May 10, 2021

Episode 015: Alternative Medicine, The Wellness Industry & goop


Sarah starts off by discussing complementary and alternative medicine, as well as the history behind some of the most common therapies, including naturopathy, homeopathy, and massage.

Becca then explores celebrity influence over public health, specifically Gwyneth Paltrow and goop. She examines how female mistrust in traditional medicine has made wellness the multi-billion dollar industry it is today. Sarah and Becca then explore some instances where goop has gone too far, like when they had a dispute with NASA and published a book on “intuitive fasting”.

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Transcript

B: Today we are going to talk about all things pseudoscience and investigate a topic that is more nutrition-adjacent...and that’s the wellness industry. Specifically, it’s largest offender: Gwyneth Paltrow’s goop. But first, Sarah is going to tell us more about alternative science in general. Sarah’s part

This is NOT a small topic. I’m going to start with a disclaimer, because discussing alternative medicine on an evidence-based podcast with two co-hosts that are going to be regulated health care professionals is challenging. There are a lot of conflicting opinions out there, and we don’t want someone who embraces complementary alternative medicine to feel alienated from the podcast, and I also definitely don’t want individuals from the scientific community to feel like this podcast isn’t credible, and so, as always, we’ve done our best to take a fair and evidence-based approach to this topic. I also want to acknowledge my personal position - I’m very pro-science, I have the utmost respect for research and medicine, and I’m not even particularly spiritual but I do love and practice yoga and sometimes meditation and massage, which are all alternative therapies. So - science lover and alternative medicine skeptic, and I think there is a need for a lot more research on alternative medicine. I felt that was important to disclose before we dive into this topic that can be divisive. 
 
Becca: Where do you fall on the traditional vs alternative medicine spectrum? 
 
I’ll start by discussing what exactly alternative medicine is and then provide a brief overview of the different types.
 
So what exactly is complementary and alternative medicine? Complementary medicine usually refers to alternative therapies that might be used alongside standard medical treatment, and this is more common and in some cases can even be helpful when managing certain conditions, while alternative medicine can sometimes refer to non-standard treatment used in place of medical treatment, which definitely has the potential to be unsafe. So alternative medicines can also be complementary, but complementary medicines are not intended to be your sole treatment system.  
 
There are many different types of alternative medicines and therapies, including: Traditional alternative medicines like ayurveda, homeopathy, naturopathy, and traditional Chinese medicine. There are body therapies, which include acupuncture, chiropractors and osteopaths, and massage. There are nutrition and herbal therapies, including dietary supplements and herbal medicine. There are external energy therapies like reiki, tai chi, yoga, qigong. And there are alternative mind therapies, like meditation and hypnosis. All of these therapies fall on a spectrum of evidence, so some do have a growing body of research - like meditation, yoga, acupuncture, and massage have some evidence to support their efficacy in managing certain conditions in conjunction with conventional medicine, and others have very little evidence beyond personal testimonies. Now, lack of evidence does not necessarily mean it’s completely ineffective, but it does mean that it might not work, it might be a placebo effect, it might not be safe, and in some cases it might even be dangerous. 
 
Let’s go through a couple types of alternative medicine in a little more detail. 
 
Ayurveda: Ayurvedic medicine was developed in India over 3000 years ago. It’s based on the belief that health depends on a delicate balance between the mind, body, and spirit. It typically focuses on promoting health and preventing disease instead of treating specific conditions. Those who practice Ayurveda believe that there are five basic elements in the universe and within each of us: space, air, fire, water, and earth. These combine in the human body to form three doshas or life forces. Those doshas control how your body feels and how it’s functioning. They are Vata dosha (space and air); Pitta dosha (fire and water); and Kapha dosha (water and earth). And so as a person, you are a blend of those characteristics but one is usually stronger than the others. The theory says someone who embodies the kapha dosha would be strong, thick-boned, caring, supportive, but also maybe prone to depression, fatigue, and brain fog. In Ayurvedic medicine, it’s believed that the balance of your dosha’s is linked to your health, and if one is too strong or too weak, you’ll have an imbalance and it will impact your health.
 
