This is a part of a series, the fact that it is number one only has to do with it’s chronological order in the series. It is not meant to imply that it is the primary reason to hate WebMD, it’s just the first one we are writing about. There are plenty of reasons to hate WebMD, and we’ll get there.
Now, a site that has MD in it’s name should give sound medical advice, especially when it comes to diet and exercise. As an aside, diet and exercise are not alternative medicine, they are the very foundation of science based medicine, or as one of this author’s personal skeptic hero’s, Dr. Mark Crislip calls it, reality based medicine. A healthy, active, well nourished person is much less likely to fall ill, period.
Anyway, on to our first rant on WebMD. The article in question is “Superfoods Everyone Needs: Blueberries, Tea, Salmon, & More” written by Susan Selliger and reviewed by Charlotte E. Grayson Mathis, MD. The article’s premise is that we can live better, happier, healthier lives by eating certain foods. Right out of the gate, it’s full of woo:
Imagine a superfood — not a drug — powerful enough to help you lower your cholesterol, reduce your risk of heart disease and cancer, and, for an added bonus, put you in a better mood. Did we mention that there are no side effects? You’d surely stock up on a lifetime supply. Guess what? These life-altering superfoods are available right now in your local supermarket.
This is intriguing, lowering cholesterol, reducing the risk of hear disease and cancer, plus I will be in a better mood, how can I say no? There’s no horrible side effects, none at all, not even anal leakage? We can identify this as an extraordinary claim. Given that, it will, as James Randi so eloquently puts it, require extraordinary evidence. Let’s see how they do. Her source is Elizabeth Somer, RD, MA:
The effect that diet can have on how you feel today and in the future is astounding,” says nutritionist Elizabeth Somer, author of Nutrition for a Healthy Pregnancy, Food & Mood, and The Essential Guide to Vitamins and Minerals.
Well, sure, that’s a supportable claim. Eating a diet that meats USDA & FDA recommended allowances for your body size would mean that you are properly nourished. It would, at minimum, prevent the serious condition known as “hangry”.1 You would also not be suffering from any number of metabolic conditions (not all of them, but a good chunk). You’d also be maintaining your weight, have enough energy to get through the day, and overall, you’d probably, assuming you don’t have any co-morbidity for pooping, have good bowel movements. And there is nothing more satisfying than a good poop2.
She then goes into dangerous territory, in my humble opinion:
“Even people who are healthy can make a few tweaks and the impact will be amazing,” Somer says. “I’d say that 50% to 70% of suffering could be eliminated by what people eat and how they move: heart disease, diabetes, cancer, hypertension can all be impacted.”
Well, let’s start with the obvious. She’d say that 50% to 70% of suffering could be eliminated. Please define the medical condition known as “suffering”. I’m not quite sure what it is. But whatever it is, how would we reduce it? What we eat and how we move? What? Okay, what we eat. I get it, kind of. Don’t eat McDonalds every day. Although, there’s no reason you couldn’t so long as you are watching your calories properly and ordering a variety of items off the menu, but that’s a blog post for later. How we move, though, what does this have to do with the article? Okay, if she’s referring to our sedentary nature as Americans, I am in full support. This author used to tip the scales at 230 pounds. I now weigh 170 pounds, due to controlling my diet through calorie counting and increasing my exercise levels (that’s a lie, I didn’t exercise before I started losing weight, so just exercising). I’ll give her that. But, let’s move on to her thesis, that heart disease, diabetes, cancer, and hypertension could be impacted. There is scientific evidence that shows a link between obesity and the conditions she mentioned. She is grossly overstating and drawing conclusions not supported by the evidence, few if any of the superfoods listed, which we will get to below, have an effect on diabetes3, cancer4, heart disease5, or hypertension (high blood pressure)6.
DANGER! Panacea claim ahead!
You don’t need specific foods for specific ailments. A healthy diet incorporating a variety of the following superfoods will help you maintain your weight, fight disease, and live longer. One thing they all have in common: “Every superfood is going to be a ‘real’ (unprocessed) food,” Somer points out. “You don’t find fortified potato chips in the superfood category.”
