Wednesday, January 30, 2019

First Mood, Then Weight (#BellLetsTalk)

(First posted in 2017)

People often come to me wanting to lose weight or improve their lifestyle, but their moods are anything but well.

Sometimes, when I ask them about it, they'll say that their weight is why they think they're struggling with depression or anxiety.

I always tell them the same thing.

Mood comes first.

Intentional weight loss requires the very things that mood disturbances often preclude - the ability to consistently, plan, organize, and motivate. Setting yourself up to struggle with weight loss by attempting to affect intentional changes when your mood is squarely in the way is not only unfair, it might make matters worse by giving you something to feel guilty about when you're understandably and realistically challenged. And it's also important to note that your mental health is far more important than your weight.

So regardless of your weight, whether its working with your family physician, your employee assistance program, reading books, talking to friends, or looking into community based counselling resources (many of which offer sliding scales for payment), mental health should be your first priority.

Sometimes I use a running analogy.

You can't start work on learning to run if your ankle's currently sprained.

First you work on your ankle. Then you learn to run.

Same here.

First mood. Then weight.

(And remember, for every #BellLetsTalk tweet, RT, and Facebook share today, Bell will donate a nickel towards mental health. And yes, it's marketing for them, but unlike hospitals raising money with cookies, telecommunication does not contribute to the burden of societal illness or promote an unhealthy lifestyle - so tweet and share away!)

Monday, January 28, 2019

Canada's New Food Guide's Biggest Missed Opportunity (And How To Fix It)

As I mentioned last week, Canada's new Food Guide is a giant step forward.

But having read through all the published materials to date, and putting aside things that are beyond the ability of a food guide to address (like food insecurity for instance), I do believe there's one very large missed guidance opportunity - nutrition, kids and sports.

As it stands, I couldn't find anything.

And that's a shame because there's a huge amount of misinformation out there about kids  "refuelling", "recovering", or "rehydrating". There's also a massive industry built to prey on kids and their parents telling them that they need electrolyte enhanced sugar water, or chocolate milk every time they move for a few minutes. There are community races that teach kids running a 5km fun run that they need a banana, bagel, juice, and a protein bar for their 40 minute trot. There are league run programs like Tim Hortons' "I just played I'm thirstyto bring kids and their parents in and cultivate brand loyalty. There are partnerships between dairy producers and the NFL designed to promote chocoloate milk, and I guess determined not to be left out, Nesquik partnered with the American Youth Soccer Organization to sell chocolate syrup.

And as any parent today knows, snack time for pretty much any organized sport is a sport-washed junk parade.

Consequently, I would have loved to see a section of Canada's Food Guide's guidance devoted to kids and sports. A section that explained that if it's less than an hour, probably the only thing the kids need is water - and even then, only if they're thirsty. And that there are no sugary beverages that kids can quaff that will appreciably improve their performance, or help them to recover, and that when it comes to organized sport, leagues and coaches should be encouraged to affect changes to see sidelines and post game snacking relegated to the water and fruit slices of yesteryear. Though that guidance alone would not lead to immediate change, having it be part of Canada's Food Guide would support public health advocates and parental champions in their efforts to affect change, and over time, slowly seep into the public consciousness.

As to how to fix it?

Well here's the thing. In 2019 the new Food Guide need not be a static set of documents. Living online the guide can expand, contract, and change on an evidence-based and as needed basis. Which means there's nothing stopping Health Canada from spending the tiny bit of time required to suss out this topic and publish it alongside already available guidance.

Here's hoping we see it soon.

Thursday, January 24, 2019

Now That Canada's Food Guide Has Markedly Improved, What's Left For Canadian Nutrition And Public Health Advocates To Champion?

Ok. So we have an exciting new food guide here in Canada, but please don't think that means there's nothing left to push for in Canadian nutrition policy.

Back in 2009, I published a piece about the top 10 nutritional hills worth fighting on.

Included on that list were:
  • An evidence based food guide
  • A national trans fat ban
  • Mandatory menu-board calories
So it's nice that at least some progress has been made.

