Saturated Fats, Conflicts of Interest, and Nutritional Partisanship

Last week saw the British Medical Journal publish an op-ed on the American dietary guidelines written by Nina Teicholz. I think a fair summary of Teicholz' piece is that she believes conflicts of interest and shoddy science led the Dietary Guidelines Advisory Committee (DGAC) to get everything all wrong in recommending diets lower in saturated fats.

I think it's important though to know, that Teicholz isn't just any old journalist, she's a journalist who recently authored a global, absolutely blockbusting, bestseller on diets, a fair summary of which, "Why Butter, Meat and Cheese Belong in a Healthy Diet", is included on its cover.

Oddly, despite her BMJ thesis being in large part about how conflicts of interest and personal biases clouded the DGAC's recommendations, in the embargoed version of Teicholz' BMJ piece that was shared with reporters in advance of publication, her conflict of interest statement failed to mention her million dollar (or more) baby,

"I have read and understood BMJ policy on declaration of interests and declare I have received modest honorariums for presenting my research findings to a variety of groups related to the medical, restaurant, financial, meat, and dairy industries. I am also a board member of a non-profit organization, the Nutrition Coalition, dedicated to ensuring that nutrition policy is based on rigorous science. This article was fully funded with a grant from the Laura and John Arnold Foundation."

What wasn't as odd, or at least not as unexpected as Teicholz' original lack of disclosure, was the passionate nature of responses to her piece, and then of course the passionate and rather partisan nature of the rebuttals to the rebuttals, and rich in all of them were cries of conflict of interest.

Coincidentally, on the same day that Teicholz' piece published, so too did a new saturated fats position statement from Canada's Heart and Stroke Foundation (HSF). The HSF, up until very recently, had some major food industry inclusive conflicts of interest, but over the course of the past few years the HSF has divested itself of those.

So what was the HSF's take on saturated fats? In summary, they argue that the current science on saturated fats would suggest that there may be health benefits if you replace them with unsaturated fats, and that,

"There is emerging evidence to suggest that the health effects of saturated fats could vary depending on the food sources in which they are found."

They then make a series of recommendations that eschew a threshold or limit for saturated fat and instead are reminiscent of Brazil's recently published national dietary guidelines - which can be boiled down to cooking more with fresh, whole ingredients while minimizing restaurant and ultra-processed foods.

Of Teicholz' and the HSF's takes, I'm with the HSF. That's not to say that Teicholz' concerns hold no water at all, but rather that they, perhaps consequent to her own clear and significant conflicts of interest, do the very thing she rages against - draw sweeping conclusions from less than sweeping data. The HSF on the other hand, at least in my opinion, are doing their best to summarize the unfortunate truth of nutrition research - that it's nowhere near as clear cut as it's often presented, and that our best evidence to date is supportive of benefits to broad patterns of eating that unfortunately haven't yet been drilled down to best diet style specificity.

The frustratingly partisan nature of the responses to Teicholz, and to the responses of the responses, I think is well summarized in this tweet by MPH candidate Sarah Kunkle

This back & forth is becoming so stale. Can we focus on what we agree upon? I.e. more whole foods, less processed https://t.co/FHdEnV3yrN

— Sarah Kunkle (@sareve) September 25, 2015

Amen.

If you're interested in wading through them, here are a collection of responses to Teicholz' piece in order of their publication, including a newly launched petition for the oped's removal which was posted just a few hours ago (last in line):

BMJ Publishes Error-Laden Attack on Dietary Guidelines Report - CSPI

Medical journal’s bogus investigation could derail better dietary guidelines - The Verge

Expert is as expert does: in defence of US dietary guidelines - The Conversation

The DGAC's official response to Teicholz' accusations - The BMJ

An Open Letter to the BMJ Regarding US Dietary Guidance - Dr. David Katz

Nina Teicholz Reports in the British Medical Journal ~ The Conflicts & Funding - The Carb-Sane Asylum

British Medical Journal (BMJ) gives low-carb journalist Nina Teicholz an outlet to blast the Dietary Guidelines Advisory Committee (DGAC) - U.S. Food Policy Blog

Call for The BMJ to retract Teicholz article on Dietary Guidelines Committee and Science - Evelyn (CarbSane)

Saturday Stories: Walking, Ultramarathoning, and Human Garbage

Antonia Malchik in Aeon Magazine laments the death of walking.

Bradley Stulberg in Outside covers what happens to a person's body when they run a 100 mile ultramarathon.

James Hamblin in the Atlantic covers the human garbage that is Martin Shkreli.

Personal Trainers of the World, This 6 Year Old is Coming For Your Jobs

Today's Funny Friday video is of a truly up and coming personal trainer from Jamaica.

Oh, and he's 6.

Have a great weekend!

Alberta Health Services Says, "Eat A Cookie For a Good Cause"

The Calgary Health Trust is the official fundraising arm of Alberta Health Services, and they want you to eat cookies, specifically Tim Horton's cookies, and more specifically their annual Smile campaign's cookies where $1 buys you a cookie and the proceeds go to charity.

