Tuesday, July 9, 2019

Retrospective #143: Fruit Consumption & Diabetes – a Theater of the Absurd Plot

No sooner had I posted #138 in 2013, “Fruit, the 3rd Rail for Prospective Low Carbers,” when my Medscape Alert (not “The Onion”) brought me an absurdist piece: “Consumption of Certain Fruits Linked to Lower Diabetes Risk.” I was dumbfounded. How could the consumption of any food, whose only macronutrient is simple sugars, “lower diabetes risk”? It just made no sense. Am I living in an incomprehensively illogical world? A world without meaning? Has the respected research community abandoned rational thinking, I asked? I had to read the piece.
The report was from the Department of Nutrition, Harvard School of Public Health, and appeared as an online article in BMJ, the British Medical Journal. The Medscape writer wrote, “Increasing fruit consumption has been recommended for the primary prevention of many chronic diseases, including Type 2 diabetes, although epidemiologic studies have generated somewhat mixed results regarding the link with risk of Type 2 diabetes.”
The impetus for the study writer’s hypothesis appears to be, “The inconsistency among these studies may be explained by differences in types of fruits consumed in different study populations as well as difference in participants' characteristics, study design, and assessment methods, although a meta-analysis did not show that the associations differed by sex, study design, or location." Okay, all epidemiological studies inherently have many confounding factors and biases, but the hypothesis proposed to address these factors is, IMHO, also inherently flawed. Just because “differences in types of fruits consumed” was not previously studied, does not lead to the conclusion that the types of fruit consumed are a differentiating criterion. True, the authors cache their hypothesis carefully in the word “may,” but that did not similarly constrain the report’s conclusions, or the gushing headlines.
The authors’ conclusion: "Overall, these results support recommendations on increasing consumption of a variety of whole fruits, especially blueberries, grapes, and apples, as a measure for diabetes prevention." Unbelievable!
The article received funding from the National Institutes of Health and was published on August 29, 2013. It immediately was picked up and ‘broadcast’ in such places as The Guardian, Science Daily, Medical News Today, The Huffington Post, the Daily News, Today.com and FoxNews.com. The lede in the e! Science News piece was, “Eating more whole fruits, particularly blueberries, grapes, and apples, was significantly associated with a lower risk of Type 2 diabetes, according to a new study led by Harvard School of Public Health (HSPH) researchers.” WOW!
Sadly, and invariably, the headline and the lede is all that the mass media market will pick up: “Eat more fruit to lower your risk of diabetes.” I feel at times like a character in an absurdist plot, “facing the chaos of a world that science and logic have abandoned,” to borrow from a Wikipedia passage describing Theatre of the Absurd.
The absurdity is further confounded by the inherent contradiction of the perfunctory conflicts of interest disclaimer: “The study received funding from the National Institutes of Health. The authors have disclosed no relevant financial relationships.” In other words, fruit growers didn’t pay them to say that “eating more whole fruits...was significantly associated with lower risk of Type 2 diabetes.” But the National Institutes of Health did! No conflict of interest there! We taxpayers paid the costs in furtherance of the government’s goals to promote “healthy” fruits and vegetables and avoid animal-based “unhealthy” saturated fats and dietary cholesterol.
Note also that the authors were careful to say that the results were “linked” to the outcomes. The conclusions of all such epidemiological “studies” show only an association, not a causal relationship, and a weak one at that. The confounding factors, including multiple biases assumed, are expressly discussed near the end of such “studies,” inevitably making the conclusions subjective. The final paragraph of such full “studies” then invariably acknowledges that the conclusions are inconclusive and require “further study,” preparing the ground, in the name of “science,” for another grant application to pay for another round of so-called “research.” Call me cynical, if you want, but to me this ongoing charade is phantasmagorical and surreal, if not downright Machiavellian.
Oh, well, at least you can be comforted to know that your humble blogger is not paid for his opinions.

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