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!
Friday, November 30, 2007
Another week without the Colbert Report and the Daily Show.
Thursday, November 29, 2007
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.
Wednesday, November 28, 2007
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.
Tuesday, November 27, 2007
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,Good lord we're in trouble.
Thank you God, for the cow!
For Burgers, fries and all we chew!
For all who work at this drive-thru!"
[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]
Monday, November 26, 2007
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?
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.]
Friday, November 23, 2007
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!
Thursday, November 22, 2007
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.
Wednesday, November 21, 2007
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:
Tuesday, November 20, 2007
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:
- She wanted to assert that on the Food Guide advisory panel she sat on (the Dietary Reference Intake panel) there was no industry influence.
- 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.
- 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.
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.
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?
Monday, November 19, 2007
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.
Friday, November 16, 2007
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!
Thursday, November 15, 2007
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?
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.
Wednesday, November 14, 2007
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:
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:
Tuesday, November 13, 2007
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:
- 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
- The Heart and Stroke Foundation believes that a food is healthy so long as it provides specific nutrients
- The Heart and Stroke Foundation thinks that drinking juice is a good idea as it will help busy people consume more fruit
- The Heart and Stroke Foundation thinks that their products are better than some of the other products out there
- The Heart and Stroke Foundation thinks Slush Puppies Plus is a "great" product
- The Heart and Stroke Foundation thinks that products packaged with Disney characters on them don't target children
- The Heart and Stroke Foundation based their Health Check criteria on the 1992 Food Guide
In point form I wanted to discuss how:
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- 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 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.
Monday, November 12, 2007
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?
Posted by Yoni Freedhoff at 5:29 a.m.
Friday, November 09, 2007
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!
Thursday, November 08, 2007
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]
Wednesday, November 07, 2007
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.
Posted by Yoni Freedhoff at 10:42 a.m.
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.
[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]
Tuesday, November 06, 2007
Yes, that is an ad promoting the consumption of a burger, and yes, that is the Heart and Stroke Foundation's Health Check with it's small print disclaimer that always says,
"This is not an endorsement"Interesting thing here is the fact that the Heart and Stroke Foundation not only know it's an endorsement they in fact brag about it.
Here's Heart and Stroke Foundation registered dietitian Carol Dombrow quoted in a press release from 2005 detailing the Health Check on ground beef for burgers,
"The Health Check symbol complements mandatory nutrition labelling, in a 2004 research study, sixty-five percent of consumers recognized the Health Check logo as meaning the food is 'nutritious', 'healthy', 'good for you' or 'approved by the Heart and Stroke Foundation.' Sixty-eight percent agreed with the statement: 'I can rely on Health Check to help me make healthy food choices."And how about her views on burgers specifically?
"With ground beef burgers being one of the most popular meats in the summer months, having the Health Check symbol in place now helps consumers understand that lean and extra lean ground beef can be part of a healthy diet."So in fact the Heart and Stroke Foundation markets their Health Check as something that let's consumers know that a food is "nutritious", "health", "good for you" and "approved by the Heart and Stroke Foundation". You might even say they market their Health Check as something product manufacturers can put on their foods to sell more of them....sort of like an, what's that word again, ENDORSEMENT.
In that same press release David Ryzebol, the vice-president of public affairs for a large Supermarket firm concurred,
"Given a choice, most of our customers would choose a Health Check labelled product over one that doesn't have that designation"Now back to beef - so that World Cancer Research Fund Report just came out - maybe Carol and the Heart and Stroke Foundation didn't know that red meat wasn't good for you and now they're going to take back that Health Check.
I wouldn't bet on it.
Of course, were it to be true that this is the first they're hearing that red meat's not a healthy choice it would reflect not a lack of research as the most recent report merely summarized existing literature, it would instead reflect either a lack of understanding of the research, a lack of reading of the research or a lack of caring about the research.
Unfortunately, none of those are really heartwarming options.
So anyone want to take bets on whether or not Health Check rescinds its endorsement of red meat? Can you guess what answer my money's on?
(Side questions for all of my non Heart and Stroke Foundation dietitian readers - do you encourage your patients to eat beef burgers and promote them as healthy choices?)
And speaking of money, stay tuned tomorrow when I discuss just how much money Health Check makes and how that's likely to influence both their recommendations and their ability to change them.
Monday, November 05, 2007
Just received an email from Sally Brown, the CEO of the Heart and Stroke Foundaiton of Canada in response to my letter of last week.
I will post it below along with my response, and let you draw your own conclusions.
I'm quite curious what you folks think.
Dear Dr. Freedhoff,Here's my response in return,
Thank you for sharing your comments with us.
We also appreciate your acknowledgement of the important role that the Foundation is playing in funding important heart disease and stroke research, and championing a healthy lifestyle.
