Monday, April 30, 2012

It Doesn't Need To Be So Complicated

I received an email on Friday from a reader who had read some of the writings of a nutrition guru and wanted my take on them. I get emails like that a lot.

Regardless of the guru, my answer's always the same, "It doesn't need to be so complicated" I'll tell them.

Even if the nutritional gurus and zealots were absolutely, 100%, scientifically bang-on with their edicts and commandments, I'd still stick with that message.

Not because I necessarily know better about nutrition, but rather because I work with actual people, real life folks who go to work, who worry about their finances, who shuttle their kids back and forth to hockey, who are trying to do their best. And while there's no doubt that it's possible one of these nutrition gurus will actually, indisputably, get it right, it won't change the fact that real people need to like the lives they're living, even if they're not nutritionally perfect.

Real life folks? Here are my recommendations:
  • Cook more.
  • Use whole ingredients.
  • Eat out less frequently.
  • Cook together as a family.
  • Eat together around a table.
  • Exercise regularly and with joy.
And while those instructions may not satisfy the gurus and zealots who demand perfection, I'm guessing they'll take you a very long way health wise.

It doesn't need to be so complicated.

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Saturday, April 28, 2012

Saturday Stories: Bug girl, Brawley and Despain


Bug girl amusingly explains why there never actually were ground up beetles in Starbucks

An absolutely must watch hour long video (yes I realize I said must watch and hour long together) from Dr. Otis Brawley from his keynote address at last week's Association of Health Care Journalists on how regarding American healthcare, "the system really isn't failing, quite honestly, failing is the system".

David Despain covers the recent sugar wars debate at the Experimental Biology 2012 conference.  Short version - scientists don't buy the hype.

[Thanks to David for link to phenomenal cartoon up above]

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Friday, April 27, 2012

Downton Abbey....now on Spike TV?

If you don't watch Downton Abbey, today's Funny Friday video just isn't going to do it for you.

If you do watch it, today's Funny Friday's a must watch too.

Have a great weekend!

(Friday's my day off whining. Email subscribers you need to head to the blog to watch)



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Thursday, April 26, 2012

The Biggest Loser Destroys Participants' Metabolisms

[This is an updated and edited version of a post originally published in February 2011. I'm updating it as the original post referred simply to a poster presentation but yesterday the full article was published ahead of print in the Journal of Clinical Endocrinology and Metabolism]

Talk about setting people up for long term struggle.

The term metabolic adaptation is given to the phenomenon whereby when a person loses a certain percentage of weight, their metabolisms slow by greater amounts. This process may be theoretically accelerated with more rapid weight loss as a consequence of the rapidly losing body metabolizing calorie burning muscle along with fat to make up for its massive energy deficit.

And as far as rapid non-surgical weight loss goes, there's probably no weight loss program more rapid than that of the television show The Biggest Loser, where it’s not uncommon for contestants to lose upwards of 150lbs at an averaged pace of nearly 10lbs a week.

Of course what’s different about the Biggest Loser as compared with most other non-televised rapid weight loss programs is the incredibly large amount of exercise concurrently involved, along with an almost certainly severe degree of stress, peer pressure and dietary restriction given the team and competitive nature of the show (where the team who loses the least weight has a member voted off, and where the last man or woman standing wins $250,000).

So is the weight lost on the Biggest Loser, a show now formally endorsed by the First Lady as an inspiration to the nation, healthy? Does the huge amount of exercise protect contestants against the show doing marked damage to their metabolisms?

The answer to both of those questions certainly appears to be, "No".

In an article published yesterday ahead of print, Darcy Johannsen and friends studied the impact 7 months of Biggest Loser weight loss had on the resting and total energy expenditures of 16 participants. They used all the latest gadgets to do so including indirect calorimetry and doubly labeled water. So what happened? By week 6 participants had lost 13% of their body weight and by week 30, 39%. More importantly by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected simply as a function of their weight loss and by week 30, by 504 more.

That's basically a meal's worth of calories a day that Biggest Loser contestants no longer burn as a direct consequence of their involvement. How do you think you'd do at maintaining your weight if you ate an extra meal a day?

But maybe that's typical. After all, metabolic adaptations are a known consequence to weight loss - couldn't that be all we're seeing here? I guess it's too bad there's no control group the study could have used for comparison.

Actually there kind of is. Bariatric surgery patients lose massive amounts of weight in a hurry as well, and they generally do so without the inane extremes of lifestyle endorsed by the Biggest Loser. If there were a study on the impact bariatric surgery losses had on resting and total energy expenditure, that would certainly offer some insight as to the healthfulness of Biggest Loser's weight loss program.

Good news! There is such a study. Published in 2003 in the American Journal of Clinical Nutrition researchers looked at the impact bariatric surgical losses had on the resting and total energy expenditures of 30 men and women whose pre-operative average BMIs of 50 were within 1 point of the Biggest Loser contestants' averages of 49, and who lost a Biggest Loser style average of 117.5lbs. And guess what? While resting energy expenditure indeed was shown to slow, it didn't slow down in excess of what would be expected by weight loss alone. In other words? Looking at these two studies, Biggest Loser style weight loss destroys metabolisms dramatically more than does bariatric surgery and does so in huge excess of what would be expected simply as a consequence of losing weight (though I suppose to be fair, the study on the surgical patients was done at 14 +/- 2 months, while the Biggest Losers' was at 7 - perhaps the Losers' metabolisms will improve with time)

That's a rather ironic finding given that one of the Biggest Loser study's authors, Biggest Loser's TV doctor Dr. Robert Huizenga, regularly trash talks bariatric surgery on the show as a terrifically unhealthy way to lose weight. Metabolically speaking, it would seem to me that his own study would suggest bariatric surgical weight loss is far healthier to a body's metabolism than is Biggest Loser style loss.

