Sadly this isn't an early April Fool's joke.
Readers might not know it, but I collect antique weight loss doodads. In my collection is an advertisement for tapeworms for weight loss from the turn of the century.
Well apparently what's old becomes new again as dieters in Hong Kong are swallowing parasites in a bid to lose weight.
I imagine soon we'll see raw chicken weight loss centres pop up all over the place -salmonella can certainly be lightening.
[Hat tip to Toronto RD Doug Cook and more specifically to his twitter feed]
Wednesday, March 31, 2010
Tuesday, March 30, 2010
I see it all too often.
A patient comes to see me wanting to lose weight. I go through a medical, diet and lifestyle history and find out this person's eating out 3 or more times weekly at fine restaurants, enjoys a glass of wine nightly with supper (and like me they have large glasses and heavy hands) and travels 4 or more weeks of the year. They've got sincere desire to lose but yet no desire whatsoever to change their biggest ticket weight loss items - fine dining, fine wine and frequent travel.
It's tough to blame them too. Oftentimes these folks are in their 50s, they've worked hard all of their lives and they've finally carved themselves out enough time to enjoy some of the fruits of their labour.
They've got Good Life Syndrome.
Desire, willingness and readiness for change are all very different things.
What stage are you in?
Monday, March 29, 2010
You may have heard Jamie Oliver's Food Revolution. It's on Friday's at 9pm on ABC and it's a reality show featuring British chef and nutrition advocate Jamie Oliver trying his hand at reforming American eating.
Food Revolution certainly fits the mold of the reality TV genre, replete with type casting of villains, rubes and heroes, but frankly I don't think it's fit of the mold takes away from the impact of seeing just how much of a train wreck mainstream nutrition has become.
Jamie's Food Revolution is set in Huntington, West Virginia - apparently the unhealthiest city in America where nearly 50% of the residents are not just medically definable as overweight, but rather as obese. Nicely adding to the drama, folks in Huntington don't really know who Jamie is and what he's about and he's not welcomed with open arms.
The first two episodes revolve around Jamie taking on an elementary school where the students can't name common vegetables and where the cooks serve up both refined food and attitude, as well as around Jamie's work with a family where everyone's morbidly obese and cooking involves a deep fryer which upon Jamie's urging the family ceremoniously buries.
Hopefully the show will serve as a catalyst for change by exposing the problem for prime time America to see. As Jamie notes at the end of the second episode, the nuclear weapon of change are parents and if he can trigger some concern, maybe, just maybe, the timing's right to tackle the issue. Between Michelle Obama's championing of childhood obesity, the fires stoked by a decade of fear mongering around obesity along with the passage of a bill that will see some modicum of societal health responsibility in the US maybe the ground really is remotely ripe to till.
The show's got flaws. It's at times overly saccharine. It seems disjointed with flashbacks to scenes that were never aired and it doesn't seem to follow an entirely linear story line, but it is most certainly worth watching.
If you're a parent of a child going to school in North America where they're buying or being provided food in school take some time this Friday night to watch Jamie Oliver's Food Revolution or easier still, do what I did and watch the episodes online on CTV.
To wet your whistle, here's the trailer:
Saturday, March 27, 2010
Very busy week! Didn't get to read very much.
The telegraph decides that Facebook use leads to syphillis.
Daniel Gordis wonders whether Barack Obama will ignite the third Palestinian intifada.
Seth Godin is mad at everyone.
Colby Borland from Nutritonal Blogma and his take on why super fruits aren't so super.
The New York Times explains by means of a fictitious gasoline powered alarm clock how that Energy Star logo probably isn't much to brag about.
Friday, March 26, 2010
Thursday, March 25, 2010
Not sure how many more posts will have the same title but yet another study has come out that suggests exercise doesn't have a tremendous impact on weight.
This study, out of Harvard, tracked 34,000 women for 13 years and monitored their weight and their exercising.
Only 13% of the women didn't gain weight over the course of those 13 years and those women began the study at a healthy weight and exercised on average an hour a day.
For women who began the study overweight, no amount of exercise was sufficient to prevent weight gain.
The lessons to be learned?
1. Intake, not output, is what has got us into this mess.
2. If you are part of the nearly 2/3rds of the population who's overweight or obese exercise alone is not likely to help you maintain your weight let alone help you to lose it.
3. If you've got a healthy weight and don't want to gain you'll have to do a ridiculous amount of daily exercise.
and most importantly,
4. The more research that gets published failing to show causal benefit to exercise on weight loss the more difficult it'll be to promote exercise.
What I mean by that statement above is that each and every time studies like this are splashed around the newspapers and blogosphere it diminishes the absolute importance of exercise. That's just plain bad because exercise is likely the second most important determinant of health (nutrition being the first).
To me it seems the story on exercise is very clear - it's absolutely crucial for health, in extreme quantities it's helpful for maintaining weight, and it's really, really lousy as an exclusive modality for weight loss.
Bottom line? I would love to see more studies funded to demonstrate the health benefits of exercise and less studies funded that ultimately serve only to dissuade people from bothering to exercise in the first place by having outcomes that are extremely, predictably, disappointing.
I-Min Lee, Luc Djoussé, Howard D. Sesso, Lu Wang, & Julie E. Buring (2010). Physical Activity and Weight Gain Prevention Journal of the American Medical Association, 303 (12), 1173-1179
Wednesday, March 24, 2010
Certainly not if you don't do or say anything.
