Clean Your Plate Club - The Board Game?!

Yep, eat everything your parents put on it and you get to the final, covered, space - dessert.

The plate has won a 2016 National Parenting Product Award, a 2016 Family Choice Award, and was featured by the National Parenting Product Awards.

Yet according to research on feeding kids, pressuring kids to eat "healthy foods" along with using food as a reward are linked with dis-inhibited children's eating patterns.

Having 3 kids, all of who went through their picky eater stages, I know what it feels like when they don't eat. But rather than pressure them, trick them, coerce them (with the promise of dessert if they eat their dinners), or encourage them to ignore whether or not they're full by having required portion sizing, we kept offering them healthy choices, encouraged just "one bite to be polite", allowed fruits and vegetables to their hearts' contents after any meal, involved them in both menu planning and cooking, and didn't ever link dessert with how much or what they ate for dinner (and yes, we have dessert at least once weekly and usually more).

And while your mileage may vary with the strategies we employed, if your kids are turning their noses up at what you're serving them, the gamification of the clean your plate club strikes me as something that could generate some unhealthy, unintended, consequences.

Saturday Stories: Scott Adams, Heady Topper, and Definition of Obesity

Caroline Winter in Bloomberg with an engaging longread about how Scott Adams (Dilbert) became captivated by Donald Trump.

Sam Riches in Longreads tells the story of Heady Topper - the best beer I've ever had.

My friend and colleague Arya Sharma, writing with Denise L. Campbell-Scherer, with an editorial in Obesity on why we need to stop using BMI as the means to define obesity.

Meanwhile in Canadian Politics....

To be fair, today's Funny Friday video is from November 2016, but in light of the terrifying daily news cycle emanating from the States these days, I thought it would be illuminating to share a scandal from here in Canada.

Have a great weekend!

Guest Post: Introducing Froogie, the Fruit and Veggie Eating App for Kids

While many people spend their time bashing "screens" as our children's undoing, others, like my friend Dr. Sara Kirk and colleagues, spend their time trying to figure out ways to leverage reality to help with furthering public health goals. Recently she helped to design and launch a new smartphone app aimed at getting kids to eat more fruit and vegetables and I asked her if she'd like to share more about it here.

Helping Families Live Life on the Veg: A new, free, research-informed smartphone app designed to encourage families to eat more fruits and veggies!

We all want our children to have a healthy start and a healthy future. Healthy eating and active living are two of the most important things we can do to improve our general health and boost our overall feeling of well-being. As part of a healthy, balanced diet, a high intake of fruits and veggies (at least five servings every day) can reduce our risk for developing some types of chronic diseases. These include heart disease, diabetes and certain types of cancer. Although there are other things that we can do to be healthy, like cutting down on processed foods and sugary drinks and snacks, eating more fruits and veggies is an easy, positive change that we can all make for a big impact.

Unfortunately, only 1 in 10 Canadian children and youth are achieving the recommended intake of fruits and veggies. And our earlier research found that parents and youth reported that they were overscheduled in ways that limit options for healthy meal preparation. In other words, healthy eating was often being sacrificed due to scheduling of leisure-time physical activities, which took priority among busy families.

So we wanted to find ways to support healthy eating among busy, time-crunched families, using smartphone technology. Through support provided by the Canadian Institutes of Health Research (CIHR) and Heart and Stroke to the Healthy Populations Institute (HPI) at Dalhousie University, and informed by our earlier research, we worked with a local developer to craft the Froogie app for families to track their intake of fruits and veggies in an engaging way.

The Froogie app is designed to provide a fun and interactive experience for children and families to eat healthily together. A combination of the words “fruits” and “veggies”, Froogie offers tips and reminders to promote daily fruit and veggie intake and help meet age-appropriate goals. With each animated Froogie character having a special twist for families to discover, regular use can encourage families to eat more fruit and veggies, so they can live life on the veg!

You can learn more about Froogie by visiting www.froogieapp.ca. The app is free to download on the App Store or Google Play and was featured as a “New and Notable” app on the App Store shortly after launch.

Dr. Sara Kirk is a Professor of Health Promotion and the Scientific Director of the Healthy Populations Institute at Dalhousie University in Halifax, Canada. She also holds cross-appointments with the IWK Health Centre and Mount Saint Vincent University, Halifax. Originally from the UK, Kirk worked as a registered dietitian for several years before entering academia. Having moved to Canada in 2007 she now runs a multi-million dollar research program to understand how we can create supportive environments for chronic disease prevention.

Kirks has led several nationally funded projects that focus on the environment within schools and has over 100 peer-reviewed publications in her academic career. Through her vibrant and highly policy relevant program of research, Dr. Kirk has mentored a new generation of applied health researchers, and was recently the inaugural recipient of the 2015 Dalhousie University Award for Excellence in Graduate Supervision.

