Ethan Weiss, in STAT, with a personal essay about his daughter, albinism, CRISPR and ethics.

Jonathan Freedland, in The Guardian, with the last desperate warnings of Auschwitz’ few remaining survivors.

Olga Khazan, in The Atlantic, on what abortion will look like if it once again becomes illegal.

       

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Alex Hutchinson, in Outside, on why you probably don’t need to stretch.

Peter J. Turnbaugh, in Nature, on diets and microbiomes.

Tamar Haspel, in The Washington Post, asks why people are spending $35 billion on supplements if they don’t do anything?

[And if you don’t follow me on Twitter or Facebook, here’s a piece I wrote for Elemental on how when it comes to the Biggest Loser, there are no winners]

       

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Well, I guess there’s nothing to do today really except laugh, so here goes:

Published this week in the International Journal of Obesity is Effectiveness and cost-effectiveness of The Daily Mile on childhood weight outcomes and wellbeing: a cluster randomised controlled trial whereby researchers reported on the impact a school year worth of 15 minutes of daily running had on children’s BMIs.

It’s an odd study in that we’re talking about 15 minutes of running per day which literally no one should expect to have a marked effect on childhood obesity given both math (15 mins of children running, jogging, or walking a mile probably doesn’t even burn the calories of a single Oreo) and the fact that multiple meta-analyses have shown that even far more involved school based PE initiatives don’t have an impact on childhood obesity.

It’s also odd because The Daily Mile itself doesn’t tie itself to weight,

“The aim of The Daily Mile is to improve the physical, social, emotional and mental health and wellbeing of our children – regardless of age, ability or personal circumstances“

And it’s a problematic study in that consequent to the wholly predictable non-exciting outcome, it’s the sort of study that might be used as a means to discourage the program’s continuation.

What might have been studied instead? How about the impact of the Daily Mile on marks, concentration, endurance, or physical literacy (note, they attempted to do some of this, but data collection was too poor for them to make many conclusions), or if there was a strong desire to tie it to something medical, how about blood pressure, heart rate recovery, mood, sleep, or lipid levels?

As I’ve said many times, dumbing down exercise to weight management shortchanges both the benefits of exercise and the realities of weight management, and frankly doing that in the name of a program that sees kids running an extra 15 minutes a day, and then seeing that published in a credible journal, speaks to just how pervasive and dangerous that practice is.

       

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There’s no denying the hype around the microbiome with buzz suggesting that it’s integral to anything and everything – from our immune systems, to obesity, to dementia.

So let’s for a moment agree that it is.

Even if we do, it’s difficult to imagine there would be one universal “best” mircobiome makeup spanning age, sex, race, diet, geography, comorbidities, etc. Meaning even if we had thoughts about what a “healthy” microbiome was, what’s healthy for one person might not be healthy for another.

But back to us agreeing they’re hugely important and implicated in everything.

If that’s the case, should you really be purposefully trying to mess with yours given we basically haven’t even begun to study the impact of messing with them over time?

Me?

I’ll stick to the basics.

        

Thomas Harding, in The Guardian, on surviving the loss of his teenage son.

Jason McBride, in Toronto Life, with a profile of the inimitable flu shot crusader Jill Promoli.

Jane Coaston, in Vox, on the conspiracy theories fuelling New York’s exploding antisemitism.

       

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Darkest Hour was on, so I was able to watch this great scene again today:

Here’s some tweets that I have been enjoying today:

Rather than call out the specific paper that led to this blog post (I also don’t want to add to its Altmetrics), just a question.

If your systematic review findings demonstrate that a particular supplement/food/diet led to an average total weight loss of 0.7lbs is it appropriate to describe that effect as significant even if statistically you believe you’re able to make that claim?

Personally, I don’t think so.

Especially not when we’re discussing food, because as Kevin Klatt recently pointed out on his blog, there are no food placebos. and as John Ionnidis pointed out, we eat thousands of chemicals in millions of different daily combinations which markedly challenges our ability to conclusively opine about the impact of any one food.

