Could Carbs be Killing your Brain?

Media Item: Aired on ABC7 Chicago, October 18, 2014

The zeitgeist of health has been marked by diet regimes. Society continues to turn to healthier eating for appearance, longevity and namely health benefits. With this, comes stockades of incoming and outgoing fad diets promising a ‘new improved you.’ It seems that diets are growing and spreading from not only, the number one contrivance against obesity, but to an array of less obvious health benefits. Specifically, we now have a market for ‘neuro-benefiting’ diets. One such diet has been popularised in the news media by Dr David Perlmutter, a neurologist, and so we have examined an ABC7 Chicago (2014) news segment where he made an appearance to promote his position.

In the segment, Perlmutter attacks conventional dietary wisdom with theatrical iconoclasm, arguing that campaigns against saturated fat have "absolutely no scientific merit", and contending that a carbohydrate-rich diet is "...a totally foreign diet for humans, we've never had carbohydrates like this in our diet." This resonates with existing fad diet narratives demonising grains, like the dubious non-coeliac gluten sensitivity movement, the high-protein high-fat Atkins diet, and the "Paleo diet." Perlmutter uses pseudo-evolutionary justification for the claims, maintaining humans have not adapted to the quantities of carbohydrates now present in the average diet.

An official promotional advertisement for Perlmutter's book, demonstrating its wide media coverage and commercial success. Source: http://www.drperlmutter.com/

Start of annotationAl KingProvided explicit description of the Grain Brain hypothesis and illustrative image, per peer feedback.End of annotationThe main thread of Perlmutter's claims, as presented in the media and his book Grain Brain, is that carbohydrate rich diets are disease-causing; that they contribute to obesity, fatigue, and neurological disorders such as dementia. This contention will be referred to as 'Grain Brain hypothesis'. The associated book has become a New York Times bestseller, and so the claim warrants particular scrutiny.

His media savvy alone cannot justify or condemn these claims, so we have chosen to consider the evidence and proposed mechanisms for a carbohydrate-dementia brain health link. Are Dr Perlmutter's claims defensible with the current state of scientific evidence? And have the media given due coverage to contrary claims? We will first define what dementia is, and briefly mention possible causes. We will weigh up the evidence from scientific journals and discuss social and ethical implications of treating dementia with a diet, and then analyse the accuracy of claims made by the media and Dr Perlmutter.

Dementia is a neurocognitive disorder characterised by a persisting decline in mental processes including memory and cognition, so much so, that it interferes with an individual’s ability to perform everyday activities (American Psychiatric Association, 2003). It includes Alzheimer’s disease (AD) which accounts for 60 to 80% of dementia cases. Approximately 35 million people are diagnosed with AD (Figure 1) and these numbers are expected to reach 60 million by 2030 (alz.org, 2015; Glazer et al., 2014)

Start of annotationMelissa RifkinAdding a number of visual stimuli to support content as per review feedback. End of annotationFigure 1: Comparison of brain volume between a healthy brain and an advanced Alzheimer's brain. Notice that AD causes major atrophy (cell death) in the brain. ("Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging"). Notice that AD causes major atrophy (cell death) in the brain https://commons.wikimedia.org/wiki/File:Alzheimer%27s_disease_brain_comparison.jpg

Multiple factors can cause or predispose someone to dementia. Research is still being done in these areas, hence the following lists of causes and risk factors is not exhaustive, yet the Alzheimer’s Association (alz.org, 2015) have indicated the following as causes of dementia:

• Traumatic brain injury
• Infections and immune disorders
• Metabolic / endocrine abnormalities
• Nutritional deficiencies (mainly Thiamine, and B-vitamins)
• Hypoxia

The following are predisposing risk factors for dementia:

• Alcoholism
• Atherosclerosis (plaque build-up in arteries)
• High or low blood pressure
• High cholesterol
• Depression
• Diabetes
• High oestrogen levels
• Obesity
• Smoking

Source: http://calorielab.com/news/2013/09/12/a-mediterranean-diet-might-be-beneficial-to-your-brain/

Pharmacological treatments thus far have been unsuccessful in treating or delaying dementia, they merely mask symptoms (alz.org, 2015). Research has therefore broadened to using dietary changes as an approach to prevent neurological disorders, coining the phrase ‘neuro-benefitting diets.’

The media item, “Could Carbs be Killing Your Brain?” addresses several points, all relating to the risks of an over-consumption of sugar and carbohydrates in the modern day diet. The main premise of the piece is that evolutionarily, humans did not consume as many carbohydrates as we do now, and the key to weight loss and prevention of neurodegenerative diseasess is to eat less of these carbohydrates and more fats.

