bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Fat does not equal fat

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The article: Anyone Silly Enough to Think Fat is Good for You Needs to See This Brain Study made me want to scream and scarf a bag of potato chips out of spite.

The article reports that the study found that body fat doesn’t just sit around your midsection, it also affects your cognitive function. This lead them to the conclusion that recent reports that dietary fat has been wrongly demonized are incorrect.

What’s my problem with this? One, body fat and dietary fat are not the same! You can become obese by consuming too many fat-free foods. Dietary fat does not equal body fat. The study was looking at  body fat not dietary fat. This means that we can’t go blaming butter. Two, the study was done on mice. Mice are not humansYes, it’s quite likely that excess body fat has negative effects on many aspects of your system. However, we can’t make the leap from a study on mice to humans. And we most certainly can’t make the leap to dietary sources of fat.


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Fed Up – Movie review

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I went to see the movie Fed Up last week. I think that the overall message was a good one: cook more, avoid highly processed packaged foods. Because of this, I feel a little bit torn about being critical of it. However, I feel that it’s going to be “preaching to the choir” anyhow so bringing up my issues is probably unlikely to do much to impact ticket sales. And even with my issues, it’s worth a watch.

First issue: why did they have to include so many people with quackerific tendencies (such as Mark Hyman and Robert Lustig)? Fortunately, there were some credible people with backgrounds in nutrition (such as Marion Nestle). Why were there no dietitians? I’m seeing the examples of what the obese children were eating and proclaiming as “healthy” (low-fat cereal, Special K chips, NUTELLA DIPPERS) and I’m thinking that maybe the problem here is lack of education and understanding of what “healthy” is. One of the mums was saying that they had the tools, and knew what to do, so they were going to do it on their own as her daughter was too young for Weight Watchers. Well, if those are the choices that you think are healthy, then you clearly don’t have the tools. Any dietitian could have set things straight. But no, Fed Up had to go and conflate the issue of obesity with the issue of excess sugar.

I’ve said it before, and I’m saying it again no one nutrient is to blame in the obesity epidemic. Yes, indeed, too much of anything is bad for us but sugar alone is not what’s making everyone fat. The movie even talked about the true cause: the proliferation of inexpensive calorie-dense, nutrient lacking food everywhere we go. Our food system and environment. Why on earth they had to go and lose credibility by demonizing sugar is beyond me. Suggesting that sugar is the problem only provides the food industry with the ability to provide the “solution” by creating low-sugar and sugar-free foods. I can tell you right now that, that solution is going to work just as well as the low-fat, fat-free solution did. When you visit the home page for Fed Up the first thing you see is an option to sign-up for the challenge “sugar free for 10 days”. Not, cook supper and eat as a family for 10 days. Sigh.

Even though it was only a brief moment in the film, there was mention of how chefs like Jamie Oliver are going into schools and trying to help children to get excited about preparing and eating nutritious food. Yes, this is a good thing but I question how much more Jamie Oliver is a part of the solution than he is a part of the problem. Putting aside his lack of knowledge of nutrition, and his terrible lesson of teaching children to choose oranges over chocolate bars by forcing them to run around a track to burn-off the calories from their snack of choice, have you seen how many packaged foods he has in grocery stores? If the problem is unhealthy processed foods then a chef who is profiting from sales of said foods should not be too loudly lauded for his efforts to teach children and families about cooking on tv (which he is also profiting from). I’m not sure how much this differs from the much reviled McDonald’s selling crappy food but running a lovely charity like the Ronald McDonald House.

And why, oh why, did they feel the need to say “cook real food”. This is redundant. Who is cooking fake food? Just cook.

They also brought up the “calorie is not a calorie” argument. This makes me want to tear my hair out!!! A calorie is a unit of measure. Arguing that a calorie is not a calorie is like arguing that an inch is not an inch or a kilogram is not a kilogram. Yes, you should consume foods that contain vitamins and minerals alongside the calories but that does not negate the value of a calorie.

Okay… I’m almost done… The other issue I took exception to was the evidence presented that healthy eating is less expensive than unhealthy eating. They showed the cost for a fast food meal in comparison to the cost of a home made meal consisting of a whole chicken, rice, and veg. There are a couple of problems with this. One, the cost of the meal was based on what was used to make the meal, not what all of the ingredients would actually cost. You can’t just buy the exact amount of oil, rice, spices, etc to make one meal, you would spend considerably more to buy the full containers. Someone living in poverty might not have that money. And where the heck are they getting a whole chicken for only $5 and change!? Two, it presupposes that people have the skills, time, and facilities necessary to prepare a roast chicken dinner. Sadly, many people living with food insecurity (and obesity) lack these conveniences.

Did I learn anything while watching the film? No. Did I agree with everything in the film? No. Do I think it’s a worthwhile watch? Yes. Despite all of my issues with specific content, I’m still a supporter of the overall message to cook more food at home.

After writing this post a colleague on twitter (David Despain @daviddespain) shared a link to an excellent article critiquing the science in the movie.

…After publishing this post, a colleague informed me that the authors of the article (linked above) are actually a front group for the food industry. I still think that they made some valid points in their critique of Fed Up but this is a good lesson that we should question everything.


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The “real food” fallacy

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All of a sudden, it seems that Zoe Harcombe is everywhere. She was providing ludicrous nutrition advice for sufferers of yeast infections (thanks @RD_Catherine for the link). Sorry y’all yoghurt won’t cure yeast infections. Yes, choosing a yoghurt with probiotics is great for overall health but it’s more because of the by-products produced by the bacteria (e.g. B vitamins) than because of the bacteria themselves. Unfortunately, most of the bacteria in yoghurt will not survive your stomach acid.

