Wednesday, February 29, 2012

Have you Engaged an Indulgence Autopilot?

It's something I hear about frequently when I meet new patients,
"....and Friday is Pizza Night",

"Every Thursday the gang at work goes out for Dim Sum at lunch",

"After the kids' hockey on Saturday mornings we do drive thru Tim Horton's and share 20 Timbits
Now I'm not knocking any of those choices directly. While certainly they're not healthy choices, and where I might even label them as nutritionally "bad" foods, the fact is they might be great indulgent choices.

What I mean is that we don't just eat food for sustenance.

Whether it's pizza, Chinese food or doughnuts, if those are part of your life's seminal guilty dietary indulgences, well then I think you probably owe it to yourself to continue to have them, because blindly cutting them out? I'm not sure taking away your favourite foods in honour of your health is a great plan because doing so will likely, over time, lead you to fully abandon whatever overly strict healthy living strategy you've adopted.

That said, you might want to take a moment to ask yourself a question like,
"Is the fact that it's Friday a good enough reason to order in pizza"
Ultimately, when it comes to dietary indulgences and hedonistic pleasure, the question isn't, "Are you allowed", but rather, "Is it worth it" and if so, "how much do I need to be satisfied?", where sometimes the answer may be, "No and none", and other times significantly more than that.  To illustrate what I mean - I'm thinking you'll be eating far more indulgent foods on your birthday than you'll be eating on my birthday.

But just because it's Friday? I'm guessing you can do better.

Disengage your indulgence autopilot and thoughtfully navigate your nutritional skies!

Tuesday, February 28, 2012

More Breathtaking Hypocrisy from Canada's Health Minister Leona Aglukkaq

Or are they outright lies?

The subject this time? Childhood obesity.

Yesterday Leona Aglukkaq, Canada's Minister of Health, launched a national "Summit on Healthy Weights" geared to discuss childhood obesity.

Her opening statement includes these remarks,
"We're here because this public health challenge requires our collective commitment and action."

"Today's Summit on Healthy Weights is another milestone that will move us forward in creating lasting change for children and their families. It represents a "first" in bringing together such a broad cross section of partners to address this issue."
So what's my problem? Those sure sound like important things, a call to action and a cross sectional representation of experts to help guide said action sound necessary.

Sure, except that we've said and done those things before, just 5 short years ago, and at taxpayers' expense.

Back in 2006 the House's Standing Committee on Health, over the course of eight months, heard hours and hours worth of testimony (including mine) which in turned helped to shape their March 2007 report Healthy Weights Healthy Kids.

How much expert testimony and consideration? By my count, over eight months the Committee heard 111 different experts representing 65 different public and private institutions which they then summarized in a formal 60 page report with 42 explicit recommendations.

Does anyone think that the science has change dramatically over the course of the past 5 years? Was 111 different experts too few? Why are we duplicating a 5 year old effort, and why are we paying for that effort's duplication?

At this point we desperately, desperately need action and sure maybe we need a Summit once we've gone ahead and implemented those first 42 recommendations (because there's no doubt, we're still going to be in a world of hurt even once/if we implement them all), but until then, do we really need to still be discussing where to start?

In terms of recommendations from Healthy Weights Healthy Kids, they were split over 13 subheadings and included:

- More research into childhood obesity
- More funding for advertising campaigns designed to educate about childhood obesity
- A call to implement the findings of the trans-fat task force
- Research on the special needs of first nations Canadians in the battle on obesity
- Improvement of nutrition labeling
- Better data collection for research
- The sharing of data with health professionals
- The identification of what will become the "lead agency" on childhood obesity in Canada
- The finding of means to reduce the costs of "nutritious" foods to the more remote parts of Canada
- The tracking of children's' involvements in sports
- Improvement of school health and fitness curricula
- New funding for improved infrastructure in schools for healthy fitness and food choices
- The evaluation of the efficacy of the ban against advertising to children in Quebec.

Of which to the best of my knowledge Health Canada has implemented a grand total of none.

So for those keeping score, it's breathtakingly hypocritical to talk of a need for a commitment to action when to date your office has been dedicated to explicit and deliberate inaction, and it's an outright lie to suggest that this summit is a first at bringing a broad spectrum of experts together to discuss childhood obesity.

Ultimately this is just more of the same from Aglukkaq and Health Canada - politicized inaction, hypocrisy and lies.

Anyone out there willing to wager that if recommendations actually come from the Summit, that they're not either rejected out of hand or simply brushed under the rug of time, cause I'm guessing that just like everything else that's come across her desk that might actually benefit the health of Canadians, Leona Aglukkaq's going to find some way to either avoid or ignore them.

Monday, February 27, 2012

Do Artificial Sweeteners Help with Weight Loss?

While it's always possible that real and conclusive dangers linked to the consumption of modern day artificial sweeteners will emerge, to date the data suggesting risk has been underwhelming to say the least, in great part due to the fact that the studies have been flawed in that they look at all comers' dietary consumption patterns and without very careful controls for diet, their conclusions are highly suspect. Reason being that there's a very real possibility that many people out there who drink artificially sweetened beverages do so as a means to assuage their guilty consciences in making less than stellar dietary choices - the "I'll have the super-sized combo with a Diet Coke please" phenomenon. Consequently it's certainly possible that artificial sweeteners are serving as a marker for chronic disease inducing diets rather than the chronic diseases' actual cause.

