Friday, December 21, 2007

I Have no Words to Describe This

Let me apologize in advance for this week's Funny Friday installment.

If juvenile humour isn't your thing, definitely don't click the video.

If any of my readers are from Japan, I'd love an explanation of what the heck is going on.

Folks, I'm taking a week off blogging next week so I want to wish those of you celebrating holidays happy ones and I'll be back in the New Year and already I've got some posts lined up about further hypocrisies over at the Heart and Stroke Foundation, a nice quobesity from the American Beverage Association and more.

Thanks for tuning in this year!

Have a great week!



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Thursday, December 20, 2007

The New Obesity Map


Boy this study had legs.

Researchers at the University of Alberta did a study whereby they mapped Canadian obesity rates in relation with fast food restaurant density.

What they found was

"was actually a fairly strong relationship, a strong correlation between the two, that those cities that had higher obesity and overweight rates tended to have a higher density of at least the larger fast-food restaurant chains, so there were more restaurants per person in those cities".
The media loved it!
You Want Size with That?
- The Toronto Star

Fast food fuels fat cities; As restaurant tally rises, obesity rates follow, study suggests
- The Toronto Star (must have been a later edition)

Survey Links Restaurant Numbers, Fat
- The Vancouver Province

Fast Food Helps Put Hamilton on Obesity Map
- Hamilton Spectator

Where's the beefiest?; Closest to the highest density of fast-food outlets, one new study into obesity in Canada suggests.
- The London Free Press

Obesity rates lower in cities with fewer fast-food restaurants: Study
- The Calgary Herald

Weight may be linked to geography: study
- The Daily News (Halifax)

'Obesity map' plots fattest, greasiest cities
- The Saskatoon Star

More fast-food equals higher obesity: research
- The Edmonton Journal

More fast food choice makes for fatter cities, study confirms
- The National Post

Study finds greasy cities create chubbier residents
- Times Columnist (Victoria)

Greasier the city, fatter its residents; New research. 'Strong relationship' between flab and access to fast food
- The Gazette (Montreal)

Cities with more fast food are fatter; Edmontonians thinner than us
- The Calgary Herald

Greasier the city, the fatter its citizens; Study links greater obesity to more fast-food outlets
- The Windsor Star

Fast food cooks up portly people
- The Edmonton Sun

More fast food = fatter folk
- Edmonton Rush Hour

When it comes to obesity, location matters
- The Globe and Mail

You Are What You Eat
- The Daily News (Kamloops)
- The Daily Courier (Kelowna)
- The Welland Tribune
- The Brantford Expositor
- The Belleville Intelligencer (I didn't make up that name)
- The Toronto Sun
- The Sudbury Star
- The St. Catherine's Standard
- The Simcoe Reformer
- The Penticton Herald
- The North Bay Nugget
- Cornwall Standard Freeholder
- The Record (Kitchener, Cambridge and Waterloo)
- Winnipeg Free Press
- Prince George Citizen
- Times and Transcript (Moncton)
- Woodstock Sentinel Review

Best part of this whole business?

The quote by the study's author, Dr. Sean Cash, a fine young economist that I had the pleasure of meeting and chatting with a few years ago at an obesity think tank. When asked what to make of the study this was his quote,
"I wouldn't say our study proves anything"
You see, some cities with high densities of fast food outlets had low rates of obesity and some cities with low densities of fast food outlets had high rates of obesity. Moreover there are literally dozens if not hundreds of other variables that may have influenced the results and even if the relationship was solid, it doesn't answer the question of chicken or egg.

Gee, you sure wouldn't guess that from the headlines would you? Well maybe if you lived in Vancouver as the Dr. Freedhoff award for journalistic integrity goes out to one lonely newspaper, The Vancouver Sun. Here's their headline:
"'Obesity map' shows strong link to fast-food access; But study doesn't prove anything, creator says"
Don't move yet.

[Hat tip to Rob our fitness director for noticing Sean's quote]

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Wednesday, December 19, 2007

Holiday Eating Strategy

Many of my newer patients are worried about Christmas.

They're worried about the family gatherings, the meals out, the eggnog, the celebrations etc.

They worry because every time they've tried to "be careful" or "be good" during the holidays they've either eaten foods they feel they "shouldn't" or they've succeeded at being "good" at the expense of feeling bitter.

Well I've got news for you - life includes Christmas (and the myriad of other religious holidays and life events that involve celebrating with food).

If your eating plan or weight management strategy is such that you can't celebrate with food or one that makes you feel guilty if you do, it's probably time for you to do some thinking and ask yourself the question I often tell folks to ask themselves, "Could you live like this forever?".

The fact is who in their right mind would forever deny themselves the ability to comfort and celebrate with food - a function of food that is integral to our human existence.

What would I recommend?

Simple.

Eat because it's Christmas, but not because you're hungry.

One of the most common mis-strategies employed by folks trying to watch their weight over a celebratory season is the, "I'll eat less all day long because I know I'll be eating more at night" approach. I think that's an awful strategy because inevitably what happens is they then arrive at their evening affair hungry.

Do we behave differently when we're hungry? Of course, and anyone who's ever gone to the Supermarket hungry can attest to the influence hunger has on their food buying decisions.

Do you think that sitting down to a meal hungry is any different? Nope, it's just that now instead of shopping from the aisles you're shopping from the menu, the table, your plate, the cupboards, the fridge or the freezer and rest assured you'll shop differently.

While you may well still eat more calories than a regular old day even if your hunger was prevented, without a doubt if you're hungry and faced with celebratory high calorie options the number of calories your hunger will lead you to over consume at dinner will greatly out weigh the number of calories you would have had if you had eaten regularly all day long and then sat down to a celebratory meal not hungry.

So this long winded post boils down to this. If you're not hungry at a celebratory meal or a restaurant meal you'll be able to pick foods thoughtfully and certainly having more indulgent foods for celebration is a very appropriate and human thing to do. On the other hand if you're hungry when you sit, well now you've got a great reason to eat (celebration) and you're combining it with a preventable reason to eat (hunger) and the synergy between those two eating motivations is going to have you eating far more than if you simply stuck with celebratory food.

Willpower is the absence of hunger.

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Tuesday, December 18, 2007

The McDonald's Report Card


What's the best way for McDonald's to ensure that you spend your hard earned fast food dollars at their cash registers? Hook you when you're young.

McDonald's has had a long history of child-directed advertising, with much of it not in the formal guise of advertisement.

Well, here's a new one - team up with a local school board and offer free McDonald's foods as rewards for good grades.

A number of bloggers have already written about this.

Michael Long from Rudd Sound Bites is,

"worried about how it explicitly links performance and self-esteem with eating fast food"
Marion Nestle from her What to Eat blog was wary about what else was in store from public-private partnerships with the food industry and steered people to the New York Times article which is critical of what they labeled as, "the commercialization of educational culture".

Me, I'm not too upset with McDonald's. As I often remind folks here and in my talks, the food industry's job is to sell food, not to look after your health. While it might to many be an unappetizing and disingenuous way to promote themselves, I really don't think you can fault McDonald's for finding an innovative way to not only get customers through the door, but to link themselves with the tacit endorsement of schools in the promotion of the message that eating at McDonald's is something one should consider so great as to be a reward (and of course not just for scholastic accomplishments but for anything you might feel's worth celebrating with your child).

No, the folks that I'd call to question are the members of the Seminole County School Board, a school board with at least a decade long tradition of selling out to Big Food whereupon according to the New York Times article prior to McDonald's picking up the $1,600 report card printing tab, Pizza Hut used to do it offering a personal pan pizza as a reward and with their logo in place of Ronald.

If anyone is interested in writing to the school board, click right here and you can send an email to all of the members of the board and the board's superintendent, though I'd wager that with all the publicity to date, when this contract runs out, so too will fast food report cards.

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Monday, December 17, 2007

Big Milk's Mouthful of Foot

For those of you who may be new subscribers one of my recurring features is something I call, "Quobesities".

