Fear and Loathing in Clinical Nutrition – Part III

Iodine, Glutamate, and Beyond

In this installment of “Fear and Loathing in Clinical Nutrition” I would like to start by again bringing to your attention a serious issue relating to toxicology that I last discussed in this forum in 2000.  Why am I mentioning this again?  My observations suggest that, in the nine years since I last mentioned one of  the great, under appreciated toxicologic issues of our time, little has changed in terms of prevalence in our environment or recognition by our society of the true dangers.  To what am I referring?  DHMO, or dihydrogen monoxide.  Therefore, I feel it is necessary to bring to you much more dramatic and detailed information on the dangers of DHMO than what I presented nine years ago.  Fortunately, a number of excellent websites are now available that give much more detail than what was formerly available the last time I addressed the subject.  One of the best is http://www.dhmo.org/.  On this site you will find a detailed discussion about almost every facet of this deadly substance.  However, in order to motivate you to read the contents of this site in detail, I would like to present a brief quote that comes from the section of the site entitled “Frequently asked questions about dihydrogen monoxide (DHMO)”:

What is Dihydrogen Monoxide?

Dihydrogen Monoxide (DHMO) is a colorless and odorless chemical compound, also referred to by some as Dihydrogen Oxide, Hydrogen Hydroxide, Hydronium Hydroxide, or simply Hydric acid. Its basis is the highly reactive hydroxyl radical, a species shown to mutate DNA, denature proteins, disrupt cell membranes, and chemically alter critical neurotransmitters. The atomic components of DHMO are found in a number of caustic, explosive and poisonous compounds such as Sulfuric Acid, Nitroglycerine and Ethyl Alcohol.

For more detailed information, including precautions, disposal procedures and storage requirements, refer to one of the Material Safety Data Sheets (MSDS) available for DHMO:

What information on the dangers of DHMO can be gleaned from material safety data sheets?  An example would be the following quote that can be found on www.DHMO.org.

“SPECIAL PRECAUTIONS:

KEEP CONTAINER TIGHTLY CLOSED. SUITABLE FOR ANY GENERAL CHEMICAL STORAGE AREA. DIHYDROGEN MONOXIDE IS CONSIDERED A NON-REGULATED PRODUCT, BUT REACTS VIGOROUSLY WITH SOME MATERIALS. THESE INCLUDE SODIUM, POTASSIUM AND OTHER ALKALI METALS; ELEMENTAL FLUORINE; AND STRONG DEHYDRATING AGENTS SUCH AS SULFURIC ACID. IT FORMS EXPLOSIVE GASES WITH CALCIUM CARBIDE.  AVOID CONTACT WITH ALL MATERIALS UNTIL INVESTIGATION SHOWS SUBSTANCE IS COMPATIBLE. EXPANDS SIGNIFICANTLY UPON FREEZING. DO NOT STORE IN RIGID CONTAINER AND PROTECT FROM FREEZING.”

Another excellent source of information on the dangers of DHMO comes from Coalition to ban DHMO.  One of their articles, which can be found on the Internet is “Ban dihydrogen monoxide.”  Quoted below is a segment from this article:

“The Invisible Killer”

Dihydrogen monoxide is colorless, odorless, tasteless, and kills uncounted thousands of people every year. Most of these deaths are caused by accidental inhalation of DHMO, but the dangers of dihydrogen monoxide do not end there. Prolonged exposure to its solid form causes severe tissue damage. Symptoms of DHMO ingestion can include excessive sweating and urination, and possibly a bloated feeling, nausea, vomiting and body electrolyte imbalance. For those who have become dependent, DHMO withdrawal means certain death.

Dihydrogen monoxide:

  • is also known as hydroxyl acid, and is the major component of acid rain.
  • contributes to the “greenhouse effect.”
  • may cause severe burns.
  • contributes to the erosion of our natural landscape.
  • accelerates corrosion and rusting of many metals.
  • may cause electrical failures and decreased effectiveness of automobile brakes.
  • has been found in excised tumors of terminal cancer patients.