But that's a whole separate debate. Today I want to talk about the role of artificially sweetened beverages in a population that's actively trying to manage their weight, because after all, if there's any reason to encourage the consumption of artificial sweeteners, it has to be in the context of their use as overall calorie reducers, and unlike all comers, folks actively trying to lose weight are the ones I see on an every day basis in my practice.

This month's American Journal of Clinical Nutrition has just such a study where 318 folks with obesity who were drinking 280 or more calories daily from beverages were randomized to 6 months of either:

A) A control group that received monthly weigh ins, weekly monitoring and monthly group sessions on weight management.
B) A group where they received the same education but were encouraged to replace 200 or more of their liquid calories with water.
C) A group where they received the same education but were encouraged to replace 200 or more of their liquid calories with artificially sweetened beverages.

The results?

Somewhat to the chagrin of my own confirmation bias, they were rather underwhelming too. All groups lost roughly the same small amount of weight - including the control group who perhaps unsurprisingly, without explicitly being told to do so, also reduced their liquid calorie intake.

My take?

It was still the wrong population. These weren't the folks drinking 2L (808 calories) of Coca Cola a day, these folks were drinking on average 348 liquid calories a day, from all sources of liquid calories, not just sugar-sweetened ones. So yes, while it might have been soda pop, it could just have easily have been a few coffees with cream, half a glass of juice and a glass of wine a night, or for someone else, 2 fancy lattes. Yes, all targets worthy of reduction, but relatively tiny and potentially unfair targets - after all, it's improssible to replace milk, coffee cream, juice or alcohol with Splenda. Moreover, given the study folks aren't drinking enormous numbers of calories to begin with, reductions will likely be rather small, and indeed, at the end of the intervention the treatment groups were down about 200 liquid calories a day whereas the control group was down 100.

So perhaps it's not actually surprising to see an underwhelming result and I do wonder,would it really have been that difficult to specifically select a group already drinking a large amount of sugar-sweetened beverages with obviously available artificially sweetened alternatives?

So do I recommend artificially sweetened beverages?

Yes and no.

In an ideal world we'd drink far fewer sweet beverages. Whether they're sweetened by means of sugar or by means of artificial sweeteners, having palates craving cloyingly sweet isn't going to help in navigating through lower calorie choices or healthy fare.  For many, liquid calories, are the low hanging fruit of weight management - easy to reduce and consequently, I think it's certainly worth your own personal exploration of liquid calories, and if indeed you're drinking huge amounts of them, especially sugar sweetened ones, as a step-down strategy if you think you can use artificially sweetened beverages as you reduce the sweet drinks overall, I say go for it.

As far as I'm concerned, everyone's end goal is simply the smallest number of liquid calories they need to be satisfied, and ideally, the smallest amount of "sweet" beverages regardless of how the beverages got their "sweet" in the first place.

Tate, D., Turner-McGrievy, G., Lyons, E., Stevens, J., Erickson, K., Polzien, K., Diamond, M., Wang, X., & Popkin, B. (2012). Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial American Journal of Clinical Nutrition, 95 (3), 555-563 DOI: 10.3945/ajcn.111.026278

Saturday, February 25, 2012


According to this blog

Can anyone confirm?

If true - thanks to everyone for spreading the word!

[UPDATE: Confirmed. The website's down too and official word is that the exhibit is being retooled. Kudos to Disney for addressing this so quickly. As I mentioned to the press, I doubt it was their intention to vilify children who struggle with weight and am confident they'll do better with the exhibit the second time around]

Saturday Stories: Ice cream, lard and exercise

Peter Janiszewski from Obesity Panacea wonders if you've built up an ice cream tolerance?

NPR, in a fascinating piece, asks who killed lard?

The New York Times' Tara Parker Pope explores the physiology behind exercise making you smarter.

Friday, February 24, 2012

Cutest Dog Video Ever!

Or at least that's how it was billed to me.

Today's Funny Friday comes from Jimmy Kimmel.  It's not long, but resist the urge to stop watching before it's done.

Have a great weekend!

(New readers, Friday's my day off ranting...and to make up for them, I post a funny video. Email subscribers, you've got to head to the blog to watch)

[Hat tip to Dr. Chris Cobourn]

Thursday, February 23, 2012

Disney's Horrifying New Interactive Childhood Obesity Exhibit at Epcot

Joining the State of Georgia's Strong4Life campaign in demonstrating a complete lack of understanding for childhood obesity is Disney with its new Epcot exhibit and online campaign Habit Heroes.

According to the Orlando Sentinel, Epcot's exhibit has kids following two characters, "Will Power" and "Callie Stenics", through a 4,700 square foot attraction that has them shooting virtual hot dogs with broccoli and dancing to defeat a super-super morbidly obese character named Lead Bottom.

Because after all, kids with obesity are obviously just gluttonous and lazy and they probably lie around and eat junk food all day, right?