According to the information provided by Calgary Health Trust, nationally, since its inception in 1996, Tim Horton's Smile Cookie campaign has raised $3.6 million. That's $189,473 raised annually (though no doubt it's been a growing campaign).

Take that number and divide by the 345 charities supported by the event and you get an average of $519 per charity per year.

Now that said, bigger cities like Calgary are able to generate more money for their local charities because there are both more people and more Tim Horton's locations, and an email sent out by Alberta Health Services' South Health Campus hospital encouraging its health care professionals to buy and promote the sale of cookies, reports that since 2010 in Calgary the Smile Cookie campaign has raised $813,000.

That's $135,500 per year. Sure sounds like a lot, but with South Health Campus' annual operating budget of $345,000,000, the cookie fundraiser covers less than 4 hours a year of the hospital's annual costs. And there are 9 other hospitals in Calgary.

So is that worth it? For Tim Horton's it sure is. It buys them incredible PR, a cause beyond reproach, brand loyalty, a ridiculous and invaluable amount of social media advertising, and a hefty tax deduction that undoubtedly more than covers the cost of the cookies' flour and sugar. It also supports the concept of junk food fundraising - a concept integral to Tim Horton's outright purchase of kid sport in this country.

Sure, it would require more work for Alberta Health Services to raise an additional $135,500 per year than it does to partner with Tim Horton's to sell cookies - that they choose not to make that effort is a failure of both vision and leadership.

The Canadian Olympic Committee Wants You To Eat Lots of Chocolate Bars

Thanks to Ottawa Fit Club for sending this my way.

It's Team Canada, Canada's official Olympic team, shilling for Cadbury with a contest sponsored by The Canadian Olympic Committee (COC) for a year's supply of Caramilk bars.

And if you, like me, are scratching your head and asking yourself "WTF, why would the Canadian Olympic Committee be sponsoring a contest for a year's supply of chocolate bars?", the answer is either money or stupidity

Or both.

And if the COC is reading this, let me remind you of how you bill yourselves,

"The COC is an internationally recognized leader in the fields of marketing and education. We work to promote sport as a positive and powerful force for all Canadians. In so doing, the COC will help ensure that sport continues to contribute to Canadians’ physical, social and moral development from coast to coast to coast."

I would love to hear how a year's supply of Caramilk bars fit into that mandate.

Parental No Files: Welcome to School Dance and "Candy Bar" Edition

I think the problem is the notion that "fun" requires junk food or candy.

Certainly food is celebratory and comforting, and while indeed it is and can be "fun", the use of junk food to supply entertainment at events that ought to be fun on their own have become endemic.

Take this welcome back to school "Dance and Candy Bar" that was put on through the Calgary Board of Education. Kids from Kindergarten through Grade 4 were tasked to bring different types of candy to school so that the "dance" would have a candy bar for them to eat from, whereas the associated school picnic - optional.

The photos below are from the party and were sent to me by an RD/parent who'd prefer anonymity and who in the end chose not to exclude her children from this wholly unnecessary elementary school/kindergarten event.

Odd, last time I checked with my Grade 1 and 3 year olds, helping them to have "fun" wasn't a high bar. While it's true that it might have taken a teeny tiny bit of thought, creativity, effort, and caring, I have to imagine that the administration involved could have found ways for kids to have "fun" that didn't include organizing for them a school sponsored Halloween in September.

Saturday Stories: Medical Recertification, Cheese Pizza, and Cryogenics

Kurt Eichenwald in Newsweek on the "medical game of Trivial Pursuit" that is American Board of Internal Medicine recertification.

Friend and fellow blogger Darya Pino over on her Summer Tomato discusses eating a whole cheese pizza in the context of a glowing book review.

Laura Segall in the New York Times and the longread story of a dying young woman's cryogenic hopes.

A Mountain Marmot Reacts to Two GOP MDs Debating Vaccination

Did you catch the GOP debate this week?

If you didn't, you missed Drs. Carson and Paul debating vaccination.

Today's Funny Friday video is the amazing footage of a marmot who happened to be watching a live feed of the proceedings.

Have a great weekend!

(and for more on the GOP MDs and the "debate" on vaccination, have a read of Aaron Carroll's take in the NYTs here)

Is This Epic Study Disclosure Statement the World's Greatest or Most Absurd?

And I'm not asking snarkily, I honestly don't know.

Thanks to Marion Nestle for sending my way the disclosure statement (all 1,349 words of it) that's attached to a recent meta-analysis of controlled feeding trials and the impact of fructose on lipid levels and published in The Journal of the American Heart Association.

Given of late there has been a great deal more media scrutiny around conflicts of interest and science, perhaps this epic statement, which includes the disclosure of a second place win in the student food competition "Mission Impulsible", is meant to protect researchers against any suggestion shy of total disclosure. That said, given the disclosure statement's incredible size and scope, I wonder if it helps readers?

