The Journal of Nutrition Describes Gut Bacteria Prevotella Abundance As "The Key To Successful Weight Loss" Following Short Study Where Subjects With No Prevotella Lost Comparable Amount Of Weight

Hype around preliminary findings, animal studies, cell culture studies, underwhelming studies, and more is the clickbait that sells papers and likes. Some of the time hype comes from journalists, sometimes from press-releases, and sometimes from the authors themselves. Today's blog post sees the hype coming from an invited oped published by the American Society of Nutrition's flagship The Journal of Nutrition.

The oped, entitled, The Key to Successful Weight Loss on a High-Fiber Diet May Be in Gut Microbiome Prevotella Abundance, was written in reference to the results of the study entitled, Prevotella Abundance Predicts Weight Loss Success in Healthy, Overweight Adults Consuming a Whole-Grain Diet Ad Libitum: A Post Hoc Analysis of a 6-Wk Randomized Controlled Trial.

The op-ed described the "key" to successful weight loss on a high-fiber diet as gut microbiomes containing an abundance of the bacterium Prevotella, and was written to amplify the - hold onto your hats now - findings from a very small, very short study that was not originally designed to test the relationship between Prevotella abundance and weight, that found a whole 3.5lb greater weight loss among the 15 study subjects with the highest Prevotella abundance vs. the lowest (but still present amount) when consuming a whole grain (WG) diet.

But wait, there's more!

Though it's confusing because of the way they reported weight loss, the same study found that particpants with microbiomes containing no Prevotella also lost weight on a WG diet. In fact, looking at the study's diagram detailing the losses between groups it sure appears as if subjects whose microbiomes contained no Prevotella (0-P) lost statistically comparable amounts of weight as those whose microbiomes contained the most Prevotella (High-P).

So to summarize, people with microbiomes containing what The Journal of Nutrition called, "the key to weight loss on a high-fibre diet" lost pretty much the same amount of weight as people with none of it on a high-fibre diet. Oh, and that key that worked as well as not having a key at all? If we make the enormous leap that it was causal, it led to a 3.48lb weight loss. Whoop whoop?

Bottom line I guess is that if you're going to describe something at the "key" to successful weight loss on a whole grain diet in the title of an op-ed in a prominent journal, and where we're talking about a 4lb weight loss, but having none of that key leads you to lose pretty much the same amount of weight, not only is that not much of a key, but it's incredibly irresponsible as it blatantly contributes to the ongoing erosion of societal scientific literacy and promotes the harmful and erroneous belief that magic exists when it comes to weight loss.

[Also, unless I'm misreading the very small amount of actual data provided, it would seem that the authors of the study also reported the difference between high Prevotella and low Prevotella groups wrong whereby the high group was found to have lost 4lbs (-1.8kg), and the low 0.5lbs (-0.22kg), but rather than report a -1.58kg (3.48lb) difference between the two, they added their losses and reported a -2.02kg (4.45lb) difference.]

Saturday Stories: Altmetrics, Abuse, And Alan (Dershowitz) #TIMESUPHC

John Ioannidis, in JAMA, on how we, as evidenced by Altmetrics, are failing at conveying information about health related risks, in a manner that's conducive with its importance.

Lisa Miller, in The Cut, with the horrifying must read story of how medical celebrity and stature let a serial sexual abuser into New York's Mount Sinai emergency room where he abused Aja Newman (and others) #TIMESUPHealthcare

Lyz Lenz, in the Columbia Journalism Review, on the wheel of pain and Alan Dershowitz' self-perceived victimhood.

[And if you don't follow me on Twitter or Facebook, A few weeks ago I did a Q&A for Elemental on my philosophy and approach to weight management. tl;dr I'm not fond of suffering, scales don't measure health, one person's best diet is another's worst, medicine should be free of blame]

Real World Self-Selected Intermittent Fasting (IF) Vs. Continuous Energy Restriction (CER) Study Sees 73% of IF and 61% of CER Participants Not Lasting Even 6 Months

So what happens when you offer people with obesity the choice between 5:2 style intermittent fasting (IF) (very-low calories (VLC) 2 days weekly with 5 days of less restricted eating) and more traditional caloric restriction 7 days a week? Would encouraging people to choose between two strategies increase their likelihoods of successful weight management a year later? Would one group lose more weight than the other? Would adherence be the same?