That's what Disney thinks.

Think I'm exaggerating?

There's an online component where you get to fight the "Bad Habits".

Here's some photos of the bad habit characters.

A little Dance, Dance, Revolution and some broccoli spears ought to clear everything up, right?

It couldn't possibly be a problem with the environment the kids are growing up in, could it?  Geez, kids these days, they just don't try hard enough, do they?

So thanks for being so helpful Disney - I mean if your kid's not overweight or obese, here's to Disney reinforcing society's most hateful negative obesity stereotyping, and if they are overweight or obese - what kid doesn't want to be made to feel like a personal failure while on a Disney family vacation?

[UPDATE: 48 hours after this blog was posted, and after intense uproar in social media circles and in the press, Disney did the right thing and closed the exhibit for retooling. Kudos to them for responding quickly - I'm sure their intent wasn't to vilify children with obesity and am hopeful that Habit Heroes' next iteration will be a helpful ally in good health]

Wednesday, February 22, 2012

Ontario's Useless School Food Policy Costs Schools and Students Alike

It's a rare thing to champion a policy so bad that everyone loses but yet that's what Ontario's School Food Policy seems to be doing.

Principals are complaining of lost revenues from their banks of junk filled vending machines, and the children? Well they're still being served garbage, except now they're being taught that garbage is healthy.

What do I mean?

Take this article from the Leamington Post. In it Leamington District Secondary School Principal Mike Hawkins notes that there'll be less money coming in than there was before, but it's the other comments and notations that I found telling.
"The vending machines at Leamington District Secondary School used to be teeming with pop, Gatorade, chips and candy. Now, a few bags of baked chips are visible through the glass, as well as some granola bars, selected diet pop and bottled water."

"We still have pizza, but it’s whole wheat, with a healthier sauce and toppings"

"Gone are deep fried french fries and panzerottis, replaced with baked fries and quesadillas.
While I'd love to ask, "On what planet are baked chips, granola bars, fast food pizza, baked fries and quesadillas healthy?", the answer clearly is pretty much everywhere on Earth, and it's that answer that's going to leave our current degree of school food reform a non-player in improving the health of our children.

So there you have it. Less money for schools and for all nutritional intents and purposes, the same garbage for kids. Way to go?


Tuesday, February 21, 2012

Health care professionals, Twitter, and the Abuse of Public Trust

I had a brief Twitter scuffle this past Friday with a fellow MD.

While I'm all for debate, this one left me concerned. Not because I'm unhappy or unsure of the positions I took, but rather because I realized that Twitter's particularly dangerous when wielded by health professionals.

While I've seen discussions in medical journals and medical forums about the risks of Twitter to such things as patient confidentiality, I think there's a much greater risk when Twitter's wielded by health professionals - patient misinformation.

Physicians and other allied health professionals rightly or wrongly are often inherently trusted by the public. Physicians who tweet will likely collect their own patients as followers along with other members of the public who while not directly under their care, will be looking to them as a purveyor of expertly vetted medical information.

But what if the information isn't expertly vetted?

What if the health professional simply retweets press releases or newspaper articles that fit nicely within the confines of their own personal confirmation biases without taking the time to actually review the press' sourced articles for accuracy and authority?

Unfortunately, institutional press releases and lay press reporting is often lacking in critical appraisal and regularly misrepresents outcomes or simply doesn't appreciate methodological, paper-negating flaws.

Yet if retweeted by a health care professional those misrepresentations and flawed papers may be seen by that person's followers/tweeps as factual.

And hence my tweet up above. While the directive won't protect followers from health care professionals who do a cruddy job of critical analysis, I think it's the very least a health professional can do in protecting their tweeps. Not to do so - well I think that's a frank abuse of public trust.

[Strange after story. Unless there's a Twitter glitch, my co-scuffling MD has deleted our conversation from her timeline]

Monday, February 20, 2012

After School Sports Increase Junk Food and Total Calorie Consumption

That's the conclusion drawn by a recent meta-analysis of the impact of after school sports on pediatric obesity and diet.

Weight wise, despite what between the lines reading of the paper suggests the authors wanted to find, they were unable to conclude that after school sports had a beneficial impact on weight status.  While there were some studies that suggested benefit, there were many others that did not, leading the authors to ultimately state,
"there is not sufficient evidence to conclude that sport participation protects against the development of obesity"
So why might that be? After all, it may be fair to assume that kids who play after school sports are more active than kids who don't and consequently burn more calories. In fact according to this review paper, that'd be true in that to date the data would suggest that kids in after school sports are in fact more active overall than kids who aren't (they cite one study that used accelerometry to suggest a 30minute daily difference in physical activity due to organized sport).

But if they're burning more calories, why aren't they lighter?

Well, if they're burning more but aren't lighter, it'd probably follow they're eating more. And indeed, that's what the research also suggests with extra calories in after school sports participants coming from sugar sweetened beverages (can you say, "Gatorade"?) and from fast food (can you say, "Drive-Thru"?).

