Saturday Stories: Isaiah, IT bands and willpower

Don Berwick's incredible Harvard medical school commencement speech.

Alex Hutchinson on new thinking around how to effectively treat IT band syndrome.

Meg Selig on the psychology behind how a large soda cup ban might actually fuel willpower.

How to Walk Your Human

Please show today's Funny Friday video to your cat.

He/she is bound to appreciate it.

Have a great weekend!

(email subscribers head to the blog to watch)

What Reading That Low-Carb Gives You Heart Disease Paper Actually Told Me

Low-Carb Version of MyPlate Designed by Low-Carb Conversation's Mindy Noxon Iannotti

The short version is that it told me that in this case the British Medical Journal, and possibly the authors and this study's peer reviewers, value the publication of unsubstantiated alarmist and media friendly hype over true journalistic and scientific integrity.

Let me start the longer version with a question. Is your style of eating - your dietary repertoire if you will - the same today as it was 15 years ago? Mine's certainly not. 15 years ago I was a bachelor doing my residency. My diet consisted of burgers, steaks, sausages, pizza, chicken wings, french fries, restaurants, take-out, pots and pots of coffee, and horrible, horrible hospital cafeterias. The fact is, whether it's consequent to life changes, medical conditions, dietary fads, new relationships, new jobs - eating style for many varies wildly with time and circumstances.

Yet the researchers of this paper, one that looked at the impact dietary style would have on cardiovascular risk among 43,396 Swedish women, which concluded that women who followed low-carb diets had an increased risk of heart disease, used only one single baseline dietary data set upon which to base their 15 years long study and its conclusions.

And about that single, solitary, data set.  It consisted of a food frequency questionnaire in which subjects were asked to identify how frequently they consumed 80 different food and beverage items over the course of the past 6 months.

Think that'd be accurate? Can you remember how many of anything, let alone 80 items, you've had over the past 6 months? And what if you ate and drank more than 80 items?

But let's not guess about accuracy, let's actually look at it.  Taking the study subjects' reported average caloric intake, it's immediately evident that their dietary recall data is inaccurate as the authors report an average daily calorie consumption of only 1,561 calories.  That's an incredibly small number, and one which flies in the face of the Food and Agriculture Organization of the United Nations reporting of a Swedish per capita average calorie consumption of 2,990 calories during the same time period this study's data was collected.

But let's for a moment pretend that the data was in fact accurate and that you could fairly extrapolate that your style of eating today will remain the same for the next 15 years. My next question would be do you think the quality of your diet's various proteins, carbohydrates and fats might have a bearing on your risk of developing cardiovascular disease over the next 15 years? Would eating a diet higher in trans-fats confer a different degree of risk than a diet higher in unsaturated fats? Would eating a diet rich in whole grains confer a different risk than a diet rich in ultra processed pulverized flours? How about if you ate out regularly versus cooked from scratch? Deep fried versus baked? Sausages versus salmon? Quinoa versus white rice? Kale versus potatoes?  Of course it would matter, and thats a fact that I'd bet even a straw poll of 10 year olds would agree with.

Not this paper's researchers.  You see they simply reported and analyzed the data from that single time point questionnaire by means of 10 different centiles of carbohydrate consumption. They didn't pay any attention to the quality of the macronutrients being consumed, just their total quantities.  The only consideration they gave as to the quality of macronutrients was a very broad "animal protein" vs. plant sources. There was no consideration given to quality of fats (this despite the well established impact of trans-fat on increasing cardiovascular risks and on unsaturated fats for decreasing them), or carbohydrates (again despite data suggesting cardio-protective benefits from whole grain and risk from refined).

But ok, let's even pretend for a moment that the data was in fact well controlled for dietary factors known to impact on cardiovascular disease, is the risk reported here worthy of concern and press release? Here the relative risk increase of 5% per increase in low-carb score means an extra 4-5 cases of cardiovascular disease per 10,000 women in the lowest carb group per year. Should we stop the presses?  Given how incredibly small that is absolutely, and given how incredibly complicated it is to control for confounding variables (and here I'm not just talking about the unbelievably glaring confounders that were explicitly ignored by the researchers but non-dietary and lifestyle variables of which this study looked at very few), can and should cautionary conclusions truly be drawn let alone publicized?

Lastly let's pretend for a moment that data is in fact conclusive and that the risk is real and scary enough to shout from the rooftops.  Do you think then it would matter if the diets studied and were being reported as risky weren't in fact "low-carb" given that the caution being shouted is that low-carb dieting increases the risk of heart disease?   Looking at the data, the 1st quartile of lower carb consumption is in fact a diet where the 154.7g of carbohydrates account for 40% of calories. Simply put, that's not a low-carb diet! Atkins for instance starts at just 20g and then over time people tend to work themselves up to between 50-100g. 154.7g?  That's.  Not.  Low.  Carb.  Nor is even their reported 10th percentile at 123.7g or 32% carbohyrdate.

So to review. The paper's basing all of its 15 years worth of conclusions off of a single, solitary, and clearly inaccurate, baseline food frequency questionnaire, it didn't control for clearly known smack-you-in-the-face dietary confounders, it found just a miniscule absolute increase in risk, and the diet it's reporting on can't even be fairly referred to as a low-carbohydrate diet.

