Holford Watch: Patrick Holford, nutritionism and bad science

Back in January we wrote to Professor Patrick Holford of Teesside University, Head of Science and Education at Biocare and CEO of Food for the Brain: we asked some questions about the survey to help us perform a robust review. We waited for three weeks but did not receive any responses and, thus hampered, continued to review the survey and uncovered about as grisly a work of ineptitude with statistics as has ever come our way.

The FFTB Child Survey literature review was irrelevant and incompetent. But the number-crunching and display of summary data were breathtakingly, unbelievably bad. Office-neighbours-should-have-been-pounding-on-the-wall-and-calling-the-statistics-authorities-and-reporting-a-hazard-to-health bad. The-guilty-parties-should-be-having-their-keyboard-privileges-revoked bad. (more…)

Having just posted about Professor Patrick Holford of Teesside University’s curious relationship with the mainstream media, we were fascinated to see Patrick Holford responding to the Radio 4 programme: The Rise of the Lifestyle Nutritionists. From what he writes, it sounds like he does feature in Part 2 of the series. I haven’t heard Part 2 yet - it’s scheduled to be broadcast on March 31 at 8pm - but it’s already clear that Holford fails to offer an adequate response to the questions raised. His responses range from dodging the questions asked, to answering while giving a clearly incorrect answer, and so gobsmackingly wrong that they even fail to qualify as wrong. Now I’m really looking forward to the radio programme: Holford digs himself in deep enough without having heard the programme, but I’m sure that the BBC’s research skills will allow them to provide a JCB or two to join Holford in his hole. (more…)

In a fine example of convergent evolution, some information posted on HolfordWatch, the digging by Letting off Steam and Ben Goldacre’s tenacity have a welcome airing as the Durham fish oil zombie once again swims through the nutrient-rich waters of the Bad Science blog. This week, Ben Goldacre returns again to the Durham fish oil (non)trial:

And so an epic saga comes to a close. You will remember the Durham Fish Oil tale - don’t switch off now, the punchline’s funny. The county council said it was doing a “trial” of fish oil pills in children, but the trial was designed so that it couldn’t possibly give useful information - not least because it had no placebo group - and was very likely to give a false positive result.

However, we don’t feel that the story is over quite yet. There is still plenty of information to come out: although any hopes of meaningful results from this trial are long dead, the Durham fish oil zombie still swims this morning and will return to swim another day. For starters, we would like to tell you the story of the fabulous mutating press release to come out (more…)

I was interested to see JQH at Letting Off Steam blogging about his difficulties in extracting information about Durham’s Council’s (non)trial of fish oil in their schools. Apparently, Durham referred JQH to a Council meeting response to a question put to them. However, at least one of the Council’s claims about Durham’s fish oil (non)trial is false - as a simple search of Durham’s own website makes clear. Oops…

Durham Council claims that their fish oil (non)trial

was never intended, and the County Council never suggested, that it would use this initiative to draw conclusions about the effectiveness or otherwise of using Fish Oil to boost exam results.

This is - to be blunt - simply not true. Searching Durham’s website for ‘fish oil’ brings up a 2006 press release, where the Council states that:

All Year 11 pupils at Durham County Council’s 36 comprehensive schools are to be offered omega-3 fish oil supplements to see whether the proven benefits it has already brought children and young people in earlier trials can boost exam performances too…the first test of the supplement’s effectiveness will be when [the pupils] sit their ‘mock’ exams this December.

Given that Durham Council said - in its own press release - that this (non) trial was going to let us see whether fish oil pills could boost exam performance, the Council was clearly wrong to state in 2008 that it “never suggested [that] it would use this initiative to draw conclusions about the effectiveness or otherwise of using Fish Oil to boost exam results”. Moreover, while one can’t know the Council’s intentions back in 2006, it would have been remarkably foolish of them to put out the press release quoted above if they did not intend to use this (non)trial to draw conclusions about the efficacy of fish oil.

Oh dear. This really is a fishy business.

