Friday, October 31, 2014

If Only We Found Pumpkins To Be This Delicious

Today's Halloween Funny Friday video features the world's cutest porcupine.

Have a great weekend!

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Thursday, October 30, 2014

What I Learned By Actually Reading That Drinking Milk Will Kill YouStudy

So a study was published the other day in The BMJ. In it authors explored their theory that milk consumption might in fact increase your risk of death and of hip fracture. Why? Well they finger D-galactose, one of the breakdown byproducts of the lactose in milk, which in animal models has been shown to be pro-inflammatory and lead to shortened lifespans and neurodegeneration. Extrapolating from the mouse models led the authors to infer that 1-2 glasses of daily milk would provide sufficient D-galactose for human harm. The authors further assert that not only can D-galactose lead to shortened life and neurodegeneration, but also to cardiovascular disease, cancer, and ironically, age-related bone loss. And it's not all dairy that worried these authors, just milk, as both cheese and yogurt have lower concentrations of lactose and galactose, and cheese and yogurt also may have positive probiotic related health contributions.

To explore their theory the researchers used two Swedish cohorts. The first included 61,433 women, and the second 45,339 men (both after all exclusions), and with them the authors explored the cohorts' relationships between milk intake (ascertained by way of just two food frequency questionnaires with the women and only one with the men) and mortality and hip fractures over a 20.1 year mean follow-up period. As far as possible confounders go, they considered hormone replacement therapy, menopausal status, and whether or not the women had children, smoking status, body mass index, vitamin D supplementation, alcohol consumption, a healthy dietary pattern, cortisone use, leisure time physical activity, education, and marital status.

Results wise the researchers found that the mean intake of milk was roughly a glass a day for both men and women but that some folks were drinking more than 3 glasses daily, and some less than 1. During the 1,231,818 person years of follow up 15,541 women died as did 10,112 men. Fracture wise there were 4,259 hip fractures among women and 1,166 among men. As far as milk goes, the researchers found those women consuming >3 glasses a day vs. women consuming <1 had a hazard ratio of total mortality of 1.93 (and 1.60 for hip fractures). Comparing male heavy vs. light milk drinkers, the risk found was less pronounced (though still significant according to the researchers) at 1.10 for mortality, but nothing for hip fractures. But bear in mind, those hazard ratio span an average of 20 years of follow-up.

So should you stop drinking milk because it's going to kill you after it leads you to have a hip fracture? These sorts of studies are brutal. No doubt the researchers do their utmost to try to ensure they control for confounders, but given the food data utilized are often single contact food frequency questionnaires (as was here) which are then extrapolated to represent decades worth of consumption, and that lives in general are complicated, it really is difficult to get too worked up about the results. For instance it's difficult to put a great deal of stock in this particular study's FFQ validities as they report the frequent milk drinkers as consuming nearly 40% more calories than the infrequent, and yet the weights of those two groups are within about 3lbs of one another.

So I remain unconvinced that milk is in and of itself markedly toxic, but that said, drinking 3 or more glasses of the stuff a day isn't something I'd be advising anyone to do simply on the basis of liquid calories not being particularly filling. Given that there are many studies that dance around milk providing ever so slight health benefits as well as many studies that dance around milk providing ever so slight health risk, I'm still comfortable with my belief that milk is neither a magic fairy brew nor a devil's broth and consequently should be consumed in the name of loving it (in the smallest quantities you need to like your life), but not in the name of health, and that eating your dairy, from a health perspective, is likely preferable to drinking it.

