Saturday, December 29, 2018

Saturday Stories: Body Nos, Blood Spatter Analysis, and Caregiver PTSD

Christopher Solomon, in Outside, on when your body says no.

Leora Smith, in ProPublica, on the virus of blood spatter analysis.

Jennifer N. Levin, in The Washington Post, on caregiver PTSD.

Wednesday, December 26, 2018

Why You Might Want To Step Away From The Kale Chips

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
I spotted these as I wandered around Whole Foods before heading to the movies.

The packaging screams out health. "Kale", "Air Dried, Not Fried", "GMO Free", "MSG Free", "Gluten Free", "Vegetarian"

Turn the package over however and you might be surprised to learn a few things.

The bag's 640 calories clock in at 16% more than a Big Mac's 549 (and more gram for gram than Doritos), and they're also packing the same amount of sodium gram for gram as Lay's potato chips (regular flavour).

The nutrition data is also a bit curious.

Looking at 28g of raw kale you'll notice that it contains 86% of your Vitamin A %DV and 56% of Vitamin C. And yet 28g of these dehydrated kale chips, which you might imagine would in fact represent more than 28g of raw given the dehydration, have 97% less vitamin A and 73% less vitamin C.

Putting aside the fact that if you're actually looking for the nutritive benefits of kale, at least as compared with Kaley's Kale Chips, actual kale's the way to go, some might say that I'm being too harsh. They might say that the bag isn't meant to be consumed in one sitting. But as you can see from the photo where I'm holding it, the bag's no larger than your average checkout aisle chip bag, and at least with chips, you won't for a moment convince yourself they're a healthful choice.

If you want chips buy chips. Simple.

Monday, December 24, 2018

Supplement Maker Arbonne Thinks You're An Idiot

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
Well truthfully I don't know that for sure, but what other explanation is there for their trying to sell their product with this statement as their proof of its efficacy?
"Data based on consumer perception after a 60 day home-use trial of PhystoSport products by 25 Arbonne Independent Consultants, Arbonne employees, and friends."
As to what that means? Well basically Arbonne, referred to by many as a multi-level marketing scheme, asked its own salespeople, employees and friends about the very products they were trying to sell, and then compiled their answers into really awesome sounding statistics with a tiny disclaimer that they're hoping no one will read.

Scumbags might be too kind a descriptor.

Wednesday, December 19, 2018

Successful Weight Management May Depend on the Embrace of Imperfection

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
Or at least that's the conclusion you might draw after reading a study recently published in the Journal of Health Psychology.

The study, How does thinking in Black and White terms relate to eating behavior and weight regain? explored what the authors referred to as "dichotomous" thinking and whether or not it had an association with weight regain.

Dichotomous thinking is commonplace in weight management. It encompasses the notions of "good" and "bad" foods, cheat days, forbidden foods, and for many, adhering to its rules is the cornerstone of their efforts. Dichotomous thinkers are the all-or-nothing'ers, the perfectionists, and they are legion.

By way of a survey, researchers explored scores of the validated Dichotomous Thinking in Eating Disorders Scale (DTEDS) and their correlations with weight regain among 241 Dutch respondents. They found that for each 1 unit increase in DTEDS, there was a 142.4 percent increase in the odds of regaining weight compared to maintaining it. When controlled for BMI, those odds decreased and became less exciting but in a sense, in their place, came the finding that for each 1 unit increase in BMI, there was an increase in DTEDS by 0.043 - meaning weight itself seemed to associate with dichotomous thinking.

What does this all mean? Well, food serves as both comfort and celebration and perhaps, not respecting those roles leads people to undertake strict and traumatic diets replete with dichotomous thoughts which in turn may well be a formative driver of a lifetime of yo-yo dieting and higher weights.

Life is a rich tapestry of colours and not just black and white. Ditch the dichotomies and embrace imperfection.

