Your Questions Answered!

by birtanpublished on August 17, 2020

We're gonna be answering your questions it's a very special episode and that's the topic of this week's healthcare triage we're joined today by dr. Tiffany Doherty who is a PhD in neuroscience and joined the healthcare triage team last July she's been helping to write

Episodes produce episodes do all kinds of stuff Tiffany welcome she's also gonna be reading your questions that's her job yet yes okay nice to meet you up alright so first of

All a lot of people ask this mr. big noodle has asked it a couple times okay so we have learned a lot about the dangers of smoking from observational trials so why is it that especially here at healthcare triage we're always saying

That you cannot do the same with nutrition and disease okay well first of all with some things it would be unethical to to do a randomized control trial smoking is probably one but it's important to know that a lot of this is

Because some of the other things we've talked about the absolute value of the risk on top of the you know relative risk and even here the relative risk a lot of times when we're talking about something in an episode we're saying

Well does this really matter the relative risk is like one point one meaning that the overall risk increase is maybe 10 percent in a relative way so what's a relative risk if there's no risk at all it'll be one so be the same

Serve what is the same difference is that for smoking for some things it's like smoking you know pack a day or whatever has a relative risk of like a hundred and fifty not one point two but like your risk goes up by like 15 what

Is that fifteen thousand percent I don't know but it's a hundred and fifty times what it was not 1.2 times what it was it's so massive that we can't possibly ignore it it's just so big and so then the absolute risks are like so much

Larger than even in an observational trial we're so concerned because this thing is so massively large that we're like this is this really looks like it's real like if they can't even it no matter how much controlling you do for

Other things it's a massive huge super important respect so what are some examples the ethical problems we could have well when you have a risk that that that that's that's that large it becomes then

Problematic to say that we're going to randomize people to then check to see if it's true just because we want to be sure and it's also the fact that like smoking is incredibly addictive so if we randomize people to smoke for the

Purposes of a trial they may not be able to stop and it's not like eating well you know I guess we didn't make something but this is clearly SuperDuper addictive and it would not be right to start people on it with the idea that

They could you stop later and then what about ethical issues in like the nutrition why can't I take a group and say I could make them eat steak every day all day so you can't make them what you can do is try to ask them to and

What happens even in trials we ask people do they don't stick to the diet yeah and so it's very hard to get people to say we're only gonna eat meat for three years where you've got only vegetables for three years and then make

Sure that they do the one way that we can do that and unfortunately has been done is some of these studies have been conducted and institutionalized individuals where people don't get to control what they eat but then that's

Also and how ethical is that especially if you know if they're prisoners it's unethical in the sense that like is it really right that we use prisoners of researchers because we can but oftentimes they do it on

Institutionalized individuals who are either sick or have issues that make them unable to properly consent and that's unethical for all whole bunch of other reasons someone asked why do we discuss results from observational

Trials in episodes like sleeping but then we really kind of demonize them so much in the nutrition studies here so again it's important to think about the the relative risks and the absentee or the absolute risks and then also to talk

About you know how much of a change we ask people to make and what benefit are they gonna get versus what are the harms so with respect to diet the problem is that we've conducted massive huge studies over and over and over again we

Have a pretty good sense of what the absolute risks are and they're very small and yet people come out with pronouncements and say everyone must do this for health that's overreaching on the other hand

It's probably fine to say well looks like people who sleep more ten to do better for this with that reason you might want to think about sleeping more we don't pass guidelines saying change the world so that everybody gets

Eight hours sleep we say you might want to consider this personal change and if the benefits turn out to be good for you great and if they don't untold early fine with that I'd be fine if that's how the nutrition recommendations went out

To but they don't they come out with these massive like huge must do this versus well maybe with this I would also say that the sleep studies of some of the observational stuff they're small and we're still in the realm of like

We're not sure let's go follow this up perhaps with some RCTs or by doing better but bigger and better studies and we've been seeing a lot of that with respect to change in school start times for reason and we're following up that

With better and better quality studies to try and get at what does this actually do when we do that a lot of times with food it it goes against what we think we're going to see with the observational data so far with sleep and

The sleep times the stuff we're getting a better and better and high quality studies backs up what we're seeing in the observational data and so one more inclined to believe it okay sounds great okay so vitamin D I know you really love

Vitamin D yeah so someone actually a few people want to know if vitamin D supplements don't work why does my doctor prescribed them and then someone else I want also wanted to know don't you need it if you never see

The Sun so the first question was their wider look flyer doctors to pilot ask him I'd ask your doctor why he or she is still prescribing because I don't know now part of it is like let's be honest doctors are people too and lots of

People believe that vitamin D works and you know this is a hugely contested thing even in the medical world you're getting my read of the literature which I will argue and back up and should your doctor ever come and be sitting next to

