Saturday Stories: Suicide, Goop, Vaccines, And Kurbo

Connie Schultz, in Creators, on what to say (and not say) to someone whose loved one has died by suicide.

Amanda Mull, in The Atlantic, on what Goop really sells.

Richard Conniff, in National Geographic, on the world before vaccines.

[And if you don't follow me on Twitter or Facebook, here's my take on Weight Watcher's new kids Kurbo app and how while Weight Watchers might know kids aren't likely to lose much weight, do the kids?]

The Rewards Project - A Registered UK Charity Geared At Putting An End To Sugary School Rewards

So it's back to school time, and zero doubt, many of your kids are going to have teachers and schools who will use candy and junk food as a reward.

It's a shame too, not just because they'll be providing your kids with junk, but also because they'll be teaching them, over and over and over, that junk is a reward for anything and everything.

I've written before about easy non-junk food rewards for teachers, I've also written about how you might want to approach things with your kids' sugar pushers, and I even kept track one year of just how much junk other people were offering my kids. What was clear from the response to all of these pieces was just how prevalent this problem was, and just how frustrated parents are.

Well as a sign of those times, in the UK, a new charity has popped up called The Rewards Project and its mission is trying to change this common practice. Click through and you'll find some sample letters to send to your child's school (though I think they'd be much better were they to offer some alternatives and suggestions in them and as I wrote about and linked above, lead with praise for the school and its teachers).

All this to say, if there are charities popping up geared at tackling this issue, clearly there's a real appetite out there for change. In turn this suggests - and my experiences with my kids' schools and more would definitely support this notion - that your kids' schools and teachers might be more open to changing things than you might think.

You'll never know unless you try.

(Thanks to Dr. Miriam Berchuk for sending this my way)

Saturday Stories: Fitness Evolution, Soda Taxes, and Tick Saliva

James Steele, in The Evolution Institute, on how evolution best informs exercise.

Jeremy B. White, in The Agenda, on how the food industry may be winning the war against soda taxes.

Sarah Zhang, in The Atlantic, marvels about tick saliva.

9 Great Suggestions For Improving The Quality Of Dietary Research (And 1 That According To @JamesHeathers Is "Deeply Silly")

Last week saw the publication of an op-ed authored by Drs. David Ludwig, Cara Ebbeling, and Steven Heymsfield entitled, "Improving the Quality of Dietary Research". In it they discuss the many limitations of dietary research and chart a way forward that includes the following 9 great suggestions,

1. Recognize that the design features of phase 3 drug studies are not always feasible or appropriate in nutrition research, and clarify the minimum standards necessary for diet studies to be considered successful.
2. Distinguish among study design categories, including mechanistic, pilot (exploratory), efficacy (explanatory), effectiveness (pragmatic), and translational (with implications for public health and policy). Each of these study types is important for generating knowledge about diet and chronic disease, and some overlap may invariably exist; however, the findings from small-scale, short-term, or low-intensity trials should not be conflated with definitive hypothesis testing.
3. Define diets more precisely when feasible (eg, with quantitative nutrient targets and other parameters, rather than qualitative descriptors such as Mediterranean) to allow for rigorous and reproducible comparisons.
4. Improve the methods for addressing common design challenges, such as how to promote adherence to dietary prescriptions (ie, with feeding studies and more intensive behavioral and environmental intervention), and reduce dropout or loss to follow-up.
5. Develop sensitive and specific biomeasures of adherence (eg, metabolomics), and use available methods when feasible (eg, doubly labeled water method for total energy expenditure).
6. Create and adequately fund local (or regional) cores to enhance research infrastructure.
7. Standardize practices to mitigate the risk of bias related to conflicts of interest in nutrition research, including independent oversight of data management and analysis, as has been done for drug trials.
8. Make databases publicly available at time of study publication to facilitate reanalyses and scholarly dialogue.
9. Establish best practices for media relations to help reduce hyperbole surrounding publication of small, preliminary, or inconclusive research with limited generalizability."

But there is one recommendation that seems at odds with the rest,

Acknowledge that changes to, or discrepancies in, clinical registries of diet trials are commonplace, and update final analysis plans before unmasking random study group assignments and initiating data analysis.

For those who aren't aware, clinical registries are where researchers document in advance the pre-specified methods and outcomes being studied by way of an observational experiment. The purpose of pre-registration is to reduce the risk of bias, selective reporting, and overt p-hacking that can (and has) occurred in dietary research.

