Weighty Matters

Odds, ends and help wanted!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sat, 07 Nov 2009 14:33:00 +0000

It's one of those rare weekend posts.

A quickie though.

First I wanted to let Ottawa based personal trainers know that my office, the Bariatric Medical Institute, is looking for someone for part-time work. Some group classes and some one on one. Unfortunately our fabulous trainer Kelly decided that for some reason job security, benefits and pensions were more important to her than making us happy and she's taking a job with Canada Post. Good for her. Bad for us. If you're an Ottawa based trainer who's interested, or know an Ottawa based trainer who's great please give Rob Matthews, our fitness director, a shout (click here to email him).

Secondly I wanted to let you know of a pending post. It's my review of Food Inc. A great movie but be forewarned, it tends to change your eating habits. In my case it's had me shy away from store bought ground beef. To that end I've decided to start grinding my own ground beef and I'm going to have some help. The folks from Cookware.com who have all sorts of kitchenware for sale have offered to send me a fancy meat grinder for a review. I've also read somewhere that brisket makes the best burgers. I'll be putting both the meat grinder and the brisket to the test in the coming weeks (yes, I know, red meat's bad - that said I've always preached it's about having the smallest amount of bad food in your life that you need to be happy and frankly I need an occasional burger to be happy!).

Enjoy your weekends!

The secret winning strategy of Nascar (drive fast)

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 06 Nov 2009 10:30:00 +0000

Now I can't say I understand the fascination with Nascar and I guess neither does the Onion.

Today's Funny Friday is the Onion's report on the winningest coach in Nascar and his secret strategies.

Have a great weekend!

Free workouts at all Gold's Gyms this Saturday!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 05 Nov 2009 10:30:00 +0000

On Saturday November 7th working out in Gold's Gyms the world over won't cost you a penny, as Gold's Gyms and the American Diabetes Association team up for their first ever "Burn-A-Thon" to help raise diabetes awareness.

Their goal?

They want to see 180,000,000 calories burned this Saturday.

The Burn-A-Thon is also the launch event for the American Diabetes Association's "Stop Diabetes" campaign and exercise, independently of weight loss, can have a dramatic impact on a person's glycemic control and insulin sensitivity.

Sadly there's no Gold's Gym here in Ottawa.

To find one near you click here.

(BTW - thanks to Gold's for designating Weighty Matters one of their Gold's Gym approved blogs and for providing me with the shiny blog badge)

Kellogg's Froot Loops are soooo good for you!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 04 Nov 2009 15:58:00 +0000

Really Kellogg's is shameless.

First there was their ridiculous "Now helps support your child's IMMUNITY" claim they plastered over their Cocoa Krispies and other sugary sundry (for which they may face charges in San Francisco).

Now?

Now on television they've got children pretending to be doctors extolling the benefits of Froot Loops and Apple Jacks and their complement of 3gr of fibre.

I can't do the stupidity and shamelessness of their commercial justice so I've included a video below (email subscribers you've got to visit the blog to watch).

(Hat tip to Rob, BMI's fitness director - he saw the commercial on television just this morning)

The PEI Healthy Eating Alliance endorses chocolate milk.

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 04 Nov 2009 10:30:00 +0000

A number of people yesterday forwarded me an article from the CBC detailing a call to equalize the price of chocolate milk and regular milk in PEI schools.

School principal Doug Doyle was quoted by the CBC as saying,

"I would love to see the chocolate milk subsidized"

and this was in reference to the price differential between his cafeteria's sale of 500mL of white milk for $0.75 versus 500mL of chocolate milk at $2.00.

Now Doug I don't entirely fault. He's a school principal, not a dietitian or a health professional and frankly the buzz on milk out there is that it's magic. Here's his quote on the matter,

"From what we understand, the nutritional value is the same in chocolate and white milk. So if we want them to drink milk, they're drinking the chocolate milk but they're paying more for it."

What was really astounding to me however was this quote from Charmaine Campbell, a registered dietitian and spokesperson for the PEI Healthy Eating Alliance (HEA) - a non-profit group dedicated to the improvement of eating habits of children and youth on Prince Edward Island,

"The HEA would be supportive of having chocolate milk subsidized"

Pardon me, what? The HEA of PEI wants chocolate milk subsidized? That 500mL box of chocolate milk that Doug wants subsidized contains 10 added teaspoons of sugar, 400mg of sodium, and the caloric equivalent of a litre of Coca-Cola, and the Healthy Eating Alliance wants to subsidize its sale to promote its consumption?

Honestly, I didn't believe it. I thought perhaps Charmaine was voicing her own opinion rather than the HEA, and it's not because Charmaine works for Big Milk either. Unlike some of the other characters who've come out in strong support of chocolate milk Charmaine seems like an incredibly well-intentioned healthy eating advocate and not simply a corporate shill. So I called Dr. Jennifer Taylor, the volunteer president of the HEA to ask what was going on and in a very congenial discussion she affirmed that the HEA would indeed support the subsidization of the cost of chocolate milk in a bid to get children to drink more "nutrient rich" beverages.

So is chocolate milk nutrient rich, and more importantly does that matter? Well certainly chocolate milk has more nutrients than Gatorade or Coca-Cola but at double the calories and double the sugar of Coke and Gatorade I certainly wouldn't be rushing out to recommend children drink it.

If you're not sure where your opinion lies ask yourself this question, if there existed Coca-Cola with twice the sugar and calories of regular Coke and it was fortified to share the identical nutrient profile of chocolate milk, do you think it'd be a healthy beverage to serve your children?

In my discussion with Dr. Taylor it seemed that the seal of approval the HEA is affording chocolate milk is one that comes from an it's less bad than what they're currently choosing stance and she readily admitted to me that,

"in an ideal world they'd only be drinking 1% or skim white milk"

My stance is certainly more black and white. Chocolate milk is a liquid chocolate bar. It's a sometimes food, and when the HEA reports that they'd support chocolate milk's subsidy it elevates it from what at best could be described as a "less bad" option to a "healthy eating" option which in turn may well encourage PEI's children, parents, educators and health professionals to think that somehow magic nutrients in chocolate milk offset the insane amount of sugar it packs.

