Novak Djokovic has just published his autobiography (entitled, somewhat predictably, Serve to Win) charting his rise from a injury-dogged, ache-plagued asthmatic to a level of fitness and endurance reached by few, even among the elite sporting community.
No, I have not yet read the book but I have read the review in the Wall Street Journal which suggests that the health regime to which he attributes his amazing physical turn-around consisted of far more than just his vastly over-hype and hugely controversial gluten-free diet. But, none the less, it has sparked the usual round of coeliac outrage (not helped by the climb-on-the-bandwagon title strap line and the publicity blurb which focuses yet again on the gluten-free diet to the exclusion of all other interventions).
Alex Gazzola and I have an excellent relationship and work closely together but there is one topic over which we always fall out – complementary/alternative medicine. Alex is a straight up and down Western medicine supporter, I lean far more towards energy medicines and the many alternative disciplines which are often called into play when Western medicine fails to solve the problem.
Alex was incensed by the publication of the Djokovic book and the massive hype once again projected around Djokovic’s gluten-free diet (to the exclusion of the other dietary measures that he has adopted). He therefore penned a vigorous ‘disgusted’ blog last week – Novak Djokovic: Wimbledon runner-up, gluten free, not a diagnosed coeliac – on which he got a number of equally ‘disgusted’ comments.
Having been away for the weekend, I have only just seen it – and in my turn I was so incensed by both Alex’s and his commenters’ comments, that I penned an equally ‘disgusted’ comment myself. However, so carried away did I get in my ‘disgust’ that I wrote more than Alex’s blog would accept! Hating to waste my spleen, I chopped it for his blog but am copying it in full below! (If you enjoy blog rants, then you should probably read Alex’s before you read mine…)
Oh dear…. I think a cold shower is needed here and then we need to start again….
Djokovic never claimed to be a coeliac or to have been diagnosed as such – I doubt that he even knows what a coeliac is.
That the coeliac community fell on his neck and claimed him as one of their own can scarcely be laid either at his door or at that of his nutritionist advisor, Dr Igor Cetojevic. Nor can the vast amount of unjustified hype that has resulted from his decision, however many months/years ago to cut gluten out of his diet.
I have not (yet anyhow) read his book but, if the WSJ article that Alex quotes is accurate, removing gluten from his diet was only one of a whole raft of dietary and lifestyle measures that Dr C. advised: drink lots of warm water and protein pea shakes, eat plenty of avocados and cashew nut butter but very little sugar. Banish caffeine, get plenty of sleep, drink licorice tea, eat Manuka honey…. And…. don’t eat gluten or dairy. Yet the only one of these measures which got picked up on was the gluten avoidance.
(Interestingly, he apparently says that his asthma improved dramatically on this new regime, which included dairy avoidance – and dairy is well known to be implicated in a number of allergic respiratory reactions. So it is perfectly possible that the improvement in his asthma was entirely dairy related and had nothing to do with his gluten avoidance.)
Djokovic suggests that everyone should remain open minded – not a trait that was obvious in either Alex’s blog or in the comments to date…
We could all wish that the arrival of Western ‘science-based’ medicine on the scene had been able to sort all our medical problems. And yes, it is amazing at patching together soldiers who have had their legs blown off by Afghan ‘explosive devices’ and has devised some miracle drugs, like the one that has got an acquaintance with MS from a point where he was not only bed bound by could scarcely speak to being a normally functioning human being holding down a job as a coroner. But there remain all too many other areas (from cancer to allergy) where it is failed fairly dramatically. Indeed, it can sometimes be argued to have killed almost as many as it has cured.
So, since Western ‘science based’ medicine does not provide all the answers it seems only common sense to consider some of the other approaches, many of which pre-date the arrival of Western medicine and are still in use in many parts of the world.
Kinesiology and what Alex describes as ‘some staggering tosh involving positive energy and water’ both fall under the heading of ‘energy medicine’ – a concept on which five thousand year’s worth of Chinese medicine is based, but which ‘science-based’ medicine enthusiasts find it very hard to get their heads around because, maybe, they can neither see it nor measure it.
Yet ‘energy’ is, in essence, electrical current. It is what allows the cells in our bodies, and the neurons in our brains to communicate with each other and keep us alive and functioning. This is not the ravings of some far out alternative crank but accepted science. I wonder why it is therefore, that the concept of ‘energy’ playing a larger role in the way that we function is apparently so hard to grasp.
No, we certainly do not understand how it works much of the time – and some people do come up with what, on the surface at least, do appear to be some pretty bizarre ideas (such as water turning green if you project negative emotions at it). But the fact that we do not understand it does not mean that it does not exist. Merely that we do not understand it.
