The Awful Poo Lady

September 30th, 2006 by Ben Goldacre in bad science, gillian mckeith, nutritionists, PhDs, doctors, and qualifications, very basic science | 64 Comments »

Ben Goldacre
Saturday September 30, 2006
The Guardian

I wouldn’t want you to think that I’m an overly sensitive person, but sometimes I get a bit upset by Dr Gillian McKeith PhD. There she is on the television, talking about science, making an obese woman cry, in her own back garden, by showing her a tombstone with her own name on it, made out of chocolate. And here she is, in an article headed “I lost 4 stone after telly’s Gillian said You’ll be dead by the time you’re 40″ (The Mirror, September 6 2006), where one of her delighted customers describes Gillian’s bedside manner in glowing terms: “Kim MacDonald credits a single movement for changing her life. Sitting on her bed … Gillian said: ‘Do you want to see your daughter get married and have babies? Because the way things are going you’ll have a heart attack at 40′, says Kim, from Cambridge … with tears streaming down her face, Kim agreed to change – and ended up becoming Gillian’s most successful candidate.”

It’s hard to imagine an NHS doctor attaining wealth, the adoration of patients, or professional acclaim by deploying this kind of approach. In fact, it’s hard to imagine a doctor like this having many patients at all, after all the professional complaints against them, and endless meetings with the clinical director, and probably the GMC, to discuss their bedside manner.

I’m not for one moment suggesting that she should be forbidden from practising whatever it is she practises, or censured.

If people want theatrically abusive nutritional advice from someone with qualifications such as a PhD from a non-accredited correspondence course college in the US (which sells its own range of alternative health products online) then that’s fine by me, and she’s absolutely entitled to call herself doctor, even if she does apparently have some slightly odd ideas about science.

They include, to take the briefest example, nutritional energy and photosynthesis, explaining in her 1.5m copies (gosh) bestselling books that chlorophyll is “high in oxygen”; eating it will oxygenate your blood (not without a searchlight up your bum to drive the photosynthesis of oxygen, I would suggest); and that “each sprouting seed is packed with the nutritional energy needed to create a full grown healthy plant” (I have an apple seed in my left hand and an apple tree in my right, for comparison, as I try to work out what she means).

Anyway. I’m not bothered by her nastiness, in the “regulate them” sense of the word: it’s just a lot more extreme than I remembered, and that makes her popularity interesting. Because people elect to see McKeith, to be told off and made to cry, both in her clinic and on her Channel 4 TV shows.

There’s clearly a place in the healthcare market for this kind of Victorian and authoritarian approach. In fact, it seems to me that many of the key traits of alternative therapists are, paradoxically, the key traits of old fashioned paternalistic medicine. They provide certainty, and a sense of expertise: “I know what’s wrong with you,” they say. “I am the expert, I am telling you exactly what to do to get well.” Then, like McKeith, they hand over an ambitious herbal concoction, and some reasonably sensible housewife’s wisdom, with unswerving conviction. It’s not just the medicine that’s old fashioned, the proprietary preparations, the “horny goat weed” in McKeith’s “Fastformula Horny Complex” for men, it’s the whole bedside manner. Gillian is a Victorian doctor.

But stranger than the attraction to her patients is the attraction for us. We choose, in droves, to watch her bully very fat people on television. People racked with low self-esteem, and guilt, are abused, and told they will die young because of their own actions, then they cry, and we watch it, as entertainment, satisfied it’s their own fault. Fatties.

· Please send your bad science to bad.science@guardian.co.uk

Another favourite McKeith quote is here:

“An acid body means that there is an excess of hydrogen ions which combine with oxygen to form water. This excess hydrogren depletes the body’s oxygen. Simply stated, a shortage of oxygen causes cells to break down and die, creating acidosis.”

Watch science nerds try and get to the bottom of what on earth she means by that published statement here.


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64 Responses



  1. Frank said,

    September 30, 2006 at 9:08 am

    Re: that image. I think someone’s been surfing ratemypoo.com again.

    But why didn’t you mention the mind-bending McKeith interpretation of acidosis?

  2. asmilwho said,

    September 30, 2006 at 10:11 am

    I’m not usually a fan of synchronicity, but here in Germany there is a snack called “brezel”:

    en.wikipedia.org/wiki/Brezel

    oh no ….

  3. raygirvan said,

    September 30, 2006 at 11:46 am

    Talking of awful poo, it’d be nice to see a Bad Science hatchet job on mucoid plaque. Classic scam of the “product makes the phenomenon it claims to cure” variety. You drink a psyllium/bentonite gunge that comes out as a stringy cast of the colon, which the vendors claim was inside you all along. One Richard Anderson is the prime mover.