That were the question post-doc RD Rona Antoni and colleagues set out to explore and they recently published a paper discussing their results.

197 patients with obesity presenting to the Rotherham Institute for Obesity were offered the choice between 5:2 IF (630 calories from liquid meal replacements on the VLC days), or an aimed 500 calorie continuous energy restriction (CER) 7 days per week with diet based off that recommended by the UK's dietary guidelines. Both groups received support from specialist obesity nurses for 6 months and were also asked to return for measurements and discussion at one year. All were also provided with access to, "a variety of specialist facilities, resources and multidisciplinary specialists including exercise and talking therapists", and all were reviewed in clinic monthly where measurements were taken (weight, total body fat, fat-free mass (FFM), waist circumference, systolic and diastolic blood pressure and an overnight fasted blood sample) and adherence was discussed.

99 patients chose IF, and 98 chose CER. 6 months later, 73% of IF patients and 61% of CER patients had dropped out. At one year, 83% of IF and 70% of CER patients were lost to follow up.

Of those who quit IF by 6 months, 18% explicitly reported they did so because they could not tolerate the diet, something that none of the CER drop outs reported, other IF drop outs reported they quit due to fainting or hypoglycemia on VLC days.

Regarding completers' weight losses at 6 months, the IF patients lost a statistically significant, but likely clinically meaningless, 4lbs more than the CER group. All blood measures (including fasting glucose, insulin, hsCRP, and lipids) were found to be the same between groups. Blood pressure changes were also not different between groups.

At one year, the 17 remaining IF patients were found to have regained their lost weight, while the 30 CER patients were found to be maintaining their albeit small amount (3%) of weight loss.

So what to make of this study?

I think the most striking finding was the overall 66% attrition rate across both arms. Certainly this study does not suggest that IF is an easier regime to follow than CER (at least not when provided at the Rotherham Institute for Obesity - given weight management support is a service and not a product, it's certainly possible that different providers might have seen different outcomes for both arms, but I do think this speaks to the challenge of scalability of behavioural interventions). But what I really think this study highlights is the fact that the real-world likelihood of purely dietary interventions treating our increasing weights is very low indeed. Instead, we need more tools for treatment (certainly including medications and surgeries), and more importantly, if we're going to see change, we're going to need environmental level changes to turn this boat around.

As to whether IF or CER will work for you don't forget that one person's horribly restrictive diet is another person's happy lifestyle. If you're trying to find your own right road, even if the first road fails, and even if angry diet gurus and zealots try to tell you there's no other road, keep trying different forks until you find the one that suits you best, as when it comes to diets, adherence is all that matters in the end, and if you don't like the way you're living, you're not likely to keep living that way.

Saturday Stories: Jimmy Dorsey's Generosity, Eating Disorder Recovery, And New Coke

Petula Dvorak, in The Washington Post, with two incredible stories, the first about hunting for one man whose generosity and $80 helped launch an incredible career, and then the story about finding that man - Jimmy Dorsey

Amelia Boone, in Race Ipsa Loquitur, discusses her eating disorder recovery.

Tim Murphy, in Mother Jones, on the murder of New Coke.

Dear @BowlCanada, Selling Chocolate Should Not Be A Prerequisite For A Child To Play In Your Leagues

This is not the first time someone has shared the story of a kids' sports league that requires junk food fundraising, but it may be the first time that the league's program coordinator explicitly stated that the child of a parent willing to pay a bit more instead of being stuck selling $50 of chocolate wouldn't be welcome.

