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.

Guest Post: The Problems With Balancing Accuracy And Reach In Science Communication: What To Do When Even Journals Want To Contribute To Media Hype (HIIT Edition)

Last week saw the publication of a new study in the BJSM entitled (highlighting mine), "Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT)". Understandably intrigued given a prominent medical journal was suggesting there was a magic bullet for fat loss, I clicked through, and then reading the piece I learned that the amount of fat lost that the BJSM was calling a "magic bullet" was a 1 pound difference, one which the study's abstract's conclusion described as, "a 28.5% greater reductions in total absolute fat mass (kg)". Duly surprised, I then took to Twitter to poke around and found that one of the study's authors, James Steele, was tweeting out a corrective thread to his own study's hype - hype which understandably and predictably led to an onslaught of media overreach. Intrigued, I approached him directly to ask about the discordance in tone between his tweets and his study's title and conclusion, and he sent me such a thorough and thoughtful response (explaining how it was the BJSM's editor who'd changed both), that I asked him if he'd mind my sharing his thoughts here as a guest post. Suffice to say, in my opinion, medical journals and their editors shouldn't be in the business of clickbait hype, as it diminishes themselves, research, and furthers societal scientific illiteracy by suggesting that such things as "magic bullets" for weight or fat loss can conceivably exist.

I was first slightly concerned that the findings would be overhyped and potentially misrepresented when I saw the press release that was sent to the media. I was forwarded various requests by our institutions news team and saw the wording of the first line of which was

“Short bursts of high intensity exercise are better for weight loss than longer sessions in the gym, research suggests.”

My colleague James Fisher noted to me that he also thought the press release didn’t reflect the findings accurately and wondered whether the title change resulted in the perception of a different finding.

The original title in our submission to the journal was

"Comparing the effects of interval training versus moderate-intensity continuous training on body adiposity: is it possible to find a signal in the noise? A systematic review and meta-analysis"

which was chosen as an homage to Nate Silvers' book and the use of meta-analysis to find the ‘signal’ from among the ‘noise’ of conflicting findings in smaller studies The paper underwent peer review as normal and we made changes suggested by the reviewers to improve the manuscript; but, none of the reviewers commented on the title if I recall. After the reviewers were happy with the paper and had no further changes they wanted we received a recommendation that it be published, but with minor revisions which were suggested by the editor. Most of the revisions suggested where helpful as they seemed to be aimed at improving readability of the manuscript. However, it was also suggested that the title was changed, as well as the addition of the percentage difference to the conclusion of the abstract. This was suggested to be intended to attract more attention to the article, make it seem more compelling, and ensure recognition was received for the work. I didn’t particularly like the newly suggested title, nor did some of my co-authors, but it was not strictly saying that anything ‘was’ a ‘magic bullet’ and so I did not push the issue. I must confess I did not at the time notice the seemingly minor change to the abstract conclusion though. I personally dislike the presentation of % values in this manner as to me they are often misleading and detract from whether the absolute values are really meaningful or not (a big problem in sport and exercise IMO wherein a lot of studies make interventions seem better than they are by reporting % values). The value is not inaccurate, but it does lead the less wary reader to potentially draw the wrong conclusions.

I did suspect that the changes were suggested because the paper would likely be selected for a press release which turned out to be correct. I’m glad the paper got some wide coverage, but wanted to make sure it was covered in a nuanced manner. So I tweeted a little thread to try and provide some balance and when I was interviewed about it on BBC World Service I also made sure to provide as balanced a commentary as I could in the time permitted.

It doesn’t surprise me that the media initially interpreted things to be saying that ‘HIIT’ (high-intensity interval training) was better than ‘MOD’ (moderate-intensity continuous training) for fat loss without considering all the nuance… that’s just how it goes sadly. I also can empathize with the journal and publisher in wanting to try and increase the reach of the work that they publish. To my mind if we can widen the reach of good science, and raise appreciation of its importance, then that’s a good thing. This is something I’d like to be able to do more of. But, though this is good in principle, in execution it proves to be difficult. It’s tough to get the nuance across because science is hard and most people aren’t really able to understand it. I guess it’s part of the media cycle though. The wider media wants ‘stories’ and just regular boring old science doesn’t make for a good story. So to get the wider media’s attention journals and academic publishers need to try and make things seem more exciting. In that process though nuance gets lost. However, I can’t think of any other way to communicate science more widely at the moment. I guess what we need to ensure is that, once the media get hold of a story and want to run it, the actual scientists themselves are the ones they speak to and interview so they end up with a platform and captive audience to explain the nuance and implications in an understandable manner. At least, that’s what I’ve tried to do and hope I achieved.

I think if I was able to ‘do over’ this example specifically then I would have likely pushed back more on the issues. I would like to have kept the original title and would have argued for this position as I suspect my co-authors likely would have too. I definitely would have pushed back on the change to the abstract conclusion and will be more vigilant to these issues in future. In likelihood this might have meant the paper would have been less ‘impactful’ as a story for the media. But it would have meant that the paper itself didn’t contribute to any potentially misleading publicity. The publisher could have still put out the press release as they desired… Can’t stop them from doing that. But at least the paper would have better reflected what we found in full. I think I would advise authors who face similar situations to make sure they think and have a conversation about this. We all want our work to reach the widest audience to hopefully have the biggest impact possible. But we don’t in the process want it to distort in terms of its message. Make sure to discuss it with your co-authors and the journal/publisher and find the right balance so that scientific integrity is retained, whilst reach is maximized. It’s tough to do, but worth striving for IMO.