Let’s face it, virtually every medical (and ‘scientific’) discovery that has ever been made has been dismissed as ‘staggering tosh’ by those who purported ‘to know’ when it was first made. Ask Galileo…..
But, to return to Djokovic…
Whether or not his new regime has actually improved his fitness and his ability to win tennis matches, he obviously believes that it has – which may be all that he, or any of the rest of us, need.
Meanwhile, Dr Cetojevic’s suggestions are no more than sound nutritional sense – drinking warm rather than ice cold water is well established as being gentler on the digestion, good hydration is essential if you are expending a lot of energy, avocados and cashew nuts are recognised as excellent sources of nutrition and plenty of sleep is essential to replenish energy sources – and not only many athletes but many of us could benefit by following a number of them.
So, I sincerely hope that the ATP (Association of Tennis Professionals) keeps well out of this. It has nothing to do with tennis – and, as it happens, nothing to do with coeliac disease.
I also hope that coeliac/gluten-free community goes and takes that cold shower, backs off and actually looks at the facts rather than the hype.
Its amazing how ignorance breeds furiously held opinions. It seems that the less people know the hotter under the collar they become. Its also interesting that the more people know the less dogmatic they usually are. I wonder why?
While being diagnosed coeliac myself, I, myself, bear no cross with Djokovic. It may be that he has some form of gluten intolerance which, although similar, is not the same as coeliac. Coincidentally, when I started the gluten free diet, it was through the likes of him and many others that gave me some form of inspiration in that I could deal with my new diet. I may not eat as healthily as he does but it gave me one thing I needed when being diagnosed – comfort! The comfort in knowing that I’m not alone. It does not bother me that he’s not Coeliac……he’s an athlete and he needs the right diet for what he does. Who can argue with that?
I have to say first my experience is the polar opposite of Jeemboh’s: the more people know, the hotter under the collar … There’s quite a lot to get angry about!
But allow me a little clarification … I don’t see myself as a ‘straight up and down Western medicine supporter’. I actually don’t really believe in this geographical division of medicine into Eastern and Western which serves the alternativists very well, as it confuses the gullible, and pits itself as something *different*: something different to something which (as you observe) doesn’t have all the answers and sometimes goes wrong.
But there is no difference. I believe in medicine. Medicines which works. If it works it is medicine irrespective of geography. Chemistry and physics are the same in London as they are in Beijing.
To find out whether medicine works I believe in scientific method. I believe the best we have are blinded trials with placebo where possible / appropriate. (Alternativists also believe in these methods, though only when they find in favour of the therapy they espouse; find against them – find that they’re nothing but placebo – and of course the old saw about DBPC trails not being best to test complementary medicines gets wheeled out. I wish they’d make up their minds …)
If a purported medicine – call it complementary, alternative, orthodox, what you will – passes these tests, it becomes medicine. It’s happened to some herbal remedies – aspirin derived from birch. It may well happen to some potent Chinese herbs, which have shown promise in allergy. Good, if so.
We have moved on from Galileo and from 5,000 year old ‘medicines’. We now know about atoms, molecules, chemical interaction, and about human physiology, in a way ancient generations could not have known. With knowledge comes (or should come) revision of previously held thoughts. It’s notable that nobody believes any longer in the demonstrable untruths – that we are made up of the elements of fire, water, air, ether etc, for example – yet in some quarters hold on to ideas that are from the same pre-science revolutionary era – that energy lines flow through our bodies – the non-existance of which cannot be proved, though no evidence can be found in support. This isn’t about picking on ‘Eastern’ ideas: we’ve also let go of medieval English blood-letting too.
As I said in a comment in my own blog, if the energy in ‘energy medicine’ is based on electric current and we can measure electric currents (thanks to, yes, science), then ‘Western’ medicine’s failure to ‘neither see it nor measure it’ might just imply it isn’t actually there. ‘Eastern’ medicine can’t see it nor measure it either …
Thanks, David. I suspect that you are not alone in having been in some way ‘inspired’ by Djokovic. And, let’s face it, it is the likes of Djokovic who, wittingly or unwittingly, have raised the profile of gluten-free food thereby encouraging the food industry to create more and better gluten-free offerings – which can only benefit genuine coeliacs!
Alex – I entirely agree! Well, at least on one thing…. Eastern and western are an irrelevance – what matters (certainly what matters to the patient) is whether the medicine works.
Where we cease to agree is over how you assess whether a medicine works. You believe that DBPC (double blind placebo controlled) trials, while not perfect, are pretty good; I really do not think they are much use at all – either for ‘orthodox’ or for complementary medicine – because they simply do not (cannot) take account of the individual nature of each patient. (See my short post ten days ago – Do clinical trails work?)