  4. BobP said,

    September 30, 2006 at 12:39 pm

    Got this from the Welwyn & Hatfield times …

    ————– quote ——————–
    SELF-proclaimed TV food fascist Gillian McKeith will be holding auditions for her new series at the Galleria in Hatfield on Tuesday October 3.

    The host of Channel 4’s You are What you Eat is looking for participants for the new series and she will be auditioning them herself… call it the XXL Factor.

    Gillian will be looking for the liveliest characters and she’s got several surprises up her sleeve for the new series which broadcasts on Channel 4 early next year.

    Hundreds of people are expected to turn up, each with their own reasons for needing a switch to a healthier lifestyle.

    They will all get the chance to see Gillian in action, and some may get more than they bargained for!

    The auditions will run from 10am to 5pm.

    If you want to go along you can phone 020 7153 6134, email YAWYEauditions@celador.co.uk or just roll up!
    ——————- end quote ————————

    Go for it!

  5. eponerd said,

    September 30, 2006 at 1:21 pm

    Well, at least you can’t accuse these guys of being anal retentive…

    Btw, asmil, everyone else calls them ‘pretzels’ (yiddish word, spot the etymology). and yes, I see what you mean…

  6. Ben Goldacre said,

    September 30, 2006 at 2:35 pm

    ah bugger forgot that one when i was writing yesterday:

    “An acid body means that there is an excess of hydrogen ions which combine with oxygen to form water. This excess hydrogren depletes the body’s oxygen. Simply stated, a shortage of oxygen causes cells to break down and die, creating acidosis.”

  7. stever said,

    September 30, 2006 at 4:00 pm

    check out her latest evil money making wheeze

    www.mckeithinteractive.com/

    £39 quid – total scam/ rip off. – FFS- the book is cheaper than that.

    I bet you £38.50 (ther approx proit margin on this) that there are just a couple of alternative versions -at best an extremely simple bit of code that sorts entries into a couple of different catagories and then chugs it off – totally automated – although the implication from the weasly wording on the website is that she does it persoanlly.

    she must be absolutely coining it.

  8. stever said,

    September 30, 2006 at 4:04 pm

    Im a total liar – its actually £34.95

    *tetracts above post and apologises to said rip off pseudoscientific poo lady*

  9. stever said,

    September 30, 2006 at 4:07 pm

    good grief – you dont even get a hard copy – its emailed to you. 20 pages – including, by the look of the FAQ, a page describing carrots.

  10. stever said,

    September 30, 2006 at 4:29 pm

    can i suggest mass posting at the channel four – you are what you eat – forum here

    community.channel4.com/groupee/forums/a/frm/f/258603069

    obviously we should be positive about encouraging healthy eating etc – but promoting bad science shouldnt be acceptable to channel 4, nor should they be endorsing her unaccredited correspondence course PhD or promoting her crappy porducts and services.

  11. Tessa K said,

    September 30, 2006 at 4:35 pm

    Not only is she like some Victorian moralist, she is also like one of those old-time Revivalist preachers who come to town, pitch their tent, tell everyone they are evil and going to hell, then fleece the locals.

  12. BobP said,

    September 30, 2006 at 5:26 pm

    Stever – www.mckeithinteractive.com/ has a refund policy :
    [quote]
    12. Refund Policy
    If you are not totally satisfied with your on-line profile report you can write to us within 7 days of the date you completed the Profile explaining why you are not happy and you will receive a refund of the full amount you have paid for the service. Refunds will only be made to the debit/credit card originally used for payment.
    [end quote]

    So you could give it a risk-free tryout and let us know what it did for you.

    The last line of the “Terms & Conditions” is a bit puzzling …
    [quote]
    If you have any queries please contact Customer Services at your retailer.
    [end quote]

  13. pv said,

    September 30, 2006 at 6:14 pm

    “…she is also like one of those old-time Revivalist preachers who come to town, pitch their tent, tell everyone they are evil and going to hell, then fleece the locals.”

    A concise description af all CAM peddlars.

  14. j said,

    September 30, 2006 at 6:22 pm

    You wonder what the outtakes for the show are like. Have any of the intended victims told her to piss off? And, in the bit at the start where she goes around taking nice food off random people, has anyone grabbed it back :)

    Would be interesting to know how victims have done after the show, too. After all, a ridiculously restricted diet – eating rabbit food and snake oil for a month, and no red meat/alcohol/caffeine/chocolate! – normally isn’t recommended cause of the temptation to ‘fall off the wagon’. And victims seem to lose weight almost too quick – do they slow down their metabolism and make it easier to gain weight later on?

