bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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The other evening I was out with my brother and his girlfriend and she stopped at Starbucks to order an iced coffee. I haven’t ordered an iced coffee in years but it reminded me of the first time that I did from a Starbucks. I ordered my iced coffee, black, got a straw, took a sip, and was surprised to find that it was sweet. I went back up to the counter, thinking that there had been some mistake, apparently there was. It was my mistake for not specifying “unsweetened”. Since when did sweetened iced coffee become the default for iced coffee? They wouldn’t automatically put sugar in a hot coffee, latte, or espresso, so why assume that customers want their cold coffee sweetened?

This is a great example of what’s wrong with the food system in North America. The healthy choice is not the easy choice. I should have to ask if I want sweet coffee. Or add the sweetener myself. It shouldn’t be the default. That sweet coffee left a bitter taste in my mouth.


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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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Chocolate milk, juice, and marketing untruths

 

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After I wrote about how sugar’s not inherently evil on Monday, I’d now like to take exception (again) to the marketing of chocolate milk as a healthy beverage choice.

As I’ve mentioned before, just because there’s nothing wrong with having some sugar in our diets, that doesn’t mean we can’t have too much. Just because sugar’s not bad for you doesn’t mean it’s good either and it certainly doesn’t mean that most of us couldn’t stand to cut back on it a bit.

So… My best friend sent me the above photo (taken from a Dairy Farmers of Canada booklet) last week. It’s a great example of the food industry twisting the facts. Sure, a glass of chocolate milk has the same amount of sugar as a glass of apple juice. That doesn’t lead to the conclusion that chocolate milk is a nutritious choice. Both beverages have 24 grams of sugar per cup. That’s 6 teaspoons of sugar! That’s a lot of sugar in something that’s not going to fill you up. The conclusion should really be that neither chocolate milk nor apple juice is a healthy choice. Both are liquid candy, with a few added nutrients, and should be treated as treats.

I also would like to add my annoyance at the chocolate milk sponsored half marathon I ran on Sunday. The only beverages I could find at the end of the race were chocolate milk, juice, and coffee. Now, if anyone deserves chocolate milk, it’s probably someone who just finished a long run. However, sweetness doesn’t appeal to me after a race and all I wanted was a drink of water. I ended up settling for a cup of black coffee until I got home. As we were exiting the finish area, someone on the sound system was extolling the benefits of chocolate milk as the ultimate post-race rehydrator. Actually, no. If you missed it before, here are my thoughts on that. I get that the race needs sponsors, and I don’t mind there being chocolate milk available. However, I don’t think that it should necessitate the exclusion of water.


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Insane in the Grain Brain

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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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What the WHO sugar recommendations look like

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It was all over the news last week: the World Health Organization has released draft guidelines on sugar intake. These guidelines recommend a further reduction in added sugar intake from less than 10% of total daily calories to less than 5% of total daily calories. They state that this would be roughly 6 teaspoons of sugar a day for the average person. But what does this really look like?

Let’s look at the “average” person first. The “average” sedentary Canadian woman (31-50 years of age) needs roughly 1, 800 calories per day (1). Honestly, that sounds like rather a lot to me. I’m shorter than the average Canadian woman but far more active; my job is very physical and I’m currently training for the Boston Marathon and that’s about all I need in a day. Anyway… Let’s pretend that Health Canada isn’t over estimating our caloric needs. That would mean that the average Canadian woman should aim to have no more than 90 calories a day from added sugars. Knowing that one gram of sugar contains about 4 calories that means that this Average Woman would be permitted 22.5 grams of added sugar a day, or 5.63 teaspoons.

The Average Man (same age range) needs about 2, 350 calories a day. That would mean that he could have 117.5 of those calories from added sugar, or 29.38 grams, or 7.34 teaspoons.

Now, just to be clear, even though your body doesn’t distinguish between added sugar, refined sugar, unrefined sugar, naturally occurring sugar, yada yada, the WHO is only referring to added sugars. Lest you think that the food industry can get tricky and use pureed fruit or fruit juice concentrate to sweeten foods and get around these counting as “added sugars” these have been included in the definition of added sugar.

Just as most of the sodium in our diets is hidden in processed and packaged foods, so is much of the sugar. It’s not going to be as simple as eliminating the teaspoon of sugar in your cup of tea. Although, if you’re one of those people who adds two sugars to your coffee, once you’ve had two cups you’re creeping up on that limit.

How easy is it to reach that limit? Here are a few common “foods” and their respective sugar contents:

A small (16oz) Coke contains 41.4 g of sugar or 10.35 teaspoons (2).

A medium DQ Blizzard contains 74 g of sugar or 18.5 teaspoons (3).

A vanilla latte at Starbucks has 35 g of sugar or 8.75 teaspoons (4).

A 3/4 cup serving of Liberte 2% Coconut Greek Yoghourt contains 19 g of sugar or 4.75 teaspoons (reference: the tub in my fridge).

Two slices of Dempster’s 12 Grain Bread contain 6 g of sugar or 1.5 teaspoons (5).

Check out this infographic for more.

To be fair, some of these sugars will be naturally occurring. But… How are we as consumers to know how much of the sugar is naturally occurring and how much is added? And does it really matter? Unless we are eating diets that consist solely of unprocessed foods it’s going to be damn near impossible for any of us to know precisely how much sugar in a food is added and how much is naturally occurring. Unless food labels start changing to indicated added and naturally occurring sugars it’s going to be a bit of a guessing game. Personally, I think it would be better if we focussed less on individual nutrients and focussed more on overall diet. Recommending limits on processed and fast food and encouraging increasing consumption of home cooked meals and minimally processed foods would be easier to follow. The way these recommendations are framed they just steer people in developed countries toward foods sweetened with non-nutritive sweeteners and allow the food industry to market nutritionally-void foods as healthy choices by replacing sugar with other things. They also make things like fruit juice perfectly acceptable even though they are essentially just liquid candy.

If you’re interested in contributing to the draft guidelines you can download the complete document here and send your comments in by March 31st.