Holford Watch: Patrick Holford, nutritionism and bad science

Professor Patrick Holford has a remarkably agile PR team with helpful lacunae in their collective memories. 27.02.2007, Holford’s email subscribers received an email, What’s the alternative to ineffective anti-depressants? (more…)

Bella Blisset previously ran a pretty dismal article on nutrition in the Evening Standard (9/10/07, p. 41) - pretty much reproducing some of Holford’s claims that food is better medicine than drugs, without allowing any experts in evidence-based nutrition and medicine to challenge his - often dubious - claims. To make things worse, the article referred to “Dr Patrick Holford, the UK’s top nutritionist” (Holford does not have a PhD). Depressingly, another version of this article has been carried by the Scotsman - with the main change being that it now refers to “Patrick Holford, the UK’s best-known nutritionist”. The article is , however, still riddled with dubious claims. You can leave your comments on the Scotsman article here, or contact the paper with your views.

Unsurprisingly, I’m not impressed with the article. (more…)

Patrick Holford adopts a certain triumphalist tone when praising the academic and scientific gravitas of Food Is Better Medicine Than Drugs:

Every single section, on arthritis, on diabetes, hormonal imbalance, depression, attention deficit, etc. Every single chapter was checked by a professor who specialised in that area.

For reasons we’ve previously explained, Holford Watch begs leave to express polite disbelief about this claim. (more…)

Patrick Holford makes many interesting claims during a promotional segment for Food Is Better Medicine Than Drugs on The Late Late Show.

Timestamp on video: 20:00 The Late Late Show, RTE Television. 3 November 2006

Patrick Holford: Every single section, on arthritis, on diabetes, hormonal imbalance, depression, attention deficit, etc. Every single chapter was checked by a professor who specialised in that area.

This means that somewhere, some cardiovascular/cardiology expert signed-off on the Food Is Better Medicine Than Drugs claim that the Number Needed to Treat for statins is 19,600. It would be fascinating to know the identity of this un-named reviewer, particularly as that claim was so outlandish that it was obvious to anyone else less than half a second after it hit the eyeball. And it only took that long because the eyeball was still fluttering with unfocused outrage at having been subjected to such nonsense.

Read remainder of entry

Patrick Holford the international bowel-whisperer and supplement entrepreneur is familiar to us. Prepare to be dazzled by Patrick Holford the tap-dancer as he delivers a very partial account both of the training of nutritionists and the status of his own nutritional qualifications in a bravura performance on RTE’s The Late Late Show.

Patrick Holford had a 20 minute slot to promote Food Is Better Medicine Than Drugs on the Late Late Show (watch the video). As with the recent encounter Patrick Holford v. Dr. Sarah Jarvis smackdown on GMTV (partial transcript and commentary), Holford came up against one of those splendidly feisty women GPs who have embraced the right to speak their minds plainly in fine contradistinction to anything that their mothers might have tried to instill into them regarding that stifling social convention, “If you can’t say anything nice, don’t say anything at all”.

Discussions on the Late Late Show tend to be conducted in the seductively attractive cadences of well-read Hibernians and are both entertaining and soothing even if you have no interest in the subject-matter. Read remainder of entry

As Dr Crippen notes, Patrick Holford has taken it upon himself to educate the British Dietetic Association (BDA) on the benefits of dietary interventions for autism. On this blog, Shinga has also analysed Holford’s wisdom on this issue. I’m also going to look over some of Holford’s ‘evidence’ base on this.

If you’re going to take it on yourself to lecture a learned body like the BDA, you had better make sure your research stands up to scrutiny. Sadly, the ‘evidence’ that Holford provides for a gluten free casein free (GFCF) diet to treat autism doesn’t stand up to even cursory scrutiny.