  15. DO USA said,

    September 30, 2006 at 8:05 pm

    I have worked on renal wards for years, both in the States and laterly in the UK and PH balance the way she describes it, bears no relation to reality whatsoever. Respiratory or metabolic acidosis is just not the same and how food can affect it heaven alone knows.

  16. jackpt said,

    October 1, 2006 at 1:25 pm

    I hope she is a passing trend, and goes the same way as sandwich makers or fondue sets. Relegated to the back of a cupboard where her books slowly gather sticky kitchen dust from moderately consumed fried eggs. I think not only is there the Victorian paternalistic parallel, but also the 1970s self-help parallel. I have seen the philosophy and science sections of my bookstore diminish in the face of the encroaching self-help and alternative X books. I recommend putting in post-stick notes telling people that they’d be better off investing in some kind of adult education, or mountain bike.

  17. apothecary said,

    October 1, 2006 at 2:33 pm

    I don’t know if anyone else noticed, but the week before last, Radio Times described her (in the listing) as “no-nonsense dietician, Dr Gillian McKeith”. Now, isn’t dietitian a protected title? I know proper RDs read and contribute to this site – just thought I’d bring this to your attention. I’m not suggesting Mrs Poo made that claim herself, but a) it illustrates the meeja perception of her and b)would any RDs like to take this further via BDA? Or is it just not worth it?

  18. adamt said,

    October 1, 2006 at 2:40 pm

    “In fact, it’s hard to imagine a doctor like this having many patients at all, after all the professional complaints against them, and endless meetings with the clinical director, and probably the GMC, to discuss their bedside manner.”

    Ben, you’re spot on – have a look in this week’s private eye. MD tells of the anaesthetist who was landed with a £44000 payout for “harassing” a patient. His crime? Saying the same thing to her that the poo lady said to Kim from Cambridge:

    “You’ve seen your daughter born, if you give up smoking you might see her get married too”.

  19. David Mingay said,

    October 1, 2006 at 2:50 pm

    I should really be practising my double bass for an upcoming performance of Barber’s Adagio, but find myself perusing www.mckeithresearch.com/ instead. I see she is promoting Tibetan Monks’ favourite foodstuff, the Goji Berry, a sacred superfood which they honour in a two-week celebration every year (£3.99 a 100g tin).

    Then I go to encyclopedia.thefreedictionary.com/Tibetan+Goji+berry and find that:

    “The name Tibetan Goji berry is in common use in the health food market for berries from the Wolfberry plant that are claimed to have been grown in the Himalaya region. Tibet as a significant wolfberry source is almost certainly a myth, however, as it is an unlikely region for commercial supplies of berries of any kind. The Tibetan Plateau is more than 10,000 ft altitude with poor soil and climate conditions unfavorable for fruit crops. Year-round cold temperatures and frost would inhibit bud development and prevent fruit formation…There are no objective commercial, scientific, or government reports on wolfberries from Tibet, whereas reports on wolfberries from the Xinjiang Uyghur Autonomous Region and the Ningxia Hui Autonomous Region of north-central China [thousands of miles from Tibet]….The berry has been eaten locally in Asia for centuries and is celebrated in an annual festival held in Ningxia.”

    Can’t she be done under the Trade Descriptions Act or something?

  20. Snoop said,

    October 1, 2006 at 3:00 pm

    Nice journalistic style Ben – reminds me that Brutus is an honourable man!

  21. Dr Aust said,

    October 1, 2006 at 9:10 pm

    Was struck my the same serendipitous coincidence with the Private Eye MD column AdamT mentioned. In private medicine you pay the Drs to schmooze and suck up to you, and sue if they don’t. In the NHS you can sue them without even paying them in the first place. While in McKeith land you pay to be scolded.

    Does this make McTeeth the first authentic “Dietary Dominatrix”?

    The McKeith “revelation moment” reminds me slightly of cult brainwashing techniques – days of undermining / breaking the person down / exploiting their self-loathing, then the revelatory love-bombing moment (“but we love you”) which persuades people to give their life to the cult. Or even the moment in some evangelical services when people stagger down to the front to weep and confess their sins.

    Incidentally, back in the 20s when all UK medicine was private, it was often said that the essence of a successful expensive Harley St practitioner was to be forbidding and scold his (always his) rich patients, often rich women who were paying to be “verbally disciplined” by the stern paternalistic doctor. I’m sure AJ “Dr Finley” Cronin wrote about this based on his own experiences in Harley St practise.

  22. pv said,

    October 2, 2006 at 11:15 am

    “Can’t she be done under the Trade Descriptions Act or something?”

    More than likely – when anyone can be bothered.