Useful?  Conclusive?  Press worthy?

It gets worse.

Here the BMJ didn't just publish a completely useless paper, they gave this very clear, yet completely non-evidence based advice to clincians in their accompanying editorial,

"Despite the popularity of these diets, clinicians should probably advise against their use for long term control of body weight"

Worse still highly reputable socially networked curators of medical information tweeted the resultant media stories as relevant and even Journal Watch, a New England Journal of Medicine publication reported it as valuable to scores of physician subscribers who trust Journal Watch to keep them abreast of the latest important journal studies.

As far as the true state of the evidence on the long term risks or benefits of low-carbohydrate diets goes this paper, and the BMJ's editorialized conclusions, add absolutely nothing.  Given the paper's scientifically horrifying flaws and the editorial's completely clueless conclusion they're useless contributions to the medical literature.  In fact I'd describe them as worse than useless in that they're unforgivably, irresponsibly, shamefully and knowingly misinformative - something our already incredibly nutritionally confused world really didn't need.

[For another take on this paper by someone who also actually read the paper, have a peek at Larry Husten's take on Cardiobrief (I'm quoted there too).]

Remember This Every Time the Food Industry Claims They're Trying to Help

A few weeks ago Coca-Cola sent out an email to Canadian researchers involved in the study of obesity.

I'm going to cut and paste it in its entirety but the gist is that Coca-Cola's working tirelessly to help. But before you read it, I want to bring you back to those quotes I mentioned yesterday from Coca-Cola's marketing chief Joe Tripodi. He told it like it is to the Wall Street Journal

"If we can get 40 million-plus fans, or even some subset of them talking positively about the things we’re doing, ultimately that’s a good thing for us”

And by "good thing" Mr. Tripodi means sales,

"I think it’s probably a leading indicator of potential sales."

And what kind of sales does Mr. Tripodi hope for? He told CNBC in 2011,

"We want to double our business in basically a decade."

Somehow I don't think a doubling of Coca-Cola's business is going to help obesity much, do you?

At the end of the day the food industry's job is to increase sales.  Period.  Anything it does, from public private partnerships with health organizations, to funding research, to changing advertising practices, to seemingly following through with health reforms - all of it is designed ultimately to help with sales.  That's not an indictment of the food industry, it's just the nature of corporations.

Please don't forget that when you hear about how the food industry is a "partner", a "stakeholder", or "part of the solution".

[Email sent to Canadian health researchers from Coca-Cola's Director of Public Affairs and Communications on May 17th, 2012:]

Last week in the USA, the Center for Disease Control and Prevention hosted its second Weight of the Nation Conference in Washington, D.C. The event brought together some of the best and brightest in the fields of health, academics, research, marketing and education to share what they’re doing to fight overweight and obesity. A lot of information was shared and many ideas presented, but one message was clear— there are no simple solutions to address a problem as complex as obesity. A problem of this magnitude will require the collective efforts of all of us to make an impact.

We believe a lot can be gained by collaborating and modeling best practices that work. I wanted to take this opportunity to state that Coca-Cola is committed to working with all sectors of society to be a part of the solution and outline some of the steps that we are taking – both nationally and locally – to promote active, healthy living. For example:

• We worked with industry partners to remove sparkling, full calorie beverages from schools and reduce the calories available to students
• We do not market our brands in media channels where children under the age of 12 make up more than 35% of the audience
• We offer Canadians over 30 low- and no-calorie beverages to choose from, in addition to portion-controlled versions of our most popular brands
• We have placed calorie information on the front of nearly all of our packages. We are also phasing in calorie information on our vending machines and working with our customers to determine how best to place calorie information on fountain equipment as part of the beverage industry’s Clear on Calories program
• We recently launched a major marketing initiative demonstrating how our partnership with ParticiPACTION is getting youth active across the country while encouraging more youth and community groups to apply for grants designed to break down local barriers to active living. If you have not seen our commercial I encourage you to take a moment to watch - http://www.livepositively.ca/who-cares/sogoParticipaction/index.jsp
• Through our work with ParticipACTION we have enabled over 30,000 youth from across the country to get active. In addition, we have provided funding to over 2000 community-based organizations across the country.
• In addition, we are advancing the importance of physical activity through our sponsorship of Exercise is Medicine with the Canadian Society of Exercise Physiologists. The CSES hope to launch the program later this year. Exercise is Medicine® is an initiative focused on encouraging primary care physicians and other health care providers to include exercise when designing treatment plans for patients.

We are committed to providing people with the beverage options they want, along with the information they need to make the right decisions for their individual diets and lifestyles. We will continue to collaborate with others working towards these and other real-world solutions.

For more information about our products, policies and programs, visit www.LivePositively.ca . If you have any questions or require additional information, please don’t hesitate to reach out to me directly.

Regards,

Christina De Toni
Director, Public Affairs & Communications
Coca-Cola Refreshments
T: (613) 736-4232

Chatting with Body Break's Hal Johnson on Coca-Cola and Participaction

Took this photo outside a local corner store

On Saturday I had the opportunity to have a nice long chat with Hal Johnson, the iconic co-host of Body Break, and a name that for Canadians over the age of 25 is likely closely linked with ParticipACTION (a Canadian physical activity promoting NGO).

