Thursday, March 22, 2018

There's Perhaps An 80% Chance That Your Bloating Woes Aren't Related To Gluten

Are you scared of gluten?

Are you avoiding it because gluten containing foods leave you feeling bloated or otherwise unwell?

It's probably not the gluten.

Adding to a growing pile of evidence that it's not the gluten that's causing your symptoms (no one's doubting the symptoms, it's more a matter of figuring out where they're coming from) is this recently published, albeit small, study highlighting a randomized, double-blind placebo-controlled challenge of twenty patients without celiac disease or wheat allergy who were suspected of having non-celiac gluten sensitivity (NCGS), and who had all experienced relief from their symptoms following a gluten-free diet.

Every one of the study's participants went through four separate periods of double-blinded challenges - two with gluten, and two without, in random order. They were asked to consume two muffins per day which did or did not contain 11g of gluten for 4 days followed by a 3 day washout all the while continuing to eat their otherwise gluten free diet. They simultaneously tracked their gastrointestinal symptoms and were asked their thoughts as to whether they were consuming gluten containing muffins or not during each treatment. All subjects diets were also analyzed after the fact for their FODMAP content.

Looking at the participants self-reported symptoms scores, they were worst after the challenge with the placebo (gluten-free) muffins - significantly so even - with a p value of 0.012. Of the 20 subjects, only 20% (4) correctly identified the two periods they received gluten containing muffins. Of course 4 people of 20 correctly identifying which muffins contained gluten may well occur simply by chance and consequently conclusions can't be drawn on their basis.

All this to say, taking those 4 as real data points, this study suggests that 80% of people with unexplained food-related discomfort aren't reacting to gluten, and though people's bloating, flatulence, abdominal pain, fatigue, and other symptoms, are real, what's causing them is not yet clear.

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Monday, March 19, 2018

Dear Teachers, Please Don't Weigh Your Students

A few weeks ago my 11 year old daughter's math teacher brought in a scale and weighed her Grade 5 class in front of one another in the context of learning about volume.

I'm sure it was well intentioned.

And for some of her students, I'd venture it was their worst day of the school year.

Given weight has been found to be far and away the number one source of childhood bullying, it should have been predictable that there'd be snickers when the heaviest kids in the class were weighed.

The lightest kids' weights elicited snickers too.

11 year olds' teachers ought not to be contributing to their students being self-conscious, embarrassed, or ashamed of their bodies.

So here's my very simple request.

Teachers, schools, coaches, educators of all sorts - please, unless it's essential (and it's difficult to imagine many circumstances when it would be), never weigh your students, and if you do, do so privately.

And this goes for so called BMI report card programs as well, whereby children are weighed at school and notes are sent home to parents as to their child's BMI. While here in Canada these programs are fewer and further between, in the US, 25 states have legislated that schools weigh kids, and 11 of those have legislated that BMI report cards be sent home to parents. The legislation arose consequent to a 2005 recommendation from the National Academy of Medicine that such programs be implemented as part of a childhood obesity prevention strategy.

The issue with these report cards aren't their intentions, but rather their efficacy and potential risks. To date, the evidence is equivocal as to whether BMI report cards affect children's weights. It's also equivocal as to whether or not they might increase weight-based stigmatization, unhealthy weight control behaviours, and/or body dissatisfaction (though we ought to know more in the next year or so as the results from this trial get reported).

If schools and teachers want to have a positive impact on kids' health, I'd encourage them instead to focus on the one thing well within their control to change - food. And there are ample targets for improvements including in-class rewards, class parties, chocolate milk programs, pizza programs, school fundraisers, holiday celebrations, vending machines, cafeteria fare, planting and tending to school gardens, and using (or establishing) school kitchens to teach children how to cook healthy meals, to name just a few.