Now bear in mind the review didn't have that many papers to draw upon, and the results consequently aren't the most robust, but if my patients' and my family's experiences are anything to base things on - many families will hit drive-thrus or take out so as to allow for rapid transit to after school sports and it seems as if a child simply setting food on a blade of grass buys him or her some sort of sugar sweetened treat at game's end.

Who said fixing this problem was going to be simple?

Nelson TF, Stovitz SD, Thomas M, LaVoi NM, Bauer KW, & Neumark-Sztainer D (2011). Do youth sports prevent pediatric obesity? A systematic review and commentary. Current sports medicine reports, 10 (6), 360-70 PMID: 22071397

Saturday, February 18, 2012

Saturday Stories: Wi-Fi, Non-Dairy Milk and Cause Marketing

Orac covers the Ontario Catholic School Board's wi-fi witch hunt.

Andy Bellatti covers Big Dairy's inane attacks on non-dairy milk

Author and former Big Food spin doctor Bruce Bradley talks cause marketing.

Friday, February 17, 2012

A Heavily Processed, Refined White Flour Burrito I'd Eat in a Heartbeat

Today's Funny Friday video is more cool than funny.

NASA chefs - are those whole grain wraps?  Sure doesn't look like it.

Have a great weekend!

(email subscribers you'll need to head to the blog to watch)

Thursday, February 16, 2012

A Tale of Two Oz's

First Dr. Oz the doctor who during his interview with Maclean's Science-ish's Julia Belluz, commented on the benefits of raspberry ketones for weight loss by stating,
"The amount of weight you’ll lose is two, three, four pounds more than you would have."
He also qualifies the statement with a "could be"

And how about Dr. Oz the television personality?

The episode on raspberry ketones was literally entitled,"Miracle Fat-Burner in a Bottle".

Dr. Oz the television personality described them as,
"I never understood how powerful it could be until I started doing research",
that he's,
"a big fan of these things",
and then to demonstrate how they supposedly worked in the body, took red balloons that he called fat cells and put them into liquid nitrogen where they promptly deflated.

To help make his case he brings on Lisa Lynn, a trainer who, yup, you guessed it, sells raspberry ketone supplements ($791.76 for a year's supply), and near the end of the segment he asks her,
"I want to be practical, I don't want to over promise, how long will it take to see a benefit"
Her unchallenged answer?
"5 days"
They then go through some exceedingly dramatic before and after photos, without commentary as to what changes aside from taking raspberry ketones the subjects had undertaken, and with the second subject a frank discussion that overtly suggested it was just the raspberry ketones that had done the trick.

His conclusions?
"I think this is worth experimenting with",
and that,
"they're going to help your body think it's thin."
The science behind raspberry ketones, if you want to call it that, are two shaky mouse studies....but even if we take them to be fully translatable into humans (a gigantic and unwarranted "if", but I'll be generous), let's go back to Dr. Oz the doctor who points out we're talking a 3lb (I split the difference) total loss consequent to their ingestion.

The miracle here isn't raspberry ketones. The miracle here, and it's not a pretty one, is that a doctor is recommending his patients (because his viewers see him as a purveyor of expertly vetted medical advice) spend $791.76 a year for a remotely plausible, but admittedly not conclusively attainable, 3lb total weight loss, and that he's describing that 3lb loss as, "powerful", "amazing", and, "a miracle".

Though I guess it's not exactly a miracle. It's just fame and fortune - powerful, powerful, drugs which seem in Dr. Oz' case, to allow for some interesting rationalizations.

[Pssst, hey, want a super secret miraculous way to lose those 3lbs without spending hundreds of dollars on questionable supplements?  Try a 3 minute walk a day.  A year later, those same 3lbs will be gone.]

Wednesday, February 15, 2012

This Might Just be the Dumbest "Fitness" Study I've Ever Read!

File this under "How could this possibly have been published", along with, "Really. Really?".

From the University of Tennessee comes a paper that quantifies the calories burned by adults who while watching an hour of television, were instructed to stand up and step in place during commercial breaks.

The results?

Apparently you can take around 2,000 steps during an hour of television if you just get up and step on the spot during commercials.

My favourite part though has to be the researchers' conclusion,
"Because adults are spending more time than ever in front of the TV screen and only a small percentage of American adults engage in adequate amounts (30 min·d-1) of physical activity using standard approaches, we believe that modifying TV-viewing behaviors by having adults step in place during commercial breaks could be useful in promoting physical activity."
While I think it's unbelievable that there are at least 3 healthy living researchers out there who think that public health departments and allied health professionals should recommend nonsense as a means to combat obesity or to promote physical activity (because it's complete nonsense to imagine anyone would ever stand up during commercials and step in place on a regular and ongoing basis), what's more unbelievable is that this nonsense also passed peer review.

But hey, maybe I'm the crazy one. Maybe this is a phenomenally great idea, and so in that spirit, here are ten other super awesome recommendations of my own:
  • When you go to start your car, instead of just getting in, walk around your car at least 20 times, or better yet - run.
  • When you go to the supermarket, carry, don't push, your cart.
  • While waiting for your meal to arrive in a restaurant do jumping jacks.
  • When reading stories to your children pick your kids up and read to them while walking up and down your stairs.
  • When surfing the net do one burpee every time you navigate to a new webpage.
  • If you do take the elevator, do pushups while it's moving.
  • When you shovel your driveway, first shovel it, then shovel it back onto your driveway, then shovel it off again.
  • Tape your fork and knife to at least 10lb dumbbells so that every bite's a workout
  • When you go through a drive thru, put your car in neutral and push.
  • While waiting in your doctor's office, do wall squats.
Who knows, maybe those folks from Tennessee will help to quantify the impact of these oh so helpful suggestions?