Now to be clear, I'm a clinician, not a researcher, and I'm not sure how commonplace changes to or discrepancies in clinical registries of diet trials are, but I'm also not sure that's an argument in their favour even if they are. I do know that recently two of the authors claiming registry changes are commonplace were found to have modified one of their pre-specified statistical analysis plans which if it had been adhered to, would have rendered their results non-significant.

But commonplace or not, is it good science?

To answer that question I turned to James Heathers, a researcher and self-described "data thug" whose area of interest is methodology (and who you should definitely follow on Twitter), who described the notion of accepting that changes and discrepancies to clinical registries were commonplace was, "deeply silly".

He went on to elaborate as to why,

First of all - the whole definition of a theory is something which sets your expectations. the idea that 'reality is messy' does not interfere with the idea that you have hypothesis driven expectations which are derived from theories.

Second: there is nothing to prevent you saying "WE DID NOT FIND WHAT WE EXPECTED TO FIND" and then *following it* with your insightful exploratory analysis. In fact, that would almost be a better exposition of the facts by definition as you are presenting your expectations as expectations, and your after-the-fact speculations likewise.

Third: if you have a power analysis which determines there is a correct amount of observations necessary to reliably observe an effect, having the freedom to go 'never mind that then' is not a good thing by definition.

Fourth: The fact that changes were made is never ever included in the manuscript. i.e. they are proposing being able to make changes to the protocol in the registry *without* having to say so. it's a 'new plan' rather than a 'changed plan'.

Fifth: If you can still do the original analysis then no-one will ever believe that you didn't change the plan after looking at the data. you have to protect yourself, and the best way to do that is to follow your own damned plans and be realistic from the get.

Lastly, Heathers is unimpressed with the argument that registry changes are A-OK because they're commonplace, and he discussed ancient Aztecan punishments for those citing it.

All this to say, there's plenty of room to improve the quality of dietary research. Here's hoping the bulk of these suggestions are taken to heart, but please don't hold your breath.

Saturday Stories: Morning People, In Sickness, And Mom Bods

Olga Khazan, in The Atlantic, discusses people like me - cursed to wake up every day before 5:30am.

Mark Lukach, in The Pacific Standard, discusses love in the face of severe mental illness.

Alice Sueffert, in ScaryMommy, discusses finally showing her mom bod some love.

Kellogg's Partners With Random House To Use Free Books To Sell Ultra-Processed Sugary Junk Food To Children

To be clear, neither Random House, nor Kellogg's, should be fairly expected to do the right thing when it comes to health.

Kellogg's job is to sell food. Random House's job is to sell books. Nothing more, nothing less.

So it's hard to get mad with either company for their "Feeding Reading" initiative which provides parents with permission or excuse to buy their children such health foods as:

• Frosted Flakes
• Pop-Tarts
• Eggos
• Nutrigrain Bars
• Froot Loops
• Rice Krispie Treats
• Apple Jacks
• Frosted Mini-Wheats (note, unfrosted mini-wheats are not eligible)
• Corn Pops
• Raisin Bran
• Krave
• Keebler cookies
• Cheez-its
• Austin crackers
• Pringles

Truly, not a single choice parents or children should be encouraged to make. All ultra-processed, sugary, junk (and some crackers and potato chips).

Again, no reason to expect either Random House or Kellogg's to be doing the right thing by kids, but in my opinion, their clear partnership in doing the wrong thing here certainly doesn't reflect well on either of them.

Saturday Stories: Apples, Crystals, and Mindfulness

James Hamblin, in The Atlantic, on how fresh apples (and other fruit) are perhaps the only probiotics you should be buying.

Emily Atkin, in The New Republic, explains why even if you believe in the nonsense around healing crystals, you probably shouldn't be buying them.

Sahanika Ratnayake, in Aeon, with some truths about mindfulness.

[And in case you don't follow me on social media, in Medscape this week I ask does the anger, zealotry, and ugliness of the more vocal parts of the low-carb community hinder its wider adoption?]

The Recipe For Aging Gracefully And Adding Life To Your Years

No one wants aging to happen to them, and yet.

While eventually we'll all lose the fight, that doesn't mean we can't go down swinging, and the good news is the recipe for aging without frailty is exceedingly straight forward and was recently spelled out in a systematic review published in the British Journal of General Practice.

The magic formula the 46 included studies pointed to? A mix of regular strength training with regular protein supplementation.

Spelled out a bit further?

20-25 minutes of strength training 4x per week and the purposeful inclusion of protein with every meal and snack (or alternatively, two daily protein supplements providing 25g of protein each).

Though the aforementioned formula won't guarantee a long life, the evidence certainly suggests it'll help to provide a better one adding life to your years if not years to your life.