Though far from exhaustive, and in no particular order, here are 6 hills still worth fighting on (adapted from that same original post):
  1. We need to get fast food out of our schools. Though pizza days, sub days, shawarma days, and more may well raise a bit of money for our school system, and may give parents a day where they need not pack their kids a lunch (assuming they haven't taught their children to do so - and here I'll say that yes, kids can do so, even kids as young as 8 or 9), I don't think those ends justify the means. And here I don't care if the fast food pizza (or whatever) is formulated in a way to satisfy a nutrition policy document, because it doesn't change the fact that school provided branded fast food weekly just because it's Thursday teaches children, even those who don't order it, that fast food is a normal and healthy part of weekly life. Given that some schools have a different fast food offering every day of the week, consider the message that's teaching our children.
  2. We need a national school food program. Canada is one of very few Western nations that does not support a publicly funded national meal program for its students. It has been shown that school food programs markedly improve the mental and physical well being of students who utilize them with some reporting increases in standardized test scores, less illness, better discipline and improved alertness. According to Dr. David Butler-Jones, Canada's former Chief Medical Officer of Health,
    "When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school. Almost one quarter of Canadian children in Grade 4 do not eat breakfast daily and, by Grade 8, that number jumps to almost half of all girls. The reasons for this vary – from a lack of available food or nutritious options in low-income homes, to poor eating choices made by children and/or their caregivers. As a result of being hungry at school, these children may not reach their full developmental potential – an outcome that can have a health impact throughout their entire lives"
    If interested, sign this formal House of Commons e-petition to the government requesting one.
  3. We need to ban advertising to children. Plain and simple, young children are not able to discern the difference between truth and advertising and consequently I believe it's entirely unethical to allow marketers to target them. Furthermore food, and specifically unhealthy food, is the number one source of television commercials seen by children. Frankly to me whether or not they impact childhood obesity rates (they do) is beside the point as I think targeting children period is unethical.The somewhat heartening news is that unlike in 2009, there's action now, with Bill S-228 having passed its third reading in Canada's House of Commons, but given it has yet to receive royal assent, it still needs support.
  4. We need a soda tax. Nanny state alarmists tend to try to paint soda taxes as a draconian cash grab and an infringement of civil liberties, but really what's generally called for is a nominal tax on beverage manufacturers for each ounce of sugar-sweetened beverages produced which would raise the cost of a can of soda by roughly 12 cents. Hardly a huge amount of money for each individual but likely to generate well over $1 billion annually in Canada which if utilized to fund such things as a National School Food Program, would be an unbelievably beneficial tax (and according to studies would also result in a 10% decrease in national soda consumption). And as far as the tax being regressive, as my friend RD Andy Bellatti has been heard to say, try diabetes, and also have a peek at this piece which expands on this thought in The Lancet.
  5. We need to put an end to front-of-package health claims, or at the very least, dramatically rein them in. Sure, the new food guide states, "be aware of food marketing", but why should the onus be on the consumer to turn packages over to ensure that the claims on the front aren't deceitful, or that the product in the package isn't nutritional chaff? There's a great deal of room to improve our reality where Kellogg's can brag about Froot Loops' Vitamin D content and whole grains on the front of its boxes. Personally, I'd prefer a marketplace with no health claims, and though I don't think we're going to necessarily get there, boy does there look nice.
  6. We need to treat the supplement industry (and their purveyors) the same way we do pharmaceuticals. Plainly, if a product is being sold to treat a medical condition, the same burden of proof we require of pharmaceuticals (actual evidence of safety and efficacy) should be applied to so-called nutraceuticals. That would mean a huge hit to supplement sales given Canada's Natural Health Product Directorate is comfortable accepting stuff like traditional use claims as a means to receive approval. Doing so costs Canadians in more ways than one in that not only do these products often cost a significant amount of money, but some will certainly forgo actual medical care and evaluation in place of shameless hucksters who prey upon fear, goodwill, and personal misfortune by selling hope in bottles.
Here's hoping that I can cross a few more of these off my list over the coming decade.

