Saturday, October 25, 2014

Saturday Stories: Body Image, Complementary Medicine, and Autism

Lauren Fleshman in Runners World asks, "Do I Look Like a Man?"

Nicola Davis with a great interview of Edzard Ernst, Professor of Complementary Medicine

Judith Newman in the New York Times with an incredible read on the friendship between the iPhone's Siri virtual assistant and a boy with autism.

[And if you don't follow me on Twitter or Facebook, here's a piece I wrote for The Globe & Mail asking why aren't RDs covered by Canada's public servant health care plan, here's a piece I wrote for US News and World Report on obesity and morbid self-righteousness, here's an op-ed I wrote for on predatory journals and medical "evidence", and here's a podcast I recorded with Evidence Magazine's Armi Legge on weight management and more.]

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Friday, October 24, 2014

Between Two Ferns and Brad Pitt

If you need proof that Zach Galifianakis' Between Two Ferns is the best talk show around look no further than today's Funny Friday video featuring him interviewing Brad Pitt.

Have a great weekend!

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Thursday, October 23, 2014

A Halloween Survival Guide for Parents

Reposting an old Halloween piece of mine as I imagine that many families will be out shopping for Halloween loot this weekend.

It's coming.

And I'm not really all that worried. At least not about Halloween night.

The fact is food's not simply fuel, and like it or not, Halloween and candy are part of the very fabric of North American culture and to suggest that kids shouldn't enjoy candy on Halloween isn't an approach I would support.

That said, Halloween sure isn't pretty. On average every Halloween sized candy contains in the order of 2 teaspoons of sugar and the calories of 2 Oreo cookies and I'd bet most Halloween eves there are more kids consuming 10 or more Halloween treats than less - 20 teaspoons of sugar and the calories of more than half an entire package of Oreos (there are 36 cookies in a package of Oreos).

So what's a health conscious parent to do?

Use Halloween as a teachable moment. After all, it's not Halloween day that's the real problem, the real problem are the other 364 days of Halloween where we as a society have very unwisely decided to reward, pacify and entertain kids with junk food or candy (see my piece on the 365 days of Halloween here). So what can be taught on Halloween?

Well firstly I think it's worth chatting about sugar and calories, and those rule of thumb figures up above provide easy visualizable metrics for kids and parents alike.

Secondly it allows for a discussion around "thoughtful reduction". Remember, the goal is the healthiest life that can be enjoyed, and that goes for kids too, and consequently the smallest amount of candy that a kid is going to need to enjoy Halloween is likely a larger amount than a plain old boring Thursday. Ask your children how much candy they think they need to feel Halloween was awesome. In my house it's 3 pieces - so our kids come home, they dump their sacks, and rather than just eat randomly from a massive pile they hunt out the 3 treats they think would be the most awesome and then take their time enjoying them.

The rest?

Well it goes into the cupboard and gets metered out at a rate of around a candy a day....but strangely....and I'm not entirely sure how this happens....after the kids go to sleep the piles seem to shrink more quickly than math would predict.

You might also check to see if the Switch Witch works in your neighbourhood, where like the Tooth Fairy, the Switch Witch, on Halloween, flies around looking for piles of candy to "switch" for toys.

And if you do happen upon our home, we haven't given out candy since 2006 and we haven't been egged either. You can buy Halloween coloured play-doh packs of 50 for $15 at Costco, Halloween stickers or temporary tattoos at the dollar store, and last year had a tremendous response to our dollar store glow wands and swords. If your community is truly enlightened, you might even be able to buy free swim or skate passes for your local arena (they run about 50 cents per so if you're in a very busy neighbourhood this can get pricey).

Do you have other strategies you'd like to share?

[Here's me chatting about the subject with CBC Toronto's Matt Galloway]

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Wednesday, October 22, 2014

Guest Post: A Reader Provides His Recipe for Weight Loss

His name is Brian Abernathy and a few weeks ago he reached out to let me know what has worked for him with his weight. And while I'm not suggesting everyone follow his plan (there's no one right way, and what's right for one, is no doubt wrong for another), I thought it was thoughtful, well written, realistic, and very much in line with my philosophy, and so I asked him if he'd mind if I shared.


