Saturday, February 13, 2016

Saturday Stories: Media Bias, Ruining Lives, and Robin Hood

Zenobia Ravji, a Zoroastrian journalist, discusses her experiences in the Middle East and the bias she sees in its reporting.

Tess Owen in Vice covers Motherisk, describing it as the Canadian lab that spent 20 years ruining lives.

Simon Oxenham in Big Think tells the story of the Robin Hood of science who steals from the rich (scientific journals) and gives to the poor (the public).

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Friday, February 12, 2016

"Cranberries are, I think we can all agree, nature's most disgusting berry"

Thanks to Dr. Dylan MacKay for reminding me that at 7:40 of this John Oliver piece of sugar, he covers cranberries - "cherries that hate you". Seemed fitting given #Craisingate.

Whole thing's well worth a watch.

Have a great weekend!

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Wednesday, February 10, 2016

Weight, BMI, BF% - Should MDs Measure Things That Shouldn't Change Treatment?

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Something I struggle to understand is the medical community's (and much of the public's) use of some combination of weight, body mass index, body fat percentages, or waist circumferences as a means to determine whether or not a person might benefit from an exploration of their lifestyle.

While all of those measures to a degree do inform risk, are they really useful to the clinician in determining the need for the exploration of a person's lifestyle? Does it simply follow that if one or more of weight, BMI, body fat percentage, waist circumference or waist to hip ratio is high that said person's lifestyle isn't healthful, or that treatment (lifestyle, meds, or surgery) is required?

A more important question though would be if all of those numbers were in so-called healthful ranges, does that mean your patient's lifestyle shouldn't be explored?

I know plenty of people with weight whose lifestyles are tremendous, and plenty of folks without whose lifestyles are horrifying, and as such, regardless of numbers, clinicians are best to explore lifestyle with every single patient. Artificially hinging a discussion on lifestyle on a number which even with the best of intentions and efforts, might not change much, can both lead a person to abandon their efforts to live more healthful lives when things don't change, and preclude conversations that in turn might benefit your patients and their families.

The goal is the road (a healthful one), there is no destination (the numbers).

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Monday, February 08, 2016

Craisins Are More Candy Than Fruit

A strange thing happened last week.

In response to a tweet that included the photo up above that inferred Craisins are a healthful handful of "Nature's Candy", I pointed out that Craisins were in fact candy, as in order to make them palatable, heaps of sugar are added.

That's not the strange part.

The strange part was the somewhat heated debate it seemed to spark on Twitter. One RD wrote to say that though there's more sugar than raisins, there's not that much more (I'll come back to the raisins in a bit), and that she'd certainly choose Craisins over chocolate chips for her trail mix.

So I decided to compare the two.

First, by weight, gram for gram the Craisins have 34% fewer calories than Hershey's semi-sweet chocolate chips (I'd say that's a good thing), but with 89% of the Craisins' calories coming from sugar (versus 46% of calories coming from sugar in the chocolate chips). Interestingly, when compared by weight with chocolate chips, Craisins have 10.5% less fibre (who knew chocolate chips had fibre?), and 18% more sugar.

If we compare them by volume though (as I think volume is probably the way most assemble trail mix), the Craisins come out a bit better still, containing just half the calories of the same volume of chocolate chips and with 10% less sugar. So maybe this RD's got it right - Craisins, as a sugar source for your trail mix, will provide a tiny bit less sugar than chocolate chips and at half the calories.

Next up was an RD who took issue with my use of the terms, "heaps", and "piles", to describe the sugar content of Craisins.

Now it's true that heaps and piles are not formal units of measure, but yes, to me the 5.4 teaspoons of sugar contained in the single serving package of Craisins featured in the original tweet can be fairly described as both a heap and a pile. Another way to consider Craisins' sugar content is to ask how much sugar is found per tablespoon of Craisins? The answer is that 60% of each tablespoon of Craisins is sugar, and therefore piles of Craisins definitely mean piles of sugar.

And now back to raisins. The same RD who didn't like my heaps and piles comment decided also to build a strawman argument (she misrepresented my argument to make it easier to attack) when faced with my answer that yes, 7 teaspoons of sugar per quarter cup serving of Craisins is a pile, and asked me if I was "against" raisins as well.

The answer's yes - if the question is the non-strawman version asking me if I'm also opposed to considering raisins a fruit equivalent.

It's true, unlike inedibly-tart-without-added-sugar Craisins, sugar isn't directly added to raisins, instead it's concentrated in them by way of dehydration. By volume raisins contain 4.17x the calories of red grapes, and 3.7x their sugar, and just one of those little, unlikely to help fill even a child up, 1.5oz boxes of raisins, contains 6.25 teaspoons of sugar representing 77.5% of the raisins' total calories. And they're not exactly nutritional powerhouses either as raisins pack little to nothing in the way of nutrients.

Here's are some breakdowns of the nutrients found in a 1.5oz box of raisins

Whereas a cup full of actual grapes, an amount likely to provide some real satiety, and containing 18% fewer calories and 9% less sugar than that tiny, not-filling box of raisins, brings a fair bit more in the way of nutrients.