Dr James Steele is the Principal Investigator at the ukactive Research Institute, and Associate Professor of Sport and Exercise Science at Solent University. James completed his BSc (Hons) in Applied Sport Science in 2010, and hid PhD examining the role of lumbar extensor resistance training in chronic low back pain in 2014. He has extensive experience of research and applied consultancy in the area of physical activity, exercise, and sport from over the past decade, working with a wide range of populations ranging from elite athletes across a range of sports, to the general population across the lifespan, and both those who are healthy and diseased. James has published numerous peer-reviewed articles and delivered several invited talks at international conferences on a variety of areas relating to sport, strength and conditioning, physical activity and exercise, health and fitness. He was appointed to the Expert Working Group revising the Chief Medical Officers Physical Activity Guidelines for the UK and is a Founding Member of the Strength and Conditioning Society, as well as the Society for Transparency, Openness, and Replication in Kinesiology, and member of both the British Association of Sport and Exercise Sciences and the American College of Sports Medicine.

Guest Post: The Truth about Detox Diets (and “Nutritionists”)

Todays guest post comes from Colleen O'Connor and Justine Horne, two registered dietitians who recently set out to investigate whether there's a difference between the information provided online by regulated health professionals (registered dietitians), and unregulated sources of dietary information (nutritionists), when it comes to "detox" diets. Guess what? There was. Here's their study published in the Canadian Journal of Dietetic Practice and Research and below are their thoughts on same

With January being prime time for New Year’s resolutions, you’ve probably recently seen a plethora of social media ads preaching the life-changing benefits of every diet under the sun, including detox diets.

So do we really need to detox? Is drinking lemon water for a week going to cleanse our bodies from all of those supposedly evil toxins that surround us day to day? Is a detox diet the solution to your life-long struggle with weight management? Is “cleansing” your body with things like activated charcoal beverages even safe?

You may have guessed that the answer to all of these questions is no. So why are we so intrigued by detox diets?

Part of the reason may lie in the information we read online. Our group from Brescia University College at Western University in London, Ontario reviewed information posted on nutrition blogs about detox diets and this research was published today in the Canadian Journal of Dietetic Practice and Research. The study aimed to determine if nutritionists and dietitians in Ontario are providing safe, science-based information and advice about detox diets online.

But wait...is there a difference between a dietitian and nutritionist?

In Ontario, yes there is - anyone can call themselves a nutritionist. That’s right, you can open up your own business as a self-proclaimed “nutritionist,” sell your nutrition services to friends, family, and whoever else you wish and hey, some insurance companies will even cover the cost of your services! You may have never read a single word about nutrition, yet you can call yourself a “nutritionist.” Do you see anything wrong with this situation?

We certainly do.

Alberta, Nova Scotia, and Quebec do too. That’s why their provincial legislation protects the title “nutritionist” for use exclusively by those with extensive scientific education and nutrition training - registered dietitians (also referred to as ‘dietitians’). Registered dietitians complete an accredited 4-year bachelor of science program to learn about the science behind food and nutrition, complete a competitive internship consisting of at least 1250 hours of supervised practical training, and pass a national 6 hr exam. They must continually keep up with the latest and greatest scientific evidence in nutrition, and are registered members of a regulatory college which is responsible for ensuring dietitians are promoting science-based, safe nutrition advice through a quality assurance program.

So our group from Brescia University College at Western University looked at the information posted online about detoxes from Ontario-based dietitians’ as well as “nutritionists’” websites. We compared this information to the latest peer-reviewed scientific review article on detox diets and overall, found the following:

• Unregulated “nutritionists” are providing unproven, misleading, and potentially harmful information about detox diets on their blogs.
• Registered dietitians, on the other hand, are providing safe, science-based information about detox diets on their blogs.

If you consider that anyone can call themselves a “nutritionist” in Ontario, these findings really aren’t surprising. But they are concerning.

Our study highlights that the current situation in Ontario has the potential to do harm to the general public. Ontario legislation around the open use of the term “nutritionist” needs to change. If you agree, feel free to show your support through e-signing this change.org petition.

The fact that somebody can easily get roped into spending their precious time, energy and money on nutrition services that have no scientific merit and the potential to do harm is really upsetting. If you’re seeking out nutrition information, make sure it’s coming from someone credible, like a dietitian.  In Canada, you can search for a dietitian near you by clicking here, or by clicking here. Many health insurance companies cover the cost of dietitian services. Dietitians are also available through family health teams, hospitals, community health centres, and other public healthcare organizations. If you just have some quick questions about nutrition, dietitians are now part of TeleHealth Ontario. Give them a call at 1-866-797-0000 to chat for free or visit UnlockFood.ca.

So rather than detox dieting, devote your efforts to making sustainable, life-long, science-backed lifestyle changes. Start small, with 1 or 2 specific changes and keep these up until they become habits. Then add something new. Small, sustainable lifestyle changes can add up to a major lifestyle overhaul and set you on your road to health and well-being.

Colleen O’Connor is a registered dietitian and an associate professor in the School of Food and Nutritional Sciences at Brescia University. She worked as a clinical dietitian in various settings before returning to school and completing her Ph.D. at the University of Guelph. She teaches undergraduate and graduate courses in clinical nutrition. Recent research has included interests in the effects of fermented foods on human health, effects of smart phone apps on influencing healthy behaviours in youth, and nutrient intake of residents in long-term care. She is registered with the College of Dietitians of Ontario and is also a member of Dietitians of Canada and the Canadian Nutrition Society. You can find her on Twitter here.