I define a quobesity as,

"quotes that in one way or another embody what's wrong and hopefully, occasionally, what's right with relation to our attitudes and knowledge about weight and weight related matters."
Yesterday there was a beauty in the New York Times. This one was from Bruce W. Krupke, the executive vice president of New York State Dairy Foods, a trade organization paid for by milk producers. He was writing the Times to complain about their December 10th editorial piece, Junking Fat Food in Schools which detailed an amendment to the farm bill that called for the limitation of milk in schools to be low-calorie milk.

Why would milk be considered "junk food"?

Because frankly in some cases it is, like for instance the 3 Musketeers Slammers that I detailed in a previous post that at 340 calories provides your children with over 10 teaspoons of sugar and more than double the Calories of a can of Coca Cola.

So what did Mr. Krupke have to say?
"Senator Harkin has included in his amendment provisions to limit container sizes (the 16-ounce container sold in vending machines is outlawed), to eliminate whole and 2 percent milk, and to impose serving-size calorie restrictions. In his quest to dictate what can be sold in schools, milk has been caught up in his net.

Drinking milk is not contributing to children's obesity. Milk has essential vitamins and nutrients essential for good growth and health
."
Damn that Senator Harkin and his evil "net", doesn't he know milk has nutrients!

Unfortunately in many cases vending machine milk also has added sugars, chocolate and insanely large serving sizes (like the 14oz, 340 calorie, 10+ teaspoons of sugar Slammers in the picture above that Mr. Krupke would apparently love to see increase in size by 2oz).

So can Mr. Krupke really believe that providing children with 16oz servings of sugar sweetened candy-milk is a healthy choice and one that doesn't contribute to childhood obesity?

Well, here is another quote from Mr. Krupke that probably does a better job at explaining his objections. This quote is from his article in the New York State Dairy Food Inc.'s September newsletter,
"Another example of policy shift was with the introduction of bills aimed at creating “healthier” food choices for kids in schools by mandating package size restrictions while tying them all into calorie and sugar limitations. These bills if passed would be a disaster for milk and ice cream companies. Fortunately our lobbying efforts combined with other groups kept the bill at bay."
Mr. Krupke, your touching concern for our children is duly noted.

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Thursday, December 13, 2007

If I didn't have ethics, I'd be rich!

I collect antique weight loss gizmos, doodads and quackery objects.

I've got one of those jiggly machines from the 20s that wraps a belt around your waist and vibrates. I've got a rolling pin with suction cups from South America circa 1900 that was supposed to suck the fat off. I've got old pill bottles, books and lotions.

Sometimes people ask me if they worked, or more commonly they ask me about some new-fangled doodad.

I explain to them that while I don't have a study proving that they don't work, if they did work, I'd undoubtedly have a study on my desk telling me so and a drug rep knocking at my door trying to convince me to prescribe them.

That being said, the placebo effect is very powerful, as is the suffix MD which is why I'd love to see regulation in the weight loss industry so that the less ethical MDs out there who may be capitalizing on folks who are desperate to lose weight would have someone to answer too.

I can dream can't I?

Today for Funny Fridays I've got Penn and Teller's Bullsh!t demonstrating the power of both placebos and pressed white lab coats.

Have a great weekend!



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Do 3 Year Olds Really Need Pizza Day?

My 3 year old daughter goes to pre-school 3 half days a week.

At the beginning of the year we received a letter from the school asking us for $45 to pay for her monthly pizza day.

"What's Pizza Day?", we asked ourselves.

Well, pizza day is a day where the school orders pizza for the kids and serves them that along with pretzels, cookies, juice and carrot sticks.

We didn't pay.

On pizza day we send our daughter to school with homemade pizza on a whole grain whole wheat pita, watered down juice in a sippy cup, yogurt and fruit.

And guess what, she's young enough not to care; she's 3 and peer pressure and conformity haven't really hit her yet.

I think the more important question to ask is, "Do 3 year olds really need pizza day?".

It's not as if they're going to know any different. It's not as if they wouldn't be just as happy with fruit salad day, or pita and hummus day, or simply not having a special food day that at the age of 3 teaches them about the culinary rewards of junk food. After all, they're 3 and they're simply happy to be 3. Certainly if the kids were older and they had a concept that pizza days were in fact a possibility and something to look forward too I'd have an easier time with them (though I'd still have a tough time with the need for the pretzels, cookies and apple juice), but again I've got to reiterate, these kids are 3 - they're not quite forward thinkers yet.

I'm embarrassed to say that I haven't gone to the school to talk to them about it. Many of our friends' children are in our daughter's class and many of them are happy about pizza day. For them it's a day where they don't have to pack a lunch and for some a day that they're pleased because at least their children will eat their lunch that day.

I'm truly split about whether this is something worth bringing up with the school or just leaving it alone. Any thoughts out there?

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Wednesday, December 12, 2007

Exercise - the Videogame?

This one's for the Nintendo Wii and it's called Wii Fit and currently it is the number two selling video game in Japan (it's not available in North America yet). For those of you who don't know, the Nintendo Wii is a video game console whose controllers have motion sensors and so games on the Wii are played more actively.

With Wii Fit we see the addition of a balance board sensor.

While I can certainly envision its use in areas like stroke rehabilitation, Wii Fit just doesn't do it for me. I'm a gamer (at least I used to be before having children) and these really don't look like games to me.

My advice? If you want exercise, go outside and play. If you want to play video games, play video games. Please don't waste your money on a product that will do little for you in the way of exercise and as far as fun quotient goes....well, I don't want be seen as a stick in the mud, so here is Sarcastic Gamer's overdubbed parody of the original Wii Fit trailer.

Go outside!



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Tuesday, December 11, 2007

Diabetes - the Videogame?


Wow - someone's really been thinking laterally.

While type II diabetes is the one making most media headlines these days, type I diabetes is still a devastating diagnosis for many young families. Given that the disease often hits when children are far too young to understand the medical consequences of high blood sugars, finding ways for them to improve their glycemic (sugar) control is paramount for parents given that we know, the higher the sugars, the greater the damage from the disease.

Enter Glucoboy - as far as I'm aware, the first videogame based glucometer (blood glucose meter). It works with both the Nintendo Game Boy Advanced and the Nintendo DS and when you plug the glucometer into the Nintendos, something magical happens - it gives kids a tangible reason to care about their blood sugars whereby,

"test results are converted into Glucose Reward Points (GRPs) that can be used to unlock games, or converted to in game currency. For example, in the included Knock ‘Em Downs game, GRPs can be converted into tokens. In the game, tokens can be spent to purchase items."
Hopefully the company, Guidance Interactive Healthcare, will continue to develop more glucometer based games.

If you're interested in learning more or buying your own, feel free to visit their website at www.glucoboy.com.

Currently the device is available in Australia for AUD $299. A small price to pay for a healthier child.

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Monday, December 10, 2007

More on the Useless Ontario School Trans-Fat Ban


So did you think I was being too harsh on Ontario's Premier Mr. McGuinty with my criticism of his school trans-fat ban?

Turns out, I was being too easy.

Someone pointed me to one of the pieces that the CTV had done on the ban and sent me both the link to the video and some screen captures and asked for my thoughts.

That picture at the top of this blog, those are the foods that Dalton McGuinty tells a bunch of students will,

"Give us energy, help us stay awake in class. Right?"
Well they sure would "Give us energy".

The muffins...they look to me like a commercially baked cranberry (let's assume low-fat) and some kind of a raisin bran version. They also look to me about the size of a small cake. If we use Tim Horton's nutritional information as a yardstick, the raisin muffin likely has in the neighbourhood of 390 calories (the equivalent number of calories as 1 litre of Coca Cola) and 790mg of sodium (2/3rds of your child's daily requirement). The low-fat cranberry one's not a heck of a lot better with 290 calories and 750mg of sodium. They also contain on average 8 teaspoons of added sugar.

The Quaker Oatmeal to Go? 220 calories and 5 teaspoons of sugar. Roughly identical numbers to a bar of Hershey's Milk Chocolate.