  23. Delster said,

    October 2, 2006 at 11:33 am

    I had a read of that forum item by the “science nerds” trying to get to the bottom of her statement and had my curiosity tweaked (not difficult unfortunatly) by the “distilled water is acidic” statement… so off i went to the web site that claimed it (www.ctds.info/acidic-foods.html)

    This is a quote from that site.

    *I get a lot of email from people saying distilled water is not acidic or that it is very healthy for you to drink. According to the Enviromental Protection web site, “the pH of distilled water is between 5.6 and 7″, which makes it acidic”

    The link they got the information from is www.epa.gov/airmarkets/acidrain/education/experiment1.html

    This claims that carbon dioxide from the air can dissolve in distilled water sufficient to lower the ph to 5.6.

    They totally ignore the part that say’s pure distilled water is ph 7 in favour of the bit they like.

    What i love though is the disclaimer on that site…. below is just one of the clauses

    “3. In view of the possibility of human error, neither the owner nor any other party involved in providing this Web site, warrant that the information contained therein is in every respect accurate or complete and they are not responsible nor liable for any errors or omissions that may be found in this Web site or for the results obtained from the use of such information. The entire risk as to use of this Web site is assumed by the user”

    you gotta love these people

  24. Delster said,

    October 2, 2006 at 11:34 am

    sorry… to clarify the disclaimer came from the acid foods site.

  25. Michael Harman said,

    October 2, 2006 at 12:07 pm

    The next thing is for the woos to realize that the lungs are bathed in a high concentration of carbon dioxide more than once a second, and come up with some magic formula (nasal spray, perhaps) to counteract the resulting high acidity which highly sensitive tissue is being exposed to.

  26. Dr Aust said,

    October 2, 2006 at 12:17 pm

    As we have rehashed a number of times on the forums, the “pH” of water is meaningless in this “should I drink it” context since there is little or no pH buffering.

    Consider water with a total of less than 1 mM HCO3- (bicarbonate) ions.

    You can measure a pH but the buffering is tiny, so even if it is 6.0 (acidic), who cares?

    To give a concrete example, now mix this an equal vol with a fluid containing 20 mM HCO3- (like many biological fluids, for instance saliva) with a pH of 8.0. The final pH will be close to 8.0 because the pH 8.0 fluid contains 20 X as much pH buffering (i.e. substances which tend to “hold” the pH near-constant.

    So in fluids with tiny amounts of pH buffers, you can MEASURE a pH, sure, but what is the point?

    Ans: It depends what you are doing with it.

    In terms of it falling on your garden over a period of years, or being the pH in your garden pond, it does matter.

    But in terms of DRINKING it, it doesn’t matter a stuff because everything in your body is heavily pH buffered to the alkaline side of neutral (7.3-7.4). Plus your body has a highly developed “internal acidity self-regulation” system, involving (i) buffering (ii) your lungs breathing out CO2 and (iii) your kidneys peeing out acid. Both (ii) and (iii) can be regulated to keep your “acid levels” in bounds.

    This will NOT change depending on what sort of tap water / mineral water you drink, or what sort of food you eat. Anyone who tells you otherwise is a snake-oiler, probably trying to con you into buying deionized tap water for a 5000% mark-up.

  27. jdc325 said,

    October 2, 2006 at 1:09 pm

    Didn’t somebody once obtain a PhD qualification for their family pet from the same correspondence course college as the Poo Doctor? If not, does anyone have the web address and I’ll try and get a PhD from said college for our goldfish.

  28. Weefz said,

    October 2, 2006 at 4:35 pm

    That was Dr Ben buying one of her Professional Associations. www.badscience.net/?p=131

  29. pv said,

    October 2, 2006 at 5:06 pm

    Re this disclaimer:

    “3. In view of the possibility of human error, neither the owner nor any other party involved in providing this Web site, warrant that the information contained therein is in every respect accurate or complete and they are not responsible nor liable for any errors or omissions that may be found in this Web site or for the results obtained from the use of such information. The entire risk as to use of this Web site is assumed by the user”

    I’m sure it doesn’t stand up legally. The fact they’ve written the last sentence in that way is indicative of their knowledge of the dubious nature of the site’s content, in which case it should be on the front page in big writing (e.g. Use this site at your own risk), not the last in small writing. But they don’t really want people to know, do they? Can’t think why!