For someone who's doing something - let's talk Mrs. Q.
I first mentioned Mrs. Q. a few weeks ago. She's a school teacher somewhere in Illinois who has pledged to eat the same school lunches fed to the kids for the remainder of this school year. Her blog, Fed Up with School Lunch - The School Lunch Project details her experiences and has also garnered the attention of many guest bloggers. The site's explosion into the blogosphere is a testament to how important this issue is to so many people - in the scant 3 months since Mrs. Q. hit the scene her site's recorded over 350,000 visits, with over 100,000 of those in the past 10 days alone.
I had contacted Mrs. Q. for an interview a ways back and while at first she was hesitant as she's become fearful that her undercover work is going to cost her job, she later emailed me and kindly offered to answer some questions. When I asked her about her change of heart she replied,
"I've just come to the conclusion that the project is more important than whether or not I lose my job"Here's what Mrs. Q. had to say:
Clearly you’re concerned about the kids, in your wildest dreams how do you see your project helping to inspire change?
I see myself as a catalyst. I want parents to get a glimpse into what their kids are eating every day since most have no idea. I want people, teachers and parents, to start demanding the best possible food for the children of this country. I'd like to see fewer processed foods, more variety, and more fruits and veggies.You mentioned to AOL Health that you’re, “waiting for the moment I'm called to the principal's office and let go. I do believe it's a matter of 'when' not 'if' they find out and it's curtains for me and then of course the project.” How might what you’re doing be grounds for dismissal?
The project might not lead to my outright firing, but it's possible that things might be "uncomfortable" for me and I might just need to leave. I mean, I'm showing something that could be interpreted as criticism of the school and/or the district. That's not my point, but school administration could be offended.What do you think the school would do in their damage control efforts if you were found out given the incredible interest in your story?
Damage control? Well, not firing me would be one way to not make this turn into a PR disaster.Is there a natural extension to your project? What happens once the year is up?
I can't predict where this project is headed. Honestly, I've been shocked that I've gotten this much attention this fast. So I wasn't able to predict what happened with the blog thus far and now, well, it's anyone's guess.Could teachers band together to form a lobby promoting healthy school food or would employment contracts forbid any such type of organized dissent?
I think that forming a lobby or some kind of organization devoted to school food is overdue. I don't know enough about labor contracts to answer if that would be possible. Teacher leadership is critical.In your school, who’s fault is it? Meaning is it a consequence of a State or Federal program that’s failed the kids, the school itself, the school board, etc? Follow up question – who’s job would it be to fix it?
What you see on my tray is a systematic failure over years. Small changes to save money accumulated and the increased involvement of corporations has changed everything and convinced us that functional kitchens are expensive. Unfortunately like so many advancements, the old way was sustainable and best for humanity. Also the Child Nutrition Act needs more money. Not to sound cliche but children are our future and even poor kids deserve high quality food. If people don't want to pay for good food for poor kids, they will pay later when healthcare costs continue exploding and these children are adults who are fat and unhealthy and cannot contribute to our society.Can you comment about what’s taught to the kids about nutrition in your school? Is it just the Food Pyramid in gym class or is there more time spent in other classes as well?
Nutrition is not taught explicitly to the students. The food pyramid is not on display although I have seen it incorporated into the occasional classroom lesson.Is there anything you’d like to add that you haven’t said elsewhere or that you feel is essential to any article about you and your project?
I'm not against lunch ladies or food service workers. In fact I'm advocating for them to get the respect they deserve as people who do something amazing for children every day. If they served fresh food that was less processed and got training in nutrition, I believe it would elevate the profile of their profession nationally -- to where it should be.Thanks to Mrs. Q. for taking the time to answer my questions and more importantly for helping to call attention to the incredible need to fix this broken system.
I've heard it said that it'll take villages of villages to fix this problem. Mrs. Q.'s work shines a powerful spotlight on why that might be and while there won't be any quick fixes here, that doesn't mean it isn't doable but one thing's for certain - we need a great many more folks as engaged as Mrs. Q.
Tuesday, March 23, 2010
In a move I strongly support, the new American health care bill includes the provision of chain restaurant calories at point of sale directly on the menu boards. Sure it'll preclude tougher State based laws but all told, this is a huge step forward for calorie awareness and for folks who might be trying to track their caloric intakes.
I've never really understood why it is that so many folks think calorie counting is difficult.
I'd like to make the argument that counting calories is easy, though accuracy can be difficult.
Before I get into the how of counting calories I'd like to talk about the why. As I've said many times before, calories are the currency of weight. If weight's a concern to you, whether the concern's to gain, maintain or lose, caloric intake is certainly the most important factor for you to consider. The problem of course is that calories aren't visible or intuitive and simply looking at a food or a meal doesn't tell you anything about its calories. If you wouldn't consider shopping without looking at pricetags, I'd argue you shouldn't consider eating without looking at calories.
There is some good news. There's more caloric information available now than ever before. Whether it's a calorie counting book, a website, the product's package, the restaurant's nutritional information webpage and thanks to the new US health care reform bill all American chain restaurant menus and apparently even vending machines, it's not tough to find calories. There's also umpteen different means to track. From hardcopy food diaries, to free online services such as Sparkpeople, to iPhone, Android and Blackberry applications, to Twitter as well as cheap recipe analyzing programs such as Mastercook 9.0.
Regardless of the way you go about it, I'd argue on a terrible day tracking calories will take you 20 minutes of effort and that once you're good at it, that effort likely won't exceed 5. Why? People are pretty boring. We eat the same foods over and over again and once you've learned the calories in your foodscape off by heart, tracking will take seconds.