You can also follow Sara on Twitter!

The Nannies In Philadelphia Will No Longer Sell You 2L Bottles of Soda

Yup, you read that right - if you live in Philadelphia and you want to buy a 2L bottle of soda, soon you'll be forced to buy two 1L bottles.

And yet there's no outcry from the beverage industry.

You'd think there would be. After all, back when nanny Bloomberg tried to pass his cup size ban - the one that would have forced you to buy two 500ml cups if you wanted to drink the volume of a human stomach (1L) worth of soda at once, the beverage industry bought a full page advertisement in the New York Times to complain about it (that's it up above).

But what about Philadelphians' rights to buy as many giant bottles of Pepsi as they want? Why no screaming about Philadelphia's fun and freedom stealing nanny?

Because Philadelphia's nanny is the beverage industry. You see the beverage industry, consequent to Philadelphia's new soda tax, wants to ensure people keep buying plenty of product, and to help ease the tax' sting, they're going to stop selling 2L bottles (which incur more tax) altogether.

So the next time you're tempted to shout about the nanny state when someone like Bloomberg proposes a new policy designed to encourage decreased consumption of junk food, remember, you already live in a nanny state, and the food industry is your nanny.

Saturday Stories: Opioids, Integrative Dietetics, and DNA Horoscopes

Travis Rieder in The Washington Posts explains how doctors got him hooked on opioids, and then didn't help him come off them.

Kevin Klatt in Science Based Medicine bemoans his dietetic profession's new found embrace of integrative and functional medicine.

Sarah Zhang in The Atlantic on how commercial DNA testing is akin to a modern day horoscope.

Rare Footage of the GOP's AHCA Planning and Prep

And yes, today is Funny Friday.

Have a great weekend!

Junior Kindergarteners and The Unnecessary Crutch of Junk Food

Sent to me by a reader and I wanted to share.

It's part of a school newsletter for her kid's Junior Kindergarten class. Here's what caught her (and my) eye. On Wednesday's the school has a "WOW" day - where the students are encouraged to walk to school.

Those who did most recently received a free hot chocolate.

Also, kids who rode the bus to school received a free hot chocolate, because though not walkers, their use of public transport reduced greenhouse gas emissions.

Oh, and to raise money for the Canadian Wildlife Federation, the children were able to purchase hot chocolate. In all they raised $166.

In looking for a photo for this post, I came across another school's page discussing how, "Math plus Zippers equals Hot Chocolate Party!" whereby the kids in the class ate cookies and then learned how to graph by plotting how delicious they were, and then completed a second graph of whether or not they enjoyed marshmallows in their hot chocolate. Later that same week, to celebrate the fact that every kid learned how to do up their own jacket's zipper they were rewarded with a "Zipper Party" to celebrate the achievement with cookies and hot chocolate.

To be very clear, these schools aren't examples of schools that don't care about their kids, they're just examples of how normalized the use of junk food has become in rewarding and entertaining our children. Bet all of these kids would have had just as much, or more enjoyment, with an extra gym class, extended recess, a dress up day, a dance party, helping with the school's morning announcements, etc.

Just because junk food works, doesn't mean we need to use it.

California Public Libraries Giving In-N-Out Burgers to 4 Year Olds

I've written about child literacy and junk food before with the young reader marketing partnerships and cause-washing of McDonald's, Pizza Hut, Burger King, and Arby's. Today's example comes from California Public Libraries and their promotion of In-N-Out's "Cover to Cover Club"

Here are the program's details as described by the Saratoga Springs Public Library

For every 5 library books your kid reads, they'll receive a coupon good for an "achievement award".

The award?

An In-N-Out hamburger or cheeseburger (limit 3 per child apparently)

Kids today have no shortage of opportunities to eat fast food. Should public libraries be encouraging, enabling, and permitting more? I'd also love to know if this initiative actually increases library foot traffic and books read or just rewards kids who were already reading for the love of reading with fast food?

And if city run public institutions wanted to provide some incentive for young kids to read and use libraries, how difficult would it be for them to partner with city run community centres to hand out coupons for free admissions to local public pools or with the Parks Service to hand out free day use fee coupons for a nearby State park?

Saturday Stories: Feminism, Old Queens, and Lactic Acid

Mayim Bialik, in Grok Nation, explains why yes she (and anyone) can be a feminist and simultaneously believe that the Jewish people have a right to their own nation..

Sam Knight, in The Guardian, with a fascinating and incredible long read on the inevitable death of the Queen.

Michael Joyner, in Sports Illustrated, on the myths and truths about lactic acid.

