Your Breakfast Skipping Teen Might Do Better With Breakfast Protein

It's just a pilot study, but some interesting findings.

First the surprising (at least to me). According to the paper, 30% of adolescents skip breakfast every day and as many as 60% skip breakfast 3–4 times per week. While there are no hard and fast rules around breakfast (meaning some people do well with it, and some do just as well without it), that the majority of teens skip the majority of breakfasts I find a bit shocking.

This small crossover study set out to compare the impact of a 350 calorie "normal" protein breakfast (13g), vs. a "high" protein breakfast containing the same number of calories, but with more protein (35g). The normal protein meals were breakfast cereals with milk, while the high protein meals were egg and pork based. The test subjects were 28 habitual teen breakfast skippers (avg. BMI 29.9) and the primary endpoint that the researchers considered was glycemic (sugar) control by way of 24 hour glucose monitoring. The reason the researchers cared about sugar was the fact that prior studies had found associations between breakfast skipping and risk of developing type 2 diabetes.

The researchers found that when consuming high protein breakfast, the teens' peak glucose readings and the time their blood sugar levels spent above its high limit were lower than after the normal protein breakfast.

Breakfast is a funny thing in that it seems to inspire very strong opinions about its worth or lack thereof as it might pertain to a myriad of things - obesity, attention, hunger, and more. My experiences with patients demonstrate that for the many, if not most, breakfast, especially high protein breakfasts, help with fullness and dietary control throughout a person's day and evening.

If you're curious about whether or not a high protein breakfast would benefit you, perhaps the easiest thing to do would be to experiment and to keep track of how you feel on days you have one, vs. days you don't.

[Update: Sorry, earlier version had word higher rather than lower with conclusion. Thanks to those who noticed!]

Saturday Stories: Apocalypse Pig, Babushkas, and Dunning-Kruger

Maryn McKenna with as great a headline as they come, and for a terrifying story of Apocalypse Pig.

George Johnson in the New York Times covers the babushkas of Chernobyl.

Melanie Tannenbaum in Gizmodo and the over-claiming of self-proclaimed experts.

Adele, Settling Feuds Across the Galaxy

As a measure of just how out of touch I am with popular culture, the first time I heard Adele's new blockbuster Hello was in today's Funny Friday video of Ms. Piggy covering it.



Oh, and for my fellow nerds, here's a bonus video.



Have a great weekend!

One Weird (Evidence Based) Trick To Help You To Eat Less Pizza

Photo source: Someone who already likes 16 slice pizzas.

The sciency way to explain it is to, "Make small food units".

The practical way that you might help yourself to mindlessly eat less pizza? When you make or order your next pizza, have it cut into at least twice as many pieces (from 8 to 16) and ideally eat it from a plate placed on a large table. Do so, and if this study's findings hold true, you might consume nearly 50% less!

Via the Journal of the Association of Consumer Research.

Coca-Cola Partners with Police to Hand Out Drink Coupons

Yesterday Ontario's Peel Regional Police and Coca-Cola held a joint press conference to promote their new partnership - one that will see police officers in Peel hand out coupons for Coca-Cola to drivers who haven't been drinking and driving.

Given the awareness and illegality surrounding drunk driving, the likelihood that this "partnership" will lead those who were otherwise considering driving drunk to not do so is low at best.

What that means of course is that this is a partnership that only benefits Coca-Cola who in turn receive the incredible opportunity of having a police force freely serving as respected, trustworthy, brand ambassadors.

By involving themselves in causes like this one, causes that are themselves beyond reproach, Coca-Cola secures powerful, and virtually free advertising, while accumulating public relations victories that they can use when trying to convince politicians that soda taxes are bad ideas. A great move for Coca-Cola, with pretty much nothing in it for Peel.

Unfortunately, though it was there before, the Peel Regional Police have apparently removed the video of their joint press conference with Coca-Cola.

Juice as a Gateway Drug For Soda

Is juice a gateway drink?

That's the question asked by some Harvard and University of Michigan researchers in their paper, "Juice and water intake in infancy and later beverage intake and adiposity: Could juice be a gateway drink?" (free full text link here)

It may follow. Train your child's palate to enjoy cloyingly sweet beverages in early childhood and they'll be more likely to continue consuming them later in life.

To try to shed some light on that question the researchers studied the association between 1 year olds' juice and water intakes (as reported by their mothers) to their reported intakes of sugar sweetened beverages in early and mid childhood.

After controlling for confounding maternal socio-economic, ethnic (though the authors report that there was limited ethnic variation), and health variables the researchers found that higher juice intake at 1 year correlated with higher juice and sugar sweetened beverage intake, and higher weights, at early and mid childhood.

