Monday, February 29, 2016

Got Spin? Dairy Farmers of Canada Talks Sugar With The Senate

Chocolate milk brochure and colouring book sent home this year with Ontario kindergarteners as part of  the Elementary School Milk Program
Unless you're a subscriber to Blacklock's Reporter you probably didn't see this story, but last week Canada's Standing Senate Committee on Agriculture and Forestry met to discuss market access to Canada's agricultural and forestry products.

Invited to this particular chat were representatives from Dairy Farmers of Canada including their President Wally Smith, and their Executive Director Caroline Émond.

During the discussion, Nova Scotia Senator Kelvin Ogilvie, took issue with the way the Dairy Farmers of Canada represented the sugar in chocolate milk in the materials presented to the Committee,
"I came across some remarkable statements about the amount of sugar and the fact that the sugar in chocolate milk is not an issue and we shouldn't be concerned about that. It shocked me, quite frankly, because sugar is a serious contributor to the obesity problem that we have in Canada and around the world.

Just to take a quick example, a 250 millilitre glass — that's one quarter of a litre, for those of you who want to follow this — of chocolate milk, 1 per cent, has 160 calories and contains 25 grams of sugar. A glass of Coca Cola of about the same size is 100 calories and 26 grams of sugar.

Now I understand there are other things in the glass of chocolate milk, but the idea that you can state unequivocally in here that there should be no concern whatsoever about the sugar in chocolate milk astounds me. It would take an ordinary person in ordinary exercise approximately an hour and a half to work off that many calories. It would take a vigorous workout to do it in half an hour. The issue is not just the amount of calories; it is in fact the amount of sugar. They are empty calories, they are high calories and they contribute negatively to health overall.

I was startled to see that. I happen to like chocolate milk, by the way. I had never seen a statement such as that and I'd like your reaction.
The non-answer provided to him by Ms. Émond didn't satisfy Senator Ogilvie and he minced no words calling her on that,
"You have spoken to obfuscate the issue, and I congratulate you on that.

In the basic white milk, there is far less sugar, so you actually have significant added sugar in here, and it is the added sugars, absolutely, that are the very serious issue.
Ms Émond responded that she understood Senator Ogilivie's concerns, and perhaps tried to reassure him by explaining that Dairy Farmers of Canada markets chocolate milk responsibly - to athletes,
"We position chocolate milk as a sport recovery beverage. It's a great positioning and it works well with athletes and sporting people who are using chocolate milk as a recovery beverage instead of energy drinks, which are, again, empty calories. We try to position the product in the best possible light. I understand your concern."

I wonder how Ms. Émond and Dairy Farmers of Canada would explain all the photos on this page?

You see they're all photos of the marketing materials that Dairy Farmers of Canada recently distributed to elementary school children and their parents as part of their Elementary School Milk Program.

And front and centre in those materials that are marketed to Canada's youngest school children and their parents are the very claims that shocked Senator Ogilvie. And not only are the claims front and centre, but the brochure itself is clearly designed to position chocolate milk preferentially over white milk with 3 of the 4 pages of the brochure literally being brown (with only the back of the brochure promoting white milk), and the line, "Get your child off to a great start" framing a carton of the chocolate stuff.

The inside of the chocolate milk brochure up above
There's no denying that Dairy Farmers of Canada are doing their best to position chocolate milk as a recovery beverage to athletes, but there's also no denying that they're positioning it to children and their parents as health food. A positioning echoed by the brochure sent home with children last year.

Kindergarteners and elementary school children aren't athletes. Chocolate milk isn't health food. And Dairy Farmers of Canada, if their statement to the Senate was meant to suggest that they don't market chocolate milk to anyone other than athletes, are plainly lying.

[Thanks to Blacklock's Reporter's publisher Holly Doan for sharing the Senate transcript with me - I will attach a link to the full testimony once it's posted on the Senate Committee's webpage]

Friday, February 26, 2016

Did You Know That Canada Is In America's Presidential Race?

You know America can, and terrifyingly maybe will, do worse.

Today's Funny Friday is Canada's first ad in pursuit of the presidency.

Have a great weekend!

Wednesday, February 24, 2016

Vending Machines Earn Schools Way Less Than You Might Expect

Had a nice chat with a local school principal the other day about vending machines.

Their school has 5 vending machines serving 800 students. They made the school $2,000 last year, a number which is small not because sales are small, but rather because the school's cut is only 20%.

That's just $2.50 per student per year to sell them school sanctioned junk food.

