Dear @OttawaCitizen, Your 83 Word Byline Free Drink Milk "Artice" Isn't Journalism And It Contributes to Scientific Illiteracy

Now to be clear, I'm not a journalist, though I have written my fair share of articles for various publications (including the Ottawa Citizen).

What I would never have submitted, let alone gotten away with, would be an 83 word (truly, that pic above is all there is), byline free, advertorial replete with a large photo promoting milk consumption in the name of Vitamin D and calcium citing a "report" that urged Canadians to drink milk, and mentioning "experts" three times, without actually naming the report or the experts.

Though I'm not sure which report the 83 words is referring to, my friend and PhD/RD Dr. Kevin Klatt (who you should absolutely be following on Twitter) was able to steer me to this study looking at non-dairy milk consumption and vitamin D levels in Canadian children which clearly demonstrates drinking non-cow's milk leads to lower, but still fine, vitamin D status markers.

He noted, as actually cited experts should, that vitamin D's daily recommended intake (DRI) levels were derived from intake studies performed in very high northern latitudes so as to remove the confounding issue of sunlight, and that consequently daily recommended intake levels are far more than are necessary to maintain safe vitamin D levels for everywhere but the far north. He also pointed out,

"there's not very strong evidence to suggest that not consuming milk places one at risk of having Vitamin D status in the range of insufficiency."

And though it may surprise you given the certainty of the 83 words up above, the data on dietary intake and Vitamin D are so limited that anyone who has concerns about their vitamin D status, regardless of whether they drink milk or not, should have their levels checked and not simply assume milk will be magical. Or better yet, not try to drink their way to higher levels of Vitamin D if they're concerned and simply take supplements (with meals if this is your plan as Vitamin D is a fat soluble vitamin)

Given the full court press the Canadian dairy industry has been making since our new Food Guide rightfully relegated dairy to simply a source of protein rather than suggest it is a unique food group, I can't help but wonder if this published seeming advertorial is consequent to their efforts and overtures, and while it might play to at least 50 years of Canadian dairy marketing, the Ottawa Citizen should know better than to simply pass along uncritical food takes suggesting magic benefits to specific foods to a population primed to believe them.

(Thanks to my friend and colleague Andrew Kujavsky for sending the photo of the article my way)

Most Generous Conclusion Of Chocolate Milk In Exercise Systematic Review And Meta-Analysis? It Will Increase Your Time To Exhaustion By 47 Seconds Over Placebo

Literally every time I write about chocolate milk being a beverage worth actively minimizing in your diet (have the smallest amount of it you need to like your life), someone inevitably chimes in to tell me I'm wrong because it's great for exercise recovery.

And I'm not sure how I missed this when it came out, but last year, the European Journal of Clinical Nutrition, published a systematic review and meta-analysis of randomized controlled trials involving chocolate milk and exercise recovery.

After excluding studies that didn't meet their inclusion criteria, the (non-conflicted) authors were left with 12 studies, 2 deemed of high quality, 9 of fair quality, and 1 of low quality with 11 having extractable data on at least one performance/recovery marker including ratings of perceived exertion, time to exhaustion, heart rate, serum lactate, and serum creatine kinase.

Their overall conclusion?

The systematic review and meta-analysis revealed that chocolate milk consumption had no effect on any of those variables when compared to placebo or other sport drinks.

Their most generous conclusion?

If they excluded one study from their analysis of the effect of chocolate milk on time to exhaustion then chocolate milk was found to increase time to exhaustion by 47 seconds over a placebo beverage. They also found, in another subgroup analysis, that lactate was slightly attenuated in chocolate milk drinkers compared to placebo (a finding that was not present in the high quality RCT looking at same).

(for a brief discussion on the stats involved and the subgroup analysis, here's a post on same from epidemiologist @GidMK who concluded that chocolate milk is "not a fitness drink").

Happy to have this post published so that I can share the next time someone inevitably tries to suggest that chocolate milk is magic.

No, New York State Academy Of Family Physicians (@NYSAFP), Sugar Sweetened Milk Is Not "Essential", Just Ask The @AAFP

So what possible reason could the New York State Academy of Family Physicians (NYSAFP) have to highlight in their weekly eNews circular sent to 10,447 family physicians and students, an article that claims, "Flavored milk is essential" and "a tasty way for kids to get the 9 essential nutrients that they need"?