To provide an expert opinion I asked business professor/philosopher/ethicist Chris MacDonald for his thoughts, and more specifically asked him the question,

"Does this level of disclosure raise the bar for disclosure and provide readers with valuable information, or does it instead venture, whether intentional or not, into a degree of disclosure that borders on the absurd and consequently unhelpful?"

He was kind enough to read and here are some of his more expert thoughts:

"Listing grants from government agencies and listing scholarships seems odd, but perhaps that's normal?

Anyway, the net effect -- intentional or not -- is that the disclosure amounts to information overload. It's a bit like a physician answering a patient's questions about side-effects by handing him or her a long fact sheet from the pharmaceutical company. It's hard for the reader to sort out what matters and what doesn't. Perhaps the authors' fellow scientists would know what to look for -- whether there are financial ties that are worrisome. But to most readers, it would just be overload.

To a non-scientist, it reads like a bit of a joke. Maybe the authors are tweaking the noses of the editors, and of those who think disclosure of financial ties is an important thing."

He also had this last point, one that I think cuts right to the quick,

"If we take disclosure seriously, we need to make sure that we do it in a way that is useful to interested stakeholders. Simply dumping information on people is a poor way to satisfy the relevant obligations."

[Full text of the disclosure below - and yes, it's written as one long, 1,350 word, paragraph in the journal as well]