Four main claims were presented to support this “Grain Brain” idea:

• A New England Journal of Medicine study presented claims that an increase in blood sugar increases the risk of dementia (Crane et al., 2013)
• The same study reported that Type II diabetes increases the risk of Alzheimer’s twofold
• A 350,000 person study found no link between saturated fat and heart disease or stroke. (Siri-Tarino, Sun, Hu, & Krauss, 2010)
• A study from The Mayo Clinic (Roberts et al., 2012) claims that low carb/high fat diets in the elderly reduced the risk of dementia by 42%

Through taking a closer look at the research papers’ claims, we shall deduce whether the title Start of annotationCarmen HungerfordI deleted the initial wording "carbohydrates are killing our brains" and replaced it with "could carbs be killing your brain". It was mentioned in the review comments that there was confusion of the title. End of annotation'could carbs be killing your brain', is a justified claim.

A study published in the New England Journal of Medicine (Crane et al., 2013) investigated whether glucose levels in blood is associated with the risk of developing dementia in participants diagnosed with diabetes and those that were not. The blood work of 2067 participants from an earlier study taken at several points over 5 years was analysed for glucose and/or glycated haemoglobin and compared to incidence and severity of dementia in participants, which was determined by a Cognitive Abilities Screening test. This questionnaire is designed to determine the type and severity of dementia in a patient on a 0-100 point scale, where lower scores indicates more severe dementia. In this study the participants that scored below 85 were given further clinical and neurophysiological tests.

The study found that higher levels of glucose in blood correlated with a higher incidence of dementia. As mechanisms for this, they propose insulin resistance and microvascular disease of the central nervous system, but the study concludes that this mechanism and correlation needs to be clarified in future studies. The authors concede confounding factors may have affected the results, such as the flaws of self-report questionnaires, potential differences between ethnic groups and under-diagnosis of diabetes in the study pool. This study supports a correlation between increased glucose levels in the blood and increased incidence of dementia but cannot by itself be cited as proof that carbohydrates cause of dementia.

Perlmutter refers to a meta-analysis by Siri-Tarino et al. (2010) of 21 epidemiological cohort studies, involving over 350,000 people, that investigated the associated risk of dietary saturated fats with cardiovascular diseases (CVD). The review concludes that the analysis of the studies showed no associated risk with CVD, although they mention some other cohort studies that show an associated link between the ratio of saturated to polyunsaturated fats. The authors also speculate that the glycemic index of dietary carbohydrates is linked to some CVD. Again large drawbacks in self-reporting of diet and exercise levels may contribute to confounding factors

Another study the Start of annotationCarmen HungerfordOK, I changed it to be all-encompassing, since we were unable to find, with 100% certainty, who made the reference.End of annotationmedia piece references to substantiate the “Grain Brain” argument Start of annotationMelissa RifkinAre we certain that Perlmutter cites these claims? I could be wrong but I've made reference to the fact that the journalist cites these studies to substantiate Perlmutter's claims... Thoughts? Two different things.End of annotationis a study conducted by the Mayo Clinic, (Roberts et al., 2012). This research was an observational Start of annotationCarmen HungerfordDeleted "correlational" as per review comments. It was an observational study; it shows correlations.End of annotationstudy of 937 elderly people (between 70 - 89 years of age) from Olmsted County, Minnesota, USA, over a period of approximately 3.7 years. Participants were initially assessed for mild cognitive impairment (MCI) or dementia and every 15 months following the baseline test underwent a series of examinations, including an interview, a neurological evaluation, cognitive testing, and a self-report questionnaire on their daily food habits over the past 12 months. After testing for associations between the percentage of macronutrients (carbohydrates, proteins, fats) consumed and the occurrence of MCI or dementia, the researchers concluded “A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons.” It was also found that those who consumed the greatest percentage of carbohydrates in their diet doubled the risk of being diagnosed with MCI or dementia, with those consuming more fat and protein reducing their risk. A multivariable analysis resulted in a significant association between carbohydrates and MCI or dementia.