Let’s start at the beginning of this paragraph, because I like the direction of time flowing in the way to which I have become accustomed. First, there isn’t a list of specific foods for specific ailments. Well, if as your introductory paragraph stated, these can help with specific conditions, you should have a list of specific foods for specific conditions. These are magic foods with magic abilities, I should be able to line up a certain magic food with my disease. At least your lawyers read this. It may make the article worse, because you set it up to go eat this to cure that, but hey, nobody likes getting sued.
Eating a healthy diet incorporating these superfoods… Well, if you eat a healthy diet, with or without these superfoods, you’ll be doing great. Hell, you’ll be doing better than most Americans. If you want help with a healthy diet, take a look at the USDA’s ChooseMyPlate website7. So, what she is doing here is actually negating any effect these foods may have. By invoking diet and exercise as part of the treatment, it becomes the treatment, given that her remedy is specific foods. It’s a common technique of the fad food movement, along with supplements, alternative, and complementary medicine, but that’s a post for another day.
The author cites the nutritionist, Sommer, again. She states that all superfoods are ‘real’ foods, then she clarifies with ‘unprocessed’. Okay, I get it, processed foods, generally are higher in sodium. Also, I’m just going to dismiss the “fortified potato chip” line. Here’s why, potato chips, unhealthy as they can be in large quantity, are actually a great source of potassium, a nutrient which most Americans are grossly under consuming. But hey, who gives a crap, potassium, that’s boring stuff. You know, heart disease, wait… potato chips, the new superfood. Just get the low salt ones, monitor your intake, and heart health will follow. Actually, it could work. The trick there is that most potato chips are relatively high in sodium, which negates most of the benefit of potassium, as it has a faster and more detrimental effect on heart health. But hey, if she get’s to make shit up, so do I.
She then provides a list of superfoods under the heading “Top Super Foods Offering Super Health Protection”, apparently she garnered them from a Google search, we will get to why in a few moments,but they are: Beans, Blueberries, Broccoli, Oats, Oranges, Pumpkin, Salmon, Soy, Spinach, Tea (green or black), Tomatoes, Turkey, Walnuts, and Yogurt.
Then the article starts into specific superfoods and why they are, supposedly, good for you. First up is Blueberries, billed as an Antioxidant Superfood. The claim is simple, based on the free radical theory of aging, oxidation causes damage to cells due to free radicals. A free radical is a chemical with an unpaired electron, or having a charge of -1. The presumed treatment was antioxidants, or chemicals which slow the process of oxidation, would interfere with the free radicals doing damage to biologic materials. The hypothesis is that if we can block uncontrolled oxidation, then cancer can be prevented. Well, current evidence, and evidence that was available when the article in question was written, not only doesn’t support the claims of antioxidant therapy8, but actually shows it can increase all cause mortality9. Further, evidence, published in 2010, indicates that the consumption of fruits and vegetables does not have an effect on cancer rates, specifically. This study showed a hazard ratio of .99 to .95, depending on the cohort10. This means that the null hypothesis, no effect, stands. So all in all, blueberries taste good, especially in muffins and pancakes, but they don’t really do anything for you, besides making you less hungry.
The article then moves on to Omega 3 fatty acids. First, a little background before we get into the claims made. Omega 3 fatty acids are essential, meaning that humans do not synthesize the molecule and therefore must be consumed through food, and we need them to live. They are commonly found in plant and marine life. Omega 3 fatty acids are used in brain function and normal development11. So now let’s hear what the article has to say:
“We know that the omega 3s you get in fish lower heart disease risk, help arthritis, and may possibly help with memory loss and Alzheimer’s,” Somer says. “There is some evidence to show that it reduces depression as well.”
Omega-3s are most prevalent in fatty, cold-water fish: Look for wild (not farmed) salmon, herring, sardines, and mackerel. Aim for two-to-three servings a week. Other forms of omega 3s are available in fortified eggs, flax seed, and walnuts. These superfoods have the added benefit of being high in monounsaturated fats, which can lower cholesterol.