Justine Horne is a registered dietitian and PhD candidate in Health and Aging at the University of Western Ontario. She received a CIHR Frederick Banting and Charles Best Doctoral Award for her PhD work, which aims to assess the utility of innovative personalized nutrition strategies to help patients improve health behaviours and achieve a healthy body weight. Justine currently works as a dietitian at the East Elgin Family Health Team. She is registered with the College of Dietitians of Ontario and is also a member of Dietitians of Canada and the Canadian Nutrition Society. You can find her on Twitter here.

Guest Post: If You Serve It, We Will Drink It (Medical Resident Edition)

12oz can of Coca-Cola = 39g of free sugar (9.75tsp) offered to residents at recent CaRMS event

Today's guest post comes from first year medical resident Jen Crichton (who you can follow on Twitter). After she came back from a recent CaRMS event and told me what was being served (she's spending a month with us at our office), it reminded me that people consume what they're given, and that of all people, physicians ought to be considering that in their offerings.

Canada’s 2019 Food Guide was released in January. One of many welcome changes is the recommendation for water as the beverage of choice. The new Guide also recommends that sugary drinks (100% fruit juice, milk or milk substitutes with added sugars, soda pop, sports and energy drinks, etc.) not be consumed regularly. Section 2 of the Guide states that:

"Foods and beverages offered in publicly funded institutions should align with Canada's Dietary Guidelines.”

Many universities have previously banned the sale of bottled water on campus (to name just a few: McGill, Ottawa, Queen’s, York). These initiatives are motivated by obvious and warranted sustainability concerns about plastics. However, by continuing the sale of other sugary drinks in plastic bottles we are ignoring the elephant in the room. Why do we vilify bottled water but not bottled water with added sugar? A 2016 guest post by Sean Bawden explored this idea:

“Bottled water is seen as wasteful and unnecessary (See this video as an example); a stigma that did not seem to attach to a similar disposable bottle if filled with something other than water […] A plastic bottle is a plastic bottle; any environmental concerns and any objections to the use of such containers should apply equally, regardless of the container’s contents.”

Sustainable water drinking containers are great but let’s not throw the baby out with the bathwater.

It’s no secret that food environments shape our choices. Anecdotally, I was a part of one undergraduate medical event where organizers made the effort to purchase still and sparkling water off campus and bring it back on-site themselves. Many students had a relieved and refreshed reaction at the less common option of sparkling water.

Conversely, having just completed the CaRMS tour a year ago, I remember the challenges of making healthy choices amid the constant travel, social events, and interview day breakfasts and lunches. This year I empathized with the candidates who were on just one of many stops on a cross-country journey. Each interview day is high stakes; all are hoping to match to a residency program in order to complete their medical training. Do they really need the added decision of choosing water over freely available orange juice or soda pop? Or perhaps it’s not even a conscious decision because of the social stigma associated with bottled water compared to other beverages? Or the stress and vulnerability of the day leads them to choose a sugary option that they would not otherwise consider? Similar to at other medical events:

“All of the [people] here are human, when faced with indulgent dietary choices, they choose them.”

As residents, we are the next generation of physicians in training. Across many different medical specialties, we counsel patients to avoid sugar-sweetened beverages for their own health. We lament with our patients that the food environment around us can be challenging to always make healthier choices. And then on a personal level, residency can be a time of sleep deprivation and limited self-care activities such as cooking and exercise. In medicine, and really in any field where one has public influence, we need to stop shying away from opportunities to be leaders in the promotion of water as the beverage of choice for health.

Sure, it can be hard to please everyone at events. However, in an area where there’s really no longer any debate in terms of health impacts and recommendations, let’s choose to be better role models with respect to excessive sugar consumption and its role in obesity and other chronic diseases. I’m not suggesting that we embrace the disposable plastic water bottle wholeheartedly but rather that we should re-think our indifference (or even preference) towards other sugary drinks delivered in plastic bottles or otherwise.

The challenge is ours in how to create supportive environments that remind us to bring a reusable bottle or cup, that make access to safe drinking water readily available, and that do not punish our health by offering sugary drink choices.

It does not need to be complicated. It just needs to be the default.

Proposed simple guidelines for colleges, universities, hospitals, and other publicly funded institutions to follow:

1. Water’s number one: Always offer water as the beverage of choice.
2. Sustainability whenever possible: Water delivered in an environmentally-friendly cup or bottle is optimal.
3. Avoid sugary drinks: Do not forego bottled water in favour of 100% fruit juices, sodas, sports or energy drinks, or other sugar-sweetened beverages.

Jen Crichton is a Family Medicine resident doctor in training at the University of Ottawa with interests in nutrition and exercise as they intersect with all aspects of primary care. She loves all things active: CrossFit, running, and puppies.

Guest Post: What I Learned When I Actually Read That New BMJ Breakfast Study

Last week saw the BMJ's publication of a new meta-analysis on whether breakfast is useful to weight management. And, entirely predictably, it was clickbait for journalists as well as for those who believe breakfast's benefits are a myth. The question that leaped to my mind when reading the coverage was whether or not anyone actually read the study. Because to describe it as weak, at least in my opinion, would be unbearably generous. But at least one person read it. Finnish registered dietitian Reijo Laatikainen, as he published his own thoughts on his blog, and so rather than write up mine, I invited him to write an English language version here as a guest post.