Professor Patrick Holford of Teesside University and Head of Science and Education at Biocare has an unerring sense for his endorsements (see, e.g., the qLink with the unconnected coil and the dLan that may enhance your exposure to EMR and YorkTest, the IgG food intolerance tests criticised by both the House of Lords and the ASA). Holford managed to procure some useful backing for the Food for the Brain project. One of the companies is Equazen. Equazen donated essential fat supplements to school projects. With an astonishing sense of inevitability, Equazen has just been criticised by the ASA and found to be unable to substantiate some of its advertising claims: e.g. “A Hi-EPA fish oil formula that may help maintain concentration levels and healthy brain development”. (more…)

In the Irish Independent, Holford is quoted as stating that “The UK’s National Institute of Clinical Excellence [NICE] recommends that all doctors prescribe one gram of fish oil to patients who have had a heart attack. The trouble is, most of us don’t eat nearly enough omega 3 and 6 fats.” However, NICE actually recommend [PDF, p.5] that patients “Eat two to four portions of oily fish a week, such as herring, sardines,mackerel, salmon, trout and tuna.,,,If you have had a heart attack in the last 3 months and do not eat enough oily fish, your doctor may offer a medicine to supplement your diet.”

In other words: eat oily fish, it’s tasty and healthy. If eating enough fish is a problem, then your doctor may suggest supplements (and, obviously, do not stop taking a prescribed supplement due to a blog post). One more thing - most people eating a ‘Western diet’ will consume too high a ratio of omega 6 fats to omega 3 fats. However, if you do feel that you are deficient in omega 6 fats, these can easily be topped up with things like sunflower seeds and oil.

According a terrible article by Ann Coogan - where Prof Holford of Teesside University describes “5 steps to perfect health” - Holford eats oily fish three times per day, and seeds, but still feels the need to take omega 3 and 6 supplements. All I can say is - why? That type of diet will provide plenty of omega 3 and 6 fats, without the need to resort to pills… But, still, Holford says he takes supplements. (more…)

Prof Patrick Holford of Teesside University excites remarkable admiration; so much so that Holford Watch is regularly reproved for merely questioning the Holford interpretation of science and nutrition.

We’ve previously referred to the oddities of the Holford way with simple numbers whereby, e.g., 4 days is the equivalent of a month and a striking inability to interpret simple messages accurately. (more…)

The Times had an article today on Food for Thought. Lots of decent stuff here: they quote a proper dietitian and everything. Sadly, though, they also use Holford as an expert commentator. Fay Schopen writes that:

Patrick Holford, the author of several books on nutrition and a visiting professor at the University of Teesside, says that there is good evidence for some supplements, especially omega-3. “It’s hard to do a randomised mackerel trial,” he points out, but he says that six studies have suggested that omega-3 supplements are effective in reducing depression, details of which can be found on his Food for the Brain website. “There’s an ever-increasing incidence of mental health problems in the workplace,” he says, pointing to stress, anxiety, depression, insomnia and memory decline. “Our world has speeded up immensely with the internet and e-mails, and we have to process much more information, I believe part of the reason for mental health problems is that we need much better nutrition.”

On the plus side, hopefully this means that The Times have realised that calling Holford a ‘nutritionist’ does not mean much. However, I’m still not sure that “the author of several books on nutrition” is a good descriptor for Holford: given the significant amounts of money he has made from the supplement industry, perhaps something like ‘nutritional entrepeneur’ would be more fitting.

Of course, if Holford provided good quality evidence for his claims, I wouldn’t particularly mind about his competing financial interests. Sadly, he doesn’t. Holford states that “six studies have suggested that omega-3 supplements are effective in reducing depression, details of which can be found on his Food for the Brain website”. Sounds fair enough - and, of course, in a quality paper like The Times a journalist would always check this type of thing, right? They would, wouldn’t they…?

Well, apparently not. Being picky about these things, I looked at ‘the evidence‘ on the Food for the Brain (FFTB) website. It listed twenty studies. Sounds good, doesn’t it - even better than the six Holford mentioned. Well, it would be good - except only two of these twenty studies focus on omega 3 fats and depression. One might also note that one of these studies focuses on bipolar depression - and results therefore may not map well across to typical depression. (more…)

Patrick Holford had a problem with numbers. Sometimes, he cannot reproduce numbers accurately when they are laid out plainly, nor can he interpret them. However, there are times when his presentation of numbers is fishier than ever and this is causing some confusion. Some young readers have written to us.