As I blogged about yesterday, Hal's tweet regarding his opposition to the ParticipACTION/Coca-Cola partnership made a bit of a splash and I wanted to explore his thoughts in more than just 140 characters. I had planned on posting it as a podcast, but given that we spoke for over an hour, I'd best distill it down to its essence.

While Hal had been aware and uncomfortable of Coca-Cola's partnership with his former employer for some time, it was at the movies with his daughter that he realized he needed to speak out. There was an advertisement for SoGo Active (embedded below) - a Canadian move more program co-sponsored by ParticipACTION and Coca-Cola.



While watching the ad Hal reports his 13 year old daughter turned to him and said,

"Dad, that doesn't seem right. Why is Coke with ParticipACTION. Isn't ParticipACTION all about health?"

And so Hal sent out his tweet.

I am disappointed that Participaction has partnered with Coke, it doesn't fit no matter how much money they are getting ow.ly/bL0wl
— Hal Johnson (@bodybreak) June 22, 2012

Hal worries about the partnership,

"It sends out a mixed message, and it doesn't fit with the brand and Coke gets the halo effect of the ParticipACTION brand. It's an iconic brand and they benefit from it."

I agree with Hal, and frankly so does Coca-Cola.

Here's Coca-Cola's marketing chief Joe Tripodi to the Wall Street Journal on how these sorts of partnerships benefit Coke,

"If we can get 40 million-plus fans, or even some subset of them talking positively about the about the things we’re doing, ultimately that’s a good thing for us”

And by "good thing" Mr. Tripodi means sales,

"I think it’s probably a leading indicator of potential sales."

And what kind of sales does Mr. Tripodi hope for? He told CNBC in 2011,

"We want to double our business in basically a decade."

As for the message being promoted by Sogo Active to Canadian youth in a ParticipACTION/Coca-Cola cobranding?  It's pretty clear the message is in Coca-Cola's best interest too, because the message SoGo Active is actively promoting is that obesity isn't about food, it's about fitness - it's not the Coca-Cola, it's the internet.  And to tackle obesity, what does Sogo Active recommend?  Here's an official SoGo promotional video and its roughly 13 year old spokesperson  explaining it's all about laziness,

"The obesity rate is going to skyrocket and the only way for us to change that is to get off our butt"

You know I fully understand why Coca-Cola would want to double its sales in the next 10 years. What's completely lost on me is why ParticipACTION would want to help them to do so.

Hal sums up my feelings about the ParticipACTION's partnership with Coca-Cola perfectly,

"I think it's wrong.  There's no question it's wrong.  And that's why I said it.  And I believe it and I certainly would not back down from that."

Me neither Hal, and thanks for speaking up.

A Crash Course in Coca-Cola Apologetics.

(My first attempt at Storify! Unfortunately what I didn't realize was Storify doesn't play nice with Blogger so if you want to actually click the links within the story, and read it more clearly, just click here and you'll arrive at the Storified host. A shame you can't embed this on blogger, I'd have used the service again.).

Saturday Stories: Cake, Dragons and Corporations

Tumblr and National Weight Loss Registrant Mike reflects on the world's most dangerous piece of cake.

Overcoming Gymnausea's Kerry talks dragon boating and fit pride

PLoS Medicine publishes an excellent series on Big Food - a must read.

The Safest NSFW Titled Video You've Ever Seen

Don't worry.

Today's Funny Friday video is an exceedingly safe click and it'll only get you fired if your boss is one of those folks who thinks you should be working rather than watching funny videos.

Have a great weekend!

(email subscribers need to head to the blog to watch)

Why Are We Eating an Extra Meal a Day?

Recent data suggest that since the 1970s on average we're consuming in the neighborhood of 550 additional calories daily - about a meal's worth.

The question that matters of course is, "Why"?

Undoubtedly there will be many plausible answers. The world has changed quite dramatically since the 1970s with many of the changes impacting upon the way we choose to live our lives and the foods we choose to include in them.

One thing that's certainly changed is the ubiquity of food advertisements. A CSPI report notes that even in just the decade between 1990 and 2000, a decade where we were already well into the era of Big Food, the dollars spent on food advertising increased by 50%. While I can't find the figure I'd be surprised if food advertising dollars hadn't increased at least 10 fold since 1960.

Some people believe that common sense will see them past advertisements - that they can cognitively protect themselves against their impact.

I wonder if that's true.

A study in this month's journal Obesity, albeit a small one, examined the impact that photographs of food had on 8 healthy subjects' levels of the hunger hormone ghrelin (the strongest hunger hormone identified to date). Subjects were given breakfast at 8:30am and then at 10:30am fifty pictures in 6s intervals were presented to them. In one session they were shown neutral pictures, and in the other hedonic foods. Ghrelin levels were measured throughout, and were measured every 10 minutes between 10:30am and 11:30pm. Perhaps not surprisingly, but certainly importantly, ghrelin levels were found to increase in response to the photos of hedonic foods.

