bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


My Boston Marathon experience


I’d like to begin by noting that Boston is a beautiful city full of friendly people! I absolutely loved my visit here. From the shop owner who offered me a free potted tulip on Easter to the amazing hosts we had at our Airbnb accommodation.

The morning of the marathon I was wished good luck by a stranger as we walked down the street to catch the subway. Love the feeling of support and excitement from everyone in the city!

The race itself was extremely well-organized. Hopped right on a bus to Hopkinton after getting off the subway. I was sitting next to a middle-aged runner from Italy on the ride out. He told me that he and his friends had decided to run Boston after the bombings last year as a show of support; sport should not be subject to political action. It was his tenth marathon but first outside Europe. He started running because he was overweight and had a sedentary job and wanted to be healthy. He asked my motivation for running. I told him it was my brother who’s super fast (and who should really run Boston next year – ahem). The drive out took about an hour which made me think “we have to run back all this way??!”. On the upside, it gave me time for my anxiety to subside and for me to eat the better part of a clif bar.

The athlete’s village was madness. It was a sea of people sitting on the grass. I wandered around a little bit. Got a foil cape because, despite the throw-away pants I had worn over my shorts on the recommendation of a runner from last year, I was so cold that my teeth were chattering. I had been concerned that I would be bored and anxious waiting to load into the corral at 9:50 after arriving at 8:30 but a 45 minute wait in line for the porta-potty managed to kill all of the time after my wandering.

I quickly learned why the corral loading takes place so much earlier than the start time. There’s a bit of a walk to the corrals. Met a couple of Canadian doctors from London who had gone to med school in Halifax while I was walking. Such a small world!

By the time the race started, things had warmed-up quite a bit and I pretty much immediately regretted wearing a long-sleeved shirt. My legs were hurting before I even started from all the walking we had done exploring Boston the previous day. Not a great start. I just ran and hoped for the best. I tried not to push too hard but I also wanted to make good time. Having only run one previous marathon (in 3:19) I kinda wanted to beat my time but I also knew that it was a harder course and might not be possible. I didn’t know how I was doing but apparently I was doing quite well: 44 minute 10k, 1:35 at the half, 3:11 at the 40k. I even stopped for water WAY more than I usually would because with the sun shining it was HOT! I even ducked in to use a porta potty (all that water!) around 19 miles. I really didn’t think I was pushing it too hard.

The number of spectators was amazing! There were people along the entire 42.2k route; cheering, proffering orange slices, water, beer (haha). For a while there was a man in a Canadian shirt running near me and there were continual cheers of “go Canada!!” from spectators; I kept thinking they were cheering for me and then remembering my coral shirt indicated nothing of my nationality. I wanted to revel in the moment; having all of those people cheering all of us on, running the freaking BOSTON MARATHON but I couldn’t. Every little hill was killing me and it took all of my focus to keep running.

I didn’t feel great for most of the race but things really fell apart after 20 miles. I kept considering walking but I just wanted to be done so I pushed myself to keep running. With every mile marker I figured I was that much closer and may as well just keep running for as long as I could. I could feel my face getting sunburnt and whenever I touched my face I could only feel a layer of gritty salt. Then my head felt a bit like it was separate from my body and I was having trouble seeing. I had been scanning the spectators for my boyfriend as I neared the finish but I had to stop because I couldn’t focus. I knew it wasn’t good but I couldn’t quit. I’d come so far! I was the running dead.

About a half mile (or maybe less because I have a vague recollection of seeing the 26 mile marker) from the finish line my legs gave out. I crumbled to the pavement. I kept trying to get up but I couldn’t. I was like a baby deer with zero control of my legs. I had a brief moment in which I wondered what I would do since I couldn’t use my legs. Suddenly another runner was helping me up. She let me cling to her as I slowly stumbled the rest of the way to the finish line, for a short period another woman joined me on the other side. This was an act of true altruism, sacrificing her race time to help a complete stranger. I wouldn’t have finished with out her and I will be eternally grateful. I was so out of it my head kept flopping around and I don’t even remember crossing the finish line. I just remember thanking her and apologizing while we shuffled along, her asking me if I could see the finish line. The next thing I remember was being put into a wheelchair and brought to a cot in the medical tent where I was helped onto my back on a cot with a box elevating my feet. I was asked a bunch of questions like who I was, emergency contact, my finish time (I had no clue what it was but I think I accurately answered the rest of the questions). Someone brought me a medal for finishing and then water and Gatorade. I tried to eat a couple of potato chips for the salt but they were like sawdust in my parched mouth.