Disclosures

Chiavaroli has received research support from the Canadian Institutes of Health Research (CIHR) and is a clinical research coordinator at Glycemic Index Laboratories, Toronto, Ontario, Canada. Ha has received funding from the CIHR, McMaster University, Province of Ontario, and the University of Toronto. She is the recipient of The Ashbaugh Graduate Scholarship. She has received payment from the World Health Organization (WHO) for work on a systematic review and meta-analysis commissioned by the WHO for work on the relation of saturated fatty acids with health outcomes. She and her colleagues received a cash prize for placing second in the regional “Mission Impulsible” Competition where they conceived and developed a marketable food product that contained dietary pulses. She received a travel award to attend the “Journey Through Science Day” hosted by PepsiCo and the New York Academy of Sciences as well as the Nutrica Travel Award from the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD). de Souza was funded by a CIHR Postdoctoral Fellowship Award and has received research support from the CIHR, the Calorie Control Council (CCC), the Canadian Foundation for Dietetic Research, and the Coca-Cola Company (investigator initiated, unrestricted grant). He has served as an external resource person to WHO’s Nutrition Guidelines Advisory Group and received travel support from WHO to attend group meetings. He is the lead author of 2 systematic reviews and meta-analyses commissioned by WHO on the relation of saturated fatty acids and trans fatty acids with health outcomes. A.L. Jenkins is part owner and vice-president of Glycemic Laboratories, Inc, a clinical research organization. She has received grant support from the Canadian Diabetes Association (CDA). Wolever is a part owner and the President of Glycemic Index Laboratories, Inc, Toronto, Canada, and has authored several popular diet books on the glycemic index for which he has received royalties from Phillipa Sandall Publishing Services and CABI Publishers. He has received consultant fees, honoraria, travel funding, or research support from or served on the scientific advisory board for CIHR, CDA, Dairy Farmers of Canada, McCain Foods, Temasek Polytechnic, Northwestern University, Royal Society of London, Glycemic Index Symbol program, CreaNutrition AG, McMaster University, Canadian Society for Nutritional Sciences, National Sports and Conditioning Association, Faculty of Public Health and Nutrition—Autonomous University of Nuevo Leon, Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD). Beyene has received research support from the CIHR, CCC, and The Coca-Cola Company (investigator initiated, unrestricted). Kendall has received research support from the Advanced Foods and Material Network, Agrifoods and Agriculture Canada, the Almond Board of California, the American Pistachio Growers, Barilla, the California Strawberry Commission, the CCC, CIHR, the Canola Council of Canada, the Coca-Cola Company (investigator initiated, unrestricted grant), Hain Celestial, the International Tree Nut Council Nutrition Research and Education Foundation, Kellogg, Kraft, Loblaw Companies Ltd, Orafti, Pulse Canada, Saskatchewan Pulse Growers, Solae, and Unilever. He has received travel funding, consultant fees, or honoraria from Abbott Laboratories, the Almond Board of California, the American Peanut Council, the American Pistachio Growers, Barilla, Bayer, the Canola Council of Canada, the Coca-Cola Company, Danone, General Mills, the International Tree Nut Council Nutrition Research and Education Foundation, Kellogg, Loblaw Companies Ltd, Nutrition Foundation of Italy (NFI), Oldways Preservation Trust, Orafti, Paramount Farms, the Peanut Institute, PepsiCo, Pulse Canada, Sabra Dipping Co, Saskatchewan Pulse Growers, Solae, Sun-Maid, Tate and Lyle, and Unilever. He is on the Dietary Guidelines Committee for the DNSG of the EASD and has served on the scientific advisory board for the Almond Board of California, the International Tree Nut Council, Oldways Preservation Trust, Paramount Farms, and Pulse Canada. He is a member of the International Carbohydrate Quality Consortium (ICQC) and Board Member of the DNSG of the EASD. D.J.A. Jenkins has received research grants from Saskatchewan Pulse Growers, the Agricultural Bioproducts Innovation Program through the Pulse Research Network, the Advanced Foods and Material Network, Loblaw Companies Ltd, Unilever, Barilla, the Almond Board of California, Agriculture and Agri-food Canada, Pulse Canada, Kellogg’s Company, Canada, Quaker Oats, Canada, Procter & Gamble Technical Centre Ltd., Bayer Consumer Care, Springfield, NJ, Pepsi/Quaker, International Nut & Dried Fruit (INC), Soy Foods Association of North America, the CocaCola Company (investigator initiated, unrestricted grant), Solae, Haine Celestial, the Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, the Canola and Flax Councils of Canada, the CCC, the CIHR, the Canada Foundation for Innovation, and the Ontario Research Fund. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from the Almond Board of California, Canadian Agriculture Policy Institute, Loblaw Companies Ltd, the Griffin Hospital (for the development of the NuVal scoring system, the Coca-Cola Company, Saskatchewan Pulse Growers, Sanitarium Company, Orafti, the Almond Board of California, the American Peanut Council, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Herbalife International, Pacific Health Laboratories, Nutritional Fundamental for Health, Barilla, Metagenics, Bayer Consumer Care, Unilever Canada and Netherlands, Solae, Kellogg, Quaker Oats, Procter & Gamble, the Coca-Cola Company, EPICURE, the Griffin Hospital, Abbott Laboratories, the Canola Council of Canada, Dean Foods, the California Strawberry Commission, Haine Celestial, PepsiCo, the Alpro Foundation, Pioneer Hi-Bred International, DuPont Nutrition and Health, Spherix Consulting and WhiteWave Foods, the Advanced Foods and Material Network, the Canola and Flax Councils of Canada, the Nutritional Fundamentals for Health, Agri-Culture and Agri-Food Canada, the Canadian Agri-Food Policy Institute, Pulse Canada, the Saskatchewan Pulse Growers, the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), Nutra-Source Diagnostics, the McDougall Program, the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), the American Society of Nutrition (ASN), Arizona State University, Paolo Sorbini Foundation, and the Institute of Nutrition, Metabolism and Diabetes. He received an honorarium from the US Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the CDA. He is a member of the ICQC. His wife, ALJ, is a director and partner of Glycemic Index Laboratories, Inc, and his sister received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. Sievenpiper has received research support from the CIHR, CCC, American Society of Nutrition (ASN), CDA, The CocaCola Company (investigator initiated, unrestricted), Dr Pepper Snapple Group (investigator initiated, unrestricted), Pulse Canada, and The International Tree Nut Council Nutrition Research & Education Foundation. He has received reimbursement of travel expenses, speaker fees, and/or honoraria from the American Heart Association, American College of Physicians, ASN, National Institute of Diabetes and Digestive and Kidney Diseases, CDA, Canadian Nutrition Society, University of South Carolina, University of Alabama at Birmingham, Oldways Preservation Trust, Nutrition Foundation of Italy, CCC, DNSG of the EASD, International Life Sciences Institute (ILSI) North America, ILSI Brazil, Abbott Laboratories, Pulse Canada, Canadian Sugar Institute, Dr Pepper Snapple Group, The Coca-Cola Company, Corn Refiners Association, World Sugar Research Organization, Dairy Farmers of Canada, Societ a Italiana di Nutrizione Umana, III World Congress of Public Health Nutrition, C3 Collaborating for Health, White Wave Foods, Rippe Lifestyle, and mdBriefcase. He has ad hoc consulting arrangements with Winston & Strawn LLP, Perkins Coie LLP, and Tate & Lyle. He is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of both the CDA and EASD, and Canadian Cardiovascular Society, as well as being on an ASN writing panel for a scientific statement on sugars. He is a member of the International Carbohydrate Quality Consortium (ICQC) and Board Member of the DNSG of the EASD. He serves an unpaid scientific advisor for the ILSI North America, Food, Nutrition, and Safety Program and the Technical Committee on Carbohydrates. His wife is an employee of Unilever Canada. None of the other authors had a relevant disclosure to report

Pharmacist Stops Selling Soda and Whole Community Benefits

Long time readers here might recall this guest post from the small town of Baddeck, Nova Scotia pharmacist Graham MacKenzie. In it he details his experiences in the week following his decision to stop selling soda in his store.

At the time, I think everyone's expectation was that his decision was primarily symbolic and that any decrease in his store's sales would be made up for in the town's supermarket and convenience store.

But it wasn't, at least not according to Professor Leia Minaker who analyzed the supermarket and convenience stores to study MacKenzie's ban's impact on their soda sales.

According to this CBC piece, supermarket and convenience store soda sales dropped between 11 and 21 percent in the 8 months following the ban, which Minaker says would amount to Baddeck drinking 350 fewer litres of soda a week!