[And if you don't follow me on Twitter or Facebook, here's a recent Q&A I did with Lisa Borden from Borden Communications covering diets, sugar, public policy, my favourite breakfast, most desired lunch date, and more]

Just a Spectacular Supermarket Commercial Championing Produce Over Products

Thanks to one of my Facebook readers for sharing this incredible supermarket video that's serving as today's Funny Friday.

Have a great weekend!

A New Heart and Stroke Funded Report Calls For a "Sugary Drink" Tax

Not a soda tax. And not a sugar-sweetened beverage tax. Instead Canada's Heart and Stroke Foundation's (HSF) latest funded report makes the case for a "sugary drink" tax which would include of course sodas, sugar-sweetened beverages (chocolate milks and drinkable yogurts for instance), but also naturally sugary drinks like 100% juice.

According to the report, Canadians purchased an average of 444ml of sugary drinks per day. And that's a per capita average which includes people like the 5 members of my family who purchase an average of none a day - so clearly those who are drinking sugary drinks, are actually averaging more than that. Dishearteningly, things are even worse for youth with the report finding them buying 578ml per day for Canadians between 9-18 years old.

That's a huge amount, and while some might be confused given the regular coverage of decreasing soda and juice consumption, the report explains,

"Over the past 12 years (2004 to 2015), the per capita sales volume has decreased for regular soft drinks (-27%), fruit drinks (-22%), and 100% juice (-10%). In contrast, per capita sales volume increased for energy drinks (+638%), sweetened coffee (+579%), flavoured water (+527%), drinkable yogurt (+283%), sweetened tea (+36%), flavoured milk (+21%), and sports drinks (+4%). In 2004, sales of flavoured water, flavoured milk, drinkable yogurt, and energy drinks were negligible. However, by 2015, these categories accounted for approximately 18% of all sugary drink sales, and compensated for the 7% proportional reduction in sales of regular soft drinks since 2004."

Breaking it down into dollars and cents, the report estimates that sugary drink consumption will lead to over $50 billion in direct health care costs over the next 25 years coming from the costs associated with their projections of 25 years of unchecked sugary drink consumption contributing to

"900,000 new cases of type 2 diabetes, 300,000 new cases of ischemic heart disease, 100,000 new cases of cancer, and 40,000 strokes. Canadians’ sugary drink consumption is estimated to account for 63,000 deaths and almost 2.2 million disability adjusted life years (DALYs), which represent premature death or poor health."

In turn, according to their modelling, a 20% sugary drink tax would generate $43.6 billion in tax revenue as well as $11.5 billion in direct health care savings from averting many of the cases, conditions and DALYs noted above.

In my opinion it's a matter of when, not if, we'll have some form of sugary, or sugar-sweetened beverage tax in Canada, and the sooner, the better.

[If you're curious about the report's methodologies and assumptions, please head over to the HSF's media centre where they're hosting the full report.]

New Research: Unless You Have Celiac Disease, It's Probably Not the Gluten

No one's saying that people's symptoms aren't real, but there's little doubt that more folks believe they have gluten sensitivities than actually have gluten sensitivities.

A recent study sought to explore that a bit further. The paper, Suspected Non-celiac Gluten Sensitivity Confirmed in few Patients After Gluten Challenge in Double-blind, Placebo-controlled Trials, examined all of the double blind placebo controlled trials that in turn showcased a gluten and a placebo challenge in people with self-identified non-celiac gluten sensitivity (NCGS). All told, when combined, there were 1,312 such study participants involved in 10 studies (most with differing methodologies).

Without getting stuck too deep in the weeds, the authors assert that someone who truly suffered with NCGS should both develop symptoms while being presented with their gluten inclusive challenge, as well as lack those same symptoms when presented with their placebo challenge. While many did in fact show sensitivity to the gluten challenge, they also demonstrated sensitivity to the placebo challenge (meaning they reported side effects on placebo too).

This finding led to the authors' conclusion

"The present review shows that over 80% of non-celiac patients, labelled as suffering from NCGS upon a favorable response to a gluten-free diet, cannot reach a formal diagnosis of NCGS after a double-blind, placebo-controlled gluten challenge."

Of course there are weaknesses to their analysis (as the authors point out) including the fact that there is no consistent, evidence based, methodology for these sorts of studies and that many of the studies used smaller gluten doses than the average daily amount currently being consumed in Western countries.

As to what's going on, the authors wonder too whether or not some studies are confounded by a failure to truly exclude those with celiac disease and/or whether some simply developed symptoms consequent to being sensitive to high FODMAPs. The authors also point out that it would be important to explore the many non-gluten proteins also found in wheat, and they included a diagram to explain the many possible symptomatic overlaps.

But at the end of the day, does it matter for those who report suffering?

Certainly if you suffer with a food sensitivity, and avoiding that food makes you feel better, no one, not me, nor the authors of this paper, would ever tell you to stop avoiding it.