To put the sugar in perspective, if kids in PEI schools drank one 500mL carton of chocolate milk a day for a year they'd be drinking 76 cups of added sugar! That's just over 7 five pound bags of sugar and that doesn't include the sugar naturally found in milk. Add that in and they'd be drinking 118 cups or almost 60lbs of sugar a year. And with 200mg of sodium per 250mL they'd also be drinking a third of their daily recommended maximal sodium allowance and enough non-satiating, liquid calories to support a 37.5lb gain.

The only silver lining here is that apparently PEI's milk program doesn't have the funds to subsidize the liquid sugar.

Lastly I have to give kudos to Dr. Taylor. While we wholeheartedly disagreed, we had a nice, civilized chat - I wish more folks involved in nutrition were able to take the emotion out of their disagreements.

[Hat tip to my friend Andrea from the fabulous Ottawa based parenting blog a peek inside the fishbowl who was the first to send this scariness my way]

Burger King's $0.0019 per calorie campaign

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 03 Nov 2009 10:30:00 +0000

Of course they're not calling it that but I think doing so illustrates just how cheap food has become.

That $0.0019 per calorie applies to Burger King's new $1.00 Double Cheeseburger campaign.

Burger King's Double Cheeseburger has 520 calories and with a cost of a dollar that'd be $0.0019 for each and every calorie. Per calorie that's exactly 10 times cheaper than their $3.99 Garden Salad with Tendergrill Chicken without croutons or dressing which clocks in at $0.019 per calorie and 13 times cheaper than the $1, 40 calorie side salad ($0.025 per calorie). Add in the dressing and croutons and it's still 4-5x cheaper per calorie to hit the burger.

So let me ask you - if you didn't have much money, were hungry, and you walked into a Burger King what would you buy?

I know where I'd spend my money.

And people claim weight's only about willpower.

Dr. George Bray said it best (and happily having met him last week I can confirm that my attribution all these years has been accurate),

"Calories load the gun, the environment pull the trigger"

And boy did Burger King squeeze it hard.

Family physicians resign MD group protesting Coke partnership

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 02 Nov 2009 10:30:00 +0000

Readers of my blog and listeners of my podcast might remember just last week when I interviewed American Academy of Family Physician president-elect Dr. Lori Heim about the AAFP's partnership with Coca Cola.

During the interview I asked Dr. Heim whether or not any physicians had resigned from the AAFP as a consequence.

She said she hadn't heard of any.

Well I'm guessing she's heard of these folks. More than 20 doctors from Contra Costa Health Services told the AAFP to coma-caca over their partnership with coca-cola and resigned, complete with a press release, a podcast and a video.

Personally I hope more AAFP physicians take their lead to protest this abominable partnership.

Dr. William Walker, the Director of Costa Contra Health Services summed it up perfectly with his statement,

"I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death."

and at the end of his speech he symbolically tore up his AAFP membership card - a card he'd been carrying for 25 years.

Good on you Dr. Walker.

For those of you who might be curious, below is a copy of their video protest.

(Remember, email subscribers need to visit the blog to view the video)

Weekend listening - Sunday House Call

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sun, 01 Nov 2009 10:54:00 +0000

I first met my friend Dr. Barry Dworkin in 2004 when he invited me onto his show to discuss my office's approach to weight management and since then I've enjoyed many visits back to chat with him.

Barry's a family physician and since 2003 he's been a broadcaster, first locally and now nationally, with his radio show Sunday House Call.

Barry's show runs Sunday afternoons from 3-5pm EST and recently Barry launched his own website, www.drbarrydworkin.com where he's collected many of his interviews.

I have many favourites but if you've only got time for a brief listen today have a listen to Barry chat with Dr. Brian Wansink. Dr. Wansink is the director of Cornell's Food and Brand Lab and his research focuses on why we tend to eat mindlessly and what we can do about it. He's a fascinating researcher and an entertaining interviewee.

Barry's a stand up guy, an evidence based physician and a great listen.

Pumpkins Inc.

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 30 Oct 2009 09:30:00 +0000

If Food Inc. scared you off meat wait till you see today's Funny Friday video - you may never carve a pumpkin again!

Have a great weekend and Happy Halloween!

(Remember, email subscribers you've got to visit the blog to watch)

See calories on menus - eat more at home?!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 29 Oct 2009 09:30:00 +0000

There's an odd question, but if new research holds true the answer may be yes.

In a study currently in press (meaning accepted but not yet published) by Roberto and colleagues, 303 subjects were studied with 3 different dinner menu situations.

The first menu was a standard fast casual style menu with no calories posted.

The second menu was the same food/layout but with calories posted beside each item.

The third menu was the same food/layout with calories beside but with a line at the top that explained that 2,000 calories was how many the average person needed each day.

The results were fascinating.

Without calorie labeled the average consumer ordered 2,189 calories, with calories that went down to 1,862 calories and with the 2,000 calorie anchor statement, 1860.

So? That doesn't sound fascinating. Calories posted lowered calories. Um, not exactly. It lowered ordered calories.

Next the researchers looked as consumed calories (by subtracting food left on the plates). Without calories labeled the average consumer ate 1,459 calories, with calories that went down to 1,335 and with the 2,000 calorie anchor statement, 1,256.

Ok, that's pretty neat but fascinating?

Here's the really cool part. Researchers then contacted these folks the next day and using dietary recall (yes, it's inaccurate but still useful to see trends) they explored what these folks ate after dinner.

Folks who had menus without calories ate an additional 179 calories, folks with calories labeled ate an additional 294 calories, and those with the anchor statement in addition to calories ate 177 more.

Putting it all together (calories eaten at dinner and then later at home), folks without labeled menu calories ate a total of 1,630 calories, folks with calories labeled ate a total of 1,625 calories and those with the 2,000 calorie anchor statement ate a total of 1,380 calories.