The butterfly effect? Can't help but wonder whether or not we would see similar unexpected effects were other trusted community institutions (schools, arenas, hospitals, etc.) to follow suit.

Chocolate Milk Marketing Via Post-Race Survey

This year my sister ran her first Ontario cottage country triathlon.

It was sponsored by the Dairy Farmers of Canada "Recharge with Milk" program, and of course included the requisite branded Recharge gear and samples of chocolate milk, but it was the post race survey that she found interesting enough to kick my way.

Here are the chocolate milk related questions:

The food industry is all about marketing - not sport, not health, not altruism - just sales. There's nothing wrong with that, it's their job after all, but it's a good idea not to forget their singular aim.

[For more on chocolate milk and recharging, here's RD Diana Chard's take]

Food Banks Canada Fights Food Insecurity With Large Slurpees

No this is not The Onion.

In the Bizarro world we've created, where selling illness to fund charity is totally normal, the fact that Food Banks Canada has elected to partner with 7-11 and sell "Name Your Price Day" large sized Slurpees to raise money to fight food insecurity won't bat many eyelashes.

RT @SlurpeeCanada: Sept. 16 is #NameYourPriceDay! What would you pay for a large #Slurpee? Whatever it is, 100% goes to @FoodBanksCanada

— Food Banks Canada (@foodbankscanada) September 11, 2015

A large Slurpee is 28oz (828ml), and if you order the Dr. Pepper flavour (that's the one I would have ordered if I were a kid), your large's 525 calories will come from the 3/4 of a cup of sugar (36 teaspoons) it'll contain.

For 7-11, this is killer marketing. Water and sugar cost them virtually nothing. 7-11 generates tremendous brand goodwill, gets huge social media marketing via the public's sharing of the day's event, draws huge numbers of customers through the door, and rather than you getting a tax receipt for a charitable donation, they get one - and I'm betting it'll more than cover the cost of the day's Slurpees.

There's no doubt that the practice of junkfood fundraising with sugar-sweetened beverages (where I'm betting a huge percentage of those taking advantage of 7-11's Name Your Price larges will be children) will one day end, but that day won't come until the general public recognizes just how backwards these cause-washing initiatives are in the context of health.

Food Banks Canada should know better.

Saturday Stories: BMI, Precision Medicine, and Diabetes' Overdiagnosis

Friend and colleague Dr. Bryan Chung, in his blog Evidence Based Fitness, explores the medical philosophy of the body mass index.

Orac, on his blog Respective Insolence, explores the philosophy of the term and discipline being referred to as "Precision" medicine.

Gary Schwitzer from Health News Review (disclosure, I'm an unpaid reviewer there), with a fantastic summary and a terrific PODCAST! on the overdiagnosis of diabetes and the idolatry of the surrogate (A1C).

Dad Joke Survivors (My Poor Girls)

My three girls each began rolling their eyes at my jokes at successively younger ages.

Poor things. Today's Funny Friday video gives a glimpse as to why.

Have a great weekend!

Guest Post: School Food and Lessons Learned

When my friend and colleague Dr. Sara Kirk and her team published their latest study on school food policy I immediately reached out to see if they might be interested in discussing their paper here. To that end, here is one of Dr. Kirk's team, post-doctoral fellow Dr. Jessie-Lee McIssac and her thoughts and findings

Moving forward with school nutrition policy implementation in Nova Scotia

As the school bells rang in Nova Scotia last week, our paper looking at school lunch menus attracted some attention in the news. We appreciate the opportunity to discuss our work further on Weighty Matters and highlight how we might move forward to create healthier school environments.

In 2006, Nova Scotia became one of the first provinces in Canada to introduce a mandated School Food and Nutrition Policy. The policy provides standards for the types of foods and beverages that can be served and sold in schools using maximum, moderate and nutrition categories. The policy also outlines many other important components like pricing, fundraising, promotion, role modelling and local food products to create a supportive healthy eating environment in schools.

Prior to our research, there was no formal evaluation or monitoring of the policy. Through the Children’s Lifestyle And School-performance Study (CLASS) in 2011, we first had the opportunity to learn about school nutrition practices and the associated barriers and facilitators. Our recently published paper builds on these findings to shed further light on policy adherence using online school lunch menus.

Over a period of one month during the 2012-13 school year, a registered dietitian reviewed available menus from 110 schools and compiled list of commonly offered items. Because there was a lack of detailed nutrient information available, we had to categorize menu items based on healthy and less healthy methods of preparation (e.g., low vs high sugar, fat, and sodium). You can find complete detail of the results in our article, but in short, we found a great deal of variability in adherence to the policy.

First, the good news. Many schools were offering items of maximum nutrition (e.g., vegetables, fruit, and milk) which according to the policy should make up the majority of items served or sold. Items of moderate nutrition can include no more than 30% of choices and we found that schools were following this rule if we assumed they were preparing common items in a healthy way (e.g., sandwiches, pizza and pasta with whole grain bread/pasta, lean meat and low-fat cheese).