The above results can be seen to support the Grain Brain hypothesis, particularly if other considerations are not taken into account. In the discussion section of the paper, Roberts et al., (2012) suggest many alternate explanations for such results. One such idea is that participants who consumed a high percentage of carbohydrates did so at the expense of fats and proteins, which have important roles in brain maintenance. It therefore could be argued that it is not the large quantity of carbohydrates consumed, but the low level of healthy fats and proteins which appeared to have affected brain function. Start of annotationCarmen HungerfordI deleted a couple of sentences because, after review, they didn't seem neuroscientifically relevant - they were more about the study design.End of annotation

High fat/low carb diets are not the only ‘neuro-benefiting diets’ peddling the medical research arena. A very different diet, which claims the same benefits of minimising cognitive decline and lowering risks of developing dementia is the Mediterranean diet. A systematic review by Lourida, et al (2013) was conducted into lowering risks to cognitive decline by way of consuming this diet which includes fruits, vegetables, legumes and wholegrains, with moderate consumption of oily fish and dairy, and low in meat, sugar and saturated fat (Mayo Clinic, 2013). Adherence to a Mediterranean diet consistently correlated with lower cognitive decline and a reduced risk of AD in nine out of twelve studies overall (Lourida et al, 2013). Though most of these studies were observational, the pattern was consistent.

Both the high fat/low carb diet and the Mediterranean diet have provided evidence for lowering AD risks, yet both promote opposite eating plans. It seems problematic to arrive at the conclusion that a person's diet is a contributing factor in preventing dementia. Furthermore, the lack of causal relationship through experimental manipulation confounds the findings of both diet regimes.

The most recent research in ‘neuro-benefitting diets’ have implicated docosahexaenoic acid (DHA), as an important dementia preventing nutritive ordnance as it appears to slow the pathogenesis of AD (Cole & Frautschy, 2010). Yet, beyond vitamin deficiencies in the B vitamins (Wang et al 2001) and introducing DHA into a diet, it becomes unclear to deduce the better ‘neuro-benefiting diet.’

To claim either diet can prevent dementia is precarious and raises ethical implications when crooned to the public as being an unquestionable preventative measure. AD currently affects 35 million people worldwide, and while alternative treatments should be made available, it should be done so with solemn sobriety. It is the scientific community’s position to give paramount solutions and treatment therapies, and more causal based research is clearly needed in both diets to confirm their preventive neurodegenerative mechanisms. Encouraging a high fat/ low carb diet to improve cognitive function as scientifically valid to the public with no causal evidence, is ethically and socially irresponsible. If people switch to a high fat diet to avoid getting dementia, a possible result may include a rise in CVD, stroke and obesity (World Heart Federation, 2015). Such an event may labour already strained health systems and shorten life expectancies. Further research should be conducted which includes experimental manipulation to justify grandiose claims that grains could be killing our brains.

Source: https://liveto110.com/less-grains-more-brains/

‘Could carbs be killing your brain?’ is a segment that aired on ABC7 Chicago, October 18, 2014. ABC7 is an ABC owned and operated television station, located in Chicago, Illinois, USA. The station presents local news in an ‘eyewitness news’ format and claims to be “the most watched television station in Chicago” . A Google search has it placed in the top three search results when searching ‘breaking news Chicago’, further emphasising it’s presence and the role that it plays as a go-to news source in the Chicago region. It is safe to say that the segment is not aimed at a specific target audience, but rather it has wide appeal across a broader spectrum of the Chicago population. Given the prevalence of fad diets, and the rising rate of both obesity and neurodegenerative disease amongst an ageing population, we assume that this piece would be of interest to the average ABC7 viewer but that they would have a limited understanding of the science underpinning the views presented in the segment.Start of annotationMelissa Rifkindeleting as no longer required. End of annotation

The segment’s credibility appears to be supported by the findings of Neurologist David Perlmutter, MD, FACN, author of Grain Brain, whom they cut to in an interview style approach throughout the piece. In conjunction to Dr Start of annotationMelissa Rifkinadding 'Dr' to all 'Perlmutter' references, consistent with the writing of the overall piece. End of annotationPerlmutter, the segment references three recent studies that support the claim that carbohydrates cause a blood sugar spike which increases ones risk of dementia and Alzheimer’s, as discussed in section 2.3.

Dr Perlmutter claims “history proves grains are not meant for our brains” and that “we should prevent the disease because we know how to do it right now, and it's not going to cost anything". A quick Google search of Dr Perlmutter informs us that he is a best-selling celebrity neurologist having a number of books on the New York Times best seller lists, including Grain Brain and Brain Maker, however there is also a significant amount of speculation that he has a long history of profiting from inaccurate medical advice. A credentials check also illustrates that he has not had any full-length peer-reviewed journal articles published, which in the science community is indicative of credible evidence of having undertaken research. This suggests that he may not have conducted any research of his own in the area of nutrition and neurodegenerative disease.