The study concludes,

"Unfortunately, fat free mass preservation did not prevent the slowing of metabolic rate during active weight loss, which may predispose to weight regain unless the participants maintain high levels of physical activity or significant caloric restriction"
Gee, ya think? "May"?

Here's how I'd spell it out. While some contestants of the Biggest Loser will translate their new lifestyles into careers as product spokespeople or fitness trainers and hence have new external motivators to maintain their extreme behaviours, those who don’t are doomed by the show itself to regain their weight, as the lifestyles promoted by the reality television show The Biggest Loser are only "realistic" to those whose livelihoods and/or fame depend on them.

Case in point? That picture up above, that's Eric Chopin. He was the winner of the third season of the Biggest Loser. He lost just over 200lbs. A few years later he was on Oprah to talk about his massive regain. Think Eric dropped the ball? Not me. I think the Biggest Loser provided him with a nonsensical and metabolically dangerous approach to weight management, and in the process, stacked his deck entirely against him.

[UPDATE: Received a thoughtful email from obesity researcher Dr. Jennifer Kuk who wondered whether or not the Biggest Loser subjects had their energy expenditures measured in the week or days leading up to the finale. If so, she feels (and I'd agree) that given the competition they might have all been severely under eating so as to increase their chances of winning, and that it therefore might have been their temporary under feeding that led to their abysmal energy expenditure results.]

Darcy L. Johannsen, Nicolas D. Knuth, Robert Huizenga, Jennifer C. Rood, Eric Ravussin, & Kevin D. Hall (2012). Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass The Journal of Clinical Endocrinology and Metabolism : 10.1210/jc.2012-1444

Das SK, Roberts SB, McCrory MA, Hsu LK, Shikora SA, Kehayias JJ, Dallal GE, & Saltzman E (2003). Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. The American journal of clinical nutrition, 78 (1), 22-30 PMID: 12816767

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Wednesday, April 25, 2012

McDonald's Peddling Olympic Happy Meals

What? Did you somehow think that the official "restaurant" of the Olympics wouldn't use that status to encourage kids to eat there more frequently or to teach them that it's all about moving more, and not about eating less?

Apparently now if you buy a Happy Meal in the UK, you get a pedometer to track your hops, skips and jumps in order to "help" the kid-friendly Olympic mascots get to the Olympic games (video posted down below, email subscribers need to visit the blog to watch).

Aside from the obvious cache of Olympic co-branding this campaign really typifies what's in it for McDonald's. Co-branding allows McDonald's to easily spread the idea that "movement" and "exercise" are what are required for health and silently imply that dietary discretion isn't necessary if you're active. But maybe that's just jaded, cynical, old, me, reading into messaging, though there's no denying that Olympic co-branding allows McDonald's to promote meals out and further the normalization of fast food.

Shifting the blame from dietary intake to dietary output and/or normalizing meals out for children all the while tapping in to the incredibly powerful emotions associated with the Olympic games - that's a gold medal win for McDonald's marketers.



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Tuesday, April 24, 2012

The Heart Attack Grill Is Not The Problem


Yesterday there was another national news report about someone having a heart attack while eating at the Heart Attack Grill and while I understand the juicy and ironic lure of the story, I have to ask, is the Heart Attack Grill really the problem?   I'm quite certain heart attacks at restaurants aren't unique to burger joints.

I'm actually kind of fond of the Heart Attack Grill, because unlike virtually every other restaurant around, at least they're up front about the risks of regularly visiting. Yet I'm guessing the calories in their flatliner fries and their triple bypass burger aren't any higher than those found in their Five Guys' or Carl's Jr.'s counterparts, and that the Heart Attack Grill's Coca-Cola's pretty much the same as everyone else's as well.  And yes, as ABC's shoot from the hip Dr. Richard Besser (I'm a big fan BTW) pointed out to me yesterday, they do have an 8,000 or so calorie burger, but yet so do so many other restaurants with shock value, get-your-picture-on-the-wall-if-you-can-eat it meals.

The problem isn't inherent to the Heart Attack Grill. It's also not the other umpteen-gazillion restaurants out there. The problem is how normalized the practice of eating out has become. What was once a rare family or personal indulgence is now a regular occurrence, with more than 50% of our food dollars being spent on foods we buy outside of the home, and lord knows what percentage of the remainder being spent on reheating boxes, stirring packages together and ultimately just pretending to actually cook.

As part of our intake questionnaire in my weight management practice we ask how many prepared meals a person purchases on a weekly basis. While I haven't crunched the numbers, I'd be surprised if the average were lower than 5.

I guess what I'm getting it is that all the Heart Attack Grill is doing is meeting a demand, and that it's the demand that's broken, not the suppliers.

What I want to know is what has happened to society to lead to that increase in demand? Why don't we value home cooked meals any more? Why do we as a society utilize restaurants like our parents utilized grocery stores?

While it's impossible to finger point at specific answers to those questions up above, that doesn't mean we can't do something about them. In fact I'd argue that there's no shortage of things we can do, just that there seems to be little, if any, political or personal will to do them. Environmental problems require environmental changes. We need to change what we consider to be "normal" such that meals out again become rare treats, and that sitting around family dinner tables again becomes the norm.

So how do we do that?

Some off the top thoughts - re-prioritizing after-school activities to include at least one family shared cooked meal, turning off our electronic smart phone tethers when we leave the office, actually scheduling cooking and shopping times into our agendas, bringing home economics back to our schools, running public health campaigns vilifying purchased meals as a whole (and/or promoting actual cooking), changing crop subsidies such that places like the Grill can't serve ridiculously cheap calories, changing zoning laws to curtail the practice of fast food setting up within walking distances of schools, eliminating school and public institution based no-name fast food, instead of cities giving out free trees giving out free seeds and compost for backyard vegetable gardens, tax subsidies on fresh fruits and vegetables.......

