Chapter grade for scientific accuracy: F (46.67%). How this grade was obtained is elaborated on in The Scienciness Scale section at the bottom of the article.
Back in my Chapter 1 post, I said I wasn’t going to comment on any of the anecdotes littered throughout It Starts With Food (ISWF). I lied 🙊. The personal story at the beginning of this chapter caught my eye and I thought it needed to be addressed. I think you’ll see why in a moment.
Whole30
““I was diagnosed with Lyme disease in October of 2009 … I hurt everywhere … I was in so much pain! My doctor told me it could take six months of antibiotics or more to start feeling better. I thought to myself, ‘I do not have six months to wait!’ I found the Whole30 and thought, ‘Let me try it—what do I have to lose?’ Well, I had a lot to lose—like every one of my Lyme disease symptoms, and a few pounds as well! I started feeling better after day three, and I just kept feeling better—to the point at which I feel healthier now than I did before I had Lyme, as long as I stay on my dietary course!””
Let’s assume that Anita had been correctly diagnosed with Lyme disease and that she did not seek out treatment for it. Judging by her story, these seem like reasonable assumptions. The first oddity is that her doctor told her she needed six months of antibiotics. The NIH and Infectious Disease Society of America’s Lyme Treatment Guidelines don’t suggest any course of treatment over 30 days [1-5]. Maybe she got a bad doc or maybe she’s remembering it wrong (or something else). At any rate, here is what happens when you don’t treat Lyme disease [1,2,5]:
“Untreated patients may be at especially high risk for development of Lyme arthritis” [6]
Symptoms may come and go.
Untreated, Lyme disease can spread to the brain, heart, and joints.
Stage 3 Lyme disease can cause long-term joint inflammation and heart rhythm problems.
Brain and nervous system problems are also possible, and may include:
Decreased concentration
Memory disorders
Nerve damage
Numbness
Pain
Paralysis of the face muscles
Sleep disorders
Vision problems
Yikes! That does not sound fun.
Now, we don't know if Anita opted to take medication in addition to doing the Whole30. However, it's ethically irresponsible to include this anecdote in the book with its implication that the Whole30 has super-curative powers against diseases like Lyme. No evidence exists to indicate any dietary measures can cure you of this infectious illness. Lyme disease is no joke and to suggest that a diet plan can cure it is careless. The Hartwig's did include this medical disclaimer at the beginning of the book, but it comes off as disingenuous when they routinely include stories like Anita's.
““The information included in this book is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in this book does not create a physician-patient relationship.” ”
Onto the meat of the chapter. ISWF begins by laying out their Good Food Standards. Foods that they say violate the following rules are out:
Doesn’t promote a healthy psychological response
Doesn’t promote a healthy hormonal response
Doesn’t support a healthy gut
Doesn’t support immune function or minimize inflammation
First on the chopping block, we have sugar.
Whole30
“Sugar does not make you healthier … In a most unscientific experiment, we Googled “sugar is healthy” to see if we could find any support for this hypothesis. The first link that appeared was titled “Experts agree—sugar is a health destroyer.” True story .”[40]
Unfortunately, the article cited was a link to Natural News. I know their experiment was supposed to be tongue-in-cheek, but the selection of a Natural News article makes me cringe.
Natural News is run by the “Renegade Health Ranger”, Mike Adams, and is one of the most popular online repositories for junk science and conspiracy theories. He once suggested that certain scientists and journalists who disagreed with his ideology should be murdered (covered here, here, and here). Adams even published a list of names of those who he thought should be targeted. I think Mike Adams can be summed up quite nicely with this quote.[7]
“[Adams] is a one-stop shop … of virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general … what Adams lacks in fame he makes up for in sheer crazy.”
