Tuesday, April 17, 2018

Aspartame Doesn't Increase Lean Adults' Weights, Appetites, Or Blood Sugars, In 12 Week Randomized Controlled Trial

So what happens to healthy, lean, adults, if you randomly assign them to consume 0mg, 350mg or 1,050mg of aspartame daily for 12 weeks?


Well at least nothing if you're measuring their weights, body fat percentages, appetites, blood sugars, insulins, incretins (GLP1), lipids, fasting leptin levels, or liver function tests. Those were in fact all the things that were looked at in this recent study.

Sorry chemophobes.

(but conspiracists can still rest easy knowing that funding was provided in part by aspartame producer Ajinomoto, and of course it would be nice to see this study repeated with study participants with obesity)

(And if you're interested here's a recent review that looked at both observational studies on non-nutritive sweeteners and randomized trials looking at non-nutritive sweeteners which found that while observational studies suggest risk to weight, to date, randomized trials, now including this one it would seem, don't).

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Monday, April 16, 2018

Ontario Schools Inviting Pizza Nova To Teach Nutrition To Kindergarteners Is Apparently A Thing Now

Thanks to a colleague that probably should remain nameless for sending me this story about his 7 year old's recent nutrition lesson.

Here's the letter and photos he sent.
Hi Dr. Freedhoff,

Hope you are well, I got into a heated debate with my stubborn 7yr old son (who is starting to test the theory that I am the smarter person he knows) and I thought of you because I have seen you blog about this before.

Monday he came home with homework from a special nutrition lesson they got today from a rep from Pizza Nova. The Pizza Nova came in and fed them pizza (unknown to us), taught them to make pizza dough, and continued to teach these young impressionable minds that pizza is one of the healthiest foods there is because it has all of the food groups.

The homework included an activity book and once complete they receive a coupon for a free pizza.

This is a tipping point for me, the school already has pizza day every 2 weeks, theme food days all the time, bake sales, freeze sales regularly, food fundraisers and the list goes on, now we have food companies advertising to children false info about nutrition.
When he questioned his 7 year old's teacher, the one who invited Pizza Nova to teach her students about nutrition, about the wisdom of the guest teachers, she saw nothing wrong with it and explained to him how it is nice to have community partners come in to break up the regular school day.

As part of writing this story, I did some Googling. Apparently this isn't a one-off, and that rather this is a common event at Kindergartens across Ontario including Oakville, Hamilton, Toronto, Whitby, and Bowmanville (that's where the letter writer's son goes to school).

In fact, according to Pizza Nova, last year,
"over 120 schools, participated in over 600 workshops, entertaining more than 27,000 children."
Call me old fashioned, but I don't think schools should be providing the food industry, or any industry for that matter, with access to our children. let alone inviting a fast food company to teach nutrition to Kindergarteners.

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Saturday, April 14, 2018

Monday, April 09, 2018

Tony Robbins, With Estimated Net Worth of $500 Million, Not Rich Enough, Peddles Expensive Nutritional Bullshit

Thanks to my friend and colleague Brant Slomovic who alerted me to the fact that self-help guru Tony Robbins has apparently got himself into the nutritional nonsense business.

There's his $79/month BioEnergy Greens,
"packed with superfoods, this powder nourishes your body at a cellular level giving you more energy, quicker recovery from exercise, mental clarity and overall increased well-being."
Oh, and then there's $69/month Energy Now which
"will help boost your energy, focus and strength all vital elements of staying sharp and keeping your body at its peak."
Or how does strengthening and supporting your immune system to prevent illness sound? If good then maybe you need $39/month ImmunoBoost-C which apparently Tony takes,
"to prevent falling sick during his rigorous, nonstop travel and 16-hour workdays."
And how can you resist Vital Energy? At $189 per month it's a steal given Tony says it'll
"prevent illness, eliminate brain fog and experience lasting endurance all day, every day."
But if you're serious about your health, clearly you'll need to pony up another $219 to buy Tony's 10 day Pure Body Cleanse, because as Tony points out,
"Toxins. They are in the air we breathe, the water we drink and the food we eat. And they are hurting every part of our body.

Toxic buildup in our body can contribute to chronic fatigue, body odor, insomnia, skin problems, bloating, headaches and our mood.

Your body is a machine, and when you fail to take care of it, it breaks down. Even when you make healthy choices, detoxing is a crucial step in maintaining lasting peak health.
And hey, if you're struggling to lose weight and keep it off, Ultimate Weight Loss has you covered, where you can,
"achieve and maintain successful, healthy weight loss in 14 days with Ultimate Weight Loss."
No really, just 14 days, I mean it even says, in big letters,
"Hit your weight loss goal in just 14 days – and keep it off for good."
And just $189 for lifetime weight loss, who could say no?

Of course, there is this disclaimer on each and every page. I wonder if it'd be worth paying attention to?

Oh, and Tony, if you're reading this, though of course I knew you were a salesman, somehow I didn't think you'd stoop this low. My mistake.

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Tuesday, April 03, 2018

Guest Post: Coca-Cola's "Commitment To Transparency" Fails To Identify Over 95% Of The Authors They've Funded Since 2008

Today's guest posters Paulo SerĂ´dio, Martin McKee, and David Stuckler, recently published a paper in Public Health Nutrition about Coca-Cola's transparency initiative whereby using a tool they'd created, they found that Coca-Cola's transparency initiative failed to identify over 95% of the 907 authors who published one of the 389 articles funded by Coca-Cola. What was also clear was that Coca-Cola's funded research focused primarily on emphasizing the importance of physical activity and the concept of ‘energy balance’. Stay tuned for more from these 3 on this file in the nearish future!

