Dispelling nutrition myths, ranting, and occasionally, raving


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What came first: the fried chicken or the heart disease?

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Last month a study was published about fried food consumption and the risk of coronary artery disease. The study was conducted with US military veterans and concluded that: “In a large national cohort of U.S. Veterans, fried food consumption has a positive, dose-dependent association with CAD.” Meaning that the more fried food a veteran consumed, the more likely they were to have heart disease. But what does this mean for the average person?

It’s important to note that the vast majority of study participants were men (90%) and the average age was 64. It’s well known that heart disease in women is poorly researched and important to acknowledge that the results of this study don’t necessarily apply to women. There are also many factors that contribute to the risk of developing heart disease and the researchers took the following into account: race (insofar as to categorize participants as black, white, or other), BMI, alcohol use, education status, exercise, smoking status, pre-existing type 2 diabetes, consumption of fish, fruit, and vegetables. After controlling for these factors, the researchers still found a relationship between fried food consumption and CAD.

However, the authors neglected to control for one important factor: poverty. Poverty is a significant risk factor for many so-called “lifestyle-related diseases”, including CAD. Other lifestyle factors are often also enmeshed with poverty making it nearly impossible to determine true contributing factors. People who live in poverty often have poorer diet quality than those with higher incomes and may rely on fast food, including fried foods. If poverty is indeed a greater risk factor than fried food consumption, or if fried food consumption is a result of poverty, this means that simply telling people to consume less fried food may not be the most helpful advice. It takes a certain level of privilege to be able to “choose” to consume the recommended diet. It means having the financial means, time, access, and facilities necessary to prepare nutritious meals.

While the findings of this study support the common belief that fried food is not a healthy choice they also serve to entrench the belief that diet is all about choice when for many people it is not. We need to look further than fried food to determine the root causes of illnesses such as coronary artery disease if we truly want to work to reduce incidence of these diseases.


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The real cause of Type 2 Diabetes

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The other day someone I follow on Twitter shared a tweet from an MD/PhD student that said that, “excess calories causes diabetes” and that this results from ready availability of palatable food, sedentary lifestyles, and genetics. Apparently anyone who disagrees with this assertion is either trying to sell you something or wants you to think they’re smart. I scrolled back and forth a few times before deciding I really didn’t want to get into a “thing” on twitter but it really got under my skin and I just can’t let it go. I decided that blogging about it would be more productive than arguing with someone who’s already made up their mind about the motives for my disagreement without hearing why I take issue with his sweeping statement. Just to be clear: I have nothing to sell you and I’m not trying to make you think that I’m smart. I just don’t like this simplification of a complicated disease.

To begin, I am assuming that the tweeter was referring to Type 2 Diabetes, not Type 1. A little bit of a pet peeve of mine when people don’t distinguish between the two because despite leading to similar consequences they really are separate diseases with different causes and treatments.

Okay, so my problem with this doctor’s statement is really the implications that it has for people with T2D and the lack of acknowledgement of health inequities that contribute to the development of T2D. Yes, he mentions that it’s the food environment and the inactive lifestyle that is common in our society that’s the problem. This, I will admit, is a step above simply blaming people for eating too much and not exercising enough. However, the implied solution is the same for both messages: don’t eat too many calories and get off your lazy butts and you won’t get T2D. Unfortunately, it’s not that simple. For many, poverty and health inequities are at the root of many chronic diseases, including T2D.

Recent research has highlighted the relationship between the social determinants of health and chronic diseases, such as T2D. This research has shown that, “social determinants (such as income, education, housing, and access to nutritious food) are central to the development and progression of Type 2 diabetes” and, “individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals”. That’s right, privilege provides greater protection against developing Type 2 Diabetes than does lifestyle “choices” while poverty greatly increases risk. Not to mention that certain racialized and ethnic groups are often touted as having greater risk for T2D even though much (if not all) of this increased risk can be attributed to inequities and racism experienced by these groups.

We need to stop thinking about T2D as the result of lifestyle choices and start thinking about it as the result of societal structures. If you have the level of privilege where you can choose to eat healthfully and be physically active that’s great and you should absolutely do so. But we need to stop pretending that it’s lifestyle “choices” that are causing this disease when many people do not have that choice.


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Only the thin die young

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I’m all for looking at overweight and obesity in new ways. I absolutely believe that it’s possible to be overweight and healthy. I am, however, sick of seeing claims that being overweight is protective against death. The implication being that those of us who are “healthy” weights are actually more likely to die than those who are slightly overweight.

Yet another article came out last week touting the headline: People deemed overweight may actually have a lower risk of dying than those who are healthy, study says. The fact that we’re all going to die notwithstanding there are other significant issues with such claims.