And really, they are selling junk.

Despite Ontario's school food policy when this principal explored their school's vending machine options they discovered that despite explicit policies banning the sale of sport drinks, chips, etc., that's precisely what they were stocked with (actual photo up above and down below).

When I inquired as to the how and why I was told that the vending machine company fills up the machines, and that without enforcement, and despite some fanfare when the new Ontario school food policy was released, the vendor decided they didn't care. This principal had the company come back in and swap out the stuff that wasn't supposed to be there.

Now I've written before about how I think that baked chips are probably worse than fried due to the false impression provided that the chips are now somehow healthful, but putting that aside, what good's school food policy if no one enforces it?

Moreover, if school vending machines earn just $2.50 per student per year, what's the point of the machines in the first place? Whether by way of empty bottle drives, plant bulb sales, walkathons, or more, $2.50 a student isn't a particularly high bar to clear to get junk out of our schools.

Monday, February 22, 2016

Welch's Study Finds Grape Juice Makes You Smarter #NotTheOnion

Oh, and a better driver.


The findings were part of a study published ahead of print in the American Journal of Clinical Nutrition. The funded at least in part by Welch's study, Concord grape juice, cognitive function, and driving performance: 1 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children, started with 25 participants randomly assigned to consume 1.5 daily cups of Concord grape juice (containing 233 calories and more than a quarter cup of sugar (13.5 tsp)), or an energy and sugar matched non-concord grape juice "placebo" for 12 weeks followed by a cross-over of treatment arms.

19 participants described as "working mothers" completed the battery of cognitive tests, and 11 sufficiently completed driving simulations. Outcome measures for cognitive function included the number of correctly identified sequences, false positive responses, reaction times, a grooved pegboard assessment of manual dexterity (fill the holes with the pegs), and "Tower of Hanoi" testing. Outcome measures for driving performance included a 25 minute virtual driving scenario.

Now up front I should disclose I'm neither a statistician nor an expert in cognitive function testing so please consider that with my assessment. Ultimately, within the battery of tests (and there were plenty), a few in fact were found to show a statistically significant improvement in favour of the grape juice - most with p values of 0.05. Of course, do enough tests, and chance alone will dictate one will turn out to have a p value of 0.05. Putting that aside, I also can't help but question the significance, even if true, of for instance completing a psychomotor skill test in 60.4s vs. 63.2s (P < 0.05), or as it would pertain to driving, a "car following" accuracy of 0.96 vs 0.97 (P = 0.05).

Sounds like the authors may have wondered the same given their use of the word "subtle" in describing the improvements and their proviso when considering the battery of tests that were run,
"it is important to acknowledge that there were no effects on most cognitive outcomes".
Not surprisingly, that proviso did not stop Welch's from putting out a press release that opened with,
"New research by the University of Leeds in the UK suggests that drinking Concord grape juice daily can benefit certain aspects of memory and everyday tasks in people with stressful lifestyles – specifically working mothers".
So there you have it - the 13.5 teaspoons a day of sugar way to just barely, sort of, in a very small number of very specific tests, as revealed by an incredibly small sample size, make yourself smarter and a better driver.

[And to consider too - did these, acknowledged even by the authors to be meagre, findings really warrant publication in the American Journal of Clinical Nutrition, a journal with an impact factor (nearly 7) higher than roughly 95% of all other scientific journals, and one that was selected by the Special Libraries Association as one of the top 100 most influential journals in Biology and Medicine over the last 100 years? And/or does this just speak to impact factors' lack of utility?]

Saturday, February 20, 2016

Saturday Stories: Selling Sugar, Complementary Medicine, Bullshit, and a Video

CSPI's summary of their report on how soda companies, facing sagging sales in North America, are turning to the developing world to sell sugar.

Pharmacist Scott Gavura in Science Based Medicine asks if it's ethical to sell "complementary" medicine.

Brian D. Earp in Quillette on "the unbearable asymmetry of bullshit"

And a bonus video from Dr. Trish Greenlaugh on "Real Rubbish vs. Evidence Based Medicine"

Friday, February 19, 2016

Don't Go To Jamba Juice, But Do Watch This Video of Adele at Jamba Juice

Today's Funny Friday involves Adele, with Ellen in her ear, pranking some hard working folks at Jamba Juice.

And if this tempts you to head to Jamba Juice, don't forget that many smoothies there contain the calories of Big Macs and pack in the neighbourhood of half a cup of sugar.

Have a great weekend!