(A version of this post was originally published on the blog of Public Health Nutrition)
Is Coca-Cola really a model of research transparency?

Can we trust research on nutrition paid for by Big Food? Some argue that, as the industry profits from sugar-sweetened beverages, known to increase risks of childhood obesity and diabetes, they can be expected to support research that creates confusion and doubt about those risks. Others contend that researchers are independent and, as funders have no role in the study design, methods, interpretation or publication, the findings can be trusted.

What both sides agree on is the need for transparency. Its importance became clear in August 2015, when the New York Times published documents, obtained using freedom of information laws, that Coca-Cola had provided $1.5 million in financial and logistical support to the “Global Energy Balance Network”, a non-profit organization led by influential academics at the Universities of Colorado, West Virginia and South Carolina, and whose main message was that there was no compelling evidence of a significant link between sugar-sweetened beverages and obesity.

In response, Coca-Cola company published its so-called “Transparency Lists” of a combined 218 researchers and health professionals whom they had funded since 2010.

In our recent paper, we constructed a new database of the scientific articles published since 2008 reporting funding from Coca-Cola. We did this by writing a computer program to extract and parse funding statements from articles, captured by Thomson Reuters’ Web of Science database. We have made the program, written for R-software, publicly available and we hope that others will use it to search systematically search for literature funded by those with vested interests in research, such as the agrochemical, alcohol, tobacco, and other industries (freely available for download here).

Using this new dataset, we investigated four important questions:

Question 1: Are Coca-Cola’s transparency lists complete?

Using the data we gathered from Web of Science, we built a list of researchers who authored scientific articles where Coca-Cola’s funding was acknowledged, by following the same criteria that guided the makeup of Coca-Cola’s own transparency disclosure, which are available from Coca-Cola’s transparency website. We found discrepancies between the list of names that Coca-Cola’s disclose as people they fund and what can be found publicly in Web of Science. Overall, we identified 471 authors, involved in 128 Coca-Cola-funded journal articles (published between 2010 and 2015), who report Coca-Cola funding but do not appear in Coca-Cola’s transparency disclosures.

Question 2: How many studies and authors are funded by the Coca-Cola brand?

If we expand our search to the Coca-Cola brand, and include research published before 2008 and after 2015, we find that the company and its affiliated organizations have funded 461 studies between 2008 and 2016, involving 1,496 different authors (we concede not all were grant recipients). We provide a visualization of this research in the form of a co-authorship network where every researcher (nodes in the network) is linked to another researcher if they co-authored an article that acknowledges funding from the Coca-Cola brand (see Figure 3). To put Coca-Cola’s transparency initiative in perspective, we apply a network partition color scheme that highlights (1) researchers that appear on Coca-Cola’s transparency disclosures; (2) researchers that declare funding but did not appear on Coca-Cola’s transparency disclosures, and (3) researchers funded by Coca-Cola’s international affiliate companies (subsidiaries and bottlers).

Question 3: Which research topics and interventions are supported by the company?

Using structural topic modeling, a method of quantitative text analysis, we found that this research focused predominantly on topics such as “energy balance” and “physical activity”, a narrative that tends to divert attention from sugar and calorie consumption (you can find an interactive data visualization of the research topics here).

Question 4: Are Coca-Cola funded researchers declaring their links to the company in their publications?

We found that 17% (38) of researchers on Coca-Cola’s transparency list did not acknowledge funding from the company in their subsequent publications. Obviously, we could not tell whether this omission was intentional, but were it not for the company’s public acknowledgement, we would not know these researchers had collaborated with the company.

So can we trust Coca-Cola’s disclosures?

Our study suggests that Coca-Cola has taken a positive step in releasing details of research it funds, but it is clear that still a great deal of information is missing. Both the company and the researchers underreport their funding. This may be in an effort to minimize funding when it could be attached with a stigma in the eyes of public health researchers. Relying exclusively on funding statements may also give us an incomplete picture, as they often do not include the necessary information to identify the Principal Investigator(s) and the year in which the grant was awarded.

Nonetheless, approaches such as ours can help improve transparency in two ways. First, by aggregating research funded by Coca-Cola we can reveal the scale of the company’s involvement in research as well as providing a benchmark that can be used to evaluate the company’s transparency pledge; second, we leverage the company’s transparency disclosure to assess how good are researchers at revealing Coca-Cola’s financial support.

Our results underscore the need for transparency to avoid potential conflicts of interest in research funding.

Paulo SerĂ´dio is a postdoctoral researcher at the School of Economics of the University of Barcelona, an associate member of the Department of Sociology of the University of Oxford and a visiting fellow of the Paris Institute of Complex Systems. His research merges insights from the fields of political economy, network science and data mining to study corporate influence on politics.

Martin McKee, CBE MD DSc. Martin is Professor of European Public Health at the London School of Hygiene and Tropical Medicine, Research Director at the European Observatory on Health Systems and Policies, and past President of the European Public Health Association. His work has been recognised by election to the US National Academy of Medicine and UK Academy of medical Sciences, as well as by numerous visiting professorships, five honorary doctorates, and prizes and awards. He is best known for his research on the health effects of the collapse of the Soviet bloc, European law and health policy, and the health effects of the financial crisis

David Stuckler is a Professor of Policy Analysis and Public Management, Bocconi University in Milan. His research uses large datasets and statistical modelling to understand the root causes of epidemics.

