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Episode 231:
Show Notes
Episode 231:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:17) Good morning, my lovely friend. How are you today? It is, in Melbourne, a grey old day. But a little ray of sunshine is joining me on this podcast, which is, of course, the wonderful, very effervescent Dr Mary. Hello, gorgeous one. How are you?
Dr Mary Barson (0:34) I am well, Dr Lucy. We're both in our pink today.
Dr Lucy Burns (0:38) Yes.
Dr Mary Barson (0:39) For those joining us on YouTube.
Dr Lucy Burns (0:43) Yes. I know, we had a little laugh because we've both popped on and we've gone, right, well, you know, according to marketing experts, we should be in our brand colours. But, you know, we're just thinking, yeah, we're not doing that.
Dr Mary Barson (0:54) Maybe it's time to rebrand. I don't know.
Dr Lucy Burns (0:58) Yeah, yeah, I know. We both wear a lot of pink and a lot of rainbow.
Dr Mary Barson (01:18) I'm excited by today's topic. As someone who did science before I did medicine, it's a topic very close to my heart. We're going to be diving into the world of evidence and weight loss supplements, which I think our listeners will love this one.
Dr Lucy Burns (01:22) Absolutely. And I think we would like to thank our Momentum member, Kim, who alerted us to this particular supplement and asked our opinion of it. And we get these questions a lot. And so we're going to do a whole series on supplements. But we have this system where I love it because it's called Doctor In Your Pocket. So you mostly do them, Mary. So Dr Mary does a weekly session to answer these exact sorts of questions because the internet is a noisy place. It honestly is. And the things that are touted, if you like, are often, often rubbish. Not always, but often. And so it's hard to tell what's rubbish and what's real. So I thought this would be a great series as we sort the low-carb wheat from the low-carb chaff and bring to you episodes where we have a look at the research and then we help you make a decision on whether this is going to be something that is helpful to you or whether you're just pouring your money down the drain.
Dr Mary Barson (02:38) Yes, all those things we do in Momentum, in our Momentum membership with the weekly Doctor In Your Pocket, we're going to take it out into our podcast.
Dr Lucy Burns (02:48) Yes, and, yes, give you the real juice. Okey-dokey. I love this particular quote which came from Dr Karen Price or Associate Professor Karen Price, who last year was the President of the Royal Australian College of General Practitioners. So she's a very smart lady. And she wrote this, and I thought it was really great, which was, if we are not a balance of curiosity and scepticism, then we've lost our scientific method. And you have a similar sort of philosophy, Miss, that you share with our members around the integrity bead. So I'd love you to share that with our listeners today.
Dr Mary Barson (03:43) I do imagine that we need to balance open-mindedness and curiosity with scepticism. You're absolutely right. And I like to kind of imagine that my integrity, my scientific integrity, my questioning integrity, is a bead that's on a stick. And at one end of the stick is when you fully believe anything, and at the other end is when you fully disbelieve anything. And you really want your bead to stay on this stick. You don't want it to fall off. As soon as you fully believe something, like fully believe it, your integrity bead falls off. As soon as you fully disbelieve it, like I'm not even going to look at it, that can't be true, your integrity bead falls off. So you want to balance this curiosity, open-mindedness, and scepticism. And this is how we look at all of these new things that come across our desk. Like we're going to talk today, spoiler alert, about matured hop extract as a potential weight loss supplement. And when I first heard about that, I didn't think, ah, that's rubbish, I'm not going to look at that. I thought, okay, let's look at this. Let's see what's there. You want to maintain your integrity.
Dr Lucy Burns (04:50) Yes, absolutely. And it is this curious questioning and it's interesting to do that thing where you sort of observe yourself. I do this quite a lot when I'm observing my own biases. So, you know, I recognise that I have a bias now to low-carb nutrition. Like I think it is really helpful for people who have insulin resistance and as we get older, particularly moving past 50, our rates of insulin resistance rapidly rise. And so I think that low-carb nutrition is an effective way to manage that.
Dr Mary Barson (05:30) I would say, Lucy, that you still also you maintain your curiosity. So I've noticed this about you. You'll read studies. You'll look at things. So even though you are, you know, very close to fully believing, you don't completely believe. You still question. You still look.
