hormones: ghrelin, leptin, insulin, and to a lesser extent glucagon. Your hunger hormones physiologically control the quantity of energy you consume from food. This process is incredibly precise, so much so that a 20-year study done in the USA (Mozaffarian et al. 2011) that followed 120,000 non-obese people found that the average long-term weight gain in the people they studied to be 0.38 kilograms per year. Over 20 years that’s a total of 7.6 kilos. But what should shock you is that the average amount of energy a person needs to consume per day is 2,000 kcal for women and 2,500 kcal for men. By the formula that 1lb of fat roughly equals 3555 kcal, that is an upset in the homoeostatic equilibrium that equals just 7 kcal per day. That is just 0.28-0.35% of the total daily requirements. 7 kcal is equal to just one single McDonald’s French fry. No one has that precision of conscious control over their diet. Obesity is caused by an upset to the homoeostatic equilibrium that is supposed to keep weight down, it is most certainly not caused by overeating.

How is fat stored in the body?

Ask yourself this question: have you ever heard the diet industry explain this to you, or do you simply take it for granted that 1lb of fat yields 3500 kcal? Fat cells are called adipocytes, and adipocytes form a connective tissue called adipose tissue. Adipose tissue is for all intents and purposes a permanent structure of the human body. Now the number I hear a lot is that on average human adipose tissue that is used for fat storage is 87% lipid by volume. We do also have some adipose tissue we use for other purposes besides fat storage (eg it makes the walls of our kidneys).

When a person gains weight and becomes pre-obese they generally are storing more fatty lipids (i.e. mostly triglycerides) in their pre-existing adipocyte cells. When that person loose weight they are in fact only burning the stored lipids, and the cells are never destroyed – like I said they’re essentially permanent. They can grow in size substantially to store more fatty lipids, but there is a limit. And the limit is actually different for different people, but generally speaking once a person becomes obese their body start to build more permanent adipose tissue. This person’s physiology has now changed, and if they loose the weight to go back to where they started they still have all that additional adipose tissue – but now it no longer contains 87% lipid by volume. And what we now know happens is that weight is controlled by the brain, and following weight loss the hunger hormones change their effect in such a way as to give people a “terrible hunger” as Joe Proietto puts it, and cause them to regain the weight.

What about the formula that 1lb of fat equals 3500 kcal?

It’s wrong. Plain and simple. It’s true that 1lb of adipose tissue will roughly yield 3,555 kcal in total – however only the lipids are easily catabolised by the body. The rest of the fat cell remains – it does not get broken down, end of story. Furthermore lipids yield an average of 9kcal per gram, so you in fact need to burn 4,082 kcal to lose 1lb of body fat. That’s substantially more than the 3500 number you often hear, and the horrible truth is that it’s far from permanent weight loss especially for obese people: your body will want to regain the weight. And if you really try to stop it you could end up with a serious eating disorder.

Next time you see someone claim this number – whether it’s a qualified personal trainer or a “health coach” or someone in the diet industry trying to peddle diet products, ask them where they got the figure from and to defend it scientifically. They won’t be able to do it.

Jenny Craig, Weight Watchers, other diets, diet products – do they work?

NO. They do not. They may work for some non-obese people, but non-medical intervention is not able to reverse obesity long term, and all the experts agree on this – Robert Lustig, Joe Proietto, etc. I originally believed otherwise, but it’s been proven well beyond any doubt. Let me ask you this: how is it possible that a large proportion of people who get bariatric surgery re-stretch their stomachs if weight gain is not driven by a biochemical process? How can you explain the rise in the rate of obese 6-months olds if the cause is anything but biochemical? Or just ask yourself this question: what kind of legitimate product blames the consumer when it fails to deliver what is promised?

What the diet industry does is provide a product that does not work to reverse obesity long term. Although the product doesn’t work, consumers blame themselves and not the product! Think about this, comedian Magda Szubanski was made a main spokesperson for Jenny Craig here in Australia – she lost 36kg and was looking healthy. Then she regained the weight and she was dropped by the company who blamed her!

If you want another example, think of David Elmore Smith – the “650 pound virgin”. He spent 2 years with a personal trainer who became his best friend losing the weight. He then had surgery to remove the excess skin. Then he regained 300 of the 400 lbs that he had lost in just 2 years, his friend decided he was no longer worth their friendship, and so he also lost his best friend. And then he blamed himself. It took him some 30 years or so to grow to 650 lbs, so how is it mathematically possible that he re-gained 300 lbs in only 2 years? Surely it should have taken at least 15 years, under the theory that weight gain is caused by overeating.

Do some genes make some people more susceptible to becoming obese?

