Saturday Stories: Conflicts of Interest, A Very Troubled Teen, and George Deek.

Friend and RD Andy Bellatti in Beyond Chron discusses conflicts of interest and nutrition.

Karen K. Ho in Toronto Life with the riveting story of a troubled young woman and the hit she took out on her parents.

Adi Schwartz in Tablet Magazine covers the incredible, true, and hopeful story of George Deek, at once an Israeli diplomate to Norway, an Arab, and a Christian.

What Do Dogs Do When Their Owners Leave Them Home Alone?

If today's Funny Friday video has any say, they do whatever it is they're not supposed to.

Have a great weekend!

The Chair of Nutritional Sciences at UofT Says Canada's Food Guide Sucks

And boy does it ever. I've been railing on about how bad it is for nearly a decade now, and just a few weeks ago, Dr. Mary L'Abbe, the Chair of the University of Toronto's Department of Nutritional Sciences, along with her graduate student, Mahsa Jessri published their paper, "The Time for an Updated Canadian Food Guide Has Arrived (Full Text)". After reading it, I invited them to write me a guest post, and here one is as written by PhD candidate Jessri.

Since 1942, Canada has published food guides with a strong emphasis on meeting nutrient requirements. Canada, like many other Western countries, however, experienced a nutritional transition decades ago where widespread micronutrient deficiency was replaced with overconsumption of energy-dense foods and calories. This phenomenon has resulted in a drastic increase in diet-related chronic diseases, such as obesity, type 2 diabetes and cardiovascular diseases; thus we now need dietary recommendations targeted specifically towards the types of foods associated with maintaining a healthy body weight and preventing chronic diseases. Recently we published a critical review of 2007 Eating Well with Canada’s Food Guide (EWCFG) calling for an urgent update to these national Canadian dietary guidelines. Now you may be asking what are the limitations of EWCFG 2007 and why it needs an “urgent update”?

Firstly, if you add up the calories recommended for the four food groups: Fruits and Vegetables, Grain Products, Meat and Alternatives, Milk and Alternatives, and healthy oils (essential calories) for each age and sex group, the total would be higher than the recommended energy requirement for Canadians, confirming the claims made by previous researchers that following the EWCFG leads to overconsumption of calories. There is also no room left for the calories from “other foods” (e.g., high fat and sugary products) which are completely omitted from the 2007 EWCFG, which is another problem. We know from the Canadian national nutrition survey data that nearly 1/4 of the calories consumed by Canadians are from “other foods”; food guides from most other countries leave some calories for these treats that we sometimes eat - which further suggests that EWCFG is obesogenic in nature. Equally important, the same number of servings are recommended for all physical activity levels, with no different recommendations for a sedentary individual and a very highly active athlete.

As pointed out by other researchers, the Canadian EWCFG was highly influenced by the food industry; one-third of all stakeholders involved in consultations were from the food industry who could therefore have influenced much of its development.

Another important issue that’s lacking in the current food guide is consideration of cultural dietary behaviors. We know that one in every 5 Canadians was a visible minority in 2011 and yet our EWCFG 2007 neglects their cultural food preferences and practices, and instead recommends one eating pattern for all, while we already know there is more than one way of healthy eating. Of course, the first step towards development of a comprehensive evidence-based, culturally-sensitive dietary guideline would be to collect food intake information from multi-ethnic individuals in Canada. Unlike other countries, Canada does not have a plan for conducting multiethnic nutrition surveys.

These along with other limitations mentioned in our article, call for an evidence-based unbiased action for drafting a new Canadian food guide using the most recent national Canadian nutrition survey, considering the changes in food supply, the epidemics of chronic diseases, and using a socio-ecological perspective of different food patterns. Such an “ideal” Food Guide would be more focused on maintaining a healthy body weight and reducing the risk of chronic diseases, rather than preventing nutrient deficiencies - which Canadians have a very few of!