First, thank you for your reasonable approach to weight loss and for pointing the finger at the dismal food environment we’ve created. I’ve been following your blog for a few years now and I thought I would give you a brief account of my recent weight loss of which a lot of credit goes to your simple approach, though I haven’t read your book (sorry). I have been dieting or exercising for weight loss for probably 25 years all to no avail until this year. I’ve gone from about 155-160 (at 5’9”) when I graduated high school in 1985 to a high of 215 lbs. at the end of 2013. As of today I’m at 178 lbs and still working at it (37 lbs total loss).

I think part of the problem was that I wanted society to change my eating environment for me or perhaps for there to be a way to eat as much of some kind of esoteric diet (Ornish, vegan, paleo, etc.) as I wanted and still lose weight. I came to the realization that two things had to happen:
  1. I needed to take charge of my weight loss because the food environment was unlikely to change.
  2. I needed something that was guaranteed to work and would be simple.
I’m fairly well read on the literature so I took your advice along with some others and just started. My plan was simple:
  • Set a fixed calorie amount per day – in my case 1,800 and try to get about 100-150g of protein per day. Fat and carbs could vary (I didn’t track them). I had tried 1,600 before and it was way too low and 2,000 didn’t give me fast enough results to keep me motivated.
  • Write down and weigh all the food I was eating – the good, the bad and the ugly. This is really not that hard – takes a few minutes a day at most now. Early on, I realized I had eaten 3000-3500 calories some days and the scary thing was how easy that is to do if you don’t pay attention. If I wasn’t sure about a food’s calorie count, like at restaurants, I would just estimate and try to be close – don’t get trapped into being perfect. The food log ended up being the most critical part of the weight loss – I can’t emphasize this enough.
  • DO NOT have a weight loss goal or a date to have lost the weight – too easy to fail. Better approach is to remember than not quitting is the only way not to fail.
  • Focus on systematically meeting my calorie/protein goal DAILY – the rest will take care of itself.
  • Eat any kind of food – nothing is off limits. However, I quickly figured out that whole foods are just more filling than processed ones. Really, I’m not pious about this at all, but the reality is that an 8 oz chicken breast, 6 oz. of boiled golden potatoes with salt & pepper and a couple of cups of broccoli with a pat of butter is so much more filling than a large milkshake for the same calories.
  • Eat cake at parties, pie at Thanksgiving, ribs on the 4th of July, etc. without guilt.
  • Don’t use setbacks to quit – get back on track and keep working at it even if your weight goes the wrong direction for a few days.
  • Don’t get trapped into being perfect.
  • Exercise daily for fitness and not for calories – I focused on getting faster in my running and lifting more weight.
While losing I also decided to write down lessons learned and follow them (here they are so far):
  • Always look at the menu and decide what to eat BEFORE having a drink - drinking lowers my inhibitions and I go off the rails with my eating
  • Write down the meal and calories before eating it – then go to town and enjoy!
  • Eat whole foods because they are bulky and fill me up more than refined ones
  • Alcohol takes up calories I would rather be eating
  • Eat lots of vegetables – they are stupidly low calorie and fill you up
  • Meatless days are very hard on a low calorie diet for me.
  • Starches like potatoes, rice & pasta seem to have too many calories for how little I enjoy them – replace with veggies I like or more protein.
  • Prepare my lunch the night before – I never regret this small chore
  • Rolled oats are cheap, low calorie, high protein, fast to cook and I don’t seem to tire of them for breakfast – cinnamon, applesauce, walnuts, brown sugar – lots of ways to mix them up.
  • Controlling your food intake by cooking at home is HUGE – very hard to manage calories while eating out regularly
  • You can eat healthy and low calorie at practically any restaurant – it’s just not always easy to do
  • Don’t let yourself get too hungry or you go off the rails – an apple is usually enough to take the edge off.
  • Man up! - you have to be a leader and stay in your own frame – don’t let other people influence you to eat the way they eat even though it doesn’t fit your lifestyle
  • Your family will start to follow your lead – my wife weighs the food now before she cooks it!
I started out using an app on my phone and tried various ones (Fitday, MyFitnessPal, etc.) but I eventually went a more Luddite route. After a few months of logging foods, I figured out that I don’t eat 1000’s of different foods and I could just put them in a spreadsheet and print them out and keep them in my notebook. It’s four pages and includes calories for common recipes we use too (lentil soup, ragu sauce, balsamic dressing, etc.). I use the notebook to log workouts, food, etc. and I really like the portability of the notebook over my phone. Unlike some other people I try not to be tethered to a cell phone and I can throw my notebook around, sweat on it and it never needs charging.