Contamination Is Reaching Epidemic Proportions!

Quantities of dihydrogen monoxide have been found in almost every stream, lake, and reservoir in America today. But the pollution is global, and the contaminant has even been found in Antarctic ice. DHMO has caused millions of dollars of property damage in the midwest, and recently California.

Despite the danger, dihydrogen monoxide is often used:

  • as an industrial solvent and coolant.
  • in nuclear power plants.
  • in the production of styrofoam.
  • as a fire retardant.
  • in many forms of cruel animal research.
  • in the distribution of pesticides. Even after washing, produce remains contaminated by this chemical.
  • as an additive in certain “junk-foods” and other food products.

Companies dump waste DHMO into rivers and the ocean, and nothing can be done to stop them because this practice is still legal. The impact on wildlife is extreme, and we cannot afford to ignore it any longer!

The Horror Must Be Stopped!

The American government has refused to ban the production, distribution, or use of this damaging chemical due to its “importance to the economic health of this nation.” In fact, the navy and other military organizations are conducting experiments with DHMO, and designing multi-billion dollar devices to control and utilize it during warfare situations. Hundreds of military research facilities receive tons of it through a highly sophisticated underground distribution network. Many store large quantities for later use.

It’s Not Too Late!

Act NOW to prevent further contamination. Find out more about this dangerous chemical. What you don’t know can hurt you and others throughout the world.”

Of course, I am assuming that most of you “got the joke” very early on that all of the above refers to, as I last stated nine years ago, water.  Nevertheless, how effective has this somewhat obvious parody been in convincing the public to advocate a total ban of DHMO?  Interestingly, surveys on http://www.dhmo.org/ indicate that, of the different groups questioned, anywhere from 30 to 80% answered “Yes” to an outright ban.

To me, these startling statistics lead to another, more disturbing question.  How successful are websites dealing with more complicated issues in creating more fear and trepidation that what is warranted for virtually anything, including any particular constituent found in today’s food supply?  As you will see in the next section, more successful than you might hope or expect.  Of course, as I hope I demonstrated with my discussion on glutamate in the last issue where, among other recommendations, a certain website is advocating avoidance of foods labeled as “organic” by those with a history of adverse reactions to MSG, legitimate, websites are excellent places to transform justifiable concern into fear that has a minimal basis in logic and rationality.  Furthermore, as you will see in the next section, the problem of converting appropriate concern to irrational fear that can occur on the Internet goes way beyond websites relating to orally ingested substances.  However, before proceeding to the next section, I would like to ask another question that goes to the very heart of the age old problem of propaganda and its impact on society.  For, very often, propaganda is nothing more than, as seen in http://www.dhmo.org/, publishing factual information using language and sentence construction in a way that uses the readers’ ignorance as a tool to create fear, which as I hope I have demonstrated in this series, are inextricably linked.  In turn, I feel we need to ask why so many authors of Internet text feel that the best way to advance their cause is to mine the ignorance of the reader to create fear.

One answer suggested by some is that fear is the best way to stimulate people to take action.  Hopefully, I have demonstrated in this series that, while fear can certainly lead to action, it rarely leads to rational and intelligent action.  Therefore, I summarily reject the often used argument that creation of fear is the best way to stimulate constructive responses to challenges.  Others suggest that those who have a desire to create fear also demonstrate a desire for less than admirable goals such as establishing control or demonstrating superiority so as to create a following.  In turn, creating a following based on fear is a time-tested way to successfully engage in less than noble pursuits such as feeding egos and pocketbooks.  Unfortunately, my experience over the years suggests this scenario occurs all too often.  Therefore, anytime I read information from websites or any other source that constructs facts in a way that appears to have a goal of creating fear, I feel I must first ask a question before deciding whether I or anyone else should take the information seriously.  Who will benefit most by heeding the information; the author or the reader?  If my inner sense does not say immediately and unmistakably, “the reader,” I move on to what I consider to be more legitimate and ethical sources of information as quickly as possible.