Worse though, is the fact that the media (both traditional and social), won’t bother to qualify their enthusiasm when describing these findings and instead will report them as beneficial, significant, and important, as of course will PubMed warriors.

So how to fix this? Perhaps including a qualifying, “but not likely to have any clinical relevance” statement in the abstract might lead to more balanced media coverage (or less media coverage ) which in turn would be less likely to report significant but clinically meaningless outcomes as important, which ultimately would be good for science and scientific literacy.

       

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I started out planning to write about a different paper – a one year post intervention followup of people who had completed a prior year of being randomly assigned to 5:2 style intermittent fasting (IF) (2 days a week consuming 400-600 calories) vs. continuous energy restriction (typical of eating less daily) which showed that there was no difference between the two, but when I read it I realized the story was in the initial intervention, not the follow up.

The initial intervention involved randomly assigning 332 people to one of 3 dietary interventions:  Continuous (daily) energy restriction (CER), week-on, week-off energy restriction, and a 5:2 intermittent fasting pattern involving 5 days of habitual intake and 2 very low energy diet days each week.

Of the only 146 completers, no differences were found between the different diets in terms of weight loss, adherence, change in lipids, or fasting glucose.

And most of that is consistent with other studies of 5:2 IF which have found that it’s no better or worse than any other approach when it comes to weight loss and biochemical changes. But what’s not consistent is adherence being the same, wherein other studies tend to see more people quitting IF.

Digging the tiniest bit deeper into this two things stand out. Adherence was abysmal for both CER (49% drop out rate) and IF (58% drop out rate). But what was different here was what was involved in the CER arm. Women randomized to the CER arm were aimed at consuming only 1,000 calories daily for a year, while men were aimed at only 1,200 calories daily. That’s a life-suckingly low number of calories for anyone to be aimed at and honestly it surprises me that researchers (and peer reviewers) would think that degree of continuous restriction would be worthy of study.

All this to say, that people were just as likely to report adherence to a misery inducing 1,000-1,200 calorie per day diet as they were to a 5:2 IF approach does not reflect well on the enjoyability (and consequently the broad applicability) of 5:2 style diets.

And for the inevitable trolls, I’m not knocking 5:2 IF. If you love it, terrific! Don’t stop! But don’t anyone expect it’s a panacea for all comers.

       

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He waited as long as he could, too long in the opinion of many.

He was obviously hoping that peaceful negotiation could bring down the rail barricades, in the best Canadian tradition.

But at last Justin Trudeau’s patience was exhausted.The negotiations were going nowhere, because there were none.

“We can’t have dialogue when only one party is coming to the table. For this reason, we have no choice but to stop making the same overtures.”

And for that the blame must go to these old men, the Wet’suwet’en hereditary chiefs.

Like Montreal Simon, I could not believe how lackadaisical and disrespectful the hereditary chiefs were being in refusing to respond to Trudeau’s obvious respect.
They didn’t seem to realize that the time to make progress was NOW, this week, when they had Canada’s attention and a great deal of support across the country. 
What they cannot do is keep raising the ante.
While the story earlier this week was that the Wet’suwet’en had worked out a deal for RCMP to move back to Houston BC, the story today was that they wanted both the RCMP AND the pipeline company to leave, and then “nation-to-nation discussions with Canada and BC” should start.
And the tactic of leisurely visiting Mohawk reserves in Eastern Canada and holding news conferences instead of talking to the prime minister doesn’t make any sense.

“We are waiting for Indigenous leadership to show that it understands,” [Trudeau] said in a news conference. “The onus is on them.”

Injunctions to clear tracks must be obeyed and the law must be upheld, he said, adding that it is pointless to continue making overtures to Indigenous leaders if they aren’t accepted.

“Let us be clear: all Canadians are paying the price. Some people can’t get to work, others have lost their jobs,” Trudeau said. “Essential goods … cannot get where they need to go.”

