Saturday, December 31, 2016

Saturday Stories: World's Only Occupier, Internet Commenters, and Gene Drives

By image by Ute Frevert;false color by Margaret Shear  CC BY 2.5
Eugene Kontorovich and Penny Grunseid in The Wall Street Journal discuss the world's only occupying power.

Christie Aschwanden in Five Thirty Eight interviewed 8,500 Internet commenters about why they do what they do.

Rob Stein in NPR on the promise of "Gene Drives" on malaria.

Friday, December 30, 2016

No Video Better Sums Up 2016 Than This One

What an ugly year.

Here's hoping 2017's a better one!

Have a great weekend!

Thursday, December 29, 2016

School Vending Machines Raise Very Little Money So I Ask A Principal, "Why Keep Them?"

During my annual winter blogging break, I'll be posting some of my favourites from back in 2013.
School vending machines peddle junk. Whether it's health-washed junk (which I've reported before is likely worse for kids given their health halos misinforms children about nutrition), or true junk, when I was a kid, there certainly weren't any school vending machines, there were just water fountains.

Admittedly, we did head across the street to the convenience store to buy junk, but not every day, and really, the argument that kids can just go across the street to buy garbage is nonsensical. In my later high school days I also remember heading across the street to buy cigarettes - bet schools could raise lots of money selling those.

So I wondered aloud on Twitter one day just how lucrative vending contracts are for schools. One kind principal reached out and the answers she provided surprised me some. Sounds like at least here in Canada, schools only raise a few thousand dollars a year by selling nutritional chaff to their students (they used to make far more when sugared soda was still sellable as back then there were more sales and the big soda makers also provided in-kind donations).

Now maybe I live in a dream world, but I would have thought a few thousand dollars return would either a) Not be worth it given what the vending machines are selling, or b) Be able to be raised in a non-harmful way.

I still do think both of those thoughts hold true, but when I put it to the principal and asked her why keep them, she wrote me what I thought was a very thoughtful and practical piece and I asked her if I could share it with you (I've changed identifiers so she doesn't land in any hot water) - it speaks to the fact that there are far bigger issues for our schools to deal with and that it might not be that simple to fix them.
Hi Yoni-

To be honest with you, vending machines haven't really been on my radar until June. The Super met with us in April, and he mentioned that he and the District Education Council were taking a closer look at school compliance with vending policy. The council member who sits on my local parent committee is passionate about healthy eating, so we are certainly going to be under the microscope.

My view regarding the absence of machines in my school is similar to my battle with drugs. As soon as you suspend the drug king pin there are five others waiting to take his/her place. It's a constant Game of Thrones. I see a similar path for vending. They will take off to the nearby convenience stores. Why pay $1.10 for 10 small carrot sticks and dip at the cafeteria when you can get chips at the pizza place 50 ft. from the school property line? I find that kids that really care about what they're eating are bringing bagged lunches. The rest are up for the quick fix. Tim Hortons, McDonald's, Pizza Pizza, St. Hubert's, and China Wok are all within a 5-minute walk from us.

I am in total agreement with you regarding water fountains, but these are viewed as unsanitary by many of the kids. Springfield water is very good as we are on a well system. I do see kids using the fountains. I'll be the first to admit that they are not aesthetically pleasing- they're not as sexy as the machine that picks up the drink and beams it to a vacuumed tube. But they certainly work. Don't forget- some schools are almost 100 years old, with old pipes and hardware. Springfield Elementary was built in 1930. My school had a flood and was repaired in 1986. You push the button, let the water run for a while, then get a drink. It takes a while for the cold water to run through the pipes to the actual fountain. I'm not making excuses by any means, just trying to give you the picture. This is not lost on the teenagers.

We have a very successful hot lunch program on Thursdays. We were so proud of ourselves, we thought we would create a free breakfast program at school. We had a community supermarket partner step up to help us out. We offered a variety of healthy choices, and guess what? The kids didn't eat it. It was open to all 480 students and nobody came. I bet if we had offered Froot Loops and Eggos we would have had a full house. It shut down after a five-week attempt. We were shocked. Let me get this straight, "You would rather pay at the cafeteria than eat for free down here in the culinary tech room?" Unreal. I have been teaching for 15 years- I can count the number of times I have eaten at the cafeteria on one hand. I kid you not. I dry heave just thinking about it.

From my point of view, the money from vending isn't really on my radar. That money would barely cover my biology/physics/chemistry budget for the year. And the gym spends that amount in consumables (shuttle cocks, rackets, balls) yearly. The money comes in, but it's in such small increments that it's just thrown into the kitty.

I don't go the vending/back machine route for disposable income. I'm sure some might, but we certainly don't talk about it in admin. meetings, and we talk about just about everything. Get rid of them? I guess we could, but I don't see this as the answer. Many schools are community partners, with a variety of clubs/organizations using the facitlities in the evenings. The vending offers them a last minute snack or drink, if needed. I'm guilty of using the one at the gym when I have forgotten my bottle for spin class. Those using the gym at school may find themselves in the same boat. I just don't want you to have the perception that we have vending for profit- the profits are not lucrative. We have them because we have them- they've always been there, I guess.

On the flip side, you would be hard pressed to find a teacher that doesn't have a file cabinet full of snacks for kids who have forgotten their lunch.

The quality of these snacks? Well, that's classified information...:)

Tuesday, December 27, 2016

Eating 201lbs of Barilla Plus Omega-3 Pasta Nets you the DHA of 2oz of Salmon

During my annual winter blogging break, I'll be posting some of my favourites from back in 2013.
Today's badvertising comes from Barilla Plus Omega-3 pasta.

If you were duped by the health washed packaging of Barilla Plus pasta and thought you could consume it as a means to acquire healthy omega 3 DHA fatty acids, to obtain the equivalent amount of DHA that you'd get from eating a teeny weeny 2.6oz serving of salmon you'd need to eat between 11 and 201 POUNDS of pasta (with the amount depending on your body's ability to convert plant based ALA to DHA).

Bon appetit. And wear stretchy pants.

[Where the numbers come from:

Depending on your source of information between a low of 0.5% and a high of 9% of plant sourced alpha linolenic acid (ALA) is converted by the body to DHA.

