Saturday, March 25, 2017

Saturday Stories: Opioids, Integrative Dietetics, and DNA Horoscopes

Travis Rieder in The Washington Posts explains how doctors got him hooked on opioids, and then didn't help him come off them.

Kevin Klatt in Science Based Medicine bemoans his dietetic profession's new found embrace of integrative and functional medicine.

Sarah Zhang in The Atlantic on how commercial DNA testing is akin to a modern day horoscope.

Bookmark and Share

Friday, March 24, 2017

Rare Footage of the GOP's AHCA Planning and Prep

And yes, today is Funny Friday.

Have a great weekend!



Bookmark and Share

Wednesday, March 22, 2017

Junior Kindergarteners and The Unnecessary Crutch of Junk Food

Sent to me by a reader and I wanted to share.

It's part of a school newsletter for her kid's Junior Kindergarten class. Here's what caught her (and my) eye. On Wednesday's the school has a "WOW" day - where the students are encouraged to walk to school.

Those who did most recently received a free hot chocolate.

Also, kids who rode the bus to school received a free hot chocolate, because though not walkers, their use of public transport reduced greenhouse gas emissions.

Oh, and to raise money for the Canadian Wildlife Federation, the children were able to purchase hot chocolate. In all they raised $166.

In looking for a photo for this post, I came across another school's page discussing how, "Math plus Zippers equals Hot Chocolate Party!" whereby the kids in the class ate cookies and then learned how to graph by plotting how delicious they were, and then completed a second graph of whether or not they enjoyed marshmallows in their hot chocolate. Later that same week, to celebrate the fact that every kid learned how to do up their own jacket's zipper they were rewarded with a "Zipper Party" to celebrate the achievement with cookies and hot chocolate.

To be very clear, these schools aren't examples of schools that don't care about their kids, they're just examples of how normalized the use of junk food has become in rewarding and entertaining our children. Bet all of these kids would have had just as much, or more enjoyment, with an extra gym class, extended recess, a dress up day, a dance party, helping with the school's morning announcements, etc.

Just because junk food works, doesn't mean we need to use it.

Bookmark and Share

Monday, March 20, 2017

California Public Libraries Giving In-N-Out Burgers to 4 Year Olds

I've written about child literacy and junk food before with the young reader marketing partnerships and cause-washing of McDonald's, Pizza Hut, Burger King, and Arby's. Today's example comes from California Public Libraries and their promotion of In-N-Out's "Cover to Cover Club"

Here are the program's details as described by the Saratoga Springs Public Library

For every 5 library books your kid reads, they'll receive a coupon good for an "achievement award".

The award?

An In-N-Out hamburger or cheeseburger (limit 3 per child apparently)

Kids today have no shortage of opportunities to eat fast food. Should public libraries be encouraging, enabling, and permitting more? I'd also love to know if this initiative actually increases library foot traffic and books read or just rewards kids who were already reading for the love of reading with fast food?

And if city run public institutions wanted to provide some incentive for young kids to read and use libraries, how difficult would it be for them to partner with city run community centres to hand out coupons for free admissions to local public pools or with the Parks Service to hand out free day use fee coupons for a nearby State park?

Bookmark and Share

Friday, March 17, 2017

Just a Spectacular Supermarket Commercial Championing Produce Over Products

Thanks to one of my Facebook readers for sharing this incredible supermarket video that's serving as today's Funny Friday.

Have a great weekend!



Bookmark and Share

Thursday, March 16, 2017

A New Heart and Stroke Funded Report Calls For a "Sugary Drink" Tax

Not a soda tax. And not a sugar-sweetened beverage tax. Instead Canada's Heart and Stroke Foundation's (HSF) latest funded report makes the case for a "sugary drink" tax which would include of course sodas, sugar-sweetened beverages (chocolate milks and drinkable yogurts for instance), but also naturally sugary drinks like 100% juice.

According to the report, Canadians purchased an average of 444ml of sugary drinks per day. And that's a per capita average which includes people like the 5 members of my family who purchase an average of none a day - so clearly those who are drinking sugary drinks, are actually averaging more than that. Dishearteningly, things are even worse for youth with the report finding them buying 578ml per day for Canadians between 9-18 years old.