The situation “is unacceptable and untenable,” he said.

Canadian support has started to evaporate when the chiefs could not seem to articulate what they wanted to achieve – no pipeline at all? a pipeline but on a different route? more negotiations for the existing route?  — and when thousands of Canadians were being increasingly affected, losing jobs and fearing for their heating oil supplies. 

On Twitter, the usual suspects were berating Trudeau for not acting first and thinking later. But Trudeau tried to resolve the blockades with dialogue instead of immediately turning the dispute into a dick-measuring contest like Scheer and McKay wanted.
At least the Mohawks are clear about what they want — the Mohawks have an agreement with Indigenous Services minister Marc Miller that the Ontario trains will run as soon as RCMP have withdrawn to Houston from Wet’suwet’en territory. 
As Manitoba Premier Palliser said today, no individual or group has an absolute veto on natural resource projects.

“Public opinion matters on these things,” he said. “This federal Liberal government has said that reconciliation is a priority. But if you want real reconciliation, then you have to do the real work of achieving it. And you have to establish some parameters. You have to put a fence around the discussion to some degree. And you don’t do that if you don’t make it clear that everyone does not have a veto.”

Short post to say that watching people aggressively argue about their preferred diets of choice, and seeing reputable people willing to prop up the most shameless of medical hucksters if they happen to share a nutritional belief, and the endless debates about physiology, and meal timing, and breakfast, and fasting, and macronutrients, and lipids, and anti-science shilling, and multi-level marketing, and so much more, is so very tiresome.

As a clinician I know that what actually matters is how to help the person sitting in front of me, remembering that science, meal patterns, macronutrients, and physiology, may not always matter the way some study says they could or should in the face of an individual’s life and personal preferences. Ultimately, and regardless of what I think is “right” on paper or right for me, my job is to help patients make sustainable changes that in turn lead them towards the healthiest life that they can actually enjoy.

Similarly, as a public health advocate, I know that if there were any amount of education, or a brilliantly crafted public health message, that in turn would effectively drive societal behaviour change we’d have all already changed all of our behaviours. I can also tell you that energies spent on initiatives relegated to personal responsibility, including but not restricted to those promoting one person’s diet tribe, pale in importance to energies spent on initiatives relevant to changing the food environment. And there’s no shortage of targets that span all dietary dogmas – from advertising to kids, front-of-package health claim reforms, junk food fundraising, the provision of free cooking skills to kids and adults, national school food programs and improvements, tax incentives and disincentives, and more.

All this to say, it’s my opinion that these two flawed foci, that there’s one best or right way and that personal responsibility will be our salvation, are the two main reasons why we can’t have nice things in nutrition and nutrition related public health.

        

James Hamblin, in The Atlantic, on the bizarre and unfounded man-boob based backlash to plant-based meat.

Hannah Ellis-Petersen, in The Guardian, on how formula makers target the mothers who can least afford it.

Sarah Zhang, in The Atlantic, on DNA testing and shattered identities.

       

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Here’s some tweets I enjoyed this week.
And doesn’t it always seem that January DRAGGGGS while February goes so FAST?

TAKE. NO. CRAP. 💅🏻

pic.twitter.com/iBVE1fuQNC

— Jay Arnold 🏳️‍🌈 (@JadedCreative) February 11, 2020

Expectation vs Reality. pic.twitter.com/0PDhoroVe8

— Darwin Award 🔞 (@AwardsDarwin) February 5, 2020

I’m not sure he totally qualifies as a Good Boi™ with that food theft at the end – 🤣🤣🤣 – but he’s definitely both adorable and hilarious! https://t.co/1qpw17TXTm

— Julie Ritt (@faeryfancier) February 2, 2020

When you’re trying to end an argument, but your bird won’t let you. 🔊
(🎥: Imgur user MrPuckett) pic.twitter.com/KXYTv3Olq3

— Clare Logan (@withchillies) January 19, 2020

Good joke…

Interviewer asks Michael Bloomberg what he thinks about a possible situation where two billionaires are running against each other for the presidency

Bloomberg says ” Who’s the other one ? “

— John Cleese (@JohnCleese) February 5, 2020

If we’re being honest about these democratic candidates not only would any of them be better than this president but any of their personal assistants would be better. So let’s get the primaries over with, try not to be too mean to each other & get this guy the hell out of office.