Wednesday, January 23, 2019

Why Canada's Food Guide Matters Even If No One Ever Looks At It

Milk marketing materials distributed to Ontario kindergarten students in their classroom
Though it's terrific to finally have a national food guide which if followed would lead individuals to far healthier diets and eating patterns than current Canadians' likely average diets, it's the guide's impact on the food environment and food culture that I think matters most.

Even if no one ever downloads a copy it, the new food guide will likely have profound effects on Canadian eating patterns and food culture, and it will do so in a manner that doesn't necessitate personal responsibility or privilege.

In brief:
  • It will change Canadian school food policies as the guide serves Canada's schools as the scaffolding upon which those policies are built. This iteration, with its removal of juice and sugar-sweetened (chocolate) milk from the basket of healthy choices, will inevitably lead to the slow removal of both from the school system. Of course that won't mean parents who want their children to drink either will be banned from sending them in, it just means that schools will stop selling both and providing them in industry sponsored initiatives like breakfast and snack programs. It also likely means the end of "dairy educators" being invited to promote milk to elementary students, and certainly the end of kindergartner chocolate milk is good for you colouring books. But don't expect this to be an overnight change, but give it half a decade or so and I think both will be pretty much gone.
  • It will similarly change what's being served in hospitals and nursing homes to patients, and will lend strength to public health advocates' calls for reforms to the foods being sold in arenas, government offices, and more.
  • It will hamstring the food industry's marketing abilities as no longer does the guide suggest a minimum number of servings are required daily, a change that the dairy industry especially, who also no longer enjoy the unwarranted categorization of dairy as a food grouping of its own, will resent as they used the prior guide's minimum serving recommendations relentlessly in their advertising. It will also hamper the juice industry's efforts in that regard.
  • It will bolster ongoing and future efforts related to nutritional reforms in Canada including banning food advertising to kids, front-of-package claims, and nutrition fact panel changes.
  • It will, as past guides have done, slowly seep into our country's nutritional consciousness whereby media stories on various nutrition related issues will mention the guide's recommendation. For instance a story on juice or chocolate milk is likely now to include the message that neither are considered healthy choices by Canada's Food Guide. Over time, these sorts of mentions, lead to food culture shifts.
  • It will, as past guides, also be taught to children in schools, and provided in RD's and MD's offices, and in prenatal classes, and more - and in so doing, again, will slowly influence the country's thinking around food and nutrition.
Now none of this will happen overnight, but check back with this post 5-10 years from now and see whether these predictions held up.

I'll tell you something else, given so many years of being incredibly critical of Canada's Food Guide, it's bizarre, and a real pleasure, for me to be praising it.

Tomorrow, what I'd still love to see change in Canada's nutrition landscape.

Tuesday, January 22, 2019

BREAKING: Canada's New Food Guide Is Out - And It's A Giant Step Forward #CanadasFoodGuide

Though it would have been wonderful to not have had to wait 12 years for 2007's awful Food Guide's replacement, beyond how long it took, there's not much to complain about the 2019 edition and there's much to praise.

Whether it was consequent to past criticisms, or the insulation of the revision process from the food industry, or a change in leadership, or some combination of those and more factors, the 2019 Food Guide is incredibly different from all of its predecessors. Gone is dairy as its own food group (that doesn't mean the guide is recommending against dairy consumption), gone is wishy-washy language that excused refined grains, gone are explicit recommendations to consume 2 glasses of milk and 2-3 tablespoons of vegetable oils daily, gone is overarching fat-phobia, gone is juice being a fruit and vegetable equivalent, gone is the notion that sugar-sweetened milk is a health food, and gone is an antiquated nutrient-focused approach.

What do we have instead?