That's a huge amount, and while some might be confused given the regular coverage of decreasing soda and juice consumption, the report explains,
"Over the past 12 years (2004 to 2015), the per capita sales volume has decreased for regular soft drinks (-27%), fruit drinks (-22%), and 100% juice (-10%). In contrast, per capita sales volume increased for energy drinks (+638%), sweetened coffee (+579%), flavoured water (+527%), drinkable yogurt (+283%), sweetened tea (+36%), flavoured milk (+21%), and sports drinks (+4%). In 2004, sales of flavoured water, flavoured milk, drinkable yogurt, and energy drinks were negligible. However, by 2015, these categories accounted for approximately 18% of all sugary drink sales, and compensated for the 7% proportional reduction in sales of regular soft drinks since 2004."

Breaking it down into dollars and cents, the report estimates that sugary drink consumption will lead to over $50 billion in direct health care costs over the next 25 years coming from the costs associated with their projections of 25 years of unchecked sugary drink consumption contributing to
"900,000 new cases of type 2 diabetes, 300,000 new cases of ischemic heart disease, 100,000 new cases of cancer, and 40,000 strokes. Canadians’ sugary drink consumption is estimated to account for 63,000 deaths and almost 2.2 million disability adjusted life years (DALYs), which represent premature death or poor health."
In turn, according to their modelling, a 20% sugary drink tax would generate $43.6 billion in tax revenue as well as $11.5 billion in direct health care savings from averting many of the cases, conditions and DALYs noted above.

In my opinion it's a matter of when, not if, we'll have some form of sugary, or sugar-sweetened beverage tax in Canada, and the sooner, the better.

[If you're curious about the report's methodologies and assumptions, please head over to the HSF's media centre where they're hosting the full report.]

Bookmark and Share

Monday, March 13, 2017

New Research: Unless You Have Celiac Disease, It's Probably Not the Gluten

No one's saying that people's symptoms aren't real, but there's little doubt that more folks believe they have gluten sensitivities than actually have gluten sensitivities.

A recent study sought to explore that a bit further. The paper, Suspected Non-celiac Gluten Sensitivity Confirmed in few Patients After Gluten Challenge in Double-blind, Placebo-controlled Trials, examined all of the double blind placebo controlled trials that in turn showcased a gluten and a placebo challenge in people with self-identified non-celiac gluten sensitivity (NCGS). All told, when combined, there were 1,312 such study participants involved in 10 studies (most with differing methodologies).

Without getting stuck too deep in the weeds, the authors assert that someone who truly suffered with NCGS should both develop symptoms while being presented with their gluten inclusive challenge, as well as lack those same symptoms when presented with their placebo challenge. While many did in fact show sensitivity to the gluten challenge, they also demonstrated sensitivity to the placebo challenge (meaning they reported side effects on placebo too).

This finding led to the authors' conclusion
"The present review shows that over 80% of non-celiac patients, labelled as suffering from NCGS upon a favorable response to a gluten-free diet, cannot reach a formal diagnosis of NCGS after a double-blind, placebo-controlled gluten challenge."
Of course there are weaknesses to their analysis (as the authors point out) including the fact that there is no consistent, evidence based, methodology for these sorts of studies and that many of the studies used smaller gluten doses than the average daily amount currently being consumed in Western countries.

As to what's going on, the authors wonder too whether or not some studies are confounded by a failure to truly exclude those with celiac disease and/or whether some simply developed symptoms consequent to being sensitive to high FODMAPs. The authors also point out that it would be important to explore the many non-gluten proteins also found in wheat, and they included a diagram to explain the many possible symptomatic overlaps.

But at the end of the day, does it matter for those who report suffering?

Certainly if you suffer with a food sensitivity, and avoiding that food makes you feel better, no one, not me, nor the authors of this paper, would ever tell you to stop avoiding it.

Bookmark and Share

Saturday, March 11, 2017

Saturday Stories: Woolly Mammoths, Amish Forgiveness, Fetishised Virtue

By Flying Puffin - CC BY-SA 2.0
Ross Andersen in The Atlantic on how the resurrection of woolly mammoths might help in the fight against global warming.

Jake Edmiston in the National Post with a story of an Amish family's remarkable forgiveness.

Maajid Nawaz in The Times of Israel what what he sees as the fetishised "mother of all virtues".

Bookmark and Share

Friday, March 10, 2017

Real Italian Grandmothers Try The Olive Garden For The First Time

Today's Funny Friday is a treat. The Olive Garden? Not so much.