Challenging deep-rooted health beliefs is always welcome and refreshing, and not something to be feared, but can the BMJ's new breakfast meta-analysis really conclude whether breakfast benefits weight management?

The meta-analysis of randomized controlled studies on breakfast skipping published last Tuesday along with a related op-ed by Tim Spector.

Both the meta-analysis and the opinion piece criticize the nutritional recommendations of many countries and organizations which promote the role of a balanced breakfast as an important part of a healthy dietary pattern. Interestingly, the role of breakfast in both of the BMJ papers is reduced to a weight management issue. Neither paper discusses other potential effects of breakfast consumption such as blood glucose control, energy expenditure, or lipid metabolism, and instead, without data, both papers seem to indirectly imply that breakfast has no health benefits whatsoever.

But back to weight management which was the scope of the study. The first sentence of the conclusions of the meta-analysis reads:

“This study suggests that eating breakfast is not a good weight management strategy.”

Does it though? My faith is tested.

In order to understand the effect of any strategy, dietary or otherwise, on weight management, first and foremost, the study must be long enough, ideally years, and in fact this is regularly seen with studies of different diets. For example, there are several meta-analyses of low-carbohydrate diet (LCD) RCTs with minimum durations of 6 months, and there are even studies with multi-year durations. This is appropriate of course given the question being asked is whether a particular diet has an impact on something that by definition is of long-term duration as temporarily lost weight may not stay lost forever.

This breakfast meta-analysis is not like those compiled for LCDs. Here, a total of 13 studies were included of which 4 did not last longer than a single day. In fact none of studies lasted even 6 months with the longest being 16 weeks, and the shortest just 8 hours.  Most studies lasted 1-4 weeks. When all these short, heterogenous studies were merged together, a 260 kcal increase in energy intake and 0.4 kg (0.88lb) weight gain was observed among breakfast eaters as compared with breakfast skippers.

And whether you're on team breakfast or not, I think all would agree that the studies included were of such short duration that even compiled together, they simply cannot reliably conclude anything about breakfast's utility to long-term weight management.

So what about the actual content of breakfast studied, what did the subjects eat? This is (inadequately) explained in Table 2. Commonly mentioned breakfast was juice with cereal and/or white bread. In one study, breakfast is described as follows:

"Bran cereal between 7 and 8 am, and a chocolate covered cookie between 10 30 and 11 am."

Does anyone really assume that such a breakfast would benefit weight management? In which country or organization's nutrition recommendation is such a breakfast recommended?

A few more things are worth noting. Studies on children and adolescents were excluded from the analysis. Similarly, studies of people with type 2 diabetes, where protein-rich breakfasts were shown to improve blood glucose control and reduce weight [ref, ref, and ref] were excluded from this analysis.

As a result of these shortcomings, this study clearly can't conclude anything about the impact of consuming a balanced and protein-rich breakfast on any aspect of long term health or weight management. Its conclusions are also contradicted by cohort studies which provide some information on long-term breakfast skipping which in turn suggest that skippers tend to be heavier.

Putting aside the problem with drawing long term conclusions on short term studies, at best, the most generous conclusion that can be drawn from this BMJ meta-analysis is that a low-quality breakfast does not help in weight management, and may even make it more difficult.

In order to truly decipher the role of breakfast to weight management and to health as whole, randomized trials of at least 6 months duration, with a balanced, protein-rich breakfast, are needed, and attention should be paid to its impacts on both healthy subjects as well as those with type 2 diabetes. Furthermore, changes in glucose metabolism and blood cholesterol, should be monitored as breakfast skipping might potentially worsen glucose tolerance even among healthy people and/or elevate their cholesterol.

One thing though is certain. This paper definitely does not provide even a remotely definitive answer to the breakfast question. At best, it reveals how weak the current quality of randomized breakfast studies.

PS. Just so that there's no confusion I'd like to explicitly state that breakfast is by no means a miraculous maneuver which is a categorial prerequisite for successful weight management. If you're a breakfast skipper, and your weight is managed to your satisfaction, you don't struggle with dietary restraint in the evenings, and your lipid and glucose values are within normal range, you are encouraged to continue to skipping breakfast.

Reijo Laatikainen, PhD, MBA, is registered dietitian working at Aava medical centre and Docrates cancer centre in Helsinki, Finland. You'll find him at Twitter @pronutritionist

Guest Post: Does the BMJ publishing group turn a blind eye to anti-statin, anti-dietary guideline & low-carb promoting editorial bias?

Truth be told, I'm fond of the British Journal of Sports Medicine, but as anyone who reads it knows, it has this strange habit of publishing articles about non-sports related dietary guidelines, the dangers of cholesterol lowering medications, and on the alleged superiority of low-carb diets. That's an odd thing, or maybe it's not, for as today's 4 guest posters (Drs Nicola Guess, Ian Lahart, Duane Mellor, and David Nunan) lay out, it may simply reflect the editor in chief's personal bias. So have a peek at their story, and if while you're reading you're on the fence, ask yourself if it would be odd for the American Journal of Clinical Nutrition to publish ankle sprain treatment guidelines, or if the Journal of the American College of Cardiology published a review of the efficacy of orthotics for plantar fasciitis? And note, at the end of their guest post is a link to an open letter to the BMJ that they've penned, which by following the link, you can also sign.

