Eyes on your own plate please!

So here’s a little story that I wanted to share with you all. I’m currently enrolled in a course outside of the nutrition program. It is a professionally-related course for fourth year students, and so naturally, it brings together individuals all across the Ryerson campus. The majority of my peers in this particular class have marketing degrees, but some others have accounting or another business-related background. I’ve made friends with this one girl in my class – partly out of obligation seeing as she is my project partner. But, for the most part, I do enjoy her company. The only thing about her that drives me nuts is that she scans every piece of food that enters my mouth.

This all began during an icebreaker activity on the first day of class. As soon as I told her I was a nutrition student, she replied “OOOOOOOOH, okay I get it”, while I thought to myself, “Um, get what exactly?” I quickly learned what she meant by that. Every time I pulled a snack from my lunch bag, she laughed. “Of course you’d bring carrots”, she said sarcastically as she rolled her eyes. I felt like stuffing a couple in her mouth, especially since my family holds strongly to an Italian family saying: “Keep your eyes on your own plate”. The following week, I treated myself to a chocolate frozen yogurt, and her eyes almost fell out of her head. I hadn’t even sat down before she began to lecture me. “I can’t believe you, a nutrition student would eat, THAT! How many calories does that have?” I just put on a forced smile as she watched me finish the last couple of spoonfuls. Despite my irritation with her comments, I also felt sympathetic for this girl. I began to notice that when I was around, she was afraid to eat. She hid her snacks from me. Or if she was drinking a Tim Hortons ice cap, she would quickly admit her flaw before I would even get a chance to say hello.

I thought this story fit well with the question that Professor Manafo presented to us on blackboard: What is our role as food and nutrition professionals?” Based on my experiences with this classmate, I would have to say that our job is to educate people, not only on what foods to eat, but what it is exactly that we do. Clearly this classmate of mine, who has had no experience with nutrition, thinks I’m here to judge her about what she’s eating. After all, a ‘DIET’itian must be looking to put people on diets, right? I think it’s our responsibility to get the message through to the public that we are here to help. We are their eyes and ears when it comes to changes in the food industry, and we are responsible for guiding them in the right direction. Contrary to popular belief, we are NOT members of the food police who will snatch boxes of doughnuts away from you in the middle of the night. I really do think people forget that we are humans first and foremost, and then nutrition professionals. To prove to you how ‘human’ I am, here is my online confession:

Dear fellow nutrition students, please forgive me for I have sinned. It has been much too long since my last confession but here it is. I eat chocolate constantly. I devoured a jumbo Toblerone bar that my mom gave me for Valentine’s Day, and I’m still working on a box of Godiva. I eat while doing homework, when sad, happy, excited or bored. I love sushi and eat it 2-3 times a month. I also unintentionally skip meals from time to time. One week, I ate frozen yogurt every single day and I loved it. My friend and I do ‘lard sessions’ at McDonalds when we’ve had a bad day or after a difficult exam. And really, I couldn’t care less if other people eat ‘bad’ foods from time to time, simply because I know, like me, they’re human. We all have cravings, and yes, we also have emotional attachments to food. It’s only natural.

So there you have it. I’m human. I have cravings, but yet I’m a dietetic student. And yes, I can be both at the same time. Does that make me a ‘bad’ nutrition professional? I don’t think so. I still have the knowledge and still know what to eat, but at the same time, I’m realistic and understanding. So please, when you’re around me, feel free to eat and enjoy your food!

I promise I won’t judge. :)

Economists know best? I don't think so

Something about economists has always really bugged me, but I could never figure out what exactly, or why for that matter. That is, until I read this article: “Time for two-tier health care: Calgary Economist”. Source: http://www.cbc.ca/canada/edmonton/story/2010/02/18/calgary-health-let-the-rich-pay-economist.html

This CBC piece highlights the ideas of an economist by the name of Dr. Herb Emery (pictured above), who feels that it’s about time that Canada begin to consider a two-tiered health care system. His reasons for this? Well for one, the system would be “more sustainable if wealthy Canadians were free to pay for their own privately insured medical services”. And two, by allowing more competition into the system, Canadians who want to pay for their health insurance can do so, in turn taking “a bit of funding pressure off the public system”.