Weight Is the Wrong Measure for Physical Activity Interventions

The other day I was reading about point-of-action queues and their impact on stair climbing behaviour and I came across this study, ‘Take the stairs instead of the escalator’: effect of environmental prompts on community stair use and implications for a national ‘Small Steps’ campaignIt's a straight forward paper that looked at 8 studies and the impact they found stair climbing prompts in heavily trafficked areas had on stair climbing behaviours.

The authors found that simple point-of-action signage and prompts led to a nearly 5% increase in stair climbing among women and half that among men. Their work also predicted that every week those signs stayed in place led to 2200 new stair users.

And yet, despite these terrific and pretty much cost and effort free interventions, the authors tempered their conclusions (both in the abstract and of course the larger piece) with negativity stating,

"The projected effect on correcting energy imbalance appears small, suggesting that this intervention alone will not have a potent effect on leveraging population-level body weight or obesity prevalence"

But as I've calculated before, to burn the calories of a small Snickers bar you'd need to climb 122 flights of stairs.

That researchers apparently wondered whether or not a few extra daily flights of stair climbing in malls and office buildings would have a dramatic, let alone any, impact on weight, frightens me. Truly, that weight was included as a discussion piece in this study speaks to just how widespread, even among those who really ought to know better, is the erroneous belief that physical activity is such a large player in weight that even tiny increases to it might lead to weight loss.

Unless You're in an ER, if You Hear the Word "Detox", Run

Simple rule - if someone is trying to promote, defend, or encourage the use of a product they claim will remove toxins from your body, unless they're a physician in the emergency department or your kidney failure specialist, they're either dangerously ignorant, or unconscionably unethical.

And if you're trying to determine between ignorant and unethical, look to their education. If they haven't any, well then give them the benefit of the doubt and presume it's just well-intentioned, hopeful, ignorance. But if they are highly educated, like for instance Dr. Frank Lipman, who sells a $229 two-week cleanse he purports will,

"help to bind toxins, prevent their absorption and promote elimination"

Or Dr. Oz, who promotes a 3 day "Detox Cleanse" that he claims,

"Eliminates harmful toxins and resets your body"

I think it's probably safe to err on the side of unethical.

Recently the fabulous Australian consumer show The Checkout covered detoxing. If you've got a moment, take a peek.

The Juvenile Diabetes Research Foundation's Disgraceful Fundraising

As far as junk food fundraising goes, I don't think there are any health charities worse than the Juvenile Diabetes Research Foundation.

While in the past they've been quick to defend their sale of some of the junk food world's least healthful choices by reminding critics that they are a charity supporting type 1 diabetes - an autoimmune disease - and not type 2 diabetes, I don't give a flying hoot. Selling illness in the name of health isn't something a health charity should be involved with, let alone a charity who regardless of the etiology of their cause's illness, should assuredly know better than to promote, permit, and encourage the sale and consumption of huge boluses of sugar.

So what has the JDRF sold to date? Pictorially here are three recent campaigns:

And now, on the backs of Mega-Jugs of Pepsi at KFC, Frosties at Wendy's, and deep-fried cheesecake at Denny's comes two other new-to-me initiatives.

There's the annual Root Beer Float Day for the JDRF with the Oakland Athletics (thanks Matt Poulton)

And then there's this one. Honestly, I'm still struggling to believe it's real, but it is. It comes from JDRF Australia where they have a "Jelly Babies Month" for the JDRF.

What are these Jelly Babies that the JDRF suggests you:

• Place a box at work, in reception or in the staff room for your colleagues
• Take a box to Saturday sport, the kids will love the Jelly Babies lollies after playing a hard game
• Ask your local shops to place a box on their counter for their customers.
• Consider your local bakery, butcher, chemist, supermarket or even the gym!
• Ask your local club, like your sporting club, surf club, bushwalking club or book club to put a box on display for all members
• Use Facebook to let your friends know that you are selling Jelly Babies lollies with natural colours and flavours

Well, they're candies. Literally.

Candies which by weight are 74% sugar, with each tiny Jelly Baby (they appear to be slightly larger than a gummy bear in size) packing more than a teaspoon of the stuff.

So once again I have to point out that it's time we put an end to junk food fundraising.