What this means of course is that those hundreds of billions of dollars that are annually being spent advertising junk food - they may well be turning on the production of a powerful hormone that hundreds of millions of years of evolution has designed to make you eat. So it's not about battling your will to resist, it's about battling your body's drive to survive.

Fortunately for the species, but unfortunately for modern day nutrition, the drive to survive will likely trump our best intentions.

The Chocolate Olympics Have Arrived!

In case you weren't aware, Cadbury is one of the London 2012 Summer Olympic Games' chief sponsors.

About a month ago I was in Heathrow Airport and I came upon these chocolate medals and this vending machine.


McDonald's of course is in on the action too as a main sponsor and they've apparently built the largest McDonald's Restaurant in the world to mark the occasion. It'll seat 1,500 people and over the course of the Olympics it's expected to sell 50,000 Big Macs and 180,000 portions of fries.


Anyone else out there think it's a shame that what was once a celebration of sport is now in large part a celebration of consumerism and junk food?

Does Dieting Increase Diabetes Risk?

That's certainly the message that HAES practitioner Linda Bacon wanted her followers to believe. In fact her tweet suggests that "even short periods of calorie restriction" increase diabetes risk.

In case you're not familiar with Dr. Bacon her work challenges the assumptions made about obesity and she has been highly critical of studies linking obesity with morbidity and mortality.

In an interview she gave to Med Journal Watch she explains why she believes not everyone agrees with her conclusions,

"My experience from having worked closely with many obesity researchers who are more conventionally-minded than me is that they are so strongly mired in their assumptions, that they don't look at the evidence."

And now back to diabetes and dieting, the story of which in this case begins back in time during the Dutch famine of World War II which they not so affectionately call the Hongerwinter (hunger winter).

It was September 1944. The Germans blockaded Holland and cut off food and fuel shipments to punish the Dutch people who opposed the Nazi regime. Food stocks dwindled. By the end of November rations amounted to fewer than 1,000 calories a day, and by February, to 580. 4.5 million people suffered, and over 22,000 perished. At the famine's worst daily rations amounted to half of a medium sized potato and 2 slices of bread. To compound matters, fuel was nearly impossible to come by and despite frigid winter temperatures, gas, heat and electricity were turned off. The famine lasted until May 1945.

Can you imagine being a child in Holland during the famine? The suffering and the horror they must have felt are unfathomable and when coupled with the severe and prolonged under-nutrition they experienced perhaps it's no surprise that their cohort have seen increases in risk of a variety of medical conditions including type 2 diabetes.  It's their experiences that Dr. Bacon uses as the source for her diabetes related caution against dieting.

The link Dr. Bacon provided in her assertive tweet about dieting and type 2 diabetes risk led to a a paper entitled, "Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood". In it researchers studied 7,557 Dutch women who endured the Hongerwinter and who on average were 9 years old when it occurred. Subjects were stratified into 3 groups on the basis of their self-reported exposure to famine - none, moderate and severe. The researchers found a small and statistically significant increase in risk to those women who reported themselves as moderately or severely affected by famine and this risk, while slightly attenuated, persisted after controlling for age at start of famine, education, BMI, waist circumference and waist to hip ratio.

The authors also noted that their study was unable to distinguish whether or not this association was related to under-nutrition or to famine related stress and point readers to a Finnish study that found a similar increase in lifetime risk of type 2 diabetes associating with the results of a psychological stress test in childhood war evacuees.

So in the end it would seem that from reading the evidence enduring a moderate to severe famine at a young age increases the risk of developing type 2 diabetes perhaps by way of the impact of under-nutrition, or perhaps by way of the impact of psychological stress, or perhaps by another as yet not elucidated cause.

In no way shape or form does this data suggest that "dieting" increases the risk of type 2 diabetes and in no way shape or form is suffering through a famine where daily rations include 2 small slices of bread and half a potato fairly described as a "short period of calorie restriction".

For Dr. Bacon this seems to be a bit of a pattern - slam conventional researchers for being, "so strongly mired in their assumptions that they don't look at the evidence", and then be so strongly mired in her assumptions that either she herself doesn't look at the evidence, or if she does her confirmation bias is so powerful that she'll happily find a way to present it to fit her narrative (click here for more examples). When I questioned her about this particular example on Twitter, despite her battle cry on Huffington Post of, "Show me the data we demand, and you should, too", she blocked me.

A few days ago dietitian and HAES advocate Julie Rochefort asked me on Twitter what barriers I saw to mobilizing HAES into practice. The main one I see seems to be regularly reflected by Dr. Bacon - knee jerk anger and either the willful manipulation of evidence, or a lack of critical appraisal of data so long as it seems to fit the HAES storyline.

Dr. Bacon is certainly HAES' most visible champion and role model. Responding to criticism with anger and manipulating or simply not critically evaluating HAES friendly data undermines the credibility of HAES as a whole, makes HAES easier for detractors to dismiss, and sets an absolutely terrible example for HAES practitioners and supporters to follow.

