“The Cure for Everything” by Timothy Caulfield [Book Review]

There is no shortage of junk diet and fitness books on the market that try to persuade you to follow their vision of perfect health. Tim Caulfield’s “The Cure for Everything: Untangling Twisted Messages about Health, Fitness, and Happiness” is not one of those books. In my search for books to recommend for science-based information on health, this will be among the top of my list. It is an easy read at about 200 pages but still packed with information.

Caulfield, a distinguished academic in the field of health policy combines a unique perspective from his expertise, his own reviewing of research, and that of many expert interviews. In addition, he subjects himself to diet, exercise, and alternative medicine, humorously interjecting stories about his personal challenges and trials between descriptions of what the research tells us. As Caulfield points out in the introduction, it is important to get a multi-disciplinary perspective on health, so as not to miss the forest for the trees. I strongly share this view, and enjoy reading outside nutritional science and find that it enhances my interpretation of nutrition issues. I also share Caulfield’s love for M&Ms, though crucially we differ on the type: I prefer peanut butter, not peanut!

Through the four themes of the book, fitness, diet, genetics, and remedies, Caulfield is able to assert authority when necessary (against alternative medicine, for example), but emphasize ambiguity when research is more inconclusive. It is a rare and refreshing combination in a book intended for the public; I feel that not enough scientists will speak out against health practices not supported by science. Caulfield also takes evidence-based looks at how industries (fitness, food, pharmaceutical) impact science and public perceptions of science. I will briefly review each section (but believe me that I cannot do them justice so buy it!).

Fitness

Though obvious that the fitness industry thrives on selling sex, it is always worth a reminder that exercise has many disease risk reduction benefits that should be prioritized. In this chapter there are several major topics: the fitness industry selling weight loss, the lack of evidence for exercising for weight loss, the lack of evidence for stretching, and the favorable evidence for high intensity interval training and resistance training. As a former long distance runner turned casual weight lifter, I was encouraged with Caulfield’s statement: “…if I was forced to pick one activity to place highest on the priority list, it would be intense resistance training.” It was also great to see the muscle-metabolism claim debunked, and the yoga industry put into context. Caulfield shows evidence on how the food industry has influenced the popular perception that exercise can work for weight loss.

Experts quoted in this chapter are Todd Miller, Mark Peterson, Gary O’Donovan, Wendy Rodgers, Nick WarehamSara Kirk, Tanya BerryStuart McGill, and (shockingly) a Hollywood trainer that apparently doesn’t use bogus methods, Gina Lombardi.

Diet

Of course the section I was looking forward to most, with little exception, does not disappoint. Caulfield looks at the sobering statistics of successful weight loss and the powerful social, psychological, and industry forces at work against efforts to lose weight. But he takes counsel from his colleagues and is able to make sufficient change to successfully lose weight- and the methods are backed by evidence and non-controversial (no need to put a label on your diet).

I do think there are some minor points that might deserve further discussion, but don’t detract from the major messages that are more important. First, the “food desert” hypothesis that is used to support the socioeconomic/obesity point was dealt a couple blows recently (after the book was published). I am a also bit uncomfortable in labeling fast food and junk food “poison”. In nutrition we often deal with health risks so tiny that it seems unlikely that small departures from “healthy” patterns will do much in the long run.

Caulfield writes of a 2010 study in the Journal of the American Dietary Association on the calorie content of reduced-calorie foods; I blogged on the follow-up to this pilot study (similar results).

Caulfield is not allowed to consume diet soda during his diet, which he writes of the research as “inconclusive, although some studies have shown that the consumption of diet soda is correlated with weight gain and health issues (e.g., diabetes). In the last several months (after the book was published), 2 studies that I blogged about that were improvements in study design over originals suggested for individual metabolic syndrome components and heart attacks the evidence does not suggest health risks (associations not there or inconsistent). Importantly, as authors consistently themselves stress in these papers, there are major methodological limitations especially in original papers showing purported risks, and there is not a strong plausible biological mechanism for why diet beverages would be causing these diseases. I am less than convinced of a risk of weight gain from artificial sweeteners- the evidence in my opinion is in favor of supporting weight loss, though much more research still remains; some good reviews here and here. Though perhaps as Caulfield suggests there could be a subtle “moral licensing” effect from drinking diet if you unconsciously give yourself a free pass to eat more calories because you have consumed a diet drink instead of a non-diet.

Caulfield makes a crucial point about governmental recommendations for moderation and the food industry’s responsibility for this message. I agree on this point that industry co-ops moderation- see an example I highlighted about the American Dietetic Association (Academy of Nutrition and Dietetics) and Hershey partnering with a “Moderation Nation” health campaign. Moderation doesn’t work as it is currently used. I admit to the dissonance in agreeing with this yet disagreeing with labeling some foods/products “poison.”

Caulfield also discusses conflicting data on snacking, which I found interesting, as I blogged an interesting paper suggesting this may be underlying a large amount of the increase in energy intake at the population level. This same paper argued suggested portion size was less of a factor, which Caulfield especially emphasizes (and the more intuitive factor). I am no expert here though so I won’t speculate which is more correct. I would have liked to have seen a discussion of meal frequency, which doesn’t seem to matter for weight.

Twice Caulfield asserts that sodium should be avoided (though this isn’t a main message). This is probably good advice, though I want to point out that the effect size of sodium reduction is under heavy debate, and it is difficult to meet guidelines. Because the majority of sodium in American diets comes from ‘processed’ food (~75%), limiting these per his other suggestions is probably sufficient from my perspective, though again that is just my non-expert opinion. The mention of the ‘bad’ nitrate from bacon may raise other discussion (though admittedly my blogging has been heavily one-sided in favor of nitrate’s interesting benefits).

For all of this nitpicking, I overwhelmingly agree with the section and think that following the advice would give a much better chance of actually losing weight than pop diet books.

In the end I am left wondering if Caulfield has been able to sustain his weight loss that he achieved for the book!

Experts quoted in this chapter include team FAT (Food Advisory Team): Linda McCargar, Rhonda Bell, Kim Raine; as well as Valerie Taylor, Geoff Ball, Walter Willett, Yoni Freedhoff (blog, twitter), Marion Nestle (blog, twitter), Diane Finegood (twitter), Marlene Schwartz, and Arya Sharma (blog, twitter).

Genetics

I, like Caulfield, have a 23andme account for reasons of curiosity, and have never expected it to yield results that change my behaviors. But Caulfield looks at the hype in the genomics field and how promises have not lived up to initial expectations.

Experts quoted in this chapter are Jonathan Kimmelman, Tom Hudson, David Goldstein, Colleen McBride, Theresa Marteau, Jim Evans, and Helen Wallace.

Remedies

In the final section, Caulfield takes a hammer to various scientifically disproven alternative medicine practices and explains why they still exist: they prey on human tendencies to cling to faith-based, filtered worldviews. Importantly, he also examines how conventional medicine is influenced by the pharmaceutical industry.

Caulfield writes: “If you see the word cleanse or detoxify used to market or explain a health product or diet, you can assume it is a scam.” Amen.

Experts quoted in this chapter are James Whorton, Edzard Ernst (twitter), Bruce Charlton, and Laura Weeks.

There are also a number of other people who are listed in the last section that Caulfield notes influenced the book but were not quoted.

Conclusion

I thoroughly enjoyed the content and style in this book and learned a lot of new information. Highly recommended!

Note: follow Caulfield on twitter.

Cat endorsed!