Brian Abernathy
Upstate NY

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Tuesday, October 21, 2014

Why You're Better Off With Froot Loops Than Special K Granola

Because spoon for spoon Froot Loops contains 20% less sugar and roughly 1/3 the calories as Special K granola.

Yet here's betting the health halo of the words, "Granola", the claims, "Made with Whole Grains", "Low-Fat", and "Source of Fibre and Vitamin D", along with the weight-focused branding of "Special K", leads many to think this high calorie sugar bomb is a great, weight-safe, healthful meal or snack.

If you're going to have a dessert cereal, best you know it's a treat and not think it's a health food.

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Monday, October 20, 2014

Guest Post: Obesity, Cancer, and Mental Health. What Links Them All?

Today's guest post comes from Dr. Sandro Demaio - a rising public health champion. When he asked me if I'd write something for him, I jumped at the chance to ask him to write something for me!

There's been a lot of discussion about obesity. Whether or not it's a disease (as it is in the USA now). How this label would positively or negatively influence action taken by society and governments in addressing this large and growing burden.

This conversation is important, but I have noticed very often it ends with confusion. Questions around why we begin talking about obesity - and end discussing mental health, cancer, heart disease or diabetes. To make hings even more confusing, the term 'Non-Communicable Diseases' might even be mentioned.

So what is the link between all of these diseases, and why can we not have a discussion about obesity, without talking about a range of seemingly unrelated ailments?

Well the reality is that all these diseases are actually highly interrelated. Obesity, diabetes, heart disease, cancers, lung diseases and mental illness (all combined are called Non-Communicable Diseases, or NCDs) largely share the same drivers or "risk factors". Things like an unhealthy diet, using tobacco, drinking alcohol and not getting enough exercise are all related to, or direct drivers of obesity and diseases like diabetes and some cancers. What's more confusing though, is that obesity itself puts us at higher risk for diabetes and some cancers, as does diabetes for heart diseases - for example.

Taking a step back though, the overlap becomes even more apparent. Because at a time when as much as two-thirds of many countries are overweight or obese (and obesity is rapidly rising in even the poorest nations), this is not an issue that comes down to 'stupid individuals making poor choices'. The reason we have a poor diet, or smoke, or don't get enough exercise - is largely due to the built environment around us, the ubiquitous nature of junk-food and alcohol advertising, the way our cities are designed, the structuring of our food system, the subsidies that make unhealthy foods cheap, the over-focus of treatment at the expense of prevention in our health systems, the lack of integrated health education in schools and so on...

These are the structural and social determinants of health, and disease.

Let's just look at food for a moment - which is a leading risk factor for disease worldwide with poor diet driving obesity, diabetes, heart disease, some cancers and more. We can say that people eat poor diets because of poor choices, but I don't really buy this. Do we really make informed, un-coerced decisions on what we eat? We buy that chocolate bar because it's delicious, but also because we are bombarded with advertising which makes us want it. They use psychologists and behavioural studies to develop the right flavour, size and packaging. They place it at the check-out because they know we will impulse buy it - that is, we never really wanted it. The sugar in that bar is cheap because our governments (more so in the USA nd Europe) subsidises the cost of sugar production and having eaten the bars as a child due to clever marketing specifically pointed at young people, we associate chocolate with happy memories.

My point is that in a nation where 2 in 3 of us are overweight or obese, something much bigger is going on that simply 'stupid people making poor choices'.