I think it's a fair question given the World Health Organization, the Centers for Disease Control, and yes, the NYSAFP's parent organization, the American Academy of Family Physicians (AAFP) all recommend that added sugars contribute no more than 5-10% of total daily calories, and yes, chocolate milk contains heaps of added sugar.

In fact, the American Academy of Family Physicians explicitly discourages the consumption of sweetened or flavoured milk stating,

"It is important that you stay hydrated. However, drinks that contain sugar are not healthy. This includes fruit juices, soda, sports and energy drinks, sweetened or flavored milk, and sweet tea."

And I'm guessing the answer won't surprise you either.

The answer is money.

Specifically, $2,300.

Because that's how much the NYSAFP charges companies for a "Product Showcase" feature that goes out in 13 separate emails to reach those 10,447 family physicians and students.

That's $177 per mailing.

And what does that $177 buy the American Dairy Association North East?

Well of course it buys the ad space, exposure, and frequency, but it also buys credibility.

I'll let the NYSAFP explain,

So NYSAFP, if you're reading, please issue a correction, and to that end, here's an invitation for you. If you'd like to send out some information about what happens when chocolate milk is removed from school lunches to your 10,447 physician and student members, please take this as my permission to freely republish my blog post that covered the study on this very matter that 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.

Or at the very least, kill that ill-advised ad and maybe revisit your policies around vetting sponsors.

[Thanks to Beth Locke for sending the NYSAFP's eNews my way]

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.

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)

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?

An Incredibly Innovative Solution For Parents And Politicians Concerned About The Potential End of School Organized Chocolate Milk Sales

Chocolate Milk And Health Canada's Inaction On Canada's Food Guide Just Cost The New Brunswick Liberals The Election

Yesterday there was an election in New Brunswick.

The Conservatives won by a single seat.

So what was the main issue New Brunswickers were voting for or against in this election?

Believe it or not, it was chocolate milk in schools, which was described by the Toronto Star as the issue at, "the centre of the New Brunswick election campaign".

Seriously.

The centre of the New Brunswick campaign was whether or not the sale of chocolate milk would be banned in New Brunswick schools, with Blaine Higg's Conservatives saying "No", and the Liberals Brian Gallant saying, "Yes".

PC Leader Blaine Higgs with Blair and Ashton having Chocolate milk on The Big Blue Bus. pic.twitter.com/MIuRn56AIy

— Paul D'Astous (@d_astous) August 31, 2018

But here's the thing.

If Canada's Food Guide stated that sugar-sweetened milks were not nutritionally equivalent to white milk, and that in fact sugar-sweetened milk consumption should be limited to half a cup daily in children, school chocolate milk sales wouldn't have been an election issue in the first place, as with that admonition, schools almost certainly would have put an end to the daily sale of an item Canada's Food Guide recommends kids explicitly limit.

And there's very little doubt that the next Food Guide, if it's ever released, won't be kind to chocolate milk. And that's not just me reading the tea leaves, it's also me remembering when Dr. Hasan Hutchinson, the Director General of the Health Canada unit responsible for the Food Guide stated, over 4 years ago (honestly, what could we possibly still be waiting for) during a public debate that we held,

"One thing we're doing right now (Note: Right now means February 2014) 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"

So the next time someone tells you that Canada's Food Guide doesn't matter you remind them that Health Canada's inexplicable foot dragging on its much needed revision just cost the New Brunswick Liberals the election.

(Stay tuned, because on Thursday, I'm going to post an incredibly innovative solution to the issue of chocolate milk in schools)

Where The Hell Is Canada's New Food Guide?

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.

And here's the most pertinent question. It's been 4.5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

McDonald's, But Not Your Child's Elementary School, Removes Chocolate Milk From Their Menu

Not sure if you caught this news release last week. It detailed McDonald's announcement that they'll be overhauling their standard Happy Meal offering in a bid to, "support families".

Part of that "support" (I'll come back to the word, I promise), is ensuring,

"at least 50 percent or more of the Happy Meals listed on menus (restaurant menu boards, primary ordering screen of kiosks and owned mobile ordering applications) in each market will meet McDonald's new Global Happy Meal Nutrition Criteria of less than or equal to 600 calories; 10 percent of calories from saturated fat; 650mg sodium; and 10 percent of calories from added sugar"

And to meet those goals cheeseburgers will only be available by special request, a kids; fry size (smaller than current small) will be developed, bottled water will be a featured beverage option, and chocolate milk will only be available by special request.

