In my clinical practice, I specialize in treating Obsessive Compulsive Disorder and the so-called OC spectrum disorders. One of the most common is health anxiety, which is better known by the older and more negatively loaded term, “hypochondriasis.” Whatever you call it, this excessive worry about illness can overtake the lives of those who have it.
I can’t say for sure if the prevalence of health anxiety has increased in the last decade, but judging from my admittedly unscientific personal experience and a cursory scan of the data, it seems to be on the rise. In the days before the Internet, a person with health worries might have read the Merck manual to assess symptoms or gone to the doctor for reassurance. Now we’re all diagnosticians, taking cell phone photos of troublesome moles to compare with online examples of cancerous lesions, typing symptoms into WebMD, and using Internet forums to share stories about medical mishaps and exotic illnesses. But without the depth and breadth of information and the context for interpreting it that comes with medical training, it’s easy to misinterpret physical sensations and overestimate the seriousness of a problem or the likelihood of its occurrence.
I thought about this as I read a story in Sunday’s New York Times Magazine about how General Mills has jumped on the gluten-free bandwagon, using the latest health fad to kick start a marketing campaign for their GlutenFreely line of products. Celiac disease, the inability to digest the gluten found in wheat and several other grains, is a serious, even life-threatening, illness. It is five times more common today than it was fifty years ago, and an estimated 18 million Americans suffer from some degree of gluten sensitivity, if not full-blown celiac disease. But the explosion of gluten-free options on supermarket shelves and restaurant menus makes it seem even more prevalent.
For those with a true gluten sensitivity, this is a welcome trend. But for those prone to health anxiety, it’s just one more trigger for unnecessary worry. As the Times article points out, athletes have embraced the gluten-free diet, claiming it gives them more energy and enhances performance. So have several celebrities, including Gwyneth Paltrow, who touts it as a weight-loss method and Jenny McCarthy, who believes it cured her son’s autism. No matter that scientists dismiss such claims because there’s no research backing them. If you’re overly attuned to your body, as people with health anxiety are, you’re likely to focus on every physical sensation and are highly suggestible. And if you buy into the celebrity endorsements—and a lot more people follow Us Weekly than the New England Journal of Medicine—going gluten-free will seem like a panacea for whatever ails you.
I’m a little embarrassed to admit to my own brief, three-day experiment with the gluten-free lifestyle. Drawn in by the promise of clear-headedness and boundless energy, I decided to test it out for myself. I replaced sandwiches with salads at lunch and pasta with potatoes at dinner. And for breakfast, I tried a great recipe I found in Bon Appetit for the Garmin cycling team’s gluten-free pancakes. My husband and I both agreed we felt less weighed down and more energized than we do after eating our usual whole wheat variety.
There was only one problem. The Garmin pancakes weren’t gluten-free. They contained spelt flour, which is a wheat product, and oat flour, which gluten-free purists eschew.
As it turned out, the regimen wasn’t for me. It made me feel deprived, which caused me to overindulge in too many inferior wheat substitutes, like peanut butter cookies made with teff flour. I’m back to eating pizza and muffins, and I feel much more satisfied, albeit a little more sluggish. But maybe that’s the result of Thanksgiving, not gluten.
Without a compelling medical reason to go gluten-free, proponents of this newest dietary trend may be showing symptoms of a sensitivity not to wheat, but to health concerns. And for that, I’d say a gluten-free diet would be contraindicated.
Here’s another story from my Just Because It’s In The Newspaper Doesn’t Mean You Should Believe It files.
The New York Times Magazine ran a piece last week about some new—though not exactly groundbreaking—social psychology research on willpower. Seems that people have more trouble making decisions and act more rashly when they’re tired or hungry. Any parent of a cranky toddler could tell you that. But, wait, there’s more.
This so-called decision fatigue, according to one economist who studied (I am not making this up) soap-buying decisions among poverty-stricken villagers in rural India, explains why the poor remain trapped by their financial circumstances. He believes diminished willpower causes crime, alcoholism, poor school performance, and other problems that maintain the cycle of poverty.
“Shopping can be especially tiring for the poor, who have to struggle continually with trade-offs.” That’s why, he says, the economically disadvantaged eat junk food at the mall; they can’t resist the allure of the food court because all the trade-offs deplete their willpower.
The author goes on to talk about the mitigating effect of sugary foods on “ego depletion” (the draining of mental energy used for self-control). And then he makes the following statement: “The ego-depletion effect was even demonstrated with dogs . . .After obeying sit and stay commands for 10 minutes, the dogs performed worse on self-control tests . . .But a dose of glucose restored their willpower.”
Whoa! There’s so much wrong here I hardly know where to begin.
Problem 1: How do you measure willpower?
In one experiment, self-control was measured by how long the subjects could hold their hands in ice water before giving into the urge to pull them out; in the Indian study, it was tested by seeing how long the subjects could squeeze a hand grip. What about individual differences in cold tolerance and grip strength? And couldn’t the poorer Indians have weakened more quickly because of malnutrition rather than lack of willpower?
Problem 2: Correlation does not equal causation.
Any Statistics 101 student knows this cardinal rule. Impulse-control problems may be more prevalent in poorer populations, but that doesn’t mean poverty causes weak willpower. Other factors could just as easily enter into the equation—fatigue resulting from having to perform a physically taxing job, say, or the draw of money-making criminal activities for a person desperate to find a way out of bleak circumstances. And, if the sheer volume of decisions depletes willpower, what about the CEO who constantly has to make decisions to run a company?
Problem 3: Generalizing about human cognition from animal studies is silly.
To say that dogs suffer from “ego” depletion after exercises in sustained self-control is just plain wrong. The concept of ego implies a capacity for self-awareness, which dogs lack. If they look in a mirror, they don’t recognize the image staring back at them as themselves. This has been tested in many different species by painting a dot on an animal’s forehead and presenting it with its reflection in a mirror. Elephants investigate the spot with their trunks; gorillas poke at it; and human children after the age of eighteen months or so notice it. But dogs don’t. They have no sense of self and, hence by definition, no ego.
In all fairness, I haven’t read the original studies, so I don’t know if these problems are in the research or in the way the reporter interpreted it. Still, the average newspaper reader wouldn’t go back to the original sources, either. Most of us take what we read or hear in the news at face value.
It’s easy to confuse fact with fiction if you don’t question the evidence.