Me I'd have this debate I think I'd win it because the evidence behind it is pretty clear that for the vast majority of reasons people are using vitamin D the evidence just isn't there to support it having said that if there's a reason

And your physician can explain it to you and maybe it's just a belief and you worship find like though the risks are often low I'm not here to yuk anyone's Yong if they if they truly want to do it but I would push and ask because I don't

Think the evidence is really there okay the second question was about never seeing the Sun yes yeah yes if you never see the Sun then there could be an argument but even in those cases it's not necessarily clear that you know

Still the taking vitamin supplementation is the cure our going to fix that problem in the way that we would like it to because we randomized we do our C T's of supplementing people with vitamins and even in places where different

Climates and different amounts of Sun which is not seeing big differences if any and the people to get supplemented Jamaica's think that it's such a good idea okay so try status on one of our youtube videos wants to know if you

Would recommend sports drinks for feverish symptoms or athletic performance whoa sports drinks for feet uh-huh I mean I'm trying to think like well I thought there was it so low if you're dehydrated you should hydrate and

Sports drinks fine they're just not proven to be really any better than lots of other stuff including water unless you're massively dehydrated I mean like clinically dehydrated even then I don't know but for fever symptoms I'm like

It's not gonna help with a fever it's not gonna help with chills or aches or anything else I mean it's not gonna do any bad it's just really about hydration and so I don't know just drink some water yeah for the most part usually

You're gonna be fine with water what is this oh yeah there's no evidence for that like I mean it's again it's like if you're so dehydrated that you're clinically dehydrated and we need to be

Rehydrate rehydrating you with some kind of like saline dish solution instead of just water you probably shouldn't be participating in academic I mean athletic activities anyway so no I don't really think there's really any real

Evidence that shows that it's it makes you a better athlete at all okay Scotty awesomesauce wants to know why he was told that he does not have celiac but that he should still avoid gluten he does feel a lot better avoiding gluten

His diarrhea went away he can focus so if gluten sensitivity doesn't exist then why has going gluten gluten free helped him I can't tell you look here look I can't tell you specifically like here's the

Thing we know that every time we treat anyone for anything and they get an effect some portion of that is placebo effect and some portion of that is an actual effect I don't even say biologic effects spasibo effect is biologic but

Some effect it is due to whatever it is the treatment is for some things it's massively placebo effect – maybe a tiny of this for some things it's a lot of this and maybe a little but there's always some like on almost every control

Group there are still people that get better like that's clearly placebo effect that's not because of anything else we did so why probably and this is where I hate these kinds of questions because again I'm Yuqing you're young if

You're getting a placebo effect I'm thrilled go I'm not asking you to change your diet with Scottie awesomesauce I'm really not if this makes you happy I'm thrilled the problem is when you proselytize and start telling other

People that they should do it there's no evidence for that and if they're not going to get the placebo effect you just sent them down a pathway where they might be getting harms including loss of joy and not any benefit so why probably

Placebo effect that's the truth now I can't be guarantee that 100% but again if you're happy I'm happy feel free to keep doing it okay Robert gooo free on Facebook has been looking around for reliable information on blue

Light filters and is curious what your thoughts are on the literature on evidence that blue light from screens is damaging to a person's eyes does it affect sleep and then using any kind of adjustments so like changing the blue

Light with filters or glasses is that helpful so there are some studies that will show a benefit there are even some systematic reviews that gather studies together more argue that there is a benefit but they all have caveat sand

The fence in the sense the cities are not terribly high quality or large or with long-term outcomes or anything else so this is another thing where I'm like go ahead the cost is minimal probably doesn't have much in the way arms and if

You feel like it's making a good difference in your life that's fine but again I would not I would caution that we shouldn't start telling other people to do this because the evidence to back it up is pretty slim and again

You can find us study it's just not enough to say like this is how we should actually tell people to behave okay okay Jeff W says there's a growing movement at the healthcare facility I work in to stop wearing neckties the thought is

That they can spread germs and disease as they are never cleaned our neckties spreading contagion or are people just looking for an excuse to dress casual no no I think that there's a there's a really valid concern there it's the same

Reason that white coats are not such a good idea and people argue about that all the time neckties are just another wear place to collect stuff in between we probably don't wash them enough and so they can no I think this is a totally

Valid point having said that it's very hard to break societal norms and if you're asking like why I'm wearing a tie it's because I'm not I'm not seeing patients most days of the week and my office or work environment has not been

As enlightened as this and probably still thinks that this is the way the professionals dress but that's the societal construct and it was not designed for health reasons Alison McWatters was asking us on

Facebook she was looking at a book on audible and her BS alarm bells are going off I really love vs Lauren all the time she was wondering what your thoughts are then on this book you have actually written about this in your book it's