Yes. Some people as mentioned will build more adipose tissue more easily and this can snowball into long-term permanent weight gain. Some people are more resistant to putting on weight and their body will instead increase their metabolism when excess kcal are consumed.

Are you really saying that food intake is controlled physiologically and cannot be reversed through dieting?

Yes. You don’t get to choose how many kcal per day to consume, it’s controlled by a negative feedback mechanism that keeps your energy intake from food in homoeostasis (equilibrium). I have a pretty good way of explaining this – think of type-2 diabetes. This is caused by over production of insulin (due to eating too much sugar), which ultimately leads to the cells that insulin work on shutting down their receptors. We know that diabetes is non-reversible, but we now know that pre-diabetes, the medical condition that leads to type-2 diabetes, is reversible. The exact same principle is true for obesity: the leptin hormone losses its effectiveness to suppress hunger, even though it’s still produced in the correct amount. Pre-obesity is generally reversible without medical intervention. Obesity is not reversible long-term without medical intervention. People who lose the weight experience a “terrible hunger” (Proietto’s words) and regain the weight over time.

Lustig says that sugar causes obesity, and Cordain says that cereal grains cause obesity – who is right?

The simple answer to this is I do not know. No one knows for certain. These are both two popular hypothesis. Lustig’s proposal that fructose in particular is responsible is based on what happens to flush it out of the blood – fructose has to be converted by the liver to glucose, and this does stimulate the production of triglycerides – i.e. fatty lipids. You need lipids in your blood, but excess lipid gets stored in the adipose tissue as body fat. Cordain, and some other researchers, think that it is cereal grain consumption that causes us to develop chronic diseases (I’m not even sure Cordain himself specifically links it to obesity, but certainly there are others who do). They argue that humans have eaten domesticated grains for less than 8,000 years – and some people have only just started eating them (e.g. Aboriginal Australians who never had agriculture prior to the arrival of the Europeans). Both hypothesis are interesting – I do not come down firmly on one side or the other of this argument, it may be a combination of the two. Japan seems to do very well eating a lot of rice, so it may be that the grains that are bad for us are limited to wheat and corn (and also potato see Mozaffarian et. al 2011), and that rice is much healthier.

Is obesity a disease in its own right, and what is the scientific definition of obesity?

Yes it is a disease, according to the World Health Organisation and to American Medical Association. It is not recognised as a disease in Australia at this time. There is no one precise definition of obesity, but generally speaking it refers to a condition associated with an abnormal amount of abdominal adipose tissue.

But isn’t the body designed to store excess fat for times of famine?

That is a theory as to why we can become overweight (pre-obese). It may well be true – but it’s not true for obesity. Obesity is a chronic disorder, there’s no biological benefit in it and ancient people were not becoming obese to save themselves in times of famine, they were only becoming overweight. Obesity leads to less mobility, sleep apnoea and difficulty in breathing, type 2 diabetes, arthritis and chronic pain. All of those issues would certainly have been relevant to all ancient humans even when life expectancy was much younger. There was an interesting study done in the UK that found that non-obese people respond differently to increased energy intake from food – some absorb it completely by speeding up their metabolism and gain no weight at all, others gain most of the excess kcal in stored weight but then some of those people stored it as muscle and not fat. Our bodies actually have quite a range of different ways it can behave and the explanation that the body is just “doing what it is supposed to do” is not really a valid explanation for obesity.

Selected References

  1. ABC News. (2014). Is obesity a disease? Retrieved from http://www.abc.net.au/news/2014-10-10/is-obesity-a-disease-fact-check-special/5766114
  2. Baxter, D. (2014). Obesity in Australia. Retrieved from https://blog.aractus.com/obesity-public-policy-essay.pdf
  3. Cordain, L. 1999. Cereal grains: Humanity’s double-edged sword. Evolutionary Aspects of Nutrition and Health, 84, 19-73.
  4. Enriori, P. J., Evans, A. E., Sinnayah, P. and Cowley, M. A. (2006). Leptin resistance and obesity. Obesity, 14(S8), 254S-258S. http://dx.doi.org/10.1038/oby.2006.319
  5. Mozaffarian, D., Hao, T., Rimm, E. B., Willett, W. C. and Hu, F. B. (2011). Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine, 346(25), 2392-2404. http://dx.doi.org/10.1056/NEJMoa1014296
  6. Proietto, J. (2011). Why is treating obesity so difficult? Justification for the role of bariatric surgery. The Medical journal of Australia, 195(3), 144-146.
  7. Wargo, R. (Producer), & Ford, J. (Producer). (2013). The complete skinny on obesity . Retrieved from http://youtu.be/moQZd1-BC0Y