Wednesday, February 17, 2016

RDs Gather in Peru For Secret Food Industry PR Conference

Yesterday was the last day of this year's Food 3000 conference held in Lima, Peru. The conference is for RDs and other nutrition influencers. In previous years, the conference, as pretty much all conferences are, was shared widely by way of hashtags, tweets, Instagrams and Facebook posts. This year however, there's silence. The word is that attendees were expressly told not to share their experiences. While clearly I can't tell you what's going on there this year, I thought I would take the occasion to bump up a post I wrote back in 2014 that covered that year's Food 3000 conference. Given the sentiment these days on the merits and risks of food industry partnerships, I can't say it's surprising to learn that industry sponsored conference organizers would prefer secrecy.

The conference organizer is quite transparent BTW. Here's how they describe their role in working with RDs, and presumably the aim of this clandestine conference,
"The Porter Novelli food practice not only knows how to reach influencers, we are the influencers. Our team has seats on influential panels for the Institute of Food Technologists, Food Marketing Institute and the Academy of Nutrition and Dietetics to name a few. We have an in-house team of registered dietitians as well as a global network of influencers and researchers with whom we develop award-winning strategies and campaigns for our clients."
Here's that 2014 post:
Those of you who follow various nutrition professionals on Twitter have no doubt seen the #F3K hashtag these past few days.

Briefly, the #F3K hashtag stems from an annual influencers conference run by Porter Novelli, a multinational PR firm that boldly (and rather creepily) exclaims,
"We motivate people to change deeply ingrained behaviors rooted in cultural and social norms. Our results are greater than influencing people. We make them believe"
And here's Porter Novelli describing their annual PN Food3000 (#F3K) conference),
"We boast long-term relationships with the individuals and organizations that influence consumers’ attitudes, beliefs and behaviors related to food and health. The Food and Nutrition practice annually hosts PN Food3000, at which American Dietetic Association media spokespeople are exposed to the latest innovations and research in nutrition communications. Our team of expert communicators and registered dietitians helps clients devise intelligent strategies to introduce new products or line extensions against well-chosen market segments, including multicultural audiences. We are skilled in developing platforms that create a point of differentiation, establish strategic alliances and sponsorships, grow consumption and position brands for new growth segments."
And judging from the tweets emanating from this year's #F3K that took place in Amsterdam, they've done a bang up job and the sentiment from many non-attending RDs on Twitter is that those who did attend did so at least partially on the conference's industry sponsors' dimes.

I'm going to post these tweets without commentary. Most come from RDs at the conference, many of who boast large social networks and presumably are Academy of Nutrition and Dietetic spokespeople . And to be clear, the tweets are my own quick cherry picking. They're not meant to disparage or shame those who tweeted them (in many cases they're just quotes from speakers), but rather for readers here to consider the wisdom of these sorts of conferences and their promotion, as well as whether the hashtag #spon is sufficient to explain to the public that the tweets come from food industry sponsored talks (it wasn't for me - I had to ask someone what it meant).

[BTW - I did ask Porter Novelli for further information regarding sponsorship and program. They have yet to send a response. I can only suppose then that transparency doesn't make for good PR.]

Tuesday, February 16, 2016

How Dental Floss Can Help You With Weight Management Success

One of the most reproducible findings coming out of successful weight management programs is that attendance matters.

It would seem that regardless of approach, generally speaking, the longer the program and the more regular and frequent the attendance, the better the outcomes.

Though no doubt part of that effect is due to self-selection (people doing better are more likely to continue going), after working with patients on behaviour change for the past dozen years, I can tell you part is also due to what I refer to as the dental floss effect.

You know the one, where when you realize you've got a dentist appointment coming up you suddenly up your flossing game.

All this to say, whether it's a pay-for program, a buddy system, an online coach, or a local support group, having someone other than yourself to check in with may help you in fostering lasting change.

Friday, February 12, 2016

"Cranberries are, I think we can all agree, nature's most disgusting berry"

Thanks to Dr. Dylan MacKay for reminding me that at 7:40 of this John Oliver piece of sugar, he covers cranberries - "cherries that hate you". Seemed fitting given #Craisingate.

Whole thing's well worth a watch.

Have a great weekend!

Wednesday, February 10, 2016

Weight, BMI, BF% - Should MDs Measure Things That Shouldn't Change Treatment?

Image Source
Something I struggle to understand is the medical community's (and much of the public's) use of some combination of weight, body mass index, body fat percentages, or waist circumferences as a means to determine whether or not a person might benefit from an exploration of their lifestyle.

