So apparently McDonald's is rolling out a new "snack sized" McFlurry.
Sounds low-cal-ish, right?
The new McFlurry's 15 teaspoons of added sugar helps pack its 430 calorie bottom line. That's 7 calories more than you'd get "snacking" on a Snickers Bar and then washing it down with a can of Coca Cola.
With "snacks" like that, who needs meals?
Tuesday, May 31, 2011
So apparently McDonald's is rolling out a new "snack sized" McFlurry.
Monday, May 30, 2011
That was one of the cases put forth by Dr. Bob Ross during our Forks vs. Feet debate.
He had discussed an as of then unpublished study that concluded that due to changes in occupation-based physical activity, we were all on average burning 100 fewer calories per workday, and that those no longer burned calories have caused us to become obese.
Well, the paper was just published and I had a gander.
Now I do think there are weaknesses to the analysis, in that this study of theoretical energy expenditure lost at work doesn't in fact provide a picture of total daily energy expenditure. Meaning that the authors have no idea what the study subjects energy expenditures were like when they weren't working. That's problematic for a few reasons.
Firstly it's problematic because it's possible that if you take away 100 calories burned through physical labour, perhaps you'll put them back elsewhere. What I mean to say is that in children we've seen evidence for the existence of an Activitystat whereby kids who exercise more at school do less at home and vice-versa. Given such behaviour has been demonstrated to exist in children, I don't think it's an impossible stretch to wonder if it also occurs in adults, especially since we're talking about just 100 calories per day. And even if it didn't translate to intentional exercise, couldn't more sedentary jobs lead to more fidgeting? More fidgeting would mean more Non-Exercise Activity Thermogenesis. Dr. Levine suggests purposeful NEAT can add up to 500-1000 calories a day, how difficult would an unconscious 100 be?
Secondly it's problematic because doubly-labeled water studies suggest that at least between 1983 and 2005, in study populations from Holland and North America, daily energy expenditures haven't changed. Yet in both Holland and North America during that same time period obesity rates have risen dramatically and presumably, we're working progressively cushier jobs.
Thirdly it's problematic because in doubly labeled water studies that look at total daily energy expenditure of folks living in developing nations vs. developed nations, for instance subsistence farmers in Nigeria vs. urban Chicagoans, there's been no difference in calories burned, and that total daily calories burned in both populations didn't correlate with weight. I would certainly imagine that being a subsistence farmer in Nigeria would be quite physically demanding work.
Lastly, in a massive study of 98 doubly labeled water studies representing 183 cohorts including 14 from countries with low or middle "human development index" (and hence more likely to have physically demanding jobs), again there was no difference in total daily energy expenditures.
But even putting aside those concerns, I think the paper's conclusions are telling in regard to the Forks vs. Feet debate.
Clearly both forks and feet are thermodynamically implicated in obesity.
In one corner, taking this paper to be true (true despite the fact doubly labeled water studies that actually measure total daily energy expenditures suggest otherwise), we've now got 100 calories a day we're not burning due to less physically demanding jobs.
In the other corner we've got energy intake data suggesting that since 1970, based off of plate-waste disappearance data, adults are consuming 500 more calories daily now as compared with 1970.
Basically we're looking at a 600 calorie surplus. 100 from fitness and 500 from food. Put another way, our modern caloric excess is 83% food and 17% fitness, not exactly a home run for the Feet camp, but damn close the 80/20 rule I tend to believe is true.