The Special K bar? 90 calories, one third of them directly from sugar. Pretty much an identical breakdown to a 100 calorie Kit-Kat bar, and as my friend Julie from It Must Have Been Something I Ate once wrote the Special K bar,
"contains gram for gram more sugar and less fibre than Famous Amos Chocolate Chip Cookies"
I won't knock the apples or the raisins. Both have in the neighborhood of 50 or so calories.

Brilliant choices Dalton!

Some folks in the comments section over at the CTV blog where my blog is often picked up were really quite upset with my criticisms.

One individual wrote,
"Oh please. We've got to start somewhere, don't we? These people who want all or nothing solutions bother me."
and another wrote,
"It is unfortunate that a medical professional would share such a negative and limited view. Healthy adults begin with healthy kids and youth. Schools are an ideal place to support and promote healthy choices."
Would you like to see what your schools promote as lunch time choices?

Remember, this so-called at least do something solution of banning trans-fats will not in fact change menus, it'll just require the use of foods and oils that are trans fat free.

Below are some other screen captures from that very same CTV story showing a school cafeteria working doling out of an enormous mound of onion rings to go with a cheeseburger with it's huge refined flour bun and a giant spinning tower of pizza.




So for those folks who were upset with me, do you honestly think that removing trans-fats from the obscenely unhealthy foods being served to our children in schools is going to make a difference or shouldn't we be removing in fact the obscenely unhealthy foods? Also, in our ever growing epidemic of childhood obesity, do you think that providing our children "snacks" that have the caloric equivalent and nutritional benefits of chocolate bars, cookies and litres of soft drinks is a good idea?

Again, I've got to reiterate. Firstly if Mr. McGuinty truly feels that trans-fats are unhealthy enough to remove from our schools then he should be fighting to remove them from the Province. Regarding the kids whose health he feels is too important to ignore, what percentage of foods do they eat in school versus foods they bring to school or buy off school grounds? Secondly, to discuss the removal of trans-fats as part of a strategy to reduce childhood obesity is at best misguided and at worst the willful manipulation of public sentiment by preying on people's fears and love of their children for personal political gain. While I will often champion small changes in the fight against obesity, this one has no scientific legs and frankly I would have hoped, an insult to the intelligence of the voting public.

Don't shoot the messenger.

[Hat tip to Lorne from our office]

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Friday, December 07, 2007

Stay in School

Oy.

Why agree to go on a game show that demonstrates you're not smarter than a 5th grader if you're not smarter than a 5th grader?

Today for Funny Fridays, here's a young lady named Kellie Pickler who is a recording artist and a former contestant on American Idol.

She's not smarter than a 5th grader....

Oh, and the host demonstrates his redneckness as well (it's Jeff Foxworthy afterall).

Have a great weekend!



[Hat tip goes out to Arya!]

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Thursday, December 06, 2007

Ontario's Useless Trans-Fat Gesture

So a couple of days ago Ontario Premier Dalton McGuinty issued a press release detailing the Ontario Liberals coming ban of trans-fat in school cafeterias.

Should we be clapping?

Um, let me help you with this one.

Is it helpful to ban trans-fat in school but still have it sold in the variety stores and fast food outfits right across the street? Is it helpful to ban trans-fat in schools but still have it dripping in the products that parents pack in their kids' lunches?

Mr. McGuinty was quoted as stating in response to why they're pushing for this "ban",

"Our kids' health is just too important to risk."
If it's too important to risk in schools, why is it alright to risk it in the rest of the province? And what about everyone else's health? Trans-fats were referred to by the government's trans-fat task force as a toxin in our food supply that was unsafe at any level. If it's not safe in schools, why is it safe to have in our hospitals, daycares, nursing homes, government offices, supermarkets and restaurants?

He also states that one of the drives to do this is the effect of trans-fats on obesity rates. That one really irritates me as the evidence linking trans-fats specifically to rising rates of obesity is dodgy at best with most of it coming from animal studies that are far from conclusive. All he's doing is playing on Canadians' fears by throwing out the words "obesity" and "trans-fats" so he can make political hay.

Here's some free advice - if you're worried about obesity how about do something about the currency of weight? How about legislating for the inclusion of calories on menus and pushing for a Food Guide that recognizes that in Canada it's now considered abnormal to have a healthy body weight?

Bottom line - if it's not safe in the schools, it's not safe in the province. Get off the trans-fat fence and sit either on the side that feels our worry on trans-fats is overblown or on the side that thinks we should ban them outright. Impaling yourself on a fence post doesn't help anyone.

Shame on you Mr. McGuinty for such a blatant and useless attempt at manipulating the public into thinking you care.

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Wednesday, December 05, 2007

ONQI - The New Word in Nutrition


It stands for Overall Nutritional Quality Index and it'll do for you what the Health Check doesn't - steer you to more nutritious choices and do so with rigorous scientific underpinnings.

Developed by 12 of the world's leading nutritional experts in a manner explicitly designed to shield them from the influence of industry, ONQI is the dead-simple product of the complex algorithm developed by these experts which rates a food on a scale of 1 to 100 - the higher the number, the healthier the food.

The expert panel included Dr. David Katz co-founder and director of the CDC funded, Yale University - Griffin Hospital Prevention Research Center, Dr. Walter Willett chairman of nutrition at Harvard sine 1991 and regularly featured researcher on this blog, Dr. Rebecca Reeves past president of the American Dietetic Association, Dr. David Jenkins from my alma mater the University of Toronto and the inventor of the glycemic index and 8 others who I haven't been able to identify from the various news articles yet.

Dr. Willett had this to say at the press conference,

"Given the rising toll of nutrition-related health conditions in the U.S., in particular obesity, it is important to provide consumers with a simple standard regarding food choices that is as reliable as it is easy to understand. The ONQI is a labeling system that can help everyone make healthier choices in every food category quickly and easily"
Dr. Katz explained how ONQI works,
"People can improve their diets, and their health, both by changing the categories of foods they eat most - for example, by eating more fruits and vegetables - and by making better choices within a given category, including snack items and desserts. The ONQI is designed to do both. You can, in fact, compare apples to oranges (oranges win), or apples to marshmallows. But of more practical value you can compare one box of kid's breakfast cereal to another, cut right past all the marketing hype, and get to the truth at a glance."
If you want to see Dr. Katz talk about it, click here.

Awesome!

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Tuesday, December 04, 2007

World's Best Beverage?

I simply can't wait for Friday to post this.

It's just too good.

So today, for Funny Tuesday (and due to the fact that for the second morning in a row I've got to deal with my snowy driveway) may I present to you, Brawndo!

Firstly let me assure you, it is in fact an actual product.

After watching their online commercial, I have decided that I absolutely adore their product - so much so that the next time I want a sugar-laden, caffeinated "energy drink" I will absolutely reward Brawndo's truthiness with my hard earned cash.

Prepare to be amused.



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Monday, December 03, 2007

Sign of the Times


If this isn't a sign of the times I don't know what is.

Going through my spam folder yesterday.

Seeing all the usual suspects:

"No Erectile Dysfunction

Make your woman feel happy on holidays! Increase your willy!

Viagra $1,41 per pill. 100mg x 10 pills = $59.95.
"
Then I came across this one:
Fiber, whole grains may cut pancreatic cancer risk
So I clicked it thinking that perhaps it had been filtered in error.

Of course when I clicked it, it was still just someone trying to sell me Viagra.

I wonder if they know something I don't?

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Friday, November 30, 2007

Support the Writers Strike Part II

Another week without the Colbert Report and the Daily Show.

At least this week was a less angry one.

New subscribers (there were a bunch this week), Fridays are my day off getting frustrated. Fridays are "Funny Fridays"

Email subscribers - usually you've got to head to the blog to view the clips.

Today for Funny Friday it's the writers from the Colbert Report and their take on the Hollywood writer's strike.

Have a great weekend!



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Thursday, November 29, 2007

Calories for your Phone

Once upon a time I was quite techno-savvy. Now I know I'm getting old because technology's way ahead of me.

For those of you who are technologically advanced enough to access the net on your phones and PDAs, I'm pleased to report that Calorie King, my favourite calorie database, has created a webpage geared for mobile users. No graphics, no ads, it's completely streamlined to help you save bandwidth and it'll allow you to look up any food from their enormous and every growing database.

