The Only 48 Words Of Health Advice You'll Ever Need

[Yesterday @DarrenM898 reminded me of this piece I wrote in 2015, and given the volume of the diet wars these days, thought I'd reshare. Still holds up pretty well I think!]

In no particular order:

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

Comparatively, everything else is minutia.

Saturday Stories: That Low-Carb Diet Study, Medical Conflicts Of Interest, Suicidal Help, And A Movember Update

Julia Belluz, in Vox, with the best coverage of that new low-carb diet study that has everyone talking.

John Mandrola, in Medscape, reflects on conflicts of interest in medicine

Jason Cherkis, in Highline, on, "the best way to save people from suicide"

[And finally huge thanks to those who've already donated to my Movember fundraising efforts. Thanks to your generosity, I'm just a $211 shy of my $4,500 goal! If you find this blog valuable, if you enjoy these weekend shares, a tax-deductible donation would be very welcome, all you need to do is click here]

It Takes the Former Global Senior Director of the Gatorade Sports Science Institute Just 42s To Summarize Why You Almost Certainly Don't Need Sports Drinks

I caught this video a week or so ago.

It features one of the world's most prominent sports nutrition scientists, Asker Jeukendrup, answering the question,

"What is the shortest duration of exercise where eating or drinking is worthwhile?"

The answer?

It was refreshing to hear (see what I did there), especially given Dr. Jeukendrup's prior role as the Global Senior Director of the Gatorade Sports Science Institute (GSSI), that if your workout is less than 45 minutes (and by exercise he clarifies, "all out exercise, not easy running") you need nothing. And if it's 45 minutes to an hour and 15 minutes, a "mouth rinse" will do.

Wish that were printed in bold on the sides of Gatorade bottles, or that their bottles were mouth-rinse sized!



And of course this all reminded me of that time back in 2012 when I tried to create my own homemade version of Powerade after the then Senior Vice President of Coca-Cola's sparkling beverages division told the media that after her son's lacrosse practices, she took him to McDonald's for a 32oz of the stuff. Watching it I also had to wonder, "Did I even lift?" (not as much back then, no)

Saturday Stories: On Anne Frank, The Hero Chiune Sugihara, Post-Antibiotics, And A Movember Update

Dana Horn, in the Smithsonian Magazine, with an important read on Anne Frank and what might have been had she not been murdered.

David Wolpe, in The New York Times, about a here you've likely never heard of, Chiune Sugihara

Maryn McKenna, in Wired, with more on the post-antibiotic era.

[And finally huge thanks to those who've already donated to my Movember fundraising efforts. Thanks to your generosity, I'm more than 2/3rds of the way to my $4,500 goal. If you find this blog valuable, if you enjoy these weekend shares, a tax-deductible donation would be very welcome, all you need to do is click here]

A Personal Request For Help

And so it begins (again).

This month I pledge to grow my something of a Pedro Pascal inspired lip-terpillar in the name of raising awareness (and $s) for men's health.

If you enjoy my wholly non-monetized blog, I'd like to ask you to donate to my Movember fundraising efforts. I've kicked them off by donating $100 myself and I'm hoping you'll help me to raise more than last year's $4,500.

Contrary to what some believe, Movember is not a prostate cancer charity per se, and though some of its funds do support prostate cancer research and treatment, Movember supports multiple men's health initiatives including those involving mental health, suicide, body image, eating disorders, testicular cancer, substance use disorders, and more. Regarding prostate cancer, I was pleased to see that Movember encourages patients to speak with their physicians about the value (or lack thereof) of PSA screening, rather than suggesting it's a good idea for one and all.

Donating is easy. Just click here and give! And of course, Movember is a registered charity, so all donations are fully tax deductible.

In return I vow to continue to blog freely, to never allow advertisements, and to regularly post pictures of what might well have been an effective form of birth control in my home had I sported it year round back in the day.

For me the ask is also personal. My father was diagnosed with prostate cancer when I was in medical school, and soon I'll need to start wrestling with whether or not with that strong family history, I should walk the slippery slope of testing. My oldest cousin Marshall - we lost him to opioids.

Every dollar counts, no donation is too small.

(And if you want, you can make your donation anonymously so no one (me included) will know you hang out here from time to time.)