Church, T., Thomas, D., Tudor-Locke, C., Katzmarzyk, P., Earnest, C., Rodarte, R., Martin, C., Blair, S., & Bouchard, C. (2011). Trends over 5 Decades in U.S. Occupation-Related Physical Activity and Their Associations with Obesity PLoS ONE, 6 (5) DOI: 10.1371/journal.pone.0019657
Wilkin, T., Mallam, K., Metcalf, B., Jeffery, A., & Voss, L. (2006). Variation in physical activity lies with the child, not his environment: evidence for an ‘activitystat’ in young children (EarlyBird 16) International Journal of Obesity, 30 (7), 1050-1055 DOI: 10.1038/sj.ijo.0803331
Luke, A., Dugas, L., Ebersole, K., Durazo-Arvizu, R., Cao, G., Schoeller, D., Adeyemo, A., Brieger, W., & Cooper, R. (2008). Energy expenditure does not predict weight change in either Nigerian or African American women American Journal of Clinical Nutrition, 89 (1), 169-176 DOI: 10.3945/ajcn.2008.26630
Lara R Dugas, Regina Harders, Sarah Merrill, Kara Ebersole, David A Shoham, Elaine C Rush, Felix K Assah, Terrence Forrester, Ramon A Durazo-Arvizu, & Amy Luke (2011). Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies The American Journal of Clinical Nutrition, 93 (2), 427-441 : 10.3945/ajcn.110.007278
Westerterp, K., & Speakman, J. (2008). Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals International Journal of Obesity, 32 (8), 1256-1263 DOI: 10.1038/ijo.2008.74
Swinburn, B., Sacks, G., & Ravussin, E. (2009). Increased food energy supply is more than sufficient to explain the US epidemic of obesity American Journal of Clinical Nutrition, 90 (6), 1453-1456 DOI: 10.3945/ajcn.2009.28595
Saturday, May 28, 2011
Sorry, another busy week. Not too much reading for me.
Kerry from Overcoming Gymnaseous gives us her thoughts on completing her first triathlon. Maybe she'll inspire you to try one?
Great piece for health writers from Reporting on Health's William Heisel on how you've got to follow the money.
Lastly, make sure you visit Arya Sharma's Obesity Notes to read his 5 part series on bariatric surgery starting here.
Friday, May 27, 2011
Thursday, May 26, 2011
In case you haven't heard the story, apparently there's a group of OB/GYNs in Florida who are actively refusing to follow pregnant women who are obese.
The rationale they've presented is that they're too complicated, and for their patients' safety they're electing not to see them. Instead they're suggesting their patients with obesity get referred to specialized high risk obstetricians.
Now it's certainly a fair point to state that pregnancies in patients with obesity do carry more risk, both to moms and to babies, but the question that leaps to my mind is whether or not the OB/GYNs are telling the truth? Would the care they would be capable of providing these patients truly be substandard, or are they just avoiding taking on more complicated patients?
Put another way, are these OBs blatantly discriminating against people with obesity, or are they trying to protect them from their own professional inadequacies?
Now I'm not an OB, so for the sake of this discussion, I called up my friend Dr. Glenn Posner who's an OB here in Ottawa. Glenn broke it down practically. He confirmed that managing labor in women with obesity is more challenging. He told me that it's significantly more difficult to monitor the baby, and if things go sour, it takes more people to help in the OR and the skin-to-baby time for a crash C-section is much longer.
He also stated quite emphatically that just because there's a greater degree of difficulty didn't in his mind justify refusing to care for a significant, and growing, percentage of patients, and that indeed, any OB/GYN out there should be sufficiently trained to handle them.
Our discussion then turned to why these docs, who certainly are capable of caring for patients with obesity, have chosen not to.
We came up with a few options.
1. Overt and ugly bias.
2. Laziness - not wanting to have to deal with more complicated cases
3. Inadequate facilities - equipment does matter and depending on weight, may not be readily available.
4. Fear of litigation - with a much higher rate of complications, it may well stand to follow that there's a much higher risk of lawsuit.
Any way you slice it, it ain't pretty.
Wednesday, May 25, 2011
"Because I exercised"
And to be fair, I've had them run through my head as well.
What am I getting at?
Most of us folks, when we've exercised intensely, we tend to delude ourselves that we've earned some dietary leeway and indulgence.
That belief then leads to the suffix, "because I exercised".
"I can have seconds ... because I exercised",And guess what, have the, "because I exercised" indulgence and more often than not, while you'll still be racking up the incredible health benefits of exercise, you'll probably be kissing any theoretical caloric benefits goodbye.
"I can have that (insert indulgence here) ... because I exercised",
I think these 3 little words may in part explain why exercise doesn't tend to have a tremendous real-world impact on weight loss, despite having a theoretical mathematical one on paper.
That doesn't mean you can't, or shouldn't indulge.
It just means that the indulgent calories you can consume in a few minutes, to truly be "balanced" through exercise, are likely going to require a heck of a lot of exercise.
Or put another way, it means that the calories burned through exercise are usually much lower than most of us would expect, and that while indulgence is an important part of a rich and complete life, your choice to do it shouldn't be based on whether or not you've exercised, it should be based on whether or not you've decided the indulgence is worth its calories.