The new guide's primary recommendations are easy to summarize:
  • Regularly consume vegetables, fruit, whole grains, and "protein foods", where protein foods include everything from legumes, to nuts, to dairy, to meat, and where the guide suggests you consume plant-based proteins more often.
  • When you can, consume unsaturated fats instead of saturated fats (with the guide explicitly noting that there's no need to get caught up in the total fat content of your diet)
  • Make water your beverage of choice (with the guide explicitly mentioning that 100% fruit juice and sugar-sweetened milk are beverages that should be minimized)
  • Limit your consumption of processed foods and beverages that contribute excess sodium, free sugars, and/or saturated fat (the new guide recommends less than 2300mg/day of sodium and less than 10% of total daily energy intake from free sugars and saturated fats respectively)
  • Limit your consumption of alcohol
  • Plan your meals, cook more often, enjoy your food (here guide is speaking to consideration of culture and food traditions), and eat with others
  • Use food labels
  • Be aware that food marketing can influence your choices (and here I'd have preferred if they used the word "beware" which is clearly what they're getting at)
Now you may read those recommendations and wonder where the granularity is? How many servings should I have? Which foods precisely should I eat?

The thing is, we don't really have granular evidence of eat this food, not that food beyond the broad recommendations noted above. And servings wise, first off, everyone is different in terms of their needs, but more importantly, prior guides' emphases on servings were a known point of confusion - one that both the public, and health care professionals agreed should go. People don't weigh and measure their foods, and consequently, people tended to underestimate how many servings they were consuming, all the while being spurred on by the food industry to eat at least a certain number. Though it's possible that in some of the ancillary collateral published in the future (there will be a steady trickle of food guide related materials being published over the coming months), there'll be a more specific calculator, not having prescribed numbers of servings in the guide, and instead steering to a more healthful pattern of eating seems both wise and appropriate. It also allows for a much wider variety of diets with differing percentages and types of proteins, carbs, and fats (something those geared up to be furious because it doesn't espouse their particular diet over all others might want to reread).

And of course there's more than just a short document that outlines and supports those aforementioned recommendations, as also released today was the 55 page long Canada's Dietary Guidelines For Health Professionals and Policy Makers and it serves to flesh out the above and provide their rationale and evidence.

No doubt there will be complaints. Dairy champions will clearly be quite unhappy, as will those who are pushing meat and saturated fat as health foods, and my guess is, given there's strength in numbers, people upset about those two issues will likely support one another.

Here I'll simply remind you of the consensus piece on dietary fat published recently in the BMJ that concluded, with prominent low-carb researchers Drs. Ludwig and Volek's approval, that just as the new food guide recommends, "Replacement of saturated fat with naturally occurring unsaturated fats provides health benefits for the general population."

And remember too, science isn't a static set of facts, it's our best interpretation of data, and it can and does change over time. Will we see future research into the impact of saturated fat on health in individuals following low-carb-high-fat diets lead to a specific mention that on those diets it's less of a concern (or not at all)? Maybe. Maybe not. We're just not there yet.

Bottom line?

Our new food guide is a giant step forward and those responsible should be justifiably proud of themselves. Stay tuned the next few days for posts on why the food guide matters even if the majority of Canadians literally never look at it, its policy implications, and where there's room for further reform.

[Oh, and reporters who want to cover the sugar-sweetened milk angle, a reminder that Dominic Cardy, New Brunswick's Minister of Education, is your go to guy to be upset about it as just last month he asserted school based chocolate milk sales provided important calories to children, while helping to combat food insecurity and poverty, which presumably is why his government, the New Brunswick Conservatives, reversed the prior Liberal government's decision to stop its sale and provision in schools - something that clearly this food guide strongly supports]

Saturday, January 19, 2019

Saturday Stories: 'Oumuamua, A Probable Serial Rapist, and Running

Isaac Chotiner, in The New Yorker, interviewing Harvard's chair of astronomy, Avi Loeb, on why he believes 'Oumuamua may have been an alien spacecraft.

Matt Mencarini, in Lansing State Journal, with an infuriating story on probable serial rapist Calvin Kelly

Bella Mackie, in The Guardian, on the anti-anxiety medication she started when her life came crumbling down - running.

