Nutrition and Health: Dissecting The Complexity - Is nutrition science up to the task?
Siguel, E.N (2018), believes that current nutrition science is not up to the task, but not necessarily against the biomedical paradigm, but rather on methodological and technical aspects. He is of the view that a systems approach that engages biophysics would be the solution to overcome weaknesses of the current biomedical approaches to explore the nutrition, health and diseases relationships. Although he is aware of the need to accurately measure key nutritional variables.which is a notable weakness in the current nutrition research, his approach however does not resolve the standing problems in biomedical approaches in particular of limited knowledge and related measurement errors, including the pseudo-quantification of nutrients intake, issues of biochemical individuality and violations of some assumptions on which RCT are grounded.
Although not directly responding to the original article, the greatest argument against the current nutritional research as standing up to the task is provided by Flanagan, A and Baraki, A (2019), with a focus on Randomized Controlled Trials (RCTs) as the gold standard of biomedical research methods. RCTs are considered the gold standard trial design, because they offer the ability to randomly allocate a treatment, minimize potential sources of bias, and compare the exposure or intervention of interest to a placebo.
The RCT model is grounded on the presupposition that the method of investigation is fit for the purpose of investigating a certain treatment and there are there are three underlying assumptions that increase the internal validity and conclusions of the RCT model:
Violations of any of these assumptions means the finding are spurious or questionable. Just from a glance, it is apparent that RCT might be up to the task when dealing with prescription medication, but not so with nutrition exploration.
For example, with the independence of effects - that is, that the results have been caused solely by the intervention, without any interactions, this may be an impossible presupposition for nutrition to meet, an argument supported by the large failure rate of trials with antioxidants. There is no effect of any nutrient in an absolute sense, and it is more likely the cumulative and interactive effects of multiple constituents of diet coalesce to influence health and disease. Nutrition works through a variety of interactive biochemical pathways and therefore the assumption of independence of effects is almost always violated.
Another example to look at is that of assumption of a well-defined treatment and placebo. It is pretty much a monumental task to get a well-defined food pattern or food group interventions, equivalent to a treatment prescription drug and also practically impossible to get a food group or food pattern placebo.
As a basis for the need for a paradigm shift in nutrition science and research and the view that what we are made to believe about conventional nutrition facts today might not be valid , accurate or true, I agree with the conclusions by Flanagan, A and Baraki, A (2019), that: “The critical feature of the assumptions underscoring the RCT design is that if any are untrue, the conclusions of the trial are invalid. This, coupled with the aforementioned differences between the nature of drugs compared to foods, indicates that the biomedical RCT is not a panacea for nutrition research “.