Two things matter in record keeping. Completeness and accuracy and they're different. Completeness means writing foods down as you go along. Studies show that if you wait until the end of the day to recall what you've had you'll forget stuff, and you won't think you did because that's what forgetting is. So I recommend eat something and write it down immediately. However for two reasons I'd recommend not looking the calories up until the very end of the day. Firstly time. It takes virtually no time to write foods down, but it does take time to look them up. I'd rather you wait until the end of the day and set aside 10-20 minutes to look things up rather than get frustrated flipping through a calorie book all day long. Secondly because I don't think calories should be treated as a ceiling. Thinking you've only got a few hundred left for dinner is a diet and while indeed I think it's important to learn from your choices, I don't want you to feel blindly restricted and end of day addition may prevent you from getting too hung up in "what's left". Food diarizing is about guidance, not judgement.
Accuracy's the other thing I mentioned. Scales, spoons, cups - they've all got to be employed, but do remember they're there to tell you how much you had, not how much you're allowed. You're the boss, not a cup.
People seem extremely comfortable with the notion that to lose weight successfully they'd need to spend a bit more time exercising, yet many of those very same people who are willing to find 30 minutes a day to exercise seem to be hesitant to spend 5 minutes a day scribbling in a book. That's a shame because those 5 minutes of scribbling, so long as it was both complete and accurate, would likely have a far greater impact on their ability to manage their weight than the gym would.
It's easier to lose weight with pens in kitchens than in gyms with dumbbells though of course ideally you want to try to do both.
Monday, March 22, 2010
Last week I attended a health promotion conference in South Carolina. My flight book on the way there was David Kessler’s The End of Overeating.
Kessler, a paediatrician by trade, and the former commissioner of the FDA responsible for tackling the tobacco industry, takes on his own lifestyle demon – something he calls, “conditioned hypereating” in his book, The End of Overeating.
His premise is compelling. Big Food, over the course of years of trial, error, science and focus groups, have manufactured a food environment that for those susceptible, conditions like Pavlov conditioned his dogs - to overeat. Cues are everywhere. Packaging, smells, product placement on supermarket shelves, menu descriptions of meals, tenacious marketing – the world has become a Big Food marketer’s dream playground. Even the food itself has undergone hypereating evolution whereupon food has simply become fats, layered on fats, layered on sugars, layered on salts or some combination therein.
In one of the most fascinating segments on food’s evolution Kessler discusses chewing. He quotes Gail Civille, the president of food consulting's Sensory Spectrum corporation who reported that in the past it would take roughly 25 chews before a mouthful was ready to be swallowed but now as a consequence of the processing and “pre-chewing” the average person only needs 10 chews to down a mouthful allowing that person to eat faster and outpace their body’s satiety cues in place of bursts of neuronal reward. The primary means to accomplish this “pre-digestion”? The inclusion of fat which makes swallowing easier.
At one point Kessler talks with a food consultant who explains saliently that the hedonics of food involves five factors – anticipation; visual appeal; aroma; taste and flavour; and lastly mouthfeel and that mass manufacturing and processing allows the food industry to control these variables like never before with partial frying (to add a layer of fat), chemical inclusions to add aroma and flavour, and an exacting addition of the perfect amounts of fat, sugar and salt to “dial-in” irresistabilty.
Consuming these foods causes conditioning because they're highly neurochemically rewarding. We learn that when we eat these foods we feel better, even if only momentarily, and in turn that will motivate us again and again to seek out those foods that our brain has recognized as positively reinforcing. The more the cycle repeats itself, the more ingrained the behaviour and the more the pattern becomes reinforced while at the same time our memory stores the cues surrounding the behaviour. If you have become conditioned to eat highly rewarding food in response to a fight with a loved one or a stressful day at work that ties together the reward with the situation such that when you have a fight with a loved one or a stressful day at work your mind automatically steers you towards food. In Kessler’s words, “Action builds on response and response builds on action” until eventually it becomes automatic leaving us with a cue-urge-reward habit.
This leads to Kessler’s overarching theory,
“Chronic exposure to highly palatable foods changes our brains, conditioning us to seek continued stimulation. Over time a powerful drive for sugar, fat and salt competes with our conscious capacity to say no”We’ve become conditioned to hypereat as the food we’re eating for comfort leaves its mark on our brains that leaves a void ready to be filled the next time we’re cued.
Kessler’s belief is that in order to break this cycle we have to enter something he’s trademarked as “Food Rehab” which involves a series of steps:
1. Figure out your cues. Food cues, situational cues, all of them.
2. Refuse everything you can’t control.
3. Create an alternate plan with a specific behaviour to adopt in place of what normally would be conditioned hypereating.
4. Limit your exposure.
5. Remember the stakes. When faced with a situation that may involve conditioned overeating ensure that your visualization takes you all the way through to the inevitable end of the eating episode where you acknowledge that following momentary pleasure may come the pain of guilt or depression or the simple fact of it being counterproductive to your health.
6. Reframe things in terms of you vs. them. Kessler calls this active resistance. Recognize that Big Food is out to get you and try to see food in those terms.
7. Thought stopping. Try to stop your food related thoughts dead in their tracks.
8. Add negative associations to your normal cues.
9. Talk down the urge. Approach it with rationale thoughts. “Eating this will only satisfy me momentarily”, “If I eat this I’ll demonstrate that I can’t break free”.