Whilst in isolation Start of annotationMelissa RifkinMaking a few minor edits to this paragraph in regard to flow and structure.End of annotationDr Perlmutter’s credibility could be viewed as questionable, the journalist presenting the segment uses other recent independent studies as evidence to support Dr Perlmutter’s opinions. These appear to be somewhat relevant in the current neuroscience conversation surrounding the topic. These studies are scientific, peer-reviewed journal articles that have been published in reputable journals. In terms of reporting integrity, ABC7 appear to have followed up on Dr Perlmutter’s claims as fairly as they could, using scientific research to support his claims. Nonetheless, as with most mainstream commercial journalism, ABC7 have carefully selected statistics and statements from the aforementioned studies that appear to support Dr Perlmutter's claims. However, we do not believe that the overall intention of each of the studies was to make such a generalised statement as “we can prevent Alzheimer’s by changing our diet”.

Dr Perlmutter’s lack of published research on the topic area leads us to question whether ABC7’s decision to promote his work was influenced predominantly by the opportunity to increase viewer ratings as opposed to bettering public health. It is also important to note that there was no apparent attempt to interview the authors of the cited research studies to ask them if indeed the public should be drawing the conclusion that a high fat, low carb diet can prevent Alzheimer’s, further reiterating ABC7’s intentions.

After having formed our group, we began a broad search of media items relating to neuroscience. To be honest we didn’t have a particular topic in mind nor did we have an overall search strategy that each of us implemented. We used Google and searched ‘neuroscience in the news’. We discussed a number of topic areas including yoga and its effects on the brain, a computer based game-training game that could potentially improve the lives of those with schizophrenia and finally could carbohydrates be killing your brain? We chose to further investigate the diet related media item given the constant hype and prevalence of fad diets in the media. We knew that there would be a plethora of related information but were uncertain as to the likelihood of neuroscience underpinnings by way of relevant, credible research papers.

Research to locate relevant academic articles was conducted using the UNSW library database and Google Scholar.

The starting point of our investigation involved locating the studies alluded to in the media piece. These weren't formally cited in the media piece or its partner website, but the journal titles, funding bodies and statistics cited in the media piece allowed us to locate three key articles articles Perlmutter used to support his claims.

Mention of a New England Journal of Medicine (NEJM) linking blood-glucose levels to dementia and type-II diabetes to Alzheimer's led us to the study by Crane et al. (2013); the reference to a study by the Mayo Clinic finding a 42% decrease in dementia risk for high-fat diets led us to a study by Roberts et al. (2012) investigating diet and dementia risks in the elderly through a longitudinal study; and reference to a study with "350,000 subjects" refuting a saturated-fat dementia link led us to a meta-analysis (Siri-Tarino et al., 2010) investigating the effects of saturated fats and carbohydrate diet ratios on a number of health risks including dementia, stroke, cardiovascular disease and heart disease.

The publishing journals for Perlmutter's cited articles were reputable and peer-reviewed - indeed Dr Ria Arnold referred to the NEJM as one of the best medical journals published - though, as discussed in our analysis, this is not to say that the views in the published papers were represented fully by Perlmutter.

Dementia and diet are both regarded as significant public health issues, and so public health organisations publish solid information, statistics, and recommendations for the consumption of the general public online. As such, we've made use of online information published by the World Health Organization, the Mayo Clinic, the World Heart Federation, the American Psychiatric Association and the Alzheimer's Association. These were generally located using Google where additional information was needed, and used in preference to personal websites and Wikipedia, as the findings and recommendations of professional and government-funded organisations were seen as more reliable and a better reflection of current best practices.

The feedback from peer reviewers was on the whole very positive. Most specific points for improvement - grammatical fixes, inconsistent use of the media piece title, and simplifying of sentences - were directly addressed, except where it was seen to be a matter of style (like terminating dot-points with a full-stop). The research appendix was elaborated, and section titles were added to break up the flow of the analysis.

Two recurring themes in the suggestions were a) improvement of referencing, and b) incorporation of illustrative figures. Kim dedicated himself to systematically fixing the references while the team looked for appropriate images, some to provide technical illustration - e.g. illustrating the degenerative effects of dementia on brain tissues - and others to liven the page. Google Image now incorporates a 'usage rights' feature in the advanced search options, which came in handy when finding images approved for noncommercial reuse.

Reviewers called for clarification or greater specificity regarding e.g. pharmacological treatments, the key claims of the ‘Grain Brain’ hypothesis, and recommendations regarding fat intake and cardiovascular health. Referenced clarifications were duly added.