Saturday Stories: American Yahrzeit, Butter Nonsense, and Vitalistic Chiropractors

Alana Newhouse, in Tablet, with her post Pittsburgh's synagogue massacre reflections on what needs to be America's Yahrzeit.

Sarah Boseley, in The Guardian, on the "butter nonsense" of cholesterol deniers.

Paul Benedetti and Wayne MacPhail, in The Globe and Mail, on the call from chiropractors themselves for their profession to rein in vitalistic chiropractic nonsense.

[And if you don't follow me on Twitter or Facebook, here's my piece in The Walrus highlighting what my wife and I found after a year of tracking who gave my kids junk food, and what we're trying to do about it]

Book Review: Marion Nestle's Unsavory Truth

But first, definitely a disclosure. It was reading Marion's 2002 Food Politics that started me on my own path of nutrition related public health advocacy, and in the ensuing years, I've had the great pleasure of meeting her, both online and in person, and I value her friendship and counsel. I was also a bit flabbergasted to learn that I had a small part to play in Marion's decision to write Unsavory Truth, as in the afterwords she notes that it was the exposé of the Global Energy Balance Network (in which I played a small role and where I receive mention in Unsavory Truth) that triggered her interest in writing. Consequently there's zero question I'm biased, both personally and professionally, and I've no doubt, she'd approve of me disclosing this before my reviewing her work, which was sent to me freely by her publisher, which explores the many conflicts of interest that exist between the food industry and nutrition professionals.

Unsavory Truth: How Food Companies Skew the Science of What We Eat, is Marion's take on how, and why, the food industry works with researchers and health professionals. She takes us on many different conflicts of interest tours, from nutrition research as a whole, to sugar and candy, to meat and dairy, to "health food", Coca-Cola, advisory committees, the American Society for Nutrition, to nutrition education and dietetic societies.

Overarchingly, Marion sees industry's response to criticism of its involvement as following the playbook set by tobacco which sees them:

"Cast doubt on the science
Fund research to produce desired results
Offer gifts and consulting arrangements
Use front groups
Promote self-regulation
Promote personal responsibility
Use the courts to challenge critics and unfavorable regulations"

And she laments the fact that nutrition, unlike medicine, doesn't seem to take its conflicts of interest as seriously, "

Decades ago, medical professionals recognized the distorted effects of drug company practices, measures the distortions, and took steps to counter them. Medical journals required authors to disclose financial ties to drug companies that might profit from the results of their studies. Medical schools banned drug companies from marketing to students. In 201, Congress required drug companies to disclose payments to physicians. Nothing close to that level of concern, scrutiny or action applies to food-company efforts to engage nutrition professionals"

The aim of the food industry is self-evident and non-indictable. It's profit. And there are many ways for them to invest in research and partnerships to help in that regard. Citing the work of Lisa Bero and colleagues, she explains that when it comes to research, food industry funding can,

"focus on single nutrients, ingredients, or foods rather than on interactions or overall diets. They can compare the effects of single foods by contrasting diets that include them to diets that lack them. They can design trials without randomization, blinding or appropriate comparisons. They can focus on obvious or irrelevant effects. And they can give a positive spin to results that show no effect or fail to publish unfavourable results."

And then by way of examples of each, demonstrates these are anything but theoretical risks, including studies where though the conclusions are valid, like for instance, if compared with sucrose, and when neither are consumed to excess, that the slightly higher amount of fructose in high fructose corn syrup isn't likely to make much difference to health, are designed to prove forgone conclusions that can be spun by their funders and are more apt to be classified as marketing research than basic science.

Marion's also quick to note that,

"industry funding does not inevitably bias a study, although it does suggest that the research question and interpretation require more than the usual level of scrutiny"

Looking to guideline committees and dietetic organizations, the food industry is again represented in ways that require more than the usual level of scrutiny. In 2015, 10 of the 14 members of the Dietary Guidelines Advisory Committee consulted for, or received grants from the food industry, while the food industry also provides direct sponsorship and support for the works of the Academy of Nutrition and Dietetics (AND), and other dietetic organizations. And here the real question is "why?", or perhaps a slightly more nuanced, "is that really necessary?". Regarding AND for instance, Marion reports their own documents note that the cost of removing industry funding from their organization would cost just $17.17 per member per year.