For over 50 years, the Heart and Stroke Foundation has been a leader in promoting better health to Canadians, including providing information on nutrition and healthy eating. We introduced the Health Check™ program because we heard from Canadians that they were frustrated in their efforts to identify healthy food options in the grocery store, and all the nutrition advice in the world won’t help if people can’t apply it when they’re staring at the shelves.
To display the Health Check symbol, products must comply with nutrient criteria based on Canada’s Food Guide, which is accepted by most dietitians and health professionals as the best evidence-based source of Canadian nutrition information. We understand that you do not agree.
Health Check™ products are not judged on one sole nutrient, like fat, sugar or salt, but rather on the nutrient composition of the product, including beneficial nutrients like fibre and calcium. Overall, the product must be acceptable as a healthy choice based on specific criteria in each food category.
Health Check™ is designed to contribute to a general healthy diet – it is not a sodium restricted program for people already living with heart disease, or for people on a therapeutic diet. The program criteria are based on current Canadian recommendations. The Foundation is working hard to help Canadians reduce their intake of sodium to healthier levels, in part by working with manufacturers to bring sodium levels down in foods. The changes are ongoing but will take time. In fact, the National Sodium Policy Statement that you referenced, signed by the Heart and Stroke Foundation and other top health organizations in the country, calls for Canadians to reach the daily levels that you quoted by 2020.
In the case of sugar, there are no accepted, evidence-based “safe amounts” against which we can set our criteria, but we realized that leadership was needed on this issue, so our dietitians are in the process of establishing sugar criteria for the program, and we will work with food companies to bring sugar levels down even further in Health Check™ products.
Through Health Check™, we know that we are having a positive influence on the food supply, and contributing to the reduction of salt, saturated and trans fat, and sugar in food products. Companies are reformulating their products, and introducing new ones that meet the nutrient criteria required to qualify for the Health Check™ symbol. Consumers have responded very favourably to the program, and tell us we’re meeting our objective of helping them quickly and easily identify foods that can be part of a healthy diet.
Sally Brown, CEO
Heart and Stroke Foundation of Canada
Dear Ms. Brown,
Thank you very much for your response.
You are quite correct in noting that I am not fond of Canada’s Food Guide. I believe it is a nutritionally indefensible document that provides medically irresponsible dietary recommendations to the detriment of the health of Canadians.
I do realize that the HSF, like the AHA, has based its Health Check program off of national dietary recommendations and recognize too the political safety in such an approach.
I think it is truly a shame that political safety supplants best evidence in formulating and administering the Health Check program. Clearly refined flours, red meats, high levels of sodium and sugar are certainly not foods that our best evidence would suggest we strive to include as parts of our diets, nor would I have thought foods that along with a Disney character and a Health Check are promoted to our children.
Dr. Yoni Freedhoff, MD CCFP Dip ABBM
Medical Director, Bariatric Medical Institute
Roughly a year ago when I was initially writing my Canada's Food Guide to Unhealthy Eating series, I had a post detailing why the food guide matters.
I noted that not for one second do I think that Canadians put the Food Guide on their fridges or lug the ridiculously over sized 6 page document with them to the Supermarkets but rather that the Food Guide becomes Canada's nutritional backdrop.
Last week provided a stunning example.
Last week the World Cancer Research Fund released their report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective
The report is a brick. 517 pages long and it involved 9 independent teams of global scientists, hundreds of peer reviewers, 21 internationally renowned experts, and 5 years of time for them to review and analyze more than 7,000 large scale studies for the effects of diet on cancer.
Among their many conclusions was that red meat consumption is not very good for you. In fact they concluded that every 48 grams of processed meat consumed per day boosts the risk of colon cancer by 21 per cent and every 48 grams of red meat consumption beyond a weekly limit of 500grams increases colon cancer risk by 15 per cent.
Not surprisingly Big Meat was not happy with this report.
So who, or should I say what did they turn to for help to defend their product in their press release? Why Canada's Food Guide of course:
"Eating Well with Canada's Food Guide continues to recognize red meat in the diet. The Food Guide recommends 1 to 3 servings of Meat & Alternatives per day"And in today's Edmonton Journal, a letter to the editor from the Beef Information Centre states,
"The Beef Information Centre has many resources that can help Canadians continue to make beef a part of a healthy eating pattern, in keeping with Canada's Food Guide."Way to go Health Canada - once again, you've earned the moniker, Happy Corporations.
Oh, and still no word back from the Heart and Stroke Foundation.
Tomorrow will revisit the Heart and Stroke Foundation and their take on beef in explaining why Health Check matters.
Friday, November 02, 2007
I can't say I'm not looking forward to the weekend - it's been a long and angry week.
Haven't heard back from anyone over at the HSF.
Today being Friday, today's my day off making noise. So for Funny Friday today, here's my third installment of weird searches that hit my blog:
Interesting bunch this time around.
Kind of sad that my blog comes up when searching for things in Canada to be depressed about. Red meat diarrhea guy, I'd probably cut back and person eating glue, I think Calories might be the least of your worries.