What this research suggests is that if consumers are not made aware of how many calories they burn each day posting calories on menus may lead them to feel they can consume more at home because they chose a "lower" calorie choice when they were out.

Certainly suggests that any menuboard calorie initiative needs to include an educational component. Maybe it's not a huge surprise. Trying to navigate calories without context would be like trying to manage your money travelling without knowing the currency exchange.

Fascinating!

(Interesting sidebar. The American federal labeling bill that's currently being considered does include a 2,000 calorie anchor statement in its requirements. Great comment at the conference by Diane Finegood who pointed out that for many women 2,000 calories daily would in fact cause significant weight gain.)

The new skinny on New York City's menu calories

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 28 Oct 2009 09:30:00 +0000

Remember a few weeks ago when I commented on the story that suggested mandatory menu board calories actually increased consumption? I pointed out that the data therein referred to a very specific subset of New Yorkers and likely wouldn't be reflective of a generalizable pattern.

Well, guess what. We've got more data.

Two days ago at the Obesity Society meeting in Washington, the New York City Department of Health presented their preliminary findings.

Looking at 13 different fast food restaurants and over 275 locations the NYC folks analyzed 10,965 receipts just prior to mandatory menuboard labeling and 12,153 receipts in spring 2009. They also had folks complete a quick survey.

What did they find?

In fast food restaurants the number of patrons who reported seeing the information rose from 11% pre-initiative to 56% after, and in coffee shops (like Starbucks and Dunkin' Donuts) the number rose from 1.9% to 54.8%. According to their survey roughly 25% of folks who reported seeing the information reported using the information to help them with their decisions.

Overall it was found that calories did reduce post menuboard labeling. Reductions were found in 11 of the 13 restaurants with one notable outlier - Subway. In Subway calories increased - and they increased a lot, on average Subway patrons consumed 114 calories more post menuboard calories than before.

So does that mean menuboard calories are a dud?

Nope.

Looking at the Subway data researchers found that the increase corresponded with a dramatic increase in the number of foot long subs purchased compared with 6 inchers. The increase likely occurred as a consequence of the $5 foot long campaign. Tellingly however when they looked at the calories consumed per 6 inch and per foot long before and after menuboard calorie posting, turns out that while more footlongs are being consumed, their calories are lower.

Looking specifically at the folks who reported using the information, they decreased their average lunch time calories by 106, though weren't able to decrease much at the coffee shops (a non-statistically significant 14).

There are some limitations to these data. Firstly the economy in 2009 is very different than in 2007 and this in turn may impact on purchasing trends. Secondly the study would fail to capture those people who in response to menuboard calorie posting stopped eating at fast food restaurants. Lastly we're still only talking about fast food. Perhaps in the fast casual restaurants, where there's a greater selection, we'll see different results.

Stay tuned tomorrow for more breaking news on calorie posting and some fascinating work from Kelly Brownell and his friends at the Rudd Centre.

(Podcast) Coke and the AAFP on Weighty Mutters

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 27 Oct 2009 09:30:00 +0000

You read that right - podcast.

I've been meaning to start podcasting for some time and finally I've got around to figuring it out (I hope).

The inaugural episode has me interviewing Dr. Lori Heim, the President-elect of the American Academy of Family Physicians. Just two weeks ago her organization partnered up with Coca Cola to collaborate on educational materials for their website www.familydoctor.org. In return for their involvement Coca Cola is paying the AAFP $600,000.

So what is Coca Cola getting in return? Credibility and trust by association.

In preparing for the interview I went through blog posts and tweets regarding the deal and with almost no exceptions the social media world was up in arms, finding the partnership perverse.

The medical world is no less unhappy and just last week some of the world's most prominent nutritional epidemiologists and advocates sent an open letter to the AAFP asking them to rethink their plans or at the very least lend their name to campaigns supporting soda taxes and the publication of warning labels on sugar sweetened beverages.

In my interview with her, Dr. Heim gave me the sense that indeed, it was all about money and that the partnership with Coca Cola stemmed at least in part due to pressure from AAFP members to sever or reduce AAFP's ties with drug companies.

Personally I think in this case it's one of those situations where the adage, "better the devil you know" holds true. Physicians have a long history of working with drug companies and have a far better understanding both of their products and the methods they use to promote them. As well, Big Pharma has very specific guidelines on what they are and are not allowed to do and say in terms of commercial partnerships and practice. One senior Big Pharma person I know tells me that there are in fact departments within her company to ensure she markets her brands appropriately and she has numerous rules about what she is and is not allowed to do or say in their promotion. Further, the brands themselves have tremendous amounts of research, development and safety testing before they're ever sold.

Contrast those checks and balances with Big Food who have no such testing or obligations to create safe foods and while I have no proof, looking at their advertising I would be very surprised were there any oversight committees worrying about what's being said with the exception of those cases where federal advertising laws mattered or when trying to pretend like they care about children in their hollow pledges not to advertise to them.

None of this is ideal. Ideal would be a situation where the AAFP could be financially self sustainable without external funding. That's not an option, but with this Coca Cola partnership, I think they've bet on the wrong horse.

To hear my interview with Dr. Heim I'm hoping all you'll have to do is click somewhere in this post (and I suspect email subscribers will likely have to visit the blog). If I'm really lucky I'll even figure out how to get it on iTunes.

Or you can click here to download this podcast

To sleep, perchance to dream (of weight loss). New research on why sleep's crucial.

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 26 Oct 2009 09:30:00 +0000

Sleep deprivation and obesity are unquestionably linked yet the exact mechanism by which lack of sleep leads to weight gain is unknown.

A recent study presented at the Obesity Society's annual scientific assembly may help shed some light.

Any Darukhanavala and colleagues from the University of Chicago designed a small but elegant study. They took 10 overweight volunteers whose pre-study average sleep was 7.7 hours nightly and enrolled them in a two week crossover study whereby for each 2 week period they received 8.5 or 5.5 hours of nightly sleep while all were consuming low calorie diets. Physical activity levels in the groups were identical regardless of hours slept.