Saturday Stories: Defending Indefendibles, Assisted Suicide, And Archie MacIsaac-Vacon

Glenn C. Loury, in The New York Times, asks why are democrats defending "an ambulance-chasing, anti-Semitic, anti-white race hustler"?

Susie Adelson, in Toronto Life, on throwing her grandmother an assisted suicide party.

Charlene Vacon, in LinkedIn, with a heartbreaking must-read story about her son Archie. 

Most Generous Conclusion Of Chocolate Milk In Exercise Systematic Review And Meta-Analysis? It Will Increase Your Time To Exhaustion By 47 Seconds Over Placebo

Literally every time I write about chocolate milk being a beverage worth actively minimizing in your diet (have the smallest amount of it you need to like your life), someone inevitably chimes in to tell me I'm wrong because it's great for exercise recovery.

And I'm not sure how I missed this when it came out, but last year, the European Journal of Clinical Nutrition, published a systematic review and meta-analysis of randomized controlled trials involving chocolate milk and exercise recovery.

After excluding studies that didn't meet their inclusion criteria, the (non-conflicted) authors were left with 12 studies, 2 deemed of high quality, 9 of fair quality, and 1 of low quality with 11 having extractable data on at least one performance/recovery marker including ratings of perceived exertion, time to exhaustion, heart rate, serum lactate, and serum creatine kinase.

Their overall conclusion?

The systematic review and meta-analysis revealed that chocolate milk consumption had no effect on any of those variables when compared to placebo or other sport drinks.

Their most generous conclusion?

If they excluded one study from their analysis of the effect of chocolate milk on time to exhaustion then chocolate milk was found to increase time to exhaustion by 47 seconds over a placebo beverage. They also found, in another subgroup analysis, that lactate was slightly attenuated in chocolate milk drinkers compared to placebo (a finding that was not present in the high quality RCT looking at same).

(for a brief discussion on the stats involved and the subgroup analysis, here's a post on same from epidemiologist @GidMK who concluded that chocolate milk is "not a fitness drink").

Happy to have this post published so that I can share the next time someone inevitably tries to suggest that chocolate milk is magic.

Saturday Stories: #Keto, Gullibility, And Lyme Disease

Julia Belluz, in Vox, with a terrific overview of the keto diet.

Kera Bolonik, in The Cut, with a bizarre and gripping read about "the most gullible man in Cambridge"

Molly Fisher, also in The Cut, with a great read on when lyme disease becomes an identity.

Sorry, Eating Thin People's Poop Isn't Likely To Make You Thin

Though there are certainly some celebrity quacktacular physicians I would like to see eat crap, but what I wouldn't be able to tell them is that doing so would likely have a beneficial impact on their weights.

A recent small study, Effects of Fecal Microbiota Transplantation With Oral Capsules in Obese Patients, found results that to me at least, seemed wholly unsurprising. 22 patients with obesity were randomly assigned to receive either a "fecal microbiota transplantation" from a donor whose BMI was 17.5 or a placebo and to take them for 3 months (and for those curious, the induction dose was 30 capsules).

The transplants were successful in changing the microbiome of the recipients, but alas, did not affect their weights.

Perhaps the only thing surprising about all of this is that there are people out there who strongly believe that a microbiome transplant stands a chance against thousands of genes, dozens of hormones, and a Willy Wonkian food environment all of which being coupled with millions of years of an evolutionary crucible of extreme dietary insecurity.

Saturday Stories: Racism, Serena Williams, and Climate Change

Ariel Sobel, with a great piece in Jewish Journal, on how fighting anti-semitism with racism doesn't actually fight racism but rather hijacks real concerns about anti-Semitism to promote other prejudices and in so doing, destroys Jewish credibility

Serena Williams, in Harpers, with just a fabulous first person essay on why she'll never stop speaking up in the face of injustice.

David Corn, in Mother Jones, on the unique burden of being a climate scientist.

Photo By Edwin Martinez - https://www.flickr.com/photos/rhythmstrip/9630755847/, CC BY 2.0, Link

From The Journal Of If Only It Were That Easy: Walking To School Was Not Associated With Lower Weights In 4-7 Year Olds

Walking school buses for kids are often promoted on the basis that if more kids were involved with them, their weights, fitness, and maybe even learning would improve.

Wouldn't that be great? After all, it's a relatively inexpensive intervention and one it seems everyone can at least theoretically get behind.

But does it work?

This is definitely not a good news story, nor frankly is it all that surprising, but here it is - recently the MOVI‐KIDS Study set out to explore whether or not there was an association between active transport in 4-7 year olds and their weights, fitness, and cognition.