Reviewers also made two key suggestions regarding cited articles – a perceived lack of recent studies, and a sparsity of causal studies. These are ultimately related problems – dementia’s most proximate causes haven’t been unambiguously established by the scientific community, with competing camps advocating research into different culprits, such as amyloid plaques versus tau protein tangles. This makes investigation of less direct causes, like diet, more dependent on observed correlation; and good correlational studies involve studying large numbers of subjects over long periods. As such, a 5 year old meta-analysis of studies following some 350,000 subjects represents quite a recent contribution to the scientific literature in this area. Where available, relevant studies from more recent years have been added, bearing in mind that they are representative of the path of research rather than of scientific consensus per se.

Strong points

• Well organized, logical, and coherent structure – it allowed for a balanced discussion of the accurate and inaccurate components of the article, which was woven throughout the whole wiki, though only briefly in neuroscientific context such that it did not overlap with analysis. This was strategic because it meant that you critically chose sources that were relevant to your media item.
• Format is perfect
• Clarity of expression was very well done, and all studies mentioned involved complex concepts yet were translated into simple and understandable “wiki-like” language; critical and open-minded tone
  • Discussed limitations of each study, which was important especially since most were correlational or observational
• Quantity was proportionate to the weighting of each section e.g. intro vs. context = 15% vs. 50%
• Writing could be more succinct but did present convincing statistics and points e.g. “Two very different diets presenting supportive evidence for preventing dementia seems problematic”
  • Analysis was done particularly well – argument is balanced, unbiased, and explored how simplifications affected the veracity of the message
• Quotes were meaningfully integrated
• Felt you addressed Dr Vickery’s advice quite well – focusing on the neuro aspects of the item and also agreed with him in that your media item was interesting - cultural significance
• Overall, a strong wiki as all marking criteria were addressed fairly well - great sense of team work too

Weak points

• Referencing could be more thorough and consistent
• Appendix 4.1 & evaluation of sources – It was good; transparent and realistic but a little brief
• Neuroscientific detail (to an limited extent) - specific examples and evidence e.g. specific pharmacological treatments that were, and by whom, found them ineffective
• Minor grammatical errors

General suggestions for improvement

• If possible, mention thereof (or lack of) causal studies which are potentially more valid/ reliable in nature than correlational and observational studies discussed. This may help to add more depth to your arguments (but this isn’t particularly concerning since it’s already quite persuasive)
• Also if possible, add some figures or extra diagrams - these aren't necessary but they could be advantageous if chosen appropriately
• Elaborate on appendix and the whole process of choosing your article by explaining why you didn’t specifically choose the other sources
• Ensure all references in text are cited including e.g. research mentioned in 2.4

Specific suggestions for improvement

• Include all references at the end and ensure they closely follow APA
  • Cite the exact researchers behind the study published by New England Journal of Medicine, like you did with “Roberts et al., 2012” (also edit “Siri-Tarino et al. [Siri-Tarino, 2010] to Siri-Tarino et al. (2010)…, to closer resemble APA formatting)
  • In-text citations (direct quoting) must also include the page number or range of the text quoted – “A dietary pattern with relatively…” (Section 2.3.3)
• 2.1 – Next to “It includes Alzheimer’s disease”, add “(AD)” since abbreviation has been used in subsequently
• 2.3 – “…title ‘carbohydrates are killing our brains’” or “Could Carbs be Killing Your Brain” - there is some confusion here
• 2.3.3 – correlational and observational are not necessarily the same thing unless you are implying that both were conducted so just clarify just in case

Strong Points

• You guys chose a very interesting and controversial topic
• The wiki was very well organised and it flowed quite well with each of your points stated clearly and coherently
• Broke down the topic of dementia into clear headings and allocated sufficient writing amounts to each sections
• Your summaries were written really well and in an unbiased fashion

Weak Points

• Lack of referencing eg. Statistics in "What is dementia", research that was referred to in "Can diets be a preventative measure against dementia?"
• Possibly elaborate a little more on your appendices
• There were some grammatical errors (so it might be a good idea to proof-read your work )

General Suggestions for Improvement

• Use more figures
• There are some sentences that are a little wordy that could possibly be rephrased eg. "Two very different diets preventing supportive evidence for preventive dementia seems problematic"

Specific suggestions for Improvement

• Introduction
  • "Similar and similarly contentious" - maybe use a different word?
• What is Dementia
  • Reference statistics
• Causes of dementia
  • Briefly explain what words like "Atherosclerosis" is (just to show that you know what it is)
• Which diet is better?
  • Maybe include a paper to support that a high fat diet can cause cardiovascular disease, stroke and obesity
• Analysis
  • What sort of google search was used?

