Thursday, October 31, 2019

Ideally Only Donut Conferences Should Be Handing Out Free Donuts #FNCE #RDChat #IfYouServeItWeWillEatIt

Lots of hoopla on nutrition Twitter this week because RD Tracey Fox questioned the wisdom of serving donuts at the Academy of Nutrition and Dietetics (AND) annual Food and Nutrition Conference and Expo (FNCE).

Hyperbole and fallacious arguments from both sides ensued.

The people hating on the donuts predictably likened sugar to *checks tweets, sighs* heroin and cigarettes, while the people defending them, their arguments are probably fairly summed up in this tweet:

It's these arguments that I want to very briefly address.
  1. Dietitians, and everyone else, are allowed to eat donut holes whenever they want, and criticizing the provision of donut holes at a dietetic conference does not suggest otherwise.
  2. No, the *giant eye-roll* consumption of one donut hole doesn't cause chronic disease, nor does criticizing the provision of donut holes at a dietetic conference suggest otherwise.
  3. No, donuts were not the only food served at FNCE, nor does criticizing the provision of donut holes at a dietetic conference suggest otherwise.
  4. Criticizing the provision of donut holes at a dietetic conference isn't shaming colleagues (but that tweet up above using sneering straw men to call out the RD who doesn't think donuts should be served at a dietetic conference sure is)
As I've written before in reference to a physician conference I attended where they were serving soda, Clif bars, and potato chips as a snack, human beings, including MDs and RDs, when faced with freely provided indulgent choices, tend to choose them, and I can't help but wonder had they not been offered how many RDs would have gone for a donut or cookie run?

And of course it's not "just one". We are all constantly faced with indulgent choices being offered to us freely to christen every event no matter how small, and we've created a food environment whereby we have to go out of our way to make healthy choices and to actively, regularly, say no to indulgent ones. Now I think indulgent choices are part of life, an enjoyable part at that, and ones that I even actively encourage my patients to make, but I also think it would be in everyone's best interest were that food environment reversed, where the healthy choices are the defaults and indulgent choices are readily available for anyone who wants to go out of their way to get them.

And by the way, at FNCE this year they were certainly readily available. The decadent Beiler's Bakery was 92ft away from the Pennsylvania Convention Centre, while more pedestrian Dunkin' was 135ft away.

Yes, the constant provision of junk food is a societal norm, but it certainly need not be.

And honestly, if even the Academy of Nutrition and Dietetics enables and encourages poor dietary choices at RD events, why would anyone expect better from others?

Until we stop leaning on the theoretical ability of people "just saying no", or that the provision of healthy choices somehow erases the provision of junk, as the primary means to address a food environment that incessantly offers and pushes nutritional chaff at every turn, we're not likely to ever see change, and frankly this is a charge that AND should be leading.

Monday, October 28, 2019

Yes, My Kids Eat Candy On Halloween And So Should Yours

(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 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 that if you'd like, you can chat some about added sugar 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 your kids 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 treats are required (and I'm absolutely 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 a few years ago 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 host charitable 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 likes to collect things and on Halloween, she 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 26, 2019

Saturday Stories: Meat, Diets, and German Antisemitism

James Hamblin, in The Atlantic, with his typically insightful thoughts, this time about whether meat is good or bad for you.

Kim Tingley, in the New York Times Magazine, asks why isn't there one best diet for everyone?

Andrew Mark Bennett, in Tablet, on modern day German antisemitism and what German Jews are doing about it..

[And if you don't follow me on Twitter or Facebook, had a chat with the ladies from The Social yesterday about vaccinations]

Thursday, October 24, 2019

Elementary Teachers Union (@ETFOeducators) Misleads Its 83,000 Members When Explaining Cutting Benefits' Actual Dietitian Coverage In Place Of Dial-A-Dietitian

Thanks to a person who wishes to remain nameless, I was recently alerted to the fact that the Elementary Teachers Federation of Ontario, a union representing 83,000 elementary teachers and education workers, have removed coverage for Registered Dietitians (RDs) from their benefits plan.

By way of background, here in Ontario, RDs are one of a limited number of regulated health professionals, and of course are the only profession dedicated exclusively to nutrition. Also here in Ontario (and pretty much everywhere), diet and weight related diseases have long since reached epidemic proportions.

As to why ETFO has delisted RDs, the province's only regulated nutrition professionals, according to a document distributed to their members it's because,
"these free services are now available through Ontario Telehealth"
But are they?

Telehealth RDs answer one-off nutrition questions by way of phone calls. They are most assuredly not there to provide individual counselling or comprehensive ongoing care.

Plainly, cutting RDs from ETFO benefits is shortsighted, and suggesting that actual RD services are the equivalent of a Dial-A-Dietitian service designed to answer simple questions is an outright lie.

If you're an ETFO member I'd encourage you to share this post, and to contact the ETFO ELHT Board of Trustees to ask that RD coverage be reinstated.