I've said it before and will say it again, our food culture is broken and junk food fundraising is just one small aspect of that, and when you question social norms, no matter how broken they might be, don't be surprised when you get pushback. But damn, it's depressing.

Here is the redacted email exchange I was forwarded

Parent:

Hello,

My kids’ dad signed our child up for bowling and is telling me I have to sell half of these chocolates.

I asked for information and the lane said that Bowl Canada mandates this.

So I have a few things to ask.

I’ve noticed that General Mills is a sponsor. Do they make the chocolates and are they the party that is behind this arrangement?

Why chocolate when we are in the midst of an obesity epidemic? Especially for an organization encouraging health? There are all sorts of fundraisers. If given the chance I would gladly purchase fresh vegetables through Peak of the Market, for example.

Also, why not give parents the option of giving a donation for tax deductible purposes rather than making them buy a bunch of poor quality chocolate that is probably connected to child labour? You’d still cover the costs you are hoping for.

Bowl Canada Program Coordinator

Dear [Redacted],

We are happy to hear that your child will be registering for bowling this season! Yes, Youth Bowl Canada has one official fundraiser each year and our tried and true method of raising funds, to help keep costs down for families, is the sale of chocolates.

Every two years, Youth Bowl Canada considers proposals from many companies offering an array of products, with various levels of monetary return which benefits all levels of bowling in Canada. Chocolate companies can repeatedly offered the best deal to not only bowling, but to schools, community clubs, etc.

General Mills was a sponsor of Bowl Canada last year, however it was simply a free game of bowling offer on select food products in stores. They have not wished to quote on our fundraisers in the past.

I hope I have addressed your concerns. Please feel free to reply should you have any further questions.

Parent

Hi [Redacted].

Thanks for your quick response. My understanding is, then, that these chocolate sales are mandatory if we want our kids in bowling. Is that correct?

If not correct, if this fundraiser is optional, no big deal; I don’t have to take part in something I find morally objectionable in order for my kid to have this opportunity.

If correct, that you require these chocolate sales, I would urge Bowl Canada to reconsider this policy, for 3 reasons.

1. It is objectionable to force fundraising on families. Some people are very good at this kind of stuff. Others have anxiety or lack the connections to have people to sell to. Sometimes the families least able to support a fundraiser are the ones whose kids most need this kind of programming.

2. This does not support physical health. As I mentioned, obesity is a major issue in society. I can appreciate that you are looking for good money makers but I think non-profits should be mindful of other considerations.

3. Why not give parents the option of something else? I am not going to sell these chocolates. If I end up buying half from my kids’ dad I will end up with chocolate I don’t want in my house and maybe end up throwing it out. I will have spent what? $50 on chocolate so Bowl Canada can get $20? I’d much rather just give you the $20 profit you are looking for. Why not just give me that option rather than making me spend more money than is necessary?

4. Chocolate is ethically problematic. Most chocolate manufacturers have child labour and harsh conditions as part of the production process. This is wrong and I believe what we support with our money should not hurt other people.

So I find myself between a rock and a hard place: I love my kid in bowling, it has been great for him. But I don’t think it’s right to force me to take part in something I find morally objectionable.

Please reconsider your policy.

Bowl Canada Program Coordinator

Hi [Redacted].

Yes, chocolate sales are required for the YBC program to participate in all YBC programs and events.

I will, however forward your concerns on to those that review YBC policies for future consideration.

Regards

Ugh.

Saturday Stories: Stanislav Petrov, Jameela Jamil, and Fake Polish Death Camps

Greg Myre, in NPR, with an obituary for Stanislav Petrov, the man who likely literally saved the world.

Margaret Wappler, in Glamour, with a profile on the hero that is Jameela Jamil.

Omar Benjacob, in Haaretz, with the bonkers story on fake WWII Polish death camps.

Photo by Queery-54 - Own work, CC BY-SA 4.0, Link

Saturday Stories: Vaping Illness, Genetic Risks, and "Sin Taxes"

Robert Langreth and Lauren Etter, in Bloomberg, on how early signs of the new mystery vaping illness might well have been missed or ignored.