DOES THE INTERNET PROMOTE DISSEMINATION OF INFORMATION THAT STIMULATES LEGITIMATE CONCERN OR IRRATIONAL FEAR – A DISCUSSION ON “CYBERCHONDRIA” 

When considering the issue of disseminating truthful information to the public about what is helpful and what is detrimental to health, has the Internet been part of the solution or part of the problem?  Interestingly, one of the most comprehensive answers to this question has come from, at first glance, what most would consider to be one of the most unlikely of sources, Microsoft.  Recently, two researchers named Ryen W. White and Eric Horvitz authored a paper entitled “Cyberchondria: Studies of the escalation of medical concerns in web search” that has been released by Microsoft and can be downloaded from the Internet at no charge.  In this paper, the authors noted the results of a study performed on 515 Microsoft employees to determine the nature of their use of the Internet in relation to health concerns.  More specifically, the research objectives were the following:

“We specifically sought to explore the extent to which pursuing information on common innocuous symptoms can escalate into the review of content on serious, often rare conditions that may be associated with the common symptoms.  Our study aimed to characterize the nature of query-based escalation from common symptoms to more serious illnesses within a session, and the emergence of longer-term medical anxieties following the occurrence of escalation.”

Are there legitimate reasons to believe that, indeed, many who use the Internet as a source of information on their health concerns will misinterpret the information, generally assuming that the condition is of a greater concern that what is actually warranted?  As I have been suggesting in this series, there is ample data to support a conclusion that many in our society are using the Internet to confirm in their minds their worst possible health fears.  White and Horvitz use the term cyberchondria to describe this increasingly prevalent way of using the Internet in our society.  In the introduction to their paper, the authors go into more detail on the nature of cyberchondria:

“…the use of Web search as a diagnostic procedure-where queries describing symptoms are input and the rank and information of results are interpreted as diagnostic conclusions-can lead users to believe that common symptoms are likely the result of serious illnesses.  Such escalations from common symptoms to serious concerns may lead to unnecessary anxiety, investment of time, and expensive engagements with healthcare professionals.  We use the term cyberchondria to refer to the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.”

Of course, the above quote infers that the public, when searching the Internet about health concerns, is merely misinterpreting accurate information.  Unfortunately, as many of you know, the problem is not so simple.  In fact, the reality that much information related to healthcare on the Internet is inaccurate adds significant complexity to the issue.  The authors go into detail on this important point:

“The large volumes of medical information on the Web, some of which is erroneous, may mislead users with health concerns.  Much has been written in the medical community about the unreliability of Web content in general or content about specific conditions such as cancer.  Indeed studies have shown that, although 8 in 10 American adults have searched for healthcare information online, 75% refrain from checking key quality indicators such as the validity of the source and the creation date of medical information.”

White and Horvitz continue by discussing a paper that evaluated accuracy of health-related information on the Internet:

“Eysenbach and colleagues systematically reviewed health Website evaluations and found that the most frequently used quality criteria included accuracy, completeness, and design (e.g., visual appeal, layout, readability).  In their review, the authors noted that 70% of the studies they examined concluded that the quality of health-related Web content is low.”

Next White and Horvitz discuss the inherent dangers of people with no medical training trying to read and interpret medical terminology:

“Benigeri and Pluye show that exposing people with no medical training to complex terminology and descriptions of medical conditions may put them at risk of harm from self-diagnosis and self-treatment.”

Given that the quality of health-related information on the Internet is often low and given the fact that readers of this information often do not fully understand the terminology used, what do the author conclude?

“These factors combine to make the Web a potentially dangerous place for health seekers.”

In turn:

“Our results show that Web search engines have the potential to escalate medical concerns.”