So until there are calories on menu boards, at least in the big chains, use Calorie King mobile to help inform your choices.

http://www.calorieking.com/mobile/

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Wednesday, November 28, 2007

Dr. Arya Sharma's Blog

Today I'm going to direct you to Dr. Arya Sharma's blog.

Arya is a friend, the Scientific Director of the Canadian Obesity Network and the Medical Director of Edmonton's Weight Wise - Canada's largest tertiary care bariatric centre.

Arya only recently picked up the reins over there and despite a ridiculously heavy workload, he's somehow finding the time to blog.

His more recent post, "Is Reducing Global Warming the Key to Preventing Obesity?" is a very interesting take tying together dietary over consumption, the over-processing of foods, obesity and global warming whereby he asserts that,

"Each calorie of food you eat may have consumed 10 to 50 calories in fossil fuels"
and that,
"Processing 1 pound of coffee requires more than 8,000 calories of fossil fuel, the equivalent of one quart of crude oil, 30 cubic feet of natural gas or 2 1/2 lbs of coal. It has been estimated that the CO2 emissions attributable to producing, processing, packaging and distributing the food consumed by a family of four is about 8 tonnes a year."
Some very interesting reading.

Hope you enjoy it, and welcome to the blogroll Arya.

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Tuesday, November 27, 2007

Thank God for Fast Food.

Literally.

So here's an interesting societal statement.

Want to know what the 9th best selling book on Amazon.com's "prayer" category is, even though it's not even actually available yet?

It's Peanut Butter and Jelly Prayers by Julie Sevig and according to the press release ahead of its November 30th, launch, it's a book written for,

"the 21st century version of family mealtime"
So what exactly is the 21st century version of family mealtime?

Well, here's a prayer from the book that might help you figure that out,
"We want it fast, we want it now,
Thank you God, for the cow!
For Burgers, fries and all we chew!
For all who work at this drive-thru!
"
Good lord we're in trouble.

[Once again, hat tip to Brad from the Canadian Obesity Network. Don't know if I've ever had back to back hat tips before]

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Monday, November 26, 2007

Is Nothing Sacred?

There's a general consensus out there that it's wrong to market junk food to children. Consumers and activists frequently shout out at the injustice of junk food's television commercials, shelf product placements and their insidious involvement with our schools. As far as safe venues go, they are few and far between, and now, there's one less of them, because your local public library may also be part of the problem.

Try this exercise. Go to your branch's website and in their holdings search look for, "Jimmy Zangwow's out-of-this-world, moon pie adventure" by Tony DiTerlizzi.

The reviewers loved it!

Publisher's Weekly Review reports,

"This delightful romp follows red-haired, freckle-faced, goggle-wearing Jimmy Zangwow, budding inventor and adventurer, on a passionate search for his favorite treat, which his mother forbids him to eat before dinner."
The School Library Journal Review shouts,
"The dialogue includes quirky sayings like "Holy macaroni!" and "Jumping june bugs!," which young readers will relish. Large double-page watercolor, gouache, and colored-pencil illustrations enhance the story. DiTerlizzi uses various perspectives to show just how tall the Grimble Grinder really is and to send readers topsy-turvy through space. With its repetitive text and large illustrations, the story is great fun for group sharing."
Sounds like a great book for kids right?

It's not.

Not that it's not great, I can't say that because I haven't actually read it.

It's not a great book for kids because it's not actually a book - it's an advertisement. It's a lengthy, illustrated advertisement for junk food that targets children. The junk food? You guessed it - Moon Pies.

According to the Moon Pie homepage, the first Moon Pie was produced by the Chattanooga Bakery back in 1917 and while I couldn't find nutritional information on the Moon Pie site, I found it on a calorie tracking site and they're pegged at 220 calories per, or roughly the same number as a chocolate bar.

The "book" of course is sold on the Moon Pie website in their General Store, and why wouldn't it be, it helps to sell the pies.

Here are some scans:


So 1,000 Moon Pies is a year's supply? I wonder what Jimmy did those few days that his parents didn't feed him 3 of them?

So what happens after you and your child finish the book? You get to this page,


Your very own coupon for Moon Pies.

Gee thanks public library.

[Huge hat tip to Brad from the Canadian Obesity Network who sent me the scans and the report that his 3 1/2 year old son, upon finishing the book, wanted a Moon Pie for a snack. Shocker.]

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Friday, November 23, 2007

Support the Writers' Strike

I'm a Daily Show/Colbert Report junkie, and much as I miss them, it's tough not to support their demand to get paid for the clips of their show that are used online.

While not quite an episode, today for Funny Friday, is a writer from the Daily Show trying to explain the grounds for their gripe.

Have a great weekend!



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Thursday, November 22, 2007

Potatoheads at the UN

I'm not sure I truly understand the United Nations, but even putting aside my political confusions with it, my head scratching today comes from the fact that the UN has declared 2008 the International Year of the Potato.

Now I don't know how the UN usually works, but year of the potato seems pretty odd to me.

The UN has rightly noticed that in fact there are more people around the globe that are overweight or obese than are undernourished. According to one of its own press releases the UN notes 820 million undernourished people in the world and 1.6 billion overweight or obese adults - a number that increases every year.

So that being said, what's up with the potato year?

It's probable that half or so of the world's potatoes are consumed in fried form which likely doesn't do much for the prevention of chronic diseases like diabetes (declared a global pandemic by the UN on December 21st, 2006), heart disease (recognized by the UN as the world's leading cause of death) and obesity. We also know that in fact there may well be risk inherent specifically to the potato.

To quote from a previous post of my own....

"Is there any risk in eating a lot of potatoes"?

The answer is certainly yes.

Ample evidence exists to suggest that high potato consumption has risk. Potatoes increase blood sugar and insulin levels nearly as fast as pure white table sugar which is potentially why in a 20 year study looking at 84,555 women there was an increased risk of type II diabetes in women with higher potato consumption.

Dr. Walter Willett, the chair of nutrition at Harvard since 1991 and arguably the most important nutritional epidemiologist in history has this to say about potatoes in his exceptional book, Eat, Drink and be Healthy,

"More than two hundred studies have shown that people who eat plenty of fruits and vegetables decrease their chances of having heart attacks or strokes, of developing a variety of cancers or of suffering from constipation or other digestive problems. The same body of evidence shows that potatoes don't contribute to this benefit. Potatoes should be an occasional food, eaten in modest amounts, not a daily vegetable."
Clearly a bunch of potato heads over there.

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Wednesday, November 21, 2007

Three Cheers for the USDA!

I sure didn't expect to be uttering those 5 words.

Not sure if I've ever praised the USDA before (they're the American version of Health Canada with regards to dietary recommendations) but yesterday they did something with the potential to be massive.

What did they do?

They appointed Dr. Brian Wansink, currently the John S. Dyson Professor of Marketing and the Director of the Cornell Food and Brand Lab in the Department of Applied Economics and Management at Cornell University, Ithaca, NY, and the guy who wrote the book Mindless Eating, the Executive Director of their Center for Nutrition Policy and Promotion.

His research is the incredibly rare combination of the fascinating with the helpful and frankly given the USDA's role in providing guidance, if he can push his way through industry, the 2010 version of the American Food Pyramid may for once actually be useful.

There's not too much Brian on You Tube, but here he is talking about his candy dish experiment:



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Tuesday, November 20, 2007

You Can't Please Everyone

So not only did the Ontario Society of Nutrition Professionals in Public Health try to sandbag my presentation without my knowledge by not copying me on their letter of concern or contacting me to discuss the presentation, they also sent a representative to chastise me during the question and answer period.