Finally Marion ends with some thoughts on what to do about this mess, and while she covers a number of different options and initiatives, the one she sees as best would be, "an industry-wide program for research paid for by a mandatory tax or levy" whereby all food and beverage companies with sales over some pre-determined level, would pay a fee in proportion to sales revenues which in turn would serve to fund research and programs related to nutrition. Realistically though, she also notes that the likelihood and feasibility of such a system is "zero", and then encourages health professionals and organizations to at the very least, review their policies and to attempt to put some in that safeguard members and individuals, while asking all of us to remain vigilant and aware of the fact that in no way does disclosure alone always suffice.

Like all of Marion's books, Unsavory Truth is fascinating, and wherever you fall on the spectrum of worrying about food industry conflicts, a worthwhile read.

My Kids Are Going Trick Or Treating And So Should Yours (A Strategy Guide)

(A variation of this post was first published October 24th, 2013)

It's coming.

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

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

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

So what's a health conscious parent to do?

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

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

Secondly it allows for a discussion around "thoughtful reduction". Ask them how many candies they think they'll need to enjoy Halloween? Remember, the goal is the healthiest life that can be enjoyed, and that goes for kids too, and consequently the smallest amount of candy that a kid is going to need to enjoy Halloween is likely a larger amount than a plain old boring Thursday. In my house our kids have determined 3 candies are required (and I'm guessing likely a few more on the road) - so our kids come home, they dump their sacks, and rather than just eat randomly from a massive pile they hunt out the 3 treats they think would be the most awesome and then silently learn a bit about mindful eating by taking their time to truly enjoy them.

The rest?

Well it goes into the cupboard and gets metered out at a rate of around a candy a day....but strangely....and I'm not entirely sure how this happens, maybe it's cupboard goblins, but after the kids go to sleep the piles seem to shrink more quickly than math would predict (though last year my oldest told me she believed it was her parents eating them and that she was going to count her candies each night). I've also heard of some families who grab glue guns and make a Halloween candy collage, and dentist offices who do Halloween candy buy-backs.

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

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

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

Saturday Stories: College Reunions, George Soroses, and Runaway Trains

Deborah Copaken, in The Atlantic, on what her 30th year College reunion taught her about life.

Spencer Ackerman, in The Daily Beast, on every era's George Soros.

Alexandra Petri, in The Washington Post, on how difficult it is to get the train to stop.

[And if you don't follow me on Twitter or Facebook, and you have a few minutes this weekend, I really enjoyed recording this podcast with Half Size Me's Heather Robertson, where we covered a lot of ground and she asked me the sorts of insightful questions that you might expect from someone who herself has maintained a 170lb loss.]

Fast Initial Weight Loss The Secret To Success? Or Do Only Successful People Remain In Weight Loss Studies?

There was a lot of buzz last week about a new study that purportedly found that "fast initial weight loss may be key to diabetes prevention".

I say purportedly because the reporting wasn't about a published study, but rather a presentation given to the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting on the to be published one day PREVIEW study.

The presentation reported that 3 years after an initial rapid, induced by meal replacement, weight loss, by way of 4 different dietary strategies, 96% had not developed type 2 diabetes.

This was contrasted apparently with the results of the Finnish Diabetes Prevention Study (DPS) and US-based Diabetes Prevention Program (DPP), neither of which included that initial rapid 2 month meal replacement loss, and where participants without diabetes at 3 years in the DPS and DPP were 91% and 86%, respectively.

So yes, the PREVIEW results were a touch better.

Or were they?

Whereas the DPS and DPP studies had tremendous retention of participants (92% and 92.5% respectively), PREVIEW's results come from just 41% of initial participants with 59% being lost to follow up at 3 years.

Which leads me to wonder whether PREVIEW's results are worthy of much publicity, as that's a tremendous loss to follow up, and it's quite plausible that the people most likely to follow up 3 years later, are the ones who did the best in sustaining their losses. I suspect therefore, that even here, success is dependent simply on adherence, and not on weight loss modality.

Finally, as always, I'll point out, that there is no one best way, and reporting like this, whether on a study with incredibly poor retention or otherwise, suggests to the public and to health care professionals that there may be one right or best way, despite the fact that different strategies will work differently for different people, which I would argue in turn, undermines patient care.