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Saturday, March 31, 2018

Saturday Stories: Death, Bike Riding, And Cow Surfactant

By Sue Rangell (derivative), Marc29th (original) [CC BY-SA 1.0 or GFDL], via Wikimedia Commons
Rachel Aviv, in The New Yorker, asks what it means to die?

Emily Brown, in The Outline, on learning to ride a bike as an adultE.

Eric Broodman, in STAT, on how an inconspicuous slaughter house keeps the world's premature babies alive (requires STAT Plus, and they offer first 30 days free)

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Wednesday, March 28, 2018

Watch Out For These 83 Weaselly, Quacktacular, Words

A few days ago I asked on Twitter for people's red flags of quackery words - words that if seen might suggest a less than evidence based approach.

I've compiled the ones I've received so far, and while of course there will be plenty of times where these words are used credibly, I'd venture that the more of these words you see on any particular website, the less likely that site's information is worthy of attention or action (unless of course the article is about quackery).

(the list is in no particular order, and if you think I've missed any, please share with me on Facebook or Twitter)
  • Bulletproof
  • Detox
  • Cleanse
  • Optimize
  • Magnetic
  • Toxin
  • Easy
  • Quick
  • Instant
  • Simple
  • Trick
  • Hack
  • Biohack
  • Secret
  • Holistic
  • Natural
  • Organic
  • Guaranteed
  • Boost
  • Supercharge
  • Block
  • Burn
  • Alkaline
  • Acidic
  • IV
  • Ozone
  • Miracle
  • Amazing
  • Energy
  • Aura
  • Ionic
  • Ionized
  • Crystals
  • Magic
  • Cure
  • Super
  • Proven
  • Purest
  • Safest
  • Breakthrough
  • Ancient
  • Ancestral
  • Evolutionary
  • Revolutionary
  • Pioneering
  • Chemicals
  • Integrative
  • Functional
  • Quantum
  • Candida
  • Dysbiosis
  • Leaky
  • Lectin
  • Chelation
  • 100%
  • Antioxidant
  • Chronic Lyme
  • Adrenal fatigue
  • Anti-aging
  • Nutraceutical
  • Belly fat
  • Cellulite
  • Rejuvenating
  • Rejuvenate
  • Adaptogen
  • Ph-balancing
  • Buy
  • Microbiome
  • Personalized
  • Precision
  • Nutrigenomic
  • Ancient
  • Forgotten
  • Undiscovered
  • Permanent
  • Eliminate
  • Brain Fog
  • Maximize
  • Vitality
  • Nourish
  • Powerhouse
  • Sharpen
  • Vital
  • Thrive
  • Disclaimer

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Monday, March 26, 2018

What's Wrong With This Picture?

If Waterloo's Albert McCormack Community Centre wants people to drink fewer sugar sweetened beverages, instead of putting a sign up telling people to drink water right next to the soda they're selling, maybe they should only sell water?

Now expand that concept to schools, hospitals, and arenas, and address the food environment similarly on other levels, and then perhaps we'll start seeing some changes to consumption patterns.

Rather than just telling people what they should and shouldn't choose, we need to build a world where to make an unhealthy choice, you'd need to go out of your way to do so, rather than our current other way around version.

Does anyone out there still thing this is just about education? If education alone were sufficient, we'd all be living incredibly healthy lives.

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Thursday, March 22, 2018

There's Perhaps An 80% Chance That Your Bloating Woes Aren't Related To Gluten

Are you scared of gluten?

Are you avoiding it because gluten containing foods leave you feeling bloated or otherwise unwell?

It's probably not the gluten.

Adding to a growing pile of evidence that it's not the gluten that's causing your symptoms (no one's doubting the symptoms, it's more a matter of figuring out where they're coming from) is this recently published, albeit small, study highlighting a randomized, double-blind placebo-controlled challenge of twenty patients without celiac disease or wheat allergy who were suspected of having non-celiac gluten sensitivity (NCGS), and who had all experienced relief from their symptoms following a gluten-free diet.

Every one of the study's participants went through four separate periods of double-blinded challenges - two with gluten, and two without, in random order. They were asked to consume two muffins per day which did or did not contain 11g of gluten for 4 days followed by a 3 day washout all the while continuing to eat their otherwise gluten free diet. They simultaneously tracked their gastrointestinal symptoms and were asked their thoughts as to whether they were consuming gluten containing muffins or not during each treatment. All subjects diets were also analyzed after the fact for their FODMAP content.

Looking at the participants self-reported symptoms scores, they were worst after the challenge with the placebo (gluten-free) muffins - significantly so even - with a p value of 0.012. Of the 20 subjects, only 20% (4) correctly identified the two periods they received gluten containing muffins. Of course 4 people of 20 correctly identifying which muffins contained gluten may well occur simply by chance and consequently conclusions can't be drawn on their basis.

All this to say, taking those 4 as real data points, this study suggests that 80% of people with unexplained food-related discomfort aren't reacting to gluten, and though people's bloating, flatulence, abdominal pain, fatigue, and other symptoms, are real, what's causing them is not yet clear.

