[Examine Newsletter] June 2024 Updates

See what’s new at Examine over the past month!  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ [Examine]( [View in browser](=) Hello {NAME}! Here’s your recap of Examine’s June 2024 updates. --------------------------------------------------------------- 📅 Top 5 Study Summaries for June June 6, 2024 Every month, we summarize 150+ recent studies for our [Examine+ Members](. You can read five of last month’s most favorited Study Summaries for free by clicking the links below. The Study Summaries marked with are Editor’s Picks, which provide more details about the study, mention related studies, and include helpful graphics. Want more evidence-based nutrition information? We post interesting tidbits on social media every day. Find us at our verified accounts on: - [Instagram](=) - [LinkedIn]( - [WhatsApp]() - [Facebook]() - [Threads]() [High-dose creatine preserves cognitive function during sleep deprivation](=) In this randomized controlled trial, a single high dose of creatine improved cognitive performance and brain energy availability during sleep deprivation. [High-carb/low-fat diets vs. low-carb/high-fat diets for muscle gain](=) In this randomized controlled trial in resistance-trained men, a high-carbohydrate/low-fat diet was better than a low-carbohydrate/high-fat diet for increasing strength and muscle mass. However, the low-carbohydrate/high-fat diet enabled a greater energy deficit and loss of body fat. [Does eating at night increase mortality risk?]( In this prospective cohort study, eating during the night was generally associated with an increased risk of all-cause mortality, especially among the participants who consumed the most calories at night. [Sitting less and standing more to improve blood pressure]( In this 6-month randomized controlled trial in older adults, reducing sitting time by approximately 30 minutes per day reduced systolic blood pressure by 3.5 mmHg. [Creatine improves physical function and body composition in older adults](=) In this meta-analysis of randomized controlled trials, creatine with or without exercise improved some measures of muscle strength and lean body mass in older adults, but combining creatine and exercise was generally more effective. You can also check out the [most-favorited summaries from previous months]().🔥 --------------------------------------------------------------- So, did you find something of interest? If not, please reply to this email to let me know which topics you’d like us to tackle. And if you’re ready to stay on top of the latest research, you can [try out Examine+ for free for 7 days](. --------------------------------------------------------------- Recap of Examine’s team retreat June 13, 2024 Our annual Examine team retreat was a couple weeks ago in Toronto. We now have over 40 people on the team, nearly double the number we had two years ago. About 20 team members were able to come to the retreat. Here’s where we all live, by the way: Despite the nearly doubled team size, everybody somehow still likes each other. Or at least they’re really good at pretending. Examine remains chock full of quirky, kind individuals. Pictured below are some of these people: (Photo credit: Nick Milazzo, team lead in charge of page updates) Here’s a small selection of what we talked about at the retreat: Brands: Our policy has always been to avoid brand names and focus on ingredients studied in randomized, controlled human trials. Other companies run lab analyses of branded supplements to assess label accuracy and contaminants, which we have neither the money, expertise, or need to do (since other people do it as their main focus). But we can maintain our focus and objectivity while still mentioning a small number of branded supplements that we’re asked about the most. We just need to finalize talks with our attorney to make sure we don’t get sued by angry supplement companies, and then we can get this ball rolling. We take reader feedback seriously, which is why we’re working toward answering these brand-specific questions. If we’re able to make enough revenue over the coming months, we may also consider a top secret brand-related project. This project does not involve making our own supplement. It’s in our founding charter that we’ll never ever sell supplements, even though we’d make waaaaaaay more money that way than we do analyzing evidence. That hasn’t stopped our very clever team from tricking a few of our readers when we pretend to sell supplements on April Fool’s Day (with novel formulations such as [Re-Brain™](, [Adamantium Bone Broth™](, and [ZombioticPro+]()). We can never be sure whether we’re being too obvious or not obvious enough in these posts, but just remember that we cannot and will not ever actually sell supplements! Finding information on Examine: For a website so rich with useful data, it’s not easy enough to find what you’re looking for. Here are some of our solutions, from most to least exciting: First, our tech team is developing an AI chatbot that’s trained only on Examine’s own information, so it’ll be unsullied by inaccurate information that can leak into other AI chatbots on the web. This should make it much easier to get answers without clicking around the site. This will not affect our published work, because we will never use generative AI to write about or analyze studies — there’s just no replacing a human brain when it comes to health. But a chatbot will help our readers find exactly what they’re looking for in the Examine knowledge database and archives. If you'd like to help us beta test this chatbot in the future, just [click here](). Second, we’ll make some changes