tag:blogger.com,1999:blog-24341583838426281262024-03-13T16:32:58.827+00:00gibneyonfoodMike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.comBlogger127125tag:blogger.com,1999:blog-2434158383842628126.post-16400527807114320352021-09-10T10:25:00.005+01:002021-09-10T10:29:29.102+01:00<blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><b><span style="font-size: medium;">Obesity: Debate, Dogma and Harvard Dons</span></b></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><br /></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p>Extract from “The Road Not Taken” By Robert Frost</p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i><br /></i></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i>I shall be telling this with a sigh</i></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i>Somewhere ages and ages hence:</i></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i>Two roads diverged in a wood, and I—</i></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i>I took the one less travelled by,</i></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><i>And that has made all the difference.</i></p></blockquote></blockquote></blockquote></blockquote><p>Some years ago, I was invited by the President of the University of Auckland to deliver one of the university’s public lectures. I chose the title “Obesity: Down the road less travelled” and I tried to show how some of the conventional wisdom on obesity might be a bit too rigid in that it might chose to ignore some awkward data. My overall feeling was that the lay audience enjoyed the talk but that the public health nutrition experts in the audience were not impressed. They were comfortable in their prevailing paradigm. Throughout my professional career as a Professor of Nutrition, I have found that the excitement in research is not showing yet again, albeit under slightly different conditions (old/ young; fit/sedentary; diet A/B, etc), that some basic tenet of modern nutritional thinking remains safe and sound. That excitement is to be found in the unexplained, unexpected and unusual finding. In proudly pursuing this vision of science, I have been reproached, ridiculed, slandered and shunned. One learns to have a thick skin. </p><p>I was aware of a spat some years ago between a career researcher at the US CDC and the world-renowned Dons at the Harvard School of Public Health. However, it was only recently that I could read the full account of this very public spat. The CDC researcher in question was Dr Katherine Flegal and in a recent paper entitled “The obesity wars and the education of a researcher: A personal account” she provides a detailed account of how Harvard Dons rushed to the parapets of the print and electronic media to condemn, in no uncertain terms, the work of Dr Flegal (1). </p><p>In 2004, researchers at the US Centre for Disease Control (CDC) published a paper in the Journal of the American Medical Association (JAMA) which examined the main causes of deaths in the US. Tobacco was the primary cause of mortality (435,000) with poor diet second, at 400,000 deaths. The dominant factor associated with poor diet was obesity. The paper attracted significant attention and the then director of the CDC, Julie Gerdering predicted that obesity would soon overtake smoking as the leading cause of death in the US. </p><p><br /></p><p>But others within the CDC were of the view that this short paper had some flaws and they set about correcting these. Their paper, led by Dr Katherine Flegal, was vetted internally within the CDC and was published in JAMA in 2005. It showed a relationship between bodyweight and mortality rate which was quite different from the original study and which challenged conventional wisdom. The instant the paper appeared, several professors from the Harvard School of Public Health began what can only be described as an extraordinary tirade of abuse, demonising the author and discrediting the paper. This month, Dr Flegal published a paper in a leading cardiovascular journal, outlining in detail the vicious backlash to her challenging paper.</p><p>Flegal’s paper differed from the earlier CDC publication in several respects. She used actual measurements of weight and height as opposed to self-reported data which overestimates height and which underestimates weight. Flegal used three recent datasets which were nationally representative of the US population whilst the earlier paper used only one old nationally representative sample. That earlier paper did not adjust for effects of age, sex, smoking or other factors on mortality. Dr Flegal did. The earlier paper had several calculations errors which were eventually accepted by the authors. </p><p>Flegal’s paper showed that as body mass index (BMI), increased, mortality increased but in a manner quite different to conventional wisdom. That wisdom held that at the level of overweight (BMI 25-30), mortality began to rise. Above 30, it began to soar. Flegal’s data did show that mortality rose as BMI rose but not until a BMI of 30 in young people. In older persons, mortality showed no change across the entire spectrum of BMI. </p><p>One would have imagined that the Harvard dons who were instrumental in constructing this conventional wisdom would have invited Dr Flegal to discuss her paper and to explore how both could move forward in the pursuit of best science. Instead, they hit the media. Journalists were told that Flegal’s study was “really naïve, deeply flawed and seriously misleading”. Flegal points out that Professor Walter Willett, the doyen of these dons, in an interview with NPR quipped: “This study is really a pile of rubbish and no one should waste their time reading it”. Willett raised his concerns directly with the Director of the CDC who stood behind Flegal’s work, and a research fellow at Harvard blogged that the paper had been retracted and the Flegal was demoted. All utterly untrue.</p><p> Within a week of the publication, the Harvard dons hastily organised a special symposium at which expert after expert, mostly from Harvard, slated Flegal’s paper. That same week, Flegal was giving a paper at a symposium at Berkeley. Standing at the door was a young woman handing out sheets of paper setting out why Flegal’s paper was flawed. The matter reached low levels when, students taking courses at Harvard, tweeted that one of the dons had advised that Dr. Flegal’s scientific analysis shouldn’t be trusted because she was “a little bit plump herself”. </p><p>Flegal responded to these attacks exactly as any scientist should by searching the literature on the topic to see what others had found. She conducted a meta-analysis of all published papers which had examined the relationship between mortality and BMI and had her findings published in JAMA in 2013. Her work examined 141 eligible papers and concluded, as she had before, that rising BMI was associated with all cause mortality. However, she noted again that the strength of that relationship was much weaker than conventional wisdom and, again, showed no association with rising BMI within the “overweight “category. In an interview with the BBC, Professor Willett stated: “This is an even greater pile of rubbish” than the study in 2005 and in a radio interview on NPR he repeated this criticism of the 2013 study and separately noted that “rubbish” was a polite term for what he really wanted to say.</p><p>The truth is somewhere out there, be it Flegal’s truth or Willett’s truth. It matters a lot in public health to know where that truth lies. But when science gets closer to policy, be it climate change, vaccination programmes, transport or public heath, then science tends to be simplified into bite size pieces, suitable for policy makers. Shades of grey are out of the question and maybe that is necessary for policy makers. However, unanimity of opinion, as has been said, is fine for religion and politics. It has no place in science which must stick solely to risk assessment and be open to changing advice as new data emerges. The Harvard dons should know better. </p><p>(1)Flegal KM. The obesity wars and the education of a researcher: A personal account. Prog Cardiovasc Dis. 2021 Jul-Aug;67:75-79. doi: 10.1016/j.pcad.2021.06.009. Epub 2021 Jun 15. PMID: 34139265.</p><p><br /></p><p><br /></p><p><br /></p>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-3531777937505237022021-07-05T15:51:00.001+01:002021-07-05T15:51:46.463+01:00Covid caloriesThe Institute of Fiscal Studies (IFS) in London has published a paper entitled: “The dietary
impact of the COVID-19 pandemic.”(1) They used a household level database that records all food and non-alcoholic beverages purchased in supermarkets by a nationally representative sample. Within that database was sub-set of data on food purchases for out-of-home consumption. These two datasets were combined to yield data on the types of foods purchased and their calorific value. Their statistical methodology goes above the head of this blogger but given the reputation of IFS, I am taking their findings as they stand. Their data were longitudinal so they could provide data for the entire period of the pandemic and relate such data to those of the previous non-pandemic year. The figure below outlines caloric intake in the home over the period of the pandemic.
<br /><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-Am-bZXl-k-4/YOMUGiZuusI/AAAAAAAAue4/nz-DCeeOECQ3E2qCp8exXg3d7yUF9_AdACLcBGAsYHQ/s1296/Image%2B1.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="944" data-original-width="1296" height="340" src="https://1.bp.blogspot.com/-Am-bZXl-k-4/YOMUGiZuusI/AAAAAAAAue4/nz-DCeeOECQ3E2qCp8exXg3d7yUF9_AdACLcBGAsYHQ/w467-h340/Image%2B1.jpg" width="467" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">In the weeks before the pandemic, calorie intake at home was comparable to the same period in 2019. Around 10 weeks later, there is a spike in purchases, probably reflecting stockpiling and panic purchasing. For the ensuing 20 weeks of lockdown, caloric intake at home was well above the comparable 2019 period, estimated at 30% higher. From about week 27 to week 39, restrictions were eased and in home caloric intake declined but was still above the comparable levels for 2019. Thereafter, as restrictions were re-introduced, in-home caloric intake began to rise again and at a rapid pace. The figure below shows the composition of the foods purchased. The purchase of fruits, vegetables and snacks remained fairly constant. There was a significant decline in ready-to-eat foods and a sharp rise in the purchase of ingredients, indicating a swing to home cooking. </div><br /><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-AYoW0y94jaY/YOMVXI83JOI/AAAAAAAAufI/GUanFlga8uMyJtjHhd8Es5Z8fY74MA-8gCLcBGAsYHQ/s1296/Image%2B2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="906" data-original-width="1296" height="389" src="https://1.bp.blogspot.com/-AYoW0y94jaY/YOMVXI83JOI/AAAAAAAAufI/GUanFlga8uMyJtjHhd8Es5Z8fY74MA-8gCLcBGAsYHQ/w557-h389/Image%2B2.png" width="557" /></a></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both; text-align: left;">There was a significant drop in food expenditure for dine-in restaurants and a significant rise in the purchase of takeaway foods. When in-home and <i>out-of-home data is combined, net caloric intake rose. To directly quote the authors: “Over the period April to June, the impact of the pandemic on total calories was due to households increasing their at-home calories by more than the fall in their out-of-home calories</i>.”</div></div><br /></div><div class="separator" style="clear: both; text-align: left;">The next set of figures show how out-of-home purchases and calories changed</div><div class="separator" style="clear: both;"><div style="text-align: left;">during the pandemic. </div><div style="text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /><div class="separator" style="clear: both; text-align: left;"><a href="https://1.bp.blogspot.com/-G5_PbNfZV6Y/YOMYXa_ZbRI/AAAAAAAAufk/gBgQc_N_gl0zy-fFgKzjouAAUDhUfiQRACLcBGAsYHQ/s1296/Image%2B3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1020" data-original-width="1296" height="394" src="https://1.bp.blogspot.com/-G5_PbNfZV6Y/YOMYXa_ZbRI/AAAAAAAAufk/gBgQc_N_gl0zy-fFgKzjouAAUDhUfiQRACLcBGAsYHQ/w501-h394/Image%2B3.png" width="501" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div></div></div><div><br /></div></div></div>
There was a significant drop in food expenditure for dine-in restaurants and a significant rise in the purchase of takeaway foods. When in-home and out-of-home data is combined, net caloric intake rose. To directly quote the authors:<i> “Over the period April to June, the impact of the pandemic on total calories was due to households increasing their at-home calories by more than the fall in their out-of-home calories</i>.”
Finally, the authors examine how household composition influenced the net caloric increase in the pandemic:<div><br /></div><div class="separator" style="clear: both; text-align: left;"><a href="https://1.bp.blogspot.com/-7WdalM5t8_c/YOMZWvrvAeI/AAAAAAAAufs/bNewPoC46QI4P8xp8n8DLgiJCeJzHaGswCLcBGAsYHQ/s1296/Screenshot%2B2Image%2B4021-07-05%2Bat%2B15.37.17.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="820" data-original-width="1296" height="409" src="https://1.bp.blogspot.com/-7WdalM5t8_c/YOMZWvrvAeI/AAAAAAAAufs/bNewPoC46QI4P8xp8n8DLgiJCeJzHaGswCLcBGAsYHQ/w650-h409/Screenshot%2B2Image%2B4021-07-05%2Bat%2B15.37.17.png" width="650" /></a></div><div><br /></div>
Retirees showed the least change in caloric intake relative to 2019 with a graded extent of net caloric gain as household moved from those with low skilled employees (about 10%), through semi-skilled about (15%) and peaking with the highly skilled with an average rise of caloric intakes of 25%. (These calculations are my rough estimates from the above graph).
There are ample studies showing that periods of lockdown were associated with weight gain. For example, a 3-month showed very significant weight gain during lockdown : “During the lockdown period, greater pro-portion of women gained weight compared to men (46.1% vs 40.6%, P < .01). The obesity rate after the lockdown increased among women (40.7%-41.7, P < .01) but decreased among men (39.6%-38.6, P < .01) compared to before the lockdown”.
The problem with weight gain is that it always unintentional and if left unattended the weight gain will persist. There are lessons to be learned about food habits in lockdown and this paper makes a very important contribution to this area.<div><br /><span style="font-size: x-small;">
</span><div><span style="font-size: x-small;">(1) <a href="https://ifs.org.uk/publications/15503">https://ifs.org.uk/publications/15503</a></span></div></div><div><span style="font-size: x-small;">(2) Mulugeta W, Desalegn H, Solomon S. Impact of the COVID-19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts. Clin Obes. 2021 Aug;11(4):e12453. doi: 10.1111/cob.12453. Epub 2021 Apr 14. </span></div>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.comtag:blogger.com,1999:blog-2434158383842628126.post-34820444923528866032021-05-07T20:48:00.008+01:002021-05-07T20:49:41.931+01:00Birth cohorts and obesity: What do they tell us<p style="text-align: left;"><br /></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: left;">Every so many years, national data are gathered on dietary habits and such surveys also provide data on many non-dietary variables, including BMI. The data thus gathered on weight and height refer only to the date of measurement. It cannot tell us when an individual might have become overweight or obese, given that the sample will be comprised of individuals ranging in age from tens to the nineties. Thus, if a sample is taken in 1960, the extent to which subjects watched TV would vary very considerably. However, if a birth cohort born in 1960 is followed thereafter, then they all experience the same opportunity for TV viewing. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">A recent paper in the Proceedings of the National Academy of Sciences, provides data on birth cohorts and obesity in the US(1). They used data from NIH longitudinal studies: The National Longitudinal Study of Adolescent to Adult Health (Add Health) (2); The Americans' Changing Lives (ACL) survey (3); Mid Life in the United States (4); Health and Retirement Study (5). The main aim of the study was to determine for different birth cohorts, the age at which the mean body mass index (BMI) reached 30, indicative of obesity. The data are presented in the table below:</div><div class="separator" style="clear: both; text-align: left;"><br /></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: left;"><br /></div></div></blockquote><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: left;"><b>Birth cohort<span style="white-space: pre;"> </span> Age in years at</b></div><div class="separator" style="clear: both; text-align: left;"><b> which mean cohort BMI</b></div><div class="separator" style="clear: both; text-align: left;"><b> is equal or greater than 30 kg/m2</b></div><div class="separator" style="clear: both; text-align: left;">1980-1984<span style="white-space: pre;"> </span> 30-39</div><div class="separator" style="clear: both; text-align: left;">1965-1969<span style="white-space: pre;"> </span> 40-49</div><div class="separator" style="clear: both; text-align: left;">1955-1959<span style="white-space: pre;"> </span> 50-59</div><div class="separator" style="clear: both; text-align: left;">1950-1954<span style="white-space: pre;"> </span> 60-69</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">These data clearly indicate younger cohorts will endure the adverse effects of obesity for decades longer than their older or siblings or their parents. Cohorts born between 1905 and 1945 never reached a mean BMI indicative of obesity throughout their lives. However, all readily hit the overweight range (BMI 25.0-29.9 kg/m2) from their thirties onwards and some of the cohorts were knocking on the door of obesity. For example, the cohort born between 1940-1945 reached a mean BMI of 29.4 in their seventies. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">The data we obtain from birth cohorts are critically important in understanding the epidemiology of obesity. However, many take the uncomplicated but incorrect view that both overweight and obesity are entirely a recent phenomenon. In my book “Ever seen a fat fox – the biology of human obesity” I cover several earlier birth cohort studies and BMI (6) .</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Researchers at the US National Bureau of Economic Research examined the birth cohort changes in BMI using data collected by the National Center for Health Statistics covering subjects born between 1882 and 1986 (7). Their results show that in 1880, average BMI was within the normal weight range (20-25 kg/m2) at about 22. Mean BMI of black females reached 25 by 1900, while for white males, black males and white females the dates that a mean BMI of 25 was achieved was respectively, 1905, 1915 and 1920. Again, black females led the way in achieving a BMI in excess of 30 by the year 1940 with all others achieving this about 1960. Another set of research from the same US Bureau provides data on the BMI of US military recruits from 1864 to 1991(8). These are more robust data because they are based not on models but on measured weight and height. If we take men aged 45 years, the average BMI increased from 23.3 to 26.5 over this time period but the greatest part of this increase (60%) was in the period 1894 to 1961. Only 20% of the rise in BMI was explained post 1961. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">We can also look at more modern data gathered in Denmark and which looks at the rate of change in body weight in two groups (9). The first are 19-year-old military recruits studied since 1945. The second is a set of children aged 7,8,9,10 and 11, all born in 1930. In both cases, the prevalence of obesity was low at the outset of the studies at about 3 obese persons per thousand of the population. That trebled by 1960 but remarkably, it did not change at all between 1960 and 1990. However thereafter obesity again trebled to a level of about 30-40 obese persons per 1000 of the population. This wave-like growth in obesity, which I call the tsunami of lard, has also been recorded by the researchers at the US Bureau of Economic Research in their 1882-1991 modeling of the growth of obesity in the US. The concept that the rise in obesity has not been linear but wave-like is important in evaluating the present crisis of obesity. As ever in science, progress in our knowledge grows from embracing anomalies and exceptions and not from burying awkward data. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">(1) Yang YC, Walsh CE, Johnson MP, Belsky DW, Reason M, Curran P, Aiello AE, Chanti-Ketterl M, Harris KM. Life-course trajectories of body mass index from adolescence to old age: Racial and educational disparities. Proc Natl Acad Sci U S A. 2021 Apr 27;118(17): e2020167118. doi: 10.1073/pnas.2020167118. PMID: 33875595.</div><div class="separator" style="clear: both;">(2) https://addhealth.cpc.unc.edu/ </div><div class="separator" style="clear: both;">(3) https://www.icpsr.umich.edu/web/NACDA/studies/4690 </div><div class="separator" style="clear: both;">(4) http://midus.wisc.edu/puboverview.php </div><div class="separator" style="clear: both;">(5) https://hrs.isr.umich.edu/about</div><div class="separator" style="clear: both;">(6) https://www.amazon.com/Ever-Seen-Fat-Fox-Explored/dp/1910820083 </div><div class="separator" style="clear: both;">(7) Komlos J, Brabec M (2010) The trend of mean BMI values of US adults, birth cohorts 1882-1986 indicates that the obesity epidemi</div><div class="separator" style="clear: both;">began earlier than hitherto thought. National Bureau of Economic Research. Available from: http://www.nber.org/papers/w15862 .</div><div class="separator" style="clear: both;">(8) Costa D, Steckel RH. Long term trends in health. Welfare and economic growth in the United States. In RH Steckle and R,Floud eds Health and Welfare during Industrialization, Chicago: university of Chicago Press, 1997.</div><div class="separator" style="clear: both;">(9) Olsen LW, Baker JL. Holst C, Sørensen TI. Birth cohort effect on the obesity epidemic in Denmark Epid 2006;17:292-295.</div><div><br /></div></div><div style="text-align: left;"><br /></div></div><p><br /></p>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-87837482415454780142021-04-06T13:38:00.001+01:002021-04-06T17:31:58.250+01:00 Obesity goes viral - but not with Covid<p><br /></p><p> </p><p>It is a given that as soon as a child starts to attend a pre-school creche, they will come home with sniffles and occasionally a sore eye from conjunctivitis. The root cause is an adenovirus which will be readily spread as droplets in expired air and, because the adenovirus is not easily disinfected, it is readily spread by shared surfaces. Sound familiar? There is one particular adenovirus that attracts the attention of those in the obesity field that are capable of thinking outside the box, a rare breed, let it be said. Back in 1982, veterinary researchers in Mumbai noted that when chickens were injected with canine distemper virus, they became very fat. Shortly afterwards, other viruses were shown to be drivers of obesity such as the virus that causes scrapie in sheep or an avian adenovirus known as SMAM-1 . Studies then turned to humans to explore if there might be link between excess body weight and some virus and the candidate virus that has emerged is the adenovirus 36 or Adv 36. The first study (n= 502) to show this was in 2002, with an infection prevalence of 11% in those of normal weight and 30% among the obese population . Since then, an additional 36 studies have examined the role of Adv 36 in human obesity and a recent systematic review of the literature in this field has concluded that: ”Strong evidence suggested a possible association between viral infection and obesity” . In general, this blogger dislikes association studies but in this instance, it is the best we can do since it would be unethical to experimentally infect a human with Adv 36. There are, however, data other than association data to help us understand the role of Adv 36 in obesity. That very first study of Adv 36 in human obesity also included 26 pairs of twins (20 identical and 6 non-identical). What was important in this study was that infection was discordant among the twins, that is, one twin was positive and one was negative for infectivity. The infected twins had a higher body mass index (26.1 v.24.5 kg/m2) and a higher overall % body fat (29.6 v. 27.5 as measured using hydrondensitometry or dual emission X-ray absorptiometry).</p><p> </p><p>The experimental data from animals consistently shows among chickens, rats and monkeys that experimental infection with Adv 36 causes obesity. All show a significant rise in adiposity and all show no change whatsoever in energy intake. Perhaps the most interesting study was at the Wisconsin Primate Research Centre where blood samples were taken from Rhesus monkeys every 6 months for 90 months. The samples were stored frozen and accessed to test for Adv 36 infection . This study therefore relied on <i>natural</i> infection rather than <i>experimental</i> infection. Only those monkeys that remained seronegative for Adv 36 over an initial 18 moths were included in the study. During this Adv 36-free period, bodyweight changed very little (0.3% or 0.04 kg). However, once they became naturally infected, body weight increased by 15% or 1.7 kg. </p><p><br /></p><p>Both the discordant twin study and the longitudinal monkey study of natural infection provide compelling evidence for a possible role of Adv 36 in human obesity. The stand-out discovery is that neither in experimentally infected or naturally infected animals did energy intake change. So how does Adv 36 cause increased fat mass if it has zero effect on energy intake? It does this by stimulating stem cells in adipose tissue to differentiate into adipocytes thus creating more fat cells (hyperplasia) . The virus also causes a shift in biochemical regulation of fat and glucose metabolism such that the fat cells get fatter (hypertrophy). All of this centres around a protein enzyme, AMP kinase, which is a central regulator in intracellular levels of energy stores. </p><p><br /></p><p>So where does this leave us? The answer is, unchanged. Genes load the gun but the environment pulls the trigger so while obesity is highly heritable (multiple twin studies,) it is the obesogenic environment that matters: cheap, palatable and energy dense foods and a totally sedentary environment. Nobody would suggest that viral infection is the cause of obesity but it deserves more than its current orphaned role. </p><p><br /></p>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-26227052052021278352021-03-31T08:27:00.005+01:002021-03-31T08:27:46.092+01:00<p><br /></p><p><br /></p><p><b>Nutrients, immunity and Covid.</b></p><p><br /></p><p>Food manufacturers, food celebs and wannabe diet experts often discuss the immune boosting properties of some food or nutrient. Our immune system is a highly complex and orchestrated network of mechanisms that help us fend off infections and the entry of unwanted foreign matter into our bodies. So, when the issue of “boosting” the immune system is raised, it is not unreasonable to ask what part of the immune system you expect to be boosted. Do you want those antibodies (A type) that line the exterior of the body such as the gut and lungs to be smarter at keeping foreign bodies out? Do you want to boost the ability of the body to produce circulating antibodies (G type) to foreign matter that have gained entry into the body? Do you want to boost the so-called cytokine storm that wreaks havoc in Covid? Do you want to boost those antibodies (E type) that are involved in allergic reactions?