Scientific journals have the potential to allow researchers to keep up to date with developments in their field, to publish their own research, and to comment on the research and ideas of their peers. Journal editors play a vital role as impartial gatekeepers of this process, and importantly they should ensure their own personal beliefs and prejudices do not impact decisions related to content that is published in their journal.

Here we provide a synopsis of an example of poor gatekeeping we are currently experiencing and how this can skew the scientific discourse in favour of a personal agenda. A full account of this story is available here.

In April 2017, an opinion piece editorial entitled ‘Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions’ was published in the British Journal of Sports Medicine (BJSM), and then repeatedly promoted by the journals Twitter account, which is jointly run by the journal’s Editor in Chief (EIC).* Promotion of an editorial is completely normal—often an EIC will highlight an article or opinion piece that they believe to be of interest. However, it is also normal and expected that the editor acknowledges and welcomes debate and rebuttals from others who disagree with points made in the published article. Two of us (David Nunan and Ian Lahart) emailed the EIC immediately following publication of the original article offering a rebuttal, but received no response. After three months without reply, we published an open rebuttal in PubCommons (latterly Pubpeer) highlighting what we thought were important deficiencies in the original article.

We were surprised to see the EIC tweeting the saturated fat article a year later and stating that ‘importantly’ the editorial had not had any rebuttals. We immediately contacted the EIC again, and after a series of emails received acceptance that our rebuttal would be published in the BJSM.

An important point--one that we believe highlights the bias in gatekeeping at the BJSM—is that the original article was published “open access”, meaning it is was made freely available to academics, public and the media. This is important for openness and access to science, and also allows interested members of public to read articles which frequently are hidden behind a paywall. This of course is good practice. Key here though is that decisions to make articles such as these open access is made entirely by the EIC of the BJSM.

Naturally in the spirit of open debate, we would only consider it reasonable that our rebuttal would be published open access, along with some social media promotion. This way, readers could read both the original article and the rebuttal and consider all the arguments presented. However, we were told by the EIC that our article would not be made available as open access, but that we could instead pay for it (£1,950) to be made free of charge to read.

We were further concerned and surprised when we examined other articles on similar subjects also unrelated to the remit/readership (e.g., dietary guidelines, statins) published in the BJSM. Of 10 such articles, all were open access, they all had narratives that denigrated current dietary guidelines and/or statins and promoted an exclusively low-carb dietary approach. All of the articles were authored by supporters of these narratives, with some writing two or more articles. The EIC, via the BJSM twitter account, has regularly promoted these narratives on social media. Four rebuttals/counter arguments to these articles have been published (including our most recent) – none of these were made available as open access by the EIC. There has also been next to no promotion of these rebuttals via social media from the BJSM twitter account.

Furthermore, during the two-month period we were communicating with the editorial team to have our article published open access, or at the very least a footnote added to state we had been denied free open access (both requests were turned down), the BJSM produced two podcasts from authors of 2 of the 10 free articles, including the one in question here.

To be clear, our rebuttal was not in complete disagreement with all the points made in the original editorial. Our rebuttal was more about using robust methods to emphasize the strength of the evidence and highlighting knowns and unknowns that were overlooked in original editorial. Furthermore, we have healthy disagreements amongst ourselves about the evidence in this field (e.g., dietary guidelines). These disagreements, however, should be debated openly in the scientific literature. The EIC’s role is to facilitate this in an unbiased manner and ensure systems are in place to prevent biases skewing the scientific discourse to the journal’s audience. Imagine if a journal only published and promoted open access articles on the effectiveness of aspirin to prevent heart attacks, yet hid every rebuttal (highlighting potential harms) quietly behind a paywall?

We are concerned about the editorial conduct and procedures of the BJSM. Given the journal is part of the BMJ publishing group (governed by the British Medical Association (BMA)), this also raises questions over governance across over 50 of its journals The BJSM is also co-owned by the British Association of Sports and Exercise Medicine (BASEM). We think this is worth pursuing further and have written an open letter to each of these organizations requesting the issues raised here are looked into.

Our open letter is available for signing (and reading) by clicking here.

[*it would be reasonable to question the fit of such an editorial to the journal’s scope and readership: “…provides original research, reviews and debate relating to clinically-relevant aspects of sport and exercise medicine, including physiotherapy, physical therapy and rehabilitation.”]

Dr Nicola Guess is a lecturer in the Department of Nutritional Sciences at King’s College London in the UK and a Registered Dietitian. Her research interests are on the effect of diet on the pathophysiology of type 2 diabetes. 

Dr. Ian Lahart is a senior lecturer in exercise physiology and researcher at Institute of Human Sciences, University of Wolverhampton. He completed his PhD in the role of exercise in breast cancer. Through his PhD work, he conducted an exercise randomised controlled trial in women with breast cancer. Ian is also the lead author of a recent Cochrane collaboration review on the effects of exercise in women with breast cancer post-adjuvant therapy. Through his role as a research fellow at Russells Hall hospital, Dudley, UK, he helped set up and manage a MacMillan funded exercise-based cancer rehabilitation service. Although his research focus is on the role of exercise in breast cancer rehabilitation and survivorship, he has additionally worked with patients with other cancers, arthritis, cardiovascular disease, and diabetes and related metabolic conditions. He is also interested in the communication of science and meta-research—a field of research that investigates research practices and quality.