TCM: Traditional Chinese medicine (TCM) is thousands of years old, originating from China, and it’s based on the idea that a vital life force, called Qi, surges through the body and an imbalance in Qi can cause poor health. This imbalance is thought to be caused by an alteration in the opposite and complementary forces, called yin and yang, that make up the Qi. When imagining Yin energy, you can think of: night , dark, cold, feminine, negative, and when imagining Yang energy you can think of day, light, warm , positive, male. When you balance the yin and yang of Qi, you feel healthy and well. If they’re out of whack, you feel sick. TCM aims to create harmony and a healthy flow of qi. Some therapies used in TCM include Acupuncture: very fine needles placed gently in the skin, Cupping: heated cups that create suction on your skin, Herbs: tinctures, teas, powders, and pills, Meditation, Moxibustion: dried herbs burned near the skin, Tai chi: exercise with slow movements and focus on the breath.
 
Naturopathy: This one is pretty common in Canada and the US, and it uses “natural remedies” to help the body heal itself, like herbs, massage, acupuncture, and even nutrition counseling. Naturopathy was brought to the United States from Germany in the 1800s, and the goal of naturopathic medicine is to treat the whole person -- mind, body, and spirit. Naturopaths kind of grab from all the alternative medicines, so they might use herbal medicine, basic nutrition, homeopathy, traditional Chinese medicine/acupuncture, and general lifestyle coaching. Naturopaths often call themselves naturopathic doctors, which is misleading, imo, because actual doctors have to undergo 3-8 years of residency and fellowship training after their medical degree and undergraduate degree and Naturopaths do not, they have to do 3 years of school after their undergrad degree, and I think that’s an extremely misleading comparison. Naturopathy has been criticized for making false and exaggerated claims and promoting pseudoscience. 
 
Personal story! I have been to a naturopath before - not a bad experience, but not a successful one and a HUGE waste of money. In the end he actually just told me to go get a prescription from my doctors. Which was frustrating because I had spent a lot of money, but I do appreciate a naturopath that is not opposed to conventional medicine. 
 
Homeopathy: Homeopathy is based on the belief that the body can cure itself. It was developed in the late 1700s in Germany. It’s more common in European countries, but it’s not quite as popular in the United States or Canada. A basic belief behind homeopathy is “like cures like.” So, something that brings on symptoms in a healthy person could theoretically treat an illness with the same symptoms in another person. For example, red onion makes your eyes water, and so it’s used in homeopathic remedies for allergies. Homeopaths weaken these ingredients by adding water or alcohol to create a “healing essence. 
 
Reiki: Reiki is a Japanese energy healing technique, used as a way to manage symptoms and improve well-being. During a reiki session, the practitioner places their hands either directly on you or just above you to bring about energy healing. The belief is that the practitioner is able to stimulate your body’s natural healing abilities.
 
Massage: In massage therapy, a trained therapist applies pressure to the muscles and other soft tissues to help heal underlying conditions. There are more than 80 different forms of massage therapy, including shiatsu, Swedish, pressure point, and deep-tissue massage. Massage usually is intended to decrease pain and relax muscles, and this technique has been used for thousands of years and has been mentioned in ancient texts from Egypt, Rome, China, Greece, India, and Japan.
 
Okay, so here’s the thing about most alternative medicines and therapies: there’s very little evidence. For the most part, they have not been evaluated using rigorous scientific tests, and the few that have been done are often poorly designed and are increasingly industry funded by supplement companies that have a huge stake in alternative medical treatments, particularly naturopathy. The lack of high-quality evidence means there are no clinical practice guidelines for these practitioners, and so, the “evidence base” for alternative therapies relies on anecdotes, beliefs, theories, personal testimonials, and opinions, which we know from our last episode on nutrition research, are not quality forms of research. 
 
Considering that nearly 80% of Canadians will use some form of complementary or alternative medicine at least once in their lifetime, the lack of compelling evidence is troubling to say the least and could even be dangerous. Now, 80% sounds like a lot, but keep in mind that some could be using yoga to manage their stress or someone might get massages for their back pain, and on the other hand, it could mean someone completely rejects conventional medicine and tries to treat their cancer with naturopathy (which is extremely dangerous, and people have died doing that - completely unethical for a naturopath to claim that they can be the exclusive treatment for cancer). So, the spectrum is HUGE. And something that is also very concerning is that only about 40% of those that use an alternative medicine will tell their physician about it, and that’s worrisome because there could be interactions between drugs and supplements. So if you do decide to use an alternative therapy, PLEASE tell your doctor. 
 
