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McDonald's, But Not Your Child's Elementary School, Removes Chocolate Milk From Their Menu
Not sure if you caught this news release last week. It detailed McDonald's announcement that they'll be overhauling their standard Happy Meal offering in a bid to, "support families".

Part of that "support" (I'll come back to the word, I promise), is ensuring,
"at least 50 percent or more of the Happy Meals listed on menus (restaurant menu boards, primary ordering screen of kiosks and owned mobile ordering applications) in each market will meet McDonald's new Global Happy Meal Nutrition Criteria of less than or equal to 600 calories; 10 percent of calories from saturated fat; 650mg sodium; and 10 percent of calories from added sugar"
And to meet those goals cheeseburgers will only be available by special request, a kids; fry size (smaller than current small) will be developed, bottled water will be a featured beverage option, and chocolate milk will only be available by special request.

Though I'm certainly happy that McDonald's Happy Meals will generally be lower in calories and sugar, here's the rub. While the rollout of this initiative speaks to health, corporations never make changes that they think will hurt their bottom lines. This is not an indictment - corporations aren't social service organizations - their goals are profit driven, and McDonald's are no exception as evidenced by their press release's first line,
"Today, McDonald's (NYSE:MCD) announced an expanded commitment to families, supporting the company's long-term global growth plan by leveraging its reach to impact children's meals"
They hope that these changes will bring in more families more often for more meals at McDonald's, which is good for their investors, but probably not so much so for public health, even without chocolate milk.

But you know which organization's goals aren't profit driven? Your children's elementary schools', yet their chocolate milk programs continue with no end in sight, and not just for a sometimes treat, but daily. If you wouldn't serve kids who didn't eat fruit, daily pie, you might want to rethink their daily chocolate milk.

Motivation aside, it's odd to see McDonald's being more proactive than our kids' schools on this file.
Saturday Stories: Chile, Junk Food, and Opioids
Photo: Mike Mozart
Andrew Jacobs, in the New York Times, on Chile's world leading approach to junk food.

Priya Fielding-Singh, in the Las Times, on the sad reality that turn so many people towards junk food.

Benjamin Davies, in Forbes, reflects on the opioid crisis, both as a surgeon, and as a grieving friend.
PSA: Please Don't Joke About Sometimes Wishing You Had Anorexia
Given what I do for a living, it happens not infrequently that someone will joke with me about sometimes wishing they had anorexia or bulimia in the context of their struggles with weight management.

And while I can see where their unfortunate attempt at humour is coming from, it always leads me to have a gentle chat with them that contains these truths.

Lives are ripped apart by eating disorders. Families are devastated. People die.

Eating disorders aren't punchlines.
        
Some Evidence Canada's New Food Guide Will Care About Evidence
Though there's no white smoke signifying the publication of a new Food Guide billowing out of Health Canada's food directorate's chimney, there are some signs that when it's finally published, it may be evidence based.

Take for example this story.

It details the concerns of Conservative agriculture critic John Barlow and it contained some heartening quotes.

Here's my favourite,
"It is very clear…that Health Canada is going in a direction that is detrimental to our agriculture sector, detrimental to our food processors as well as our producers on the ground."
Now while I feel for any sector impacted by the future Guide's recommendations, that Health Canada is not actively capitulating to agricultural interests suggests that perhaps instead, it's sticking with science as its underpinning.

According to Barlow, his office has been flooded with concern from a broad range of agriculture groups who are nervous about Health Canada's new policy of not kowtowing to industry,
"I want to really stress this point. These letters are not only from the livestock industry or the dairy industry, there’s letters in here from grain growers, the horticulture associations — none of them want us as a government, in this food guide document, to be picking winners and losers. They all want to be successful."
While there may well be some disagreement among health professionals as to what truly constitutes a healthy diet, where there likely is no disagreement is the notion that the desires of various agricultural sectors to be "successful" doesn't factor in to dietary health at all.

And just as an odd aside, in the same article is a quote from Agriculture Minister Lawrence MacAulay who was asked to comment about agricultural concerns. His response?
"Without a question, what I want to see is Canadians make sure that they express their view on what’s presented and that’s why things are gazetted. My opinion — really, it’s Canadians opinion that really reflects what takes place on this and anything else that’s gazetted to make sure that is what they do want to have happen."
Here's hoping that's not how policy works in Canada, as while not bashing the public, I'm pretty sure Food Guides shouldn't be built on what Canadians' personal opinions about food happen to be.