While there was no difference in absolute weight loss in this short time period what was striking was the difference in where weight was lost in the two groups. During the weeks with greater sleep 50% of weight loss (as evaluated by DXA absorptiometry) came from fat and 50% from lean tissue (muscle) whereas during periods of less sleep only 25% was lost from fat with 75% coming from lean tissue. Also striking was hunger which was markedly increased in the short sleep arm of the study.

Certainly if these results were applicable to the population as a whole, especially during weight loss efforts, those folks trying to lose weight and sleeping poorly may be losing disproportionate amounts of lean tissue which in turn will disproportionately lower their resting energy expenditure (metabolism) and simultaneously increase their hunger which ultimately may lead them to abandon the effort but not without first losing enough lean tissue to allow them to not only regain the weight they've lost but potentially more.

Get your Zzzzs!

The sordid end of the Pixar lamp!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 23 Oct 2009 09:30:00 +0000

Just goes to show you, your life can change in an instant. Today's Funny Friday video details one such instance in the life of the Pixar bouncing lamp.

Savour each day.

Have a great weekend!

Frankenfood: Windows 7 Edition

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 22 Oct 2009 14:17:00 +0000

I think it speaks for itself.

To enjoy it, you'll have to head to Japan (Vincci, up for another food challenge?).

(I figured it was worthy of contributing to a dual post day)

[Hat tip to faithful blog reader Jesse!]

Overweight Canadian kids not eating enough according to Canada's Food Guide

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 22 Oct 2009 09:30:00 +0000

So yesterday I detailed the results of the Ipsos Reid based milk advertisement that concluded, surprise, that Canadians should be drinking more milk, but buried in the story is the fact that the survey determined that Canadians were not eating enough of any food group according to Canada's Food Guide.

Let me repeat that. According to the survey, Canadians don't eat as much food as the Food Guide recommends.

But wait, aren't 65% of Canadians overweight? And they're not eating as much as the Food Guide thinks they should? I wonder what would happen to the remaining 35% if suddenly they did start eating what the Food Guide recommended.

I detailed ad nauseum (really, it was nauseating how much I detailed it) how the Food Guide causes weight gain - you can read those pieces by clicking here here, and here, but interestingly this is not the first time I've noticed studies or surveys that reported Canadians don't eat enough according to the Food Guide and that if you did you'd likely gain weight.

The first time I posted on a study published out of Nova Scotia whereby the vast majority of overweight and obese children didn't meet the daily recommended number of servings from the Food Guide.

Here's the second round of data. I received an email from a loyal blog reader named Dana. She attended a lecture put on by Dr. Lise Dubois who presented data from the Quebec birth cohort showing that showing the odds ratio for overweight was 8.8 for 4.5 year old children who consumed 4 grain servings/day. and 7.1 for those consuming 1 serving of meat per day.

Yet Canada's Food Guide recommends 4.5 year olds consume 4 servings of grain per day and 1 servings of meat (thanks for the correction commenters - I had looked at the milk column).

I emailed Dr. Dubois for comment some time ago, but never heard back from her but it would seem to me that according to her data if your 4.5 year old followed the Food Guide's recommendations to consume 4 servings of grain and 1 serving of meat that their risk of obesity would be markedly increased.

Great job Health Canada!

Here's a thought - maybe Food Guides shouldn't be recommending minimum patterns of consumption in a country where it is now abnormal to have a healthy body weight and where research has shown people don't know what serving sizes are?

Just a thought.

(BTW, I checked with Ipsos Reid - the way this survey was conducted was that people reported the quantities of food consumed and then dietitians calculated the number of Food Guide servings therefore you can't make the argument that in the survey Canadians just didn't know what a serving size wise, and while I can't claim it with certainty, I'd be very surprised if Dr. Dubois' research was any different in that I'm certain she knows what a Food Guide serving represents)

St John M, Durant M, Campagna PD, Rehman LA, Thompson AM, Wadsworth LA, & Murphy RJ (2008). Overweight Nova Scotia children and youth: the roles of household income and adherence to Canada's Food Guide to Healthy Eating. Canadian journal of public health. Revue canadienne de sante publique, 99 (4), 301-6 PMID: 18767276

Conflicts of interest in professional dietetics

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 21 Oct 2009 09:30:00 +0000

According to my friends over at Fooducate, at this week's American Dietetic Association (ADA) conference there was a talk regarding whether or not we can trust industry sponsored nutrition research. The reason that's in question is because sadly right now there are no guidelines in place to help expose conflict of interest in dietetics. It was the absence of such guidelines which led Marion Nestle in 2001 to write a fascinating journal article about how food company sponsorship impacts on the profession's credibility. Ultimately it led Marion to resign her ADA membership. According to Fooducate,the lecture was not a popular one at the ADA conference and was very poorly attended.

Of course it's not just research articles that demonstrate conflicts and bias, we can see non-evidence based industry bias in a far more dangerous place - the mainstream media.

Case in point?

Yesterday there was a CBC report about an Ipsos-Reid survey which according to the CBC was, "conducted on behalf of Dietitians of Canada" (DC). What the CBC article later reported was that the survey was cosponsored by the Dairy Farmers of Canada. The DC and Dairy Farmers of Canada joint press release on the survey drew these 4 conclusions (highlighting is mine, not theirs):"1. Consumption of all four food groups is far below recommended levels;

2. A significant number of Canadian adults had not consumed any milk and alternatives or any vegetables and fruit on the day prior to the survey.

3. Many Canadian adults report they have barriers to healthy eating.

4. A majority of Canadian adults are not aware of the many health benefits of milk and alternatives and vegetables and fruit including their role in reducing the risk of some cancers, hypertension and other chronic diseases.

5. When made aware of these important health benefits, Canadians report they are motivated to increase their intake of foods from these food groups."
Well last week we covered how milk doesn't appear to actually have a benefit on hypertension and that calcium supplementation alone impacted on cancer risk while dairy might in fact up the risk of prostate cancer and given milk's failure in preventing osteoporotic fracture and in weight loss, I'm not sure what magic milk is meant to do.