</p><p><br /></p><p>Many nutrients are involved in different parts of the immune system and a deficiency can cause a significant impairment of that system . But how do you define deficiency? Firstly, measuring dietary patterns to ascertain micronutrient status is a waste of time. At the level of the individual, such measures are totally unreliable. They may give a broad sweep but they lack the definition needed to allow us make any prediction of biochemical deficiency. Secondly, when micronutrient deficiency is measured in dietary terms, it is against particular dietary reference values, the ones you might see on a packet of breakfast cereal. With these, we can have cut-off points, below which population intakes of a nutrient would be a cause for concern. Many with intakes below that minimum threshold of dietary intake may show biochemical deficiencies but, such is the variation in human nutrient requirements, that many with intakes below that value will be perfectly healthy. </p><p><br /></p><p>Cut-off levels, based on blood biochemical values, can sharpen our expectation that an individual is prone to some nutritional disorder and in such instances, nutritional supplements and dietetic advice will help restore these blood value to normal. As normality is restored, the many biochemical pathways that depend on the nutrient in question will be fully operational. But here lies the hub of the problem. Once normality is reached, further intake of the nutrient will have no effect. The petrol tank of a Jaguar has 50% greater capacity than that of a Fiat Punto. Fitting an additional petrol tank will not make the Punto overtake the Jag. When a biochemical need is met, that’s it. </p><p><br /></p><p>So should we routinely use nutritional supplements? If someone is restricting their food intake to manage their weight, it might be wise to use them. Equally, as we get older, our appetite falls as does our ability to absorb vitamin B12, and again, their use may be a good insurance. And there are specific clinical needs for certain vitamin supplements such as folic acid in pregnancy, multi-micronutrients in cystic fibrosis or calcium for low bone density. Routine use of nutritional supplements is perfectly acceptable but with the current pandemic, there has been a plethora of recommendations for supplementary intakes of individual minerals and vitamins.</p><p><br /></p><p>In the present pandemic, many immune related nutrients have come to prominence, none more so than vitamin D. Recommending vitamin D supplements to boost the immune system begs the question: Is it possible that the immune system of your target population is actually limited by another immune related micronutrient. If you don’t know that, focusing on one vitamin is pretty foolish. Besides vitamin D, many other micronutrients are involved in protecting us from unwanted visitors. Vitamins A and C are centrally involved in maintain the integrity of outward facing barriers such as the lung, the gut and the skin. Vitamin E, zinc, iron, selenium and copper all play a role in the systemic immune system. Fish oil type fatty acids can play a significant anti-inflammatory role, the opposite to immune boosting. So, focusing on one nutrient doesn’t seem to make sense. </p><p><br /></p><p>The case has been made that Vitamin D plays a particularly significant role in Covid. A first point to note is that vitamin D is a fat soluble vitamin which is preferentially stored in fatty tissue. As people become overweight and obese, blood vitamin D levels fall as it is shunted into fatty tissue. Body fat is among the highest drivers of Covid complications. A study published by the UK Biobank showed that whereas those with Covid had lower levels of blood vitamin D than those who were healthy, these differences disappeared when the data were adjusted to take account of confounding factors, of which obesity was the most important. </p><p><br /></p><p>A recent randomized clinical trial published in the Journal of the American Medical Association examined the effect of boosting Vitamin D status in Covid patients. One group received a single high oral dose of vitamin D which led to a doubling of their blood vitamin D levels. The control group received a placebo which had not effect on their blood vitamin D levels. The treatment with vitamin D had no statistically significant effect on in-hospital mortality, admission to intensive care or requirement for mechanical ventilation. Three recent UK reports from government advisory agencies (the National Institute for Clinical Excellence, the Scientific advisory Committee on Nutrition and Public Health England) concluded that there is presently no evidence to support a specific role for vitamin D in the prevention and treatment of vitamin D . </p><p><br /></p><p>Eating a healthy diet with lots of variety of food type and food colour, maintaining a healthy weight and keeping fit don’t make headlines. But they save lives.</p><p><br /></p><p><br /></p>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-11131453869940388532021-03-31T08:24:00.003+01:002021-03-31T08:24:44.184+01:00<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div class="separator" style="clear: both; text-align: left;">Nutrients, immunity and Covid.</div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Food manufacturers, food celebs and wannabe diet experts often discuss the immune boosting properties of some food or nutrient. Our immune system is a highly complex and orchestrated network of mechanisms that help us fend off infections and the entry of unwanted foreign matter into our bodies. So, when the issue of “boosting” the immune system is raised, it is not unreasonable to ask what part of the immune system you expect to be boosted. Do you want those antibodies (A type) that line the exterior of the body such as the gut and lungs to be smarter at keeping foreign bodies out? Do you want to boost the ability of the body to produce circulating antibodies (G type) to foreign matter that have gained entry into the body? Do you want to boost the so-called cytokine storm that wreaks havoc in Covid? Do you want to boost those antibodies (E type) that are involved in allergic reactions?</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Many nutrients are involved in different parts of the immune system and a deficiency can cause a significant impairment of that system . But how do you define deficiency? Firstly, measuring dietary patterns to ascertain micronutrient status is a waste of time. At the level of the individual, such measures are totally unreliable. They may give a broad sweep but they lack the definition needed to allow us make any prediction of biochemical deficiency. Secondly, when micronutrient deficiency is measured in dietary terms, it is against particular dietary reference values, the ones you might see on a packet of breakfast cereal. With these, we can have cut-off points, below which population intakes of a nutrient would be a cause for concern. Many with intakes below that minimum threshold of dietary intake may show biochemical deficiencies but, such is the variation in human nutrient requirements, that many with intakes below that value will be perfectly healthy. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Cut-off levels, based on blood biochemical values, can sharpen our expectation that an individual is prone to some nutritional disorder and in such instances, nutritional supplements and dietetic advice will help restore these blood value to normal. As normality is restored, the many biochemical pathways that depend on the nutrient in question will be fully operational. But here lies the hub of the problem. Once normality is reached, further intake of the nutrient will have no effect. The petrol tank of a Jaguar has 50% greater capacity than that of a Fiat Punto. Fitting an additional petrol tank will not make the Punto overtake the Jag. When a biochemical need is met, that’s it. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">So should we routinely use nutritional supplements? If someone is restricting their food intake to manage their weight, it might be wise to use them. Equally, as we get older, our appetite falls as does our ability to absorb vitamin B12, and again, their use may be a good insurance. And there are specific clinical needs for certain vitamin supplements such as folic acid in pregnancy, multi-micronutrients in cystic fibrosis or calcium for low bone density. Routine use of nutritional supplements is perfectly acceptable but with the current pandemic, there has been a plethora of recommendations for supplementary intakes of individual minerals and vitamins.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">In the present pandemic, many immune related nutrients have come to prominence, none more so than vitamin D. Recommending vitamin D supplements to boost the immune system begs the question: Is it possible that the immune system of your target population is actually limited by another immune related micronutrient. If you don’t know that, focusing on one vitamin is pretty foolish. Besides vitamin D, many other micronutrients are involved in protecting us from unwanted visitors. Vitamins A and C are centrally involved in maintain the integrity of outward facing barriers such as the lung, the gut and the skin. Vitamin E, zinc, iron, selenium and copper all play a role in the systemic immune system. Fish oil type fatty acids can play a significant anti-inflammatory role, the opposite to immune boosting. So, focusing on one nutrient doesn’t seem to make sense. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">The case has been made that Vitamin D plays a particularly significant role in Covid. A first point to note is that vitamin D is a fat soluble vitamin which is preferentially stored in fatty tissue. As people become overweight and obese, blood vitamin D levels fall as it is shunted into fatty tissue. Body fat is among the highest drivers of Covid complications. A study published by the UK Biobank showed that whereas those with Covid had lower levels of blood vitamin D than those who were healthy, these differences disappeared when the data were adjusted to take account of confounding factors, of which obesity was the most important. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">A recent randomized clinical trial published in the Journal of the American Medical Association examined the effect of boosting Vitamin D status in Covid patients. One group received a single high oral dose of vitamin D which led to a doubling of their blood vitamin D levels. The control group received a placebo which had not effect on their blood vitamin D levels. The treatment with vitamin D had no statistically significant effect on in-hospital mortality, admission to intensive care or requirement for mechanical ventilation. Three recent UK reports from government advisory agencies (the National Institute for Clinical Excellence, the Scientific advisory Committee on Nutrition and Public Health England) concluded that there is presently no evidence to support a specific role for vitamin D in the prevention and treatment of vitamin D . </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Eating a healthy diet with lots of variety of food type and food colour, maintaining a healthy weight and keeping fit don’t make headlines. But they save lives.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div></div><div style="text-align: left;"><br /></div></div></blockquote><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><br /></p></blockquote><br /><p></p>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-62499762637076625222020-12-02T09:52:00.004+00:002020-12-02T09:52:55.421+00:00Popes, priests and persecution: Catholicism and chocolate<p></p><div style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><br /></div><br /> </div><p></p><p>This blog is an extract from a chapter of a book I am now completing:<b>"A history of food and dining" </b>which will be published to 2021</p><p> </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div class="separator" style="clear: both;"><b>Popes, priests and persecution: Catholicism and chocolate</b></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">When the Spanish conquistadors arrived in Mexico, they encountered many new foods that would transform the dietary habits of Western Europe. They brought back potatoes, tomatoes, chillies, vanilla, squash, French and Lima beans, peanuts, pineapples and avocados. But there were one food that would be regarded as a gastronomic luxury: chocolate. </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Chocolate was consumed as a hot drink by the Aztecs and was quickly adapted by the Creole community that mixed Aztec and Spanish traditions. Creole women found it hard to stay focused during lengthy high masses and never ending sermons delivered by the Dominican friars in the city of Chiapa Real, on the Mexican-Guatemalan border. Their maids would arrive during mass bearing chocolate drinks and biscuits to sustain the concentration of these devout women. However, the Bishop noted that there was a competitive element among the Creole women to ascertain who could have their chocolate drink and biscuits served up in the most luxurious style. He decided to excommunicate anyone partaking of chocolate during mass and despite the pleas of the English Friar, John Gage who recorded these events, his order was implemented. The women abandoned the Basilica and moved to the non-Dominican community who were more than happy with their financial contributions and where they could continue enjoying chocolate drinks during mass. Alas, the bishop died from a poisoned chocolate drink and Gage records that the finger of blame lay with his female Creole flock. </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">The Dominicans and the Jesuits didn’t see eye to eye on chocolate. The two orders detested one another with the Dominican Friar Gage writing: “But above all, is this envy and hatred found between Dominicans and the Jesuits” and that “of the two, the Jesuits are more bold and obstinate in malice and hatred”. The more austere Dominicans were of the view that the Lenten fast was broken by drinking chocolate while the Jesuits, who as we will see had a vested interest in chocolate, opposed this view. And so, the Vatican was faced with two powerful forces arguing over chocolate and religious fasts. Eventually, a Jesuit-leaning Pope Alexander VII, came down in favour of the Jesuits with the famous law “Liquidum non frangit jejunum”, (“Liquids do not break the fast”). But the argument rumbled on and in time required the opinions of no less than 6 successive Popes before the issue waned.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">The Jesuits did have a significant vested interest in chocolate. Firstly, they enticed Amazonian indigenous peoples out of their normal habitat and settled them in villages where they worked and worshipped in the Catholic faith. “Besides regular indoctrination, the natives were constrained to work for the settlers, the Crown and the fathers themselves, although preserving their free status. This was the basis of a system of free Indian labour that was adopted a century later in the Amazon region”. Another account of these settlements describes how the priests micro-managed the lives of these slaves: “So regimented were the natives that it is said that the Jesuit fathers rang a bell every night to tell the men it was time to perform their marital duties with their wives.”</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">With this labour, the Jesuits became one of the biggest exporters of Brazilian cocoa beans for chocolate processing. On one occasion a ship from South America arrived in Cadiz with several large boxes addressed to the Procurator-General of the Jesuits. The contents were said to be chocolate, but the dockers found them too heavy to lift and, when the customs officers inspected further, they found gold bars coated with chocolate. Between 1743 and 1745, the Jesuits accounted for 80% of all cocoa beans exported from the Amazonian region.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">The Dominicans return to the story of chocolate through their very significant role in the Spanish Inquisition. Heresy was a major crime for the Inquisitors, but witchcraft was also very much on their agenda. Chocolate was strongly associated with magic and is mentioned in a report of the Inquisition: “Chocolate was frequently implicated in cases that came before the Spanish inquisition. The several chocolate-associated Inquisition documents presented here, appear as relics from a past era, where distrust, fear and suspicion influenced human behaviours and practice. Prying eyes and ever-vigilant Dominicans characterized the era and one never knew when there might be a knock on the door with an order to appear before the tribunal”. Magic and chocolate are synonomous.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Joan Harris in her novel “Chocolat”, now a much acclaimed film, tells the story of Vianne and her daughter Armande, who set up a chocolate shop in a sleepy town in rural France and who was made utterly unwelcome by the Mayor and the local catholic priest. Looking out at the church she muses: “Before Christ – before Adonis was born in Bethlehem or Osiris sacrificed at Easter – the cocoa bean was revered. Magical properties were attributed to it. Its brew was sipped on the steps of sacrificial temples; its ecstasies were fierce and terrible. Is this what he fears? Corruption by pleasure, the subtle transubstantiation of the flesh into a vessel for debauch? Not for him the orgies of the Aztec priesthood”.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">The mystical nature of chocolate id also described by Nina Haratischvilli, in her novel “The Eighth life”, which documents the history of Georgia and narrates the story of her great, great grandfather, a chocolatier trained in Budapest and Vienna, who ran a chocolate factory in Tbilisi. She writes of her great, great grandfathers chocolate and its “magic secret formula that would revolutionise the taste of hot chocolate… The taste was incomparable: savouring it was like a spiritual ecstasy, a supernatural experience. You melted into the sweet mass, you became one with this delicious discovery, you forgot the world around you, and felt a unique sense of bliss”. </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">It is somewhat ironic that the great Christian feast of Easter heralds the highest annual sales of chocolate in the from of eggs and bunnies, each a symbol of fertility. The next highest period is the day of romance and love Valentine’s day. Sex and magic have helped sell chocolate: “The lady loves Milk Tray “ and “Black Magic”. Despite the naysayers who would peddle the myth of chocoholics, the silken mouthfeel of chocolate and its alluring and seductive aroma will always be with us.</div><div><br /></div><br /></div></blockquote>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-59020472982621431272020-03-29T11:25:00.002+01:002020-03-29T11:27:47.113+01:00A Rant on Risk.<div class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; line-height: 24px; margin: 0cm 0cm 0.0001pt;">
<i>Apologies for a long delay in posting. I'm busy researching a book: "The story of food and dining"</i></div>
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Risk is an abstract concept and the perception that a risk exists, or the degree of that risk, is determined by an individual’s worldview. Pail Slovik at the University of Oregon has written many research papers on the topic. For the general public, risk is determined by three factors. First a high level risk is associated with dread. Everyone knows an obese person and would have seen overweight friends lead long, happy and healthy lives into old age. Thus, obesity and overweight is not dreaded. However, motor neuron disease is dreaded, seen as a fatal disease with a slow decline in wellbeing and with a growing dependence on others. A second factor is familiarity. These days, most of us know someone who was diagnosed with cancers. Decades ago cancer was, in effect, a death sentence. However, many cancers are now manageable and allow those who contract cancer to enjoy a long and happy life. So, cancer is seen as a risk which is familiar and something not to be feared as it once was. The third factor is control. Those who smoke know the risk but they retain the belief that at any point, they can quit smoking. But, during the height of the BSE crisis, Variant Creutzfeldt–Jakob disease (vCJD), was a condition which was outside our personal control. We might be a vegetarian but who’s to say that your vegetable curry wasn’t contaminated with gelatin. You might avoid a T-bone steak but could you be sure that the minced beef you just bought is BSE free. In fact, vCJD hits all the buttons: it is dreaded, it is unfamiliar and it is totally outside your control.<o:p></o:p></div>
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One would imagine that toxicologists, whose speciality involves all manners of risk analysis would have a clear and objective understanding of risk, independent of their worldview. Thus it shouldn’t matter if you are Christian, Jew, or Muslim when, as a toxicologist you consider the scientific data on the hazards to human health of some chemical or biological risk. But Slovik’s study challenges that. When presented with several scenarios, toxicologists were asked to rate the risk. In the US, male toxicologists had a higher risk tolerance than their female counterpart. The same was true in Europe except that European toxicologists had a much lower tolerance of any given of risk compared to their US counterparts. Right now, in the midst of this Covid 19 pandemic, we can see geographic or cultural variation of risk perception and thus differing strategies of risk management. In some countries, economic issues hold a higher ranking than societal issues leading to quite different messaging to the general population (Obrador, Trump, Bolsonaro).<o:p></o:p></div>
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Risk assessment is purely scientific while risk management is tainted with the politics of the problem. It follows the seat belt rule. When research showed that seat belts would save lives, car manufacturers were asked to install them in new cars. Then the were obliged to do so by law and drivers were asked to use them. In turn, drivers were legally required to wear them. In the realm of risk managements there are vested interest which either promote or downplay the risk according to their interests. And there are rogue scientists who exploit the scare to self-promote themselves<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[1]</span></span></span></a><sup>,<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[2]</span></span></span></a>,<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[3]</span></span></span></a>, <a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[4]</span></span></span></a></sup> There are also very eminent scientists, experts in the field of epidemiology, who query and challenge scientific opinion<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn5" name="_ftnref5" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[5]</span></span></span></a>. Where true debate can be held, we should remember that dissent is the oxygen of science.<o:p></o:p></div>
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In an environment where all hazards to human health are properly managed, there is no reason for people to go beyond that system and take a risk. But around half the global population don’t enjoy such sanitized existence and they have to take risks. Hunger, they say, is the best sauce and the those who suffer hunger will take risks to meet their nutritional needs. They have no choice. And it a world which favours the privileged societies, social distancing in the current Covid 19 pandemic is easy to comply with, albeit annoying to endure. But in the slums of the great cities of the world, the townships of Johannesburg, the Favelas of Sao Paulo or among the 18 million US citizens who live in trailer parks, social distancing is challenging and the risks that it seeks to mitigate can’t easily be avoided. But its not just among the world’s disadvantage that risk is tolerated.<o:p></o:p></div>
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Opioids and obesity, each account for 40,000 deaths annually in the US<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn6" name="_ftnref6" style="color: #954f72;" title=""><span class="MsoFootnoteReference" style="vertical-align: super;"><span class="MsoFootnoteReference" style="vertical-align: super;"><span style="font-size: 12pt;">[6]</span></span></span></a>. When populations find risk acceptable, politicians are slow to act. Herein the rant ends and I feel better-cheaper than therapy!!<o:p></o:p></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-90289472093301321532019-08-05T07:42:00.000+01:002019-08-05T07:42:03.636+01:00Pooh poohing the obesity microbiome theory
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<span style="mso-ansi-language: EN-IE;">Nutrition has fashions and the most attractive
fashions are those that promise the most in terms of beneficial effects. An
important determinant of durability of a nutrition fashion is the challenges it
poses to experimental challenge. At present, the best example of a long living
nutrition fashion is the human gut microbiome which represents all of the
bacteria we house in our lower gut. Their main evolutionary basis was the
extraction of energy from food carbohydrates that are not amenable to digestion
by our digestive enzymes. However, in recent times these bacteria have been associated
with many diseases. If you get the wrong bacteria in your gut you increase the
risk of many diseases such as (non-exhaustive list: depression, anxiety,
autism, cancer of the lung and colorectum, pancreatitis, liver disease and many
gut disorders such as irritable bowel syndrome, Crohn’s disease and ulcerative
colitis. Of particular importance is infection of the gut with Clostridium
difficile which can be fatal in up to 30% of cases. Considerable success has
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<span style="mso-spacerun: yes;"> </span>from a healthy donor.<o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">Another condition which receives considerable
attention in relation to the gut microbiome is obesity The gut microflora of
obese persons differ from those with a normal weight and when obese persons
lose weight their gut microbe population moves in the direction of normal. But
the big question is cause and effect. Does an adverse microbiome population
cause obesity or does obesity cause an adverse microbiome population? In an
attempt to answer that question, a recent study examined the impact of faecal
transplantation of people with severe obesity (but who were metabolically
healthy, with no sign of type 2 diabetes, fatty liver or the metabolic syndrome)
with a capsule containing filtered faecal extract from a healthy normal weight female<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>.
Twenty severely obese subjects (BMI 35+,Kg/M<sup>2</sup>) were randomly
assigned to either the treatment arm (encapsulated faecal transplant) or a
placebo arm (similar capsules with glycerol and colouring matter). The
treatment arm began with a booster level of transplantation which was then
followed by a reduced maintenance dose. They were told to eat normally and were
closely monitored throughout the 12 week treatment period. Probiotics were not
permitted for the study duration and for 4 weeks prior to treatment. Antibiotic
treatment was not permitted for 8 weeks prior to the treatment and then
throughout the treatment. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The obese patients did not lose weight. So, if
the microbiome theory of obesity is correct, why not? The first question : “did
the faecal transplant alter the gut microbiome composition’? And the answer is ‘yes,
it did’. Faecal samples were taken at several instances during the intervention
and the gut microbiome quickly resembled that of the healthy lean donor and that
was sustained throughout the study. The gut-microbiome theory also states that
the underlying effect is a change in the type of bile acids secreted with less
taurocholic acid type bile in faeces. So did the faecal transplant cause a
reduction of faecal taurocholic acid? Again, yes it did. And finally, central
to the obesity-gut microbiome theory is that the obese type is that the obesity
type microbiota alters the production of a gut hormone which plays a role in
weight regulation, the hormone glucagon-like peptide (GLP). Did the change with
treatment? No it didn’t.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Now, just as one swallow never made a summer,
one experiment never copper fastened a scientific theory. But it opens the
debate. It challenges the theory and that is what drives scientific enquiry.