75g of salmon contains 1,610mg of DHA.

An 85g serving of Barilla Plus contains 300mg of flaxseed sourced ALA.

0.5% to 9% of 300mg = 1.5mg to 27mg.

1,610mg divided by 1.5mg = 1,073. 1,610 divided by 27 = 59.6

85g x 59.6 = 5,066g = 11.16lbs

85gx 1,073 = 91,205g = 201.07lbs]

Saturday, December 24, 2016

Saturday Stories: Widowhood, Orphans, and Very Bad Pharma

Christina Frangou in the Globe and Mail with her devastating account of widowhood at 36 (this is a must read, however difficult).

Eli Saslow in The Washington Post on the opioid epidemic's orphans.

Eric Eyre in the Charleston Gazette-Mail with some incredible reporting on an almost unbelievable tale of drug companies behaving beyond badly.

[All this to say, if you're happy and healthy this holiday season, count your blessings.]

Friday, December 23, 2016

Liam Neeson Nails The Role of Mall Santa

Merry everything everyone!

Have a great weekend!

Wednesday, December 21, 2016

Beloved Pre-School Literary Character Teaches My 4 Year Old Fat Hatred

During my annual winter blogging break, I'll be posting some of my favourites from back in 2013. I'm also changing my daily posting time to 9:00am
So I was putting my four year old to bed two nights ago. We were reading Kevin Henkes' Lilly's Purple Plastic Purse. It's the one where Lilly adores her teacher Mr. Slinger, but when Mr. Slinger doesn't let her show off what she brought for show and tell, she gets mad.

And when she gets mad she draws an angry portrait of the teacher and leaves it for him.

That's the portrait up above. As you can see, in it she draws Mr. Slinger as fat, wielding both the image and the word as purposeful insults given that Mr. Slinger in the rest of the book is thin. Fat Mr. Slinger is also described as "mean", and "bad", and is portrayed as monstrous.

You know studies have shown that children as young as 3 discriminate against those with obesity. Given the pervasiveness of anti-fat bias in children's books and movies (this weekend we also saw/heard fat wielded as an insult in Despicable Me 2 and The Croods), and society as a whole, I'm betting it's a learned trait, not an intrinsic one.

(Needless to say, that page got modified during the read and the book has somehow disappeared from my daughter's library)

Monday, December 19, 2016

Coca-Cola's New Anti-Obesity Ad Provides Truly Valuable Advice (No Kidding!)

During my annual winter blogging break, I'll be posting some of my favourites from back in 2013. I'm also changing my daily posting time to 9:00am
Thanks to blog reader and exercise specialist Mike Wigger for sending along the latest in Coca-Cola's anti-obesity ad campaign. It's a commercial called, "Grandpa", and in it they juxtapose Grandpa's then life (which according to Coca-Cola included more walking, smaller meals, biking to work, snacking on fruit, taking the stairs, enjoying the outdoors, homemade meals, eating at the dinner table) with his grandson's now life.

And of course the commonality between Grandpa and his grandson's lives in the advertisement is that Grandpa apparently also enjoyed Coca-Cola with the clear implication being that it's all those other things, not the consumption of Coca-Cola, that a person ought to change if they want to enjoy the same weight and health as Gramps.

But is Grandpa's Coca-Cola the same as your Coca-Cola? Not on your life and so I produced a video to explain what I mean and why it is that I in fact totally agree with Coca-Cola's latest message that we should try to live like Grandpa (and yes, I know my collar looks funny).

Friday, December 16, 2016

If This Is The Real Santa, I Sure Wouldn't Want To Have Been Bad This Year

Pretty sure this Funny Friday's Santa doesn't need any help from the reindeer.

Have a great weekend!

Tuesday, December 13, 2016

We're Looking For RDs To Join Our Team! Deets Here

Our office, The Bariatric Medical Institute (BMI) in Ottawa, an inter-professional nutrition and weight management practice that includes a medical doctor, personal trainers, registered dietitians, a social worker, and clinical psychologist, is looking for full time and part-time/casual dietitians to join our professional and unique team.

We are looking for individuals who loves working with people & technology, are great at multi-tasking, are team players, thrive off of challenges and responsibility, and want to utilize their skills in making a dramatic, positive difference in people’s lives.

Responsibilities will include:
  • Collaboration with inter-professional team members.
  • One-on-one counseling sessions to motivate and help patients live the healthiest they can.
  • One-on-one counseling sessions with parents of children struggling with weight to help them navigate a healthy eating environment.
  • One-on-one counseling sessions to help prepare patients for bariatric surgery as well as post-surgery sessions to help patients ensure that they succeed.
  • Design individualized nutrition plans based on each individuals’ unique lifestyles, metabolic rates and dietary likes and dislikes.
  • Write for BMI’s different social media outlets: Website, blog, and monthly newsletter.
The skills you’ll need:
  • Exceptionally strong motivational counseling skills.
  • Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counseling.
  • Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal.
  • Must be innovative and give patients realistic and helpful nutrition advice.
  • Positive and non-restrictive approach to weight management.
  • Comfortable giving presentations.
  • Possess sound professional judgment, initiative and enthusiasm.
  • Good time management skills and ability to organize.
  • Excellent computer skills, and comfort with social media
  • Strong cooking skills.
The requirements we’re looking for:
  • One year of clinical experience preferred (but if you're greener than that, but think you'd be a great fit, please apply)
  • Member of the College of Dietitians of Ontario and in good standing.
  • Having obtained a Master's degree is preferred, although not required.
  • Previous experience working in weight management and childhood obesity is an asset.
  • Working with us you will have access to a full gym facility as well as shower and change rooms. Physical activity and healthy living are the primary focus of our work and therefore we view your active lifestyle as a great asset.
Because we are looking for the best candidates our wages are highly competitive.

If you're applying for a full-time position, know that medical and dental benefits are both parts of our package.

If you're applying for a part-time position, you will have a fixed number of hours, with future opportunities for full time employment.

Please send your interest and resumes to our account. Previous applicants welcome.

We look forward to meeting with you!