Overall: Great work guys!!! Keep up the great effort and good luck! :D

1. strong points

• Introduction:

  • Topic chosen is definitely interesting as carbohydrate-heavy diet is a fairly common diet people have adapted and if it does increase the likelihood of developing neurological dysfunction it would definitely encourage people to read on

  • Information is concise and provides a good overall idea of what the wiki page is going to cover

• Neuroscientific content:

  • Good description of dementia and the risk factors associated with it. Further highlighting the specific key aspects of the media item to be discussed

  • Description and summary of the findings were clear, concise and logical in structure.

  • Shows evidence of in depth and carefully planned research

  • References were generally in the right format

• Analysis:

  • Brief background of the media article and its content as well as intended purpose appropriately provided

  • Possible bias was discussed

• Appendix:

  • Research strategy and source evaluation clearly stated

• Generally a really solid work with consistent high quality throughout

2. weak points

• I’d suggest including some figures or images to support the argument and make the page more engaging. Other suggestions for minor improvements are given below.

3. general suggestions for improvement (e.g. logic, complexity, content, figures)

• Introduction:

  • Although the rationale for discussing this topic is self explanatory and did not need further explanation, it was not explicitly mentioned in the introduction but was briefly hinted in the last paragraph of neuroscientific context (2.5). Nevertheless, the introduction was concise and provided a good overall idea of what the wiki page is going to cover.

• Neuroscientific Content:

  • Although the media article was published in 2014 and referenced studies that were a couple of years older(2012) I’d suggest a brief comparison with more recent studies (2014/15) would provide a good comparison of how our understanding have evolved (maybe even some causal support and not correlational reviews as mentioned in 2.5) and a better argument for or against the claims.

  • Minor correction for the reference list where the second line of each references should be indented (hanging indent)

4. specific suggestions for improvement (e.g. typos, grammar, labels)

• Introduction:

  • Although the rationale for discussing this topic is self explanatory and did not need further explanation, it was not explicitly mentioned in the introduction but was briefly hinted in the last paragraph of neuroscientific context (2.5).

• Neuroscientific Context:

  • A little confused with the line “....neurodegenerative diseases such as dementia and Alzheimer’s...” previously mentioned that Alzheimer’s is a form of dementia

  • A few missing citations in 2.3.1 “A study published in the New England Journal of Medicine investigated….”; the citation made in 2.3.2. was missing from the reference list and 2.4 “A systematic review...” did not have citation

• Analysis:

  • A missing space in the first line regarding the publication date of the media article (“....October 182014”)

Overall an excellent polished piece of work which does not feel like a draft at all. Not much work is needed to be done from now until the due date with very minor tweaks here and there. Hope this was useful and good luck with finalising your work!

1. Strong points:

• Clear, logical structure and good flow throughout the wiki. Intro was brief and presented a straightforward roadmap of the key focus areas for discussion. Overall, a strong rationale was put forth for studying the topic.
• Key aspects of the media item were identified and elaborated using appropriate research to support points.
  • Providing a summary of the key results of each study and reasons as to why they are problematic was a great idea. They were concise and also well linked back to the media item.

• Insightful consideration of the social and ethical impacts of a high fat/low carb diet.
• Strong critical analysis of the media item although you could state more explicitly whether there was bias in the delivery of the research.

2. Weak points:

• The ‘grain brain’ hypothesis is evidently one of the major concepts discussed in the neuroscientific context, however I feel like you guys didn’t make it very clear what this hypothesis refers to. Defining it in a sentence or two would suffice.
• In 2.3, you mentioned that ‘pharmacological treatments have been unsuccessful…’ I suggest you back up this point with examples and reasons, as well as including a reference/s.
• There were some results from the studies that were mentioned but not really explained or elaborated on. For example, what is the importance of these two findings: ‘…an associated link between the ratio of saturated to polyunsaturated fats’ and the ‘glycemic index…is linked to some CVD’? What do they tell us? Furthermore, what is this index? I think it would be a really good idea to think of your reader as an intellectual ignorant
• There was little detail on how you evaluated your sources in the appendix.
• Lack of in-text citations (e.g. statistics in 2.1, studies mentioned in 2.3 and 2.4, quotes in intro and 2.3.3) and incorrect APA reference format at the end.
• Some grammatical errors.

