Saturday Stories: Suicide Pacts, Last Days, and Kippahs

Julia Medew in The Sydney Morning Herald tells the true story of her parents' suicide pact - a must read.

Paul Kalinithi in the New Yorker on his last day as a surgeon.

Jonathan Tobin in Commentary on kippahs and the future of Europe.

Some Weeks Are Just Like This

But at least we're still breathing!

Hope you enjoy today's Funny Friday as much as my 3 pre-teen children (and I) did.

Have a great weekend!

Cut Sweet From Your Diet And Only Maybe You'll Need It Less

Lots of people try to reduce sugar, and of those who succeed, I'll regularly hear them tell me that after a little while, they no longer miss it. But are they not missing it much because their taste buds "change", or do they not miss it because of the psychological sunk costs of their personal investment into a low sugar diet?

Well that's what a recent PepsiCo study sort of set out to explore. Briefly, researchers randomized a small group of matched individuals to consume either a low-sugar, artificial sweetener free diet (40% reduction in simple sugars and total ban on artificial sweeteners), or a regular one for 3 months time after which they were told to consume whatever they wanted for the final month of the study. Participants tracked food by way of food diary, and given the nature of the experiment, clearly they weren't blinded to their study condition, and nor were the researchers. Each month of the study, participants were asked to rate the perceived sweetness of vanilla puddings and raspberry flavoured sweet drinks.

By month three the sugar and sweetener reduced folks were rating the pudding as 40% sweeter than the control diet group. They did not however rate it as any less (or more) delicious. There was also no change in their weight compared with the normal diet folks.

This was a small study, but that said, its findings aren't particularly heartening. If foods perceived as sweeter by those who have reduced their sugar intake are not also perceived as less enjoyable, the swap to a low-sugar diet won't be self-reinforcing and hence will be more prone to failing in the long term, and the fact that weight didn't change speaks to the notion that simply removing sugar from your diet isn't likely to be the weight-loss panacea some bill it to be. If only it were that simple.

Is The "100th Day" of School Really Worth Celebrating (With Junk)?

It's called "100th Day", and the first reference I could find to it was a kindergartner geared book published by Scholastic in 1996 called, "100th Day of School". Perhaps it hit the big time in 1999 when the New York Times featured a letter to the editor calling 100th Day "another February holiday".

It's meant to celebrate the kids being "100 days smarter", and for the younger kids, to provide an opportunity to practice counting to 100.

It's turned into yet another school sanctioned excuse to share junk food.

The letter up above was sent home to a friend of mine in Illinois with her kindergartner. Putting aside the fact that the teacher misspelled Froot Loops and seems to be a bit math challenged, here we've got a kindergarten teacher who seems to have just given up. 5 year olds are entertained by pretty much anything and consequently leaning on junk food to serve as a source of excitement and fun, beyond teaching 5 year olds that junk food serves as a source of excitement and fun, is also incredibly lazy. Or is the teacher just doing what one does on the 100th Day, and following through with what's considered normal?

Looking online it could be either.

I found plenty of similar letters:

But I also found plenty of ideas and celebrations that didn't involve food including this one that focused on activity

Add this to the pile of "just ones" that ultimately add up to a near constant parade of junk food being pushing on our kids. Birthday cupcakes, Valentine's Day, Halloween, Easter, Christmas, class-based rewards, and many, many, more - the opportunities for school based junk are plentiful.

Would love it if you'd head over to the Weighty Matters Facebook Page and let me know what the most ridiculous junk food tie-in your kids have had. I think mine would be when my eldest, at the age of 8, joined a school book club and instead of coming home and talking about the books, came home and talked about the help-yourself bowl of Twizzlers.

[Teachers, for a gazillion different 100th Day ideas, including tons of those that exclude junk food, here's a massive Pinterest collection of them, and if you're curious, the snacks in the first letter up above add up to 268 calories coming in part from their 5.4 teaspoons of sugar]

Saturday Stories: Looking Perfect, False Confessions, and Lost Canoeists

Jennifer Weiner in the New York Times asks, "When can women stop trying to look perfect?"

Douglas Starr in The New Yorker in 2013 discusses how police interrogation tactics can be run in order to produce false confessions.

Ben McGrath, also in The New Yorker, with a riveting story about a lost, solo, canoeist.

Sometimes Even Goats Need a Good Pep Talk

Today's Funny Friday video is just 6 seconds long. You've got 6 seconds for this goat whisperer I'm sure.

Have a great weekend!

Employing the "I Forgot To Buy It" Strategy for Healthier Pantries

In working with families who are trying to improve their homes' dietary choices, one of the barriers I regularly come across are worries about how kids will react to the removal of beloved, but perhaps not healthful, dietary staples (like the cookies masquerading as a wise choice up above).

It's probably an unnecessary worry.

The last thing I would recommend is the idiotic, TV-style, black garbage bag purge of your pantry that likely would come along with the admonition that the stuff in the bag isn't good and won't be brought back into the home ever again.

That style of an approach would no doubt put a child's back up, lead to frustration, conflict, and potentially help in cultivating an unhealthy relationship with food as a whole.

Instead I recommend something much simpler. "Forget"

Forget to buy it the next time you're at the supermarket, and when questioned by your kids as to the whereabouts of the products, apologize and tell them that you forgot.

Then buy it again somewhere down the road, and then when it next runs out, forget again to re-purchase, with lengthier and lengthier periods between repurchasing until your kids forget that the product was ever a regular part of their lives.