Looking at the actual survey the bias is obvious. The only specific questions regarding choices and healthfulness have to do with either "dairy and alternatives" or "fruits and vegetables" and of the 5 conclusions of the press release, 3 directly relate back to dairy (2, 4 & 5). Absent was information regarding the health benefits of whole grains, nuts, legumes or fish.

The thing is I get it. I fully understand why the Dairy Farmers crafted the survey - it was designed to report that Canadians don't drink enough milk; that there are umpteen-million magical "benefits" to milk consumption; that milk's as healthy and important as fruit and vegetables; and that if we just teach people more about unbelievably healthy milk they'll drink more of it, but the question I've got is why do you think the Dietitians of Canada decided to lend their name and credibility to a survey that ignored multiple food groups and is basically a milk advertisement?

Unfortunately the media certainly treated it like more than simply a milk ad and they ran with it prominently featuring DC's involvement. Had the poll simply been one from the Dairy Farmers of Canada I imagine the coverage of the report, if any, would likely have been very different. As well in this case, the media also oiled the slippery slope of corporate dietetic collaboration by failing to identify quoting dietitian Kathy Furgala's corporate allegiances referring to her instead as a "Toronto-based dietitian". Frankly it was in fact Kathy's quote from the CBC story that got me riled up enough to write this post and explore the survey in the first place. She was quoted as saying,

"For people who say, 'I don't want to worry about the food groups,' just look at your plate, and see if you can't throw in one veggie or some cheese"

Yup, the two most important things you could ever add to your plate if you don't want to "worry about the food groups" - a single vegetable or of course, some cheese.

I'm not sure what's worse. DC signing off on a milk ad disguised as a national eating survey, a dietitian who would give the advice that all your plate needs for your meal to be healthy is one lonely vegetable or a hunk of cheese, or a reporter who chooses to identify that dietitian as a "Toronto area dietitian" while omitting the fact that she's in fact a nutrition educator for the Dairy Farmers of Canada in an article whose focus is on increasing dairy based on the results of a survey paid for by the Dairy Farmers of Canada.

[Oh, and in case you noticed - the survey found that "consumption of all 4 food groups is far below recommended levels". Strange in a country where over 65% are already overweight or obese. Could it be that the recommended levels recommend too much? Tune in tomorrow for more discussion.]

Nestle, M. (2007). Food company sponsorship of nutrition research and professional activities: a conflict of interest? Public Health Nutrition, 4 (05) DOI: 10.1079/PHN2001253

Frankenfood: Sherm's Ultimate Gripper

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 20 Oct 2009 09:30:00 +0000

Thanks to a hat tip from loyal blog reader Rebecca and to the adventurous spirit and palate of dietitian Vincci I bring you Sherm's Ultimate Gripper from Tubby Dog in Calgary.

What's an Ultimate Gripper?

It's a hot dog, wrapped in bacon, then deep fried, then topped with ham, homemade chili, cheese, mustard, more bacon, hot peppers, onions and a fried egg.

If you're curious what it tastes like, Vincci's posted a review (and more pictures) on her blog Ceci n'est pas un food blog where she reports,

"it wasn't particularly heavy and gross, nor was it remarkably tasty, either"

Now she's pegging this beast at 800 calories.

My rough calculations bring it much, much higher. Maybe Vincci can correct my ingredients but I figured 6 slices of bacon, 1/2 cup chili, 2 slices processed cheese, 1 slice ham, bun, hot dog, fried egg and a tablespoon of oil from the deep frying. I then ran the numbers through Mastercook.

By my accounts Vincci and her cousin each ate 2,000 calories and over 7,000mg of sodium.

That'll certainly grip you.

The Canadian Medical Association sells Echinacea for pediatric flu prevention!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 19 Oct 2009 09:30:00 +0000

I'm not sure how I found myself clicking over there, but one day last week I landed up on the webpage for Canadian Health Magazine - a magazine published by the Canadian Medical Association (CMA).

I can't remember what I was looking for, but I sure do remember what I found.

I found a series of banner advertisements by a company named A. Vogel. Head over to their webpage and you'll find they're all about, "phytotherapy and homeopathy".

Now before you get all in a huff, I've got nothing against any form of therapy - so long as the intervention you're promoting actually has an evidence-base. Prove it works and I'll happily endorse it, but if you can't, at best its prescription is premature and hopeful and at worst, risky and fraudulent.

So what did the banner ads on the Canadian Medical Association website want to sell me and what wording did they use to try to do it?

Echinaforce Junior - Get your kid's immune system ready!

Echinaforce Junior - To prevent or relieve cold and flu.

Echniaforce Junior - Clinically Proven.

Echniaforce Junior - Boost kid's immune system throughout winter.

I'll get to the details behind the claims in a minute but first this - I noticed that there was an "advertising" link on Canadian Health Magazine's site so I clicked it and learned that with over 30.3 readers per copy Canadian Health Magazine is the most read magazine in Canada and 77% of readers said the content of Canadian Health Magazine was more credible because of CMA ownership.

Those are some truly impressive statistics!

I also learned that the editorial positioning of the magazine suggests it's meant to,

"deliver the most credible and current health news and research information to Canada’s health consumers"

So back to Echinaforce Junior.

Echniaforce Junior is simply Echniacea. Looking at medline, since 1950 there have been 24 papers published that discuss the therapeutic use of Echniacea and many of these are simply commentaries and not in fact therapeutic trials. Given the advertisement's claims that Echniaforce Junior would help protect your children by preventing influenza, and given the state of alarm due to H1N1, I decided to look for studies that suggested echinacea had an impact on flu frequency, duration or severity.

Guess what? There were none. The closest I could find was a paper published in what I would consider a dubious journal already, the Journal of Alternative & Complementary Medicine, but putting my instinctual skepticism aside I read the paper and learned that the researchers only investigated symptoms suggestive of either cold or flu and did not in fact test subjects to determine if they were suffering from influenza in the first place.