Flaws can be found in this study and the authors list a few. Maybe it wasn’t
long enough for weight loss to occur. Maybe, but I doubt it since weight loss can
rapidly respond to treatment. Maybe the faecal transplant dose wasn’t strong enough.
Maybe, but I doubt this also, since the dose in use in the study changed the
composition of the microbiota.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">So I’m left with the view that more studies
like this need to be completed to properly address this question. But let me
leave you with my final thought. Obesity is a consequence of overeating and the
caloric balance theory of obesity is to the microbiome theory what the Mona
Lisa is to graffiti. To paraphrase Bill Clinton: It’s the calories, stupid. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div style="mso-element: footnote-list;">
<!--[if !supportFootnotes]--><br clear="all" />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> </span><span style="mso-ansi-language: EN-IE;">Allegretti J et al
(2019) Effects of Fecal Microbiota Transplantation With Oral Capsules in Obese
Patients. Clinical Gastroenterology and Hepatology (In press, available online)<o:p></o:p></span></div>
</div>
</div>
<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-81046293571749074852019-04-23T14:45:00.001+01:002019-04-23T14:45:09.840+01:00The genetics of obesity
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<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-IE;">The
genetics of obesity<o:p></o:p></span></b></div>
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<span style="mso-ansi-language: EN-IE;">Obesity is a very complex condition and involves
a multitude of metabolic pathways, each regulated by<span style="mso-spacerun: yes;"> </span>several genes. A disorder of one gene can lead
to severe obesity but the rate of occurrence of these single gene defects is so
low that they cannot explain the current pandemic of obesity. <span style="mso-spacerun: yes;"> </span>For example, a rare defect in the gene which
encodes for a protein, bearing the awkward title melanocortin-4 receptor
(MC4-R) can lead to obesity. But even among morbidly obese persons, this gene
defect is only found in 4% of this population. Thus a single gene defect is
never going to explain the obesity issue. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">However, twin studies have repeatedly shown
that obesity is highly heritable to a level of about 70%. So if one gene defect
can’t explain this inherited susceptibility to obesity, maybe data on multiple
genes might assist us. A recent study by UK and US scientists<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>, has
begun to throw some light on how we might begin to predict the susceptibility to
obesity based on our genes. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">The first step in their quest was to explore a published database on 300,000 individuals whose body-weight was known and who had their
entire genetic code searched for over 2.1 million common genetic variants. No single
variation explained any significant risk of obesity. Thus the next step was to
take all of these 2.1 million common genetic variants and see if they could
compute a polygenic score which would be predictive of obesity. They used advanced
computational methodologies to devise 6 candidate scoring systems. To determine
which was best, they turned to the UK Biobank which has full genetic data and
body weight data on over 120,000 subjects. Their best performing scoring system
could now be put to the test. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">They used four different data sets to explore
the predictability of their polygenic score <span style="mso-spacerun: yes;"> </span>in quite different groups. To understand their
scoring system, they could first dismiss all those common gene variants which
had simply no link with obesity. Thus our hair and eye colours are genetically
determined and different genetic variants explained redheads from blondes to
brunettes. So they were scrapped along with lots of others. They were left with
genes that had a very, very minor effect on obesity right up to some genetic
variants with a more significant link with obesity but still, on their own, would have no real predictive power. The more of the higher linked variants you
had, the higher your polygenic score. So every individual in the UK Biobank got
a score ranging from low to high. They divided the 300,000 subjects into ten
groups (deciles) with increasing polygenic scores and they showed a very strong
link between the score and body weight. <span style="mso-spacerun: yes;"> </span>Half
the people with the lowest score had a normal body mass index whereas among those
in the top 10% of the polygenic score, only 17% were of normal weight.
Conversely, among those classified as obese, only 9% belonged to the lowest scoring
decile while 38% were at the top end of the score. Across the ten deciles of
polygenic score there was a linear increase in <span style="mso-spacerun: yes;"> </span>bodyweight, BMI and the incidence of severe
obesity. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The next data sets they turned to were ones
that included subjects who underwent bariatric surgery for the treatment of
their morbid obesity. A high polygenic score was associated with a 5.0-fold
increased risk of severe obesity treated with bariatric surgery. To understand
the evolution of obesity over time, they then turned to the Framingham Offspring
and Coronary Artery Risk Development in Young Adults (CARDIA). This gave data
on 3,722 individuals who at baseline had no case of severe obesity. Over the
next 27 years they were weighed 8 times. Over that period some subjects went on
to develop severe obesity. Among those in the lowest 10% of the polygenic score
just over 1% went on to develop severe obesity. In contrast, those in the top
10% of the polygenic score, 16% went on the become severely obese. The final
database they used was one of UK babies born in the years 1991-1992 who were
followed up to their 18<sup>th</sup> birthday (Avon Longitudinal Study of
Parents and Children). The difference in birthweight between the top and bottom
10% of the polygenic score was just 0.06 kg. By 8 years of age the difference
was 3.5 kg and by 18 years of age the difference had risen to 12.3 kg. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">This has shown that we are fast becoming
capable of defining genetic profiles which predicts the likelihood development of a normal
weight or a severe obesity problem. But before you jump up and down and blame
your genes, remember the key saying: “Genes load the obesity gun. But only the
environment pulls the trigger”. That said, a knowledge of the likely risk of
sever obesity might motivate people with a high score to watch their calories
more closely than most <o:p></o:p></span></div>
<div style="mso-element: footnote-list;">
<!--[if !supportFootnotes]--><br clear="all" />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> Khera et al., 2019, Cell 177, 587–596</span><span style="mso-ansi-language: EN-IE;"><o:p></o:p></span></div>
</div>
</div>
<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-23456229493414411762018-12-22T08:42:00.000+00:002018-12-22T08:42:01.415+00:00A . brief history of Christmas fare
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<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-IE;">Christmas
fare: A brief history<o:p></o:p></span></b></div>
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<span style="mso-ansi-language: EN-IE;">In order to understand Christmas fare, we need
to appreciate the seasonality of food in mid-winter. Hay was harvested in
summer and by November, when frost and snow began to fall, stock were moved
into barns and more often than not there was not enough hay for all the stock
so some would be slaughtered for meat. At the same time, landowners now had
time on their hands and so they turned to hunting, especially hunting birds:
Pheasant, partridge, grouse, guinea fowl, pigeons, duck & geese. The story
of the turkey follows later. Medieval winter has been described as an avian
slaughter. Preserving meat was a tiresome task and so the mince meat pie was
invented. It bears simply no resemblance to today’s mince pies.<o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">To begin with, pies were baked in communal
ovens to reduce the risk of fires in cottages roofed in thatch. These pies used
a bread dough, with a thickness of at least an inch if not more, with the base
made like a mini coffin. That was the original use of the word before the
undertakers hijacked it and it became an unmentionable object in polite
circles. The ‘coffin’ was then loaded with chopped meat from hunted fowl and some
beef and mixed with seasonal dried fruits and nuts and topped with <span style="mso-spacerun: yes;"> </span>a generous dollop of strong liquor, all in the
interests of preservation. <span style="mso-spacerun: yes;"> </span>The lid of
the coffin-like pie was overlaid on top of the contents and the sides and top
sealed by pressing the dough together.<o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">Quite frequently, en route to Church on
Christmas morning, families would stop at the bakers and place their pie in the
oven which was half way between a modern barbecue and a pizza oven. Lots would
have been drawn to determine who got which position in the communal oven. Four
or five hours later, the pie was reclaimed by the household and laid on the
table. The bread dough formed a very hard crust and usually, the bottom part
was burned. In households with servants, the latter would get this burned crust
while the gentry got the ‘upper crust’! Some of these pies were enormous and
there was a general tendency in all areas of Christmas fare for the landed
gentry to outdo one another in outlandish dishes. This is the recipe for a
famous Yorkshire mince pie:<o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">“<i style="mso-bidi-font-style: normal;">First
make a good standing crust and let the wall and bottom be very thick”. The
recipe then goes on to propose that a turkey, a goose, a guinea fowl, a
partridge and a pigeon be boned and place in the pie with the turkey breasts on
top. On one side a chopped hare could be piled and on the other side some
minced beef. Dried fruit, sugar, nuts, spices and port were added along with
four pounds of butter. ‘Then lay on the lid which must be very thick and bake
in a very hot oven for four hours’. The crust alone would require a bushel of
flour, that is all of over four stone of flour and the pie would often weigh up
to ten stone!</i><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The transition from the meat-dominated crusty
mince pie to today’s mince pie required the mastery and popularisation of
pastry which differs from crusty dough with the addition of fat. The pastry pie
is tasty but not a strong as crusty pies. So adaptations were made and the
advent of fruit in mince pies began with Queen Elizabeth <span style="mso-spacerun: yes;"> </span>The First’s love of pies made with orangeado,
a candied orange peel. In time other fruits were candied as sugar became more
available and together with port and dried fruit, the recipes for modern meatless
mince pies came into vogue. Of course, the crude thick<span style="mso-spacerun: yes;"> </span>crusts of former pies were replaced with
various types of pastries from shortbread to puff pastry and the delicate
nature of pastry miniaturised the size of the now sweet<span style="mso-spacerun: yes;"> </span>pie, still retaining the title mince pie. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Now the mince pies of Christmas were the
subject of a very serious political edict in England. Cromwell and the Puritans
banned Christmas in 1645, believing it to be a sin-laden papish Catholic
festivity. One strict protestant , Philip Stubbes writing in his famed book ‘The
Anatomie of Abuses’<span style="mso-spacerun: yes;"> </span>noted that <i style="mso-bidi-font-style: normal;">“More mischief is that time committed than
in all the year besides ... What dicing and carding, what eating and drinking,
what banqueting and feasting is then used ... to the great dishonour of God and
the impoverishing of the realm”. </i>The minced pie was banned as was all
Christmas fare. It was only restored when King Charles the second<span style="mso-spacerun: yes;"> </span>took over from Cromwell that the ban was lifted.
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">As I pointed out, winter time was the season
for the hunting of wild fowl and, again, because preservation was not possible,
a disproportionate consumption ensued. For landowners, hunting brought pheasant,
woodcock, pigeon, guinea fowl and the like but not of course turkey. The
meaning of turkey then and now is very different. Colonial explorers of the day
discovered in In Madagascar, a bird that was like a guinea fowl, only much
larger. Its meat was delicious with ample white breast meat and tasty brown leg
meat. It was seen as a real luxury back in the day. It was imported into Europe
either through Turkey or India. Thus ,what the English called turkey was just a
big exotic bird imported from Madagascar via Turkey, originally called Turkey
bird and then just turkey. The French regarded the same bird as having its
origins in India which became ‘Oison d’Inde’, Goose from India, abbreviated to
Dinde, the modern French word for turkey. Either way fowl dominated Christmas
fare except for the very lower classes who ate beef. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">In England, Goose was regarded as a significant
social step up above lowly beef. The goose also provided superb feathers for
pillows, the finest quills for writing and, most importantly, the tail and
wing-tip feathers for arrows to guide flight. The inn keepers of England
ran<span style="mso-spacerun: yes;"> </span>Goose clubs for its patrons
beginning with the purchasing of young geese to be communally raised on local
commonage via <span style="mso-spacerun: yes;"> </span>a weekly subscription to
the club. <span style="mso-spacerun: yes;"> </span>But for the landed gentry, it
was this exotic imported bird from Turkey together with a range of hunted domestic
fowl that they focused on for Christmas and, for them, the social ladder
required as much culinary ostentation as possible. One way to impress was to go
as for as possible in the process of engrastation, nowadays called ‘stuffing’. <span style="mso-spacerun: yes;"> </span>It would not be uncommon to have the flesh of
a partridge stuffed into the cavity of a pigeon and for the whole pigeon to be
stuffed into the cavity of a goose and then to top it all to stuff the
multi-stuffed goose into the turkey. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The obsession with fowl at Christmas served as
a secretive way to pass on Catholic catechism across generations at a time when
all things Catholic were proscribed. The carol, The Twelve days of Christmas
celebrates the period of the birth of Christ, December 25<sup>th</sup> to the
arrival of the Magi from the East on January the 6<sup>th</sup>. Note that on
the 7<sup>th</sup> day, representing the Sabbath, the song describes what “My
true love gave to me” and ‘My True Love’ represents Christ. Thereafter the
parade of wild fowl provides guidance to young children about issues of
Catechism. Thus here is what was meant by the gifts of the 7<sup>th</sup> day
of Christmas: <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The partridge in a pear tree<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Christ,
since the mother partridge will feign injury to lure predators away from
defenceless nestlings.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Two Turtle
Doves<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The old and New Testaments<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Three French
Hens<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The 3 gifts of the Magi<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Four Calling
Birds<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The 4 gospel evangelists: Mathew, Mark, Luke and
John<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Five Gold
rings <o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">Rings have no beginning or end and are thus
representative of eternity. Five depicts the first 5 books of the Jewish Torah:
Genesis, Exodus, Leviticus, <span style="mso-spacerun: yes;"> </span>Numbers
and Deuteronomy.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">Six Geese a-laying. <o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 6
days<span style="mso-spacerun: yes;"> </span>of Creation<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">Seven Swans a-swimming<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 6 days
of creation and the 7<sup>th</sup> day of rest. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">Eight Maids a milking<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 8 beatitudes<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">Nine ladies dancing<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 9
Angelic choirs<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">Ten Lords a-leaping<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 10
commandments<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The eleven pipers playing<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-size: 10.0pt; line-height: 150%; mso-ansi-language: EN-IE;">The 12
apostles minus Judas<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="208">
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The twelve
drummers drumming<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 283.7pt;" valign="top" width="378">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-IE;">The 12 precepts of the apostle’s creed <o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Will it ever sound the same to you again?<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Let me return to the turkey. When the colonial
settlers reached the North-Western US territories they encountered a new bird
that lived in covered forests but with field breaks to allow this bird with
limited flight, to escape temporarily from the forest in search of prey. This ‘undocumented
bird’ if I may call it so, <span style="mso-spacerun: yes;"> </span>looked just
like the bird that was imported at Christmas from Africa via Turkey back in the
homeland and by then simply called, turkey, <span style="mso-spacerun: yes;"> </span>and so this new “undocumented” bird was also called
a turkey. It was first introduced into Europe in Spain, spreading northwards
and assumed the title of Turkey in England and Dinde in France. Turkeys were
domestically farmed and would be herded great distances from farming areas to
towns and cities creating the early days of the turkey Christmas market. In
time, the bird lost its already limited ability to fly and was ideal for
fattening for Christmas in Europe and in Thanksgiving in the US. We haven’t
looked back. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">But we are not quite finished with engastration
or stuffing. In the Cajun region of the US, Paul Prudhomme, the famous
Louisiana chef, whilst working at a carvery, decided that the turkey was
boring. He set out in the mid 80’s to improve it and invented and patented the
now famous Cajun treat, the Turducken. This is a Duck stuffed with a Hen and in
turn the stuffed duck is stuffed into the Turkey ~ Turkey-Duck-Hen, “Turducken”.
I have a good friend, a very famous nutritionist, who annually hosts a New
Year’s Eve party in her home in Washington where the piece-de-resistance is her
Cajun Turducken. The Turducken wasn’t the first phenomenon of stuffing smaller
de-boned birds into bigger de-boned birds. In 1807 The French food critic, Grimod
de La Reynière (one of the first of this species! ) described “roast without
equal"—a bustard stuffed with a turkey, a goose, a pheasant, a chicken, a
duck, a guinea fowl, a teal, a woodcock, a partridge, a plover, a lapwing, a
quail, a thrush, a lark, an ortolan bunting and a garden warbler: 17 birds in
all! <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">When all the savoury meats and stuffings, the
potatoes and vegetables are gone, its time to switch course and focus on the
sweet side of Christmas dinner. Pride of place is the Plum Pudding but to
understand the plum pudding we need to go back in time. Offal, <span style="mso-spacerun: yes;"> </span>fat, spices and fruits (the best preservatives
of their day) were mixed with meats, grains and vegetables and packed into cow’s
stomachs as meat puddings (as opposed to meat pies) so they would keep as long
as possible. This also had the advantage that it could be cooked at home by
boiling over the home fire and emerged in rural areas where bakers communal
ovens weren’t available. In the 1700s, dried fruit became more plentiful as in
currants (dried grapes from the Corinth region of Greece), sultanas (from the Sultans
of the Izmir region of Turkey), raisins (called after racemus meaning a bunch
of grapes) and of course dried local plums. As sugar became more plentiful from
the Caribbean, candied fruit peelings were also added to the mix. In time, the
meat component of the old savour puddings <span style="mso-spacerun: yes;"> </span>fell away, just as with<span style="mso-spacerun: yes;"> </span>mince pies. The use of animal stomachs was
abandoned in favour of muslin cloths. However, the now sweet tasting pudding
retained the tradition of exposure to the gut by incorporating suet, the fat
which surrounds the kidney, into the recipe. In fact <span style="mso-spacerun: yes;"> </span>tradition holds that there should be thirteen
ingredients in a Christmas plum pudding representing<span style="mso-spacerun: yes;"> </span>Christ and the twelve apostles. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Finally we turn to crackers which are part of
the fun of Christmas dinner. Believe it or not, Christmas crackers have their
origins in food, specifically boiled sweets. What was special about these
Christmas sweet treats is that were wrapped in pretty paper wrapping <span style="mso-spacerun: yes;"> </span>which, back in the day,<span style="mso-spacerun: yes;"> </span>was itself quite a novelty. The progression
from wrapped sweets to Cracker Bonbons, brings us back to cap guns that became
popular in the US after the Civil War. A tiny amount of explosive material was
placed in a container of a toy gun <span style="mso-spacerun: yes;"> </span>and
when the trigger was pulled the firing pin was released to make a bang. I grew
up with cap guns and can still recall the smell of the explosive and the tiny
wisp of smoke that accompanied the bang. I was The Cisco Kid! Well, in the 1860’s,<span style="mso-spacerun: yes;"> </span>Tom Smith an entrepreneurial confectioner,
decided to remove the sweet from the cracker bonbon, enlarge it, insert two
strips of material each connected to one end of the cracker <span style="mso-spacerun: yes;"> </span>and meeting in the middle in a simple
mechanism the glides an explosive material across and an abrasive material. Little
poems and trinkets and <span style="mso-spacerun: yes;"> </span>party hats. Were
inserted into the cracker. <span style="mso-spacerun: yes;"> </span>When each end
is pulled, the tiny explosive on one strip is rubbed against an abrasive part
of the other strip and the cracker bangs just as it opens, always unevenly. The
larger part has the goodies. Much more fun than boiled sweets.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Happy Christmas and Bon Appetit!<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IE;">There’s
much more to Christmas traditions beside food: from Christmas trees, to
stockings, to boxing day, to carols and of course St Nick himself. Mark
Forsyth’s “A Christmas Cornucopia- the hidden stories behind our Yuletide
traditions” tells it all. I have also consulted many volumes from the Edible
Series of Reaktion Books and of course Wikipedia, to which I make a financial
contribution. <o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-size: 8.0pt; line-height: 150%; mso-ansi-language: EN-IE;"><span style="mso-spacerun: yes;"> </span>Michael J
Gibney, Dublin, December 2018. ©<o:p></o:p></span></u></i></div>
<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-50348424730632503192018-06-30T10:54:00.002+01:002018-06-30T10:54:41.022+01:00Joking about epidemiologists
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<span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">It’s summer. <span style="mso-spacerun: yes;"> </span>Exams are over. The sun is shining. Time for a
laugh. Here are some jokes about epidemiologists<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>.
The last joke is one of my favourites which I heard many years ago and which I
told to a Spanish audience of nutritional epidemiologists (University of
Navarra)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Did you hear about the
statistician who had his head in an oven and his feet in a bucket of ice? When
asked how he felt, he replied, "On the average I feel just fine.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">When she told me I was
average, she was just being mean.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">What did the Box Plot
say to the outlier? "Don't you dare get close to my whisker”.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">I'm not an outlier; I
just haven't found my distribution yet.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Two unbiased
estimators were sitting in a bar. The first says, "So how do you like
married life?" The other replies, "It's pretty good if you don't mind
giving up that one degree of freedom!"<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">A statistician's wife
had twins. He was delighted. He rang the minister who was also delighted.
"Bring them to church on Sunday and we'll baptize them," said the minister.
"No," replied the statistician. "Baptize one. We'll keep the
other as a control."<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">What does a
statistician call it when the heads of 10 rats are cut off and 1 survives?
Nonsignificant.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">There is a group of
five statisticians on a train. At the next stop, five epidemiologists get on.
They all seemed to know each other and started chatting. It transpired that each
of the epidemiologists had bought a ticket, but the statisticians had only
bought one between the five of them. "Why did you do that?" asks one
of the epidemiologists. "Surely you're going to get caught and be asked to
leave the train". "Just wait and see!", smiled one of the
statisticians. As the ticket inspector was approaching to check everyone's
tickets, the statisticians went off to the nearest toilet -the inspector passes
the epidemiologists and inspects all their tickets then moves on and notices
that the toilet is locked. "Tickets please!" shouts the inspector.
One of the statisticians pushes their ticket under the toilet door, which the
inspector checks and returns under the door. Once the inspector has gone, all
the statisticians return to their seats to the awe and amazement of the
epidemiologists. "That's incredibly clever!" says one of the
epidemiologists. A few weeks later they all find themselves on the same train
again. They sit together and start chatting once more. "We've done what
you suggested", says one of the epidemiologists, "and just bought one
ticket between the five of us!". "Oh really", says one of the
statisticians, "we haven't bought ANY tickets this time!". The
epidemiologists look at each other in amazement. "OK, one ticket between
you is fine but not buying any at all is ludicrous! " As the ticket
inspector approaches the epidemiologists hurry off to the toilet. Once they're
inside the statisticians follow them. "Tickets please! " shouts one
of the statisticians. The ticket appears under the door and they take it away
and all bundle into a different toilet. The inspector gets to the toilet with
the epidemiologists in it. "Tickets please!" he shouts. No reply.
