This is an expansion of a post I did over on the Society for Science-Based Medicine blog about this time last year. The original post, which got far more traffic than is usual for the SFSBM, is a good example of how science works and the good that it can do. The hard work of real science illustrated here serves as a striking counterpoint to the slap-dash system of pseudoscience, which churns out fake diseases, causes, and cures by the dozen based on a fuzzy understanding of real science fueled by a healthy dose of imagination.
Naturopaths and “functional medicine” practitioners would have the public believe that they are the true experts on nutrition and health. Even though their nutritional advice contains a large serving of hooey and a big helping of dietary supplements, which they are happy to sell to patients.
So it was with great interest that I read the obituary of Dr. Lee Wattenberg in the New York Times.
Dr. Wattenberg published a landmark paper in the journal Cancer Research that reviewed 36 years of animal studies on the effects that certain compounds had on the development of cancer. The paper laid the framework for understanding how these compounds work. . . .
He showed that cabbage, brussel sprouts, cauliflower and broccoli inhibit the development of carcinogens. He isolated a compound in garlic that decreased “by a factor of three” the chances that animals injected with cancer agents would develop that cancer. He found two chemicals in coffee that neutralize free radicals, which are harmful chemicals commonly implicated in the onset of cancer.
Who was Lee Wattenberg?
Was he a naturopath? A functional medicine practitioner? No, Wattenberg was a medical doctor and his pioneering paper was published in 1966, almost 50 years ago. Long before functional medicine appeared on the scene, Wattenberg was researching the effect of diet on cancer prevention.
So was Wattenberg assailed by his colleagues as an apostate, a renegade who might destroy the medical profession’s alleged lucrative devotion to treating cancer with the tools of Big Pharma and surgery? Not at all. He was, according to the American Association for Cancer Research, “revered by his colleagues in the cancer field as a self-effacing leader.”
Wattenberg served on the Board and as president of that organization, where he was elected a Fellow. He received a number of awards from organizations devoted to fighting cancer and cancer research. For 60 years, Wattenberg was a faculty member at the University of Minnesota medical school and published many papers in the medical literature.
According to the obituary,
His interest was in helping to prevent cancer, and in a statement after his death, the American Association for Cancer Research called him the “father of chemoprevention.” . . .
“About two-thirds of all cancers are preventable,” Margaret Foti, the association’s current chief executive, said in the statement. “Because of Lee Wattenberg’s dedication to and belief in the promise of cancer prevention, the field has taken its rightful place as one of the most important areas of cancer research.”
Isn’t that something? The CEO of a respected medical research organization is talking about prevention, right there in the Times. Prevention through diet, no less. And saying it is an important area of cancer research! Doesn’t look like the stereotypical picture of medicine the pseudoscientific diet wizards try to sell. Doesn’t appear that medicine is solely interested in treating the disease rather than the “whole person,” as integrative medicine proponents would have us believe. Frankly, it appears to be – dare I say it? – positively “holistic” to me.
However, as is always true in scientific inquiry, not all of his hypotheses panned out.
Dr. Wattenberg and others once hoped that beta carotene, a substance found in carrots, squash and other vegetables, would help prevent cancer. But in clinical trials, beta carotene was found to increase the risk of lung cancer. Similarly, vitamin E, a substance once thought to lower the risk of prostate cancer, may actually raise the risk.
According to his daughter, these setbacks never discouraged her dad. He was “always eager to try the next thing.” Of course, when the next thing didn’t work, he didn’t keep advocating for its inclusion in clinical practice in spite of the evidence. He moved on.
Let’s briefly compare this approach to that of naturopaths, who wield their claimed expertise in nutrition like a truncheon, and Mark Hyman, MD, functional medicine guru.
Diet as disease prevention and treatment: naturopathic version
Guided by a “food is medicine” philosophy that relies heavily on the philosophy part, evidence be damned, the naturopath’s approach seems to dictate an endless trial-and-error elimination of this, adding that, until some positive result is achieved. This result is then attributed to the naturopath’s expertise in dietary advice, whether actual causation was involved or not.
Britt Hermes, herself a former naturopath and guest blogger on SBM, describes her own experience with naturopathic dietary advice on her own blog, Naturopathic Diaries. While anecdotal, it is a fair exemplar of standard naturopathic practice, as her “treatment” took place in a clinic run by Bastyr, where she received her naturopathic education and training. She later incorporated this dietary philosophy into her own naturopathic practice. As she describes it:
When my naturopath suggested severe dietary restrictions [for psoriasis and acne], I embraced them wholeheartedly and cultivated them into my own nutritional monster.
She was told to avoid all dairy, eat more protein, and eliminate refined sugars. Her naturopath explained the fictional gut-skin connection, reinforced when she learned about the “leaky gut” syndrome at Bastyr. For this, she was prescribed dietary supplements and herbs. She got IV “detoxification” treatments at Bastyr. Unnecessary weight loss was encouraged. She was given bogus IgG food intolerance tests. She was told not to eat any food that was the “root cause” of her acne and that she was “addicted to sugar.”
