Childhood Obesity, A Heavy Burden

As a pediatrician who treats children and adolescents with obesity, many parents have asked me, “Why is my child obese?”

I have to admit that I don’t have a good answer to this question. It’s not as simple as an imbalance between calories consumed and calories burned. The medical literature points to the interaction of genetic, physical, behavioral, and environmental factors – meaning it’s really complicated, and there’s isn’t a single culprit.

Most importantly, it’s not the child’s fault.

The Canadian Medical Association recently declared obesity to be a chronic disease. Greater than 20% of Canadian children are overweight and more than 10% have obesity. Overweight and obese children are more likely to become overweight adults.

Children with obesity carry a heavy burden, not just physically, but emotionally, too.

Obesity is associated with the development of physical problems including type 2 diabetes, high blood pressure, high cholesterol, and emotional problems such as depression, anxiety, and low self-esteem.

Although clinical treatments have shown minimal impact on body weight, lifestyle changes like improving sleep, increasing physical activity, and changing nutrition and eating behaviors can lead to long-lasting emotional health and wellness in overweight and obese children and adolescents.

My team created this video to describe the complexity of childhood obesity, reduce the obesity stigma, and provide simple advice on how to improve the health and wellness of children and adolescents. We entered it into a competition through the Canadian Institutes of Health Research (CIHR) and the Institute of Human Development, Child and Youth Health (IHDCYH). Part of the decision on who wins is by audience vote through YouTube likes. So please watch it, “like” it, and share it, and help help us to reduce the heavy burden that children and adolescents with obesity carry.

(To vote: Play the video. On the bottom right side of the video screen there’s a YouTube icon – click there to “watch in YouTube”. Then click the thumbs up icon. You’ll be asked to sign in, which you can even do using your gmail address.)

The post The Heavy Burden of Childhood Obesity appeared first on Talia Zenlea.

Social media was alive with ravenous carnivores (and smug vegetarians) after the WHO released a statement on the carcinogenic effects of red and processed meat. This prompted many news outlets to run headlines comparing red meat to cigarettes. Some serious bacon-rage ensued.

Now, before you lament your inevitable death-by-cheeseburgers, it’s important to understand what the implications of the WHO’s statement actually are.

Who are these meat-haters, anyway?

The International Agency for Research on Cancer (known as the IARC) is an agency of the World Health Organization (WHO), tasked with evaluating all sorts of things (from smoking to microwave ovens) and determining if they cause cancer or not. They do this by evaluating the body of evidence that already exists. They then make a determination – yes, no, or maybe. Being classified as Group 1 means that something is an established carcinogen, like asbestos or cigarette smoking. Groups 2A and 2B are probably and possibly carcinogenic, respectively. Group 3 means there’s not enough data to be classified.

What did the IARC actually find?

According to the full report, published Oct 26, 2015 in the Lancet Oncology, a working group made up of 22 scientists from all over the world convened to evaluate the carcinogenicity of red meat and processed meat. They reviewed 800 diverse studies, and based on their findings and the strength of their research methodologies, drew conclusions.

There were approximately 30 studies examining the association between red meat and colorectal cancer, and approximately 30 more pertaining to processed meat and colorectal cancer. About half of these showed a positive association.

There were also studies looking at the associations between red and processed meat and many other cancers, and positive associations were seen between consumption of red meat and cancers of the pancreas and the prostate, and between consumption of processed meat and stomach cancers.

On the basis of these findings, the IARC concluded that consumption of processed meat was “carcinogenic to humans” (Group 1) on the basis of sufficient evidence for colorectal cancer, and a positive association with the consumption of processed meat and stomach cancer.

They classified the consumption of red meat as “probably carcinogenic to humans” (Group 2A), based on the positive association between consumption of red meat and colorectal, pancreatic, and prostate cancer.

Is bacon as bad as arsenic?

The first important point to stress is that the IARC classification is based on the strength of the evidence supporting a relationship, not the strength of the relationship. In other words, it answers the question “Is there a relationship between red and processed meat and cancer?” but does NOT answer the question “How strong is the relationship between red and processed meat and cancer?” or more importantly, “How much more likely am I to get cancer if I eat red or processed meat?” or “If I stop eating red or processed meat, how much less likely am I to get cancer?”