"Tickets please!". The epidemiologists admit defeat and come out of
the toilet only to be thrown off at the next station. <b style="mso-bidi-font-weight: normal;">The moral of this story: Epidemiologists should not attempt to use
statistical methods they do not fully understand. </b><o:p></o:p></span></div>
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<br /></div>
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<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> </span><span style="font-size: 10.0pt; line-height: 115%; mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">I acknowledge </span><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%;"><a href="http://www.maths.usyd.edu.au/u/jchan/Statistic_joke.pdf"><span lang="EN-US" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";"><span lang="EN-US">http://www.maths.usyd.edu.au/u/jchan/Statistic_joke.pdf</span></span></a></span><span style="font-size: 10.0pt; line-height: 115%; mso-ansi-language: EN-IE; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";"> (Maths @ University of Sydney: I got my PhD at Sydney University Vet
School 1976 ~ ancient)for the source of these jokes.<o:p></o:p></span></div>
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</style>Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-36028031641990611062018-06-25T13:55:00.001+01:002018-06-25T13:55:17.425+01:00Sugar tax ~ the picture widens
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In recent times, three significant publications have emerged
which should be taken on board by those involved in the debate on sugar tax. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The first is the very recent (June 2018) report of the World
Health Organisation (WHO) High Level</div>
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Commission on Non-Communicable Diseases,
entitled “Time to deliver”<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IE;">[1]</span></span><!--[endif]--></span></span></a>.
The report highlights the global burden on chronic diseases caused by tobacco,
alcohol and poor nutrition. The report has powerful messages to Governments on
the directions to take in combatting chronic disease and it points out that
investment pays off: <i style="mso-bidi-font-style: normal;"><u>“WHO’s global
business case for NCDs showed that low- and lower-middle-income countries put
in place the most cost-effective interventions for NCDs, by 2030, they will see
a return of $ 7 per person for every one dollar invested”. </u></i>In Ireland,
where the obesity bill alone is €1.2bn, we might eat into that figure with an
investment of about €180m. At present, we spend almost a tiny fraction of that
budget on health promotion against the issues of alcohol, tobacco and
nutrition. The former two actually generate a significant income for the state
through taxation and the Commission’s report very strongly supports such
taxation. However, when it comes to sugar tax, the Commission is somewhat coy: <i style="mso-bidi-font-style: normal;"><u>The Commissioners represented rich and
diverse views and perspectives. There was broad agreement in most areas, but
some views were conflicting and could not be resolved. As such, some
recommendations, such as reducing sugar consumption through effective taxation
on sugar-sweetened beverages and the accountability of the private sector,
could not be reflected in this report, despite broad support from many
Commissioners.</u></i> This conservative language contrasts with the hype of
the advocates of the so-called sugar tax, effectively, a tax on sugar sweetened
soda. Food for thought indeed. And of course the finger is now pointed at the
US with suggestions that it was Eris Hargan, US Deputy Secretary of Health who
was the blocking commissioner<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IE;">[2]</span></span><!--[endif]--></span></span></a>. Whether
Hargan did a solo run and is playing to the gallery is anybody’s guess.<o:p></o:p></div>
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<br /></div>
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The second study is a scientific paper from a group of
British academics who explored whether taxation of sources of sugar other than
sugary sodas<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IE;">[3]</span></span><!--[endif]--></span></span></a>. Many of
us have argued, that the global fashion of taxation of sugars via a tax on
sugary sodas, fails to address the real issue of taxing sugars. These authors
looked at a broader approach to sugar taxation: “<i style="mso-bidi-font-style: normal;"><u>Policies that lead to increases in the price of chocolate and
confectionery, cakes and biscuits may lead to additional and greater health
gains than similar increases in the price of (sugar sweetened beverages) SSBs
through direct reductions in the purchases of these foods and possible positive
multiplier effects that reduce demand for other products. Although some
uncertainty remains, the associations found in this analysis are sufficiently
robust to suggest that policies, and research, concerning the use of fiscal
measures should consider a broader range of products than is currently the case”.</u>
</i>Now at least we would be forced to take a detailed look at all sources of
sugar and how that varies across age groups. These are our own research data
for the Irish population<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IE;">[4]</span></span><!--[endif]--></span></span></a>. <o:p></o:p></div>
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% contribution to <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u>Added</u></i></b> Sugars<o:p></o:p></div>
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Teenagers<o:p></o:p></div>
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</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Table sugar & jams<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">7<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">9<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">23<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Biscuits<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">11<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">8<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">9<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Cakes, buns & pastries<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">5<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">5<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">8<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Carbonated beverages<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">16<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">22<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">12<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Squashes & cordials<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">12<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">5<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">2<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Chocolate confectionery<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">13<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">15<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">10<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Non-chocolate confectionery<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">9<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">7<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">2<o:p></o:p></b></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The complexity grows and in the third of the recent papers,
the complexity of sugar taxes are elegantly illustrated. Quite how the public would respond to a tax on cakes, confectionery etc as opposed to a soda tax is as yet unknown but somehow I get the feeling that it would be way less popular. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
And now to the final report and by far the most significant. Three years ago, The New Zealand Ministry of Health commissioned
a report on the benefits or otherwise of the globally popular sugar tax. It
concluded that “<i style="mso-bidi-font-style: normal;">there isn’t yet robust
evaluative evidence on whether they are effective, or on the size and
persistence of any impacts”</i>. In late 2017, the same ministry returned to
this issue and commissioned the New Zealand Institute of Economic Research
(NZIER) to review new evidence and with a focus on the taxation of sugar
sweetened beverages (SSBs). <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Overall, the report examined 47 published scientific reports
or published studies of the theoretical or actual impact of sugar taxation on the
purchase of these products. Each study is considered in full and overall
conclusions are drawn. The report breaks down the complexity of the sugar tax
issue into 5 elements which underlie the logic of such taxes. It assumes <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
(1) that imposing a “sugar tax” will increase the price of
the taxed item, SSB’s; <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
(2) the increase in price will to lead to a reduction in
consumption of such beverages; (3) reduced SSB consumption will lead to a reduction
in calorie intake; <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
(4) lower caloric intakes will lead to lower adverse health risk
factors such as improved diabetes or hypertension management and <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
(5) in turn, that will lead to better health outcomes. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
These 5 steps were considered in turn, taking all available
evidence into account. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">Imposing a “sugar tax”
will increase the price of sugar sweetened beverages<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
There are two main possibilities here. The manufacturers of
SSBs could absorb the tax and make a loss. In the real world, those who sell SSB’s
also sell diet sweetened beverages and also juices and waters of various hues.
So, it is not beyond the bounds of possibility that the SSB manufacturer absorbs
most of the cost of the SSB tax thus protecting the consumer from a full price
hike on fizzy drinks while protecting their profits through marginally higher
prices on a range of SSB alternatives that they sell into the market (juices,
waters, diet drinks) . <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">Increased price of
sugar sweetened beverages will lead to a lower intake<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Without wishing to delve too deeply into the econometric
arguments of the report, there is one critically important point made by the
authors. The models put forward in the sugar tax debate are focused on the
sensitivity of the <i style="mso-bidi-font-style: normal;">overall market</i> to
changes in the price of SSBs. However, the report points out that there is no
data on how the response shapes out at sub-group levels of the market. Will
high SSB consumers be more or less price sensitive than low SSB consumers? Will
prevailing body weight play a role in shaping price sensitivity? Will these two
factors interact such that overweight high consumers behave differently than
normal weight high consumers?<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">A lower sugar intake
will lead to a lower calorie intake.<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The report points out that if the price of SSBs leads to a
lower intake of these products, it doesn’t necessarily follow that other untaxed
products might not fill the void. Indeed, human intervention studies, which
have <span style="mso-fareast-font-family: "MS Mincho"; mso-fareast-language: EN-US;">surreptitiously </span><span style="mso-spacerun: yes;"> </span>lowered
the sugar levels of foods have found that energy intake remains more or less
constant with other foods filling the caloric gap. The biological data would
suggest that the caloric deficit made by reduced SSB consumption would be
largely, but not completely, compensated through higher intakes of many other
foods. Thus whatever the drop in calories will be, it will be only a fraction
of the present contribution of SSBs to calorie intake among SSB consumers. All
of this debate means nothing to the majority of the population that don’t
consume SSBs, across all age groups. We must accept that among SSB consumers,
such a tax will cause a drop in caloric intake but at just a fraction of the
present contribution of SSBs to calorie intake<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">If calorie intakes are
lowered, will body weight fall?</i> <i style="mso-bidi-font-style: normal;">If
bodyweight falls, will health outcomes inevitably follow.<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The simple answer to both is yes. A small deficit of calories
over a long period of time would indeed create weight loss. One also has to
assume that weight loss will have some health benefits but one can also predict
that small changes and large changes in body weight, will have respectively
smaller and larger effects on health such as Type 2 diabetes or high blood
pressure. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The NZIER report itself, having considered all 47 studies on
the effectiveness of a tax on SSBs and examining each for the five elements of
the logic chain it set out<span style="mso-spacerun: yes;"> </span>from tax
imposition to measurable health benefits, concludes <i style="mso-bidi-font-style: normal;">“As we noted in the section on frameworks, there are multiple steps in
the chain of intervention logic from the well-established principle that an
increase in the price of a good leads to a reduction in consumption of that
good and, all else equal, to an improvement in health outcomes</i>….<span style="color: black; font-family: Times; font-size: 14.5pt; line-height: 150%; mso-bidi-font-family: Times; mso-fareast-font-family: "MS Mincho";"> </span><i style="mso-bidi-font-style: normal;">Our conclusion is that the evidence base
gets weaker further along the chain of intervention logic…</i><span style="color: black; font-family: Times; font-size: 14.5pt; line-height: 150%; mso-bidi-font-family: Times; mso-fareast-font-family: "MS Mincho";"> </span><i style="mso-bidi-font-style: normal;">We have yet to see any clear evidence that
imposing a <o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">sugar tax would meet a
comprehensive cost-benefit test”<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
All in all, the science and politics of sugar tax rolls on. Of
the three reports, that of the New Zealand Economics Institute is the one which
we need to focus most on. In particular, we need to focus on each of the links
in the chain it outlines for the sugar tax-obesity link and apply them
methodically to the monitoring of the soda tax and its effects on health<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
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<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-41009217207655187912018-06-09T19:52:00.001+01:002018-06-09T19:52:17.622+01:00Femivores, the food elite and the kitchen
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<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Femivores are neither eaten by nor eat females.
They are apparently a new fashion for women who want to opt out of the rat race
and to kiss goodbye to the glass ceiling that, as yet, remains a male
controlled architectural design. This is how Peggy Orenstein described this new
movement in the new York Times, in 2010<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>:</span><span style="background: white; color: #333333; font-family: Georgia; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-IE; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IE;">”Rather than embodying the limits
of one movement, femivores expand those of another: feeding their families
clean, flavourful food; reducing their carbon footprints; producing sustainably
instead of consuming rampantly. What could be more vital, more gratifying, more
morally defensible?”.</span></i><span style="mso-ansi-language: EN-IE;"> And what
could be more elitist? I recall two other irritating food elitists who somehow
I’ve failed to purge from my memory (maybe there is an evolutionary need to
retain the intellectually threatening?). One was a dietitian in a diabetic
clinic over 20 years ago who I heard recommend to a patient to eat a salad
based in adzuki beans every day. The other was a forgettable author who
extolled the wonders of the wild herbs she harvested as she cycled the rural
byways of the Davis campus in northern California. You might ask what planet
these people live on? But there is a creeping middle class elitist push on food
and health resulting in quite unrealistic targets being set for healthy eating.
They may not quite reside on the looney food planet but they have tendencies in
that direction and are influential journalists, bloggers and celebrity chefs.
They espouse an ideal scenario of home-prepared healthy meals, made with fresh
ingredients and eaten as a family unit at the table without the TV or digital
distractions. The reality is far from that and the sooner policy makers get a
grip on reality and tell the food police to go take a hike, the better for all
of us. So let’s look at some published data.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The first study I’d like to consider is a study
from the heart of sociology that used<span style="mso-spacerun: yes;">
</span>the tools of anthropological research in following families with varying
income levels for several weeks simply to understand their approach to home
cooking and family meals<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span><!--[endif]--></span></span></a>. This
is one example of life at the lower rungs of the economic ladder: <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="mso-ansi-language: EN-IE;">“Wanda
and her husband Marquan, working-class black parents of two young girls, were
constantly pressed for time. Both were employed by the same fast food chain,
but in different rural locations 45 minutes apart. They depended on Wanda’s
mother, who lived 30 minutes away, for childcare. During the five weeks we
spent with them, their car was broken down and since they did not have enough
money to repair it, they relied on a complex network of friends and family
members for rides. Their lives were further complicated by the fact that they
didn’t know their weekly schedules—what hours, shifts, or even days they would
be working—until they were posted, sometimes only the night before. Once they
learned their shifts, they scrambled to figure out transportation and childcare
arrangements”.</span></u></i><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IE;"> </span></i><span style="mso-ansi-language: EN-IE;">Two big factors mitigate against family meals: time overall,
synchronised time, money and facilities. Oh, and guess what? Wanda hates to
cook – planning what to cook is her nightmare.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">This is the authors’ overall conclusion: <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="mso-ansi-language: EN-IE;">“The
vision of the family meal that today’s food experts are whipping up is
alluring. Most people would agree that it would be nice to slow down, eat
healthfully, and enjoy a home-cooked meal. However, our research leads us to
question why the front- line in reforming the food system has to be in
someone’s kitchen. The emphasis on home cooking ignores the time pressures,
financial constraints, and feeding challenges that shape the family meal. Yet
this is the widely promoted standard to which all mothers are held. Our
conversations with mothers of young children show us that this emerging
standard is a tasty illusion, one that is moralistic, and rather elitist,
instead of a realistic vision of cooking today. Intentionally or not, it places
the burden of a healthy home-cooked meal on women”</span></u></i><u><span style="mso-ansi-language: EN-IE;">.<o:p></o:p></span></u></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The second study is from the UK and is based on
in-depth studies of 40 families. Whilst there was universal agreement among the
subjects in the study, that family meals were important, the reality was quite
different<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[3]</span></span><!--[endif]--></span></span></a>.
The authors point out:<i style="mso-bidi-font-style: normal;"> <u>“However, a
desire to eat together did not mean this happened. Under a third of the
families (12/40) managed to eat together most weekdays, while the same number<span style="mso-spacerun: yes;"> </span>(12/40) managed no family meals on weekdays.
Sixteen families managed meals on some days without both parents present, a
pattern we refer to as modified family meals.” </u></i><u>The authors now go on
to discuss the latter group<i style="mso-bidi-font-style: normal;">: The largest
group of families (16/40) did not usually achieve the necessary synchronicity
to realise family meals during the working week. For these households, everyone
in the household eating together took place only on some days of the working</i></u><i style="mso-bidi-font-style: normal;"> <u>week. At other times the family meal was
modified. This happened for a number of reasons: on account of fathers arriving
home from work after the children had gone to bed; the timing of children’s
activities; the children’s care regimes and whether they ate in childcare; and
because of the need to young children to eat early. Another source of
asynchronicity (though not in the cases in this analysis) relates to children
living part of the week with their fathers and hence eating with different
parents on different days of the week”.</u><o:p></o:p></i></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The following summarise reasons why family
meals are hard to plan in today’s world<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE;">Fathers and mothers having asynchronous times
of leaving home and getting home from work<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE;">Not all children’s extra-curricular activity
(e.g. sports, drama, gymnastics, sleep-overs, etc.) are synchronised and
younger children cannot hold off their appetite until an older child comes home<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE;">Even with no challenges from a-synchronised extra-curricular activity, younger children are often fed earlier than older
children to allow them to go to bed earlier. Indeed, difference in meal
practices in child care facilities can lead to conflicting degrees of appetite
among children<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE;"><span style="mso-spacerun: yes;"> </span>Because
of long commutes, early rising is common and children frequently go to bed
before their parents eat and often, parents need this time together.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-IE; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: EN-IE;">Not everyone like the same food as most parents
know and that is yet another challenge to the ideal family meal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">A third study uses the The American Time Use
Survey (ATUS) in which over 15,000 describe their time use over a 24 hour
period<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[4]</span></span><!--[endif]--></span></span></a>.
The study focused on working mothers (comparing them to non-working mothers)
and found that they spent less time grocery shopping and less time cooking with
a greater probability of purchasing prepared foods.<span style="mso-spacerun: yes;"> </span>They also found <span style="mso-spacerun: yes;"> </span>that working mothers are less likely to eat
with their children and to spend less time in child-care or supervision. Another
study using the same data set, found that among households with no children, 63%
spent 2 or more hours in the preparation and cooking of foods each day. In
contrast, for households with 2 or more children, that figure fell to just 22%<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[5]</span></span><!--[endif]--></span></span></a>. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">All in all, the image of family life and<span style="mso-spacerun: yes;"> </span>family dining which is espoused by the high
priests of public health nutrition, bears no relation to the reality. Public
health nutrition advice should first proceed with qualitative and quantitative sociological
research into family life and family dining. Only then will we have the basis
on which we can vigorously pursue the promotion of a greater reliance on home
cooking and <span style="mso-spacerun: yes;"> </span>the greater prevalence of
families dining together. But bear in mind that the present failure in this
area is an absolute outcome of the way society is organised. If you don’t fix
the latter, can you fix the former???? <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">But let’s end with the Pope of public health
nutrition, Michael Pollan<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[6]</span></span><!--[endif]--></span></span></a>.
In a lengthy article in the New York Times, Pollan recalls his mother’s cooking
and bemoans the fact that Americans will spend more than twice as much time watching
food chefs prepare meals as they do themselves in practice. And so he appeals
for a return to the kitchen, ignoring the deep bed-rock of data which explains
why family meals are such a challenge to ordinary folk. Specifically, he
writes: <span style="mso-spacerun: yes;"> </span>“You want Americans to eat less?
I have the diet for you. It’s short, and it’s simple. Here’s my diet plan: Cook
it yourself. That’s it. Eat anything you want — just as long as you’re willing
to cook it yourself.” So MIchael, forget the supermarket muesli and have
yourself some fried eggs for breakfast. But no Tabasco sauce please!!!!<o:p></o:p></span></div>
<div style="mso-element: footnote-list;">
<!--[if !supportFootnotes]--><br clear="all" />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> <a href="https://www.nytimes.com/2010/03/14/magazine/14fob-wwln-t.html">https://www.nytimes.com/2010/03/14/magazine/14fob-wwln-t.html</a>
</span><span style="mso-ansi-language: EN-IE;"><o:p></o:p></span></div>
</div>
<div id="ftn2" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> Bowen S, Elliott S and Brenton J. (2014) Contexts, Vol. 13, No. 3,
pp. 20-25. ISSN 1536-5042,</span><span lang="EN-US" style="mso-ansi-language: EN-US;"><o:p></o:p></span></div>
</div>
<div id="ftn3" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[3]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> </span><span style="mso-ansi-language: EN-IE;">Brannen J, O'Connell R
& Mooney A. (2014) <span style="mso-bidi-font-weight: bold;">Families, meals
and synchronicity: eating together in British dual earner families; Community,
Work & Family, 16:4,417-434,<o:p></o:p></span></span></div>
<div class="MsoFootnoteText">
<br /></div>
</div>
<div id="ftn4" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[4]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> Maternal Employment and Childhood Obesity: A Search for Mechanisms
in Time Use Data John Cawley and Feng Liu, NBER Working Paper No. 13600,
November 2007, JEL No. I12,J13,J22<o:p></o:p></span></div>
</div>
<div id="ftn5" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref5" name="_ftn5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[5]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> Monsivais P, Aggarwal A, Drewnowski A, </span><span style="mso-ansi-language: EN-IE;">Time Spent on Home Food Preparation and
Indicators of Healthy Eating. </span><span lang="EN-GB">Am J Prev Med
2014;47(6):796–802) & 2014 </span><span style="mso-ansi-language: EN-IE;"><o:p></o:p></span></div>
</div>
<div id="ftn6" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/u/1/blogger.g?blogID=2434158383842628126#_ftnref6" name="_ftn6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: Calibri; font-size: 10.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[6]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB"> </span><span style="mso-ansi-language: EN-IE; mso-bidi-font-weight: bold;">Out of the Kitchen, Onto the Couch By Michael Pollan <i>The New York
Times Magazine</i>, August 2, 2009<o:p></o:p></span></div>
<div class="MsoFootnoteText">
<br /></div>
</div>
</div>
<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-32585823515804066472018-05-08T10:54:00.001+01:002018-05-08T10:54:20.208+01:00Skin in the game: industry funding of science
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<span style="mso-ansi-language: EN-IE;">Of late, I have been the target of lot of
Twitterati innuendos about my independence as a scientist. I realise that short
of repenting at the feet of whatever God or Goddess of scientific purity that
might be nominated by the sacred college of the holy and undivided Twitterati, <span style="mso-spacerun: yes;"> </span>I will remain besmirched, sullied and rendered
utterly untrustworthy by the high priests of Twitterati scientific morality. <o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">Whether it was Warren Buffet or William Shakespeare
who is responsible for the phrase ‘skin in the game’, matters little. It is
still understood to represent<span style="mso-spacerun: yes;"> </span>an
apparent or real vested interest in some topic. In science, such interests must
be declared in any oral or written opinion in the context of any scientific
endeavour such as the delivery of a lecture, the seeking of publicly funded
research grants, the publication of scientific papers or the participation in
any advisory committee. To fail to adhere to the principle of<span style="mso-spacerun: yes;"> </span>a declaration of interest (DoI) is to fall
short of minimal requirements of scientific integrity. A DoI can translate into
a Conflict of Interest (CoI) if the situation arises where a scientist offers
an opinion in any forum where he or she has an interest in the outcome of the
forum’s deliberations. Usually that involves the scientist being excused or
recused, whatever the correct term might be. Because there are no written laws
or guidelines that cover every eventuality, individual integrity is an absolute
expectation in science. <o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">Some scientists and some research institutes
adopt the view that their work should not be funded by industry. Rather, they
focus all their research on public funding with no industrial ties. In so
doing, they become immune to any questioning of the provenance of their wisdom.