While all of those measures to a degree do inform risk, are they really useful to the clinician in determining the need for the exploration of a person's lifestyle? Does it simply follow that if one or more of weight, BMI, body fat percentage, waist circumference or waist to hip ratio is high that said person's lifestyle isn't healthful, or that treatment (lifestyle, meds, or surgery) is required?

A more important question though would be if all of those numbers were in so-called healthful ranges, does that mean your patient's lifestyle shouldn't be explored?

I know plenty of people with weight whose lifestyles are tremendous, and plenty of folks without whose lifestyles are horrifying, and as such, regardless of numbers, clinicians are best to explore lifestyle with every single patient. Artificially hinging a discussion on lifestyle on a number which even with the best of intentions and efforts, might not change much, can both lead a person to abandon their efforts to live more healthful lives when things don't change, and preclude conversations that in turn might benefit your patients and their families.

The goal is the road (a healthful one), there is no destination (the numbers).

Monday, February 08, 2016

Craisins Are More Candy Than Fruit

A strange thing happened last week.

In response to a tweet that included the photo up above that inferred Craisins are a healthful handful of "Nature's Candy", I pointed out that Craisins were in fact candy, as in order to make them palatable, heaps of sugar are added.

That's not the strange part.

The strange part was the somewhat heated debate it seemed to spark on Twitter. One RD wrote to say that though there's more sugar than raisins, there's not that much more (I'll come back to the raisins in a bit), and that she'd certainly choose Craisins over chocolate chips for her trail mix.

So I decided to compare the two.

First, by weight, gram for gram the Craisins have 34% fewer calories than Hershey's semi-sweet chocolate chips (I'd say that's a good thing), but with 89% of the Craisins' calories coming from sugar (versus 46% of calories coming from sugar in the chocolate chips). Interestingly, when compared by weight with chocolate chips, Craisins have 10.5% less fibre (who knew chocolate chips had fibre?), and 18% more sugar.

If we compare them by volume though (as I think volume is probably the way most assemble trail mix), the Craisins come out a bit better still, containing just half the calories of the same volume of chocolate chips and with 10% less sugar. So maybe this RD's got it right - Craisins, as a sugar source for your trail mix, will provide a tiny bit less sugar than chocolate chips and at half the calories.

Next up was an RD who took issue with my use of the terms, "heaps", and "piles", to describe the sugar content of Craisins.

Now it's true that heaps and piles are not formal units of measure, but yes, to me the 5.4 teaspoons of sugar contained in the single serving package of Craisins featured in the original tweet can be fairly described as both a heap and a pile. Another way to consider Craisins' sugar content is to ask how much sugar is found per tablespoon of Craisins? The answer is that 60% of each tablespoon of Craisins is sugar, and therefore piles of Craisins definitely mean piles of sugar.

And now back to raisins. The same RD who didn't like my heaps and piles comment decided also to build a strawman argument (she misrepresented my argument to make it easier to attack) when faced with my answer that yes, 7 teaspoons of sugar per quarter cup serving of Craisins is a pile, and asked me if I was "against" raisins as well.

The answer's yes - if the question is the non-strawman version asking me if I'm also opposed to considering raisins a fruit equivalent.

It's true, unlike inedibly-tart-without-added-sugar Craisins, sugar isn't directly added to raisins, instead it's concentrated in them by way of dehydration. By volume raisins contain 4.17x the calories of red grapes, and 3.7x their sugar, and just one of those little, unlikely to help fill even a child up, 1.5oz boxes of raisins, contains 6.25 teaspoons of sugar representing 77.5% of the raisins' total calories. And they're not exactly nutritional powerhouses either as raisins pack little to nothing in the way of nutrients.

Here's are some breakdowns of the nutrients found in a 1.5oz box of raisins

Whereas a cup full of actual grapes, an amount likely to provide some real satiety, and containing 18% fewer calories and 9% less sugar than that tiny, not-filling box of raisins, brings a fair bit more in the way of nutrients.

All this to say - if you like Craisins, raisins or chocolate chips, by all means eat them, but know that the first two have far more in common with candy than they do with fruit and probably shouldn't be confused as healthful.

When it comes to Craisins and raisins, nature's candy is still candy.

Saturday, February 06, 2016

Saturday Stories: Retired Cells, Brazilian Doctors, and Ancient Rome's Halftime Shows

Ed Yong in the Atlantic covers an exciting new anti-aging treatment prospect - getting rid of the body's retired cells (mouse model caveat applies).