That the Heart Attack Grill (and other restaurants) exist isn't the problem, it's the demand for their products and services that we need to change.

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Monday, April 23, 2012

The American Diabetes Association Wants Video Games in Your Kids' School Gyms?

A waste of a perfectly good gym?
Last week saw a press release from Konami bragging about the involvement of the American Diabetic Association in bringing their exergame Dance, Dance, Revolution to schools across the United States.

Demonstrating what I would call a questionable understanding of energy balance, the ADA's Director of Youth Markets Mary Baumann was quoted in the release as stating,
"We look forward to the impact the new classroom edition can offer schools to help keep children in the healthy fitness zone for BMIs."
Putting aside the fact that I don't actually understand what a "healthy fitness zone for BMIs" is, let's just assume Ms. Baumann was suggesting that kids can Dance, Dance their way to lighter weights.

So does Dance, Dance, Revolution actually burn a great many calories?

Looking to the medical literature helps. Check out this graph that came from a study published in the journal Pediatrics. It's of the measured energy expenditure of kids at rest and playing Dance, Dance, Revolution.


Looks awesome right, kids playing DDR were expending more than double the calories expended at rest. But wait, that's a strange way to report energy expenditure, isn't it? Usually energy expenditure is reported as calories burned per hour of activity, why not here?

Because reporting it as a function of energy burned at rest is the only way to make this study sound interesting. When you actually crunch the study's numbers you'll find that DDR helps to burn an additional 91 calories/hr.  That's less than half the calories you'd burn leisurely walking, let alone actually running around and playing some sort of sport in a gymnasium.

While I've got nothing against exer-gaming, suggesting that it will provide any sort of health benefit, be it weight management, diabetes prevention, or heart health, is more than just wrong and a gross misrepresentation of the medical literature, it's irresponsible. Unfortunately, at this stage of exer-gaming's evolution, they are much more game than they are exercise, and teaching kids, their parents and their educators otherwise, while understandable from video-game developer Konami, is inexcusable from the American Diabetes Association, as this is the exact sort of misinformation that might preclude actually healthy initiatives from being rolled out in schools. 

[Sadly, it's not just the ADA, today's ridiculousness is also being championed by Let's Move and The National Foundation on Fitness and Sports. Shame on all of them.]

Lanningham-Foster, L., Jensen, T., Foster, R., Redmond, A., Walker, B., Heinz, D., & Levine, J. (2006). Energy Expenditure of Sedentary Screen Time Compared With Active Screen Time for Children PEDIATRICS, 118 (6) DOI: 10.1542/peds.2006-1087

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Saturday, April 21, 2012

Saturday Stories: Bias, Beef and Jet Lag


Tom Philpott in Mother Jones talks of Big Pharma's influence on meat science.

Dr. Sharma asks, "Why do we expect less from people with obesity?"

Patrick Skerrett, editor of the Harvard Heart Letter, on how fasting may erase jet lag.

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Friday, April 20, 2012

The Secrets to a Happy Marriage

As told by awkward family photo's favourite grandparents.

Today's Funny Friday are their recommendations for lifelong happiness.

Have a great weekend!

(Friday's my day off complaining....and if you're an email subscriber and you want to watch the video, you've got to visit the blog)

video



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Thursday, April 19, 2012

The Debt Snowball Method of Lifestyle Change


Have you ever heard of the debt snowball method of debt reduction?

It's somewhat counter-intuitive in that the method recommends regardless of differences in interest rates you pay off your smallest debt first, pay only the minimum on your larger debts, and then slowly work your way up your line paying off your next smallest debt.

While it may not make sense mathematically its theory suggests you'll pay off your debts faster consequent to the more frequent psychological benefits of seeing debts disappear. It's about accumulating "quick wins" and then using the pride generated therein to fuel forward momentum.

For some people, the same may be said to be true about lifestyle change.

The thing about trying to improve lifestyle - change is difficult, and sometimes, almost like being deeply in debt, people feel that there's so much in need of changing that they get overwhelmed even thinking about it.

If you're struggling with the sense of an overwhelming amount of change, why not try the snowball method? Spend some time this weekend with a good cup of coffee and make a list of as many specific changes you'd like to make, and then rank them in order of ease.

Put the list somewhere prominent and then one by one, start working on crossing them off.

Pride builds a mean snowball.

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Wednesday, April 18, 2012

You Decide - Philanthropy or Marketing, Coca Cola Kids Edition.


Or both?

And does the food industry's efforts at philanthropic "goodness" trump those very same efforts' marketing and health "badness"?

I imagine it'll depend on the program.

Today I want you to consider Coca-Cola's involvement with Breakfast Clubs of Canada. Breakfast Clubs is a national non-profit dedicated to providing services and funding school breakfast programs.

Breakfast Clubs' fundraising regularly includes corporate sponsors and I was sent this video about Coca-Cola's involvement by someone who felt very strongly that Coca-Cola's impact was positive, not negative.

Email subscribers, to watch the video (which I strongly encourage), you'll need to visit the blog itself and I'll embed it here:



What the video very clearly demonstrates is that Coca-Cola's involvement includes the provision of Coca Cola Co.'s Minute Maid orange juice. Breakfast Clubs of Canada President Daniel Germain states,
"We needed Minute Maid to make sure that our breakfast program was meeting the level of nutrition"
And of course every kid's breakfast will therefore include a glass of OJ, and from what I can gather, Coca-Cola's contribution isn't monetary, it's solely product.