Dr Lucy Burns (05:47) Well, I think what I believe in this is it's one piece of the puzzle, but it's not the whole puzzle. And when people go, no, this is the key, this is the one thing, then we go, well, if that was the one thing, why doesn't it work for every single person in the whole entire universe? And we know that for some people, low-carb nutrition is not enough. It's helpful perhaps, but it's not the whole puzzle. It's one little piece of it. And I think this is the concept of the one-trick pony that becomes unhelpful. There is no one trick, one silver bullet, one magic potion. Despite what some of these supplement blogs, companies, or people selling supplements might have you believe.
Dr Mary Barson (06:37) And they will use science in a tricky way. They'll use science wrapped up inside of their marketing to convince potential buyers that this is it. This is, you know, the one-trick pony or, you know, this is the missing piece that you need. You need this particular supplement. Give us your credit card details and we'll make your problem go away. Here's some science to prove it. And this becomes extremely difficult and tricky because science, not all science, is created equal. We need to be able to, with open-mindedness and scepticism, look behind the marketing, look behind the hype, look behind the claims, and look at the actual science and try and take a balanced view of whether or not this is helpful or not. And that's a pretty tall order for people who don't have any kind of scientific training.
Dr Lucy Burns (07:37) Absolutely. It's a tall order. And, you know, as you well know and I have no problem stating, I don't love reading journal articles. I find them difficult. They're sort of long and a tiny bit boring and complicated. And there are graphs and there's words like p-values and all sorts of things that I go, oh, God, and my eyes glaze over and I'm looking out the window. So I thought today we'd give a little framework on how we can develop part of our healthy scepticism when looking at nutritional science. And the first thing I thought we might start with is something called the Bradford Hill Criteria. And, Miss, you're very familiar with that. Yes. So I'm going to throw it over to you.
Dr Mary Barson (08:24) I love this. So there are lots of potential weaknesses in nutrition science that can be exploited if people don't know what to look for. And one in particular is the idea that association is not causation. The placebo effect is a great example of this. You could get a whole lot of people and say, we're going to give you all on a weight loss supplement trial, but half of them will get a placebo, half of them will get the actual supplement that's being tested and see what happens. And actually probably all of them will lose weight, for example, if that's the intervention, at least a little bit. That is what we'll see. So that's just an example of how the placebo effect is one confounding variable. Just because something is associated doesn't mean that it's the cause. Just like if an alien dropped down onto where Lucy is in rainy Melbourne right now and could see all these people walking around with umbrellas, they might think, whoa, the umbrellas associated with the rain. Maybe it's something these humans are doing. They've got the umbrellas out. It's making it rain. Interesting. I want to take some umbrellas back and examine them. How do they make it rain? Of course, they don't. Umbrellas are associated with rain for reasons that are extremely obvious to us having grown up on planet Earth with umbrellas, but there is still a very strong association, but they're not the causation. So there is these scientific principles that exist called the Bradford-Hill criteria which are nine principles developed to determine whether there is a causal relationship in epidemiology and nutrition science. However, in nutrition science, for historical reasons, these criteria are often overlooked, which leads to pretty weak recommendations. And these are frequently ignored, leading to pretty weak data. I won't go into them in detail because it's kind of boring, but it does look at, and people can do this, look at various strengths of association, looking at whether results are consistent. Is there a really easy-to-understand mechanism between the association and the causation? Is it dose-dependent? Does it make sense? There are all of these criteria, but we tend to just ignore them, and they have been ignored for a very long time in nutrition science, which means a lot of it is very noisy, unfocused, and pretty difficult to interpret.
Dr Lucy Burns (11:07) Absolutely. And, you know, the sceptical me will believe, and I think it's a reasonable belief, that sometimes these papers are deliberately cloudy or confusing.
Dr Mary Barson (11:24) The Bradford-Hill criteria are only one component of this. There are other ways in which studies can be possibly quite deliberately misleading or people are somewhat misrepresenting their data, like the idea that statistical significance is not the same as real-world significance. Statistical significance is just a statistical sort of jargon term looking at the strength of the model, the scientific model that's being used. But just because something is statistically relevant doesn't mean that it has any real-world relevance at all, and that's something that you wouldn't necessarily know unless you dived in and you had a look.