Timothy Caulfield, in Think, on whether or not knowing more about our genetic risks and daily performance metrics really makes us healthier.

Anna Purdie, Kent Buse, and Sarah Hawkes, in the BMJ, on how words matter and how we need to reframe how we talk about risk when it comes to things like "sin taxes".

Weekly Elementary School Pizza Sales Nets Just $8.57 Per Student Per Year

Last week I gave a talk to some parents at my youngest daughter's elementary school.

The talk was about our ridiculous food environment where we are all the proverbial frogs in pots of water that have slowly been heated to a boil, where food, especially junk food, is constantly used to reward, pacify, and entertain our children as well as to fundraise for every cause.

Ironically, the day before the talk I received an email from the school's parent council extolling me to sign my daughter up for weekly pizza days. In it I was told,

"The most valuable fundraiser is Pizza Mondays. $0.50 of every order, every week goes to the [redacted]. It's a win/win/win! One less lunch for you to make, a delicious (and nutritious) slice of pizza for your child and $16.50 to the [redacted]!"

Looking past the wisdom (or lack thereof) of children been taught by their school week in and week out, from Kindergarten to Grade 7, that fast food pizza is a normal, weekly, "nutritious", meal, I couldn't help but wonder just how valuable it really was in terms of fundraising, and so I asked principal.

She told me that the school's Pizza Mondays cut raises $6,000 per year (12,000 slices served).

There are 700 students in the school.

$6,000/700 students/year = $8.57/student/year

And if Pizza Mondays are the most valuable fundraiser, then perhaps it'd be fair to assume that in total, the school raises $10,000/year in food sale initiatives. That would be $14.30 per kid per year.

Is there really no other way to raise $14.30 per kid than selling them, and normalizing, weekly (or multiple times per week) junk food?

I think there probably is, and here are 3 suggestions each of which by itself might do the job, let alone together (and these are just 3 ideas, there are so many more out there as well).

Fundscrip
Fundscrip is simple to describe. Parents buy gift cards from Fundscrip for stores they already shop at (supermarkets, gas stations, hardware stores, clothing stores, business and school supply stores, toy stores, book stores, electronic stores, restaurants etc.). The gift cards work just like regular gift cards (meaning they work just like cash) and are mailed directly to parents' homes, and the school receives 2-5% (depending on the store) of the value of the gift cards. Given the average family of 4 in Canada's weekly grocery bill runs in at a reported $220, if even only 10% of the school's parents got involved, and if they only used the cards to cover half of their grocery costs, the 3% kickback to the schools would raise $12,000. And that's just by way of groceries!

Grandparents' Day
Many schools run grandparents' days. Simply put they involve inviting all the kids' grandparents to school, putting on some sort of song and dance production, giving the proud grandparents a tour, and either charging them a nominal fee for tickets ($5), or simply soliciting donations during the event (and perhaps annually having a singular cause which then gets branded for that year's grandparents if monies raised). 700 elementary students should conservatively mean at least 1400 grandparents. If only half of them attended, and an average of $5/grandparent was raised, that would bring in $3,500.

School Parents' Goods and Services Auction
With 700 families in our child's school, there are clearly a great many different professions represented among the parents. Creating a night whereby parents can donate goods or services (with a cut to the school) is a great way to both raise money, and raise interest and awareness of the parent body's businesses. Lawyers might donate a discounted will consultations, I could donate work with one of our RDs, or with our personal trainers, artists could donate their art, restauranteurs could donate meals, etc. Done right, and certainly once established as a valuable annual event, there's no reason why this couldn't raise $3,000-$10,000.

The bottom line is that schools truly don't need to sell junk food to children to raise money as there are plenty of other means to do so. Yes, school sold junk food is convenient for parents who aren't keen on making lunches every day, but given we are literally building our children out of what we feed them, and that weekly (daily in some cases) school junk food sales teaches kids, even those who don't order them, that daily junk food is a normal, healthy part of life, taking the time to pack those lunches (or to teach our kids how to pack lunches themselves) is well worth it.