Somer, who we met before is on the case over claiming the effect of the substance. Omega 3 fatty acids are one of those alternative medicine supplements that has earned some credibility from the medical community at large, warranted or not. In 1975 a study was done on an Inuit population in Greenland. Researchers discovered that due to the high consumption of oily fish in their diet, the population had reduced levels of heart disease, blood pressure, triglycerides, and atherosclerosis12. This was interesting evidence, to be sure. The control was not so great, it’s an observational study, by definition they cannot control for other factors, especially lifestyle factors, but that is neither here nor there. In 2004 the FDA gave Omega 3 fatty acids their blessing, although it was quite limited in nature, evidence was supportive but not conclusive13. The claims Somer makes are again, overstated. A quick review of the health effects section on Wikipedia pretty much debunks everything she said14.
Alright, right now, I want you to get a beer or a coffee, your choice. We’re now able to hit the next page button on the article. This is the half way point of the critique, roughly. I promise, it’s worth the read.
We move on to Soy, I hate soy. Soy is good today, bad tomorrow, good on Tuesday again, then wait for Wednesday, it’s bad yet again. But, what the hell, inconclusive evidence should stop our intrepid article author from making grossly overstated claims about it’s effects, to the blockquote:
A study reported in The Journal of the American Medical Association (2003) showed that a diet of soy fiber, protein from oats and barley, almonds, and margarine from plant sterols lowered cholesterol as much as statins, the most widely prescribed cholesterol medicine. “Look for tofu, soy milk, or edamame — not soy powder,” says Somer. In other words, soy sauce won’t do the trick. One caveat: If you have a family history of breast cancer it is not recommended that you eat extra soy.
First, let’s go over the difference between this intrepid blogger and the author we are critiquing. I provide sources and links to those sources, I don’t make vague claims about “a study” that I “found in a hedge”15. I found the study she cited, it’s an interesting one and the results are pretty astounding16. And she correctly cited the results. But then credited it all to soy protein, in essence, by using Somer’s advice. The study did not say that soy protein was the causal agent. It was prescribed as part of the dietary portfolio group but it was part of a whole dietary portfolio, which included all the other foods they referenced. The warning to women was kind of accurate at the time of publication, except what is “extra soy”? The warning is not currently accurate according to the ACA17, they do however suggest avoiding soy supplements.
Now, they move on to fiber:
A diet high in fiber will help you maintain healthy cholesterol and blood sugar levels. As a bonus, because fiber helps you feel full longer, it’s a great tool in weight management. Whole grains, beans, fruit, and vegetables are all good sources. Try throwing some beans in your salad, recommends Kulze. “Fresh, frozen, or dried are the best. You can use canned, but they tend to be higher in sodium,” Kulze warns.
Yup, that is an accurate statement. Fiber is good for you. She missed a huge one though, if you are looking for a good dose of fiber in an inexpensive, easy to make, low calorie, and delicious form, might I recommend air popped popcorn with Kernel Seasons’ Kettle Corn topping and Kernel Seasons’ Popcorn Spritzer18. Just saying, as a popcorn fanatic, I love it this way. She get’s a pass here, although she shouldn’t, because popcorn.
They move on to tea. Again, to the blockquote:
“The overall antioxidant power of black tea is the same as green tea,” says Kulze, “but green tea does have ECGC, a powerful antioxidant that we really do think is quite special.” A recent Japanese study on green tea found that men who drank green tea regularly had lower cholesterol than those who didn’t. Researchers in Spain and the United Kingdom have also shown that ECGC can inhibit the growth of cancer cells. For a double health whammy, replace sugary sodas with tea.
Okay, I want to dismiss this paragraph at first glance for two reasons. First, she uses the acronym ECGC to make it sound all science-ey. Second, sixth to last word in the paragraph is “whammy”. What the hell, are we on Press Your Luck?19
On to more serious matter, the first part of this claim is antioxidants which we addressed in the blueberries section, I will not bore you by rehashing it. The second part is the ECGC claim. ECGC is Epigallocatechin gallate, a catechin (flavonoid) that is found in tea. It has shown some effectiveness in reducing cholesterol, about 5.5 mg/dL20.. But the cancer thing, well, that’s a whole other ball of wax. While studies show that there is some cancer reduction properties, there are also studies that show ECGC has carcinogenic properties (that mean’s cancer causing, you know, like cigarettes). This becomes especially interesting with pregnancy. High consumption of tea during pregnancy may lead to malignant juvenile central nervous system tumors21 and acute myalloid lukemia22. I’d say the author would be best leaving the cancer part out. I mean, it could stop it, it could cause it, it could make your next kid have brain tumors, who the hell knows?