Whole30
“Because the sweetness of sugar is addictive, eating an excess amount is easy.”[41]
To support their claim that “sugar is addictive” they cited a Huffington Post article written by Dr. David Katz, MD. The title of this article is “Sugar Isn’t Evil – A Rebuttal”. That may sound like an article going against the ‘sugar addiction’ claim, but Dr. Katz goes to some length to build his case that sugar meets the criteria for an addictive substance.
It should be noted that The American Psychological Association does not classify sugar as an addictive substance [17]. The current body of literature does not support the idea that sugar is addictive in humans [37,38,39]. Claiming that sugar is addictive minimizes the struggle of those who deal with real addictions. If you think you suffer from addiction you should seek out help from a professional, not go on a 30-day diet.
If you want to dive more into the scientific literature and see why the claims of 'sugar addiction' fall short, check out this podcast or read the transcript here. All discussed papers are linked to.
Whole30
“Artificial sweeteners may be even more problematic [than sugar] because they are designed to deliver a sweetness hit that is far beyond what you could ever find in nature [42].
Aspartame (Equal) and Stevia (Truvia) are 200-300 times sweeter than table sugar.
Sucralose (Splenda) is 600 times sweeter than table sugar.
Saccharin (Sweet’N Low) is up to 700 times sweeter than table sugar.”
The erroneous idea that artificial sweeteners taste hundreds of times sweeter than sugar stems from a misunderstanding of how sweetness is measured (i.e., the potency vs the intensity). Dr. Walters, Ph.D. gives a good overview of the testing procedures.
“Sucrose [sugar] is the standard to which all other sweeteners are compared. Humans can recognize sweetness in about 1% or 2% sucrose solution. Coffee is typically sweetened to about the level of 5% sucrose [and] soft drinks about 10%. 15% sucrose is really sweet and starts to feel a little syrupy. Taste panelists are often trained to quantitate sweetness on a 0–15 sweetness scale … using [a range of] 2–15% sucrose solutions as references. Other sweeteners are then tasted at a series of dilutions to determine the concentration that is as sweet as a given sucrose concentration. For example, if a 1% solution of sweetener X is as sweet as a 10% sucrose solution, then sweetener X is said to be 10 times as potent as sucrose” [8,10].
In essence, when someone says that “Sucralose (Splenda) is 600 times sweeter than table sugar” they are saying that Splenda is 600 times more potent than table sugar because you can use a dose 600 times lower than sugar to obtain the same perception of sweetness. It is not an indication that Splenda delivers a higher-intensity stimulus than sugar, merely that it triggers the taste receptors for sweetness on your tongue at a lower threshold.
But this begs the question, If you consumed higher and higher doses of these artificial sweeteners, could you eventually hit a dosage where the artificial sweetener delivers a higher stimulus than sugar?
Let’s examine that question in the context of the next quote.
Whole30
“These artificial sweeteners provide taste and reward sensations the likes of which we (biologically) have never before experienced, burning our taste buds (and pleasure centers) out on stimuli that are simply otherworldly.”
The taste buds in your mouth have a “sweetness ceiling”, meaning that after a certain concentration we see the sweetness rating level off. In artificial sweeteners, the metallic and bitter compounds begin to override the sweet taste at higher doses [11]. When artificial sweeteners are tested against natural sweeteners (sucrose, maple syrup, and agave nectar) it is actually the natural sweeteners that rank higher [9]. Aspartame (Equal), Sucralose (Splenda), Acesulfame K (Sunett/Sweet One), and Rebaudioside A (Rebiana) all have a lower maximal sweetness than table sugar [9]. Maple Syrup and Agave Nectar have the highest sweetness ratings.
[9]
The findings from this paper put it best [9]:
“Non-Nutritive Sweeteners (NNS) are not supernormal stimuli. Although NNS have low psychophysical detection thresholds compared with sugars, it is not valid to use thresholds or the dose over threshold to estimate the perceived intensity of these sweeteners … present data do not support the claim that NNS produce deleterious health effects by overstimulating sweet taste receptors to produce hyper-intense sweet sensations.”
