03 Oct 2022

Doctor criticises Happy Pear video for promoting health advice she claims is 'not true'

Doctor criticises Happy Pear video for promoting health advice she claims is 'not true'

Plant-based duo the Happy Pear have come under fire for information posted in a recent video promoting an upcoming podcast with a women's health expert. 

The controversy arose this week when the video by brothers Stephen and David Flynn suggested eating well - specifically eating mushrooms and two to three servings of soy foods a day - can reduce the risk of breast cancer. 

Breast surgeon and breast cancer survivor Dr Liz O'Riordain called the pair out on social media, stating, "Don’t believe everything you see. This video by The Happy Pear says that mushrooms reduce your risk of getting breast cancer. This is NOT true." 

A science writer and cancer researcher, Dr David Robert Grimes, also took issue with the information presented in the video, stating on Twitter that the advice "needlessly shames patients". 

He said, "Diet and cancer is complicated, and modifiable risk from diet less than you might think. Not helpful when wellness "influencers" like Happy Pear implicitly blame breast cancer on diet, needlessly shames patients." 

Hundreds of Twitter users also expressed ire about the video's content, with one user saying, "Boundaries around giving medical information are needed. Stick to the yummy curries!" 

Another said, "This made me SO ANGRY this morning when I saw it. This casual misinformation is incredibly dangerous and upsetting. Thanks so much Liz for calling it out." 

The Flynns' upcoming podcast will feature gynaecologist and women's health expert Dr Nitu Bajekal, with a focus on Dr Bajekal's writing of the first university plant-based nutrition course in the UK. 

The duo posted on social media today (Sunday April 24) to state: "We posted a video recently about breast cancer and a number of people got upset and we just that was never our intention and we're really sorry for upsetting anyone." 

Earlier this week, Dr Grimes filmed a video expanding on his criticism, stating, "We need to stop blaming people for incidences of cancer. Cancer is not a moral failing, it is a disease and it's not because you did anything wrong if you've got it." 

In it, he breaks down some of the points made in the Happy Pear's initial video. 

The Happy Pear video begins with: "One in seven women in the UK and other high income countries will get a diagnosis of breast cancer in their lifetime versus one in 1 in 100 in Hong Kong versus 1 in 1000 in China." 

Dr Grimes said comparing two groups without correcting for all other factors is "an ecological fallacy". 

He said, "In this case these are being compared naively which makes absolutely no sense. Cancer for example is primarily a disease of ageing. A woman in her 60s has about a hundred times the breast cancer risk of a woman in her 20s so comparing populations without without standardisation and cross-comparison doesn't make any sense." 

According to him, the one in seven figure quoted in the video is "at best extremely wrong". 

"That's talking about cumulative incidence, that's not diagnosis, that is incidence. If you live long enough you will start to develop cancer. Cancer is the accumulation of mutations. 

"If you on an autopsy table look at someone in their 90s, if they're a woman they'll have the beginnings of breast cancer. If they're a man they'll have the beginnings of prostate cancer, at the very least. This is a consequence of ageing." 

He called the comparison "irresponsible and wrong". 

The Happy Pear video suggested some of the possible risk factors for breast cancer include excessive saturated fat intake, excessive dairy products and excessive animal products intake. 

Dr Grimes called this "the kind of nonsense that I really despise." 

He said, "Firstly, the evidence based on dairy and breast cancer is incredibly inconsistent and mainly spurious. There are studies that find drinking milk and eating cheese decrease your breast cancer risk, there are some that found it might increase it.

"Overall, it's noise, there is no consistent literature making a confident assertion like this because the results and the effects are probably very very little and that's why we're seeing a lot of noise around it. If any effect exists at all." 

However, a recent study in the International Journal of Epidemiology found that even relatively moderate amounts of dairy milk consumption can increase women's risk of breast cancer. 

Dietary intakes of nearly 53,000 North American women were evaluated for the observational study, all of whom were initially free of cancer and were followed for nearly eight years. 

First author of the paper, Gary E Fraser, stated, "Consuming as little as 1/4 to 1/3 cup of dairy milk per day was associated with an increased risk of breast cancer of 30%." 

"Dairy foods, especially milk, were associated with increased risk, and the data predicted a marked reduction in risk associated with substituting soymilk for dairy milk. This raises the possibility that dairy-alternate milks may be an optimal choice." 

According to the authors, the results suggest an "urgent need" for further research. 

Dr Grimes said, "That goes the same for meat. There are some that find that red meat might slightly increase risk, there's other studies that find eating poultry and chicken products decrease your breast cancer risk, and again you're dancing on the edge of significance, you're dancing on the end of spurious things. 

"A confident statement about this is just wrong." 

According to the Sister Study, a comprehensive US study with over 42,000 participants, increasing consumption of red meat was found to be associated with increased risk of invasive breast cancer. 