Reed Johnson and Rogerio Jelmayer in the WSJ on the Brazilian doctors who sounded the alarm on Zika and microcephaly.

A must pre-Superbowl read in Live Science from New York Times bestselling historical non-fiction author Cristin O'Keefe Aptowicz on the horrors of the ancient Rome's damnatio ad bestias half-time show.

Friday, February 05, 2016

"Instead of Water, Might I Suggest an Ice Cold Bottle of Candy?"

Today's Funny Friday is funny because it's true. It's a soda commercial, without the marketing.

Have a great weekend!

Wednesday, February 03, 2016

The Calorie Clump Theory of Annual Weight Gain

It's a fairly frequent, and ridiculous sounding argument, and it's often brought up by those who suggest that calories don't count so as to highlight what a silly construct calories are. And truly, the suggestion that teeny tiny mismatches in energy intake are responsible for our average gain of 2lbs per year is ridiculous. It's a straw-man argument though.

Working with literally thousands of patients over the course of the past dozen years I can tell you people don't gain weight consequent to a slow, linear, one extra potato chip too many per day, sort of way. People gain weight consequent to big, giant, clumps of calories.

Sometimes those clumps come from restaurant meals. Sometimes those clumps come from vacations. Sometimes they come from religious holidays and family gatherings. Sometimes they come from comfort eating after an especially rough week. Sometimes they come from a weekend or a night out with the girls (or boys). Sometimes they come from burning the midnight oil. No doubt for most of us they come on our, and our kids' birthdays.

And none of this is to say that the quality of calories don't matter. They do, as the quality of our calories will directly and indirectly affect the size of our clumps. But there is no shortage of calorie clumps.

Even if these clumps when squished together made up only 5% of our years' days, and assuming each of those days provided only a conservative 500 calorie clump (I'm betting many day's clumps climb easily into the thousands), those clumps' contributions to calories could more than explain our slow, annual, average rise in weight - even if the remaining 95% of our days were in perfect caloric harmony.

Monday, February 01, 2016

"Constrained Energy Expenditures" and Not Outrunning Our Forks

A new study came out last week that further explained why it is that while exercise does burn calories, it doesn't help with weight management nearly enough to be fair.

The paper, "Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans", aimed to explore why it is that exercise's impact on energy expenditure doesn't appear to be linearly "additive" - meaning that studies on energy expenditure suggest that increases in exercise, don't come with a comparable increase in total daily calories burned. In part this is because with increasing exercise comes increasing exercise efficiency, but the remainder is less clear. Is there an "exercise" thermostat in our bodies that effectively dials down our activity levels outside of our workouts whereby if you workout hard in the gym in the morning you'll sit more and fidget less for the rest of the day?

Here the authors put forward their theory of "Constrained Total Energy Expenditure" to explain the phenomenon I've covered here a few times - that objectively measured energy expenditures don't seem to vary much the world over. From the first world to the third world, as a species we seem to share the same total daily energy expenditures each and every day. This fits with the authors' constrained hypothesis.

To test their constrained model they objectively evaluated energy expenditures, in 332, mixed-sex, adults drawn from Ghana, South Africa, Seychelles, Jamaica, and the United States. The measures they tracked were total energy expenditure by way of doubly labeled water method, resting metabolic rate by way of respirometry, and physical activity by way of wearable tri-axial accelerometers.

What they sought to learn was which model would be best represented by the subjects' objective measurements - additive or constrained? If additive you'd expect a linear increase in energy expenditure with activity. If constrained you'd expect adaptations to blunt increasing energy expenditure even as activity levels rose.

The authors found that the plot of their cross-sectional subjects' activity vs. energy expenditure wasn't linear and additive like the first graph, but rather was blunted and constrained like the second.

Also worth noting, the authors point out that regardless of which model you choose to believe in, their findings had physical activity accounting for only 7%–9% of the variation in total energy expenditure after controlling for anthropometric variables and population location. Translated this means that when it comes to energy balance, what you eat matters a hell of a lot more than how much you exercise regardless of how exercise contributes to energy balance. It also means that you're not likely to be able to outrun your forks.

Of course you shouldn't take this as a license not to exercise, as exercise is probably the single most important modifiable determinant of your health. Putting this another way, you lose weight in the kitchen, you gain health in the gym.

(Below is my keynote presentation for PHE Canada where I make the case for rebranding exercise)