Monday, October 21, 2019

The Journal of Nutrition Describes Gut Bacteria Prevotella Abundance As "The Key To Successful Weight Loss" Following Short Study Where Subjects With No Prevotella Lost Comparable Amount Of Weight

Hype around preliminary findings, animal studies, cell culture studies, underwhelming studies, and more is the clickbait that sells papers and likes. Some of the time hype comes from journalists, sometimes from press-releases, and sometimes from the authors themselves. Today's blog post sees the hype coming from an invited oped published by the American Society of Nutrition's flagship The Journal of Nutrition.

The oped, entitled, The Key to Successful Weight Loss on a High-Fiber Diet May Be in Gut Microbiome Prevotella Abundance, was written in reference to the results of the study entitled, Prevotella Abundance Predicts Weight Loss Success in Healthy, Overweight Adults Consuming a Whole-Grain Diet Ad Libitum: A Post Hoc Analysis of a 6-Wk Randomized Controlled Trial.

The op-ed described the "key" to successful weight loss on a high-fiber diet as gut microbiomes containing an abundance of the bacterium Prevotella, and was written to amplify the - hold onto your hats now - findings from a very small, very short study that was not originally designed to test the relationship between Prevotella abundance and weight, that found a whole 3.5lb greater weight loss among the 15 study subjects with the highest Prevotella abundance vs. the lowest (but still present amount) when consuming a whole grain (WG) diet.

But wait, there's more!

Though it's confusing because of the way they reported weight loss, the same study found that particpants with microbiomes containing no Prevotella also lost weight on a WG diet. In fact, looking at the study's diagram detailing the losses between groups it sure appears as if subjects whose microbiomes contained no Prevotella (0-P) lost statistically comparable amounts of weight as those whose microbiomes contained the most Prevotella (High-P).


So to summarize, people with microbiomes containing what The Journal of Nutrition called, "the key to weight loss on a high-fibre diet" lost pretty much the same amount of weight as people with none of it on a high-fibre diet. Oh, and that key that worked as well as not having a key at all? If we make the enormous leap that it was causal, it led to a 3.48lb weight loss. Whoop whoop?

Bottom line I guess is that if you're going to describe something at the "key" to successful weight loss on a whole grain diet in the title of an op-ed in a prominent journal, and where we're talking about a 4lb weight loss, but having none of that key leads you to lose pretty much the same amount of weight, not only is that not much of a key, but it's incredibly irresponsible as it blatantly contributes to the ongoing erosion of societal scientific literacy and promotes the harmful and erroneous belief that magic exists when it comes to weight loss.

[Also, unless I'm misreading the very small amount of actual data provided, it would seem that the authors of the study also reported the difference between high Prevotella and low Prevotella groups wrong whereby the high group was found to have lost 4lbs (-1.8kg), and the low 0.5lbs (-0.22kg), but rather than report a -1.58kg (3.48lb) difference between the two, they added their losses and reported a -2.02kg (4.45lb) difference.]



Tuesday, October 15, 2019

Real World Self-Selected Intermittent Fasting (IF) Vs. Continuous Energy Restriction (CER) Study Sees 73% of IF and 61% of CER Participants Not Lasting Even 6 Months

So what happens when you offer people with obesity the choice between 5:2 style intermittent fasting (IF) (very-low calories (VLC) 2 days weekly with 5 days of less restricted eating) and more traditional caloric restriction 7 days a week? Would encouraging people to choose between two strategies increase their likelihoods of successful weight management a year later? Would one group lose more weight than the other? Would adherence be the same?

That were the question post-doc RD Rona Antoni and colleagues set out to explore and they recently published a paper discussing their results.

197 patients with obesity presenting to the Rotherham Institute for Obesity were offered the choice between 5:2 IF (630 calories from liquid meal replacements on the VLC days), or an aimed 500 calorie continuous energy restriction (CER) 7 days per week with diet based off that recommended by the UK's dietary guidelines. Both groups received support from specialist obesity nurses for 6 months and were also asked to return for measurements and discussion at one year. All were also provided with access to, "a variety of specialist facilities, resources and multidisciplinary specialists including exercise and talking therapists", and all were reviewed in clinic monthly where measurements were taken (weight, total body fat, fat-free mass (FFM), waist circumference, systolic and diastolic blood pressure and an overnight fasted blood sample) and adherence was discussed.

99 patients chose IF, and 98 chose CER. 6 months later, 73% of IF patients and 61% of CER patients had dropped out. At one year, 83% of IF and 70% of CER patients were lost to follow up.

Of those who quit IF by 6 months, 18% explicitly reported they did so because they could not tolerate the diet, something that none of the CER drop outs reported, other IF drop outs reported they quit due to fainting or hypoglycemia on VLC days.

Regarding completers' weight losses at 6 months, the IF patients lost a statistically significant, but likely clinically meaningless, 4lbs more than the CER group. All blood measures (including fasting glucose, insulin, hsCRP, and lipids) were found to be the same between groups. Blood pressure changes were also not different between groups.

At one year, the 17 remaining IF patients were found to have regained their lost weight, while the 30 CER patients were found to be maintaining their albeit small amount (3%) of weight loss.

So what to make of this study?