  30. George_S said,

    October 2, 2006 at 8:15 pm

    I don’t think that what you eat can possibly have much to do with the acidity of your body. Everything that you swallow goes directly into a container of very strong hydrochloric acid (stomach) where it is attacked by various enzymes and surfactants as well as the acid itself. It then passes into the small intestine where it is immediately neutralized by secretions mostly from your pancreas to a basic pH (above 7) where it is further digested. When people talk about the low pH of distilled water being bad for you they don’t understand that the pH of pure water is very unstable because there is nothing in the water to buffer it so a very tiny amount of dissolved CO2 can change it, just as a very tiny amount of a basic compound will raise it above 7. An acid with a pH of 5, especially one dissolved in distilled water is an extremely weak acid and will not have any effect on ones stomach acid pH, even if you drink a lot. If I remember correctly the pH is the negative log of the H+ molar concentration of a solution. What this means is that for every pH unit change there is 10 times the concentration of H+ or acidity. So around pH 7 a change from 10-7 M (M is moles per liter) to 10-6 M (neutral to acid) requires 1 microgram of H+. (not very much)(1mole of H+ is 1 gram) per liter of water.

  31. George_S said,

    October 2, 2006 at 8:52 pm

    A few more things, after thinking about it a bit:
    I just checked with a pH meter freshly calibrated with pH 7.00 buffer and our muicipal water is pH 7.7, our reverse osmosis water is pH 6.3 (a lot bottled water is reverse osmosis purified) and our high purity deionized water is pH 5.6. I think your stomach acid is 1M hydrochloric acid so its pH would be 0 thus making it a million (10 exponent 6) times more acidic than distilled water with a pH of 6. If you drink water or anything with a pH above 0 the only possible effect would be to increase the pH of your already really acidic stomach immeasurably. I don’t think anyone can drink anything that would increase the acidity of their stomach.

  32. amoebic vodka said,

    October 2, 2006 at 9:57 pm

    2M hydrochloric acid would do the trick.

  33. Ben Goldacre said,

    October 3, 2006 at 12:17 am

    i’m absolutely gutted i didn’t spot that gem from private eye/mps reports myself, nice one.

    “Didn’t somebody once obtain a PhD qualification for their family pet from the same correspondence course college as the Poo Doctor? If not, does anyone have the web address and I’ll try and get a PhD from said college for our goldfish.”

    it’s unaccredited, but you still have to do a course/dissy etc, so if your goldfish gets one i totally want to meet and study your goldfish. there’s lots of stuff on accreditation around, although i wouldn’t recommend it as light reading, somebody mentioned the wiki page on “school accreditation” was okay recently (I’m wiki-dubious) if you’re interested.

    to be honest i think the qualifications are a bit of a red herring, it’s all about the ideas, and on that, i am absolutely loving the chat on metabolic and respiratory acidoses that has started spilling over onto here. shall i post some arterial blood gas questions so we can do patient management problems on them together?

    A patient is admitted to ICU with the following lab values:

    BLOOD GASES

    pH: 7.40
    PCO2: 38
    HCO3: 24
    PO2: 72

    U&E:

    Na: 149
    K: 3.8
    Cl: 100
    CO2: 24
    BUN: 110
    Creatinine: 8.7

    Urea 39.2
    Creatinine 769
    (apols for weird US units beforehand)

    What is(are) the acid-base disorder(s)?

    etc

    ABG’s are the work of satan.

  34. David Mingay said,

    October 3, 2006 at 1:38 am

    Turns out the bass part for Barber is pretty easy (two-thirds of it is tacet) so I’d plenty of time to email Dr McKeith about Goji/Wolf berries thus:

    Dear Dr McKeith,

    I am interested in healthier eating and was recommended to look at your website.

    I was attracted by the benefits you mention of eating Goji berries, but being a cautious person, thought I’d do a little bit of research before committing myself.

    You say that the berries were “discovered in the Himalayan mountains” and that “this sacred berry is so cherished by Tibetan monks that they traditionally honour it for a two week celebration at the end of every year”.

    However, an on-line encylopaedia says this: “The name Tibetan Goji berry is in common use in the health food market for berries from [the Wolfberry] plant that are claimed to have been grown in the Himalaya region. Tibet as a significant wolfberry source is almost certainly a myth, however, as it is an unlikely region for commercial supplies of berries of any kind. The Tibetan Plateau is more than 10,000 ft altitude with poor soil and climate conditions unfavorable for fruit crops. Year-round cold temperatures and frost would inhibit bud development and prevent fruit formation…There are no objective commercial, scientific, or government reports on wolfberries from Tibet, whereas reports on wolfberries from the Xinjiang Uyghur Autonomous Region and the Ningxia Hui Autonomous Region of north-central China [thousands of miles from Tibet]….The berry has been eaten locally in Asia for centuries and is celebrated in an annual festival held in Ningxia.”

    Now I’m not sure what to believe. Can you clarify things for me, please?