And yes, of course we have moved on from Galileo – but just because we now understand more about some aspects of how the universe (and our bodies) work, I think it is appallingly arrogant (and deserves the worst that such an exhibition of hubris could bring down on us) to assume that we now understand ‘everything’. Moreover, we should be aware that while ‘science’ may sometimes disprove previously held theories, it can also prove them to be correct. (To take a very simplistic example, way back, small pox victims were always wrapped in red blankets as it was believed to reduce scarring. Relatively recently it was ‘scientifically’ proved that using a red filter to keep direct light off wounds does indeed inhibit scarring.)
As regards energy medicine – those who work with it do claim to have ways of measuring those ‘electrical currents’. But given that by definition they cannot be the same currents that power our kettles or our electric fires or they would frizzle us rather than energising us, it is unlikely that instruments that measure the electricity running through those kettles or fires would be appropriate for measuring them.
I am not a poster boy for energy medicine – I really do not understand most of it for starters – but I do not believe that is a good enough reason to dismiss it. Especially when it does, for some people, undoubtedly work!
Quick responses ….
Of course we don’t understand everything – that’s why scientists continue to do science! We don’t understand how anaesthesia works for instance – but we know it does. Arrogant? Science is modest: it is perfectly prepared to modify itself in the face of new evidence – witness changes in advice about breastfeeding / statins / food allergen introduction / oats in a GF diet over recent years when more has become known due to trials. Homeopathy – to pick one example – has shown itself repeatedly unable to do modify itself over 200 years. That, in my view, is where you find arrogance … It’s there in the idea that you can somehow transcend science, when science is all-encompassing – by definition.
Also not saying ‘not understanding’ something is good enough reason to dismiss it. I’m saying absence of evidence (and of plausability) is good enough reason to dismiss it (at least for now, until evidence is presented, when it can then be un-dimissed). “Those who work with it” making claims about it is not enough. Clairvoyants, ghost-hunters, astrologers and alien abductees make claims too.
Yep, I believe DBPC’s are the best we have, and base my other views on that. It’s a pretty clear-cut position. But I’m genuinely interested in what yours is? If blinded trials are not much use, how do you decide whether something is medicine or it is not? Does it depend on what the practitioners say? On personal experience? On plausability? On popularity? What are your means of deciding on your truths? Do you have an example of a therapy / ‘medicine’ which you do not believe works – and can you explain why you hold that view?
Ah yes, you see, that is where we differ….. You see science (very eloquently…) as all-encompassing but I don’t. I see it as only one element in an immensely complicated universe and for me, to look at that universe only through ‘scientific’ eyes is to blinker oneself.
Absence of evidence is a good enough reason not to embrace something; I am not sure that it is a good enough reason to dismiss it.
DBPC trials deciding whether medicine is medicine or not? Does one need to decide whether something is/is not medicine? If you see medicine as an agent through which to make someone better then many things may class as medicine – a sunny day, the love of a good man/woman, good food, fresh air, herbal remedies, placebo pills, genuine drugs, a sympathetic doctor, massage, acupuncture, surgical intervention – the list is as endless and boundless as each individual. There are many ‘therapies’, some scientific, some non-scientific, some totally balmy – which will not work for many, maybe for most people but will work for some. I do not think that a therapy has to work for everyone to validate it as a therapy – nor do I really care why a therapy works as long as it does.
However, I also appreciate that one has to have some boundaries to keep out the quacks and the fraudsters and to make the whole thing work in a social society. It is just that I find the boundaries that have been set by ‘orthodox’ medicine too rigid, too inflexible and too lacking in imagination – as a result of which patients all too often do not have access to healing which a broader based approach might provide.
Its worth remembering that while there are undoubtedly quacks and fraudsters amongst the purveyors of alternative medicine, there are also quacks and fraudsters operating at the highest levels of conventional medicine. The case of Vioxx sold by Merck despite criminally flawed double blind placebo controlled trials and responsible for over 3,000 deaths in the US alone is just one of many examples.
Dear Jeemboh you attempt to use research based evidence as a pillar for your sweeping statements. Your language used gives a clear evidence that you do not know what your talking about ‘criminally flawed double blind placebo controlled trials’ this is nonsense. Such a study type simply does not exist. You seek to sway peoples opinion not on scientific fact but by mere slander such is used by the slander used by the sell as many as you can and forget about the truth tabloids.
Not sure my comments can really be described as ‘sweeping’. I pointed out that not all clinical trials are as gold standard as they could be. A view supported by the New York Times in this article. If you take the trouble to read what I actually said you will see that ‘criminally flawed’ referred specifically to the Vioxx trials. The fact that Merck has paid out over 5 billion dollars in damages and had clinical information about the damaging side effects of Vioxx at least four years before pulling the drug supports that view.