Annet van Abeelen, Sjoerd Elias, Patrick Bossuyt, Diederick Grobbee, Yvonne van der Schouw, Tessa Roseboom, & Cuno Uiterwaal (2012). Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood Diabetes DOI: 10.2337/db11-1559

World's Most Dangerous Piece of Cake has 5x the Calories & Sugar of BK's Bacon Sundae!

Amazing the hoopla over Burger King's bacon sundae when really it's quite a bore.

Sure it's got 510 calories and 15 teaspoons of sugar, and yes of course it has bacon, but compared with what else is out there nutritional travesty wise this one's a sleeper.

Here are 10 fast food desserts that make a bacon sundae look downright healthy including what I'm billing as the world's most dangerous piece of cake:

1. McDonald's Large Rolo McFlurry - 830 calories, 26 teaspoons of sugar.
2. Denny's Oreo Blender Blaster - 890 calories, 19.25 teaspoons of sugar
3. Coldstone Creamery Gotta Have It Oreo Creme Ice Cream - 1,060 calories, 22.75 teaspoons of sugar
4. Cinnabon Pecanbon - 1,080 calories, 19 teaspoons of sugar
5. Dairy Queen Banana Cream Pie Blizzard - 1,090 calories, 29 teaspoons of sugar
6. Chili's Chocolate Chip Paradise Pie - 1,250 calories, 40.75 teaspoons of sugar
7. Applebee's Chocolate Chip Cookie Sundae - 1,550 calories, 52 teaspoons of sugar
8. Outback Steakhouse Chocolate Thunder From Down Under - 1,554 calories, 33 teaspoons of sugar
9. Cheesecake Factory Chocolate Tower Truffle Cake - 1,679 calories, 51.5 teaspoons of sugar
10. The Keg Carrot Cake a la mode - 2,344 calories, 65 teaspoons of sugar (just 7 teaspoons shy of 1.5 CUPS)!

Saturday Stories: Bloomberg, More Bloomberg, and Processed Food

The studies behind the Bloomberg cup size limit.

Marion Nestle on Big Food's response to Bloomberg's cup size limit.

Tom Philpott and the American diet (doubling of processed food consumption since 1982)

Why Can't We All Just Get Along?

One of the things I both love and hate about nutrition and healthy living blogging and research is the tremendous amount of passion with which people fuel their convictions.

I love it because it sure makes life interesting. I hate it because oftentimes (and I'm certainly not innocent here either) it leads to people taking a difference of opinion as a personal slight.

At the end of the day, whatever strategy or theory you might espouse, sometimes it's a good idea to remember that we're all in this together and more likely than not, have the same end goals in mind - a happier and healthier population.

So for today's Funny Friday picture your favorite feuding duo and then watch this video.  Maybe we can learn to all get along.

Have a great weekend

(email subscribers, you need to visit the blog to watch)

Make Sure Your Inches Aren't Actually Miles

It's human nature, isn't it? If you give yourself an inch, you're liable to take a mile.

Skip your workout for no good reason, rely on boxes for your family's nutrition, have a "write-off" vacation, a regularly scheduled "cheat" day - there are no shortage of inches out there just waiting to get turned into miles.

Now of course, there will be times where real life does preclude your best intentions and inches are necessarily and understandably taken, but it's the inches for no reason that I worry about.

I blogged once that there are times when suffering's warranted. Another time I blogged about how healthy living requires effort. Both are true, but I can't help but wonder how many folks' best intentions were waylaid by the simple fact that they bit off more than they could chew - that their inches were in fact miles.

Better to take small careful steps of change than to require huge bounding leaps as this race never ends and you really best try not to get tired.

What's In That 32oz Powerade Coke Pres. Buys Her Kid Post Exercise?

Not sure if you saw this interview with Katie Bayne, the President and General Manager of Sparkling Beverages for Coca-Cola, but in it this Mom of 2 recounts how,

"if my son has lacrosse practice for three hours, we go straight to McDonald’s and buy a 32-ounce Powerade."

That intrigued me and so I visited my friendly neighborhood online nutrition database and I crunched some numbers for 32-ounce Mountain Blast Powerades (the kind sold by McDonald's).

As you might imagine, there's a whole pile of sugar, a bit of salt, some vitamins and some food coloring.

Thought I'd try my hand at creating a home made version and at the same time make my first ever video blog (please forgive a bit of camera shake when viewing fullscreen).

Email subscribers - if you'd like to watch the video, you'll have to visit the blog.

Coca-Cola's Chief Scientific Officer's Staggering Cognitive Dissonance

That's the nice way to look at it.

How else could you explain her defense of a product (sugar sweetened beverages) that accounts for a full 7% of total consumed calories and is itself devoid of any nutritional benefit?

Rhona S. Applebaum, vice president and chief scientific and regulatory officer at The Coca-Cola Co., in an article first published in the Sacramento Bee (since removed from their site it seems so I've linked to a web cache), states that,

"If we are really honest with ourselves, we know that no one group or sector can solve this problem alone and searching for a silver bullet that miraculously stops obesity is just not realistic. Targeting scapegoats or pointing fingers is simply a waste of energy."

Hmmmm, let's see.....while it's true that no single raindrop thinks it's responsible for the flood, and while one sandbag alone's not going to do the trick, what if there were one sandbag that could target 36% of the floodwater (will get to that number momentarily)? That'd be one helluva sandbag, no?