Now that we’ve cleared that up, let’s look at some more claims.
Whole30
“Research suggests that the taste organ (your tongue and taste buds) is a peripheral target for leptin. Leptin resistance … may lead to an “enhanced behavioral preference for sweet substances.” When you’re leptin resistant, the taste of sweetness is dulled, which makes you eat more to satisfy your craving [12].”
The article cited was a study performed on diabetic obese and nondiabetic thin mice. The researchers found that in nondiabetic mice, increased leptin tended to “selectively suppress [the] taste nerve responses to sweet stimuli” [12]. That suppression was not seen in diabetic obese mice, leading the researchers to hypothesize that “leptin influences food intake … at [the] peripheral level acting as a sweet-sensing modulator” [12]. It’s important to note that all currently available research in this area has only been performed on mice; this effect has yet to be demonstrated in humans. Of the animal research available the results are mixed, with some studies showing an effect of leptin levels and others showing none [13]. One paper opined that “understanding the functional logic of taste bud circuitry, including the role of leptin, remains incomplete” [14].
Whole30
“Artificial sweeteners like Splenda may also kill off your beneficial flora, even when consumed in “normal” amounts.”
To support this claim, a study about the effects of Splenda on certain gut bacteria in rats was cited. This study showed decreased amounts of beneficial gut bacteria after 24 weeks. However, this study has never been replicated and no trials have been conducted in humans. There also seems to be some questions about the validity of the methods used.
You can read the original paper here:
The critiques here:
Expert panel report on a study of Splenda in male rats.
An overview of the safety of sucralose.
And the authors reply here:
Sucralose revisited: rebuttal of two papers about Splenda safety.
Whole30
“Sugar also messes with the healthy environment of our guts, specifically altering the delicate balance of “good” and “bad” bacteria. Unfriendly gut bacteria love refined sugars, which means your added sugar intake serves only to promote the existence of the bad guys—and can reduce the population of good guys.”
If this is true, all sugar, not just ‘added’ sugar, disrupt your gut bacteria. If we assume that the above statement is accurate (I do not believe it is that black and white) sugar from fruit and sweet potatoes should also harm your gut bacteria. And don’t forget the sugar they are referring to (sucrose) is made up of 50% fructose and 50% glucose. So, does that mean that any food containing glucose or fructose can be assumed to upset your microbiome? No citation was provided for this statement, but their logic doesn’t really pan out or match up with our scientific understanding of the microbiome.
Whole30
“Numerous reports have associated the use of various artificial sweeteners with various conditions, like cancer, inflammatory bowel disease, migraines, kidney disorders, autoimmune conditions, carpal tunnel syndrome, and neurotoxicity. There have not been enough long-term studies on humans to definitively confirm or deny these associations, but for us, the potential risks represent additional downsides in an already very long list—more than enough justification to avoid artificial sweeteners altogether.”
That is a pretty bold statement to make without providing a singe citation. What reports? Are there any studies to back this up? Is there any biological mechanisms for why artificial sweeteners might cause any of these ailments?
What if I told you that there was a chemical that caused 4,000+ deaths per year, has been found in biopsies of pre-cancerous tumors, been detected in many foods, and is an industrial solvent and coolant.[15,16] Sounds pretty scary, right? The chemical I’m referring to is H2O (aka water), which contributes to about 4,000 drownings annually, is found in tumor cells, many foods, and can be used for industrial purposes.
Context is key and when no context is provided in order to spin a narrative, you’re prioritizing the promotion of ignorance over understanding. The same space the Whole30 used to foster concern over artificial sweeteners could have been better used to explain how we test the safety of these products, what those test results have shown, and what those results mean for your health. As a scientist and science communicator, I can tell you from years of experience that this process would have taken hours of work. But it is worth the time if your goal is to provide evidence-based content to people so they can then make informed decisions for themselves.
