Dispelling nutrition myths, ranting, and occasionally, raving


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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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Food as medicine

How many of you have seen memes like these?:

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imgres-1The sentiment is nice and all. Obviously a healthy diet is a huge factor in preventing and treating many illnesses. But to be honest, I loathe these sorts of memes. To me, they suggest that it’s your fault if you get cancer because you ate a bag of potato chips. It’s not. There are many factors that contribute the development of diseases. They suggest that that treats don’t have a place in a balanced diet. They do. Healthy food can be delicious but what’s a life without the occasional ice cream cone? They also imply that somehow you can cure any disease with food. I’m sorry, but eating more broccoli is not going to cure lupus, you can’t cure AIDS with apples. While food plays a role in health, medicine does as well. We shouldn’t consider replacing essential medications with food. Medicine is medicine. Food is food.


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Licence to eat?: My thoughts on classifying obesity as a disease

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Sometimes I need a little time to percolate on a subject before I weigh in. This was one of those times. A couple of weeks ago the American Medical Association decided to classify obesity as a disease. This, of course, created quite an uproar. On one side, there are the people who are saying that this will lead to a decrease in personal responsibility for the condition as well as those who believe that it will mean those of us who are not obese will be footing the bill for surgeries and new obesity drugs (1). On the other side, there are those who believe that this will lead to increased efforts to curb rising obesity rates and may be beneficial to those who are suffering from obesity (2).

Personally, I’m not sure that calling obesity a disease will lead to any improvements in obesity rates but I certainly don’t see it causing any harm. Considering how well we’ve being doing reducing obesity rates thus far I figure that classifying obesity as a disease is worth a shot. While I agree with the point made in the Globe article that the current use of BMI to measure obesity is highly flawed I would also like to point out that there are other measurements of obesity being developed (e.g. the Edmonton Obesity Staging System) and perhaps the classification of obesity as a disease will lead to wider use of these more accurate tools.

I also take issue with the notion that classifying obesity as a disease will lead to people throwing up their hands and saying “not my fault, I have a disease” and then going for a big mac meal deal. When alcoholism was classified as a disease in 1956 did alcoholics cheer and say “now I have a licence to drink!”. No. The classification raised served to raise awareness that this was a serious medical condition and increased treatment availability and options.

Did anyone else notice the photos of headless obese bodies accompanying the news articles? I hope that this classification will lead to increased sensitivity toward those who are obese.

My concern is not with the classification of obesity as a disease (keep in mind that over weight is not the same thing as obese and that individuals who are over weight may indeed be healthier than their “healthy” weight counterparts but yes, I am concerned that this classification may detract from the notion of health at every size) it’s with our current medical model in North America. Our focus is on treatment when it should be on prevention. This goes for all diseases, not just obesity. In Canada, our system will cover many treatments once you’ve fallen ill but will not cover most preventative measures. We need to start covering (at least some of) the cost of things like dietitians, certified personal trainers, gym memberships, sports equipment, etc. regardless of disease state. In the long-run it would be a lot less costly to keep people healthy in the first place rather than waiting until they become ill to provide medical and professional supports.

Yes, there is much more than our medical system that needs to be involved in preventing and curing obesity. Our food systems, environment, and societal structure are major contributors to our current high levels of obesity. However, as we’re talking about the AMA classification today I wanted to focus on the medical side of the issue.

So, these are some of my thoughts on the subject. I’ve seen many other thoughts out there as well, mostly from medical professionals and the media. What I’d really like to see are thoughts from those who are most likely to be directly affected by the classification of obesity as a disease. If any of my readers, or anyone you know, is currently (or was ever) obese and would like to share your thoughts on the recent classification of obesity as a disease by the AMA I would love to hear your thoughts on this subject. Please email me at dmc555 [at] gmail [dot] com to let me know what your thoughts are. With your permission, I will share your thoughts in a future blog post.


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Do artificial sweeteners cause type 2 diabetes?

An article published in the latest issue of the American Society for Nutrition stated that women who consumed more than 359 ml of artificially sweetened beverages (e.g. diet pop) were at an increased risk of developing type 2 diabetes. This was in comparison to women who consumed no soda (sugar or artificially sweetened). Women who consumed traditional sugar sweetened beverages were also at increased risk of developing type 2 diabetes (no news here).

The researchers did point out that this was a correlational relationship. This means that with no certainty can we say that consumption of artificially sweetened beverages causes diabetes. However, they also said that: “randomized trials are required to prove a causal link between ASB consumption and T2D”. This, to me, suggests that they believe that artificially sweetened beverages can cause type 2 diabetes.

Personally, I would be quite surprised if it was the artificially sweetened pop causing type 2 diabetes, rather than a combination of genetic and lifestyle factors. I also think that this sort of research (and probably most of us) is looking at the problem from the wrong direction. Rather than looking for a single cause of “lifestyle” illnesses such as type 2 diabetes, we should be looking for the “causes” of health.

Consider this: One in every three American children will develop type 2 diabetes in their lifetime and similar rates are anticipated for Canadian children (1). Type 2 diabetes is just one of many chronic diseases affecting Canadians. I think that we need to shift our focus from seeking a likely non-existent single cause of such diseases and start looking at what we can do to retain our health for as long as possible. It’s the difference between a preventative model of health care rather than our current model which treats only those who are already ill. There is much truth in the adage that “an ounce of prevention is worth a pound of cure.”