— Mike Birbiglia (@birbigs) February 10, 2020

Hooooly shit.

An audience member asks Warren if she ever wonders, “Who is going to be my Mike Pence? Who is going to look at me with adoring eyes?”@ewarren: “I already have a dog.”pic.twitter.com/svyS5dkCRw

— Brian Tyler Cohen (@briantylercohen) February 10, 2020

Last week I posted about a 5:2 intermittent fasting study that demonstrated terrible adherence with a 58% 5:2 drop out rate by the end of year one and where the average loss was 11lbs.

In response, Erik Arnesen shared another year long 5:2 intermittent fasting vs. continuous energy restriction study where the drop out rate at the end of year one was just 7% and the average loss was 20lbs! (and actually I blogged about this one in the past – tl;dr no difference in outcomes but 5:2 participants were hungrier)

If the diets were identical, why the tremendous difference in adherence and weight loss at a year?

Sure, could be different patient populations, but I’m guessing the much larger factor was the service provision. Because at the end of the day that’s a huge part of what’s being measured in any organized diet study. Not just in terms of how many visits or touch-points a particular program has, or what collateral materials and support they provide their participants, but also the rapport development, motivational ability, and teaching skills of the service providers themselves.

Having led an inter-professional team for 16 years, I can tell you that who you’ve got helping your patients/participants has a tremendous impact on their outcomes even within the same program’s delivery.

So the next time you consider the outcomes of any study’s diet arm, a question worth pondering is how much of those outcomes are consequent to the prescribed diet itself, and how much are consequent to the health care professionals administering it?

       

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Sirin Kale, in The Guardian, on how harassment in the gym stops women from working out.

Olga Khazan, in The Atlantic, on the repulsive rise of toddler milk.

Michael Eisenstein, in Nature, on the hunt for what even constitutes a healthy microbiome

       

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I have been away from the blogger writing for quite a time. I have been busy working to get well and after two years without being able to walk I am finally making progress. I was encouraged during the past couple of years to receive many contacts from…

I used to be totally against them.  It was always some no-talent eight year old plinking out a ghastly version of Chopsticks and you can’t tell them they suck or STFU! because their parents will get upset and report you to the facility staff becau…

Ughé Blackstock, in STAT, on why black academic physicians like her are leaving their positions.

Sam Brennan, in Fit Is a Feminist Issue, on how she watched Brittany Runs a Marathon so you don’t have to.

Virginia Sole-Smith, in Elemental, asks whether the fitness industry and body positivity can co-exist?

       

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Taxes work to decrease purchasing, and the higher the tax, the greater their impact. Period.

Which is why it’s always struck me as odd when people question whether or not sugar-sweetened beverage (SSB) taxes would affect SSB purchases (and consequently consumption).

But let’s leave that odd debate aside for a moment. If the goal of SSB taxes is to decrease added sugar consumption (which it explicitly is, while it is explicitly not about weight loss as societal obesity is not singularly caused by SSB consumption, and decreasing SSB consumption is healthy at every weight), it would appear that SSB taxes will decrease sugar consumption even if they don’t decreasing purchasing.

How?

Because when SSB taxes are enacted, the beverage industry reformulates its products.

And at least according to this bulletin from the World Health Organization, they do so not insignificantly!

