Good Health By The Cup?

In Tuesday’s newsletter, we asked you for your opinion of cupping (the medical practice), and got the above-depicted, below-described, set of responses:

• About 40% said “It may help by improving circulation and stimulating the immune system”
• About 26% said “I have never heard of the medical practice of cupping before this”
• About 19% said “It is pseudoscience and/or placebo at best, but probably not harmful
• About 9% said “It is a good, evidence-based practice that removes toxins and stimulates health”
• About 6% said “It is a dangerous practice that often causes harm to people who need medical help”

So what does the science say?

First, a quick note for those unfamiliar with cupping: it is the practice of placing a warmed cup on the skin (open side of the cup against the skin). As the warm air inside cools, it reduces the interior air pressure, which means the cup is now (quite literally) a suction cup. This pulls the skin up into the cup a little. The end result is visually, and physiologically, the same process as what happens if someone places the nozzle of a vacuum cleaner against their skin. For that matter, there are alternative versions that simply use a pump-based suction system, instead of heated cups—but the heated cups are most traditional and seem to be most popular. See also:

National Center for Complementary and Integrative Health | Cupping

It is a dangerous practice that often causes harm to people who need medical help: True or False?

False, for any practical purposes.

• Directly, it can (and usually does) cause minor superficial harm, much like many medical treatments, wherein the benefits are considered to outweigh the harm, justifying the treatment. In the case of cupping, the minor harm is usually a little bruising, but there are other risks; see the link we gave just above.
• Indirectly, it could cause harm by emboldening a person to neglect a more impactful treatment for their ailment.

But, there’s nothing for cupping akin to the “the most common cause of death is when someone gets a vertebral artery fatally severed” of chiropractic, for example.

It is a good, evidence-based practice that removes toxins and stimulates health: True or False?

True and False in different parts. This one’s on us; we included four claims in one short line. But let’s look at them individually:

• Is it good? Well, those who like it, like it. It legitimately has some mild health benefits, and its potential for harm is quite small. We’d call this a modest good, but good nonetheless.
• Is it evidence-based? Somewhat, albeit weakly; there are some papers supporting its modest health claims, although the research is mostly only published in journals of alternative medicine, and any we found were in journals that have been described by scientists as pseudoscientific.
• Does it remove toxins? Not directly, at least. There is also a version that involves making a small hole in the skin before applying the cup, the better to draw out the toxins (called “wet cupping”). This might seem a little medieval, but this is because it is from early medieval times (wet cupping’s first recorded use being in the early 7th century). However, the body’s response to being poked, pierced, sucked, etc is to produce antibodies, and they will do their best to remove toxins. So, indirectly, there’s an argument.
• Does it stimulate health? Yes! We’ll come to that shortly. But first…

It is pseudoscience and/or placebo at best, but probably not harmful: True or False?

True in that its traditionally-proposed mechanism of action is a pseudoscience and placebo almost certainly plays a strong part, and also in that it’s generally not harmful.

On it being a pseudoscience: we’ve talked about this before, but it bears repeating; just because something’s proposed mechanism of action is pseudoscience, doesn’t necessarily mean it doesn’t work by some other mechanism of action. If you tell a small child that “eating the rainbow” will improve their health, and they believe this is some sort of magical rainbow power imbuing them with health, then the mechanism of action that they believe in is a pseudoscience, but eating a variety of colorful fruit and vegetables will still be healthy.

In the case of cupping, its proposed mechanism of action has to do withbalancing qi, yin and yang, etc (for which scientific evidence does not exist), in combination with acupuncture lore (for which some limited weak scientific evidence exists). On balancing qi, yin and yang etc, this is a lot like Europe’s historically popular humorism, which was based on the idea of balancing the four humors (blood, yellow bile, black bile, phlegm). Needless to say, humorism was not only a pseudoscience, but also eventually actively disproved with the advent of germ theory and modern medicine. Cupping therapy is not more scientifically based than humorism.