Have a great weekend!



Bookmark and Share

Wednesday, March 08, 2017

London Health Science Centre Says Eat Chicken Wings For Cancer

Today's installment of what seems like a never ending parade of questionable partnerships between hospitals and junk food is the eat chicken wings for cancer campaign being promoted by London Health Science Centre.

This particular campaign comes hot off the heels of the recent report in the British Medical Journal highlighting the strong evidence of obesity being a contributor to at least 11 different types of cancer.

Once again, I have to ask, are the dollars raised in these sorts of campaigns worth the promotion of lifestyles that themselves contribute to the burden of illness being seen by the very programs and providers the fundraising is meant to support?

Bookmark and Share

Monday, March 06, 2017

My Oldest Daughter Fixes Fronts of Packages - A Pictorial

For her science fair project, my oldest daughter looked at the impact of front of packages on consumer perceptions of health. As part of her study, she fixed up some package fronts with more realistic statements.



Bookmark and Share

Friday, March 03, 2017

Who Knew Guinea Pigs Loved Pumpkin Spice?

I sure didn't, but today's Funny Friday convinced me they do.

Have a great weekend!



Bookmark and Share

Wednesday, March 01, 2017

Should We Be Treating Type 2 Diabetes with Surgery?

Photo By Mr Hyde 
I'm resurrecting this piece, for the second time now, consequent to last week's online first publication in the New England Journal of Medicine of the 5 year data that continues to strongly support the use of bariatric surgery to treat type 2 diabetes.
In case you missed the news, a recent study published in the New England Journal of Medicine demonstrated dramatic superiority of surgery over intensive medical management in the treatment of type 2 diabetes.

Now I'm not going to get into the study here in great detail, but it's a continuation of a trial that's been running for 5 years now that is regarded as being well designed. And while admittedly we still don't know what their long, long, term benefit will be, at 5 years out, they look damn good with surgery coming out worlds better than "intensive medical therapy" for the treatment (and remission in many cases) of type 2 diabetes.

Of course time's definitely a fair concern. Meaning what if 10 years down the road the folks who had the surgery are no better off than those on medical therapy? Thing is, based on what we know already about the surgeries involved, all have well known 10 year data, and the bypasses and diversions much longer than that, and those studies, while they weren't specifically designed to look at diabetes alone, did look at weight and medical comorbidity regains, and I certainly don't recall anything that suggested diabetes returned with a vengeance.

So basically here we have a surgical intervention that is dramatically better than a medical one, for a condition that causes cumulative damage and can wreak havoc on a person's quality and quantity of life.

Yet many MDs, allied health professionals and health reporters, including some who I know, respect, and admire, are taking this opportunity to discuss how we shouldn't be looking to surgical solutions for diabetes because patients could instead use their forks and feet. While there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress - the simple fact remains that we don't yet have a proven, reproducible and sustainable approach to lifestyle change.

And what of those folks not wanting to change?  I say, "so what?".   Since when did MDs, allied health professionals or health columnists earn the right to judge others on their abilities or desires to change? Our job is to provide patients with information - all information - including information on lifestyle change, medical management and surgery. We can even provide patients with our opinions as to which road we think may be best for them, and why, but honestly, given the results from these studies, I'm not sure how anyone could make an evidence based case that surgery isn't a very real and powerful option that ought to be discussed with all of their patients with type 2 diabetes and obesity.

Unless of course that someone has some form of weight (or simply anti-surgery) bias.

Let me give you another example. Let's say there was a surgical procedure that folks with breast cancer could undergo that would reduce their risk of breast cancer recurrence by roughly 30%.  Do you think anyone would question a woman's desire to have it? I can't imagine. And yet lifestyle - weight loss and exercise has indeed been shown to reduce risk of breast cancer recurrence by 30%. Think people would dare suggest the women choosing surgery were, "taking the easy way out", that they should just use their forks and feet?

We've got to get over ourselves.

Until we have a proven, remotely comparable, reproducible, sustainable, non-surgical option, if you bash the surgical option on its surface for being "easy", or "wrong", you might want to do a bit of soul searching as to whether or not you're practicing good medical caution, or if instead you're practicing plain, old, irrational bias.

[and for new readers to ensure there's no confusion - I'm not a surgeon]

Bookmark and Share