Dr. Duane Mellor has worked clinically as a dietitian, mainly in diabetes management and education and then as a researcher in clinical trials. However, reflecting back on the first 2 decades of his career he has begun to question a number of aspects of nutrition and dietetic practice. He is now interested in looking at evidence in nutrition, both in terms of causality and quality along with how this is communicated to the public by the media. Looking to challenge thinking in this area, to consider aspects of benefit and the risks of harm, ultimately looking at how the public can be best supported to eat food they enjoy that also supports good health.

Dr. David Nunan's career in academic research started over 15 years, with a focus on clinical care and evidence-based medicine over the past 8 years. Upon completion of his PhD, he joined the Centre for Evidence-Based Medicine and his role is now divided between research, teaching and outreach activities.

Book Review: The Complete Guide to Weight Loss Surgery

Today's guest post comes from our office's newest RD Alex Friel who has reviewed a book for people considering or having bariatric surgery (full disclosure, was provided with a feee copy of the book by the authors)

Thinking about weight loss surgery? You’re not alone. Bariatric surgery has been shown to be one of the most effective treatments for obesity and the number of people who undergo the procedure is steadily rising every year. Here at BMI, I work with many different clients. Some are considering bariatric surgery, others are actively preparing for it, and still more have undergone the procedure and are adjusting to life with a new anatomy. At every stage of the weight loss journey, it helps to be well informed.

Last week I was introduced to a new book written by registered dietitians Lisa Kaouk and Monica Bashaw. It’s a worthwhile read so I thought I’d share it with you. ‘The Complete Guide to Bariatric Surgery’ draws from their experiences as Weight Loss Surgery (WLS) dietitians and the many patients they have counseled over the years. Here’s what I liked:

• It’s from a trusted source. The registered dietitian (RD) credential means that Lisa and Monica are trained in the science and physiology of human nutrition. Their training and practice is regulated in much same way as that of our doctors and nurses so you can rest assured that the recommendations they make are tried, true, and grounded in evidence.
• Written in a conversational style, the book is an easy and entertaining read (or at least as entertaining as a book about a surgical procedure can probably be). There’s no jargon and you won’t need a degree in medicine or nutrition to make sense of the topics covered.
• Because the topics are drawn from the real life concerns and questions of more than 5000 patients, the book provides an honest glimpse into the realities of life after WLS. It’s a useful reference, not only for those who are considering WLS and those who have had it, but also for the friends and family who are their cheerleaders and support system.
• If you’ve ever anxiously wondered if your experience is normal, this book can provide some fast reassurance. The table of contents allows you to quickly skim questions at a glance and is organized into topic sections that range from ‘Tolerance Issues’ to ‘Hair Loss’ to ‘Emotional Changes and Support.’
• Much like this post, it’s short, sweet, and to the point. You won’t need to set aside hours of time to get through it.

My only critique is that the authors don't provide much information on additional resources, support groups, or further reading. It’s good to be aware of what’s available. Obesity Canada, for example, functions as a resource hub for professionals and lay people alike. In addition to educational webinars and videos, they also link to tools you can use to access greater health benefits for obesity care. The Bariatric Cookery, run by food writer Carol Bowen Ball, hosts a wonderful collection recipes to try at every stage of the WLS journey. As a former WLS patient herself, Carol’s first-hand experience lends the site a level of authenticity that is hard to top. Finally, a quick search on Google or Facebook will undoubtedly reveal a whole host of virtual WLS forums and support groups. Find one that resonates with you.

The Complete Guide to Bariatric Surgery is available for purchase on Amazon. It’s also available as an e-book at www.baritricsurgerynutrition.com.

Alex Friel, MSc, RD is a nutrition science nerd and one of the newest dietitians to join the BMI team. She’s convinced that everyone has a passion for food (even if they don’t know it yet) and is always on the lookout for her next favorite recipe. Alex spent six years living in Atlanta, Georgia where she completed a BSc and MSc in Nutrition Science at Georgia State University. Much to the chagrin of her dinner guests, she also gained an appreciation for collard greens and okra that persists to this day.

Registered Dietitian Christine McPhail Reviews The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes

Today's guest post, a review of The Picky Eater Project 6 weeks to Happier, Healthier, Family Mealtimes, was written by Christine McPhail MSc RD. Full disclosure: I was given a review copy of the book by Dr. Muth.

I work with parents, and picky eating is a common issue. Fortunately, there are some general recommendations that I can review such as following the division of responsibility in feeding, where parents are responsible for the what, when and where of feeding and children are responsible for whether they eat and how much they eat out of what parents offer. Within this, I ask parents to focus on neutrality when offering different foods, bridging from foods their family already enjoys, involving children in grocery shopping, growing food and cooking for buy-in and avoiding pressure in general to eat more or less of certain foods.

The most important part of addressing picky eating with my clients is working on practical steps collaboratively with them. That’s where I have found the resources within The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes by Natalie Digate Muth MD, MPH, RDN, FAAP and Sally Sampson from CHOPCHOP MAGAZINE to be very insightful and useful.