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Wednesday, October 29, 2014

One Year Into Our Office's Ministry Funded Childhood Obesity Program

A little over a year ago our office launched the Family Reset program - a program designed to work with the parents of 5-12 year old children whose weights are of concern. Some parents were worried about their children's potential future health concerns. Others were worried about current weight related bullying or self-esteem issues and weren't sure how best to help their kids. We wanted to put together a program and a team of health professionals to address all aspects of weight - from health to bias, from body image to fitness. Briefly, the fully funded (there's zero cost to families) program's highlights include:
  • All parents are followed by a physician.
  • All parents receive 6 months of unlimited one-on-one counselling from a registered dietitian, behaviourist and exercise specialist who will work on family health, parenting, nutrition, healthy active living and the cultivation of healthy attitudes surrounding weight and body image. Parents will continue to meet with all team members following those 6 months at prescribed intervals, but if the need arises, emergently as well.
  • All parents who themselves have overweight or obesity will be provided with BMI’s existing 6 month behavioural weight management program which also includes unlimited access to all team members, as well as on-site group fitness classes three times weekly for 6 months.
  • Five group classes for children, led by a specialized social worker/behaviourist with sessions focusing on self-esteem, anti-bullying, body image and stereotypes, depression, anxiety, and anger management. There will be no emphasis or discussion on weight at these meetings aside from how weight might play into the emotions and issues being discussed.
  • One group class for adults with overweight or obesity led by a clinical psychologist on common psychological roadblocks to self-efficacy.
  • Ten hours of one-on-one therapy with a clinical psychologist for parents struggling with mental health issues such as depression and anxiety as improving the treatment of mood disturbances will likely improve those parents' interactions with their children
  • Seasonal group fitness outings designed for families led by exercise specialists to introduce families to different active living options.
  • Two group cooking classes for all parents at a rented outside facility designed to teach basic cooking and meal preparation skills. Thanks too to the generosity of best selling cookbook authors Greta and Janet Podleski, each family will receive a free copy of their latest compilation The Looneyspoons Collection which was Canada's best-selling cookbook of 2012.
Today I wanted to touch on the outcomes to date.

While we haven't yet done any statistical crunching, the outcomes are pretty much what one might expect. Many kids lost weight. Some kids stopped gaining weight. Some kids continued to gain but gained more slowly. Some kids weights and gains didn't see change. That range makes sense too because parenting is fairly described as role model, guide, support and then hope for the best. Put another way, as every parent knows, no matter how badly we want something from or for our children, there simply isn't any way to guarantee we can make it happen.

The adults too had outcomes across the board. From small losses, to one couple who together over the course of their year with us, lost 191 lbs.

But one thing I'm confident of, every single family coming through our Family Reset program, learned how to approach health and weight free from nonsense, free from weight-bias, and learned how to improve upon their family's lifestyles in a manner that was body-image and self-esteem friendly, and one which regardless of weight, benefits health.

Ottawa parents, if you have a child 12 and under whose weight places them in the 85th percentile (for a calculator click here) or higher and would like to be considered for our Family Reset program please give our office a call at 613-730-0264, or send Tori an email and we will quickly contact you to set up an appointment to discuss our program further.

[And Ottawa folks, please feel free to share this post with your various social networks - we still have spots available for this year's programming and would love to help.]

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Tuesday, October 28, 2014

Read It Before You Tweet It!

I know I've said this before, but I need to say it again. I honestly don't get it.

I don't get how really smart folks, folks trained to critically appraise actual journal articles, folks for who evidence is reported to be extremely important, regularly tweet out press releases without first having read the study.

Press releases are designed for hype and publicity, not for measured and scientifically supportable conclusions.

If you care about your audience, and you also care about evidence, you owe it to both to stop, read the article in question, and link to it in your tweet along with your own 140 character sound-bite.

Read it before you tweet it!

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Monday, October 27, 2014

Guess What? Childhood Obesity Won't be Solved By Healthy Corner Stores Alone.

And no, the study wasn't published in the Journal of Duh, it was published in Obesity and it explored the impact of corner stores stocking healthy foods alongside all the junk on the obesity rates of surrounding schools' 4th-6th graders over the course of 2 years.

And, shocker, the singular intervention of stocking healthy foods alongside chips, candy, and soda in corner stores didn't all by itself lead the surrounding 9-11 year olds to lose weight.

Yet that didn't stop The Obesity Society from tweeting out,
I found this tweet incredibly frustrating as by definition complex problems won't be solved by way of singular interventions, and of all folks The Obesity Society ought to know that.

I'm not suggesting there's an easy solution, but we need to figure out a better way to consider single sandbags than to design (or publicize) studies that invariably will show them to be incapable on their own of stemming a flood.

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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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