Tuesday, November 29, 2011

Counting Carbs

Like me, do you almost automatically turn over containers and look at the carb count?  I find myself deducting the fibre count too, almost subconsciously, to see how many net digestible carbohydrates there are per portion.

I recently discovered this isn't always a good idea.  You see, some food producers deduct the fibre for you, so if you deduct it too, you're consuming more carbs than you think.

For example, look at these hemp hearts, which are available at Costco:

If you add the sugars and the fibre, they exceed the carbohydrate count, so it's pretty certain that this is a net number.

For Maranatha almond butter we see the following:

Do you see the difference?  The hemp hearts list "Carbohydrates", whereas the almond butter count is for "Total Carb." 

I don't know how I missed this important little detail before, and it's one more thing to look out for if you're counting carbs.

Wednesday, November 23, 2011

Soda in Drag: Chocolate Milk

Soda in drag.  That's what the Renegade Lunch Lady, Chef Ann Cooper calls chocolate milk, and rightfully so.

Did you know grocery store chocolate milk provides around 26g to 28g of sugars per 250ml serving, and that this is comparable to the sugar in soda pop?  That's around 5 teaspoons of sugar in one little carton

That doesn't seem to worry America's Milk Producers, whose campaign named Refuel America promotes chocolate milk to teen athletes and school kids.  It promises to provide information on the science behind low fat chocolate milk.  However, when I clicked through to the links all I found were links to a Facebook page:


I had read about a study from a couple of years ago that supported chocolate milk as a recovery drink for athletes, but until this morning, I hadn't bothered to dig it up.

You can read the 2006 study online here.  First and foremost, you need to know that

Here is what I believe is the most important information to take away from the study:
  • It studied the effects of chocolate milk, a carbohydrate replacement drink (with the same carbohydrate and protein as chocolate milk) and a fluid replacement drink (a drink with less sugar or protein than the carbohydrate replacement;  its function is to replace electrolytes) on nine endurance-trained athletes who were exercised to exhaustion in 3 separate trials.  In other words, there were 27 outcomes in total.
  • The researchers expected the chocolate milk and the carb replacement to show similar results
  • In fact, none of the three drinks stood out particularly, except in the time it took the athletes to become exhausted - unexpectedly, the carbohydrate replacement drink was the worst performer, and the chocolate milk and fluid replacement drinks were roughly equal.  The researchers speculated that the types of sugar and the amount of fat in the chocolate milk may have been the cause.

So, based on a limited study with limited results, the researchers concluded:
The dairy industry, as the sponsor, is delighted to claim that athletes of all ages are smart to choose chocolate milk.  Why not, when sport drinks are increasingly less welcome (as of this school year, energy drinks are no longer allowed to be offered by Ontario schools). 

The vast majority of people working out are hardly endurance athletes, and most never work out to exhaustion.  Certainly the dairy industry has much more money to make by aiming at young people as a group, rather than a tiny group of real endurance athletes.

I wonder how many people who believe chocolate milk has superior properties have actually read this study, which incidentally did not compare the effectiveness of chocolate milk to regular white milk.  Do people realize how underwhelming the results were and that there doesn't appear to be a whole lot of rigorous science behind the study?  And how many of them realize the dairy industry sponsored it?

Presumably there are other studies to back up the dairy industry's claim.  But I found this one to be  frustratingly flimsy, and I am afraid other studies might have little more scientific rigour to back them up.

Chocolate milk is a drink that you ought to stay well away from if you are limiting your carbohydrate intake to lose weight - even regular milk should be consumed cautiously, for the same reason.  But if you have children who are active and not at all overweight, please don't be fooled into believing you're doing them any favours by giving them chocolate milk.  Unless they are endurance athletes, it's unlikely that it's going to do them much good, and chances are much greater that the excessive sugar is setting them up with some very poor dietary habits.

Tuesday, November 22, 2011

Feeding teenagers: the prevailing pizza culture

The Ontario Ministry of Education brought in new food rules at the beginning of the 2011/12 school year.  Out went the fries and pop, to be replaced by healthier options (read: lots of whole grains and less processed ingredients) as recommended by Canada's Food Guide.  While I remain critical of the new rules, which give chocolate milk the go-ahead (even though it contains just as much sugar as pop), I certainly believe they are better than the old way of feeding the next generation to have babies and enter the workforce.