In what seemed like a mini-lecture of her own, Ms. Mary-Jo Makarchuk who was clearly visibly angered with my presentation, had a bunch to say. In a nutshell:

  1. She wanted to assert that on the Food Guide advisory panel she sat on (the Dietary Reference Intake panel) there was no industry influence.
  2. She wanted to assert the importance of DRI values in the creation of the Food Guide and cited herself the WHO Report Diet, Nutrition and the Prevention of Chronic Diseases as important evidence therein.
  3. She wanted to chastise me for recommending Dr. Walter Willett's Healthy Eating Pyramid for two reasons - firstly because it includes oils which include calories in what she called the base of the pyramid and secondly because he recommends the consumption of alcohol in moderation if appropriate.
I called it a mini-lecture because she did not in fact ask any questions and the session's moderator at one point rightly asked her if she in fact had a question to ask at roughly which point Ms. Makarchuk sat down.

So let's go through her positions one by one, starting with the position that there was no industry influence in her committee.

True to a degree, but certainly not entirely true. While there was no one on Ms. Makarchuk's committee, the Expert Advisory Committee on Dietary Reference Intakes (DRI), whose income was derived solely from industry, there were certainly individuals on food industry payrolls and therefore people with clear conflicts of interest.

Now before I get into the specifics here let me be very clear, just because someone's on an industry payroll does not necessitate that they will be influenced therein against their clinical judgment. That being said, there's no doubt that being on an industry payroll should serve as a conflict of interest to serve on a committee whose recommendations would affect the industry in question. So on that 11 member Food Guide DRI Committee 3 had clear industry based conflicts of interest.

  • One had served as an adviser to the sugar industry, sits on the medical advisory board of the International Dairy Foods Association, and though not true at the time of the Food Guide's revision process, currently sits on the board of trustees of the CCFN an organization born out of the merger of the National Institute of Nutrition (a group representing over 180 food manufacturers) and the Canadian Food Information Council (an industry organization the the CSPI once referred to as, "a wolf in sheep's clothing").

  • Another committee member, sits on the scientific advisory panel of the Canadian Sugar Institute and is also on the Board of Trustees at CCFN and in 2005 she went on record with the CBC as stating, "research shows that even when 25 per cent of calories come from sugar, it's not bad for your health".

  • Yet another member, is the former director of the McGill University School of Dietetics and Human Nutrition who during her tenure on both the Food Guide DRI committee and at McGill secured ongoing funding from Fleishmann's yeast for her department. In fact, Fleishmann's includes McGill's logo on their Breadworld website. Perhaps not surprisingly, the Fleishmnann's site's healthy related links still refer to the 1992 Food Guide which of course recommended far more bread. It also specifically calls "whole wheat" a whole grain which as we know, in Canada is not in fact the case given that the Health Canada endorsed definition of whole wheat includes wheat where 70% of the germ has been removed.


  • For those of you counting, that's nearly 30% of her committee having food industry conflicts.

    Regarding DRIs, here I was really confused. I was confused because Ms. Makarchuk made specific reference to the World Health Organization's 2003 report Diet, Nutrition and the Prevention of Chronic Disease in reference to why a nutrient focus was important in the Food Guide's development. The thing is, and as I pointed out at the conference, that same report had this to say about focusing on nutrients,
    "Seldom is there a single "best value" for such a goal. Instead, consistent with the concept of a safe range of population averages that would be consistent with the maintenance of health .... Sometimes there is no lower limit, this implies that there is no evidence that the nutrient is required in the diet and hence low intake should not give rise to concern."
    On the other hand, with regards to whole foods, Technical Report #916 has a lot to say, as does reams of research into the effects of foods and their role in chronic disease prevention. The report states that foods protective against chronic disease include (in no particular order) fruits, vegetables, whole grain cereals, non-starch polysaccharides (from whole grains, fruits and vegetables), legumes, fish, fish oils, unsalted nuts (in moderation); water(as an indicator of energy density); while the foods causative of chronic disease include free sugars, preserved and red meat, salt preserved foods; salt (as distinct from sodium), hydrogenated oils, Chinese-style salted fish.

    Regarding Dr. Willett's pyramid let's start with the oils. It's true that Dr. Willett's pyramid includes plant oils near to the base of the pyramid, however Ms. Makarchuk's statement that oils make up the base is patently false. The base of Dr. Willett's pyramid is actually, "Daily Exercise and Weight Control" which of course involves control of calories. It's also crucial to point out here that the evidence on fats would suggest that far more important than a blind 90s style reduction in total dietary fat would be the substitution of healthy fats - fats like the plant oils, in place of trans and saturated fats.

    Regarding Dr. Willett's inclusion of alcohol, the statement on his Healthy Eating Pyramid is, "Alcohol in moderation if appropriate". If Ms. Makarchuk were to read Dr. Willett's work she'd learn that, "in moderation if appropriate" means,
    "For men, a good balance point is 1 to 2 drinks a day; in general, however, the risks of drinking, even in moderation, exceed benefits until middle age. For women, it's at most one drink a day"
    But that said since his pyramid came out there has been further work on breast cancer and alcohol that suggests the link therein is even stronger than we once thought. Consequently yesterday I emailed Dr. Willett as to whether or not this new evidence would change his recommendation and here is his reply,
    "As you say, the issue of moderate alcohol consumption is complicated, especially for women because there is a small increase in risk of breast cancer with even one drink per day. However, there is a substantially larger decrease in risk of heart disease for the same amount of alcohol, so total mortality is reduced (and as you say, this applies to middle aged women and older). Further, there is quite a bit of evidence that if folic acid intake is adequate (getting the RDA), there is little or no increase in risk of breast cancer, so the balance of risks and benefits becomes even more favorable. For these reasons I don't plan to modify the pyramid at this time."
    Hearing the clear anger in Ms. Makarchuk's voice when she was talking at me really confuses me. Aren't we supposed to be on the same side? Does she actually recommend that her public health messages (she's works for the Public Health Division of the Ontario Ministry of Health) include the consumption of red meat, refined grains and willful caloric ignorance? I quite doubt it.

    I also don't understand why so many folks take this so personally, like the person who cornered me after the conference who was quite literally sputteringly angry at me for my utilization of evidence from two of the longest standing and largest epidemiologic nutritional studies (the Nurses Health Study and the Health Professional's Follow up Study). Not sure what she'd have preferred but in my talking with her she also readily admitted that she herself recommends patients minimize red meat and refined carbohydrates - once again the very messages I was suggesting should have been included in Canada's Food Guide.

    So to sum up my confusion, what I really can't understand is how, if you are a person who is passionate enough about nutrition for it to stir in you emotions like anger, how you can stare at our nutritionally indefensible Food Guide and then yell at me?

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    Monday, November 19, 2007

    I'm Still Scary?

    So on Saturday I gave a lecture at the Ontario Family Physician's Conference. The lecture had been scheduled for months and the planned topic was, "Big Food: How Politics and the Food Industry Helped to Shape Canada's Food Guide" during which I had planned to discuss many of the issues I detailed roughly one year ago in my Canada's Food Guide to Unhealthy Eating series.

    A few weeks before the conference I was contacted by the conference organizers. They had received a letter complaining about my talk. I hadn't planned on blogging about the letter as I didn't want to make things uncomfortable for the organizers but during the question and answer period of the lecture, one of the folks who was involved in sending this letter of concern mentioned it herself so I figure if she can talk about it, so can I.

    The original letter of complaint was from the Ontario Society of Nutrition Professionals in Public Health and from the Ontario Collaborative Group for Healthy Eating and Physical Activity.

    Wanna know what their concern was?

    They were concerned that my presentation of nutritional evidence to physicians, a group of individuals trained to critically appraise evidence, might sway those physicians from a sacrosanct trust in Health Canada and Canada's Food Guide and heaven forbid cause them to provide evidence-based nutritional guidance to their patients (like for instance that they should minimize red meat, processed meat, refined carbohydrates and calories - messages not provided by Canada's Food Guide). They were concerned that if this were to happen, and if one of those physicians' patients might speak with someone who believes that the information that comes from Health Canada should never be questioned or critically evaluated, that there will be a conflict between the evidence-based messages provided by the physician and those of Canada's Food Guide thereby sowing confusion.

    So let me ask you - if my recommendations are evidence based recommendations (and they most undoubtedly are), and if in fact Canada's Food Guide is evidence-based, how is it possible that they would be different?

