bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Let them drink pop: Water doesn’t = weight loss

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Big News: “Water not a ‘magic bullet’ for weight loss“. While I don’t dispute any of the information presented in the article, I do take issue with a major fact that is not presented in the article. 

The article states that the vast majority of research has shown no increase in weight loss for those who consume more water versus those who do not. Drinking water does not increase caloric burn. The article also dismisses the pervasive myth that beverages such as coffee do not contribute to overall hydration – YAY! All true. 

The article then quotes the RD as saying, “if you don’t like water it’s OK.” The idea is that you can obtain your hydration from other beverages (and foods). While absolutely true from a hydration standpoint, I think that this statement does a disservice to those who are attempting to lose weight. While I’m sure it was not her intent, I think that this could easily be interpreted to mean that it’s fine to choose beverages such as juice, pop, and coffee with sugar and cream rather than a glass of water. Yes, these will all hydrate you, however, they will also add non-satiating calories to your diet. If you drink just one 8 oz glass of orange juice, one 12 oz can of Coke, and one medium double-double (sorry, non-Canadian readers) a day you’ll be adding 458 calories to your daily intake. Compare that to zero calories from three glasses of water. 

Obviously weight loss is not as simple as replacing caloric beverages with water (or non-caloric beverages) but that can certainly be a part of it. To suggest that all beverages are equal is untrue and misleading. Water doesn’t boost your calorie burn but it can minimize your overall caloric consumption if you replace caloric beverages with it. 


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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.


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Smart Swaps: Not so smart

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Public health is hard. I get it. I was there. It’s hard to come up with ways to improve population health. Nutrition is a particularly difficult area to address. After all, it’s not like smoking where you know that it’s unhealthy and your goal is to convince people to quit (or never start). Nutrition and our relationships with food are complicated. Unfortunately, in most cases, public health campaigns fall flat. I’m afraid that’s going to be the case with the latest Smart Swaps campaign in Britain.

As a few people point out in this news article, money could have been better spent revamping the food system to encourage healthy choices. I’d also like to suggest core curriculum for students so that food skills can be learned young and shared with the entire family.

Beyond the issues raised in the article (i.e. that resources could have been better used elsewhere) I have a bit of an issue with the smart swaps included in the campaign. They seem to be predominantly focussed on calories and weight loss. Yes, there’s swapping sugary cereal to unsweetened cereal, and swapping  sugar sweetened beverages to unsweetened beverages. Not bad swaps. But how about swapping whole milk to low-fat milk, and then swapping that for skimmed milk?  Or swapping butter to lower-fat butter or spreads and cheese to reduced-fat cheese? Yes, that will save you calories but that doesn’t necessarily mean you’re making healthier choices. Fat is not the enemy. Too much of anything is the enemy. Too much highly processed convenience food is the enemy. Not cooking (using minimally processed ingredients) is the enemy. These simple swaps are too simplistic to address the growing problem of obesity and malnutrition.


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The McDonald’s Diet

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This story has been all over the Internet the past few days: “man eats only McDonald’s for 90 days and has surprising results”. ARE YOU KIDDING ME??? What exactly is surprising about an overweight man who starts to restrict calories and adds exercise to his daily routine losing weight? This is not a shocking result. Of course he lost weight. He even made an effort to meet his daily nutrient requirements by eating things like egg whites and oatmeal for breakfast and a salad for lunch. But even if he hadn’t met nutrient requirements he would have lost weight by consuming fewer calories than he expended.

Remember that professor who went on a Twinkie diet a few years back? He lost 27 pounds in two months by restricting calories and eating only snack cakes and other “junk” food most of the time. Apparently he did eat vegetables when eating with his family so that’s likely how he managed to stave off scurvy.

It seems that people are interpreting the results of the current experiment to indicate that Morgan Spurlock’s Supersize Me documentary was some sort of hoax. The truth of the matter is that you can gain weight eating McDonald’s and you can lose weight eating McDonald’s. And just by losing weight doesn’t necessarily mean that you’re healthy. A diet high in vegetables and fibre is important to protect against many diseases chronic such as cancer and dementia. A simple drop in weight and LDL doesn’t mean that you’re healthy or that you’re going to stay healthy in the long-term.