(Tackle foods you want to eliminate one by one using this method as "forgetting" a whole bunch of stuff all at once is pretty much an unspoken garbage bag purge.)

Are You Certain That For The Thing You're Certain About There's Certainty?

Certainty. When it comes to nutrition, healthful living, and weight loss advice, that's often what's being served.

There are anti-breakfast zealots who are just as passionate about no one ever needing breakfast as those who state that breakfast is an absolute must. There are low-fat fighters whose passionate beliefs, if embraced by the masses, will undoubtedly lead to new lines of unhelpful ultra-processed but high fat foods. And there are anti-calorie crusaders who'll have you believe that magically, in the context of a public that relies dramatically on boxes, jars, and restaurant meals, that calories won't count if you just choose wisely.

I could go on.

Honestly, even were the science of issues like those up above as black and white as many promote (it's not), in clinical practice, denying the fact that different approaches suit different people differently is a great way to fail patients.

All this to say, the opposite of dogma isn't dogma.

Saturday Stories: Non-Jewish Generals, Murder, and a Conversion

The report the High Level Military Group (HLMG) (here are the bios of the group made up of 11 non-Jewish, retired generals and military officials from five continents and a former UN war crimes prosecutor) on 2014's Gaza war.

Aman Sethi in The Guardian with a harrowing tale out of India involving exam fixing and murder.

Adrian Chen in The New Yorker and the amazing "conversion" of a Westboro Baptist Church member.

An Incredible Cravings Based Resolution-y Hello Parody

However you might have celebrated over the recent holidays, this Funny Friday Hello parody is for you!

Have a great weekend!

Mars Chocolates And "The Emotional Low Point of the Shopping Journey"

Flickr: bcostin

Describing their "deep understanding of the shopper" candy maker Mars reports working with retailers to try to entice consumers at "the emotional low point of the shopping journey" - checkout.

Mars explains that consumers at checkouts have three needs that retailers can meet: Refresh, Reward, and Remind.

Refresh, according to Mars, should consist of junk foods like gum, mints, beverages, and snacks, and take up 51% of checkout real estate.

Reward should be chocolate or non-chocolate candy and take up 39% of total checkout space.

Remind should be small items people might have forgotten like batteries and lip balm and take up just 10% of the checkout aisle.

Checkout is an area ripe for change. CSPI has been campaigning for candy free checkout aisles for some time, and some retailers have followed through citing consumer demand. I wonder if Mars' outreach has something to do with this changing tide?

Worth noting, the publishing industry would certainly be an ally in candy free checkout campaigns. Here is their frustrated response to Mars' push which they note, includes a "blatant omission of magazines". That said, given the contents and covers of checkout aisle magazines, it may be difficult to describe them as healthful either.

Is It Bad That Exercise Pills Might Be On The Horizon?

A little while ago I came across coverage and commentary about this article about the future possibility of pills that might in theory be able to replace exercise.

Predictably, the chorus of voices that rose up were full of indignation with sentiments that ultimately suggested that even if found to be incredibly effective, exercise pills would be the bastion of the lazy.

Is it lazy to want to improve your quality and quantity of life? Because that's what these pills would do if they did in fact provide people with the benefits of exercise. And yes, sure, it'd be lovely if everyone had the very real luxuries of possessing the health, time, money, and inclination to regularly and genuinely exercise, but except in the minds of those filled with I can do it and so should you lifestyle sanctimony, that's simply not the case for a large percentage of our real life population.

The Talk The Food Industry Couldn't Bear To Hear

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

A little over a month ago I was invited by the Ontario Medical Association to give a talk at a food industry breakfast. I was asked to speak about what I thought the food industry could do to help further public health.

3 days prior to the talk, after my flights and hotel were booked, after I cancelled a day of patients, I was dis-invited. Apparently the conference organizer, Ron Reaman, a Senior VP of the international PR and communications firm Fleishman-Hillard, decided that it would be better if I didn't come. Why he decided that I can't tell you because despite being a Senior VP at an actual communications firm, he didn't do me the courtesy of communicating to me his concerns or offering me an apology - instead he had the Ontario Medical Association simply tell me that I was no longer welcome.

The good news is the internet's a much bigger venue than that small breakfast symposium and given I'd already put together my slide set, I figured why not post it online. Online I don't have a time keeper and given I'm not speaking solely to the food industry, I don't need to be as gentle with my messaging as I'd planned. Also good news is who I'll now be able to reach. My blog is read by policy makers, public health authorities, chief medical officers, professors, physicians/dietitians and other allied health professionals, journalists and nutrition bloggers the world over - folks that wouldn't have been attending that small, intimate, food industry sponsored breakfast. You'd almost think Mr. Reaman and Fleishman-Hillard were working for me and not for the food industry as uninviting me will enable me to communicate my message far further than I ever would have done otherwise.

So here's my talk. It's about what the food industry could do to improve public health, why they're not going to, and what we can do about it. But before you click it, a quick request - I want you to share it by means of every socially networked channel and email contact you have (any Redittors here?), because if Fleishman-Hillard the communications firm hired by the food industry to help cultivate good Big Food PR didn't want it heard, I figure it probably ought to get spread.

[Fair warning too - at one point I get a bit heated and use the word "ass", and believe it or not, I wasn't using it to refer to the food industry, or even to Ron Reaman.]

Why Collecting Pop-Tabs for Ronald McDonald House Is a BAD Plan

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

Another from the parental "No" files - this one from a frustrated Canadian mom.

She told me the story of her child's school and their campaign to collect pop tabs from cans of soda-pop to help raise money for their local Ronald McDonald house.

