Tag Archives: Holford

Patrick Holford, YorkTest and a Migraine Study

Former Visiting Professor Patrick Holford but still Head of Science and Education at Biocare has an enthusiasm for interventions that we wish we might share but, too frequently, when we examine the studies on which he relies, the results do not support his claims or the scope of his optimism.

In a recent newsletter, Patrick Holford was rather excited about a recent study: Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. For reasons that may become clear, he neglected to mention the full title of the paper.

Last month a study published in the Nutrition Journal showed that 85% of people affected by debilitating migraines had their symptoms reduced, and quality of life improved, when their food triggers were discovered and avoided. Having a hidden food allergy is one of five common causes of migraines.

This recent study tested migraine sufferers for food allergy using YorkTest’s FoodScan test. Eighty four of the volunteers were put on their food allergy free diet, while 83 were given a sham ‘allergy’ diet based on fake test results. At the end of four weeks those on the real allergy free diets had had 23% less migraines than those on the sham diet.

You might be a little surprised that Holford was quite so excited by this result after 4 weeks of assessment that the newsletter was subject-lined, “Relieve your migraine without painkillers” and headlined, “What’s causing migraines?”. Holfordwatch consulted the original study and can not agree that Holford provides a useful interpretation of its outcome.[1] According to the reported results, it seems as if even the study’s authors might quibble with Holford’s optimism:

The results indicated a small decrease in the number of migraine like headaches over 12 weeks, although this difference was not statistically significant (IRR 1.15 95% CI 0.94 to 1.41, p = 0.18). At the 4 week assessment, use of the ELISA test with subsequent diet elimination advice significantly reduced the number of migraine like headaches (IRR 1.23 95%CI 1.01 to 1.50, p = 0.04). The disability and impact on daily life of migraines were not significantly different between the true and sham diet groups. [Emphasis added.]

There are many other problems with this paper (eg, the participants are effectively self-selected from a group that is pre-disposed to believe that food intolerance influences migraine; there is no clinical verification of the migraine-like headaches description; respected experts in allergy and immunology caution against the notion that Yorktest’s IgG Food Intolerance test is diagnostic of food intolerance or clinically relevant; the number of study drop-outs compromises the power of the study effect). The study lacks scientific rigour to the extent that the only surprise is that a journal reviewer changed his opinion between 1st and 2nd review:

This paper has strong deficiencies in respect to the study design, recruitment, compliance, and no medical control and assessment of the subjects, not meeting the criteria for a scientific paper. Due to the huge amount of uncertainties, also acknowledged by the authors, this paper has no new information to offer and is of limited interest.
Level of interest: Reject as not of sufficient priority to merit publishing in this journal. [1st review]

Such flaws in the design and other areas can not be corrected merely by re-writing yet the reviewer accepts the revisions (eg, the revised title now refers to “migraine-like headaches” rather than “migraine”) and changes the review comment to:

Level of interest: An article whose findings are important to those with closely related research interests. [2nd review]

Recall that the research finding is not, as Holford leads, “[You can relieve] your migraine without painkillers” but that the study revealed that at 12 weeks (the study’s stated primary outcome): “this difference was not statistically significant“. Holford’s account is partial and inaccurate. This is lamentable when one considers that he claims to be a valuable intermediary between the public and the practical reporting of health research. It is unsettling when one considers that there is considerable apprehension that some patients and healthcare providers might be persuaded by such claims to lobby for such ineffective tests and diets to be funded by the NHS despite their lack of clinical relevance or efficacy.

Notes

[1] Holfordwatch notes that Yorktest provided a similarly partial account of the study findings in their September 2011 news items and that the media that ran the Yorktest release on this study did not investigate the findings but reproduced this and other unduly favourable interpretations (the rollcall of shame includes: Metro, Red Online, Top Sante, Women’s Fitness, Women’s Weekly, OK Magazine, Woman’s Weekly, Female First.

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Holford claims a study shows his recommendations reduce Alzheimer’s risk

We were interested to see Holford’s blog trumpeting a new study by Yian Bu et al, on Alzheimer Disease and dietary patterns: claiming that the study shows that “Holford diet reduces Alzheimer’s risk”. Holford’s blog argues that the
study

findings are completely consistent with out recent 100% Health Survey and the diet I recommend in the Alzheimers Prevention Plan book.

