Does our diet need a little help?

We asked you for your take on supplements, and got the above-illustrated, below-described set of results.

• The largest minority of respondents (a little over a third) voted for “I just take something very specific”
• The next most respondents voted for “I take so many supplements; every little helps!”
• Almost as many voted for “I just take a vitamin or two / a multivitamin”
• Fewest, about 8%, voted for “I get everything I need from my diet”

But what does the science say?

Food is less nutritious now than it used to be: True or False?

True or False depending on how you measure it.

An apple today and an apple from a hundred years ago are likely to contain the same amounts of micronutrients per apple, but a lower percentage of micronutrients per 100g of apple.

The reason for this is that apples (and many other food products; apples are just an arbitrary example) have been selectively bred (and in some cases, modified) for size, and because the soil mineral density has remained the same, the micronutrients per apple have not increased commensurate to the increase in carbohydrate weight and/or water weight. Thus, the resultant percentage will be lower, despite the quantity remaining the same.

We’re going to share some science on this, and/but would like to forewarn readers that the language of this paper is a bit biased, as it looks to “debunk” claims of nutritional values dropping while skimming over “yes, they really have dropped percentage-wise” in favor of “but look, the discrete mass values are still the same, so that’s just a mathematical illusion”.

The reality is, it’s no more a mathematical illusion than is the converse standpoint of saying the nutritional value is the same, despite the per-100g values dropping. After all, sometimes we eat an apple as-is; sometimes we buy a bag of frozen chopped fruit. That 500g bag of chopped fruit is going to contain less copper (for example) than one from decades past.

Here’s the paper, and you’ll see what we mean:

Mineral nutrient composition of vegetables, fruits and grains: The context of reports of apparent historical declines

Supplements aren’t absorbed properly and thus are a waste of money: True or False?

True or False depending on the supplement (and your body, and the rest of your diet)

Many people are suffering from dietary deficiencies of vitamins and minerals, that could be easily correctable by supplementation:

However, as this study by Dr. Fang Fang Zhang shows, a lot of vitamin and mineral supplementation does not appear to have much of an effect on actual health outcomes, vis-à-vis specific diseases. She looks at:

• Cardiovascular disease
• Cancer
• Type 2 diabetes
• Osteoporosis

Her key take-aways from this study were:

• Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases
• People using supplements tend to be older, female, and have higher education, income, and healthier lifestyles than people who do not use them
• Use of supplements appreciably reduces the prevalence of inadequate intake for most nutrients but also increases the prevalence of excess intake for some nutrients
• Further research is needed to assess the long term effects of supplements on the health of the general population and in individuals with specific nutritional needs, including those from low and middle income countries

Read her damning report: Health effects of vitamin and mineral supplements

On the other hand…

This is almost entirely about blanket vitamin-and-mineral supplementation. With regard to fish oil supplementation, many commercial fish oil supplements break down in the stomach rather than the intestines, and don’t get absorbed well. Additionally, many people take them in forms that aren’t pleasant, and thus result in low adherence (i.e., they nominally take them, but in fact they just sit on the kitchen counter for a year).

One thing we can conclude from this is that it’s good to check the science for any given supplement before taking it, and know what it will and won’t help for. Our “Monday Research Review” editions of 10almonds do this a lot, although we tend to focus on herbal supplements rather than vitamins and minerals.

We can get everything we need from our diet: True or False?

Contingently True (but here be caveats)

In principle, if we eat the recommended guideline amounts of various macro- and micro-nutrients, we will indeed get all that we are generally considered to need. Obviously.

However, this may come with:

• Make sure to get enough protein… Without too much meat, and also without too much carbohydrate, such as from most plant sources of protein
• Make sure to get enough carbohydrates… But only the right kinds, and not too much, nor at the wrong time, and without eating things in the wrong order
• Make sure to get enough healthy fats… Without too much of the unhealthy fats that often exist in the same foods
• Make sure to get the right amount of vitamins and minerals… We hope you have your calculators out to get the delicate balance of calcium, magnesium, potassium, phosphorus, and vitamin D right.

That last one’s a real pain, by the way. Too much or too little of one or another and the whole set start causing problems, and several of them interact with several others, and/or compete for resources, and/or are needed for the others to do their job.

And, that’s hard enough to balance when you’re taking supplements with the mg/µg amount written on them, never mind when you’re juggling cabbages and sardines.

On the topic of those sardines, don’t forget to carefully balance your omega-3, -6, and -9, and even within omega-3, balancing ALA, EPA, and DHA, and we hope you’re juggling those HDL and LDL levels too.

So, when it comes to getting everything we need from our diet, for most of us (who aren’t living in food deserts and/or experiencing food poverty, or having a medical condition that restricts our diet), the biggest task is not “getting enough”, it’s “getting enough of the right things without simultaneously overdoing it on the others”.