Saturday Stories: Mirna Valerio, Genohype, and Oliver Sacks

"9.13.09OliverSacksByLuigiNovi" by Luigi Novi. Licensed under CC BY 3.0 via Wikimedia Commons"

John Branton in Runner's World with just a fabulous and inspirational piece on ultra-distance runner Mirna Valerio.

My friend and fancy pants professor Tim Caulfield in the BMJ talking about the dangers of "Genohype".

The great Oliver Sacks in the NYTs discussing his outlook on life as seen through the lens of his terminal, metastatic cancer.

"Stop Pushing Gross Fruits and Vegetables on Your Kids"

Funny or Die and Nick Offerman take on American school lunches in today's Funny Friday.

Have a great weekend!

3 Years of Telling People to Exercise More Doesn't Make Them Exercise More (at Least Not in Japan)

I've asked before whether or not anyone is aware of any public health intervention that has led to a sustained and objectively measurable increase in the activity level of a population (adults, kids, both, whatever)

Unfortunately, I've yet to hear of any exciting outcomes (nor have I by the way for simply telling people to eat better).

As I see it, the value of exercise as health promoting is well known. Public health campaigns that in turn simply spread that message, probably aren't teaching people anything new, and consequently, may not lead to any sustained changes in behaviour.

And that's precisely what researchers in Japan recently found whereby a 3 year-long, cluster randomized controlled trial designed to evaluate extensive, community wide interventions designed to encourage more physical activity, failed to show any significant benefits.

The interventions were definitely not trivial either, but they were definitely all geared to try to encourage conscious, individual behaviour change. According to the paper, they included,

"(1) Information delivery.

Flyers, leaflets, community newsletters, posters (those are them up above), banners, and local audio broadcasts.

(2) Education delivery.

Outreach health education program and mass- and individual encouragement by professionals during community events. Mass-encouragement included a motivating talk and demonstration of PA using a common procedure to ensure standardization of the intervention and individual encouragement including face-to-face promotion of PA while waiting for
community health check-ups

(3) Support delivery.

Development of social support, i.e., promoting encouragement by community leaders and lay health workers; material support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and DVDs on flexibility and muscle-strengthening activities at each relevant community center; and professional support, i.e., establishing a call center for questions about PA and requests for outreach"

Now to be fair, evaluation was by way of survey, though given that asked people generally overestimate their activity levels, if anything you would expect a survey to be more likely to yield a positive result than for instance accelerometry data. Ultimately though, there were no significant improvements found. Not to over-all activity, not to walking, not to flexibility (though there was a positive trend), and not to muscle strengthening.

I think this speaks to the fact that good intentions fail in the face of day to day life, and that if we want to see population wide increases in physical activity, we'll likely need to effect that by way of point of action changes (such as signs placed on escalators and elevators suggesting a person might want to instead take the stairs) and re-engineered built environments that make increased activity the unconscious default, or at the very least, the easier choice.

Dairy Queen Is Not A Partner in Health. Period.

There's no disputing the fact that Dairy Queen Blizzards are a rite of summer for many, nor am I even remotely suggesting that you shouldn't ever have one.

What I am suggesting is that organizations involved in health who encourage the sale of Blizzards in the name of fundraising, and in so doing, provide people with reason and permission to buy them, and further normalize the practice of junk food fundraising, regardless of the dollars involved, are hypocritical and doing a disservice to the healthful lifestyles they purport to be championing.

Treats nowadays are no longer consumed just, "once in a while", so defending this practice as if treats are a rarity, a one-of, is a strawman.

And the money's not so wonderful either.

When I crunched the numbers last year for Dairy Queen's Miracle Treat Day my best guess was that it raises roughly $20,000 per hospital per year in fundraising, or roughly 0.0001% of the average children's hospital's annual budget.

And though I definitely can't prove it, I wonder whether Miracle Treat Day might have inspired, or gave tacit permission to, Kidsport, an Ontario health based NGO geared at increasing sport among Ontario's children, to launch their own Blizzard fundraising event.