Monday, December 12, 2016

Guest Post: These Two Raisin Studies Read Like Advertisements

Today's guest post comes from Dr. Dylan MacKay who agreed to writing it after I sent him a breathless press release that claimed that raisins were a great snack choice for people with diabetes. Dylan's perspective is borne out not only of his work as a nutritional biochemist with an interest in functional foods, but as well of the fact that he himself has type 1 diabetes. He also has an open mind, and if need be, a sharp pen.
Last month was National Diabetes Awareness Month (NDAM), the month when everyone cares about people with diabetes. Diabetics (I can use that term because I am one) are especially popular in November, and it seems that it is a great month to dispel diabetes myths. In an email that was forwarded to me, by Yoni, the PR team Ceres was really trying to dispel the diabetes and dried fruit myth.

This myth (apparently) goes “dried fruit, such as raisins, are not suitable for people with diabetes”. It was a new myth to me, but it kind of makes sense as I generally try to avoid more concentrated sources of sugar and try to pick fresh fruit over dried (because water). The email used REAL NUTRITIONAL SCIENCE RESEARCH (which is my favourite by the way) to dispel the myth. To quote the email directly
Now, California Raisins debunks the myth that people with diabetes cannot eat raisins and other dried fruit.
In fact, scientific research demonstrates that regular consumption of raisins rather than many popular processed snacks, can actually positively influence both blood glucose levels and systolic blood pressure
Well this sounds amazing, I should eat raisins, all the time.

To be sure, before I ran out and bought a big bag of raisins, I looked up the 2 studies that were cited in the email.

Bays et al. (1) was a 12-week randomized study in 51 participants with type 2 diabetes (n=19 control snacks, n=27 raisins) looking at routine consumption of dark raisins versus “alternative processed snacks” on glucose levels and other cardiovascular risk factors.

Anderson et al. (2) was a 12-week, randomized, controlled study in 46 participants with pre diabetes (n=15 control snacks, n=31 raisins) looking at routine consumption of dark raisins versus “alternative processed snacks” on blood sugar and cardiovascular risk factors. Both studies had a parallel design and were completed by the same research group at the Louisville Metabolic and Atherosclerosis Research Center. In both of these studies raisin consumption was reported as being associated with improved glycemic control and improved blood pressure compared to the “alternative processed snack” consumption.

This is amazing news right? Raisins are great! But before I bought raisin stock I decided to read past the abstract, and well it wasn’t pretty.

I am not a fan of tearing into someone else’s work, glass house and all, I don’t want to throw bricks, I’ve done work with companies and commodity groups, but sometimes bricks are required.

The first thing I wanted to know was what were these “popular processed snacks” or “alternative processed snacks”? Because in nutrition you cannot really add something without replacing something else, the most important part, in my opinion, in designing a nutrition trial is finding the right control. The selection of the control in both of these raisin studies is problematic.

I should have guessed from the California Raisin PR email that “popular processed snacks” were likely to mean ultra-processed garbage (and I would have been right). Participants on the control “alternative processed snacks” had to choose and eat three of the following snacks daily: Fudge Shoppe or Grasshopper cookies; Fudge Shoppe mini fudge stripes cookies; Honey Maid cinnamon roll thin crisps; Keebler Cheez-It crackers; Lorna Doone baked shortbread cookie crisps; Nabisco Chips Ahoy! Baked chocolate chip snacks; Oreo baked chocolate wafer snacks and Pepperidge Farm Goldfish baked snacks. Here is the nutritional values per serving of raisins and “illustrative” or “representative” snacks, interestingly between the studies there are some differences in the snack used.

These “snacks” were consumed three times a day, that is 300 kcal per day of things I would not recommend anyone eat on a daily basis. I know that both papers present their design as a very pragmatic, “real world” example of replacing a person’s current snacks with raisins. However, a better description of the design would be what happens when you replace 300 kcals of ultra-processed junk food with dried fruit, the outcome of this trial would not be very surprising. Also if the study was going to really pragmatic the control should likely have just been the NCEP education vs NCEP plus raisins. With the design used you can’t really say that raisins were “good” for the participants, just not as bad the junk snacks.

The second big problem I have with both of these trials is the overselling of results and the reporting of p values. The overselling of the results is especially disappointing as the Andersen et al. study was a self-stated pilot study. Below is a table which summarizes the findings of both the Bays et al and Andersen et al. studies.

In the statistics sections of both of these papers say “The α for statistical significance was £ 0.05, two-sided.” And neither paper mentions correcting for multiple comparisons (which is another issue). But then right after in the next section they write something like this
compared to snacks, those who consumed raisins had reduced postprandial glucose levels by 36 mg/dL (P = 0.072), reduced fasting glucose levels by 32 mg/dL (P = 0.066), reduced fasting glucose levels by 19% (P = 0.062), and reduced HbA1c by 0.12%, although statistical significance was not achieved.
Additionally both studies used last observation carried forward to deal with missing values, a technique which Ben Goldacre referred to a “dodgy” and biased towards showing a treatment effect in his book Bad Pharma. The reporting off the “trending” p-values makes me think of this tweet I saw recently,

People love to go on about conflicts of interest in nutritional science research and how industry sponsored work can never be trusted etc. (personally I think Kevin C. Klatt has done some of the best writing on this topic).

A quick look at my CV could lead someone to call me a canola oil loving, plant sterol pushing, hemp hugger (I personally think it would be unfair to characterize me like that, but you could). I don’t think industry funding necessarily means poor science (#shill). However, when you produce two papers like the ones used in the California Raisins PR email, and you happen to be receiving money from the California Raisins Marketing Board or the California Marketing Raisin Board you make it too easy for people.

But seriously I could go on for days about what is wrong with these 2 studies and the way they were marketed. They are clearly advertisements and I do not feel they add to the world’s nutritional science knowledge. In fact, they do the exact opposite they just add noise.

So Dylan, what would you have done differently?

For starters a crossover - this type of study screams for a crossover design. It gives you much higher power with the same study population and everyone acts as their own control.