    I'll tell you how - Canada's Food Guide, as I've mentioned many times, is not reflective of the current state of medical evidence regarding the role of diet in chronic disease prevention.

    So what did I do when I heard about their concerns? Well I immediately urged the conference organizers to invite the concerned parties to my lecture and also offered to share my speaking time with them evenly and suggested a round-table discussion afterwards.

    Happily, they accepted and speaking on their behalf was Dr. Daniel Brule, currently the acting Director General of Nutrition Policy and Promotion (the folks in charge of the Food Guide).

    I also immediately informed the parties involved that I would be specifically speaking about the Food Guide's nutritionally indefensible guidance on red meat, whole grains and calories.

    So did they spend the 20 minutes I shared with them discussing how the Food Guide's recommendations on red meat, whole grains and calories were in fact evidence-based and that clearly I must have misunderstood the evidence?

    Of course not, because the evidence clearly would support guidance on minimizing red meat, refined grains and calories. However instead of addressing the clear conflict between the evidence and the recommendations of the Food Guide, Dr. Brule spent the majority of her time detailing the rigorous process behind the Food Guide's revision.

    That was a shame, because as I mentioned in my lecture - there's really not much point in talking about the process given that we've got a final product. While I certainly have major concerns with the process, we are now faced with a final product Food Guide that is anything but evidence based. Right now the only value in exploring the process would be to see where things went wrong so that next time around, perhaps the evidence can play a larger role in the final recommendations.

    By the way, the Ontario Society of Nutrition Professionals in Public Health and the Ontario Collaborative Group for Healthy Eating and Physical Activity, the folks who had such great concerns never once attempted to contact me directly and did not copy me on their letter of complaint. Instead they tried to sandbag the talk directly with the conference organizers and by cc'ing pretty much everyone else (Research Monitoring and Evaluation at Health Canada, the Ontario Ministry of Health Promotion, the Ontario Public Health Association, the Council of Ontario Medical Officers of Health and the Association of Local Public Health Agencies), tried to stir up even more dissent.

    So going back to their concern about the "inconsistent messages" my talk might lead physicians to make, I'll ask again - if Canada's Food Guide provided the evidence-based messages they purport, how exactly did they feel I would be able to convince physicians otherwise?

    Want to know what I think is the most remarkable part about all of this? I would be willing to wager a year's salary that the folks who signed that letter, the folks who complained about my "messages", are also folks who counsel their patients to minimize red meat, to minimize refined grains and to control energy intake - the very same messages I lectured were substantiated by medical evidence and glaringly absent from our national Food Guide.

    Wouldn't it be great if they would turn their clearly considerable energy and desire to advocate for nutrition towards the creation of a Food Guide that reflected our certainly shared nutritional concerns, rather than attack me, someone with no vested interest in the recommendations other than that of a physician concerned with nutrition, for attempting to advocate for Canadians by teaching physicians about the Guide's shortcomings?

    More on this tomorrow.

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    Friday, November 16, 2007

    More Funny Cats

    Thank God it's Friday.

    Today I'm off to Toronto to talk at the Annual Scientific Assembly of the Ontario College of Family Physicians. One of my talks (tomorrow's) will actually be with the Director General of Health Canada's Office of Nutrition Policy and Promotion (the folks responsible for the Food Guide). I'll let you folks know how that one goes next week.

    Today for Funny Friday, here's more funny cats because who doesn't love a funny cat.

    Have a great weekend!



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    Thursday, November 15, 2007

    Heart and Stroke Dietitians - Asleep at the Switch?


    Remember that Calendar from the Heart and Stroke Foundation? The one that had recipes with butter, non-skimmed milk and regular soy sauce? Well, here's another example from that calendar of why you might think that the Heart and Stroke's dietitians aren't paying too much attention to their recommendations - December's Chewy Cinnamon Oat Cookies.

    My wife made those cookies yesterday. Putting aside the fact that the Heart and Stroke Foundation seemingly prefers you eat almost a half cup of sugar rather than zero-calorie sweeteners (artificially sweetened juices can't apply for Health Checks) and recommended 3 tablespoons of canola oil rather than go half and half with something like apple sauce, and adds a tremendous amount of raisins and cranberries, those aren't the weird parts. The weird part is the fact that the recipe says it makes 48 cookies. It says that because it instructs you to use a teaspoon to dole out the dough.

    Really? A teaspoon?

    Recognizing that a teaspoon of dough wouldn't even yield a cookie the size of a Ritz cracker my wife decided to use a tablespoon. Doing that didn't make giant cookies, it made pretty normal sized cookies. Here's a picture:


    So why do I care about the size of the cookies?

    By allowing the recipe writer to use a teaspoon as a measure for a cookie the Heart and Stroke Foundation is helping to mislead chefs into thinking these are low calorie cookies, which they certainly are not. Make them out of a tablespoon and now each cookie will have 124 Calories - nearly double the calories of a President's Choice "The Decadent" Chocolate Chip Cookie.

    Of course if their dietitians had asked that the sugar be replaced with a zero calorie sweetener and the canola oil with apple sauce and the raisins/cranberries cut in half which is what my wife decided to do, that would have cut the Calories by close to 40% - something you might have thought the Heart and Stroke Foundation would have wanted done given the contribution of obesity to heart disease and strokes and the contribution of calories to obesity (though I imagine cutting the canola oil out of the oilseed industry sponsored Calendar might be challenging).

    Now I'm not advocating a life without cookies, but why is the Heart and Stroke Foundation making things tougher by publishing recipes with ridiculously small unrealistic portion sizes that grossly misrepresent and underestimate calories and why aren't they making any apparent effort at publishing recipes designed to trim down sugar and fat?

    My guess?

    No one ever bothered to even look at them.

    [UPDATE - just received an email from my wife,

    "Just made another batch of cookies: Splenda instead of white sugar, applesauce instead of oil, half the raisins/cranberries they called for, whole wheat flour instead of white, unpacked brown sugar instead of packed. Using the same scoop (tablespoon) and making 20 cookies again, got them down to 54 calories each. Not bad."
    So for you chefs out there - the cookies actually taste pretty good and at 54 calories each, not bad either.

    Thanks honey]

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    Wednesday, November 14, 2007

    Why Health Check Might Soon Matter Even More

    Hat tip to blog reader Paul who pointed me to a presentation made by Mr. Stephen Samis to the Canadian Council of Food and Nutrition on October 26th, 2007.

    What frightened me about this presentation was the fact that in it the Heart and Stroke Foundation is clearly maneuvering to have the Health Check program become Canada's national front of package (FOP) labeling plan.

    In his presentation Mr. Samis refers to the House of Commons Standing Committee on Health who in their report on childhood obesity made the following recommendation to parliament this past March,

    "The federal government should: Implement a mandatory, standardized, simple, front of package labelling requirement on pre-packaged foods for easy identification of nutritional value."
    Mr. Samis goes on in his presentation to make the case for the Health Check to serve as that national FOP plan.

    He outlines how market research has confirmed that:

  • 92% of Canadians support a standard FOP symbol run by the Heart and Stroke Foundation of Canada.

  • The Heart and Stroke Foundation is considered more trustworthy than Health Canada by Canadians

  • That 53% of Canadian dietitians recommend Health Check to clients.

  • That 64% of shoppers said they were more likely to purchase a food or beverage product with the Health Check symbol versus a competitive product.

  • That Health Check Consumer awareness has grown to an all time high of 73%.

  • Definitely strong figures to support the adoption of Health Check as our national FOP program.

    Question for the readers - in a nation where childhood and adult obesity rates are skyrocketing, where the World Health Organization estimates 1 in 9 Canadians will be diabetic by the year 2025, where cancer still remains a major killer, do we really want a national FOP program that promotes juice as a fruit, encourages the consumption of refined flours and free sugars, still insists that red meat is a healthy choice and beckons to our children from grocery store aisles using cartoon characters to promote unhealthy foods?

    Please feel free to write to Mr. Samis or Mr. Dean if you have any concerns. Simply click on their names and away you go.

    [Side note: The interviews from this Sunday are now available online.