With supplements, it’s a lot easier to control what we’re putting in our bodies.

And of course, unless our diet includes things that usually can’t be bought in supermarkets, we’re not going to get the benefits of taking, as a supplement, such things as:

• Bacopa monnieri
• Reishi mushroom
• Ashwaghanda root

Etc.

So, there definitely are supplements with strong science-backed benefits, that probably can’t be found on your plate!

Cosmetic Surgery: What’s The Truth?

In Tuesday’s newsletter, we asked you your opinion on elective cosmetic surgeries, and got the above-depicted, below-described, set of responses:

• About 48% said “Everyone should be able to get what they want, assuming informed consent”
• About 28% said “It can ease discomfort to bring features more in line with normalcy”
• 15% said “They should be available in the case of extreme disfigurement only”
• 10% said “No elective cosmetic surgery should ever be performed; needless danger”

Well, there was a clear gradient of responses there! Not so polarizing as we might have expected, but still enough dissent for discussion

So what does the science say?

The risks of cosmetic surgery outweigh the benefits: True or False?

False, subjectively (but this is important).

You may be wondering: how is science subjective?

And the answer is: the science is not subjective, but people’s cost:worth calculations are. What’s worth it to one person absolutely may not be worth it to another. Which means: for those for whom it wouldn’t be worth it, they are usually the people who will not choose the elective surgery.

Let’s look at some numbers (specifically, regret rates for various surgeries, elective/cosmetic or otherwise):

• Regret rate for elective cosmetic surgery in general: 20%
• Regret rate for knee replacement (i.e., not cosmetic): 17.1%
• Regret rate for hip replacement (i.e., not cosmetic): 4.8%
• Regret rate for gender-affirming surgeries (for transgender patients): 1%

So we can see, elective surgeries have an 80–99% satisfaction rate, depending on what they are. In comparison, the two joint replacements we mentioned have a 82.9–95.2% satisfaction rate. Not too dissimilar, taken in aggregate!

In other words: if a person has studied the risks and benefits of a surgery and decides to go ahead, they’re probably going to be happy with the results, and for them, the benefits will have outweighed the risks.

Sources for the above numbers, by the way:

• What is the regret rate for plastic surgery?
• Decision regret after primary hip and knee replacement surgery
• A systematic review of patient regret after surgery—a common phenomenon in many specialties but rare within gender-affirmation surgery

But it’s just a vanity; therapy is what’s needed instead: True or False?

False, generally. True, sometimes. Whatever the reasons for why someone feels the way they do about their appearance—whether their face got burned in a fire or they just have triple-J cups that they’d like reduced, it’s generally something they’ve already done a lot of thinking about. Nevertheless, it does also sometimes happen that it’s a case of someone hoping it’ll be the magical solution, when in reality something else is also needed.

How to know the difference? One factor is whether the surgery is “type change” or “restorative”, and both have their pros and cons.

• In “type change” (e.g. rhinoplasty), more psychological adjustment is needed, but when it’s all over, the person has a new nose and, statistically speaking, is usually happy with it.
• In “restorative” (e.g. facelift), less psychological adjustment is needed (as it’s just a return to a previous state), so a person will usually be happy quickly, but ultimately it is merely “kicking the can down the road” if the underlying problem is “fear of aging”, for example. In such a case, likely talking therapy would be beneficial—whether in place of, or alongside, cosmetic surgery.

Here’s an interesting paper on that; the sample sizes are small, but the discussion about the ideas at hand is a worthwhile read:

Does cosmetic surgery improve psychosocial wellbeing?

Some people will never be happy no matter how many surgeries they get: True or False?

True! We’re going to refer to the above paper again for this one. In particular, here’s what it said about one group for whom surgeries will not usually be helpful:

❝There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

For several reasons, it is important to recognise BDD in cosmetic surgery settings:

Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.

Secondly, BDD is a treatable disorder. Serotonin-reuptake inhibitors and cognitive behaviour therapy have been shown to be effective in about two-thirds of patients with BDD❞

~ Dr. David Castle et al. (lightly edited for brevity)

Which is a big difference compared to, for example, someone having triple-J breasts that need reducing, or the wrong genitals for their gender, or a face whose features are distinct outliers.

Whether that’s a reason people with BDD shouldn’t be able to get it is an ethical question rather than a scientific one, so we’ll not try to address that with science.

After all, many people (in general) will try to fix their woes with a haircut, a tattoo, or even a new sportscar, and those might sometimes be bad decisions, but they are still the person’s decision to make.

And even so, there can be protectionist laws/regulations that may provide a speed-bump, for example:

Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

Take care!