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Saturday, March 17, 2018

Thursday, March 15, 2018

Guest Post: RD Christine McPhail Reviews Greta Podleski's Terrific New Cookbook Yum and Yummer

Today's guest post comes from one of our office's wonderful RDs - Christine McPhail, who has been spending a bit of time with Greta Podleski's terrific new cookbook Yum and Yummer.
As a Dietitian, I see the difference it makes when families start cooking together and children begin to develop the important food skills that they will need as adults. I hear about children being more interested in trying new foods, helping in the kitchen, wanting to pick out recipes, and being proud of the foods they’ve made. These cooking experiences can help children learn about nutrition, balanced meals, and the importance of including a variety of foods. Our lives are busy and I do hear about food going on the back burner (see what I did there) but it shouldn’t have to. You can read Dr. Freedhoff’s past post Teaching Your Kids To Cook Is More Important Than Teaching Them To Play Soccer Or Hockey that provides strong rationale for families cooking together.

Adults in turn benefit from sharing their skills, having the opportunity to pass down their favourite recipes and traditions, and of course having more balanced and nutritious meals themselves. A great place to start is having your family go through cookbooks together and pick recipes they would be interested in making. One recipe book I can recommend is Yum & Yummer by Greta Podleski, a Canadian author and recipe developer, who you may know from her very popular Looneyspoons cookbooks, which she co-wrote with her sister Janet.

Here are a few reasons I liked Yum & Yummer:
  • The introduction is worth a read. I really appreciated that Greta addressed that healthy eating means different things to different people and that we all could try to be less judgemental. Unless there is a true risk with an eating behaviour, which as a dietitian, I am trained to look out for, I believe it’s important that we respect one another’s food preferences and choices.
  • There truly is a recipe for everyone in this book and Greta follows through with her mission to use common everyday ingredients and simple recipes. Recipes will signify if they are dairy-free, gluten-free, vegetarian etc. 60% of the recipes are vegetarian but she also has sections for fish, poultry, and red meat, soups and chilis, snacks, and desserts. Meatless meals are a great way to get your family to enjoy meat alternatives that not only provide protein but plenty of fiber as well. You’ll save some money in the process too!
  • For people who are new to cooking, are nervous to try recipes, or learn better with visuals, each recipe has a photograph and a “how to” video that you can access just by scanning the QR code on the page with your phone. They show you exactly what to expect step by step, so you can feel confident developing new skills (you can take a look at them here).
  • For those who like to know the nutrition information, each recipe shows calories, total fat, saturated fat, protein, carbohydrate (fiber and sugar included), cholesterol, and sodium. This way you can make an informed choice that works for you and your family’s needs.
  • The recipe descriptions don’t go into detail of the “nutritional benefits” or labels foods as “good” or “bad”. Greta does include some great food prep tips and food facts that are helpful. This is important because we don’t want to label recipes as “good” or “bad” and we don’t want weight to be the main motivation when trying a new recipe, especially if children are reading along. We want to hear about the fresh ingredients, flavour and texture as well as the nutrition information, when we are choosing to make a recipe or not. At the end of the day, if you don’t enjoy it you won’t continue to eat it anyways.
With some quality time in the kitchen and eating meals together, your family can appreciate the benefit and taste of whole foods, cooking from scratch, and eating together as a family. If you are interested, you can purchase the book via (where 92% of the 148 reviews (and counting) are 5 star) or any other online Canadian book retailer.

Christine McPhail MSc, RD is one of our Registered Dietitians at the Bariatric Medical Institute. Christine has worked in academic, clinical and public health nutrition settings and has been fortunate to have worked on projects relating to food sustainability, food security, food policy and politics, childhood nutrition, body image, and school nutrition programs. She believes in the power of connecting with your food from farm to table. She feels fortunate to share this passion with her clients, as she helps them strengthen their relationship with food and learn more about nutrition.

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Tuesday, March 13, 2018

Nothing Good Can Ever Come From Weighing Your Child

(This post was first published on US News and World Report in November 2013)
I'm not suggesting your child should never get weighed – certainly I'd encourage annual weigh-ins with your child's pediatrician or family doctor to track growth curves – I just don't want you weighing your child.

Aside from determining whether or not your kid has outgrown their car seat, or what size uniform or sporting equipment they require, there are three main reasons for a parent to want to weigh them. The first would be a worry about a child not growing sufficiently – and herein I'd encourage you to defer to your child's doctor to determine whether or not worry is warranted.