Second, I would have had a NCEP education only treatment and I would have added a positive control instead of the junk food treatment. I personally tend to avoid raisins because, despite having a medium glycemic index (GI =64), they tend to have a high glycemic load (GL=28). I tend to eat too many of them too fast and end up with high blood sugar (I think that might be the idea behind GL). Since raisins are just dried grapes, I think grapes (GI=59, GL =11) would have been good positive control for raisins, and one that has been used by others (3, 4). But I guess it could be argued that grapes are perishable and more expensive than raisins, so maybe apples (GI=39, GL=6) could have been a good control, or maybe pears or peaches that are canned in juice.

And finally I would have just reported the results in a balanced and clear fashion, and I wouldn’t have reported things with p-values above 0.05 as being different. Generally I would have tried to show that I was starting from a position of equipoise. However, I guess equipoise would be pretty hard to maintain when one of your treatments is 300 kcals per day of nutritional dumpster fire.

Ideally, if I was approached by the California Marketing Raisin Board (Big Raisin) to do a trial like this I would have gone to Big Almond or Big Pistachio or Big Banana or Big Avocado etc., to see if they wanted in on the study. Then I’d have competing sponsors to balance the potential outcomes. Unfortunately, this scenario is pretty unrealistic because all those “big” food groups compete against each other, and would likely be worried about “losing” in the study. However, when nutritional scientists do run studies for industries and produce results and papers (like those raisin ones) that are predictable and as subtle as the US president elect, it is ultimately nutritional science and the people in general that “lose”.

If you like/hate this post, let me know on twitter. If you are an author of one of the above mentioned papers I’ll be at EB2017, come find my poster.

P.S. if you are from California Raisin Marketing Board and you just read this give me a call and maybe we can set up a study worth doing.

(Final thoughts on those raisin papers…)

1. Bays H, Weiter K, and Anderson J. A randomized study of raisins versus alternative snacks on glycemic control and other cardiovascular risk factors in patients with type 2 diabetes mellitus. Phys Sportsmed. 2015;43(1):37-43.
2. Anderson JW, Weiter KM, Christian AL, Ritchey MB, and Bays HE. Raisins compared with other snack effects on glycemia and blood pressure: a randomized, controlled trial. Postgrad Med. 2014;126(1):37-43.
3. Patel BP, Bellissimo N, Luhovyy B, Bennett LJ, Hurton E, Painter JE, and Anderson GH. An after-school snack of raisins lowers cumulative food intake in young children. J Food Sci. 2013;78 Suppl 1(A5-A10.
4. Patel BP, Luhovyy B, Mollard R, Painter JE, and Anderson GH. A premeal snack of raisins decreases mealtime food intake more than grapes in young children. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2013;38(4):382-9.

Dylan MacKay PhD is a nutritional biochemist at The Richardson Center for Functional Foods and Nutraceuticals at the University of Manitoba in Winnipeg. He is currently working on The Manitoba Personalized Lifestyle Research (TMPLR) program. Dylan has a special interest in human clinical trials and inter-individual variability. He is originally from St. John’s, Newfoundland where he started his graduate studies at Memorial University, he completed his PhD in human nutritional science at the University of Manitoba.

Saturday, December 10, 2016

Friday, December 09, 2016

Polish Commercial Wins This Year's World's Greatest Christmas Ad

Today's Funny Friday is a must watch (and I don't say that very often).

You might want to have a tissue handy as well.

Have a great weekend!

Monday, December 05, 2016

Holiday Gift Guide Edition

Full disclosure: Each of the items I'm mentioning today I purchased myself, use regularly, and love. I was not asked or paid by anyone to provide these reviews. You should know too, that if you use the links to purchase them on Amazon, I will receive a small commission (at no extra cost to you).
The Cookbook: Jerusalem, by Yotam Ottolenghi

This past summer I had the incredible fortune to spend two weeks travelling through Israel in celebration of my oldest daughter's bat-mitzvah. If you've never been to Israel, then you probably don't realize that the food there is incredible. Jerusalem, Yotam Ottolenghi's tribute to Israeli cooking, is both beautiful to read and to explore. While we've cooked a good percentage of its meals, with all being incredible, it was only after I returned from Israel that I found what for me is its truest gem. It's Ottolenghi's take on shakshuka.

For those who don't know, shakshuka is an Israeli comfort food. Often consumed for brunch, it's equally adept at serving as a dinner time meal and at its simplest is peppers and tomatoes stewed with a hot middle eastern spice paste, finished by poaching eggs directly in the mixture, and then eaten with crusty white bread.

When we were in Israel, one of the restaurants I needed to eat at was called, "Shakshukia" and the only thing they serve there is shakshuka. It was incredible. And when we got home, and I cooked Ottolenghi's version, it was almost a dead ringer (when made with Ottolenghi's pilpelchuma (which I'd recommend making with Ancho rather than Pasilla peppers and also doing a quadruple batch and then freezing, in 1/8 of a cup measures, the extra which will allow you to make shakshuka with at most 10 minutes of prep time)).

If you do make it, know that you can keep it vegetarian by cooking it as is, or you can, like I learned to do at Shakshukia, add some grilled merguez sausage to it.

Click here to buy for US readers, or click here to buy for Canadian readers.

The Surprisingly Awesome Kitchen Gadget: A Vacuum Sealer
Though it might not seem exciting, I can't tell you how much I love our vacuum sealer. We bought it this year to use in conjunction with the sous-vide setup I received for my birthday, and honestly, I think I've used it every single day since.

Of course its primary function for us is to freshly seal cooked meals (we batch cook so we always have lunch options and quick dinner options at the ready), and because it does so with a vacuum, the foods stay fresh for far longer than if you were to use (like we used to) Ziplock freezer bags. I have read in some places that you can save a great deal of money using a food saver, both in terms of the ability to buy meats on sale and freeze them without worrying about freezer burn, and also in terms of the heat-sealed bags being cheaper than Ziplocks - but I haven't done the math. What I do know though is that a vacuum sealer is more than that, and for chip-aholics like me, it's a great way to reduce my temptation to eat more. What I mean is that heat based vacuum sealers will also re-seal bags of chips (and rice, and spices, etc.). Doing so not only stops me from going back for seconds, it also keeps the chips as fresh as they day they were opened.