Though I'm certainly happy that McDonald's Happy Meals will generally be lower in calories and sugar, here's the rub. While the rollout of this initiative speaks to health, corporations never make changes that they think will hurt their bottom lines. This is not an indictment - corporations aren't social service organizations - their goals are profit driven, and McDonald's are no exception as evidenced by their press release's first line,

"Today, McDonald's (NYSE:MCD) announced an expanded commitment to families, supporting the company's long-term global growth plan by leveraging its reach to impact children's meals"

They hope that these changes will bring in more families more often for more meals at McDonald's, which is good for their investors, but probably not so much so for public health, even without chocolate milk.

But you know which organization's goals aren't profit driven? Your children's elementary schools', yet their chocolate milk programs continue with no end in sight, and not just for a sometimes treat, but daily. If you wouldn't serve kids who didn't eat fruit, daily pie, you might want to rethink their daily chocolate milk.

Motivation aside, it's odd to see McDonald's being more proactive than our kids' schools on this file.

Guest Post: Skim Milk Makes Kids Fat. Or Does It?

Today's guest post comes from my friend and colleague Dr. Dan Flanders and it's about a topic that has in fact received a fair bit of attention over the past few years - full fat vs. skimmed fat milk and the proposed impact which you choose might have on your child's weight. If you're looking for Dan, you can usually find him on Twitter.

Last week, Target Kids!, a distinguished group of Toronto pediatric researchers, published a study on the relationship between the types of milk that young children drink and their weights. They demonstrated, quite convincingl,y that young children who routinely drink fattier milk (e.g. 3.25% whole milk) tended to be leaner than those who drank lower fat milk (e.g. skim or 1%). Likewise, children with overweight and obesity, were found by them tend towards drinking lower-fat milk than children who were leaner.

The authors suggested, as a possible explanation for these findings, that low fat milk doesn't satiate children very well and therefore probably leads to the eating of excess calories and consequently, the additional weight. Higher-fat milk drinkers, they proposed, feel fuller, and for longer, and are therefore less likely to overeat.

One can imagine how compelling this explanation might seem in light of our current international childhood obesity concerns. So is this the simple intervention we need to cure childhood obesity!? Probably not.

Consider, for example, what a sensible and caring parent of an underweight young child might do to help them to gain. As both a pediatrician and as a father of an underweight child, my first instincts and steps were to increase the fat content of my son’s milk. In fact it is common practice in the medical community for doctors and other allied health professionals to recommend switching to fattier milk as a means to encourage weight gain for young, slow-to-gain children.

Likewise, it is extremely common for parents of children who have excess weight to attempt reducing their children’s caloric intake by serving them lower-fat milk. And again, this is a practice that health professionals regularly recommend to help to “prevent childhood obesity”.

Coming back to this new study, in my opinion, the directionality is wrong, I think it highly unlikely that drinking fattier milk is causing leanness in children and that drinking low or no-fat milk is causing obesity. Rather, I would bet that the milk type that young children are drinking is probably being chosen by their parents as a consequence of their kids’ weight status’: fattier milk for the children who are lean and lower-fat milk for the ones who are heavy.

Effectively, this study shows a correlation, not a causal relationship, and its findings are just as (or perhaps more) likely to reflect sensible parenting decisions than the discovery of a new intervention to reduce childhood obesity.

So why write about this study? Well, in a word … The Media.

There can be an interesting and sometimes dangerous intersection between science and the media. As consumers and parents, we are eager to make good, health-promoting decisions for our children and families. When it comes to health and nutrition, these decisions ought to be properly informed by the process and outcomes of scientific inquiry, and be published in peer-reviewed scientific journals. But most of us are not scientifically minded enough to read, digest, and critically appraise peer-reviewed publications directly from the source, and so we turn to the media for help.

The media - broadcasters, journalists, health bloggers - play the important role of consuming, interpreting, and packaging science discoveries in a way that is digestible to mainstream consumers. Unfortunately, the media too often botch their coverage of important science discoveries by spinning stories to feed flashy and controversial narratives thereby, they hope, driving higher consumer subscriptions and ad revenues. Left in the dust is their mandate to responsibly inform consumers.