Saturday Stories: Woolly Mammoths, Amish Forgiveness, Fetishised Virtue

By Flying Puffin - CC BY-SA 2.0

Ross Andersen in The Atlantic on how the resurrection of woolly mammoths might help in the fight against global warming.

Jake Edmiston in the National Post with a story of an Amish family's remarkable forgiveness.

Maajid Nawaz in The Times of Israel what what he sees as the fetishised "mother of all virtues".

Real Italian Grandmothers Try The Olive Garden For The First Time

Today's Funny Friday is a treat. The Olive Garden? Not so much.

Have a great weekend!

London Health Science Centre Says Eat Chicken Wings For Cancer

Today's installment of what seems like a never ending parade of questionable partnerships between hospitals and junk food is the eat chicken wings for cancer campaign being promoted by London Health Science Centre.

This particular campaign comes hot off the heels of the recent report in the British Medical Journal highlighting the strong evidence of obesity being a contributor to at least 11 different types of cancer.

Once again, I have to ask, are the dollars raised in these sorts of campaigns worth the promotion of lifestyles that themselves contribute to the burden of illness being seen by the very programs and providers the fundraising is meant to support?

My Oldest Daughter Fixes Fronts of Packages - A Pictorial

For her science fair project, my oldest daughter looked at the impact of front of packages on consumer perceptions of health. As part of her study, she fixed up some package fronts with more realistic statements.

Saturday Stories: Normalized Racism, Syphillis, and a Canadian Political Train Wreck

Jamie Ford, in his own blog, highlights the normalized and tolerated racism he faced giving a talk in a Texan high school.

Sushma Subramanian, in Slate, provides us with the horrific story of how American researchers purposefully infected Guatemalans with syphillis, and then abandoned them.

Scott Feschuk, in Macleans, hilariously explains the subtext of Kellie Leitch's (Canada's Trumpian conservative) train wreck of a video (honestly, worth a read and a watch even if you're not Canadian).

[And if you don't follow me on Twitter or Facebook, here's a lengthy interview I did with Healthy Debate where we covered life, my kids, my favourite food nanny, and the future.]

Who Knew Guinea Pigs Loved Pumpkin Spice?

I sure didn't, but today's Funny Friday convinced me they do.

Have a great weekend!

Should We Be Treating Type 2 Diabetes with Surgery?

Photo By Mr Hyde 

I'm resurrecting this piece, for the second time now, consequent to last week's online first publication in the New England Journal of Medicine of the 5 year data that continues to strongly support the use of bariatric surgery to treat type 2 diabetes.

In case you missed the news, a recent study published in the New England Journal of Medicine demonstrated dramatic superiority of surgery over intensive medical management in the treatment of type 2 diabetes.

Now I'm not going to get into the study here in great detail, but it's a continuation of a trial that's been running for 5 years now that is regarded as being well designed. And while admittedly we still don't know what their long, long, term benefit will be, at 5 years out, they look damn good with surgery coming out worlds better than "intensive medical therapy" for the treatment (and remission in many cases) of type 2 diabetes.

Of course time's definitely a fair concern. Meaning what if 10 years down the road the folks who had the surgery are no better off than those on medical therapy? Thing is, based on what we know already about the surgeries involved, all have well known 10 year data, and the bypasses and diversions much longer than that, and those studies, while they weren't specifically designed to look at diabetes alone, did look at weight and medical comorbidity regains, and I certainly don't recall anything that suggested diabetes returned with a vengeance.

So basically here we have a surgical intervention that is dramatically better than a medical one, for a condition that causes cumulative damage and can wreak havoc on a person's quality and quantity of life.

Yet many MDs, allied health professionals and health reporters, including some who I know, respect, and admire, are taking this opportunity to discuss how we shouldn't be looking to surgical solutions for diabetes because patients could instead use their forks and feet. While there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress - the simple fact remains that we don't yet have a proven, reproducible and sustainable approach to lifestyle change.

And what of those folks not wanting to change?  I say, "so what?".   Since when did MDs, allied health professionals or health columnists earn the right to judge others on their abilities or desires to change? Our job is to provide patients with information - all information - including information on lifestyle change, medical management and surgery. We can even provide patients with our opinions as to which road we think may be best for them, and why, but honestly, given the results from these studies, I'm not sure how anyone could make an evidence based case that surgery isn't a very real and powerful option that ought to be discussed with all of their patients with type 2 diabetes and obesity.

Unless of course that someone has some form of weight (or simply anti-surgery) bias.

