Monday, February 27, 2017

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

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

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

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

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

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

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

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

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

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

Saturday, February 25, 2017

Saturday Stories: Facts, Evidence, and Drugs

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

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

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

Friday, February 24, 2017

This Hour Has 22 Minutes Meets Governor Mike Huckabee

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

Have a great weekend!

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

Thursday, February 23, 2017

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

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

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

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

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

Here are some of the coupons:

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

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

And just in case you're tempted to suggest that these coupon books weren't meant for kids, you should know that the coupons are (their caplocks and bold, not mine),
If we as a society want to rein in the predatory marketing practices of the food industry that target our children, we're going to need to do that ourselves as industry self-regulation continually proves itself to be worthless.

Tuesday, February 21, 2017

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

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

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

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

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

The researchers' not-meant-for-mice conclusion echoes my confirmation bias,
"physical activity should be encouraged for its overall health benefits, while expectations concerning its role in weight loss should be kept realistic."
Exercise is primarily for health, not weight loss.

Saturday, February 18, 2017

Saturday Stories: 3 Terrific Doctors' Tales

Gabor Maté for CBC News on addiction.

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

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

Friday, February 17, 2017

Standing Desk Truths From The Family Guy

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

Have a great weekend!

Wednesday, February 15, 2017

Sudbury Hospital Says Eat Blizzard Cupcakes To Support Cardiac Programs

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

Just in case you want to take the position that you'd be buying them anyhow, looking to Health Science North Foundation's Facebook page you'll see their encouragement to buy them
"for a good cause",
that you should
and that,
"now's your chance to eat cupcakes without guilt".
Remember too, you can't buy just one, you need to buy a half dozen, and each and every one packs 240 calories along with 5 teaspoons of sugar.

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

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

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

Monday, February 13, 2017

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

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

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

During that same time frame, other liquid candy sources have picked up some major steam
  • Energy drinks +638%
  • Sweetened coffees +579%
  • Flavoured water +527%
  • Drinkable yogurt +283%
  • Sweetened teas +36%
  • Flavoured milk +21%
  • Sports drinks +4%
Also shocking were the daily per capita consumption amounts - especially of the kids:
  • Children 0 – 8 years consumed 326ml/d
  • Youth 9 – 18 years consumed 578ml/d
  • Young adults 19 – 30 years consumed 504 ml/d
  • Adults 31+ years consumed 259ml/d
And you have to remember that per capita is an average per person that includes those of us whose kids consume virtually none. And when considering the incredible rise in energy drink consumption also remember that Red Bull was the 4th most commonly advertised food on the top 10 websites favoured by 2-11 year old children.

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

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

Saturday, February 11, 2017

Friday, February 10, 2017

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

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

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

Have a great weekend!

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

Wednesday, February 08, 2017

You Likely Won't Outrun Your Fork - African Edition

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

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

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

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

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

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

Monday, February 06, 2017

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

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

The other day an article caught my eye. The headline read,
"Two cups of grapes a day may keep the Alzheimer's away".
Reading the piece I learned that,
"a recent study conducted by the University of California, Los Angeles indicates that consuming them (grapes) helps protect against Alzheimer's disease",
and that,
"This pilot study contributes to the growing evidence that supports a beneficial role for grapes in neurologic and cardiovascular health".
But there were some giant red flags.
  • The study involved just 10 people.
  • The study did not involve eating actual grapes.
  • The coverage did not mention whether or not those 5 people consuming freeze-dried grape powder performed differently on the battery of cognitive tests administered to them before and after the 6 month intervention.
  • The coverage credited a press release from The California Table Grape Commission as its source.
So I decided to read the study itself.

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

The cognitive testing sure was thorough, and given there were only 5 participants in the intervention arm and 24 tests administered, the chances of one coming back with a between groups difference even just by chance was much higher. Researchers administered the following tests:
  1. Cognitive subscale/ADAS-Cog (Rosen et al., 1984)
  2. Mini-mental Status Exam/MMSE (Folstein et al., 1975)
  3. Hopkins Verbal Learning Test-Revised (Benedict et al., 1998)
  4. Benton Visual Retention Test (Benton, 1955)
  5. Rey-Osterreith Complex Figure Test delayed (Osterrieth, 1944)
  6. Boston Naming Test (Kaplan et al., 1983)
  7. Letter Fluency FAC (Strauss and Spreen, 1998)
  8. Animal naming (Goodglass et al., 1972)
  9. Stroop Interference (Golden, 1978)
  10. Trail Making Test-Part B (Reitan, 1958)
  11. Wisconsin Card Sorting Test-64 (Heaton, 1981)
  12. Speed of information processing (Trail Making Test Part A (20)
  13. WAIS-III Digital Symbol (Wechsler, 1997)
  14. WAIS-III Symbol speed (Wechsler, 1997)
  15. Complex figure test copy (Osterrieth, 1944)
  16. WAIS-III Block Design (Wechsler, 1997)
  17. WAIS-III Symbol search total (Wechsler, 1997)
  18. WAIS-III Letter-Number Sequencing (Wechsler, 1997)
  19. WAIS-III Digital Span (Wechsler, 1997)
  20. Wechsler Test of Adult Reading (Wechsler, 2001),
  21. Memory Functioning Questionnaire (Gilewski et al., 1990)
  22. Hamilton Depression Rating Scale (Hamilton, 1960)
  23. Hamilton Anxiety Rating Scale (Hamilton, 1959)
  24. The Clinician's Interview Based Impression of Change (Knopman et al., 1994)
As for the results? Even with that barrage of tests,
"No significant benefits for the active formulation arm were noted in scores on the assessments in the neuropsychological battery"
Amazingly, despite registering their trial with the stated primary outcome measure of,
"Change from baseline in neuropsychological (cognitive, functional) test results",
the authors describe their null results as being,
"not unexpected given the small sample sizes relative to large inter-individual variation on such tests."
Perhaps the most striking piece for me though was in the authors' conclusion about their study that involved the consumption of freeze-dried grape powder and demonstrated no clinical benefit despite throwing literally two dozen tests at the subjects,
"In conclusion, twice-daily consumption of table grapes was associated with significant protection from longitudinal changes in cerebral metabolism, which in turn were correlated with improvement in attention/working memory performances, consistent with a beneficial effect of daily intake of grapes with respect to preservation of metabolic activity in individuals experiencing mild cognitive decline."
Imagine my non-surprise when I came across the next line:

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

Saturday, February 04, 2017

Saturday Stories: Just One This Week

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

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

Friday, February 03, 2017

Meet Trae Crowder - A Heroic Self-Proclaimed Liberal Redneck

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

Have a great weekend!

Wednesday, February 01, 2017

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

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

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

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

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

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

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

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