Tuesday, May 24, 2011
For me, this is a bittersweet story.
Back in 2008 my colleague Rob Stevenson and I wrote an editorial for the Canadian Medical Association Journal calling for the reform of hospital cafeteria food.
It was met with a great deal of word of mouth support, but very little in the way of feet on the ground (except Quebec whose Health Minister Yves Bolduc quickly banned the use of deep fryers in hospitals).
Perhaps with the gentle encouragement of Rob (he's much nicer than me), Nova Scotia's Capital Health hospitals followed suit, and in September 2009, they also banned deep fryers.
With both of us being quite busy, I don't hear from Rob too often, but just last Friday he sent me a copy of a memo penned by Nova Scotia's Capital Health hospital's vice president of sustainability. The memo explained Capital Health's next move, one that will see Tim Horton's (a Canadian donut/coffee icon), forbidden from selling donuts and muffins that don't meet Capital Health's healthy food guidelines.
Capital Health nails the "why" argument with their explanation,
"One way Capital Health is working to improve the health of our community is by making healthier choices the easier ones in the food we sell to the staff, patients, families and visitors that use the restaurants in our facilities day in and day out."Indeed! Hospitals should not be profiting off the sale of unhealthy foods and instead should serve as role models for their communities.
So what's going to be left on Tim Horton's Capital Health shelves?
Hard to say with certainty, but this line,
"baked goods such as doughnuts and those muffins that do not meet Capital Health’s healthy food guidelines will no longer be sold"certainly suggests that some muffins will meet their guidelines.
Of course their guidelines will be based on Canada's Food Guide, and therein lies the rub.
According to a CTV article on this story, Capital Health hospital Tim Horton's will still be selling their low-fat berry muffin. Low-fat of course, is pretty much the focus of Canada's entire Food Guide.
Problem is, evidence-based nutrition would suggest that with rare exceptions, single nutrients are difficult to truly link to disease and that rather patterns of eating are more important. Using a guideline that falsely elevates the reduction of fat to the pinnacle of dietary discretion means that so long as a food's fat levels are low, the rest doesn't matter.
So let's look at Tim Horton's low-fat berry muffin.
Compared with a soon-to-be-banned chocolate donut it's made with the same highly refined carbohydrates, packs nearly 30% more calories, 150% more sodium, equivalent amounts of trans-fat, and a whopping 5 teaspoons more added sugar.
So at the end of the day, while this is a real, formative and praise-worthy step forward for Nova Scotia's Capital Health and hospital food reform, until we see our government step up with actual evidence-based dietary guidelines, these forward thinking efforts, may still ultimately end up being nutritionally backwards.
Monday, May 23, 2011
I hope my British readers forgive me, but over the course of the past few years, your country has rapidly surpassed the rest of the developed world in a bizarre quest to become the world's most backwards in regard to obesity policy.
And pip, pip, cheerio and all that rot, good chaps, your government's done a smashing job.
I used to blame it all on the asinine decisions of your Secretary of State for Health, Andrew Lansley, who among other brilliant decisions has helped to abolish your healthier school lunch program, scrap your front of package labeling program, turn over control of your national obesity strategy to the food industry, strip your food standards agency of their food labeling oversight, and has helped to include such things as processed cereal bars as part of your "5-a-Day" fruits and vegetables campaign.
Then there was your Under Secretary of State for Health, Anne Milton, who recommended doctors quite literally call their overweight and obese patients "fat", to "inspire" them to take more "responsibility" for their health.
Well your country's gone and done Anne's call to action one better.
Apparently now your physicians are not only encouraged with words to call their patients "fat", starting next year, they'll literally get paid to do so.
Never you mind that the vast majority of physicians the world over don't have a clue what to do with their obese patients. Never you mind that the weight loss industry is an unregulated morass of snake oil and false hope. Never you mind that there is as of yet no gold-standard, reproducible treatment program. Never you mind that studies show obese patients already face cruel discrimination by health professionals, and already receive substandard care.
Nope. Instead your country has determined it's in your best interests for your physicians to formally take on the role of the school yard bully in the presumptive hope that finger pointing, shame, and a free coupon for Weight Watchers is the solution.