Holford’s first piece of autism-specific evidence is a link to Robert Cade’s work. Unlike in other Holford work, the link works this time - I suppose one should give Holford some credit for this. However, he doesn’t get any credit for the quality of this ‘evidence’. Read remainder of entry

Patrick Holford regularly accuses scientists, doctors and the pharmaceutical industry of withholding or distorting research findings. In a promotional video for Food is Better Medicine than Drugs Holford casts himself and co-author Jerome Burne as Woodward and Bernstein figures battling against omnipotent forces. Holford espouses a belief in:

full spectrum dominance. [The pharmaceutical industry] literally influence the researchers, the journals, the doctors…So the information we get just simply isn’t the truth.

I’ve spent the last year with top, award-winning, medical journalist Jerome Burne, exposing the truth about the pharmaceutical industry…

We’ve…found that about 20% of drug prescriptions are given to patients for whom there is no evidence that it works at all. For example, statin drugs, designed to lower cholesterol. Almost 20,000 people have to take a statin for 5 years for one less heart attack-that is, if you haven’t already had a heart attack.

Scary stuff. (more…)

I don’t expect much of Patrick Holford. I thought that he was good for a little light relief, the occasional surge in blood pressure, a claim here, a statement there, that provokes a roll of the eyes and a shrug of the shoulders. I could never have anticipated that he would leave me goggling with disbelief and speechless. Ironically, it felt as if my heart had skipped a beat or two.

I accepted Amazon’s offer to watch a video clip and Meet the Author of Food is Better Medicine than Drugs. There was the usual riff on “Pharma Bad, Dolphins Good“. (more…)

Sadly, super has no legal definition when used to market foodstuffs. Superfoods do not have to give us super powers. We’re just expected to accept widespread assertions that they are overflowing with standard and special nutrients that confer energy, increase sexual potency, improve cognitive skills and protect us against diseases such as heart disease, strokes, diabetes and even cancer.

Where there is an extraordinary nutritional or medical claim is being made for a food, then Patrick Holford is likely to be part of the chorus, and he is. You can read about Superfoods on Holford’s own site or in his co-authored book, Food Is Better Medicine than Drugs.

Today’s Observer carries an interesting article that debunks many of the claims for superfoods and questions whether they provide nutrients that can’t be obtained from more readily available and cheaper foodstuffs: Forget superfoods, you can’t beat an apple a day.

Several experts explain that basic science shows that some claims about superfoods can not be proved, and any specific benefits may not be available to everyone who eats them. The redoutable Catherine Collins, chief dietitian at St. George’s Hospital in London, offers a helpful synopsis of the issues:

‘There are so many wrong ideas about superfoods that I don’t know where best to begin to dismantle the whole concept.’

Just because certain foods are bursting with a particular vitamin or nutrient does not mean they will be especially good for you, Collins said. ‘It might seem that eating foods rich in nutrients is just common sense, but the truth is that our bodies have a requirement for sufficient nutrients,’ she added.

‘If our bodies have an excess of nutrients and cannot store them, they will essentially go to waste. Or, more worryingly, if certain nutrients can’t be excreted in sufficient levels, they could cause serious cellular damage. Overloading our bodies is not a healthy or natural thing to do.’

Not only is there no scientific definition of a superfood, but the concept itself could be harmful. ‘Nominating some foods as nutritional talismans gives the impression that ordinary, affordable and everyday foods are somehow deficient,’ she said. ‘But rather than spend £5 on a small punnet of exotic berries, a family would be better off buying regular and larger quantities of fresh fruit and vegetables from their local market.

‘On a restricted budget, it is even more important to ignore dubious, expensive products in the belief you can take short cuts to a good diet. Rather than buying some ridiculous African algae, with all the CO2 emissions associated with travel, eating a cheap British apple would be better for the environment too.’

Berries, algae and wheatgrass make an appearance in Holford’s list of superfoods. There is a myth-busting section in which we learn how very Pooterish, rather than super, these foods are. E.g., despite the extravagant claims made for wheatgrass by its envangelists, its nutritional benefits are pitilessly compared to cheaper and more accessible foods:

The commonly held assumption that a 30ml shot of wheatgrass juice is nutritionally equivalent to a kilogram of vegetables is a complete myth. A floret or two of broccoli, or a tablespoon of spinach, contain more folic acid and vitamin C than 30ml of wheatgrass juice.

