Dispelling nutrition myths, ranting, and occasionally, raving


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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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Can we take chocolate milk out of politics already?

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You would think that I wouldn’t have anything left to say about chocolate milk by now. I wish that you were right. I would have thought that I wouldn’t either until I read this article the other day about the school nutrition policy in New Brunswick and the current provincial election there. This uninformed inane quote from the leader of the PC party got me all riled up again:

“Brian Gallant is focused on taking chocolate milk away from our kids,” Higgs said in a press release. “I’d rather accomplish the same thing by giving our kids better access to organized sports activities and the character-building experience that come from participating in activities with peers.”

Higgs said in a press release that his government would scrap the nutrition policy entirely because, despite the importance of educating children about good nutrition, “we think helping them participate in activities with their peers is the goal – not legislating what’s on the menu.”

This is the sort of thing that makes me want to tear out my hair. It shows a complete lack of understanding of the issue at hand and sends the entirely wrong message to the public.

The first quote implies that 1. the issue at hand is obesity and 2. that we can compensate for whatever we eat through exercise. These are both patent falsehoods.

To address the first issue: the purpose of school nutrition policies is not to address childhood obesity. The purpose of school nutrition policies is to ensure that children are being provided with nutritious food when they’re at school. Schools should not be making money at the direct cost of the health of their students. In some cases, the only nutritious food that children receive may be when they’re at school. This has nothing to do with weight and everything to do with health, growth, and development.

To address the second issue: as much as we may all wish that it’s true, no amount of exercise can compensate for an unhealthy diet. Playing soccer is not somehow going to miraculously provide a child with vitamins and minerals and essential nutrients that are lacking from their diet. That’s just not how it works. As I’ve mentioned before, healthy eating and physical activity are not two sides of one coin, they are both essential components of a healthy lifestyle.

The message that the would-be premier is sending here is the widespread misconception that health is measured by the scale and that we can make-up for an unhealthy diet by exercising more. This is just not true.

Finally, to address the second quote: we know that education (insofar as that means telling people what to eat, giving them a copy of Canada’s Food Guide, and lecturing them about calories) doesn’t work. However, creating a supportive nutrition environment in which healthy eating is the norm, along with teaching food literacy, can teach children life-long healthy eating habits.


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Are Clif Bars a healthy snack?

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I wanted to write a little about Clif Bars because I think there’s a lot of confusion about them. Before I start though, I should get this out of the way, this is not a sponsored post. I have no affiliation with Clif Bar whatsoever. Okay, now that that’s out of the way, let’s get to it.

For those who don’t know what Clif Bars are, I’ve linked to their website above. Basically, they are energy dense snack bars designed to fuel athletes before, and depending on the activity and the athlete, during exercise. If you go to their website the first thing you see are a collection of images of people engaged in physical activity from climbing to cycling. Much of their energy density comes from sugar. One bar contains 20+ grams of sugar (that’s about 5 teaspoons) and about 250 calories. This nutritional composition is often a good thing for athletes who are looking for easy to digest snacks that will quickly provide them with fuel. However, for non-athletes, or people who are not looking for a calorically-dense snack, possibly not the best choice.

The reason why I wanted to write about this today is because I think most people who are consuming Clif Bars as a snack are not aware that they’re intended for active people and are operation under the false impression that they’re a “health food”. Anybody else watch the new version of Queer Eye? It was great and I totally want to be the first woman on the show (hook me up!) but I digress. There was an episode in which the man they were making over was talking about how he tries to eat healthy, and then listed off fruit and Clif Bars, as examples of the healthy foods he consumes regularly. And I thought to myself how misguided this belief is that Clif Bars are a “healthy” snack for the average Joe who has a relatively sedentary job. He’s just getting a whole lot of sugar with a few vitamins and minerals thrown in. For comparison’s sake, a Mars bar contains 260 calories and 30 grams of sugar, a Snickers bar has 250 calories and 27 grams of sugar, an Oh Henry! bar has 260 calories and 26 grams of sugar. All quite similar to a Clif bar.

Despite the fact that Clif Bars are clearly intended for athletes and active individuals, I doubt that many people purchasing them are visiting their website and are likely unaware of this intended consumer. They’re sold in grocery stores with all the other snack bars, sometimes at the cash, and sometimes in free-standing displays. Aside from the picture of the man climbing the mountain on the front, there is little reason to believe that they’re not intended for the average individual.

Just for fun, I did a twitter poll to see what people thought (pictured above). Of course, my tweeps are an above average bunch and the results likely reflect that. I got a few comments from people that “it depends”, “with a caveat”, and that the question was a false dichotomy.

Now that I’ve totally ruined Clif Bars for you, I will mention that they have newer products that are actually pretty decent snacks. I always have a stash of snacks in my desk at work and one of my favourites to have on-hand is the nut butter-filled energy bar which has considerably less sugar than the original energy bar, (although the same number of calories – I should add that while I do have a predominantly sedentary job, I also run every day and regularly engage in other physical activity) only about two teaspoons. My favourite is the peanut butter flavour (yum!). Even newer on the market is the whey protein bar which has only about one teaspoon of sugar, 14 grams of protein, and 260 calories (these are good when I have a long day and a long run, otherwise they’re a little higher in calories than I’d normally want in a snack).

I should also mention that ideally a healthy snack contains two food groups, preferably with one of those being vegetables and fruit. Some examples: an apple and a handful of nuts, hummus and veggie sticks, a banana and peanut butter, bell pepper and cheese.

Long story short, are Clif Bars a “healthy” snack? Probably not for the average person but… if you’re an athlete or have a very active job and aren’t consuming many other sources of added sugar then maybe.