Saturday Stories: Admission Offers, Fat Cycling, Medical Errors, And Fanboy Me On This Week's Science Vs Podcast

Anonymous MD, in CMAJ blogs, with perhaps a more truthful offer of admission to a future physician.

Kailey Kornhauser, in Bicycling, on cycling while fat.

Benjamin Mazer, in Medscape (and yes, I know you need to register to read their free content), on the commonly cited myth that medical errors are not the third leading cause of death.

[And in case you don't follow me on social media, as a huge fanboy, I can truly say it was my great pleasure to chat with the talented Wendy Zuckerman for her podcast Science Vs and her episode on what exercise can and can't do]

Canadians Who Care About Science Might Not Want To Vote NDP

I have to admit, I found this story jaw dropping.

The federal NDP health critic, Don Davies, is opposed to plans geared to rein in the wild, wild, west of natural health products and supplements that prey on desperate Canadians.

The proposed regulations are meant to require, gasp, that natural health products have evidence to prove they're both safe and effective before they're allowed to be sold.

In the CBC story, Davies even parroted the common line that it's too expensive for supplement makers to conduct studies to prove their products work. That statement contrasts poorly with the other one he gave in the same article where he reports the natural health industry enjoys $12 billion in Canadian revenue and $2 billion in exports.

But even were it true, that there's a presumably want-to-be federal Health Minister arguing we shouldn't require proof of safety and efficacy for products being sold to Canadians in the name of treating their medical conditions, for anyone who cares even an iota about science, should be a non-starter.

And it gets worse.

Davies, in trying to push his post-science world view, was encouraging people to sign a petition developed by the Health Action Network Society (HANS), a Vancouver charity with a history of spreading anti-vaccination claims, but they themselves noted that they were not working with him directly.

Shame, shame, shame, indeed.

Let's Stop Using The Terms "Healthy Weight" And "Normal Weight"

Words matter, and your weight cannot determine whether you're "healthy", or "normal".

Honestly.

Firstly, scales don't measure the presence or absence of health, and so the term "healthy weight", means literally nothing.

Secondly, the CDC defines a "normal weight" as one giving a person a BMI between 18.5 and 24.9 yet if we were using the word normal correctly, it would differ by country and would reflect its population's mean BMI. So in Nauru for instance normal weight would be a person whose BMI was 32.5, whereas in Eritrea it would be someone whose BMI was 20.5. Given mean BMIs in the US and Canada are 28.8 and 27.2 respectively, in North America, it should be considered abnormal to have a BMI between 18.5 and 24.9.

So what could we use instead?

Risk based terms.

Weight, though not a guarantee for any medical problem, does increase the risk of many, and so I'm proposing that rather than terms which confer judgment, we categorize weight as low-risk, medium-risk, and high-risk, and by doing so we'll stop the erroneous use of healthy and normal terminology that constantly and insidiously promotes weight bias, shame, and stereotype.

Saturday Stories: Crane Wife, Domestically Violent Cops, and Brain Boosting

CJ Hauser, in The Paris Review, with the crane wife.

Kyle Hopkins, in Propublica, on the village where every cop has been convicted of domestic violence.

Kaitlyn Tiffany, in Vox, on brain boosting.

If There Were Quick, Easy, Flying Leaps That Lasted, You'd Have Already Taken Them

The saying is that long journeys begin with first steps, not flying leaps, and if there were flying leaps that routinely led to lasting change, you'd have already taken them.

It's a straightforward message, but when applied to weight management, diet culture regularly asks us to ignore it.

The inconvenient truth of healthy living is that it will certainly require effort.

Yes, there are likely those who will succeed by changing everything all at once, but for most, slowly building and layering change, and respecting the fact that their roads will absolutely also see their share of disappointments and setbacks, is the way to finally get somewhere.

