bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Is 63 grams of liquid sugar the answer to high cholesterol?

A friend recently shared this tweet with me:

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She had asked the tweeter for more details but hadn’t received a response. My response: “Ugh. No wonder so many people don’t trust us as dietitians”.

Of course, it’s Florida orange juice that imparts these benefits. Because oranges from other locales couldn’t possibly impart the same benefits (<— please note this should be written in the yet to be developed sarcasm font). Even so, is the benefit even all that meaningful? I’d argue no.

While I can’t be certain that the study I found is the one the tweeter was referring to it was the top hit and was sponsored by Tropicana orange juice so it fits the bill. The study looked at a very small group of individuals with elevated cholesterol. There were only 25 participants, 16 healthy men, and 9 post-menopausal women. This means that the results cannot be extended to apply to pre-menopausal women or “unhealthy” individuals. There were additional strict criteria that participants had to meet: 1. have initial fasting plasma triacylglycerol (blood lipid) concentrations in the normal range, 2. be habitual or occasional orange juice drinkers, 3. be free of thyroid disorders, kidney disease, and diabetes, 4. have an alcohol intake of ≤2 drinks/d, 5. not be receiving hormone replacement therapy if female. With such a small sample size of people meeting such precise criteria, no concrete conclusions can be drawn from this study.

However, the researchers still drew conclusions. Namely that three cups of orange juice a day can lower LDL and increase HDL blood levels. They found that HDL levels were increased by 21% and the HDL-LDL ratio was decreased by 16%. That sounds fairly impressive but is it really? Well, no, not really. The average HDL level increased from 1.0 to 1.3. Anything over 1.0 is good anyway so they weren’t all that badly off to begin with. The HDL-LDL ratio really only changed because of the increase in HDL as LDL levels went from an average of 3.6 to 3.5. Not a significant change.

What the study doesn’t tell you is that cholesterol recommendations are only made in relation to risk of cardiovascular disease. If your risk level is low then an LDL of under 5.0 is fine. If your risk is high then an LDL of less than 2.0 is ideal. Risk level is determined by family and medical history. None of these factors were discussed in the current study despite the fact that the cholesterol levels measured are essentially meaningless without being placed in the context of CVD risk.

Can we just go back to that THREE cups of OJ a day again? The researchers found no significant change in cholesterol levels at one or two cups of OJ a day. Only at three cups a day. That’s a considerable amount of orange juice. Considering that a serving size of juice is 1/2 cup and most dietitians recommend no more than one serving per day I find it hard to fathom recommending 6 servings of juice every day for a slight increase in HDL levels. The researchers note that as OJ increased fibre intake decreased. They didn’t mention any other aspects of diet. There was no comparison to consumption of whole oranges, other fruit or vegetable juices, or any other dietary changes. Based on this study alone I would absolutely not advise anyone wishing to improve their blood cholesterol levels to drink 63 grams (more than 15 teaspoons) of liquid sugar daily.


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Skeptic or jerk? What’s the difference?

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Eternal Damnation by Stephen L. Cloud used under a Creative Commons Licence.

Last week I tweeted the question “When did skeptic become synonymous with a**hole?” (except without the asterisks because I’m much more brazen on twitter). Something I’ve been noticing a lot lately is that people seem to be using their self-proclaimed skeptic status as justification for being condescending and rude to other people. If you know me at all, you know that I don’t suffer fools gladly. It’s damn hard to bite your tongue in the face of ignorance and stupidity. However, I don’t understand why it’s become acceptable (especially on social media) to be patently rude to other people just because they have different opinions or beliefs than you do. And those are people that you’re attacking; not avatars, not bots. You’re not advancing your cause by insulting those who disagree with you.

The definition of skeptic (according to google) is: “a person inclined to question or doubt all accepted opinions.” I consider myself a skeptic. I question most things. I tend not to believe anything until I see evidence. That’s skepticism to me. It would appear that skepticism to many skeptics is belittling or insulting those who don’t hold the same values as themselves. Interestingly, most of those I’m seeing lately are not questioning accepted opinions, only tearing down those who dare to question the status quo. I’m pro science. That doesn’t mean that I unquestioningly accept every piece of scientific research and discredit every unproven theory. There is a plethora of terrible scientific research out there. Loads of poorly designed and biased studies are published in peer-reviewed scientific journals. We also haven’t done all of the science that there is to science so there’s always the possibility that unproven theories will one day be proved. Being a skeptic means questioning everything, not just the non-science, and not just the beliefs held by others. We need to hold ourselves and our beliefs up to the same level of scrutiny as all others.