So is OJ a healthy choice?

I sure don't think so. And mine isn't a weight related concern, it's a product based concern.  Sugar water's not healthy for anyone regardless of whether or not that sugar water contains Vitamin C.  The Canadian Pediatric Society recommends we limit kids' juice to a maximal 1/2 a cup per day, and tellingly, they place no limits on actual oranges.

And what's in it for Coca Cola? The chance to build lifelong Minute Maid drinkers, and perhaps more importantly lifelong Minute Maid drinkers who believe wholeheartedly that juice is a fruit equivalent.  Moreover their involvement undoubtedly also leads to schools, trusted learning institutions, to literally teach children that juice as a healthy choice - a message that's very clearly being promoted to their benefit by their partner, Breakfast Clubs of Canada in the video up above.

So should Coca Cola be commended for charitably serving 119,000 glasses of orange juice to kids daily, or is this just plain, old, marketing?

I'm guessing you know what I think. Would love to hear from you.

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Tuesday, April 17, 2012

Church booked? Check. Flowers? Check. Feeding Tube? Check?


From the WTF files comes a new trend in wedding preparations - the pre-wedding day feeding tube diet.

For those of you who aren't familiar with naso-gastric (NG) feeding tubes, think a small hose, about the diameter of a healthy earthworm, inserted through your nose and then with the help of you swallowing, passed down into your stomach (and by the way, that photo up above is staged.  Insertion is quite uncomfortable). A balloon on the tip is then inflated so it's less likely to come out and it gets taped to your nose.

There are risks of course (it's an invasive procedure after all). Probably the most common risk is incorrect placement into the airway rather than the esophagus. If unnoticed and someone starts to access the tube for feeding there'll be a very real risk of developing an aspiration pneumonia. More remote risks included a perforated esophagus or a pneumothorax.  There are also very real risks to the very-low-calorie-diets these tubes provide the brides to be in that polyuria (peeing a lot) due to ketosis (the body making its own sugars) can lead to hypokalemia (low potassium) which can lead to cardiac arrhythmias (irregular heart rhythms) and even rarely death (yes, death).

NG tubes are medically indicated to aspirate stomach contents for diagnostic or therapeutic reasons, or to provide a route for feedings or administration of medications when swallowing is compromised (strokes, decreased level of consciousness, etc).

Apparently now they're being used to lose weight before the big day.

Now I'm not going to dwell on the women who've decided the NG tube diet is a good idea. I feel badly for them. Both in terms of the desperation they must feel to go through with it, and for their clearly challenged body images which may well be reflections of weight bias or just our screwed up societal ideals of beauty.

I'd like to focus instead on the physicians who are performing this procedure on women who clearly have no medical indication for an NG tube's insertion. I'd argue the physicians involved are in breach of their Hippocratic oaths, as to put patients at unnecessary risk of infections, perforations, and the cardiac risks inherent to very-low-calorie-diets is contrary to the spirit of "do no harm". Now I realize the Hippocratic oath isn't one that's enforceable (or even one that's taken everywhere), but I'd be shocked if these physicians' respective medical Colleges would approve of this inane treatment, and were someone to lodge a complaint I'd consequently be shocked if the College didn't caution said physician on that practice.  And if their Colleges don't have any concerns, I'd be concerned with their Colleges.

There's no doubt in my mind that eventually, if sufficient numbers of women opted to try the NG tube diet, there'll be a serious medical complication, potentially even a death. I sure wouldn't want to be the physician who inserted the NG tube when that happens as I can't imagine it'll take the prosecutor much time to ascertain that the physician's practice didn't meet the standard of care of medicine.

[Here's a link to the NYT's story on same and photo up above from their as well]

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Monday, April 16, 2012

Book Review: A.J. Jacobs' Drop Dead Healthy


[Full disclosure - Book sent to me by Simon & Schuster....and Simon & Schuster is also the publisher of my upcoming book]

A.J. Jacobs' Drop Dead Healthy is the second book I've reviewed this year involving quackery, self-experimentation and self-deprecating humour (the first was Dr. Tim Caulfield's fantastic The Cure for Everything), and Jacobs' doesn't disappoint.

Like Caulfield, Jacobs chronicles his 2+ year long series of personal experiments with which he aims to become "the healthiest man in the world".  Rather than tackle broad subjects like "diet", and "fitness", Jacobs takes a system by system approach to detailing his efforts at improving most of his big ticket bodily functions. Among many other things he tries paleo diets and raw veganism, he wears noise cancelling headphones around the home, he exercises half naked in parks, orders an add-on for his toilet so that he can squat rather than sit, creates aphrodisiacs out of cucumber and Good & Plenty candies, and runs his first triathlon.

Also like Caulfiled, Jacobs' sense of humour shines, but perhaps what I enjoyed the most about Drop Dead Healthy was how accessible his approach was.  He's not some preachy, highfalutin, health nut, he's just trying to understand himself better. In describing why he set out on his quest he notes,
"It's a bizarre situation. It's like owning a home for forty-one years and being unaware of the most basic information, such as how to work the kitchen sink. Or where to find the kitchen sink. Or what this so-called kitchen is."
Where Jacobs' and Caulfield's books differ I think may reflect their respective starting points. Jacobs is a best selling author, editor and columnist. Caulfield is an academic professor. And while Caulfield's book is certainly not written in an academic style, and is hugely entertaining, Caulfield heartily and thoroughly tackles the science behind the quackery as well as its potential societal impact whereas Jacobs spends less time on the why and more on the what, and while he rightly dismisses much of what he experiments as likely nonsense, he doesn't dwell on the impact that nonsense might have on the folks who may not take the time he took to try to understand its whys and wherefores.

