Season 1 Episode 1: An Introduction to Methodology Matters!

So there’s evidence there’s sometimes randomized control trials. Other times there’s just observational studies, often there’s both, and the evidence needs to somehow be integrated or worked with the values and preferences of the client or the patient. There’s always this interplay between, well, first, let’s go out and make sure that we have the best summaries of evidence. Right. And then working with those values and preferences for either the client or the public in order to make a recommendation.

Hello, friends and colleagues, I’m Dr. Bradley Johnston, professor of nutrition, epidemiology and health research methodology.

And I’m Matt Miller. I’m the producer of the podcast and also a curious citizen.

Well, welcome Matt. This podcast, as you know, is really meant to shine light on critical thinking or as I like to call it, systematic thinking when it comes to nutrition and nutrition science.Great.

Lots of technical stuff to cover. I think it’s going to be fun not just for people in my background who are, again, I think a curious citizen is a great descriptor, but also people of your background who are much more storied and experienced in the scientific method and how it relates to research specifically for nutrition science.

Yeah, that’s the plan really conversational, hopefully, and lots of different perspectives from different experts in the field or educators in the field.

Yeah, that’s great. I’m really excited to what we’re covering in this episode is really just kind of an overview of the podcast, sort of how you came up with the idea, who we are, and then we’ll talk a little bit, I think, about sort of the guests that we’re going to have on and some major topics that you might be covering with them. I’d love for you to kind of introduce yourself to the audience and sort of tell them a little bit more about you.

Many of them are probably students who might know you, but also many, many of them aren’t. So you are originally from Canada. Can I call you a canuck on record? Is that, of course, a Proud canuck?

So you’ve got undergraduate and graduate training that spans the fields of kinesiology, experimental medicine, evidence based health care and clinical epidemiology and biostatistics. You’ve got degrees from the University of New Brunswick, the University of Alberta and post-doctoral training at Oxford University and McMaster University. Currently, you’re based at Texas A&M in College Station, but you’ve got adjunct appointments also at Dalhousie University in Nova Scotia and McMaster University in Ontario, where you’ve taught courses in health research methods, critical appraisal of nutrition, literature, clinical trial design and systematic review methods.

You’ve also published over one hundred and twenty peer reviewed papers in some of the most prestigious medical and public health journals in the world, including the Journal of the American Medical Association, the British Medical Journal, the Canadian Medical Association Journal, the Annals of Internal Medicine and the Cochrane Library. That’s a pretty hefty resume you’ve got there, don’t you think?

Sure. I guess it’s part and parcel for what we get up to in academia. Yeah, I consider myself as more of a kind of a blue collar guy that is just really driven by curiosity more than anything and trying to improve the methodology within different fields. More recently, in the field of nutrition. Generally things are done reasonably well, but there’s often room for improvement and raising the bar. So a lot of my before I arrived here in Texas, I kind of worked with different departments, including epidemiology and anesthesiology, kind of helping, often helping different colleagues, whether they be students or faculty members, to improve the methods that they were applying to help them answer research questions.

OK, and so along the way, I was always doing a bit of nutrition research, but more and more, I wanted to kind of make it my primary focus. So I had the opportunity to come to Texas and do that. So I’m kind of new to the game.

Yeah newish territory for you, but with a, well, storied background. So I want to back up because we’ve said this term a couple of times, epidemiology for laymen such as myself. What are we talking about specifically when we were talking about epidemiology?

Sure. Great question. Well, it’s probably fair to say that epidemiology is really common when you see that at least before covid-19 people thought, oh, are you talking about like the epidermis or skin? Yeah. And it’s a little bit more, I would say a lot more recognized now. So epidemiology is essentially the study of health and disease. Gotcha. And kind of trends. So I’m just thinking about covid-19 and how many cases we have in Texas versus how many in Illinois versus maybe Ontario, Canada, and kind of tracking that kind of stuff and working with public health interventions, for example, to try and mitigate would be one example.

And epidemiology is actually really rooted in infectious disease. That’s really where it was born. OK, but then it’s kind of creeped into all different fields, including medicine and nutrition now and in medicine, we often call it clinical epidemiology, so the application of epidemiological principles at the bedside. Interesting. And you can also think about that from a nutrition standpoint. So application of epidemiological methods for your patient or your client. From a registered dietitian perspective.

One of the things that, shall we say experts such as yourself end up spending their time on is probably you have on the one hand you have the research. Right. And then on the other hand, you have the patient, shall we say. And then how do you apply that research to the patient?