So to summarize the vast dearth of research, there is not a single published study looking at the use of Echinacea for the prevention or treatment of influenza, yet of course that's what the advertisement tacitly endorsed by the Canadian Medical Association, in a periodical where 77% of readers report having more trust due to CMA ownership, quite explicitly states Echniacea does.

Regarding colds and Echinacea, there's a bit more detail as there have in fact been multiple studies looking at Echinacea's utility in treating the common cold. The most robust such study was published in 2005 in the New England Journal of Medicine where researchers studied 399 volunteers who were challenged with rhinovirus. The results? Nada. (For a brief review of some of the other Echinacea cold studies you can head over to the Canberra Journal)

Regarding jacking up my child's immune system? Combining searches for child, immune and Echinacea turned up a big goose egg.

So in short there's nothing in the medical literature to suggest that Echinaforce Junior could deliver on any of its claims.

Clearly, if there is an editorial policy for vetting CMA owned Canadian Health Magazine advertisements it's not being followed as it's inconceivable to me that a Canadian Medical Association advertising policy would allow for the advertisement of unproven products that prey on medical fears. Sadly what is wholly conceivable to me is that they have no advertising policies whatsoever and hence are in fact contributing to healthcare fraud. Worse yet is the Canadian Medical Association's potential contribution to pediatric mortality as parents who decide to choose Echinaforce Junior (in part perhaps due to their increased trust of its association with the Canadian Medical Association whose mission they know is to deliver "the most credible health news" to Canada's health consumers) over vaccination for flu prevention certainly have no medical evidence upon which to support their choice.

I've copied this post to the President of the CMA and the editor of Canadian Health Magazine and I sincerely hope the offending ads are immediately removed from their site.

Will keep you posted as to responses.

UPDATE: The CMA is looking into the ad in question (among a few others) and certainly agree that their responsibility to ensure the validity of the claims of their advertisers is greater than that of the average company.

FINAL UPDATE: The offending ads have been removed! Thanks CMA!

Lindenmuth, G., & Lindenmuth, E. (2000). The Efficacy of Echinacea Compound Herbal Tea Preparation on the Severity and Duration of Upper Respiratory and Flu Symptoms: A Randomized, Double-Blind Placebo-Controlled Study Journal of Alternative and Complementary Medicine, 6 (4), 327-334 DOI: 10.1089/10755530050120691

Turner, R. (2005). An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections New England Journal of Medicine, 353 (4), 341-348 DOI: 10.1056/NEJMoa044441

A ridiculously racy European dairy commercial

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 16 Oct 2009 09:30:00 +0000

The world over, Big Milk sure know how to market!

To be clear, I'm not anti-milk, I'm anti-milk misinformation. Milk's not magic, and with today's Funny Friday video milk week is done.

Today's video is a commercial that would never see the light of day in North America (probably for good reason), this one for easy open coffee creamers.

[remember, email subscribers you need to visit the blog to view the video]

Have a great weekend!

Milk prevents colon cancer?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 15 Oct 2009 14:45:00 +0000

We physicians get a great many free publications.

One that comes regularly is a trade journal called The Medical Post, and in it the Dairy Farmers of Canada are regular advertisers making half page buys geared to look like articles that they entitle Nutrition and the Physician. These pieces in turn are generally written or at the very least attributed to physicians, professors and dietitians highlighting some benefit of dairy consumption.

For a long while the bulk of these medical advertisements were about milk's role in weight management but that died off shortly after Big Milk in the US agreed with the Federal Trade Commission that claims regarding milk and weight loss/management were preliminary at best.

The most recent version I read was about milk products and the prevention of colon cancer and it is attributed to Dr. Parviz Ghadirian, the Director of the Epidemiological Research Unit at the Hotel-Dieu hospital in Montreal and a Professor in the Department of Nutrition at the University of Montreal.

The advertisement rightly points out that there is indeed some evidence to suggest a modest risk reduction for colorectal cancer with the consumption of diets high in dairy.

So what's my problem?

I've got a few.

Let's start with the opening paragraph where Dr. Ghadirian quotes from the World Cancer Research Fund report, "milk probably protects against colorectal cancer". The quote is true, I looked it up. Problem here is that it's not the full quote. The full quote reads,

"The strongest evidence, corresponding to judgements of ‘convincing’ and ‘probable’, shows that milk probably protects against colorectal cancer, and that diets high in calcium are a probable cause of prostate cancer"

Funny the advertisement doesn't mention anything about prostate cancer risk and hmm, isn't milk high in calcium?

Oh, and about calcium, next I looked at the meta-analysis Dr. Ghadirian referred to which demonstrated a 22% risk reduction in adults who consumed higher quantities of milk. In it I learned that calcium supplementation alone confers a virtually identical risk reduction (and in fact slightly greater) to that seen with milk products as noted by the authors in the paper's discussion,

"Interestingly, both dietary and supplemental sources of calcium showed inverse effects, with the latter reducing colorectal cancer risk by 24%"

Strange how Dr. Ghadirian's advertisement doesn't mention that fact.

Next I pulled the large prospective cohort study he referred to which demonstrated a 28% colon cancer risk reduction in women who consumed higher quantities of milk products and 15% in men. In it I learned that the results showed that in men dairy intake did associate with lower colorectal cancer incidence but again was positively associated with prostate cancer. Interestingly while the relationship between calcium supplementation and decreased colorectal cancer risk held in men, in this study non-dairy calcium supplementation did not increase prostate cancer risk,

"dairy food intake was inversely associated with cancers of the head and neck, esophagus, stomach, colorectum, and bladder, whereas it was positively associated with prostate cancer"

"Total calcium intake was significantly related to a lower risk of colorectal cancer and showed a weak inverse association with kidney cancer. On the other hand, total calcium intake was not related to prostate cancer."

Next I pulled the pooled analysis he refers to and once again the pooled study's findings were applicable both to plain old calcium supplementation as well as milk but interestingly they pointed out something else,

"Cheese intake was weakly positively associated and yogurt intake was weakly inversely associated with colorectal cancer risk".

What's that, cheese might increase colon cancer risk?