Ultimately Kessler’s premise is that Big Food created this mess, but that doesn’t abdicate our own responsibility to manage it. He likens it to alcohol in that alcoholics are often told that their disease is not their fault but it’s still their responsibility.
Food Rehab can be summarized by a single line of Kessler’s,
“The enduring ability to eat differently depends on coming to view these foods as enemies, not friends”It is this view that leads me to disagree with Kessler and I also wonder if he even agrees with himself. Kessler himself notes,
“the loss of control that characterizes conditioned hypereating is magnified by diets that leave us feeling deprived”Yet at the same time Kessler advocates for blind, overt, rule based restriction and deprivation as a means to treat conditioned hypereating.
David Kessler's The End of Overeating is certainly a fascinating and engaging read, especially the sections on Big Food's engineering, but as a treatment plan I find it lacking. Like it or not the world has become one enormous Willy Wonkian Chocolate Factory and foods which help to condition hypereating are here to stay. To succeed with food in this world requires navigating the Chocolate Factory, rather than as Kessler suggests trying to avoid it.
To paraphrase Nuval's Dr. David Katz, managing nutrition and weight today requires skillpower, not willpower. There's no amount of thought stopping or blind restriction that's going to change the fact that food is indeed pleasurable to consume and my belief is that the type of blind restriction that Kessler is suggesting will ultimately and eventually do exactly what he predicts - magnify conditioned hypereating. Zero tolerance as a dieting strategy has been around forever. If it worked, the world would already be skinny.
Saturday, March 20, 2010
Newsweek on how to tackle the problem of childhood obesity.
If you paint it, they will play - Obesity Panacea on how simply painting schoolyard play areas led to increased play!
The indefatigable and ever entertaining Respectful Insolence's Orac on why he fears for the future of medicine.
Lastly here's a great video on just how much time and resources are wasted on television:
Friday, March 19, 2010
This one's definitely not safe for work or young ears (too much swearing).
Today's Funny Friday is the Onion News Network's more literal take on the news filler that 24hr. news networks rely on as their bread and butter (remember, email subscribers have to head to the blog to watch).
Have a great weekend!
Thursday, March 18, 2010
So just in case you needed another reason to avoid processed meats along comes Harvard's Dr. Renata Micha and her colleagues who at a recent American Heart Association conference reported on their meta-analysis that looked at over 1.2 million adults and the risk of their developing heart disease and diabetes as a function of their consumption of red and processed meats.
While for red meat there was no found linkage, for processed meats the results were staggering. Every 50 grams (1.76oz) of processed meat consumed per day increased the risk of developing heart disease by 42% and diabetes by 19% and even a single weekly serving seemed to increase risk of heart disease by 3-5%.
What really struck me was the fact that she was presenting at an American Heart Association conference.
The AHA, like Canada's Heart and Stroke Foundation, runs a front-of-package labeling program with less than strict criteria. Currently there are 114 different processed meat products that carry the AHA's Heart Check. Here in Canada there are 44 different processed meat products carrying the Heart and Stroke Foundation's ignoble Health Check.
I asked Dr. Micha about her thoughts regarding public health organizations formally endorsing and promoting the consumption of processed meats as healthy and while she was very diplomatic with her answer, her hope that policies may change consequent to the research is not something I'd be holding my breath for here in Canada. Sadly the Heart and Stroke Foundation doesn't appear to care too much about research when it comes to administering their Health Check program.
Click below to download the audio file, or you can listen on the embedded player (won't work with email subscribers) and hear Dr. Micha discuss this latest salvo against highly processed foods.
Click here to download this podcast or click here to subscribe in iTunes!
Wednesday, March 17, 2010
I received an email last week from a reader asking about acai berries. I've had others asking about goji berries, melumbers and mangosteens.
The questions invariably have to do with the incredible health benefits these fruits are reputed to confer.
Funny thing is (ok, not so funny), there aren't medical studies supporting their claims or beliefs.
So what does the evidence suggest?
Studies on folks who consume larger amounts of fruits and vegetables as a whole show a myriad of health benefits that are almost certainly not a consequence of those fruits' antioxidant levels given the disappointing results we've seen on studies of antioxidants. And while indeed there are studies on fruits and vegetables as a whole, with free-living humans and all of their wonderful dietary and lifestyle differences, there's unlikely to ever be robust, well-controlled studies that are able to look at the consumptions of individual types of fruits or berries.
Of course it's possible one or more of these "Super" fruits are in fact "super" healthy. More likely though if you eat them you're just buying hope and more often than not in the case of so-called superfruits, super-expensive hope, often in the form of a large multilevel marketing campaign.
I'd stay away from things advertised (and priced) as "super" and remember Michael Pollan's 7 word healthy eating manifesto, "Eat Food. Not too much. Mostly plants". Follow those simple instructions and you'll do super.
Tuesday, March 16, 2010
Here's a interesting study.
Simple experimental design. Take 165 undergraduate students and enroll them in a study you tell them is about memory and where as part of their reward for inclusion, they'll be given a snack. Ask half of them to memorize a 2 digit number and the other half a 7 digit number and once they've memorized their numbers ask them to go into a second room where they are faced with their snack choice - either a piece of chocolate cake or a cup of fruit salad. Track choice and then follow up with an exploration of the students' perceived reasons for making the choice.
63% of the students who were trying to remember the 7 digit number chose the cake compared with only 42% of those trying to remember the 2 digit number.
