Monday, February 24, 2020

Health Canada Fails Science And Canadians By Allowing Any Purported Weight Loss Supplements To Be Sold

The latest of many systematic reviews and meta-analyses of herbal supplements for weight loss plainly makes the case that there is no justification for their sale.

They. Don't. Work.

None of them.

None. Of. Them.

So why does Health Canada license and allow the sale of 1,128 natural products whose listed purported use is for weight management? Or of the 671 products that purport they'll improve sexual enhancement? Or of pretty much any of them?

Maybe the answer lies somewhere in the taxation of the $1.8 billion annual Canadian sales of vitamins and supplements?

Maybe it lies in well-intentioned hope?

Maybe it lies is political contributions and lobbying?

But the one place where it doesn't lie is in science. Shouldn't that be the only place that matters?

Wednesday, February 19, 2020

Oh My God The Nutrition World Is Painful

Short post to say that watching people aggressively argue about their preferred diets of choice, and seeing reputable people willing to prop up the most shameless of medical hucksters if they happen to share a nutritional belief, and confirmation bias cherrypicking, and the endless debates about physiology, and meal timing, and breakfast, and fasting, and macronutrients, and lipids, and anti-science shilling, and multi-level marketing, and so much more, is so very tiresome.

As a clinician I know that what actually matters is how to help the person sitting in front of me, remembering that science, meal patterns, macronutrients, and physiology, may not always matter the way some study says they could or should in the face of an individual's life and personal preferences. Ultimately, and regardless of what I think is "right" on paper or right for me, my job is to help patients make sustainable changes that in turn lead them towards the healthiest life that they can actually enjoy.

Similarly, as a public health advocate, I know that if there were any amount of education, or a brilliantly crafted public health message, that in turn would effectively drive societal behaviour change we'd have all already changed all of our behaviours. I can also tell you that energies spent on initiatives relegated to personal responsibility, including but not restricted to those promoting one person's diet tribe, pale in importance to energies spent on initiatives relevant to changing the food environment. And there's no shortage of targets that span all dietary dogmas - from advertising to kids, front-of-package health claim reforms, junk food fundraising, the provision of free cooking skills to kids and adults, national school food programs and improvements, tax incentives and disincentives, and more.

All this to say, it's my opinion that these two flawed foci, that there's one best or right way and that personal responsibility will be our salvation, are the two main reasons why we can't have nice things in nutrition and nutrition related public health.

Saturday, February 15, 2020

Tuesday, February 11, 2020

Why Service Provision Fatally Confounds All Diet Studies (5:2 Intermittent Fasting Edition)

Last week I posted about a 5:2 intermittent fasting study that demonstrated terrible adherence with a 58% 5:2 drop out rate by the end of year one and where the average loss was 11lbs.

In response, Erik Arnesen shared another year long 5:2 intermittent fasting vs. continuous energy restriction study where the drop out rate at the end of year one was just 7% and the average loss was 20lbs! (and actually I blogged about this one in the past - tl;dr no difference in outcomes but 5:2 participants were hungrier)

If the diets were identical, why the tremendous difference in adherence and weight loss at a year?

Sure, could be different patient populations, but I'm guessing the much larger factor was the service provision. Because at the end of the day that's a huge part of what's being measured in any organized diet study. Not just in terms of how many visits or touch-points a particular program has, or what collateral materials and support they provide their participants, but also the rapport development, motivational ability, and teaching skills of the service providers themselves.

Having led an inter-professional team for 16 years, I can tell you that who you've got helping your patients/participants has a tremendous impact on their outcomes even within the same program's delivery.

So the next time you consider the outcomes of any study's diet arm, a question worth pondering is how much of those outcomes are consequent to the prescribed diet itself, and how much are consequent to the health care professionals administering it?

Saturday, February 08, 2020

Tuesday, February 04, 2020

Year Long 5:2 Intermittent Fasting Study Reports It's No Better Or Worse Than A Horribly Restrictive Diet

I started out planning to write about a different paper - a one year post intervention followup of people who had completed a prior year of being randomly assigned to 5:2 style intermittent fasting (IF) (2 days a week consuming 400-600 calories) vs. continuous energy restriction (typical of eating less daily) which showed that there was no difference between the two, but when I read it I realized the story was in the initial intervention, not the follow up.