STEEVES, J., THOMPSON, D., & BASSETT, D. (2012). Energy Cost of Stepping in Place while Watching Television Commercials Medicine & Science in Sports & Exercise, 44 (2), 330-335 DOI: 10.1249/MSS.0b013e31822d797e

Tuesday, February 14, 2012

Is Obesity a Disease?

Way smarter folks than me have duked this one out before, and while obesity has its own slot in the International Statistical Classification of Diseases (ICD-9), the debate of whether or not it's truly definable as a disease is often a heated one.

My take?

Personally I'd describe obesity as the natural consequence of placing a collection of truly ancient genes, genes forged over millions of years of incredible and constant dietary insecurity and upheaval, into an insane, calorific, modern day, dietary utopia. In other words? Obesity and overweight are our bodies' normal, natural, responses to the world they find themselves living in.

But unlike many other natural responses to our environments, obesity frequently carries with it real risks to both quality and quantity of life. Yes there are certainly people even with class III obesity who are exceedingly healthy, but that truth certainly wouldn't negate the case for obesity as a disease as many diseases have varied penetrances, and for a large percentage, especially at its extremes, obesity carries marked medical impact.

So is obesity an actual "disease"?

While I'd happily argue that obesity is a disease of the modern day environment, I'll more happily argue that unless we label obesity a disease, even if you happen to think it's not, we're less likely to see real formative changes in the way we deal with and view obesity as a society.

The fact is that right now the accepted global viewpoint is that if obesity is a disease it's a disease of willpower, of gluttony, of sloth. Consequent to that viewpoint we see tremendous, hateful and harmful weight bias that starts as bullying in elementary school and continues unabated for life.  Stereotype and bias targeting those people with obesity impacts upon their access to healthcare, employment, human rights and societal acceptance. Weight stereotyping also fuels the nonsensical weight loss quackery that steals money and hope, the well intentioned but misdirected public health campaigns that vilify obesity without offering tangible targets for change, and it's what allows medical schools and other allied health professional training programs, to virtually ignore thoughtful obesity related education - even if only to impress upon the students a non-blame based, you can in fact be fit and fat, approach.

Now there are indeed arguments that can be made regarding the risks of defining obesity as a disease, but when I've heard people discuss these risks, I've always been struck by the fact that those risks most commonly identified already exist. People already face discrimination by insurance companies consequent to weight, they already face difficulties with promotions/employment because of their weight, they already are labeled because of their weight, etc.

Were obesity to become accepted as a chronic disease, one that reflects a natural consequence of ancient genes in a modern day toxic environment, over time I would expect to see a change in societal attitudes. And there has been precedent for such a change - depression. The 60s and 70s saw society believing that people with depression need only, "pull themselves up by their bootstraps", yet now depression is readily accepted as a condition deserving of care, attention, empathy and most importantly, a lack of blame.  Shifting the focus to obesity as a disease might also lead to environmental targeting of blame and consequently, environmental targeting of treatment.

My hope is that one day obesity will be seen as a modern day scourge, a day when the trite advice "all you need to do is eat less and exercise more" is seen by the general public as over-simplified nonsense, a day where obesity's not thought to be about personal weakness, a day where obesity's known to have a a wide and varied penetrance, a day where obesity's treatment would range from absolutely nothing in those with no medical consequences, to behavioural therapy, to drugs, to surgery, and one where allied health professionals were skilled enough to know when and if obesity's treatment was actually necessary.

A day when people who struggle with obesity aren't made to feel like if they just wanted it badly enough, they'd magically wake up with a mindset that ultimately would see them to permanent weight loss, because the thing is, one thing people don't lack is desire, and if desire and strength of conviction were actually all that were required, no one would be reading this blog post, and everyone would be whatever weight they dreamed of being.

Monday, February 13, 2012

Mixing, Pouring, Adding, and Stirring Ain't Cooking!

As far as health goes, it may be Big Food's most destructive legacy - this notion that "home cooking" can consist of mixing packets, jars, and boxes together.

It's incredibly pervasive too.

Some examples:
Take box of dehydrated frozen refined flour noodles. Boil water. Add box. "Cook". Open jar of sauce. Add sauce.

Brown meat of choice. Add packet of "flavouring". Stir. Add to store bought buns, wraps or rehydrated "noodles".

Take frozen box of "food" of choice. Microwave or heat in oven. Optional - serve alongside baked bagged French fries.

Take ready made pizza. Heat in oven.

Mix package of brown powder with eggs and water. Put in cake pan. "Bake".
I could go on.

When I meet new patients, I'll always go through their eating out history, but rarely their eating-out-eating-in history, but I probably should.