I’m a big supporter of universal health care and so hearing stories like this really irritate me. To Dr. Emery, health care is likely pictured in terms of dollars and cents. Utilitarianism, efficiency and effectiveness guide his decisions. But when it comes to human life and health care, this mentality no longer works. In my opinion, the focus of health care should be help others heal, no matter their race, shape, size, or social status. I will always remember something my economics teacher said: “Economists will never make good politicians”. And she was right. They are too focused on balancing a free market, manipulating its variables of supply and demand as if it were a teeter-totter. In the process, they completely neglect the fact that there are PEOPLE in these free markets whom are clearly affected by the direction the economy takes. I also won’t lie to you: I’m irritated that an economist, of all people, is telling us how to fix a health care system. Despite his vast education and credentials, telling me how to fix the health care system is like a dietitian counseling the government on how to solve the recession. What can I say? I’m possessive of my jurisdiction. :)

There are several ideas that Dr. Emery presents in the article that I find are very indicative of backwards/individualistic thinking. First, take a look at the link for the article itself. Notice anything? The very end of it reads “Calgary health let the rich pay”. I think this is a very telling statement, even if it is delivered in the form of an HTML. Let the rich pay? Sure, the wealthy will have money to pay for these services but how will the poor pay? They’ll pay with their health of course. And to think, is it fair that the poor will have to ‘settle’ for basic care from the government simply because they cannot afford to ‘upgrade’ like the wealthy can? Is it fair that some will have to wait 6 months for a CAT scan, while a CEO can get one the next day?

I also want to address this notion of ‘funding pressure’. Dr. Emery stated that a two-tiered system would remove pressure from our current system but I say, keep the pressure on! Now before you think I’m out of my mind, let me clarify. When I say keep the pressure, I don’t mean that I want to add extra work to doctors or nurses, or stretch the system past its capacity. HOWEVER, I do want to keep funding pressure on the government. The way I see it is that if we implemented a two-tiered system, the wealthy would pay for themselves and stop complaining. The poor would get whatever minimal coverage they could, and then the government - seeing that everyone was taken care of in some way – would wash their hands of this matter. This is not what we want. We want the public to constantly pressure the government to reassess the current system, make improvements, and increase funding. Two-tiered health care, in my opinion, will only absolve politicians of their responsibilities. And let’s be honest, we all pay taxes meaning we should dictate the services we get!! (That sounds like something my 50 year old parents would say, but it’s true!) It's a funny thing: even though I barely make a measly two pennies to rub together, every February the government starts asking for a portion of what I brought home. They say the funds collected will go towards health care and other costs, but then why don’t I see an improvement in the system? It doesn’t help to hear about spending scandals, knowing that part of my taxes went to pay for a politician’s grande Chai latte at Starbucks instead of an IV drip. If this economist wants to talk about supply, demand and money with me, then maybe we should reassess wasteful spending at each level of government and see how much money we could come up with. I bet by cutting some of these trivial ‘expenses’ we could probably build and fund a whole new hospital.


Dr. Emery, nearing the end of the article, also notes that latest wave of elderly (aka the baby boomers) will be one of the leading stressors on the health care system. And to be honest with you, I’m so tired of hearing this same excuse. No doubt they will be a large group of people to accommodate, but you cannot blame health care expenses on them alone. How about all those smokers that unnecessarily add to our health care woes? Or those with cancer? Let’s blame them for rising costs because chemotherapy is really darn expensive to offer. I’m being sarcastic of course, but hopefully I’ve made my point. Don’t blame these costs on the vulnerable and the weak. That’s just a cowardly way of covering up mismanagement at a government level.

If two-tiered health care is fully initiated and accepted in Canada, I do not see a bright future for our health care system. Look at Michael Moore’s movie Sicko, which clearly illustrated the pitfalls of a privatized system. I’ll never forget how one man needed to decide which finger to reattach after two had been severed. The one he ended up choosing cost significantly less – a staggering $48,000 less – to reattach. Is this really what we envision for Canadian health care? Take a look at the U.S. right now, as President Obama fights to have others accept a national health care system. It’s a complete disaster, but I don’t get it. Why aren’t more people on board? Tommy Douglas, the founder of our system, fought so hard to establish what we have now. Why are we ready to give it up so easily?

I’m sure there is information that I’m missing information on this matter and that there’s plenty more to discuss. But in my eyes, it really comes down to one question: is access to health care a luxury or a human right? What do you think?

When Bright Minds Get Bored....

When bright minds get bored, they start to do silly things with their time and talent. Really, they do. Why would I say this? Have a read for yourself: Diabetes Drug Helps Dieting Teens Lose Weight. Does anything about that title strike you as odd? Maybe the whole ‘diabetes medication being used on non-diabetic patients’ part?

I happened to come across this article while surfing the web and couldn’t help but think to myself, “Why would you even consider doing that?” Now, before I go on, be forewarned that I have strong opinions. Anyone who knows me will tell you this is true. I also openly admit that I have not read every single piece of literature out there on this matter, nor have I checked all the references in this study. However, I do feel that as a dietetic student, I can bring a new perspective to this situation and raise some questions about this particular study.