So I am going to tell you a couple of studies that have shown alternative therapies to be somewhat effective. First, acupuncture has been shown to be effective in flipping a breech baby and managing some mild pain and nausea. Art or music therapy can improve quality of life. A Chinese herbal medicine formulation has been shown to help ease symptoms of IBS. Yoga-based interventions have been shown to be effective for stress management and improving strength and balance. Massage therapy can decrease stress, anxiety, depression, and pain. Prayer and spirituality can help with emotional effects of chronic disease management. There are some herbal remedies that have some evidence, like using St. John’s wort (mild anxiety and depression), but results are often small enough that they could be attributed to a placebo effect and concerns still exist over safety and drug interactions. 
 
Overall, while alternative health can seem interesting and enticing and trendy to a lot of consumers, there is really not a lot of evidence that this stuff works, especially compared to conventional medicine which is highly regulated and based on rigorous evidence to prove that it is safe and effective before entering clinical practice guidelines. And yet, Canadians, in the land of mostly-free healthcare, are spending nearly $9B per year on conventional and alternative medicines. & with that, I’m going to pass the torch to Becca to tell us today’s scandalous story and talk about some of the reasons WHY people are drawn to alternative medicine and some key things to watch out for.
 
Before we get into my section, have you ever purchased anything from goop?

I actually had a pretty difficult time trying to organize my thoughts for this story. There are so many issues within the wellness industry and in their connections to gender disparities in healthcare that I found it somewhat tricky to piece something together for one episode. I feel like this could have been a whole series….So I’ll discuss wellness, the impact of celebrity endorsements on public health, one theory as to why females are more likely to buy into the wellness industry, and of course, some of the cases against the brand goop.

Some of the sources I used include a paper written by Josephine Rivera called ‘How History Shaped Women’s Healthcare”, episodes of the podcast Still Processing and Wait, There’s More, another article Andrea Becker called Goop She Did It Again and some other studies and articles that you can find on our website at dieteticsafterdark.com.

So who is the lady of the hour? Gwyneth Paltrow was born in Los Angeles in 1972, making her 48 which is crazy because she looks younger than me. Her father was the director and producer Bruce Paltrow, and her mother is the famous actress Blythe Danner (Meet the Parents, Will & Grace). 

Now I’ll be honest, I have always loved her movies, and Sliding Doors was one of my favourites as a teenager. According to IMDB her acting debut was in 1989 for a TV movie called High. She has since starred in a ton of notable flicks like Shakespear in Love, The Royal Tenenbaums, Iron Man, and the associated Avengers movies. She has also authored several cookbooks. She was previously married to Chris Martin from Coldplay, with whom she had two children - Apple and Moses. She is now married to Brad Falchuk, who is a TV writer, producer, and director. And he is best known for one show that he co-created - Glee. So she was born and bred into the entertainment industry. It’s almost like she had no choice.

She has had tabloid drama and scandal throughout her life, and was actually a critical source in the Harvey Weinstein case, having worked with him multiple times, but later coming forward with accounts of sexual harassment. 

What is goop
In 2008, she founded the wellness and lifestyle brand goop. The name came from her nickname - G.P. which she added two O’s to and got goop. It started out as a weekly newsletter that included new age advice and food or diet tips. Each email was signed off with the tagline “Nourish the Inner Aspect''. Later it expanded to an entire online empire that now includes wellness and sexual health products, fashion, wellness summits, a podcast, a magazine and publishing partnership, a docuseries, and now a cruise (Wikipedia, n.d.).

Aside from its success, goop is one of the most scandalous brands in the wellness space. Most of the backlash it faces is because of its absurd prices and its harmful claims based in pseudoscience. And pseudoscience is essentially when statements or practices claim to be scientific but are not compatible with the scientific method - so there is no sound evidence to back them. Alternative therapies, which Sarah was discussing, are often based on this type of science or lack thereof. And whether or not you like Gwyneth Paltrow as an actress or business owner, this is a HUGE issue. Not only does it spread misinformation, but in the case of goop, it also takes advantage of people seeking wellness, or even those desperate for things like fertility. And in some cases what she has done has been illegal, which I will get into.