But the second and third reasons are the ones that concern me. The second reason is a parent's belief that his or her child's weight is too high. The third reason is the second reason's corollary, where a parent might be weighing a child to see if the child has lost weight or to keep track of the rate of gain.

The thing is, scales don't measure anything other than weight. They don't measure the presence or absence of health; they don't measure whether a child is being fed a nutritious diet; they don't measure whether a child is regularly active; and they don't measure self-esteem. But they sure can take away self-esteem, can't they?

And while I haven't seen a study that proves it to be true, I'd be willing to wager that scale use in children has played a formative role in their development of mood disturbances and eating disorders over the years, as well as having had many negative impacts on their self-esteem, body images, and relationships with food.

Yes, childhood obesity is worrisome. And yes, if you're worried about your child's weight – especially if it's having a negative impact upon his or her health or quality of life – you might want to try to help. But weighing your child doesn't actually do anything. All weighing your child does is teach him or her that scales measure success, self-worth, and parental and personal pride – and that weight is all that matters.

You might think that tracking your child's weight loss on a scale may be motivating, but celebrating a loss on a scale is no less risky than shaming a gain; they're flip sides of the same coin – the coin that says scales measure success. And what happens if that child who is losing one day gains?

A child's actual weight doesn't really matter, at least not in any constructive, formative way. Ultimately, a child's weight is not something that is directly controllable. Weight's primary levers – eating behaviors and activity levels – have dozens, if not hundreds, of drivers and co-drivers, and many of them won't in fact be modifiable.

Genetics, peer groups, socio-economic status, coexisting medical conditions (both mental and physical and for both child and parent), food available at school and after-school activities, and many more factors all have a very real impact on weight, while none are particularly changeable. Moreover, weight management is a struggle for highly motivated, fully mature adults with various weight-related medical conditions. Should we really be expecting children to accomplish a task that eludes many grown-ups?

If you're worried about your child's weight, look to those weight-relatable behaviours that you might actually help to change instead of weighing your child. For example, consider the source, quality and quantity of their calories and of the meals you're providing them.

Look to your own examples for fitness, and cultivate active family outings. Review your home's screen-time rules, and certainly rid all bedrooms (again, including your own) of televisions (which has been shown to dramatically increase risk of obesity in children. Cut your cable (and hence, eliminate the constant food advertisements your children are exposed to), and ensure that your child's bedroom and habits are conducive to adequate sleep (as short sleep duration is also strongly associated with increased weight).

While it's true that there are things affecting your child's weight that you won't be able to change, it's also true that there are many things affecting their weight that fall within your parental discretion – and it's there where you should expend your energies. Importantly, do so without explicitly putting a focus on weight as the cause of your home's changes or the child as their sole target; instead, put the focus on improving the health of your family as a whole, with your changes affecting every member of the home, as the cultivation of healthy living behaviours provides benefits to everyone at every weight.

Bottom line: If you're concerned about your child's weight, don't rely on a number to tell you or your child how he or she is doing. Simply measuring their weight does nothing to helping you understand how it got there nor will it do anything to help it to go away, but it may make your children hate themselves just a little bit more each time you put them on that scale.

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Saturday, March 10, 2018

Saturday Stories: Lots Of Farrakhan/Anti-Semitism

First, Yair Rosenberg, in The Washington Post, with a great, short, and very balanced piece highlighting 5 myths about anti-Semitism.

Nylah Burton, in Forward, writing, "To My Black Brothers And Sisters: I’m Black And Jewish. Farrakhan Is Bad For Us All."

Yehuda Kurtzer, in Times of Israel, with a very thoughtful piece, On friends and Farrakhan: A plea to progressives

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Wednesday, March 07, 2018

The Hunger Hormone Ghrelin May Be Another Reason To Eat Your Carbs Last

Preproghrelin: By own work - adapted from using PyMOL, Public Domain, Link
I've blogged in the past about how eating your carbs last may help reduce your blood sugar levels even 2 hours after your meal.