Those examples up above? They'll get me as close to actual cooking as watching movies will get me to winning an Oscar.

Cooking, actual cooking, is the transformation of raw ingredients. And there's definitely something special about actual cooking. A sense of accomplishment, of healthfulness, of basic goodness - even when cooking less than stellar meals nutritionally.

Sadly, over the years, the food industry has aimed to co-opt that something special, literally designing foods that require the most basic of input and effort so as to perpetuate the gigantic white lie that we're "home cooking".

Is there a meal in your home you've unfairly labeled "home cooked"? If there is, how about trying to actually home cook it this week? It may well be easier than you think, and guaranteed, it'll be far more rewarding.

Saturday, February 11, 2012

Saturday Stories: Trans fats, Mercola and the Known Universe

An access to information request from the Center for Science in the Public Interest leads to discovery that Canadian Health Minister Leona Agglukkaq personally torpedoed a plan to regulate trans fat that would have saved lives and $9 billion taxpayer dollars.

Chicago Magazine has a fascinating look at Dr. Joe Mercola.

A jaw dropping website that helps to understand the scale of our universe. Mind blowing, but takes a minute or two to load. Just wow.

Friday, February 10, 2012

Men are Stupid and I'm a Man

What a brilliant commercial.

It's today's Funny Friday video, and if you can relate to it, we'd probably have got along great in University.

Have a great weekend!

(email subscribers, you need to head to the blog to watch)

Thursday, February 09, 2012

What a World Without Ridiculous Front of Package Health Claims Would Look Like

Here in Canada (and to a lesser degree since the class action lawsuit in the United States), Danone's all about health claims. Inferred health claims, overt health claims, the bottom line it would seem is that according to Danone Canada, their yogurt's basically medicinal.

Fly across the Atlantic to Europe and it's a completely different story. You see in Europe, the standard for making health claims is different that here in Canada. First off, in Europe you can't put a claim on a food's packaging until AFTER it's been approved by the European Food Safety Authority (EFSA). Secondly, the claims better be supported by substantial human research with quantifiable outcomes.

As far as Danone goes, they've now twice removed their immunity claims for Actimel (Danactive here in Canada) and their gut claims for Activia from consideration, as removing them from consideration is better than a "NO". They keep saying they don't understand the process well enough to submit their dossiers - a claim I'd certainly believe the first time around, but have a tougher time swallowing the second.

My thought is that while indeed Danone has done more real science on their ingredients than possibly any other food manufacturer, that the data, although suggestive, isn't yet conclusive and hence not sufficient.

So what's triggered this post? An article in industry friendly e-zine with some quotes from some Danone folks.
"The European Union's uber-strict health claims regime may this year deliver a barren, claimless landscape to the world's biggest selling functional food category"
The horror!

So what does that mean?

Instead of the ridiculous packaging for Actimel (Danactive) that we have here in Canada and seen up above, we'll get this "barren, claimless" European version:

And then suddenly, instead of selling claims about immunity that Danone themselves feels are not scientifically rigorous to pass muster over in Europe, they'll have to just sell yogurt.

A guy can dream, can't he?

Wednesday, February 08, 2012

Book Review: Tim Caulfield's The Cure for Everything

If you don't feel like reading the rest of this review I'll summarize it by saying, Tim Caulfield's The Cure for Everything is the perfect antidote to the idiotic glossy paged world we're stuck with and is a definite must read.

In fact I enjoyed reading it so much, that a few pages into the copy Penguin sent me, I headed over to Kobo and ponied up my own dough and bought an e-version so that I could read it that much more often by using it to make my recumbent bike interval training, not just bearable, but something I even kinda, sorta looked forward to.

You see Tim's book is something I'm not sure I've ever read before. I'd describe it as an "evidence-based romp" (words that I'd never thought I'd string together) and his clean writing and his truly delightful and delicious self-deprecating brand of humour makes you want to pick it up again and again.

Tim covers a fair bit of ground in his personalized debunking of the scads of bunk we face when considering self-improvement projects like fitness, diet, genetics, and chronic disease prevention.  And when I say personalized, I mean it in that Tim takes himself through his own anecdotal n=1 journey through celebrity trainers, dieting (back to that in a moment), colonics, personalized gene testing, accupuncture and homeopathy.

I actually bookmarked huge swaths of the book with the intent of sharing with you some favourite passages, but sitting here now and writing this review, I don't want to.  Not because I'm lazy, but because I don't want to spoil your read.

I will however point out the one area where the book and I disagree rather conclusively.  Diet.  I say, "the book", rather than Tim, because Tim and I met last October at the Canadian Obesity Network's conference and we took the opportunity to chat quite a bit and over the course of our discussion, I think I may have swayed him some from the success=suffering formula presented in the book.  Personally I don't believe in white knuckling through hunger and cravings on an ongoing basis and rather encourage consuming the healthiest diet you can actually enjoy, and not striving for the healthiest diet you can tolerate, while simultaneously using time, macronutrients and sufficencies of calories to try to turn off physiologically driven dietary drive.  I also think he gave Canada's Food Guide pretty much a free pass, though to be fair, weight loss was more the focus of the chapter than formal evidence based nutrition.