I sure hope the guy asking about uncooked bacon wasn't the guy who later searched for how to donate your body at death; and does anyone know if the medical donuts thing is a public company because I want in.
Have a great weekend!
Thursday, November 01, 2007
Regarding the Heart and Stroke Foundation the most pressing question for me is why exactly their Health Check program is making these nutritionally indefensible recommendations.
Best case scenario, it's simply outdated criteria, oversight and bureaucracy.
Worst case scenario, politics, the food industry and funding matter more than evidence based recommendations.
I've decided that perhaps the best way to get some answers is to ask, and so this morning I sent off a letter to Sally Brown, the Heart and Stroke Foundation's Chief Executive Officer, Stephen Samis, the Heart and Stroke Foundation's Director of Health Policy, and Terry Dean the General Manager of Health Check.
Here's the letter that I sent:
Dear Ms. Brown, Mr. Samis and Mr Dean,If any of my readers would care to write any of these individuals just click their names below:
I'm writing to you today to express my concerns and ask some questions regarding the Heart and Stroke Foundation's Health Check program.
Firstly let me say that in principle I think the Health Check program is a wonderful idea - given the incredible variety of products in the marketplace and given the incredible impact an unhealthy diet and weight have on health, steering Canadians to healthy choices should in fact be something that more organizations strive to do.
I also want to commend the HSF for their co-signatory status on the National Sodium Policy Statement that rightly identified dietary sodium reduction as an important national goal. In that statement the HSF and others recommended that Canadians limit their dietary sodium intake to less than 1500mg per day and were those recommendations followed it was estimated that this would result in the prevention of 1 in 7 stroke deaths, 1 in 11 coronary artery disease deaths, 1 in 14 of all deaths and 1 in 6 cases of hypertension.
Similarly deserving of commendation are the Heart and Stroke's stance on the need to treat and prevent obesity in Canadians. In the HSF position paper on obesity one of the calls to action is, "Encourage and promote healthy food choices and restrict the advertising of 'junk foods' (energy dense, nutrient-poor foods) to children, for example during children's television programming and in schools.".
With that as background, since starting to pay attention to the Heart and Stroke's Health Check program, I have been regularly shocked and frankly appalled by many of the products, recipes and meals that have secured Health Checks and am very concerned that the Health Check program is not only not steering Canadians to healthier choices, but rather steering Canadians to truly unhealthy ones.
I have a very difficult time understanding how the Health Check program is comfortable providing Health Checks to meals that alone contain 1,260mg of sodium (the Health Check'ed Boston Pizza entree of the Thai Chicken Wrap), beverages that contain 961mg per glass (V8Go Smooth and Seasoned) and children's entrees that per serving provide 850mg (Compliments Junior Clubhouse Diner, which therefore provides per single serving more than 3/4s the HSF recommended amount of sodium for children and 2/3rd the recommended amount for adults).
I have a very difficult time understanding why the Health Check program has deemed it appropriate to extend their seal to the Compliments Junior line of foods - a line of foods clearly targeting children with energy dense, nutrient poor foods including Milk Buddies (sugar sweetened milk beverages that have as much sugar drop per drop as sugared soda and almost double the Calories), Clubhouse Diner Macaroni and Cheese (refined white flour and processed cheese pasta), red meat Mickey Burgers (each containing 0.5grams of trans fat) and processed potato Alpha-Taters - all utilizing Disney characters to entice children from the grocery store aisles.
I also have a difficult time understanding why it is that refined white flour products can ever meet Health Check criteria, this despite an irrefutable wealth of evidence that prove their contribution to the development of metabolic syndrome; that red meat products can ever meet Health Check criteria despite their clear contribution to breast cancer, colon cancer (reaffirmed yesterday by the report of the World Cancer Research Fund) and diabetes; and that sugar and Calories are not currently criteria that are considered at all - thereby allowing products like Welch's Grape Juice, a juice that drop per drop almost double the Calories and sugar of sugared soda (10.5 teaspoons of sugar per glass and 170 Calories; enough Calories whereby one glass a day would provide over 17lbs of Calories per year) to receive a Health Check.
Lastly I have a difficult time understanding how the Heart and Stroke Foundation can put it's name on a calendar (the Heart and Stroke Healthy Living Calendar 2008) where recipes contained therein call for cooking with butter, non-skimmed milk, and regular soy sauce leading to recipes where single servings contain 999grams of sodium.
To say that I'm disappointed in both the Heart and Stroke Foundation and Health Check would be a tremendous understatement.
I have been blogging about these matters for some time and if you'd care to review all of my entries and concerns, please feel free to head over to my Heart and Stroke post summaries by clicking here.
I'm hoping you can shed light on my concerns.
I would be very pleased to share your responses with my readers.
Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5
Sally Brown, CEO of the Heart and Stroke Foundation
Stephen Samis, Director of Health Policy of the Heart and Stroke Foundation
Terry Dean, General Manager of Health Check
I'll keep you all posted of any responses I receive.