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Miracle foodsmyths and the media
Miracle foodsmyths and the mediaA Behind the Headlines reportJanuary 2011
Analysing food studies in the media“Curry could save your life.” “Beetroot canfight dementia.” “Asthma risk linked toburgers.” Every day there’s a new crop ofseemingly life-changing headlines abouthow the food we eat affects our health.We all know that a good diet is an essentialpart of a healthy lifestyle, so it’s not surprisingthat newspapers, magazines and the internetare full of stories about miracle superfoods andkiller snacks.Of course, there’s more to it than that. There’sa vast industry devoted to finding new ways topersuade us to eat this or that food and an armyof scientists bent on exploring the links betweenwhat we eat and how healthy we feel.Beetroot has been called ‘the elixir of life’Unfortunately, much of what is reported can beeither inaccurate or unhelpful. The news is full ofcontradictory reports and often the same food isdeclared healthy one day and harmful the next.Take alcohol. Sometimes it’s reported to begood for your health, while other times it’s bad.Some days we’re told to drink in moderation,while on others even a single glass is too much.The facts about the latest dietary discoveriesare rarely as simple as the headlines imply.Accurately testing how any one element of ourdiet may affect our health is fiendishly difficult.And this means scientists’ conclusions, andmedia reports of them, should routinely betaken with a pinch of salt.That’s where Behind the Headlines fits in. Forthe past three years, we have reviewed healthscience stories in the media and checked thereported claims against the research on whichthey are based.Food stories are one of the most frequentlyoccurring topics that Behind the Headlinescovers, featuring in about a fifth of the 1,750appraisals since mid 2007.A quick analysis shows just how confusingthese stories can be. Of the 1,750 Behind theHeadlines appraisals carried out up to January18 2011, based on stories in the national press,344 were about foods that had repercussionsfor health. We analysed those that reported ona single food or drink, grouping them into 106single foodstuffs. Categorising these stories intowhether the food was reported to be good forhealth or harmful gives a crude yet revealingindication of how food science is portrayed inthe press.As shown in the diagram overleaf, althoughsome stories highlight the potential harms ofparticular foods, most proclaim benefits.When grouped as foodstuffs, 27 foods hadbeen labelled harmful by headline writers, while65 had been declared beneficial. Fourteen,however, have been labelled both healthy andharmful in different headlines. Chocolate, forexample, can reportedly cause weak bones anddepression, but other studies have claimed thatit can also help fight cancer.Behind the HeadlinesBehind the Headlines provides an unbiasedand evidence-based analysis of health storiesthat make the news. The service picks twopopular health stories from the national mediaevery day and aims to respond to them thesame day they appear in the press. The serviceis intended for both the public and healthprofessionals, and endeavours to: explain the facts behind the headlinesand give a better understanding of thescience that makes the news provide an authoritative resource thatGPs can rely on when talking to patients become a trusted resource for journalistsand others involved in the disseminationof health newsBazian, a provider of evidence-basedhealthcare information, produces impartialevidence-based analyses, which are editedand published by NHS Choices.
How foods have been reported in the media65 foods were good for health14 foods wereboth good andbad for health27 foods were bad for health5 a day high carbbitter melon blackcurrant chillies fruit passionfruit pomegranate purple fruit purple tomatoesrosehip tomatoes beetroot broccoli broccolisprouts carrots cauliflower celery garlic gingermushrooms onions spinach whole cookedcarrots dairy organic milk skimmed milk yoghurtcaveman diet fatty food low-fat diet Mediterraneandiet veganism whole cooked carrots binge drinkingchampagne red wine beetroot juice black tea cherry juicegreen tea hot drinks mint tea tomato juice bacon and eggsbreakfast cereal fry-ups meat and potatoes porridge chewinggumgummy bears honey jam ketchup marmitepeanut butterturmeric almonds nutswholegrains cod liver oil fibre probiotics proteincurcuminolive oilricepopcorndiet organic foodWestern diet burgerseggsbaconalcohol(three a week) chickenprocessed meatred meat sausages coffeeenergy drink fruit juicegrapefruitlow carb dietvegetarianism water fast food packedlunch pre-packedbeer whitesandwiches takeawayswine hotsugary drinkstea chocolatenut productscaffeinefish oilssaltcake chewing gumsoya-based foodsunsoakedpotato chips nutsweetsproducts fructosepolyunsaturatessweetenersBased on UK national press reports analysed by Behind the Headlines between July 2007 and January 2011