Students who chose the cake reported a stronger emotional decision making drive while those who chose the fruit salad reporter a stronger cognitive drive.
Researchers hypothesized that the difference was explicable on the basis of the 7 digit memory group having "lower levels of processing resources" with much of their cognitive brain power being spent on trying to remember their 7 digit number.
Moral of the story?
Don't eat on a full brain.
Shiv, B., & Fedorikhin, A. (1999). Heart and Mind in Conflict: the Interplay of Affect and Cognition in Consumer Decision Making Journal of Consumer Research, 26 (3), 278-292 DOI: 10.1086/209563
Monday, March 15, 2010
"Don't eat when you're not hungry"
Despite living in a time of unparalleled abundance, hunger is still a major contributor to our health woes.
Ever go shopping hungry? What happens? I know in my case my cart's a lot fuller on the days I shop hungry than the days I don't, and the choices often differ as well.
Ever stop to think what happens when you sit down to a meal hungry?
You shop from your plates, your fridges, your freezers, your cupboards, or worse still, from a menu.
And just like shopping in the supermarket you're going to choose a great deal more and a great deal differently waiting until you're hungry to eat than if you'd sat down not hungry.
I'm also betting that my definition of hunger is likely broader than yours. As far as I'm concerned, hunger doesn't just come from your stomach, it also comes from your brain. Some folks like to call brain hunger, "appetite" and growling in your stomach, "hunger". I don't bother with the distinction. The drive to eat is second only to the drive to breathe in terms of importance to our survival. Consequently our body has many mechanisms and backup mechanisms in place to ensure that we do it. Just as there are a myriad of different physiologic pathways to encourage eating, so too are there a myriad of different sensations, emotions and rationalizations built in to encourage us to seek out food, specifically high calorie food.
So aside from stomach growling, brain growling consists of things such as cravings, compulsions, needs for a "taste" of a certain flavour/tartness/saltiness/sweetness, starting something and having difficulty stopping, and overt losses of dietary control and discretion.
When you're hungry it's easy to eat a full day's calories at a single sitting. The good news is, given the world we live in, hunger is entirely preventable and were you to go out of your way with well planned meals and snacks to ensure the hunger hydra doesn't rear its ugly heads, you can make it through the day in control of your portions, choices and your calories.
While it may feel unnatural to eat when you're not hungry I can assure you, it's the wise way to go and it's very easy to do.
Here's a basic hunger prevention strategy. Try it - you might be surprised at how well it works (note calorie range to represent minimums for women-men):
Saturday, March 13, 2010
Dan Gardner (who's rapidly become one of my favourite columnists) on the changing face of Canadian demographics.
Marion Nestle explores how the fight against childhood obesity may well involve fighting big corporations.
In a related story to Marion's the New York Times discusses how Disney helped force the eviction of the same non-profit that forced Disney to offer Baby Einstein refunds.
Tooled around my friends and fellow bloggers Travis and Peter's new digs over at Science Blogs.
Watched a stunning HD video of the Milky Way by some guy named Charles up on Vimeo.
Friday, March 12, 2010
Thursday, March 11, 2010
Roll out the barrel because if you believe the news reports alcohol contains magical negative calories!
Yup a recent study is making waves in the media and blogosphere and the gist of the reporting is that a few alcoholic drinks a day may help control your weight - though of course that's not the whole story.
The study's a big one. It looked at 19,220 American women aged 38.9 years or older who had a baseline normal BMI and followed them for 12.9 years and tracked alcohol consumption and self reported exit weight.
As with any long term prospective study, the authors tried valiantly to control for potentially confounding variables and they adjusted for age, race, baseline BMI, smoking status, non-alcohol energy intake, physical activity, menopausal status, postmenopausal hormone use, multivitamin use, comorbid medical conditions, and macronutrient distribution. They then stratified results into alcohol intake by grams with a 5 level subdivision.
Firstly it's important to note that statistically all groups of women gained weight. Average weight gain for the women who didn't drink at all was 3.63kg over 12.9 years and for those drinking an average of 30g or more of alcohol daily the average weight gain was 1.55kg. That's a difference of 4.6lbs over nearly 13 years.
So best case scenario is the study has indeed accounted for all variables and the association is causal and if you're a woman, drinking 2 glasses of wine daily will help you not gain roughly a third of a pound extra per year.
Worse case scenario? The study proves just how difficult it is to study nutritional variables and that it's one of those association doesn't prove causality pieces.
The lead author, Dr. Lu Wang, very kindly responded to a few email questions regarding potential confounding variables and both in the paper and in her emails made it very clear the authors did a truly bang up job trying to control for everything they could think of. At the same time Dr. Wang readily admitted that there are,
"an endless list of potential confounders."Given we're talking about a difference of only 4.6lbs over more than a decade of time, it would therefore certainly be possible there's some subtle difference or differences other than alcohol intake to account for the results.
But does that matter?
Ultimately research on heart disease and moderate drinking in women has already suggested benefit to tempered imbibing and with this study, perhaps there's more. More to the point of this post though, the press' reporting on this story has been abysmal with some articles suggesting that alcohol will cause weight loss, others not noting the small actual absolute differences seen in the study and sadly most of the articles doing a better job of reflecting the media's need to sensationalize study results than to practice good science journalism.
So will booze make you skinny? Nope. But maybe, just maybe it'll make you ever so slightly less fat.