What are these concerns?  The authors continue:

“We show that escalation is influenced by the amount and distribution of medical content viewed by users, the presence of escalatory terminology in pages visited, and a user’s predisposition to escalate versus to seek more reasonable explanations for ailments.  We also demonstrate the persistence of post-session anxiety following escalations and the effect that such anxieties can have on interrupting user’s activities across multiple sessions.”

In “Microsoft examines causes of ‘cyberchondria,'” an article by John Markoff that appeared in the November 25, 2008 issue of The New York Times, additional information about the significance of this study is offered:

“‘People tend to look at just the first couple results,’ Mr. Horvitz said.  ‘If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.”

“They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare.  For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.”

“The researchers said they had not intended their work to send the message that people should ignore symptoms.  But their examination of search records indicated that researching particular symptoms often led quickly to anxiousness.”

The final statement I would like to feature from this article by Markoff, to me, says the most in terms of the underlying theme of this series that fear and the toll it takes on logical, rational thought processes is playing a very profound and detrimental role on healthcare decision making in our society:

“The researchers said that Web searchers’ propensity to jump to awful conclusions was basic human behavior that has been noted by research scientists for decades.”

Interestingly, it has been the assumption of many for years that the antidote to irrational, fear-based decision-making that is derived from ignorance is education.  In turn, it was assumed that the increased popularity of the Internet over the last 10-15 years would provide the solution to reducing ignorance in relationship to healthcare.  Unfortunately, those who confidently assumed that the Internet would eliminate health-related ignorance failed to consider three important possibilities.  First, the belief that we could rely on the “honor system” in terms of the accuracy of information on health-related websites was, in retrospect, quite naive.  In fact, as you know, there is, realistically, no way that anyone without advanced training in medicine and clinical nutrition can consistently determine if information on any particular website is totally accurate, totally false, or, as what is seen fairly often, a combination of the two.  Second, those who believed that the Internet would be the ultimate solution to ill-health did not consider the possibility that many users of the Internet will not understand much of the language used and then, in a knee-jerk fashion, assume that whatever is not understood, as suggested in the quote above, has negative implications.  Third, I would guess that many in the early days of the Internet who thought that this would be the ultimate healthcare educational tool for the population at large failed to consider how much the Internet would grow in terms of websites that provide health-related information.  As you know, most searches on virtually any subject will yield thousands of different websites.  Does this bounty of choice provide increased security and satisfaction to the confused, ailing consumer or increased anxiety and uncertainty?  This question has been asked and answered in a book authored by Barry Schwartz entitled The Paradox of Choice (1):

“When people have no choice, life is almost unbearable.  As the number of available choices increases, as it has in our consumer culture, the autonomy, control, and liberation this variety brings are powerful and positive.  But as the number of choices keeps growing, negative aspects of having a multitude of options begins to appear.  As the number of choices grows further, the negatives escalate until we become overloaded.  At this point, choice no longer liberates, but debilitates.  It might even be said to tyrannize.”

When people are ailing, what do they want the most; the opportunity to whittle down thousands of possibilities to the one that is right for them or someone or something, such as a website, to hold their hand, tell them they will get better, and then make sure improvements in health, indeed, follow?  I would guess, in the vast majority of instances, the answer is the latter.

Before closing this brief discussion on the dangers of frequent Internet use in healthcare, I would like to leave you with another quote from Schwartz’s book that sums up these dangers well:

“It isn’t easy to pass up opportunities to choose.  The key thing to appreciate, though, is that what is most important to us, most of the time, is not the objective results of decisions, but the subjective results.  If the ability to choose enables you to get a better care, house, job, vacation, or coffeemaker, but the process of choice makes you feel worse about what you’ve chosen, you really haven’t gained anything from the opportunity to choose.  And much of the time, better objective results and worse subjective results are exactly what our overabundance of options provides.”

