Monday, June 24, 2019

On Instagram, RD Working For Welch's Implies That Drinking Welch's Grape Juice Won't Raise Your Blood Sugar (By @DylanMacKayPhD)

Today's guest post comes from Dylan MacKay. Dylan is a nutritional biochemist who has type 1 diabetes and when I saw RD Marie Spano's Instagram post, I knew he would have both personal and professional thoughts to share and so I invited him to do so.
I don’t know what it is with grapes but they always seem to be raisin my ire…

I mean as a person with type 1 diabetes, a PhD in Human Nutritional Science, and who does diabetes research and occasionally clinical trials looking at glucose response, maybe I’m not the one to talk about this, but I just can’t not.

Recently a Welch’s (*cough* big grape juice) "nutrition advisor" posted the above nutrition translation travesty on Instagram.

This really surprised me because when I have low blood sugar I often drink grape juice, How am I still alive? I mean I can honestly say there are times grape juice may have saved my life (by raising my blood sugar). Yet you could potentially look at this Instagram post and fairly think
drinking 100% juice made from polyphenol-rich fruit juice does not raise your blood sugar
unlike apparently that bad candy or pop that raises your blood sugar.

That would be of course 100% wrong.

Polyphenols are not magic sugar blockers, otherwise we would be using them to treat diabetes and you would get serious gastrointestinal upset from eating berries and grapes. I feel like you don’t even really need to be an RD to see this messaging is bad (Seriously, Welch’s advisors, how much do you get paid for your credibility?). Especially on a social media platform, where someone might not scroll to the end of the associated comment and look at the “reference” provided.

Speaking of the reference used for this knowledge translation crime, it is for a review article called Impact of Dietary Polyphenols on Carbohydrate Metabolism and having reviewed it I can say it does not support the claim in that post. Most of the article talks about animal or cell culture results that show polyphenols may impact glucose digestion or absorption, but there's nothing in the article showing it stops it. It even concludes that
To confirm the implications of polyphenol consumption for prevention of insulin resistance, metabolic syndrome and eventually type 2 diabetes, human trials with well-defined diets, controlled study designs and clinically relevant endpoints… are needed.
The closest thing in the article supporting the Instagram post is
The shape of the plasma glucose curve with reduced concentrations in the early phase and a slightly elevated concentration in the later phase indicates delayed response due to berry consumption
about a study done with 12 healthy participants looking at berry puree (rich in polyphenols). The polyphenols (or something else in the berries) changed the timing of the blood sugar elevation.

I suppose the Welch’s RD nutrition advisor might say
well actually Dylan, changing the shape of the blood sugar elevation means it doesn’t actually raise blood sugar like candy
and we could get into a long argument of how you define “like”. When people are arguing over minutia or semantics big food companies have won.

This type of nutrition misinformation advertising works because ultimately it is designed to ruin peoples’ trust in nutritional science and nutrition experts (especially RDs). If consumers are confused and can’t trust anything in nutrition, they are ripe for the next trend or fad or advertising claim. That is a good thing for companies, but a bad thing for people.

If you like grape juice, drink it, I sometimes do when I have low blood sugar (I have chugged maple syrup for that too so…), but know that grape juice will raise your blood sugar, and liquid calories, like those found from the 9 teaspoons of sugar per glass of grape juice, are an easy way to go over on your energy intake. Most of us are trying to avoid excess energy intake, so for that, in my opinion, you can’t beat water.

Dylan MacKay PhD is a nutritional biochemist and an Assistant Professor at the University of Manitoba in Winnipeg. He is also a Clinical Trialist at the George and Fay Yee Center for Healthcare Innovation. Dylan has a special interest in human clinical trials related to lifestyle and diabetes. He is originally from St. John’s, Newfoundland where he started his graduate studies at Memorial University.

Saturday, June 22, 2019

Saturday Stories: Anti-Vax Conferences, Vulnerable Child Syndrome, and Taffy Brodesser-Akner

Anna Merlan, in Jezebel, in what she learned getting kicked out of America's biggest anti-vax conference.

Rachel Pearson, in The New Yorker, on vulnerable child syndrome

Jen Ortiz, in Cosmopolitan, with a fabulous profile of celebrity profiler and author of the book I ordered on my kindle yesterday Fleishman is in Trouble's Taffy Brodesser-Akner

[And if you don't follow me on Twitter or Facebook, here's my most recent piece for Medscape on what actually works for obesity at a population level (hint, it's not shame, blame, or fear)]

Wednesday, June 19, 2019

Scotland's "National Walking Strategy" Actually Increased Recreational Walking (A Tiny Bit) For The Whole Population!

Cynically, I've been known to ask for examples of population based initiatives that actually led to sustained increases in physical activity (with the expectation of there not being any).

Well, I can't do so anymore as Scotland's managed to increase recreational walking by 13% over a 6 year period for the whole of their population!

Their National Walking Strategy targeted Scotland's 5 million residents with messages about the health benefits of walking.