My other point is that whilst we might think of these diseases as separated outcomes, they actually have common root causes, risk factors and social determminants. Many of them far beyond the health sector.

Some biting food for thought.


In the month of October, NCDFREE is running a campaign called The Face of NCDs. Here are some crowd-sourced reflections on the overlaps between these diseases, from people like you around the world.

"The idea of NCDs as a result of broader social engineering, rather than from the intentions of individuals, is something that needs to be more widespread. Too much of our approach to conditions like diabetes, pulmonary disease, and heart attacks blames the sufferer when we should be looking to the societal and economic determinants of health. When two thirds of Australians are overweight, there have to be larger forces at work than the personal failings of patients." - Oscar, Australia

How ironic is it that man created antibiotics and medicines that keep us alive, but also created societal structures, alcohol, cigarettes and processed foods that are killing us? We need to realize that NCDs are problems of the way we constructed our societies and that there is a way out.” - Signe, Denmark

"In more and more countries being overweight or obese is the norm. Its the most shocking sign that our food system is simply failing. It’s going to take concerted effort from governments, the food industry and the public to make the changes needed to tackle this problem. Failure to do so will have catastrophic consequences for humanity.” - Henry, Denmark

"Coming from the US and living in Denmark has shown me the massive influence that political and public infrastructures have on health-related behavior. It can be argued that an unhealthy lifestyle is simply a matter of individual choice, but when roads are designed for automobiles rather than bicycles or when cheap, highly processed foods are available in excess rather than moderation, the odds are stacked up against you from the start.” - Hillary, USA

"Major sporting events often talk about leaving a legacy to inspire the youth of today to live a more physically active lifestyle. However these same events, which are watched by billions around the world, are sponsored by leading food and drinks companies which are contributing to the current global epidemic of obesity and type 2 diabetes. Is this the legacy we really want to leave?”- Jack, Denmark

For more stories, head to today.

Dr Alessandro Demaio trained and worked as a medical doctor in Melbourne, Australia. While working as a doctor at The Alfred Hospital, he completed a Masters in Public Health including field-work in Cambodia. In 2010, Alessandro relocated to Denmark and completed a PhD fellowship in Global Health with the University of Copenhagen, focusing on Non-Communicable Diseases.

In 2013 Dr Demaio co-founded NCDFREE, a global social movement against NCDs – reaching more than 1.5 million people in its first year. His team convened two international launches and has made 4 short advocacy films; two in collaboration with the World Health Organization.

Currently, he holds a Postdoctoral Fellowship at Harvard Medical School and continues a part-time role as Assistant Professor at the Copenhagen School of Global Health. He also serves on the Advisory Board of the EAT: Stockholm Food Forum.

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Saturday, October 18, 2014

Saturday Stories: Viola Vanclief, Environments, Ebola x 2, and Marathons

Viola Vanclief
Garrett Therolf in the LA Times tells the haunting story of Viola Vanclief's too short life.

Brad Stulberg in The Harvard Public Health Review makes the case for levee building over swimming lessons in behaviour change.

Josephus Weeks, the nephew of Ebola victim Thomas Eric Duncan, with a must read story in The Dallas News on why his uncle's death might have been preventable.

Frank Bruni in The New York Times on how Ebola has highlighted our messed up health priorities and asks, among other things, if you've had your flu shot?

Alex Hutchinson in Runner's World with an amazing example of why the Internet's a great place to write, with his incredibly presented piece on what it's going to take to run a sub 2 hour marathon.

[And if you don't follow me on Facebook or Twitter, here's my piece this week from US News and World Report where I make the case for "Guerrilla Nutrition."]

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Friday, October 17, 2014

Dear Kitten, About that Dog

Today's Funny Friday video has Ze Frank lending his comedic styling to a cat food commercial. It's fantastic.

Have a great weekend!

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Thursday, October 16, 2014

What Actually Reading that Fast vs. Slow Weight Loss Study Taught Me

I imagine this one will be all over the news today, and superficially I can certainly see why - a new study reportedly proves that if you lose weight fast or slow, 3 years later, regardless of the speed you lost your weight, you'll have gained back the same amount. This of course flies in the face of the advice that slow and steady wins the weight loss race.