What is a superfood?So more than half of the articles discussing afoodstuff focus on some sort of benefit.But what really seems to capture the imaginationof journalists and consumers is the idea that asingle food, sometimes called a superfood, canconfer remarkable health benefits.There is no official definition of a superfoodand the EU has banned the use of the word onproduct packaging unless the claim is backed upby convincing research. A number of well-knownbrands have been forced to drop the description.However, there are still some proponents of theterm, in spite of its loose definition.News headlines, meanwhile, abound withclaims that certain foods have super healthbenefits. Celery, broccoli, jam, popcorn andcereals have all been hyped as superfoods inthe past couple of years. Other foods are saidto be packed with chemicals that can ward offmajor killers such as cancer and heart disease.The health benefits of chocolate are debatableEven our beloved cuppa has been givensuperfood status. Black tea has been allegedto protect against heart disease. Green tea cansupposedly cut the risk of prostate cancer. Andit has been claimed that camomile can keepdiabetes under control.Miracle claims are also made for chocolate,including that a daily bar “can cut the risk ofheart attack and stroke”.Wine, for example, can allegedly: “add five years to your life”“help keep teeth healthy”“protect your eyes”make women “less likely to gain weight”While broccoli can allegedly “undo diabetesdamage”, “stop breast cancer spreading” and“protect the lungs”.The nation’s favourite drink is supposedly good for youAnd it’s not uncommon for headlines to claimthe most miraculous health benefit of all – thata food can save your life. The following are allgenuine claims from UK media from the pasttwo years: Popcorn is reputedly high in antioxidants“2½ bottles of wine a week can save your life”“A daily dose of garlic can save your life”“Just one bite of chocolate a day can helpsave your life”“Beetroot juice could save your life”“Curry could save your life”You could be forgiven for thinking the secret ofeternal life is a daily vindaloo, washed down witha glass of wine or two and a chocolate dessert.
The trouble with food researchOf course, the truth is that these claims arealmost always overstated. Unfortunately,research into the effects of single foods on ourhealth is notoriously tricky to carry out. We havecomplex diets and it is difficult to disentanglethe effects of one particular food or compoundfrom all of the others we consume. This meansthat many of the studies behind the superfoodclaims have limitations. These limitations arerarely reported in the media, and even morerarely given their true significance.Some of these limitations are discussed below.Knowing about them will help you to sortscience fact from news fiction.Red wine features regularly in the newsConfounding factorsConfounding is a common problem in healthresearch. Confounding is where somethingother than the main factor that is beingassessed (a confounding factor) may beresponsible for effects.Take the story about half a glass of wine a dayadding five years to your life. The results of thisstudy of 1,373 Dutch men who were followedfor over 40 years certainly sounded promising.The study found that men who consumed anaverage of about half a small glass of either redor white wine a day lived about five years longerthan those who didn’t drink alcohol. It alsofound a lower risk of death from cardiovasculardisease among those who drank a smallamount of wine compared with teetotallers.In humans, this type of study, called a cohortstudy, is often used to find out more about dietand health. Cohort studies enable researchersto follow large groups of people for many yearsto find out if a specific food or supplement isassociated with a particular health outcome. Along follow-up period is particularly importantwhen researchers are looking at the relationshipbetween diet and outcomes such as cancer andheart disease.The difficulty is that there are many things thatcan affect how long we might live or whetherwe’re at risk of cardiovascular disease. Theyprobably include, for example, social status,physical activity, body mass index (BMI) andthe overall quality of our diet. Therefore, if thegroups being compared (in this study those whodrank a small amount of wine and teetotallers)differ in any of these other factors this could becontributing to the differences in lifespan, ratherthan just wine consumption.Researchers call things that can affect theresults of a study in this way confounders, andthe best cohort studies adjust their findingsto take into account as many confounders aspossible. The wine study, for example, adjustedits findings for several possible confounders,such as smoking status, BMI, medical historyand socioeconomic status. Surprisingly,however, it didn’t adjust for how much physicalactivity the men did. If more wine drinkers thanteetotallers exercised regularly, then this couldbe why the former lived longer than the latter.A study that suggested that green tea couldreduce the likelihood of developing prostatecancer had a similar weakness. It found thatmen who drank five cups of green tea a daywere about half as likely to develop advancedprostate cancer as those who drank only onecup. This study involved nearly 66,000 men inJapan, who were followed for 14 years. It was astudy with a large number of participants and aGreen tea is part of the traditional Japanese diet
long follow-up, both of which are strengths. Butit’s possible that men who drink lots of green teaare also more likely to adhere to a traditionalJapanese diet. This means diet may be aconfounding factor. In fact, this is partly whatthe researchers found – that men who drankmore green tea also ate more miso and soy, aswell as fruit and vegetables. They also differedin other ways from men who drank less greentea. So it’s difficult to say for certain whetherthe green tea is responsible for the lower riskof cancer or whether other elements in the dietwere involved.People react differently to different thingsInaccurate memoriesMany studies looking at foods rely on peoplebeing able to recall what they have been eatingand drinking in some detail, sometimes severalmonths or more in the past. Recall bias is animportant problem. Do you remember howmany eggs you ate last year? Do you thinkyour memory of those eggs would be affectedif you found out you had high cholesterol?In the Dutch study of alcohol and mortalitymentioned above, men were asked to recallhow much they were eating and drinking upto a year ago. This