Diet notwithstanding, the book's undeniably fabulous.  I couldn't recommend it more highly.

Tim, in a tribute to where you spent much of your time writing, close at hand while writing this review was an ice cold beer.

(If you'd like, you can follow Tim on Twitter)

[If you're in Canada, here's the link.

If you're in the USA, you can pre-order on Amazon over here]

Tuesday, February 07, 2012

Does Dietary Elitism Scare People off "Healthy" Eating?

What is "healthy" eating?

I suppose everyone has their own definitions of what's involved, and certainly there are some dietary adherents where food becomes nearly a religion, but forget about them. I'm talking about the masses, the folks who don't spend their every waking moment living and breathing a particular dietary regime. What do your average Joes and Janes who aren't inherently keyed into nutrition picture when they hear the word, "healthy" regarding food?

My guess?

Sprouts - both brussel and otherwise.

And certainly salads. And maybe weird looking (to them) plates full of grains with currants or raisins. Maybe cottage cheese.  Definitely lots of water.

Probably also they think "vegetarian" or "fancy", or "complicated".

And while "healthy" need not be any of those things, sometimes I do have to wonder whether or not part of the problem in inspiring the world to choose healthier food is that the notion that healthy's fancy is one that does in fact get regularly perpetuated by folks preaching eating healthfully.

Take for example last week's New York Times. In it readers are presented with Martha Rose Shulman's ideas for, "a week’s worth of light and simple ideas for dishes that travel well.....lunches they can take to work and eat at a desk". Her ideas? I'll present them in picture form down below, but among them they include the ingredients: Beet greens, Swiss chard, chickpeas, Lundberg Black Japonica Rice, edamame, soaked red lentils, dark sesame oil, walnut oil, pinenuts, lightly toasted cumin seeds, Aleppo pepper, fennel, nigella seeds, and peeled kohlrabi.

Really? Those are "simple"? If that's "simple" for healthy eating, I'd hate to see fancy. And I bet I'm not alone.

Could articles suggesting dishes like these are "simple" actually hinder progress towards nudging people back into their kitchens?  Do we over complicate "healthy"?

Me? I'm pretty damn happy with my oven roasted chicken sandwich on whole grain bread with an apple, but I guess the problem with that "recipe" is that it wouldn't sell newspapers, books or glossy magazines.

So if the media is our primary influence on what is and isn't healthy, and if actually simple recipes don't grab readers, who's going to help get our nation re-learning how to cook actually simple, healthy meals?

I've got nothing.  Do you have any ideas?

(all food photos taken by Andrew Scrivani)

Monday, February 06, 2012

Why that Diet Soda/Stroke Paper is Worthless and a Failure of Peer Review


So without spending too much time on this, here's the thing, that paper that purported daily diet soft drink consumption was associated with several vascular risk factors including strokes? It's worthless, and it's a glaring failure of peer review.


Because the authors didn't even attempt to control for dietary quality, and moreover, the dietary recall data itself was obviously inherently flawed.

First the control issue. As I'm sure you're aware, what we eat has a tremendous impact upon our risk of developing various chronic diseases. Consequently not accounting for the folks who for instance ate 10 meals a week from fast food restaurants, take aways or diners, versus those who actually ate at home and transformed raw ingredients would likely skew the data. But even if you want to try to suggest that such differences would be accounted for by the dietitians conducting the dietary recall effort, if all you actually analyzed at the end of the day was amounts of consumed protein, carbohydrates and fats, what you'd fail miserably in doing would be to actually usefully compare the quality and caliber of the diets you were studying. By not looking at the quality of the macronutrients you'd be comparing quinoa to white rice, salmon to bacon, and olive oil to Crisco. Yet that's exactly what the authors did. And it's certainly not at all implausible that folks who regularly indulge in lower caliber dietary choices assuage some of their dietary guilt and build their own health halos by choosing a diet beverage over a fully loaded one.

But even if the authors accounted for (as they should have at the very least tried) meals out, vs transformed raw ingredients, as well as the actual quality of dietary macronutrients this study would still be useless.


Because according to the dietary recall data presented in their study, and despite an average body mass index of 28 (overweight), the self-reported overall caloric intake of the study population was a measly 1,575 calories, whereas 2000 NHANES data pegs the average for men between the ages of 59-79 to be between 2,123-2,590 and women between 1,596 and 1,828. And that's 12 year old NHANES data.  Given what we've seen with obesity rates, it's certainly quite plausible if not exceedingly likely, that average caloric consumption has risen over the past decade and change.

So basically here we have a study where we know the self-reported dietary recall is inaccurate and where the authors didn't even attempt to account for the actual quality of the participants' diets, that's making conclusions about the impact of diet soft drink consumption on strokes and suggesting diet was a controlled for variable? 

How this got through peer review is completely beyond me, but the worst part is the coverage. This paper got plenty of press making its publication not only an embarrassment to the Journal of General Internal Medicine and its peer review process, but also a powerful source of misinformation in a world that certainly doesn't lack for nutritional confusion.