Here is what I liked about this book:

• It is a project. The book is very interactive and includes goal setting, action planning strategies, and ways to measure your progress at each stage of the project. Each section also uses to do/check lists.
• Picky eating is defined and explained and the book follows examples from real life families as they progress through the project. This shows families that it’s OK to stumble when they are trying to make changes and it allows them to see the recommendations translated into realistic outcomes.
• The concept of picky-free parenting allows parents to review their current behaviours around food to see if there is anything they could change in their behaviour that may be influencing their child’s picky eating behaviours. This also aligns well with learning about the Division of Responsibility in Feeding.
• There is a focus on changing your home food environment with sample pantry lists, snack lists, a how to use herbs and spices resource, recipes etc. which can be a useful tool for parents especially when they are tried and tested!
• Involving kids in the kitchen has its own section with a focus on age-appropriate kitchen tasks, tips for beginner chefs, meal ideas and recipes. This is so important for families to review and understand as we know that kids who participate in meal preparation are more likely to WANT to try new foods.
• Similarly, there is a section on involving kids in grocery shopping, growing foods, and visiting local farms with a focus on learning about food but also math and literacy skills too. It’s all buy-in and family involvement.
• Family meals are a primary focus of the picky eating project with tips on how to make them a priority, meal planning, meal time rules, and even packed lunch mix and match ideas.
• The project does not leave out all of the other factors and people that can either support or hinder your efforts to have your family eat a wider variety of foods. Those important people include peers, school staff, caregivers, grandparents etc. As the section is appropriately titled…it takes a village!
• To finish up the project, there is a section that addresses that behaviour change is hard! I think this is important for parents to understand but it’s equally important to for them to have tips on how to make changes stick. The focus is on starting small, using SMART goals, having a plan, anticipating problems, and involving your kids the whole way!
• The last section of the book discusses severe picky eating and when to seek more professional help. I was impressed with this because it identifies red flags for parents to watch out for so they know when they may need to incorporate health professionals into their journey.

The only issue I had about the picky eating project was the risk associated with labelling your child as picky i.e. they live up to the expectation. On the other hand, with the family-focussed nature of the book the journey is not simply for the “picky” child, it’s for the whole family to expand their palette in an open and honest way that includes all family members.

Christine McPhail MSc, RD is one of our Registered Dietitians at the Bariatric Medical Institute (though is moving on soon to work with the eating disorders team at Hopewell). 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.

Guest Post: What Happens to Weight Bias when Obesity is Named a Disease?

Source: Obesity Canada's Image Bank

Today's guest post is a group one coming from Sarah Nutter and Shelly Russell-Mayhew from the University of Calgary Werklund School of Education, and Cara C. MacInnis from the University of Calgary, Department of Psychology. It's a post detailing their recent study on the impact labeling obesity as a chronic disease has on weight bias.

In the years leading up the declaration of obesity as a chronic disease, much debate surrounded the possible impact that the label of ‘disease’ would have on weight bias in the general public. Opinions at the time were strongly divided, and remain so today. Our research team (also comprised of JH Ellard from the University of Calgary and Dr. AS Alberga from Concordia University) found one research study investigating the impact of labeling obesity a disease on weight bias, conducted by Hoyt and colleagues. We set out to extend this research by examining a number of different factors that we felt important when considering the impact that declaring obesity a disease would have on weight bias attitudes.

Most notably, we examined the impact that the declaration of obesity as a disease had on emotions towards people living with obesity. In addition, we were curious about how the degree to which people believe that the world is a place where people get what they deserve (i.e., good things happen to good people; bad things happen to bad people) might affect weight bias when obesity was declared a disease. Finally, we wondered how participants’ satisfaction with their own body weight might influence how this labeling was perceived in terms of weight bias scores.

Residents of either Canada or the U.S. (n=309) read one of three articles. The first two articles were identical in content, providing factual information about obesity; The only difference between these two articles was the description of obesity as a disease versus not a disease. The third article was unrelated to obesity.

Respondents that read the article stating that obesity is a disease had more positive emotions towards individuals with obesity compared to respondents who read either of the other two articles. This increase in positive emotion then contributed to less negative attitudes (weight bias) towards people with obesity. We also found that, for respondents who strongly believed that the world is a place where people get what they deserve, reading the obesity is a disease article (vs. the others) was related to less blame towards individuals with obesity, which in turn predicted less weight bias. Finally, among respondents who were the most satisfied with their body weight, reading the obesity is a disease article (vs. the others) was also associated with lower blame towards individuals with obesity.

Our finding that reading about obesity as a disease had an impact on the emotions of our respondents is particularly noteworthy.

In research related to other stigmatized conditions, the promotion of a genetic explanation for a condition has been associated with more negative reactions. The findings from this study suggest that understanding obesity as a disease has a positive impact on emotions, which then has a positive impact on overall attitudes towards people living with obesity. Findings from this study also support the idea that reducing blame might be an avenue to reduce weight bias attitudes. This provides interesting directions for future research, which could examine other factors that increase positive emotions or reduce blame towards people with obesity. Labelling obesity a disease seems to be related to less weight bias for individuals who hold strong beliefs about people getting what they deserve and who are satisfied with their own body weight at least in terms of reducing blame. Future research should aim to understand why this seems to be the case.

Guest Post: Celebrated Canadian Chef Fred Morin Reflects Darkly Following His Friend Anthony Bourdain's Death

I've had the pleasure of knowing Fred (co-owner/chef at Montreal's Joe Beef, Liverpool House, Le Vin Papillon, and Mon Lapin) since we met on a panel during the 2012 Trottier Symposium. One of the things I never did, but always wanted to, was ask him to let me know when his friend Anthony Bourdain was coming to town as I, like it seems everyone, found Bourdain's authenticity and manner intoxicatingly cool. I didn't ask because it would have been the opposite of cool to do so, I'd have been comparably, insufferably, boring, and it would have overstepped our friendship, and so too, when I heard the news of Bourdain's death, and my mind immediately turned Fred, and I wondered what his thoughts were and how he was doing, I didn't feel it would be appropriate for me to add to his likely large pile of inquiry. All that said, he contacted me a few days later with some dark reflections, and I think they're very much worth reading, even if they may shine a light on things in a manner that is unsettling. People, and life, are complicated.