If you do buy one, or even if you use Ziplocks, another tip I've got is once sealed, smooth out the contents of the bags so that they're as thin and as flat as you can make them. That way they'll take up far less room in your freezer, and they'll thaw that much more quickly. The link below is to a Foodsaver version, I bought the one from the US link because it's cheaper and I didn't want fancy bells and whistles (and it's been great), but I couldn't find the same one for sale on Amazon Canada.

Because the prices vary regularly, and because there are many makes and models, make sure you hunt around on Amazon before choosing one, and you might also consider buying some discount bulk no-name vacuum sealing bags - so far they've worked well for us.

Click here to buy for US readers, or here to buy for Canadian readers.

The Incredibly Useful Kitchen Gadget: The Instant Pot Pressure Cooker

We bought ours a few years ago and we're using it more and more often and not just for speedier rice, beans, and quinoa. Don't worry about the space it takes up as the Instant Pot actually replaces a whole pile of devices in your kitchen as it is at once a pressure cooker, rice cooker, steamer, slow cooker, and even can be used as a saute pan. The online Instant Pot communities on both Facebook and Reddit are incredibly helpful, and recipe wise, Serious Eats has a pile as well.

Lately we've been using our Instant Pot to take a shortcut with Ottolenghi's shakshuka (using a can of San Marzano tomatoes and then a 45 minute high pressure run through the Instant Pot as opposed to the long simmer recommended by Shakshukia's chef and owner) - a shortcut inspired by this recipe for an almost as good all-day red sauce for pasta. The one thing we have yet to try is the yogurt making feature which I hear is easy and great.

These Instant Pots go on sale regularly, and there are many models, so once again, have a hunt around on Amazon before buying.

Click here to buy for US readers, or here to buy for Canadian readers

The Home Barista: The Breville BES870XL Barista Espresso

I bought this for my wife for her birthday 3 years ago and we've both used it virtually every single day since. Though it's definitely not describable as inexpensive (generally it runs around $500-$600), if over time it precludes your need to buy espressos, cappuccinos, americanos, or lattes at an expensive coffee shop, you may make some of your money back. For us, because we buy green coffee beans in bulk and roast them ourselves, I'm guessing a fancy coffee costs us somewhere on the order of $0.40 each. Multiply their savings over the at least 730 cups we pull a year and that argument about paying for itself probably holds water.

That aside, this thing is an absolute workhorse and it allows for tremendous customization of grind (the built in grinder works great), tamp, and temperature which in turn yields coffee shop worthy cuppas. It's also incredibly speedy. From turning it on, to a double espresso in my hand in just over a minute (and this includes the time it takes for the machine to heat, the beans to grind, me to tamp, and the pour).

Click here to buy for US readers, or here to buy for Canadian readers.

For other ideas, feel free to have a peek at my last year's gift guide which also includes the simple, relatively inexpensive coffee roaster we've been using for the past 4 years now.

Saturday, December 03, 2016

Saturday Stories: Post-Truthism, Anti-Semitism, And At Least 2 More Hate Filled Isms.

Photo Source: Nick Solari, Michael Vadon CC BY-SA 2.0 / Mario Santor, Georges Biard CC BY-SA 3.0
The inimitable Margaret Sullivan in The Washington Post on the post-truth world of the Trump presidency.

Alana Newhouse in Tablet with an incredible piece on anti-Semitism in America.

Tiffany Martínez, in her online journal, covers how the word "Hence" highlighted at least 2 more hateful biases currently in America.

Friday, December 02, 2016

Are There People More Dysfunctional Than Infomercial Befores?

It's hard to pick a favourite moron in today's Funny Friday, but if I had to vote, it'd be the guy cracking eggs.

Have a great weekend!

Wednesday, November 30, 2016

Guest Post: Skim Milk Makes Kids Fat. Or Does It?

Today's guest post comes from my friend and colleague Dr. Dan Flanders and it's about a topic that has in fact received a fair bit of attention over the past few years - full fat vs. skimmed fat milk and the proposed impact which you choose might have on your child's weight. If you're looking for Dan, you can usually find him on Twitter.
Last week, Target Kids!, a distinguished group of Toronto pediatric researchers, published a study on the relationship between the types of milk that young children drink and their weights. They demonstrated, quite convincingl,y that young children who routinely drink fattier milk (e.g. 3.25% whole milk) tended to be leaner than those who drank lower fat milk (e.g. skim or 1%). Likewise, children with overweight and obesity, were found by them tend towards drinking lower-fat milk than children who were leaner.

The authors suggested, as a possible explanation for these findings, that low fat milk doesn't satiate children very well and therefore probably leads to the eating of excess calories and consequently, the additional weight. Higher-fat milk drinkers, they proposed, feel fuller, and for longer, and are therefore less likely to overeat.

One can imagine how compelling this explanation might seem in light of our current international childhood obesity concerns. So is this the simple intervention we need to cure childhood obesity!? Probably not.

Consider, for example, what a sensible and caring parent of an underweight young child might do to help them to gain. As both a pediatrician and as a father of an underweight child, my first instincts and steps were to increase the fat content of my son’s milk. In fact it is common practice in the medical community for doctors and other allied health professionals to recommend switching to fattier milk as a means to encourage weight gain for young, slow-to-gain children.

Likewise, it is extremely common for parents of children who have excess weight to attempt reducing their children’s caloric intake by serving them lower-fat milk. And again, this is a practice that health professionals regularly recommend to help to “prevent childhood obesity”.

Coming back to this new study, in my opinion, the directionality is wrong, I think it highly unlikely that drinking fattier milk is causing leanness in children and that drinking low or no-fat milk is causing obesity. Rather, I would bet that the milk type that young children are drinking is probably being chosen by their parents as a consequence of their kids’ weight status’: fattier milk for the children who are lean and lower-fat milk for the ones who are heavy.

Effectively, this study shows a correlation, not a causal relationship, and its findings are just as (or perhaps more) likely to reflect sensible parenting decisions than the discovery of a new intervention to reduce childhood obesity.

So why write about this study? Well, in a word … The Media.