We're barely three months into the new system, and the local press has a negative story to hype:  apparently high school students hate the new rules.  They prefer to leave the school grounds to buy their highly processed junk food at restaurants in the neighbourhood rather than facing what the cafeteria has to offer.  This is negatively impacting school revenues from food sales, which are down as much as 30%, so some administrators aren't very happy either.

Reading the article made me wonder if there is any hope for healthy food for teenagers.  At my children's school I listen to the parents discussing food matters at the monthly parent council meetings, and it's evident to me that quite a few of them do not have a problem with the status quo.  I also regularly see the high school students in my neighbourhood crossing the road to the local McDonald's or convenenience store during their lunch hour.  Where are they getting the money from?  Their parents must be supplying them with the cash to purchase lunches every day, rather than insisting on them bringing a healthy lunch from home.

British schools are ahead of us in the fight against poor nutrition at schools, and for some time their councils have had the power to ban fast food outlets from setting up shop within a specified distance of a school.  To my knowledge, this is not something that has been seriously discussed in Canada.

In our household, where we eat completely differently, I know it's sometimes hard for my children.  Kids generally don't like to stand out from their group, after all.  While our kids don't eat the same way that my husband and I do (their consumption of grain in the form of pasta and bread being the big difference), I have noticed that even they are eating a little more primally than before.  And their sugar consumption definitely lags that of all their friends.  What a contrast it is to live in a household where pizza is served less than once a month, as opposed to their friends' houses, where it might be on the table as often as three times a week?

We have several years to go before my kids enter high school.  Maybe things will improve a little by then, as both students and their parents get used to the new rules.  However, I am afraid the well-intentioned new food regulations won't go far enough to change the prevailing junk food culture.  I am afraid it will take more than provincially-mandated rules to turn it around.  To me, it often seems like an unwinnable battle against corporate interests with very deep pockets that enable them to market their heart-clogging offerings on every street corner.

At least, that's my observation from this city of 200,000, where the concentration of fast food outlets exceeds the national average, correlates positively with our residents' waistlines, and where there appears to be no political will at the municipal level to promote access to healthier eating.

It's really very sad.  Most of us are aware that many of today's teenagers will experience more weight-related health problems at a much younger age than their parents or grandparents who grew up on real food.  And as a community, we aren't doing enough to help turn the tide.

Monday, November 21, 2011

Half the man he used to be

"Vainglory" is the pseudonym of a remarkable man.  He is a 30 year old who weighed 538 lb in March 2010.  Today, just 20 months later, he is 257 lb lighter.

What's even more remarkable is that he did this without surgery.

Sometimes I think that all bets are off once you reach a certain weight;  maybe there's something to all those bariatric surgery ads for people who are morbidly obese.  After all, what do I really know about severe food addiction or morbid obesity?  I have spoken to people who have had bariatric surgery and they are convinced this was the only way they could have regained a normal life.

It sounds plausible, though I don't understand why the numerous bariatric surgery centres make their pre-op patients follow a specific diet for several weeks prior to surgery.  And afterwards, there are also strict dietary rules.  The FAQ will often mention that failure to lose weight occurs when post-op patients eat starchy foods.

In other words, the surgery will only work if you stick to a low-carb eating plan.

So what I've always wondered is that if it weren't for the lucrative nature of the surgery, wouldn't it make more sense to have prospective bariatric patients follow a ketogenic (i.e. extremely low carb) diet, together with extensive counselling and support to understand why this is necessary, for, say, three to six months?  Only if that failed, would it make sense to me to start investigating surgical options.

But here is a man who, not very long ago, appeared to be a lost cause.  Something connected in his brain after he learned about the role of carbohydrates.  First he reduced his daily carb count to 100g, then, he cut it even more.

Today, he looks like a completely different man.  Please take a look at his blog.  If a man weighing half a ton can cut his bodyweight in two and transform his life, everybody else can take charge of their lives as well.

You just have to believe that you can do it.  Just like he did.

Tuesday, November 15, 2011

Coca Cola's $2billion Investment in the World's Diabetes Capital

The Coca Cola Company announced yesterday that it will be investing $2 billion to increase its market share in India's non alcoholic beverage market. India is a strategic growth country for The Coca-Cola Company and ranks among its top 10 markets in global volume.

Ahmet C. Bozer, Coca-Cola's President, Eurasia and Africa Group, said, "India is one of our most important growth markets as we work toward our 2020 Vision of doubling system revenues and servings this decade. The opportunity in the packaged beverage segment is immense, and our efforts in India are focused on being the beverage of choice all day, every day. If we continue to do the right things each day and at all times, it would not surprise me if India becomes one of the top five markets for the Company globally by the end of this decade."