Monday, December 17, 2018

New Obesity Study From the Annals of Idiotic Goalposts

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
If I looked at 279,000 men and women for a decade and studied whether or not they qualified for the Boston Marathon, but I didn't actually look to see if they were runners, and if they were runners I didn't bother exploring what their training plans and distances were like, but instead simply looked at how many people from that 279,000 qualified for Boston, I'm guessing I'd be left with an incredibly small number.

And yet, that's pretty much exactly what the latest depressing weight loss study did. They followed 279,000 men and women for ten years to see what was the probability of those with obesity losing back down to "normal" weight (a BMI less than 25). They didn't exclude people who weren't trying to lose weight or who might not have wanted to lose weight. They also didn't pay any attention to the means with which those who did lose weight only to regain it lost it in the first place.

The odds weren't good. Over the course of a decade, only 1 in 210 men with obesity, and 1 in 124 women managed to bring their weights down to a place where a table would define them as "normal".

It's not particularly surprising. Putting aside the surprising fact that this study didn't exclude people who weren't trying to lose weight, it remains that the vast majority of folks trying to lose weight these days do so by undertaking ridiculous diets. Go figure people don't sustain the results of ridiculous diets; weight lost through suffering comes back when you get sick of suffering. This study of course misses all of that.

And is getting down to a "normal" weight really the right yardstick to measure success? I mean getting down to a BMI under 25 is to weight loss what qualifying for the Boston Marathon is to running. Most runners will never qualify, and consequently qualifying would be a very poor way to measure whether or not people were runners.

But what if you change the goal posts?

If for instance, you set out to study the number of runners who continue to enjoy running as often and as much as they're able to enjoy, rather than simply the number of runners who qualified for Boston, well suddenly the number of runners will be much much higher, though of course not all of those who take up running, keep up with it either.

Extended that to weight, if the goal posts become your "best weight" which is whatever weight you reach when you're living the healthiest life that you can enjoy, suddenly the numbers change.

How much do they change?

Looking at, for instance, the 8 year data from the LOOK AHEAD trial, where lifestyle changes were thoughtful and the goal wasn't qualifying for Boston, 8 years out and 1 in 2 of the participants were maintaining losses of greater than 5 percent of their presenting weights, and more than 1 in 4 were maintaining losses of greater than 10 percent.

So did the publication of this depressing study add to obesity's literature? Quantifying the number of people who don't qualify for the Boston Marathon of weight loss, without quantifying how many of them were actually runners, and what sort of training program they were adopting doesn't strike me as a helpful addition.

I also can't help but wonder what the impact the publication and coverage of studies like these have on individuals who might be considering lifestyle change - both in terms of reinforcing idiotic goalposts, and in terms of them even starting out of the gates.

Wednesday, December 12, 2018

The False Dichotomy Between Food Calories and Food Quality

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
I come across it all the time. Angry folks who claim that when it comes to weight and/or health, calories don't matter at all and that what really matters is the quality or types of foods, or the folks who claim that the quality or types of foods don't matter at all, it just comes down to calories.

It's both of course.

The currency of weight is certainly calories, and while we all have our own unique internal fuel efficiencies when it comes to using or extracting energy from food or from our fat stores, we still need a surplus of calories to gain and a deficit to lose.

But foods matter too. Choice of food matters in terms of health, but also in terms of how many calories our body expends in digesting, and more importantly, upon satiety, which in turn has a marked impact upon how many calories, and which foods, we choose to eat.

So if you do come across a zealot from either camp that claims one or the other doesn't matter, feel free to ignore them.

Monday, December 10, 2018

10 Easy Ways to Save Your Money and Improve Your Health in 2019

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
Who wouldn't want to both save money and improve their health? If you're looking for some ways to do so, here are some quick thoughts:
  1. Unless you have a medically proven reason or need, stop buying vitamins and supplements that at best provide only the most marginal of benefits to your health (estimated savings $100-$1,000/yr).
  2. Reduce your dinners out (including sit down, fast food, take-out, and supermarket take-out) by 50% across the board (estimated savings $1,000-$5,000/yr depending on family size and meal out frequency).
  3. Never eat lunch out unless someone else is buying or unless you have a business obligation to do so (estimated savings $500-$3,000/yr).
  4. Cancel cable or satellite TV, buy an HDTV antenna (so you can still watch your local sports, news and some TV), and use Netflix, Hulu Plus, Amazon Prime or some other comparable service (estimated savings even after expenditures $250-$1,000/yr).
  5. Buy a thermos or a travel mug and a great coffee maker and kick your fancy coffee habit (estimated savings even post purchases $100-$500/yr)
Now of course there will be readers who spend more and less on various aspects of those points, but if there are readers where all 5 apply, making these changes might save them between $1,950 and $10,500 dollars.