Of the 83 products they surveyed in both 2014 (before the SSB tax) and in 2018 (after the SSB tax), the mean sugar content decreased by 42% (from 9.1 g/100mL to 5.3 g/100m) while the mean energy content decreased by 40% (from 38 kcal/100mL to 23 kcal/100mL). Putting this into the context of a standard 355ml can – that would represent 2.45 fewer teaspoons of sugar and 53 fewer calories per can.

And this was in response to a fairly nominal tax. Presumably larger taxes would drive larger (or more expansive) reformulations which of course would also be coupled with decreased purchasing.

All this to say, this is yet another reason why if you’re living somewhere without an SSB tax, my bet is that it’s a matter of when, not if, you will be.

       

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Some time ago, I lost my life partner to cancer. Two prominent right-wing bloggers, with whom I had crossed swords many a time, expressed what I believed were sincere commiserations, a genuine reaching across the aisle. It was much…

I find myself reading a number of the advice columnists these days. And as I read about all the problems people have with their families, I often think of this great poem:

This Be The Verseby Philip Larkin

They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.

But they were fucked up in their turn
By fools in old-style hats and coats,
Who half the time were soppy-stern
And half at one another’s throats.

Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don’t have any kids yourself.

Someday I will share this with my own adult children, if I ever have the courage.

Here are some good animal tweets:

I don’t really follow Alberta news, but the constant “cut, cut, cut” and “whine, whine, whine” I am hearing from there recently is getting chaotic.

Whatever is going on in Alberta, I sure hope its not catching.

Hmmm — I’ve been saying for years that SOMEBODY in Trump’s inner circle is a Russian asset.  I am convinced that someone very close to him has been feeding him all the pro-Putin and pro-Russian stuff he has been parroting since 2016, convincing him that the Russian world-view is correct, leading him to say things like how unfair it is that Russia is out of the G7, etc.

I’m very glad to see that Canadian authorities are taking these scams seriously: A Burnaby, B.C., man has been identified as a suspect in an RCMP investigation into organized crime groups;accused of scamming Canadians by posing as Canada Revenue Agency…

Let me be clear: when it comes to Meghan Murphy and her followers at the Toronto Public Library versus the protesters outside, I stand with the protesters. Now, let me be less clear. At this point, I’m beginning to…

My favorite passages from A Christmas Carol are the descriptions of Christmas in Victorian London:Meanwhile the fog and darkness thickened so, that people ran about with flaring links, proffering their services to go before horses in carriages, and con…

Well, I’m not exactly giddy, but I am excited.  I think it will be great if Harry and Meghan and little Archie moved to Canada.

Brett Martin, in GQ, profiles the inimitable Larry David

Elizabeth Wurtzel, in Medium, discussing her life’s final year

Helen Branswell, in STAT, with the story of how scientists on 3 continents together produced an Ebola vaccine

Photo of Elizabeth Wurtzel by Blonde1967; this photo was taken with an iPhone SE by my mother, Lynne Winters – Own work, CC BY-SA 4.0, Link

       

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So last week saw the Canadian launch of timbits cereal and as evidenced by the number of people have sent press releases about it to me, not everyone is pleased.

Timbits, for readers who don’t know, are donut holes from Canadian donut chain giant Tim Hortons.

People are upset because apparently this sugary cereal is over the top and somehow extra wrong or extra awful.

But why?

Tim Horton’s certainly isn’t in the business of protecting or promoting public health. Nor is Post Foods. Nor should anyone expect either to be.

Presumably the sugar is a concern for people, and at 17g per cup (4.25 teaspoons), it’s definitely not an insignificant amount, but it’s not more than many other sugary cereals, and is in fact less than Post Raisin Bran which packs 24% more sugar at 21g (5.25 teaspoons) per cup.

All this to say, it’s difficult to get angry with Tim Horton’s or Post Foods for trying to sell food as selling food is literally their only job, and frankly this food isn’t any worse than comparable foods they’re already selling.

So what should the cereal aisle make people angry about?