To start, I’d like to take exception to the headline itself. Who writes these things? If they had inserted weight after “healthy” it would have made quite a difference. As it’s written it implies that “healthy” and “overweight” are two discrete mutually exclusive categories. This is not the case. It’s entirely possible to be overweight and healthy. It’s entirely possible to be “healthy” weight and unhealthy.

Now that, that’s out of the way, let’s get to the bigger problems with the study results, as covered in the news article. When people are ill, especially mortally ill, they often lose weight. As a result, when looking at death rates and weight it’s incredibly difficult to tease these issues apart. Thus, claims that being overweight protecting against death are essentially meaningless and potentially detrimental. I say detrimental, because if people are dissuaded from eating healthily and exercising regularly by the suggestion that it’s healthier for them to be overweight then it’s quite likely that their health will suffer. We also know that many chronic diseases such as type 2 diabetes and hypertension can be better managed with weight loss, following a balanced diet, and incorporating regular physical activity. While it’s possible that being overweight is actually protective, it’s more likely that the apparent association between lower weight and death is a result of weight loss during illness.

The other significant problem with the claim that overweight is protective against death is that it doesn’t take into consideration quality of life. Many people who are overweight will be prescribed various medications to keep related conditions in-check. This may result in a longer lifespan than someone who’s “healthy” weight who, because of appearing to be in good health (as a result of the conflation of overall health and healthy weight) may go without similar treatment. The “healthy” weight individuals may lead shorter but higher quality lives without the side effects of medications (i.e. they may have shorter lifespans but longer healthspans).

To sum it up: yes, you can be healthy and overweight. You can also be unhealthy. Ditto for both for “healthy” weight. Regardless of your weight the best way to ensure that you lead the longest healthiest life possible is by taking care of yourself.

 


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What’s the *BEST* diet?

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There are so many diets out there; from low-carb (and its many iterations), vegetarian, vegan, low-fat, paleo, gluten-free and on and on. The one thing that many of their followers seem to have in common is the absolute certainty that their diet is the best diet. It amuses me when I see back-to-back tweets from people praising their chosen religion diet.

I’m sick of seeing people (especially my fellow dietitians) passing judgement on the diets of others, presuming that their chosen diet is superior. Power to you if you are healthy and enjoy following your diet of choice. That doesn’t mean that the diets followed by others are inferior. It doesn’t mean that only you (and others following the same diet) are eating “real food”. What the heck does that even mean?? I’m fairly certain that I didn’t imagine my last meal, that I didn’t consume “fake” food. Just because it works for you doesn’t mean that it’s going to work for everyone. This isn’t Mormonism, you’re not going to secure your place in foodie heaven by converting more people to your way of eating.

Each diet has its drawbacks and nutrients of concern. Each of these diets has its benefits. I could go through many of them and list out the pros and cons but that would be tedious for me to do and tedious for you to read. So which one is the best? The one that you are happiest and healthiest following. The one that you can easily follow for the rest of your life without feeling like you’re on a “diet”. Yeah, sorry, I sucked you in with that title. It’s the truth though. Me, I don’t follow a diet with labels. I enjoy a variety of foods. I eat meat, but I have been known to go weeks without it. I eat grains, but I try to vary them and may not have them at every meal. I’m an agnostic eater.


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Bad news for science: naturopaths get positive press

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The twitterverse was all abuzz the other day with the release of a journal article that found that patients who received counselling from naturopaths reduced their risk of heart disease significantly more than patients who only went to see a doctor.

Of course, a number of the authors of the paper reported potential conflicts of interest such as receiving funding from alternative medicine groups and naturopathic organizations. Naturally, they would have a vested interest in showing that there is a benefit to seeing a naturopath.

Doctors, unfortunately, are more often than not, ill-equipped to provide lifestyle and nutrition counselling. It seems pretty obvious that patients provided with an additional level of care would experience better outcomes than the patients who only met with their family doctors. This does not mean that all patients with elevated risk for cardiovascular disease should seek the help of a naturopath. It means that they should be receiving specialized nutrition and lifestyle counselling from a trained health care professional. Ideally, a dietitian as our advice is science-based and we do not promote homeopathic remedies.

The two things I get out of this study are: 1. patients with elevated risk for diseases which can be mitigated by lifestyle changes should receive counselling in the appropriate area(s), 2. doctors should be referring their patients to their appropriate counterparts in healthcare to supply that counselling. The fact that naturopaths were the providers of the counselling in this study is unimportant and gives the false impression to the public that naturopaths are a suitable alternative to doctors and dietitians.