is not unusual in studies offood. Estimating how much alcohol a personhas consumed is especially tricky as the alcoholcontent varies between drinks. There are manyreasons why people may look back with rosetinted spectacles (and rosy cheeks) at theiralcohol consumption and may underestimatethe amount they consumed. Some may do thisdeliberately because they don’t want to lookbad when they complete their questionnaire.Recall bias wouldn’t be such a problem if itaffected all people in a study equally, but oftenthose with a particular outcome will remembertheir consumption differently from those whodon’t have that outcome. The eggs/highcholesterol example above is one, but the samemay happen to people with food poisoning.People who have had food poisoning are muchmore likely to remember the evening out andthe funny tasting curry than someone who didn’tget ill. This inconsistency in recall depending onthe outcome leads to bias in studies.Additionally, what we eat and drink can varyfrom day to day and from year to year. So, ifwe are asked about our current eating habits,our answers may not be representative of whatwe have eaten throughout the rest of our lives.Food questionnaires often also ask about howmany portions or cups of certain foods areeaten per week, and people may have differentideas about portion or cup sizes.Proxy outcomesOften, studies measure outcomes that aren’tdirectly relevant to people’s health. Instead,they choose a proxy, which is something thatis easier to test and which may be an indicatorof a health benefit. The trouble is that mediareports often confuse these proxy measureswith the real thing.Let’s look at an example. A claim that omega-3fats may be an “elixir of youth” was basedon research in heart patients that didn’t lookprimarily at patients’ health, but at the lengthof telomeres, which are regions of DNA at theends of chromosomes.Telomeres shorten each time a cell divides,so telomere length is often used as a proxymeasure for (an indicator of) biological ageing.Our memories aren’t always very reliable
The study found that people with higheromega-3 levels in their blood also had lessshortening of their telomeres. That’s interesting,but it tells us nothing about whether omega-3fats had any impact on the patients’ health or onthe cardiovascular disease process.Similarly, one study that reportedly showedthat oily fish could reduce memory loss didnot measure people’s memory. It scannedpeople’s brains for areas starved of oxygen(called infarcts) and other abnormalities, to findout if there was any association between fishconsumption and brain changes.Eating fish three times a week was associatedwith a non-statistically significant reduction inrisk of these brain abnormalities. Even if thedifference had been significant, the study couldnot say whether oily fish prevents memory loss,as memory was not measured. Only a trial thatdirectly measures people’s memory can tell usabout the link between oily fish and memory.Testing on mice is not the same as testing on humansAnimal and laboratory studiesUsing a study in humans to link an indirectoutcome measure to a disease is one thing,but many of the health stories reported in thepress have not been carried out in people at all.Animal and laboratory studies are often used totest what researchers suspect to be the activecomponents of foods, which might in time bedeveloped into drug treatments or supplements.There’s been a lot of excitement, for example,about resveratrol, a compound found in redwine that has been shown to extend the life ofyeasts, roundworms, fruit flies and also obesemice fed a high-calorie diet. Studies of thiscompound have suggested that resveratrol maycause cellular changes that have a positiveeffect on age-related processes, and maypossibly have other benefits.However, the doses of resveratrol used in labstudies may bear no relation to how muchresveratrol humans can realistically get fromdrinking red wine. In one study, which foundresveratrol helped stop abnormal growth ofblood vessels in the eyes of mice, the humanequivalent of the dose given would be severalbottles of wine a day.Before you reach for the resveratrolsupplements (which do exist), bear in mind thatjust because this compound was associatedwith cellular changes in mice and someinvertebrates, that doesn’t mean it will have thesame effect in humans. Animal studies are avaluable first step in finding out more about theactive ingredients in a food or drink, but we needto wait for the results of clinical trials to find out ifthe same results hold true for humans.Studies on cells or tissues in the laboratory maygive useful clues to a food’s properties, but theyare often overinterpreted by the media. There isoften a long way to go before we know whetherlab findings could be relevant to humans eatingfood in real-life situations.In one lab study that inspired the headline“Broccoli may undo diabetes damage”,researchers applied sulforaphane, a compoundfound in broccoli, to human blood vesselsincubated with sugar. Their aim was to find outwhether sulforaphane could prevent damage tosmall blood vessels caused by high blood sugar(which can happen if you have diabetes). Theyfound that sulforaphane did seem to protectcells from potentially damaging chemicals. Thisis an interesting finding, but a far cry from theclaims of the news headline.In another study, sulforaphane was applied tohuman breast cancer and mouse cancer cellsin the laboratory and injected into mice withmammary gland tumours. The results suggestedthat the compound may be able to target cancerstem cells and stop them from dividing as much.This finding is promising and certainly warrantsfurther research, but it would be misleading,possibly dangerous, to assume it means thateating broccoli can stop cancer in its tracks.