Then, to make it a bit more rational, she goes on to calcium:
OK, OK, you know the drill: Calcium helps build strong bones and prevents osteoporosis. Look for it in dairy products or supplements. Added bonus: Some studies show that calcium helps with weight loss. Here are the calcium levels recommended for adults by the USDA:
- Age 9 to 18 — 1,300 mg
- Age 19 to 50 — 1,000 mg
- Age 51 and over — 1,200 mg
Like normal, she starts out with some readily available medical wisdom, calcium is good for you, eat some cheese or take a pill if you are like our co host Patrick, that is evil. Then she throws in a great phrase “some studies”, which ones? Geesh! Do I have to crawl pubmed all by my lonesome to find these mysteriously non-cited articles that she is using for evidence?
Well, I did crawl through the pipes and tubes of PubMed and found two studies2425 that when taken together support her claim, surprisingly. It’s not that calcium helps with weight loss, it’s actually kind of essential to weight loss. What the data show is that people who are loosing weight need more calcium to burn the fat, that by maintaining a healthy calcium, or even high calcium level, you’ll loose weight faster while on a hypo-caloric (energy restricted) diet.
I almost gave her credit there, sorry. I shouldn’t. Calcium isn’t a superfood by anyone’s
definition marketing hype. It’s an element essential to life. If you tried eating pure calcium, which is a metal, well, you’d catch on fire or explode, it’s highly reactive.
For the Sex and the City crowd, we now get to go to Chocolate:
New research has shown that dark chocolate is packed with antioxidants and can lower blood pressure. Kulze recommends that you look for chocolate with 60% or higher cocoa content; the darker, the better. In addition, the darker it is, the lower the fat and sugar content. Now that’s our kind of health food!
Yup, this one is currently true26. Except, and here’s the fun part, the study she cited, again I had to find it on the internet myself, used a 100g dose of dark chocolate per day, which is a 546 calorie serving. That’s a meal, that’s two and a half Hershey’s Special Dark chocolate bars per day. Now, the medical literature is clear, and I’m not going to go out finding an article on this because it’s not controversial: there is a causal link between obesity and hypertension. Adding 546 calories per day to the diet, especially 546 calories that won’t really fill you up, will cause weight gain. Over the course of a month, assuming the patient doesn’t cut out anything else in their diet to make room for the 2 and one half chocolate bars, that equates to nearly 5 pounds of weight gain per month. This is cutting off your nose to spite your face, plain and simple. Yes, chocolate may have a vasodiolating effect, but the benefit is way out weighed by the risk. Yes, we can lower your blood pressure today, but in three months it will be worse. What kind of treatment efficacy is that?
Well, we’ve gotten to the end of the article. Here’s the short an sweet of this critique. It’s a bad article written quickly to get inbound links. It’s easy to read and digest. It’s also chock-full of bad information, half truths, and advice that should be taken by no one. I’m not a doctor, I don’t pretend to be one. I like to read. I know how to read statistics and do math. I assume I am not the norm. If it took me, over 3,000 words to explain every factual and logical problem that I could identify in this article, I’m pretty sure I didn’t catch them all, either. Why would a team of doctors publish it? Remember, it was reviewed by an MD. if you’ve made it this far, thank you.
Hangry, adjective, describing the state of being so hungry that you are angry. Ex. “I bit off the waiters head because food was slow to come out the kitchen. I guess I was hangry ↩
See 10 Ways to Fight High Blood Pressure without Medication, Mayo Clinic ↩
This article was written on 10/5/2013, during the government shutdown. I assume this site will be accessible eventually ↩
I know I shouldn’t use Wikipedia as a source, but this isn’t an article on Omega 3 woo, it’s on how WebMD is a horrible website. We’ll do one on Omega 3 woo, I promise. Please give us a pass on this horrible citation. To make up for it, here’s a really cute puppy. ↩
Eddie Izzard, if you read this, I think you are totally awesome, and I miss the drag ↩
It’s basically butter flavored Pam, it’s a trivial amount of calories that allows the deliciousness to stick ↩