So what does Dr. Applebaum recommend? That,

"Instead, we should apply our energy to solutions that have been shown to work."

I'm sorry Dr. Applebaum - I'm not familiar with any interventions that to date have been shown to work, especially not those you allude to including more physically active jobs and of course, just moving more.

It's curious that moving is what Dr. Applebaum points her finger at all the while talking about solutions that have been "shown to work" given that there has never been any real world studies demonstrating a dramatic impact of exercise on weight loss. Nor am I aware of any public health interventions that have ever sustained increases in population based exercise levels. As far as real world studies go some suggest that even exercising an hour a day for 20 years won't protect against weight gain, and with kids, that a 10 fold difference in activity won't matter a whit.

Recently one of my favourite bloggers Stephan Guyenet posted a graph that might interest Dr. Applebaum. It's a graph superimposing America's weight gain with caloric intake over time.



So since 1970 or so we've seen caloric intake rise by roughly 550 calories per day.

If we take the beverage industry's own data at face value, that for the average American sugared beverages account for a staggering 7% of their total daily calories, that would account for 196 of the 550 calories we're now over consuming as a nation, or to put that another way, 36% of the 550 calorie a day flood. Now to be fair, we were drinking sugar sweetened beverages back in 1970 - but rates of consumption since then have tripled. Subtracting 1970 consumption from today still leaves Dr. Applebaum's baby accounting for a full 24% of the flood.

Sure seems like one hell of a juicy raindrop/giant sandbag to target to me, and frankly anyone who thinks differently I'd argue is either mired in some cogency crippling cognitive dissonance, or is on someone's corporate payroll.

Or both.

How Many Meals a Day Should You Eat?

"Should" is such a strong word.

Looking to the evidence base isn't much help either as there's plenty of evidence to support pretty much each and every eating style, modality, and diet.  Moreover, I'd argue that even if the evidence did firmly fall into the camp of one style or diet being "the best", that wouldn't change the fact that following it may prove non-enjoyable (and hence non-sustainable) to many.

"Should" presumes that everyone is the same. Same genetics, same co-morbidities, same lifestyles, same likes, same dislikes, same, same, same.

The thing is we're not all the same.

In my practice we tend to start people on 3 meals and 2-3 snacks a day, all inclusive of protein and at least 300 calories a meal and 100 a snack. We do that because experientially with us, for a great many folks, that spread has proven helpful in reducing cravings, hunger and struggle, and for busy people with jobs and young families, it's often more practical than larger, less frequent meals.

But it's not useful for everyone!

We have other folks on 3 square meal a day regimes.

I've even suggested an intermittent fasting (IF) style 2 meals a day to folks whose lifestyles and struggles suggested they may be well suited to it.

And as far as dietary style goes we've had Paleo folks, classic low-carb'ers, vegetarians, vegans, low-fat fanatics and certainly everything in between.

In my clinical practice, I'm not married to anything other than a person living the healthiest life they can honestly enjoy.

Those folks who firmly believe everyone "should" be doing things a certain way? That there's one "right" way to diet; one "right" way to eat; one "right" form of exercise; one "right" road to health?

I think they're wrong.

Saturday Stories: Behaviour Change, Calories and Gulps

Weight Maven's Beth Mazur has a funky video as part of her piece on facilitating behaviour change.

Whole Health Source's Stephan Guyenet on why calories still count (though why we're eating so many more, that's still up for debate).

Mark Bittman's brilliant take on the large cup ban in NYC (it's not a soda ban).

And a bonus - former Coke marketing exec states he has a large karmic debt to pay for the Cokes he helped to sell.

I Think I Need a Case of This Stuff!

It's "Naptime!", and I'm guessing most parents wish they had a bottle stashed around somewhere.

And it's also today's Funny Friday video, probably best described as both horrifically inappropriate and hilarious.

Have a great weekend!

(email subscribers, you need to head to the blog to watch)

Guest Post: Cake Wars Rock Nova Scotia Schools

There are cake wars in Nova Scotia.

On the one side is Nova Scotia's school food policy that specifically advises schools not to fund raise with junk food. On the other side is Ms. Pamela Lovelace who believes that schools have no business in banning specific foods and that,

"Quite frankly, it's up to the parents to determine whether or not we want to allow our kids candy."

Now I've covered why I think the but parents can just say "NO" argument falls short before - instead today we have a much more civil discussion from my colleagues Drs. Sara Kirk, Tarra Penney and Jessie-Lee McIssac out of Dalhousie University and their Applied Research Collaborations for Health (ARCH).

Let’s stop fighting about cake and focus on what’s important!

