Monday, April 30, 2018

What Is It About Diets That Make Some MDs Believe There Can Be Only One?

It seems like it's a growing phenomenon.

MDs, enamoured by a particular diet, strongly recommend it to all of their patients, their colleagues, and even write op-eds in the media about why the entire country ought to be following it.

It's such an odd thing.

In part it's odd because there's no doubt that the evidence on "best" diets, whether for weight management, or overall health, is far from conclusive, is fraught with confounding, and is built, regardless of what diet we're talking about, on evidence buttressed by the inherent flaws of food frequency questionnaires and dietary recall.

It's also odd because doctors, more than most, ought to know that different treatments work differently for different people, and that adverse effects are both real and unpredictable.

Whether it's depression, hypertension, high cholesterol, arthritis, etc. - there are a myriad of treatment options and patient considerations. What works well for one patient may not work for another, and what is well tolerated by one patient, may drive intolerable side effects in another.

Yet here some MDs seem intent on promoting the notion that when it comes to diet, there can be only one.

If you do come across an MD who's doing that, maybe best to move on to another MD.

Wednesday, April 25, 2018

Please Don't Encourage Your Kids To Diet

Image Source: The Los Angeles Loyolan
I wish it went without saying, but it doesn't, so I'll say it again, please don't encourage your kids to diet.

The worry is that by doing so, you may inadvertently have a negative affect on their self esteem, their body image, and/or their relationship with food, and given they're likely not the ones doing the shopping, cooking the meals, or deciding how frequently to eat out, drive-thru, or take-out, even if there wasn't risk to encouraging them to diet, their dietary landscape is primarily in your hands.

And that risk may not just be theoretical.

A study published in last month's issue of Pediatrics found that parents encouraging their adolescents to diet was associated with,
"a higher risk of overweight or obesity, dieting, binge eating, engaging in unhealthy weight control behaviors, and lower body satisfaction 15 years later as a parent, after adjusting for sociodemographics and baseline measures of the outcomes"
It also demonstrated an inter-generational effect whereby kids who were encouraged to diet, 15 years later, were more likely to encourage their children to do so as well.

If you're worried about your child's weight, rather than suggest that they go on a diet, I'd encourage you to explore your home's food environment. Look for ways to reduce liquid calories and energy dense food availability within the home, purchase fewer meals, make it a point to help your kids learn to cook (this recent study found those reporting cooking skills at 18 were more likely to have healthful diets a decade later), and improve your family's health by looking for ways to be active together. And while there's not likely to be any quick fixes, working towards living the life you want your children to live may go a long way.

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).

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.

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.

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.