Central to the humour in Jacobs' book is his long-suffering wife Julie. I write long-suffering not because I think she's suffering at all, but more because I'm guessing her sense of humour will appreciate it. She's a wonderful foil for her husband's misadventures and how I wish I could have been a fly on their wall following their "intenSati" experience.

What I love most about Jacobs' book is how well I think it resonates with my own personal and professional healthy living philosophy - live the healthiest life that you can enjoy. What I'm getting at is while his 2 year adventure chronicles his trying to live the healthiest life he could tolerate, his plans now are to downgrade those efforts into the healthiest life that he can enjoy, which in my clinical experience means that he's got a great shot of maintaining real, long lasting change.

Drop Dead Healthy was definitely a great read.

(You can follow AJ Jacobs on Twitter)

[Here's an Amazon Associates link to the US Amazon listing of Drop Dead Healthy.

Here's an Amazon Assocciates link to the Canadian Amazon listing of Drop Dead Healthy]

[AJ if you're reading this, I've got 3 gorgeous little girls pretty much the same ages as your boys.....]

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Saturday, April 14, 2012

Saturday Stories: PCRM Resignations, "Pre-Diseases", and Health Guruism


The Vegan RD resigns from the Physicians Committee for Responsible Medicine for their incredibly irresponsible ads that vilify those with obesity. Special bonus feature to her post - the response from PCRM President Dr. Neil Barnard where he explains why "making light" of those who suffer with obesity is a-ok by him.

Reuter's Ivan Oransky calls pre-diseases pre-posterous (via the Atlantic's Brian Fung).

Lindy West skewers weight loss guru-ism and nutritional zealotry.

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Friday, April 13, 2012

How I Wish this were Real!

Gotta love this kid's spunk.

Today's Funny Friday is a grounding for sure.

Have a great weekend!

(for those of you confused, Friday's my day off whinging. Email subscribers who want to watch the video need to visit the blog itself)



[Hat tip to our office's Director of Operations Lorne]

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Thursday, April 12, 2012

Justin Sherwood, Refreshments Canada President, Defends Sugar

I don't envy the food industry spin doctors their jobs, as at least some of them must realize how ridiculous their arguments are to folks who take the time to critically appraise them.

Take for instance Justin Sherwood. Mr. Sherwood is the President of the Canadian Beverage Association and just this week he was tasked with defending sugar as a contributor to obesity, diabetes and heart disease.

Let's review Mr. Sherwood's letter, but seen through the lens of Kelly Brownell and Kenneth Warner's Big Tobacco Playbook - whereby they came up with a list of plays that the food industry has co-opted from the early days of the fight to prove tobacco harmful:

  • Focus on personal responsibility as the cause of the nation’s unhealthy diet.
    "The Canadian beverage sector is committed as an industry to providing a variety of products for every lifestyle and occasion through our expanding portfolio of low-and no-calorie beverages, smaller package sizes and through our voluntary, national industry calorie label initiative, Clear on Calories, that provides clear calories information on front of pack to enable informed purchasing decisions and consumption"
  • Raise fears that government action usurps personal freedom.
    Mr. Sherwood failed to make this play (though he did make it here)
  • Vilify critics with totalitarian language, characterizing them as the food police, leaders of a nanny state, and even “food fascists,” and accuse them of desiring to strip people of their civil liberties.
    Mr. Sherwood failed to make this play (though he did make it here)
  • Criticize studies that hurt industry as “junk science.”
  • "Contrary to the vast amounts of nutritional science available, the article, based on one controversial study, inaccurately tries to paint the consumption of sugar-sweetened beverages as a direct contributor to obesity, heart disease and diabetes."
  • Emphasize physical activity over diet.
  • Mr. Sherwood failed to make this play (though he did make it here)
  • State there are no good or bad foods; hence no food or food type (soft drinks, fast foods, etc.) should be targeted for change.
    "Research shows that no one single food or beverage can be linked to obesity, and scientific evidence does not support that sugar, in any of its various forms, is a unique cause of any health condition."
    "No one single food or beverage alone is responsible for people being overweight or obese. All calories count from whatever food or beverage they come from."
  • Plant doubt when concerns are raised about the industry.
    Mr. Sherwood failed to make this play (though he did make it here)
  • So is Mr. Sherwood right? Is there only a single study out there linking sugared soda as a primary contributor to rising rates of obesity, heart disease and diabetes?

    Of course not.

    For a brief summary of literature, here's one from Harvard's Frank Hu.

    I'm not sure how much money Mr. Sherwood takes home each year but I sure hope it's a great deal. It'd have to be in order to make up for the impact his statements must have on how folks might perceive him as a person.

    Kelly D. Brownell, & Kenneth E. Warner (2009). Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? The Milbank Quarterly, 87 (1), 259-294 PMID: 19298423

    [For those interested, I've posted Mr. Sherwood's remarks below in their entirety as I couldn't seem to find a way to link. They were published in the London Free Press on April 10th, 2012 and a hat tip to blog reader Gay for sending my way]
    "I read with interest the article, "Sugar can be found in unexpected places (April 9 2012)" in The London Free Press. Contrary to the vast amounts of nutritional science available, the article, based on one controversial study, inaccurately tries to paint the consumption of sugar-sweetened beverages as a direct contributor to obesity, heart disease and diabetes.

    The Canadian Beverage Association would like to provide scientific facts on the consumption of sugar-sweetened beverages.

    Research shows that no one single food or beverage can be linked to obesity, and scientific evidence does not support that sugar, in any of its various forms, is a unique cause of any health condition.

    Statistics Canada's own data indicates that, full calorie soft drink consumption has declined by 30 per cent in the past 11 years but obesity continues to rise-these numbers alone show that there is no link between the two.