I think the most striking finding was the overall 66% attrition rate across both arms. Certainly this study does not suggest that IF is an easier regime to follow than CER (at least not when provided at the Rotherham Institute for Obesity - given weight management support is a service and not a product, it's certainly possible that different providers might have seen different outcomes for both arms, but I do think this speaks to the challenge of scalability of behavioural interventions). But what I really think this study highlights is the fact that the real-world likelihood of purely dietary interventions treating our increasing weights is very low indeed. Instead, we need more tools for treatment (certainly including medications and surgeries), and more importantly, if we're going to see change, we're going to need environmental level changes to turn this boat around.

As to whether IF or CER will work for you don't forget that one person's horribly restrictive diet is another person's happy lifestyle. If you're trying to find your own right road, even if the first road fails, and even if angry diet gurus and zealots try to tell you there's no other road, keep trying different forks until you find the one that suits you best, as when it comes to diets, adherence is all that matters in the end, and if you don't like the way you're living, you're not likely to keep living that way.

Saturday, October 12, 2019

Saturday Stories: Jimmy Dorsey's Generosity, Eating Disorder Recovery, And New Coke

Petula Dvorak, in The Washington Post, with two incredible stories, the first about hunting for one man whose generosity and $80 helped launch an incredible career, and then the story about finding that man - Jimmy Dorsey

Amelia Boone, in Race Ipsa Loquitur, discusses her eating disorder recovery.

Tim Murphy, in Mother Jones, on the murder of New Coke.

Monday, October 07, 2019

Dear @BowlCanada, Selling Chocolate Should Not Be A Prerequisite For A Child To Play In Your Leagues

This is not the first time someone has shared the story of a kids' sports league that requires junk food fundraising, but it may be the first time that the league's program coordinator explicitly stated that the child of a parent willing to pay a bit more instead of being stuck selling $50 of chocolate wouldn't be welcome.

I've said it before and will say it again, our food culture is broken and junk food fundraising is just one small aspect of that, and when you question social norms, no matter how broken they might be, don't be surprised when you get pushback. But damn, it's depressing.

Here is the redacted email exchange I was forwarded

Parent:
Hello,

My kids’ dad signed our child up for bowling and is telling me I have to sell half of these chocolates.

I asked for information and the lane said that Bowl Canada mandates this.

So I have a few things to ask.

I’ve noticed that General Mills is a sponsor. Do they make the chocolates and are they the party that is behind this arrangement?

Why chocolate when we are in the midst of an obesity epidemic? Especially for an organization encouraging health? There are all sorts of fundraisers. If given the chance I would gladly purchase fresh vegetables through Peak of the Market, for example.

Also, why not give parents the option of giving a donation for tax deductible purposes rather than making them buy a bunch of poor quality chocolate that is probably connected to child labour? You’d still cover the costs you are hoping for.
Bowl Canada Program Coordinator
Dear [Redacted],

We are happy to hear that your child will be registering for bowling this season! Yes, Youth Bowl Canada has one official fundraiser each year and our tried and true method of raising funds, to help keep costs down for families, is the sale of chocolates.

Every two years, Youth Bowl Canada considers proposals from many companies offering an array of products, with various levels of monetary return which benefits all levels of bowling in Canada. Chocolate companies can repeatedly offered the best deal to not only bowling, but to schools, community clubs, etc.

General Mills was a sponsor of Bowl Canada last year, however it was simply a free game of bowling offer on select food products in stores. They have not wished to quote on our fundraisers in the past.

I hope I have addressed your concerns. Please feel free to reply should you have any further questions
.
Parent
Hi [Redacted].

Thanks for your quick response. My understanding is, then, that these chocolate sales are mandatory if we want our kids in bowling. Is that correct?

If not correct, if this fundraiser is optional, no big deal; I don’t have to take part in something I find morally objectionable in order for my kid to have this opportunity.

If correct, that you require these chocolate sales, I would urge Bowl Canada to reconsider this policy, for 3 reasons.

1. It is objectionable to force fundraising on families. Some people are very good at this kind of stuff. Others have anxiety or lack the connections to have people to sell to. Sometimes the families least able to support a fundraiser are the ones whose kids most need this kind of programming.

2. This does not support physical health. As I mentioned, obesity is a major issue in society. I can appreciate that you are looking for good money makers but I think non-profits should be mindful of other considerations.

3. Why not give parents the option of something else? I am not going to sell these chocolates. If I end up buying half from my kids’ dad I will end up with chocolate I don’t want in my house and maybe end up throwing it out. I will have spent what? $50 on chocolate so Bowl Canada can get $20? I’d much rather just give you the $20 profit you are looking for. Why not just give me that option rather than making me spend more money than is necessary?

4. Chocolate is ethically problematic. Most chocolate manufacturers have child labour and harsh conditions as part of the production process. This is wrong and I believe what we support with our money should not hurt other people.

So I find myself between a rock and a hard place: I love my kid in bowling, it has been great for him. But I don’t think it’s right to force me to take part in something I find morally objectionable.

Please reconsider your policy.
Bowl Canada Program Coordinator
Hi [Redacted].

Yes, chocolate sales are required for the YBC program to participate in all YBC programs and events.

I will, however forward your concerns on to those that review YBC policies for future consideration.

Regards
Ugh.