As far as what to do with that windfall?
  1. Join a CSA farm share to increase your consumption of fresh fruits and vegetables (estimated average annual cost $400-$1,000 depending on size of share)
  2. Join a great local community centre or gym (estimated annual cost of $200-$600)
  3. Buy some used recreational fitness equipment (bikes, skis, snowshoes, etc.) from your local buy and sell (estimated one time cost of $200-$400)
  4. Take a cooking class at your local Community College (estimated cost of $100-$300)
  5. Save it all and use it for a stress relieving active vacation, or stress relieving debt relief.
(And sure, some of your own personal numbers and mileages will vary.)

Saturday, December 08, 2018

Wednesday, December 05, 2018

Why I Resigned My Membership In The Obesity Society

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
For those of you who don't know, The Obesity Society (TOS) is, according to them,
"North America's premier scientific organization devoted to understanding obesity"
And I wholeheartedly agree, they really are, which is why I'm anything but happy to be resigning my membership.

I've been a member for the past decade, and I do my utmost to attend their annual meeting (now known as Obesity Week).

Paying to be a member of a professional organization, to me at least, means that you believe the organization's mission and methods to be congruent with your own, and sadly, that's no longer the case with me and TOS.

My concerns began in early 2013. That was when TOS published their, "Guidelines for Accepting Funds from External Sources" position paper (the document is long longer available on TOS' page but was published by Longwoods back when). In it TOS,
"expressly eliminates all forms of evaluation or judgment of the funding source"
and instead,
"TOS chooses to focus its ethical mission on transparency in disclosing the sources of funding, clear stipulations outlining our commitment to the ethical use of funds, and a commitment to non-influence of the funding sources over the scientific aspects of funded projects and TOS as a whole."
Lastly they stipulated,
"TOS should seek funding from as wide a variety of donors as possible."
Many, myself included, felt that without explicitly saying so, these guidelines were designed as a means to open the door for TOS to seek and take money from the food industry.

Shortly thereafter TOS struck their, "Food Industry Outreach Task Force", which seems to have morphed into their "Food Industry Engagement Council", the most recent meeting of which included representatives from Kellogg's, PepsiCo, Nestlé, Dr. Pepper and Ocean Spray. There appears to be no doubt that TOS meant what they said back in early 2013.

To be clear, I'm all for dialogue, debate, and discussion with the food industry, but I just can't support taking their money, formally working with them on joint projects, or giving them votes at tables. To be sure, in these difficult fiscal times, for public health organizations, the benefit of food industry partnerships is funding. But partnerships of course need to benefit both parties, and for the food industry, partnering with health organizations has much to offer. Public health partnerships provide the food industry with high gloss brand polish, they may lead to direct or indirect co-branded sales, they may confer undeserved positive emotional brand associations, they may silence or soften industry or product criticism, they may provide industry with ammunition to fight industry unfriendly legislative efforts, and they necessitate that the partnered public health group water down public health messaging that may conflict with their partnered private industries' bottom lines.

Put plainly, a public company cannot invest in a group, program, or intervention that in turn would ultimately serve to decrease sales more than not being involved in that same group, program, or intervention. Doing so would not only be an affront to their shareholders, it'd be grounds for their lawsuits.

Let’s hope I’m wrong in thinking history won’t look kindly on these partnerships, that public-health efforts won't be hindered by them, and that instead I’ll look back one day and think I made much ado about nothing, but until then, while I'll still likely see you at Obesity Week, this is why I'll no longer be sporting a "TOS Member" ribbon on my badge.