    The “Doctor” was obviously too busy slagging off fat people to reply herself, but here’s the reply I got from one of her minions:

    Hi David

    Thanks for your interest in the goji berries. They are certainly grown in various parts of Asia and, as you say, are a celebrated fruit.

    They contain 19 amino acids and are rich in trace minerals including zinc, iron, calcium, copper, germanium, selenium and phosphorus. They are also one of the richest sources of carotenoids. Weight for weight, Goji berries contain 500 times more vitamin C than an orange. They also contain B vitamins, iron and vitamin E. On top of all that they are delicious so why not try them?

    Best wishes
    Josie
    McKeith Research Ltd

    So that’s all pretty clear then…

  35. Symball said,

    October 3, 2006 at 10:53 am

    you might have them now david- give it a couple of weeks for them to correct their mistakes. if they don’t you can report them to trading standards and use your e-mail as proof that they haven’t just made a mistake, but are deliberately misleading the public.

  36. Dr Aust said,

    October 3, 2006 at 12:37 pm

    - units for creatinine?

  37. Tessa K said,

    October 3, 2006 at 12:51 pm

    Trinny and Susanna are pretty bossy but they are never horrible about the person’s body shape and, let’s face it, most women would put up with a bit of bossing for a grand’s worth of clothes free. No one is forced to go on their show. And it is only about clothes. Those other two who clean people’s houses are bossy too. The English seem to have a love-hate relationship with women like this.

    But this same mentality leads people to be suckered in by others who are less harmless. Teeth McKeith is not bossy (which is mostly a word used to describe women with strong opinions), she is a bully. There’s that American soldier who shouts at people on Celeb Fat Camp too.

    What interest me is the psychology of her show – why do people respond to bullying? What is it in our nature that needs someone to humiliate us before we change our lives? Why would a real doctor with real qualifications giving someone a reasonable warning about their health not work?

    People fall for her garbage science because they don’t understand the real thing. But why do they fall for her?

  38. David Mingay said,

    October 3, 2006 at 1:04 pm

    Symball: Thank you – I hadn’t thought of that, but that’s exactly what I’ll do.

  39. Dr Aust said,

    October 3, 2006 at 3:49 pm

    “shall i post some arterial blood gas questions so we can do patient management problems on them together?”

    Assume this was cruel irony.

    Mean one as the ABGs are ostensibly “normal” apart from the low oyxgen.

    How about: severely dehydrated (high blood [Na]), therefore kidneys suffering ‘cos not getting enough blood (BUN etc high), plus not enough blood flow thru’ lungs so blood oxygen is low, but hyperventilating to get rid of CO2, so other blood gases look normal?

  40. Ben Goldacre said,

    October 3, 2006 at 4:56 pm

    what about the anion gap? this is an entirely mischievous cryptic one by the way. I got really into abg brain teasers for about a day five years ago, pleasingly mathematical, it didn’t last…

  41. Dr Aust said,

    October 3, 2006 at 5:22 pm

    I computed the anion gap as (149+4)-(100+24) = 29 so no overwhelming evidence for unmeasured anions…

  42. terry hamblin said,

    October 3, 2006 at 8:27 pm

    I suggest someone puts Rogue Traders on to her.

  43. Ben Goldacre said,

    October 3, 2006 at 8:33 pm

    i suggest someone asks her how a metabolic acidosis and a metabolic alkalosis can coexist in the question from #33.

  44. Robert Carnegie said,

    October 4, 2006 at 1:53 am

    Tibetan monks, now what does that remind me of… Terry Pratchett’s street hawker, “Cut-Me-Own-Throat” Dibbler, selling bottles of dragon repellent or whatever is called for this week, made by an order of monks to a secret recipe, yours for a pony and that’s cutting me own throat…

    At the end of the book in question I think we see two monks loading a donkey with bottles and one is like, “Lobsang, do you ever wonder what he does with the stuff…”

    At least the product of Buckfast Abbey has a demonstratable effect… and I think young Scots (in this particular area) drink it because it’s sweet. And the other thing too, but sweetness is Buckfast’s selling point. Alcopop in party size.

    By the way, never mind quibbling “Gillian McKeech, dietitian”, what about the “no-nonsense” part???

  45. jdc325 said,

    October 4, 2006 at 8:12 am

    The Observer’s TV guide this week has a preview describing a certain channel 4 programme as follows:
    “Faintly unpleasant diet doctor Gillian McKeith attempts to help a binge drinker by bullying him mercilessly”.

  46. Silverfin said,

    October 4, 2006 at 10:55 am

    Anyone else slightly put off by Ms McKeith’s underlying implication that reproducing (getting married first, of course) is the most important thing said daughter will achieve in her life?