The medical staff and volunteers were very kind and helpful. I knew they wanted to get me out of the tent so that they could get someone else into my cot but they let me take all the time I needed until I could walk again.

Looking around the tent, I felt better about the sad state I was in. I think I was “just” overheated and dehydrated. There were first wave (the fastest) runners hooked-up to IVs, unconscious, people with injuries. It could have been worse. And on the upside, I had a Boston Marathon experience that few other people did. I was still embarrassed. I thought that I was too smart to let myself get in such a state. I guess my one previous marathon wasn’t enough to predict this race experience. It was much hillier (heartbreak hill, what? Every hill broke my heart!) and warmer (I would have given just about anything for an overcast day). I finished that race excited to run another one. This one I finished swearing no more full marathons!

Once I was able to stand again, one of the medical staff walked out of the tent with me and then left me to slowly hobble my way down to the appropriate family meeting point to find my boyfriend. Why did the start of the alphabet have to be so far away?! Why couldn’t my last name begin with “Z”?

After finding my boyfriend we hobbled to the subway and then caught a cab back to the apartment we were staying at in Cambridge. I promptly lay down on the bed and stayed there for a couple of hours. I was alternately hot and cold, I had a headache, and my legs were killing me. It was like having a combined flu and hangover and extreme DOMS. My boyfriend was a great and patient nurse. Offering me water and going out to Whole Foods to buy me some fruit when I finally started to feel like I might be able to eat something again.

Lessons learned: unless running a hypothermic marathon, long sleeves are not a good idea on a sunny day. Run faster on the days the training schedule says “race pace”. Try a longer training run even if the schedule puts the longest at 20 miles. Try bringing salt tablets on sunny marathon days. Water, gu, and a little Gatorade were no competition for the sodium loss I experienced. Previous experience doesn’t necessarily predict future experience and every race will be different.

Thanks for sharing this journey with me. Back to your regularly scheduled nutrition rants next post!


I received an email with a link to my official race photos today. Based on the bib number I was able to find my saviour! Her name is Anne Zannoni. You can find her on twitter: @anne_zannoni and read her blog (although if you’re like me, you may need to translate it as it’s in Italian) at: I cannot express my gratitude to her enough and I’m so glad that I was able to thank her!


Insane in the Grain Brain


My library hold finally came in! No way was I paying to read Grain Brain. I like to financially support quacks as little as possible.

First thought: Including a quote from Dr. Oz on the front cover of your book does little for your credibility.

Second thought: I really like the font used for the Contents page.

Introduction“I’m also a founding member and fellow of the American Board of Integrative and Holistic Medicine.” Cue alarm bells! He said the “H-word”! I promptly googled the organization to learn more. Hmm… While I like the general notion of treating the patient as a whole I’m not sure about this principle: “Integrative holistic physicians strive to relate to patients with grace, kindness and acceptance, emanating from the attitude of unconditional love as life’s most powerful healer.” Love as the most powerful healer?? Call me crazy but I’m not going to my doc for love to heal me when I have an injury or infection. For more about the ABIH check out this post on Science-Based Medicine. Which confirms my fear that this certification has essentially zero meaning. Okay… So the author, David Perlmutter, is the founder of a quack organization. Still, just for fun, I’ll keep reading and see what his “proof” regarding the toxicity of grains is.

Modern wheat is not the same as the wheat of our ancestors. Yeah, yeah. We’ve heard this all before.

“Why is precious little information made available about how we can keep our brains healthy and stave off brain diseases?” I do like this question. Also, I suspect the answer is the same for the brain as for other organs: get plenty of exercise, avoid being sedentary, cook for yourself, and eat more veg. Oh, wait. Not according to Perlmutter, “it’s pointless to consume antioxidants.” Forget the veg, apparently we should all be eating more fat and cholesterol.