I've got news for Mr. Lansley, Ms. Milton and the NHS. If obesity were truly treatable as a disease of personal responsibility the world would already be much skinnier. Obesity is a disease of the environment, and you folks across the pond are doing a dandy job making your environment more, not less, conducive to obesity with your 2012 Cadbury Olympics, your regulatory free food marketplace, your pulverized flour and sugary school lunches, and your food industry funded "healthy active living" campaigns - because guaranteed, in Britain, it won't be about modifying intake with Big Food at the helm, it'll be all about exercise.
Saturday, May 21, 2011
Weight Maven Beth Mazur's take on emotional eating.
Fabulous NPR article on food deserts and poverty in the Southern US.
For those of you who missed the debate and have a bunch of time to kill this long weekend, here's me and Dr. Bob Ross debating forks vs. feet! Thanks to Adrian Ebsary of Peer Review Radio and Twitter for the recording!
Friday, May 20, 2011
As the father of three beautiful little girls, I can only hope that they all meet people who love them as deeply as it would seem the man who put together this wedding proposal does his soon-to-be bride.
Today's Funny Friday is more of a feel good Friday, but it's a doozy, and if you're an email subscriber, may be worth a blog visit to watch.
(Sorry I didn't ask first father-in-law Mike! I thought I should ask Stacey first. Now that I'm a dad....)
Thursday, May 19, 2011
Can't say I ever wondered how many calories I'd burn digging worms, but that didn't stop me from being amused to find that very activity in the bible of energy expenditure, The Compendium of Physical Activities Tracking Guide.
So, digging worms, with shovel? That's a 4.0 MET activity.
What's a MET?
It stands for metabolic equivalent of task, and the easiest way to define it is as a reference, where 1.0 METs is the energy required to laze around doing nothing. Worm digging with a shovel therefore, takes 4x the energy required to lie around.
Actual calories burned will vary based on many factors, though a rough generalization would be that a 1.0 MET activity would burn 1kcal/kg/hr. Laze around for an hour, and if you're a 72kg guy like me, you'll burn 72kcal doing so.
A great many folks trying to lose weight keep track of the calories they burn exercising. Often they'll use them as negative calories whereby they'll subtract them from the calories they've consumed to give a net total.
Unless you're a truly hardcore record keeper or exerciser, I don't think that's the greatest plan.
Reason being is that record keeping is fraught with error.
I'd look at your exercise as being a means to buffer your error, not as a means to lower your count. Only exceptions there would be incredibly accurate record keepers, or folks who were exercising significant amounts.
The exercising folks, it's not that I'd want them to calculate net calories, just that I think it's important, if exercising for more than 45mins, to fuel properly so as to minimize the potential impact of exercise on hunger.
Oh, and in case you were wondering, that same bible notes caulking or chinking a log cabin as a 5.0 MET activity.
Playing the accordion? 1.8. Bookbinding? 2.3 Horse grooming? 6.0. Pushing a plane in and out of a hanger (huh?)? 6.0, and SCUBA diving as a navy frogman? 12.0.
Wednesday, May 18, 2011
I'm having a difficult time believing this story's real.
Apparently the mighty State of Texas has decided to spend $2 million dollars installing high-tech spy cameras in some San Antonio elementary school cafeterias.
What're they going to do?
They're going to read bar codes embedded in the cafeteria trays of 5 schools where students have a higher rate of obesity and poverty.
The program's stated aim is to help cut down on childhood obesity by providing parents and school officials with information about what kids are eating in school.
Now here's a crazy idea Texas school folks.
Bear with me.
How about instead of installing high tech cameras to spy on cafeterias, you use that same $2 million to creatively troubleshoot and reform the foods actually being served in those cafeterias, and instead of sugar, pulverized flour and flavored milk, you serve healthy, nutritious, calorie controlled meals cooked from real, whole ingredients?
Nuts, I know.
[Hat tip to loyal blog reader Linda]
Tuesday, May 17, 2011
It's strange that our official diabetic charity has traditionally shunned the diet that was once the cornerstone of diabetic treatment - low carb.
Stranger still that despite reams of evidence that link processed carbohydrates to type 2 diabetes, and the virtually complete exoneration of saturated fat as evil, that the Canadian Diabetes Association still promotes low-fat, high carb diets to diabetics.
Diabetes UK and the American Diabetes Association have both put out official position pieces that, albeit cautiously, support low-carb diets for diabetics.
The Canadian Diabetes Association?