At her naturopath’s prompting, she detailed every bowel movement and her symptoms of bloating, pain and constipation. Instead of properly diagnosing these as a result of her pseudoscientific treatments, they were chalked up to “food reactions,” as were her irritability and depression, which were actually caused by hunger and malnutrition. Hermes instituted her own regimen of unproven dietary measures prompted by her faith in naturopathy and vetted in discussions with other Bastyr students and her naturopath.
As she notes:
Even by critics, naturopaths are often acknowledged for having training in nutrition . . . However, the nutritional training is wrapped up in pseudoscience, which makes it difficult to tease apart what is real and what is fake. For example, naturopaths often make dietary recommendations based on applied kinesiology tests, unvalidated blood tests, or far-fetched medical explanations. A commonly prescribed, but unproven, naturopathic diet theory is the elimination of nightshades to reduce the symptoms of inflammatory diseases, especially arthritis.
This is but one example of how naturopaths’ claim of special expertise in health and disease prevention through diet crumbles under closer examination, a subject we’ve examined on SBM a number of times in posts addressing dubious naturopathic dietary advice and diabetes, autism, infertility, allergies, and hypertension.
Diet as disease prevention and treatment: functional medicine version
The medical profession has its own “food as medicine” gurus, characterized by their splashy diet books and money-making diet schemes. Notable among these is Mark Hyman, MD, a family practice doctor and the main public face of “functional medicine.”
What is functional medicine? Good question. Here’s David Gorski’s take:
Functional medicine is pure pseudoscience, as Wally Sampson has explained. It postulates “imbalances” in hormones and neurotransmitters, oxidation-reduction, detoxification and biotransformation, immune function, inflammation, and cell structure. It’s all so vague that these “imbalances” could mean almost anything, and when practitioners of “functional medicine” refer to them, they usually do.
And that of the late, great Wally Sampson, who wrote a classic series on functional medicine (Functional Medicine (FM): What Is It?; Functional Medicine II; Functional Medicine III; Functional Medicine IV):
After extensive searching and examination, my answer is still – only the originators of “FM” know. Or, at least one must assume they know, because so far as I can see, I certainly see nothing that distinguishes “FM” from other descriptions of sectarian and “Complementary/Alternative Medicine” practices. A difference may lie in the advocates’ assumptions to have found some “imbalance” of body chemistry or physiology before applying one or more unproved methods or substances. From what I could determine, the “imbalance” or dysfunction is usually either imaginary or at least presumptive. And the general principles are so poorly defined as to allow practioners vast leeway to apply a host of unproven methods.
Hyman has adopted the naturopathic mantra that “conventional” medicine treats only symptoms by reaching for the prescription pad, while “functional medicine” gets at the “root cause” of disease. In fact, Hyman’s articles on the treatment of psoriasis and acne sound remarkably like the naturopathic regimens prescribed for Britt Hermes.
Hyman’s outfit sells proprietary programs online, including dietary supplements prescribed by these programs. According to his website, he has authored journal articles on the subject, but, according to PubMed, all of them have appeared in one journal of dubious scientific rigor, Alternative Therapies in Health and Medicine.
Unfortunately, the “Institute for Functional Medicine,” where Hyman serves as board chair, is an approved provider of continuing medical education credit, where its courses are chock full of quackery, aided by lectures from not only the supposedly science-based professions, like medicine and dentistry, but a fair helping of naturopaths and chiropractors.
Hyman’s poor understanding of the diseases about which he pontificates have been the subject of several take downs in the science blogosphere: autism, dementia, and, relevant to our subject here, cancer. He regularly holds forth on the Huffington Post, free from the restraints of science and evidence.
As Steve Novella opined, practitioners like Hyman:
seem to search for any tenuous evidence to support their philosophy or marketing strategy and then make huge hand-waving extrapolations from the evidence to their practice.
Jerome Groopman, MD, chronicled Hyman’s extrapolations versus actual evidence more recently in a New Yorker article, where several experts disagreed with Hyman’s conclusions. Even in the face of this, according to Groopman:
Mark Hyman holds fast to his view. “Inflammation is the final common pathway for pretty much all chronic diseases,” he told me. His recommended solution is an “anti-inflammatory diet”—omitting sugar, caffeine, beans, dairy, gluten, and processed foods, as well as taking a variety of supplements, including probiotics, fish oil, Vitamins C and D, and curcumin, a key molecule in turmeric.
Although, Groopman added, Hyman, “at times, acknowledges the possible limits of his paradigm” and that it is hard to “connect the dots.” This reads more like another act of hubris on Hyman’s part rather than an actual admission that he might be wrong. “Possible” limits?
Note the contrast here between Dr. Wattenberg’s work and that of functional medicine practitioners and naturopaths. Dr. Wattenberg reviewed the research before developing his theories. He published his work in well-regarded peer-reviewed journals. And he was willing to move on when the evidence wasn’t there. No clinging to a “philosophy” or pet ideas despite the evidence. Just a lot of hard work and devotion to the scientific method. Dr. Wattenberg was “revered” by other scientists. No one would ever say that about Hyman or naturopaths.
Happy Holidays, everyone! See you in January.