I've said it before and clearly I'll keep on saying it, it's time to put an end to junk food fundraising - feel free to click the link if you're interested in a more fulsome discussion as to why.

[Hat tip to Kat Murphy for sending me the Kidsport campaign]

St. Michael's Hospital Foundation Tells Patients Honey and Maple Syrup Are Healthy

St. Michael's Hospital Foundation, in the summer issue of their patient magazine Urban Angel, have an article on sugar and ways to cut down its consumption.

Here's one of their recommendations,

"Another way to deal with (sugar) cravings is to explore alternative sweeteners in your recipes like applesauce, dates or bananas"

I wholly agree. But check out this next line,

"You might also consider unrefined products like organic honey and maple syrup"

They then, on the next page, go on to describe maple syrup as a source of zinc, manganese and calcium, containing 90% less sodium than sugar (less sodium?!), and that honey's slower absorption makes it better.

Healthwashing honey, maple syrup and agave nectar by perpetuating the naturalistic fallacy and using words like "organic" and highlighting trace minerals is not something any health foundation should be doing.

Free sugars are free sugars regardless of how "natural", "organic", or full of manganese they might be.

The Heart and Stroke Foundation would agree as they note,

"The Heart and Stroke Foundation’s position statement on sugar indicates that excess consumption of free sugars is associated with a number of adverse health effects. It encourages Canadians to avoid drinking their calories, including honey and syrups. Instead the Foundation encourages Canadians if they have a sugar craving to consume whole fruits, which are packed with heart-healthy minerals, vitamins and fibre."

For all intents and purposes honey, maple syrup and agave nectars are all free sugars and hence, the stuff we should be minimizing, not healthwashing.

If St. Michael's Hospital Foundation want to do right by patients, they should publish a prominent correction in their next issue.

New Obesity Study From the Annals of Idiotic Goalposts

If I looked at 279,000 men and women for a decade and studied whether or not they qualified for the Boston Marathon, but I didn't actually look to see if they were runners, and if they were runners I didn't bother exploring what their training plans and distances were like, but instead simply looked at how many people from that 279,000 qualified for Boston, I'm guessing I'd be left with an incredibly small number.

And yet, that's pretty much exactly what the latest depressing weight loss study did. They followed 279,000 men and women for ten years to see what was the probability of those with obesity losing back down to "normal" weight (a BMI less than 25). They didn't exclude people who weren't trying to lose weight or who might not have wanted to lose weight. They also didn't pay any attention to the means with which those who did lose weight only to regain it lost it in the first place.

The odds weren't good. Over the course of a decade, only 1 in 210 men with obesity, and 1 in 124 women managed to bring their weights down to a place where a table would define them as "normal".

It's not particularly surprising. Putting aside the surprising fact that this study didn't exclude people who weren't trying to lose weight, it remains that the vast majority of folks trying to lose weight these days do so by undertaking ridiculous diets. Go figure people don't sustain the results of ridiculous diets; weight lost through suffering comes back when you get sick of suffering. This study of course misses all of that.

And is getting down to a "normal" weight really the right yardstick to measure success? I mean getting down to a BMI under 25 is to weight loss what qualifying for the Boston Marathon is to running. Most runners will never qualify, and consequently qualifying would be a very poor way to measure whether or not people were runners.

But what if you change the goal posts?

If for instance, you set out to study the number of runners who continue to enjoy running as often and as much as they're able to enjoy, rather than simply the number of runners who qualified for Boston, well suddenly the number of runners will be much much higher, though of course not all of those who take up running, keep up with it either.

Extended that to weight, if the goal posts become your "best weight" which is whatever weight you reach when you're living the healthiest life that you can enjoy, suddenly the numbers change.

How much do they change?

Looking at, for instance, the 8 year data from the LOOK AHEAD trial, where lifestyle changes were thoughtful and the goal wasn't qualifying for Boston, 8 years out and 1 in 2 of the participants were maintaining losses of greater than 5 percent of their presenting weights, and more than 1 in 4 were maintaining losses of greater than 10 percent.