Recently as I lost a friend, we all lost a hero. Most struggle to grasp why our culinary knights while basking in praises and porcine dripping can still pay rent on such a dark den within the tenements of their souls. Here is a short tale of how and why based on my livings.

There is an ancient proverb that say’s that war killed many folks but not nearly as much as the table!

The chubby teen didn’t attend prom, for a slew of made up reasons, mostly because he was a chubby teen. He failed at getting shit done although all the while labelled as somewhat a genius, I could extend, explore and extrapolate on the topic and throw his parents and teachers into the crosshairs of his own failure, but he pays a good chunk of cash weekly to decipher what is etched deep in the confines of his “why”.

School, life and jogging were arduous tasks that he fractioned into infinite parts of bearable duration, hoping that soon enough more had passed than remained to come, until it was over for good. Until someone told him that cooking might be what he was chasing since his early days, and whatever academic pursuit that stood in his path should be dropped out of, wise words.

Time spent cooking, the coup de feu, the dinner rush, there was no “prior”, there was no later, all the boxes on the list; checked! The shrieking grind of the dot matrix printer sounded to him like a cheer from his corner-man, 45 veal chops to prep, 45 veal chops to cook, 45 veal chops to re-order, bliss! Nothing left undone, forgotten, no neglected to-do’s . Everything tasted great, when he left, surfaces were clean and reeked appropriately of bleach.

The pudgy teen had fun, but he couldn’t find sleep, 44 chops were great but the 45th was a bit rough, perhaps he who ate it didn’t know real veal from tenderize Tyson shit!? The waiter dropped the wrong knife? Or the supplier sent us shit calf! Anyway, he rehearsed the shit stew he will lay thick onto the innocents. He fell asleep, but printer woke him up, there was no printer.

55 veal chops, 75 veal chops, 90 veal chops; the pudgy teen is a warrior, a hero, his skin now bears the seared branding of his culinary kin. The printer still shrieks at 4 am but he doesn’t hear it because he hopped along with the tribe for some beers, a lot of them.

He missed the shriek of the printer, but the calls he didn’t, he got up, sobered up and went, he picked up his tribe-mates, from the ground they fell on, from jails and from the psych wards.

Now half an hour after the printed used to buzz, he would expects the phone to bling, most of the time it doesn’t, when it doe’s he’s there in an instant to sanitize the grounds and heal the troops after the bloodbaths. Sometimes it rings and it’s just bad news, but he’s not going back to bed; overdoses and murder suicide are no lullabies.

The beers, Jagger bombs and Player lights no longer dampen the bleeps of the 4 am calls, furthermore, it sorts of make you tired. Cocaine is conveniently priced and packaged, it certainly doesn’t mute the rings, but the buzz generated by this circle jerk of tongue chewing dick heads redoing the world with false promises effectively muffles it.

Among the fans of pudgy teen’s veal chop are a few doctors, and pudgy teen, not completely honest, opens up about his anxiety and his inability to sleep. Sure, he omits a few details; the thefts, the betrayals, the powders and the liquids. After all the life of a chef without the inclement add-ons it's harsh enough to legitimize a Xanax script!

Solace! The beer numbs the anger of the night’s mistakes, the vodka catalyses the beer’s effect, but cocaine is there to help you go further, Xanax will soon shield the rising sun, awesome.

Most of his culinary heroes count their achievements in vintages and grams, anyways, he looks up to them, they seem happy doing it, he will get there someday, just has to dial in the dosage.

He misses the phone calls, fish didn’t come in, later that night, 5 or 6 veal chop sucked. Of course, it not his fault, he’s not cooking them anymore, using the people skills he learned however he could, he addresses the situation, a dish basket nearly misses his head, later the dishwasher stabs a happy go lucky manager with a bottle.

Pudgy kid took from his paycheck to pay the night chef on site, so the House could serve Grey Goose until 3am.

Earlier that night, a food writer managed to snatch a table at 9:30, between the Buddha Bar replays and the budding DJ remixes of U2. Not glorious, it’s obvious. Will be either stars in print or stars on pills.

Pudgy teen worked long shifts so now another voice joined the choir of screams, he’s never home, leaves too early and can’t stop looking at his phone. But he’s a cool dude now and he drinks champagne, he’s an epicurean Mohican, not a trashy line cooks that drinks beer, he tells himself that.

When the Champagne swells his forehead a bit too much he moves to craft beers and small batch spirits, helping the small farms and artisans in the process. He makes wise decisions, socially inclined choices of intoxicants. He drinks from magnums to lower his bottle count, lays down early, or so he was told.

But he’s not cooking 45 chops a day anymore, there’s no ways he could. People who flock in love him for who he has become, a legendary glutton, an emotional cesspool of epic proportions who turned to wheat grass and one liners to limp his way thru service.

He stacks fatty cuts, and metaphors, skillfully intersects them with meaty opinions, he gets quoted by media folks.

Pudgy kid is grown up, mostly happy now, but still stuck; between wine soaked layers of truffles, pills and crafty banter.

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 Serôdio, 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 Serôdio 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.

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.