Insulting other people doesn’t make you a skeptic. It just makes you a jerk.


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Can peanut consumption prevent allergies?

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Last week the headlines all boasted that feeding babies peanuts could prevent peanut allergies. A new study in the New England Journal of Medicine assigned children thought to be at high risk for peanut allergy development to either an exposure group or an avoidance group. It was found that 10.6% of the infants in the exposure group tested positive for peanut allergy at 60 months of age, versus 35.3% of infants in the avoidance group. I’m not quite as convinced as the headlines that this is a cure for peanut allergy. Certainly, there was a large difference between groups. However, we have seen in previous research that peanut exposure in allergic children may increase tolerance, although not to the extent that they would be able to safely munch on a peanut butter and jam sandwich for lunch.

This may be a matter of semantics, and it’s purely my own interpretation, but I think that the current study provides more support for the stance that peanut (and likely other allergens) avoidance in at risk children increases the likelihood of allergy development. More so than the consumption of peanuts decreases the risk of peanut allergy.

Peanut allergy does not occur upon the first exposure to peanuts. It usually occurs upon the second exposure. Although it may occur upon subsequent exposures, this is unlikely in the case of peanut allergy. I can’t help but wonder how this may have effected the results. The authors don’t mention whether or not the infants in the study had been exposed to peanuts prior to enrolment. I can’t help but wonder if this could have affected the results in some way. There is also the question as to whether the withdrawal of infants from the study was a result of the development of peanut allergy in the consumption group, or perhaps discovery of the absence of allergy in the avoidance group. Could this have significantly affected the results? Adherence was quite good, over 90% in both groups, however, reasons for withdrawal could still have an impact on the results.

While the infants included in the study were all identified as being at risk of developing peanut allergies due to either the presence of eczema and/or egg allergy, these are not necessarily the best ways to identify risk. The children at greatest risk of developing peanut allergy are those who have an immediate family member (i.e. a parent or sibling) who has a peanut allergy. The children in the study would be at greater risk than those without eczema or other allergies but they would not necessarily be those at greatest risk. Perhaps infants at greatest risk would benefit from early peanut exposure, perhaps not. Perhaps infants in the general population would benefit from early peanut exposure, perhaps not.

Okay, so, I’m sure that parents are wondering what all of this means. Firstly, what many of the news articles are failing to impart is that the current guidelines recommend waiting until 6 months of age before introducing solids. Introducing peanuts, or any solid foods, at younger ages is not recommended as infants do not have fully developed digestive systems. Peanuts and peanut butter may also be choking hazards for infants, please be sure to use age appropriate foods and supervise your infant during feeding. Finally, this research supports the current guidelines which indicate that there is no reason to avoid providing your infant potentially allergenic foods at the same time that you introduce other foods. Regardless as to whether or not early introduction reduces the risk of allergy development or later introduction increases risk, at this point we know that there is no benefit to waiting, and there may be disadvantages to doing so.


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Will an avocado a day keep the doctor away?

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Avocado photo by Paree on Flickr. Used under a Creative Commons Licence.

Last week everyone was all excited about new research touting the health benefits of avocados. The gist of it being that everyone should eat an avocado a day to lower improve their cholesterol profile. Now, I love avocados, but I still had to take a look at the study myself.

The first thing I noticed was that the research was “supported by a grant from the Hass Avocado Board” and that the lead author, Dr Kris‐Etherton, is a member of the Avocado Nutrition Science Advisory. According to one of the news items I heard, she insisted that she still would have published the research if it had not shown avocados to impart special benefits on cholesterol levels. Despite this, it’s still a significant red flag to me that the research was supported by the Avocado Board.