Dear Holford Watch,

It was bad enough when we were being force-fed healthy-eating dogma during PSHE but now it is infesting our after-school clubs where we have to learn about nutrition with only brownie points on offer rather than the real thing.

We are tired of older people looking at us with crocodile tears in their eyes as they gloat that we will be the first generation to die before our parents. Then teachers set up projects where we have to review the research and data that assure us of our untimely deaths through toxic overload, pollution, Wi-Fi, too much food, too few nutrients etc. but certainly not a deficit of Prozac or Ritalin.

Last night we were advised to eat fish but to be careful because it contains toxins. We were told to look at a table of Omega-3 and mercury levels in different fish and to write a poem about how it made us feel. The table was quoted from a book by Patrick Holford so we were already a little suspicious. After all, Patrick Holford is the bowel-whisperer and doom-monger in residence for GMTV.

We couldn’t work out what the last column was supposed to tell us. The supervisor looked in the book but it didn’t say anything helpful. Then there was a fight because some people said that the numbers were wrong but when we asked the adults they did a nervous count on their fingers, giggled and changed the subject. Then they said that it is in a book that has been released in this new edition so it must be right.

Please help us.

Class 9, Erewhon School for the Jaded

Holford Watch is sympathetic to the plight of the young who are subjected to jeremiads about their health and bamboozled by adults who fail to understand the flaws in the basic science or maths of the ‘research’ that they thrust at them.

Dear Class 9,

We can understand why you are puzzled by the chart and we, too, find it annoying when we see a table without a legend to explain it. Before we address the errors in basic arithmetic, we recommend that you read Sandy at Junkfood Science who reassures us about the safety of fish despite the flip-flopping news headlines that are enough to frighten anyone into math hysteria.

There is no source given for the values that Holford quotes and some of his advice for fish consumption differs from that of the Food Standards Agency. Reading the text that precedes the chart, we learn that it:

lists fish in order of best to worst, in terms of the greatest amount of omega-3 with the lowest amount of mercury.

You were right to have misgivings about the numbers; what we have here is a failure to understand and convert units of measurement. The detail follows but we can only speculate that there are typos in the chart and errors in basic arithmetic.

The fresh wild salmon has 2.7 g/100g Omega-3, 0.05 mercury mg/kg but the 3rd column estimates that the ratio (or whatever that is supposed to be) is 54.0. Holford Watch reasons that the salmon has 27 g/kg of Omega-3 (or 27,000mg) which makes it a little easier to compare to the mercury. We estimate that Holford’s calculation is out by a factor of 10,000 but what’s a few orders of magnitude between guru and follower. We think that the number in the final column should be an unwieldy 540,000 rather than 54.

Ever ready to give Holford the benefit of the doubt, we ran some of the other calculations to determine whether there was (say) a consistent error in the units which would make some sort of sense. Sadly, there isn’t. E.g., Holford reports that marin has Omega-3 of 1.1 g/100g and mercury of 1.1 mg/kg and calculates the ratio as 1. We think that this should read 11g/kg (11,000mg) and 1.1 mg/kg with a ratio of 10,000 rather than 1. This is the same error of order of magnitude as for the fresh wild salmon. However, at a glance, it was obvious that there was a different order of magnitude error for the fresh mackerel: Holford reports around 10x more mercury, and a similar amount of Omega-3, yet the ratio is approximately the same, rather than differing by an order of magnitude (as it should). Fresh mackerel is reported to have 19.3 g/kg (19300mg) Omega-3 and 0.54 mg/kg of mercury: Holford calculates this as a ratio of 35.7. Holford Watch estimates that this should read 35,741: so, this is a lower order of magnitude than the other calculations.

Holford Watch is delighted that you spotted something fishy with the numbers as soon as you saw the table but we are a little dispirited that the adults who gave this to you didn’t spot the errors. It is irritating that these mistakes have obviously persisted despite the new edition of the book.

Did you write a poem about how you felt?

Pisces vobiscum - Holford Watch

Dear Holford Watch,

Our mothers always taught us that we should never be unkind
But they’ve never read New Optimum Nutrition for the Mind.
If Class 9 could have one retrospective, fervent, longed-for wish
It would be we’d never looked at Patrick Holford’s chart of fish.

Yours - Class 9