They have a plate broken down into quarters. According to the CDA, one quarter of your plate should be filled with "Starch". Specifically mentioned? Potato, rice or pasta. They recommend eating starchy foods at each and every meal. Why? Because,
"Starchy foods are broken down into glucose that your body needs for energy"Um, psssst, CDA, ummm, isn't diabetes a disease where the body's not particularly good at handling boluses of glucose? Oh, and have you seen the size of most plates out there? Do you really think that telling people to fill a quarter of their plates with potatoes, pasta or rice is a good idea?
Now I'm not suggesting that the only diet endorsed by the CDA be low-carb. On the other hand, I am suggesting that the CDA make it a top priority to change their dietary recommendations to reflect our current understanding of the impact of diet on diabetes.
Their recommendations need to very clearly and unequivocally reflect the importance of carbohydrate quality, the current thinking on the not-evil status of saturated fat, and the not so scary option of a low carb diet.
If they did that then maybe, just maybe, our hospitals will stop serving white flour pancakes, syrup, Rice Krisipies and fruit juice to diabetics for breakfast.
Sliding scale insulin shouldn't need to be an automatic consideration for every admitted diabetic patient.
Monday, May 16, 2011
|Photo by Michael Goodin|
Last week I enjoyed debating Dr. Bob Ross on the relative merits of food vs. fitness, as they pertain to obesity treatment and prevention.
Ultimately we concluded, that of course both are important, though we disagreed on whether or not it has been primarily a decline in levels of physical activity, or an increase in caloric intake that has led us to this point.
Some might think that doesn't matter. That "how" we got here isn't important.
"How" is crucial because it's the "how" we got here that helps us to understand why effective treatment and prevention is so elusive, and also will hopefully help to inform future innovation and policy. While Bob and I disagree on the fundamental caloric basis of the "how", we certainly agree that the "how" isn't by means of personal choice.
What do I mean by personal choice?
Well, one camp of "how" is the camp that posits that we got here through the individualized personal choices of gluttony, sloth and laziness. That camp was actually well represented during the concomitant debate that was taking place on Twitter, while Bob and I were duking it out on stage.
Readers of my blog's comments will certainly know Paul Boisvert, but for those of you who don't, Paul is the coordinator of the Obesity Research Chair at Quebec's Laval University.
Paul's tweet reveals that his explanation for the "how" is that people with obesity are, ""Born to be lasy [sic]",
Which he then clarified with this statement,
Seemingly, according to Paul, the "how", is that obesity is the personal choice of people too lazy to exercise.
Bob and I would disagree.
While we were standing on opposite sides of forks vs. feet, we did share a common ground in that we feel it's changes to society as a whole that explain "how", not individually laid blame.
Bob explained how the world has changed in that life nowadays requires less "feet". We do far less physical activity, not because we're lazy, but because the world is now doing it for us. Labour saving jobs and devices have supplanted the need for physical labour, and our kids, when faced with a myriad of heretofore unknown, incredibly entertaining, sedentary alternatives to playing outside, often and not surprisingly, choose from their menu of heretofore unknown, incredibly entertaining, sedentary alternatives.
I explained how the world has changed, in that life nowadays goes out of its way to push energy intake. Virtually each and every one of us inadvertently consumes more calories than we used to, thanks to such things as our faster pace of life, federal farm subsidies that drive the increased availability of low-cost calories, an exponential rise in food advertising (especially the advertising targeting children), increased reliance on meals purchased outside of the home, scientifically engineered hyper-palatability, the health-halos of front-of-package health claims, mindless eating cues, growing portion sizes and the incredible failing of public health officials to provide useful, evidence-based guidance on nutrition and energy balance.
Couple those issues with what we're learning about things like genetics, epigenetics, obesogens, fMRI food addiction studies, weight contributing medical co-morbidities, drug-induced weight gain, and the failing of our medical education system to educate physicians about how to deal with obesity, and the "how" reveals itself to be a highly complex, multi-factorial, amalgam of cause.
It is this complexity that precludes simplified to the point of useless, "eat less, move more" messaging, and certainly it also reveals the error and bias in an individualized, blame based attribution to obesity's causes and solutions.
Saturday, May 14, 2011
Such a busy week.
Minimal reading time.
That said, check out:
Melanie Warner on the basically unstudied chemicals Pepsi's about to start adding to their soft drinks.
Peter from Obesity Panacea on the human limits of starvation.
