bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Can yoghurt prevent diabetes?

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A friend of mine recently shared the news of a new study reporting an association between yoghurt consumption and decreased risk of type 2 diabetes.

The study was actually a meta-analysis of three large studies. Meta-analyses always make me a little nervous due to the ease of cherry picking and interpreting the results to yield the desired effect. The results of a meta-analysis can only be as good as the results of the original studies on which they’re based. I’m not saying this was the case here, just that it’s something to bear in mind when reading about meta-analyses. The researchers do have on their side the fact that all three studies had large sample sizes. After examining the results of these three studies, they added an additional 11 prospective-cohort studies for their meta-analysis.

The researchers controlled for a number of potential confounders. However, there’s always a remaining risk that an unaccounted for confounding variable might be the true reason for any observed effect. While the researchers reported a significant decreased risk of type 2 diabetes in regular yoghurt consumers they were also quick to acknowledge that this does not indicate causation. Yes, people who consume yoghurt appear to be less likely to develop type 2 diabetes than people who don’t. However, the studies all relied upon self-reported food frequency questionnaires and they were observational. It is possible that there is some unaccounted for variable that’s reducing the risk of type 2 diabetes in yoghurt consumers other than the yoghurt.

The researchers do make an interesting suggestion that the probiotics in yoghurt may be responsible for the decreased risk of type 2 diabetes. I do wonder about the validity of this as many yoghurts contain limited live bacteria due to their processing. In addition, it’s unlikely that many probiotics in yoghurt survive the acidic stomach environment to make their way to the intestines. Perhaps it’s the by-products of the bacteria in the yoghurt (e.g. vitamins, lactic acid) that are responsible for decreased risk of type 2 diabetes. Just postulating here. I would love to see a study in which participants are prescribed diets containing either yoghurt with live bacteria, yoghurt without live bacteria, and no yoghurt. Yes, it would take a long time to determine if the yoghurt reduced the risk of type 2 diabetes but other effects could be examined as well and it would be interesting to see what the true effects of  regular yoghurt consumption are on health.


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Book Review: The Diet Fix

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I should start with a disclosure: I briefly worked with the author, Dr Yoni Freehoff at his weight management clinic in Ottawa, and I consider him a friend. That being said, I no longer work with him, he didn’t ask me to read or review his book, I didn’t even get a free copy! Okay, well, I kind of did, I borrowed one from the library. The book in question is The Diet Fix

Having worked with Yoni, and being a dietitian, there wasn’t anything in the book that was new or surprising to me. Basically, it was a refresher of everything we would cover with clients, minus specific nutrition information and individual concerns. In addition, I’m not someone who struggles with weight so it wasn’t of personal benefit to read the book. It’s hard to set aside my personal lens when writing about the book. However, as I was reading, I could think of several people I know who would likely benefit from reading The Diet Fix.

Yoni provides a great overview of the information that’s imparted at his clinic in the book. For anyone who doesn’t have access to services provided by a place like the Bariatric Medical InstituteThe Diet Fix is a decent stand-in. There’s a valuable emphasis on living the best life that you can and de-emphasis on the numbers on the scale. Many of us have developed unhealthy relationships with food and this book does its best to help the reader (re)gain a healthy relationship with food.

While there is a section about “resetting” various diets, the book is not a diet book. It’s a lifestyle guide book. The problem with diets is that they always have an end date, and then what? Yoni doesn’t harsh on Paleo (even though it’s so easy and tempting) or Clean Eating or any other money-making diet out there. As long as you’re able to happily and healthily live the rest of your life adhering to whatever style of eating you’ve chosen that’s okay. There are tips for how to make the most of any diet style.

Honestly, the only thing in the book that really bothered me was how often he says “folks”. And that’s probably just because I know someone else (who I can’t stand) who calls people “folks” all the time and it’s become like nails on the chalkboard to me. But I digress… The only statement in the book that I took any exception to was this:

Fruits and vegetables also fall into the carbohydrate catchall. For the most part, they’re all wonderful. The only possible exception is the potato. Dr. Walter Willett, Harvard’s chair in nutrition  since 1991 and the world’s second-most-cited scientist in history, once suggested that consuming one was akin to spooning pure white table sugar into your mouth.

Who am I to question the wisdom of Willett? I will anyway though. Sure, many people consume potatoes far too frequently and in less than nutritionally optimal forms (i.e. chips and fries), however, it’s my belief that the potato is an under-rated vegetable.

Minor quibbles aside, I enjoyed the last sections of the book the best. They addressed a number of issues, such as medications and raising healthy eaters, that most “diet” books would never touch. This makes it a great resource for anyone who wants to take charge of their health, impart healthy habits on their children, or who works with people who do. If you want to lose weight and don’t know where to start, if you’re a doctor or a dietitian, I definitely recommend giving this book a read.


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Are apples the key to curing obesity?

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A few weeks ago the media was reporting that apples may provide the cure for obesity. I was a little more sceptical. I mean, how many overweight and obese people do you know who eat apples? Probably lots. If apples were capable of curing obesity everyone would be thin.

My first concern was that this research was conducted on mice. That means that it may (likely) is not translatable to humans. A couple of things to consider: these mice were fattened up by being fed a very specific high-fat diet. Obesity is a complex condition with myriad factors. Unless the reason for people being overweight is due to consuming a similar diet to these lab mice, it’s quite likely that they will not respond to this weight loss treatment in the same manner as the mice. I also wondered how much apple the mice were fed. How much apple would humans need to consume to see similar results? Here’s where it gets crazy: the mice did not eat the apples. Yep, that’s right. We have no idea how much apple would be beneficial to humans as we don’t know how much would be beneficial to mice. Rather than feeding the apples to the mice, the researchers made a slurry of apple compounds and mouse faeces. They found increased levels of certain bacteria that are commonly found in the faeces of slim mice in the cultured faeces of obese mice. Their results were not statistically significant. They showed a trend toward increased levels of some bacteria and butyric acid, and decreased levels of other bacteria in the faeces-apple slurries of obese mice but none of the changes (save the decreased bacteria) were large enough to be statistically significant.