Using this milk study as an example: a fair and responsible way to cover this story might be to write some version of the following:

A correlation has been found between the type of milk that young children drink and their weight status. The study was unable to determine whether the type of milk consumed caused changes in body size or whether existing body size influenced the type of milk consumed. Future studies are needed to establish any causal connection.

Instead, here’s but a sampling of irresponsible headlines cranked out by some well-respected news publishers in response to this study:

• Which milk is healthiest for kids? New study suggests it isn't skim
• Full-fat milk leads to leaner children, says study
• Children who drink full-fat milk end up slimmer than those on skimmed
• Children who drink full fat milk are SKINNIER because it stops them from snacking

I am concerned that parents, wanting to do what's best for their children, have been misled by these headlines. Not only does this type of reporting send a statistically inaccurate message, but there is a real chance that these headlines will change (or have changed) parents’ family nutrition decisions with the risk of actually making things worse for their children.

I am even more concerned that this sampling of misleading health journalism is but a spit in the ocean; reckless health reporting is routine and commonplace. As a global community we must demand better from our journalism communities.

Dr. Daniel Flanders is a Toronto pediatrician and founder/owner of Kindercare Pediatrics. He has a special interest in pediatric nutrition and childhood obesity. Dr. Flanders completed his medical education at McGill University in Montreal and the University of Toronto’s Hospital for Sick Children. He is on staff at the North York General Hospital and is an adjunct lecturer at the University of Toronto’s Department of Pediatrics, Faculty of Medicine.

Why Are Dairy Farmers' "Dairy Educators" Invited To Teach Our Kids?

"What the hell is a Dairy Farmers of Ontario 'Dairy Educator' and why are they allowed to speak to my kids?"

That was the question posed to me by the reader who sent in this video.

Apparently it was shown to his Grade 4 student in school by a 'Dairy Educator' who clearly was invited by that kid's school to teach kids about "The Miracle of Milk" (that's literally the title of the video).

The claims in the video?

Milk contributes to (all direct quotes):

• Strong bones and teeth
• Strong muscles
• Energy
• Healthy blood and a healthy nervous system
• Help prevent diseases like cancer
• Healthy brain development

The video goes on to talk about how many servings kids should have, with the majority of kids in the video drinking from almost comically large glasses, and of course it features both chocolate milk and ice cream.

The video and the 'education' are part of a larger 'curriculum' offered to Ontario's schools.



The claims made by the video, and presumably amplified by the 'educator', certainly aren't those approved by the Canadian Food Inspection Agency, nor is milk miraculous.

So as far as what Dairy Farmer of Ontario Dairy Educators are - well they're marketers. But as to why they're being invited in to schools to market a product dishonestly to trusting children, I haven't a clue.

Sorry Corn Refiners Association, Chocolate Milk Doesn't Increase Intelligence

From the annals of corporate sponsored research comes this gem that was sponsored by the Corn Refiners Association,

"No Effect of Sugar Sweetened Milk on Performance of a Battery of Cognitive Assessment Tests".

Unfortunately for the Corn Refiners, no amount of p-hacking saw chocolate milk increasing brain function.

While undeniably there's great research out there that is and was funded by industry, including the food industry, there's really only one purpose for research like this - sales.

There's no doubt that if even the tiniest change had been found, the finding would have served industry as a talking and marketing point, just as was the case with the Welch's study that had them claiming grape juice gave working mothers better memories.

Those ends certainly aren't a mystery to the researchers who run these studies. And probably not a my$tery either as to why researchers agree to run them.

Maybe by way of a blind universal fund, or by way of sugar-sweetened beverage tax revenues, or by more innovative approaches (see below), we need to find new ways to fund research because clearly, research funding is broken, and it needs fixing.

I think we've found a solution to the #research funding i$$ue #phdlife #gradschoolproblems pic.twitter.com/DufmBNmMl3

— Kevin C. Klatt (@Nutrevolve) August 4, 2016

Got Spin? Dairy Farmers of Canada Talks Sugar With The Senate

Chocolate milk brochure and colouring book sent home this year with Ontario kindergarteners as part of  the Elementary School Milk Program

Unless you're a subscriber to Blacklock's Reporter you probably didn't see this story, but last week Canada's Standing Senate Committee on Agriculture and Forestry met to discuss market access to Canada's agricultural and forestry products.

Invited to this particular chat were representatives from Dairy Farmers of Canada including their President Wally Smith, and their Executive Director Caroline Émond.