    The international scientific community disagrees with the direct association of sugar consumption as the cause of health issues. For example; & From the Canadian Sugar Institute; "Through scientific reviews such as the Institute of Medicine Dietary Reference Intakes (DRI) report, does not support the view that sugar is "toxic" and a cause of non-communicable diseases"[1] <#_ftn1> & The Dietitians Association of Australia (DAA) "believes it is simplistic and unhelpful to blame sugar alone for rising obesity rates and other related health problems across the world"[2] <#_ftn2> & British Nutrition Foundation: "Current evidence does not support the dramatic claims about the association between sugar and health" [3] <#_ftn3> No one single food or beverage alone is responsible for people being overweight or obese. All calories count from whatever food or beverage they come from. The Canadian beverage sector is committed as an industry to providing a variety of products for every lifestyle and occasion through our expanding portfolio of low-and no-calorie beverages, smaller package sizes and through our voluntary, national industry calorie label initiative, Clear on Calories, that provides clear calories information on front of pack to enable informed purchasing decisions and consumption.
    "


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    Wednesday, April 11, 2012

    Why I Can No Longer Trust Medscape


    Continuing medical education (aka CME) is a requirement for physician recertification, and there are many different means to obtain it, including online. Medscape is probably the largest online CME provider and by means of smart phone and tablet applications, email reminders and just plain old web visits, it undoubtedly services thousands of physicians daily.

    So let me ask you, if you're a physician and you're using Medscape to try to stay at least partially up to date with the latest literature, and you inherently trust Medscape as a reputable source of quick, expertly vetted information, how frustrating might it be to learn that at least in regard to nutrition, Medscape doesn't know what it's talking about?

    Well, I've got bad news for you.

    Looking at the 3 most recent observational study failures, where the studies were so poor as to make conclusions impossible, 2 of the 3 made it to Medscape as CME exercises, and one was put out in their news to family physicians segment.

    I blogged about all of these studies. There was the diet soda being linked with strokes study, the white rice being linked with diabetes study, and the chocolate being linked with weight loss study.

    Of the 3, the worst was probably the chocolate study which frankly never should have been published.

    And what did Medscape do with the study?

    It included it in their CME program where their learning points included the erroneous and downright irresponsible "clinical implication", that,
    "Greater frequency of chocolate intake is associated with lower BMI, but the amount of chocolate intake is not associated with BMI"

    And then to hammer this erroneous information home they include that very statement in their CME required post-test,


    I do feel badly publicly bashing a free service, but know that I tried the quiet route first.  Following Medscape's inclusion of the diet soda study in their family practice newsletter, I wrote to them to express my concerns.  I never did hear back from them and certainly no correction was ever sent out.

    While Medscape in theory is a fabulous service, if their understanding of other areas of medicine is on par with their understanding of nutrition, in practice they're putting patients at risk by actively misinforming their physicians.  Given I have no reason to think otherwise I'm going to err on the side of caution and assume the same lack of care, attention and critical appraisal they're paying nutrition is their norm.

    The solution?

    Stop using their services or simply assume that their take on medical literature isn't in any way, shape or form, critical, thoughtful or helpful.

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    Tuesday, April 10, 2012

    Need Running Motivation? Try the Zombies Run! App (Review)


    Now I do love me my Nike +GPS, but when I saw an article detailing the new app Zombies, Run! I immediately wrote the developers and offered myself up as a reviewer (full disclosure, was provided the app freely for review), reason being, I'm a huge fan of the Walking Dead television series and running away from zombies while getting my sweat on sounded too good to be true.

    Now the app's pretty steeply priced ringing in at $7.99 and I'll come back to whether or not I think it's worth it at the end, but first, the app itself.

    Zombies, Run! is easy to set up - you select the music you want to run to, and whether or not you want zombies to chase you (of course you do!) - and then you slide to run.

    Immediately you're immersed in the story line. You're "Runner 5" (why give names to folks who likely won't be around for long), and you've been dropped into the middle of the zombie hordes on your way to Abel Township, a small fortified enclave of living, breathing, non-zombie folk. You've got a radio ear piece, and the comm tower in Abel Township helps to guide you to pick up essential supplies....and of course warns you of upcoming zombie attacks.

    There are 25 missions, with each mission lasting roughly 25 minutes of running, but if you're not up to 25 minutes yet, they're subdivided as well and you can pick up nearly where you left off the next time you strap on your shoes. The supplies you pick up during your mission both enrich the story line, and also help you to fortify Abel in the non-running aspect of the app, which allows more survivors to live there.

    During each mission it would seem that you have to evade 2-3 different zombie hordes (though perhaps there'll be more in specific missions), which if you're playing the game seriously means forced interval training of roughly minute long zombie-evading sprints. The zombies definitely can get you, though that doesn't seem to end the game, but I think it causes you to drop some of your supplies. The zombie chases work by means of the GPS in the iPhone I suspect by requiring you to sustain a specific percentile increase in speed until you're radio'ed that you've evaded the undead. My last run the zombies came after me just as I was about to start a hill climb and....

    The story line's well done and actually quite amusing. If you finish a mission and keep on running the app switches into "radio mode" which will continue to play the music of your choice but will also have cut-ins of equally amusing chatter from the local pirate radio station.

    I have a few small quibbles with the app. The volume's a bit wonky in that my music isn't particularly loud compared with the narration so sometimes when the story cuts back in, I have to quickly adjust the volume because it's so damn loud [UPDATE: Realized you can control this setting via the game's setting. Readjusted and it works great!]. It also doesn't seem to remember where I was in my playlist, so going out for my second mission, my playlist began at the beginning again [UPDATE: While it doesn't remember, you can set your playlist to shuffle via the in game settings]. Lastly, if you're accustomed to pacing yourself with music, sometimes the narrations are rather lengthy and may affect your time. But you know what, it's not so difficult to adjust volume, and music wise, I'll just have to remember to run to different albums each time I head out.