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Monday, March 19, 2018

Dear Teachers, Please Don't Weigh Your Students

A few weeks ago my 11 year old daughter's math teacher brought in a scale and weighed her Grade 5 class in front of one another in the context of learning about volume.

I'm sure it was well intentioned.

And for some of her students, I'd venture it was their worst day of the school year.

Given weight has been found to be far and away the number one source of childhood bullying, it should have been predictable that there'd be snickers when the heaviest kids in the class were weighed.

The lightest kids' weights elicited snickers too.

11 year olds' teachers ought not to be contributing to their students being self-conscious, embarrassed, or ashamed of their bodies.

So here's my very simple request.

Teachers, schools, coaches, educators of all sorts - please, unless it's essential (and it's difficult to imagine many circumstances when it would be), never weigh your students, and if you do, do so privately.

And this goes for so called BMI report card programs as well, whereby children are weighed at school and notes are sent home to parents as to their child's BMI. While here in Canada these programs are fewer and further between, in the US, 25 states have legislated that schools weigh kids, and 11 of those have legislated that BMI report cards be sent home to parents. The legislation arose consequent to a 2005 recommendation from the National Academy of Medicine that such programs be implemented as part of a childhood obesity prevention strategy.

The issue with these report cards aren't their intentions, but rather their efficacy and potential risks. To date, the evidence is equivocal as to whether BMI report cards affect children's weights. It's also equivocal as to whether or not they might increase weight-based stigmatization, unhealthy weight control behaviours, and/or body dissatisfaction (though we ought to know more in the next year or so as the results from this trial get reported).

If schools and teachers want to have a positive impact on kids' health, I'd encourage them instead to focus on the one thing well within their control to change - food. And there are ample targets for improvements including in-class rewards, class parties, chocolate milk programs, pizza programs, school fundraisers, holiday celebrations, vending machines, cafeteria fare, planting and tending to school gardens, and using (or establishing) school kitchens to teach children how to cook healthy meals, to name just a few.

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Saturday, March 17, 2018

Thursday, March 15, 2018

Guest Post: RD Christine McPhail Reviews Greta Podleski's Terrific New Cookbook Yum and Yummer

Today's guest post comes from one of our office's wonderful RDs - Christine McPhail, who has been spending a bit of time with Greta Podleski's terrific new cookbook Yum and Yummer.
As a Dietitian, I see the difference it makes when families start cooking together and children begin to develop the important food skills that they will need as adults. I hear about children being more interested in trying new foods, helping in the kitchen, wanting to pick out recipes, and being proud of the foods they’ve made. These cooking experiences can help children learn about nutrition, balanced meals, and the importance of including a variety of foods. Our lives are busy and I do hear about food going on the back burner (see what I did there) but it shouldn’t have to. You can read Dr. Freedhoff’s past post Teaching Your Kids To Cook Is More Important Than Teaching Them To Play Soccer Or Hockey that provides strong rationale for families cooking together.

Adults in turn benefit from sharing their skills, having the opportunity to pass down their favourite recipes and traditions, and of course having more balanced and nutritious meals themselves. A great place to start is having your family go through cookbooks together and pick recipes they would be interested in making. One recipe book I can recommend is Yum & Yummer by Greta Podleski, a Canadian author and recipe developer, who you may know from her very popular Looneyspoons cookbooks, which she co-wrote with her sister Janet.

Here are a few reasons I liked Yum & Yummer:
  • The introduction is worth a read. I really appreciated that Greta addressed that healthy eating means different things to different people and that we all could try to be less judgemental. Unless there is a true risk with an eating behaviour, which as a dietitian, I am trained to look out for, I believe it’s important that we respect one another’s food preferences and choices.
  • There truly is a recipe for everyone in this book and Greta follows through with her mission to use common everyday ingredients and simple recipes. Recipes will signify if they are dairy-free, gluten-free, vegetarian etc. 60% of the recipes are vegetarian but she also has sections for fish, poultry, and red meat, soups and chilis, snacks, and desserts. Meatless meals are a great way to get your family to enjoy meat alternatives that not only provide protein but plenty of fiber as well. You’ll save some money in the process too!
  • For people who are new to cooking, are nervous to try recipes, or learn better with visuals, each recipe has a photograph and a “how to” video that you can access just by scanning the QR code on the page with your phone. They show you exactly what to expect step by step, so you can feel confident developing new skills (you can take a look at them here).
  • For those who like to know the nutrition information, each recipe shows calories, total fat, saturated fat, protein, carbohydrate (fiber and sugar included), cholesterol, and sodium. This way you can make an informed choice that works for you and your family’s needs.
  • The recipe descriptions don’t go into detail of the “nutritional benefits” or labels foods as “good” or “bad”. Greta does include some great food prep tips and food facts that are helpful. This is important because we don’t want to label recipes as “good” or “bad” and we don’t want weight to be the main motivation when trying a new recipe, especially if children are reading along. We want to hear about the fresh ingredients, flavour and texture as well as the nutrition information, when we are choosing to make a recipe or not. At the end of the day, if you don’t enjoy it you won’t continue to eat it anyways.
With some quality time in the kitchen and eating meals together, your family can appreciate the benefit and taste of whole foods, cooking from scratch, and eating together as a family. If you are interested, you can purchase the book via Amazon.ca (where 92% of the 148 reviews (and counting) are 5 star) or any other online Canadian book retailer.