to our menu system and top-of-page area to make it easier to find what you’re looking for. Our entire goal for the next few months is to polish up our UX/UI, and allow you to personalize your experience so you can get the information you need quickly! Third, we’ve been working on a frontend rewrite that is coming out very soon. Visually, nothing will change, but the entire website will feel much snappier and load much faster! Lastly, we’re going to make it easier for new users of Examine to dive into the website without getting overwhelmed by information that doesn’t apply to them. New products: We don’t release a lot of new products, even though new products are a great way to bring in more money, which means a bigger team that can better serve our readers. Actually, we don’t really release any new products because we rolled everything up into the [Examine+ membership]( a few years ago. Everything we offer is in there. But there are two products we’re figuring out that are aimed at different types of readers, and which don’t fit into our existing model. First, a product for health professionals that’s specifically designed to help them help their patients or clients. Second, an Examine certification that teaches you about evidence in quite a unique way. Tons of details are left to figure out for these two products, but we have the scaffolding set up and are working on filling everything else in! --------------------------------------------------------------- Thanks for reading this far. In case you couldn’t tell, Examine tries to be transparent not only about the evidence we cover, but also how business is going and what’s coming down the pike. I’m thankful that some readers find us useful enough to also be interested in these things. As a reward, I’ll leave you with a picture of Helo, my co-founder Sol’s senior (15-year old) dog who joined us for some of the retreat, and who has one of the sweetest dispositions of any pup around. As you can see, he was clearly enthralled by the discussion. (Photo credit: Nick Milazzo) Until next time! P.S. Did you know that you could use a [Health Savings Account (HSA)]( or [Flexible Spending Account (FSA)]( to cover the costs associated with Examine? [Yes]( [No]() --------------------------------------------------------------- Weaponizing "the science" to gain followers June 20, 2024 Have you ever seen posts like these on social media? - Follow the science: organic is no different than conventional produce - The science is clear: artificial sweeteners are safe Ignoring the topics themselves for a moment, I very much dislike the way “science” is used in these kinds of posts, and find it harmful to open discourse. There are two main reasons why: 1. Science is iterative and complex, not a blunt weapon to be wielded Science includes two related components: - The existing body of knowledge about how the world works - Cultivating new and more accurate knowledge by hypothesizing, experimenting, and iterating Science isn’t about running across a review paper, skimming the abstract, then raising it up like baby Simba and declaring yourself the Science King. That’s social media. Science is the part before all that. Science can be contentious, even among scientist colleagues, and the unknowns are too numerous to wield “the science” as a singular weapon. To further elaborate on this point, let’s quickly touch on the above topics: While organic produce isn’t vastly different from conventional produce in terms of nutrient content, many organically farmed plant foods have at least a bit higher levels of certain minerals and antioxidants (such as [organic garlic and onions]()). But nutrient differences are small potatoes ([pun intended]()) in the grand scheme of things. Rather, the burning questions are: “At typical human intake levels, which residual synthetic pesticides and fertilizers used with conventional produce might be substantially more harmful than their counterpart naturally-derived pesticides and fertilizers used with organic produce? And which naturally-derived ones might be more dangerous than their synthetic counterparts?” The answer to this question informs whether the huge price premium on organic produce is worth it. Unfortunately, I’m not knowledgeable enough to answer with any confidence and granularity, and without devoting much, much more research time. [All of Examine’s revenue comes from our [Examine+ membership](. The more funding we have, the more we can do and the more we can dig into questions like “Is the huge premium on organic produce worth it?” If you like what you read every week, we have a 60-day money-back guarantee and a 7-day free trial, so there’s no risk to trying us out.] Artificial sweeteners aren’t one monolithic category, and different ones act differently in the body. Artificial sweetener risk is also difficult to assess precisely, partly because you can’t easily do long-term randomized trials in humans, so various lines of animal research weigh more heavily. Here are a couple snippets from previous emails I’ve sent: [This mouse study]() released after the WHO reports came out showed heritable learning and memory deficits from relatively low aspartame intake. It’s obviously in mice rather than humans, so it shouldn’t be weighed too heavily, but preclinical evidence is still important to incorporate into an overall evidence base on safety. Very limited human trial evidence does suggest that aspartame may have [mood-depressing]() or [headache-inducing](=) effects in some subsets of people, even at doses below the maximum recommended by the WHO and FDA, but these trials need to be replicated in larger samples, given that the evidence on those