But before we do, what the heck is wellness. It’s the “act of practicing healthy habits on a daily basis to attain better physical and mental health outcomes, so that instead of just surviving, you're thriving.” (Pfizer, n.d.). So it's things like exercise, being social, good nutrition and adequate sleep. And I like this definition because nowhere in it does it state that you must purchase any items to achieve wellness - other than maybe food. But companies like goop have led us to believe that optimal wellness has a price tag. In one of the podcasts I listened to in my research, they mentioned that wellness now means reaching beyond what we have. Like achieving beyond our means. And large corporations and celebrity promotion have fed into this cycle, which makes us feel like this wellness ideal isn’t really attainable. It’s something you should keep striving for. 

So goop is really a business-to-consumer business model disguised as a wellness hub. And Gwyneth Palrow isn’t the first to do this. Celebrities like Tom Brady and Jessica Alba also have brands that push these idealist lifestyles. And an even more controversial example is Oprah Winfrey who is so beloved by the world (me included), but she initially perpetuated this type of business model before consumers were even aware of its implications. 

When you think about it, she brought both Dr Phil and Dr Oz into the spotlight - who are two very problematic figures to the health and wellness world. She has also used her platform to sell products and to evoke panic when it came to certain topics, like mad cow disease. In 1996, she and an activist guest famously said that it could make AIDS look like the common cold. And beef prices crashed the next day (Selk, 2018).

But why is it that we elevate Oprah and her platform, but not Gwyneth’s? Reporter Taffy Akner has an algorithm for this. So she claims that it has to do with where you come from and how much visible suffering you’ve experienced (Akner, 2018). And she makes some great points. So Gwyneth comes from immense white privilege, whereas Oprah is a self-made successful black woman. Gwyneth tends to keep most drama from her private life out of the public eye and really only reveals the things that “work” for her - like her skincare routine and diets; whereas Oprah would bare her soul to the world every week on her show...and now does so on her podcast.


In a lot of ways their messages and values are the same. They go against the norm and make you question conventional ways of doing things. Which isn't always bad, until it is.

But something has led us to this point. There are SO many consumers who buy into this alternative thinking or science, making goop almost a quarter billion dollar business. And one theory is that it stems from the mistrust of traditional healthcare, and in this case, specifically among women. I am going to add a trigger warning here, as I am going to be discussing fertility and loss. So skip through the next few minutes if you need. Alright...let’s talk a little bit about how the history of healthcare has shaped female perceptions of healthcare and medicine today.

So before the time of Christ, many cultures worshipped female goddesses that encompassed virtues like motherhood, beauty and creativity. But as history progressed, there was a patriarchal shift in thinking - where men were believed to know more about the female body than females themselves. Childbirth was already incredibly dangerous, with many women dying during it. And for ancient Greeks and other civilizations it was also seen as being “impure”. Even touching a woman who was giving birth led to unclean hands. 

In ancient Rome, the C-section, or Caesarian section began picking up traction. It was once believed that the name came from the birth of Julius Caesar, which likely isn’t true since his mother survived. But many others believe it came from the Casar-era law that stated that pregnant women who died in Rome couldn’t be buried unless their fetus was removed. So the procedure was initially performed to remove stillborn children (Thorpe, 2017). It then began being used to save live infants from their dying mothers. Then in the 1800’s doctors began using it more on mothers who were in distress when giving birth. BUT the methods of conducting the procedure weren’t standardized, and some doctors thought that stitching up the uterus would lead to infection, so a lot of the times they just didn’t; and because of this many more women died in childbirth due to blood loss. But also infection since sanitation practices weren’t what they are today (U.S. National Library of Medicine, n.d.). It was a mess.

Midwives and healers who continued to practice ancient medicine at this time were often labeled witches, ultimately limiting the power females had in the healthcare system. It was thought that anything a doctor couldn’t heal was the result of sorcery. And of course at this time, doctors were pretty much exclusively male. Later in the 1800’s and early 1900’s gynecologists became the new male-midwives. Except they would often perform hysterectomies, ovariectomies (OVARY-ECTOMIES) and castrations to “cure female insanity”, which was essentially when females wouldn’t comply with the demands of their fathers or husbands.