So did the publication of this depressing study add to obesity's literature? Quantifying the number of people who don't qualify for the Boston Marathon of weight loss, without quantifying how many of them were actually runners, and what sort of training program they were adopting doesn't strike me as a helpful addition.

I also can't help but wonder what the impact the publication and coverage of studies like these have on individuals who might be considering lifestyle change - both in terms of reinforcing idiotic goalposts, and in terms of them even starting out of the gates.

Saturday Stories: Soda Taxes, Earthquakes, GMO Must Read, and Protein

Lizzie Wade in Wired covers the success to date of Mexico's newly established soda tax.

In case you somehow missed this piece by Kathryn Shulz in the New Yorker on the massive earthquake that's due to destroy the coastal Northwest, here it is!

William Saletan, in Slate, takes a fascinating, must read, deep dive into the war against GMOs.

Lou Schuler, in Men's Health, discusses health, aging, exercise, and diet with McMaster's awesome Stu Phillips.

I May Just Take Up Meditation!

This awesome meditation video (assuming you're good with cursing) is today's Funny Friday video .

Have a great weekend!

Celebrity Pediatrician Dr. Jim Sears Gives His Endorsement to Diluted Sugar Water

Dr. Jim Sears is the co-host of The Doctors. He's a licensed paediatrician. And given that he's quoted in Mott's press release about their "Pediatrician Approved" watered down apple juice, I'm guessing he is the actual, singular, pediatrician who approved it.

Now reading the Mott's For Tots press release you might think that this product is aimed at parents who are already diluting fruit juice with water so as to try to minimize the massive sugar bolus that is fruit juice. The press release suggests that those parents who worry about their kids getting the full strength stuff when their kids are out at birthday parties and such, can just pack a box of this stuff which, rather than containing 7 teaspoons of sugar per glass, contains 3.75 teaspoons per glass.

But let me ask you, what do you think the big blue "Pediatrician Approved" stamp is more likely to do? Lead parents to think that watered down juice is a healthful choice (clearly that's the way it's being advertised by Mott's), one that they can, or even should, continue serving their children on a regular basis, or instead lead parents to understand, as the World Health Organization, the American Academy of Pediatrics and the Canadian Heart and Stroke Foundation would recommend, that juice should be considered a treat that should be actively minimized in a child's diet, and where a single glass of even this diluted stuff meets/exceeds the American Heart Association's total daily recommended free sugar kid maximum?

Dr. Sears seems a savvy MD - both in terms of business and marketing, and maybe even in terms of medicine. Consequently, I have to imagine he understands the well-established "Health Halo" effect of front-of-package labelling which lead people to consume (or parents to provide) more of products whose package fronts infer health. That Sears has chosen to ignore that by "approving" the "Pediatrician Approved" labelling of watered down (and I bet marked up) juice, speaks more about his business acumen, than his clinical judgement.

[Thanks to friend and RD Andy Bellatti for highlighting this product on Twitter]

Yellowknife Police Handing Out McDonald's Happy Meals to Kids

Similar to the Ontario police campaign that rewards kids' good deeds with Mac's Milk's version of a large Slurpee, Yellowknife police are reportedly handing out coupons for McDonald's Happy Meals to kids riding their bikes with their helmets on.

Am willing to wager that rather than the promotion of fast food, the Yellowknife Police force, with just a little bit of effort, could have promoted health by partnering with the City's own Ruth Inch Memorial Pool and handing out coupons for free swims.

Dairy Farmers Did Not Break Law by Stating Milk Products Prevent Colon Cancer

Received an email on Friday from the Dairy Farmers of Canada's Executive Director Caroline Emond.

In it she expressed her concern that my blog post from June 29th was inaccurate. That blog post assumed that making the claims that milk products prevent colon cancer and type 2 diabetes, improve bone health, and confer healthy blood pressure wasn't legal by way of the laws guiding nutrient function claims which clearly state,

"Nutrient function claims may not refer to the treatment, prevention or cure of a Schedule A disease; or claim to treat, mitigate, or prevent a disease, disorder or physical state; or claim to correct, restore or modify an organic function [3(1) and 3(2), FDA]. Such claims are considered to be drug claims (see Drugs vs. Foods)."