Monday, December 03, 2018

What I Learned When I Actually Read That Prominent School Chocolate Milk Study

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.
I was amazed by the uproar the publication of a Dairy Farmers of Canada funded chocolate milk study inspired last week. The study, "Impact of the removal of chocolate milk from school milk programs for children in Saskatoon, Canada", at least according to the breathless press release and the resulting press coverage apparently concluded, "it's chocolate milk, or no milk at all for many children", and while it's no surprise given the funding that the spin was chocolate milk positive (including the study's mind-numbing use of the word, "enhanced" to describe sugar-sweetened milk), after reading the actual study, I'm beyond gobsmacked.

The study methodology was pretty straight forward. For 4 weeks they offered elementary school children both chocolate milk and white milk and measured how much of each they drank and how much went to waste. Next, they stopped providing the chocolate milk for 4 more weeks and kept measuring. Lastly, they brought back the chocolate milk option for a final 4 weeks of measurements.

Now hold onto your hats. As readers of the press are likely to already know the study found,
"the children waste more milk when it’s plain."
How much more waste you ask? Just 4/5ths of a tablespoon more a day. Yup, if you actually read the study you find out that when chocolate milk disappeared the kids drank a scant 12mL less per day than they did when chocolate milk was available. If these numbers continued, kids who drank milk would drink about a cup less milk a month for a grand total of just 9.6 fewer cups over the course of their entire chocolate milk free 200 day school year.

Or would they? What about the kids who stopped drinking milk altogether because they could no longer get chocolate? Well when the researchers tried to quantify total daily consumption of milk for all students they found,
"that students’ total milk intake at home, or milk consumption at school, did not change across the study phases."
The researchers also found,
"that on average students were meeting the 3–4 servings per day recommended by Canada’s Food Guide for 9- to 13-year-olds"
and that school milk only accounted for 13%–15% of total dairy consumed.

What else did the researchers find? Well if you want a non-Dairy Farmers of Canada "enhanced" spin on things, the researchers also found that in just the first month following the removal of school chocolate milk the number of students drinking white milk increased by 466%! A number which might well have increased further over time as palates and norms in the schools changed. And what happens to former chocolate milk drinkers when they swap Beatrice 1% chocolate milk for Beatrice 2% white? Well over the course of each week they'll drink 22 fewer teaspoons of added sugar and over the course of a 200 day school year, 14,000 fewer calories and 19 fewer cups of added sugar.

So to sum up. The study found that taking chocolate milk out of schools did not affect the students' total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy (recommendations which by the way are almost certainly higher than the evidence would suggest they need be), that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added chocolate milk sugar.

If anything this study lends very strong support for those thinking schools shouldn't be offering sugar sweetened milk to students.

Clearly the reporters didn't bother to actually read the study. Shouldn't they have?

Saturday, December 01, 2018

Saturday Stories: The Death Of Family Medicine, Brain Terrorism, Alcohol, and A Final Movember Update

Physician Frank Warsh, in his blog, writes about "the death of family medicine", and though there are definitely those who don't share his frustrations, this is a worthwhile read to understand some of the challenges facing family medicine in Canada today.

Robin Williams' widow Susan Schneider Williams, in the journal Neurology, on the terrorist (Lewy body disease) inside her late husband's brain.

Jane O'Donnell, in USA Today, on the crisis we're not talking about that's worse than opioids - alcohol.

[And finally huge thanks to those who've already donated to my Movember fundraising efforts. Thanks to your generosity, I've raised more than $6,000 for men's health! And it's not too late - if you find this blog valuable and/or if you enjoy these weekend shares, a tax-deductible donation would be very welcome, all you need to do is click here]

Wednesday, November 28, 2018

Call For Help Part 2: Are You Currently On A Diet? Can You Take 2 Minutes To Complete A VERY Short Survey About It?