On the placebo side of things, there probably is a little more to it than that; much like with acupuncture, a lot of it may be a combination of placebo and using counter-irritation, a nerve-tricking method to use pain to reduce pain (much like pressing with one’s nail next to an insect bite).

Here’s one of the few studies we found that’s in what looks, at a glance, to be a reputable journal:

Cupping therapy and chronic back pain: systematic review and meta-analysis

It may help by improving circulation and stimulating the immune system: True or False?

True! It will improve local circulation by forcing blood into the area, and stimulate the immune system by giving it a perceived threat to fight.

Again, this can be achieved by many other means; acupuncture (or just “dry needling”, which is similar but without the traditional lore), a cold shower, and/or exercise (and for that matter, sex—which combines exercise, physiological arousal, and usually also foreign bodies to respond to) are all options that can improve circulation and stimulate the immune system.

You can read more about using some of these sorts of tricks for improving health in very well-evidenced, robustly scientific ways here:

The Stress Prescription (Against Aging!)

Take care!

What’s The Real Deal With The Paleo Diet?

The Paleo diet is popular, and has some compelling arguments for it.

Detractors, meanwhile, have derided Paleo’s inclusion of modern innovations, and have also claimed it’s bad for the heart.

But where does the science stand?

First: what is it?

The Paleo diet looks to recreate the diet of the Paleolithic era—in terms of nutrients, anyway. So for example, you’re perfectly welcome to use modern cooking techniques and enjoy foods that aren’t from your immediate locale. Just, not foods that weren’t a thing yet. To give a general idea:

Paleo includes:

• Meat and animal fats
• Eggs
• Fruits and vegetables
• Nuts and seeds
• Herbs and spices

Paleo excludes:

• Processed foods
• Dairy products
• Refined sugar
• Grains of any kind
• Legumes, including any beans or peas

Enjoyers of the Mediterranean Diet or the DASH heart-healthy diet, or those with a keen interest in nutritional science in general, may notice they went off a bit with those last couple of items at the end there, by excluding things that scientific consensus holds should be making up a substantial portion of our daily diet.

But let’s break it down…

First thing: is it accurate?

Well, aside from the modern cooking techniques, the global market of goods, and the fact it does include food that didn’t exist yet (most fruits and vegetables in their modern form are the result of agricultural engineering a mere few thousand years ago, especially in the Americas)…

…no, no it isn’t. Best current scientific consensus is that in the Paleolithic we ate mostly plants, with about 3% of our diet coming from animal-based foods. Much like most modern apes.

Ok, so it’s not historically accurate. No biggie, we’re pragmatists. Is it healthy, though?

Well, health involves a lot of factors, so that depends on what you have in mind. But for example, it can be good for weight loss, almost certainly because of cutting out refined sugar and, by virtue of cutting out all grains, that means having cut out refined flour products, too:

Diet Review: Paleo Diet for Weight Loss

Measured head-to-head with the Mediterranean diet for all-cause mortality and specific mortality, it performed better than the control (Standard American Diet, or “SAD”), probably for the same reasons we just mentioned. However, it was outperformed by the Mediterranean Diet:

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults

So in lay terms: the Paleo is definitely better than just eating lots of refined foods and sugar and stuff, but it’s still not as good as the Mediterranean Diet.

What about some of the health risk claims? Are they true or false?

A common knee-jerk criticism of the paleo-diet is that it’s heart-unhealthy. So much red meat, saturated fat, and no grains and legumes.

The science agrees.

For example, a recent study on long-term adherence to the Paleo diet concluded:

❝Results indicate long-term adherence is associated with different gut microbiota and increased serum trimethylamine-N-oxide (TMAO), a gut-derived metabolite associated with cardiovascular disease. A variety of fiber components, including whole grain sources may be required to maintain gut and cardiovascular health.❞

~ Genoni et al, 2020

Bottom line:

The Paleo Diet is an interesting concept, and certainly can be good for short-term weight loss. In the long-term, however (and: especially for our heart health) we need less meat and more grains and legumes.