Other scientists adopt an entirely opposite view and are of the opinion that
engagement with industry is an essential societal role to deliver economic
growth and increase employment, in effect, to give the funding agency and the
tax payer, a return on investment. <i style="mso-bidi-font-style: normal;">Neither
of these positions is either right or wrong</i>. They simply represent a world
view of individuals or institutes and in that regard are no different from
other contrasting choices: vegetarianism v. meat eating; democrat v.
republican; theism and atheism; tax cuts v. social investment. A constant
difficulty for scientists who engage with industry, is that the advocates that
populate Twitter, just don’t understand the mechanics of industry involvement
in research. So for their benefit, here is a tutorial on joint academic
industry funding with apologies for the length.<o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">Two types of industrial funding exist which
involve academic researchers. First, there is research commissioned by a single
company to solve some particular problem they need investigating. This is far
more rare an event than would popularly be believed by the Twitterati. <span style="mso-spacerun: yes;"> </span>The main reason why academics don’t like such
work is that, often, it is pure contract research and frequently involves research
questions that are marginal to their publicly funded strategy. All researchers
have such a strategy which maps out a research path they want to pursue. It
governs their choice of conferences to attend, journals to read and funding to
chase. But, for practical and political reasons, academics often have to
undertake this type of contract work for some commercial entity. The last one I
was involved in, perhaps only one in the last decade of my working life, was an
Irish mushroom company who had used special lighting techniques in the growing
of mushrooms to boost the levels of the mushroom Vitamin D<sub>2</sub>. We
found in our human intervention studies that whereas the D<sub>2</sub> type was
well absorbed, the active component of <span style="mso-spacerun: yes;"> </span>blood
vitamin D, did not improve; important for the company, not for us, other than a
published paper on the results<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>. However,
for a publicly funded academic to tell a small local company with a research
need to sod off and not be a nuisance will win one no favours in the university
and would be frowned upon by state agencies. But, as I say, such industry
funding is rare enough and is generally very low in the pecking order of
largely publicly funded scientists..<o:p></o:p></span></div>
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<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;"><span style="mso-spacerun: yes;"> </span>The
second type of industry involvement in research is as a full partner in
publicly funded research. Here in Europe, most of that international
competitive public funding is from the Commission of the<span style="mso-spacerun: yes;"> </span>European Union, through its Directorate General
on Research and Innovation. It is probably the largest global funder of multi-centre
and multi-disciplinary research programmes, addressing what they regard as
‘grand societal issues”. Thus, my last EU grant was that of Food4me (</span><span lang="EN-GB"><a href="http://www.food4me.org/"><span lang="EN-IE" style="mso-ansi-language: EN-IE;">www.food4me.org</span></a></span><span style="mso-ansi-language: EN-IE;">)
which amounted to a €12m investment in research on personalised nutrition ( a
current output of 46 peer-reviewed papers). And, as is obligatory under EU
funding, the inclusion of industrial partners within the research consortium
was 100% mandatory. These companies receive funds just as academic partners do.
In Food4Me, our biggest industrial partner was the Dutch electronics giant,
Philips, who have an interest in personalised nutrition for their smart kitchen
research. The Swiss food giant DSM was involved with a major interest in
companion diagnostic tools alongside a small University of Oslo start up, Vitas.
We had a global legal firm Heller & Heckman who worked with Swedish
academics on the legal and ethical side, we had a Belgian food business
consultancy (Biosense looking at business models) and an Irish software <span style="mso-spacerun: yes;"> </span>company, Crème Global, who wrote the software
code. These companies worked with a group of 14 academic research groups. <span style="mso-spacerun: yes;"> </span>Across most individual EU states and
definitely here in Ireland, the same rule applies: to get research income, you
must<span style="mso-spacerun: yes;"> </span>have appropriate industrial partners.<o:p></o:p></span></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;">These consortia, small or large, always enter a
legally binding agreement over the ownership of new knowledge generated in the
grant and the nature of its dissemination and use. This consortium agreement
will list every single deliverable envisaged for the project. These
deliverables include the publication of scientific papers. No company can dream
of gagging research findings that emerge from the work since that would involve
a breach of contract under Belgian law. Worse still, it would do massive
reputational damage to the company. The scientific world works in small cells
and word travels fast. <span style="mso-spacerun: yes;"> </span>The research
agreement will also allow the industrial partners to licence intellectual
property from the consortium as a whole. If they don’t use it, the intellectual
property reverts back to the project funder to dispose of, as best suits them. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">The next form of industry-academia engagement
involves consultancy work where an academic, with a global reputation in his or
her research field, is engaged by a company to help them with technical issues
of both a general or specific nature. I will illustrate the issue with two
examples. In 2009, I was invited to join Google’s Food Innovation Lab
community, specifically to a small group that wanted to explore options in
personalised nutrition. I visited their headquarters in Silicon Valley,
California about 9 times over a three year period before deciding that their
interest in personalised nutrition was quite a long way from where I saw it
going. Now, neither I nor my employer, UCD, got any payment from Google: Zippo,
Nada. Apparently, I was to serve on this Google think tank because I was
privileged to be asked and should be honoured to work for nothing for the
richest company in the world! I began calling them Froogle. In contrast, I was
invited to join a top level international advisory committee for Nestl</span><span style="mso-ansi-language: EN-IE; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;">é </span><span style="mso-ansi-language: EN-IE;">for
which I received an honorarium. They wheeled out their different research
projects and we tore them apart. For their own good of course. So which is the
greater sin? To share my hard won expertise<span style="mso-spacerun: yes;">
</span>with the richest company in the world for nothing or with the largest
food company running the largest food lab in the world (400 PhDs) for an
honorarium?? High priests of the Twitterati School of Scientific Morality,
please advise. On my first visit to Google, I tore strips off one group for
their sheer naivety in studying the school food programme in Mountain View Ca.
That was my job, to speak my mind. In Nestl</span><span style="mso-ansi-language: EN-IE; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;">é</span><span style="mso-ansi-language: EN-IE;">, I grew tired of some of
their hype about how great they were at food fortification and let them know in
no uncertain terms. They re-shaped their interest in public health nutrition,
for the better, and maybe my crankiness to senior management was a contributory
factor. In neither case would I ever dance to their tune. Nobody tells me what
to do!!<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Then there is the case of accepting<span style="mso-spacerun: yes;"> </span>a task which is not so general in nature but
has a very specific purpose and one which neatly fits into one’s research
portfolio. Thus I chair an international consortium ) (US, Canada, Denmark,
France , UK, Spain), co-funded by Cereal Partners Worldwide (Switzerland) and
General Mills (US) on breakfast in human nutrition and for this I receive a
consultancy fee. The project will lead to about 6-9 papers, individually peer
reviewed and will, for the first time, outline options for an evidence-based
approach to defining nutritional standards for breakfast, the meal everyone
agrees is of great importance (e.g. WHO. AHA, all dietetic associations, most
governments and almost all parents). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Finally, scientists are asked to sit on Boards
of non-profit organisations which are industry funded or boards which are state
funded. As regards the former, I am an unremunerated <span style="mso-spacerun: yes;"> </span>non-executive member of the Board of the European
branch of the International Life Sciences Institute (industry funded) and I have
just retired as chair of the Board of the state funded Food Safety authority of
Ireland, which carries a small remuneration.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Some scientists make the decision not to accept
the honorarium for themselves but rather to pass it on to their university and
ultimately to their research students. That doesn’t seem to matter to the high
priests of <span style="mso-spacerun: yes;"> </span>the Twitterati School of
Scientific Morality. Nor did it matter to the British Medical Journal. In 2015,
it ‘uncovered’ a network of scientists advising the UK government who had
connections with the food industry<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span><!--[endif]--></span></span></a>. In
particular, it singled out Professor Susan Jebb from the Oxford School of
Public Health, who at the time of the alleged naughty industrial collusion was
at the MRC’s (Medical Research Council) Nutrition Lab in Cambridge. Jebb
pointed out that all of this work followed the MRC protocol for external
funding, that the contribution of industry was made public in the relevant
scientific papers, that she personally received no money from industry and that
all this pre-dated her taking on the chair of a very important UK advisory
committee on strategies to reduce obesity<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[3]</span></span><!--[endif]--></span></span></a>. A
phone call from the BMJ would have revealed such but why let the truth get in
the way of a good story.<span style="mso-spacerun: yes;"> </span>In this
business, we get used to the constant harassment on industry funding. Here in
Ireland, the law requires all academics to complete an annual Declaration of
Interest under the Ethics in Public Office Act 1995<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[4]</span></span><!--[endif]--></span></span></a>.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Of late. There is growing interest in seeking
declarations of interest which do not involve industry or financial
remuneration<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[5]</span></span><!--[endif]--></span></span></a>. Let’s
imagine that some appropriate state agency is asked to review the evidence that
veganism is perfectly compatible with optimal nutrition in adolescents. Would
you be impressed if the chair was a vegan? Would you be happy for someone to be
a member of the committee if they had an adolescent child who was a practicing
vegan. <span style="mso-spacerun: yes;"> </span>And what about someone who has
written several popular books which argue some issue or other. Are they capable
of being independent thinkers? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Transparency is the key to ensuring honesty and
integrity in all aspects of scientific evaluation. And all interests must be
made transparent whether they involve industry or anything else that might be
seen by the outside world to shape world views. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<br /></div>
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<br /></div>
<div style="mso-element: footnote-list;">
<!--[if !supportFootnotes]--><br clear="all" />
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<br /></div>
</div>
<div id="ftn2" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""></a><span class="MsoFootnoteReference"><span lang="EN-GB">[1] </span></span><b><span style="mso-ansi-language: EN-IE;">Effect of supplementation with vitamin
D2-enhanced mushrooms on vitamin D status in healthy adults.</span></b><span lang="EN-GB" style="font-size: 10pt;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/25191578" title="Journal of nutritional science."><span lang="EN-IE">J Nutr Sci.</span></a></span><span style="font-size: 10pt;"> 2013
Aug 29;2:e29. doi: 10.1017/jns.2013.22. eCollection 2013.</span></div>
<div class="MsoFootnoteText">
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<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-67317195566748413602018-03-16T04:39:00.002+00:002018-03-16T04:39:42.704+00:00Weight loss: Are calories less important than food patterns?
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<i style="mso-bidi-font-style: normal;"><u><span style="mso-ansi-language: EN-IE;">{For
personal reasons, mainly involving the restoration of an 1843 cottage in Dublin’s
south coastal village of Blackrock, I have been absent from blogging for a
while. I’m back now with renewed vigour to pursue the best of nutrition science
and to tackle, mercilessly, nutribabble.}<o:p></o:p></span></u></i></div>
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<br /></div>
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<span style="mso-ansi-language: EN-IE;"><span style="mso-spacerun: yes;"> </span>One of
the latest trends in nutrition is to reduce our focus on nutrients and to
sharpen our focus on the role of particular food patterns in promoting health.
High up on the list of foods to avoid are processed (or ultra-processed) foods or foods high in fats,
refined sugars and salt. A recent paper from Stanford University has been
widely cited (not by the authors) as evidence that advice on caloric intake is less important in weight loss than the
quality of the diet consumed<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></a>. In
this study which was well designed, with adequate statistical power and ample
duration, the authors describe the advice given to subjects (all were obese) thus:
<i style="mso-bidi-font-style: normal;">“No explicit instructions for energy
(kilocalories) restriction were given. Both diet groups were instructed to (1)
maximize vegetable intake; (2) minimize intake of added sugars, refined flours,
and trans fats; and (3) focus on whole foods that were minimally processed,
nutrient dense, and prepared at home whenever possible.” </i>There were two
treatment groups: a high-carbohydrate, low-fat diet and the opposite, a high-fat,
low-carbohydrate diet. The two groups were given dietary advice to achieve the
food pattern outlined above. Both groups lost weight after the 12 moths of
intervention to the level of about 5.5 ( lbs) on average. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">Here is how the New York Times reported the
findings (Anahad O’Connor February 8<sup>th</sup>, 2018):</span> <i style="mso-bidi-font-style: normal;"><span lang="EN-GB">“</span></i><i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-IE;">Anyone
who has ever been on a diet knows that the standard prescription for weight
loss is to reduce the amount of calories you consume. But a new study,
published … in JAMA, may turn that advice on its head. It found that people who
cut back on added sugar, refined grains and highly processed foods while
concentrating on eating plenty of vegetables and whole foods — without worrying
about counting calories or limiting portion sizes — lost significant amounts of
weight over the course of a year”.</span></i><span style="mso-ansi-language: EN-IE;"> A distinguished Dean from Tufts in Boston was quoted as saying: <i style="mso-bidi-font-style: normal;">“The research lends strong support to the
notion that diet quality, not quantity, is what helps people lose and manage
their weight most easily in the long run. It also suggests that health
authorities should shift away from telling the public to obsess over calories
and instead encourage Americans to avoid processed foods that are made with
refined starches and added sugar, like bagels, white bread, refined flour and
sugary snacks and beverages</i>”. <span style="mso-spacerun: yes;"> </span>The
NYT piece was quoted across the globe by lazy editors to fill column inches
with a pretty impressive story. Regrettably, it was a misleading story which
opted to hide from its readers one awfully important point.<o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">You see, the JAMA paper gives data on caloric
intake at the beginning of the study and also at 3, 6 and 12 months of the
intervention. Right throughout the study, irrespective of which of the two
diets were being followed, no differences were seen between the two groups in
calorie intake. So, for convenience of communication, I’ll give the average values
of the two treatments at the different times. At baseline, the average daily
caloric intake was 2150. By month 3, it had fallen to 1580. It then rose to
1620 by month 6 and at the 12 month conclusion, it was 1700. Thus, the 12 month
figure was all of 450 fewer calories consumed</span></div>
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<span style="mso-ansi-language: EN-IE;">every day. The average body mass
index (BMI; kg/m<sup>2</sup>) was 33, which means that the two groups were well
into the obesity category of body weight. At that body weight and that daily
caloric deficit from food alone, weight loss was no miraculous discovery. Which
raises now a few questions.<o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;"><br /></span></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span style="mso-ansi-language: EN-IE;">Why were readers of the New York Times (NYT)
misled so as to believe that calories don’t matter in weight loss? Is it so
obvious to the NYT that the food patterns recommended were somehow so bound to
lead to a caloric deficit that it needn’t be mentioned to its readers? Or is it
remotely possible that the NYT never really read the paper and thus missed this
whopping caloric deficit? I doubt I’ll ever know the answer. But if I was a
journalist, I would be inclined to poke a bit further into this paper. We know
from the paper that there was considerable variability in weight loss but no
data are given. We also are not given any data about the changes that occurred in
food intake , particularly to provide supporting data on the target foods (less
of the sugary type, more of the complex carbohydrate food, more vegetables etc.).
But the big question is why was the average relapse so low? Thus at three
months, the mean daily caloric intake was 1580 and by month 12, it had slipped
back a bit but only to 1700 kcal per day, a 9-month average regain of just 120 kcal
per day. The human body absolutely defends a prevailing weight such that as all
dieters know, the maintenance of weight loss requires enormous perseverance.
Take your eye off the tiller for one moment and the tidal wave of our
obesogenic environment will sweep you back on the rocks. So why not on this
diet? I don’t know the answer to that but I do know that the anti-processed
food lobby will argue that it is proof that processed food fosters a false
appetite and that once that is taken away with a change to minimally processed home
prepared foods, appetite regulation returns and low energy intakes are the
result. There is however a little fly in the ointment here from another paper
which set out to study the link between the intake of ‘ultra-processed foods’
and cancer<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span><!--[endif]--></span></span></a>. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">This study from France used a cohort recruited
through the Internet and who had their diet analysed through digital
interaction using a multiple pass 24-hour recall. In all, 104,980 subjects were
eligible to participate and did so over the period <span style="mso-spacerun: yes;"> </span>2009-1017. The study was about cancer and that
will not feature in this blog. Rather, we will focus on the weight of these
subjects expressed as BMI<i style="mso-bidi-font-style: normal;"> </i>(kg/m<sup>2</sup>).
The population was divided into quartiles according to the contribution (weight
by weight) of ultra-processed foods to overall food intake. The respective
contributions (% w/w) of ultra- processed foods to the diets of the French
subjects were thus: Q1 = 9; Q2 = 14 ; Q3 = 20 and Q4 = 32. And across this
spectrum of ultra-processed food intake, BMI remained constant to the first
decimal point at 23.8 kg/m<sup>2</sup>. The literature abounds in studies
linking ultra-processed foods to obesity. Mais apparemment, pas en France. (But
apparently, not in France). <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">So returning to the Stanford study, we have no
differences in weight loss between those on a low fat-high carbohydrate diet as
opposed those on a high fat-low carbohydrate diet over a 12 month period. They
showed precisely the same caloric deficit over that period so one concludes
that it simply doesn’t matter what advice one is given for a reduction in fat
or in carbohydrate, the bottom line is that if that advice leads to a calorie
deficit, then weight loss will accrue, irrespective of what the NYT might say.
Quite how there was so little mean relapse in this study is as yet unexplained
but as mentioned above, the anti-processed food advocates will argue that the abandonment
of such foods returns people to a diet where appetite control in returns. The
fly in the ointment of the French paper will never be raised. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">Fine up to a point. However, <span style="mso-spacerun: yes;"> </span>a previous NIH funded study, the “Pounds Lost
Study” with weight loss programmes varying in fat and carbohydrate and reaching
a similar conclusion to the Stanford study, showed a steady weight loss to 12
months with a significant weight loss relapse thereafter<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[3]</span></span><!--[endif]--></span></span></a>.
My calculation of the data presented in the tables of the Stanford study is
that the average resting metabolic rate might be about 1,450 kcal per day which
might not seem a million miles from the reported energy intake at 12 months, 1,700
kcal. However, the former is calculated based on weight stability but with
dieting, this will fall by about 15%<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "Calibri",sans-serif; font-size: 12.0pt; mso-ansi-language: EN-IE; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[4]</span></span><!--[endif]--></span></span></a> to
1,230 kcal/d. Either these people will continue to lose weight or that deficit
will drive a weight regain process. All the available science would show a slow
relenting return to original bodyweight in a large proportion of the
population. Maybe the Stanford study will show that better investment in food
choice and tutoring on home cooking might help. Here’s hoping it does. <o:p></o:p></span></div>
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<span style="mso-ansi-language: EN-IE;">This Stanford study is very well designed, well
executed and fairly reported. More data on food intake (% consumers and
consumer only intake) would have been welcome but there’s only so much one can
do for modern journals with page restrictions and charges. It adds
significantly to the data on the relative role of the main energy macronutrients
(carbohydrate & fat) and it is consistency with existing data. Regrettably,
it will be long cited out of context as the study which showed that its diet
quality that counts, not calories. <o:p></o:p></span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 8.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 8.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB" style="font-size: 8.0pt;"> </span><span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Christopher D. Gardner, PhD; John F. Trepanowski, PhD;
Liana C. Del Gobbo, PhD; Michelle E. Hauser, MD; <o:p></o:p></span></div>
<div class="MsoFootnoteText">
<span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Joseph
Rigdon, PhD; John P. A. Ioannidis, MD, DSc; Manisha Desai, PhD; Abby C. King,
PhD . Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in
Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion <span style="mso-spacerun: yes;"> </span>The DIETFITS Randomized
Clinical Trial. <i>JAMA</i>. 2018;319(7):667-679. doi:10.1001/jama.2018.0245 <o:p></o:p></span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 8.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 8.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[2]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB" style="font-size: 8.0pt;"> </span><span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Thibault Fiolet, Bernard Srour, Laury Sellem, <span style="mso-spacerun: yes;"> </span>Emmanuelle Kesse-Guyot, Benjamin Allès, Caroline<o:p></o:p></span></div>
<div class="MsoFootnoteText">
<span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Méjean,Mélanie
Deschasaux, Philippine Fassier, Paule Latino-Martel,</span><span lang="EN-US" style="font-family: "MS Gothic"; font-size: 8.0pt; mso-ansi-language: EN-IE; mso-bidi-font-family: "MS Gothic";">
</span><span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Marie Beslay, Serge Hercberg,, Céline Lavalette, Carlos A Monteiro,
Chantal Julia, Mathilde Touvier; Consumption of ultra-processed foods and
cancer risk: results from NutriNet-Santé prospective cohort; BMJ 2018;360:k322
| doi: 10.1136/bmj.k322 <o:p></o:p></span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 8.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 8.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[3]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB" style="font-size: 8.0pt;"> </span><span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Frank M. Sacks, M.D., George A. Bray, M.D., Vincent J.
Carey, Ph.D., Steven R. Smith, M.D., Donna H. Ryan, M.D., Stephen D. Anton,
Ph.D., Katherine McManus, M.S., R.D., Catherine M. Champagne, Ph.D., Louise M.
Bishop, M.S., R.D., Nancy Laranjo, B.A., Meryl S. Leboff, M.D., Jennifer C.
Rood, Ph.D., Lilian de Jonge, Ph.D., Frank L. Greenway, M.D., Catherine M.
Loria, Ph.D., Eva Obarzanek, Ph.D., and Donald A. Williamson, Ph.D.<o:p></o:p></span></div>
<div class="MsoFootnoteText">
<span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Comparison
of Weight-Loss Diets with Different Compositions of Fat, Protein, and
Carbohydrates; N Engl J Med 2009;360:859-73<o:p></o:p></span></div>
</div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 8.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-family: "Calibri",sans-serif; font-size: 8.0pt; mso-ansi-language: EN-GB; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[4]</span></span><!--[endif]--></span></span></span></a><span lang="EN-GB" style="font-size: 8.0pt;"> </span><span style="font-size: 8.0pt; mso-ansi-language: EN-IE;">Erin Fothergill, Juen Guo, Lilian Howard, Jennifer C.
Kerns, Nicolas D. Knuth, Robert Brychta, Kong Y. Chen, Monica C. Skarulis, Mary
Walter, Peter J. Walter, Kevin D. Hal; <span style="mso-bidi-font-weight: bold;">Persistent
metabolic adaptation 6 years after “The Biggest Loser” competition; Obesity (2016)
24, 1612-1619. doi:10.1002/oby.21538<o:p></o:p></span></span></div>
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<!--EndFragment--><br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-31269471247426204422017-06-21T17:01:00.001+01:002017-06-21T17:01:16.459+01:00The fast food-obesity myth<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">The fast food-obesity myth<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Fast food is high on the ratings scale to explain the modern
epidemic of obesity. It makes sense. These foods are high in calories, high in
fat, highly palatable, cheap, available 24-7, heavily marketed to younger
persons and totally convenient. Moreover, these compelling attributes of guilt
are bolstered by data showing that in the last several decades, the number of fast
food outlets has soared, as have the portion sizes of food they serve. Thus it
is easy to understand why the term ‘fast food’ rolls so easily off the tongue
of policy shapers and makers and why restrictions are called for to limit the
number of fast food outlets and to make fast foods unattractive through higher
taxation and consumer education. But, as Oliver Cromwell said in addressing the
assembled Church of Scotland: “Gentlemen, in the bowels of Christ, I beseech
thee. Think it possible you may be mistaken”. So let us turn to several
recently published scientific articles on this topic.<o:p></o:p></div>
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The <b style="mso-bidi-font-weight: normal;">first </b>of these
draws on two data sets from the US<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>.
The first is county-level data on obesity (BMI>30kg/m<sup>2</sup>) rates
from the Center for Disease Control and the second is county-level data on both
fast food restaurants (FFRs) and full service restaurants (FSRs) from the US Department
of Agriculture’s economic database. It should be noted that this database lists
not only large chain type FFRs and FSRs but also small local such restaurants.