Friday, May 13, 2011
Wednesday, May 11, 2011
Somehow I doubt it.
I mean, accepting donations or funds raised by corporations whose very products contribute to the burden of disease in your hospital would be anathema to your responsibility as a hospital to promote public health and combat disease, wouldn't it?
But what if your hospital really, really needed the money?
Um, it's a tobacco company handing out free cigarettes and simultaneously asking for hospital donations.
Yeah, there's not too much debate there. It's not good, right?
So why do our hospitals, specifically our children's hospitals, regularly partner up with the purveyors of sugary treats to raise money in their names?
These photos, taken by an anonymous tipster from Toronto, show a recent Dairy Queen Guinness Book of World Records attempt at making the world's largest ice cream cake. Stamped right on the sign, "donations to Sick Kids Hospital will be accepted" in lieu of course of free ice cream cake.
And the same happens here in Ottawa where CHEO regularly partners up with Dairy Queen to raise funds.
I wonder what the HALO team at CHEO think about these partnerships - they're the folks who are busily researching means to try to help combat the rapid rise in childhood obesity in Canada.
Guessing they might think that children's hospitals probably shouldn't be in the brand polishing business for Dairy Queen.
That same tipster did some quick calculations.
Through it, Dairy Queen distributed 5,000lbs worth of calories, 4,276.8lbs of added sugars and 44.5lbs of trans fat all with the blessing (they used Sick Kids' logo - they had their explicit blessing) of the Hospital for Sick Children.
These partnerships have got to stop.
I know, I know, fast food's not going away, and children definitely still need to enjoy cake from time to time, but that doesn't mean it's ethical or responsible for hospitals to help in its sale or promotion.
Hospitals used to sell cigarettes too you know.
[If you enjoy Weighty Matters you might want to subscribe via email, follow me on Twitter or join the Facebook page]
Very interesting study just came out ahead of print in the American Journal of Clinical Nutrition.
In it, researchers studied the impact of over-feeding on stool based calorie loss.
Basic principle is that we're not perfectly efficient creatures when it comes to extracting calories from our food. Further, mouse experiments have suggested that their guts' microbial flora and fauna causally impacted their weights.
To start exploring this in humans, here researchers studied whether or not changing dietary patterns led to changes in either gut microbiota, or energy lost in stool.
The study was a small one. Twelve lean and 9 men with obesity participated. Volunteers were put on a weight maintaining diet for 3 days and then in a random crossover fashion, they consumed either 2400 or 3400 calories for the next 3 days.
Ingested and excreted calories were measured by means of bomb calorimetry and gut flora was analyzed microscopically.
Interesting result #1?
There was no difference initially between the gut microbiota in lean and obese individuals.
Fascinating result #2?
Changing the nutrient load rapidly changed the bacterial composition of the human gut.
Indirectly important result #3?
In lean individuals these same changes led to a lesser loss of calories in stool - the more food they were fed, the greater their efficiency at retaining the calories.
What does all this mean?
Hard to say, these are definitely the early days. No initial difference in gut flora between people who are lean and people who are obese, to me suggests that gut microbiota might not be a big, natural player.
Rapidly changing bacterial composition fascinated me because who would have thought you could see dramatic changes so quickly.
That those changes actually improved efficiency of calorie absorption in lean individuals is potentially important because it's the opposite of what one might have thought (that one of the protective mechanisms by which perpetually lean folks stay lean might have been less efficient stool absorption), but more importantly, because regardless of the impact being in the wrong direction, it certainly suggests that modifying gut microbiota can in fact dramatically modify the gut's ability to absorb calories - and that in turn might lead one day to yogurts that can actually validly claim that their contents help with weight management.
[If you enjoy Weighty Matters you might want to subscribe via email, follow me on Twitter or join the Facebook page]
Jumpertz R, Le DS, Turnbaugh PJ, Trinidad C, Bogardus C, Gordon JI, & Krakoff J (2011). Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans. The American journal of clinical nutrition PMID: 21543530
Tuesday, May 10, 2011
You may have read or heard about a research paper that came out a few weeks ago in JAMA. The study followed 3,681 Europeans and looked for relationships between sodium excretion (the gold standard means of determining sodium intake), and cardiovascular disease and death.
The study's findings were in contrast with what most would have expected. Though higher sodium excretion did in fact correlate with higher blood pressures, surprisingly, it also correlated with decreased mortality.