During the discussion, Nova Scotia Senator Kelvin Ogilvie, took issue with the way the Dairy Farmers of Canada represented the sugar in chocolate milk in the materials presented to the Committee,

"I came across some remarkable statements about the amount of sugar and the fact that the sugar in chocolate milk is not an issue and we shouldn't be concerned about that. It shocked me, quite frankly, because sugar is a serious contributor to the obesity problem that we have in Canada and around the world.

Just to take a quick example, a 250 millilitre glass — that's one quarter of a litre, for those of you who want to follow this — of chocolate milk, 1 per cent, has 160 calories and contains 25 grams of sugar. A glass of Coca Cola of about the same size is 100 calories and 26 grams of sugar.

Now I understand there are other things in the glass of chocolate milk, but the idea that you can state unequivocally in here that there should be no concern whatsoever about the sugar in chocolate milk astounds me. It would take an ordinary person in ordinary exercise approximately an hour and a half to work off that many calories. It would take a vigorous workout to do it in half an hour. The issue is not just the amount of calories; it is in fact the amount of sugar. They are empty calories, they are high calories and they contribute negatively to health overall.

I was startled to see that. I happen to like chocolate milk, by the way. I had never seen a statement such as that and I'd like your reaction."

The non-answer provided to him by Ms. Émond didn't satisfy Senator Ogilvie and he minced no words calling her on that,

"You have spoken to obfuscate the issue, and I congratulate you on that.

In the basic white milk, there is far less sugar, so you actually have significant added sugar in here, and it is the added sugars, absolutely, that are the very serious issue."

Ms Émond responded that she understood Senator Ogilivie's concerns, and perhaps tried to reassure him by explaining that Dairy Farmers of Canada markets chocolate milk responsibly - to athletes,

"We position chocolate milk as a sport recovery beverage. It's a great positioning and it works well with athletes and sporting people who are using chocolate milk as a recovery beverage instead of energy drinks, which are, again, empty calories. We try to position the product in the best possible light. I understand your concern."

Huh?

I wonder how Ms. Émond and Dairy Farmers of Canada would explain all the photos on this page?

You see they're all photos of the marketing materials that Dairy Farmers of Canada recently distributed to elementary school children and their parents as part of their Elementary School Milk Program.

And front and centre in those materials that are marketed to Canada's youngest school children and their parents are the very claims that shocked Senator Ogilvie. And not only are the claims front and centre, but the brochure itself is clearly designed to position chocolate milk preferentially over white milk with 3 of the 4 pages of the brochure literally being brown (with only the back of the brochure promoting white milk), and the line, "Get your child off to a great start" framing a carton of the chocolate stuff.

The inside of the chocolate milk brochure up above

There's no denying that Dairy Farmers of Canada are doing their best to position chocolate milk as a recovery beverage to athletes, but there's also no denying that they're positioning it to children and their parents as health food. A positioning echoed by the brochure sent home with children last year.

Kindergarteners and elementary school children aren't athletes. Chocolate milk isn't health food. And Dairy Farmers of Canada, if their statement to the Senate was meant to suggest that they don't market chocolate milk to anyone other than athletes, are plainly lying.

[Thanks to Blacklock's Reporter's publisher Holly Doan for sharing the Senate transcript with me - I will attach a link to the full testimony once it's posted on the Senate Committee's webpage]

Canada Food Guide's Director General Agrees It's Broken

In February 2014 I had the pleasure of debating the Director General of Health Canada's Office of Nutrition Policy and Promotion (the folks in charge of the Food Guide), Hasan Hutchinson, about whether or not Canada's Food Guide could promote weight gain.

You can watch the whole debate if you want, but I want to focus on a statement that Dr. Hutchinson made during the discussion. It was just a single line and it had to do with chocolate milk.

I had mentioned that chocolate milk, given it's high in both calories and free sugar, should lose its billing as a Canada's Food Guide sanctioned dairy serving. Delisting chocolate milk matters as the trickle down effect of that might ultimately lead to its removal from school milk programs, which in turn might have the trickle down effect of fewer kids and adults believing that milk's such an important beverage to consume that it's ok to add piles of free sugar to it to encourage its consumption (a practice akin to encouraging more fruit consumption by serving more pie).

Dr. Hutchinson agreed.

He stated,

"One thing we're doing right now (Note: Right now means February 2014) 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"

Well that screen capture up above was snapped just this past weekend so certainly no changes yet.

