Holford on migraines: the referenciness is giving me a headache

Writing on “Migraines, methylation & B vitamins”, Holford argues that supplementation with B vitamins can be useful. He offers two suitably referency links to pubmed-indexed papers. However, both links fail substantiate Holford’s claims and are the source of a little embarrassment for one who so frequently upbraids others for their knowledge or being up to date with recent research.

The first article linked looks at the connection between genetics and migraines. It does not support Holford’s position re supplementation (although it suggests that supplementation may be worth investigating). We wonder if Holford meant to link another study?

The second article linked by Holford is an open label study with no control group. We don’t have access to the journal, but if this PDF is the full article then the study in question only involved 26 patients. We would suggest that Holford conducts a more detailed review of the literature on this topic, and that Biocare consider funding some good quality research on the pills they sell: a small, open label study such as this is a poor basis for treatment recommendations.

The first link is to the wrong paper and we can’t identify the one that he intended. The second link to ‘evidence’ involves a tiny, open-label study with unimpressive results that the authors admit disappear if subjected to a more rigorous analysis.

This may explain the fact that in our study we could demonstrate a significantly reduced intake of triptans [in conjuction with riboflavin supplements]. If we have looked for all abortive agents, our results would not have reached statistical significance. [Emphasis added.]

In fact, never mind the literature review, a blog post with accurate linking and appropriate discussion of a paper’s contents would be good. Surely someone with the research resources of Patrick Holford and Biocare could manage that – surely?

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20 Comments

Filed under patrick holford, supplements

20 responses to “Holford on migraines: the referenciness is giving me a headache

  1. One must assume that the majority of Holford’s loyal readers:
    i) are not reading his blog posts
    ii) read the posts but don’t follow the links
    iii) deprecate their own response of “That doesn’t make sense” in favour of their confidence in his expertise
    iv) wouldn’t recognise adequate research if they saw it.

    It is heart-breaking that, nonetheless, Holford and his adherents will probably succeed in having nutritionists integrated into the NHS in preference to RDs in the not too distant future (for some disorders and conditions).

  2. “The first link is to the wrong paper”
    Oh, I don’t know about that Jon. The possibility that folate might be useful and the idea that it should therefore be investigated as a potential therapy could easily be pounced upon by an eager nutritionista and be (re-)interpreted as being a whole-hearted endorsement for folic acid tablets. I think this sort of thing is probably more common in Alt.Reality than one might hope.

    dvnutrix – I have a suspicion that points three and four on your list will both be relevant to a number of Holford’s readers. I also think that if (iv) is true, it probably makes (iii) more likely to occur.

    Actually, those who find it difficult to judge the quality of research may be inclined to read only the “conclusions” section of a paper. If the authors say something in the conclusions that can be (mis-)interpreted as an endorsement of Product X then it doesn’t matter that the only mention of Product X in the rest of the paper is in terms of it being potentially promising for a different condition to the one being investigated in the paper. I’m not sure whether this applies to Holford or his followers – or perhaps both.

    It’s sad that we aren’t better informed in this area – given that most science stories in the media are about health I think it would be a good idea for some basics to be taught in schools (sort of an introduction to Evidence-Based Medicine).

    • Hm – thing is that Holford had this to say about the first link:

      They recruited 52 people diagnosed with migraine. The participants were randomly assigned to receive either vitamin supplements providing a daily dose of 2mg of folic acid, 25mg vitamin B6, and 400 micrograms of B12, or placebo, for six months…

      Results showed a reduction in homocysteine levels by 39 per cent, compared to baseline, and statistically significant compared to placebo. Furthermore, the supplements were associated with a reduction in the prevalence of migraine disability from 60 per cent at the start of the study to 30 per cent after 6 months. No reduction was observed in the placebo group, said the researchers.

      Now, this bears no resemblance to the link that he gives which is actually quite a complex study involving genetic heritability and transmission disequilibrium. At no time in this study did they hand out pills and do the tests that he mentioned for Hcy etc.

      But, you’re quite right, we must give up caring about the details and go more for the spirit of the thing.

      • jdc

        Whoops. I was trying to see if the paper linked to could be (mis-)interpreted in order to make it look as if it endorsed folate supplementation. Hadn’t realised that Holford’s text made it fairly clear it was the wrong paper and I’m now feeling slightly embarrassed to have made this mistake. I sometimes wonder if that’s a feeling that Cher Patrique is familiar with, but it may be that he doesn’t “do” embarrassment.

        • Not your fault, jdc. Reading Holford addles the brain – trust me on this. There gets to be a point where you think, “No, he can’t possibly have made up that reference/misinterpreted that paper/given the wrong reference again” but, “[America], yes he can”.

          Successful entrepreneurs don’t do embarrassment.