Wang, L., Lee, I., Manson, J., Buring, J., & Sesso, H. (2010). Alcohol Consumption, Weight Gain, and Risk of Becoming Overweight in Middle-aged and Older Women Archives of Internal Medicine, 170 (5), 453-461 DOI: 10.1001/archinternmed.2009.527
Wednesday, March 10, 2010
Judging by our growing waistlines probably not, but I'm reporting on this study to support a point.
The study, a small one published in the journal Diabetes Care in December of last year, investigated blood levels of GLP-1 (a satiety peptide which when produced increases satiety), glucose and insulin in 22 healthy weight individuals following the ingestion of diet soda or carbonated water prior to the consumption of 75grams of glucose.
Following ingestion of artificially sweetened beverages the subsequent ingestion of a sugar load led to enhanced release of GLP-1.
So can anybody draw real life conclusions from this study?
Nope. The study's small, it didn't look at actual satiety and there are many more components to diet soda than just artificial sweeteners.
So why did I bother to post?
When it comes to artificial sweeteners it seems to me that the media and blogosphere tends to report based on the visceral belief that artificial sweeteners must be bad for us and that belief supersedes good evidence based reporting and leads folks to report on bad, preliminary or weak studies as evidence that sweeteners are unhealthy. The corollary to this is that bloggers and the media, while regularly trumpeting results from small studies as vilifying for sweeteners virtually ignore studies that suggest perhaps sweeteners aren't so bad or in some cases perhaps even good.
While I don't have any disclosures to make regarding ownership of shares or income streams from the sweetener industry my take on the weight of the evidence places the consumption of excess amounts of sugar as a riskier behaviour than the consumption of artificial sweeteners.
The point of this post? To remind my fellow nutrition bloggers, writers and readers that evidence trumps belief.
Before/when writing/reading a blog post or article consider the underlying study and ask yourself whether or not it's important enough to care about. Rat and mice studies, studies with very small numbers of folks, poorly controlled studies - certainly they can be interesting and can also point the way to future research, but please don't hang your hats on them.
Brown RJ, Walter M, & Rother KI (2009). Ingestion of diet soda before a glucose load augments glucagon-like peptide-1 secretion. Diabetes care, 32 (12), 2184-6 PMID: 19808921
Tuesday, March 09, 2010
"But Yoni, the advertisement for the Del Monte Fruit Twists says says there's "no sugar added"."I beg to differ.
With the exception of natural flavour, colour and pectin the only ingredients are fruit concentrates. Wanna guess what the main ingredient of fruit concentrates are? Sugar. So much sugar that in each and every Health Check'ed serving of Fruit Twists there's 3 teaspoons of the stuff which account for nearly 70% of each serving's weight and 80% of each serving's calories. Buy hey, it's "natural" sugar, right?
According to the copy,
"Get your daily servings of fruit in a convenient and delicious way with new Fruit Twists"Fruit?
Let's compare blueberries with Blueberry & Raspberry Del Monte Fruit Twists. Gram per gram the Health Check'ed Twists have 600% more calories and 666% more sugar (Hmmm). Put another way, if you wanted to consume the equivalent number of calories from berries as you'd get from a two Twist "serving" you'd need to eat 3/4 of a cup of blueberries (and that 3/4 of a cup still won't give you the sugar of the two tiny Twists).
But as with virtually everything Health Check'ed it gets worse.
Given that the Twists look exactly like Twizzlers, I decided to compare the two. Comparing Del Monte Fruit Twists - endorsed by the Heart and Stroke Foundation's stellar dietitians - with Twizzlers, gram per gram we see identical calories and get this, 40% more sugar in the Health Check'ed Twists.
So once again here we have the dietitians from the Heart and Stroke Foundation discouraging the consumption of actual fibrous, nutritious, satiating fruits and berries by promoting and endorsing a heavily processed product that's basically just a sugar-sweetened Twizzler.
They sure seem like a smart bunch.
As far as I'm concerned, the misinformation the Heart and Stroke Foundation is providing Canadians should be downright criminal but sadly there's no law that prevents them from abusing the public's trust.
Monday, March 08, 2010
As usual there are lots of news stories about Omega 3s (including last week's that some omega 3 supplements may contain high levels of PCBs) but two really caught my eye.
The first detailed a hypothetical plan to force feed convicts omega 3 supplements as a means to reduce violent and aggressive episodes. That plan is being born out of the results of a recent study titled, "Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners".
The study tracked 221 adult prisoners and randomized them to receive either placebo or a nutritional supplement containing 25 vitamins and minerals along with omega-3 and omega-6 fatty acids. Staff then tracked aggressive and rule breaking behaviours.
The authors found that the supplemented group saw their aggressive and rule breaking behaviours decrease by 34% versus a 14% increase in the control group.
Sounds really impressive until you see the absolute numbers whereby we're talking about 11 incidents per 1,000 prison days in the supplemented group vs. 9.7 incidents per 1,000 prison days in the control. I also have to question the blinding in this study in that fish oil capsules are absolutely noticeable, even enteric coated ones, when you burp. Oh, and no, this wasn't truly an omega 3 study given the supplements had many other vitamins and minerals in them.
So colour me unimpressed.
The second story I mentioned? Apparently the American Department of Defense is considering force feeding the US military omega-3 supplements as a means to, "enhance stress resilience, wellness, and military performance".
Now I'm not sure on which study they're basing their recommendations but hope if they do use them on the military that it doesn't hinder their troops' combat skills by rendering those fighting men and women less violent and aggressive.