How might the above quote be applied to ailing, frightened patient who is using the Internet as a source for diagnosis and treatment planning?  By using the Internet as a source of healthcare information, an objective need for easy access to a large amount of information is met.  However, as suggested above by White and Horvitz, people who lack the knowledge to discern false information and/or lack the ability to understand medical terminology will have a tendency to make poor choices in the direction of medical apocalypse.  Therefore, for example, if such an individual decides, after consulting the Internet, that chronic headaches are the result of a brain tumor instead of reactive hypoglycemia caused by excessive intake of refined carbohydrates, I would suggest the individual, as suggested by Schwartz, will almost always feel worse about the choice, yielding no real gain, especially if the true cause is the latter.

With the above in mind, it should be no surprise that so many people have taken http://www.dhmo.org/, a website clearly meant to be satirical in nature, seriously.  Furthermore, it should be no surprise that similarly formatted sites, where deception and not humor seems to be the overriding intent, have successfully transformed fear into a viable marketing tool.  In turn, with all of the above in mind, it should be no surprise that, as use of the Internet continues to grow, fear seems to be one of the most important factors influencing the healthcare choices that are being made today.

FEAR AND LOATHING IN CLINICAL NUTRITION – SOME THOUGHTS ON SOLUTIONS

In this series on fear and loathing I wanted to emphasize two overriding themes.  First, I wanted to emphasize how fear, ego, and the ignorance upon which these are largely based act as powerful forces in shaping our attitudes and ultimately our decisions and actions concerning clinical nutrition.  Second, I wanted to emphasize that one of the ultimate solutions is detailed and accurate information based upon both the best research and clinical data available.  However, given that so much of what I have discussed is primarily based on reliance on credible research, I would like to now provide some additional ideas on how to spot quality research.  Of course, I have already suggested how I personally try to weed out published information that, whether or not there was deliberate intention, create fear and concern that is not warranted.  However, I would also like to present some recommendations that are a bit more objective, yet presented with language that can be easily understood by patients or anyone else who lacks advanced knowledge in statistics and other complexities of research interpretation.  One simple article that I feel makes an excellent effort in accomplishing this is “Q & A: Which diet studies are worth attention?” by Liz Szabo that appeared in the January 6, 2009 issue of USA Today.  In this article, which is written in a question and answer format, Szabo primarily discusses the thoughts of Dr. J. Michael Gaziano, who is affiliated with the VA Boston and Brigham and Women’s Hospital.

“Q. Why do the new studies contradict the findings of earlier research?

A. Many of those earlier studies were preliminary.  That means they usually can’t prove cause and effect, Gaziano says.  Scientists are familiar with these limitations.  ‘Conflicting results are part and parcel of the scientific process,’ Gaziano says.  ‘It’s why we’re often reluctant to make a clinical recommendation based on a single result.’  But consumers-who pay much closer attention to diet news than to other areas of medicine-can easily get confused if they mistake these early findings for solid results, says Peter Gann of the University of Illinois…”

Q. So which studies should we pay attention to?

A. The strongest studies are called randomized clinical trials.  These are the best experiments for proving that one thing causes another, Gaziano says.  In these tests, researchers randomly assign one group of people to do one thing, such as take a vitamin, but assign a comparison group to do something else, such as take a placebo pill, he says.  In a ‘double-blind trial’ – the most rigorous kind – neither patients nor their immediate doctors know which pills they are taking.  Only the researchers running the trial know who’s in which group.  An outside panel oversees the study to make sure that patients aren’t harmed and may stop the study early if problems surface.

Q. Are all diet studies randomized trials?

A. No.  There are many other kinds of studies, Gaziano says.

-Observational studies: In these studies, doctors observe different groups, such as people who choose to take vitamins and those who don’t.  They follow both groups for many years, then note how each group fares.  They might measure which people develop cancer, for example.  This kind of study can find associations, such as the fact that people who take vitamins are less likely to get cancer, Gaziano says.  But an observational study can’t prove that vitamins actually prevent cancer.  That’s because there could be something different about people who choose to take vitamins compared to others.  For example, people who take vitamins might be more likely to exercise and get regular checkups.