These principles are also incorporated into the Holford Diet which also factors in eating a low GL diet. In our 100% Health survey we found that the consumption of sugar-based snacks and sugar were strongly associated with worsening memory and concentration. All the other findings in this recent study, soon to be published in the Archives of Neurology (Arch Neurol. 2010;67[6]), are completely consistent with our survey results.

However, the study states that

We identified a DP [dietary pattern] strongly associated with lower AD risk: compared with subjects in the lowest tertile of adherence to this pattern, the AD hazard ratio (95% confidence interval) for subjects in the highest DP tertile was 0.62 (0.43-0.89) after multivariable adjustment (P for trend = .01). This DP was characterized by higher intakes of salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables and a lower intake of high-fat dairy products, red meat, organ meat, and butter.

This seems rather close to the advice of mainstream organisations such as the BDA (or to my Gran’s advice to ‘eat your greens’). As far as I can tell, the study doesn’t consider the benefits (or disbenefits) of a low glycaemic load diet. It certainly doesn’t show that Holford’s supplement recommendations are effective: instead, “nutrient intakes from foods and from supplements were separately estimated, and only the nutrient intake from foods was used in the RRR analysis.”

Certainly, we have no objection to some of Holford’s recommendations: for example, eating lots of green veg seems perfectly sensible. However, these good recommendations are not at all original and we have not seen any convincing evidence that his more novel recommendations are any good.

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Food for the Brain still describing Holford as a Teesside Visiting Professor

Teesside University previously gave Patrick Holford a Visiting Professor post – which, we believe, has now ended. However, the charity Food for the Brain (CEO: P. Holford) are currently referring to Holford as

Visiting Professor at the University of `Teesside, School of Social Sciences and Law

It does appear that these endorsements tend to linger.

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Holford, Burne and homeopathy on the NHS

JDC has just put up an excellent post about Holford, Burne and Serotonin pills: noting that, while Jerome Burne is given space on Holford’s blog to argue for the need to “Save NHS money on ineffective drugs, not homeopathy”, Holford’s own recommendations for depression are neither cheap nor based on good evidence. I think that two further things are worth emphasising re this post on Holford’s blog:

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Not-so-super Times article on Holford and superfoods

We were disappointed to see Peta Bee in the Times with an article on “Anti-ageing superfoods”: giving an article over to the uncritical discussion of some of Holford’s dietary beliefs. It’s worth quickly going through some of the problems with the article here. Continue reading

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Holford: “Research has shown that women in particular tend to put on 7 pounds a year”

In the holiday season, people often worry about weight gain. I’m not sure that things quite add up with Holford’s blog’s contribution to the discussion, though. A contributor has blogged that

Research has shown that women in particular tend to put on 7 pounds a year. This steady weight gain is often linked to the excesses of the festive season, which are not discontinued come January, so more weight piles on year after year.

Assuming that a women starts out at 150lb at 18, a steady weight gain of 7lb/year would mean that she reached 500lb by her 68th birthday. This type of sustained weight gain is – clearly – unusual. While I am not sure on what research ‘has shown’ this level of weight gain, I suspect that things may be rather more complicated than the blog post suggests.

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BANT fail to reply to complaint from 25/10/09

As noted here, I e-mailed the British Association for Nutritional Therapy (BANT) to complain about some of Holford’s problematic online health advice. I have not, as yet, even had a reply from BANT – not even an acknowledgement of my e-mail.

This is an organisation which represents itself as

a professional body for nutritional therapy practitioners and those working in the wider application of nutritional science

BANT asserts that it seeks to

promote high standards of education, training, practice and integrity in the nutrition profession

Given these goals, I am rather disappointed by this lack of response – I would argue that BANT should have sought to deal with this promptly.