What I really want to address though, is her popular article in the Daily Mail (thanks to @ERHWG for sharing the article and her rage): Diets Make Us Fat. The Solution is Simple. The basic premise is that we need to eat “real food” as opposed to fake  “manufactured food”. Calories don’t matter, and we shouldn’t be counting them. All that matters is eating “real food”.

But what is “real food”? I don’t think you’ll find many dietitians who disagree with the importance of cooking and eating more vegetables, fruits, and minimally processed foods for overall health and weight loss. However, I don’t think the division between “real” and “fake” food is particularly useful. Nor is the vilification of whole grains. Grocery shopping is complicated enough and people are hard-pressed for time. Making them feel guilty for buying anything in a package is not going to help them to adopt healthier habits.

It’s also possible to be over weight when consuming a “real food” diet. You know why? Because calories do matter. I’ve met plenty of people who are over weight who eat very healthy diets. Simply telling people that if they eat “real food” is not going to solve the obesity crisis. If I was over weight and someone gave me this advice I would be insulted. Not everyone who is over weight or obese is subsisting on a diet of big macs and kit kat bars. Consuming more calories than we need, regardless of the source, will result in weight gain.

Finally, the reason that diets don’t work is because they’re short-term fixes. Not because people are necessarily consuming the wrong types of foods or because they’re counting calories. The problem with diets is that they have an end date. They are not sustainable lifestyle changes. The other reason that they don’t work is because our food system is broken. Our environment is structured such that the unhealthy choice is the easiest choice and it’s a lot of work not to be over weight. Placing the onus on the individual and suggesting that if they only stopped counting calories and ate “real food” doesn’t even come close to addressing the true societal roots of the obesity epidemic.


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Sugar and obesity

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I don’t dispute the fact that most of us likely consume too much sugar. As with too much of anything it’s also likely doing more harm than good. However, I do take exception to the sentiment I’ve seen from some vocal supporters of Action On Sugar on twitter. There’s the dichotomy that you’re either with them or against them. Along with that, there’s the implication that any dietitians questioning the assertion that sugar is toxic must be in the pocket of the food industry.

Why can’t it be possible that some of us think there’s a middle ground? That perhaps, as with other nutrients before (e.g. fat, salt, carbs) it will turn out that there is nothing intrinsically harmful about sugar, and that some dietary sugar is perfectly safe as part of a healthy diet.

I resent the implication that if I dare to question the sensibility of demonizing sugar that I must be brainwashed by the food industry. After the harm we’ve seen done by demonizing nutrients in the past, you would think that we would have learned our lesson. The likelihood that a single nutrient, such as sugar, is the cause of the obesity epidemic is extremely unlikely. Reformulating products is not the solution. We’ll probably just end-up replacing sugar with something that will turn out to be even worse for us. Instead, we should be teaching people to cook and to consume fewer highly processed calorie-dense, nutrient-light foods.


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Low-fat vs low-carb

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There’s a lot to unpack from this Daily Mail article a friend alerted me to. The premise: a couple of identical twin doctors decide they need to lose weight. In order to determine which fad diet is better, one goes low-carb, the other goes low-fat. The fact that they are genetically identical and maintained similar levels of physical activity means that they assumed any differences observed would be due to diet. While there is merit to using identical twins in research studies it’s important to note that this was not a scientific experiment. One subject in each group doesn’t lead to robust findings. Other issues: obviously both men knew which diet they were on and there was no control group. So, this wasn’t good science but it’s still possible that we could learn something interesting from their little “experiment”.

Before we look at what they “learned” from the experiment there are a few things in the article that I want to touch on. Firstly, the headline states that “one twin gave up sugar”. Well, yes, but this twin also restricted all forms of carbohydrate, not just sugar. The twin who went on the low-carb diet thought that it would be effective because of the insulin hypothesis of weight gain.

Because these carbohydrates are highly refined, they tend to raise blood sugars and blood insulin levels quickly.  This will tend to cause weight gain and obesity.  This is known as the Carbohydrate-Insulin Hypothesis (CIH), and is the basis of the Atkins diet and many other low carbohydrate (Dukan) and very-low-carbohydrate diets (ketogenic diet). (1)

While it sounds convincing, we know this hypothesis to be incorrect. For one thing, there are many people/populations who consume high-carbohydrate diets and never develop obesity. For another, insulin on its own does not cause obesity (2). Minor quibble, really, but as doctors discussing weight loss they should have their facts straight. Obesity is complicated and there’s no smoking gun out there.

An important point that they make is:

…despite being doctors – I also have a degree in public health – neither of us knew much about losing weight and eating healthily. 

These topics fall between the cracks at medical school. Yes, we understood biochemistry and food metabolism, and knew a lot about the consequences of being overweight. But which diets work, why we eat too much and why losing weight is so hard don’t sit within any medical speciality.

Pity that they didn’t take the opportunity at this stage to point out that this means that assuming your family doctor will tell you if your weight is a health concern or that they are a good resource for weight loss are dangerous assumptions. If you are concerned about your weight being a health issue you need to speak up and voice those concerns. Ask for a referral to a dietitian who specialises in weight management or to a reputable weight management clinic. I really wish they would have mentioned the great resource that we dietitians can be for all things diet and nutrition.

As you may have guessed, both doctors lost weight during the course of their experiment. I hope that they were the only ones who were surprised by this outcome. Naturally they lost weight; they were both on highly restrictive diets, they were both active males, and this was done over a very short period of time (one month). Imagine trying to sustain a diet with the barest minimum of fat or no carbohydrates for the rest of your life!

Fortunately, the doctors reached a conclusion that I actually agree with! That: “For any diet to work you have to be able to keep it up for the rest of your life.”  As I’ve said many times before: to see sustainable weight loss you need to make sustainable changes.