Published this month in the Archives of Paediatrics & Adolescent Medicine, the bright minds at Glaser Pediatric Research Network provided a glimpse into a potentially new realm of treatment for obesity. In fact, their study’s background statement reported: “Metformin has been proffered (proposed for acceptance) as a therapy for adolescent obesity, although long-term controlled studies have not been reported”. This is where they stepped in. For a total of 48 weeks, 39 individuals were placed on metformin XR (extended release) and were tracked using various measures, as compared to placebo groups. At the end of the study, it was concluded that “Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle invention program.”

For those of you who are not familiar with this drug, Metformin is a pharmaceutical compound used to treat type II diabetes. It helps to decrease the amount of blood sugar your body absorbs from food, and also decreases the amount of sugar your liver makes on its own. The theory then is that the less excess sugar in the blood, the less excess energy there is to be converted to fat. Plus, obese individuals are already at risk for diabetes, so why not get a head start on regulating their blood sugars? Simple, right? Wrong. Metformin has a whole host of side effects, only some of which were BRIEFLY LISTED in the study (pg. 6). But to reassure their readers, researchers reinforced that Metformin was “well tolerated” by this population. What does that even mean? Who defines well-tolerated?

A little digging on the internet revealed that Metformin can not only cause hyper and hypoglycaemia if it is not regulated properly, but can also be held responsible for other fun side effects like: diarrhea, unpleasant metallic taste in mouth, flushing of skin, nail changes and muscle pain (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a696005.html#special-dietary). And for bonus points, a disclaimer at the bottom notes: “Some female laboratory animals given high doses of Metformin developed non-cancerous polyps in the uterus…it is not known if Metformin increases the risk of polyps in humans.” Well isn’t this convenient? Testing a medication that could have implications for fertility on obese teenagers in the midst of puberty (13-18 yrs)? Fantastic! Did the researchers also consider the frequency with which teenagers skip meals, or take twice the dose of Metformin when they’ve had a little too many calories for the day? Is that not also a danger?

As a dietetic student, I can only help to wonder, what happened to promoting lifestyle changes, behaviour modification, and health over diets. The scientists at the Glaser Pediatric Research Network seem not to support such ideas as illustrated in this statement: “Short term prospective trials using various lifestyle modification programs have shown that effectiveness is often related to the intensity of the program…..and has limited longevity”. I have scanned through each page of this report, curious to know more about this magical regimen. Although the study was relatively thorough and was a legitimate randomized, double-blind, controlled trial, I still came across a couple of ‘gems’, statements that would get yours gears turning.

Quote 1: “Metformin, in combination with lifestyle modification had a small but statistically significant effect to reduce BMI in obese adolescents; this effect WANED within 12-24 weeks of DISCONTINUING Metformin treatment.”

So in short, using Metformin is just as ‘ineffective’ as they had accused behaviour modification of being? Could this be because this is a short-term Band-Aid solution that never addresses the root causes of obesity?

Quote 2: “While healthy eating was a major component of the lifestyle modification program [initiated as part of the study], no specific calorie goal was assigned to the subjects.”

No calorie restriction on a weight loss program? This would explain why those following the ‘lifestyle modification’ treatment didn’t fare so well. It’s a well known equation in the dietetic community that: Eating pattern – 500 calories/day = loss of 1lb per week.

Quote 3: “To mitigate the possible impact of diet modification on vitamin and calcium intake, as well as possible EFFECTS OF METFORMIN on vitamin B metabolism… subjects were instructed to take a multivitamin and calcium carbonate…”

Is this what we’re really trying to teach the public? That all these years, we have lied to them and there really is a magic pill for weight loss (Metformin)? And that true health can be managed by balancing pills and not meals?

There is something very backwards about this thinking that goes against everything I’ve learned and have come to value. Why would they promote pills so readily for patients without a diabetic or pre-diabetic diagnosis? I suspect it might have something to do with Bristol-Myers Squibb, the makers of Metformin XR, who were the sole group listed in the financial disclosure portion of the study. A tiny little conflict of interest, n’est pas?

Studies like these, I believe, really undermine the dietetic profession. They subliminally suggest our techniques (e.g. diet modification) and knowledge about the power of food is nowhere near close to that of the power a drug. Much like rock beats scissors, drugs beat food. I’m still left with the question of why we would use metformin so readily on young, pubescent teens even though dietitians have been trained to regulate glucose through timing of eating, the glycemic index, and combining carbohydrate and protein.

*Sigh* I wasn’t lying to you. When bright minds get bored, they REALLY do take part in silly things, like putting children on metformin for obesity. Maybe if they really want a challenge, they can help Adam Giambrone solve the service issues with the TTC. But that, my friends, is a story for another day. :)