It’s impossible to say whether or not eating apples (how many, how frequently) would have similar effects on the fecal microbiomes of mice or humans. We also don’t know if these microbial changes do occur if they would result in weight loss. Without knowing this, it’s a ridiculously huge leap to suggest that consuming apples could be a treatment for obesity. This didn’t stop the authors from concluding that:

These results suggest that dietary fibre and phenolic compounds remaining in apples after IVD might help to prevent metabolic disorders driven by an altered microbiota in obesity, and potentially protect from an obesity-disturbed balance of microbiota.

It also didn’t stop the media from publishing articles with headlines like: “An apple a day could keep obesity away: Granny Smiths promote friendly bacteria helping us feel fuller for longer” and “Granny Smith apples can help prevent the damage of obesity“.

I do think that research into our microbiomes is going to provide insight into many illnesses and conditions. However, our individuals microbiomes are extremely variable. Suggesting that this research using mice will translate to obesity treatments for humans. It’s also extremely unlikely that consuming one healthy food will negate the effects of an overall unhealthy diet. That being said, apples are nutritious and it’s certainly not going to hurt you to have an apple a day.


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Dr Oz gets schooled and says: #sorrynotsorry

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I’m sure that the whole Dr-Oz-goes-to-the-senate-and-gets-scolded thing is going to be all over all of the blogs for at least the next few days. Despite this, I still feel the need to throw my voice into the fray. I’ve ranted about Dr Oz and his ridiculous supplement (and dietary) proclamations many a time (too many for me to be bothered to even give you a link right now, feel free to search my blog for my scorn). It’s not just weight loss that’s a problem. It’s pretty much every dietary and supplement recommendation that he’s made. Eat a papaya every day? Come on, are we made of money (perhaps Dr Oz should read yesterdays post)? And what happened to variety is the spice of life. Any dietitian worthy of the “RD” after their name will tell you that variety is a key component of a healthy diet.

But that’s all history now, right? Dr Oz, the great and powerful Oz, has (gasp!) apologised for his role in the popularization of useless weight loss supplements. Does this really sound like the words of someone who is truly sorry: “For years I felt that because I did not sell any products that I could be enthusiastic in my coverage and I believe the research surrounding the products I cover has value.”? What I see here is Oz saying that by not putting his name on any product labels that he thought it was okay to tout each and every one of them as the next great MIRACLE weight loss cure on his show. Even more importantly, I see that Oz still believes in the “research” conducted on the products he promotes. Never mind that most of them have little to no scientific research to support their use as weight loss supplements. Never mind that those that do have research invariably have weak biased research. Never mind that he conducted his own “research” into the efficacy of green coffee bean extract using audience members.

Do I think that we’ll see any meaningful change as a result of this hearing? I doubt it. Dr Oz doesn’t believe that he’s done anything sincerely wrong and what he does is popular. Horrifyingly popular. Just a taste of some of the comments on his facebook “apology”:

Dr.Oz, you are amazing. You get people excited about living healthier and happier lives! You show is interesting, lively and is very enjoyable as well as more importantly very informative to watch. Thank you!!!

You have done far more good in your career than any other public medical professional, helping people take responsibility for their health and promoting preventive care and wellness. Don’t listen to the politicians, who are the MOST self-serving of our population and sell out every day to lobbying money. You owe no apologies.

You are a good doctor, and you have done nothing wrong. I am glad you stood up for what is right. Keep on doing what you do best Dr. Oz…
They go on and on in that vein. People want miracle cures. They don’t want to hear that losing weight (and keeping it off) is hard work. That’s why Dr Oz has 4.6 million likes on FB and a syndicated television show and dietitians (like yours truly) are tapping away writing unpaid blogs about nutrition in their spare time. As long as Dr Oz is being given a platform, as long as the network is getting the ratings, and as long as the public are swallowing every pill he proffers he is going to keep dishing them out.

 


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Diet of privilege

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A few weeks ago I saw someone comment on an Instagram photo of rhubarb. They said they didn’t know why anyone would ever buy rhubarb anymore because it grows like a weed in their garden. It’s true, rhubarb is very easy to grow (as my parents can surely attest to) but not everyone has a garden. That comment really got under my skin. It was innocent enough but it came from a place of privilege. I’m fortunate that I can afford to buy rhubarb at the local farmer’s market and that I have parents who are always happy to share their crop with me. Not everyone is so lucky and I think that most of us could do with a reminder of that before we pass judgement or dole out advice.

I recall seeing a recipe for healthy sugar-free cookies posted by a dietitian on twitter a while ago. It was full of expensive ingredients like almond flour and chia seeds. Putting aside the fact that the recipe actually sounded rather revolting, how many people can afford to purchase all of these ingredients to make a batch of “cookies”? Sure, share that recipe with your friends, family, and well-off clients but bear in mind that many people can’t afford such things. By telling people that these types of recipes are the way to go if you want to eat healthy then you’re quite likely to discourage people from making any steps to improving their diets. Sugar-free gluten-free chia seed cookies can be a part of a healthy diet, but they are not essential to a healthy diet.