Today's survey is a followup to the one we sent out a few months ago. Since then we tweaked it on the advice of both those of you who responded, and some expert input. Even if you filled this out last time, we'd love for you to do so again as we're trying to iron out the kinks and I think (hope) we're pretty much there.
Back in 2012 I first posted my wish for there to be a questionnaire that would serve to help individuals and researchers determine how easy or difficult a particular diet would be to follow.

I called it the Diet Index Enjoyability Total or DIET score, and my hope was that by using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach's DIET score where high scores would identify diets that could actually be enjoyed, and where low scores would identify under-eating, highly restrictive, quality of life degrading, dieting misery. This would be useful both to individuals who could use the DIET score to evaluate whatever approach they were considering, but might also serve as a surrogate for shorter term diet studies to give a sense as to whether or not there's a low or high likelihood of long term adherence to a particular study's strategy.

I'm happy to report that the first work on using the DIET score has been conducted by Michelle Jospe at the University of Otago in New Zealand as part of the SWIFT trial, and her and Jill Haszard's early look at the data is promising.

Part of the process required to validate a questionnaire involves a qualitative review to see whether or not it's easy to use, comprehensive, and unbiased, and this here is our second kick at that can.

Monday, November 26, 2018

Once Again I'll Ask, Where The Hell Is Canada's New Food Guide?

This post was first published back in June. Since then, still no Food Guide, as well as the real possibility that not releasing the Guide influenced the New Brunswick provincial election, and just this past week, an incredible dive into juice, food politics, and our as yet unpublished guide. I really can't wrap my head around why it's not out yet beyond politics. That's not something this country should be proud of.
In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,
"Don't tell Mom, but Chocolate Milk is good for you"
The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,
"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"
And in May 2015 he was quoted by the CMAJ on juice stating,
"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."
I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?
"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."
Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick (unless of course the Conservatives, as they promised prior to their election, repeal the ban).

And here's the most pertinent question. It's been 5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3.5 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

Saturday, November 24, 2018

Saturday Stories: Juice, George Soros, Death, and a Movember Update

Ann Hui, in The Globe And Mail, with a great case study on how the food industry works by way of the machinations of Big Juice and their attempt to influence Canada's next Food Guide.

James Kirchik, in Tablet, with a useful backgrounder and just who is George Soros?

Peter Kaufman, in Everyday Sociology, with his take as a sociologist on his relatively imminent death.

[And finally huge thanks to those who've already donated to my Movember fundraising efforts. Thanks to your generosity, I've cleared my original goal and now and just a few hundred dollars shy of my stretch goal of $5,500! If you find this blog valuable, if you enjoy these weekend shares, a tax-deductible donation would be very welcome, all you need to do is click here]

Wednesday, November 21, 2018

Yes, Current Evidence Still Suggests That Replacing Saturated Fat With Unsaturated Fat Is Good For You

I was somewhat disheartened the other day when in response to my post about the only 48 (I added "Get Vaccinated") words of health advice you'll ever need that there was quite a bit of confusion and pushback about my recommendation to swap unsaturated fat for saturated when you can - some even suggested it must have been a typo. Well, it wasn't a typo, but it seems it's confused people. "Substitute unsaturated fat FOR saturated fat if you can" is the same thing as stating "Replace saturated fats WITH unsaturated fats if you can".

But there were also plenty who read it right, and who were confused because they believe saturated fat is in fact a healthy choice.

Now I know there's been a whole host of diet gurus, once journalists, and TIME magazine covers telling you that saturated fat is good for you, and while I agree that likely it's not nearly as bad for you as the 90s (or me in the early 2000s) would have asserted, and while yes, there are nuances to all of this, the evidence still implicates saturated fat in the genesis and progression of heart disease.

Don't believe me?


But would you believe Drs. Ludwig and Volek? They're both prominent figures in the low-carb movement (Dr. Ludwig is the lead author on that low-carb diet and increased energy expenditure that dropped last week and the Director of the New Balance Foundation Obesity Prevention Centre at Boston's Children's Hospital, and Dr. Volek is one of the most prolific low carb researchers around and the Founder and Chief Science Officer of Virta Health) and both were contributors to a terrific consensus piece published this week in Science entitled, "Dietary fat: From foe to friend?" (it's full text free right now btw).

