Saturday, September 29, 2018

Saturday Stories: Remembering, Revenge, And Not Debating

Anita Hill, February 2018
Jessica Shortall, in Medium, with a rage and sorrow inducing piece about everything she can remember.

Jennifer Weiner, in the New York Times, on wanting to burn the frat house of America to the ground.

Laurie Penny, in Longreads, on not debating.

And here's a recent live podcast I did with Darya Rose at this year's Fireside conference where we cover the basics of successful weight management and why I think chocolate's more important to success than hunger.

[Photo By Gage Skidmore, CC BY-SA 3.0, Link]

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Tuesday, September 25, 2018

Chocolate Milk And Health Canada's Inaction On Canada's Food Guide Just Cost The New Brunswick Liberals The Election

Yesterday there was an election in New Brunswick.

The Conservatives won by a single seat.

So what was the main issue New Brunswickers were voting for or against in this election?

Believe it or not, it was chocolate milk in schools, which was described by the Toronto Star as the issue at, "the centre of the New Brunswick election campaign".

Seriously.

The centre of the New Brunswick campaign was whether or not the sale of chocolate milk would be banned in New Brunswick schools, with Blaine Higg's Conservatives saying "No", and the Liberals Brian Gallant saying, "Yes".
But here's the thing.

If Canada's Food Guide stated that sugar-sweetened milks were not nutritionally equivalent to white milk, and that in fact sugar-sweetened milk consumption should be limited to half a cup daily in children, school chocolate milk sales wouldn't have been an election issue in the first place, as with that admonition, schools almost certainly would have put an end to the daily sale of an item Canada's Food Guide recommends kids explicitly limit.

And there's very little doubt that the next Food Guide, if it's ever released, won't be kind to chocolate milk. And that's not just me reading the tea leaves, it's also me remembering when Dr. Hasan Hutchinson, the Director General of the Health Canada unit responsible for the Food Guide stated, over 4 years ago (honestly, what could we possibly still be waiting for) during a public debate that we held,
"One thing we're doing right now (Note: Right now means February 2014) is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"
So the next time someone tells you that Canada's Food Guide doesn't matter you remind them that Health Canada's inexplicable foot dragging on its much needed revision just cost the New Brunswick Liberals the election.

(Stay tuned, because on Thursday, I'm going to post an incredibly innovative solution to the issue of chocolate milk in schools)

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Saturday, September 22, 2018

Saturday Stories: Obesity, Mortality, and Belief

Michael Hobbes, in Huffington Post's Highline, explains why everything you know about obesity may be wrong.

Bari Weiss, in The New York Times, on the occasion of Yom Kippur, with her thoughts on facing our own mortality.

Caitlin Flanagan, in The Atlantic, with a powerful piece on why she believes Dr. Christine Blasey Ford.

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Monday, September 17, 2018

There's No Realistically Prescribable Amount Of Exercise That Will By Itself Lead To Useful Weight Loss, But That Doesn't Mean You Shouldn't Exercise!

This isn't the first time I've noted that there is no realistically prescribable amount of exercise that by itself will lead to clinically meaningful weight loss, and it probably won't be the last. And that said, it doesn't mean it's impossible, but reality really is a useful place to live, and is probably a worthwhile frame of reference.

Today's reiteration stems from a recent-ish study that looked at "energy compensation in response to aerobic exercise training in overweight adults" which when translated refers to whether or not people eat back the calories they burn exercising and if that's why the results of exercise for weight loss studies so often disappoint.

The authors followed 36 men and women with varying degrees of excess weight (BMIs ranged from 25-35) and randomly assigned them to exercise either 30 minutes daily or 60 minutes daily, 5 days a week, for 12 weeks.

3 months on analyzed data later and the authors summarized conclusions include this statement,
"Results of the current study suggest the recommendation should be closer to 300 minutes per week to achieve appreciable fat loss"
because in their study it was only the participants who averaged 335 minutes of weekly exercise who were seen to lose a statistically significant amount of weight (and though significant statistically, it was only an average of 5.7lbs).

Though it's not noted in the study, it should go without saying that whatever intervention you employ to lose weight, if you stop that intervention, the weight you lost by way of its impact will likely return. And so while perhaps 335 minutes of weekly exercise for another bunch of months would lead to further loss, if you stop or decrease exercising that much, the weight you lost with it is likely to return.