The study involved 1,159 children in Spain and they were categorized on the basis of whether the active components of their school commutes totalled more or less than 15 minutes and then tested and measured to explore walking to school's possible impact. Heights and weight were measured, a validated cardiorespiratory fitness test was administered, as were multiple batteries of validated cognitive tests. Efforts were also made to control for familial socio-economic status, as well as of course the children's ages and sexes.

As you might have gathered, the walkers were found to be no better off on any studied variable with the authors very plainly concluding,

"Walking to school had no positive impact on adiposity, physical fitness, and cognition in 4‐ to 7‐year‐old children."

Too bad. Truly.

I have to say too, I did scratch my head reading the next bit of their conclusion though,

"it would be of interest for future studies to examine the intensity and duration of active commuting to school necessary to provide meaningful benefits for health and cognitive performance."

I can't say I agree with them here as I'm not sure lengthy, intense, daily school commutes for 4 year olds is something we need to explore regardless of their impact on anything. Moreover, I don't need to see "meaningful benefits" to want to continue promoting more movement and play in our children, and if we buy into the need for same, we'll risk the cessation of programs that don't prove themselves to provide perhaps broader reaching or more dramatic outcomes than could ever be fairly expected of them.

Saturday Stories: Doctor Patients, A Letter Written While In Line To Be Murdered In Auschwitz, And Billionaire Sean Parker

Olga Khazan, in The Atlantic, with further evidence that education alone is insufficient for behaviour change with her stories on how physicians make for terrible patients.

Will Higgins, in The Indy Star, with the story of perhaps the only such letter in existence, written by Vilma Grunwald while in line to be murdered in Auschwitz' gas chambers, and given by her to a guard who amazingly hand delivered it to her husband who was also in Auschwitz. May her memory be a blessing.

Rebecca Robbins, in STAT, with the story of billionaire Sean Parker and the incredible impact he's having on cancer research.

Only 41% Of People Who Were Given Free Preventive Medications Following Their Heart Attacks Were Still Taking Them 1.5 Years Later

You might think that having a heart attack would be motivating when it came to behaviour change, and that taking medications is a very straightforward behaviour.

And yet.

The Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial set out to study whether or not cost had a role to play in why so many patients, even post heart attack, don't take the medications prescribed to them in the hopes of preventing another one by freely providing them with those medications.

Results wise, though the group receiving free preventive medications were taking more of them than the group that did not, at the end 1.5 years, only 41% of those receiving all their medications for free, medications prescribed to them after they had an actual heart attack, were taking them.

So file these results under human beings, even when faced with knowledge, and in this case knowledge coupled with a very real glimpse at mortality, struggle to maintain even the easiest of behaviour changes, and consider that in the context of the trope of education and personal responsibility as the sole means to target diet and weight related diseases. If we want to see population level changes, we're going to need to change the food environment.

Saturday Stories: Mars Murder, Blood Pressure, And Solving A Rare Medical Mystery

Geoff Manaugh, in The Atlantic, on Law and Order: Mars.

Aaron Ross Coleman, in Buzzfeed, on fast food, blood pressure, and black Americans.

Pam Belluck, in The New York Times, on a scientist who solves her daughter's rare medical mystery.

[And if you've the time and inclination, I really enjoyed speaking with the Balance365 podcast on healthy attitudes regarding weight management]

Cancer Research UK (@CR_UK) Launches Awful New Fat Shaming Advertising Campaign

According to Cancer Research UK's new public advertisements, obesity is apparently the new smoking.

What that means of course is that by formally adopting, amplifying, and promoting the message that obesity, like smoking, is a choice people make, Cancer Research UK fuels hateful weight based stigma.

More amazing perhaps is that the aim of the campaign is to apparently target the environment with their ads steering people, in the small print that people will likely miss and certainly can't click on in train stations, to their web page calling for an end to junk food advertising to kids.

Obesity is the normal consequence of normal people living in abnormal, obesigenic, environments. Obesity often has hugely negative impacts upon health and quality of life (especially at its extremes), fuelled in no small part by the never ending blame, shame, and scorn heaped upon those who have obesity by society, and yet here is Cancer Research UK's campaign to further justify that weight hate.

Shame on them. They absolutely should have known better.

Saturday Stories: Flight MH370, Adult Vaccination, and A Lost Aircraft Carrier

William Langewiesche, in The Atlantic, with just incredible reporting on what we do and don't know about the final flight of Malaysia Airlines MH370.

Andre Picard, in The Globe and Mail (but via his Tumblr), on how we've forgotten that vaccination isn't just for children.

Ed Caesar, in The New York Times, on the epic hunt for a lost WWII aircraft carrier.

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.