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Holford argues that “ignorance” is the main reason for not being healthy

When discussing “why you crave sugar the way you do” with East Coast Radio in South Africa, Patrick Holford blames “ignorance” as the main cause of ill health. There are a number of issues here:

  • I remain unconvinced that Holford’s work on topics such as nutrition or HIV has helped to improve the knowledge of the general public.
  • In his discussion with East Coast Radio, Holford draws extensive conclusions (on issues including causal relationships) from a survey of 60,000 people; I would also have concerns re the design of the survey.  This suggests a problematic understanding of research design and interpretation.
  • I am unconvinced that ignorance is the main cause of ill health.  Issues around poverty, inequality, addiction, disease and access to appropriate treatments all play significant roles.  Even if people know for example that smoking is bad for them, this will – sadly – not be sufficient to enable them to stop.

 

There are currently serious health problems in South Africa. Rolling out Holford’s ‘100% health’ ideas – as a supposed solution to the dangers of ignorance – would not be an appropriate solution.

Evidence-based social policies to target inequality, poverty and access to healthcare all have important roles to play in South Africa. ‘Alternative’ nutritionism marketed by British media nutritionists would not be a helpful import.

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Holford demonstrates why online health advice can be problematic

Patrick Holford has made clear his opinions on vitamin C and swine flu (we have already discussed an earlier version of his post, and I don’t know that there is much else to add). However, I was interested to not some of the user comments now on this post, and Holford’s responses. Giving health advice online is always problematic, and Holford does a good job of demonstrating some of the pitfalls.

It is always problematic to give advice without a full – and competently taken – patient history, not something which can be done in blog comments. This issue comes to light when one woman asks in the comments:

I think I have swine flu with a terrible cough and phlegm. What do you recommend I eat and drink?

In such circumstances, one would have hoped that the commenter would have been advised to phone her GP’s surgery or another competent medical professional: a lot of things cause coughs; many (thankfully) heal fine without any intervention, but some will require medical treatment.

Perhaps most worrying, though, is advice relating to current product use. ‘Vix’ states that

I am trying to ensure that both of my sons (aged 2 and 9) are well prepared to battle the impending flu season. I currently give my eldest son 500mg of Vitamin C per day – along with Echinacea, 2 teaspoons of Sambucol and a teaspoon of Colloidal Silver. My youngest gets about the same. Is this enough? And is there a childrens Vitamin C powder that you can specifically recommend? I can’t seem to find one on the Totally Nourish website – only capsules.

Colloidal silver carries risks, but does not bring any benefits. Dosing varies between products, so it is quite possible that a 2 year old and 9 year old child could be getting significant doses of the stuff. I would have hoped that Vix would have been warned of the risks of the product and referred to a competent professional; at a minimum, one would have hoped that enquiries could have been made as to the doses used. However, Holford responds by stating that:

I am not sure that Echinacea is the right thing for swine flu during infection. RE vit C BioCare do a good value vit C powder. I don’t see it on the Totally Nourish website though. I’m sure they can get it for you if you ask. That, in some diluted juice, works best for children.

I do not think that Holford’s blog post is an appropriate setting to offer this type of advice. I also have concerns about some of the advice offered. I will therefore be sending a complaint off to BANT (Holford is a Fellow) this weekend; I hope that they take prompt, effective and transparent action on this issue.

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Holford Diet site’s interesting take on Cochrane Review

Holford has had varied engagements with Cochrane Reviews, so we were interested to see the Holford Diet site – which promotes a low glycaemic load (LGL) diet plus supplements – celebrating one Review’s alleged finding that

a low GL diet is more effective than any other diet for weight loss and improving overall health…’Overweight or obese people lost more weight on a low Glycemic Load diet and had more improvements in lipid profiles than those receiving conventional diets.’

However, on looking at the Review itself we noted that it did not distinguish between LGL and low glycaemic index (LGI) diets. This was a review of

Randomised controlled trials comparing a low glycaemic index or load diet (LGI) with a higher glycaemic index or load diet or other diet (Cdiet) in overweight or obese people.

The review found some evidence that LGI and LGL diets can be especially beneficial, but did not aim to find whether an LGI or LGL diet was best. Given that this was a review of only six trials involving only 202 participants, this seems a sensible decision.

While it is nice to see a Holford site referring to such good quality sources, it is a shame that the Review could not have been reported more accurately.

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