    So is it worth the comparatively steep $7.99 iTune's cost?

    Well what else costs $7.99? A couple of lattes, a fast-food combo, popcorn at the movies, a glossy magazine. I'll often talk about how one of the best ways to help motivate yourself to exercise is to increase exercise's value by tying something enjoyable to it. Given the only way to enjoy the storyline is to run, this fits that bill perfectly and is exactly the sort of app I'd love to see more of.  There's no doubt, it's increased my desire to run.

    25 missions, that's over 10 hours of storyline even if I stop before radio mode (which is enjoyable itself). In dollars and cents...or actually cents, that's $0.79 per hour of more enjoyable exercise. [UPDATE: The developers just added 7 additional "supply" missions and a "long run" mode that stretches each mission out to an hour (though then you'd miss the entertaining radio mode banter)]

    Seems a downright bargain.

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    Monday, April 09, 2012

    Heart and Stroke Foundation Health Check on 10 Teaspoons of Sugar a Glass


    Over the years I've made a great deal of noise about the Health Check program. For those of you who aren't aware, it's a Heart and Stroke Foundation program where they sell their Health Check logo to food manufacturers to use in front-of-package product branding.  Sadly the criteria they use to award their Checks is weak.

    The Heart and Stroke Foundation's own research has demonstrated that not surprisingly, consumers interpret Health Checks to mean a particular item is good for them, healthy, and approved by the Heart and Stroke Foundation.

    Sitting down to our first Seder I noticed the grape juice in front of me had a Health Check.

    The Health Check'ed grape juice, while indeed delivering 100% of my daily Vitamin C needs per glass, did so along with 40g of sugar. That's 10 teaspoons of sugar a glass! I also noticed it delivered pretty much nothing else in the way of nutritional benefits and that an unbelievable 94% of its calories came directly from sugar.

    One glass of Health Check'ed grape juice then has 2.5 more teaspoons of sugar than a full sized Snickers bar, or as much as you'd find in 90 M&Ms. Drop per drop the grape juice also has 60% more calories and 60% more sugar than Coca Cola!

    Of course if you ate the 90 M&Ms (or the 1.3 Snickers bars) at least you'd likely curb some of your appetite, as studies on eating vs. drinking calories demonstrate we compensate for the calories we eat, but not the ones we drink, meaning drink a glass of grape juice and regardless of its calories or sugar, you'll still eat as much for the meal as if you hadn't drank any.

    The Canadian Pediatric Society recommends limiting juice to just half a cup a day and as far as I know the Heart and Stroke Foundation is the only health authority in North America who is explicitly advising consumers that 10 teaspoons of sugar to make your vitamin C go down is good for them, healthy, and approved by Registered Dietitians.

    As to why they do it.

    The only plausible reason is money as last time I checked, no one in their right mind would suggest consuming 10 teaspoons of sugar a glass could in any way shape or form be healthy. There's simply nothing that could be added to a glass of 10 teaspoons of sugar that would make that glassful a healthy choice. Delicious? Maybe to some. But certainly not healthy.

    So how much money?

    Currently there are 138 juice products whose parent companies have paid for Health Checks. That's just under 10% of all the Checks they currently sell.  As far as dollars go, my guess then would be somewhere in the neighbourhood of $300,000-$400,000 just from Health Check'ed juices.

    I don't know about you, but I'd sure cost a lot more then $400,000 to sell out.

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    Saturday, April 07, 2012

    Saturday Stories: Shiny food, a PETA murderer, and the Case FOR Pink Slime

    Jeannie Marshall on what our kids are up against when it comes to that shiny food they sell on TV.

    Douglas Anthony Cooper on the butcher at PETA.

    Ezra Klein's case for pink slime.

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    Friday, April 06, 2012

    This Appeals to my Inner Sh*t Disturber!

    I know, I know, telling people that I have a rather juvenile sense of humour isn't the best way to cultivate credibility.....but it is the truth.

    Watching today's Funny Friday video all I could think of was, "I sure hope the Lord of the Rings is still a relevant pop culture reference when I retire because I so want to do this"

    Have a Happy Holiday Weekend!

    (For those who aren't sure what's going on - Friday's are my day off whinging. If you're an email subscriber, you've got to visit the blog to watch)



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    Thursday, April 05, 2012

    Since When Did "Responsible Medicine" Include Vilifying Obesity?


    You may have never heard of them, but there's an organization out there called the, "Physicians Committee for Responsible Medicine".

    While that sounds right up my alley, I've never joined because despite sharing some views (like dairy not being a magic fairy food), the stances they seem to take, to me, bordered on zealotry, and zealotry ain't me.

    One of their positions is that meat will kill you and that going vegan's the best way to go.

    More recently they've decided to promote that message by tying veganism with skinniness.

    First off let me tell you, I've had my share of vegan patients. That's not surprising because while vegetables are healthful, there's plenty of vegan calories to go around, and to suggest going vegan automatically will lead to weight loss is in fact irresponsible as it's simply not an if/then statement, and in my mind at least, misinforming patients is not "Responsible Medicine".

    But you know what's really not "Responsible Medicine"? Contributing to the weight stigma faced by folks with obesity by making fun of people who struggle with their weights and portraying them in a negative light.

    Take a gander at this advertisement and tell me, do you think the "Physicians Committee for Responsible Medicine" is responsibly addressing a chronic medical condition?