Read the actual paper and the story becomes far less exciting.

In brief, study participants were randomized to either lose weight quickly with an all-liquid meal replacement shake program (Optifast), or to lose weight slowly using that same Optifast shake to replace one to two meals daily. Once a target weight loss of 15% was reached all patients who got there were then instructed to follow Australia's national dietary guidelines and to see a dietitian once every 3 months for the next 3 years.

Over that same 3 year period, everyone, regardless of whether they lost weight with Optifast quickly, or lost weight with Optifast slowly, regained the same amount of weight when following Australia’s national dietary guidelines – guidelines not even remotely designed for weight management or satiety (15% protein, 30% fat, 55-60% carbs) - while being provided with very little in the way of ongoing support.

Put another way, being prescribed a weight loss program that involves zero changes to lifestyle (aside from drinking shakes in place of meals), and then once weight is lost quickly or slowly, being told to follow a diet not designed in any way shape or form for weight management while receiving infrequent ongoing support, is clearly equally ineffective.

The fact that weight lost comes back when the intervention you undertook to lose the weight is stopped is anything but surprising, and yet that is precisely what was done with both the rapid losers and the slow losers. That there was no difference in their rate of regain speaks more to the authors' failure of recognizing obesity as a chronic condition, which like any chronic condition, returns once treatment is stopped, than it does to the speed participants lost weight using weight loss interventions that they were explicitly instructed to stop once their weight was lost.

The more weight you'd like to permanently lose, the more of your life you'll need to permanently change. All this study proves is that temporary changes lead to only temporary results and that what matters to your longterm success isn't the speed with which you lose your weight, but whether you lose your weight with a lifestyle that you enjoy enough to sustain.

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Wednesday, October 15, 2014

The New York Times, Ebola, and "Immune Boosters"

While we may tell ourselves we live in a time of enlightenment, when it comes to our health, one walk through a pharmacy or health food store's aisles of Dr. Oz-esque nonsense and nostrums, and it's easy to see we're certainly not all the way there yet.

And while I fully expect the likes of both tabloid television and tabloid journalism to ascribe super powers to supplements without the requirement of super proof of those same powers, for some reason (naiveté I'm guessing) I wouldn't have expected the same from the New York Times. And yet...

Yesterday I clicked on a link to a story in the Times that detailed a reporter's experiences travelling from Liberia to New York in this new context of Ebola. When I got to this sentence, had I been drinking coffee I might have spit it out,
"I carried a blue canvas handbag crammed with wallet, laptop, two cellphones, passport, change of clothing, bleach wipes, and two Ziploc bags full of the malaria pills and immune boosters I had been taking for the two weeks I had been covering the Ebola outbreak".
Immune boosters?

To date, there are no products that I'm aware of that have been found to have a direct connection between their ingestion and heightened immunity. Sure, there are some theoretical connections (probiotics for instance), but nothing that would make me not scratch my head about the New York Times' journalist (and her editor) who felt that including a casual mention of "immune boosters" as if they were, akin to malaria pills, real and obvious things to pack (and take), in an article about Ebola, during a time of knee jerk medical paranoia, was in the public's best interest.

Why? Well beyond the responsibility a credible newspaper has in providing the public with fact and not fiction, there may be risk to those pharmacy shelf/health food store products that purport to boost immunity, because if they actually did, they would likely cause harm. Mark Crislip of Science Based Medicine explains this succinctly,
"If you really, truly, could boost your immune system, you would almost certainly increase your risk for thrombotic events."
The reason there would be risk is that a genuinely boosted immune system is pro-inflammatory which in turn would increase your risk of thrombotic events (like strokes, heart attacks, blood clots, and embolisms).

That a New York Times reporter is not only comfortable purchasing and taking products purported to "boost" her immune system, let alone casually including a mention of them in her article (and having that casual inclusion get past her editor), is a true testament to us needing far more regulation when it comes to our aisles of nonsense.

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