Juice is a glass of sugar water with a small smattering of vitamins. It's not sating. It has little if any fibre, and it is stripped of much of the originating fruit's phytonutrients. The World Health Organization, Canada's Heart and Stroke Foundation, the American Academy of Pediatrics and the Canadian Pediatric Society all caution against its regular consumption.

Juice is basically flat soda pop, and should be treated as such, with the aim being the consumption of the smallest amount of juice you need to enjoy your life, and its marked limitation in children.

[Thanks to Laval University's Dr. Michel Lucas for sending this study my way]

Four Brief Thoughts on Conflicts of Interest

• Just because a study is funded by industry that doesn't mean its findings aren't valid.
• Literature on conflicts of interest clearly states that while perhaps no one believes they can be influenced, being influenced by your conflict, consciously or unconsciously, is a great evidenced based bet.
• Dollars aren't just used to fund studies that industry believes will be beneficial, they're also used to provide megaphones to researchers whose messages and research are industry friendly (no better example of this than the Global Energy Balance Network).
• Dollars aside, relationships matter to industry. I'd wager friendships are far more influential in motivating conscious and unconscious biases than dollars, and are relevant even when actual dollars are small.

Saturday Stories: Rejected Peace Treaties, Guns, and Global Jihadist Insurgency

The Tower with a story about the Palestinian Authority's Mahmoud Abbas' admission that in 2008 he rejected a comprehensive peace deal that would have provided for an independent Palestinian state containing all of the Gaza Strip, much of the West Bank (with land swaps), and a tunnel connecting the two areas, that was offered to him by Israel.

Damien Spleeters via Motherboard on the US Military and defective machine guns.

Former Islamist Maajid Nawaz in The Daily Beast makes his case for calling what's going on a "global jihadist insurgency" rather than World War III.

Who Doesn't Need an Easy Laugh This Week?

Awful week.

Hopefully today's Funny Friday video will afford you a quick and easy laugh (but maybe don't try this at home with your cat)

Have a great weekend!

I Love This Food Industry Funded Initiative

To be more accurate, it's funded by produce (not product) manufacturers, is run by the Ontario Federation of Agriculture, and it's called Six by Sixteen.

Why does it exist and what will it do?

"We're serving up food literacy.

There's a very clear link between healthy eating habits and lifelong health. Six by Sixteen wants to ensure the next generation knows how to make healthy, nutritious food choices. That's food literacy.

Six by Sixteen will help young people learn to plan and prepare six nutritious, locally sourced meals by the time they are sixteen years old. We'll arm them with lifelong skills, lifelong health and they'll be supporting local farmers, food processors and our economy."

Here are the program's sponsors

Though I've yet to see any Six by Sixteen collateral, getting kids into the kitchen and teaching them how to cook meals from fresh whole ingredients is definitely something I can support.

[H/T to RD Rebecca Davids for sending my way]

The Only 46 Words of Health Advice You'll Ever Need

In no particular order:

• Avoid trans fats.
• Substitute unsaturated fats for saturated if you can.
• Cook from fresh whole ingredients.
• Minimize restaurant and ultra-processed foods.
• Cultivate friendships.
• Don't smoke.
• Nurture sleep.
• Drink alcohol at most moderately.
• Exercise as often as you can enjoy
• Only drink those calories that you love

Comparatively, everything else is minutia.

Toronto Hospitals Rewarding Flu Shot Receiving Staff With Chocolate Bars

Post vaccination lollipops for kids may be one thing (though are clearly debatable), but do fully grown adults, adults who are physicians, nurses and other allied health professionals, really need to be rewarded, let alone with a chocolate bar, for getting a flu shot?

Toronto's University Health Network hospitals clearly think so.

As a whole, society needs to be striving to provide fewer opportunities for the consumption of junk food, not encouraging and permitting more, and who better than hospitals to be leading that charge?

A Personal Post (Or Why This Blog Will be Dark for the Next 12 Days)

Tomorrow I'm heading to Israel to join a group of Canadian physicians receiving disaster relief training from the Israeli ambulance service Magen David Adom (MDA).

Organized by the Canadian Friends of Magen David Adom, the course will see us trained in basic life support, advanced cardiac life support, advanced trauma life support, some mass casualty training, and will also include a live MDA mobile intensive care unit shift. Once trained our cadre will become part of the Magen David Adom family and be available to help with emergency relief efforts not only in Israel, but around the globe.