Sara Kirk, Tarra Penney and Jessie-Lee McIssac

In 1986, Canada became a world leader as the home of the Ottawa Charter for Health Promotion, a landmark international agreement that sought to build healthy public policy and create supportive environments for health. This culmination of evidence and call for action acknowledges the powerful role that our own individual circumstances play in our ability to live healthy, rich lives. It is based on the notion that, as a society, we thrive or wane together and it provides recommendations to ensure that our citizens, families and children have the best chance to create wellness for themselves by providing the best possible environment for them to live, work and play. Although the charter itself remains a long way from its goal of “health for all by 2000”, in 2005, Nova Scotia became recognised across Canada and internationally for its leadership in creating a Food and Nutrition Policy for Nova Scotia Public Schools. Rooted in evidence and community consultation, the policy is designed to protect school environments from the constant barrage of cheap, nutritionally void, highly processed foods that challenge us all in our decisions to make healthy choices and engage in healthy behaviours. Given that Nova Scotians are among the least healthy in the country – with high rates of chronic disease, the highest proportion of individuals with multiple chronic conditions and high rates of food insecurity - it could be argued that we are desperate for environments that make being healthy a little easier, and why not start with our children? Our schools?

In the province, a weekend school fundraiser, and the resulting media coverage (and a video here), has raised questions regarding the interpretation of the policy for Nova Scotian schools. The criticisms put forward highlight how much work still needs to be done to ensure that parents, families and citizens understand the difficult choices we need to make as a society in order to create the supportive environments necessary to make the healthy choice the easy choice, especially in places where our children spend significant amounts of their time. The policy challenges us as parents and citizens to come up with innovative ways to combine tradition, health and fun in ways that will set up the next generation of citizens for life-long health. The policy sets an important precedent that schools are one place where we can help our children to learn about healthy eating and active living and model these behaviours. We need to recognise that supporting healthy behaviours could actually save lives and money, as well as helping our children to succeed. Why would we not want this for our children? As a colleague who works in school health so eloquently put it, “it’s amazing that some people will put up such resistance to offering healthy food choices to our students…when it is the right thing to do”.

Think a Class Action Lawsuit Will Stop Nutella from Making Ridiculous Claims? Think Again.

In case you hadn't heard Nutella was hit with a class action lawsuit consequent to their promotion of Nutella as, "An example of a tasty yet balanced breakfast", when in actuality, at least by the numbers, Nutella's not quite as balanced as no-name chocolate icing.

Now much has been made about the suit and how it's going to stop Nutella from making that claim, but the thing is, it's not.

I took a phone call the other day from a consumer advocate lawyer named Mark Lavery who's opposed to the settlement as written. He alerted me to this paragraph,

"Ferrero will modify the back panel of the label for Nutella (the “Information Panel”) by removing the phrase "An example of a tasty yet balanced breakfast” and replacing it with “Turn a balanced breakfast into a tasty one” (the “Revised Statement”). Ferrero retains the right to determine, in its sole discretion, the location, size and other design characteristics relating to the Revised Statement"

Mr. Lavery's concern, and it's one that I share, is that the new statement, "Turn a balanced breakfast into a tasty one", is just as disingenuous as the original. Wouldn't adding chocolate icing to your breakfast "unbalance" it, or is the goal to "balance" healthy with sugar to ensure it's not too healthy? My additional concern is that not only does it still seem to suggest Nutella is a nutritious choice, it now suggests that actually healthy breakfasts aren't tasty.

Now I realize that many people felt this lawsuit was frivolous and I'm not going to get into that here, I just want to ask you, do you think the new statement is any less misleading than the old one?

I've written a brief statement for Mr. Lavery. If you're interested in doing the same, you can reach him here. Deadline's this Friday.

Declaration of Dr. Yoni Freedhoff, MD

My name is Yoni Freedhoff and I’m a physician, an Assistant Professor of Family Medicine at the University of Ottawa, the former Family Medicine Chair of the Canadian Obesity Network, a Diplomate of the American Board of Obesity Medicine, and a vocal public health advocate.

People often think healthy living is intuitive. They think that since they can envisage what “healthy living” looks like in their minds, that it’s therefore a simple choice. If only that were the case. While there is no shortage of impediments to healthy living in our modern world, certainly one of the most prevalent and dangerous is disingenuous marketing. People simply don’t have the time, background or frankly the inclination to read food labels carefully, let alone understand them - a fact that perhaps has not been lost over the years on the marketers of Nutella.

Looking at the settlement’s injunctive relief I’m confused by the proposed wording which in my mind is no less misleading than the original which was in question. The statement, “Turn a balanced breakfast into a tasty one” implies two things. First that adding Nutella to a balanced breakfast would still leave that breakfast “balanced”, and secondly that actually balanced breakfasts aren’t tasty.

Again, nutrition isn’t intuitive, and in large part that knowledge gap is fueled by marketing. Having watched my fair share of television commercials, and read my fair share of magazine advertisements, I know that included in Nutella in some capacity are hazelnuts and milk - nutritional heroes to many. Perhaps that’s why even I was surprised to learn that in a head to head comparison with no name chocolate icing, Nutella was found to have 25% more calories and nearly 30% more sugar. In fact by weight Nutella is 57% sugar (21g of sugar per 37g serving) and as far as nutritional benefits go, Nutella’s are negligible at best providing an effectively insignificant 4% of daily calcium and iron needs.