Your first step might be as small as losing one restaurant meal a week in place of cooking, or trying to reduce your sugar sweetened beverages by 50%, or actually scheduling a day to buy, or a service to deliver, weekly groceries, but if you choose steps you can actually accomplish without suffering, you're more likely not to fall, which in turn, will help keep you moving forward.

Saturday Stories: Running While Fat, Running While Female, And Frustrating, Confusing, Israel

Kate Brown, in Runners World, on running while fat.

Cara Harbstreet, in Human Parts, on running while female.

David Horowitz, in The Times of Israel, with an incredibly insightful interview with Matti Friedman with some background on how and why for many, Israel may baffle or infuriate.

Why You Should Turn Off Your TV And Holster Your Devices Before You Eat

Ok, it's a short study and it relied on dietary recall, but if taken at face value, the results certainly suggest you should be turning off your devices and eating away from the TV.

The study involved the 3 day recall of both diet and media use among 473 individuals.

Plainly, researchers found that meals that were consumed along with some form of media distraction contained 149 more calories. They also found that people consuming those extra calories at a media meal did not compensate by eating less at their next meal.

Given how easy it is to do this, and how by doing so you might even strengthen some interpersonal relationships by eating with friends or family around a table, you really have almost nothing to lose by trying, except perhaps a few calories.

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.

Saturday Stories: Anti-Vax Conferences, Vulnerable Child Syndrome, and Taffy Brodesser-Akner

Anna Merlan, in Jezebel, in what she learned getting kicked out of America's biggest anti-vax conference.

Rachel Pearson, in The New Yorker, on vulnerable child syndrome

Jen Ortiz, in Cosmopolitan, with a fabulous profile of celebrity profiler and author of the book I ordered on my kindle yesterday Fleishman is in Trouble's Taffy Brodesser-Akner

[And if you don't follow me on Twitter or Facebook, here's my most recent piece for Medscape on what actually works for obesity at a population level (hint, it's not shame, blame, or fear)]

Scotland's "National Walking Strategy" Actually Increased Recreational Walking (A Tiny Bit) For The Whole Population!

Cynically, I've been known to ask for examples of population based initiatives that actually led to sustained increases in physical activity (with the expectation of there not being any).

Well, I can't do so anymore as Scotland's managed to increase recreational walking by 13% over a 6 year period for the whole of their population!

Their National Walking Strategy targeted Scotland's 5 million residents with messages about the health benefits of walking.

The strategy involved multiple sectors including:

• Communication and public education.
• Transport and the environment.
• Urban design and infrastructure.
• Health and social care.
• Education.
• Community-wide approaches.
• Sport and recreation.

And together their aim was to create a culture of walking by way of developing better walking environments that supported ease and convenience.

How to counsel patients on physical activity became a topic in medical schools. The Daily Mile encouraged 1,000 schools to help every student walk, run, or jog a mile a day, increased funding for active transport programs was obtained including a doubling of infrastructure funding for same, #SoMe was leveraged to share encouragement and information to the public, and community walking programs were launched nationwide.

Now before you get too excited, the bar was low to begin with whereby the increase in walking represented the self-report of walking at least 30 minutes for recreation once over the past month, but at least it's a start.

Changing behaviour requires more than just education and a good reason to do so, it also requires a change to social norms and culture, as well as environmental engineering. Clearly there's more to do in Scotland and elsewhere, but nice to see that these needles might actually be movable.

Photo by Kim Traynor [CC BY-SA 3.0], via Wikimedia Commons

Saturday Stories: Quantum Solutions, Stockpiled Insulin, and Multiple DNA Tests

Jana Asenbrennerova, in Quanta Magazine, on how a gifted grad student’s solution to a fundamental problem in quantum computing is an incredible breakthrough.

Maris Kreizman, in the New York Times, on why she's stockpiling insulin in her fridge.

Rafi Letzler, in Live Science, discusses the results of his 9 different commercial DNA tests.