Overall, it looks as if berries, wheatgrass, algae and other superfoods thought to have remarkable super powers should give up looking for phone boxes. The powers of superfoods lie in their earning potential for marketeers and supermarkets rather than superior nutrition for consumers.

UPDATE: Patrick Holford has been in touch to clarify his position - emphasising that nutritional approaches to HIV/AIDS should be used “alongside medication”, and stating that he has “never advised anyone to stop taking, or not to take ARVs”. Obviously, this is extremely welcome - I’ve e-mailed Holford to ask for some further details, but I’m very glad to see him clarifying his position on this.

I’ve received an e-mail arguing that it’s unfair for me to attack Jerome Burne by noting that he was apparently videoed at a Matthias Rath rally, applauding. As I say in the original post, I wasn’t entirely comfortable with taking this line: it could easily seem like an unfair personal attack on Burne and Holford. That’s why I’m going to review this issue here - and it would be great if readers could let me know what they think of my position on this.

With this in mind, I think the first thing I ought to do is to provide a link to the video so that readers can watch it, and see Burne’s response to Rath’s speech - that way, you can judge for yourself whether or not Burne’s reaction is acceptable. So, you can watch Rath’s latest London speech here (for some reason I can’t get the video to embed in the blog; blogging’s great like that - the future’s here, but it’s broken).

I don’t apologise for the fact that Matthias Rath makes me very angry. Rath has claimed that the proprietary vitamin pills he sells can treat a startling range of illnesses - from cancer to heart disease. However, I’m going to focus (as did in the London speech) on HIV/AIDS.

While estimates as to numbers of deaths in South Africa vary, it is apparent that - at ‘best’ - several hundred thousand South Africans have died of AIDS-related illnesses in the past couple of years. The people dying of AIDS tend, disproportionately, to be relatively young (there is a particularly high increase in the death rate among 25 to 49-year-olds). While such deaths are always tragic, this is compounded by the fact that AIDS is a relatively nasty way to go. Those dying of AIDS are often survived by their children: there are currently over one million AIDS orphans in South Africa.

The reason that I am so angry with Rath is that he has been using his - considerable - to intervene in South African politics. The Guardian observes that Rath has taken out adverts in South Africa (and elsewhere in the world) claiming that “Aids drugs are toxic and potentially deadly“. For The Guardian, this has increased the widespread public uncertainty [in South Africa] around whether these drugs are safe to use and are beneficial.In the video above, Rath claims - misleadingly - that people on antiretroviral drugs have a 4-6 times higher chance of dying of AIDS than those who are not taking these drugs.

Antiretroviral drugs do have unpleasant side-effects - to state the obvious, one should do everything possible to avoid contracting HIV in the first place - but, for those who have contracted HIV/AIDS, these drugs save lives. To misquote Woody Allen (talking about aging) - the effects of antiretroviral drugs can be really nasty, but they sure beat the alternative. One can first note the dramatic fall in AIDS-related deaths in the US, after the introduction of these drugs (at the same time as the number of people living with HIV/AIDS has been going up):

Some have argued that it is not helpful to focus on the benefits of these drugs in the US: it has been claimed that, in poorer communities, other problems like malnutrition will mean that people do not benefit from antiretrovirals. However, the evidence is that antiretrovirals are still useful to these communities. For example, a study of the efficacy of these drugs in a Jo’burg township shows that they are effective (and cost effective).