Given what's been going on in Israel of late, I can't say I'm not at all anxious. I'm not so much worried about my own safety, or the injuries I might see, as I am about those injuriues' possible nature. Though I've certainly seen my share of tragedy in emergency rooms, I've never been a witness to terror, and there's a real chance that will change on this trip. Since September 14th Israel has faced nearly daily terrorist attacks which have included 58 stabbings, 5 shootings, and 6 car rammings resulting in over 150 casualties and 11 deaths. Among those stabbed are women, children, and senior citizens, including a toddler, a 13 year old riding his bicycle, and, 3 days ago, an 80 year old grandmother out for a walk in central Israel (the after scene in the above photo).

For more on the MDA's relief efforts, here's a fascinating and detailed Reddit AMA with Tal Rabin, an Israeli paramedic who joined the MDA's mission to Nepal after last year's disaster.

While I might find time to periodically update this blog while gone, the updates will likely involve my experiences with MDA.

If you're looking for more information on MDA as a whole, or to give a donation, here's a link to the Canadian friends of Magen David Adom, and here is a link to the American friends of Magen David Adom.

Why You Might Want To Step Away From The Kale Chips

I spotted these as I wandered around Whole Foods before heading to the movies.

The packaging screams out health. "Kale", "Air Dried, Not Fried", "GMO Free", "MSG Free", "Gluten Free", "Vegetarian"

Turn the package over however and you might be surprised to learn a few things.

The bag's 640 calories clock in at 16% more than a Big Mac's 549 (and more gram for gram than Doritos), and they're also packing the same amount of sodium gram for gram as Lay's potato chips (regular flavour).

The nutrition data is also a bit curious.

Looking at 28g of raw kale you'll notice that it contains 86% of your Vitamin A %DV and 56% of Vitamin C. And yet 28g of these dehydrated kale chips, which you might imagine would in fact represent more than 28g of raw given the dehydration, have 97% less vitamin A and 73% less vitamin C.

Putting aside the fact that if you're actually looking for the nutritive benefits of kale, at least as compared with Kaley's Kale Chips, actual kale's the way to go, some might say that I'm being too harsh. They might say that the bag isn't meant to be consumed in one sitting. But as you can see from the photo where I'm holding it, the bag's no larger than your average checkout aisle chip bag, and at least with chips, you won't for a moment convince yourself they're a healthful choice.

If you want kale buy kale. If you want chips buy chips. Simple.

Did the Muppets Reboot Really Need Fat Jokes?

So I watched the first few episodes of The Muppets reboot as I'd heard that they were full of fat jokes.

Here are some that I caught:

Kermit: "Hey Zoot, listen, the next time we do a sketch where Piggy flies across the stage we should choose a wire that actually supports her weight.
Zoot: "Huh, it should have worked, it was a cable from a wrecking ball"

Kermit: "From now on let's just be honest with each other, ok?"
Piggy: "Ok. I don't know what you see in your girlfriend and you're getting a little tummy"
Kermit: "What?! I mean if I stand up straight it uh, goes away doesn't it, uh, oh no, it doesn't"

Weird looking muppet: "Well I was fitting Piggy for a new dress"
Kermit: "Oh no, you didn't cut out the tag, she knows her size?"
Weird looking muppet: "Oh please, I've woven such a cocoon of lies she doesn't know her size, weight, or even how old she is"

Gonzo: "Keanu Reeves says he's in (to date Miss Piggy). Oh, no, no, no, he says he's put on 100lbs"

Though there may have been fat jokes in the original Muppets as well, it aired between 1976 and 1981, a different time and era when it came to rates of childhood obesity, and also in regard to the recognition of weight bias.

Given it's 2015, with weight being the number one source of childhood bullying and where 1 in 3 children watching the show will have overweight or obesity, I'd have hoped that The Muppets wouldn't have decided to add to their bullies' piles.

Goes back to the notion that people don't question social norms, and sadly, fat jokes, even in kids' shows, movies and books, are very much an awful norm.

Saturday Stories: Hedonic Balancing, Weight Loss Myths, and Fake Meat

Alex Hutchinson in the New York Times on how salad can make us fat through "hedonic balancing".

Kevin Hall in The Washington Post covers 5 pervasive weight loss myths.

James Hamblin in the Atlantic on how the future of meat won't be meat at all.

What I Learned Actually Reading That New Low-Fat Diets Are Dead Study

So last night the embargo lifted on a study that looked at low-fat diets and weight loss. I read the article a few days ago as it was sent to me so that I could discuss with the CBC. Given the tenor of the discussion I'm seeing on Twitter right now, I've decided to share the 7 tweets I posted yesterday that coincided with the embargo's lifting.