-Subgroup analyses: Doctors sometimes look through their data to see if there are other interesting trends.  Gaziano says.  These findings also can mislead, though, because each subgroup may be so small that any trends could be caused by chance.

-Laboratory studies: Studies in animals or cells are interesting, but doctors usually don’t base their advice to patients on these tests, Gaziano says.  Instead, scientists use these tests to decide whether to do more definitive studies.

Q. What is the best way to research a health study?

A. Because all drugs – including vitamins and herbs – have side effects, it’s worth taking the time to do some research before putting them in your body, Gaziano says.  Gaziano suggests that consumers read news stories carefully to assess how doctors got their results.  If a story isn’t clear, patients should consider looking up the original article in a medical journal or asking their doctors.  Patients can also consult the website of major medical organizations, such as the American Cancer Society, the Centers for Disease Control and Prevention or the National Cancer Institute.  These groups sift through scientific evidence when making recommendations about diets, screening tests and other health issues.

Q. Why is there so much confusion about diet news?

A. Everyone likes good news, Gaziano says.  So it’s tempting for everyone – from researchers who want to further their careers to journalists looking for a scoop – to overplay preliminary results.  Consumers are often quick to put too much faith in the latest ‘advance’ out of wishful thinking.  Lots of people, for example, would rather take a pill than go through the hard work of diet and exercise.”

Of course, I realize that those of you who are experienced with detailed, critical evaluation of medical research will undoubtedly point out that the above commentary falls short of resolving the mass of complexities and contrasts seen in published nutritional research today.  However, if fear truly begins with ignorance, ultimately the best solution is education.  Therefore, I hope we can all agree that the article by Czabo does provide a solid beginning for those who want to learn more about nutritional research but are uncertain about how to determine reliable sources of information.

Another interesting, simple and somewhat self evident solution to fear and loathing was suggested by Marc Siegel, MD in his book False Alarm: The Truth About the Epidemic of Fear (2).  Could it be that one of the most effective solutions to health-related fear is us?  Siegel states:

“Without mentors, without people we can trust, we grow more fearful.  Doctors are among the groups of former good guys who have been discredited by our culture of worry.  At the outset of the twenty-first century, patients are frightened by the latest technologies, but even more so by the impersonal and robotic way medical information is sometimes delivered.  In context of today’s fear-provoking parceling out of health factoids, a well-informed communicative caring physician-a throwback to an earlier time in history-can make a big difference in calming fears and providing perspective.”

While I am all too aware that the realities of today’s economic environment are making it increasingly difficult to be the kind of practitioner who can both educate and transform creeping fear into calm perspective, it is my hope that by better educating ourselves about nutritional controversies such as glutamate and iodine, we can become, more and more, part of the solution when considering the epidemic of fear-based decision-making that continues to plague the nutritional community.

WHY DOES GLUTAMATE GENERATE SO MUCH FEAR AND WHY DOES IODINE GENERATE SO LITTLE?

Now that I have explored both the issue of fear in health care and the biochemistry of glutamate and iodine in detail, I would now like to go back to the question that began this fear and loathing series.  Why does there seem to be an excessive amount of fear concerning glutamate and why does there seem to be an excessive lack of fear concerning iodine?  I would like to propose several possible answers to this question.

1. We are hard-wired for fear – In Siegel’s book (2), this concept that was initially addressed in part I of this series was reiterated in the following quote by David Ropeik, director of risk communication at the Harvard Center for Risk Analysis:

“We are hard-wired in our brains to fear first, think second.”

Furthermore, as also suggested in part I of this series, the amount of fear seems to be inversely proportional to the level of familiarity.  Siegel (2) explores this point in his discussion on cigarettes:

“There is a deep-rooted public resistance to thinking that familiar objects are perilous.  We tend to believe that an invisible remote pathogen like SARS or sarin gas can infiltrate our air more easily than a common cigarette.