Dr. Hutchinson also seems to be on the same page as me in regard to fruit juice not being a fruit equivalent. Back in May of this year he was quoted by the Canadian Medical Association Journal on juice's fruit billing as 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."

Well, that juice quote was from 5 months ago now, and chocolate milk - that was 21 months ago.

Wonder if we'll ever see those changes?

Brings to mind the article I wrote for the Globe and Mail this past April, Canada's Food Guide is broken - and no one wants to fix it.

It sure sounds like Dr. Hutchinson wants to fix at least some of it. I wonder what or who is getting in his way?

Ontario Schools Allow Dairy to Shamelessly Target Kindergartners

Thanks to fellow Ottawan Sarah Wise for sending these my way.

They're photos of the milk propaganda provided to her 5 and 7 year olds at school in support of their school milk program.

Putting aside your stance on whether you think milk is a magical beverage or the devil's brew, can we at least agree that providing the dairy industry with direct access to children who can't discern truth from advertising, let alone advertising from actual teaching at school, is plainly wrong?

For a story worthy of teaching kids in school, have a peek at pediatrician Aaron Carroll's short video on how the milk emperor has no clothes.



Schools should not be places that industries can pay or partner with to provide children with advertising collateral.

Chocolate Milk Marketing Via Post-Race Survey

This year my sister ran her first Ontario cottage country triathlon.

It was sponsored by the Dairy Farmers of Canada "Recharge with Milk" program, and of course included the requisite branded Recharge gear and samples of chocolate milk, but it was the post race survey that she found interesting enough to kick my way.

Here are the chocolate milk related questions:

The food industry is all about marketing - not sport, not health, not altruism - just sales. There's nothing wrong with that, it's their job after all, but it's a good idea not to forget their singular aim.

[For more on chocolate milk and recharging, here's RD Diana Chard's take]

More Questionably Legal Claims Made By The Dairy Farmers of Canada

You might remember a few weeks ago when I questioned the legality of the claims being made by the Dairy Farmers of Canada at a recent Canadian Obesity Network conference.

The issues at hand were two-fold.

Firstly claims were being made about milk products' abilities to prevent colon cancer and type 2 diabetes, improve bone health, and confer healthy blood pressure. Secondly, those claims were being made about milk products as a whole, and not about the nutrients found in milk.

Both of those are a no-no, as according to the Canadian Food Inspection Agency,

"Nutrient function claims may not refer to the treatment, prevention or cure of a Schedule A disease; or claim to treat, mitigate, or prevent a disease, disorder or physical state; or claim to correct, restore or modify an organic function [3(1) and 3(2), FDA]. Such claims are considered to be drug claims (see Drugs vs. Foods)."

And,

"Nutrient function claims are not made for a food per se; they may only be made respecting the energy value or nutrients in a food. For example, the nutrient function claim "Milk helps build strong bones and teeth" is unacceptable, because a nutrient function claim refers to the nutritional function of energy or a nutrient (e.g., calcium) in a food, not a particular food (e.g., milk). An acceptable claim is "Milk is an excellent source of calcium which helps build strong bones and teeth"."

The Dairy Farmers' Executive Director, Caroline Emond, reached out to me to explain that because the conference wasn't targeting the general public, Dairy Farmers of Canada were free to make whatever claims they wanted, and to support her case, she cited a 1987 decision of an Alberta Court of Appeals judge who stated,

"By including the word "general" as a modifier in s. 3(2) the broad term "public" is narrowed. The section totally prohibits advertisement to the general public. It is designed not to interfere with advertisements to the "specialized" professional medical community in specialized trade and professional publications, such as medical journals, pharmaceutical journals and so on."

And yet here, the Dairy Farmers of Canada are claiming, on their "Get Enough" website (and the same information and graphics are available in its accompanying app) - a venue that's definitely targeting the general public - that milk products reduce the risk of hypertension, keep your bones healthy, lower your risk of colon cancer, help you to manage your weight, and decrease your risk of developing type 2 diabetes.

My take on dairy literature is that milk products have not been proven to be magical or particularly dangerous. They're simply a protein source that includes calcium, and definitely aren't deserving of their own dietary category, or of their blind restriction. Seems to me though that the Dairy Farmers' inflated claims here might not meet the letter of the law - though perhaps there's another loophole that I'm unaware of that makes these kosher too.