Christine McPhail MSc, RD is one of our Registered Dietitians at the Bariatric Medical Institute. Christine has worked in academic, clinical and public health nutrition settings and has been fortunate to have worked on projects relating to food sustainability, food security, food policy and politics, childhood nutrition, body image, and school nutrition programs. She believes in the power of connecting with your food from farm to table. She feels fortunate to share this passion with her clients, as she helps them strengthen their relationship with food and learn more about nutrition.

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Tuesday, March 13, 2018

Nothing Good Can Ever Come From Weighing Your Child

(This post was first published on US News and World Report in November 2013)
I'm not suggesting your child should never get weighed – certainly I'd encourage annual weigh-ins with your child's pediatrician or family doctor to track growth curves – I just don't want you weighing your child.

Aside from determining whether or not your kid has outgrown their car seat, or what size uniform or sporting equipment they require, there are three main reasons for a parent to want to weigh them. The first would be a worry about a child not growing sufficiently – and herein I'd encourage you to defer to your child's doctor to determine whether or not worry is warranted.

But the second and third reasons are the ones that concern me. The second reason is a parent's belief that his or her child's weight is too high. The third reason is the second reason's corollary, where a parent might be weighing a child to see if the child has lost weight or to keep track of the rate of gain.

The thing is, scales don't measure anything other than weight. They don't measure the presence or absence of health; they don't measure whether a child is being fed a nutritious diet; they don't measure whether a child is regularly active; and they don't measure self-esteem. But they sure can take away self-esteem, can't they?

And while I haven't seen a study that proves it to be true, I'd be willing to wager that scale use in children has played a formative role in their development of mood disturbances and eating disorders over the years, as well as having had many negative impacts on their self-esteem, body images, and relationships with food.

Yes, childhood obesity is worrisome. And yes, if you're worried about your child's weight – especially if it's having a negative impact upon his or her health or quality of life – you might want to try to help. But weighing your child doesn't actually do anything. All weighing your child does is teach him or her that scales measure success, self-worth, and parental and personal pride – and that weight is all that matters.

You might think that tracking your child's weight loss on a scale may be motivating, but celebrating a loss on a scale is no less risky than shaming a gain; they're flip sides of the same coin – the coin that says scales measure success. And what happens if that child who is losing one day gains?

A child's actual weight doesn't really matter, at least not in any constructive, formative way. Ultimately, a child's weight is not something that is directly controllable. Weight's primary levers – eating behaviors and activity levels – have dozens, if not hundreds, of drivers and co-drivers, and many of them won't in fact be modifiable.

Genetics, peer groups, socio-economic status, coexisting medical conditions (both mental and physical and for both child and parent), food available at school and after-school activities, and many more factors all have a very real impact on weight, while none are particularly changeable. Moreover, weight management is a struggle for highly motivated, fully mature adults with various weight-related medical conditions. Should we really be expecting children to accomplish a task that eludes many grown-ups?

If you're worried about your child's weight, look to those weight-relatable behaviours that you might actually help to change instead of weighing your child. For example, consider the source, quality and quantity of their calories and of the meals you're providing them.

Look to your own examples for fitness, and cultivate active family outings. Review your home's screen-time rules, and certainly rid all bedrooms (again, including your own) of televisions (which has been shown to dramatically increase risk of obesity in children. Cut your cable (and hence, eliminate the constant food advertisements your children are exposed to), and ensure that your child's bedroom and habits are conducive to adequate sleep (as short sleep duration is also strongly associated with increased weight).

While it's true that there are things affecting your child's weight that you won't be able to change, it's also true that there are many things affecting their weight that fall within your parental discretion – and it's there where you should expend your energies. Importantly, do so without explicitly putting a focus on weight as the cause of your home's changes or the child as their sole target; instead, put the focus on improving the health of your family as a whole, with your changes affecting every member of the home, as the cultivation of healthy living behaviours provides benefits to everyone at every weight.

Bottom line: If you're concerned about your child's weight, don't rely on a number to tell you or your child how he or she is doing. Simply measuring their weight does nothing to helping you understand how it got there nor will it do anything to help it to go away, but it may make your children hate themselves just a little bit more each time you put them on that scale.

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Saturday, March 10, 2018

Saturday Stories: Lots Of Farrakhan/Anti-Semitism

First, Yair Rosenberg, in The Washington Post, with a great, short, and very balanced piece highlighting 5 myths about anti-Semitism.

Nylah Burton, in Forward, writing, "To My Black Brothers And Sisters: I’m Black And Jewish. Farrakhan Is Bad For Us All."

Yehuda Kurtzer, in Times of Israel, with a very thoughtful piece, On friends and Farrakhan: A plea to progressives

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Wednesday, March 07, 2018

The Hunger Hormone Ghrelin May Be Another Reason To Eat Your Carbs Last

Preproghrelin: By own work - adapted from http://www.pdb.org/pdb/files/1p7x.pdb using PyMOL, Public Domain, Link
I've blogged in the past about how eating your carbs last may help reduce your blood sugar levels even 2 hours after your meal.

Well here's another reason why you might want to eat your carbs last - ghrelin.

Ghrelin is one of the body's primary hunger hormones. More ghrelin, more hunger (more on this though in a tiny bit).