But there's a catch as Ms. Emond's letter clearly lays out, which means that at least in Canada, it would seem the Dairy Farmers' claims are allowed.

Ms. Emond points out that according to the letter of the law, if the audience for the claims being made isn't the general public, the rules don't apply.

In her letter she quoted the 1987 decision of a judge from the Alberta Court of Appeals who stated,

"By including the word "general" as a modifier in s. 3(2) the broad term "public" is narrowed. The section totally prohibits advertisement to the general public. It is designed not to interfere with advertisements to the "specialized" professional medical community in specialized trade and professional publications, such as medical journals, pharmaceutical journals and so on."

I responded to Ms. Emond immediately and asked her if I could share her entire letter with the readers here, but since I have yet to hear back I wanted to publish this clarification which ultimately has me scratching my head about the fact that it's potentially legal in Canada to advertise and promote any claim you want to a community of influencers.

I was also curious about the judge's decision so I Googled the case law she cited. That decision was made in a case whereby the defendant offered to sell a product to an individual undercover food and drug inspector to who he described the product as being a treatment or preventative for heart disease, diabetes, hernias and ulcers. The judge's ruling, while it included the paragraph up above, also stated,

"The critical aspect is that the offer is made indiscriminately to everyone and anyone without regard to who may accept it."

and he continued,

"In this case there is no evidence that the accused made an indiscriminate offer to the general public; rather, her representations were directed at a specific individual."

I do wonder how this judge would feel about a booth placed in a room, which while filled no doubt with many health professionals and researchers, also included members of the general public, and certainly was not aimed at a specific individual.

(I have appended a link to this post to the original as well.)

We Definitely Have a Nanny State - The Food Industry is Our Nanny

It would seem that Cineplex is pulling a Bloomberg in that last week Cineplex announced that as a means to make more money and to reduce the shock when calorie counts get posted, they were going to reduce their cup sizes but charge you the same as before.

Bloomberg, in case you don't recall, had suggested that cup sizes be reduced and that half a litre be the largest cup size sold.

Here's what happened next.

Yet I haven't heard one cry of "Nanny State" about the fact that Cineplex will be reducing their largest drink offering by nearly 25%.

Of course the reduced sized cups are still bonkers big!

• Small drinks are still 1/2 a litre (16oz) - 2.7x larger than Coca-Cola's original 6oz single serve bottle.
• "Regular" drinks are now 3/4 of a litre (24oz) - 50% larger than the bottle Coca-Cola used to advertise as being able to "serve 3 over ice - nice".
• Large drinks are now a litre (32oz) (down from 1.3 litres) - 10% larger than the average capacity of a human stomach.

So the food industry has decided that half a litre be the smallest cup size sold.

Movie drink sizes are a great example of how we definitely have a nanny state, it's just that the food industry is our nanny.

Saturday Stories: Cancer, Cancer, and False Balance

Image from Skeptical Raptor's blog

Graham Richardson in The Australian recounts part of his experiences with his cancer and chemotherapy.

My friend Joe Schwarcz in the Montreal Gazette on science, cancer, and unexpected consequences.

Steven Novella in Science Based Medicine rips U of T a new one for their false balance defence of an indefensible course taught by the campus Dean's wife.

And if you don't follow me on Twitter or Facebook, below is my most recent segment from The Social where we chatted about energy drinks, chocolate milk, coconut water and the trots.

Babies React To UofT's Defence of Its Anti-Vaccination Course

In case you hadn't heard, the University of Toronto (my alma mater), as recently as last year, offered students a course taught by a homeopath who was busted in a CBC Marketplace exposé, which featured anti-vaccination theory, "quantum" theories of health, and more just plain and dangerous woo.

The whistle got blown on that course, and UofT dutifully launched an investigation. Their investigation concluded, I kid you not, that it was ok for them to have been offering a course full of nonsense because "other courses" taught the truth.

Today's Funny Friday video is a montage of babies reacting to that press release.



Have a great weekend!