Who gets it wrong?Sometimes it’s not newspapers that are at faultin misinterpreting these kinds of studies, butresearchers and press officers anxious to garnerpublicity. One study found that broccoli improvedheart muscle function in rats whose hearts hadbeen removed and subjected to a simulatedheart attack. The title of the study called broccolia “unique vegetable”, when it is unknown if othervegetables might have the same result. It alsoimplied that the results could apply to mammalsgenerally, when that remains to be seen.Sometimes, a suggested association betweena food and a health outcome looks doubtfulon the basis of common sense. In suchcases we have to ask ourselves whether theassociation seems plausible. For instance, inthe study linking chocolate consumption tobetter cardiovascular health, people who atethe most chocolate had a 39% lowered risk ofheart attack or stroke compared with those whoate the least chocolate. However, the differencein consumption between those who ate themost and those who ate the least chocolatewas minimal: less than one small square (5g)of a 100g bar. Common sense tells us thatthis difference is unlikely to account for a 39%reduction in cardiovascular risk. The idea thathelping yourself to a bar of chocolate a day willstop you having a heart attack or stroke maysound attractive, but this research does notprovide any basis for it.Compounds in food may react differently in the bodyFunding and independenceIt’s important to know the source of funding infood studies, as with drug studies. One studythat claimed chocolate lowered stress levelsinvolved only 30 healthy young adults and hadnumerous flaws, including a very short follow-upperiod (14 days). It was also funded by a largechocolate manufacturer.But just because a study is funded by the foodindustry doesn’t necessarily mean it will be ofpoor quality. However, there may be a vestedinterest in giving a positive spin to results orgetting it into the newspapers for a little publicity.Oily fish is part of the Mediterranean dietOvercoming biasGenerally, the best type of study for findingout if a food has any effect is a randomisedcontrolled trial (RCT). RCTs can avoid someof the problems of other studies and there isusually more confidence in their results. InRCTs, participants are assigned randomly todifferent groups to decide which intervention (infood studies, which diet or dietary supplement)they will receive. This is the best way togenerate groups that are balanced for knownand unknown factors that could affect theresults. A control group that is not exposed tothe intervention is used as a comparison. Thismeans that any differences seen between thegroups can be attributed to the differences indiet or dietary supplement used.RCTs are not always feasible for looking at thelong-term health effects of a specific food. RCTsare expensive and people may not be willing toalter their diet for an extended period. Therefore,the randomised trials that are performed usuallymeasure the results of short-term consumptionof a food or test the active component of a foodtaken as supplement.Interestingly, one randomised trial that lookedat fish oil and cognitive function in 867 elderlypeople, found no significant difference incognitive function between fish oil supplementsand placebo. There’s been much excitementsurrounding the possible effect of fish oils oncognitive function, yet this study, one of thefew RCTs looking at this area, came up withnegative results. This may be because this is abetter quality study, but it also lasted only twoyears, which, as the researchers say, may havebeen too short a period to detect any effect.