Photo Richard Wheeler (Zephyris) at en.wikipedia - Originally from en.wikipedia; description page is/was here., GFDL, Link

Guess What? A Single In Office Visit Encouraging People To Weight Themselves More Often And Exercise Doesn't Prevent Weight Regain

From the Journal of Duh! (ok, actually it was PLOS Medicine) comes Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial). The study involved 288 people who had lost ≥ 5% of their weight in the preceding 12 months who were randomized into two groups. One where they received periodic newsletters, and the other where they had a single face-to-face visit where they discussed goal setting and self-monitoring (including being told to weigh themselves daily) followed by every other day automated text messages. The hope was that the single visit and text messages would help prevent weight regain in the group that received them. So did that minimal intervention help?

No, both groups regained the same amount of weight over the study's duration.

What was most surprising about this study wasn't that minimal interventions don't help prevent weight regain, but rather that someone thought they might. Because if minimal interventions prevented weight regain, do you really think weight regain would be so commonplace?

So in case you were looking for proof that single office visits and text messages aren't in and of themselves sufficient to prevent weight regain, there you have it I suppose.

Saturday Stories: Only One Read This Week

Every once and a while there's a story that has such an impact on me that I want to feature it by itself.

Today's Saturday Story, written by Dana Horn for the Atlantic, was searing. It detailed her recent visit to a "massive blockbuster exhibition (about the Holocaust) that opened in May at the Museum of Jewish Heritage in downtown Manhattan", by the same people who brought you Human Bodies, and how it left her feeling flat.

Her closing paragraph,

"The Auschwitz exhibition does everything right, and fixes nothing. I walked out of the museum, past the texting joggers by the cattle car, and I felt utterly broken. There is a swastika on a desk in my children’s public middle school, and it is no big deal. There is no one alive who can fix me."

shouldn't be the only one you read. Please click it for more.

Bullying Or Teasing Kids With Obesity Doesn't Lead Them To Lose Weight But It May Lead Them To Gain

The recently published Weight‐based teasing is associated with gain in BMI and fat mass among children and adolescents at‐risk for obesity: A longitudinal study is an important paper for many well-intentioned parents, educators, and physicians who think that weight based teasing might help motivate a child to make behaviour changes that will lead them to weight loss.

In it authors followed 110 children at risk or with overweight or obesity for 8.5 years and tracked their weight and its association with weight-based teasing. They found that after adjusting and controlling for baseline sex, race, age, socio-economic status, BMI and fatmass, kids who reported the most teasing gained the most weight (p≤.007). Quantified, the authors found that the most teased kids' fat masses increased by 91% more per year (1.4lbs/yr) than those not reporting weight based teasing.

While it's important to note that causality can't be proven here, certainly these results fit with the notion that if any amount of teasing led kids to lose weight, we'd be seeing dramatic reductions in childhood obesity rates because weight is far and away the number one target of school based bullies, and even at home, 60% of kids with excess weight report being teased about same.

If you have a child with obesity, sadly you can rest assured that they'll receive plenty of shame, blame, fear, and bullying from the world around them, and if you're worried about your child's weight, instead of burdening them with it, ask yourself what you as a parent can do to help, where if nothing else, one thing for certain you can do is to make your home a safe space where weight is not something anyone's welcome to joke about or comment on.

(and if you live in Ottawa, and you have a child between the ages of 5 and 12 whose weight is concerning, and you're interested in our office's parent-centric, Ministry of Health funded, inter-professional, Family Reset childhood obesity treatment program feel free to call us at 613-730-0264 and book an appointment to chat)

Saturday Stories: Let Downs, Incels, And Unlimited Mothering

AC Shilton, in The New York Times, on the personal crash that sometimes follows a great accomplishment

Alice Hines, in The Cut, with just a bonkers and disturbing story on incels (involuntarily celibates) and plastic surgery.

Lindsay Jones, in Topic Magazine, on mothering without limits.