All this to say - if you like Craisins, raisins or chocolate chips, by all means eat them, but know that the first two have far more in common with candy than they do with fruit and probably shouldn't be confused as healthful.

When it comes to Craisins and raisins, nature's candy is still candy.

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Saturday, February 06, 2016

Saturday Stories: Retired Cells, Brazilian Doctors, and Ancient Rome's Halftime Shows

Ed Yong in the Atlantic covers an exciting new anti-aging treatment prospect - getting rid of the body's retired cells (mouse model caveat applies).

Reed Johnson and Rogerio Jelmayer in the WSJ on the Brazilian doctors who sounded the alarm on Zika and microcephaly.

A must pre-Superbowl read in Live Science from New York Times bestselling historical non-fiction author Cristin O'Keefe Aptowicz on the horrors of the ancient Rome's damnatio ad bestias half-time show.

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Friday, February 05, 2016

"Instead of Water, Might I Suggest an Ice Cold Bottle of Candy?"

Today's Funny Friday is funny because it's true. It's a soda commercial, without the marketing.

Have a great weekend!

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Wednesday, February 03, 2016

The Calorie Clump Theory of Annual Weight Gain

It's a fairly frequent, and ridiculous sounding argument, and it's often brought up by those who suggest that calories don't count so as to highlight what a silly construct calories are. And truly, the suggestion that teeny tiny mismatches in energy intake are responsible for our average gain of 2lbs per year is ridiculous. It's a straw-man argument though.

Working with literally thousands of patients over the course of the past dozen years I can tell you people don't gain weight consequent to a slow, linear, one extra potato chip too many per day, sort of way. People gain weight consequent to big, giant, clumps of calories.

Sometimes those clumps come from restaurant meals. Sometimes those clumps come from vacations. Sometimes they come from religious holidays and family gatherings. Sometimes they come from comfort eating after an especially rough week. Sometimes they come from a weekend or a night out with the girls (or boys). Sometimes they come from burning the midnight oil. No doubt for most of us they come on our, and our kids' birthdays.

And none of this is to say that the quality of calories don't matter. They do, as the quality of our calories will directly and indirectly affect the size of our clumps. But there is no shortage of calorie clumps.

Even if these clumps when squished together made up only 5% of our years' days, and assuming each of those days provided only a conservative 500 calorie clump (I'm betting many day's clumps climb easily into the thousands), those clumps' contributions to calories could more than explain our slow, annual, average rise in weight - even if the remaining 95% of our days were in perfect caloric harmony.

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Monday, February 01, 2016

"Constrained Energy Expenditures" and Not Outrunning Our Forks

A new study came out last week that further explained why it is that while exercise does burn calories, it doesn't help with weight management nearly enough to be fair.

The paper, "Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans", aimed to explore why it is that exercise's impact on energy expenditure doesn't appear to be linearly "additive" - meaning that studies on energy expenditure suggest that increases in exercise, don't come with a comparable increase in total daily calories burned. In part this is because with increasing exercise comes increasing exercise efficiency, but the remainder is less clear. Is there an "exercise" thermostat in our bodies that effectively dials down our activity levels outside of our workouts whereby if you workout hard in the gym in the morning you'll sit more and fidget less for the rest of the day?

Here the authors put forward their theory of "Constrained Total Energy Expenditure" to explain the phenomenon I've covered here a few times - that objectively measured energy expenditures don't seem to vary much the world over. From the first world to the third world, as a species we seem to share the same total daily energy expenditures each and every day. This fits with the authors' constrained hypothesis.

To test their constrained model they objectively evaluated energy expenditures, in 332, mixed-sex, adults drawn from Ghana, South Africa, Seychelles, Jamaica, and the United States. The measures they tracked were total energy expenditure by way of doubly labeled water method, resting metabolic rate by way of respirometry, and physical activity by way of wearable tri-axial accelerometers.

What they sought to learn was which model would be best represented by the subjects' objective measurements - additive or constrained? If additive you'd expect a linear increase in energy expenditure with activity. If constrained you'd expect adaptations to blunt increasing energy expenditure even as activity levels rose.

The authors found that the plot of their cross-sectional subjects' activity vs. energy expenditure wasn't linear and additive like the first graph, but rather was blunted and constrained like the second.

Also worth noting, the authors point out that regardless of which model you choose to believe in, their findings had physical activity accounting for only 7%–9% of the variation in total energy expenditure after controlling for anthropometric variables and population location. Translated this means that when it comes to energy balance, what you eat matters a hell of a lot more than how much you exercise regardless of how exercise contributes to energy balance. It also means that you're not likely to be able to outrun your forks.

Of course you shouldn't take this as a license not to exercise, as exercise is probably the single most important modifiable determinant of your health. Putting this another way, you lose weight in the kitchen, you gain health in the gym.

(Below is my keynote presentation for PHE Canada where I make the case for rebranding exercise)

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Saturday, January 30, 2016

Friday, January 29, 2016

This Little Boy is a Cookie Ninja

Hide your cookies! Today's Funny Friday kid will steal them and you'll never find out!

Have a great weekend!

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