Pseudoscience Friday – Sweden abandons “diet dogma” (not), and sugar addiction

There are some pieces of information that one could call “zombie facts”, for two reasons – first, they are compromised in terms of their mere existence (zombies don’t exist, and these aren’t facts) and second because they are very difficult to kill.

In February 2012, we learnt that Keanu Reeves had died in a snowboarding accident, and it took myself and a few others most of the day before we managed to get South African Twitter to stop circulating this zombie fact.

When pointing out that the website in question has a footnote attesting to being 100% fake made no difference, I started tweeting that I – and many others – had died also. Go ahead and die for yourself, if you like, by editing this URL.

While some zombie facts can be defeated in a mere day, others are more resilient, for example the (false) claim that Sweden has become the first nation to reject the low fat “diet dogma” in favour of low carb high fat dietary guidelines.

That blog post, as well as one from “Diet Doctor”, were written in late 2013, yet I get this zombie fact tweeted and emailed to me on a fairly regular basis, mostly by the disciples of Prof. Tim Noakes (who has himself previously circulated this zombie fact – in fact, even before the Swedish report was available in English. But maybe the diet helps you translate, too.).

Here’s why it’s a zombie fact (why it’s false, I mean – I’ve already remarked on how difficult is is to kill): because these are neither national guidelines, and nor are the guidelines being reported accurately.

As it turns out, reporters had mistaken a review published by the Swedish Council on Health Technology Assessment (SBU) in September for new national guidelines. Måns Rosén, PhD, executive director at SBU, was anxious to squelch the rumors. “First, I would like to stress that we do not do guidelines, only systematic reviews and health technology assessment reports,” he says. “Second, we have earlier focused on patients with diabetes and now obese persons, not the general population.”

Let’s now hear from the authors of the SBU report on how their findings are being misrepresented (Google translate, which I’ve then edited lightly for clarity):

SBU report “Food in obesity” attracted huge media attention and was over-interpreted by some. We would like to clarify the report’s message and correct some interpretations for which we did not find evidence.

Two mis-interpretations have, in our opinion occurred in the wake of the publication of the SBU report. One is that low carb high fat is by far better. Yes, during the first 6 months you lose weight faster on low carbohydrate diets. But after one and two years that diet has no advantage than other diets for obesity. Possibly this may be due to adherence to dietary advice abate over time.

SBU has made two assessments on food, partly on diabetes and partly about obesity. The results of these evaluations are valid just for people with diabetes and obesity, and not necessarily for the general population. Issues related to food and health for the general population, we have not investigated.

The most important aspect is the food affects the risk of becoming ill or dying prematurely, but most studies are designed to investigate the weight loss for up to a year or two. However, there is evidence that intensive counseling about the Mediterranean diet to obese individuals reduces risk of stroke, myocardial infarction and cardiovascular mortality compared with advice on low-fat diets. For other food types, such as low carbohydrate diets (like Atkins or carb) or diet with a low GI, no scientific evidence to determine whether they affect morbidity or mortality in people with obesity.

So, as per the growing consensus, we’ve demonised some fats unfairly (I strongly recommend the Harvard School of Public Health’s resource on this), the Mediterranean diet sees good outcomes for obese individuals, and we see good short-term effects on obesity with LCHF, but have no evidence that morbidity and mortality improve with low carb diets. Plus, the study has implications for obese and diabetic people, not for the whole population.

Not quite what the “Sweden discards diet dogma” headline promises, is it?

Second, sugar – that “addictive toxin”, according to some. It’s back in the news locally thanks to this Times Live piece which has a “sugar addict” telling all, including how she “helps others who have a self-diagnosed sugar and carbohydrate addiction”. There’s your first clue that something is amiss: you wouldn’t need to self-diagnose if medical professionals were willing and able to diagnose this “addiction”.

There’s no question that some people have impulse control disorders with regard to food that tastes good – and there’s also no question that for most of us, sugary and high carb foods do taste good, so could easily become vectors for expressing whatever impulse control issues we might have.

But that’s not the same thing as “addictive”, unless we’re happy to completely subvert the meaning of the word, and simultaneously insult people who have addictions of the regular sort – ones recognised in the DSM, perhaps, or ones where we’ve identified receptors for the addictive substance in the brain, or ones where we have physiological consequences for not getting your “fix”.

In a nugget of pseudoscience that’s fairly typical in this area, the piece linked above quotes a dietician, Rael Koping, as saying that sugar is indeed physiologically addictive, as “It acts on the same centre of the brain as heroin. It can calm you down”.

Yes, it is true that there is dopamine release after the intake of sugar – but you’ll get that with anything you enjoy, whether it be music, being in love, fried chicken or even – gasp – fat. Yes, LCHF people, fat is perhaps “addictive” too, in that research is suggesting that fatty foods cause an initial dopamine surge, but later, desensitisation – meaning that you need to eat more and more to satisfy your cravings.

It goes without saying that things you like will “calm you down” – especially if you’ve pathologised liking them to the extent that a self-diagnosed “addict” would have. Closing my Twitter client “calms me down”, because I no longer see links to bad science journalism, but I’m not sure what that means in terms of my addictions. I think I’ll self-diagnose as “addicted” to common sense, just to be safe.

If you want to read more about how dopamine release by itself doesn’t equal addiction, there’s some good information in this post on sugar addiction, by a group of local dieticians.

Then, as for toxicity, the first thing to note is that “the dose makes the poison“, as Paracelsus is said to have told us. It’s sheer hysteria to say that sugar is toxic without making reference to dosage, as doing so implies that no amount of it is safe. I’d strongly recommend that you read this (long) piece on sugar by James Hamblin in The Atlantic, but this extract speaks to my point on dosage:

‘To say that fructose is toxic is a total misconception of the nature of the molecule,’ Fred Brouns, a professor of Health Food Innovation at Maastricht University in the Netherlands, recently told me. ‘If you have too much oxygen, it is toxic. If you get too much water, you have water intoxication. That doesn’t mean we say oxygen is toxic’.

Robert Lustig has enjoyed 4 761 509 views on his “Sugar: the bitter truth” video, and has also published opinion pieces in Nature, the New York Times and elsewhere, telling you that sugar is going to kill you (or at least, make you very sick). But popularity doesn’t solve scientific questions, and opinion pieces – even in the most prestigious journals – are not equal to peer-reviewed science.

Some of his colleagues think he’s wrong too, but I’d again suggest that you read the Hamblin piece above to understand how complex issues are being oversimplified in the current sugar panic, and how so long as you’re not gluttonous about it, there’s nothing wrong with eating sugar. And, it’s probably not addictive either, unless you’re a Humpty Dumptyist about language.