The whole piece is worth the read, but in case reading whole pieces isn't your thing, here are their points of consensus with Drs. Willett and Neuhouser (highlight is mine)

Monday, November 19, 2018

The Only 47 Words Of Health Advice You'll Ever Need

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

In no particular order:
  • Get vaccinated.
  • Avoid trans fats.
  • Replace saturated fats with unsaturated if you can.
  • Cook from whole ingredients.
  • Minimize restaurant and ultra-processed foods.
  • Cultivate friendships.
  • Don't smoke.
  • Nurture sleep.
  • Drink alcohol at most moderately.
  • Exercise as often as you can enjoy
  • Only drink those calories that you love
Comparatively, everything else is minutia.

Saturday, November 17, 2018

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

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

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

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

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

Monday, November 12, 2018

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

I caught this video a week or so ago.

It features one of the world's most prominent sports nutrition scientists, Asker Jeukendrup, answering the question,
"What is the shortest duration of exercise where eating or drinking is worthwhile?"
The answer?

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

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

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

Saturday, November 10, 2018

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

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

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

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

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

Monday, November 05, 2018

A Personal Request For Help

And so it begins (again).

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

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

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

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

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

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

Every dollar counts, no donation is too small.

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

Tuesday, October 30, 2018

Book Review: Marion Nestle's Unsavory Truth

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

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

Overarchingly, Marion sees industry's response to criticism of its involvement as following the playbook set by tobacco which sees them:
"Cast doubt on the science
Fund research to produce desired results
Offer gifts and consulting arrangements
Use front groups
Promote self-regulation
Promote personal responsibility
Use the courts to challenge critics and unfavorable regulations"
And she laments the fact that nutrition, unlike medicine, doesn't seem to take its conflicts of interest as seriously, "
Decades ago, medical professionals recognized the distorted effects of drug company practices, measures the distortions, and took steps to counter them. Medical journals required authors to disclose financial ties to drug companies that might profit from the results of their studies. Medical schools banned drug companies from marketing to students. In 201, Congress required drug companies to disclose payments to physicians. Nothing close to that level of concern, scrutiny or action applies to food-company efforts to engage nutrition professionals"
The aim of the food industry is self-evident and non-indictable. It's profit. And there are many ways for them to invest in research and partnerships to help in that regard. Citing the work of Lisa Bero and colleagues, she explains that when it comes to research, food industry funding can,
"focus on single nutrients, ingredients, or foods rather than on interactions or overall diets. They can compare the effects of single foods by contrasting diets that include them to diets that lack them. They can design trials without randomization, blinding or appropriate comparisons. They can focus on obvious or irrelevant effects. And they can give a positive spin to results that show no effect or fail to publish unfavourable results."
And then by way of examples of each, demonstrates these are anything but theoretical risks, including studies where though the conclusions are valid, like for instance, if compared with sucrose, and when neither are consumed to excess, that the slightly higher amount of fructose in high fructose corn syrup isn't likely to make much difference to health, are designed to prove forgone conclusions that can be spun by their funders and are more apt to be classified as marketing research than basic science.

Marion's also quick to note that,
"industry funding does not inevitably bias a study, although it does suggest that the research question and interpretation require more than the usual level of scrutiny"
Looking to guideline committees and dietetic organizations, the food industry is again represented in ways that require more than the usual level of scrutiny. In 2015, 10 of the 14 members of the Dietary Guidelines Advisory Committee consulted for, or received grants from the food industry, while the food industry also provides direct sponsorship and support for the works of the Academy of Nutrition and Dietetics (AND), and other dietetic organizations. And here the real question is "why?", or perhaps a slightly more nuanced, "is that really necessary?". Regarding AND for instance, Marion reports their own documents note that the cost of removing industry funding from their organization would cost just $17.17 per member per year.

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

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

Monday, October 29, 2018

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

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

It's coming.