3. General suggestions for improvement:

• Expand on how you chose your sources in the appendix i.e. what features did consider? For example, are they the most up to date research done in this area? Were they credible/peer-reviewed sources?
• Adding some visuals (e.g. figures, tables or diagrams) might be useful and could improve the reader’s understanding.
• Insert in-text citations – this is important! See ‘weak points’ for where I suggest you particularly add them.
• Reread over your wiki for grammatical errors. Reading aloud might even help improve your sentences and the clarity of expression

4. Specific suggestions for improvement:

• For the intro, the last sentence of the first paragraph is somewhat confusing and long (‘…uses similar and similarly contentious arguments’). I recommend rewording the sentence or even splitting it, if necessary, to make it clearer.
• In 2.2, it’s not clear whether the first set of dot points are the causes of dementia so I suggest writing something before it to better connect the two e.g. ‘Some causes of dementia include…’
• In 2.3.2, ‘Siri-Tarino et at. [Siri-Tarino, 2010]’ doesn’t follow APA referencing. Instead, it should be ‘Siri-Tarino et al. (2010)’.
• It should be “effect/s” instead of “affect/s” in 2.3.3, 4.1.
• Need to fix up the first reference (Alz. Org) – incorrect APA format for websites.
• Other specific suggestions (e.g. defining terms) have been suggested in the ‘weak points’ section!

Overall, you guys did a great job. Good luck with your final project!

1. Strong Points
- appropriate use of quotations from the media item as a vehicle to both substantiate the media item’s claims, and provide coherence in the introduction
e.g. "...a totally foreign diet for humans, we've never had carbohydrates like this in our diet."
- application of questioning format throughout the wiki was effective and unique, as it distinguishes it from the rest of the text, by clearly identifying what is to be understood by the reader, while also clearly addressing criteria (e.g. rationale in the introduction and subheadings in the neuroscientific context)
- discussion of the studies presented by the media item was well sectioned, with the analysis of each study being very consistent throughout. Explanations, comparisons ( e.g.”This study share some of the same weaknesses…”), limitations and understanding of the implications of the studies can be recognised throughout, further contributing to the comprehension of the chosen topic
- divided up the sections suitable to their respectable weightings; the word count is within the parameters
- successfully integrated the criteria to address social and ethical implications
- overall a very succinct, and well expressed wiki (in particular the introduction), with a logical and clear progression in terms of sectioning the neuroscientific context

2. Weak Points
- a tad unclear in terms of the ‘grain brain hypothesis’, as at times it appears to be a segregated concept that is integrated throughout the wiki, but is not as clearly defined as the subheading implies it would be (“A taster for ‘grain brain”)
- in-text citations need to be more uniform throughout, especially in the neuroscientific context
- insufficient neuroscientific context in regards to ‘neuro diets’, asides from the studies mentioned in the media item; can be elaborated on in order to provide information on this field of literature, and to place the studies in context
- appendix is a bit brief and lacking in depth, compared to the rest of the wiki
- more references needed to support ‘evidence of independent research’?

3. General suggestions for improvement (e.g. logic, complexity, content, figures)
- possibly in the introduction, link the paragraphs introducing the media item with the rationale
- an additional broader, and if possible more up to date information of the neuroscience behind neuro-diets, asides from the mentioned studies, could be applied
- provision of schematics (tables/figures) can be introduced to break up text if it is relevant to the text itself; in particular from the studies examined to illustrate the main results
- possibly separate the analysis into sections with headings
- broader spectrum of references to be used

4. Specific suggestions for improvement (e.g. typos, grammar, labels)
- grammatical errors:
- full stops needed at the end of intro and 2.2
- should introduce abbreviation prior to continual use e.g. Alzheimer’s disease (AD)
- in-text citations particularly needed at 2.3.1 (“A study published in the New England Journal of Medicine…”) and 2.4 (“A systematic review was conducted …”)
- source the statistic for validity. e.g. “Approximately 35 million people are diagnosed with AD with these numbers expected to reach 60 million by 2030”)

Carmen Hungerford: z5022856

Al King: z5060844

Melissa Rifkin: z3060572

Teresa Swain: z3465075

Kim Dahl-Hansen: z3245156

October 18, 2014 - web article from same media company:
http://abc7chicago.com/health/could-carbs-be-killing-your-brain-/355945/

Background Research - All

Introduction - Al

Neuroscientific Context - Carmen/Teresa/Kim

Analysis - Melissa

Appendix - All

Editing - Teresa

Web layout / formatting - Carmen

Deadlines:

- Form group, and submit topic and work plan in the wiki by Monday, August 10 at 5 pm.

- Draft of the project ready by Monday, September 7 at 5 pm.

- Provide review comments on allocated project by Monday, September 14 at 5 pm.