Gardener, H., Rundek, T., Markert, M., Wright, C., Elkind, M., & Sacco, R. (2012). Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study Journal of General Internal Medicine DOI: 10.1007/s11606-011-1968-2

Saturday, February 04, 2012

Saturday Stories: Simon Singh, Infographics and Food Allergies

Fascinating interview with Simon Singh, the science writer who was sued for libel by the British Chiropractic Association following his critical remarks.

The Atlantic's Megan McArdle with a masterful takedown of infographics.

Science Based Medicine's Scott Gavura explains why food intolerance/allergy testing is pure quackery.

Friday, February 03, 2012

The World's Best Rendition of Suess' Oh the Places You'll Go

Honestly, whoever it was that realized that Burning Man was a real life Suessian utopia was a genius.

Today's Funny Friday?

Dr. Suess' Oh the Places You'll Go as read by the attendees of Burning Man (and even if you don't know what Burning Man is, you'll get the gist pretty quick)

Have a great weekend!

(Email subscribers, head to the blog to watch)

Thursday, February 02, 2012

Breathtaking Heart Health Hypocrisy from Health Minister Leona Aglukkaq

So February is Heart Health Month, and yesterday in a supposed show of support, Canada's Health Minister Leona Aglukkaq released a statement spelling out what Canadians can do to help themselves live a heart-healthy lifestyle.  In it she also brags about what the government's doing to help - primarily she points out they're funding basic research and a hodge podge of feel good, eat less, move more initiatives .

But to me that's not really doing anything, though rest assured, it's not as if Leona Aglukkaq's done nothing for heart friendly public policy.  She's stifled it.

What am I talking about?

As far as Canadian public health initiatives that might have had a positive impact on heart health, here's her legacy:

Leona Aglukkaq disbanded her own office's Sodium Working Group and ignored their recommendations.

Leona Aglukkaq refused to accept a proposed plan for sodium reduction that had been prepared and approved by federal and provinicial health officials.

Leona Aglukkaq without any publicized actual discussion, and despite strong public support, refused to have her office even consider banning junk food ads that target children.

Leona Aglukkaq rather than actually acting on our Standing Committee on Health's recommendations regarding childhood obesity instead launched a useless portal for "dialogue".


Leona Aglukkaq has thus far refused to enact a regulatory approach to trans-fat despite promises from her own office reporting that it would in fact do so if by June 2009 voluntary efforts were to fail, and also despite her own admission on April 21st, 2010 that fail those efforts most certainly had.

Considering Leona Aglukkaq's track record on heart healthy policy, her call to action to Canadians for Heart Health Month is both an embarrassment and a disgrace, and not coincidental to her inactions up above?  "Embarrassment" and "disgrace" are the same two words that leap to mind, when I consider Ms. Aglukkaq's performance to date as Canada's Minister of Health.

Wednesday, February 01, 2012

Obesity in Women Linked to Living Near Parks?!

If you like your data clean, pretty and predictable, you probably don't want to read the rest of this post.

Researchers from my hometown here in Ottawa recently published a study ahead of print in the journal Obesity. The paper, Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City looked at a number of different built environment variables and their impacts upon the probability of both leisure time physical activity and overweight and obesity in the population.

The statistical models controlled for: Age, education, household income, smoking status, and, given we live in a city where there's a lot of snow, season of data collection.

The variables that were considered as potential neighborhood based influencers of physical activity and obesity were: Total bike and walking path length, number of free or minimally expensive indoor and outdoor recreational facilities, park area and green space, social cohesion, neighbourhood safety, number of grocery stores, fast food chains, convenience stores, specialty food stores and full service restaurants.

The findings?

In men, almost nothing mattered. In fact with weight, nothing at all mattered. Number of fast food joints, convenience stores, grocery stores, park space or recreational facilities - none of these things seemed to impact upon a man's weight. There was however one variable that correlated with increased physical activity. Crime rate. Yup, the more dangerous the neighbourhood, the more active the man, to the tune of a 14% increase in their odds of being physically active for every standard deviation increase in crime rate.   Running away from the bad guys?

In women? With women for every standard deviation increase in park area they were found to be 17% more likely to be physically active. So far so good, but check this, for every same standard deviation increase in park area women were also 15% more likely to be overweight or obese. In fact the increased risk to overweight and obesity seen with increasing park size in women was only ever so slightly eclipsed by the 17% increased risk conferred to their weights by a standard deviation increase in numbers of convenience stores.  The riskiest thing for women's weights according to this paper?  Fast food restaurants with a 38% increased risk of weight for every standard deviation increase in those. 

So what do these numbers mean? So many questions.  Should inactive men be encouraged to live in dangerous neighbourhoods? Does nothing in a man's environment really matter to their weights?  Should women rethink that new home they're considering beside the park?

I don't think so.

I think all these numbers mean is that the reasons why people gain weight and exercise, they're stupidly complicated and trying to suss out the impact of a dozen or two different criteria on this sort of ridiculous complexity, might in fact be turn out to be a bit of an exercise in statistically meaningful futility.

Prince, S., Kristjansson, E., Russell, K., Billette, J., Sawada, M., Ali, A., Tremblay, M., & Prud'homme, D. (2012). Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City Obesity DOI: 10.1038/oby.2011.392