The campaign involved kids from Kindergarten through Grade 4 and prizes were awarded to the kid and the class who collected the most tabs. Ironically it was organized by the school's health teacher.

Now this mom's all for charity, but wonders whether or not the task and the competition attached to it wouldn't in turn encourage the community's consumption of soda pop, lead young and impressionable children to tie soda pop consumption with the very important and positive emotion and message of charity, and further normalize soda's regular consumption.

Apparently her child's school, collected 3 large garbage cans full of tabs - 90 gallons worth (340 litres for us Canadians).

Looking online it would seem that scrap aluminum sells for somewhere on the order of $0.30-$0.60/lb and that a gallon milk jug holds roughly 4,000 tabs and weighs roughly 3.3lbs.

Crunching a bunch of numbers tells me this:  A health teacher linked drinking soda pop with being charitable in the minds of kids between the ages of 4 and 10 and in so doing helped to galvanize her community of only 3,000 people to drink 360,000 cans of soda pop (an astounding 120 cans per resident) all in the name of raising a measly 133 dollars and 45 cents.

Now I'm all for raising money for charity, but is this really a wisest and best way to do so? Couldn't the health teacher come up with an actually healthy behavior with which to raise funds, let alone one that raises a more substantial sum? To give the briefest of examples - a few weeks ago my 3 little girls set up an organic vegetable stand at the end of our driveway to support their CIBC's Run for the Cure fundraising efforts.  In just 1 hour of selling our home grown cucumbers, oregano, and basil they raised 115,200 pop tabs worth of money ($48).  And if garden vegetable sales aren't the school's thing perhaps the kids could clean up local parks and go door to door asking for donations? Or how about a used book fair? Or a physical activity fundraiser where the kids ask for sponsorship? Or a kid run car wash?

Now this mom did in fact say "No" to drinking soda for Ronald McDonald House, but I wonder how many kids' parents, when asked while shopping with their kid if they could buy some soda to help raise money for kids with cancer, didn't pick up a case or two they wouldn't have otherwise?

Does your kids' school collect pop-tabs for Ronald McDonald house? If they do, please show them this post - there's no doubt there are healthier and far more lucrative ways to raise money for charity than to promote the consumption of soda pop.

If This Isn't Proof Society Is Broken, I Don't Know What Is

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

Thanks to my friend Kev for forwarding to me this actual photo of his microwave that clearly identifies what the world must perceive "Kids Meals" to be - mac and cheese, chicken nuggets and hot dogs.

If that's kid food, what do you think those kids who are eating it regularly are going to gravitate to as grownups, let alone what they're going to feed their future children?

Parents - as far as I'm concerned it's your obligation to ensure that before your children move out, they can cook 10, healthy, from fresh whole ingredients, meals. Much more important that they learn to do that than learn how to play soccer or hockey.

Do You Confuse How You're Doing With What You Weigh?

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

It's certainly what society teaches.

If you're trying to lose or maintain your weight the scale will tell you how you're doing.

Bollocks.

The scale never tells you how you're doing. The scale only tells you what you weigh.

How you're doing is what you're actually doing. Are you cooking healthful meals? Are you organizing your dietary timing, calories, and proteins? Are you minimizing meals out? Are you being thoughtful? Are you keeping track of your choices and intake? Are you exercising? Are you consistent in your efforts?

Boiling it down even further ask yourself,

"Am I living the healthiest life that I can honestly enjoy?"

If the answer's yes, you're doing great - scale be damned.

The fact is sometimes you weigh more than how you're doing even when you're doing great.

Why Is Weight Loss Quackery Being Sold By Pharmacists?

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

A reader sent me the photo up above. It shows at best non-evidence based, at worst completely useless and not necessarily safe weight loss quackery is being prominently sold by placard in at least one Ontario pharmacy at their pickup counter.

How is this legal?

The short answer is that it's legal because Health Canada just doesn't care. They don't care that pharmacy shelves are filled with nonsense that not only wastes their money, but also potentially their health as they may supplant physician visits and medical care for the promises festooned on the side of a bottle.

But do pharmacists care? In this case do they care that my reader thinks customers will take the promotion of Dr. Oz miracle pills at their pickup counter to be a professional endorsement by the pharmacists themselves?

Pharmacists are highly educated health professionals and here in Ontario (where the photo up above was taken), they're regulated by the Ontario College of Pharmacists (OCP), and represented in Canada by the Canadian Pharmacists Association (CPhA).

Peeking at the OCP website I came across their Model Standards of Care document and in it, this statement,

"23. recommend non-prescription drug therapy only having collected and interpreted patient information to ensure that:

• there are no significant drug interactions or contra-indications, and
• the medication is the most appropriate in view of patient characteristics, signs and symptoms, other conditions and medications, and
• the dose and instructions for use of the medication are correct"

But given that there is no dose (no human trials) how could any amount of it ever be considered "appropriate"?

And what of the CPhA?

While they don't have the same sort of Standards of Care document, they do have one on Direct-To-Consumer Advertising and in it they note,

"the information available to patients must be objective, accurate and comprehensive."

Does that sign up above suggest objectivity, accuracy and comprehensiveness?

Beyoncé, Why Do You Hate My Children? (an open letter)

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

Dear Beyoncé,

I have 3 beautiful little girls - 8, 5 and 3. While they're not quite old enough yet to know who you are, I've no doubt they'll both discover and adore you over the course of the next few years. What you say to them, what your advertisements will say to them, will likely carry a great deal more weight than what I might say - after all, I'm just their dad, whereas you, you're Beyoncé. And apparently you're going to tell them, either directly or indirectly, that you love drinking Pepsi Cola.