So when you read that processed meat has “Grade 1” status, just like cigarette smoking, arsenic or asbestos, it just means that the WHO is as confident in the relationship between processed meat and cancer as it is the relationship between cigarette smoking and cancer. NOT that processed meat is as likely to cause cancer as cigarette smoking is. And want to know what else is classified as Grade 1? Alcohol. Epstein-Barr virus (the virus that causes mono). And a bunch of life-saving medications.

So… Can I have my bacon and eat it too?

I’m not trying to downplay the IARC’s findings. They are meaningful. An association was found and it wasn’t thought to be random. This means more research into this is warranted, to answer those other questions we all now have, like how risky is consuming red and processed meat? And how beneficial would it be to stop eating them? But the WHO’s statement didn’t give us much by way of guidance. They told us to eat these foods in moderation, and balance this potential risk with all the benefits of eating meat…. So, like alcohol, consume in moderation and exercise caution. And my two cents, as a gastroenterologist – if you really want to prevent colorectal cancer? Get a screening colonoscopy!

The post Beefmageddon: Understanding the WHO Warning About Meat appeared first on Talia Zenlea.

“Food For Thought” is a recurring column on bellyblog.ca, where we will share a well-curated collection of high quality, thought-provoking pieces, usually about food, diet, nutrition, and the gut.

Irritable Bowel Syndrome, or IBS, is a complex syndrome characterized by abdominal pain and altered bowel habits. It’s very common, and can have a major impact on quality of life. Read more about IBS here.

Despite IBS making up about 30% of all consults to a gastroenterologist (in my practice, I’d say it makes up upwards of 75% of all consults!), our understanding of what causes it is still pretty poor. As a result, our treatments often focus on managing the symptoms.

One thing we do know is that for a lot of IBS sufferers, diet plays an important role in causing symptoms, and dietary manipulation is often suggested as a first-line therapy. The most common foods that trigger IBS are dairy, gluten, and FODMAPs, so elimination of these foods commonly recommended. Read more about elimination diets here.

Here’s a fantastic article I wanted to share from a well-respected scientific journal discussion the relationship between food and IBS symptoms. A “must-read” for anyone with IBS, in my opinion.

The post Don’t Eat That! appeared first on Talia Zenlea.

How many times have you reached for the bottled smoothie, thinking you were about to consume something “healthy”?

Most store-bought smoothies have a large amount of added sugar in them – up to 54 grams per bottle. That’s like drinking two cans of regular soda!

Added sugars are syrups and sugars that don’t naturally occur in foods and are added during preparation and processing, or added at the table. Natural sugars are those naturally occurring in food, for
example, lactose in milk and fructose in fruit. Added sugars contribute to excess weight gain and obesity, and thereby negatively impact your health. So unless you have a medical reason why your doctor told you to be monitoring your sugar intake, it’s OK to have some sweetness – just try to find it from some of these naturally occurring sources, instead.

Here is a recipe for a healthier smoothie!

It will get you through the morning, and only has 16 g of natural sugar!

INGREDIENTS (Serves 1):
1 cup frozen blueberries
2 tbsp peanut butter
1 cup almond milk
1 scoop/serving size of protein powder (I use MRM 100% All Natural Unflavored Whey  Protein Powder)

Combine all the ingredients in a single serve blender. blend until smooth. Now you’re ready to
head off to work with a nutritious smoothie in your hand!

The post Not So Smoothie appeared first on Talia Zenlea.

Are you a vegan or vegetarian, and considering nutritious meals for the whole family?

A plant based diet has many health benefits, but can be accompanied by deficiencies in vitamins, minerals and protein.

Here’s a checklist for some nutritious options the whole family can enjoy.

CALCIUM (non dairy sources)

Unsweetened  “Alterna-Milks”, i.e. Soy, Hemp, Rice, Almond, Flax and Oat (Calcium Fortified)

Tofu (look for Calcium Sulfate on the list of ingredients)

Breakfast Cereals fortified with Calcium (look for low-sugar options)

Broccoli

VITAMIN D

Unsweetened  “Alterna-Milks”, i.e. Soy, Hemp, Rice, Almond, Flax and Oat (Vitamin D Fortified)

Breakfast Cereals fortified with Vitamin D (look for low-sugar options)

Egg Yolk

IRON

Breakfast Cereals that are fortified with Iron (Original Cheerios is an excellent choice)

Tofu

White Beans

Lentils

Spinach

VITAMIN B12

Breakfast cereal fortified with 100% of the Daily Value of Vitamin B12

ZINC

Baked beans

Cashews

Chickpeas

Oatmeal (Plain)

Almonds

Kidney Beans

PROTEIN                       

Tofu

Tempeh

Pinto beans, black beans, kidney beans, lentils, split peas, or garbanzo beans

Nuts and seeds, including almonds, hazelnuts, mixed nuts, peanuts, peanut butter, sunflower seeds, or walnuts

The post Grocery Store Must-Haves for the Vegetarian Family appeared first on Talia Zenlea.