But unfortunately, although items of minimum nutrition (e.g., garlic fingers, cookies, nachos, poutine and hot dogs) are only allowed twice per month during special school events and occasions, and not through regular school lunch options, these items were listed on 12-45% of school menus, depending on our preparation assumptions.

We were not that surprised by the findings of our review. In our current environment where unhealthy foods are heavily marketed, widely available and socially acceptable, we know that the mere existence of a policy will not have a significant impact. Higher-fat and more processed food options will continue to be offered within schools unless we establish a compelling moral purpose that opposes marketing and challenges our current social norms. Alongside of provincial/territorial nutrition policies, we need national investment in school nutrition and efforts to address the issue of food marketing to help redefine what we mean by healthy eating. This systems-level change requires a paradigm shift, with broad support of all partners to inspire a culture where healthy and nutritious food is available and accessible to children at home, in their schools and communities.

There are lots of great examples of success across the country that can help to support this change. Nourish Nova Scotia is a province-wide, non-profit organization that supports nourishment and food literacy programs in school communities. They share stories of inspiration that highlight the passion of so many schools that are helping to create healthy school food environments. Many of these stories include engagement of students who are critical to leading the change within our schools. We will continue to explore school nutrition in Nova Scotia through a more comprehensive research project that focuses on school nutrition policy implementation, the costs associated and the experiences of students (co-funded by CIHR and the Max Bell Foundation). Please stay tuned through social media as we will continue to share our research and work together with our partners in Nova Scotia to create healthier school food norms.

Dr. Jessie-Lee McIsaac (@jlmcisaac) is a Postdoctoral Fellow funded by the Canadian Cancer Society and is working with Dr. Sara Kirk (@sflkirk), a Canada Research Chair and Professor of health promotion at Dalhousie University. Dr. Kirk’s research group, the Applied Research Collaborations for Health, uses a “socio-ecological” approach to understand how we can create supportive environments for chronic disease prevention.

Dr. Norm Campbell Asks Health NGOs to Stand Up to Food Industry

While there are indeed many health NGOs who are comfortable partnering with the food industry (usually to fundraise), there are others who feel that this is an untenable conflict. To that end, Dr. Norm Campbell, the CIHR Canadian Chair in Hypertension Prevention and Control, has been calling on Canada's most prominent health related NGOs and asking them to pledge their support for increased transparency and safeguards that would limit industry's financial interests from influencing Canadian food policy. When he shared his message with me, I asked him if I might share it with you.

Conflicts of interest between the food industry and the health of Canadian abound. These conflicts create a toxic food environment for Canadians in which there are no national level policies that effectively ensure equitable access to healthy, affordable food. Food company representatives and people whose work is funded by food companies dominate the federal government’s Food Expert Advisory Committee (FEAC). This ensures that FEAC advice to the government - a chief source of stakeholder feedback - comes from an industry perspective more so than a public health one.

The food industry is increasingly global and is valued at 4 trillion dollars per year. It flexes its economic might and global reach to influence politicians and bureaucrats and to undermine attempts at implementing healthy food policy. Transparent monitoring and reporting of conflicts of interest between businesses and government is virtually non-existent in Canada.

Much so-called scientific research is funded by food companies. One extensive review found that research results where the investigators had ties to the food industry were more than seven times as likely to support an industry perspective, and in no studies, did harm to the food industry’s interests. This is not transparent to most people. Even research consulting companies explicitly catering to the food industry feature publications where researchers do not declare any potential conflicts of interest. Many in the scientific community, including those who have conducted industry-funded research, consider this to be flatly unethical.

Research by those with undeclared interests often opposes healthy public policy proposals relating to important challenges like dietary salt. Even more disgraceful is food industry support of health care professional organizations where the conflict has the potential to influence education programs and policy advice from professionals trusted by the public and governments. Many dietitian and nutritional organizations in Canada and globally receive significant funding from the processed food industry. This helps to explain decades-long advocacy apathy from these organizations when it comes to healthy food policies, and a concurrent trend that has seen unhealthy diets become the leading risk for death and disability in Canada.

At a personal level, I was deeply disturbed by two recent incidents. First, a disease-related health charity raised millions of dollars by promoting the purchase of hamburgers from a fast food restaurant, and having a portion of the proceeds come back to benefit the health charity. This promotion was allowed to proceed even though people living with the disease in question are advised to eat a healthy diet because a high sodium diet from foods like hamburgers are suspected to speed the disease’s progression. This same health charity has also refused to sign a consensus statement of health and scientific organizations calling for limitations of conflicts of interest with the food industry that which will be released in the coming weeks.

In the other example, the World Heart Federation partnered with the Canadian Academy of Health Sciences to host a food policy meeting sponsored by food companies. After confirming a roster of speakers who uniformly stood against best-practice public policies that would reduce dietary salt, the chair of the meeting organizing committee wrote an editorial suggesting that we should drop the current evidence based targets for reducing dietary salt and make incremental changes instead. The World Heart Federation then refused to join an international consortium to develop recommendations for setting quality research standards for dietary sodium and to review the evidence on dietary salt. Rather the World Heart Federation formed its own committee to review evidence, co-chaired by a former consultant / advisor and paid witness for the Salt Institute ( an umbrella group for the salt industry) and a tobacco company (claiming it was not proven that tobacco caused cancer), respectively.