Yeah, that’s a great kind of curiosity that you have Matt. Yeah. Yeah. So there’s evidence, ideally, when we look at the evidence for a particular question of interest, like maybe what diet might be best for lowering blood pressure or for helping improve your diabetic markers if you’re someone that is pre diabetic or diabetic. Sure. So there’s evidence there are sometimes randomized control trials. Other times there’s just observational studies, often both. And the evidence needs to somehow be integrated or worked with the values and preferences of the client or the patients.

So sometimes, you know, sometimes you might have great evidence, but the client or patient may not actually value changing their lifestyle radically in order to, for example, reverse their diabetes. So there’s always this interplay between. Well, first, let’s go out and make sure that we have the best summaries of evidence. It really should be the totality of evidence that we’re using in order to inform either our patient or client recommendations and to inform the public and then working with those values and preferences for either the client or the public in order to make a recommendation.

Yeah, that’s really interesting and I think so important right now, because when you look specifically at the public and public health, you know, we’ve got so many diseases that either are based in nutrition or malnutrition or poor nutrition or could be reversed by an application of nutrition. And I think from the curious citizen perspective, I see more and more, more and more research and reading on specifically how important nutrition is. So I’m not surprised that you have come to this point in your life where you’re speaking about how we find the totality of evidence and then and then how important it is to apply that to specifically, public health.

And the idea, too, is I think we all value nutrition and diet and eating. I would say the problem is with nutrition, a lot of people almost treat it as religious. They feel very strongly about foods and what you should and shouldn’t eat. And I think the media plays a part in this. People start to believe that if I just eat more of this one food, I’m going to live longer or I’m going to feel better. But, nutrition is very complex.

You know, what’s curious about nutrition is there’s a lot of, I would say, students that may believe that you can make a causal inference or there’s a causal relationship between Food A and outcome B, but when you really look closely, not sure if we can do that. In many instances and in some instances, of course we can. It depends on a lot of different inputs.

Sure. Yeah. Well, you know, it seems to me that’s the challenge. There are so many different factors you have to take into account? We’re eating three times a day. We’re eating as you say. We’re eating multiple meals, multiple types of foods with multiple nutrients like there are so many factors involved in just that process.

Yeah. And it’s really about so if you’re going to eat less, for example, saturated fat, what are you going to replace that with? Are you replacing it with simple carbohydrates, right? Complex carbohydrates, proteins, or are you replacing it with another type of fat, maybe with polyunsaturated fat or monounsaturated fat? So it gets really complex really quickly. And to just assume that one nutrient causes a bad outcome, I think sometimes there’s a little bit of the truth that might be stretched sometimes through the media or sometimes even through scientific papers.

Oh, interesting. So I guess and let’s take a little bit of a right turn here. I’d love to know. I think the audience would love to know your approach? What are we doing with this podcast? And then also, who are we going to hear from and sort of what ideas we’re going to cover?

Yeah, sure. And so this is why it’s so great to have you. Matt is just kind of just a curious citizen who eats three times a day. Sometimes less. Sometimes more. yeah. So really, at least for me, the overarching question here is when it comes to nutrition or food science, what can we say with certainty and what is a matter of speculation? OK, you know, so maybe I’ll just go back a little bit to my background, training, again.

It’s more in the field of experimental medicine and then evidence based medicine principles and health research methodology.

OK, so, not dealing with new nutrition specifically, but with more disease.

Yeah. In a lot of different fields. So just kind of I’ve done a lot of research on research for more than 10 years. So how can we do better randomized control trials? How can we do better systematic reviews of the literature? How can we better measure patient outcomes or patient reported outcomes? So a lot of this kind of stuff and what’s nice about this background training is it’s kind of crosscutting. Yeah. It’s kind of like being a biostatistician or a producer.

You can kind of help a lot of different people regardless of what their question is or what their domain is. So that’s kind of how I see my role. In making this podcast the hope is to just really talk to some leading scientists, academics and teachers in the field of nutrition, epidemiology and public health and just get some perspective, really, like, you know, so we have a few guests lined up. Yeah.

Dr. Dennis Bier, Dr. Gordon Guyatt, Dr. Lahaina Tiboni, these individuals are Dennis is a pediatrician who was the editor in chief of the American Journal of Clinical Nutrition for almost 12 years. Oh, wow.

That’s a stint.