    Click the player below to hear a taste with Mr. Dean and Dr. Dworkin discussing the merits of juice and Slush Puppies (if you're an email subscriber and the player doesn't work, just head over to the blog):



    To listen to Barry's entire interview with Mr. Samis and Mr. Dean from the Heart and Stroke Foundation, use this player:



    To listen to Dr. Dworkin interview me (the Health Check stuff starts a few minutes into my interview with him) use this player:



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    Tuesday, November 13, 2007

    I'm Scary?

    So on Sunday I had the pleasure of joining Dr. Barry Dworkin at CFRA's studios for his syndicated radio show Sunday House Call to talk about the Heart and Stroke Foundation's Health Check program.

    When I arrived I was excited to learn that his producers had contacted both Mr. Stephen Samis (the Director of Health Policy at the Heart and Stroke Foundation) and Mr. Terry Dean (the General Manager of Health Check) and that they had agreed to come on the show. Barry's producers had made no secret that I was to be in attendance and at the onset of the show Barry had asked if Stephen and Terry would be willing to hang around for a round table discussion following a very brief interview with me and what ended up being a fairly lengthy interview with them.

    I was excited because frankly I can't fathom how the Heart and Stroke Foundation can endorse the consumption of foods that increase Canadians risks of cancer, increase their risks of diabetes, increase their risks of obesity and increase their risks of heart attacks and strokes. I also can't fathom how the Heart and Stroke Foundation can lend its good name to the virtually universally maligned industry practice of marketing nutrient poor foods to children utilizing popular cartoon characters.

    While Sally Brown (the CEO of the Heart and Stroke Foundation) had responded to my letter outlining these and other concerns, in her response she certainly left those questions unanswered and instead fell on Canada's Food Guide to defend Health Check.

    So the show started off with a very brief interview with me during which I basically stated that while I greatly respect the Heart and Stroke Foundation, I felt their Health Check program not only fails to uniformly steer Canadians to nutritious foods that in fact it steers Canadians to non-nutritious ones.

    Then Barry chatted primarily with Mr. Dean whose points I'll try to summarize below:


    1. The Heart and Stroke Foundation likes to rely on large meta-analyses to help them with their recommendations. They especially like the work of the World Health Organization
    2. The Heart and Stroke Foundation believes that a food is healthy so long as it provides specific nutrients
    3. The Heart and Stroke Foundation thinks that drinking juice is a good idea as it will help busy people consume more fruit
    4. The Heart and Stroke Foundation thinks that their products are better than some of the other products out there
    5. The Heart and Stroke Foundation thinks Slush Puppies Plus is a "great" product
    6. The Heart and Stroke Foundation thinks that products packaged with Disney characters on them don't target children
    7. The Heart and Stroke Foundation based their Health Check criteria on the 1992 Food Guide
    So after hearing all these points, I was very excited to chat with the Heart and Stroke folks about them.

    In point form I wanted to discuss how:
    1. The World Health Organization, an organization whose reports Mr. Dean specifically mentioned were integral and useful's technical report #916, Diet, Nutrition and the Prevention of Chronic Diseases cautioned against targeting nutrients. To quote the report,
      "Seldom is there a single "best value" for such a goal. Instead, consistent with the concept of a safe range of population averages that would be consistent with the maintenance of health .... Sometimes there is no lower limit, this implies that there is no evidence that the nutrient is required in the diet and hence low intake should not give rise to concern."
      On the other hand, with regards to whole foods, Technical Report #916 has a lot to say, as does reams of research into the effects of foods and their role in chronic disease prevention. To be consistent with our best evidence the WHO report would suggest unambiguously encouraging Canadians to preferentially consume (in no particular order)fruits, vegetables, whole grains, legumes, fish and nuts, while minimizing the consumption of free sugars (white rice, white flour, white sugar, potatoes), red meat, salt and hydrogenated oils.
    2. People eat foods, not nutrients and just because a food may contain a few nutrients does not mean it's a healthy food. Putting vitamins in Coca Cola would not make Coca Cola a healthy choice and by that token, nor should the vitamins that God put in grape juice make it a healthy choice
    3. Childhood obesity experts around the globe have called on explicit limits to be placed on juice consumption. Why? One glass of Welch's grape juice has double the calories and double the sugar of Coca Cola. It is a glass of water with 10.5 teaspoons of sugar and some vitamins thrown in. It has the caloric equivalent of consuming 50 grapes. In a country where childhood obesity rates rise annually, where the World Health Organization predicts by 2025 1 in 9 adults will have type II diabetes, it is exceedingly unwise to equate drinking juice with eating fruit.
    4. Being less bad than the product beside you on a shelf does not by definition make you a healthy or nutritious choice. Light cigarettes are not better than regular ones.
    5. There are no words to describe the look of wonder on my or Barry's faces hearing the General Manager of Health Check describe Slush Puppies as a "great" product. Drinking concentrated apple juice with artificial flavouring sprinkled over some crushed ice is not a healthy drink. The fact that the Slush Puppie website brags it gives "2 servings" per day means the serving size is at least 250mls and therefore exceeds the recommended daily limits on juice recommended by both the American Academy of Pediatrics and the Canadian Pediatric Society for 1-6 year olds and maxes out every kid over 7.
    6. The child's eye level giant posters of Mickey Mouse from a sorcerer's apprentice pointing at the foods in bins, that in turn have Mickey Mouse, Donald Duck, Buzz Lightyear, Winnie the Pooh and others absolutely target children. That these foods contain red meat, refined flour, added sugar, and tons of sodium only adds insult to injury.
    7. Unfortunately from an evidence based perspective, falling on the Food Guide is like falling on a sword - it'll cut you as the Food Guide unfortunately suffers from many of Health Check's same failings and lacks the evidence-based underpinning that would have allowed for a rigorous defense.
    So as you might imagine I was quite saddened when in a flurry of activity at the producers desk, Barry and I were told that the communications director of the Heart and Stroke Foundation had called and that they were not at all happy. Initially I was told that Mr. Dean and Mr. Samis were unhappy to be talking with me about things but then it became clear that the Heart and Stroke Foundation was no longer willing to stay on the line. Dr. Dworkin very kindly gave them a face-saving out by stating that they had other engagements.

    So why wouldn't they want to talk with me? The word from the control booth was that they were "wary" to do so. Why? I'm not slinging mud or name calling and frankly I have absolutely no vested interest in the recommendations made by Health Check other than those of a physician who cares about nutrition. All I'm doing is asking questions about whether or not the Heart and Stroke Foundation's Health Check recommendations are reflective of our current evidence-based understanding of the effects of diet on chronic disease prevention.

    I also know that it's not the individuals involved. I've met Mr. Samis before and we've had very nice conversations about some of the issues facing society and obesity and I have found him in the past to be a very sincere and caring individual whose intentions and commitment to helping improve the health and welfare of Canadians I do not doubt for a second, nor do I doubt the intentions of the Health Check program itself.

    That I don't doubt the Heart and Stroke Foundation's intentions is what makes this all the more upsetting to me. It's not like we're talking here about PepsiCo's Smart Spot which is an industry generated Health Check like device from which I would expect the worst - we're talking here about the Heart and Stroke Foundation - an organization that certainly should be held to a much higher degree of accountability and I would have hoped an organization that would have possessed an eager willingness to in fact utilize the best available evidence in formulating their recommendations.

    (Tapes of the interviews will be forthcoming and obviously I'll post them when available)

    Stay tuned tomorrow to hear why this all might matter even more than I had originally thought.

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    Monday, November 12, 2007

    It's a Big World After All

    Saw this on one of my media hunts.

    The, "It's a Small World" attraction at Disneyland is being shut down so that they can make the canal deeper and wider.

    It seems that that boats are getting stuck more frequently.

    Disney claims it's not due to the increasing weight of the occupants, but rather due to fiberglass patching of the boats over the years.

    Of course Disney also rightly notes that the average weight of an adult has gone up at least 25lbs in the 41 years since this ride opened when the average man weighed 175lbs and the average woman 135lbs.

    Apparently this is happening so frequently that at one of the trouble spots (Canada) they built an exit ramp.