So what's going on here?
Well here are two obvious possibilities:
1. We've been barking up the wrong tree sodium wise, and sodium's not something the general public should be worrying too much about (unless they suffer from congestive heart disease or hypertension).
2. We're right, sodium's bad, and this study, due to methodological limitations, shouldn't be one that influences us on not lowering our sodium intake.
I think there's at least one more possibility:
3. Sodium's isn't a causal agent of disease but instead given that processed foods are phenomenally high in sodium, is a useful biomarker for the degree of processed foods a person's consuming, and that it's the huge volumes of sugar and pulverized flour (that's more often than not packaged with gobs of sodium) that's actually causal for cardiovascular disease and death.
This study, where data was amassed from European countries from in some cases as far back as 26 years ago, may be looking at a days gone by Europe where processed foods and meals out were anything but the norm, and where a high sodium consumption reflected some other, in this case protective, dietary pattern. I wonder if the study were repeated here and now in North America, if the findings wouldn't stand in stark contrast, with sodium excretion here likely reflecting a highly processed lifestyle which in turn would correlate dramatically with cardiovascular disease?
Of course if option #3's viable it would mean that sodium reduction will likely only benefit those who rely on a return to actual cooking to reduce their dietary sodium, and not to those who eat large volumes of sodium reduced processed foods.
The great news is that science marches ever forward, and while it may take some time, eventually we'll have solid answers. Until then, and before I'd worry about absolute sodium intake, I'd recommend we all work on markedly reducing our consumption of processed and restaurant foods.
No doubt in my mind, sodium be damned or not, if we could all just re-discover our kitchens, the world would rapidly become a much healthier place.
Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovský J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA, & European Project on Genes in Hypertension (EPOGH) Investigators (2011). Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA : the journal of the American Medical Association, 305 (17), 1777-85 PMID: 21540421
Monday, May 09, 2011
This Thursday should be fun.
Firstly it's the 9th anniversary of my marriage to my wonderful wife (who I surely don't deserve).
Secondly, courtesy of the Canadian Obesity Network's Student and New Professionals division, I'll also have the honour and pleasure of debating Queen's Dr. Bob Ross on whether or not it's been forks or feet that have led us to where we are with obesity in society, and which deserves more of our attention on our way out.
The event's free and will take place from noon until 1:30pm on May 12 in Room 2005 in the Roger Guindon building at the University of Ottawa Health Sciences Complex (the building is sandwiched between the Ottawa General Hospital and the CHEO). For a map of the site, click here.
For those who think feet matter more, light refreshments will be served. For those who are concerned about their forks, I have no idea what "light refreshments" means, so it may be wise to arrive well fed and not particularly hungry, lest you be tempted to eat something you might not feel is worth its calories.
Through some Internet magic, the CON-SNP folks have managed to organize live streaming audio for those who can't attend using a service called Talk Shoe. The live-stream will begin at 11:55 am on May 12th, and you can logon here, or with the widget down below.
I understand the organizers are also trying to figure out a means to stream live video, and if they succeed, I'll be sure to let you know.
Readers here will certainly know that my bias falls on forks, but that said, you might be quite surprised by the stance I take on Thursday. With ample time to flesh things out, nuances that may escape the blog are easier to explore.
Having heard Bob speak a few times, and being familiar with his work, I have tremendous respect for him, and think that by no means is my positioning here a slam dunk.
Saturday, May 07, 2011
Friday, May 06, 2011
Thursday, May 05, 2011
"Finger Cooking" - referring to using one's fingers to call in a meal.
It's also a series of commercials from Heart and Stroke Foundation darling Boston Pizza.
Sadly, the fact that these commercials exist suggest that there are plenty of folks who can readily relate (email subscribers, you'll have to head to the blog to watch the video).
Wednesday, May 04, 2011
Further to yesterday's post on just how awful diabetic diets can be in Ontario hospitals, today's post keeps the discussion going. I'll get to prisoners in a second, but first let's talk sodium.
An RD in Alberta left this comment yesterday (edited for a bit of brevity),
"I am an RD in an Alberta hospital and unfortunately that probably is typical.3,000-5,000mg per day is considered a low sodium diet?