Let's take a look at the World Cancer Research Fund's report on cheese - did they find it might increase colon cancer risk? Yup.

"There is limited evidence suggesting that cheese is a cause of colorectal cancer."

Hey, isn't cheese a milk product?

So what did Dr. Ghadirian's medical advertisement say on cheese,

"A study using the Swedish Mammography Cohort of 60,708 women that included approximately 15 years of follow-up suggests that consumption of higher fat milk products (especially cheese) and the CLA in dairy fat are also important in reducing risk."

Pulling the Swedish study one learns that the researchers weren't clear on why their results on cheese differed from everyone else's and they hypothesized that it might have to do with the fact that their cohort ate a tremendous amount of cheese and admit that the differences in their diets don't stop there leading me to wonder if perhaps they're not the greatest population upon which to draw global, or at least North American, conclusions.

So to summarize Dr. Ghadirian's milk sponsored medical advertisement: Milk products, especially cheese, reduce the risk of colon cancer.

To summarize the actual medical literature used by Dr. Ghadirian: Milk products decrease the risk of colon cancer to a degree pretty much identical to that seen with calcium supplementation but at the same time in men increases their relative risk of prostate cancer, while diets high in cheese potentially increase colon cancer risk except in Sweden.

My advice to my dear readers? If you read anything sponsored by the Dairy Farmers of Canada you'll probably want to read the studies themselves before drawing any conclusions, and if Big Milk comes a' knockin' on your door asking you to write one of their medical advertisements tell them, "no thank you" and while you might lose a few bucks of chump change (literally perhaps), at least you'll keep your ethics.

And here I'm really at a loss. Dr. Ghadirian is a world class researcher and epidemiologist. How is it that he agreed to put his name on an advertisment that omits such highly pertinent data?

Huncharek, M., Muscat, J., & Kupelnick, B. (2009). Colorectal Cancer Risk and Dietary Intake of Calcium, Vitamin D, and Dairy Products: A Meta-Analysis of 26,335 Cases From 60 Observational Studies Nutrition and Cancer, 61 (1), 47-69 DOI: 10.1080/01635580802395733

Park, Y., Leitzmann, M., Subar, A., Hollenbeck, A., & Schatzkin, A. (2009). Dairy Food, Calcium, and Risk of Cancer in the NIH-AARP Diet and Health Study Archives of Internal Medicine, 169 (4), 391-401 DOI: 10.1001/archinternmed.2008.578

Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den Brandt PA, Colditz GA, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Pietinen P, Potter JD, Rohan TE, Terry P, Toniolo P, Virtanen MJ, Willett WC, Wolk A, Wu K, Yaun SS, Zeleniuch-Jacquotte A, & Hunter DJ (2004). Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. Journal of the National Cancer Institute, 96 (13), 1015-22 PMID: 15240785

Larsson SC, Bergkvist L, & Wolk A (2005). High-fat dairy food and conjugated linoleic acid intakes in relation to colorectal cancer incidence in the Swedish Mammography Cohort. The American journal of clinical nutrition, 82 (4), 894-900 PMID: 16210722

Big Milk RD wants kids to drink 1/2 cup of sugar daily

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 14 Oct 2009 07:04:00 +0000

Meet Shannon Crocker.

She's a registered dietitian who runs her own nutritional consulting company whose clients include Gaylea foods (a dairy company) and Dairy Farmers of Canada.

On her personal website S. Crocker Consulting, Shannon recommends,

"when seeking life advice to go to people who are required by law to get their information from the most credible sources and held accountable for the information they dispense"

I couldn't agree more - so let's talk about the information you recently dispensed.

In a recent advertisement gussied up as a pretend newspaper article with the lead recommendation of,

"Research shows that two to three servings of milk products each day, included as part of a balanced diet and active lifestyle, are vital in maintaining our families’ health."

Shannon is quoted as stating,

"I personally am a great lover of chocolate milk. It has a bit of added sugar to it but all those essential health benefits are there and as long as it is part of a healthy diet, that extra sugar should not do children who shy away from ordinary milk any harm.”

A "bit" of added sugar Shannon? Per cup of your client Gaylea's 1% chocolate milk there are nearly 5 teaspoons of added sugar. If unsuspecting parents followed your advertisement's advice to give their children a "harmless" 3 glasses of chocolate milk a day that's now 15 teaspoons of added sugar, not to mention the sugar already in the milk. In total those children will be consuming 23 1/4 teaspoons of sugar a day - 3/4 of a teaspoon shy of half a cup.

Want to know what else they'd be drinking Shannon? They'll also be drinking 600mg of sodium (who would have thunk chocolate milk had so much sodium - um, maybe a dietitian working for the company who makes the product?), or a full 1/2 of the total recommended daily maximum for kids under 8 and 40% of total recommended daily adult maximums.

But wait, there's more. They'd also be downing 540, not satiating, liquid calories a day, or roughly the same amount they'd get if they were chugging 1.5 daily litres of Coke.

Doing the math - a year's worth Shannon's advice would have your kids drinking just over 90 pounds of sugar, that's eighteen 5lb bags, as well as 2 full cups of salt and 54lbs worth of calories.

Fantastic advice Shannon. So glad we've got "credible sources" of information like you to help us navigate as you put it on your website, "the incredible amount of myth and misinformation", because surely it's just a myth that chocolate milk is an unhealthy choice, and advertisements dressed up as newspaper articles with quotes from registered dietitians stating that magic nutrients in milk make the daily consumption of 1/2 a cup of liquid sugar and far too much sodium and calories a-ok, are meant to help, not misinform.

Parents, think of a glass of chocolate milk like a liquid chocolate bar. If you think giving your kids a Hershey's bar with each meal is a good plan, well then you and Shannon would probably get along great. If not, consider it a sometimes food.

Big Milk PhD bares her bias

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 13 Oct 2009 09:30:00 +0000

Meet Dr. Susan Barr.