Cigarettes are familiar props in our society.  We saw them romanticized in movies, television ads, and glossy magazines, before promoting cigarettes was restricted.  We are still slow to accept the danger of casual exposure.  Even if most people have now accepted that smoking itself is dangerous, secondhand smoke is still tied to the dreamy images in our youth, wafts of it tickling our faces on a moonlit night.”

Similarly, I feel the same can be stated about glutamate and iodine.  On one hand, glutamate relates to an area of the body that is relatively unknown to most practitioners and is considered to be relatively complicated, the central nervous system and neurotransmitters.  In addition, some of our most deep seated, health-related fears relate to degenerative neurologic diseases such as multiple sclerosis, ALS, and Alzheimer’s disease for which, even now, we have few solutions compared with many other chronic illnesses.  Therefore, it should be no surprise that anything that adversely affects the nervous system will generate fear that is out of proportion to the biochemical realities.  In contrast, discussions on iodine and the organ it most directly affects, the thyroid, have been a staple among virtually all members of the health care community and many in the general public for years now.  In turn, this has led to the kind of familiarity, as with cigarettes, that makes predictions of adverse effects somewhat hard to believe no matter what the dose.  Thus, given our comfort level with iodine and the thyroid that has come from years of familiarity, it should not be surprising that iodine is considered by many to be almost completely immune to the laws of dose/response that suggest everything is detrimental to health at a certain dose.  On the other hand, given our relative ignorance about the central nervous system and amino acids such as glutamate and our fears about central nervous system degeneration, it should not be surprising that the biochemical realities of glutamate are often not highly correlated with the level of fear.

2. “It is what we think we know already that prevents us from learning.” (Claude Bernard) – I feel this very apropos quote, which I not only used previously in this series but have had posted at my desk at home for years, not only provides an excellent answer to the question posed in this section but, as I have repeatedly suggested, gives valuable insight into many of our biggest controversies not only in clinical nutrition but, quite possibly, the world at large.  More specifically, I feel that some important and timely clinical and research data have been filtered by long held and quite popular beliefs and agendas relating to nutrition to create a product that is of questionable accuracy and functionality.  While I feel that there are many beliefs and agendas that would fit this description, I also feel that there is one that stands above the rest in terms of creating misunderstandings and confusion that ultimately lead to inappropriate usage and less than satisfactory results.  What is this belief/agenda?  As I have stated repeatedly in this series and over the years in both seminars and other newsletters, it is the belief/agenda that nutrients, by virtue of being “natural,” will have no adverse effect on anyone no matter what the dose.   Hopefully I have convinced you that this is simply and completely inaccurate.

With the above in mind, how did glutamate gain such a negative reputation?  I feel that important and timely clinical and research data on the dangers of ingesting excessive amounts of processed foods laden with glutamate was filtered though an ignorance-based, fear-based agenda about amino acids and the central nervous system.  In turn, a product of questionable value was created.  This product, largely being disseminated via the Internet and certain highly influential authors and lecturers, suggested that anyone who has ever experienced “Chinese restaurant syndrome” should avoid all dietary sources of glutamate and glutamine.

What about iodine?   I feel that my iodine series has shown that advocates of milligram dosing of iodine such as Abraham and his colleagues have performed an incredibly valuable service by reporting on clinical data and largely ignored research papers that suggest many patients will experience significantly improved outcomes by ingesting amounts higher than the RDI.  However, I also feel that an overwhelming body of research and clinical data makes it clear that the impact of this important message was deluded by what appears to me a belief by these advocates in the popular agenda mentioned above that nutrients are exempt from the dose/response principles as outlined so simply by Paracelsus and others.  More specifically, I feel the information presented in this series makes it clear that milligram dosing of iodine will have adverse effects on thyroid function in a small but significant portion of all populations, including the Japanese.  Therefore, any suggestions that iodine is a benign panacea that will have absolutely no adverse effects on anyone at virtually any dose up to several dozen milligrams are simply not supported by any well documented research or clinical data I have seen up to this point.