Well here's another reason why you might want to eat your carbs last - ghrelin.

Ghrelin is one of the body's primary hunger hormones. More ghrelin, more hunger (more on this though in a tiny bit).

Well, a small crossover study looking at the effect of food order on ghrelin levels found that eating carbs last led to a sustained suppression in ghrelin levels 3 hours later, while eating carbs first led to not only ghrelin levels returning to baseline at 3 hours, but also their slight rise (-11.45 ± 3.86% vs. +4.13 ± 4.38%; P = 0.003).

But that said, ghrelin is a surrogate end point for hunger and/or consumption.

Unfortunately, at least in this small study, subjective hunger wasn't different between conditions at any point, and consumption at later meals wasn't measured.

Looking forward to future research on this file, but given the ease of this intervention, I'd file it under maybe worth a try.

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Monday, March 05, 2018

Hey @CR_UK, If Any Amount Of Guilt, Shame, Blame, Or Fear, Were Sufficient To Treat Obesity, It Wouldn't Exist

Thanks to Anthony Cox for sharing Sofie Hagen's reaction to CancerResearchUK's new awareness campaign.

The campaign, which is meant to let people know that there are strong associations between obesity and cancer (and some plausible biological mechanisms that would suggest some causality), though factual, is troubling.

Here's the thing.

By vilifying obesity directly, rather than focusing on the social determinants of health and the built environments that fuel our behaviours and weights, Cancer Research UK's campaign is simply contributing to fear and stigmatization. But if any amount of guilt, shame, blame, or fear were sufficient to treat obesity, obesity wouldn't exist.

And what's odder still is that Cancer Research UK seems to know that, at least partially, as in their pinned video that highlights their campaign shows them telling people that obesity is a risk factor for cancer, they mention that they're asking the government to take action.

If Cancer Research UK wants to make a difference, given that there are no gold standard treatment programs (let alone programs covered by the NHS) that will reliably lead to sustained population based behaviour change/weight loss, and that the personal responsibility approach to treating obesity is a luxury that many people's lives preclude, and that the one thing people with obesity don't lack is constant messaging that tells them that there are risks to obesity, instead they could mount a campaign to educate doctors about how weight bias has been shown to lead physicians to screen their patients with obesity less frequently for various cancers (including colorectal, cervical, and breast), and to encourage those physicians to treat their patients with obesity the same as they treat all of their other patients.

[And lastly, content aside, it's also odd to see Cancer Research UK's lack of people first language with obesity. Does Cancer Research UK describe people who have cancer as being cancerous? If not, perhaps they should stop referring to people who have obesity as being obese.]

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Saturday, March 03, 2018

Saturday Stories: New England Journal Of Medicine Edition (Read Them Before They Go Behind Paywall)

Michael S. Weinstein, in The New England Journal of Medicine, recounts his experiences as a surgeon-patient with severe depression.

Audrey M. Provenzano, in The New England Journal of Medicine, describes how she overcame her fear of treating opioid use disorder.

Anupam B. Jena, and Andrew R. Olenski, B.S., in The New England Journal of Medicine, with their letter highlighting the reduction in firearm injuries during NRA annual conventions (and here's Vox' Julia Belluz with her coverage of same)

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Wednesday, February 28, 2018

Maybe Stop With The Hot-Take Childhood Obesity Rate Trend Stories And Reports?

Or at the very least stop until we're actually as a society trying to do something about it? Because why would we expect it to change if we're not doing anything about it?

As to why stop? Well because despite not doing anything as a society, it seems to be changing....but not really the way you might expect.

Here's what coverage has looked like for the past 8 years

FALL IN 2013
All this to say, these annual takes? They don't make sense both in terms of the outcomes (up, down, sideways, gone, up, down, etc.), but also not in the context of change. Changes tend to occur consequent to changes, and given there really aren't any initiatives going on in the US or Canada that one might expect to impact on childhood obesity rates, perhaps the coverage instead could be about our inaction as a society on this sad file, rather than whether there's been a tiny blip up, down, or sideways in some survey's reported incidence.

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