Are any foods especially good for me?By now you may well be despairing of anyresearch ever being able to prove anythingabout our diet or about so-called superfoods.Finding out about the effects of particularfoods on health is a bit like doing a jigsaw. It’sa gradual and painstaking process in which,by conducting different types of studies,researchers gradually fit together the pieces sothat a tentative picture begins to emerge.Eating greens reduces cancer riskEating more non-starchy vegetables, suchas broccoli, is associated with a reduced riskof cancer according to the WCRF systematicreview on cancer prevention (see above). It ispossible that some of the compounds in broccolimay have health benefits, but clinical trials areneeded to investigate this.The best way to get a look at this overallpicture is by looking at what systematic reviewshave to say about diet and health. Systematicreviews take the best quality available datafrom individual studies and see how theevidence stacks up. By looking carefully at allthe research, systematic reviews can give anaccurate picture of the state of the evidenceso far and are, therefore, more reliable thanlooking at a single study in isolation.It would be a huge undertaking to carry outa comprehensive review of all the studiesinvestigating the potential health propertiesof food. But, here’s what systematic reviews(considered to be the strongest type ofevidence) have found up to the end of 2010.Drinking alcohol increases cancer riskA systematic review by the World CancerResearch Fund (WCRF) in 2007 concludedthat alcohol consumption is associated with anincreased risk of some cancers, with apparentlysimilar effects for different types of alcoholicdrinks. Their recommendation was that alcoholconsumption should be limited, even takinginto account the likely link between moderatealcohol consumption and reduced risk of heartdisease. In the UK, current guidance from theNHS recommends avoiding binge drinking andfor women to consume no more than 2-3 unitsa day, and men no more than 3-4 units a dayon a regular basis.Alcohol consumption should be limitedBroccoli is good for you as part of a healthy balanced dietNo evidence that oily fish boosts brain powerA Cochrane systematic review from 2006 foundthat at that point there was no evidence fromRCTs about whether omega-3 fats (thought tobe one of the “active ingredients” in oily fish)could reduce the risk of cognitive impairmentor dementia. As we mentioned earlier, asubsequent placebo-controlled RCT has foundthat a daily fish oil supplement given for twoyears did not improve cognitive function incognitively healthy older adults. This single RCTdoes not rule out the possibility that longerterm supplementation might affect cognitiveperformance or help those who are alreadycognitively impaired, but it does suggestthat the effects of omega-3 fats on cognitiveperformance are not clear-cut.
Children should eat a healthy balanced dietA Mediterranean diet increases the chanceof living to a healthy old ageThere’s also good evidence supporting thehealth benefits of a Mediterranean-style diet. TheMediterranean diet is high in fish, olive oil andfruit and vegetables, while containing relativelylittle meat. One systematic review, publishedin the British Medical Journal, shows that thistype of diet can reduce the risk of some chronicdiseases and increase the chance of living to ahealthy old age.Oily fish may reduce age-related maculardegeneration (ARMD)One systematic review we covered in 2008 foundthat there was evidence from observationalstudies that eating oily fish two or more times aweek reduced the risk of age-related maculardegeneration, a common cause of blindness inolder people. However, the review suggestedthat this should be interpreted cautiously due toweaknesses in the underlying studies.The jury’s out on green teaAs yet, green tea cannot be recommendedto stave off cancer because, according to aCochrane systematic review from 2009, theevidence from studies is “highly contradictory”.It appears to be safe in moderate amounts, solovers of green tea can continue to enjoy it.Chocolate may lower blood pressure but Systematic reviews of RCTs in The AmericanJournal of Clinical Nutrition, Archives of InternalMedicine and Nature have found that cocoaor chocolate can reduce blood pressure.However, they identified no RCTs looking at theeffects on important clinical outcomes such ascardiovascular disease or mortality. Chocolateof any variety is high in fat, sugar and caloriesand, if eaten to excess, is likely to increasethe risk of obesity, heart disease and diabetes.Whether any potential benefits of eating amoderate amount of chocolate can outweighthe potential harms remains to be seen.Eating plenty of fruit and veg will help to keep you healthyA balanced dietYou will have gathered by now that there’s noreal evidence that superfoods exist, if by thatwe mean a single food or compound that willkeep us healthy, stop illness in its tracks or saveour life.When it comes to keeping healthy, it’s bestnot to concentrate on any one food in thehope it will work miracles. Current advice is toeat a balanced diet with a range of foods, toensure you get enough of the nutrients yourbody needs. Limiting your intake of alcoholand high fat, high sugar, salty and processedfoods, keeping to a healthy weight and regularphysical activity are also important.
Miracle foods myths and the media A Behind the Headlines report January 2011. Analysing food studies in the media “Curry could save your life.” “Beetroot can fight dementia.” “Asthma risk linked to burgers.” Every day ther
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