There can be an interesting and sometimes dangerous intersection between science and the media. As consumers and parents, we are eager to make good, health-promoting decisions for our children and families. When it comes to health and nutrition, these decisions ought to be properly informed by the process and outcomes of scientific inquiry, and be published in peer-reviewed scientific journals. But most of us are not scientifically minded enough to read, digest, and critically appraise peer-reviewed publications directly from the source, and so we turn to the media for help.

The media - broadcasters, journalists, health bloggers - play the important role of consuming, interpreting, and packaging science discoveries in a way that is digestible to mainstream consumers. Unfortunately, the media too often botch their coverage of important science discoveries by spinning stories to feed flashy and controversial narratives thereby, they hope, driving higher consumer subscriptions and ad revenues. Left in the dust is their mandate to responsibly inform consumers.

Using this milk study as an example: a fair and responsible way to cover this story might be to write some version of the following:
A correlation has been found between the type of milk that young children drink and their weight status. The study was unable to determine whether the type of milk consumed caused changes in body size or whether existing body size influenced the type of milk consumed. Future studies are needed to establish any causal connection.
Instead, here’s but a sampling of irresponsible headlines cranked out by some well-respected news publishers in response to this study:I am concerned that parents, wanting to do what's best for their children, have been misled by these headlines. Not only does this type of reporting send a statistically inaccurate message, but there is a real chance that these headlines will change (or have changed) parents’ family nutrition decisions with the risk of actually making things worse for their children.

I am even more concerned that this sampling of misleading health journalism is but a spit in the ocean; reckless health reporting is routine and commonplace. As a global community we must demand better from our journalism communities.

Dr. Daniel Flanders is a Toronto pediatrician and founder/owner of Kindercare Pediatrics. He has a special interest in pediatric nutrition and childhood obesity. Dr. Flanders completed his medical education at McGill University in Montreal and the University of Toronto’s Hospital for Sick Children. He is on staff at the North York General Hospital and is an adjunct lecturer at the University of Toronto’s Department of Pediatrics, Faculty of Medicine.

Monday, November 28, 2016

Can School Based Rummage Sales Put The Boot To Junk Food Fundraising

Right now our garage is literally filled with boxes of outgrown toys and kid related paraphernalia. Our plan had been to donate it all to one charity or another, but what if it could be put to use to help fund our kids' schools?

Thanks to the forward thinking of 13 year old Belle Pan, that might be possible one day soon.

The daughter of an entrepreneur, Pan developed iRummage - an online and app based infrastructure to allow schools to host year long rummage sales where the items for sale, and their listings, come from the schools' families. What else will this app do? According to Pan,
"We're going to train 100,000 ten year old CEOs. Raise money for schools? Check. Provide business education for kids? Check. All I'm asking of you is your old couch".

Here's hoping iRummage finds the funding it needs to launch, and that we continue to see innovations and ideas like Pan's push school junk food, bake sales, and fast food fundraising to the curb.

Saturday, November 26, 2016

Saturday Stories: Cancer, Locked Wards, and 1984

Hugely powerful piece by an oncology nurse who herself gets diagnosed with cancer and her apology to her patients for not understanding them before.

Haunting story from Taylor Elizabeth Eldridge in The New Yorker on her 17 days spent on a locked psychiatric ward.

And Andrew Simmons in The Atlantic on teaching kids about George Orwell's 1984 in 2016

Friday, November 25, 2016

Even Bears Are Better Dancers Than I Am

Sadly I was not blessed with any dancing genes.

Today's Funny Friday bears were.

Have a great weekend!

Wednesday, November 23, 2016

Why Are Dairy Farmers' "Dairy Educators" Invited To Teach Our Kids?

"What the hell is a Dairy Farmers of Ontario 'Dairy Educator' and why are they allowed to speak to my kids?"
That was the question posed to me by the reader who sent in this video.

Apparently it was shown to his Grade 4 student in school by a 'Dairy Educator' who clearly was invited by that kid's school to teach kids about "The Miracle of Milk" (that's literally the title of the video).

The claims in the video?

Milk contributes to (all direct quotes):
  • Strong bones and teeth
  • Strong muscles
  • Energy
  • Healthy blood and a healthy nervous system
  • Help prevent diseases like cancer
  • Healthy brain development
The video goes on to talk about how many servings kids should have, with the majority of kids in the video drinking from almost comically large glasses, and of course it features both chocolate milk and ice cream.

The video and the 'education' are part of a larger 'curriculum' offered to Ontario's schools.

The claims made by the video, and presumably amplified by the 'educator', certainly aren't those approved by the Canadian Food Inspection Agency, nor is milk miraculous.

So as far as what Dairy Farmer of Ontario Dairy Educators are - well they're marketers. But as to why they're being invited in to schools to market a product dishonestly to trusting children, I haven't a clue.

Monday, November 21, 2016

Some Reflections After 3,000 (!) Blog Posts (And A Personal Request)

After 3,000 blog posts, 43,000 tweets, apparently of late, I'm a cyberbully.

So was the conclusion of the two "Keto Dudes" who felt that me tweeting my thoughts about what I saw as Dr. Jason Fung's fat shaming was bullying behaviour. Never mind that I didn't mention him by name in my original tweets, or that I refused repeatedly to name him when asked afterwards, or that when he later outed himself and was questioned about his tweet by Julia Belluz he confirmed his intent and shamed another marginalized group by explaining to her that the opinions of experts with obesity on obesity are as worth listening to as the opinions of the homeless on finance.

The Dudes also provided some decontextualized tweets of mine as their proof of my bullying using this tweet launched at Dr. Oz in response to his continued anti-science, magic weight loss, predation promotions, this tweet sent to a local radio station whose morning show host had told listeners that he thought the government added mind control agents to vaccines and encouraged people not to get them, this tweet inspired by the Women's World cover I was standing in front of at checkout that had Dr. Oz' unflinching smile promoting "Metabolism Boosting Detox Diet Soup" with the promise of losing "30lbs in weeks", and this tweet, directed at a "functional" physician with an online store front to sell his cleanses and detoxes that among other things promise the desperate they'll be, "tonifying and rejuvenating" for their "entire adrenal systems".

I'd send each of them again.