- Final project due by Monday, September 21 at 5 pm.

Scheduled meetings:

Group met and discussed potential topics Friday, August 7

Online communication was initiated and group decided on topic: Sunday, August 9

Gather background information and decide on direction/planning: Friday, August 14, 4pm

Flesh out research: Friday, August 21, 4pm

Rough draft, outline and headings TBC: Friday, August 28, 4pm

Discussion of wiki's to review and make comments: Thursday, September 10, 4pm

Editing: Thursday, September 17, 4pm

Dr Vickery's comments

I like it - there is always a new fad diet on the horizon; now we are getting neuro-diets

Make sure you stick to the neuro aspects - the blood sugar dementia risk etc

approved!

ABC7 Chicago. (2014). Could carbs be killing your brain? Retrieved 10/8/2015, 2015, from https://www.youtube.com/watch?v=Qq25KNtE-A8

Alz.org. (2015). What is Dementia? Retrieved 10/9/2015, 2015, from http://www.alz.org/what-is-dementia.asp

APA. (2003). Diagnostic and statistical manual of mental disorders: American Psychiatric Association.

Cole, G. & Frautchy, S. (2010). DHA may prevent age-related dementia. The American Institute of Nutrition, 140(4), 869-874.

Crane, P. K., Walker, R., Hubbard, R. A., Li, G., Nathan, D. M., Zheng, H., . . . Kahn, S. E. (2013). Glucose levels and risk of dementia. New England Journal of Medicine, 369(6), 540-548.

Freeman, M. P., Hibbeln, J. R., Wisner, K. L., Davis, J. M., Mischoulon, D., Peet, M., . . . Lake, J. (2006). Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. Journal of Clinical Psychiatry, 67(12), 1954-1967.

Glazer, H., Greer, C., Barrios, D., Ochner, C., Galvin, J., & Isaacson, R. (2014). Evidence on Diet Modification for Alzheimer’s Disease and Mild Cognitive Impairment (P5. 224). Neurology, 82(10 Supplement), P5. 224-P225. 224.

Lourida, I., Soni, M., Thompson-Coon, J., Purandare, N., Lang, I. A., Ukoumunne, O. C., & Llewellyn, D. J. (2013). Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology, 24(4), 479-489.

Mayo. (2013). Mediterranean diet: A heart-healthy eating plan. Retrieved 10/9/2015, 2015, from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Roberts, R. O., Roberts, L. A., Geda, Y. E., Cha, R. H., Pankratz, V. S., O’Connor, H. M., . . . Petersen, R. C. (2012). Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia. Journal of Alzheimer's disease: JAD, 32(2), 329.

Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition, ajcn. 27725.

Wang, H., Wahlin, A., Basun, H., Fastbom, J., Winblad, B., & Fratiglioni, L. (2001). Vitamin B12 and folate in relation to the development of Alzheimer’s disease. Neurology, 56(9), 1188-1194.

World Heart Federation. (2015). Diet. Retrieved 10/09/2015, from http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/

• Section	Marker's Comments
  Introduction choose an interesting and appropriate media item provide a good rationale for studying the item.	Introduction - I like the way the introduction builds up to exactly how you will assess the claims. Some of your language is as hyperbolic as Perlmutter's "stockades of fad diets" and "demonising grains" - but perhaps that is intentional? ;)
  Neuroscientific Context identify the key aspects of the media item provide a concise and up-to-date summary of the neuroscience show evidence of independent research, with appropriate referencing.	Neuroscientific Context - I think I'd rather have a peer-reviewed article for causes of dementia that Alzheimer's Assoc. There is no mention of age which is the major risk factor, or of any genetic link. - Great job getting the papers cited in the original item and then analysing them. A common science "trick" is to use Web of Science to look for papers that cite the one you are studying to see whether it is attracting criticism. The contrast with the Mediterranean diet, and the consideration of the ethical issues is well-handled. The critical Crane paper could have clarified better how much the findings applied to diabetic, vs pre-diabetic vs healthy individuals.
  Analysis demonstrate understanding of the intended purpose identify the target audience, and determine if the item is pitched appropriately do simplifications affect the veracity of the message? is the item presented in an unbiased manner?	Analysis Nailed it!
  Appendix describe the search strategies employed and how the sources were evaluated summarise the reviewers' comments and how these concerns were addressed	Appendix - Good work on sources. - I think you assessed the reviewer critiques fairly. - reference list has some formatting errors.
  Overall	Overall - Really good deductive work, striking a good balance of research and presenting your own views. Great project - well done!