Dr Lucy Burns (12:03) Absolutely, and I would like to clarify that confusingness, if that's a word, with the concept that they will say, you know, X, Y, and Z cause significant weight loss. And as a layperson, if I hear significant weight loss, in my mind that means lots, heaps, you know, piles, huge, significant, whereas in statistical terms that just means a data point. That means that the intervention was potentially the reason, I think. Have I got that right?
Dr Mary Barson (12:44) Exactly. For the change. Statistically, it's unlikely that a weight loss, even if it was a tiny amount, was due to something else other than the intervention. It could be a tiny amount and still statistically significant without actually having any real-world significance. Same with studies that look at medical interventions for things like, you know, diabetes and other diseases. You could be looking at things that are statistically significant but don't necessarily have great real-world significance. And so in those sorts of studies you really want to go straight into looking at the all-cause mortality data, you know, are people living longer, are they living better. You want to try and understand what's the real-world implications here and look beyond the little statistical noise because people can trump that up and make it sound more interesting and potentially more important than it is.
Dr Lucy Burns (13:37) Absolutely. And, yes, and as soon as you write significantly, again, you just go, you know, and it might be that the intervention caused significant reduction in blood pressure. Like if I hear that, I'm thinking, awesome, significant reduction. That sounds amazing. Everybody wants that. And then you realise that the significant reduction was like two millimetres of mercury on your blood pressure thing and, honestly, does that make any difference to anything in the long term? Well, maybe they didn't look at that.
Dr Mary Barson (14:12) Yes, exactly right. Another way that data can be misrepresented is by looking at the relative risk ratio as opposed to the, yeah, have you seen this one? That's right. Absolutely. As opposed to the complete risk ratio. So if somebody has a very small chance of developing heart disease, you know, like it's 0.002% and some kind of intervention halves it and it goes to 0.0001, that's still not a very significant reduction. But people will use that relative risk and say, 50% reduction in heart risk, heart disease risk, which makes you sort of think that with this intervention half the people in the world are going to have heart attacks overnight. It's deliberately misleading and that's not what it means at all. So I think that the fact that studies are even allowed to report relative risk I think just shows you one way in which the system is flawed.
Dr Lucy Burns (15:13) Absolutely. And to get my sceptical hat on even further, one of the things that we need to note is that journals are a business. So people aren't running these journals out of the goodness of their hearts. They're not charities. They're not not-for-profits. They are a business. And they make money by selling their articles or their magazines, if you like, whether it's hard copy or soft copies, digital copies. They make money by doing that. And so interestingly even the name or the headline of the research piece can be manipulated a bit like a headline in a newspaper. It can be like clickbait. And journal magazines want these because, of course, they want their readers or their audience to click on them, to read them. And I'd never realised this. I just thought I don't know what I thought. It never occurred to me to even consider it. I just thought, oh, these are reputable. And that's not to say that every single article needs to be disputed. Again, we don't need to go to the other extreme, but it is definitely worth knowing that journals are it's a business proposition.
Dr Mary Barson (16:42) It is. And speaking of business propositions, I'd love to dive into this particular question from our beautiful Momentum member, Kim, about matured hops extract. And lovely, Lucy, I'll leave you with this one because I know that you've dived into the research such as it is. So yes, please elaborate.