Whole30
“Splenda has more in common with pesticides than table sugar.”
This statement encapsulates one of the primary overarching messages I've seen repeatedly from the Whole30:
"You should be afraid of food. But, if you listen to us, we can guide you to safety."
The intention of a statement like this is to cause fear, not to inform. It plays health concerns over Splenda against health concerns over pesticides — cementing in the readers' mind that this is a 'bad food' you must avoid.
You don't have to be afraid of Splenda or that it might have commonalities with pesticides. Since the best antidote for fear is information, let's try and unpack these claims and see if we can't ease some of these fears.
Just what is a pesticide?
Pesticides, be they naturally-occurring or man-made, are "any substance used to kill, repel, or control certain forms of plant or animal life that are considered to be pests."[44] The term 'pesticide' is catch-all that includes the following (among others):
Herbicides: for killing weeds
Fungicides: for halting molds and mildew
Bactericides: for stopping unwanted bacteria from spreading
Insecticides: for killing certain insect species
Rodenticides: for managing rats and mice
Larvicides: for killing larvae
I should avoid ingesting any pesticides, correct?
Some pesticides can be harmful if ingested, yes. But the vast majority of the fruits and vegetables we eat actually contain naturally-occurring pesticides. These plants produce pesticides that, while not harmful to us in the amounts we consume, can be toxic to potential predators — which dissuades them from eating the plants. Here are a few examples:[45-48]
Caffeine, found in coffee, tea, and chocolate, can be used as an insecticide.
Capsaicin, found in chili peppers, can be used to repel or kill insects.
Caffeic acid can be used against rodents. It is found in apples, carrots, celery, cherries, eggplants, endive, grapes, lettuce, pears, plums, and potatoes.
2-undecanone from the wild tomato plant, Lycopersicon hirsutum, and garlic oil can be use to repel ticks.
Limonene, found in many citrus fruits, is used to kill and repel insects.
All of these above-mentioned foods are Whole30 approved. So, technically speaking, they are advocating for you to eat pesticides. Isn't that something? 😉
So is there a Splenda-pesticide link I should be worried about?
In a word, no. From a safety standpoint, it does not matter if Splenda has “more in common” with pesticides than table sugar (there are literally thousands of pesticides with vastly different chemical structures. So, I’m not sure which ones they are referring to). What matters is how Splenda affects your body, and in this area research tells us that it is very unlikely to cause major or moderate health issues.
We eat many safe, naturally occurring products that share chemical similarities with unsafe substances. For example, sodium explodes when you put it in water.[49] Chlorine, an important ingredient in mustard gas, is poisonous.[50,51] When combined, chlorine and sodium form sodium chloride, otherwise known as table salt. Splenda (aka sucralose) is made by combining chlorine and sucrose (sugar). I suspect Splenda might have more in common with table salt than any pesticide.
Associating Splenda with pesticides is a fear-mongering tactic used to prey on the reader and their general unfamiliarity with chemistry. The Whole30 statements around artificial sweeteners are just unnecessary promotion of chemophobia — the fear of chemicals. Wouldn't it be better to understand them, and what they do, then to fear them?
Whole30
“Alcohol is addictive [17].”
I'd modified this to say alcohol can be addictive, but it is not inherently addictive. Not everyone who drinks alcohol will become addicted, but some do. I’m just glad to find something the authors and I can largely agree on! [17]
Whole30
“ … when combined with sugar (Jack and Coke, anyone?), alcohol increases insulin secretion, which pulls too much blood sugar out of the bloodstream, causing temporary hypoglycemia [18,26].”
This is pretty much true. An alcohol+carb drink will stimulate insulin to a greater extent than a carb drink alone, but alcohol by itself has very little effect on insulin secretion [18,19]. And as they note, the effect is temporary and is dependent upon when your last meal was.
Let’s run through the next series of claims made about alcohol.
