Holford Watch: Patrick Holford, nutritionism and bad science

Former Visiting Professor Patrick Holford and Head of Science and Education at Biocare has been interviewed in South Africa as part of his promotional work for Optimum Nutrition Made Easy. Parts 1, 2, 3 and 4. Regular readers are accustomed to Holford’s alternate reality (and part 2) so will not be surprised that he refers to himself as an expert in diabetes.

We’re tempted to say that he has recourse to this because few knowledgeable people, credulous journalists don’t count, are prepared to describe him as an expert in a named field. You may recall Dr John Marks’ and Prof Andre Tylee’s withdrawal of support.*

For those who find it difficult to lug around the New Optimum Nutrition Bible or its siblings, Holford has thoughtfully produced this vade mecum version: Optimum Nutrition Made Easy. Millions of us will now be slapping our heads and exclaiming “D’oh!” as we realise how we’ve been over-complicating the aetiology of most chronic disease.

Holford outlines a state of health in which people are not only free from pain but “wake up full of energy” and “should have a good mood and concentration all day long”. How do we attain this Nirvana? The answer is Holford’s take on ’simple nutrition’ - which really isn’t by the time you have added in all of the supplement recommendations and depends on how easy it is for you to adopt a low GL diet. But, it is always good to imply that your method is “easy” because it means that the client/consumer is responsible for any perceived failures and are thus doubly blameworthy. On the topic of chronic diseases, Holford says:

Most of the chronic diseases, but also most of our general malaise, from digestive problems to weight problems to energy problems to concentration problems, are all down to what you put in your mouth…
When you are optimally nourished you simply don’t need any medicine. [Part 1, 1:30-5]

Who knew, eh? It’s obviously just foolish people who fail to see the equivalence between diabetes, depression, COPD, asthma, sleep apnoea, angina etc. and “general malaise” in terms of seriousness and even implications for your work activity and socio-economic status. And, keep your opinions to yourself, those of you who think that socio-economic status is a useful proxy for health and life expectancy. We’re looking at you, Dr Ben Goldacre:

And that’s the most sinister feature of the whole nutritionist project…it’s a manifesto of rightwing individualism - you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.

Holford and the interviewer don’t explore the issue of (say) hepatitis B or C or the papilloma virus and their links to cancer but it would be useful to see if Holford believes that such viruses don’t take hold in optimally nourished people.

Asked if he sees a role for medicines, Holford acknowledges that they have some utility:

When you are in an emergency situation, or a chronic disease, so perhaps the odd painkiller and so on. But, really, we should not be using medicines on a long-term basis. So, I’ll give you a classic example. Yes, it’s true that Lipitor, one of the statin drugs, can somewhat decrease your risk of heart disease, but nothing like as effectively as changing your diet, eating a low glycaemic load diet and so on.
So, it doesn’t take a lot of intelligence to realise that pain is not simply caused by a lack of painkillers, and heart disease isn’t principally caused by a lack of statins. And depression isn’t principally caused by a lack of anti-depressants. So, even those kinds of drugs may be useful in the short-term [but] in the long-term you have to get to the underlying cause which is about nutrition. It’s also about stress, the state of your mind and also exercise. [Part 1, 1:38-2:35]

The ‘odd painkiller’. Gosh, again, who knew? And, although it would be delightful if everyone could avoid long-term medicines, for some people, they really are necessary. People with under-active thyroids, for example. And, why is it so much more desirable that everyone should take supplements every day but that long-term use of appropriate medication is to be deplored? As for the final insights into the lack of Y not prinicipally causing X…OK, it’s embarrassing, but is there a general feeling as to whether it is less cringe-making than the belief that dowsing or applied kinesiology can detect nutritional deficiencies or health conditions?

Just in case you were despairing of the interviewer, she does ask what has the potential to be a useful question, albeit it doesn’t elicit a useful answer.

Interviewer: If we start off good, we will generally stay good.
Holford: Yes, that’s part of the message. There’s another, quite radical, message…When we develop disease, it means that your biological matrix, your biochemistry has gone out of balance. And many people don’t realise that a major discovery has been made, and that is, that to bring your biology back into balance, you often need amounts of nutrients that you simply can not achieve from a well-balanced diet…
If you ate, like we used to eat, living in the jungle, you might consume 50mcg of chromium which is an essential mineral that makes insulin work properly. Now if you’re diabetic 50mcg of chromium will really do nothing. However, 500mcg, 10 times, way more than you can eat, is actually very profound in making insulin work better, stabilising your blood sugar and therefore it is really something that every diabetic should really be taking. [Part 1, 2:40-3:54]

Well, yet again, and to borrow a phrase, Goldacre thinks that it may be a little more complicated than that:

I rent a flat in London’s Kentish Town…This is a very poor working-class area, and the male life expectancy is about 70 years. Two miles away in Hampstead…male life expectancy is almost 80 years. I know this because I have the Annual Public Health Report for Camden open on the table right now.

This phenomenal disparity in life expectancy - the difference between a lengthy and rich retirement, and a very truncated one indeed - is not because the people in Hampstead are careful to eat a handful of Brazil nuts every day, to make sure they’re not deficient in selenium, as per nutritionists’ advice.

And that’s the most sinister feature of the whole nutritionist project, graphically exemplified by McKeith: it’s a manifesto of rightwing individualism - you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.

HolfordWatch is not entirely sure if Holford is suggesting that eating well (according to his definition) can overcome the diseases that tend to go alongside damp housing, fuel poverty etc. And, we are a little hazy as to the evidence base for:

[a] major discovery has been made, and that is, that to bring your biology back into balance, you often need amounts of nutrients that you simply can not achieve from a well-balanced diet.

What major discovery and where was it assessed and published? HolfordWatch is not entirely sure about the implication that disease is related to a disordered biology that can be brought back in line through supplementation. And, without knowing either of those two, it is difficult to comment on the claim that you need more nutrients that is available from a well-balanced diet.

As for Holford’s claim about chromium, despite his self-reference:

Myself and other experts in the diabetes field…[Pt 3, 2:23-5]

there is no clear evidence that chromium is effective for stablising the blood sugar of people with diabetes.

We shall discuss more of the topics that were covered in the Holford interview at a later date: we are hunting for evidence for some of Holford’s more extravagant claims for the GL diet and collating some of his more obscure references for it (the GL heavily featured in Part 3). Not least of all, HolfordWatch would dearly like to see the study that compares and contrasts the relative efficacy of statins and a low GL diet as suggested in Holford’s interview. And we are longing to identify all these other studies that prove the supremacy of the low GL diet for such a wide range of illnesses, and particular clinical evidence of its efficacy.

Notes

*You may have noticed that Professor Jonathan Waxman’s endorsement of Food Is Better Medicine Than Drugs had disappeared from the patrickholford.com website. We had heard that Waxman had requested that his endorsement should be removed. However, since the re-vamp of the patrickholford.com website, it seems that the endorsements have re-appeared. It is difficult to know if this is a site re-building glitch or if Waxman has changed his mind. Time will tell.