Dr Lucy Burns (17:09) Absolutely. So Matured Hop Extract or MHE, as it's known, is a supplement. So it's made from distilling down some hops. And the reason they distil down or break down the hops is hops is quite bitter. So most people, you know, wouldn't tolerate the taste of it. But they've come up with a formulation that takes the bitterness out for a supplement. Now, there are companies that sell this. And that's fine. People are allowed to sell things. You know, that's how the economy works. Like I have no problem with people selling stuff. That's fine. What I have a problem with is when claims are made about their products that are, and again, here's a little caveat, if it's too good to be true, it's often too good to be true. And this particular supplement promises effortless weight loss and promises to melt away in particular visceral fat without you having to do anything. And I thought, oh, okay, let's look into this. Sounds great. Yep, absolutely. So the marketing around this links to journal articles. Again, very compelling. And when I clicked on the four articles they provided, well, two were actually completely irrelevant. Two were about the harms of alcohol. That's fine. Like nobody's disputing that. So I'm thinking, oh, well, what's the point of that? I guess because hops is part of beer as its main use, maybe that's what the point is there, but, again, it was sort of more like I suspect people are just looking at the number of articles to add weight because, in fact, there's actually one journal article that's been published looking at the visceral fat or looking at the body's fat using this hop supplement. One. So one article was published in 2015. So it's now nine years old, which means there's plenty of opportunity for this to have been re-studied or re-looked at, but it hasn't. So I'm always thinking clearly one of the things about science, and I think one of the Bradford Hill criteria, is that it needs to be reproducible. Nobody's reproduced this. So that already automatically I kind of go, ooh, that's interesting. It's not like you search it and there are 25 articles or 100 articles, there's one. When I scroll down to the bottom of this one article to look at the funding, which is actually where I always start now, it's funded by a company called Kirin, which is a Japanese beer company, and a food and beverage company. Concerning. And it's not a small little company that is, you know, just a sort of craft boutique brewery. It is a massive conglomeration. So this is a huge company. Huge companies have huge wallets and will research things that are going to be of some benefit to them. So I'm thinking, all right, automatically Hopps Company is funding research that somehow says Hopps is good for you. Okay. All right. scepticism's moved a little further down the list. So then when we look at this study, and, again, around the marketing they talk about after eight weeks, you know, there is significant, there's that word again, reduction in visceral fat. At 12 weeks, it's an even more significant reduction in visceral fat. So I looked at it, and, again, there is initially some reduction in the visceral fat area, and they measure it in centimetres squared. So it's not measured in kilos or anything that we would normally use that people would be familiar with in looking at terms of fat loss. It's used as an area. And they did measure it using CT scans. So I guess that seems reasonably accurate. But the bit they don't report in any of their marketing is that after 12 weeks, all of the fat loss seems to be starting to trend up. And by 16 weeks, the levels of the intervention and the levels of placebo are almost identical. So I find it incongruous in some ways because all of the marketing around this suggests and states, in fact, not even suggests, that if you want continued fat loss, you need to stay on this supplement, that it's not a short-term intervention. Whereas, in fact, their own data seems to think that if you stay on it, it's going to trend back upwards. So I feel like there is a whole lot more to this picture that we need to know about, but there is no data on it. There are no trials. There's nothing, nothing else at all. Except for an incredible amount of noise on the internet and on Facebook, it seems that this supplement is largely distributed through multilevel marketing. And that in itself to me is problematic.
Dr Mary Barson (22:51) Mm-hmm. We say that a lot, don't we? Yeah. Just to clarify, you're saying that they cherry-picked the data in this study and cut it off at eight weeks, but if you follow their own data, like if you follow what's buried within the study is that if you continue on to 16 weeks, people's weight was tracking back up. And just to paint a picture for people, could you tell did people were on the placebo effect, did they lose weight as well? What happened there?