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

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

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

So what's a health conscious parent to do?

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

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

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

The rest?

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

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

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

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

Saturday, October 27, 2018

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

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

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

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

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

Monday, October 22, 2018

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

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

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

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

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

So yes, the PREVIEW results were a touch better.

Or were they?

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

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

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

Wednesday, October 17, 2018

Wow! 29 Teams of Analysts, One Identical Data Set, One Identical Research Question, 29 Different Outcomes.

This is an incredible paper, Many Analysts, One Data Set: Making Transparent How Variations in Analytic Choices Affect Results, saw 61 analysts (in 29 teams), be given the same data set meant to address the same research question (are soccer referees more likely to give red cards to dark skinned players than light skinned players).

The outcomes?

20 teams found a statistically significant positive effect, while 9 teams did not, and where effect sizes ranged (in odds-ratio units), despite all teams working from the same data set, from 0.89 to 2.93 (where 1.0 would be no effect).

Why so many differences?

Because results depend a great deal on any team's chosen analytic strategy which in turn is influenced by their statistical comfort and choices and their interplay with their pre-existing working theories.

Now these results weren't incentivized examples of p-hacking. The authors of this study point out that the variability seen was based on "justifiable, but subjective, analytic decisions", and while there's no obvious means with which to ensure a researcher has chosen the right methodology for their study, the authors suggest that,
"transparency in data, methods, and process gives the rest of the community opportunity to see the decisions, question them, offer alternatives, and test these alternatives in further research".
Something all the more important in cases where authors might in fact have biases the would incentivize them to favour a particular outcome, and why I wish I was offered more in the way of stats and critical appraisal in medical school (and maybe less in the way of embryology for instance).

[Photo by Timur Saglambilek from Pexels]

Monday, October 15, 2018

From The Education Alone Isn't Enough To Change Behaviour File: Fast Food Edition

Two weeks ago I gave a talk at Ottawa's 6th Biennial Championing Public Health Nutrition Conference. I was part of a group of speakers talking about the how can it possibly not be published yet new Canada Food guide.

I was struck, both during the other presenters talks, and during the question and answer period, how focused people were on how the Food Guide will be utilized by individuals.

In my opinion, as a direct tool, it pretty much won't be. That's not to say it can't or won't have an impact on Canadian dietary patterns (it will by way of its impact on policy), nor that a person who picked it up couldn't choose to follow it, but rather speaks to the simple fact that education alone doesn't seem to be enough to change behaviour. Because time and again we learn that education, even when tied to terrifying events like heart attacks, doesn't seem to be able to consistently lead people to sustain consequent lifestyle changes, nor does genetic knowledge of specific disease risks.

The reasons why are likely myriad, but probably boil down to a combination of normal human nature and change being difficult, along with the impact of a person's food environment and social determinants of health.

For a food related example of this, take this recent paper regarding perceptions about the consumption of fast food. In it, among many other statistics, the authors note that 73% of weekly fast food consumers reported that they believed fast food wasn't good for them.

When it comes to behaviour change, knowledge alone does not seem to correlate particularly strongly with power.

Saturday, October 13, 2018

Saturday Stories: Labour Antisemitism, The Name Of The Dog, And a Risk Conundrum

Man Booker prize winner Howard Jacobson, in The Atlantic, with perhaps the definitive piece on Jeremy Corbyn and Labour's antisemitism.

Taimer Safder, in The New England Journal of Medicine, with a lovely read about the name of the dog (do read this one before it disappears behind a paywall).

Lisa Suennen, in Venture Valkyrie, on the conundrum of divergent ways to evaluate cardiac risk that span from biology to social determinants of health.

[photo by Alexandru Rotariu via Pexels]

Thursday, October 11, 2018

On Physicians Who Support, Promote, And Recommend, Only One Type Of Diet

Oh they're out there.

Tunnel vision physicians who believe that everyone should be vegan, or be intermittently fasting, or in ketosis, or on an incredibly low-fat diet, or vegetarian, or low carb high fat, - and I'm sure the list goes on.