This doesn’t mean that vitamin supplementation is pointless. For example, there is some evidence for supplementation with vitamin A, C, and a multivitamin in HIV/AIDS patients (although the evidence is not conclusive, and there are potential risks - speak to your Dr or dietician if you’re considering this type of supplementation, as this isn’t an area where one should rely on online advice from a blogger). Clearly, it is also a good idea for those with HIV/AIDS to eat a healthy diet (food poverty in South Africa has, sadly, been an issue for some time - and needs to be addressed ASAP). However, a healthy diet and vitamin supplements can be a helpful complement to antiretroviral drugs. Sadly, though, those who use these as an alternative to antiretrovirals are very likely to die unnecessarily early.

Moreover, the Treatment Action Campaign argues that Rath’s marketing techniques, and experiments, have been linked to specific unnecessary deaths in South Africa. Treatment Action Campaign offer five case studies of South Africans who died while on a Rath trial; they argue that, “for three of these patients Rath is at a minimum responsible for contributing to their deaths“. In his speech in London, Rath talked about this trial. The video above appears to show Burne applauding.

Hopefully, it will now be clear to you why this makes me angry with both Rath and Burne. I could give plenty of additional examples of reasons to be angry about Rath, but this post is getting a bit long already. There’s lots more detail on Treatment Action Campaign’s site.

So - is it fair for me to write about Burne’s behaviour on the video, and criticise Burne for this? I can understand why people might be unhappy if I seem to be condemning Burne by his association with Rath. Had Burne just being in the audience at the talk, that would have been understandable - after all, Burne is a health journalist. However, applauding Rath is a different matter.

Burne is the co-author (with Holford) of a book titled Food is Better Medicine than Drugs. I therefore think that Burne’s behaviour at a Rath speech is worth noting. Rath is a famous advocate of vitamins (what Burne and Holford would probably call ‘food’) as an alternative to antiretroviral drugs. Burne appears to have responded very positively to Rath’s position, despite the fact that people have died and are dying in South Africa (and elsewhere) because they are choosing to rely on ‘food’ instead of effective antiretroviral drugs. I do think that it is quite acceptable to discuss this on a blog.

A second question is whether it is acceptable for me to write about this on a blog about Patrick Holford - am I trying to somehow condemn him just because of his association with Burne and therefore with Rath? Holford has not made his position on antiretroviral drugs and HIV particularly clear. Given that his previous statements on HIV and vitamin C have been criticised - and that Holford was recently on a speaking tour in South Africa, where this was a hot media issue - I think it is perfectly reasonable to ask Holford to clarify his position. Again, I would note that Holford co-authored Food is Better Medicine than Drugs with Burne: I’d like to know whether Holford acknowledges that, in the case of HIV/AIDS, drugs are a necessary part of the best treatment approaches.

If Holford is aware that antiretroviral drugs are the best available treatment for HIV/AIDS, he should quite explicitly say so: people are currently dying unnecessarily because of misconceptions about antiretroviral drugs. Given that his co-author has apparently been caught on video responding so positively to Rath, I think it is also reasonable to ask that Holford makes explicit his opinion of Rath: is Rath wrong to advocate vitamin pills as an alternative to antiretroviral drugs?

This is all a messy business, though - looking at how well the character of Burne and Holford stands up, instead of analysing Holford’s science. Hovever, given the fact that, even as I write this post, South Africans are dying unnecessarily because they do not have access to, or choose not to take, effective HIV/AIDS medications, this may not be an appropriate time for moral niceties. I think it’s reasonable for me to ask about Burne and Holford’s views on HIV/AIDS, antiretroviral drugs and Rath. If an influential nutritionist like Patrick Holford were to publicly and unambiguously back proven treatments for HIV/AIDS - while condemning the sale and promotion of ineffective ‘alternative’ treatments - this could have a positive effect: Holford could help save lives. It’s worth noting that Holford has previously lectured in South Africa, and gives his name to a line of vitamin pills sold there: it’s not as if he’s unknown in South Africa, or unfamiliar with the situation there.

So, do you agree with me? Is this important information to get out, or am I being unfairly harsh on Burne/Holford/Rath? Let me know what you think.