Monday, January 14, 2019

Because Finding Them Now Is Too Difficult? PepsiCo Launches Mobile, Self-Driving, Health-Washing, Vending Machines

Caught this the other day.

PepsiCo has partnered with the University of the Pacific campus in Stockton, California to launch mobile vending machines that, at least according to PepsiCo, deliver "healthier" snacks to college students by way of a smartphone app.

Peeking at the launch video one can see that the "healthier" snacks include Pure Leaf Lemon Flavor tea (with its > 10 teaspoons (41g) of added sugar), and an assortment of baked chips (which generally have marginally fewer calories but are otherwise comparable to their fully fried brethren).

Because no doubt it's tough these days for college students in in California to find junk food. I mean before Snackbots, they actually had to walk to buy some.

I wonder how much money the University of the Pacific is reaping from PepsiCo in return for feeding up their students and in so doing, helping to market sugar water and baked chips as "healthier"?

Saturday, January 12, 2019

Wednesday, January 09, 2019

The Only Thing Public Health And The Food Industry Fully And Firmly Agree Upon About Canada's Next Food Guide Is That It Definitely Matters

Generally speaking, there probably isn't much that public health professionals and the food industry agree upon when it comes to Canada's imminent new Food Guide.

Briefly, public health would like to see the Guide discouraging the consumption of sugar sweetened beverages, ultra-processed foods, processed meats, trans-fats, and see a swap recommended so that people are encouraged to replace their saturated fats with unsaturated fats. Public health would also like to see the Guide discourage frequent use of restaurants, encourage cooking, and promote the free-from-distractions consumption of those cooked meals, ideally with loved ones, on a regular basis. There's more, but that's the basic gist.

The food industry would like to see the Guide avoid the discouragement of any particular food, would like to see dairy maintaining its undeserved separate food category while simultaneously not admonishing against chocolate milk, saturated fat swaps, and would like soft, ambiguous language around processed foods and more.

But there is one area where public health and the food industry wholeheartedly agree - they both agree that the Guide matters a great deal and it wields real influence on the eating patterns of Canadians.

No, Canadians don't shop with the Guide in hand, but industry relies on the Guide's messages in their marketing and sales. For instance, if the Guide, as drafts suggest, has indeed eliminated the dairy category and rightly lumped dairy in with other sources of protein, the dairy industry may no longer be able to suggest to kids (even kindergartners), parents, educators and more that we need a particular number of servings of dairy per day. This in turn, along with the removal of chocolate milk as a dairy equivalent, will likely, over time, affect school milk programs, and will certainly impact the "dairy educators" that schools bring in to chat with students. It will also preclude the dairy industry's ability to buy skewed surveys designed to provide a veneer of health to their products, to launch apps to ensure you're having enough, and when articles are written about dairy in the media, no longer will there be a throw away line included about how many servings the Guide recommends daily.

And all of that will undoubtedly affect dairy sales.

Which of course is why the dairy industry has mounted a years long campaign to try to prevent changes to the Guide's dairy recommendations. They've sent in letters to Health Canada and ministers, they've seeded the media with interviews and concerns, and they've even created an astroturf front group called "Keep Canadians Healthy" that pushed Facebook ads to the public encouraging them to be concern and upset about the plans to downgrade dairy, and provided the public with a call to action and a fill in the blank form to mail their MPs (scroll down through the link to see).

So the next time you hear someone cluelessly (or insidiously) suggesting that the Guide doesn't matter (like the feckless Canadian Taxpayers Federation did on CBC's The National two days ago for instance), remember that pretty much the only area where public health and the food industry fully agree in regards to the Guide is the fact that it matters a great deal to what Canadians buy, and consequently, to what Canadians eat.

Monday, January 07, 2019

Caring About The Quality of Your Food Is Not A Disorder (Orthorexia's Many False Media Positives)

That's not to say people can't see their concerns about diet quality not deteriorate into a disorder - where their concerns have sometimes even dramatically negative effects upon their qualities of life and/or mental health.