Self-Assessment: Ooh! This should be fun! I got 7 out of 20. Zero is optimal but at least I’m not in the “hazard zone” which is anything over 10.

Chapter 1“As many as 40 percent of us can’t properly process gluten”. Reference please. Where did this figure come from and what precisely does inability to properly process gluten mean?

Yes, cholesterol is essential in our bodies. However, a dietary source of cholesterol is not essential. Our bodies can make it. Also, what does this have to do with grains being the cause of brain degeneration and diseases?

Chapter 2: I wonder what this “test for gluten sensitivity” he’s ordering for his patients is. I can’t dispute these tales of improvement in patients following elimination of gluten. However, it’s important to note that we don’t have all of the details and elimination of gluten may not have been the “cure” for migraines and bipolar disorder Perlmutter wants us to believe it is.

A lovely image of a brain scan of a “gluten sensitive” patient versus one of a “normal” patient shows extensive damage in the GS brain. Obviously, this is proof that gluten causes brain damage. Or is it? Remember, correlation does not equal causation. And one brain scan image does not mean gluten will destroy your brain.

In the chapter about gluten Perlmutter says, “one of the main reasons why consuming so many grains and carbs can be so harmful is that they raise blood sugar”. Huh? So the cause of brain disorders is gluten, which is a protein, which would not impact blood sugar. So why are we now talking about carbs?

Chapter 3: “I’ll explain why consuming excess carbohydrates – even those that don’t contain gluten – can be just as harmful as eating a gluten-laden diet.” Sigh. Carbs are evil, fat is good. This is just Wheat Belly redux. Also, while I’m in agreement that all fats (with the exception of man-made trans-fats) can be part of a healthy diet and some of us need more (or less) than others, I think we also need to remember that fats contain more calories per gram than other macronutrients. Thus, if weight control is a concern, we must be careful not to consume overly large portions of calorie-dense high-fat foods.

Perlmutter argues that elevated cholesterol is not only not a risk factor for cardiovascular disease, it’s actually protective against CVD, ALS, and other diseases. The primary basis for this claim was a large study in Norway. The researchers found that there was a U-shaped association between total cholesterol and mortality from CVD. This would suggest that cholesterol has an optimal level (between 5.0 and 7.0 mmol L -1). People below 5.0, or at 7.0 or above, were more likely to die from CVD during the course of the study. Interesting indeed. However, those who had CVD at the start of the study were excluded and the researchers didn’t look at the difference between HDL and LDL profiles. I can’t help but wonder if examining these things would have made any difference to the findings. Even assuming their findings are accurate, they still don’t suggest that high levels of serum cholesterol are protective. They merely suggest that both high and low cholesterol may be associated with CVD.

Perlmutter moves on to argue that the use of statins increases the risk of developing Type 2 Diabetes (remind me again how this pertains to grains and gluten being toxic?). He cites a 2012 study that found a 48% increased risk of developing diabetes for women who took statin medications in contrast to women who did not. That sounds huge but it’s actually not as big as it sounds; 9.93% of statin users were diagnosed with DM2 versus 6.41% of non-statin users. This was also an observational study so causal claims cannot be made. While researchers did control for some confounders it’s entirely possible that there was another reason for the relatively greater risk experienced by the statin users, like, oh, say elevated LDL or another related health condition. There was also a large difference in the sample sizes for each group (10, 834 statin users and 143, 006 non-statin users) which makes me leery about drawing precise comparisons.