Coincidentally, and certainly ironically, yesterday also marked World Diabetes Day.  Of course not all Coke products are sweetened, but I read the announcement of this investment with some alarm.

You see, India has the dubious distinction of having the most diabetics in the world.

Some stats on the severity of India's diabetes pandemic:
Over 30 million have now been diagnosed with diabetes in India. The CPR (Crude prevalence rate) in the urban areas of India is thought to be 9 per cent. In rural areas, the prevalence is approximately 3 per cent of the total population.
According to the Hindustan Times,
Various studies have shown that the high incidence of diabetes in India is mainly because of sedentary lifestyle, lack of physical activity, obesity, stress and consumption of diets rich in fat, sugar and calories.
The most prevalent is the Type 2 diabetes, which constitutes 95 per cent of the diabetic population in the country. 
When I visited India almost 20 years ago, we were advised to drink bottled pop rather than risking picking up malign amoebae from the drinking water.  Although the country has developed considerably since then, I know there are still significant problems with its water supply.

As India's middle class continues to grow, more and more people have the money to buy bottled beverages.   From Coca Cola's point of view, it certainly makes sense to capture a piece of this lucrative market.

I think it's a terrible pity that the $2 billion investment is going towards products that will only contribute to India's health care problems.

A $2 billion investment towards providing India's billion inhabitants with access to clean drinking water would be so much more helpful.

Monday, November 14, 2011

The Elephant in the Room

If you are an NPR listener, you may have caught today's piece on Morning Edition on doctors  who don't directly address weight issues with their patients, even though it is standard practice to weigh each patient on arrival and to record their weight in their chart. 

In many cases, patients would welcome support and advice on how to shed their excess pounds, but family physicians typically face a number of barriers which lead to them skirting the issue.

Some of the barriers mentioned include the following:
  • The reimbursement system is typically based on treatment, rather than prevention.  It is based on treatment of specific medical issues, like hypertension or diabetes, even though these are usually weight-related.  So nutritional counselling might not be reimbursable.
  • Doctors typically lack training to provide weight counselling and nutrition is not something that is covered in detail in their medical training. 
  • There is often too little time in a typical doctor's visit (an average of 8 minutes was mentioned), to address weight issues.
These are all valid points that are worthy of further discussion, but I would add a couple of points of my own. 

Some patients are easily offended when their physician addresses their weight.  They may be in the office for something they don't believe to be related to their weight, and with visits being undeniably brief, there might not be enough time for their physician to explain the relationship of weight to health.  More complex issues like the relationship of excess weight to the risk of wound-healing complications when it comes to surgery are even trickier to cover.  The linkage between fast and processed food consumption and health is another touchy one, and it doesn't take much for some patients to feel their doctor has crossed over into interference in an area of their lives that has nothing to do with them.

Another barrier many doctors face, ironically, comes from the nutrional profession.  Almost all the official nutritional guidelines from Canada's Food Guide, the USDA's My Plate, the Heart & Stroke Foundation, the Canadian Diabetes Association, as well as all the other governmental channels promote a "balanced" approach to nutrition that involves eating "more healthy grains." They never advise people to radically restrict carbohydrates, not least if they have diabetes.  They prefer to tell people instead, erroneously, as it happens, that carbohydrates are essential for health.  These organizations often enjoy hefty financial support from big food corporations, and the potato and grain lobbies, and they can't bring themselves to say an outright NO to sugar and starches that cause blood sugar to spike.  This is in spite of a growing body of credible evidence that excessive sugars underlie our society's weight and health problems.

In our litigious society which allows patients to make College complaints whenever they feel their doctor is out of line, doctors have to be careful when they offer opinions or advice that don't enjoy mainstream support.  Having been married to a doctor as long as I have, I have heard enough stories of shoddy patient treatment by some of his less competent colleagues to believe very strongly in the complaint process.  On the other hand, I do understand very well how stressful and time-consuming it is for doctors to answer the College when a complaint is made, even if it is trivial or unjustified. 

This is why it is perfectly understandable to me why risk-averse doctors with busy practices choose not to address weight issues and nutrition with their patients, even though they may be fully on board with the literature and increasing number of peer-reviewed studies that support carbohydrate restriction as the key to losing weight and improving long-term health. 

They are simply too busy, many patients are too easily offended.  Avoidable unjustified College complaints are the last thing they want to deal with.