Dr Lucy Burns (23:22) Yeah. Yeah, absolutely. So, you know, the details of the study was that there were essentially 100 people in each arm. So 100 got the placebo and 100 got the intervention. And they tasted the same and they were put into a drink. And so that's a reasonable method that we would look at. And, you know, like all studies, there were people that dropped out and all of that sort of stuff. So, I mean, it's not massive numbers but it's numbers there. And they were only looking at people with a BMI between 25 and 30 who had otherwise no health implications. So they didn't have type 2 diabetes and they didn't have all these other things. So that's all fine. But initially, again, the people on placebo also lost weight, as you mentioned earlier. And they explained this by just talking about a subconscious, like all they could say was, oh, well, this was probably due to a subconscious bias to lose weight or something like that. And it's like, hmm, well, yeah, the placebo effect. The placebo effect is it's a real effect and it's very helpful. You know, and I think that the way I like to think about the placebo effect is that really it adds a whole heap of weight to the mind-body-medicine side of things, that, you know, as humans we are very easily influenced by what we think will happen. And that does change the lens through which we look at whatever it is that we're doing. Our minds are powerful. Very, very. And, I mean, you know, I would like to be able to harness the placebo effect because the placebo effect, you know, markedly reduces side effect profiles of all sorts of things because there is, you know, again, you might be taking a tablet of some sort, but it's got no active ingredients. And so, therefore, it's not going to interact with anything. I'm waffling off on a different tangent here. But, again, what we did see was that the fat losses that occurred happened in the placebo as well as in the active ingredient. They were different pathways like they didn't mirror the same. So within the placebo effect, there was a decrease down to 12 weeks and then a plateau out between 12 and 16, whereas, in this intervention group, it went down further at 12, which is why they're making claims that this is more effective than taking a placebo. But then between 12 and 16 it started to trend back up and met the placebo arm. It's like, hmm. So one of the other things that you mentioned, Miss, was making sure that the method or the hypothesis around how this works is sound. So, again, caught up in a waffle of jargon, it seems that the hypothesis that they're pontificating is that the supplement activates our brown adipose tissue, so our brown fat. Brown fat or brown adipose tissue, shortened to BAT, is a much more metabolically active form of fat tissue, which is much higher in babies and decreases as we age. But, again, this effect on the brown adipose tissue hasn't been replicated or proven in any human studies. There is one study done by the same company on mice in 2015 suggesting that it could increase brown adipose tissue. Now, humans and mice are completely different in our fat distribution and it's a bit like comparing humans and bears. Bears have a completely different brown adipose tissue mass because, you know, it's very important in hibernation and, you know, humans don't hibernate. But it's not the same thing. So to then extrapolate this one tiny study that they did on some rats, move it into their same hop study and then go, you know, bim, bam, ba-da-boom, this is how it works.
Dr Mary Barson (28:11) Multilevel marketing, here we go.
Dr Lucy Burns (28:14) Yeah, and then sell it via multilevel marketing, which means the person at the top of that pyramid, ah, they're making gazillions because every single person that sells a supplement to somebody else, the person at the top of the scheme is cashing in. So, yeah, it's really this. So this particular supplement gets a big fat no from me..
Dr Mary Barson (28:39) Cool. Yep. I am inclined to agree that on the basis of available evidence, which is scant indeed, that this is probably not going to be living up to its claims and probably most likely not worth your money. Yep. So that's our take on matured hop extract.
Dr Lucy Burns (29:00) Yes. And I think the thing is that in this series of supplements, we're not going to be canning every single supplement. Like I want people to know that there's coming forth. There are some supplements that are potentially helpful, but what we want to do is just, again, elucidate the ones in particular that are hot topics right at the moment because there are people targeting, scamming and manipulating you to believe that this might be helpful. Indeed. Good. I'm going to finish with one little second of brown adipo se tissue because I think we can talk more about this over the next few weeks as well. Brown adipose tissue is helpful and probably part of the metabolic picture, which is why, again, whilst low carb is a very significant proportion of it, it's not the only thing. The people who have more brown adipose tissue are more likely to be metabolically well. So it is helpful to be able to increase your brown adipose tissue. And there is a thing that you can do that I love this phrase where you can, whilst you can't specifically convert your white adipose tissue into brown adipose tissue, you can do this thing called beiging it. It's like it behaves like brown adipose tissue. And the thing about this, though, is that it's particularly through cold exposure. So that pre-shivering time is where we will activate brown adipose tissue and the more we do this, then the more likely we are to beige our white tissue. The problem is that shivering and getting quite cold is really unpleasant. And so for the majority of us, it's not something that we can maintain, which is why supplement companies come along with these claims and go, you don't have to do this cold business, just take my thing. So I think over, again, as part of this series, we will be looking at things like cold plunging and all of those sorts of things. So, my loves, stay tuned where, as I said, we will help you sort out the wheat from the chaff.
Dr Mary Barson (31:26) In a wonderful, low-carb way. Excellent.
Dr Lucy Burns (31:29) Indeed.
Dr Mary Barson (31:30) Bye-bye, lovely one.
Dr Lucy Burns (31:31) All right, lovely ones, we'll see you next week.
Dr Lucy Burns (31:34) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