But that's not what I'm talking about here.

Here I'm talking about the knee jerk comfort people have in ascribing a disorder to someone else's dietary concerns or choices, especially in the both traditional and social media.

Just because you might personally find someone else's attention to their diet excessive, that doesn't mean it is to them. Their caring about the choice and types of their foods, so long as it isn't negatively affecting their physical health, mental health, or their quality of life, isn't an eating disorder!

Wednesday, January 02, 2019

Dominic Cardy, New Brunswick's Minister of Education, Champions School Chocolate Milk Sales In Name of Hunger, Poverty, Food Insecurity, And Fundraising

Before the break, New Brunswick's new Conservative government proudly honoured their promise to restore the elementary school sanctioned sale of chocolate milk.

Never mind that the World Health Organization and Canada's Heart and Stroke Foundation have explicitly called for the marked limitation of the free sugars provided to children.

Never mind that the Director General of Health Canada's Office of Nutrition Policy and Promotion (the folks in charge of the Food Guide), Dr. Hasan Hutchinson, has been on record since February 2014 that chocolate milk's inclusion in the 2007 (and sadly still current) Food Guide was a mistake - a mistake which almost certainly will be remedied when (if) the Food Guide's revisions are ever published.

Never mind that research on what happens when chocolate milk sales are stopped in schools found that stopping the sale of chocolate milk in 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, 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 the sale of 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 sugar.

No, the New Brunswick Conservatives clearly know better, and in late December, Dominic Cardy, their Minister of Education and Early Childhood Development, explained what it was about chocolate milk that made its sale in schools so important - calories. In an interview with the CBC, Cardy explained that selling chocolate milk in schools was important because, "Would you rather have kids have some calories in their stomach or none? You need the calories to start with"

So the sale of chocolate milk in schools is to ensure New Brunswick children consume enough calories? Given New Brunswick's own health council reports the province's rates of childhood obesity are among the highest in the country, I wouldn't have thought that was a problem, and that's putting aside the fact that white milk provides calories too.

And honestly, I wondered if perhaps he was misquoted, or his words were used out of context.

Apparently not. Oh, and also, there's more.

On Twitter, Cardy doubled down on his kids need calories therefore elementary schools need to sell them chocolate milk stance, and then added in that my concerns were due to my privilege and that the sale of chocolate milk was also there to address hunger,

And when RD Karine Comeau quickly pointed out that if food insecure New Brunswick children were the concern, enabling and promoting the excess consumption of sugar in that vulnerable population, a population already at increased risk of chronic disease, probably isn't in their best interest, and instead perhaps an emphasis should be placed on increasing their access to fresh fruits and vegetables, Cardy agreed but stated that the problem with the prior policy was, "yanking milk and juice with no replacement plan"

Yet milk and juice had not been "yanked". You might have noticed that I've bolded the word "sale" throughout this piece - the reasoning is simple - the policy that Cardy and the New Brunswick Conservatives have reversed was the end of school chocolate milk sales. Meaning there was never a ban on chocolate milk (or juice) - they weren't "yanked", they simply weren't sold. Nor were (or are) schools distributing chocolate milk freely to hungry, impoverished children. And when schools weren't selling it, there was nothing stopping a parent from sending their kids with a thermos of chocolate milk (or a juice box) to school, or signing their kids up for the white stuff's sale.

And finally, Cardy calls the concerns of various public health professionals, "self-righteous indignation", and shifts the goalposts a fifth time (from hunger, to poverty, to food insecurity, to yanking) to fundraising. As if there are no other ways to raise funds for schools than by selling sugar.

And perhaps here it's worth repeating, Cardy is New Brunswick's Minister of Education and Early Childhood Development. Drink that in for a moment.

(And reporters who will inevitably be covering the new Food Guide's eventual release, if the Guide, as expected, calls for a limitation on sugar-sweetened milk, I'd suggest an interview with Mr. Cardy with a focus on his chocolate milk beliefs and New Brunswick's school food policy might make for a delicious side story)