Chapter 4: Near the end of this chapter Perlmutter cites a 2012 study of weight loss maintenance (he fails to make the maintenance part very clear) as proof positive that a low-carb, high-fat diet is “the best diet for maintaining weight loss.” To be clear, the study had participants lose weight and then put them on one of three possible weight-loss maintenance diets for 4 weeks. They did find that the low-carb diet “produced the greatest improvements in most metabolic syndrome components examined herein” with a couple of caveats: 1. participants also experienced elevated urinary cortisol excretion 2. C-reative protein was found to be higher in this group. So, while some areas, such as resting metabolic rate, were better for participants on this diet, there were also negative effects. In addition, it’s important to note that the sample size was very small, only 21 people. Also, four weeks is not the same as a lifetime. It’s impossible to extrapolate from this experiment that a low-carb, high-fat diet is the optimal diet for health. Nor can we tell if it’s a realistic diet. Even if it does prove to be optimal for health it doesn’t really matter if nearly no one finds it possible to adhere to. I think that Perlmutter is taking it a little too far (yes, I’m being kind) to draw the conclusion that we should all switch from carbs to fats on the basis of this study.

Chapter 5: Perlmutter is making the argument for neurogenesis and discussing the benefits of exercise (I fully support this) as well as caloric restriction (I think the jury’s still out on this one). I do find it interesting that he’s advocating for a high-fat, low-calorie diet. I would think that this would be very difficult to follow; eating small amounts (Perlmutter recommends reducing caloric intake by 30%) of calorie-dense foods likely wouldn’t be very satiating. Just me speculating though.

I can’t help but think that Perlmutter is cherry picking research that supports his hypothesis. Grain Brain reminds me of how I used to write research papers in high school. I would develop an outline, start writing, and find sources that supported my hypothesis to use as citations.

Chapter 6: In this chapter, Perlmutter discusses the possible connection between gluten sensitivity and various mental illnesses; including: depression, autism, tourette’s, and ADHD. Complete with compelling tales of curing patients by placing them on gluten-free diets. While there may be some connection to gluten sensitivity in some of these illnesses (a recent study found a correlation between autism spectrum disorders and positive serologic celiac disease – but not for gut mucosa – test results) I think that without the corresponding evidence that Perlmutter is providing many individuals with false hope. Anecdotal evidence is not the same as scientific evidence and it’s important to note that, in most cases, no link (correlational or causal) has been drawn between gluten and mental illness. That’s not to say that gluten-elimination isn’t worth trying but in the majority of cases it’s unlikely to alleviate symptoms.

I’m reading about how a study of children with celiac disease found an increased risk of headaches of 833% in comparison to the general population. I decided to take a look at the original research Perlmutter cited with the hope of going on a little rant about relative risk (after all, it was 5% of the children in the study with celiac disease who experienced “headache”, versus 0.6% in the general population, still a small minority of children). However, the article that I found that matches the citation by Perlmutter doesn’t contain any such information. In fact, it contains zero mention of celiac disease or gluten whatsoever. Perhaps the citation is mismatched? (Let’s give Perlmutter the benefit of the doubt here). Regardless, it makes it that much more difficult to dispute (or support) his claims when the claims and the citations don’t correspond.

Chapter 7: In this chapter Permutter states, ” many of today’s physicians… don’t have a firm grasp of nutrition and its effects upon your health.” Hear hear! Cue the opportunity to promote the services of registered dietitians. Oh, wait. Perlmutter simply says that he hopes this will change with the next generation of doctors. Sigh. He then goes on to list a number of supplements that apparently we should all be taking.

DHA – Yes, along with EPA in fish oil, this may provide some neurological and cardiovascular benefits (1). Resveratrol – The jury’s still out on this one but more recent research has put a damper on earlier studies praising it as a life-extender (2). Turmeric – This spice is still being researched, and while promising, no conclusions have been reached regarding its benefits. The study Perlmutter cites was epidemiological research which asked residents of Singapore how often they ate curry. Those who ate curry occasionally, often, or very often, performed better on a test of cognitive ability. Of course, there’s potential for missed confounding variables, as well as the possibility that the difference could be attributed to some other component of curry. Probiotics – Again, we are still in the early stages of research linking gut microbiota and brain health. Perlmutter advises against consuming some probiotic foods as they often come with too much sugar. Instead he suggests taking a supplement. As a dietitian, I always think that it’s best to obtain your nutrients from foods whenever possible. Add foods like plain yoghurt, kefir, sauerkraut, miso, and kimchi to your diet to obtain probiotics. Coconut oil – There is some interesting research underway investigating the effects of coconut oil on Alzheimer’s patients (3). I certainly think that it’s a good idea to incorporate a variety of fats in our diets. However, I don’t think that we should go overboard with any one food. Alpha-lipoic Acid – May have some neurological benefits but the research thus far is not strong (4). Vitamin D – It seems like for every positive study regarding vitamin D there’s another study claiming that it’s useless, or even harmful. In our Northern climate, until research shows otherwise, it is still prudent to supplement with Vitamin D during the winter months.