But these tweets aside, to be sure there are definitely those I've sent, and blog posts I've written, that if given the chance, I'd do differently. Some because my opinions have changed. Some because the science has evolved. And some because, especially in the early days of my blogging and social media, I was too aggressive or arrogant. And yes, a few times over these past 11 years, 3,000 posts, 43,000 tweets, and 2,000,000 words, I've definitely gone too far. For those times, I'll point out that I'm human, fallible, and sorry.

All told, I'm proud of this blog. I started it as an outlet - both for my thoughts and for writing as a whole (I was an English major before switching into genetics), and I was writing it regularly long before anybody was reading it. And then, through a combination of the magic of the Internet and good luck, people took notice. Through it, and over 14,000,000 visits later, I've been able to affect real change - like when this blog post led Disney to, within 48 hours of its posting (and subsequent media swirl), to shutter an Epcot based ride that would have furthered fat-shaming of kids, or how being pathologically attached to Twitter, helped to expose Coca-Cola's cynical promotion of "energy balance".

My agenda is easy to describe - I enjoy writing and believe that through it, I am able to advocate for better health far beyond my office's four walls. No one pays me to write anything, and I refuse to host advertisements. In the blog, as I did in those tweets up above, I call things as I see them. I don't expect people to always agree with me, and certainly if you're hoping that I'll never write something that you find to be upsetting or wrong, eventually I'm sure I'll disappoint you. The good news of course is that you can always stop reading, or if you're so inclined, just as the Keto Dudes did, write about it - the Internet's everyone's canvas to share their opinions.

And now the ask.

While this blog will always remain free to read and free from advertising, if you've enjoyed it and found it to be valuable or entertaining, please donate to my Movember fundraising and my absolutely ridiculous lipterpillar.

Not a Snapchat filter
With this 3,000th post ask I'm hoping to raise $3,000 for men's health. Contrary to what some believe, Movember is not a prostate cancer charity, and though some of its funds do go to prostate cancer research and treatment, Movemeber funds multiple men's health initiatives including those involving mental health, suicide, body image, eating disorders, testicular cancer, and more. Regarding prostate cancer, I was pleased to see that Movember encourages patients to speak with their physicians about the value (or lack thereof) of PSA screening, rather than suggesting it's a good idea for one and all.

For me the ask is personal. My father was diagnosed with prostate cancer back when I was in medical school, and soon I'll need to start wrestling with whether or not with that strong family history, I should walk the slippery slope of testing. My oldest cousin - we lost him to substance abuse.

Every dollar counts, no donation is too small, and if you want, you can make your donation anonymously.

Donating is easy. Just click here and give! And of course, Movember is a registered charity, so all donations are fully tax deductible.

So here's to another 3,000 blog posts, and thanks for reading.

(Oh, and keto folks who might be reading this, please know that there's nothing stopping you from being pro-keto/IF, anti-CICO, and at the same time, anti-fat shaming)

Friday, November 18, 2016

Patton Oswald Says The Election's Over and It's Time to Choke It Down

Pretty much.

Today's Funny Friday, so good, though it's not all that funny now is it?

Have a great weekend!

Wednesday, November 16, 2016

The Two Easiest Lifestyle Tweaks To Improve Your Blood Sugar

In my practice I see loads of patients who have diabetes, and loads more of patients on their ways there.

No doubt many of those patients do, or will, take medication to control their blood sugars, but there's also no doubt that attention to diet and exercise can, in many cases, either preclude the need for medication, or reduce the medication needed.

While I've written before about the challenges that reality throws at intensive behavioural changes geared towards health, there are two easy, accessible, tips that evidence suggests can have a real impact on your blood sugar.

1. Take short, post-meal, walks: A study published in the December 2016 issue of Diabetologia compares the impact of 10 minute post-meal walks on blood sugar levels. According to their findings, those short walks led to post-walk decreases in blood sugar of 22%. And while walking after each and every meal may not be doable for everyone, it's not all or nothing. Simply put, if blood sugar's a concern, anytime you're able, here's a great incentive to add a few steps to your day.

2. Eat your carbs last: A study published in Diabetes Care last year explored the impact of food order on post-meal blood sugar. The thinking is that eating proteins, fats, and fibrous vegetables first, slows down the speed with which the body absorbs the meal's carbohydrates. Though it was just a small study, the results were heartening. After eating identical meals, but where subjects were instructed to either eat the carbohydrate portion of their meals first (in this meal's case it was orange juice and ciabatta bread), or last, blood sugar levels were monitored. And when eating their carbs last, their blood sugar levels were 29% lower after the first half hour, 37% lower after one hour, and 17% lower after two hours.

While it's important to bare in mind that these were both small studies, given that they carry zero risk, and that they're both quick and easy, there's certainly no harm done employing them.

(and here's hoping someone's studying the impact a combination of these two simple interventions might have)

Monday, November 14, 2016

Ontario & Quebec Schools - A Food Industry Partnership You Should Explore

They're called Green Apple Grants and they're a program run by the Metro supermarket chain.

The $1,000 grants are available to every public and private elementary and high school in Ontario and Quebec and the grant applications are due by December 31st.

The grants are for projects designed to increase students' consumption of fresh fruits and vegetables. Schools can apply for up to two grants and past projects in other schools have included the establishment of school gardens, cooking classes, revamping school cafeteria options, hiring RDs or chefs to give workshops, and many more.

As to who can apply, anyone affiliated with the school (principal, teacher, professional advisors, nurses, etc.) can submit an idea with the principal’s approval.

The program has allocated $500,000 for Ontario schools, and $1,000,000 for Québec schools.

For more information and application instructions, have a tour of the Green Apple School Programs page here (and if you're in Québec make sure to hit the change province button).

Saturday, November 12, 2016

Saturday Stories: Post-Election Edition

Of the hundreds of post-election stories out there, here are some that resonated with me.

Michael Schur has his Twitter based election post-mortem compiled in Paste.

Lindy West in The New York Times with her version of what happened on election day.

James Hamblin in The Atlantic on health care under Trump.

Mark Joseph Stern in Slate on why as a gay Jew in Trump's America he's afraid for his life.