    The message I get from it is along the lines of obese people are oafish, clumsy, thoughtless, boobs, and that "fat" is "sickening".

    Shame on you PCRM, both for your misinformation on veganism and obesity, as well as for your perpetuation of hateful weight bias, but thank you for reaffirming my decision not to sign up.

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    Wednesday, April 04, 2012

    Toronto Mayor's Public Diet a Public Health Disaster


    And no surprise either.

    Why?

    Because the Mayor did what so many out there do - he embarked on a traumatic diet.

    For those who aren't in the know, back in January the Toronto Mayor and his brother publicly vowed to lose 50lbs by June. Their strategy according to the Mayor,
    "Running a lot, lifting weights and eating like a rabbit."
    Translation? A mindless eat-less-move-more plan.

    The Mayor dropped 10lbs in his first week. Over the course of the next 11, he's down 9.

    So where's the disaster?

    9lbs in 11 weeks for a public figure who undoubtedly has a great many working meals and more stress than most folks sounds pretty good to me. I'd also guess that it's very possible the Mayor has medical problems that could complicate his efforts.

    For all of those reasons, had he been a patient of mine, I'd probably have been aiming him at about 1-1.5lbs per week, which is pretty much bang on what he's averaged, so no disaster there.

    The disaster's in the reporting - his, and the media's.

    He's reporting weight management as sacrificial. As a struggle. As a fight.

    The media's reporting his lack of more profound loss as an implied failure.

    And so what's the public to learn? That success means suffering, willpower and crazy amounts of sweat, and that reasonable, small losses stink.

    Those messages?

    They're the public health disaster.

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    Tuesday, April 03, 2012

    Are Recovery Drinks the Nutritional Scam of the Century?


    They get my vote!

    It's been 4 decades since the first glass of Gatorade was quaffed. Since then? A $4 billion dollar industry's been born which in turn has perhaps provided more sugar and more misinformation than any other.

    So does anyone actually "need" a "recovery" drink?

    I know I don't, and I exercise quite a bit, but to be fair, I'm not an elite performance athlete, and in general I don't work out in beast mode.

    Me? My workouts range from 30 minutes to an hour and I drink water if I'm thirsty or sweat a ton, and usually try to have a bit of protein when done.

    Are you an elite performance athlete or work out in beast mode for hours at a time?  Really, unless you're competing (and even then, only if you're competing at high levels), or just absolutely killing yourself, recovery drinks just aren't necessary.

    If I had to venture a guess, I'd bet that over 95% of all so-called recovery drinks were consumed by people who truly don't need them.  I'd also wager that a large percentage of those same folks only decided to exercise in order to lose or maintain weight, in which case that "recovery" drink's more likely to aid in the "recovery" of a few pounds, than of muscle or performance.

    But the thing that really gets my knickers in a knot is that they're being aggressively marketed to children, virtually none of who are elite performance athletes, and all of who burn substantially fewer calories than full grown adults.

    Take a gander at the photo down below. It's from a lengthy article that ran in the Montreal Gazette extolling the virtues of chocolate milk.  Do you think they're targeting you and me, or our children?  That's Olympic gold medalists Shawn Johnson, Chris Bosh, Apolo Ohno and Elana Meyers along with a giant cartoon bunny and they're promoting the Refuel Chocolate Milk campaign, where Refuel style bottles tend to be 500mL in size and on average contain 20% more calories and double the sugar of a Snickers bar.  How well do you think a campaign to get kids to down a Snickers bar post every workout would fare?  Probably not too well, which is a shame, because it might be a healthier choice than that god awful chocolate milk.


    That photo at the top? Those kids lined up like an assembly line, probably at a school, as part of a Refuel with Chocolate Milk promotion, where their school's teaching them the "benefits" of liquid, double-sugar'ed, Snickers'.

    (Both photos by Jemal Countess)

    So basically what we have with the Refuel campaign are high octane liquid chocolate bars being peddled to children on the basis of something that virtually nobody needs - frickin' recovery drinks.

    What a scam.

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    Monday, April 02, 2012

    Canadian Government Will No Longer Police Accuracy of Food Labels


    Just in case you need another reason to cook more frequently, the Canadian government has given the Canadian food industry the biggest birthday present ever - the end of oversight.

    Yup, with our most recent budget the Harper Conservatives have elected to stop funding the Canadian Food Inspection Agency to oversee the accuracy and integrity of our food labels.

    According to the budget document,
    "The government will change how the Canadian Food Inspection Agency monitors and enforces non-health and non-safety food labelling regulations. The CFIA will introduce a web-based label verification tool that encourages consumers to bring validated concerns directly to companies and associations for resolution"
    According to veteran Postmedia health and public affairs reporter Sarah Schmidt, "non-health and non-safety" includes, "net quantity" and "size".

    So what does that mean for you?

    It means the food industry has just been told that Mom and Dad are going away on vacation and they've left the liquor cabinet open and $200 cash on the dining room table to, "use as you kids see fit".

    What do you think is going to happen? Do you think the food industry's going to ensure it reports calories and sizes accurately?

    Given that it doesn't even do so now, I'm thinking whatever small amount of trying they once did is about to be shuttered.

    But here's my question for the Government. How are "net quantity" and "size" both "non-health" regulations? Canadians with diet related chronic diseases including obesity, diabetes, kidney failure, hypertension and more count on labeling accuracy in quantities and sizes to help them make more thoughtful and healthful decisions.

    Daniel Tencer from the Huffington Post managed to interview Bob Kingston, the President of the Agricultural Union that represents food inspectors on this recent announcement.  His quote on the matter pretty much sums it up,
    "it's a total farce"
    Indeed. A sad one at that.

    Here's hoping the vague language of "non-health and non-safety" allows for backpedaling.

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