The initial intervention involved randomly assigning 332 people to one of 3 dietary interventions:  Continuous (daily) energy restriction (CER), week-on, week-off energy restriction, and a 5:2 intermittent fasting pattern involving 5 days of habitual intake and 2 very low energy diet days each week.

Of the only 146 completers, no differences were found between the diets in terms of weight loss, adherence, change in lipids, or fasting glucose.

And most of that is consistent with other studies of 5:2 IF which have found that it's no better or worse than any other approach when it comes to weight loss and biochemical changes. But what's not consistent is adherence being the same, wherein other studies tend to see more people quitting IF.

Digging the tiniest bit deeper into this two things stand out. Adherence was abysmal for both CER (49% drop out rate) and IF (58% drop out rate). But what was different here was what was involved in the CER arm. Women randomized to the CER arm were aimed at consuming only 1,000 calories daily for a year, while men were aimed at only 1,200 calories daily. That's a life-suckingly low number of calories for anyone to be aimed at and honestly it surprises me that researchers (and peer reviewers) would think that degree of continuous restriction would be worthy of study.

All this to say, that people were just as likely to report adherence to a misery inducing 1,000-1,200 calorie per day diet as they were to a 5:2 IF approach does not reflect well on the enjoyability (and consequently the broad applicability) of 5:2 style diets.

And for the inevitable trolls, I'm not knocking 5:2 IF. If you love it, terrific! Don't stop! But don't anyone expect it's a panacea for all comers.

Saturday, February 01, 2020

Wednesday, January 29, 2020

Study Published Stating The Daily Mile Doesn't Improve Childhood Obesity Speaks To Risks Of Tying Weight To Exercise

Published this week in the International Journal of Obesity is Effectiveness and cost-effectiveness of The Daily Mile on childhood weight outcomes and wellbeing: a cluster randomised controlled trial whereby researchers reported on the impact a school year worth of 15 minutes of daily running had on children's BMIs.

It's an odd study in that we're talking about 15 minutes of running per day which literally no one should expect to have a marked effect on childhood obesity given both math (15 mins of children running, jogging, or walking a mile probably doesn't even burn the calories of a single Oreo) and the fact that multiple meta-analyses have shown that even far more involved school based PE initiatives don't have an impact on childhood obesity.

It's also odd because The Daily Mile itself doesn't tie itself to weight,
"The aim of The Daily Mile is to improve the physical, social, emotional and mental health and wellbeing of our children – regardless of age, ability or personal circumstances"
And it's a problematic study in that consequent to the wholly predictable non-exciting outcome, it's the sort of study that might be used as a means to discourage the program's continuation.

What might have been studied instead? How about the impact of the Daily Mile on marks, concentration, endurance, or physical literacy (note, they attempted to do some of this, but data collection was too poor for them to make many conclusions), or if there was a strong desire to tie it to something medical, how about blood pressure, heart rate recovery, mood, sleep, or lipid levels?

As I've said many times, dumbing down exercise to weight management shortchanges both the benefits of exercise and the realities of weight management, and frankly doing that in the name of a program that sees kids running an extra 15 minutes a day, and then seeing that published in a credible journal, speaks to just how pervasive and dangerous that practice is.

Monday, January 27, 2020

If The Microbiome Is As All Important As We're Led To Believe Isn't That's All The More Reason Not To Mess With Yours?

There's no denying the hype around the microbiome with buzz suggesting that it's integral to anything and everything - from our immune systems, to obesity, to dementia.

So let's for a moment agree that it is.

Even if we do, it's difficult to imagine there would be one universal "best" mircobiome makeup spanning age, sex, race, diet, geography, comorbidities, etc. Meaning even if we had thoughts about what a "healthy" microbiome was, what's healthy for one person might not be healthy for another.

But back to us agreeing they're hugely important and implicated in everything.

If that's the case, should you really be purposefully trying to mess with yours given we basically haven't even begun to study the impact of messing with them over time?

Me?

I'll stick to the basics.