Let me give you another example. Let's say there was a surgical procedure that folks with breast cancer could undergo that would reduce their risk of breast cancer recurrence by roughly 30%.  Do you think anyone would question a woman's desire to have it? I can't imagine. And yet lifestyle - weight loss and exercise has indeed been shown to reduce risk of breast cancer recurrence by 30%. Think people would dare suggest the women choosing surgery were, "taking the easy way out", that they should just use their forks and feet?

We've got to get over ourselves.

Until we have a proven, remotely comparable, reproducible, sustainable, non-surgical option, if you bash the surgical option on its surface for being "easy", or "wrong", you might want to do a bit of soul searching as to whether or not you're practicing good medical caution, or if instead you're practicing plain, old, irrational bias.

[and for new readers to ensure there's no confusion - I'm not a surgeon]

The Coca-Cola Company Supports Stricter Sugar Guidelines Than Health Canada

By Romain Behar

Last week Coca-Cola announced that they supported the World Health Organization's recommendation to limit added sugars to 10% of total daily calories.

Putting aside that it's difficult to limit that which you can't see or count, Health Canada recently announced that rather than recommend limits and listings to added sugars on food labels, they are going to do so only for total sugars.

Their rationale has been explained to me and others as being in part reflective of the fact that as a percentage of Canadians' total sugar consumption (the other was a regulatory concern that they couldn't identify added vs. intrinsic sugar by way of testing), added sugars make up roughly half of those, and therefore with Health Canada's proposed 100g limit to total sugars, and using simulated diets, they expect 50g of those to be free or added. Working off a 2,000 calorie diet (which itself may not be all that wise, but is the convention everywhere), that reflects the WHO's 10% recommended daily added sugar limit. Of course that's only if you follow Canada's Food Guide. And given that soda, candy, and what were once known as "other" foods, aren't part of the Guide, suggesting a total sugar value will serve as a useful surrogate will fail the vast majority of the population given studies have suggested  that 25% of the average Canadian's calories come from "other" foods.

Even if you put dietary reality aside for a moment, there's a big problem with the plan as more recent research calls Canadians' presumptive added sugar consumption into question. The research, spearheaded by PhD candidate Jodi Bernstein and working out of Dr. Mary L'Abbé's lab notes that prior guesstimates were based off data generated in part from the limited Canadian Nutrient File (CNF) - a database that according to Bernstein et al. lacks, "scheduled, systematic and comprehensive updating", and does not contain any brand specific data.

In the CNF's stead, Bernstein et al created their own database, the Food Label Information Program (FLIP) database, which they update every 3 years. The data was collected by way of boots on the ground in Toronto, Ottawa, and Calgary grocery stores representing 75% of the market share. There, researchers used a smartphone to scan and categorize every single item with a Nutrition Facts table (NFt). Next, an algorithm was utilized to calculate the products' free and added sugars.

Among their FLIP derived conclusions is that rather than the 50% derived from the CNF, 62% of consumed sugar in Canada is from free and added sources.

In turn that means that Health Canada's arguments in support of their much criticized plan to list simply total sugar on future NFts, are weak, and may underestimate added sugar consumption, and that if you consume 100g of total sugar, you'll be exceeding the WHO's recommended daily added sugar maximum by 24%.

It also means that The Coca-Cola Company may now be supporting stricter added sugar limits than Health Canada.

[I should note though, both the 50% and the 62% are best guess estimates. In turn I'd say that speaks to why we'd be far better off with an added rather than total sugar listing on our NFts.]

Saturday Stories: Facts, Evidence, and Drugs

Elizabeth Kolbert in The New Yorker on why facts don't change our minds.

David Epstein and Propublica in The Atlantic on when evidence says no, but the doctor say yes.

John LaMattina in Science on drug approval in the era of Trump.

This Hour Has 22 Minutes Meets Governor Mike Huckabee

National Canadian treasure Rick Mercer interviews Governor Mike Huckabee who congratulates Canada on what-now for today's Funny Friday?

Have a great weekend!



[h/t to friend and colleague Dr. Mario Elia]

Industry Self-Regulation of Marketing to Kids is Worthless - McDonald's Edition

So maybe you've heard of The Canadian Children’s Food and Beverage Advertising Initiative Commitment (CAI) - it's the voluntary program that the food industry has adopted as their defense against a legislated ad ban for marketing their products to children. The thinking goes that legislated regulation (which undoubtedly will be stricter than the CAI) isn't necessary if the industry is able to police itself.

Just a few weeks ago I wrote about the Heart and Stroke Foundation's newest report card on health, The Kids Are Not Alright, which highlighted the fact that companies signed onto the CAI were serving up millions of online annual junk food advertisements to kids.

Well here's yet another example of the failure of industry self-regulation.

It was sent to me by a mom whose 2 year old came home from daycare on Valentine's day with a McDonald's coupon book.

