Great job showing everything in Absolute risks. AR is the best way to communicate risk. RR is great if you want to sell your supplement! Cifu and Mandrola take note please :)
One little suggestion I had is to use GRADE to assess the certainty and report it as "Low/Very low certainty" evidence. So let people take these numbers it with a grain of salt.
Perfect cap to a fantastic mini-series. And this answers my question from commenting after part 2: what are the absolute risk changes from any dietary behavioural change? And not surprisingly, they are small.
Also agree that “better” evidence in the form of proper RCT is unlikely to be forthcoming. So “associations” is likely the best we will ever have.
Which makes this series all the more important, as it helps to quantify what the absolute benefits might be. Without the histrionics. Well done!
The discussion of baseline risk is really important and you did a great job explaining them. What the reader shouldn't conclude however is that if their baseline CVD risk was 30%, that they would still have only an absolute reduction of, say 1-2%, down to a CVD risk of 28%.
Thanks again to the author for putting all this together. Diet studies are essentially worthless from a purely scientific standpoint but seeing these very tiny differences in endpoints reinforces the position that diet has little or nothing to do with health and disease. The extensive body of knowledge on the physiology of the digestion of food into a number of molecules for absorption and, often, further biochemical alteration by the cells of the intestinal lining and the liver, should be sufficient to conclude that broad categories of food are irrelevant to overall health.
But it is just a subset of the illusion that healthy "lifestyle" choices can prevent disease and/or prolong life. These are all scientifically unfalsifiable but immensely profitable. Just consult any list of best-selling non-fiction books or take a stroll down the aisles of a health food store. Those who rightfully complain about the pharmaceutical industry rarely mention the enormous profits of the vitamin and supplement merchants.
Since all the nutritional "data" is crappy, we cannot say we "know" how unhealthy it is. Not eating UPF because you "know" it is unhealthy is a fake decision. But not eating UPF because you don't know whether it is healthy or unhealthy is a real decision.
Why do we continue to analyze poor, observational data just because it’s the best we have? The author even claims that low-level research creates the “illusion of certainty” when no better research is present. How was this analysis any different? People in the upper quartile of UPF intake are assuredly different from the bottom quartile (socioeconomic factors, where they live and what they have access to, etc.), and the same can be said for processed meat consumption. A poor diet is often a slow burn and 10 years may still not be enough for hard outcomes such as death to occur, all while the body may be in decline. Until we get serious about biology and can define what “good health” is, quality evidence will continue to be out of reach. We are wasting our time doing these observational meta-analyses when the foundation of all current nutritional evidence has sand-like structure.
Thank you for your series - indeed a sensible summary of this timely topic! Our culture is always so focused on minimal risks that we often lose perspective. My attitude is mostly to include as much natural unprocessed food in my diet as I can, but I'll really enjoy that Maine red hot dog when I'm at the 4th of July BBQ!
I’m sensing that Big Nutrition has figured out how to keep the money coming. Failure on their part to make any positive difference in health outcomes doesn’t deter them from the use of observational studies in forming useless dietary recommendations. So now on to UPFs. Acknowledging that observational studies are weak but the “best we can do” doesn’t make them worth anything at all. The nutrition industry needs to extricate itself from the failed paradigm of calories in and out and instead concentrate its efforts on understanding the biology of the fat cell.
Here is a simple study I would like to see: take 1000 kids diagnosed with ADD with UPF consumption 30%+ (or 1000 people with Type I Diabetes, or whatever); have half of them change nothing; give half of them a nutritionist and provide them with daily meals and snacks made without UPF; observe any changes in diagnoses. Doesn't seem like an impossible study to conduct.
All these statistical analyses can be overwhelming complex. The most important conclusion you showed is virtually never shared. The difference between relative and absolute statistics. All studies quote relative statistics because they are trying to sell you something. Always. When, in fact, what you want to know the absolute statistics. Same when looking at the all the Statin trials.
Now it seems intuitive that UPF is not healthy. Throwing off too many ROS. So in the end, you only proved that nutrition may not matter. A daunting prospect.
Very informative. Giving people absolute risk data on UPF’s and highlighting personal choice is what is needed. I personally stay away from them but if I want something I’ll eat it. Moderation is important. Thanks for the great series.
Excellent work as usual, James!