The New York Times reports that your recently inked Pepsi deal will last for years, cost them $50 million, and for Pepsi it's meant, "to enhance its reputation with consumers".

Of course it's also meant to sell Pepsi - at least $50 million dollars more worth.

Beyoncé I'm sure you're aware that these days the world isn't the healthiest of places, and that the consumption of huge amounts of empty and often sugary calories is contributing to the burden of chronic diseases like diabetes, heart disease, and obesity - and here I'm not even talking about adults. With truly terrifying regularity, kids under the age of 10 are being diagnosed with what was once referred to as "adult-onset" diabetes. Teens are having heart attacks. In your own lifetime, childhood obesity rates have tripled. You might even be aware that in North America, teen girls get 15% of their daily calories from soft drinks. Why would you want to perpetuate that tragedy? In fact I'm virtually positive you're aware of all that given your involvement with Let's Move. So I have to ask: Is your star fading? Did you make some terrible investments? Do you think sugared soda's not as bad as the medical community makes it out to be?

I can't fathom why a star as successful as you would want your own wagon and brand selling Pepsi. While I appreciate that you owe my little girls nothing, I would have hoped that someone with your star power wouldn't need or want to sell children sugar water.

Beyoncé, why do you hate my 3 little girls?

Sincerely,
Yoni Freedhoff, MD

The Greatest Danger of Processed "Home Cooking"

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

It's not necessarily the actual food, but rather it's what it teaches.

Take the fish example up above. Nutritionally I'm guessing that it's pretty much the same as if you breaded, seasoned and pan fried the fish yourself.

But the message?

The message is that good healthy food comes in boxes.

And the message that's lost?

That it's actually not even remotely difficult to buy fresh fish, season it and pan fry it. And if fresh is a challenge, perhaps even preparing plain frozen fish fillets that you first thaw for a few moments in a sink full of water. 

Reliance on boxes robs people and their highly impressionable children of the basic life skill and healthy living importance of cooking while simultaneously perpetuating the de-prioritization of actual meal preparation from our modern day lives.  While the final outcome in this case might be nutritionally comparable, and might even take 1 or 2 minutes less time than from scratch, I'll still label it as part of the problem, rather than part of the solution.  Sure, rely on products like this in a pinch, but I'm guessing many rely on them more often than not.

We're not going to solve society's nutrition related woes with boxes.

Saturday Stories: Shrimp Slavery, Anti-Zionism, and Conflict of Interest Bingo

The AP's Margie Mason, Robin McDowell, Martha Mendoza, and Esther Htusan with a devastating report on how you might well be eating shrimp peeled by slaves.

Alan Johnson in Fathom on the call to boycott just one state in the whole wide world, the Jewish one.

Daniel Goldberg in the BMJ with an expanded edition of his conflict-of-interest Bingo.

Maybe I Should Start Watching Ellen

Because my sense of humour is definitely juvenile enough to enjoy today's Funny Friday.

Have a great weekend!



[Thanks to our office's Lorne for sharing]

Badvertising: For God's Sake, Just Frickin' Eat Butter!

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

Yet another example of why national Food Guides matter.

Here's an advertisement from Becel for its Becel Buttery Taste Margarine which they flog as,

"having 80% less saturated fat than butter and with a delicious buttery taste"

They also make sure to note,

"A healthy diet low in saturated and trans fat may reduce the risk of heart disease"

Yet saturated fat has been exonerated as being a dramatic independent risk factor of disease....probably something worth telling the general public, but of course Health Canada can't possibly respond to a changing evidence base by actually changing recommendations. I mean come on, that would mean changing the Food Guide more frequently than every 10-15 years.  That's just crazy talk.

You know what else has a "delicious buttery taste"? Frickin' BUTTER! And it has the same number of calories as the margarine you're buying because you like the taste of butter but are scared of it because your government told you to be.  Well guess what?  using butter as a condiment isn't likely to hurt you and guaranteed, it'll be far more delicious than your "buttery",

"Canola and sunflower oils 74%, water, modified palm and palm kernel oils 6%, salt 1.5%, buttermilk powder 1%, soy lecithin 0.2%, natural & artificial flavor, potassium sorbate, vegetable monoglycerides, citric acid, alpha-tocopherol acetate, calcium disodium EDTA, vitamin A palmitate, beta-carotene, vitamin D3."

Just frickin' eat butter!

Sigh.

If Coca-Cola Doesn't Market to Kids, Why Do they Sell Toys?

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

No one can ever say Coca-Cola doesn't have chutzpah.

A few days ago The Chicago Tribune's Julie Deardorff published a critical article on Coca-Cola's funding of playgrounds suggesting doing so was effectively marketing to kids (something Coca-Cola has pledged not to do). Her story led Kevin Morris, Coca-Cola's vice president of Public Affairs and Communications, to write the Tribune to express his indignation at the very suggestion that Coca-Cola targets children in their marketing,

"You can imagine my disappointment when I read Tribune reporter Julie Deardorff’s 'Kids who play sports eat more junk food: Study(News, Feb. 24), the second article this month that failed to provide readers with a balanced perspective about the Coca-Cola Co.'s business practices.

To set the record straight, Coca-Cola does not market our beverage brands in venues where children under the age of 12 years are the primary audience. Coke has adhered to this policy for more than 50 years, and it extends to youth sporting events and clubs."