Sexual health education was also only taught in universities, which females weren’t allowed to attend. So they were left in the dark about their own bodies. In the early 1900’s nursing did become a profession, but nurses were still limited to the education and activities laid out by doctors. And it was even thought that “too much development of the brain…would atrophy the uterus”. Even when proper treatment was given there were discrepancies based on status, with females of a lower socioeconomic status receiving less quality care. 

To this DAY there are still protests and laws against women having rights over their own bodies. 

And in addition to this, very little research has historically been done on females. Clinical trials and other research has predominantly been done on male subjects. For instance, with heart disease, symptoms present themselves differently in females vs males. But since a lot of the evidence we have is on males, females tend to be diagnosed later than males, which has a slew of consequences (Maas & Appelman, 2011). So there have been some strides forward in that the FDA now requires all drug manufacturers to display evidence of safety for all sexes and ages. And in 2016 females accounted for about half of clinical trial participants for trials funded by the US National Institutes of Health (Burrowes, 2021).

But overall females have had a tough go when it comes to healthcare. And most individuals who turn to alternative medicine are female - about 60% (Zhang et al., 2015). But it makes sense why females are more likely to seek out this type of treatment. Mistrust does exist and alternative medicine may offer a different (yet less science-based) perspective, as well as comfort. Healthcare practitioners in a hospital setting or clinic may be overworked, especially in this era of COVID-19, and alternative medicine may offer more structured therapeutic relationships, since clients often pay by the hour for treatment.

With all this being said, goop does offer alternative methods, and encourages sexual liberalization, something we don’t often see promoted in healthcare for females. But it also leverages the mistrust in traditional medicine to sell products. And Goop has been known to take the foundations of cultural practices, white-wash them a bit, and then rebrand them to make them seem groundbreaking.

And as I mentioned, many goop products and claims are not based on evidence. But they use science-y terms like “microbiome” or the goop “lab” - which makes you think that evidence was involved. Gwyneth herself has been criticized for using terms like “clean eating” or “detox” and considers things like pasta a “cheat meal” yet aligns herself with notable chefs and has pasta meals posted on her website. She also has a tendency to create fear around certain chemicals or “toxins”. She recently claimed that conventional sunscreen has too many chemicals in it, which sent many dermatologists to make media statements in defence of sunscreen.

In 2017 Truth in Advertising, which is an advertising watchdog group; they called on California consumer protection regulators to investigate goop’s marketing claims, stating that they had found over 50 instances of "unsubstantiated, and therefore deceptive, death and disease-treatment claims." These varied from crystals that can treat female reproductive issues and stickers that reduce inflammation to a consumable essence blend that prevents ‘shame spirals’ (CBC, 2017). In 2018 the company agreed to comply with a court order that it would stop publishing health claims that don’t have FDA approval, but according to the Truth in Advertising organization it continues to violate this order (Miller, 2020). I should clarify that making claims like this with or without a court order are illegal.

I could spend the rest of this episode naming off all the scandals, because there would be enough to fill the next hour, but instead I am going to tell you about a few instances when goop went too far. First off, have you heard about the jade eggs?

Ok, so we know goop promotes sexual health. And the website sells what are called jade eggs, which are sometimes also referred to as yoni eggs. The intention with jade eggs is for women to place one inside their vagina like a tampon and to essentially do kegels with it in there. Initially it was recommended to keep the egg there for long periods of time. They claimed that this practice was done by Chinese royalty, and that it could intensify your feminine energy, improve your sex life, strengthen your pelvic floor, and balance your hormones during your menstrual cycle. However, not a single one of these claims could be backed by science - except maybe intensifying your feminine energy, because how would you ever measure that? A lawsuit was filed against goop, and they settled for $145,000. They also had to refund anyone who purchased these eggs while the false claims were advertised, so from January to August of 2017. They also had to add a disclaimer to an article that talks about the product. It states that: “This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.” (Bryant, 2018).

The jade eggs are still sold on the goop website, for $84 Canadian. Yet medical professionals advise against their use. The claim that it strengthens your pelvic floor is a bit far fetched, since putting weight on that area for extended periods of time is about the equivalent of doing a bicep curl and remaining in that curled position for an extended period of time. The material that these eggs are made of is also porous, meaning it has pores and more easily traps bacteria. So overall experts say you are better off just doing kegels (Thomason, 2021).