The strategy involved multiple sectors including:
  • Communication and public education.
  • Transport and the environment.
  • Urban design and infrastructure.
  • Health and social care.
  • Education.
  • Community-wide approaches.
  • Sport and recreation.
And together their aim was to create a culture of walking by way of developing better walking environments that supported ease and convenience.

How to counsel patients on physical activity became a topic in medical schools. The Daily Mile encouraged 1,000 schools to help every student walk, run, or jog a mile a day, increased funding for active transport programs was obtained including a doubling of infrastructure funding for same, #SoMe was leveraged to share encouragement and information to the public, and community walking programs were launched nationwide.

Now before you get too excited, the bar was low to begin with whereby the increase in walking represented the self-report of walking at least 30 minutes for recreation once over the past month, but at least it's a start.

Changing behaviour requires more than just education and a good reason to do so, it also requires a change to social norms and culture, as well as environmental engineering. Clearly there's more to do in Scotland and elsewhere, but nice to see that these needles might actually be movable.

Photo by Kim Traynor [CC BY-SA 3.0], via Wikimedia Commons


Saturday, June 15, 2019

Saturday Stories: Quantum Solutions, Stockpiled Insulin, and Multiple DNA Tests

Jana Asenbrennerova, in Quanta Magazine, on how a gifted grad student’s solution to a fundamental problem in quantum computing is an incredible breakthrough.

Maris Kreizman, in the New York Times, on why she's stockpiling insulin in her fridge.

Rafi Letzler, in Live Science, discusses the results of his 9 different commercial DNA tests.

Photo Richard Wheeler (Zephyris) at en.wikipedia - Originally from en.wikipedia; description page is/was here., GFDL, Link

Monday, June 10, 2019

Guess What? A Single In Office Visit Encouraging People To Weight Themselves More Often And Exercise Doesn't Prevent Weight Regain

From the Journal of Duh! (ok, actually it was PLOS Medicine) comes Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial). The study involved 288 people who had lost ≥ 5% of their weight in the preceding 12 months who were randomized into two groups. One where they received periodic newsletters, and the other where they had a single face-to-face visit where they discussed goal setting and self-monitoring (including being told to weigh themselves daily) followed by every other day automated text messages. The hope was that the single visit and text messages would help prevent weight regain in the group that received them. So did that minimal intervention help?

No, both groups regained the same amount of weight over the study's duration.

What was most surprising about this study wasn't that minimal interventions don't help prevent weight regain, but rather that someone thought they might. Because if minimal interventions prevented weight regain, do you really think weight regain would be so commonplace?

So in case you were looking for proof that single office visits and text messages aren't in and of themselves sufficient to prevent weight regain, there you have it I suppose.

Saturday, June 08, 2019

Saturday Stories: Only One Read This Week

Every once and a while there's a story that has such an impact on me that I want to feature it by itself.

Today's Saturday Story, written by Dana Horn for the Atlantic, was searing. It detailed her recent visit to a "massive blockbuster exhibition (about the Holocaust) that opened in May at the Museum of Jewish Heritage in downtown Manhattan", by the same people who brought you Human Bodies, and how it left her feeling flat.

Her closing paragraph,
"The Auschwitz exhibition does everything right, and fixes nothing. I walked out of the museum, past the texting joggers by the cattle car, and I felt utterly broken. There is a swastika on a desk in my children’s public middle school, and it is no big deal. There is no one alive who can fix me."
shouldn't be the only one you read. Please click it for more.

Monday, June 03, 2019

Bullying Or Teasing Kids With Obesity Doesn't Lead Them To Lose Weight But It May Lead Them To Gain

The recently published Weight‐based teasing is associated with gain in BMI and fat mass among children and adolescents at‐risk for obesity: A longitudinal study is an important paper for many well-intentioned parents, educators, and physicians who think that weight based teasing might help motivate a child to make behaviour changes that will lead them to weight loss.

In it authors followed 110 children at risk or with overweight or obesity for 8.5 years and tracked their weight and its association with weight-based teasing. They found that after adjusting and controlling for baseline sex, race, age, socio-economic status, BMI and fatmass, kids who reported the most teasing gained the most weight (p≤.007). Quantified, the authors found that the most teased kids' fat masses increased by 91% more per year (1.4lbs/yr) than those not reporting weight based teasing.

While it's important to note that causality can't be proven here, certainly these results fit with the notion that if any amount of teasing led kids to lose weight, we'd be seeing dramatic reductions in childhood obesity rates because weight is far and away the number one target of school based bullies, and even at home, 60% of kids with excess weight report being teased about same.

If you have a child with obesity, sadly you can rest assured that they'll receive plenty of shame, blame, fear, and bullying from the world around them, and if you're worried about your child's weight, instead of burdening them with it, ask yourself what you as a parent can do to help, where if nothing else, one thing for certain you can do is to make your home a safe space where weight is not something anyone's welcome to joke about or comment on.

(and if you live in Ottawa, and you have a child between the ages of 5 and 12 whose weight is concerning, and you're interested in our office's parent-centric, Ministry of Health funded, inter-professional, Family Reset childhood obesity treatment program feel free to call us at 613-730-0264 and book an appointment to chat)

Saturday, June 01, 2019