That argument, that Coca-Cola is an upstanding corporate citizen that would never, ever, target kids is one I've covered before, where thanks to the magic of YouTube I was able to quickly pull out 16 different Coca-Cola commercials that in my mind at least, dispute Kevin and Coca-Cola's self-righteous claims of innocence. I also blogged about Coca-Cola's recent "Great Happification" campaign, which if it isn't designed to target kids, then I guess bikini-clad beer commercials also aren't designed to target men.

So according to Kevin, Coca-Cola has a 50 year old policy of not marketing brands in venues where children under the age of 12 are the primary audience, and that the aforementioned policy extends specifically to sporting events. If that's the case Kevin, what do you think went on with the 2011 Vienna City Marathon's literally entitled, "Coca-Cola Kids Challenge" a sporting event where the sole criterion for entry was being younger than 10 years old (photo up above and down below)?

But you know Kevin, let's not nitpick about whether or not Coca-Cola branded sporting events for kids 10 and under are in fact Coca-Cola branded sporting events for kids 10 and under. Instead let me ask you this, if Coca-Cola doesn't market to kids, why does Coca-Cola sell toys?

Looking at Amazon.com's online Toys and Games category there are 719 different Coca-Cola branded toys, including dolls with packaging that clearly states they're for kids aged 3+, 100 piece puzzles aimed at the more sophisticated 5+ crowd, Barbies, stuffed animals, toy cars and more.

Don't branded toys count as marketing?

It's shameful Kevin. Not the fact that your company makes a profit by selling various products, that's the American way, but rather what's shameful is what seems, at least on the surface, as a bald faced lie that Coca-Cola doesn't specifically hold children squarely in their marketing cross hairs.

But maybe I'm confused? Maybe I'm misunderstanding your claim and you've got a way to explain to my readers why I'm out to lunch. If you'd like to make the case that products like the Coca-Cola Kids branded Carmen, where her very packaging suggests the intended audience is aged 3+, along with all the other products posted below, as well as that 10 and under sporting event last year in Vienna, still fit within your company's supposed 50 year promise of not targeting children, please feel free to post a comment.

"Coca-Cola Kids" Dolls for Ages 3+

100 Piece Puzzles Advertised for Ages 5+

Barbie Dolls

Toy Cars

Toy Trucks

Lego

Stuffed Animals

Wind Up Toys

Yo-Yos

A Food Industry/Public Health Partnership I Could Support

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

A few weeks ago I at a talk I was giving in Halifax I was asked by my colleague Dr. Geoff Ball if I was still diametrically opposed to partnerships between public health organizations and the food industry.

My answer was, "Yes".

That said, over the past few years of my very vocal opposition to such partnerships I've been regularly challenged to come up with a mechanism that I could in fact stand behind.

So for what it's worth, here's what I've been considering.

What if there were a nutritional research fund that was financially supported by the pooled resources of the food industry, but governed by academics?

Where the various food industry players who want to be "a part of the solution", put their money where their mouths were - with unrestricted grants to this hypothetical fund?

Those monies would then be distributed on the basis of merit and need to nutritional research projects by means of academics with no industry ties.

The food industry folks could still talk of their being part of the solution by means of corporate social responsibility reports that would highlight the money they're sinking selflessly into the fund, while researchers wouldn't be beholden to the food industry, nor would projects be chosen on the basis of what the food industry believed would result in product favourable outcomes. Keeping the food industry at arms length would also preclude industry's use of health organization's logos or specific researcher's good names to sell their products and healthwash their brands.

It's not a perfect system as the industry players could still use their involvement in the fund as proof of their playing ball and might leverage that involvement into political gains and deflecting industry unfriendly legislation, but compared with the mess that currently exists consequent to these partnerships - I'd call an arrangement like this one as close to a win-win that I could imagine.

"Diabetic Surgery" Uncovers Irrational Weight Biases

While I'll be taking a break from blogging for the next few weeks, I'll be posting some of my favourites from back in 2012.

In case you missed the news, two recent studies (here and here) published in the New England Journal of Medicine demonstrated dramatic superiority of surgery over intensive medical management in the treatment of type 2 diabetes.

Now I'm not going to get into the studies here and dissect them for you, but I think that they were well done studies, and while admittedly we still don't know what their long, long, term benefit will be, at 2 years out, they look damn good with surgery coming out worlds better than "intensive medical therapy" for the treatment (and remission in many cases) of type 2 diabetes.

Of course time's definitely a fair concern. Meaning what if 5 or 10 years down the road the folks who had the surgery are no better off than those on medical therapy? Thing is, based on what we know already about the surgeries involved, all have well known 5 year data, and the bypasses and diversions much longer than that, and those studies, while they weren't specifically designed to look at diabetes alone, did look at weight and medical comorbidity regains, and I certainly don't recall anything that suggested diabetes returned with a vengeance.

So basically here we have a surgical intervention that is dramatically better than a medical one, for a condition that causes cumulative damage and can wreak havoc on a person's quality and quantity of life.

Yet many MDs, allied health professionals and health reporters, including some who I know, respect, and admire, are taking this opportunity to discuss how we shouldn't be looking to surgical solutions for diabetes because patients could instead use their forks and feet. While there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress - the simple fact remains that we don't yet have a proven, reproducible and sustainable approach to lifestyle change.

And what of those folks not wanting to change?  I say, "so what?".   Since when did MDs, allied health professionals or health columnists earn the right to judge others on their abilities or desires to change? Our job is to provide patients with information - all information - including information on lifestyle change, medical management and surgery. We can even provide patients with our opinions as to which road we think may be best for them, and why, but honestly, given the results from these studies, I'm not sure how anyone could make an evidence based case that surgery isn't a very real and powerful option that ought to be discussed with all of their patients with diabetes and obesity.