While the connection between industry funding and public health policy inaction is obscured by layers and layers of hidden influence, in my opinion these persistent conflicts of interest and the lack of transparency around them reduces the credibility of the sponsoring organizations, health care professionals and researchers involved. Much more can and should be done to prevent financial interests from undermining the health of Canadians. The Canadian public has a right to demand transparency, monitoring and evaluation of conflicts of interest with the food industry as well as safeguards that limit the influence of financial interests on public policy.

You can pledge your support here for the implementation of these and other healthy public policy best practices by Canada’s next government.

Norm Campbell MD FRCPC

Dr. Campbell is a General Internist, a Professor of Medicine, Community Health Sciences and Physiology and Pharmacology and a member of the O’Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta at the University of Calgary.
Dr. Campbell is currently:

• The HSF CIHR Chair in Hypertension Prevention and Control (2011-2016).
• Chair of the Canadian Hypertension Advisory Committee (of national health and scientific organizations) to lead the collaborative nongovernmental effort to prevent and control hypertension (2012-2016).
• President of the World Hypertension League (2013-2015).
• Co-Chair of the Pan American Health Organization / World Health Organization Technical Advisory Group on Cardiovascular Disease Prevention through Dietary Salt Reduction (2012-2015)
• Co-chair of the Vascular Risk Reduction program of the Alberta Health Services Strategic Clinical Networks.
• Member of the World Health Organization Nutrition Advisory Group, Non Communicable Disease, (NutNCD group 2012-2016).

Dr. Campbell has over 380 publications in peer-reviewed journals and has received recognition for his efforts including the Order of Canada.

Book Review: Dr. James Beckerman's Incredible Heart to Start

Full disclosure: Jamie's a friend, a colleague (we were both speakers for Trench Talks), and he sent me a copy of Heart to Start way back when for me to blurb (which I did), but then I got a new iPad, lost all my annotations, and had to find the time to read it again before I could review it. The good news though - the information in Heart to Start is timeless.

The full title of Jamie Beckerman's latest book is Heart To Start: The Eight-Week Exercise Prescription to Live Longer, Beat Heart Disease, and Run Your Best Race, and he wrote it both as a tribute to his late father-in-law, and as a labour of love for his patients. Having already written The Flex Diet (which I reviewed here), I've no doubt Jamie could have had Heart to Start published traditionally, but rather than go that route, Jamie chose instead to have his hospital publish it so that he could donate 100% of the proceeds to the Play Smart Youth Heart Screenings program that he founded in the name of providing a free service to screen children for asymptomatic heart conditions in order to prevent tragic and sudden cardiac arrests.

The book starts off with Jamie recounting the event that forged his career in medicine. He was a third year medical student spending some time with his then girlfriend and her family at their summer cabin, when in the middle of the night she woke him up with the words,

"I think my dad is having a heart attack"

An hour of compressions later and the paramedics arrived, and though her father didn't make it, his death and that experience changed Jamie's life. Jamie made two promises that day, the first to devote his career to the prevention of heart disease and the second ... you'll need to read about it in Heart to Start's acknowledgments (but I'd bet you might be able to guess what it was).

Jamie's compassion and enthusiasm shines through Heart to Start which is designed to serve as a coach not just to those looking to prevent illness, but more importantly, to those who have been given a cardiac diagnosis, or are at great risk for one - a population that may quite frankly be afraid that getting moving might be the end of them.

First Jamie introduces you to a simple fitness test to determine whereabouts your starting line lies, and then along with a thoughtful and engaging summary of the research behind them, he helps to guide you from couch to action. He takes you through the quick sitting-rising test and reminds you that those with the lowest scores have been found to have lifespans three years shorter than those with the highest scores. Next is the 6 minute walk test which very simply looks at how far you can comfortably walk in 6 minutes. Those in the lowest 25th percentile of the test had 4x the rate of cardiac events as those in the highest 25th percentile - and if that fact's not enough to make you want to find out where your score lands you, Jamie reminds you that every additional 100m increase was associated with a 30% lower risk of cardiac events!

In briefly covering diet, Jamie explains that

"the purpose of exercise is not to burn calories"

and that,

"the cheesecake stands alone"

What he's getting at is something I've written about extensively - that while on paper a calorie burned is the same as a calorie not eaten, we don't live on paper. We're not research subjects in metabolic wards, and food serves us in roles other than just fuel. We comfort with it, we celebrate with it, and not only is that ok, it's important! Jamie insists that exercise should never be approached as penance for a piece of cheesecake as if you approach exercise as a punishment, you might be less likely to see it sustained in your lifestyle.