I know with many hospitals dietitians actually have very little to do with the menu despite what is often the public perception. Menu decisions are often made by untrained food services supervisors or managers with often little or no input from an actual dietitian. A dietitian has to compare the menu to Canada's Food Guide in Alberta to make sure that it meets the minimum servings of each Food Group, but I of course know your opinion on CFG :)
Alberta Health Services is also becoming quite strict in terms of things like sodium, which you would be disgusted to know is very high in hospital diets (even a low sodium in our hospital is allowed to have 3 to 5 grams per day!)"
Now to prison. Another commenter, a thoughtful nutrition manager from Ontario, pointed this out,
"The problem lies in the amount of money the government provides us to feed each person per day: $7.33. That amount is way less than the $11-$12 given to the criminals in prison."Can anyone else confirm this? Honestly, while I knew hospital food stunk, I'm not sure I had any idea how bad, nor did I have any idea how hamstrung hospitals may be with costs.
RDs! Health care professionals! Caring public! Please continue to weigh in on this. You can leave anonymous comments and you need not identify your hospitals, but please tell us more about patient food woes.
The first step in fixing a problem is identifying one!
What barriers do you see to patient food reform? Where are the stumbling blocks? Is it hospital administrators? Cost? Logistics? Canada's Food Guide?
Tuesday, May 03, 2011
(That pie represents the caloric macronutrient breakdown of a Rice Krispie.)
A reader of mine emailed me yesterday with a video she took of the diabetic breakfast she was served at an Ontario hospital.
What'd she get?
A refined flour based pancake, syrup, a bowl of Rice Krispies, a glass of apple juice, and a coffee.
The only diabetic consideration? She received an artificial sweetener for her coffee, rather than sugar. Basically, she received a breakfast full of refined carbohydrates that her body'll process nearly instantaneously into simple sugars. And for good measure I suppose, she was provided with a glass of sugar water to wash the carbs down.
I don't think her case was unique.
I know that when my grandmother-in-law, also a diabetic, was recently in hospital, she too was given highly refined carbohydrates and juice with virtually every meal.
RD readers - if any of you folks work in a hospital can you let me know if this is typical, and also if there's anything a patient can do about it?
How difficult would a breakfast inclusive of protein, and with only whole grain carbohydrates, be to prepare, and how is it that her hospital's doctors, dietitians, and other allied health care professionals are ok with this being served to their patients (diabetic or otherwise)?
Monday, May 02, 2011
Yesterday marked the end of the Canadian Obesity Network's 2nd National Summit, and once again, CON threw a great conference.
For folks who care about nutrition, conferences can be tough events, and despite it having been a CON conference, the food was still challenging.
Take breakfast yesterday morning - a giant mound of muffins, fresh fruit, juice, and coffee. Nary a protein source to be found, and the muffins almost certainly each packing 500 calories and piles of sugar.
Now all told, the food at the CON conference was in fact better than most, but still likely was a long way from healthy.
The reason healthy conference food's a challenge is because to a large degree, the conference organizers are at the mercy of the hosting hotel, and with food often being left to the end to arrange, conference organizers may not have much energy or leverage to advocate for health.
To that end, I have a few suggestions for CON to consider when organizing their 2013 3rd National Summit in Vancouver - suggestions that would be applicable not just to CON, but for anyone organizing a major event.
- If healthy meals aren't always options, at the very least empower conference goers with nutritional information. In CON's case, prior to the conference why not lean on some RD members to crunch the numbers in the meals that are to be served, and then create little cards that can be placed in front of choices such that at least choices can be informed. I wonder too if this information isn't something that could actually generate sponsorship revenue with nutritional information cards having logos or visible sponsorships attached.
- Leverage meal costs/choices at the very outset of organizing. Talking food options from the get go may allow for configuring healthier menus as part of actually sealing the deal, and may also provide enough lead time for the hotel to round up ingredient lists for nutritional analysis.
- Potentially provide fewer meals. Sounds crazy, but that'll keep conference costs down, while at the same time allowing people to make their own choices. If there's a talk scheduled and the only thing available a big mound of muffins, most folks will have a big, honking muffin. On the other hand, start the talks a bit later and let folks fend for their own meals, and at least those who care, which at a CON conference I would hope would be a few, will find healthier options.
But please don't take this post as a slam. Conferences are enormous things to organize, and CON did an absolutely phenomenal job. More of a focus on food would just have been the proverbial icing on an already fabulous cake.
That said, I'm holding out hope for icing in 2013 in Vancouver!