Unless of course that someone has some form of weight (or simply anti-surgery) bias.

Let me give you another example. Let's say there was a surgical procedure that folks with breast cancer could undergo that would reduce their risk of breast cancer recurrence by roughly 30%.  Do you think anyone would question a woman's desire to have it? I can't imagine. And yet lifestyle - weight loss and exercise has indeed been shown to reduce risk of breast cancer recurrence by 30%. Think people would dare suggest the women choosing surgery were, "taking the easy way out", that they should just use their forks and feet?

We've got to get over ourselves.

Until we have a proven, remotely comparable, reproducible, sustainable, non-surgical option, if you bash the surgical option on its surface for being "easy", or "wrong", you might want to do a bit of soul searching as to whether or not you're practicing good medical caution, or if instead you're practicing plain, old, irrational bias.

[and for new readers to ensure there's no confusion - I'm not a surgeon]

Saturday Stories: Toxic Hucksters, Pediatric Antipsychotics, and Nothing

Kavin Senapathy in Forbes covers the rise of the toxic hucksters Joe Mercola, The Food Babe, and Mark Hyman.

Alan Schwarz in the New York Time covering the disturbing rise in the prescription of anti-psychotics to children.

Sasha Martin in Global Table Adventure on the joy of giving her family nothing for Christmas.

Shakespeare and Chillis

Today's Funny Friday highlights what happens when you take British actors, have them eat some of the world's hottest peppers, and then recite Shakespeare monologues.

Have a great weekend!

Coca-Cola Latest Ad Says, "Don't Believe Everything You're Told"

Took my eldest to see The Martian this past weekend, and a pre-movie Coca-Cola Christmas ad aired.

The ad's below.

The ad's premise is straightforward. The spot highlights sentiments that with the help of Coca-Cola and Christmas, are proven to be wrong.

"Don't open the door to anyone" sees a boyfriend dressed in a reindeer costume surprising his girlfriend.

"Don't accept anything from strangers" sees a father and daughter buy a man painting a Christmas mural a bottle of Coca-Cola

"Nothing in life is for free" sees a woman drop her change and stranger in return buying her a bottle of Coca-Cola from a vending machine

"Nothing lasts forever" sees a couple's kids looking at a photograph of their parents young and in love and sharing a bottle of Coca-Cola followed by their parents old and in love sharing a bottle of Coca-Cola.

But there were two messages that didn't have any obvious explanations.

There was,

"Don't believe everything you're told",

and,

"Don't mind everything you hear".

The first features a very young boy excited to see Santa, and the second has Santa chugging a bottle of Coca-Cola.

Could these messages be Coca-Cola's subtle response to their absolutely disastrous year in regard to public relations, sponsored research, public-private partnerships, the rising tide of calls for sugar-sweetened beverage taxes, and the seemingly global effort at encouraging a reduction in the consumption of added sugars?

Guest Post: Help the Environment by Eating More Processed Food?!

Today's guest post comes from our office's fantastic RD Emily Spencer

TerraCycle is an up-cycling and recycling company that collects difficult-to-recycle packaging and products and turns the material into a variety of consumer products like cutting boards, garbage cans, and picnic tables.

Here’s the catch.

TerraCycle has made its way into schools with an aim to teach children about the environment by having them collect and recycle their processed food containers and wrappers, among other items. Don’t get me wrong; I think that teaching children about creating sustainable environments is important. The issue with this is that the school receives points from TerraCycle based on the amount of empty food packaging they send in. These points can then be redeemed as cash rewards for the school. In other words, the more processed, packaged food sent in school lunches, the better. There are even contests in schools where the child who collects the most packaging will win a prize. Wrappers and containers from Schneider’s Lunchmates, Kraft Lunchables, Koolaid Drink Pouches, and Mr. Christie Cookies are a few examples of waste accepted by TerraCycle.

While I’m all for recycling, I can’t help but think that rewarding the frequent consumption of processed, packaged food is not the right approach to help the environment…or the health of our children.

And the story isn’t over yet.

The large majority of the repurposed products made with the children’s empty food packages are covered in recycled food companies' logos (see examples here and up above). So in addition to being rewarded for eating processed food, children (and adults) can now have the pleasure of doing free advertising for the food industry by carrying around heavily branded items like tote bags and backpacks.

I wonder how long it will take until a Koolaid pencil case or Lunchable notepad ends up in a landfill anyway?

Unfortunately this is yet another clever partnership for the food industry that provides little in terms of teaching children about the environment. TerraCycle should stick with repurposing ink cartridges and laptops into useful, unbranded consumer products, not in causewashing "foods" that kids would likely be better served without.

Emily Spencer, RD, MScFN
Registered Dietitian

Emily Spencer, MScFN, RD graduated with a Master’s of Science in Food and Nutrition from Brescia University (affiliated with Western University) in 2014. Her major research project during her master’s degree was focused on evaluating a community based lifestyle and behaviour change program for adults with prediabetes. Her undergraduate BSc in Food and Nutrition was also completed at Brescia University in 2012.

As an adventurous food lover, Emily enjoys cooking and experimenting with foods from all cultures, trying just about anything – even scorpion! You never know what you’ll like until you give it a chance!

Holiday Gift Guide

I haven't done any reviews for a long time so today I'm reviewing and recommending a bunch of items I love. You should know, that if you use the links to purchase them on Amazon, I will receive a small commission.

The Cookbook: The Food Lab: Better Home Cooking Through Science, by J. Kenji López-Alt

(Personally purchased)

The second this cookbook was available for pre-order on Amazon, I jumped on it, and it's so much more than just a cookbook. Think cooking meets science. The book has received beyond glowing reviews (like this one in the New York Times) and seems to be on everybody's must buy list - mine included. Not only will Kenji guide you in making incredible food (including beautiful pictures and careful step by step instructions of the techniques required to master a dish), but he'll review the scientific process he applied to perfect each and every one. The book's a monster, and it's a great buy for home chefs new and old (and if you're buying it as a gift, consider buying yourself one too - it's that good).

Here's an here's an Amazon link for the US, and here's an Amazon link for Canada.

The Pleasure Read: Dr. Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine, by Cristin O'Keefe Aptowicz

(Cristin and I share the same incredible literary agent (Yfat Reiss Gendell) and agency (Foundry Literary and Media) and I was sent a free copy to read. Shortly after I started reading it however, I elected to purchase a Kindle copy)

Dr. Mütter's Marvels is an engrossing read. It tells the tale of Dr. Thomas D. Mütter, a surgeon who practiced his craft just before, and just after, the dawn of anesthesia. Mütter exemplifies what it means to be a caring physician, and reading it left me feeling humbled and awestruck by Mütter's skill, compassion, and genius. The history recalled is amazing - from the fact that nitrous oxide was originally promoted by its inventor as a hangover cure, to the ushering in of its use in anesthesia with the observation made by Massachusetts General Hospital's John Collins Warren, "Gentlemen, this is no humbug".

Aptowicz brings her long dead characters back to life, and in so doing, gives us a glimpse at what might have been with us, had we not the fortune of being born 150 years later. Many of Mütter's quotations resonated with me. Here's one on surgery that might as well be about nutrition,

"It is a surprising as well as humiliating reflection, that even with all this energy and vigor, with all the lights of modern science to guide us, with all the accumulated facts, false as well as true, of the crowd of laborers in the field, there should exist such diversity of opinion on subjects of the most constant observation."

And this one on life as a whole,

"This world is no place of rest. It is no place of rest, I repeat, but for effort. Steady, continuous, undeviating effort."

Here's an Amazon link for the US, and here's an Amazon link for Canada.

The Coffee Roaster: FreshRoast SR500 Automatic Coffee Bean Roaster

(I was given one of these as a birthday present 3 years ago. Have been roasting my own coffee ever since)

I love coffee. Years ago I made the switch to black coffee and along with it, to roasting my own beans. Though there's definitely an investment in buying one of these roasters (they'll run you between $150 and $200), if you've been grinding pre-roasted beans at home, it'll rapidly pay for itself. I buy one 50lb bag of green coffee beans a year (green beans can be stored for up to 3 years before going bad) from Toronto's Green Beanery. By buying in bulk I'm paying, depending on the bean, somewhere between $6-$9/lb - markedly less than the pre-roasted beans I'd be buying - savings that more than cover the cost of the machine within a year of purchase. If you do decide to home roast, buy some bean samplers and play around with times and temperatures. For US readers, Sweet Maria's is a great green bean wholesaler and there's lots of terrific FAQs and how-tos there as well.

Here's an Amazon US link (sorry, no link for Canada but you can buy at Green Beanery or use the US Amazon link which does ship to Canada).

The Portable Speaker: FUGOO Tough - Portable Rugged Bluetooth Wireless Go Anywhere Speaker Waterproof Shockproof Mud-proof Snow-proof

(Received this speaker for my birthday this year)

I love this portable speaker. The battery life is a ridiculous 40 hours, you can buy an accessory handlebar bike mount (I received one with the gift), it's loud, sounds great, and is virtually bomb proof. Biking with it on my commute to work I'm able to hear both the music and the world around me. We use it at home for impromptu dance parties with the girls as it hooks up via Bluetooth to my smartphone which allows me to stream their favourite songs via Youtube videos. I also use it as an internet radio as once connected to my smartphone, via the free app TuneIn radio, I can listen to radio from anywhere in the world.

Here's an Amazon US link and here's an Amazon link for Canada

The Ultimate Workout Headphones: Jaybird X2 Sport Wireless Bluetooth Headphones

(Received these as a birthday gift two years ago)

I'm so taken with these headphones that I'm reviewing them here a second time. I tried for years to find workout headphones that were comfortable, delivered great sound, and actually stuck in my ears regardless of how hard the workout or the amount of sweat. Then I got the Jaybirds. Not only did they meet all my needs, but they also were Bluetooth headphones that allowed me also to take calls. Truth be told, my experience with the calls feature hasn't been stellar - some connections are great, others less so - but friends who have these headphones as well have told me they've never had a problem so perhaps mine are a bit wonky. At two years old mine are still going strong, but were they to break, I'd spend my own money buying them again in a heartbeat.

Here's an Amazon US link, and here's an Amazon link for Canada.

The Smartphone Sport Armband: Grantwood Technology's TuneBand

(I've bought one for each new smartphone I've ever owned)

If you're looking for a stocking stuffer for the exerciser in your life, or the perfect accessory to go with the Jaybird headphones consider the TuneBand. It's a simple silicon sleeve that securely houses your smartphone while its easily adjustable velcoro armband secures your phone to your arm. I've used one since my first smartphone (the iPhone 4), and I'll likely keep on buying them as phone shapes and sizes change.

Here's an Amazon US link, and here's an Amazon link for Canada.

Holy Crap, My Blog's 10 Years Old!

2,797 articles and I'm guessing nearly 2,000,000 words later and this blog's turned 10.

I started writing it at the suggestion of a friend and I've kept writing it because I love doing it.

Moving forward I plan to keep writing, though I have been mulling over reducing the frequency of posts a bit. I think it may help me (and readers) with some sanity.

Thanks to Google and Blogger for providing the free platform, and thanks to you for taking the time to read.

Saturday Stories: Extremism, Gaslighting, and Boycotting

Doug Saunders in The Globe and Mail discusses built environments and how they might help to discourage religious extremism.

Amber Rogers at her blog Go Kaleo gives an internet manipulation 101 lesson on "gaslighting", something I see regularly on this blog's Facebook page.

Brendan O'Neill in The Telegraph explains the bigotry and hypocrisy of the BDS movement.

For Jewish Users of Medical Marijuana

What could be more festive than this Funny Friday chanukiah?

Have a great weekend, and for those who celebrate, chag sameach!

Ottawa City Hall Gives Free Coca-Cola to Children In Return For Hugs

Children lined up yesterday to hug an Ottawa City Hall based Coca-Cola vending machine to get a free cola.

Why is the City of Ottawa currently handing out free Coca-Cola at City Hall? What could possibly be in it for the city?

I'm genuinely not sure what the answer is. I asked the Mayor yesterday, but unfortunately didn't hear back.

I have to imagine it might be along the lines of holiday spirit, or "fun".

I know what's in it for Coca-Cola though. Virtually free, powerful, emotional, branding, along with the opportunity to inculcate themselves with Ottawa City Hall where at least one City Councillor tweeted out a video (which I've uploaded to YouTube) of the next door school's kids having at it. His positive tweet suggests the probability that the hug based vending machine bought some Coca-Cola goodwill with him - something that might be useful were the city to one day consider a soda tax or moves to limit the vending of sugar sweetened beverages in city run buildings.

.
Here's how a reporter on the scene described the influx of kids seeking City endorsed free Coca-Cola,

Literally one million Lisgar kids are getting free full-sugar pop from a huggable Coke machine at City Hall.

— David Reevely (@davidreevely) December 2, 2015

The question that we have to consider as a society is whether there are ways other than handing out sugar water or junk food to inspire holiday spirit or "fun", and perhaps more reflectively, how it is we've come to a point in time where using junk food and sugar water to entertain at every event no matter how small, is so normalized that it occurs even in the City Hall of the city whose Mayor is Ontario's former Minister of Health Promotion?

[Thanks to Twitter's Alan D for sharing.]

UPDATE: According to reporter David Reevely, the city has a $250,000 per year "Pouring Rights" contract with Coca-Cola.

The city says the Cokes-for-hugs machine is part of a 5-year "pouring rights" deal with Coke. They move it around. A day here, a day there.

— David Reevely (@davidreevely) December 2, 2015

Are Menu Board Calories a Flop?

A recently publicized study reports that 5 years on and menu board calories out of NYC haven't led to behaviour change.

I'm still a supporter.

Why?

Well, firstly we know that posted menu board calories only matter to those who care about calories, and given pre-order surveys of patrons in New York City (where the recent study was conducted) showed that only about 15% of folks care, it's not particularly surprising to learn that overall drops didn't occur. Speaking personally, and with my patients, and with folks online, there's no doubt that those who care do use the labeling.

Secondly, what no study of menu board calorie impact will ever measure are the calories not ordered by the patrons who decided consequent to menu board calories postings, to eat out in restaurants less frequently and hence weren't included in the study at all.

Thirdly the study looked at the impact menu board labeling had on exclusively fast food purchases. Of all venues, fast food restaurants don't strike me as the places where we'll see major changes. People go to fast food restaurants to get specific and "fast" foods. People know what they're going to order before they even step in the door. People go for their Big Mac's, their nuggets, their chicken buckets, etc. Fast food restaurants have far less variety, and likely, aren't frequented as often by folks who'd report caring about calories/nutrition in the first place.

And lastly, there is never going to be a singular intervention that'll do the trick, but that doesn't mean we should scrap the single interventions, especially ones that simply provide consumers with information that will help to inform their decisions.

As I've mentioned on this blog before, couple menu board calories with better nutritional education in schools, public health campaigns surrounding daily caloric needs as well as a call to action to bring back home cooking, the end to crop subsidies that allow fast food to be sold for pennies, an advertising and toy ban for fast food companies targeting children, and maybe we'll see some changes.

Canadian Beverage Association Poised to Take Credit for Existing Consumer Trend

Did you hear about the "Balance Calories" initiative launched by the Canadian Beverage Association, Coca-Cola, PepsiCo, and Motts?

The strap line for their press release is,

"Industry aims to reduce beverage calories in the Canadian diet by 20% over the next 10 years"

But beverage calorie reduction is an existing trend. Between soda taxes and news like yesterday's which saw Applebee's restaurants removing soda from their kids' menus, change is here, and it's much to the chagrin of the soda industry, not consequent to its good behaviour.

I think a more accurate strap line would be,

"Industry aims to take credit for ongoing reduction of beverage calories in the Canadian diet over the next 10 years in a bid to try to forestall industry unfriendly legislation like sugar sweetened beverage taxes."

And it's already paying off for them. On their website are quotes of praise from the Ontario's Minister of Health Promotion, the Ontario Minister of Agriculture and Food and Rural Affairs, the managing director of EPODE Canada and director of the EPODE International Network, the President of the Global Alliance for Improved Nutrition, and the Mayor of Toronto.