Next up is Jamie's Heart to Start Exercise Prescription which in turn could serve as a stand alone cardiac rehabilitation program, or as an adjunct to one that was established and hospital based. It starts off with an estimation of something called your V02 max which in turn serves to figure out how quickly you ought to be coming off that starting line for what will amount to be an 8 week "cardiac reboot" which covers both aerobic and resistance training. His program has no need for fancy equipment (running shoes and some dumbbells (if you're looking to buy some, check your local online buy and sell style marketplace)) and the workouts he prescribes are accessible, straightforward, and time-tested.

And once rebooted, if you're so inclined, Jamie wants to teach you how to run. 12 weeks to go from rebooted to a 5K.

Jamie is the kind of doctor that makes us other doctors wish we were more like him. Here's hoping that his book becomes required reading at cardiac rehabilitation programs the world over, that Heart to Start groups spring up like weeds, and that as a consequence of his passion, lives will be lived not just longer, but also better.

At the end of the day, if you or someone you love has been diagnosed with, or is at risk of heart disease, following Jamie's $9.99 book will prove a far more powerful medicine than any pill any doctor has ever prescribed.

If you want your own copy of Jamie's Heart to Start, here's an Amazon Associates link.

Saturday Stories: Trigger Warnings, Refugees, and Big Soda

"14-05-06-budapest-RalfR-11" by © Ralf Roletschek 

Greg Lukianoff and Jonathan Haidt in the Atlantic explain why they believe trigger warnings are disastrous for education and mental health.

Anemona Hartocollis in the New York Times documenting the de Facto refugee camp at Budapest's Keleti train station.

Patrick Mustain in Scientific American covers how small amounts of soda industry dollars have purchased large amounts of mayoral silence and friendship (with brief quote from me).

And also below is my latest segment with The Social - this one on the hosts' daily habits.

Maybe You Could Use Some New Prescription Strength Nature™

Thanks to Adri Baltadjian for sending along today's Funny Friday video that asks you to ask your doctor if Nature is right for you.

Have a great weekend!

Serena Williams Joins Long List of Pro Athletes Shilling for Sugar Water

In 2015, Serena Williams' net worth was estimated at $145 million, coming in part from a 5 year, $40 million endorsement deal with Nike.

Part also clearly comes from her comfort in promoting Pepsi and Gatorade to children and adolescents.

In May 2015, Williams was named the face of the Pepsi Challenge relaunch, and just this week, a raft of new advertisements featuring her rise to stardom has been launched by Gatorade.





While it may not be reasonable to expect professional athletes, musicians, and actors to turn down millions of dollars in unhealthy endorsements simply because it's the right thing to do for their impressionable young fans, here's hoping that as public awareness around the risks of sugar-sweetened beverages grows, a day will come where celebrities will have to think twice before entering into these sorts of partnerships consequent to concerns around public condemnation and the erosion of their images' marketability.

An Interesting Twist to the Epigenetic Theory of Obesity (in Rats)

I found this study to be fascinating, but first and foremost, it's a rat study, so it may not extend at all to people.

That said, the study looked at three successive generations of rats following the original parents' generation's switch to a purposefully obesogenic diet where the diet/environment was kept constant for each successive generation. The thinking was, as per prior research, altering the original parents' environment would lead to offspring more likely to have obesity by way of something called "epigenetic inheritance". The question the researchers had was whether or not that "adipogenic" trait was carried forward in their successive offspring if the environment remained constant (and obesogenic).

According to the authors, keeping the rats' successive generations' environments constant was important because it,

"bears more relevance to the human scenario in which populations worldwide are transitioning to and have subsequently continued to experience obesogenic environments"

And epigenetic inheritance is certainly a hot topic in obesity these days, with some researchers suggesting it's responsible for much of why we've been struggling with weight as a society.

Well the good news here, at least if you're a rat, is that with successive generations, each facing the same obesogenic environment, body fat decreased, caloric intake decreased, male rats' ability to convert carbohydrates to body fat decreased, lean mass increased, as did the rats' ability to convert protein to lean mass.

Until I saw this study, everything I'd read regarding epigenetics and obesity had been doom and gloom. Here's hoping that this is one rat study that does point to some hope for humans, as we, like these rats, over the course of our past few generations, have seen our diets change from grain based unrefined ones, to ones rich in refined-ingredients, sugar, and fats.

(and these great graphics - they all come from Nestlé who sees epigenetic research as something worthy of investment)

Two Can Dine for $14.99? Please. Six Can Dine for $14.47.

Really?

"Two Can Dine for $14.99" as incentive to eat at Swiss Chalet? And for just 2 quarter chicken dinners (quarter chicken plus french fries)?

Looking at my local online flyers, $10 will buy 6 quarter chickens (or a 3lb whole chicken) and $4.47 will buy 3lbs of potatoes.

So if you spend the few minutes it would take you to roast the chicken yourself, 6 can dine for $14.47 (or 2 for $4.82).

(And if you want to buy whole chickens and roast them up the effort, as evidenced by this simple recipe, is minimal.)