In all, data was available for the year 2012 involving 3138 counties across the
US involving a population of 170 million. The results were clear cut and expressed
thus by the authors: <i style="mso-bidi-font-style: normal;"><u>“Our a priori
prediction that FFRs and FSRs would be positively linked to obesity prevalence
was not supported”.</u></i> They did find some evidence, which suggested that
such establishments were more likely to be located in areas where there was a
higher level of both income and education.<span style="mso-spacerun: yes;">
</span>The authors then pint out that if that is the case, it would make
commercial sense for FFRs and FSRs to be located in more affluent areas and
that given the lower level of obesity with higher income and education, these
outlets were thus located in lower obesity areas. The authors went on to
quantify the extent to which variation in FFRs and FSRs density would explain
variation in obesity, and, controlling for all variables (poverty, ethnicity,
education, employment, household income, local recreational facilities and
health insurance), FFR and FSR density accounted for only 0.8% of obesity. <span style="mso-spacerun: yes;"> </span>They also calculated that FFR and FSR together
contribute to about a quarter of total US caloric intake.<o:p></o:p></div>
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The <b style="mso-bidi-font-weight: normal;">second</b> paper
is based on data for 25,000+ European adults, 50 years or older drawing on a
database from the project: ’Survey of Health, Ageing and Retirement in Europe’
(SHARE)<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>.
The countries involved are: Denmark, Sweden, Austria, France, Germany,
Switzerland, Belgium, the Netherlands, Spain, Italy and Greece. This survey
measured body mass index and household food expenditure, including expenditure
on ‘Food Away From Home” (FAFH). The findings are explained thus by the
authors: <i style="mso-bidi-font-style: normal;"><u>”Our results suggest,
contrary to normative views, that away from home food expenditures negatively
affect BMI and that BMI is negatively related to the percentage of the food
budget spent away from home”. </u></i>They go on to conclude: <i style="mso-bidi-font-style: normal;"><u>“Given our findings, the implication
seems to be that a policy intervention related to the food away from home and
obesity issue is not warranted for older Europeans. But if a policy
prescription is really needed, then a policy that is directed at promoting
better nutritional quality of foods for food-away-from-home might be in orde</u></i>r.”
The authors note that these data refer only to older Europeans and may not
apply to younger citizens. The main findings are summarized in Figure 1 below.<o:p></o:p></div>
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<o:p></o:p></div>
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<a href="https://4.bp.blogspot.com/-682TcpT9NKg/WUqX-ugWBoI/AAAAAAAAdAY/gHtMsXkr4bcT08cVte13B0naQJDYmy3cwCLcBGAs/s1600/Slide1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="720" height="480" src="https://4.bp.blogspot.com/-682TcpT9NKg/WUqX-ugWBoI/AAAAAAAAdAY/gHtMsXkr4bcT08cVte13B0naQJDYmy3cwCLcBGAs/s640/Slide1.jpg" width="640" /></a></div>
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Figure 1 from the second study above on the SHARE database of
older Europeans<o:p></o:p></div>
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The <b style="mso-bidi-font-weight: normal;">third</b> study is
US based and draws on The Coronary Artery Risk Development in Young Adults
(CARDIA) study which in this case involved 12,174 person-observations who participated
in 6 examinations; 1985–2011) across four US cities (Birmingham, AL; Chicago,
IL; Minneapolis, MN; Oakland, CA)<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a>.<span style="mso-spacerun: yes;"> </span>The database was used to provide statistical
input into a variety of models linking the percentage of neighbourhood food
stores or restaurants (per total food outlets within 1 km network distance of
respondent residence) with BMI (kg/m<sup>2</sup>). The models were adjusted for
socio-demographic and health behaviour data and for city of residence, timing
of subjects examinations, total food outlets and market-level prices. Once
again the findings were clear-cut: <i style="mso-bidi-font-style: normal;"><u>“Neighbourhood
convenience stores and fast-food restaurants were not associated with BMI in
any mode</u></i>l”.<o:p></o:p></div>
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The <b style="mso-bidi-font-weight: normal;">fourth</b> and
final study brings us away from out of home food purchases to old-fashioned
home cooked meals<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[4]</span></span><!--[endif]--></span></span></a>. It
recognises that there is ample documentation of the gradual increase in portion
size of foods served outside the home. It then asks the question: Has this also
happened inside the home. The abstract is short and it is worth presenting it
in total: <i style="mso-bidi-font-style: normal;"><u>“Since portion sizes have
increased outside the home, could caloric content have increased over the years
within the home? To examine this, a content analysis of common recipes in <span style="mso-bidi-font-style: italic;">Better Homes & Gardens</span>, the
bestselling book in its genre, was compared from its first edition in 1930 to
its most recent edition in 2010. Recipes were categorized into appetizers, side
dishes, entrées, and desserts and analyzed for significant changes in total
calories, number of servings, and calories per serving. From its first edition
to its most recent edition, the total calories and calories per serving in
appetizer recipes significantly increased by 51.18% and 52.5%, respectively.
Furthermore, entrée recipes had a significant increase in total calories by
32.96%. As these increases have gone unnoticed for scratch cooks and their
families, cookbook users should be wary of these drastic changes and the amount
consumed to counteract ever-increasing weight gain”.</u></i><o:p></o:p></div>
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All of the above suggests that when there is a knee jerk
policy move to curb fast food to reduce obesity, we should absolutely demand
evidence. Certainly the first three studies won’t support this knee jerk
reaction. The fourth is a bit of a shocker since home cooked food has been the ideal
for decades. It is the Walton family shrine of all things wonderful from family
home cooked meals to “Goodnight John Boy”. Sometimes such dreams are shattered.
So we should focus more on the home and ask ourselves how food portion size in
the home (and everywhere else of course) should be reduced. Controlling portion
size was recorded by the McKinsey Global Institute as the top priority for
policy action in tackling obesity. But rest assured, fast food will always be a
handy whipping boy by the evidence-averse mouthpieces of dietary change. Fast food
is s corporate villain but what about my local Chinese or Indian takeaway or my
local fish and chip shop?<o:p></o:p></div>
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<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText" style="text-align: justify; text-justify: inter-ideograph;">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
<span style="font-size: 10.0pt;">Mazidi m & Speakman JR . Higher densities of
fast-food and full-service restaurants are not associated with obesity
prevalence. American Journal of Clinical Nutrition. May 2017</span>.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
</div>
<div id="ftn2" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>
<span style="font-size: 10.0pt;">Body Weight Outcomes and Food Expenditures Among
Older Europeans: A simultaneous equation approach Andreas C. Drichoutis1,
Panagiotis Lazaridis2 and Rodolfo M. Nayga, Jr. Paper prepared for presentation
at the 113th EAAE Seminar “A resilient European food industry and food chain in
a challenging world”, Chania, Crete, Greece, date as in: September 3 - 6, 2009</span><o:p></o:p></div>
</div>
<div id="ftn3" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a>.
<span style="font-size: 10.0pt;">Rummo PE, Guilkey DK et al. Does unmeasured
confounding influence associations between the retail food environment and body
mass index over time? The Coronary Artery Risk Development in Young Adults
(CARDIA) study. International Journal of Epidemiology, 2017, 1–9 doi:
10.1093/ije/dyx070</span><o:p></o:p></div>
</div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[4]</span></span><!--[endif]--></span></span></a>
<span style="font-size: 10.0pt;">Wansink B & Mukund A. Bigger Homes &
Recipes: How recipe calories have increased over the years FASEB J April 2017
31:957.8</span><o:p></o:p></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-91854539744317996112017-06-07T10:58:00.005+01:002017-06-07T10:58:49.742+01:00Satiety: Chews your food wisely<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Over 100 years ago a health enthusiast named Horace Fletcher
warned us that “nature would castigate those that don’t masticate” One hundred
ears on and we live in an ‘obesogenic’ food environment characterized by highly
palatable, high energy dense foods that are often served in large
portions.<span style="mso-spacerun: yes;"> </span>These features combine to
promote energy intake, and when the foods are softly textured, they can
increase the rate of eating (g/min) and promote energy intakes even
further.<span style="mso-spacerun: yes;"> </span>The current global rates of
obesity would be enough to make Fletcher grind his teeth in disappointment!<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
We are told that hyper-palatable, energy dense foods rich in
sugar and fat and are ‘engineered’ to be less satiating and to encourage
consumption.<span style="mso-spacerun: yes;"> </span>These commonly come in
packaged processed foods but also in the home food environment where energy
dense Dauphinoise potatoes, tagliatelle carbonara and cheesecake can also
promote passive overconsumption. Very high levels of fat and sugar are absolute
characteristics of dessert dishes such as franigpan or baklava and are more
often home made than purchased as a prepared dish.<span style="mso-spacerun: yes;"> </span>However we may well ask, is it possible to
also apply the same rationale to reversing this trend and use the sensory
properties of foods to promote eating behaviour’s that drive satisfaction while
supporting energy intake reductions?<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
This is the approach being applied by a group of researchers
led by Professor Ciaran Forde at the Clinical Nutrition research Centre of the
National University of Singapore in one of their recent scientific publications<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>.
<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The authors begin with an elaboration of the research that
they and others have done, which show definitively, that the rate at which we
eat a food (eating rate: ER) greatly influences overall meal intake.<span style="mso-spacerun: yes;"> </span>The basic unit in this regard is grams of
food per minute and is strongly influenced by bite size and the total number of
bites taken within a meal.<span style="mso-spacerun: yes;"> </span>That
determines what goes into the mouth. Thereafter, the key measures are chews per
bite and time in mouth with the longer the chewing the more satiating the food
per kcal consumed (remember what Fletcher said about ‘castigate’ and
‘masticate’).<span style="mso-spacerun: yes;"> </span>In effect this is about
bites, chews and swallows.<span style="mso-spacerun: yes;"> </span>All can be
quantified using simple behavioural coding of video recordings of people as they
eat.<span style="mso-spacerun: yes;"> </span>All available evidence shows that
the larger the portion size, the greater energy density, and the faster one
eats, the more energy is consumed within a meal. The key question posed by the
team in Singapore is whether we could use food texture to better regulate food
intake within a meal and could this offer some protection against larger
portions and higher energy density?<span style="mso-spacerun: yes;"> </span>They
opted to conduct their experiments with a traditional rice-based breakfast
widely consumed in Singapore among a group of healthy regular breakfast
consumers.<span style="mso-spacerun: yes;"> </span>The key part of the study was
to modify the texture of the breakfast to effect a change in eating rate, and
this was achieved by greater or lesser milling of white and brown rice
grains.<span style="mso-spacerun: yes;"> </span>The energy density served was
low (0.5kcal/g) or high (1.0kcal/g) and was changed by varying the amount of
both sunflower oil and the starch product, maltodextrin.<span style="mso-spacerun: yes;"> </span>In the study, the portion sizes offered were
either 700 grams or 1050 grams. Thus the effect of thickness was examined for a
given portion size when energy density varied and in the second study, the
effect of thickness was studied when energy density was held constant but with
portion size varied. The key points of the results are as follows:<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">Constant
portion size</b>: Increasing the thickness of the breakfast led to a higher
bite size (about 30% higher), higher oral exposure per bite (about twice as
high) and more chews per bite (about three times higher). This was not
influenced by the energy density of the diet. The overall eating rate was
halved by the thicker porridge leading to a decline in caloric intake at
breakfast of about 75 calories<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">Constant
energy density:</b> Higher portion sizes led to an increase in breakfast intake
compared to smaller portion size (487 v. 425 g). Thicker porridges led to lower
intakes than thinner porridges (425 v. 488g). The thicker porridge almost
halved the eating rate.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The bottom line is that by manipulating texture, significant
beneficial effects in caloric intake from the test breakfast were seen. <span style="mso-spacerun: yes;"> </span>Thus the options for the reformulation to
consider extend beyond portion size and energy density to also use food texture
in a way that effectively changes eating behaviour.<span style="mso-spacerun: yes;"> </span>In each case there were no differences in
post-meal hunger or fullness and the changes did not reduce palatability, if
anything in the thicker breakfast liking tended to go up.<span style="mso-spacerun: yes;"> </span>These results are encouraging at a time when
food processing is under attack and the results suggest that processing
techniques like thickening, hardening, extruding and adding ‘crunch’ can be
used to change our eating behaviours and effect a change in energy intake
without a loss in eating pleasure or satisfaction<b style="mso-bidi-font-weight: normal;">. <o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Food technology can help alter the characteristics of foods
such as texture and energy density to extend eating time and thus to reduce
energy intake.<span style="mso-spacerun: yes;"> </span>Here is where the rubber
hits the road.<span style="mso-spacerun: yes;"> </span>How do everyday food
choices and eating behaviours, which are often habitual and routine link up with
our internal biologic control of food intake? With the huge failure rates of
dieting with a 2-year relapse rate of about 50% and a 5-year relapse rate of
about 95% we can ask – is it possible to restrict intake long term to prevent
weight re-gain? The study described above could help to mitigate the need to
feel restricted or deprived, by re-engineering the food environment to extend
the eating time for meals and support energy reductions.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
We are largely unaware of the precise energy content of the
foods we eat, and the largest variations in energy intake tends to occur within
meals in calories consumed to the onset of fullness (satiation).<span style="mso-spacerun: yes;"> </span>The present study is one of a new breed of
controlled feeding trials that highlight how a food’s sensory properties can be
used to promote fullness and show that the act of consuming a satisfying meal
is itself a strong satiation cue. Here we see the application of sensory
properties like meal texture to not only promote palatability and liking, but
also to act as functional cues to promote satiation and satiety. All this is
now possible in the modern processed food world, far removed from the original
ideas proposed by Horace Fletcher. Today, modern food processing techniques
contribute food safety, and reformulation and food processing techniques can be
applied to change energy density, and enhance the eating experience through
food texture.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">My thanks to Prof Ciaran
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<!--StartFragment-->
<!--EndFragment--><br />
<div style="mso-element: footnote-list;">
<!--[if !supportFootnotes]--><br clear="all" />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
Keri McCrickerd et al (2017) Texture based differences in eating rate reduce
the impact of increased energy density and large portions on meal size in
adults. Journal of Nutrition, March 27<sup>th</sup>.<o:p></o:p></div>
</div>
</div>
Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-60663005416798440942017-03-14T13:05:00.000+00:002017-03-14T13:06:36.321+00:00The Paradox of Oz: Sugars down, obesity up<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
A casual glance at either the print or social media would
lead one to conclude with absolute certainty that the world is eating more and
more sugar and consequently is getting fatter and fatter. No one could dispute
the latter with very clear objective data to show that global obesity rates are
experiencing a relentless rise. The former part of this apparent ‘fact’ is very
much out of kilter with the objective data. In a review of the changes in the
percentage calories from sugar over recent times based on national dietary
surveys, it is clear that there is no relentless rise in sugar intake globally
and, if anything, there are clear signs of a drop in sugar intake over recent
times. The following data has been extracted from a major review of global
patterns of sugar intake based on national diet surveys<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "cambria"; font-size: 12.0pt;">[1]</span></span><!--[endif]--></span></span></a>:<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184; width: 453px;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Country<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Survey 1<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Survey <o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">2<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Sugar calories<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>(%)<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>in survey 1<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Sugar calories <o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">(%) in survey 2<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">Sugars defined <o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 150%;">as:<o:p></o:p></span></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Australia<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1983<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2011/12<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">17.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">18.6<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">All<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Austria<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1998<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2012<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sucrose<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Denmark<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1995<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2003/6<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Added<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Finland<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1992<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2012<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.2<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sucrose<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">France<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1993/4<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2006/7<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">12.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">14.4<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sugars<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">New Zealand<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1989<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2008/9<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">6.6<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">8.2<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sucrose<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Norway<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1997<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2010/11<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.5<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">7.2<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Added<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sweden<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1989<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2010/11<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">7.7<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">9.4<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Sucrose<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Netherlands<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">1987/8<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2007/10<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">23.6<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">18.0<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">All<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 72.9pt;" valign="top" width="73"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">UK<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2000/1<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 55.55pt;" valign="top" width="56"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">2011/12<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="113"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">13.5<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">11.6<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 10.0pt; line-height: 150%;">Added<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
From the above data, it is clear that over the last 30 or
more years, the intake of sugars, however defined, has not shown any concerted
global tend to increase. The above data are for males and the female data is
pretty similar. Some countries have data on both sexes combined and again they
show no upward trend: Ireland constant at 16.6% of calories from non-milk
sugars over the period 1997-2006 and the USA with values of 13.9 and 11.8% of
calories from added sugars over the period 1971/75 to 2007/8.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The most exact analysis of trends in sugar intake comes from
my <i style="mso-bidi-font-style: normal;">alma mater</i> at Sydney University
led by Professor Jenny Brand-Miller<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "cambria"; font-size: 12.0pt;">[2]</span></span><!--[endif]--></span></span></a>.
These authors looked at four independent data sets to examine the changing
patterns of sugar intake in Australia. The authors point out that obesity
continues to rise in the Land of Oz: obesity rates have quadrupled from
childhood into adulthood for both males and females with Australia and New
Zealand exhibiting the largest single absolute rise in obesity since 1980 in a
global comparison such data<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "cambria"; font-size: 12.0pt;">[3]</span></span><!--[endif]--></span></span></a>.
So what of their sugar intake?<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The Food & Agricultural Organisation (FAO) of the UN
measures the “disappearance” of sugar in countries worldwide which takes overall
national production data, adds imports and subtracts both exports and non-human
use. If used wisely and for time trends only, such data can be very valuable.
In Australia, such data shows a decline in per capita intake of sugar from 152 grams
per day in 1980 to 127 in 2011. Using similar techniques, data from the
Australian Bureau of Statistics shows a 17% reduction in apparent sugar
consumption from 1961 to 2011 (139 to 115g/hd/d). Data from Australian National
Nutrition Surveys, which are based on surveys of actual sugar intake at
individual level, also show a decline in total sugar intake, from 115 grams per
day in 1995 to 105 in 2012. Given that among the devils of sugar sources, those
from beverages are considered as the Satanic level, it is interesting to note
that such Satanic influences have also fallen over time. No matter how defined
(soft drinks, sugar sweetened beverages, sugary products, sodas plus juices etc.),
the time-related decline of sugar intake in liquid form is still obvious. Data
from industry sources were also made available to the authors and once again, no
matter how defined, the same pattern of a decline in solid and liquid sugar
intake is seen. <span style="mso-spacerun: yes;"> </span>For example, the % of
children classified as “consumers “ of sugar-sweetened beverages declined from
about 65% in 1995 to 25% in 2012. Energy from sugar-sweetened beverages plus
juices in children fell from an average of 9.2 % of calories in 1995 to about
5.5% in 2012. All in all, there is not a shred of evidence from the either global
overview or the Australian deep-dive into sugar intakes to suggest any rise
whatsoever in sugar intakes.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Why therefore do we suffer the avalanche of data telling us
about the poisonous nature of sugar and the wicked damage it is doing to the
health of our children? In my view this is a consequence of our post truth era
where post-truth is defined by The Oxford Dictionary as: <i style="mso-bidi-font-style: normal;">‘An adjective relating to or denoting circumstances in which objective
facts are less influential in shaping public opinion than appeals to emotion
and personal belief’</i>. You see, sugar was extracted on the back of the
global slave trade and is now used by corporate food giants to manipulate the
food supply to make a tasteless mechanically derived ultra-processed foods into
ones which are rendered hyper-palatable with copious levels of added sugars. Gurus
from California with impeccable medical backgrounds have shown conclusively
that sugar is toxic, the new tobacco in fact. Tax the damn thing and be done
with it! That’s the emotional argument. It wins out every time against the
peer-reviewed data cited in this blog. As a life timer in nutrition I have come
to accept this and other such misuse of nutritional data and its adaptation by
populist experts and governmental departments. But at least I can rant on my
blog. It’s cheaper than therapy!!!<o:p></o:p></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-size: 10.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: "cambria"; font-size: 10.0pt;">[1]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 10.0pt;"> Wittekind A & Walton J (2014) Worldwide trends in
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Study 2013. Lancet 2014;384:766–81.<o:p></o:p></span></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-26408975094720720972017-02-02T20:15:00.001+00:002017-02-02T20:15:59.123+00:00Lustig on processed food: a critical review<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
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In a recent opinion piece in JAMA, Robert Lustig has written
a ‘viewpoint’ entitled: “Processed Food – An Experiment That Failed”<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>.<span style="mso-spacerun: yes;"> </span>This blog attempts to provide a critique of
that article. I apologise for the length but I’m afraid it is necessary. <o:p></o:p></div>
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The article begins with a definition of processed food. Not
one drawn up by the internationally recognised organisations such as the FDA<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>,
the FAO<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a>
or EFSA<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[4]</span></span><!--[endif]--></span></span></a>.
Instead he choses the definition established by the prolific food writer Joanna
Blythman<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[5]</span></span><!--[endif]--></span></span></a>,
whose 7 popular food and health books range from: <i style="mso-bidi-font-style: normal;">“Swallow this - Serving up the food industry’s darkest secrets” </i>to <i style="mso-bidi-font-style: normal;">“How to avoid GM foods”.</i> <span style="mso-spacerun: yes;"> </span>Blythman has 7 criteria for defining processed
foods:<o:p></o:p></div>
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<br /></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Mass
produced<o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Consistent
batch to batch<o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Consistent
country by country<o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Uses
specialised ingredients from specialised companies<o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Consists
of pre-frozen macronutrients, <o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Stays
emulsified<o:p></o:p></i></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Long shelf
life or freezer life<o:p></o:p></i></div>
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<br /></div>
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It isn’t clear from Lustig’s article (I haven’t read nor do I
intend to read Blythman’s books) if a processed food must meet <i style="mso-bidi-font-style: normal;">all </i>of the above in which case the vast majority
does not (Coca Cola isn’t emulsified and doesn’t have pre-frozen macronutrients;
bread is mass produced and consistent batch to batch but not country to country).
It isn’t clear whether a processed food must meet a given number of these
criteria, some of which are quite subjective. For example, what is a
‘specialised ingredient’ and a ‘specialised supplier’? And what is meant by the
term ‘pre-frozen macronutrients’. Who would pre-freeze sugar or fat? In effect,
the definition chosen by Lustig is one that suits his general argument: It is
vague in detail and all embracing in its scope.<o:p></o:p></div>
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<br /></div>
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He then goes on to cite his own work to illustrate the nutritional
properties of processed foods, of which he raises 11 issues.<o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">1. Fibre.</b> We eat
too little fibre for good health, a challenge that we have identified half a
century ago. Lustig sees processed food as a poor source of fibre and advises
us to seek “real food”, a term that I find a tad challenging as a nutritionist.