outcomes is mixed. So while artificial sweeteners are far from categorically unhealthy and can be a useful option (especially for [weight loss](), at low-to-moderate doses and not using the same sweetener every single day during your entire adulthood in order to minimize cumulative exposure), there are open research questions about safety that are actively being researched. Science isn’t static, so social media posts implying that the poster is a “defender of the science” often rub me the wrong way. 2. Speaking of “the science”, we know much less than we think I’m 44 years old, and this is my 20th year of being formally in the nutrition science space. When I was 24, I worked with a professor at the Johns Hopkins School of Public Health to help compile findings of the [100 most important](=) randomized public health trials of all time, including a variety of nutrition ones. The trial-centric world was compelling to me. Well-conducted trials saved millions of lives. Trials and meta-analyses also seemed to show which diets and foods were healthiest, making my job as a nutrition student easier. And then, between the ages of 24 and 44, I became much more skeptical about the trial-centric world. Or at least how trials and reviews were commonly utilized. You see, Examine does secondary research: We don’t directly do experiments or care for patients, and because of that, I keep my ear keenly to the ground to get some sense of what we’re missing. Reviews and meta-analyses are amazing for certain purposes: tiering what generally “works” and “doesn’t work”, getting a lay of the land as a clinician or policy maker, figuring out how findings change over time, assessing potential publication bias, etc., etc. But showing reviews at the top of a pyramid, implying evidential superiority, is in my opinion misleading. Important details are easy to miss when individual participant data is synthesized into a trial that reports averages, and even more granularity is lost when that study is included in a meta-analysis with a bunch of other studies. Example #1: A famous low-carb vs. low-fat study One issue with over-applying trial findings is that they’re designed to show averages, not individual results. A great example is a famous large [low-fat vs. low-carb study](=). Researchers wanted to shed light on which diet works better for weight loss. They found that ultimately, it doesn’t matter: both diets resulted in weight loss in roughly equal amounts. You might have seen similar statements on social media. But that’s on average. For some participants in the study, the diet mattered a lot. Check out Examine’s chart detailing the specific amount of weight lost by each participant: Pay especially close attention to the left side of the figure, where participants who lost the most weight are charted. The low-fat and low-carb diets really worked for several people! The correct conclusion from this paper may not be that low-fat or low-carb are equivalent for weight loss. It might actually be that efficacy is dependent on the individual: what works for one person may fail for another. The way to test that hypothesis would be to repeat this study but make it a two-year crossover study, where each participant gets both diets sequentially for a year each, to test for intra-individual variation in results. These trials are extremely expensive though, and adherence plummets as time goes on, so don’t hold your breath waiting for the twice-as-long sequel trial to come out! Example #2: Genetic variability Large trials and especially meta-analyses can lag behind clinician and patient observations by years or even decades. And while reviews are great for summarizing, they can’t fit in all the important details present in the full body of literature. For example, many years ago I noticed that sometimes local anesthetic injections didn’t work very well for me, and doctors sometimes didn’t believe that my pain could still be present. Later on, I was diagnosed with a genetic connective tissue disorder called Ehlers-Danlos Syndrome (EDS), and discovered that [up to 88% of EDS patients reported anesthetic resistance](). How many clinicians haven’t believed patients because their claim wasn't reflected in published research? Of course, the clinician’s job is extremely difficult, because pathophysiology and life science in general are so complex, and patients can also misreport. This is where having caring, open, and balanced bedside manner becomes critical. Example #3: Atypical food reactions Similarly, atypical food reactions are sometimes overlooked when a food has an air of healthfulness and shows positive results in trials and meta-analyses. For example, natto (the Japanese fermented bean that smells quite strongly) is frequently cited as one of the healthiest foods you can eat. Which it is, partly due to having uniquely high [vitamin K2]( levels and historically being a dietary staple of long-lived Japanese people. In 2021, a handful of [bacterial bloodstream infections]() were reported in Japanese people with gastrointestinal perforations, stemming from the bacteria that ferments natto. While this was a novel finding, it kind of made sense because the patients had perforations that made them susceptible. In 2024, [another natto bacteria infection]() was reported in a Japanese patient without gastrointestinal perforations who was not immunocompromised. Whaaaa?!? Natto can also cause gastrointestinal or other issues in people with [histamine sensitivity](), [FODMAP issues,]( or mast cell activation syndrome. My point isn’t to show that natto is dangerous, because by and large it isn’t, plus these people were eating natto pretty much every single