Dr Grimes continued: "Again the dietary fats hypothesis, which is much beloved of a lot of cranks, has been pretty much shown to be incredibly weak for many many years and widely considered refuted." 

The Happy Pear video suggested several things to reduce breast cancer risk, including aiming for a healthy body weight, eating a mostly whole foods plant-based diet, aiming for eight to thirteen portions of fruit and vegetables a day, reducing alcohol consumption, avoiding smoking, and moving regularly. 

Dr Grimes said, "I often find when you're dealing with what some authors call nutribollocks that you often get good advice sprinkled with absolute nonsense. So it is absolutely true there is a link between obesity and breast cancer, and all cancers, indeed. And there's a lot of different reasons for that I've written on before. 

"But it involves mainly having excess fat cells which have their own problems, and also the hormonal signalling that can cause. But the idea you suddenly have to eat a plant-based diet to avoid this is not evidence-based. That's just wrong. So keeping a healthy body weight, that's great, fantastic. We should all strive for that for a variety of reasons. 

"To say that you need to eat soy products all the time, that is not supported by the evidence whatsoever. There is very limited data to support that kind of contention, and particularly giving frequencies like two to three times per day, that is nonsense." 

Dr Grimes agreed a reduction in smoking is "probably one of the biggest things you can do to reduce your cancer risk" as well as keeping active. 

The Happy Pear video goes on to recommend eating mushrooms, which they claim reduces the risk of breast cancer. 

Dr Grimes said, "The thing about the mushrooms I find a bit strange. I assume they're basing that confident assertion off studies like [Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women by Min Xhang et al] because there's very limited data on this.

"And that's a problem, because limited data in medicine is not how you make good policy decisions or good medical decisions." 

He goes on to list some of the flaws he found with the paper, including what he claims is a reporting bias. 

The paper by Min Xhang et al quoted by Dr Grimes details a case-control study conducted in China with 1,009 women with histologically confirmed breast cancer, and the same number of healthy women. 

It concluded that higher dietary intake of mushrooms decreased breast cancer risk in pre and postmenopausal Chinese women, and an additional decreased risk of breast cancer from a joint effect of mushrooms and green tea was also observed. 

According to the researchers, more research is warranted to examine the effects of dietary mushrooms on breast cancer. 

However, Dr Grimes said the idea that people are responsible for their cancer is a "pet hate" of his. 

He said, "But one of my pet hates about this is the idea that you're responsible for your cancer that you can just eat a healthy diet or and do this or do that and you're not going to get cancer. That is nonsense. Cancer is mainly a disease of stochasticity, it has a huge random element. 

"You can do everything 'right' and still get cancer, or you can have the least healthy lifestyle in the world and never get cancer. Your modifiable risk for breast cancer is the amount of risk that you can control by doing everything right or wrong is about 30%. 

"That means 70% is just down to luck." 

Although he said there are "loads of things we can do to kind of control our risk", he also said there are many factors in breast cancer that are "hereditary or hormonal or societal that we cannot control". 

He said, "And I think it shames people unnecessarily, it makes food a moral thing too. 

"It's like 'Ooh if you eat the good food you'll be fine' and 'You eat the bad food, you kind of deserve it', and you would be surprised by the amount of patients I have talked to that have struggled with guilt over thinking that they're responsible for their cancer when they are not. And I know this may be a reassuring comfort [sic] to people, thinking 'Oh if I just eat blank then I won't get cancer'. Well, you're wrong. And it's not helpful. 

"So I think this kind of stuff, what may be well-intentioned is really irresponsible and that people who are essentially making their career hawking lifestyle foods should maybe think a little bit more or be a bit more responsible before they [sic] this kind of stuff. Because it's not a fair burden to put on people." 

Medical doctor, Dr Alan Desmond, defended the Flynns on Twitter, stating: "This weekend my friends were criticised for sharing diet and lifestyle tips to reduce the risk of breast cancer. But they were right!" 

He went on to say: "The WCRF Cancer Prevention Recommendations are based on a scientific evidence: Maintain a healthy body weight; be physically active; make wholegrains, vegetables, fruits and beans a major part of your diet; avoid fast food, red & processed meat, alcohol and sugary drinks." 

According to Dr Desmond, no diet or lifestyle change can make humans "disease proof" but well-informed choices can reduce risk. 

He said, "There is no diet or lifestyle change that can make humans “disease proof”, but well-informed choices can certainly reduce our risk. This is true for many of the chronic illnesses that have become the norm in high income countries like Ireland, and it is true for many cancers. 

"Dr David Grimes’ widely-publicised criticism of Stephen and David Flynn, coupled with his assertion that 'if you had the healthiest lifestyle in the world, cancer is just cancer', is not based on the existing scientific consensus." 

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