Great job showing everything in Absolute risks. AR is the best way to communicate risk. RR is great if you want to sell your supplement! Cifu and Mandrola take note please :)
One little suggestion I had is to use GRADE to assess the certainty and report it as "Low/Very low certainty" evidence. So let people take these numbers it with a grain of salt.
Perfect cap to a fantastic mini-series. And this answers my question from commenting after part 2: what are the absolute risk changes from any dietary behavioural change? And not surprisingly, they are small.
Also agree that “better” evidence in the form of proper RCT is unlikely to be forthcoming. So “associations” is likely the best we will ever have.
Which makes this series all the more important, as it helps to quantify what the absolute benefits might be. Without the histrionics. Well done!
The discussion of baseline risk is really important and you did a great job explaining them. What the reader shouldn't conclude however is that if their baseline CVD risk was 30%, that they would still have only an absolute reduction of, say 1-2%, down to a CVD risk of 28%.
Thanks again to the author for putting all this together. Diet studies are essentially worthless from a purely scientific standpoint but seeing these very tiny differences in endpoints reinforces the position that diet has little or nothing to do with health and disease. The extensive body of knowledge on the physiology of the digestion of food into a number of molecules for absorption and, often, further biochemical alteration by the cells of the intestinal lining and the liver, should be sufficient to conclude that broad categories of food are irrelevant to overall health.
But it is just a subset of the illusion that healthy "lifestyle" choices can prevent disease and/or prolong life. These are all scientifically unfalsifiable but immensely profitable. Just consult any list of best-selling non-fiction books or take a stroll down the aisles of a health food store. Those who rightfully complain about the pharmaceutical industry rarely mention the enormous profits of the vitamin and supplement merchants.
Since all the nutritional "data" is crappy, we cannot say we "know" how unhealthy it is. Not eating UPF because you "know" it is unhealthy is a fake decision. But not eating UPF because you don't know whether it is healthy or unhealthy is a real decision.
Why do we continue to analyze poor, observational data just because it’s the best we have? The author even claims that low-level research creates the “illusion of certainty” when no better research is present. How was this analysis any different? People in the upper quartile of UPF intake are assuredly different from the bottom quartile (socioeconomic factors, where they live and what they have access to, etc.), and the same can be said for processed meat consumption. A poor diet is often a slow burn and 10 years may still not be enough for hard outcomes such as death to occur, all while the body may be in decline. Until we get serious about biology and can define what “good health” is, quality evidence will continue to be out of reach. We are wasting our time doing these observational meta-analyses when the foundation of all current nutritional evidence has sand-like structure.
Thank you for your series - indeed a sensible summary of this timely topic! Our culture is always so focused on minimal risks that we often lose perspective. My attitude is mostly to include as much natural unprocessed food in my diet as I can, but I'll really enjoy that Maine red hot dog when I'm at the 4th of July BBQ!
I’m sensing that Big Nutrition has figured out how to keep the money coming. Failure on their part to make any positive difference in health outcomes doesn’t deter them from the use of observational studies in forming useless dietary recommendations. So now on to UPFs. Acknowledging that observational studies are weak but the “best we can do” doesn’t make them worth anything at all. The nutrition industry needs to extricate itself from the failed paradigm of calories in and out and instead concentrate its efforts on understanding the biology of the fat cell.
A superb,comprehensive review of a very complex subject. Kudos to Dr. McCormick.
When all is said and done, my mama was correct;
“moderation in everything and you’ll live a long and healthy life”
(and she never went to college)😁
Hourani
Here is a simple study I would like to see: take 1000 kids diagnosed with ADD with UPF consumption 30%+ (or 1000 people with Type I Diabetes, or whatever); have half of them change nothing; give half of them a nutritionist and provide them with daily meals and snacks made without UPF; observe any changes in diagnoses. Doesn't seem like an impossible study to conduct.
All these statistical analyses can be overwhelming complex. The most important conclusion you showed is virtually never shared. The difference between relative and absolute statistics. All studies quote relative statistics because they are trying to sell you something. Always. When, in fact, what you want to know the absolute statistics. Same when looking at the all the Statin trials.
Now it seems intuitive that UPF is not healthy. Throwing off too many ROS. So in the end, you only proved that nutrition may not matter. A daunting prospect.
Very informative. Giving people absolute risk data on UPF’s and highlighting personal choice is what is needed. I personally stay away from them but if I want something I’ll eat it. Moderation is important. Thanks for the great series.