I also can’t resist pointing out that McDonald’s provided the man with free food for the duration of his experiment. Wasn’t that generous of them? Providing a man with free food for a month in exchange for a huge amount of positive publicity. Kind of makes you wonder how a grade school teacher managed to garner so much publicity for his “personal” experiment and little documentary.


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Dissecting the Wheat Belly

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I wasn’t planning on blogging about Wheat Belly. I just thought that I should actually read it so that I could discuss it knowledgeably. However, I made the mistake of starting to read it right before bed and was seething with frustration by the end of the introduction! I’ve decided to record my thoughts in response to particular statements in the book as a cathartic exercise.

I am going to argue that the problem with the diet and health of most Americans is not fat, not sugar, not the rise of the Internet and the demise of agrarian lifestyle. It’s wheat – or what we are being sold that is called wheat.

The advice we’ve been given to eat more “healthy whole grains” has deprived us of control over appetites and impulses…

Hold up! So, is wheat the problem? Or are grains in general the problem? After all, there are many other grains besides wheat. I sure hope that Davis can make up his mind before the end of the book.

Davis provides a couple of examples of people benefiting from eliminating wheat from their diets. Are these your average overweight Americans? Nope. A woman with ulcerative colitis and a man with joint pain. It’s entirely possible that these two people were suffering from some form of wheat allergy. Two people with specific health conditions are not enough to prove that wheat is what’s making everyone fat.

Just looking at the cover… Those bagels look delicious. I never eat bagels. What voodoo is this book?

Chapter One: Davis keeps mentioning weight gain being concurrent with the increased consumption of “healthy whole grains”. Then he uses whole wheat bread as the example because it has a high glycemic index (putting aside the fact that this would likely be mitigated by consuming bread with other foods). To me, this is not a healthy whole grain. How about wheat berries? One quarter of a cup of which contains only 170 calories, 6 grams of fibre, and 7 grams of protein. The problem here is not the grain, it’s the processing. Oh, and let’s not forget the consumption of excess calories!

Chapter 2: All this talk about the message from health organizations being to “eat more healthy whole grains”. Funny, I always thought the message was to make more of your grain servings whole grain. Not simply to eat more whole grains overall.

This chapter focuses on the vast genetic difference between modern wheat and its ancestors. Haven’t we hugely altered the genetic profile of all of our crops though? None of them would be the same as those consumed by previous generations. This loss of diversity is certainly unfortunate from an environmental as well as a culinary standpoint. However, I’m not sure why wheat has been singled out here. Why not corn, or milk, or honeycrisp apples? Etc.

I also love Davis’s little “experiment” on himself (wherein he feels fab after eating a three egg cheese omelette for breakfast but foggy after toast). Of course there could be no bias or psychological factors involved when he has a vested interest in the results showing that modern wheat is toxic. (Please read the previous sentence in sarcasm font).

Chapter 3: Where we learn that wheat is dangerous for numerous reasons. One reason: it’s abundant in carbohydrate which gives it a high glycemic index. I’ve blogged before about the foolishness of claiming a snickers bar is healthier than whole wheat bread simply because it has a lower GI. In addition to the carbohydrate, wheat is uniquely dangerous because it contains gluten which causes illness in those with celiac disease and wheat allergy. Funny that this should also make wheat perilous for those of us without those conditions to consume. People can be allergic to any food. Just because some people react badly to a food doesn’t mean that no one should consume it. If that were the case we would all be extremely malnourished.

Chapter 4: Some mention of interesting sounding research involving gluten and the brain. As my first degree was in psychology I love research that marries nutrition and psych. Must check-out the original articles to see if it was good research.

Can’t help but wonder why it’s necessarily a bad thing that wheat is allegedly a mood enhancer. Perhaps there may be psychological benefits to wheat consumption.

Chapter 5: Am starting to get very annoyed with Davis’s persistent claim that the health care industry pushes “more healthy whole grains”. 1. We do not. We push more vegetables and to choose whole grains instead of white flours. 2. There are many grains other than wheat. We encourage variety

I am also getting frustrated with the yammering on about the high GI (glycemic index) of whole wheat bread. GI isn’t very meaningful. GL (glycemic load – how much an actual serving of a food increases blood sugar) is more helpful. Still not the be all and end all in diet but better than GI. The GL for whole wheat bread is only 9. That’s a low glycemic load food.