So he knows lots about nutrition in general and kind of the state of the science field of nutrition. Dr. Gordon Guyatt actually coined the term evidence based medicine. So he’s been in the field of so-called evidence based medicine for, I think, over thirty or thirty five years now. So he’s kind of seen the field grow and he’s really kind of operated within the scope of medicine. But I think his experience can provide some insights into how evidence based medicine principles might lend themselves or do lend themselves to the field of nutrition.

And the question is, and we’ll explore this, what’s the difference between evidence based nutrition, for example, and. Yeah, and personalized nutrition? Are they the same or are they different and then are third guessed that we’ll eventually have Dr. Lahane at the bottom? He’s a biostatistician. He works at McMaster University. And he really does a lot of work in the field of clinical trials, again, as a methodologist as well as a biostatistician.

And he’s been in the field for a long time. And I’m looking forward to speaking to him about his experience from a bio-statistical standpoint within the field of medicine. And also, he really emphasizes his career mentorship. And I do know that he mentors well over one hundred different students and or trainees in different fields. So across and spanning many, many countries. So I think it will be fun to talk to him.

Yeah, that’s great. It sounds like some pretty smart people. So let’s talk a little bit about what we’re going to hear in the future. It sounds like the way we’re structuring this podcast is going to be a little more idea based. For example, you’ve interviewed Denny already or I shouldn’t call them Denny. I don’t know him. You’ve interviewed Dr Dennis Bier. So we’re going to hear from Dr. Bier on a few different topics. But the very first one is on critical thinking.

And you’ve said to me that that’s really one of the more central ideas about this, this podcast specifically and super useful to your students and people that are looking, people like you that are looking at the science. What do you talk about that a little bit more?

Yeah, sure. So when I arrived here, A&M right away, I was asked to help out or to teach to take over course, and the course was for fourth year nutrition students and it was basically a course in communication and critical thinking that we were looking at the nutritional literature and seeing if, you know what the paper said, whether it was trustworthy, believable, credible, valid. And so I was a little reluctant to take the course on right away.

But once I got into it and met the students, I really, really enjoyed it. And I’m doing the same this semester, although with the first year students. Yeah. And right away I think I got the sense because before arriving at at A&M, I was mostly working with either medical doctors, sometimes nurses or just, let’s say, graduate students that were working more in the field of epidemiology and biostatistics. And so it was kind of really in a different field.

Yeah. Now all these fields kind of interrelate. But this was really my first experience solely in nutrition. And right away, I guess I was always somewhat aware of it, but it just struck me as there’s a real need for this in the field of nutrition. And my sense was the students were enjoying the materials, I was enjoying teaching it. And I just thought, how can we kind of build this out a bit so that it’s an asset for Texas A&M and but ultimately an asset and something that’s of high utility for the students when they graduate and especially those that go on to be a registered dietitian, helping them make better clinical decisions.

Yeah, I think from from the perspective of the public, any time we look at dietitians or nutritionists or people that are recommending food to us for specific reasons, whether it’s weight loss or health or trying to reverse a disease like diabetes, I find that from public scrutiny of dietitians or nutritionists is very much like, well, if you’ve got the clinical chops, then I’m much more likely to trust you.

Mm hmm. And so maybe another part of the story of getting to this, what I perceive to be a need for more training and critical thinking and in order to improve clinical decision making before or around the time I arrived at Texas A&M, my group, Nutra X, we just finished a large project where we made basically recommendations on red and processed meat, a hot topic, a very hot topic. And we had, I would say, a different conclusion than those that had come before.

And there were a lot of people, I would say, that were unhappy with our saying that maybe red meat isn’t the big problem, that it’s been made out to be OK. Maybe it has to do with the totality of foods that you eat in sort of a dietary pattern over the span of a week, a month, a year, ten years, a lifetime that kind of bring one to have a higher risk of cancer or heart disease than just one food.

And so I just to say that it really stirred things up. And my sense was there was a lot of pushback from maybe some of the more established nutrition folks in the field. Yeah. And I understand that it’s human nature. We kind of don’t like change a lot, especially when it catches us by surprise. Yeah. And so my sense was like, wow, like maybe we need to work from the grassroots up and work more with the students that are actually at the ground level starting out in nutrition in order to eventually kind of help people kind of hopefully have some more intellectual curiosity and not just assume that these foods, for example, cause like cancer or heart disease or diabetes, a single food.

