Why is nutrition so hard to study?

Although the water is muddy and difficult to traverse, there have been substantial victories in the field of nutrition research. For instance, scientists have determined that vitamin C prevents scurvy, that beriberi develops due to a thiamine deficiency, and that vitamin D deficiency causes rickets.

In all of these cases, there is a link between a particular compound and a specific condition. However, the picture is rarely so clear-cut. This is especially true when investigating conditions wherein multiple factors are at play, such as obesity, osteoporosis, diabetes, or heart disease.

Also, nutrition-related conditions have changed over time: The most common threats to health used to be deficiencies, whereas in Western countries today, overeating tends to be the primary concern.

Understanding the role of food in health and disease is essential and deserves attention. In this feature, we discuss some of the reasons that nutrition research seems to be so indecisive, difficult, and downright confusing.

In an ideal world, to understand the health impact of a given food — goji berries, for instance — an experiment would go something like this:

Scientists recruit 10,000 participants (both males and females, from a range of nationalities and ethnicities) and house them in a laboratory for 10 years. The scientists feed each person the exact same diet for the duration of their stay, with one difference: Half of the participants consume goji berries surreptitiously — perhaps blended into a mixed fruit smoothie.

Alcohol and tobacco are banned for the duration of the study.

The participants must also exercise for the same amount of time each day; if some people exercised more, they might become healthier, regardless of their goji berry intake. This would skew the data.

Neither the researchers nor the participants are aware of who is receiving the goji berry smoothie; if the participants knew they were receiving a “superfood,” they might benefit from the placebo effect. This so-called double-blinding is vital when running clinical trials.

During the decade-long study, the scientists monitor the participants’ health intensively. This might involve running regular blood tests and medical imaging.

Of course, the astronomical cost of this type of study is the very first stumbling block. Also, ethics and good sense say that this is beyond impossible.

In lieu of perfection

Nutritional research has to make some concessions, as the perfect study is unachievable. So, in “observational studies,” nutrition scientists look for links between what a person consumes and their current or future state of health.

Observational studies can be incredibly useful. Using this method, scientists proved that tobacco causes lung cancer and that exercise is good for us.

However, these studies are far from perfect.

One issue with observational studies is the researchers’ reliance on self-reported food intake. They ask participants to note down everything they eat for a set amount of time, or to remember what they ate in the past. This could refer to yesterday or months earlier.

However, human recall is far from perfect. Also, some people might purposely miss certain food items, such as their third candy bar of the day. In addition, participants do not always know the exact size of their portions, or the full list of ingredients in restaurant or take-out foods, for instance.

Studies often ask questions about the long-term impact of a nutritional component on health. However, researchers tend to take dietary information at just one or two points in time. In reality, people’s diets can change substantially over the course of a decade.

The issues associated with measuring nutrient intake are so ingrained that some authors have referred to self-reporting as a pseudoscience.

The Role of Industry:

These issues prompted a highly critical study, which appeared in the journal PLOS One, to pull apart data from the National Health and Nutrition Examination Survey (NHANES).

The NHANES, which began in the 1960s, “is a program of studies designed to assess the health and nutritional status of adults and children in the United States.” Experts use the findings to guide public health policy in the U.S.

The primary method of data collection for the NHANES are 24-hour dietary recall interviews. Researchers use this information to calculate energy intake.

The authors of the critical paper conclude that “the ability to estimate population trends in caloric intake and generate empirically supported public policy relevant to diet-health relationships from U.S. nutritional surveillance is extremely limited.”

In an opinion piece, lead author Edward Archer pulls no punches, explaining that their paper demonstrated “that about 40 years and many millions of dollars of U.S. nutritional surveillance data were fatally flawed. In […] nutrition epidemiology […], these results are commonplace.”

Here, we meet the double-edged sword of industry: The PLOS One paper declares that funding for the critical study “was provided by an unrestricted research grant from The Coca-Cola Company.”

Industry funding certainly does not invalidate the findings of studies, but it should prompt us to wonder what the funder might gain from such research. In this case, a company that produces sugary drinks might benefit from destabilizing people’s faith in the research that has deemed their products unhealthful.

Perhaps this example is a little unusual; more commonly, an industry with a vested interest will fund studies that demonstrate the benefits of a product.

As an example, the California Walnut Commission regularly fund research concluding that walnuts are good for us. Meanwhile, one study supported by the U.S. Highbush Blueberry Council proudly states in its abstract: