Saturday Stories: Flight MH370, Adult Vaccination, and A Lost Aircraft Carrier

William Langewiesche, in The Atlantic, with just incredible reporting on what we do and don't know about the final flight of Malaysia Airlines MH370.

Andre Picard, in The Globe and Mail (but via his Tumblr), on how we've forgotten that vaccination isn't just for children.

Ed Caesar, in The New York Times, on the epic hunt for a lost WWII aircraft carrier.

On Instagram, RD Working For Welch's Implies That Drinking Welch's Grape Juice Won't Raise Your Blood Sugar (By @DylanMacKayPhD)

Today's guest post comes from Dylan MacKay. Dylan is a nutritional biochemist who has type 1 diabetes and when I saw RD Marie Spano's Instagram post, I knew he would have both personal and professional thoughts to share and so I invited him to do so.

I don’t know what it is with grapes but they always seem to be raisin my ire…

I mean as a person with type 1 diabetes, a PhD in Human Nutritional Science, and who does diabetes research and occasionally clinical trials looking at glucose response, maybe I’m not the one to talk about this, but I just can’t not.

Recently a Welch’s (*cough* big grape juice) "nutrition advisor" posted the above nutrition translation travesty on Instagram.

This really surprised me because when I have low blood sugar I often drink grape juice, How am I still alive? I mean I can honestly say there are times grape juice may have saved my life (by raising my blood sugar). Yet you could potentially look at this Instagram post and fairly think

“drinking 100% juice made from polyphenol-rich fruit juice does not raise your blood sugar”

unlike apparently that bad candy or pop that raises your blood sugar.

That would be of course 100% wrong.

Polyphenols are not magic sugar blockers, otherwise we would be using them to treat diabetes and you would get serious gastrointestinal upset from eating berries and grapes. I feel like you don’t even really need to be an RD to see this messaging is bad (Seriously, Welch’s advisors, how much do you get paid for your credibility?). Especially on a social media platform, where someone might not scroll to the end of the associated comment and look at the “reference” provided.

Speaking of the reference used for this knowledge translation crime, it is for a review article called Impact of Dietary Polyphenols on Carbohydrate Metabolism and having reviewed it I can say it does not support the claim in that post. Most of the article talks about animal or cell culture results that show polyphenols may impact glucose digestion or absorption, but there's nothing in the article showing it stops it. It even concludes that

“To confirm the implications of polyphenol consumption for prevention of insulin resistance, metabolic syndrome and eventually type 2 diabetes, human trials with well-defined diets, controlled study designs and clinically relevant endpoints… are needed.”

The closest thing in the article supporting the Instagram post is

“The shape of the plasma glucose curve with reduced concentrations in the early phase and a slightly elevated concentration in the later phase indicates delayed response due to berry consumption”

about a study done with 12 healthy participants looking at berry puree (rich in polyphenols). The polyphenols (or something else in the berries) changed the timing of the blood sugar elevation.

I suppose the Welch’s RD nutrition advisor might say

“well actually Dylan, changing the shape of the blood sugar elevation means it doesn’t actually raise blood sugar like candy”

and we could get into a long argument of how you define “like”. When people are arguing over minutia or semantics big food companies have won.

This type of nutrition misinformation advertising works because ultimately it is designed to ruin peoples’ trust in nutritional science and nutrition experts (especially RDs). If consumers are confused and can’t trust anything in nutrition, they are ripe for the next trend or fad or advertising claim. That is a good thing for companies, but a bad thing for people.

If you like grape juice, drink it, I sometimes do when I have low blood sugar (I have chugged maple syrup for that too so…), but know that grape juice will raise your blood sugar, and liquid calories, like those found from the 9 teaspoons of sugar per glass of grape juice, are an easy way to go over on your energy intake. Most of us are trying to avoid excess energy intake, so for that, in my opinion, you can’t beat water.

Dylan MacKay PhD is a nutritional biochemist and an Assistant Professor at the University of Manitoba in Winnipeg. He is also a Clinical Trialist at the George and Fay Yee Center for Healthcare Innovation. Dylan has a special interest in human clinical trials related to lifestyle and diabetes. He is originally from St. John’s, Newfoundland where he started his graduate studies at Memorial University.

Saturday Stories: Anti-Vax Conferences, Vulnerable Child Syndrome, and Taffy Brodesser-Akner

Anna Merlan, in Jezebel, in what she learned getting kicked out of America's biggest anti-vax conference.

Rachel Pearson, in The New Yorker, on vulnerable child syndrome

Jen Ortiz, in Cosmopolitan, with a fabulous profile of celebrity profiler and author of the book I ordered on my kindle yesterday Fleishman is in Trouble's Taffy Brodesser-Akner

[And if you don't follow me on Twitter or Facebook, here's my most recent piece for Medscape on what actually works for obesity at a population level (hint, it's not shame, blame, or fear)]

Scotland's "National Walking Strategy" Actually Increased Recreational Walking (A Tiny Bit) For The Whole Population!

Cynically, I've been known to ask for examples of population based initiatives that actually led to sustained increases in physical activity (with the expectation of there not being any).

Well, I can't do so anymore as Scotland's managed to increase recreational walking by 13% over a 6 year period for the whole of their population!

Their National Walking Strategy targeted Scotland's 5 million residents with messages about the health benefits of walking.

The strategy involved multiple sectors including:

• Communication and public education.
• Transport and the environment.
• Urban design and infrastructure.
• Health and social care.
• Education.
• Community-wide approaches.
• Sport and recreation.

And together their aim was to create a culture of walking by way of developing better walking environments that supported ease and convenience.

How to counsel patients on physical activity became a topic in medical schools. The Daily Mile encouraged 1,000 schools to help every student walk, run, or jog a mile a day, increased funding for active transport programs was obtained including a doubling of infrastructure funding for same, #SoMe was leveraged to share encouragement and information to the public, and community walking programs were launched nationwide.

Now before you get too excited, the bar was low to begin with whereby the increase in walking represented the self-report of walking at least 30 minutes for recreation once over the past month, but at least it's a start.

Changing behaviour requires more than just education and a good reason to do so, it also requires a change to social norms and culture, as well as environmental engineering. Clearly there's more to do in Scotland and elsewhere, but nice to see that these needles might actually be movable.

Photo by Kim Traynor [CC BY-SA 3.0], via Wikimedia Commons

Saturday Stories: Quantum Solutions, Stockpiled Insulin, and Multiple DNA Tests

Jana Asenbrennerova, in Quanta Magazine, on how a gifted grad student’s solution to a fundamental problem in quantum computing is an incredible breakthrough.

Maris Kreizman, in the New York Times, on why she's stockpiling insulin in her fridge.

Rafi Letzler, in Live Science, discusses the results of his 9 different commercial DNA tests.

Photo Richard Wheeler (Zephyris) at en.wikipedia - Originally from en.wikipedia; description page is/was here., GFDL, Link

Guess What? A Single In Office Visit Encouraging People To Weight Themselves More Often And Exercise Doesn't Prevent Weight Regain

From the Journal of Duh! (ok, actually it was PLOS Medicine) comes Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial). The study involved 288 people who had lost ≥ 5% of their weight in the preceding 12 months who were randomized into two groups. One where they received periodic newsletters, and the other where they had a single face-to-face visit where they discussed goal setting and self-monitoring (including being told to weigh themselves daily) followed by every other day automated text messages. The hope was that the single visit and text messages would help prevent weight regain in the group that received them. So did that minimal intervention help?

No, both groups regained the same amount of weight over the study's duration.

What was most surprising about this study wasn't that minimal interventions don't help prevent weight regain, but rather that someone thought they might. Because if minimal interventions prevented weight regain, do you really think weight regain would be so commonplace?

So in case you were looking for proof that single office visits and text messages aren't in and of themselves sufficient to prevent weight regain, there you have it I suppose.

Saturday Stories: Only One Read This Week

Every once and a while there's a story that has such an impact on me that I want to feature it by itself.

Today's Saturday Story, written by Dana Horn for the Atlantic, was searing. It detailed her recent visit to a "massive blockbuster exhibition (about the Holocaust) that opened in May at the Museum of Jewish Heritage in downtown Manhattan", by the same people who brought you Human Bodies, and how it left her feeling flat.

Her closing paragraph,

"The Auschwitz exhibition does everything right, and fixes nothing. I walked out of the museum, past the texting joggers by the cattle car, and I felt utterly broken. There is a swastika on a desk in my children’s public middle school, and it is no big deal. There is no one alive who can fix me."

shouldn't be the only one you read. Please click it for more.

Bullying Or Teasing Kids With Obesity Doesn't Lead Them To Lose Weight But It May Lead Them To Gain

The recently published Weight‐based teasing is associated with gain in BMI and fat mass among children and adolescents at‐risk for obesity: A longitudinal study is an important paper for many well-intentioned parents, educators, and physicians who think that weight based teasing might help motivate a child to make behaviour changes that will lead them to weight loss.

In it authors followed 110 children at risk or with overweight or obesity for 8.5 years and tracked their weight and its association with weight-based teasing. They found that after adjusting and controlling for baseline sex, race, age, socio-economic status, BMI and fatmass, kids who reported the most teasing gained the most weight (p≤.007). Quantified, the authors found that the most teased kids' fat masses increased by 91% more per year (1.4lbs/yr) than those not reporting weight based teasing.

While it's important to note that causality can't be proven here, certainly these results fit with the notion that if any amount of teasing led kids to lose weight, we'd be seeing dramatic reductions in childhood obesity rates because weight is far and away the number one target of school based bullies, and even at home, 60% of kids with excess weight report being teased about same.

If you have a child with obesity, sadly you can rest assured that they'll receive plenty of shame, blame, fear, and bullying from the world around them, and if you're worried about your child's weight, instead of burdening them with it, ask yourself what you as a parent can do to help, where if nothing else, one thing for certain you can do is to make your home a safe space where weight is not something anyone's welcome to joke about or comment on.

(and if you live in Ottawa, and you have a child between the ages of 5 and 12 whose weight is concerning, and you're interested in our office's parent-centric, Ministry of Health funded, inter-professional, Family Reset childhood obesity treatment program feel free to call us at 613-730-0264 and book an appointment to chat)

Saturday Stories: Let Downs, Incels, And Unlimited Mothering

AC Shilton, in The New York Times, on the personal crash that sometimes follows a great accomplishment

Alice Hines, in The Cut, with just a bonkers and disturbing story on incels (involuntarily celibates) and plastic surgery.

Lindsay Jones, in Topic Magazine, on mothering without limits.

Saturday Stories: Ultra-Processed Kids, Un-Dead Cons, And Modern German Antisemitism

Bettina Elias Siegel, in her blog The Lunch Tray, on what that recent ultra-processed study means for our children.

Nathaniel Penn, in GQ, with the case of the curious con who wouldn't die.

James Angelos, in The New York Times, on Germany's modern day antisemites.

According To This Comparison Of Canadian Dietary Recall Data, Underestimations May Help To Explain Purported Decreasing Sugar Consumption

This recent report from Health Canada about sugar consumption was an interesting read.

Not so much in terms of sugar, and yes, the report says we eat too much of it (I'll come back to that) but rather in terms of dietary recall. It seems we're getting worse at it.

According to their determination, whereby they compared dietary recall data's caloric totals with those that would be predicted by a respondent's age, BMI (measured, not self-reported), sex and activity levels, if your self-reported intake was less than 70% of that predicted, you were classified as an under-reporter, and if it was more than 142% of predicted, you were classified as an over-reporter.

Overall, compared with 2004, people were significantly more likely to under-report and less likely to over-report. In adults, under-reporters increased by 22% (from 28.2% to 34.5%), in kids aged 9-18 by 59% (from 16.5% to 26.3%), and in younger children it more than doubled (from 6.7% to 14.1%). Simultaneously, over-reporting dropped by 45% in adults (from 13.6% to 7.4%), in kids aged 9-18 by 41% (from 22% to 12.8%), and in young children by 35% (from 27.6% to 18%).

So how does this affect sugar consumption data?

Well you may have read that dietary sugar consumption is decreasing. And maybe it is (dietary recall data is fraught with error). But this data suggests that while consumption is shifting, with more added sugars coming from food and less from beverages, totals, if looking at plausible reporters only, have stayed pretty much the same, and has increased slightly in children.

As to what's going on, could it be that with ongoing discussion of the dangers of unhealthy diets that people become less likely to want to disclose what they're eating? Either way, it's further evidence that we need a better way of tracking dietary intake and a possible confounder for those reporting that sugar consumption is decreasing.

Saturday Stories: Dietary Guidelines, "Vaccine Injury", and "Chronic Lyme"

Kevin Bass, in his blog Nutritional Revolution, with the data driven case on how you can't blame people following dietary guidelines for a country's obesity rates.

James Hamblin, in The Atlantic, on the truth behind vaccine injury compensation.

Abby Hartman, in It's Training Cats and Dogs, with her first person account on walking to, and then away from, treatment for "chronic lyme disease".

Pic By Alan R Walker - Own work, CC BY-SA 3.0, Link

Calling People Successfully Maintaining Long Term Weight Loss "Unicorns" Is Dehumanizing, Unhelpful, And Misleading (And No, 95% Of Weight Loss Efforts Don't Fail)

A few weeks ago I tweeted about a patient of mine who is maintaining a 19% weight loss for 2 years, and who attributes her success to keeping a food diary and tracking calories, as well as to including protein with every meal and snack.

The point of my tweet was a simple pushback to those who want to claim that calories don't count or that counting can't help (like The Economist for instance whose recent article entitled Death of the calorie was the main reason I bothered to tweet), and those who claim that the only way to lose weight is their way (these days that's usually either #keto or #lchf).

A great many folks weighed in with their success stories, and some pointed to the National Weight Control Registry (where their over 10,000 registrants have kept off an average of 70lbs for 5.5 years). Others though weren't having it.

Instead they asserted that 95% of diets fail, that the weight loss industry was predatory (much of it is, no argument there), and called people who have succeeded "unicorns".

Unicorns. Not people. Mythical creatures.

And the implication of course is clear. Sustained weight loss is impossible. Those who succeed aren't human, or to succeed they employ superhuman efforts, sometimes even described as disordered eating and/or that those who succeed must be miserable. Consequently, trying is futile and those offering help (like me, as to be clear I am the medical director of a behavioural weight management centre) are unethical and are motivated by greed (despite the obvious irony that those championing explicitly non-weight loss programs are targeting the very same population of people and regularly charge a great deal of money for their services).

But boy, there sure are a heck of a lot of unicorns roaming around for something that supposedly fails 95% of the time. Putting aside the anecdotal facts that we all know people who have maintained weight losses, as well as my own office based experiences, this 2010 systematic review found that one year later 30% of participants had a weight loss ≥10%, 25% between 5% and 9.9%, and 40% ≤4.9%. In the LOOK AHEAD study, 8 years later, 50.3% of the intensive lifestyle intervention group and 35.7% of the usual care group were maintaining losses of ≥5%, while 26.9% of the intensive group and 17.2% of the usual care group were maintaining losses of ≥10%. Here's the DIRECT trial where mean weight loss at 2 years was 7.5% with 24% of participants maintaining losses greater than 22lbs. And in the recent year long DIETFITS study the average weight loss of all participants was 5%, with over 25% of participants losing more than 10% of their weights.

The Examine.com waterfall plots of the DIETFITS data

(And for an interesting thought experiment, have a peek at this thread from Kevin Bass that argues that even if the 95% failure number were true, those outcomes would be worlds better than the vast majority of medical treatments currently being offered for other chronic diseases)

So where does this 95% number come from? I could imagine it to be true if the goalpost for successful weight loss was total weight loss and reaching a so-called "healthy" or "normal" BMI. But that would be as useful a goalpost as qualifying for the Boston Marathon would be for running whereby the vast majority of marathoners won't ever run fast enough to qualify to run Boston. Does that mean non-qualifiers should be discouraged from running and told that running is impossible? It's also important to contextualize failures. If the methods being undertaken to lose weight are misery inducing overly restrictive diets, it's not people who are failing to sustain them, it's that their diets are failing to help them (which, with full disclosure, is the premise of my book The Diet Fix).

As far as what needs championing, it's certainly not failure. Given the medical benefits of weight loss, as well as the real impact weight often has on quality of life (especially at its extremes), what we need to collectively champion are the embrace of a plurality of treatments (including ethical behavioural and surgical weight management programs and greater access to them), along with more effective medications. What can simultaneously be championed is the removal of blame from the discussion of weight, fighting weight bias and stigma, recognizing that a person need not have a so-called "healthy" or "normal" BMI, that scales don't measure the presence or absence of health nor measure lifestyles, respecting people rights to have zero interest in losing weight or changing their lifestyles, that there is value to changing behaviours around food and fitness regardless of whether weight is lost as a consequence, and acknowledging that intentionally changing lifestyle in the name of health reflects a tremendous degree of privilege that many people simply don't possess.

Given the evidence maybe we can stop with the unhelpful, dehumanizing, and misleading unicorn talk, and while we're at it, stop telling everyone that failure is a foregone conclusion.

Saturday Stories: Assisted Death, Insulin Pumps, And Supplements

Kathleen Venema, in The Globe and Mail, on her mother and why we need to change the rules surrounding assisted death for those with dementia.

Sarah Zhang, in The Atlantic, on why there's an underground market for old insulin pumps.

Markham Heid, in Medium, on how the evidence against the regular use of supplements is stronger than ever (happy to find this story for reader Pug Piper).

[And if you don't follow me on Twitter or Facebook, here's my first column for Medscape on what scales do and don't measure and why that matters]

What's The Point of Tracking Your Calories With a Food Logging App?

First up, the quantity and quality of calories matter both to health and to weight. You can't gain without a surplus. You can't lose without a deficit. And the quality of the calories you're consuming will affect health and satiety which in turn will affect the quantity of them that you consume. Moreover, the bioavailable calories you consume will differ by food, and also likely differs by individual (which is why some gain and lose with more ease than others).

Next up, we're crappy food historians. We may forget portions, choices, or both, not all the time, but certainly some of the time. We can't possibly know what's in meals we haven't cooked ourselves. And even if we are cooking ourselves, most aren't going to be weighing and measuring everything and eyes are terrible at both.

And a recent study confirms some of the above whereby researchers looking at users of myfitnesspal found the average user was missing nearly a meal's worth of calories a day (445). Yet studies on food diary use pretty much invariably report they markedly benefit weight loss efforts.

Personally, though I think having some rough inaccurate sense of caloric intake is valuable (if you were in a foreign country and didn't know the exchange rate, price tags would still be somewhat helpful), more valuable is the use of the food diary to remind yourself that you're trying to eat thoughtfully and likely differently.

Human nature being what it is, without a system designed to consciously remind you to change your usual default behaviours, you're likely to drift back to those behaviours, healthy or not, and a food diary, even if inaccurate, if kept in real-time, will remind you many times a day that you're trying to change.

So long as you're not using your food diary as a tool of judgment, as it's not meant to be there to make you feel badly about your choices, chances are it'll be of benefit, and likely it'll be of benefit regardless of what it is you're tracking (calories, macros, carbs, whatever) and even if inaccurate, because it's primary job is to serve you as your constant change reminder service, not as your judge and jury.

Saturday Stories: Holocaust Memorial Day, Poway, And Synagogue Metal Detectors

Lori Gilbert-Kaye, may her memory be a blessing, murdered for being Jewish

A few days ago it was Holocaust Memorial Day, the day we commemorate the murder of 1 out of every 3 living Jews on earth prior to World War II. A week ago saw another murder for the crime of being Jewish, this time in California. Before that it was Pittsburgh. Though there's not much I can do about any of this, at least I can call your attention to these three pieces that try to weave it all together

Daniella Greenbaum Davis, in The Spectator, on antisemitism's new normal.

Rabbi Yisroel Goldstein, in The New York Times, on how being almost killed by a terrorist last week has affected his resolve.

Carly Pidlis, in Tablet Magazine, on how Jews can no longer simply consider themselves safe in America.

New Study Suggests ADHD Steers Children To An Unhealthy Diet, Not The Other Way Around

To be taken with a grain of dietary recall data, but a new study, Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort, found that an ADHD diagnosis led children to a less healthy diet, whereas less healthy diets did not lead children to ADHD.

The study was conducted in the Netherlands and it followed 3,680 children starting at age 6 and then ending when they reached the age of 10.

Put plainly, though more ADHD symptoms at age 6 were associated with less healthy diets at age 8, diet quality at age 8 was not associated with ADHD symptoms at age 10.

There are a number of proposed pathways to help explain how ADHD might affect diet quality. ADHD and its impulsivity may increase the risk of binge eating or loss of control eating, and the impact of ADHD on neurotransmitters may affect hunger and fullness. It's also possible that some parents of children with ADHD may offer foods their children prefer in order to decrease risk of conflict and/or reward desired behaviour.

Clearly more research on this would be welcome.

Saturday Stories: Freds, Sexism in Science, and Anti-Vaxx Marriage

Danielle Kosecki, in Medium, with her defense of Freds (less serious cyclists, and disclosure, I am one).

Mallory Picket, in The New York Times Magazine, on sexism in science's highest echelons.

Anonymous, in The Cut, on marriage with an anti-vaxxer.

Move More, Eat More? New Study Suggests People Do Eat More When They're More Active, But Not Much

One of the possible reasons that in freely living humans exercise doesn't seem to add up to weight loss as math might predict is that freely living humans might eat back their burned calories. Some may do so consequent to increased hunger. Others to a sense of virtue and the inclination to reward themselves for their hard work. Others still because marketing has convinced them that they must refuel, recover, replenish, etc..

A new study,Activity energy expenditure is an independent predictor of energy intake in humans, published this year in the International Journal of Obesity, set out to look at this phenomenon.

Now to be clear, the study certainly wasn't designed to explain exercise's impact on weight. It was just 7 days long and it involved the retrospective analysis of data from 5 prior studies and did not directly measure energy expenditure or energy intake. Instead researchers utilized estimated energy expenditure by way of heart rate and indirect calorimetry data, and energy intake by way of known to be problematic food diaries.

My stats skills are nowhere near good enough to comment on the various treatments of the data, but here's the scatter plot of the impact of energy expenditure on energy intake.

The increase in energy intake the authors attributed to energy expenditure wasn't high, roughly 3% of total daily calories (around 70 in this sample), an amount too small to explain away exercise's often uninspiring impact on weight loss.

Truth be told, I'd have predicted the difference to be larger as eating more consequent to exercise is something I know many people do for one or more of the various reasons mentioned above.

Of course none of this changes the fact that exercise has tremendous health benefits at any weight and that weight shouldn't be your driver for upping yours if you're able.

Saturday Stories: IN MICE, Cancer, and Future Dementia

James Heathers, in Medium, explains why he started the Twitter account that only ever tweets "IN MICE"

Anne Boyer, in The New Yorker, on what cancer takes away.

Tia Powell, in Elemental (on Medium), on how she's preparing for her future dementia.