If you'd like to read a different viewpoint on dairy, here's an interesting Q&A with Alissa Hamilton, the author of Got Milked, whose tough talk on dairy is certainly more extreme than mine, but if you're looking for something to balance the Dairy Farmer's magical claims, definitely have a peek.

[Thanks to the public health RD who'd prefer to remain anonymous who sent this my way]

Dairy Farmers Did Not Break Law by Stating Milk Products Prevent Colon Cancer

Received an email on Friday from the Dairy Farmers of Canada's Executive Director Caroline Emond.

In it she expressed her concern that my blog post from June 29th was inaccurate. That blog post assumed that making the claims that milk products prevent colon cancer and type 2 diabetes, improve bone health, and confer healthy blood pressure wasn't legal by way of the laws guiding nutrient function claims which clearly state,

"Nutrient function claims may not refer to the treatment, prevention or cure of a Schedule A disease; or claim to treat, mitigate, or prevent a disease, disorder or physical state; or claim to correct, restore or modify an organic function [3(1) and 3(2), FDA]. Such claims are considered to be drug claims (see Drugs vs. Foods)."

But there's a catch as Ms. Emond's letter clearly lays out, which means that at least in Canada, it would seem the Dairy Farmers' claims are allowed.

Ms. Emond points out that according to the letter of the law, if the audience for the claims being made isn't the general public, the rules don't apply.

In her letter she quoted the 1987 decision of a judge from the Alberta Court of Appeals who stated,

"By including the word "general" as a modifier in s. 3(2) the broad term "public" is narrowed. The section totally prohibits advertisement to the general public. It is designed not to interfere with advertisements to the "specialized" professional medical community in specialized trade and professional publications, such as medical journals, pharmaceutical journals and so on."

I responded to Ms. Emond immediately and asked her if I could share her entire letter with the readers here, but since I have yet to hear back I wanted to publish this clarification which ultimately has me scratching my head about the fact that it's potentially legal in Canada to advertise and promote any claim you want to a community of influencers.

I was also curious about the judge's decision so I Googled the case law she cited. That decision was made in a case whereby the defendant offered to sell a product to an individual undercover food and drug inspector to who he described the product as being a treatment or preventative for heart disease, diabetes, hernias and ulcers. The judge's ruling, while it included the paragraph up above, also stated,

"The critical aspect is that the offer is made indiscriminately to everyone and anyone without regard to who may accept it."

and he continued,

"In this case there is no evidence that the accused made an indiscriminate offer to the general public; rather, her representations were directed at a specific individual."

I do wonder how this judge would feel about a booth placed in a room, which while filled no doubt with many health professionals and researchers, also included members of the general public, and certainly was not aimed at a specific individual.

(I have appended a link to this post to the original as well.)

Dairy Farmers of Canada Break The Law At Medical Conference

I took that photo up above at the recent Canadian Obesity Network conference's exhibit hall.

According to Health Canada and the Canadian Food Inspection Agency,

"Nutrient function claims may not refer to the treatment, prevention or cure of a Schedule A disease; or claim to treat, mitigate, or prevent a disease, disorder or physical state; or claim to correct, restore or modify an organic function [3(1) and 3(2), FDA]. Such claims are considered to be drug claims (see Drugs vs. Foods)."

And,

"Nutrient function claims are not made for a food per se; they may only be made respecting the energy value or nutrients in a food."

And yet here we see, in a room full of influencers important enough for the Dairy Farmers to buy a booth, that Dairy Farmers of Canada have explicitly claimed that the consumption of "milk products" prevents colon cancer and type 2 diabetes, improves bone health, and confers healthy blood pressure.

While dairy has a longstanding tradition of marketing a protein source with calcium as a uniquely magical elixir of strength and health, even I was surprised at how blatantly they ignored CFIA guidance in a room that among others might well have included conference attendee Dr. Hasan Hutchinson, the Director General of the Office of Nutrition Policy and Promotion within the Health Products and Food Branch of Health Canada.

Guess that means either the Dairy Farmers of Canada don't care about CFIA's guidelines, or that they're not worried about their enforcement, as the notion that they were unaware of the guidelines is simply not a possibility.

UPDATE, July 14th: The Dairy Farmers of Canada reached out to me, and citing 1987 Alberta case law, pointed out that in Canada, if the target of the message isn't the general public, they can make any claims they see fit. See more here.