I published an analysis of strategies to improve the fibre intakes of adult
Irish women based on a national dietary survey data<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[6]</span></span><!--[endif]--></span></span></a>.
There were four areas, which if taken together, would increase fibre intake in
this group from 16 to 23 g/d: <span style="mso-spacerun: yes;"> </span>increase
whole meal bread intake (from 20% of bread intake as whole meal to 60%),
increase % of women consuming breakfast cereals from 40 to 70% and increase
intakes of both fruit and pulses from 1 to 3 servings per week. So three
processed foods help us achieve the dietary guideline for fibre in women: whole
meal bread, breakfast cereals and also pulses, which in Ireland will be mainly
tinned or frozen.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">2 & 3. Too few
omega 3 and too much omega 6 fatty acids.</b> The focus here is on the
inflammatory system (pro and anti; fostered by omega 6 and 3 respectively) and
completely ignores the role of long chain omega 3 fats in brain function, blood
clotting, arterial wall function, vision and reproduction. Lustig puts the
omega 6 to 3 ratio at 25:1 (no references supplied) whereas US literature puts
the figure at 10:1<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn7" name="_ftnref7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[7]</span></span><!--[endif]--></span></span></a>.
No mention is made of increasing oily fish intake (the main source of long
chain omega 3 fats) to modify this imbalance to a more favourable level.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">4.</b> <b style="mso-bidi-font-weight: normal;">Too few micronutrients. </b>Lustig talks
about antioxidants with vague terms such as ‘cellular damage’. He ignores food
fortification, which is one route favoured by the WHO to redress micronutrient
deficiencies<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn8" name="_ftnref8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[8]</span></span><!--[endif]--></span></span></a>.
Thus, recent studies have shown that infantile beriberi (thiamine deficiency)
can be eliminated in rural Cambodia by giving pregnant women a local processed
fish sauce, fortified with thiamine<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn9" name="_ftnref9" style="mso-footnote-id: ftn9;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[9]</span></span><!--[endif]--></span></span></a>.
Among Irish women of childbearing age, the level of the B-vitamin, folic acid
in their red blood cells, increases as they consume more folic acid fortified
foods, mainly in the form of breakfast cereals<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn10" name="_ftnref10" style="mso-footnote-id: ftn10;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[10]</span></span><!--[endif]--></span></span></a>.
Again, we see processed foods as part of the solution and not necessarily the
problem<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">5. Too many trans fats</b>.
These were regulated in the US in 2014 and in the EU a decade earlier. In
Ireland, the Food Safety Authority in 2008 noted “<i style="mso-bidi-font-style: normal;">the low levels of TFA observed in the current survey corroborate
industry commitments to reduce levels of TFA in fast-foods in Ireland” </i>but
the report went on to warn about replacing trans fats with saturated fats<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn11" name="_ftnref11" style="mso-footnote-id: ftn11;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[11]</span></span><!--[endif]--></span></span></a>.
<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">6. Too many branched
chain amino acids.</b> Lustig says that when they are consumed in excess, they
are metabolised (deaminated to be technical) in the liver, causing fat
accumulation. This to me was mind blowing. In all the years I’ve spent in
nutrition research, I had never associated branched chain amino acids (BCAA)
with processed foods and never associated them with liver fat accumulation. Lustig
references his own published paper here. It is not a BCAA study but yet another
of his reviews with a catchy title: <i style="mso-bidi-font-style: normal;">“Sickeningly
sweet: does sugar cause diabetes? Yes”. </i>One systematic review in the
literature concludes that plasma BCAA levels may be a <span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">“useful
biomarkers for early detection and diagnosis of insulin resistance in non
diabetic patients with obesity.” </i>However, they add that this is strongly
influenced by ethnicity, genes, gender and diet<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn12" name="_ftnref12" style="mso-footnote-id: ftn12;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[12]</span></span><!--[endif]--></span></span></a>.
A Japanese group (The Takayama Study) followed 13,525 adults for 10 years and
concluded: <i style="mso-bidi-font-style: normal;">“Data suggest that a high
intake of BCAAs may be associated with a decrease in the risk of diabetes<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn13" name="_ftnref13" style="mso-footnote-id: ftn13;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[13]</span></b></span><!--[endif]--></span></span></a>”.
</i>So this somewhat limited literature on BCAA and diabetes is quite
inconclusive. Lustig maybe is mixing up BCAA intake and plasma BCAA profile,
which are horses of quite different colours. It is beyond me as to how BCAA
intake in the diet might be linked to processed foods. I would imagine it is
linked primarily with protein intake.<o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">7. Too many emulsifiers.
</b>According to Dr Lustig, the consumption of too many emulsifiers (they allow
fat and water to mix) in processed food, <i style="mso-bidi-font-style: normal;">“may
strip away the mucin layer that protects intestinal epithelial cells,
predisposing individuals to intestinal disease or food allergy”.</i><span style="mso-spacerun: yes;"> </span>The reference cited is to a web site on super
weeds where the word “emulsifier” isn’t mentioned. So, this says to me that a
sloppy editorial approach was taken to this viewpoint. Leaving aside the
absence of any meaningful reference to back up this bizarre statement, Lustig
ignores the largest source of human gut exposure to a very powerful emulsifying
agent: human bile which daily secretes about 10-12 grams of bile acids into our
guts. This bile allows ingested fat to mix with the watery nature of the gut
contents so that enzymes can digest the fat. Nothing but nothing that we have
in processed foods comes near that. It is quite simply an absurd point for
Lustig to make. <o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">8.</b> <b style="mso-bidi-font-weight: normal;">Too many nitrates.</b> The author
associates cured meats with nitrates and increased risk of colon cancer. In
fact, cured meats are rich in nitrites but vegetables and fruits are rich in
nitrates. For example, 100 grams of cured ham contains about 1 milligram of
nitrite. Of plant based foods, the next highest are 100 grams of French fries
with about 5 times less (2 milligrams) nitrites<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn14" name="_ftnref14" style="mso-footnote-id: ftn14;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[14]</span></span><!--[endif]--></span></span></a>.
When it comes to nitrates, spinach has a staggering 125 times more nitrates
than any processed meat. So what is the dietary problem: Nitrates or nitrites? In
fact the problem is overall meat intake of which fresh unprocessed red meat is
the biggest culprit, at least according to the World Cancer Research Fund<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn15" name="_ftnref15" style="mso-footnote-id: ftn15;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[15]</span></span><!--[endif]--></span></span></a>
and its link to cancer has nothing to do with nitrates or nitrites. US red meat
intakes accounts for about 55% of total meat intake with processed meat
contributing just 25%<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn16" name="_ftnref16" style="mso-footnote-id: ftn16;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[16]</span></span><!--[endif]--></span></span></a>.
Processed meat intake rich in nitrites should be reduced but more so, we should
focus on unprocessed red meat. <o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">9 & 10. Too much
salt and alcohol.</b> Few can argue with this and it’s nice to see wine, beer
and spirits included as processed foods. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;">11. Too much fructose.</b>
This is Dr Lustig’s signature tune. However, while his headline is fructose,
the text refers to sugar, which is 50% fructose and 50% glucose.
Overconsumption of fructose in alone can only be achieved in humans under experimental
conditions and most of those studies exceed the existing 95<sup>th</sup>
percentile of normal fructose intake (from sugar) in the US diet<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn17" name="_ftnref17" style="mso-footnote-id: ftn17;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[17]</span></span><!--[endif]--></span></span></a>.
<span style="mso-spacerun: yes;"> </span>Lustig shares the same principles of
Gary Taubes who argues that not all calories are equal and that sugar is more
fattening per calorie than fat, a fact refuted by the recent experiments of Kevin
Hall<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn18" name="_ftnref18" style="mso-footnote-id: ftn18;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[18]</span></span><!--[endif]--></span></span></a>
of the NIH Diabetes group, incidentally funded by the Taubes-Lustig Nutrition
Science Initiative (<a href="http://www.nusi.org/">www.nusi.org</a>).<o:p></o:p></div>
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<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Based on all of the above, the case now moves to four
concluding points. The first is on the US diet and involves a series of figures
on changing nutrient intake in the US, and as expected, a conclusion is reached
that says the US caloric intake has risen dramatically in last few decades and
this is dominated by sugar and processed foods. Not a single reference appears
in this section so I can’t argue with the exact figures. <span style="mso-spacerun: yes;"> </span>The changing pattern of food intake in the US
has two opposing schools of thought. The difference between the two is the
estimate of food wastage in the US<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn19" name="_ftnref19" style="mso-footnote-id: ftn19;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[19]</span></span><!--[endif]--></span></span></a>
and you can believe whichever you like. As I have come to expect in such
arguments, the compelling evidence of physical activity in health protection<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn20" name="_ftnref20" style="mso-footnote-id: ftn20;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[20]</span></span><!--[endif]--></span></span></a>
and the decline in work-based physical activity<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn21" name="_ftnref21" style="mso-footnote-id: ftn21;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[21]</span></span><!--[endif]--></span></span></a>
are utterly ignored. The next overarching point is that all this change in food
intake leads to ill health. Here, would you believe, the focus is on sugar. The
level and composition of dietary fats don’t seem important to mention nor do
issues such as minerals (good and bad) nor vitamins. Thirdly we move to the
environment and again the focus is on sugar where it is argued that sugar
production and corn monoculture leads to soil erosion and loss of arable land which
is associated with herbicide resistance and super weeds. Nothing of ruminant
methane production and its contribution to greenhouse gas loads,
notwithstanding that these dominate the climate change agenda. A report of the
FAO on Global Food and Climate change concluded: <i style="mso-bidi-font-style: normal;">“However, for many crop and country combinations there was not enough
evidence to draw any general conclusions; thus, the authors concluded that the
evidence was either inconclusive, absent or contradictory for rice, cassava and
sugar cane<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn22" name="_ftnref22" style="mso-footnote-id: ftn22;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[22]</span></b></span><!--[endif]--></span></span></a>”.
</i>The final conclusion that Lustig draws is in relation to the top 10 global
food companies. However, he makes the common mistake of thinking that these are
the dominant suppliers of food in general or processed food in particular. One
major review concluded<i style="mso-bidi-font-style: normal;">: “Although the top
ten soft drink companies account for half of global sales, the top ten packaged
food companies account for only a small proportion of market share with most
individual companies contributing less than 3.3% each. Major multinational
companies need to be joined by the myriad of small- and medium-sized
enterprises in developing and implementing programs to improve the health of
the public, globally<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn23" name="_ftnref23" style="mso-footnote-id: ftn23;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[23]</span></b></span><!--[endif]--></span></span></a></i>”<o:p></o:p></div>
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<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
And so, back to the beginning, where Lustig starts off by
saying that: <i style="mso-bidi-font-style: normal;">“Those of who have
participated in science know that 9 out of 10 experiments are failures”.</i>
Having spent 4 decades as an experimental biologist in human nutrition, I can
say that based on my experience, the good doctor is talking through his hat. I
did have one experiment that failed and was binned forever when a fish oil
encapsulating company mixed up the placebo and fish oil capsules half way
through a large human dietary intervention study. Scientists start off with
hypotheses, which they do not try to prove true but rather, they try to prove
false. Whatever the result yields it is more knowledge than we had before
allowing a new aspect of the hypothesis to be examined and on and on.<o:p></o:p></div>
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<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<span style="mso-spacerun: yes;"> </span>Now the idea that food
processing was an experiment that failed is absurd. Food processing took the
wheat from flour to make bread, cakes, biscuits; it took grapes to make us wine
and milk to make us butter, cheese and yogurt. It allowed us to preserve food
through pickling or smoking or drying. And all of these are millennia old.
Popcorn was used as a garland for young Aztec women in ceremonial dances. Pizzas
were sold in Venice 800 years ago and every city in Europe had its unique
patented sausage: Chorizo, Bratwurst, Biroldo, and Salami etc. Canned food came
centuries ago and frozen foods a 100 years ago. High sugar foods such as cakes
or biscuits were common in ancient Rome such as Cantuci or Savillum. Fundamentally,
from the advent of fire, man has transformed the food chain to make it safer
and tastier and modern times have done little to add to this except to make
food cheaper and more available. I have argued this area at length in my recent
book: <i style="mso-bidi-font-style: normal;">“Ever seen a fat fox ~ Human
obesity explored”<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn24" name="_ftnref24" style="mso-footnote-id: ftn24;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[24]</span></b></span><!--[endif]--></span></span></a><o:p></o:p></i></div>
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<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
All in all, this ‘Viewpoint’ would be failed if an
undergraduate student were to present it, at least in my time. The editor of
JAMA paediatrics should be ashamed of his or herself for gross negligence of the
peer review process.<o:p></o:p></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref14" name="_ftn14" style="mso-footnote-id: ftn14;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[14]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> </span><span style="font-family: "Times New Roman"; font-size: 10.0pt;">Hord
NG et al (2009)<span style="mso-spacerun: yes;"> </span>Am J Clin Nutr;90:1–10.</span><o:p></o:p></div>
</div>
<div id="ftn15" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref15" name="_ftn15" style="mso-footnote-id: ftn15;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[15]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> <a href="https://www.wcrf-uk.org/uk/preventing-cancer/cancer-prevention-recommendations">https://www.wcrf-uk.org/uk/preventing-cancer/cancer-prevention-recommendations</a>
<o:p></o:p></span></div>
</div>
<div id="ftn16" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref16" name="_ftn16" style="mso-footnote-id: ftn16;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[16]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Daniel CR et al (2011) Public Health Nutr. Apr; 14(4):
575–583.<o:p></o:p></span></div>
<div class="MsoFootnoteText">
<br /></div>
</div>
<div id="ftn17" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref17" name="_ftn17" style="mso-footnote-id: ftn17;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[17]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Fructose, High Fructose Corn Syrup, Sucrose and Health
Ed: James M. Rippe<o:p></o:p></span></div>
</div>
<div id="ftn18" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref18" name="_ftn18" style="mso-footnote-id: ftn18;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[18]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Hall K et al (2016) Am J Clin Nutr. Aug; 104(2):324-33</span><o:p></o:p></div>
</div>
<div id="ftn19" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref19" name="_ftn19" style="mso-footnote-id: ftn19;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[19]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;">Hall K et al (2009) <span style="mso-spacerun: yes;"> </span>PLoS One. Nov 25;4 (11):e7940<o:p></o:p></span></div>
</div>
<div id="ftn20" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref20" name="_ftn20" style="mso-footnote-id: ftn20;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[20]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Ekelund, U et al (2005) American Journal of Clinical
Nutrition, 103 (3): 613–21<o:p></o:p></span></div>
</div>
<div id="ftn21" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref21" name="_ftn21" style="mso-footnote-id: ftn21;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[21]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Church TS et al (2011 ) PLOS One | Volume 6 | Issue 5 |
e19657<o:p></o:p></span></div>
<div class="MsoFootnoteText">
<br /></div>
</div>
<div id="ftn22" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref22" name="_ftn22" style="mso-footnote-id: ftn22;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[22]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> <a href="http://www.fao.org/3/a-i4332e.pdf">http://www.fao.org/3/a-i4332e.pdf</a>
<o:p></o:p></span></div>
</div>
<div id="ftn23" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref23" name="_ftn23" style="mso-footnote-id: ftn23;" title=""><span class="MsoFootnoteReference"><span style="font-size: 9.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[23]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 9.0pt;"> Alexander E et al (2011) Global Health. Aug 1;7:26.<o:p></o:p></span></div>
</div>
<div id="ftn24" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref24" name="_ftn24" style="mso-footnote-id: ftn24;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[24]</span></span><!--[endif]--></span></span></a> <a href="https://www.amazon.co.uk/Ever-Seen-Fat-Fox-Explored-x/dp/1910820083">https://www.amazon.co.uk/Ever-Seen-Fat-Fox-Explored-x/dp/1910820083</a>
<o:p></o:p></div>
</div>
</div>
Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-76048743844943513322017-01-01T14:53:00.001+00:002017-01-01T14:53:47.480+00:00Think sweet ~ stay slim<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Think sweet ~ stay slim<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Notwithstanding the overwhelming evidence that an excess of
calorie intake <i style="mso-bidi-font-style: normal;">per se</i>, irrespective
of the source of calories, causes obesity, there remains a populist and a policy
view that sugar, rather than fat is the primary culprit. Although the
biological argument that not all calories are equal and that carbohydrate
calories are more fattening has been debunked by sound experimental evidence<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>,
the case moves more to appetite as the causative factor. Since people don’t eat
what they don’t like, an understanding of the “liking” of particular foods
becomes important. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
To study this phenomenon, two approaches are possible. One is
to use a ‘cross sectional’ approach which seeks to compare obese persons and
lean persons for their food preferences at a single moment in time. The problem
here is that the obese persons may have acquired a view of what putatively
‘causes’ obesity and in so doing, they may bias their response to any study
questionnaires. Thus obese subjects at a given point in time might express a
lower liking for sugar-sweetened beverages compared to diet beverages because
that is what they are conditioned by society to believe. Moreover, obese
subjects may in fact use sugar free beverages to manage their weight. The
alternative to this approach is to complete a ‘prospective’ study in which
people’s likings for food are measured at a single point in time and the group
subsequently followed over several years to see who gets obese and who stays
slim. That way, the presence of obesity is independent of the answers to the
original questionnaire.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
A recent paper from the French research consortium
“NutriSanté” has examined the effect of liking for fat, sugar and salt on
subsequent development of obesity<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>.
The NutriSanté study is an internet-based study, initiated in 2009, with a
current enrolment of some 65,683 volunteers. Data is gathered at the point of
recruitment on many aspects of health such as diet, physical activity, weight,
smoking and alcohol habits, weight management and so on and is repeated
annually. <span style="mso-spacerun: yes;"> </span>Each month, volunteers are
invited to complete questionnaires related among other things to food
behaviour. <span style="mso-spacerun: yes;"> </span>The questionnaire covered
salt (11 questions) and sweet (21 questions) tastes plus preferences of
fat-and-salt (31 questions) and fat and sweet sensations (20 items). <span style="mso-spacerun: yes;"> </span>Some 49,066 subjects agreed to answer these
questions. However, when the data were cleaned up to ensure that all
respondents had completed every aspect of the overall NutriSanté study, there
were full data on 24,776 subjects. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
In the 4 years of follow up, 24,112 subjects remained non-obese
while 664 subjects became obese. The key sensory findings are thus:<o:p></o:p></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Sensory liking scores<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Non-obese subjects<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Obese subjects<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Statistical conclusions<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Liking for fat<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.79<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
4.03<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Liking for sweet<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.73<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.66<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
No
difference<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Liking for salt<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.77<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.93<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Those who gained weight had a higher preference for fat and
salt but not for sugar.<span style="mso-spacerun: yes;"> </span>Another approach
to the data analysis is to look across the “liking” score data and to divide
subjects according to their ranking, starting at the “low liking” (lowest
quarter or ‘quartile’) right up to the “highest liking”<span style="mso-spacerun: yes;"> </span>(highest quartile). These data are controlled
statistically for all known confounding variables.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
</td>
<td colspan="2" style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 265.05pt;" valign="top" width="265">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Statistical difference in risk of
developing obesity between lowest and highest quartiles of “liking”<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Men<o:p></o:p></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Women<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%;">
Fat liking<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
up 85%<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
up 49%<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%;">
Fat + salt liking<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
up 106%<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
No<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%;">
Fat + sweet liking<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
No<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
up 37%<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%;">
Sweet liking<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
down 59%<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
No<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 161.35pt;" valign="top" width="161">
<div class="MsoNormal" style="line-height: 150%;">
Natural sweetness liking<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 138.7pt;" valign="top" width="139">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
No<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yes,
down 69%<o:p></o:p></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The authors also looked at baseline food intake (as opposed
to liking) and observed no association between sugary food intake and obesity.
Indeed, the evidence was that those who did not develop obesity had higher
sugar intakes at baseline. The results are summarised below.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Food group intake g/d<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Non-obese subjects<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Obese subjects<o:p></o:p></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">Statistical conclusions<o:p></o:p></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Fruits<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
279<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
234<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Meat<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
45<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
57<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Processed meat<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.77<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.93<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Milk and yogurts<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
169<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
192<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Cheese <o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Not
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Oil<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
9.3<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
8.1<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div class="MsoNormal" style="line-height: 150%;">
Whole grain products<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
28<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Highly
different<o:p></o:p></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
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Sugar and products<o:p></o:p></div>
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24<o:p></o:p></div>
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19<o:p></o:p></div>
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Highly
different<o:p></o:p></div>
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Fatty sweet products<o:p></o:p></div>
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69<o:p></o:p></div>
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65<o:p></o:p></div>
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Not
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Sugar-sweetened soft drinks<o:p></o:p></div>
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39<o:p></o:p></div>
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41<o:p></o:p></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top">
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Not
different<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The authors conclude thus: <i style="mso-bidi-font-style: normal;"><u>“This prospective study reinforced results from cross sectional
studies, by highlighting that fat liking was prospectively associated with an
increased risk of obesity and diet appeared to substantially explain this
relationship. Results have also shown that sweet liking is associated with a
decreased risk of obesity, and there is no significant association between salt
liking and obesity risk”.<o:p></o:p></u></i></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Once again, we have a fully public funded comprehensive and prospective
study from a highly reputable group, with the study suitably powered for
optimal statistical analysis, which challenges conventional wisdom. It will be
ignored but, you see, it won’t go away and one day, when the false gods of the
demonic sugar sect are reduced to clay, these papers will come back to haunt
the high priests of public health nutrition. I wanna be there!!!<o:p></o:p></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
By the way, the blog stands now at <span style="mso-bidi-font-weight: bold;">231,325 views. Thank you all and </span>a happy New Year to all of you.<o:p></o:p></div>
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<!--[if !supportFootnotes]--><br clear="all" />
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<!--[endif]-->
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-size: 10.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 10.0pt;"> See blogs of November 21<sup>st</sup> 2016 and of
August 14<sup>th</sup>, 2015.<o:p></o:p></span></div>
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<div id="ftn2" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a> <span style="font-size: 10.0pt;">Lampuré et al. International Journal of Behavioral
Nutrition and Physical Activity (2016) 13:74<o:p></o:p></span></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-53090365964719587852016-12-27T20:38:00.000+00:002016-12-27T20:38:38.946+00:00Diet and poverty: Mind over money?<div class="separator" style="clear: both; text-align: center;">
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Diet and poverty: Mind over money?<o:p></o:p></div>
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Obesity is popularly linked with
low-income groups and with a low socio-economic status (SES). This relationship
is frequently explained by a lack of money, a lack of understanding of healthy
nutrition, a general disdain for healthy eating and both isolation from
supermarkets and proximity to convenience and fast food outlets. I won’t argue
with this except to say that while obesity is more prevalent in low SES, there
are a lot of fat judges, mayors, prime ministers, presidents elect,
ex-sportsmen, doctors, nurses and others for whom the putative drivers of
obesity in poverty are generally absent. New research<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
on obesity and SES has recently been published by scientists from Singapore’s
A*STAR and published in the prestigious journal, The Proceedings of the
National Academy of Sciences. The key question they asked was thus: <i style="mso-bidi-font-style: normal;">Irrespective of your true SES, if you were <b style="mso-bidi-font-weight: normal;">made to</b><u> <b style="mso-bidi-font-weight: normal;">think</b></u><b style="mso-bidi-font-weight: normal;"> you were</b> <b style="mso-bidi-font-weight: normal;">of a low SES</b>, would that influence your
food habits?<o:p></o:p></i></div>
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They started their thinking process
with reference to the animal kingdom where in any social organisation, those
that are marginalized for whatever reason (too slow, too weak, too fussy), also
tend to overeat and gain weight. This might be a precaution for survival in the
event that they might one day be in fact ousted from the group. They cite a
hamster study where a smallish hamster living in harmony with other small
hamsters is placed alone in a cage into which a larger hamster is admitted. The
latter will assert itself as dominant within less than a minute and the <span style="mso-spacerun: yes;"> </span>“defeated” smaller hamster is left to sulk.