Back to the headline of this blog post. If you think the average person, living a real life, replete with its many stressors, challenges, and responsibilities, can sustainably and consistently find upwards of 300 minutes of weekly exercise, I'd invite you first to get that much yourself even for just 3 weeks, as for the majority of people out there, it's not even a remotely realistically prescribable amount.

Instead of continuing to tie exercise to weight, and in so doing motivate people to start exercising in the name of weight loss, which in turn risks disappointment and the cessation of exercise if while successfully increasing exercise to a more realistically obtainable amount no weight is lost, the focus needs to shift to the fact that exercise is arguably the single healthiest modifiable behaviour anyone can undertake, that any amount is terrific, and that it's incredibly beneficial regardless of whether or not weight is lost in the process.

Photo by David Whittaker from Pexels

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Saturday, September 15, 2018

Saturday Stories: Museum Fires, Non-Sexual Harassment, and Lucy Wills

Ed Yong, in the Atlantic, with his coverage of the devastating Brazilian museum fire.

Linda Bloodworth Thomason, in The Hollywood Reporter, on Les Moonves and how not all harassment is sexual 

Hilda Bastian, in The James Lind Library, with the life and times of the remarkable Lucy Wills

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Wednesday, September 12, 2018

Every Physician Ought To Know Which Common Medications Cause The Most Weight Gain

While it would be wonderful if all primary care physicians were interested enough in understanding how to treat their practices' most prevalent chronic condition to actually go out of their way and take the time to learn how to do so, there's a bare minimum that I think they do need to know, and that's which medications contribute to weight gain and their weight friendly alternatives.

Last week, my friend and colleague Sean Wharton, along with his collaborators, published an open access article summarizing drugs and weight gain, and I think it's a must read for all prescribers.

And for those who struggle with clicking, here's a summary of their summary by way of the article's various tables, because while it may be too much to ask for all MDs to truly take the time to learn about obesity, understanding which drugs are more likely than others to cause weight gain is something there's no excuse for them not to know.

[Cautionary note: If you're currently on one or more of the medications that are shown below to lead to greater weight gain, please don't stop it without first consulting with your prescriber, but do feel free to bring these lists along with you to discuss whether or not there are possible alternatives]



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Saturday, September 08, 2018

Saturday Stories: Tucker Carlson, Medical Error, and Physicans' Moral Injuries

By Gage Skidmore, CC BY-SA 2.0, Link
Lyz Lenz in Columbia Journalism Review, with a masterful profile of Tucker Carlson.

Deborah Cohen in BBC news details the heart breaking case of the medical error of Dr. Bawa-Garba.

Simon G. Talbot and Wendy Dean in STAT, on physicians' moral injuries.

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Tuesday, September 04, 2018

Small, Short, Crossover Breakfast Study Says Maybe You Shouldn't Skip It

This was a very small study, but unlike many other "breakfast" studies, it prescribed specific breakfasts, and more to the point, they're not bowls of ultra-processed carbs, but rather high protein options with a breakdown of 340 calories made up of 30g of protein, 36g of carbohydrates, and 9g fat.

What the authors were interested in were the differences, in the same individuals, of having a high protein breakfast vs. skipping breakfast (first meal at noon), on hunger, fullness, desire to eat, prospective food consumption (PFC) and related hormones, food cue–stimulated functional magnetic resonance imaging (fMRI) brain scans, ad libitum evening food intake, sleep quantity and sleep quality.

The participants were healthy young men and women without obesity and each arm of the experiment lasted for 7 days with a 3 day washout period in between.

The results saw breakfast eaters see their hunger, desire to eat, PFC, and ghrelin levels decrease on breakfast days versus skipping days, while their fullness and related hormones increased.

What didn't differ however was total energy consumed, this despite the fact that when they ate breakfast, participants on average consumed 30% fewer carb based evening snacks. There was also no real impact on sleep or sleep markers.

What was great about this study was that it didn't just look at next meal consumption, but rather the impact of breakfast on whole days, something my clinical experience has been screaming for years was necessary. That said, at least in this short study, it didn't seem to matter, at least not to total daily energy intake.

So does this mean you shouldn't skip breakfast? Not exactly, but it does suggest that eating a high protein breakfast, though it won't make you eat fewer calories, it may leave you feeling fuller and decrease evening processed food snacking.

And so once again, the answer is personal and not particularly complicated. If breakfast helps you to eat less, eat better, or feel better, then yes, you should eat it, and if it doesn't, don't.

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Saturday, September 01, 2018