Whole30
“Alcohol directly promotes intestinal permeability and overgrowth of gut bacteria … [20]”
“Both acute and chronic alcohol use impair cellular immunity … [22]”
“Alcohol is also pro-oxidative … [25]”
| Intestinal Permeability
The intestinal permeability data reviewed in the cited article were from studies looking at rats who had been chronically fed alcohol and human alcoholics [20]. The article did not discuss what, if any, intestinal permeability would be seen in those who drink moderately.
| Overgrowth Of Gut Bacteria
The studies that found an overgrowth of gram-negative bacteria were, again, all conducted in alcoholics making it hard to extrapolate these results to a more casual drinker. As noted by the authors of the article, the following questions still remained [20]:
Does alcohol affect bacterial growth in a dose-dependent manner?
Is bacterial growth associated with increased amount of endotoxin production?
What types of bacteria are affected by alcohol?
The researchers noted that in rats administered an oat supplement (oats, ironically, being banned while on the Whole30) saw decreased severity of gut leakiness as well as liver injury while simultaneously being fed large amounts of alcohol [20,21]. It is a rat study so who knows if this would help human alcoholics, but it seemed an interesting aside.
| Impairs Cellular Immunity
It is well established that chronic alcohol consumption is good for no one [22]. However, the effects of acute alcohol consumption are a bit more nuanced than “acute alcohol consumption impairs cellular immunity”. In fact, the paper cited had many positive things to say about moderate alcohol intake:
Associated with decreased mortality and cardiovascular morbidity
Alcohol-induced elevation in HDL cholesterol may help protect against atherosclerosis
Can reduce inflammation, a key component of CHD
The researchers also stated that any hit your immune system takes will most likely be short term and that the “clinical implication of such a transient [short] immunodepression after acute, moderate alcohol use need further studies” [22].
| Pro-Oxidative
So are components of tea and the nitrates (when converted to nitric oxide) found in plants like celery and green leafy vegetables [24]. Having too few pro-oxidative substances in your diet isn’t necessarily a good thing [23]. A balance between oxidants and antioxidants is important as both play critical roles in the body. Oxidants, for example, help to limit the growth of tumor cells [24]. The amount and frequency of alcohol consumption will be a determining factor in the anti/pro-oxidant balance and low, infrequent alcohol doses are highly unlikely to cause any meaningful harm. Many cohort studies have shown potential health benefits from moderate alcohol intake [33,34,35,36].
Whole30
“ … If you were Mr. Red Wine Producer, you might read (or fund) some studies on the heart- healthy effects of certain antioxidants, like resveratrol, realize your wine contains tiny amounts of this healthy compound, and start marketing your wine as “heart-healthy” [27].”
“A fluid ounce of red wine averages 160 micrograms of resveratrol … [28]”
“To get the same dose of resveratrol used in the mice studies, a person would have to drink more than 60 liters (that’s 80 bottles) of red wine every day [29].”
I can’t figure out where they got this number from:
“A fluid ounce of red wine averages 160 micrograms of resveratrol.”
Two things going on here.
Firstly, the paper they cite was actually a study of resveratrol content in peanuts. It only makes a single passing mention of red wines' resveratrol content. There are many other papers that directly assess or review the resveratrol content of wines. So why cite a study about resveratrol content in peanuts?
Secondly, the papers passing mention about red wine resveratrol content stated the range was between 0.6–8.0 mcg/mL. But that would make the range per ounce 17.74–236.59 mcg/oz. which averages out to 127.17 mcg/oz., not 160 mcg/oz as they stated. I know these points must seem trivial, but it speaks to their attention to detail and the integrity of their research.
It is true that the potential benefits of resveratrol consumption through wine have been over-hyped (although there may be future applications for a resveratrol supplement) [31,32] but cohort studies have consistently shown a modest benefit of low to moderate alcohol consumption. [33,34,35,36]
The Scienciness Scale
Of the claims made in this chapter, here is how they stack up on the Scienciness Scale.
