Recommendations about the relationship between which foods (and supplements) and good or bad health seem to change every so often, confusing not only lay people but also doctors.

There seems no end to this problem – in fact, scientific controversies continue to rage about dietary advice and are being further exacerbated by nutritional therapists and so-called personal trainers, most of whom have little or no biochemical or medical scientific background.

These confusing pronouncements in both the scientific and popular media must be undermining confidence in medical science itself.

Could there be, in fact, something wrong with medical science? Interestingly, Randy Schekman, a 2013 Nobel prize-winner for physiology, has recently openly criticised the way scientific journals are run and announced that his laboratory at Berkeley (University of California) will boycott what he describes as “luxury journals” – meaning those regarded as the most prestigious, such as Cell, Nature and Science.

Schekman claims such journals artificially restrict the number of accepted papers, which is more conducive to selling subscriptions than publishing the best research. He also argues that science is being distorted by the tyranny of the “impact factor” – researchers whose work is published in high-impact journals can expect promotion, pay rises and professional accolades. Those who do not can expect obscurity or even the sack, a sort of Darwinian system known as ‘publish or perish’.

Many admit to worry that the pressure to publish flashy research in glitzy journals encourages hype, and rewards being first rather than being thorough. Most scientists would be reluctant to speak up, fearing rocking the boat and damaging their careers, but one of the perks of being a Nobel laureate is that you no longer have to worry about such things.

In 2005, John Ioannidis, an epidemiologist who was then at Ioannina University in Greece, claimed that most published research findings are false and exposed the ways they are rendered irreproducible, that is, wrong.

He claimed that over-interpretation of statistical significance in studies with small sample sizes is the main reason for irreproducible, wrong scientific conclusions.

Ioannidis has in the meantime moved to the US and is launching, with colleagues, the Meta-Research Innovation Centre (known as METRICS) at Stanford. They plan to create a “journal watch” to monitor scientific publishers’ work to “identify and minimise persistent threats to medical research quality”.

Scientific controversies continue to rage about dietary advice and are being further exacerbated by nutritional therapists and so-called personal trainers

Irreproducibility is one such threat. METRICS will make recommendations about how future work might be improved – for the study of reproducibility should, like any branch of science, be based on evidence of what works and what doesn’t.

METRICS will also look into wasted effort. It has been claimed that around 85 per cent of the world’s medical research spending is squandered on studies that are flawed in design, redundant, never published or poorly reported.

Ioannidis’s pet offender is publication bias. Not all studies get published – the ones that do tend to be those that have significant results, leaving a skewed impression of the evidence, when negative findings are not published.

How does all this medical research quality debate affect nutritional science which, as we increasingly realise, has important implications for our understanding of diet and lifestyle’s ability to ‘switch on or off’ both good and bad genes?

This is the relatively new science of epigenetics, which is providing scientific answers as to how modifications in diet and lifestyle can bring about health improvement or deterioration.

There are now claims that decades-long nutritional medicine beliefs may be incorrect, having been based on poorly conducted clinical studies. Some of the topics to be addressed in future will be:

Has the epidemic of obesity, metabolic syndrome and diabetes type 2 been caused by a combination of adulterated vegetable oils and the high-grains and carbohydrate/low-fat diet advice?

Metabolic syndrome is characterised by bulging tummy, high triglycerides in the blood cholesterol profile, fatty liver, high blood pressure and risk of diabetes type 2 and cardiovascular disease.

This common syndrome may also lead to liver cirrhosis and may now actually be a commoner cause of cirrhosis than alcohol abuse.

Can diabetes type 2 be reversed by nutritional and lifestyle modifications alone? Probably yes – there are clinics overseas devoted to the nutritional management and reversal of diabetes.

Are omega-6 fatty acids healthier than fish-derived omega-3? Are omega-6 fatty acids the anti-inflammatory ones, rather than fish-derived omega-3? This is now a hotly-contested controversial subject, particularly in the US.

Have fish-derived omega-3 fatty acids any cardiovascular benefits, and has an excess intake of fish oil products any possible long-term harmful effects? This is another controversial fish oil debate.

Are the previously demonised saturated dietary fat and blood LDL (“bad”)-cholesterol related causally to arterial narrowings and their complications (heart attack, stroke, renal failure, gangrenous leg amputation), or have we been taken for a ride by bad science?

Can omega-6 fatty acids improve arterial wall compliance and reverse arterial narrowings, something aspirin and statins alone appear unable to do?

Do omega-6 fatty acids increase oxygen-binding capacity of cell and mitochondrial membranes? Is chronic relative cellular hypoxia an important risk factor for cancer initiation and promotion and do omega-6 fatty acids decrease this risk?

Prof. Cilia-Vincenti is a pathologist, a scientific delegate to the European Medicines Agency (London), chairman of the Academy of Nutritional Medicine (London) and a former teacher at London and Malta universities.

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