Chapter 8: Shocker: I wholeheartedly agree with everything Perlmutter has to say in this chapter. He is emphasizing the importance of exercise for brain health. Nothing about grains or carbs.

Chapter 9: Another chapter without mention of grains and carbs. Another chapter I actually agree with Perlmutter. Sleep is vitally important for health.

Chapter 10: We’re just getting into general healthy living tips now and recommendations for how to implement the Grain Brain diet. Most of them are perfectly reasonable. Following this, there are some recipes.

As I sat eating birthday cake (it’s birthday season in my family) and contemplating how to conclude this post I commented to my boyfriend, “Who knows, maybe eating cake will give me Alzheimer’s one day.” Considering how few people develop Alzheimer’s disease (14.9% of Canadians over 65 have some form of dementia) and how many people consume grains (statistics unavailable but I’m assuming it’s roughly 100%) based on the current lack of robust evidence it’s a risk I’m willing to take. I hope to celebrate my birthday tomorrow with some cake.

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Will teenaged milk consumption increase hip fracture risk in old-age?


I recently saw someone touting the results of a study as indicating that milk consumption may increase the risk of bone fractures. Now, if you’ve been reading my blog for a while you’ll know that I’m not always on board with the promotion of milk. I question the inclusion of milk and alternatives as a food group on Canada’s Food Guide. However, I don’t believe that there’s anything inherently wrong with consuming milk (in moderation) if it’s a beverage that you enjoy. It’s certainly better than juice! Anyway… Despite my posts deriding “research” promoting the consumption of milk (usually of the chocolate variety) I lean towards siding with the milk-drinkers on this one.

The study looked at data from the Nurses’ Health Study and the Health Professionals Follow-Up Study in the US. Milk consumption of participants during adolescence was reported based on dietary recall ten years into the study. Considering that, depending on the study, participants were between 30-55 and 40-75 years of age at the start of the study, they would have been estimating their adolescent milk consumption anywhere from about 17 to 60+ years after the fact. Maybe it’s just me, but at 35 years of age I can’t recall how much milk I drank as a teenager. As dietary recall tends to be inaccurate the day following consumption I would hazard to guess that it’s even less accurate decades down the road.

“Participants were excluded at entry if they had reported a prior hip fracture, a diagnosis of osteoporosis or cancer”. I wonder if this exclusion affected the results. It would be interesting to look at the excluded participants to determine if they were milk-drinkers or not during adolescence. The researchers also divided the results into three groupings: those who consumed milk less than twice a week, those who consumed it once a day, and those who consumed it four or more times a day. Four or more times a day seems like rather a lot of milk to me. I would be interested to see the level of risk for hip fracture played out for those consuming the recommended number of servings based on the Food Guide (i.e. 3-4/day) also taking into consideration other foods from the milk and alternative group.

The researchers found an increased risk of 6% of hip fracture for each glass of milk consumed by men during teenaged-years (this was presumably over the average of 2.1/day reported). Interestingly, for women, there was no relationship between milk consumption and hip fracture risk. The researchers did rely on participants to report hip fractures so there may have been some degree of inaccuracy in the findings.

I think that this statement by the authors in the discussion is worthy of note: “it is not entirely clear that an early gain in bone mass will persist into adult years as the young skeleton is replaced through many years of remodeling, which may erase any initial advantage.” In other words, consumption of nutrients, and participation in exercise, which increases bone density when you’re young may not matter if you don’t carry on with these behaviours as you age. The argument here is less whether or not milk consumption during adolescence affects bone density and hip fracture risk during old age and more that it’s important to continue to be active and to consume foods that are rich in calcium and vitamin D as our bones are not static.


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