Well, a small crossover study looking at the effect of food order on ghrelin levels found that eating carbs last led to a sustained suppression in ghrelin levels 3 hours later, while eating carbs first led to not only ghrelin levels returning to baseline at 3 hours, but also their slight rise (-11.45 ± 3.86% vs. +4.13 ± 4.38%; P = 0.003).

But that said, ghrelin is a surrogate end point for hunger and/or consumption.

Unfortunately, at least in this small study, subjective hunger wasn't different between conditions at any point, and consumption at later meals wasn't measured.

Looking forward to future research on this file, but given the ease of this intervention, I'd file it under maybe worth a try.

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Monday, March 05, 2018

Hey @CR_UK, If Any Amount Of Guilt, Shame, Blame, Or Fear, Were Sufficient To Treat Obesity, It Wouldn't Exist

Thanks to Anthony Cox for sharing Sofie Hagen's reaction to CancerResearchUK's new awareness campaign.

The campaign, which is meant to let people know that there are strong associations between obesity and cancer (and some plausible biological mechanisms that would suggest some causality), though factual, is troubling.

Here's the thing.

By vilifying obesity directly, rather than focusing on the social determinants of health and the built environments that fuel our behaviours and weights, Cancer Research UK's campaign is simply contributing to fear and stigmatization. But if any amount of guilt, shame, blame, or fear were sufficient to treat obesity, obesity wouldn't exist.

And what's odder still is that Cancer Research UK seems to know that, at least partially, as their pinned video that highlights their campaign showing them telling people that obesity is a risk factor for cancer, they mention that they're asking the government to take action.

If Cancer Research UK wants to make a difference, given that there are no gold standard treatment programs (let alone programs covered by the NHS) that will reliably lead to sustained population based behaviour change/weight loss, and that the personal responsibility approach to treating obesity is a luxury that many people's lives preclude, and that the one thing people with obesity don't lack is constant messaging that tells them that there are risks to obesity, instead they could mount a campaign to educate doctors about how weight bias has been shown to lead physicians to screen their patients with obesity less frequently for various cancers (including colorectal, cervical, and breast), and to encourage those physicians to treat their patients with obesity the same as they treat all of their other patients.

[And lastly, content aside, it's also odd to see Cancer Research UK's lack of people first language with obesity. Does Cancer Research UK describe people who have cancer as being cancerous? If not, perhaps they should stop referring to people who have obesity as being obese.]

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Saturday, March 03, 2018

Saturday Stories: New England Journal Of Medicine Edition (Read Them Before They Go Behind Paywall)

Michael S. Weinstein, in The New England Journal of Medicine, recounts his experiences as a surgeon-patient with severe depression.

Audrey M. Provenzano, in The New England Journal of Medicine, describes how she overcame her fear of treating opioid use disorder.

Anupam B. Jena, and Andrew R. Olenski, B.S., in The New England Journal of Medicine, with their letter highlighting the reduction in firearm injuries during NRA annual conventions (and here's Vox' Julia Belluz with her coverage of same)

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Wednesday, February 28, 2018

Maybe Stop With The Hot-Take Childhood Obesity Rate Trend Stories And Reports?

Or at the very least stop until we're actually as a society trying to do something about it? Because why would we expect it to change if we're not doing anything about it?

As to why stop? Well because despite not doing anything as a society, it seems to be changing....but not really the way you might expect.

Here's what coverage has looked like for the past 8 years

FALL IN 2013
All this to say, these annual takes? They don't make sense both in terms of the outcomes (up, down, sideways, gone, up, down, etc.), but also not in the context of change. Changes tend to occur consequent to changes, and given there really aren't any initiatives going on in the US or Canada that one might expect to impact on childhood obesity rates, perhaps the coverage instead could be about our inaction as a society on this sad file, rather than whether there's been a tiny blip up, down, or sideways in some survey's reported incidence.

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Monday, February 26, 2018

Yes, Calories Counted (Literally) In The Recent #DIETFITS, Low-Carb, Low-Fat, Shootout Study

(Credit goes to RD Daniel Schultz for finding this reference in his read of the DIETFITS study and for sharing it via his excellent Twitter thread of thoughts on same)
In case you somehow missed it (though that seems hard to imagine), last week saw the publication of the excellent DIETFITS study - a year long, randomized, controlled trial, that compared the effects of low-carb and low-fat diets, on weight loss and other metabolic outcomes.

Briefly (and if you want to read a detailed synthesis you can read this one over at Examine.com), DIETFITS found that over the course of a year, both low-fat and low-carb diets produced similar weight losses and had similar effects on various metabolic outcomes.

The coverage of the study was widespread, and integral to it was this notion that counting calories isn't necessary for weight-loss, or that it's less important than the foods consumed, in that this successful study's approach involved counselling participants to eat whole foods, be they low-carb or low-fat, while eschewing the rest. Put another way, according to the coverage, people were taught to monitor and care about the quality of their calories, not their quantity, and that this was sufficient to drive significant weight change regardless of whether the foods they consumed were low-carb, or low-fat.

That conclusion is problematic for two reasons.

First, there was no study arm that explicitly taught participants to carefully track their quantity of consumed calories with no emphasis on their quality. Such an arm would be important to conclude that quality of calories trumps quantity of calories for dieters.