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Healthspan app review

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I read this article about a “new app that identifies your nutrition gap” a little while ago. According to the article, the app (Healthspan) will make individualized supplement recommendations that you can order in-app based on your diet. Naturally, I was concerned. Ideally, we should be aiming to obtain the majority of our nutrients from food. I envisioned an app designed to push supplement sales and was concerned about the safety and accuracy of recommendations made through an app. I figured I shouldn’t knock it until I tried it though so I downloaded the free app and tried it out for a week.

Healthspan is very similar to other food and activity tracking apps in that you enter your daily food consumption and your physical activity. I’ve written about some of the pitfalls of these apps before, in particular their accuracy when it comes to calories burned and the notion of “earning” more food with exercise.

When you first download Healthspan you enter your weight, height, age, etc and it gives you your daily caloric intake to attain your goal. According to the app, for me to maintain my current weight I should consume 1143 calories a day. This is quite low and certainly lower than the number of calories I actually consume every day. Of course, I “earn” more calories through my regular exercise. Just for fun I changed my goal to see what my daily caloric allotment would be if I wanted to lose two kilos. I now have a measly 914 calories per day to work with. To put that in perspective that’s roughly the calories in a Big Mac and medium fries. A 900 calorie per day diet is generally considered to be a very low calorie diet and not recommended to be undertaken without medical supervision. The app however, provided me with no warning. It just readily lowered my daily calorie goal. Interestingly, when I further decreased my goal weight to 44 kg (which would render me significantly underweight for my height) my calorie goal remained at 914/day.

Healthspan does offer you the opportunity to obtain free supplement samples when you register. Unfortunately, they’re only available to those in the UK so I was unable to determine what the samples were. Following that, you can order supplements through the app but the description of this process given in the original article is a little off-base. The app doesn’t make recommendations based on your recorded dietary intake. Rather, you complete a questionnaire and based on your responses it recommends a multivitamin supplement. The recommendation seemed pretty generic for any woman of my age (see below). Despite this, it still concerns me that supplements are available through the app given the questionable quality and safety of many supplements available on the market.

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Aside from this, another rather significant issue I had with the app was logging my food intake. While it was quite user-friendly to enter foods and beverages I’d consumed, the selection was extremely limited and there was no way to determine ingredients in mixed dishes, nor to enter your own recipes or nutrition information. For example, I made a vegetable curry for supper one evening. There was a vegetable curry option I could add but there was no way of knowing if the ingredients were similar to the curry I ate and for anyone who’s ever had curry, you know that the recipes can vary considerably. The same held for other dishes such as smoothies, lasagna, granola, stir-fry, and so on. There was also a number of foods that I couldn’t find at all in the database and had to make my best guess at what would be most similar. Based on this, I question the ability of the app to record calorie and nutrient intake even remotely accurately.

Each day, the app gives you a score out of 100 that appears to be based on your physical activity and calorie consumption. However, participation in challenges also counts toward this score. Without participating in these optional challenges, I was never able to achieve better than a 60 on any one day. On most days, I was even lower than this. Personally, even though I wasn’t using the app to genuinely achieve any goal, I found this really discouraging. If I was actually trying to reach personal nutrition and physical activity goals I can imagine this score would be off-putting.

I know that people really like apps to track things like food and exercise but I’d give Healthspan a pass if you’re looking for an app for these things.

 

 

 


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The case for breaking up healthy eating and physical activity

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Have you ever noticed that healthy eating and physical activity are often lumped together? I’ve worked on Healthy Eating Physical Activity (HEPA) teams and seen Healthy Eating Active Living (HEAL) strategies and Healthy Eating Active Fun (HEAF) programs. If you haven’t already noticed it, you probably will now that I’ve introduced that thought to your brain. The thing that I’ve been wondering lately is “why”? At what point did someone say, “hey, let’s lump these two health behaviours together”? And what was the reason for that?

On the face of it, if you’re thinking about healthy eating and physical activity purely from a weight management standpoint it seems to make sense. Most people trying to lose weight will incorporate some sort of combination of the two. Although there are people who will argue that one of the two is more important than the other, but generally in our minds they’re linked. But does it really make sense? I don’t actually think that it does.

On the one hand, you’ve got a health behaviour that involves choosing, preparing, and ingesting food. On the other hand, you’ve got a health behaviour that involves moving your body. These are not two sides of the same coin. They are two completely separate coins. Yes, they both have positive effects on our health and they can both contribute to reduced risk of certain chronic diseases and conditions. However, they are completely independent activities. You can absolutely eat a terrible diet and exercise regularly. You can also eat a super healthy diet and be highly sedentary. If you really wanted to lump health behaviours together why not pair healthy eating and alcohol consumption? Those make far more sense together than physical activity and healthy eating do.

I think that putting physical activity and healthy eating together all the time diminishes the importance of both these activities. It implies that neither is important enough to focus on, on its own. Allowing organizations and those in healthcare and related industries to focus their efforts on one over the other or to spread time thinly across the two. I think it may also help to perpetuate the notion that these behaviours are only important for weight management. When you hear about the two together, what first comes to mind? Is it enjoying a healthy life or is it a certain degree of torment undertaken to stave off obesity?

It’s time for physical activity and healthy eating to break-up. This relationship isn’t healthy and it’s affecting everyone around it. We need to recognize that these behaviours don’t necessarily go hand in hand and that they each have things to offer. If we actually start to value healthy eating and physical activity independently for their own strengths we might be able to improve our own individual relationships with both of these behaviours.