1. So embargo now lifted on meta-analysis that found low-fat diets no better than any other diet for weight loss.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

2. Study did find that calorie restricted low-fat had worse outcomes than non-calorie restricted high fat (low-carb) diets.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

3. But what's amazing to me is that diet proponents and the media are going to be shouting about a study that in the end is quibbling

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

4. about weight losses amounting to just 5-7lbs in a year, and differences of 1-2lbs between diets. Ultimately study shows all "diets" suck.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

5. That all diets suck isn't news. Nor do findings provide brag-worthiness to diets conferring an additional 1 or 2lbs of yearly losses.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

6. Biggest predictor of longterm success is whether or not U actually enjoy your life/diet while losing. If you don't, weight's coming back.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

7. Inconvenient truth of healthful living is that it does require effort, but if effort is perceived as suffering, it's not going to last.

— Yoni Freedhoff, MD (@YoniFreedhoff) October 29, 2015

A Tale of One Marathoning Woman's Incredible Bravery

Today's Funny Friday is an almost unbelievable tale of bravery.

Have a great weekend!

Making Halloween Into a Positive Teachable Moment

(This post first published October 24th, 2013)

It's coming.

And I'm not really all that worried. At least not about Halloween night.

The fact is food's not simply fuel, and like it or not, Halloween and candy are part of the very fabric of North American culture and to suggest that kids shouldn't enjoy candy on Halloween isn't an approach I would support.

That said, Halloween sure isn't pretty. On average every Halloween sized candy contains in the order of 2 teaspoons of sugar and the calories of 2 Oreo cookies and I'd bet most Halloween eves there are more kids consuming 10 or more Halloween treats than less - 20 teaspoons of sugar and the calories of more than half an entire package of Oreos (there are 36 cookies in a package of Oreos).

So what's a health conscious parent to do?

Use Halloween as a teachable moment. After all, it's not Halloween day that's the real problem, the real problem are the other 364 days of Halloween where we as a society have very unwisely decided to reward, pacify and entertain kids with junk food or candy (see my piece on the 365 days of Halloween here). So what can be taught on Halloween?

Well firstly I think you can chat some about sugar and/or calories, and those rule of thumb figures up above provide easily visualized metrics for kids and parents alike.

Secondly it allows for a discussion around "thoughtful reduction". Ask them how many candies they think they'll need to enjoy Halloween? Remember, the goal is the healthiest life that can be enjoyed, and that goes for kids too, and consequently the smallest amount of candy that a kid is going to need to enjoy Halloween is likely a larger amount than a plain old boring Thursday. In my house the kids have decided upon 3 pieces - so our kids come home, they dump their sacks, and rather than just eat randomly from a massive pile they hunt out the 3 treats they think would be the most awesome and then take their time enjoying them.

The rest?

Well it goes into the cupboard and gets metered out at a rate of around a candy a day....but strangely....and I'm not entirely sure how this happens, maybe it's cupboard goblins, but after the kids go to sleep the piles seem to shrink more quickly than math would predict. I've also heard of some families donating candy to a local mission or homeless shelter, and others who grab glue guns and make a Halloween candy collage.

A few years ago we discovered that the Switch Witch' territory had expanded to include Ottawa. Like her sister the Tooth Fairy, the Switch Witch, on Halloween, flies around looking for piles of candy to "switch" for toys in an attempt to keep kids' teeth free from cavities for her sister. The joy and excitement on my kids' faces when they came downstairs on November 1st that first Switch Witch year was something to behold.

And if you do happen upon our home, we haven't given out candy since 2006 and we haven't been egged either. You can buy Halloween coloured play-doh packs at Costco, Halloween glow sticks, stickers or temporary tattoos at the dollar store (glow sticks seem to be the biggest hit in our neighbourhood), or if your community is enlightened, you might even be able to pick up free swim or skate passes for your local arena (they run about 50 cents per so if you're in a very busy neighbourhood this can get pricey).

[Here's me chatting about the subject with CBC Toronto's Matt Galloway]

We've Got a Serving Size Problem

Will posting more realistic serving sizes on packages help consumers make wiser choices?

I certainly used to think so.

The thinking was straightforward. If faced with the high calories (or sugar, or salt, or whatever an individual might themselves be focused on reducing) identified by a more realistically portrayed serving size, people might eat less.

Recent research however calls that thinking into question. A study published this year in the journal Appetite found that proposed changes to include more realistic serving sizes led those utilizing them, in laboratory settings, to serve themselves and others more, and that the serving sizes were perceived as amounts that people were supposed to eat.

What the study did not show was whether or not more realistic serving size postings would impact upon the frequency with which people ate a particular product, or whether they might lead them not to purchase certain products in the first place - behaviours which in turn would support the practice.

But those questions aside, the research was pretty clear in that the public's perception of "servings" including the erroneous notion that they were recommended amounts.

Makes me wonder whether or not having a dual column nutrition facts panel that includes a commonly consumed portion amount alongside the whole package coupled with the removal of the word "servings" would help (see up above)?

Future research for someone I'm sure.