day. Nor am I trying to scare you away from eating healthy foods based on rare case reports. Rather, I’m trying to show you that quick summaries declaring that something is healthy/unhealthy or safe/dangerous can be based on incomplete and highly summarized knowledge. For many people, it’s okay to use these summaries to guide decisions about health. But for many others, especially people with certain health conditions (gastrointestinal conditions, rare conditions, or multiple conditions) or atypical reactions to foods and medications, patient and clinician observations can be as or more important than the published literature. --------------------------------------------------------------- Examine still has a relatively small social media following. Part of the reason is that we don’t try to attract followers using declarative statements, and we don’t have any particular viewpoint on controversial issues — we present pros, cons, and nuances. We will continue not weaponizing “science” to gain followers. Instead, we’re going to meet our (future) readers where they are: more and more people are getting their health science information from social media and podcasts. Look for more (and more interesting) such content from Examine starting in the next month or two. And as always, if you liked or hated this type of long form email, just reply back and let me know! Using the scientific method, I can iterate and test reader feedback again and again with these emails. :) P.S. Our tech team rewrote the front end of the site, and while everything looks the same, Examine’s pages should load two to three times faster than before. If you see any issues, please let us know! --------------------------------------------------------------- Ask your local library to sign up for Examine+! June 27, 2024 I love, love, love public libraries. How I attained that love is a bit of a strange story. --------------------------------------------------------------- Before I start that story … do you want free, full access to [Examine+](=) through your public or school library? Let your librarian know about our [library access page](). Here are three way to do that: - Head to your local library’s website and tell them you love Examine and want library access, through their Contact Us page or “Suggest a Resource” link. - Visit your local library in person and let a librarian know. - Reply to this email and we’ll do the legwork if you send us your library’s contact page. They’ll be much more interested if the message comes directly from you though, so choose option #1 or #2 if possible! If you’re a librarian heading to the American Library Association conference in San Diego this weekend, drop by Examine’s booth and chat with us! We’re at #2825! --------------------------------------------------------------- I grew up with an immigrant single mom on a very tight budget, so there weren’t any kids’ books in the house. Then when I was 8 years old I found an ancient, discarded, age-inappropriate book in the place we just moved into: Memoirs of a Mangy Lover by Groucho Marx. Somehow, a neurotic vaudevillian launched my love for reading (parents: don’t use this strategy on your kids). From age 8–14 I spent countless hours at the Stark County Public Library in Canton, Ohio, unconstrained by conventional time sucks like playing video games or having friends. I became intimately familiar with Dewey and his decimal system. The texture and smell of old books comforted me, almost like I was buoyed by the spirit of those who read them before me (but not in an evil way like Tom Riddle’s diary in Harry Potter). And like for many Examine readers, learning through reading became intoxicating. --------------------------------------------------------------- That intoxication tends to morph over time. As people age, many spend more and more time reading to learn about practical concerns, and a little less for pure enjoyment. The most practical of all concerns is health. But wading through books at the public library isn’t a very efficient way to address health concerns. Popular nutrition books that line library shelves are often biased in favor of the author’s pre-existing viewpoint, and become out of date as the evidence evolves. Examine is the exact opposite of that: as objective and up to date as it gets. Imagine if you could log in to your library account and have free access to the [Examine+ membership](. Examine should be available to everybody! Currently, that’s only the case at around a dozen libraries in the U.S. We’re going to grow that number over time, but we need your help to do that. Libraries have grown and evolved with the times, and aren’t just for books anymore. They tend to be staffed by intellectually curious people who care more about the public good than about ways to extract maximum profit from society or become internet-famous. Wait a minute! That sounds a lot like Examine! So don’t be shy to contact your library and request that they get Examine. And if you work at a library, we especially want to hear from you. Lastly … if you have any formative library experiences to share, I’m all ears. 🙂 Libraries still hold a magical sway over me, and I love to hear library-related stories. If you’re like that, too, you might enjoy my favorite movie about a public library, [Party Girl](=). --------------------------------------------------------------- Sincerely, Kamal Patel and Morgan Pfiffner Follow us on: [LinkedIn]( [Instagram](=) [Facebook]( [YouTube]() [WhatsApp]() [About Examine]( | [Careers]() | [Member’s Area]() [Unlock Examine+]( PO Box 592, Station-P, Toronto, Ontario M5S 2T1 [Switch to weekly emails](=) | [Opt out of all emails](