Zaalberg, A., Nijman, H., Bulten, E., Stroosma, L., & van der Staak, C. (2009). Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners Aggressive Behavior DOI: 10.1002/ab.20335
Saturday, March 06, 2010
The Toronto Life has a great piece on what many might construe as over-parenting.
The Globe and Mail starts off what's bound to be decades of thought over just how broken Canada's Health Care system is and what needs to be done to fix it.
Maclean's' Colby Cosh takes the Globe and Mail to task for their reporting on relief homeopathy work in Haiti.
CanWest's Sharon Kirkey does a phenomenal job tackling a subject dear to my heart - it's about energy in, not energy out when it comes to weight loss.
The Jewish Journal has an absolutely fascinating piece on Tarantino's Inglourious Basterds detailing responses from screenings in Germany, screenings to holocaust survivors, interview with Tarantino on the influence (or lack thereof) of Israel on the narrative, Simon Wiesenthal folks questioning whether the movie trivializes the holocaust etc.
Posted by Yoni Freedhoff at 5:09 am
Friday, March 05, 2010
Who doesn't love the Muppets?
Today's Funny Friday video features Beaker playing Kansas' Dust in the Wind. Unfortunately he forgot to turn off comments. The internet is a cruel, cruel place.
Have a great weekend!
Thursday, March 04, 2010
Readers will likely remember just a few days ago when I commented on product placement by Kellogg's on CBC Kids' morning shows with Yamma Mamma talking about healthy breakfasts while the camera provided multiple plate and product shots of an Eggo Waffle.
Comments on the blog were mixed. Some thought I was out to lunch, some thought I was bang on, while one person demonstrated incredible ignorance by invoking Godwin's Law by suggesting that my depiction of product placement was at a level comparable to how I might complain about Nazi propaganda.
The CBC wrote me back and while they didn't suggest I was on a Nazi witch hunt, they certainly didn't agree that the Eggo shots were in fact product placement,
"At no time are brand-name products promoted. In the example cited, we focus on the importance of a complete, balanced breakfast even within the time, cost or other constraints faced by many people.But isn't that what product placement is? Not mentioning a product by name but placing it in the show - in this case a round, commercially produced, breakfast waffle product into a show that explicitly suggests it's a healthy choice?
In other words, a waffle matched with fresh fruit, nuts, yogurt and/or milk and juice represents a nutritious, enticing choice for kids."
A new and interesting twist to all of this came by way of Dr. Brain Cook.
Brian's a researcher for Toronto Public Health and his area of expertise is advertising to children. When he read my blog piece he wrote to inform me of Kellogg's commitment to the Children’s Food and Beverage Advertising Initiative.
The initiative very clearly states,
"Kellogg will implement the Product Placement principle by not paying for or seeking out promotional product placement (i.e., embedding our products within program/editorial content, as distinguished from sponsorship of programming) for our products in any medium directed primarily to children under 12. Kellogg does not currently engage in this type of marketing directed to children under 12."I've written to Johanne Trudeau, the Director of Nutrition Marketing for Kellogg's Canada for comment and will keep you posted.
The whole thing seems pretty clear to me.
1. Kellogg's paid for segments involving Yamma Mamma and healthy breakfasts on CBC Kids.
2. The segments included Eggo product placement (and perhaps other Kellogg's products, I'm only aware of the one example).
3. According to Kellogg's, product placement in kids shows is an advertising modality that they themselves report voluntarily avoiding.
4. The CBC disagrees with Kellogg's in that according to the CBC who report explicitly banning advertising on Kids shows, product placement isn't an advertising modality.
Can't wait to hear what Kellogg's has to say.
Wednesday, March 03, 2010
Regular readers of my blog will certainly already be aware of Health Canada's push to fortify the global food supply.
In researching the story I had the opportunity to interview Dr. Valerie Tarasuk from the University of Toronto. Dr. Tarasuk is a Professor of nutrition and a former member of Health Canada’s expert advisory committee on dietary reference intakes.
No thanks to me (I just ask the questions), the interview's fascinating and really a great tour of many of the issues surrounding discretionary fortification. Dr. Tarasuk is a clear and cogent speaker and is quite entertaining to boot - it was certainly one of the most enjoyable interviews I've ever conducted.
Click below to download the audio file, or you can listen on the embedded player (won't work with email subscribers) and hear Dr. Tarasuk rip apart Health Canada's proposed gift to Big Food the world over.
Click here to download this podcast or click here to subscribe in iTunes!
Tuesday, March 02, 2010
Here's a great example of why front-of-package health claims should be banned entirely - Sara Lee's Soft and Smooth Plus DHA bread. According to the press release per slice there's 6mg of DHA.
Sara Lee Soft and Smooth Plus' marketers try to gussy up the importance of 6mg by noting 2 slices worth is,
"is at least 10 percent of the Institute of Medicine’s suggested daily amount for kids, depending on age, ranging from 1-13 years old"Sounds like a fair bit, no?
Except for one thing, the Institute of Medicine doesn't have a suggested daily amount of DHA for kids.
Page 469 of the very reference that Sara Lee Soft and Smooth Plus' marketers point to as proof states,
"Because of a lack of evidence for determining the requirement for n-3 fatty acids during childhood, an AI is set based on the median intake of α-linolenic acid in the United States where a deficiency is basically nonexistent in non-institutionalized populations (Appendix Table E-11), and rounding."Translation? There isn't enough evidence to recommend a particular DHA intake in kids so instead the Institute of Medicine has created an arbitrary number for what they're calling an "adequate intake" based on the average intake of α-linolenic acid in the population. Sara Lee's Soft and Smooth marketers then took 10% of that arbitrary number and claimed that it was the Institute of Medicine's "Kids Suggested Daily Amount".