Called grain brain oh yeah the surprising truth about wheat carbs and sugar your brains silent killers so before you answer just in case anyone doesn't know about this book I just want to read the Amazon

Description okay so a renowned neurologist exposes a finding that's been buried in the medical literature carbs are destroying your brain even so-called healthy carbs like whole grains and whole plant food searches can

Cause dementia ADHD epilepsy anxiety chronic headaches depression decreased libido and more also statin drugs might be erasing your memory oh well that wasn't so look the big issue as soon as they say cause like

They're not doing randomized control trials in human beings as if anything so these things are happening look we've covered so many episodes and if anyone who's read my book yeah I'm gonna disagree with that I don't think

That I don't think anyone's been bearing the evidence and I don't think that it's shown in any way that carbs are destroying your brain again carbs are necessary for life I mean glucose isn't necessary to live and every other animal

Model exists where they do consume you know some kind of sugars now granted they're not all eating refined carbohydrates and making bread we do that but we've been doing that for a long time without any major decrease or

Terrible outcome in fact all of those things that you described are almost the it's the best it's ever been in terms of our ability to treat those things and keep people from getting them for a long period of time so trying to argue that

Somehow you know our ability to eat bread has been horrific ly bad for the human race and resulted in terrible death and illness it's the evidence just is not there okay so I think we should give our kudos to

Alison for those excellent Buse yes I was yes I'm not endorsing I'm not endorsed okay okay this next person wrote in with our with our viewer question doc that we had up a while ago and they under their name said I will

Keep this anonymous so they might feel a little embarrassed oh I know okay good no no it seems like they think their question is silly okay they actually said this is probably a silly question but I have nowhere else

To ask fine it's what we're here for does the amount of cow's milk you drink as a kid influence how much breast milk you can give to your baby I'm trying to even think what the mechanics of this are so

How much so much cow's milk there woman drinks I believe how much milk yes no no that's a chop ro no not not even as an adult no no I know of no link at all okay none okay so Troy on Facebook wants to know

If it's better to cook vegetables or eat them raw and if that is the case for only some vegetables which one um how do you like them that's really probably the only thing still get the same nutrients yes again

What's like you probably could do some study which can show some statistically significant difference one way or the other but I swear to God if you're eating vegetables we should only be thrilled not be concerned about how

You're preparing them that's the wind more vegetables good I don't I'm not gonna argue that one way of preparing vegetables is bad you're doing it wrong if you're not doing it that way there are raw vegetables I enjoy cooked

Vegetables I enjoy target but raw vegetables are not cooked vegetables are sometimes better because they've been prepared with seasoning that makes them taste good that's what makes stuff taste good and so you know don't force people

To eat raw vegetables so they don't like the taste and they're more likely cooked vegetables I'd rather than me vegetables what if I bred and deep that fry my broccoli that's you're now making it slightly less good than before but still

Roughly I suppose I mean I'd rather you you didn't try to make it worse but I'm trying to think like what a what a good analogy of this is like I I wouldn't turn down deep five you know vegetables if they were delicious but it's probably

Not the way you want to eat them every day okay knocking from Israel wants to know is wearing facemasks in public places such as trains something that results in better health outcomes well okay first of all it

Depends what you mean by better health better health outcomes but it also depends why how you're wearing the mask a lot of people wear the mask in certain cultures because they know they could be sneezing or making other people sick I

Think in that case yes cuz like if you're containing the droplets or anything else you might spray all over the place that's being very polite like sure if however you think you're going to prevent yourself from catching

Something that's not as likely now it might be as likely if it prevents you from touching your face but you're probably touching the mask and then making the mask infected and then you're now keeping it right in front of

Yourself so no no about that so you know in a sense of preventing yourself from getting ill probably not a lot of evidence preventing others from getting ill yes doctors wear masks when they operate not

To protect themselves well sometimes you got you could argue from blood but for the most part it's to keep them from infecting the sterile environment that's why doctors are wearing masks to prevent them from

Transmitting not as much to prevent the other direction a little bit but not as much same thing out in the world if you're putting on a mask because you're sick and you don't want to get other sick good on you if you're putting it on

Because you're panicked that other people are gonna get you sick not really no but in fact that's the biggest issues I think I mean there's a run on like these masks at the moment yeah because everyone's worried about

Coronavirus very few people are thinking I have coronavirus and I want to make sure I don't transmit it they're all panicked I could get Corona fires and if I wear this mask it's gonna protect me as I wrote that's and we've talked about

Before not a lot of evidence for that okay all right we probably probably should stop although I see there's a lot more questions there keep them coming we'll do this again in the future thanks for watching hatred during this episode

You might enjoy a previous episode where John and I answer your questions that you sent yes while we've got you also consider liking and subscribing down below going to care triage where you like our research

Associate Josef it's an hour surgeon Admiral Sam and I'll make the show bigger and better you

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