Dr. Barr is a professor of nutrition at the University of British Columbia and she has had a truly illustrious career, having published dozens of peer reviewed articles. She's also been a workhorse for the milk industry serving as a member of the Medical Advisory Board of the Milk Processors' Education Program, the Medical Advisory Board for the International Dairy Foods Association and speaking and writing regularly for the Dairy Farmers of Canada.

So what's got my knickers in a knot about Dr. Barr? It's her quotes from the recent "article" published in CanWest papers across the country last week where she tries to make the case that increased dietary dairy consumption reduces blood pressure. I put the word article in quotations because CanWest reports that the articles are "a joint venture with Dairy Farmers of Canada"and refer to them as a "special advertising feature".

Dr. Barr's case for dairy's role in reduction of blood pressure rests on a famous study from 1997, the Dietary Approaches to Stop Hypertension Study which resulted in what's now known as the DASH diet. Dr. Barr reports,

"The findings showed that those on the fruit and vegetable rich diet experienced a significant reduction in blood pressure. Those on the diet with milk products as well showed an even more significant reduction."

A true statement, except of course it omits the fact that the study was not designed to examine the specific effects of dairy on blood pressure and more importantly omits the fact that the diet with dairy had other differences from the fruit and vegetable rich diet including lower overall saturated fat, lower total fat and lower cholesterol.

Looking at the last 15 years of clinical trials research I was able to find only a handful of studies that were specifically designed to investigate the effects of dairy on blood pressure, and of those none were large or robust enough to draw firm conclusions.

Thankfully I was able to find a recent review article published in the Journal of the American College of Clinical Nutrition which summarized the most pertinent studies detailing dairy's effects on blood pressure. The review reported that a few studies indeed showed decreases in blood pressure with increased dairy, another showed increases in blood pressure with yogurt but not cheese, and many showed no dairy/blood pressure relationship at all. Regarding the DASH study the review specifically concluded,

"The greater reductions in BP seen with the DASH diet compared to the high fruits and vegetable diet cannot be ascribed to dairy products per se"

and the review goes on to conclude that there are certainly some plausible mechanisms by which dairy might improve blood pressure and that further research is warranted.

Fair enough, and really that's it? That's what's got me hot and bothered? The fact that Dr. Barr perhaps misconstrued the DASH study and overblew the preliminary suggestion that maybe blood pressure and dairy have a connection?

Nope.

It was this. The review article summarized the only studies that have ever been published that were designed specifically to address whether or not an intervention involving increasing dairy would have a positive impact on blood pressure, all 5 of them. According to the review none of those studies showed significant improvements to diastolic blood pressure while 3 showed minor improvements to systolic pressure, the greatest of which was 5mm Hg.

Again, so? So why are you so pissy you're actually devoting an entire post to Dr. Barr and suggesting she's "bared her bias", yeah it doesn't look like there's much data to conclusively recommend increasing dairy for blood pressure benefit, but so what, at least there's some?

It was this. Included in those 5 studies was this one,

"Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults"

This study, conducted in the year 2000, followed 204 healthy, middle aged men and women and tracked what happened to their blood pressure and their weight following randomization to either stick with their current diets (low in dairy) or to add 3 glasses per day of milk to their diets for 12 weeks. At the end of 12 weeks researchers found that the increased dairy group did not see any statistically significant reduction in their blood pressures (nor did the subgroup of pre-existing hypertensives in the sample), but they did see statistically significant increases in weight, triglycerides and blood sugar - not exactly healthful results.

Want to know who the lead author of this study, one of only 5 studies ever published which was actually designed to determine the effect of increasing dietary dairy consumption on blood pressure, the results of which showed increasing milk not only failed to have a positive effect on blood pressure but rather, significantly worsened weight, triglycerides and blood sugar? You guessed it, Dr. Susan Barr.

Ain't it funny (and by funny I mean awful) that she didn't mention the paucity of conclusive research linking increased dairy with decreased blood pressure along with her own study's negative and potentially harmful results while misrepresenting the findings of the DASH study in the "article", I mean "joint venture", I mean "special advertising feature" meant to sell more milk?

Kris-Etherton PM, Grieger JA, Hilpert KF, & West SG (2009). Milk products, dietary patterns and blood pressure management. Journal of the American College of Nutrition, 28 Suppl 1 PMID: 19571168

BARR, S. (2000). Effects of Increased Consumption of Fluid Milk on Energy and Nutrient Intake, Body Weight, and Cardiovascular Risk Factors in Healthy Older Adults Journal of the American Dietetic Association, 100 (7), 810-817 DOI: 10.1016/S0002-8223(00)00236-4

Appel, L. (1997). A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure New England Journal of Medicine, 336 (16), 1117-1124 DOI: 10.1056/NEJM199704173361601

Horizon Organic Milk Plus DHA - Brain Milk Badvertising

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 12 Oct 2009 09:30:00 +0000

All I can say is "Oy".

Ok, clearly that's not all I can say...the other day I was estimating the number of words I've typed these past 5 years on this blog and figured it was near a million.

Here are some words that Horizon has to say on their carton,

"Helps Support Brain and Eye Health

Kids' brains grow incredibly fast. In fact the brain nearly quadruples in the first five years of life. Up to 20% of the human brain is made of DHA, yet most kids don't get their recommended DHA from common dietary sources like fish. By making Horizon Organic Milk Plus DHA your family choice, you're bringing home all the goodness of organic plus an extra nutrtional boost for growing mids and bodies"

So how much DHA do you get per glass of this miracle brain milk?

32mg.

According to the Center for Science in the Public Interest 32mg of DHA is less than what you'd get from a single bite of salmon.

My recommendation?

Save your pennies by not buying this badvertised milk and use them to buy your kids at least one weekly serving of fish instead.

Their brains (and yours) will thank you.

(Oh, by the way, it's milk week here at Weighty Matters and also thanks to Hemi from Fooducate for tracking down the mg of DHA)

The glamorous life of a wildlife photographer

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 09 Oct 2009 09:30:00 +0000

I'm sure at times wildlife photography is awe inspiring. Other times boring.

This time?

Funny Friday.

Have a great weekend!