Which brings me back to the question of whether or not Nutella can be a part of a “balanced” breakfast? As a medical doctor and an expert in both nutrition and obesity I would argue that adding a dollop of no-name chocolate icing to a “balanced” breakfast would in fact unbalance it, making what was once healthy, not. Consequently one might argue that adding a dollop of Nutella with 25% more calories and 30% more sugar than no-name chocolate icing, regardless of the miniscule amounts of calcium and iron Nutella may contain, would perhaps make that breakfast 30% more unbalanced than would adding the icing were such a measure actually quantifiable.

Personally I liken Nutella to a spreadable chocolate bar. If you believe that adding a chocolate bar to a balanced breakfast leaves it balanced, then by all means give Nutella this marketing get-out-of-jail free golden ticket. On the other hand, if you think allowing Nutella to explicitly continue to suggest, in a society where 1 in 3 children are overweight or obese and the rates of pediatric diabetes are skyrocketing, that the inclusion of chocolate bars with children’s meals precludes nutritional balance, perhaps the wording of this settlement’s proposed injunctive relief deserves a sober second look.

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

Executed on June 5th, 2012

Sincerely,

Dr. Yoni Freedhoff, MD, CCFP, Dip ABOM
Assistant Professor, Family Medicine, University of Ottawa
Medical Director, Bariatric Medical Institute
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

The Greatest Danger of Processed "Home Cooking"

It's not necessarily the actual food, but rather it's what it teaches.

Take the fish example up above. Nutritionally I'm guessing that it's pretty much the same as if you breaded, seasoned and pan fried the fish yourself.

But the message?

The message is that good healthy food comes in boxes.

And the message that's lost?

That it's actually not even remotely difficult to buy fresh fish, season it and pan fry it. And if fresh is a challenge, perhaps even preparing plain frozen fish fillets that you first thaw for a few moments in a sink full of water. 

Reliance on boxes robs people and their highly impressionable children of the basic life skill and healthy living importance of cooking while simultaneously perpetuating the de-prioritization of actual meal preparation from our modern day lives.  While the final outcome in this case might be nutritionally comparable, and might even take 1 or 2 minutes less time than from scratch, I'll still label it as part of the problem, rather than part of the solution.  Sure, rely on products like this in a pinch, but I'm guessing many rely on them more often than not.

We're not going to solve society's nutrition related woes with boxes.

SickKids Foundation President Defends Junk Food Fundraising

So last Monday I blogged about how SickKids Foundation was hypocritically normalizing eating out and encouraging the consumption of junk food in the name of raising money to combat childhood obesity .

I sent my post over to SickKids Foundation president Ted Garrard and he was kind enough to send me a response as well as give me permission to post it.

Basically Mr. Garrard's position is that because those same institutions that are inviting people to purchase such things as onion rings, pizzas, cookies, desserts, Chinese take out have "low fat" items too, that it's alright.

To me that's the food industry apologists' version of the, "but I was just following orders" argument.

Have a read, and if you're interested in sending your thoughts to Mr. Garrard, you can do so by clicking here, or leave a comment on the blog as I'm hopeful the Foundation will be reading,

Dear Dr. Freedhoff,

Thank you for your e-mail and for taking an interest in our first-ever Healthy & Happy campaign. We take all comments and feedback seriously.

In your recent blog about SickKids, you allude to several cause marketing relationships linked to our current campaign. These are valued corporate partners of SickKids Foundation who have come on board to help us raise critical funds for The Hospital for Sick Children.

These corporate sponsors offer a wide range of food and beverage choices, including low-fat options for the health conscious consumer. These are also family-friendly retailers and restaurants and we believe their customers align with our target demographic for this campaign. We believe that important components of a healthy and happy lifestyle include making healthy food choices, being active, being mindful of portion sizes and all things in moderation.

That said, we will take feedback like yours into consideration as we move forward with planning next year’s Healthy & Happy campaign.

The Healthy & Happy effort is based on one simple premise – every child deserves to be healthy and happy. Ultimately we are trying to create a platform to discuss the seriousness of child health issues while reflecting the spirit of happiness which we believe is so important for all children. It is meant to be a positive and feel good experience for anyone who is touched by our campaign. If you visit our site at www.dothehappy.com you will see the positive influence this campaign is having for families who rely on SickKids every day.

Please know that we appreciate and value your perspective, and I want to thank you again for your feedback.

Ted

Saturday Stories: Fructose Science, Fat Consumption, and fMRI Flaws

David Despain posts a what I would consider a must read interview with Dr. John Sievenpiper on the non-hyped state of the science surrounding fructose.

Evelyn over at the Carb Sane-Asylum looks at some recent NHANES data and concludes that NHANES data probably isn't very good data but that if you do believe it, society hasn't swapped fat for carbs since 1970 (just to help when you read her piece - she's talking about absolute consumption, not percentiles as the graphs do demonstrate a percentile decrease whereas absolutes would put fat consumption at only a roughly +/- 5g a day change since 1970).

And lastly two awesome pieces explaining why fMRI studies probably aren't too exciting. The first is an oldie from Wired magazine on how an fMRI machine suggested a dead salmon could interpret human emotions and the second is last weeks' Vaughan Bell article from the Guardian that steered me to the dead salmon.

This Is Exactly How I Eat Peas

Today's Funny Friday video was like looking in a mirror.

Have a great weekend!

(email subscribers you need to go to the blog to watch)