The plot of body weight over time comparing those hamsters subject to defeat
against those spared this ignominy shows that the defeated hamsters,
stigmatized and “psychologically” marginalised, get fatter. <!--[if gte vml 1]><v:shapetype
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://2.bp.blogspot.com/-Teosp91HQiM/WGLQNfZeg7I/AAAAAAAAcnI/iP127MevyjIK6xuz89PTvyb0fMsKTFuiwCLcB/s1600/Hamster%2Bdata.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://2.bp.blogspot.com/-Teosp91HQiM/WGLQNfZeg7I/AAAAAAAAcnI/iP127MevyjIK6xuz89PTvyb0fMsKTFuiwCLcB/s320/Hamster%2Bdata.jpg" width="320" /></a></div>
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Against that background from the
animal kingdom of which the hamster data is merely illustrative of so many such
studies, they set out to study if an “imagined” low SES could alter food
habits.<o:p></o:p></div>
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The human volunteers were placed in
a private room and the study was conducted in what were effectively laboratory
conditions. They were shown a ladder with the following instructions:<o:p></o:p></div>
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<div class="MsoNormal" style="line-height: 115%; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;">Think of this ladder as
representing where people stand in Singapore. Now, please compare yourself to the
people at the very top of the ladder. These are the people who are the best
off—those who have the most money, most education, and most respected jobs. In
particular, we’d like you to think about how YOU ARE DIFFERENT FROM THESE
PEOPLE in terms of your own income, educational history, and job status. Where
would you place yourself on this ladder relative to these people at the very
top? Please select the number that corresponds to the rung where you think you
stand in relation to these people</i>.<o:p></o:p></div>
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<span style="mso-spacerun: yes;"> </span>A second group was similarly treated but they compared
themselves to people at the bottom of the ladder: poor, less education and
rotten jobs. To emphasise the mental induction of subjective higher or lower
SES, subjects had to write down in detail how a conversation might go with the
group above or below themselves and to suggest how such a conversation might
flow. Now, suitably indoctrinated into a feeling of subjective high or low SES,
the experiments began and the easiest way to communicate the studies is to simply
focus on the results.<o:p></o:p></div>
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<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: 115%; mso-list: l0 level1 lfo1;">When
asked to select the foods they might be subsequently included in a meal,
those who subjectively thought of themselves as lower SES, chose higher energy
dense foods and overall indicated an intention to eat more calories than
those who were attuned to think of themselves as higher SES<o:p></o:p></li>
<li class="MsoNormal" style="line-height: 115%; mso-list: l0 level1 lfo1;">When
asked to rate foods according to descriptors such as pleasant (e.g.,
tasty, delicious, wonderful) and unpleasant (e.g., disgusting, nasty,
awful) those in the lower SES subjective state chose the higher energy
density foods as the most pleasant<o:p></o:p></li>
<li class="MsoNormal" style="line-height: 115%; mso-list: l0 level1 lfo1;">In a
third study, the subjects viewed a short documentary video while freely
eating three snacks (potato chips, M&M candies, and California
raisins) from separate bowls. Those with the lower SES frame of mind ate
more calories and they more or less favoured the chips and M&Ms over
the raisins.<o:p></o:p></li>
<li class="MsoNormal" style="line-height: 115%; mso-list: l0 level1 lfo1;">Finally, the
subjects were given access to a meal in the form of noodles and asked to
eat to appetite. For completeness, a control group who did not take part in
the imagined SES ranking exercise was included. The outcome showed that
those who subjectively rated themselves as lower SES ate significantly
more then the other two groups.<o:p></o:p></li>
</ul>
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<a href="https://4.bp.blogspot.com/-ferx1fwOd4w/WGLQtPmqGmI/AAAAAAAAcnM/lZfvnC7i7xwWQuoUuY2c3OwoTI9c4q3-ACEw/s1600/KCal%2Bv%2BSSES.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://4.bp.blogspot.com/-ferx1fwOd4w/WGLQtPmqGmI/AAAAAAAAcnM/lZfvnC7i7xwWQuoUuY2c3OwoTI9c4q3-ACEw/s320/KCal%2Bv%2BSSES.jpg" width="320" /></a></div>
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These studies were carefully
designed and the analysis took statistical account of all key variables (age,
gender, weight etc.) including the actual SES of the subjects. The results could
be interpreted thus: When induced to think they are of a low SES, people
overeat because that’s what they think those of low SES actually do. However,
there are a few reasons to downplay this potential explanation. First, each
experiment involved different volunteers so there could be no sense of
training. Secondly, food was not portrayed as a central element of the study
but rather the self-imposition of a state of mind. Finally, and most
importantly, those induced to imagine themselves as low SES, were comparing
themselves to those at the top of the social ladder who were the economic
elite. <o:p></o:p></div>
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So, once again, we see what we
refer to as the “mind” playing a driving role in one of nature’s most powerful
biological drives, the drive to eat<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>.<o:p></o:p></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a> <span style="font-size: 9.0pt;">Cheon BK & Hong Y-Y (2016) Mere experience of low
subjective socioeconomic status stimulates appetite and food intake Proceedings
of the National Academy of Sciences (Early edition) </span><span style="font-size: 9.0pt; mso-fareast-font-family: "Times New Roman";">www.pnas.org/cgi/doi/10.1073/pnas.1607330114</span><span style="font-size: 9.0pt;"><o:p></o:p></span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="font-size: 10.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 10.0pt;"> Mind over matter: Perceived time as opposed to real
time on blood glucose in type 2 diabetes: Blogged October 14<sup>th</sup> 2016<o:p></o:p></span></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-13360424206815537792016-11-28T16:31:00.000+00:002016-11-28T16:31:00.601+00:00Dieting and the appetite battle<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
I have previously written that if slimming were a drug, it
wouldn’t be allowed for sale given that after 5 years of treatment, less than
5% would be successful in their weight loss. This is worse than the cure rate
for the worst cancer.<a href="https://draft.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
To many in public health nutrition, this relapse tendency is utterly ignored as
some arcane piece of physiology, which quite simply is inconvenient to their
strategy and, anyway, not as important as is made out to be. Indeed “Look at
all the people who have lost weight” they cry, while all the time ignoring the
far greater numbers who weren’t so lucky. A new paper from the NIH National
Institute for Diabetes and Digestive and Kidney diseases, led by Prof Kevin
Hall who is doing stalwart work in this field, throws strong light on this
issue of relapse and is well worth reflecting on.<o:p></o:p></div>
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When we organise experimental weight loss programmes, we use
dietary advice on weight loss and comparable expert advice on physical
activity. There can be no placebo. We can have a control group who receive
little structured and certainly not personalised or customised advice, but
until now, the experimental advantages of a placebo controlled diet is almost
impossible to achieve, Until now that is. A drug, with the silly name
Canagliflozin, which, as the lawyers say, hereinafter is known as the “drug
treatment” has been used in this study.<a href="https://draft.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>
It is presently available for the management of type 2 diabetes and leads to a
sizeable excretion of glucose each day. That means that the subjects pee out a
lot of untapped calories and therefore this drug leads to some weight loss. <span style="mso-spacerun: yes;"> </span>The key question the researchers set out to
address was that in a placebo controlled blind trial using this drug, how did
subjects respond in terms of compensating energy intake to the weight loss
anticipated from the drug. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
As is seen from the attached figure, the drug did lead to
weight loss but it reached a plateau. The daily drug-induced loss of untapped
calories from urinary glucose remained for the 54 weeks but the initial weight
loss was checked by a compensatory rise in energy intake. Normally energy
intake is measured using dietary assessment methods but in this case the change
in energy intake was related back to changes in bodyweight using a complex
equation that had been previously shown to be valid<a href="https://draft.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a>
against very robust biomarkers (doubly labeled stable isotope water along with
multiple dual-energy X-ray absorptiometry scans).<span style="mso-spacerun: yes;"> </span>The authors estimated that the energy intake compensation
was 100 kcal per day per kg of weight loss. Adaptations in terms of changes in
energy expenditure were minimal.<o:p></o:p></div>
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<a href="https://3.bp.blogspot.com/-8XakTRucp-U/WDxbSBick_I/AAAAAAAAcfg/eZCm_8AqOuAGvk4hLRd10YtTx3aYkb9BQCLcB/s1600/Slide1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://3.bp.blogspot.com/-8XakTRucp-U/WDxbSBick_I/AAAAAAAAcfg/eZCm_8AqOuAGvk4hLRd10YtTx3aYkb9BQCLcB/s320/Slide1.jpg" width="320" /></a></div>
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In this study, half the subjects (153 Type 2 diabetics)
received the drug and half the placebo and there was no advice on weight loss.
So there was no psychological effect of the intervention on weight loss or on
appetite. As weight was shed, appetite responded to a strong and lasting
effect, which minimised the process of weight loss. As the authors point out,
those who successfully diet and who achieve significant and prolonged weight
loss, battle by <i style="mso-bidi-font-style: normal;">‘heroic and vigilant
efforts’ </i>against the powerful effect of this compensatory rise in appetite.
Maybe there is a threshold of weight change below which the body choses to
ignore in which case we can win limited success in mass weight loss programmes.
But if as this study shows, weight loss is not minimal (>3kg average), then
we will need to have a much better understanding of how to motivate people for
that long term battle against compensatory weight loss. May I end this blog by
once again citing the Sir David King FRS formerly Chief Scientific Adviser to
HM Government, and Head of the Government Office for Science who in the UK Foresight
Report on Obesity wrote: <i style="mso-bidi-font-style: normal;">“What quickly
becomes apparent to anyone who examines the body of evidence from several
different disciplinary sources is that the answers are neither straightforward
nor, as is popularly supposed, necessarily known. Although a great deal of
research has been done into the problem, much of the evidence is not
integrated”. </i><span style="mso-spacerun: yes;"> </span>What is the threshold
of weight loss for energy intake compensation? What aspects of appetite
adaptation are most affected by the most and least successful dieters? What are
likely to be the most helpful strategies to those who want to lose weight and
must battle this enhanced appetite phenomenon? There are no simple answers.<o:p></o:p></div>
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Ever seen a fat fox ~ human obesity explored (2016). UCD Press <a href="https://draft.blogger.com/My%20new%20book%20on%20obesity">My new book on obesity</a><span style="font-family: Times; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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Polidori D et al (2016) Obesity, <b style="mso-bidi-font-weight: normal;">24</b>,
2288<o:p></o:p></div>
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Sanghvi A et al (2015) Am J Clin Nutr <b style="mso-bidi-font-weight: normal;">102</b>,
353<o:p></o:p></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-33803194641015240132016-11-21T00:39:00.001+00:002016-11-21T00:39:08.975+00:00Fat calories count most in obesity ~ new study<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Conventional wisdom, at least from the media and the high
priests of public health nutrition, tells us that sugar causes obesity and all
its ailments to the point where it is likened to tobacco in its sinister
provenance and its foul health implications. Sugar is to be taxed and
restricted in every way and politicians of all persuasions win popular support
for their call for yet more extreme measures to decry the putative effects of
sugar. And all the time, this conventional wisdom is promoted by the media and
by celebrity chefs and diet gurus.. So it should come as no surprise that when
a study from a high quality group using high quality data, publish a high
quality paper in a high quality journal, which flies in the face of
conventional wisdom, that this fine data, is simply ignored.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The paper<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
is based on data from the UK Biobank database that tracks individuals over time
(2011 and 2012). It uses direct measures of body weight and height and classified
the 132,479 subjects into underweight, normal weight, overweight and obese with
obesity further divided into grades I, II and III obesity. Data were also
obtained for each subject on % body fat and on waist circumference. Dietary
data was collected using four 24-hour recalls over 2011 and 2012. Subjects were
excluded from the study if there was any possibility that their diet or weight
might be compromised in some way. For example, smokers, who tend to be under-weight,
were excluded, as were those with a reported energy intake deemed by
international norms to indicate under-reporting of calorie intake.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The bottom line in the findings was that moving across
increasing grades of either body weight or body fat, energy intake, as in
calories per day, also increased. As I have previously paraphrased US President
Bill Clinton in his election campaign: “It’s the calories, stupid!” Compared
with normal BMI, obese participants had 11.5% higher total energy intake and 15%,
14%, 10% and 5% higher intake from fat, protein, starch and sugar,
respectively. Hence, the proportion of energy derived from fat was higher (34.3
v. 33.4) but from sugar was lower (22.0 v. 23.4). <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
This simply tells us there is a direct positive association
between calorie intake and rising levels of overweight. A key question remains
as to the contribution of fat and carbohydrate (with sugar specifically in mind)
to obesity when we statistically control for the calorie intake. The authors
thus transformed the data to control for the following: sex, ethnicity,
physical activity and calorie intake.<span style="mso-spacerun: yes;"> </span>This
allows us look at data where fat intake and sugar intake are examined for their
links to obesity where caloric intake is controlled to a common level. Now we
see that when sugar intake and starch intake (all carbohydrates) are compared
across rising levels of obesity, they <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u>actually fall</u></i></b>. In contrast,
fat <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u>rises.</u></i></b>
This isn’t anything new because when energy intake is fixed at a constant point,
as one contributor to caloric intakes rise (e.g. fat) others, (carbohydrates
including sugar) falls, a fact recorded so many times (the sugar-fat see-saw)
and so repeatedly ignored by the anti-sugar lobby. <span style="mso-spacerun: yes;"> </span>The figures below are taken from the journal where quintiles if nutrient intake are compared to BMI.<o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-T3fyscAlLME/WDJBTj0zusI/AAAAAAAAceY/Q3nMziTWJYwaewbmgFLLXby0yAuuALcLwCLcB/s1600/Slide1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://1.bp.blogspot.com/-T3fyscAlLME/WDJBTj0zusI/AAAAAAAAceY/Q3nMziTWJYwaewbmgFLLXby0yAuuALcLwCLcB/s640/Slide1.jpg" width="640" /></a></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
The authors conclude as follows from their research:<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-spacerun: yes;"> </span>Key Messages<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
• Adiposity is associated with higher intake of sugar; but
the association is stronger for fat intake and strongest for total energy
intake.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
• Fat is the largest contributor to overall energy intake.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
• There is only a weak correlation between absolute energy
derived from sugar and from fat. Therefore, targeting high sugar consumers will
not necessarily target high consumers of fat and overall energy.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
• Focusing public health messages on sugar consumption may
mislead the public on the need to reduce fat intake and overall energy intake.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Cambria; font-size: 12pt;">This was a study funded by a University of
Glasgow internal grant and was not funded by the sugar lobby nor have the
authors any conflict of interest to report. But it doesn’t conform to
conventional wisdom so it will largely remain ignored by the media and senior
policy makers will find it awkward reading, if at all, because they have
already </span><span style="font-size: 12pt;">followed
the herd of the anti-sugar lobby.</span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>
Andersen JJ (2016) Adiposity among 132 479 UK Biobank participants;
contribution of sugar intake vs other macronutrients. International Journal of
Epidemiology, 2016, 1–10<o:p></o:p></div>
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Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0tag:blogger.com,1999:blog-2434158383842628126.post-43297079727789789092016-10-14T15:49:00.001+01:002016-10-14T15:49:34.827+01:00Mind over matter: Perceived time as opposed to real time on blood glucose in type 2 diabetes<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
To most experimental human biologists, among whose company I
include myself, life, in its most basic form, is a series of biological steps,
relentless biological steps but beautifully masterminded by genes, orchestrated
by hormones and managed by enzymes. These biological steps are shaped by our biological
clock, our age, our sex, and by a myriad of inherited factors. They are also
shaped by the food we eat and the drugs we take which together, dominate human
biology experimental studies. <span style="mso-spacerun: yes;"> </span>From time
to time, we face assertions that biological processes can be mastered by mental
power. We accept that relaxation causes biological effects but do so with the
same thought process that tells us that physical activity causes biological
effects. We even accept that relaxation can be trained to quite high levels
through techniques of, for example yoga or other forms of meditation. The
neurological systems are very complex and thus those not expert in the field of
neurobiology simply accept such findings on trust.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Now data is beginning to emerge that one of the most measured
aspects of life, blood glucose, might be somehow subject to forces other than
food, exercise, drugs, disease and other such tangible matters. We are now
beginning to see mental forces enter this once biological citadel. This summer,
a paper<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></a>,<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></a>
appeared in the highly rated scientific journal, <i style="mso-bidi-font-style: normal;">“The proceedings of the National Academy of Sciences (PNAS)” </i>which
opens up a whole new vista on mind and biology. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Volunteers suffering from type-2 diabetes (the type
associated with obesity as a causative factor) were recruited. All were
receiving dietary management therapy and also they were taking metformin as a
medical treatment to manage their diabetes. Prior to the study, they were asked
to monitor their blood glucose levels before and after every meal and to create
a diary of blood glucose fluctuations. Thus they were trained to fully
understand their own blood glucose measurements. On the morning of the study,
they were asked to arrive having fasted for at least 8 hours. They were asked
to hand in phones, watches and anything else that could be used to monitor time
such as fit-bits, bleepers, computers, etc. They were also asked to hand in all
medication. Now they were ready for the study, which quite frankly was straightforward:
sit, relax and watch videos, changing the video every 15 minutes (the actual
changing of the video was done by the research staff so the volunteers simply
sat and relaxed). <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
Having taken away all time-related devices, the subjects were
left with just one indicator of time, a wall clock. And herein lies the rub. The
true time spent by each group was 90 minutes. However, two groups were tricked.
For one third of the subjects, the clock was set perfectly accurate and when
the allotted 90 minutes was up, they could see so on the clock. For the other
two groups, the clock was rigged. For half, it ran twice as fast as it should
in reality and for the other, it ran half as slow as reality. Thus one group
spent the true allotted 90 minutes in the test. For another group, the test
lasted just 45 minutes and for the third group, the time taken was 180 minutes.
Blood samples were taken before and after the test and the drop in blood
glucose noted. At the conclusion of the test, the subjects were asked to state
how long the study lasted and they all more or less agreed with the clock, even
though all of them had just spent 90 minutes under the the test conditions.
They did not differ in terms of perceived stress but hunger ratings did differ.
Those with the fast clock showed the highest level of hunger compared to those
rigged to imagine a longer time period. The critically important finding was
that the blood glucose levels were dramatically altered by the covert
manipulation of time. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Group<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;">Perceived time<o:p></o:p></b></div>
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(Minutes)<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Real time<o:p></o:p></b></div>
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(Minutes)<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Blood glucose<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;">Decrease over the study</b> (milligrams
per deciliter)<o:p></o:p></div>
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1<o:p></o:p></div>
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59<o:p></o:p></div>
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90<o:p></o:p></div>
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2<o:p></o:p></div>
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112<o:p></o:p></div>
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90<o:p></o:p></div>
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-15<o:p></o:p></div>
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3<o:p></o:p></div>
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175<o:p></o:p></div>
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90<o:p></o:p></div>
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-24<o:p></o:p></div>
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<o:p></o:p></div>
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The authors conclude thus: <i style="mso-bidi-font-style: normal;">“Our findings that the mind can actually adjust the body’s glucose
suggests new avenues for treatment and prevention”.</i> <span style="mso-spacerun: yes;"> </span>The study was well conducted by experts in
psychology from Harvard and Milan. But at the end of the day, experimental
biologists should really not be surprised. We use placebo treatments in our
study and expect always to see some placebo effect albeit very differently fro
the true treatment effect. But it does reinforce the need to have much stronger
links between the biological and behavioural sciences.<o:p></o:p></div>
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Note: Almost 60 years ago, in a review in Science<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a>,
the effect of tricking people on time as regards appetite were reported by the
great Stanley Schachter at Columbia and these effects are covered in a chapter
in my new book on obesity. The dictum that “an hour in the library saves days
in the lab” still rings true! <o:p></o:p></div>
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My new popular science book on obesity: "Ever seen a fat fox ~ Human obesity explored" is outlined</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-justify: inter-ideograph;">
on my blog of Tuesday, May 17th, 2016 and at <a href="http://www.ucdpress.ie/display.asp?isbn=9781910820087&">UCD Press</a></div>
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<div id="ftn1" style="mso-element: footnote;">
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-size: 10.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[1]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 10.0pt;"> Park C et al (2106) PNAS, <b style="mso-bidi-font-weight: normal;"><u>113</u></b>, 8169-70<o:p></o:p></span></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="font-size: 10.0pt;"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[2]</span></span><!--[endif]--></span></span></span></a><span style="font-size: 10.0pt;"> I am grateful to Professor <span style="mso-bidi-font-weight: bold;">Bobby Cheon of Singapore’s A*STAR nutrition group for pointing out this
paper to me and I look forward to blogging on his forthcoming studies</span><o:p></o:p></span></div>
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<br /></div>
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<a href="https://www.blogger.com/blogger.g?blogID=2434158383842628126#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-family: Cambria; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US;">[3]</span></span><!--[endif]--></span></span></a> <span style="font-size: 10.0pt;">Schachter S (1968) “Obesity and eating: the internal
and external cues differentially affect the eating behaviour of obese and
normal subjects” Science, 161: 751-6</span><o:p></o:p></div>
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<br />Mike Gibneyhttp://www.blogger.com/profile/05334362855336437143noreply@blogger.com0