Paul Krugman in The New York Times and his "thoughts for the horrified"

Russian dissident and journalist Masha Gessen in The New York Review of Books with her rules for surviving an autocracy

Friday, November 11, 2016

Never Rake Leaves Around Panda Cubs

Today's Funny Friday was probably a lot less funny for the zookeeper.

Have a great weekend!

Thursday, November 10, 2016

There Are Thin Bodies Too

I was surprised a few weeks ago to learn that a joint advertising campaign between the Toronto Ballet and the Toronto Transit Commission was deemed controversial and criticized as promoting
"unrealistic and highly regimented bodies as some sort of an ideal of ‘beauty."
The campaign, titled, "We Move You", features members of the Toronto Ballet in poses in and around Toronto's subway stations, street cars, buses, and trains.

There's no denying of course the dancers are very lean, and don't look like you or me.

But the campaign isn't tied in any way to self worth, beauty, or health.

It's a campaign highlighting the incredible athleticism and grace of ballet dancers, along with the fact that subways literally move people.

Though I definitely agree with the critic's statement that
We can’t deny that there is a lot of body-based discrimination that happens … within our moves around the city”,
isn't the suggestion that the bodies depicted in these pictures are somehow wrong or unhealthy a form of body-based discrimination?

While I'm clearly not shy to call out fat shaming, I just don't think this is that. There are thin bodies too.

Monday, November 07, 2016

The Canadian Armed Forces Need Help On Obesity

Today's anonymous guest post is a letter I received a few weeks ago from a member of Canada's armed forces who wanted to fill me in on how obesity is being handled with our soldiers. The letter speaks to the fact that doctors and dietitians are not uniformly trained or capable of providing helpful, or thoughtful, advice, and that despite all evidence to the contrary, that the way to deal with obesity is at once simple and easy.
Good Morning Dr. Freedhoff,

Please let me start by thanking you for your efforts on promoting bariatric health (I own your book and subscribe to your blog).

It took me some time to work up the courage to write you on the issue surrounding obesity in the Canadian Armed Forces (CAF) as we are not meant to air our dirty laundry in public. However, I thought you might be interested in some of the recent media attention surrounding obesity in the CAF and how the issue is dealt with in our organization.

First, please note that I am obese. I weigh approximately 230lbs and am 5’7". I am active (running, cycling) and do not have any issues meeting the minimum fitness standards in the CAF. I would describe myself as someone who is carrying extra fat (read not a body builder).

This article (along with a couple of variants) have been getting media attention inside my organization of late and the issue of obesity is something that the organization wants to address (adding weight and waist circumference measurements to our fitness testing routine, introducing incentives to motivate members to improve their fitness scoring, and general fitness promotion). The article discuses more stringent fitness standards for a deployment when, in fact, the battle fitness test is a more specific assessment (marching with a “heavy” pack, fireman’s carry, etc.).

I was provided with some advice on how to lose weight from the CAF health services organization:
  • Establish a starting weight (i.e. 230 lbs), and by the next week aim to be at 229. If by the next week I am not at 229, do not eat until I am. Repeat as required until I achieve goal weight (Medical Officer)
  • Restrict calories (especially carbohydrates) in the evening (Medical Officer)
  • After reviewing my food log (that didn’t contain ice cream) I was advised to reduce caloric intake by eating a bowl of ice cream each night instead of a full pint (Dietitian).
Needless to say, there is a negative connotation with being obese in the CAF. It is my opinion that the organization could find better ways to support its members in their efforts. As an example, at my most recent medical appointment I was happy to find that I had lost 15lbs over the past year (largely due to increased activity) but I was told that it was probably just water, not fat and that there was much more work to do to reduce my BMI to a healthy level.

As someone who is struggling to improve my fitness/health, it is fairly obvious that my organization does not understand the complexity of the issue they are trying to address. I appreciate your efforts to promote bariatric health and to advocate for obese/overweight people.
Here's hoping that over time, the military, and everyone else, starts to wrap their heads around the straightforward fact that scales (or BMIs) don't measure the presence or absence of health, and that the truism of "eat less, move more" is no more helpful to obesity than "buy low, sell high" is to wealth.

Saturday, November 05, 2016

Saturday Stories: Performance Enhancement, Slow Cookers, and Scientific Training

Picture by J. Kenji Lopez-Alt
Brad Stulberg in The Science of Us on the only performance enhancing supplement truly proven to work.

J. Kenji Lopez-Alt in Serious Eats on why slow cookers sit on the low rung of flavour.

Nick Tumminello in Shredded by Science tackles what he sees as the top 10 arguments against science based training and nutrition.

Friday, November 04, 2016

Candidate For World's Greatest Dog Owner

Even if you're not a dog person, it's impossible not to love today's Funny Friday video.

Have a great weekend!

Wednesday, November 02, 2016

New Brunswick Says Slush Puppies Provide "Maximum Nutritional Value"

Need proof that 5-10 years is too long to wait for improved nutrition guidelines from Health Canada?

That photo up above is from New Brunswick's George Street Middle School's cafeteria's Facebook page. They're highlighting the fact that they've recently installed this Slush Puppie machine for their students.

Slush Puppies, for those who aren't clear, are non-carbonated, vitamin fortified, juice concentrates, poured over ice.

Each glass of Slush Puppie Plus contains 7 teaspoons of free sugars - more than the World Health Organization and Canada's Heart and Stroke Foundation recommends as a total daily limit for kids.

This led one concerned parent to write to George Street Middle School's cafeteria to express her concern.

The response she received in reply?

It spelled out that the vitamin fortified liquid candy machine that the school installed was not only not cause for concern, but rather was a drink that was defined by New Brunswick's Healthier Foods and Nutrition in Public Schools Policy 711 as being of Maximum Nutritional Value which
"indicates foods that are a good or excellent source of important nutrients and are low in fat, sugar and/or salt. These foods are considered nutrient dense relative to the energy they provide. These foods should be offered on a daily basis and comprise the majority of foods/beverages served in schools."
And it's not just a New Brunswick inanity by the way. When writing this blog post I noticed that Slush Puppie Plus is making the rounds in US schools as well where it is reported to meet the “Alliance for a Healthier Generation” Guidelines for 100% Juice in Elementary, Middle and High Schools.

And no, just in case you were wondering, this isn't The Onion.