  47. Dr Aust said,

    October 4, 2006 at 12:14 pm

    Did you get the numbers for creatinine and BUN back to front in the acid-base teaser, Ben?

    110 (mg/dL) for creatinine
    8.7 (mM) for urea

    .. would look more “plausible”, both in normal range

  48. jdc325 said,

    October 4, 2006 at 1:54 pm

    Re #19 and #34 –
    Check out www.tibetauthentic.com for info on Goji berries.

    According to their booklet:
    “Tibet Authentic Pty Ltd is the exclusive global distributor to the western world of the Tibetan Medical College (part owned by the government of Tibet). Tibet Authentic works closely with the Tibetan Medical college, the government of Tibet and the people of Tibet to bring to the western world Tibet’s most beneficial, valuable products and ancient secrets”.

    I have been asked to look into the health benefits of Goji berries and was able to summarise the benefits in one sentence “I have been able to find absolutely zero good scientific evidence regarding the benefits of Goji berries”. This news was not well received.

  49. billgibson said,

    October 4, 2006 at 6:51 pm

    If I’ve translated the values correctly (have you gone all American on us Ben?) then this patient has both a metabolic acidosis and metabolic alkalosis, with a low-ish chloride and a raised urea. This would fit with renal failure (hence met. acidosis), and vomiting (losing HCl).

    Tough one though…

    Bill

  50. Ben Goldacre said,

    October 4, 2006 at 6:56 pm

    yeah sorry about the loopy american BUN and units stuff, i meant to translate but didnt get the chance, no computer at work etc. i think for a while ABG pro only worked in funny US units (excellent program for calculating stuff from ABGs if you go through a one day period of being interested by them).

    anyway, yup, absolutely correct, a mixed metabolic acidosis from renal failure and an alkalosis from vomming, giving a weirdly unweird pH etc. fly moves dr gibson and apols dr aust about the confusing units..

  51. billgibson said,

    October 4, 2006 at 7:08 pm

    As we’re all serious scientists and dedicated to advancing our knowledge, you may all like to know the SI equivalents are Urea 39.2, Creanine 769.

    Conversion is urea 1 mg/dl = 0.357 mmol/l, Creatnine 1mg/dl = 88.4 micromol/l

    I think I deserve bonus points because I worked it out having never had an Omega 3 Fish Oil capsule in my life. If only I’d gone to school in Durham….

    Bill

  52. Dr Aust said,

    October 4, 2006 at 10:08 pm

    Of course, one of the things the problem highlights is that the interpretation benefits from other seemingly basic info… like “had barfed repeatedly”… or “had not passed urine for n hrs”.

    This is an interesting point WRT the med students I teach, BTW – they love NUMBERS and TESTS and, at least when interpreting their “paper case scenarios”, tend to largely neglect more mundane “observations”.

    On a more acid-base theme, becoming alkalotic by losing acid (vomiting) or acidotic by losing HCO3- (eg cholera) are also concepts students tend to find tricky to grasp.

    I guess the thing this discussion shows wot we can ALL agree on is that acids and bases in yer body is a flddly business, about which G McTeeth knows F all squared.

    Still on acids and bases: A medical Q for the MBChB gang: is it REALLY possible to acid-load yourself significantly by eating anything FOOD related (cf all the bleatings of the Alt nutrition lobby about “food acidity”?)

    ..And I mean a food food, not necking 100 grammes of Ammonium Chloride or something like that. Could you really give yourself a metabolic acidosis by eating loads of lemons? And how many would you have to eat in what time frame?

  53. billgibson said,

    October 4, 2006 at 10:18 pm

    You can make yourself hypertensive and hypokalaemic by eating liquourice allsorts.

    I doubt very much that you’d be able to significantly alter your acid/base balance with any food though – the body has some really amazing ways of correcting for a disturbance, and when they go wrong it’s fairly serious. Anyone we see on the wards with any degree of acidosis makes us run round shouting STAT! and things like that. We don’t need to, but it’s fun.

    Seriously, though, any food sufficiently acidic to mess about woth your pH would make you feel very ill and vomit. Evolution is fucking brilliant like that.

    Bill

  54. Dr Aust said,

    October 4, 2006 at 11:33 pm

    Thanks Bill, that’s what I thought – and Mrs Dr Aust, formerly a battle-hardened med reg, couldn’t think of any either. But good to hear others say it too.

    Any chance we could persuade Dr McT to have the juice from a kilo of lemons instilled into her stomach via multi-barrel cannula, with repeat blood gas analysis and online stomach pH measurement?

    Now that’s something I would set the HDrecorder for.

