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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Stephen McNeil gets a failing grade for his response to Nova Scotia’s poor health report card

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Provincial Health Report Card from the Conference Board of Canada

I was driving home from work a couple of weeks ago, listening to the CBC (as per usual), when a segment came on about the recently released provincial health report cards. Nova Scotia did not fare well. We received an overall “D” grade, brought down by our “D” grade for cancer mortality. We also scored poorly on ratings for infant mortality, mortality due to respiratory diseases, and overall life expectancy. Our Premier, Stephen McNeil, made a statement to the effect that while the government does play some role in the health of Nova Scotians, we need to take more ownership of our heath. He said that we should eat better, exercise more, and drink less alcohol. WHAT?! 

I suppose I shouldn’t be all that surprised after the ill-informed op-ed piece by our Minister of Health last year. Really, though, has our Premier never heard of the social determinants of health? How is it possible for someone in such an important governmental role not realise the impact of government on the health of citizens? It’s hard for people to be healthy in our society. In a province where working longer hours is expected, where unhealthy processed foods are more widely available and affordable than nutritious foods, where the weather and poorly cleared sidewalks make even going for a walk difficult, where urban sprawl limits active transportation, where doctors are in short supply and wait times for specialists are outrageous, where many health care plans don’t cover dietitian’s services, where the government profits from the sale of alcohol, where jobs are scare and pay dismally, and so on, the onus should not be placed on the individual to improve population health. It’s the government’s job to make healthier choices more accessible for citizens and to provide us with the services and opportunities we need to be healthy. It’s embarrassing that our Premier would place the blame for our collective poor health on citizens of Nova Scotia when the environment we live in so clearly sets us up for illness.


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Leo Glavine: Meet the social determinants of health

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I had another post scheduled for today but then I read this article and got all fired-up. Just to cement the fact that I’m never going to be able to get a job working in public health in this province – you know, a master’s degree is far more important than actual experience in this province – I have to say: I am appalled that our provincial minister of Health and Wellness would write such an ignorant column.

To boil it down, the minister, Leo Glavine, states that to earn healthcare Nova Scotians must first prove that they’re taking care of their own health. This seems to particularly apply to those with lower-income levels as they are the ones who would be applying for financial assistance. This is so backwards!

I find it highly disturbing that Glavine appears to be unaware that income is the number one determinant of health. A whole other raft of issues go hand-in-hand with insufficient income; lack of time (how does one find the time to exercise, grocery shop, cook healthy meals, etc. when one is working a couple of part-time minimum wage jobs in an effort to pay the bills?), lack of access to programs and services (part-time work means no benefits which means no access to dietitians – let’s not get into the fact that we are woefully under covered by the majority of health care plans anyway, fitness facilities and equipment – some might argue that no equipment is necessary, everyone can walk, walking is great but not sufficient for optimal health and besides, many people who are living in poverty may live in dangerous areas and places without sidewalks and even in the city, the state of sidewalk clearing has been abysmal this winter, other healthcare providers – with the current lack of family doctors many of us don’t have a primary healthcare practitioner regardless of income or benefits). You get the point.

Aside from the fact that the social determinants of health undermine what Glavine is saying, isn’t it the government’s job to improve population health? This is done by implementing programs and policies which are designed to improve the health of all Nova Scotians. To tell us that we should be making more of an effort to improve our own health is tantamount to victim blaming. Yes, there will always be people who are not going to exercise or eat enough vegetables. Is that reason to stop encouraging everyone to lead healthier lives. The burden of proof should not be placed on the individual. We should not be being asked to “improve our attitudes” by the minister. Our government should instead be looking inward and asking themselves why we, as a population are unhealthy, and what they can do to change that.


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Physical labour and heart disease

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A recent article in The Star reported on a couple of studies that found physical labour was linked to heart disease. Once again, I’d like to point out the difference between correlation and causation. Just because people who work in physically demanding environments are more likely to have heart attacks than people who work in sedentary environments does not mean that the physical demands of the job was the cause of the heart attacks. I can think of plenty of other factors which may have contributed to the development of heart disease in physical labourers. For one, physically demanding jobs are often associated with lower social determinants of health such as: education, income, and social status. These factors are also tied to higher rates of smoking, poor diet quality, poorer living conditions, and decreased medical care.

Of course heavy lifting at work will increase your chance of a heart attack or stroke when your lifestyle is unhealthy. It’s not the job that’s to blame though. It’s our societal structure which traps people in these unhealthy lifestyles.