It's a head scratcher for me because a physician's training ought to have them know better.


Because for virtually every medical problem, multiple therapies and therapeutic modalities exist. And because physicians know that some drugs work better than others with different patients - sometimes predictably, and sometimes unpredictably, and that sometimes people have adverse reactions to certain drugs that require them to try alternatives.

Diets are the same.

Whether for weight management, general health, or the treatment of particular medical conditions, certain patients, sometimes explicably and sometimes not, will do better with different diets, both in terms of the impact that diet has on whatever they're trying to treat, but also on their ability to enjoy that diet enough to sustain it long term.

And so even if there were a scientifically proven best diet for a particular issue (and for weight, plainly at this point, there isn't), there'll still be some people for whom it fails, and some people for whom its adverse effects on their lives leads to its discontinuation, and if they happen to be on that diet because they're following or seeing one of those MDs who is so stuck on there being only one diet to rule them all, I guess they're just out of luck.

So what drives those MDs? I think the answer varies. For some it's likely the extension of their own personal experience and success with a particular dietary approach. For others, it may be the consequence of literal or intellectually sunk costs. And finally some may not have sufficient background to evaluate much on their own and instead simply parrot an eloquently delivered diet zealot's talking points (perhaps especially in the cases of MDs converted by other MDs). But regardless of why one thing's for sure, the promotion of one right or best diet isn't good medicine, it compromises patient care, provides oxygen to the fire of fads, serves as catnip for publishers, the media, and the public, and solidifies the notion that there are dietary demons and deities, all of which in turn torches the hope of improved nutrition related scientific literacy in society.

Nutritional populism is a bad look irrespective of which diet it happens to be promoting.

[Photo by Anthony DeRosa from Pexels]

Tuesday, October 09, 2018

About That New Lancet Study: Maybe Don't Expect 9 Year Olds To Change Their Own Food Environments

It's difficult for me to imagine what exactly researchers expected would happen as a consequent of this study's intervention which hoped to help children with obesity.

The Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial, enrolled 9 and 10 year olds from 32 different UK schools and randomly assigned some schools to deliver a year long curriculum to the children which included,
"dynamic and interactive activities such as physical activity workshops, education sessions delivered by teachers with short homework tasks, drama sessions, and setting goals to modify behaviour"
And while parents were involved, their involvement was dictated by their children primarily who in turn were instructed to "reflect on their own behaviours and goals" with their parents.

Various weight related outcomes, activity related outcomes, and dietary choices outcomes over 2 years were collected, and the results weren't in any way exciting, with pretty much no differences found between study and control groups on any weight related or physical outcome.

But should anyone have expected anything different?

Are there really those out there who believe that if you teach 9 and 10 year olds in school that they should eat less and better and exercise more, that they'll do so? Fully grown adults with newly diagnosed weight or diet related diseases rarely do, so why should children? Or that 9 and 10 year olds who themselves have zero responsibility for their food environments, even if they actually "reflected" on their behaviours and goals with their parents, could see their food environments appreciably and sustainably change?

And what of these kids, and especially of the kids who already have obesity? It does not appear as if this study even attempted to explore whether or not the 2 year long intervention had any negative psychological impact. But certainly, if the crux of the program is to teach 9 year olds that they are personally responsible for their lifestyle choices, I think it would be fair to consider the possibility that the program will lead some to question their self-worth, self-efficacy, body-image, and potentially affect their relationships with food and even risk disordered eating. It may have also been important to study whether or not there was any increase in weight related bullying in the intervention schools.

All this to say, relying on 9 and 10 year olds to modify what for them, given they're in charge of next to nothing related to when, where, and what they eat, are almost certainly unmodifiable food environments, wholly unsurprisingly, isn't an effective plan. While I am supportive of robust programs that work with parents to change their families' lifestyles (disclosure, I'm the medical director of just such a program), focusing just on the kids is akin to focusing all of your efforts on lecturing life's passengers and ignoring the drivers, and where the drivers aren't just the kids' parents, but their food environments as a whole.