Now he’s using celiac disease as an example. Yes, of course people lose weight if they give up gluten (which is in more grains than just wheat; negating the blame wheat for everything theory) and don’t replace it with calorie dense gluten-free alternatives. This is because they are consuming fewer calories! I will give Davis credit for advising people not to replace glutenous foods with highly processed gluten-free alternatives.

Chapter 6: I’m mostly fine with the information about celiac disease although there is some manipulation of stats to make it appear as if gluten is also the cause of other ailments such as diabetes, cancer, gastric reflux, and IBS. I’m finding myself wondering if every little ailment I have might be cured by the elimination of wheat.

Chapter 7: I agree that carbohydrate reduction may be beneficial to glucose control for those with diabetes. However, I disagree with Davis laying the blame on wheat. There are many sources of carbohydrate and blood glucose control would likely be seen by limiting all sources, not just wheat.

Chapter 8: Davis writes about the association between celiac disease and osteoporosis. The problem with association is that it doesn’t equate to causation. Isn’t it likely that the cause of osteoporosis in celiac sufferers is due to chronic nutrient malabsorption? Therefore, extrapolating that wheat causes osteoporosis to non-celiac sufferers is quite a stretch.

Chapter 9: I find it interesting that Davis states that eliminating wheat will reduce blood acidity. Unless you have a medical condition, our bodies are excellent at regulating blood pH balance. In addition, the ketosis that Davis encouraged with his low-carb diet can, if extreme enough, actually increase the acidity of blood: keto acidosis.

Chapter 10: This chapter is all about how wheat causes heart disease through increased small particle LDL and triglycerides. While it’s true that wheat products may contribute to these undesirable particles in the blood it’s important to note that wheat is not the only culprit. Any simple carb can contribute to elevations in these particles. As can a lack of exercise/sedentary lifestyle, excessive alcohol consumption, and genetics. Wheat is the easy target because it’s dominant in our North American diet. This doesn’t mean that it’s to blame for heart disease.

Chapter 11: Absolutely terrifying to think that suddenly we could start suffering from cerebral ataxia. Davis sure is doing a good job of scaring the wheat out of us. It’s true that gluten may play a role in some cases of cerebral ataxia. However, how common is cerebral ataxia? According to the National Ataxia Foundation, an estimated 150, 000 Americans have hereditary or spontaneous ataxia. That’s about 0.04% of the population. If we look only at the prevalence of sporadiac ataxia, we’re looking at about 0.0084% of the population. Considering that some of these cases may be related to gluten, we’re looking at a really small percentage of the population. We already have so much to worry about. This is fear mongering.

Chapter 12:

Wheat is really the worst in carbohydrates. But other carbohydrates can be problem sources as well, though on a lesser scale compared to wheat.

Davis then goes on to list foods that should be reduced or eliminated: cornstarch and cornmeal, snack foods (e.g. Chips, pretzels, and crackers), desserts, rice, potatoes, legumes, gluten-free foods, fruit juices, soft drinks, dried fruit, other grains,

Are you thinking what I’m thinking? This sounds very much like many other low-carb fad diets with a touch of paleo thrown in for good measure.

Note that once wheat is eliminated and an otherwise thoughtful approach to diet is followed – I.e., eating a selection of foods not dominated by the processed food industry but rich in real food – there is no need to count calories or adhere to formulas that dictate optimal percentages of calories from fat or proteins. These issues, very simply, take care of themselves…

This is quite simply untrue. Calories do matter. If you consume more calories than you burn you will gain weight. If you consume fewer calories than you burn you will lose weight. Of course it’s not a simple mathematic equation but to suggest that the mere elimination of wheat will lead to weight loss is incredibly misleading.

As I was reading I made note of all the conditions which Davis stated that wheat elimination could alleviate or cure:

Obesity (especially visceral fat), schizophrenia, depression, breast cancer, various digestive problems, eating disorders, diabetes, IBS, GERD, cancer, hair loss, arthritis, LDL, heart disease, encephalopathy, peripheral neuropathy, cerebellar ataxia, seizures, and myriad skin conditions.

I’m sure that I missed a few in there. I don’t know about you, but when I hear about a cure-all like that I think “snake oil!”. There are too many promises here. Too good to be true? I’m afraid so.

While most of us could benefit from consuming more varied sources of grain and fewer processed foods, eliminating wheat is not a magical cure. It’s just another fad diet.

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