          In a burst of insight, Ezra Pound once wrote,

          Stupidity beyond a certain point becomes a public menace.

          What the Patrick Holford blog is revealing is that the standard of his research is such that some people approach that point on an astonishingly regular basis. If people want to pay for this stuff, that’s fine – but the mainstream media should not collaborate in promoting him and the NHS should not be expected to fund Holfordism.

  3. JDC- and there I was trying to be charitable…

    And, yes, one must wonder how Holford’s loyal – and paying – readers feel about these things.

  4. I think the first link must be a typo – and to be fair, they happen to us all. But what are the chances he’ll correct it with a hat-tip to HolfordWatch?…

  5. FYI – I have access behind-the-paywall through my university and can confirm that the PDF you’ve linked to is indeed the paper in question.

    It will definitely be interesting to see if he corrects the “typo”. I wonder if this (http://www.migraine.org.uk/index.php?sectionid=541) is the same study? The Telegraph has covered it too (http://www.telegraph.co.uk/health/healthnews/4523675/Vitamin-B-and-folic-acid-help-fight-migraines.html)

    Found a press release from Griffith University, where the study took place (http://www3.griffith.edu.au/03/ertiki/tiki-read_article.php?articleId=19663) but still no mention of it on PubMed or Google Scholar. It’s now over two months since the story broke in the Telegraph. Over-enthusiastic press office at Griffith University, perchance?

    • I wrote to Sabrina Rashid at the press office of Griffiths to enquire about this on Monday but have yet to receive a reply – must write again. It seems absurd that it has received press coverage but the paper either hasn’t been published or is untraceable in the usual places (which doesn’t bode well).

      • As a follow up to this, just to say that Prof Lea of Griffiths has (today) sent us an advance copy of the paper which is now in press at Pharmacogenetics and Genomics (unclear as to intended publication date).

        Given the hyperbole of the press release, I’m not giving anything away if I reveal the conclusion:

        We have provided initial evidence that homocysteine-lowering via vitamin supplementation may reduce migraine disability in a subgroup of patients. Our data suggest a larger clinical trial is warranted to establish whether vitamin supplementation including folic acid is a safe, inexpensive and effective preventative treatment for increasing the quality of life of migraineurs more generally and also whether such treatment should be based on MTHFR genotype.

        I feel constrained to point out that of the 60 people recruited to the trial, 52 made it through to the baseline and 47 patients completed the trial (13 placebo:34 vitamin intervention). 7/20 drop-outs for placebo and 6/40 for the intervention – I can’t identify the baseline figures and drop-outs.

        I’ve been through the paper a couple of times and I still can’t see anything about an intention to treat analysis nor any adjustment made to compensate for the loss of power with that number of drop-outs.

        Power estimates indicated suggested that n=20 patients in each treatment group (n=40 in total) was required to detect the primary outcome variable as statistically significant at α = 0.05.

        But, the number in the placebo group was (eventually) 13 so I’m not sure that the comparisons hold.

    • Thanks for confirming that that was the real paper. The fact that I was left wondering whether that was a genuine, published paper may be a reflection on either my own standards or on the paper itself…

  6. Wulfstan

    When will you people stop giving Patrick Holford the benefit of the doubt. If you can’t find the paper, he didn’t – he is going off the press release, grabbed the nearest published paper from the centre he could find and assumed that was it and all about it.

    Not that I would be surprised to learn that Holford is claiming an in-depth understanding of genetic heritability and transmission disequilibrium – just to add to his portfolio of Things In Which I Claim Expertise and on Which I Assert That I Speak With Authority.

    Realistically, when has lacking even a basic grasp of a topic ever prevented him from spouting off about it and claiming expert status?

  7. jdc

    BTW, I notice that it appears PH is now soliciting anecdata from his 100% health members:
    “If you suffer from migraines what else have you found that works?”

    • That’s very NLP – assume a success frame and tacitly suppress the ‘fail’ frame.

      I doubt he would receive it well if someone said, “Triptans – work really well for avoidance. I don’t care if it’s the generic Sumatriptan, it works for me”.

      • Praise for triptans on PH’s blog? I imagine that is a fairly unlikely scenario. I doubt his 100% health followers have much truck with such things – and the general public are unable to comment on Mr Holford’s ‘blog’. Unfortunately.

        P.S. I like this phrasing: “Successful entrepreneurs don’t do embarrassment.” That’s very nicely put (and almost exactly what I wanted to say in my earlier comment).

  8. Pingback: The Paper That Never Was « jdc325’s Weblog

  9. Pingback: Patrick Holford and the Vitamins for Asthma That Become All About Food Intolerance and YorkTest « Holford Watch: Patrick Holford, nutritionism and bad science

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