The last non-food related example I am going to give you is that of the Body Vibes stickers. So goop promoted these products, which are stickers that cost between $60-120 a pack. They claimed that they ease anxiety, pain, hangovers; improve strength, endurance, skin, sleep and focus. And if that were to be true...I can’t believe they were only charging $60. In the article that goop wrote promoting the stickers, they also claimed that they were made up of the same “conductive carbon material” that is used to line NASA space suits. The only issue is that NASA came forward saying that they don’t have a conductive carbon material. The inventor of the product used in the stickers also claims that the research done on the product is “confidential”. Which is a bit too convenient. Shin Lin, a PhD in biological sciences has stated that it's possible that the stickers produce a placebo effect if the individuals wearing them believe these things are going to happen (Praderio, 2017). Regardless, both goop and Body Vibes were required to take down these false statements.

Lastly, let’s touch on some recent food drama, since I am guessing that is why a lot of people are listening. And I should state that goop does have a registered dietitian on staff - who works in product development. But I think they might need some help in the marketing department, and also on their decision-making board. Earlier this year, Paltrow announced her most recent project - Goop Press, which will sell health literature. And her first book is one she worked on with her friend and functional medicine practitioner Will Cole called Intuitive Fasting.

Right off the bat, what do you think about when you hear the term “intuitive fasting”?

There has been a lot of controversy with this book in the world of dietetics. First off, Will Cole, or Dr. Will Cole is a self-proclaimed functional medicine expert. He has received a certification in functional medicine from the Institute for Functional Medicine. I looked this up and there are 6 education modules in this certification program - GI, Environmental Health, Immune, Hormone, Cardiometabolic and Bioenergetics (IFM, n.d.). So there’s nothing nutrition-specific in the program. He also got the “Dr.” in his title because he is a chiropractor (Ivanina, 2019). So talking about nutrition is kind of out of his scope of practice. But he and Paltrow wrote this book and have been promoting it since the beginning of the year.

There are a lot of issues with its release. First off, they are promoting a diet that involves limiting food and nutrients during a global pandemic, where illness is already prevalent. It also takes intuitive eating language, which is an eating style or lifestyle method used by some healthcare practitioners to treat eating disorders, and it’s promoting it as a diet. Which could clearly lead to more disordered eating patterns for some individuals. Intuitive eating is intended to promote a healthy attitude towards food and body image long-term; but intuitive fasting is a 4-week program that Gwyneth starts with a 6-day bone broth cleanse. They claim that it is anti-diet, but anything that is not sustainable beyond 4 weeks is clearly a diet (Becker, 2021). I will give it some credit, because intuitive fasting has been somewhat studied...on rats. But there is very little known about the psychological or physical effects of the diet on humans (Kumar & Kaur, 2013).

Despite its criticisms and potential harms, it continues to be promoted by goop and basically all online bookstores. So what can we do to avoid manipulation or deceptive claims laid out by unqualified brands? If you are still interested in trying alternative medicine, there are a few things to watch out for:
 
Be suspicious of any treatment that says it can cure difficult-to-treat diseases (like cancer, chronic fatigue, multiple sclerosis orIBS). 
Be suspicious of any treatment that claims to offer benefits with no side effects. Even herbs and vitamins have possible side effects. If the treatment is marketed as having no side effects, it has likely not been studied in rigorous clinical trials, where side effects would be seen.
Be suspicious of practitioners who attack the medical or scientific community or who tell you not to use standard or traditional medical treatment.
Beware of terms like “scientific breakthrough,” “miracle cure,” “secret ingredient,” or “ancient remedy.” and of any conflicts of interest. If a celebrity is praising far-fetched effects of a product, are they also selling that product?
And lastly, beware of personal stories that claim amazing results but provide no actual scientific evidence or plausible mechanism. Testimonials are not science.

With all of that being said, the take home message here isn’t to not use alternative therapies, but to be cautious if you do use them. As future healthcare professionals, I think it’s actually really important for you and I to follow along with what goop is doing. There is clearly demand for these products and this way of thinking, and we should be paying attention. I think it would be almost careless for us to dismiss goop or its mission, even if some of the claims may be untrue and out of touch. 
 
Q: Becca, have you ever had food poisoning?