How about laxity in advertising laws that allows for cartoon characters to be festooned on boxes of sugary cereals and prey on children? Or laxity in front-of-packaging laws that allow Froot Loops boxes to brag about their whole grain or vitamin D content? Or the failure of our government to create a front-of-package warning system like the one that was enacted in Chile.

What would life in Canadian cereal aisles look like if we followed Chile’s lead?

Here’s Frosted Flakes before and after Chile’s laws came into effect

Sure looks great to me.

(And for the grammar police, ‘donut’ is how Tim Horton’s spells doughnut)

       

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We were talking yesterday about the possibility of a US-Iran war and how we are experiencing misty, water-coloured memories of the awful build-up to the invasion of Iraq way back in 2003, when related scare-mongering about Iran was also going on.One of…

Back in 2012, I wondered aloud about creating a scoring system for dietary enjoyment. I blogged about it a few times here and there, and happily, a wonderful team of researchers in New Zealand took notice. Now, thanks to the hard work of Michelle Jospé, along with Jillian Haszsard, and Rachel Taylor, the first step towards its formal use has been taken.

Our paper, A tool for assessing the satisfaction of a diet: Development and preliminary validation of the Diet Satisfaction Score, was published late last year and it details our Diet Satisfaction Score’s preliminary reliability and validity.

With the help of the 1,604 people (spanning 24 different countries!) who answered our survey questions, as well as 6 diverse experts (thanks to Melanie Dubyk, Kevin Hall, Scott Kahan, Silke Morrison, Marion Nestle, Sherry Pagoto, Arya Sharma and Ethan Weiss), we arrived on the following questions geared to address various aspects of dietary adherence and satisfaction

The simplest way to think of the Diet Satisfaction Score’s use is the higher the overall score (each question is answered on a 5 point Likert scale and the final DSS score is calculated by way of taking the mean of all available items yielding a total score between 1 and 5), the greater an individual’s satisfaction/enjoyment of that diet is. The hypothesis then would be higher scores correlating with better adherence and consequently better/sustained weight loss.

And that’s what our preliminary findings suggest whereby each 1-point higher Diet Satisfaction Score correlated with a 1.7 week longer diet duration. It was also found that compared with those who had abandoned their diets, those maintaining them reported larger losses.

The value of a simple and quick score like this to individuals would be as a means to assess how much (or how little) they were enjoying their diets taking into account more than just whether they like the foods they’re eating, but also the impact their chosen diet might be having on related aspects of life (socializing, time, cost, etc.). Those evaluating their new diets and finding their scores low, might explore means to tweak their diets, or to try new ones.

The DSS score’s value to clinicians would be as a quick means to screen their patients’ efforts and perhaps to use the tool to help trouble shoot, or to triage referrals to professional resources such as registered dietitians.

The value of the DSS score to researchers would be using this tool with shorter term studies as a means to predict whether or not their studied diets are likely to be sustainable (as who really cares how much weight a person might lose on a particular short term diet if few people would actually sustain it).

Of course now what’s required is the repeated use of the Diet Satisfaction score in a long-term prospective trial. The good news is that because the tool, like me, is diet agnostic, it can be administered with any and all dietary strategies. Should you be interested in using the Diet Satisfaction Score in your trial Dr. Jospe is the person to contact and her contact information is just this one click away.

       

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Today is Twelfth Night AKA Epiphany Eve.Here is one classic version:   And another much earlier classic too: The director, Wendy Toye, was one of the few female film directors in the 1950s (or in any decade, for that matter).

Dexter Filkins, in The New Yorker, with the definitive piece on who was Qassem Suleimani

Isaac Chotiner, also in The New Yorker, on the rise in antisemitism from both the left and the right.

Amanda Mull, in The Atlantic, on how modern life gets in the way of our home cooked best intentions

[And if you don’t follow me on Twitter or Facebook, My first byline for the New York Times is a balm for aggressive New Year’s resolutions, nutrivangelistic diet gurus, magic food stories, and all other forms of healthy living hyperbole]

       

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