SOME FINAL THOUGHTS

Since I realize that many of you may have diverging opinions on our new president, discussions about politics in forums such as this can be risky.  Nevertheless, as clinicians and nutritional scientists I hope we can agree, no matter what our opinions of President Obama may be in other areas of policy, his statement “…restore science to its rightful place…” is a step in the right direction in terms of what we are trying to accomplish with patients.  However, in keeping with the theme of this series, I do feel we need to ask specifically why it is so important to change popular perceptions of science.  This question was recently explored in an eloquent fashion by Dennis Overbye in an essay that appeared in the January 27, 2009 issue of The New York Times.  In this essay Overbye discusses what science is and why it is so necessary to a healthy society:.

“Science is not a monument of received Truth but something that people do to look for truth. 

That endeavor, which has transformed the world in the last few centuries, does indeed teach values.  Those values, among others, are honesty, doubt, respect for evidence, openness, accountability and tolerance and indeed hunger for opposing points of view.  These are the unabashedly pragmatic working principles that guide the buzzing, testing, poking, probing, argumentative, gossiping, gadgety, joking, dreaming and tendentious cloud of activity-the writer and biologist Lewis Thomas once likened it to an anthill-that is slowly and thoroughly penetrating every nook and cranny of the world.

Nobody appeared in a cloud of smoke and taught scientists these virtues.  This behavior simply evolved because it worked.”

The last quote from this excellent essay I would like to present is actually a statement by Hu Yaobang, the general secretary of the Chinese Communist Party in 1980″

“‘Science is what it is simply because it can break down fetishes and superstitions and is bold in explorations and because it opposes following the beaten path and dares to destroy outmoded conventions and bad customs.'”

As noted by Overbye, it is ironic that China itself has not yet allowed these words to become reality.  Nevertheless, the fact that they were stated is no less significant.

Over the years, I have done my best to make sure that Moss Nutrition lives up to this view of science, that no matter how popular or profitable an idea, policy or product, it can never be allowed to become a “sacred cow” that cannot be subjected to “testing, poking, probing,” and a good dose of healthy skepticism.

Have I been guilty of allowing agendas to guide my words and actions?  Unfortunately, yes.  Most recently, I began the iodine series with a somewhat obvious intention of “digging in” in opposition to all statements made by Abraham and his colleagues due to their attacks on the personal integrity of those who disagree with them.  However, I soon realized that my initial viewpoint was much too simplistic.  On one hand, as I mentioned, while I found the personal attacks to be less than professional, I did find their information on the efficacy of milligram dosing of iodine for many patients to be truly outstanding.  On the other hand, as I also mentioned, I found their scientific and clinical support for their insistence that iodine is benign for everyone, even at substantial doses, without merit.  Would any other method of investigation other than the scientific method as described by Overbye enabled me to separate myself from my initial prejudices so as to clearly see both positive and negative points?  Not from my perspective.

In closing, I hope we can all start doing a little better job of restoring science to its rightful place by being a bit more vigilant for times when we are “digging in” with our agendas.  For, very often these are times when “fear and loathing” are starting, in a sometimes subtle and almost unrecognizable manner, to commandeer our good judgment.   Hopefully, at these times, our better sense will immediately recognize what is happening and signal us that we need to step back, take a deep breath, and let all that is good about the scientific method take its rightful course.

One final comment.  While, again, I realize that references to politics can be dangerous in forums such as this, I hope you can enjoy and appreciate the editorial cartoon on the following page.

Moss Nutrition Report #225 – 02/01/2009 – PDF Version

REFERENCES

  1. Schwartz B. The Paradox of Choice: Why More is Less New York: Harper Collins; 2004.
  2. Siegel M. False Alarm: The Truth About the Epidemic of Fear Hoboken, NJ: John Wiley & Sons, Inc.; 2005.