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.