This was also a rather small study, looking at 45 individuals over five weeks. While the results were interesting, a larger study would be needed to draw any definitive conclusions. What were these interesting results? Bearing in mind that dietary adherence was self-reported, 90% allegedly stuck to their prescribed diets, and all participants maintained their starting weights. Participants were assigned to one of three treatment diets: low-fat, moderate-fat, or avocado. All three diets were found to lower LDL-C and total cholesterol. However, the avocado diet decreased both (LDL-C and TC) significantly more than the low- and moderate-fat diets. The avocado diet was also the only diet found to decrease the number of small, dense LDL particles (the really bad guys).

Okay, so avocados may impart health benefits. Does this mean we should all exponentially increase our grocery bills and start eating an avocado a day? Probably not. The participants in the study were predominantly white, overweight and obese, healthy Americans. If you’re not part of that group, the results may not apply to you. The study also only ran for five weeks and did not incorporate other life style changes such as exercise and weight loss. We can’t say if eating an avocado a day would impart the same health benefits to someone of a lower weight, different ethnicity, or disease state. We also don’t know if the benefits would continue beyond five weeks or if eating an avocado every day would be more beneficial than increasing exercise and/or losing weight. What about the effects of all three of these together?

Avocados are delicious and full of good nutrients. I don’t want to discourage anyone from eating them if they enjoy them. However, they are expensive, and their use in the treatment of conditions such as elevated cholesterol needs further investigation before we start prescribing an avocado a day.


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Supplements: Should I take truBrain drinks?

I guess promoted tweets do come in handy every now and again. Blog fodder. This tweet appeared in my feed last week:

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Naturally, my response was: that sounds like complete and utter bullshit.

I went to their website to look for the science to back-up their claims; i.e. an increase in productivity. Naturally, the truBrain research team conducted the study. Surely no bias there. The study itself? Seven. Yep, seven, participants were examined for changes in EEG results following one week of truBrain consumption. The EEG was used to measure brain activity. There was no control group and no blinding (read: high likelihood of bias). Even with the deck so well stacked in their favour, the “researchers” found no significant results at a group level. This pilot study is the only research cited on their website.

Okay, so there’s no real science to support the claim that truBrain can increase productivity. Perhaps a look at the ingredients can provide more illumination:

375 mg of CDP-Choline – The lovely folks at examine.com indicate that there is some minor evidence to support the use of CDP-Choline to support memory and attention, and decreased cognitive decline in older adults. If there is a benefit conferred by CDP-Choline, this might be an effective dose.

200 mg of DHA – This is an omega-3 fatty acid. There may be benefits seen at this dose, although there is no scientific consensus. Also, benefits are most likely seen in individuals who do not regularly consume fatty fish.

375 mg of L-carnitine – This is quite a low dose. While there is some limited research to support the use of L-carnitine to increase cognition in the elderly, there is no research to support its use in the young.

300 mg of L-theanine – This is an amino acid that may promote relaxation. There is no research supporting its use to improve cognition.

375 mg of L-tyrosine – Another amino acid. As a supplement, it may reduce stress and memory in the presence of an acute stressor.

120 mg of magnesium- Many of us don’t consume enough magnesium in our diets so it’s hard for me to knock the inclusion of this mineral in their beverage. However, this is a rather low dose. Some forms of magnesium can cause gastrointestinal distress and diarrhea. It’s also important to note that magnesium supplementation is unlikely to have any effect on cognitive performance.

800 mg of oxiracetam – This is a mild stimulant that may improve memory but there aren’t currently human studies to support this.

In addition to the “medicinal” ingredients, truBrain drinks also contain the following “natural” sweeteners: pomegranate, stevia, blue agave, cranberry, sugar cane, and monk fruit. Six sweeteners. Sweet enough for ya? Not mentioned in any of the ingredient lists is caffeine. The website shows an option for purchasing “non-caffeine drinks” but at the moment they have not yet developed any.

At the low end of the scale you can purchase 15 drinks for a one time fee of $60 or $50 per month. That’s $4 per packet. Unfortunately, the website doesn’t clearly state the size of each drink packet nor the full ingredient list or nutrition information. Without complete information, I can’t completely rip these truBrain supplements to shreds.

Apparently these supplements were developed by neuroscientists. While this might seem to lend an air of believability to their claims, it truly only shows that no profession is exempt from quackery and the desire to turn a profit.