Soft and smooth marketing? I'd say. Slippery too.
Looking at the front of the bag of bread one can see a cartoon head replete with brain beside the bag's DHA announcement and I imagine the back of the bag has some quotes about DHA and childhood brain development.
Looking at Sara Lee's Soft and Smooth Plus product partner's website (Disney), you'll learn,
"With New Sara Lee® Soft & Smooth® Plus, moms can enjoy knowing they are serving a great tasting, soft textured made with whole grain bread their little ones will love, plus providing DHA Omega-3 which helps to support healthy brain development.To help push their message even harder, Sara Lee's Soft and Smooth Plus marketers even purchased their own MD spokesperson in one Dr. Alanna Levine.
DHA is important for brain and eye development particularly during the first two years of life and early childhood. It is important that children consume adequate amounts of DHA in their diet to support brain and eye growth and development during the early years of rapid development. DHA ensures that cells in the brain, retina, heart and other parts of the nervous system develop and function properly."
According to Alanna Levine's homepage, not only is she a designated spokesperson for the American Academy of Pediatrics, she's also a member of the National Association of Medical Communicators, and a member of the American Academy of Pediatrics’ Council on Communications and Media. Oh, and she's also a self-professed, "Parenting Expert".
She sounds great. She's is a pediatrician, an "expert parent" and someone incredibly well versed in medical communication and public speaking with exposure on shows like Fox News, the Tyra Banks Show and CBC's Early Show. Someone like that would never steer you wrong, would they?
For the sake of discussion let's ignore the fact that Sara Lee's Soft and Smooth Plus' marketers took soft and smooth liberties with the Institute of Medicine's report on DHA requirements. Instead let's take a quick look at those 6mg of DHA per slice and compare them to what you might find in let's say salmon.
So how many slices of bread would your child need to eat to consume the equivalent amount of DHA as you might find in let's say a child sized, 2.5oz serving of salmon? An astounding 13.5 loaves or 268 slices.
And how much salmon would you need to convince your child to eat to consume the 6mg that a slice of Sara Lee Soft and Smooth Plus contains? My calculations peg that as a piece of salmon roughly 1/12th the size of a single, solitary, lonely pea.
So tell me Dr. Alanna Levine, MD, pediatrician to the stars, brilliant spokesperson and expert parent - don't you think that suggesting that Sara Lee Soft and Smooth Plus bread is a useful means to help your child consume more DHA is more than a touch disingenuous?
Me? I would imagine "parenting experts" and pediatricians would be much more interested and capable of helping find ways for parents to actually feed their children fish, a pea sized serving of which would have the DHA equivalent of 12 slices of Sara Lee Soft and Smooth Plus bread, than push bread with significantly less DHA per slice than you'd find in a single flake of fish.
It's cases like these that are exactly what's wrong with front-of-package nutrition claims and as far as doctors go, I would have thought we make a good enough living on our own than to sell our good names for the promotion of products of questionable benefit.
[BTW - I tried to contact Dr. Alanna Levine, MD for comment but never did hear back from her.]
Monday, March 01, 2010
CBC Policy 1.3.8: Advertising Directed to Children Under 12 Years of Age,
"The CBC/Radio-Canada does not accept advertising of any kind in programming and websites designated by the CBC/Radio-Canada as directed to children under 12 years of age."Seems pretty clear to me. No ifs, ands, or buts, the CBC does not accept advertising of any kind for kids under 12.
I guess Kids' CBC is aimed at kids over the age of 12?
I imagine most teenagers and adults can't tear themselves away from the antics of Sid, Mamma Yamma and the Doodlebops.
Why do I say that?
Well the CBC have partnered up with Kellogg's and just last week as part of their product placement agreement Sid, Mamma Yamma and a child guest all sat together to shill for and eat Eggo Waffles in a segment about "Healthy Breakfasts" complete with plenty of plate shots and close ups. There's also that website up above.
So is product placement technically advertising? Absolutely, only it's worse than plain old ads. Product placement takes trusted characters that children and parents have come to know and love and uses them to serve as corporate shills to give the products placed the gleaming sheen of trustworthy endorsement.
The CBC's Kim Wilson the Creative Head of Children and Youth Programming at the CBC explains in the January 2010 Production Notes,
"The spots are called, "Mighty Mamma" and feature Mamma Yamma as a superhero of breakfast proportions who helps kids (and our hosts) learn about breakfast foods and keeping active."So with Eggo Waffles what has Mamma Yamma endorsed?
If your child eats the recommended serving of 2 Eggo waffles, Yamma Mamma is recommending your child consume: 190 calories of refined white flour containing 430mg of sodium and 32 other ingredients including multiple polysyllabic preservatives and artificial colours.
Funny, when my wife makes waffles at home she uses 6 ingredients, the names of all of which even our 5.5 year old can both read and pronounce, including whole grain whole wheat flour and virtually no salt.
Shame on you CBC.
Want to complain? I sent my complaints to the CBC Kids' department and copied them to the CBC's ombudsman. You can do the same by clicking here.
[Hat tip to a concerned parent whose 6 year old immediately following the segment asked her if they could buy some Eggos]