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.)

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]