Here are some of the coupons:

Now McDonald's is pretty clear on their CAI commitment. They committed to ensuring that 100% of their advertising to kids was for "healthy dietary choices" and/or promoting "healthy lifestyle messages" ,

Clearly these coupons don't meet either of those criteria.

And just in case you're tempted to suggest that these coupon books weren't meant for kids, you should know that the coupons are (their caplocks and bold, not mine),

"REDEEMABLE BY CHILDREN AGE 12 AND UNDER ONLY."

If we as a society want to rein in the predatory marketing practices of the food industry that target our children, we're going to need to do that ourselves as industry self-regulation continually proves itself to be worthless.

Running More Doesn't Burn Any Extra Overall Calories (In Mice)

In terms of the constrained energy expenditure model of physical activity (whereby beyond a certain increase in activity, total daily calorie expenditure stays the same), this small mouse study is pretty cool.

15 mice were housed in indirect calorimetry chambers that contained running wheels. The experiment included a habituation phase, then a locked wheel phase, and finally a run as much as they wanted phase.

All told, despite a doubling of wheel use, the mice' total daily energy expenditures stayed roughly the same - elevated somewhat from their wheel locked baseline, but stuck at an elevation seen with slight use.

The researchers observed a pattern they'd previously hypothesized - mice who ran more on the wheel, were less active when off the wheel. And though not measured, researchers also wondered whether increased muscle efficiencies with time might also be playing a role in the lack of increased energy expenditures.

The researchers' not-meant-for-mice conclusion echoes my confirmation bias,

"physical activity should be encouraged for its overall health benefits, while expectations concerning its role in weight loss should be kept realistic."

Exercise is primarily for health, not weight loss.

Saturday Stories: 3 Terrific Doctors' Tales

Gabor Maté for CBC News on addiction.

That Lady Doctor on That Lady Doctor and what she does for $37.05.

Michael Lewis in Nautilus with a fascinating backgrounder on Dr. Don Redelmeier (who I was fortunate enough to briefly train with as a medical student).

Standing Desk Truths From The Family Guy

Laughed out loud while watching this week's Funny Friday.

Have a great weekend!

Sudbury Hospital Says Eat Blizzard Cupcakes To Support Cardiac Programs

From the Annals of Junk Food Fundraising I bring you this gem from Sudbury's Health Sciences North Foundation. Buy a half dozen Dairy Queen Blizzard cupcakes for $15 and the hospital's cardiac programs will receive $2.

Just in case you want to take the position that you'd be buying them anyhow, looking to Health Science North Foundation's Facebook page you'll see their encouragement to buy them

"for a good cause",

that you should

"#treatyoself",

and that,

"now's your chance to eat cupcakes without guilt".

Remember too, you can't buy just one, you need to buy a half dozen, and each and every one packs 240 calories along with 5 teaspoons of sugar.

That hospitals and their Foundations are comfortably shilling half a dozen cupcakes in return for $2 isn't so much reflective of incompetence but more that junk food fundraising is so normalized that no one bothers giving it a second thought.

And it's not as if this sort of fundraising can't be done right. Also for heart month, last week my inbox saw this initiative from Roots and Canada's Heart and Stroke Foundation (HSF). Buy a Roots toque for $26 and $10 will go back to the HSF. Buy a $10 bracelet and $5 goes back to the HSF.

[Thanks to RD Ashley Hurley for alerting me to the cupcake campaign]

Remember This The Next Time You Hear Soda Consumption's Going Down

Last week saw the release of yet another important initiative from Canada's Heart and Stroke Foundation - this one on sugary drinks.

Now the news often talks about how soda consumption is going down (-27% according to this report), and while it was slightly heartening to learn that juice consumption has gone down by 10%, neither are going down in a vacuum.

During that same time frame, other liquid candy sources have picked up some major steam

• Energy drinks +638%
• Sweetened coffees +579%
• Flavoured water +527%
• Drinkable yogurt +283%
• Sweetened teas +36%
• Flavoured milk +21%
• Sports drinks +4%

Also shocking were the daily per capita consumption amounts - especially of the kids:

• Children 0 – 8 years consumed 326ml/d
• Youth 9 – 18 years consumed 578ml/d
• Young adults 19 – 30 years consumed 504 ml/d
• Adults 31+ years consumed 259ml/d

And you have to remember that per capita is an average per person that includes those of us whose kids consume virtually none. And when considering the incredible rise in energy drink consumption also remember that Red Bull was the 4th most commonly advertised food on the top 10 websites favoured by 2-11 year old children.

Looking to my experiences in our office's Ministry of Health funded program that works with parents of children whose weights are a concern, I can tell you that it's not at all uncommon for kids to be consuming 300 or more calories of chocolate milk and juice a day. In most of these cases, the kids were doing so consequent to their parents great intentions - intentions that have been poisoned by a national Food Guide that includes chocolate milk as a healthy dairy choice, and juice as a fruit and vegetable equivalent this despite chocolate milk being to milk what apple pies are to apples, and juice being just a flat soda pop alternative with a smattering of vitamins.