Scienciness Categories
True (4 Points) – true statements
Mostly True (3 Points) – where the bulk of the claim is factually accurate
Misleading (2 Points) – where statements are presented out of context
Mostly False (1 Point) – where the bulk of the claim is factually inaccurate
False (0 Points) – false statements
Results
15 Statements Evaluated
28 Out of 60 Possible Points Earned
46.67% Overall Factual Accuracy
Chapter Grade: F
Chapter 8 Scienciness Scale
Statement Categorization
True
“Alcohol is addictive [17].”
“To get the same dose of resveratrol used in the mice studies, a person would have to drink more than 60 liters (that’s 80 bottles) of red wine every day [29].”
Mostly True
“ … when combined with sugar (Jack and Coke, anyone?), alcohol increases insulin secretion, which pulls too much blood sugar out of the bloodstream, causing temporary hypoglycemia [18,26].”
“A fluid ounce of red wine averages 160 micrograms of resveratrol … [28]”
Misleading
"Research suggests that the taste organ (your tongue and taste buds) is a peripheral target for leptin. Leptin resistance … may lead to an “enhanced behavioral preference for sweet substances.” When you’re leptin resistant, the taste of sweetness is dulled, which makes you eat more to satisfy your craving.
“Artificial sweeteners like Splenda may also kill off your beneficial flora, even when consumed in “normal” amounts.”
“Splenda has more in common with pesticides than table sugar.”
“Alcohol directly promotes intestinal permeability and overgrowth of gut bacteria … [20]”
“Both acute and chronic alcohol use impair cellular immunity … [22]”
“Alcohol is also pro-oxidative … [25]”
Mostly False
"Sugar also messes with the healthy environment of our guts, specifically altering the delicate balance of “good” and “bad” bacteria. Unfriendly gut bacteria love refined sugars, which means your added sugar intake serves only to promote the existence of the bad guys—and can reduce the population of good guys.”
“Numerous reports have associated the use of various artificial sweeteners with various conditions, like cancer, inflammatory bowel disease, migraines, kidney disorders, autoimmune conditions, carpal tunnel syndrome, and neurotoxicity. There have not been enough long-term studies on humans to definitively confirm or deny these associations, but for us, the potential risks represent additional downsides in an already very long list—more than enough justification to avoid artificial sweeteners altogether.”
False
"Because the sweetness of sugar is addictive, eating an excess amount is easy.”
“Artificial sweeteners may be even more problematic [than sugar] because they are designed to deliver a sweetness hit that is far beyond what you could ever find in nature.
Aspartame (Equal) and Stevia (Truvia) are 200 to 300 times sweeter than table sugar.
Sucralose (Splenda) is 600 times sweeter than table sugar.
Saccharin (Sweet’N Low) is up to 700 times sweeter than table sugar.”
“These artificial sweeteners provide taste and reward sensations the likes of which we (biologically) have never before experienced, burning our taste buds (and pleasure centers) out on stimuli that are simply otherworldly.”
Sources
http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
http://www.sciencebasedmedicine.org/mike-adams-on-dr-mehmet-ozs-colon-polyps-spontaneous-disease/
http://articles.latimes.com/2012/jan/12/news/la-dipak-das-resveratrol-diederik-stapel-20120112
http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/red-wine/art-20048281
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0019881
http://www.huffingtonpost.com/david-katz-md/sugar-health-evil-toxic_b_850032.html
http://permanent.access.gpo.gov/lps1609/www.fda.gov/fdac/features/2006/406_sweeteners.html
https://www.niehs.nih.gov/health/topics/agents/pesticides/index.cfm
https://www3.epa.gov/pesticides/chem_search/reg_actions/reregistration/fs_PC-079701_1-Sep-94.pdf
https://www.health.ny.gov/environmental/emergency/chemical_terrorism/chlorine_general.htm