Yeah, that’s really interesting. If you really take a step back and think about it like we were saying before, work, it’s a lifetime and nutrition is a lifetime commitment. You know, from infancy to our deathbed, we are consuming food of some kind. We’re getting nutrients from that food, our bodies utilizing it. And it’s, of course, our environment, our genetics. What time of day we ate it, I’m sure. To do with it, and so Matt you’re touching on a bunch of things that we haven’t even talked about outside of nutrition, right?

Like, sure, the amount of exercise maybe is your genetic kind of profile, maybe the environment that you live in, maybe there’s more pollution in your city or your region than there is in other regions. So there’s many, many components. That kind of complexity is probably the best way to say it to how we get from A to B. So but sometimes it could be the food, too, right? Like, it really depends on what the question is.

Your research question is what the intervention is and what you’re measuring, what the outcome is and then what data exists in order to help answer that question. Yeah, but I just think the theme, at least from my perspective, is complexity.

Yeah. Yeah, that makes sense. Well well, with all of that complexity, it seems pretty easy to me to see that your initial approach to it is crystal clean methodology, so to speak. Now we’ve got to approach the data in the best way that we can and then we can be a little more and then we can be more accurate about our terminology. Is it the cause? Is it? And if so, how have we determined that we’re not as careful about that vocabulary maybe as we as we as a layman such as myself might say, like, oh, well, I read this study that said red meat causes blank, but or this article mentioned that red meat causes blank.

Well, maybe it wasn’t that it was, maybe they didn’t find that it was causal. Maybe they found that it was an association. An association. Thanks. Maybe it was very different then than there’s no causal relationship in an associate relationship. There are two very different things. And that terminology does get mixed up a lot by the media, sometimes by scientists, certainly by students. And it’s just good to explore what all of this stuff means and and explore the certainty that we can have within the complexity of the environments and the data that that we’re often faced with when we talk about associative versus causal.

Right. So if the outcome is cancer or red meat is associated with cancer. Right. Drinking coffee is associated with cancer as if you had no cigarette in your hand and put that to your mouth 50 times a day, that’s also associated with cancer. So, wow, they’re all associated with cancer. OK, a better way to say it is if you have an outcome in mind like cancer and you’re wondering what might be the causal agent.

Well, is it a cigarette? Is that your hand moving to your mouth with the cigarette or red meat or is it the salt? Is it the cycling that you do every day? There’s many things that can be associated, but it doesn’t necessarily mean that they’re causal. Sure. The distinction between your hand moving to your mouth and the cigarette is an important distinction.

Sure. Yeah. Oh, that’s interesting. Yeah. So as you say, lots of complexity and lots of lots of really interesting data to dig through. I’m really excited about listening to Dr Bier, Dr Guyatt and Dr Tavani. Am I saying that right?

Yes. Yep. Yeah.

I’m really interested to hear your conversations with all of them and and to kind of see this podcast grow and sort of dig into really interesting topics like curiosity and critical thinking and methodology and other big, long words that make me feel fancy, like epidemiology and biostatistics. Well, I think I think this is going to be a really fun podcast. Originally, you said your idea was sort of that it’s meant for nutrition students and maybe junior faculty that are working in nutrition or epidemiology and public health.

I think as a curious citizen, I think also it’ll be really interesting for anyone like myself in the public that sort of interested maybe more in some of the nuts and bolts about nutrition science and how we come to understand things like how the food we eat affects us.

Yeah. Or how we come to believe what we believe. Yeah. With respect to nutrition.

Great. Well. I’m super excited and Brad, I’m happy to be part of this podcast. I appreciate you letting me join with a microphone as well. And I’m really looking forward to all the things that you’re going to cover with all these brilliant minds.

Yeah, well, thanks, man. I’m looking forward to it. And you’re definitely a curious citizen and you have the knack for, obviously, production and sound quality. So I’m looking forward to working with you on multiple levels, both from curiosity and from a production standpoint. So thank you.

I appreciate that. Thanks, Brad.

Thanks for listening, if you’d like to hear more episodes of Methodology Matters, a podcast on evidence based nutrition. Please head over to MethodologyMatters.Podbeam.com.

And if you’d like to learn more about Dr. Johnston and his work, you could find his faculty profile on Texas A&M University’s Department of Nutrition website. Or you can find him on Twitter where his handle is at Method’s Nerd.

Thanks for tuning in and we’ll see you on the next episode of Methodology Matters.