Liquid calories, especially sugary ones, are perhaps healthier diets' lowest hanging fruits. That Canada is still dithering on them, especially those that are marketed to kids as being healthy by way of the Food Guide and school milk programs, is quite unfortunate.

Saturday Stories: Lunch Lady, Unfounded, and Trump's Lies

Image Source: www.thedailybeast.com

Jane Black in The Huffington Post on "The Revenge of the Lunch Lady"

Robyn Doolittle in The Globe and Mail with the background to her incredible, infuriating, and heartbreaking Unfounded series (including this piece on police dismissal of rape claims, and this piece on whether or not the police in your jurisdiction will believe you).

Nick Cohen in The Guardian on Trump's lies and those who swallow them.

Singapore's Answer to Added Sugar - Sugar Defending Darts?!

If today's Funny Friday is to be believe, Singapore is really taking the fight against added sugars seriously!

And as an aside, though I don't miss North American commercials, I may not have cancelled cable had we been living in Singapore or Japan.

Have a great weekend!



[Hat tip to blog reader Laurie for sending my way]

You Likely Won't Outrun Your Fork - African Edition

Thanks to RD and PhD candidate Nanci Guest for sending this new study my way.

The study, Accelerometer-measured physical activity is not associated with two-year weight change in African-origin adults from five diverse populations, followed 1,944 young adults of predominantly African descent in 5 different countries of varying degrees of socio-economic development (Ghana, South Africa, Jamaica, Seychelles and the USA). Researchers were interested in the relationship between the participants' weights and their baseline physical activity levels (as measured by 8 days worth of objective accelerometer data) over the 3 years of study.

The participants were categorized as either meeting the USA Surgeon General's recommendations for weekly physical activity (PA) of 30mins/d most days of the week or not.

The researchers were surprised to learn that the total weight gain at every site was greatest among those meeting the PA guidelines, though to be fair, the differences were minimal. For instance in the USA those meeting the PA guidelines were found to be gaining an average of roughly half a pound per year, while those not meeting them were found to be losing half a pound per year. What was clear though was that the measured PA did not appear protective vs. weight gain, and clearly not a driver of weight loss.

Researchers also explored sedentary behaviour as a separate entity and found that it too failed to correlate with weight change over time (in either direction).

All this to say, this is another paper for the pile suggesting that forks tend not to be outrun.

Study Finding It Isn't Concludes Eating Grapes Beneficial to Alzheimer's Care

I'm a gadget guy, and I regularly read a tech blog called New Atlas. Their coverage is wide-ranging, and it isn't just gadgets they cover but science-y topics as a whole.

The other day an article caught my eye. The headline read,

"Two cups of grapes a day may keep the Alzheimer's away".

Reading the piece I learned that,

"a recent study conducted by the University of California, Los Angeles indicates that consuming them (grapes) helps protect against Alzheimer's disease",

and that,

"This pilot study contributes to the growing evidence that supports a beneficial role for grapes in neurologic and cardiovascular health".

But there were some giant red flags.

• The study involved just 10 people.
• The study did not involve eating actual grapes.
• The coverage did not mention whether or not those 5 people consuming freeze-dried grape powder performed differently on the battery of cognitive tests administered to them before and after the 6 month intervention.
• The coverage credited a press release from The California Table Grape Commission as its source.

So I decided to read the study itself.

Reading it, along with its study record detail, I learned that the study was designed to determine the degree of cognitive benefit associated with the consumption of freeze dried grape powder as well as whether benefits correlated with neuro-imaging changes in the participants

The cognitive testing sure was thorough, and given there were only 5 participants in the intervention arm and 24 tests administered, the chances of one coming back with a between groups difference even just by chance was much higher. Researchers administered the following tests:

