I’ll cut right to the chase.
If you’re going to conclude that diet soda consumption is linked to weight gain and increased abdominal circumference you’d damn well better control for diet as a whole given that diet beverage consumption may simply be a marker for people who eat more indulgent foods and think, erroneously, that choosing the diet pop with their mega combo will somehow protect their weights and waists, and because there is no known plausible mechanism for a direct link. This study didn’t.
This new paper has made international news, and as you might imagine, that critical methodological shortcoming up above, is missing from much of the coverage and certainly all of the headlines including this Dr. Sanjay Gupta tweet which included a graphic and a teaser and was sent out to his nearly 2 million followers:
— Dr. Sanjay Gupta (@drsanjaygupta) March 18, 2015
Honestly, that researchers would feel comfortable publishing a study with the end points of weights and waists, and not control for diet and caloric intake, is just mind boggling. Seeing the study published also makes me wish for more transparency in peer review. Would love to know who thought this was publishable as is.
(and for the conspiracists out there, I don’t consult for, or own shares in, any artificial sweetener or soda company, and I think we should be striving for less sweet as a whole, including from artificial sweeteners, but I’m also for evidence based recommendations, peer review, and media coverage)
If you’re not aware, there was a recent announcement of a new program entitled FNV, the aim of which is to aggressively market fruits and vegetables to kids.
The pros and cons of this idea were recently virtually debated by Casey Hinds (she’s not a fan) and Bettina Seigel (she is a fan). I think both make great arguments, though I side with Casey, I think it’s a bad idea.
And while I agree with all of Casey’s argument, especially her concerns around juice, I want to add another to the mix. Seeing photos of food, any food, causes the release of ghrelin, one of our bodies’ primary hunger hormones. In turn this may help to explain the findings of one study that looked at advergames and children and how even when the advergames promoted fresh fruits and vegetables, the outcome for the kids playing them was an overall energy intake increase – not exactly a great plan for a country struggling with childhood obesity.
While I’m all for children consuming more fresh fruits and vegetables, especially in the place of junk and fast food, I just can’t wrap my head around the notion that adding more food advertising to our kids’ lives is going to help. I think kids (and adults frankly), would be far better off if they weren’t being continually being told to eat and shown photographs of luscious foods (healthy or otherwise) given these advertisements may well be physiologically priming them for larger portions, and regardless of what’s being advertised, indulgent cravings.
And out of curiosity, is anyone aware of any data on the availability of fresh fruits and vegetables for the average kid in America? Does the average household have fresh fruits and vegetables at all times? Are they readily available in schools and arenas?
All that said, fingers crossed the program has wonderful outcomes, and that my concerns lack merit.
A few months ago a study was published in JAMA entitled, “Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity: The Omni Carb Randomized Clinical Trial” and it proved to be interesting and important enough for the New York Times to cover it with Anahad O’Connor’s piece, “Questioning the Idea of Good Carbs, Bad Carbs“.
O’Connor’s coverage is solid, and if you’re curious about the study’s results, and don’t feel like reading the full text (also linked up above), have a click, but my question is simple. Is there a problem with discussing “low-carb” diets when the diets themselves aren’t in fact low-carb?
I think there is.
The New York Times rightly highlighted the fact that really the study was of the impact of glycemic index. But have a peek at MedpageToday’s (a newswire read by many MD’s), headline, “OmniCarb Study: Cutting Carbs No Silver Bullet”And I don’t blame MedpageToday for it either given that the study itself describes one of their diet arms as “low carbohydrate“.
But a diet containing 40% of calories coming from carbs to me anyhow, just isn’t fairly describable as “low-carb“, and yet that’s what Omni Carb’s “low-carb” arm contained.
Sometimes too, unlike this study, there are times when while the diet prescribed is low-carb, but the adherence to it isn’t, and yet the authors still report their findings as if they pertain to the prescribed, rather than the consumed, diet.
Given the battle lines that are drawn around dietary dogma, and that many don’t read beyond headlines, I think it would be great if there were some agreed upon “low” nomenclature. If diets must be labeled as “low-carb“, or “low-fat“, is there no way to ensure that journals won’t allow such descriptors if the diets that were actually consumed (let alone prescribed), don’t in fact meet some very basic and even conservative definition of “low“?
So what should the cut-off be? I asked on Twitter and there wasn’t any clear consensus. But for what it’s worth, a recent low-carb review paper published by Richard Feinman et al. in Nutrition defined “low” carb as being either fewer than 130g of daily carbohydrates, or a diet whereby carbohydrates contribute less than 26% of total daily calories (thanks @RobertOhMD for pointing me to it). Both values sound fair to me. What say you?
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