But more importantly, and again, thanks to Daniel Schultz, it would seem that the bulk of participants were in fact counting calories as reported by the previously published DIETFITS study design and methods wherein it was reported,
"The most common dietary monitoring method used was the on-line MyFitnessPal tool"
And as anyone who has ever used MyFitnessPal (or any of the other app based trackers - some of which were also utilized by DIETFITS participants) knows, while yes they'll track what you're eating, their primary end-user feedback is calories. And so even if somehow participants did not know in advance that calories were a consideration in weight loss, MyFitnessPal use would have seen to it that they learned that fact very quickly.

You see, setting up a MyFitnessPal account requires the input of a number of different variables: Weight, height, goal weight, age, sex, and some demographics.

And once input, MyFitnessPal then lets you know how many calories you should be aiming at daily to hit your stated weight loss goal.

Finally, when you start entering foods, though macronutrients are also tracked, calories are MyFitnessPal's most prominent field whereby there's a running calorie tally at the top of your diary, along with their meal by meal breakdown.

So while participants may not have been provided with specific calorie goals by the researchers, they were recruited on the basis of being involved in a weight loss study, and without a doubt, they all knew, that when it comes to weight loss, calories do count, and the majority of them used an app that tracked their calories, provided them with a personalized daily calorie goal based on their desired losses, and reported those calories to them prominently every time the app was utilized. And it's difficult for me to imagine that information didn't affect participants' choices, and certainly is enough of a confounder so as to render the conclusion that counselling solely on dietary quality is sufficient to drive significant weight loss.

This doesn't diminish the study's actual findings, but when it comes to calories' quantity and quality, it would seem that there are those who want to promote the existence of a false dichotomy stating that only one or the other of those two variables count. Honestly, I come across it all the time. Angry folks who claim that when it comes to weight and/or health, calories don't matter at all and that what really matters is the quality or types of foods, or the folks who claim that the quality or types of foods don't matter at all, it just comes down to calories.

It's both of course.

The currency of weight is certainly calories, and while we all have our own unique internal fuel efficiencies when it comes to using or extracting energy from food or from our fat stores, at the end of the day, we still need a surplus of calories to gain, and a deficit of calories to lose.

But don't kid yourself - foods matter too. Choice of food matters in terms of health, but also in terms of how many calories our body expends in digestion, and more importantly, upon satiety, which in turn has a marked impact upon how many calories, and which foods, we choose to eat (and of course to health, but that's a whole different matter).

All this to say, the DIETFITS study is terrific, and speaks directly to my published confirmation bias that adherence to one's dietary strategies matter far more than the macronutrient breakdown of said strategy. It also speaks to my bias that when armed with information about both the quality and quantity of the calories we're consuming, and provided with ongoing attention and support, weight loss and improvements to various metabolic parameters are far from an impossibility.

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Saturday, February 24, 2018

Saturday Stories: World's Worst Roommate, Sobriety, and Sexual Harassment

William Brennan, in The New Yorker, with a surprising story about the world's worst roommate.

Edith Zimmerman, in Spiral Bound, detailing her first year sober.

Kayla Webley Adle, in Marie Claire, on sexual harassment in science.

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Tuesday, February 20, 2018

McDonald's, But Not Your Child's Elementary School, Removes Chocolate Milk From Their Menu

Not sure if you caught this news release last week. It detailed McDonald's announcement that they'll be overhauling their standard Happy Meal offering in a bid to, "support families".

Part of that "support" (I'll come back to the word, I promise), is ensuring,
"at least 50 percent or more of the Happy Meals listed on menus (restaurant menu boards, primary ordering screen of kiosks and owned mobile ordering applications) in each market will meet McDonald's new Global Happy Meal Nutrition Criteria of less than or equal to 600 calories; 10 percent of calories from saturated fat; 650mg sodium; and 10 percent of calories from added sugar"
And to meet those goals cheeseburgers will only be available by special request, a kids; fry size (smaller than current small) will be developed, bottled water will be a featured beverage option, and chocolate milk will only be available by special request.

Though I'm certainly happy that McDonald's Happy Meals will generally be lower in calories and sugar, here's the rub. While the rollout of this initiative speaks to health, corporations never make changes that they think will hurt their bottom lines. This is not an indictment - corporations aren't social service organizations - their goals are profit driven, and McDonald's are no exception as evidenced by their press release's first line,
"Today, McDonald's (NYSE:MCD) announced an expanded commitment to families, supporting the company's long-term global growth plan by leveraging its reach to impact children's meals"
They hope that these changes will bring in more families more often for more meals at McDonald's, which is good for their investors, but probably not so much so for public health, even without chocolate milk.

But you know which organization's goals aren't profit driven? Your children's elementary schools', yet their chocolate milk programs continue with no end in sight, and not just for a sometimes treat, but daily. If you wouldn't serve kids who didn't eat fruit, daily pie, you might want to rethink their daily chocolate milk.

Motivation aside, it's odd to see McDonald's being more proactive than our kids' schools on this file.

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Saturday, February 17, 2018

Wednesday, February 14, 2018

PSA: Please Don't Joke About Sometimes Wishing You Had Anorexia

Given what I do for a living, it happens not infrequently that someone will joke with me about sometimes wishing they had anorexia or bulimia in the context of their struggles with weight management.

And while I can see where their unfortunate attempt at humour is coming from, it always leads me to have a gentle chat with them that contains these truths.

Lives are ripped apart by eating disorders. Families are devastated. People die.

Eating disorders aren't punchlines.