1. Cognitive subscale/ADAS-Cog (Rosen et al., 1984)
2. Mini-mental Status Exam/MMSE (Folstein et al., 1975)
3. Hopkins Verbal Learning Test-Revised (Benedict et al., 1998)
4. Benton Visual Retention Test (Benton, 1955)
5. Rey-Osterreith Complex Figure Test delayed (Osterrieth, 1944)
6. Boston Naming Test (Kaplan et al., 1983)
7. Letter Fluency FAC (Strauss and Spreen, 1998)
8. Animal naming (Goodglass et al., 1972)
9. Stroop Interference (Golden, 1978)
10. Trail Making Test-Part B (Reitan, 1958)
11. Wisconsin Card Sorting Test-64 (Heaton, 1981)
12. Speed of information processing (Trail Making Test Part A (20)
13. WAIS-III Digital Symbol (Wechsler, 1997)
14. WAIS-III Symbol speed (Wechsler, 1997)
15. Complex figure test copy (Osterrieth, 1944)
16. WAIS-III Block Design (Wechsler, 1997)
17. WAIS-III Symbol search total (Wechsler, 1997)
18. WAIS-III Letter-Number Sequencing (Wechsler, 1997)
19. WAIS-III Digital Span (Wechsler, 1997)
20. Wechsler Test of Adult Reading (Wechsler, 2001),
21. Memory Functioning Questionnaire (Gilewski et al., 1990)
22. Hamilton Depression Rating Scale (Hamilton, 1960)
23. Hamilton Anxiety Rating Scale (Hamilton, 1959)
24. The Clinician's Interview Based Impression of Change (Knopman et al., 1994)

As for the results? Even with that barrage of tests,

"No significant benefits for the active formulation arm were noted in scores on the assessments in the neuropsychological battery"

Amazingly, despite registering their trial with the stated primary outcome measure of,

"Change from baseline in neuropsychological (cognitive, functional) test results",

the authors describe their null results as being,

"not unexpected given the small sample sizes relative to large inter-individual variation on such tests."

Perhaps the most striking piece for me though was in the authors' conclusion about their study that involved the consumption of freeze-dried grape powder and demonstrated no clinical benefit despite throwing literally two dozen tests at the subjects,

"In conclusion, twice-daily consumption of table grapes was associated with significant protection from longitudinal changes in cerebral metabolism, which in turn were correlated with improvement in attention/working memory performances, consistent with a beneficial effect of daily intake of grapes with respect to preservation of metabolic activity in individuals experiencing mild cognitive decline."

Imagine my non-surprise when I came across the next line:

While I completely understand why authors funded by the California Table Grape Commission might want to make their study sound more exciting than its results would warrant, I have more difficulty understanding why journalists would choose to report on it non-critically? I mean if you're going to write a piece about it, isn't the bigger story the spin? Yesterday I asked the journalist who wrote the New Atlas piece on Twitter what made him want to cover it. Unfortunately I didn't hear back.

Saturday Stories: Just One This Week

Because I think it's such an important read, this week I'm only posting a single story.

Here's David Frum, with this week's The Atlantic's cover story, on how Trump could build an autocracy.

Meet Trae Crowder - A Heroic Self-Proclaimed Liberal Redneck

Honestly, if you haven't already seen today's Funny Friday video, it's a must watch.

Have a great weekend!

Canada's Heart And Stroke Foundation's Latest Food Industry Body Slam

The Kids Are Not Alright - that's the blunt title of Canada's Heart and Stroke Foundation's (HSF) 2017 Report on the Health of Canadians, and it examines how Canada's food industry preys on our kids through marketing.

According to the HSF's review, the average Canadian child watches 2 hours of television daily and sees 4-5 food and beverage ads per hour. But of course, televisions are not a child's only screen. To dive deeper, the HSF asked Dr. Monique Potvin Kent to review the advertising on the top 10 most popular websites for children and adolescents. She set out to determine the volume of ads aired there and even she was blown away by what she found. Those 10 websites together served up over 25 million food and beverage ads to children between the ages of 2-11, and 2.5 million to adolescents aged 12-17 (the lower number for the teens reflective of the fact there were less teens visiting the sites studied, not that the sites served up fewer ads) over just one year.

While the most frequently advertised products for the most part weren't surprises (Pop Tarts, Frosted Flakes, Happy Meals and Lunchables), it was horrifying to me to learn that the 4th most frequently advertised product on the top 10 most popular web pages for 2-11 year old children was Red Bull Energy Drink (and it was the third most frequently advertised product to teens).

And of course advertising works. That's why companies spend billions of dollars a year on it. But given the known impact of advertising on kids' preferences and consumption along with the rise in their rates of diet-related chronic diseases.

It's important to note that these findings come out of an environment where industry self-regulatory efforts exist (the Canadian Children's Food and Beverage Advertising Initiative or CAI), and that fact further strengthens the HSF's strong call for the legislated removal of food and beverage marketing to children in that Potvin Kent's web survey revealed that the worst corporate offenders were CAI participants.

The well worth a read report ends with a series of expanding recommendations about what we can do as individuals and parents, what the various levels of government can do, what schools and school boards can do, as well as communities, health organizations and of course, what the food industry can do - though I'm willing to wager that without legislation it's not particularly likely that they will follow the HSF's recommendation to simply stop marketing foods and beverages to kids.

[This report continues Canada's Heart and Stroke Foundation's new path of forcefully speaking out against industry influence, a path they enabled by actively cutting their own food industry partnerships and ties.]