    While Disney may deny that weight has anything to do with it, Disney blogger Al Lutz in his somewhat frighteningly extensive Disney blog MiceAge points out that,

    "the Cast Member's operating the ride try their very best to eyeball the girth and size of the riders coming down the line and purposely leave a row or two empty on many boats nowadays to hopefully keep them floating, even those discreet tactics don't always work with today's riders."
    There is a silver lining however - for the next 10 months you can take your kids to Disneyland and not have to sit through that ridiculously annoying song.

    Stay tuned tomorrow when I discuss my weekend radio discussion with Dr. Barry Dworkin which had the communications director of the Heart and Stroke Foundation pull the plug on Barry's interview with the folks from Health Check right before we would have started our round table discussion.

    To give you a taste, I will leave you with one question therein - if you built a series of recommendations on a solid foundation of evidence would you ever pull the plug on an interview where you'd have a chance to defend them?

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    Friday, November 09, 2007

    Schoolyard Safety

    Can't say I'm unhappy it's Friday.

    For the new subscribers here, Friday's my day off frustration and the day that I post something that reminds me how to smile.

    Today it's a clip from a newscast about two twin boys whose lives were so tough that they took it upon themselves to invent wedgie-proof underwear.

    Poor chaps - those ties can't help.

    Have a great weekend!



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    Thursday, November 08, 2007

    Germany's New Food Labels

    Germany kind of gets it.

    While much of Europe uses the traffic light means of food labeling, Germany has opted not to discuss food as good or bad, but rather in terms of energy.

    One of my regular lines on this blog and in my practice is that healthy eating and weight management are two separate, important determinants of health. Healthy eating involves the foods you choose and weight management the calories.

    Up until now it seemed that the world felt that healthy eating was more important and the focus has been on describing a food in terms of its health benefits (with front of box labels screaming out, "zero trans-fat", "low-carb" and "low-sodium) all the while pretty much ignoring the calorie side of the equation.

    The new German labels will follow the "1 plus 4" approach with extra focus on calories. On the front of the label will be the calories per serving in the package along with how that number translates into average total daily calories. The back will detail fat, salt and sugar, leaving out all the micronutrients that tend to serve to confuse consumers and in some cases give false impressions of healthy contents.

    Here's Germany's Director General of Food and Safety,

    "We do not want to say there are good products and bad products. We think showing the calorie intake is the best way to inform consumers. When we launched the product at the food fair in Cologne, people were surprised to see that a glass of lemonade provided a quarter of the daily need for sugar"
    But don't get too excited yet.

    The new plan in Germany is being launched as voluntary and my experience certainly tells me that high calorie food manufacturers are not likely to opt in. Also, the labels may well highlight calories per serving, but they don't necessarily highlight how much constitutes a serving.

    Me - I'd like to see labeling like this become mandatory, but instead of Calories per serving listed on the front, I'd like to see Calories per package, as most consumers do not weigh or measure their servings, nor follow the rather arbitrary serving size guidelines.

    At least it's a step forward rather than the perpetual side-steps these shores have seen.

    [For those of you who might have missed last night's CBC Marketplace on restaurant calories you can watch it online. It was a great show and truly highlights the need for point of sale labeling of calories in restaurants]

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    Wednesday, November 07, 2007

    Watch CBC Marketplace tonight at 7:30pm

    Well, just got a ring from the CBC that allows me to mention that I helped out on a story that is going to air tonight on their exceptional investigative journalism show Marketplace.

    The piece is on calories in restaurants and should be both entertaining and eye opening.

    Don't miss it.

    7:30pm EST on CBC tonight with repeats Saturday on CBC Newsworld at 3:30pm, Sunday on CBC at noon and on CBC Newsworld at 7:30pm.

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    $3,016,000

    Before I get to that dollar figure, let me remind you of something that has happened recently in the medical management of diabetes.

    Avandia, a drug commonly used in the treatment of weight-related diabetes, was found to increase the risk of heart disease in its users. Doctors, myself included, immediately began recommending that their patients discontinue avandia in place of a less risky alternative.

    Good thing that I was never paid by avandia's parent company Roche to endorse avandia, because boy, that would have been awkward and it might have even made it more challenging to change my recommendations or accept this new research. You might even say, it would be a really bad idea for someone to accept money for an endorsement or a recommendation regarding something that has the potential to change with a changing body of evidence - especially if that something had the potential to have a dramatic impact on your health.

    I'm guessing you see where I'm going with this.

    Health Check, the Heart and Stroke Foundation's program that with their little logo, steers patients to products in a manner that they promote as,

    "when you choose foods with the Heart and Stroke Foundation Health Check symbol, it's like shopping with their dietitians."
    Health Check was established in early 2000 and as the HSF CEO Sally Brown pointed out a few days ago,
    "products must comply with nutrient criteria based on Canada’s Food Guide"
    What she didn't point out was that the Canada's Food Guide she's referring to was the 1992 Canada's Food Guide that even Health Canada recognized as being deficient and behind the times which is why this past February they released a revised version (albeit only slightly less woefully deficient).

    You know what hasn't changed since February 2007? The criteria applied to products for the application of Health Checks. A set of criteria that are therefore now effectively over 15 years old (since they're based on the 1992 Food Guide) - a set of criteria that are therefore outdated even by Health Canada's flimsy standards. The Heart and Stroke Foundation's Health Check site, since around February, has had a little information box that states due to the new Food Guide, the criteria will be revised and that they hope to finish their revisions in the next few months.

    So what's taking them so long? It has been 9 months since the Food Guide's revision, and why frankly do they need to rely on a Food Guide that is not evidence-based and only undergoes revisions every decade or more? Why aren't the criteria set by an organization that is purportedly looking out for your best health interests not in a dynamic and ever changing state based on our evolving understanding of the effect of diet on chronic diseases?

    Well, I've got over three million possible reasons for you, because that's perhaps how much the Health Check program generates annually.

    Our Director of Operations spent a few hours yesterday (thanks Lorne!) crunching numbers and if you'd like you can have a peek at his spreadsheet here, but based on the posted Health Check fees and program participants, Health Check seems to generate a minimum annual income of $1,000,000 and a potential annual maximum of over $3,000,000 (depending on the size of the products' markets - information to which we're not privy) and have generated one-time evaluation fees of between $100,000 and $800,000.

    That sure seems like an awful lot of money.

    Medicine has come a long way since the days that drug representatives sent doctors gifts and extravagant vacations - we long ago recognized the risk inherent in accepting money or gifts from drug companies because we recognized that of course that would taint our ability to be objective, especially in the face of changing evidence. And those gifts by the way, were never meant to serve as explicit payments for our endorsements - the drug companies just hoped that by spending money on doctors, that the doctors on their own would be more likely to recommend their products.

    Perhaps it is that $3,000,000 annually, a $3,000,000 that has explicitly purchased the Health Check seal, that prevents Sally Brown from explaining how it is the Heart and Stroke dietitians are unable to state that in fact red meat's not healthy, that refined flours lead to metabolic syndrome, that sugar contributes to calories which contributes to obesity, that using cartoon characters to promote nutritionally deficient foods to children is wrong, and that steering people to Slush Puppies (yes I said Slush Puppies - click this link if you don't believe me) by giving them a Health Check and consequently an undeserved halo of health is not in the best interests of the health of Canadians - something I might have thought the Heart and Stroke Foundation would have cared about.

    Sadly, the health of Canadians is clearly not something that stands head and shoulders above all else at the Heart and Stroke Foundation. It seems that either money, politics, bureaucracy or laziness not only prevents the Heart and Stroke Foundation from changing their outdated 15 year old Health Check criteria to reflect current medical knowledge, it leads them to endorse and recommend foods and dietary practices that are exceedingly unhealthy, that increase your risks of cancer, obesity, and diabetes and thereby also increase your risks of heart attacks and strokes.

    Madness.

    [If you'd like to hear more, tune in this Sunday to Dr. Barry Dworkin's national radio show Sunday House Call where from 3pm-4pm EST we will be discussing Health Check and other issues. You can also listen online at www.cfra.com]

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