  55. David Mingay said,

    October 5, 2006 at 1:28 am

    Re #48. When they say the government of Tibet, they mean the government-in-exile of Tibet; in other words some monks living over the border in India (I sympathise with them politically but not medically). When they say the Tibetan Medical college, they mean the Tibetan Medical and Astrological college, which was set up by said monks to study horoscopes and dish out useless herbs.

    The real (Chinese-run) government in Tibet provides an appalling medical service which discriminates against Tibetans. If idiots in the West gave their surplus cash to helping proper medicine in Tibet rather than frittering it away on wolfberries, the world would be a better place.

  56. Ben Goldacre said,

    October 5, 2006 at 3:21 am

    a genuinely serious academic once emailed me once suggesting that eating acidic foods could deplete the calcium salts in your bones as they are used as a buffer. it was one of those situations where i frankly couldn’t be bothered to to look into it any further as it sounded a bit unlikely and i wasn;t that bothered either way, but if there are any renal physicians/clinicalbiochemists etc out there who know… incidentally, dr aust mentioned that his wife used to be a medical reg. i should point out for those who don’t know that they are the hardest cleverest people in the world.

  57. Dr Aust said,

    October 5, 2006 at 2:45 pm

    We (me and Mrs Dr Aust, aka “The Doc”) had a think about this and the most “test case” scenario we could come up with was the very rare people with specific (mostly genetic) defects of kidney acid secretion (renal tubular acidosis), who are actually given oral sodium bicarb.

    Since they can’t excrete “metabolic acid” properly, and actually need to take oral alkali to “mop up” the metabolic acid, you would think they would be the absolute test case of people who would need to avoid “acidic foods”.

    However, as far as I have been able to find out there is no hint these people are told to avoid “acid foods”. One US pediatric site with info on R Tubular Acidosis specifically said “diet changes to avoid acid foods don’t make any difference”.

    – Implication being that the metabolic acid produced by your body going about its work is quantitatively more important than any acid in the foods you eat. reminds me a bit of dietary vs. “body-made” cholesterol.

    The Doc stresses that people with these renal acid handling defects are v. rare – says she never saw one in 8+ yrs of hospital medicine, including a spell as a renal SHO (but had to learn all the syndromes periodically for exams…!).

    Having said all the above, I HAVE dug up a learned opinion article in JASN (Journal of the American Soc Nephrol) which does argue that people should eat “alkaline foods”:

    jasn.asnjournals.org/cgi/content/full/13/8/2186

    [Ben - this paper also alludes to the evidence your email correspondent was probably talking about re acidity and bones, see their refs 34-36. ]

    But…! …it turns out that eating alkaline foods equals – wait for it –

    “increased dietary intake of fruits and vegetables ”

    …hooray! Six portions of fruit and veg…again!

    – I always like it when learned high-powered science turns out to support simple common-sense everyone-already-knews-this diet advice (“eat properly” – see above) rather than the obscurantist Boggleberry-bollocks of the alt “nutritionist” gang.

  58. Jeremy Zeid said,

    October 7, 2006 at 2:49 am

    Look, let’s forget the niceties, the woman is a QUACK., pure and simple.

    As for that cobblers abouit chlorophyll and that absolute tosh regarding Hydrogen ions… Does nobody check out this rubbish prior to transmission?

    And why do people like this get away with it?? Because we let them, we are so eager to be told what to do. certainty in an uncertain world.

    Carry this microchip, you’ll “be safe”. Give us your fingerprints for your “security”. take this pill to make your mind “right”. Give us your DNA, “just in case”. And the best laugh…. Look at your poo, it’s the wrong colour and texture, you’re gonna DIE….. QUACKERY pure and simple, worse it’s legal accepted quackery. certainty in an uncertain “war on terror” world.

  59. Jeremy Zeid said,

    October 7, 2006 at 10:17 am

    I wish I could coin it by making people examine their own crap. As for the TV companies that actually make a programme examining shit, AND it gets decent ratings… All I know is that the fox that crapped in my driveway yesterday was not eating enough fruit and vegetables… Like it or not, there is big money to be made from the gullible, the insecure and those who just love to be in on a fad. No wonder I have an overdraft….

  60. Mat Tautou said,

    December 12, 2006 at 12:59 pm

    Good Old Dr Poo! She was trying to find ways in to Suma Wholefoods, one of the Uk biggest whole foods suppliers (and the largest European worker’s collective) not too long back.

    I’m reliably informed that dear Gillian’s vanity is as fragile as her right to her title. Whilst admirers are allowed to gaze upon her fair form, contractual obligation, no less, states that her age must never be questioned…

    Please note how I refrain from making the Dr Poo in her Turdis joke…

  61. funkyfarmacist said,

    November 25, 2008 at 2:31 pm

    Does she use the Bristol poo scale in her work?

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