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Monday, February 12, 2018

Some Evidence Canada's New Food Guide Will Care About Evidence

Though there's no white smoke signifying the publication of a new Food Guide billowing out of Health Canada's food directorate's chimney, there are some signs that when it's finally published, it may be evidence based.

Take for example this story.

It details the concerns of Conservative agriculture critic John Barlow and it contained some heartening quotes.

Here's my favourite,
"It is very clear…that Health Canada is going in a direction that is detrimental to our agriculture sector, detrimental to our food processors as well as our producers on the ground."
Now while I feel for any sector impacted by the future Guide's recommendations, that Health Canada is not actively capitulating to agricultural interests suggests that perhaps instead, it's sticking with science as its underpinning.

According to Barlow, his office has been flooded with concern from a broad range of agriculture groups who are nervous about Health Canada's new policy of not kowtowing to industry,
"I want to really stress this point. These letters are not only from the livestock industry or the dairy industry, there’s letters in here from grain growers, the horticulture associations — none of them want us as a government, in this food guide document, to be picking winners and losers. They all want to be successful."
While there may well be some disagreement among health professionals as to what truly constitutes a healthy diet, where there likely is no disagreement is the notion that the desires of various agricultural sectors to be "successful" doesn't factor in to dietary health at all.

And just as an odd aside, in the same article is a quote from Agriculture Minister Lawrence MacAulay who was asked to comment about agricultural concerns. His response?
"Without a question, what I want to see is Canadians make sure that they express their view on what’s presented and that’s why things are gazetted. My opinion — really, it’s Canadians opinion that really reflects what takes place on this and anything else that’s gazetted to make sure that is what they do want to have happen."
Here's hoping that's not how policy works in Canada, as while not bashing the public, I'm pretty sure Food Guides shouldn't be built on what Canadians' personal opinions about food happen to be.

So bring on the evidence, and for the matter, bring on the new Food Guide. Remind me again, why are we still waiting?

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Saturday, February 10, 2018

Saturday Stories: Gender Balance, One In 259, And Terminal Wisdom

Am somewhat pleased to report that after being inspired by this piece by Ed Yong in The Atlantic, on how he spent two years correcting the gender imbalance of his quoted sources, I went back over my last year of Saturday Story pieces to discover that 46% of the 292 stories I've shared were written by women.

Chika Stacy Oriuwa, the only black student in her medical school class of 259 at U of T, in Flare, on how in her white coat she is more black than ever.

Alastair McAlpine, in The Guardian, expounds on his viral tweets about the lessons he's learned from terminally ill children.

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Wednesday, February 07, 2018

Have Diabetes And Motivated To Change Your Lifestyle? Virta (And Maybe #Keto) Could Be Right For You

A quick post regarding an exciting study that dropped today in the release of Virta Health's one year data on the impact their intensive lifestyle counselling, coupled with their ketotic diet, had on patients with type 2 diabetes.

The results were impressive.

Of the 262 patients who started the year long study, 83% finished, and of those their metabolic biomarkers and weight improved dramatically. On average their hemoglobin A1C (a long term measure of blood sugar) dropped from 7.6 to 6.3, type 2 diabetes medications other than metfromin dropped from 56.9% to 29.7%, and insulin was reduced or eliminated in 94% of subjects who started out on insulin, while sulfonylureas were eliminated entirely. Weight dropped an average of 30lbs. Insulin resistance as measured by HOMA-IR dropped by 55%, hs-CRP by 39%, and triglycerides by 24%. Though LDL did rise by 10%, HDL rose by 18% and apolipoprotein B was unchanged.

All this to say that if you have type 2 diabetes, and you're motivated to make lifestyle changes, Virta health's program definitely appears to be worth considering.

But there are some caveats.

Firstly the study looked at individuals who self-identified as wanting to affect lifestyle change, and so their comparison with "usual care", which consisted of individuals identified by their MDs as having diabetes and then being relegated to their local diabetes education program, may not be a fair one.

Secondly, the intervention was incredibly robust and intensive. That's not a knock. I think it's terrific. It included,
"continuous care through intensive, digitally-enabled support including telemedicine access to a medical provider (physician or nurse practitioner), health coaching, nutrition and behavior change education and individualized care plans, biometric feedback, and peer support via an online community"
And where behaviour change techniques taught included,
"education of natural consequences, shaping knowledge, goal setting, self-monitoring, feedback, monitoring and reinforcement from health coach and medical provider, self-belief, social support, relapse prevention, associations, and repetition"
Patients were provided a cellular connected body weight scale, a glucometer and ketometer, and a bp cuff. Patients were then given access to a web-based application to input data and where they received monitoring, education, and communication with their team.

Food wise participants reported daily hunger, cravings, energy, and mood by way of a Likert scale and health coaches worked with patients individually to adjust intake.

It is notable that daily protein intake was targeted to 1.5g/kg, and also that their weight losses had pretty much leveled off by year's end.

I bring up the robust intervention only in that I'm not aware of any prior interventions with other dietary strategies that would compare and therefore at this point it's difficult to divvy up what percentage of outcomes relate to the intensity and frequency of the intervention, and what percentage to their high protein, low-carb, ketotic diet.

The cost of Virta Health (if not covered by your insurer), is reported by them to be (I have no affiliation BTW) $400/month, but given the cost of diabetes medications and the outcomes reported herein, those costs may well be offset by your results.

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