So bring on the evidence, and for the matter, bring on the new Food Guide. Remind me again, why are we still waiting?
Saturday Stories: Gender Balance, One In 259, And Terminal Wisdom
Am somewhat pleased to report that after being inspired by this piece by Ed Yong in The Atlantic, on how he spent two years correcting the gender imbalance of his quoted sources, I went back over my last year of Saturday Story pieces to discover that 46% of the 292 stories I've shared were written by women.

Chika Stacy Oriuwa, the only black student in her medical school class of 259 at U of T, in Flare, on how in her white coat she is more black than ever.

Alastair McAlpine, in The Guardian, expounds on his viral tweets about the lessons he's learned from terminally ill children.
Have Diabetes And Motivated To Change Your Lifestyle? Virta (And Maybe #Keto) Could Be Right For You
A quick post regarding an exciting study that dropped today in the release of Virta Health's one year data on the impact their intensive lifestyle counselling, coupled with their ketotic diet, had on patients with type 2 diabetes.

The results were impressive.

Of the 262 patients who started the year long study, 83% finished, and of those their metabolic biomarkers and weight improved dramatically. On average their hemoglobin A1C (a long term measure of blood sugar) dropped from 7.6 to 6.3, type 2 diabetes medications other than metfromin dropped from 56.9% to 29.7%, and insulin was reduced or eliminated in 94% of subjects who started out on insulin, while sulfonylureas were eliminated entirely. Weight dropped an average of 30lbs. Insulin resistance as measured by HOMA-IR dropped by 55%, hs-CRP by 39%, and triglycerides by 24%. Though LDL did rise by 10%, HDL rose by 18% and apolipoprotein B was unchanged.

All this to say that if you have type 2 diabetes, and you're motivated to make lifestyle changes, Virta health's program definitely appears to be worth considering.

But there are some caveats.

Firstly the study looked at individuals who self-identified as wanting to affect lifestyle change, and so their comparison with "usual care", which consisted of individuals identified by their MDs as having diabetes and then being relegated to their local diabetes education program, may not be a fair one.

Secondly, the intervention was incredibly robust and intensive. That's not a knock. I think it's terrific. It included,
"continuous care through intensive, digitally-enabled support including telemedicine access to a medical provider (physician or nurse practitioner), health coaching, nutrition and behavior change education and individualized care plans, biometric feedback, and peer support via an online community"
And where behaviour change techniques taught included,
"education of natural consequences, shaping knowledge, goal setting, self-monitoring, feedback, monitoring and reinforcement from health coach and medical provider, self-belief, social support, relapse prevention, associations, and repetition"
Patients were provided a cellular connected body weight scale, a glucometer and ketometer, and a bp cuff. Patients were then given access to a web-based application to input data and where they received monitoring, education, and communication with their team.

Food wise participants reported daily hunger, cravings, energy, and mood by way of a Likert scale and health coaches worked with patients individually to adjust intake.

It is notable that daily protein intake was targeted to 1.5g/kg, and also that their weight losses had pretty much leveled off by year's end.

I bring up the robust intervention only in that I'm not aware of any prior interventions with other dietary strategies that would compare and therefore at this point it's difficult to divvy up what percentage of outcomes relate to the intensity and frequency of the intervention, and what percentage to their high protein, low-carb, ketotic diet.

The cost of Virta Health (if not covered by your insurer), is reported by them to be (I have no affiliation BTW) $400/month, but given the cost of diabetes medications and the outcomes reported herein, those costs may well be offset by your results.
Canada, Where Dr. Feelgood Beer Sales Are Banned, But Vitamin Water's Are Allowed
What's wrong with this picture?

Last month the Liquor Control Board of Ontario banned the sale of Dr. Feelgood IPA on the basis that the snake encircling the hops paddle, coupled with the prescriptive looking ℞ in the D℞., would implicitly lead consumers to believe that the beer was a health food.

Yet Vitamin Water's liquid candy sales are just dandy (including of course in stores frequented by children). And so too are the hundreds, if not thousands, of packaged foods that explicitly purport to confer health benefits, not to mention an entire industry of supplements that promise health miracles.

It is so disappointing that Canada continues to allow the food industry to dupe consumers with impunity.

(And for the record, and not just because I enjoy IPAs, I think the LCBO is overreaching here, while Health Canada and the CFIA don't bother lifting any fingers at all)
Saturday Stories: Dutch Famine, Cooking Classes, And "Clean" Labels
Carl Zimmer, in The New York Times, on the lasting effects of World War II famine on Dutch genes and health.

Lela Nargi, in NPR, on cooking classes as heart failure medicine.

Nadia Berenstein, in The New Food Economy, on "clean" food labels.