So in Part 1, we talked about probiotics – what they are and what is their job-description within the body. The next question is – what does this mean for you, and should you be taking them.

Here are a few important things to keep in mind about probiotics:

“Probiotics” is a general term for good bacteria. But there are THOUSANDS of potentially good bacteria, and they aren’t all created equally, and certainly haven’t all been studied.
Yogurt that contains “live cultures” is sometimes misleading, because a lot of the bacteria die when the yogurt is pasturized, or are killed by the acid encountered in your stomach after you’ve eaten it.
Now certain probiotics have been studied and show promise in the treatment of certain conditions.

Here’s a summary:

A number of probiotics have shown promise in improving IBS symptoms. Some of the most robust data is with B. infantis (Align) in people with diarrhea-predominant IBS.
Lactobacillus GG (Culturelle) and S. boulardii (Florastor) can be of benefit in people with infectious diarrhea.
For certain conditions like ulcerative colitis and pouchitis, VSL#3 may have some benefit.
Again – so what does all of this mean? Well, it’s a hard question to answer. If you have infectious diarrhea (like travelers diarrhea), try Culturelle, it can’t hurt.  Or IBS? Try Algin. Does that mean it’ll help? I have no idea. Does it mean other probiotics won’t help? Again – no idea. But these are the ones that have been studied for these conditions so they are your best bets.

Now if you’ve tried Align for your IBS for example and have noticed no improvement in your symptoms, there’s no benefit to continuing it. Similarly, if you’re on a different probiotic and notice it’s making a huge difference for you, don’t switch!

Probiotics are a therapeutic option with a lot of promise, but there’s a lot of research still left to be done.

The post Probiotics: The Good, the Bad, and the Bug-ly. Part 2 appeared first on Talia Zenlea.

Drug store, health food store, and even in your breakfast. But what are they, and do they actually do anything??

The intestine is like a big garden hose that runs through the body and contains a ton of bacteria. We commonly think of bacteria as a bad thing – bugs that cause disease.

The truth is, when it comes to bacteria, like most things in life, there are good ones, and there are bad ones.

The intestine acts as a barrier between the body and the outside world, keeping the bad bacteria out of the blood stream and the rest of the body. Within the intestine, the good bacteria, also known as probiotics, are like policemen, or peacekeepers. They make sure the bad bacteria don’t get out of control, and they protect the intestine from some of the effects of the bad bacteria, allowing the intestine to properly do its job. Some good bacteria go above and beyond, and even stimulate the body to make certain chemicals, like the ones it needs to fight inflammation or mediate pain.

So what does all of this mean – should you be taking a probiotic or investing in yogurt stock?

Tune in for Part 2 of this post to find out!

The post Probiotics: The Good, the Bad, and the Bug-ly. Part 1 appeared first on Talia Zenlea.

There is a lot of fuss about gluten these days – gluten is good for you, bad for you, the gluten-free craze is just a “fad”, gluten sensitivity is not a real condition, and so on.

It’s hard to keep it all straight. Well, it turns out, there is a lot of validity to the fuss surrounding gluten for patients who have a condition called celiac disease. Celiac disease is a genetic, autoimmune condition characterized by inflammation of the small intestines.

The genetic part means that this condition is passed down in families due to the fact that individuals with celiac disease have inherited genes that predispose them to this condition. The genes can be “activated” at any time or not at all due to certain environmental factors.

Celiac disease is an autoimmune condition since the immune system in patients with this condition attack a healthy part of the body by mistake.

Celiac disease affects at least 1% of the U.S. population, possibly higher in other parts of the world. This condition affects all races and ethnic groups and can occur at any age.

In celiac disease, exposure to dietary gluten (a protein found in wheat, rye and barley) leads to inflammation of the small intestine, as well as other parts of the body. Because the small intestine plays a key role in absorbing vitamins and minerals, inflammation can lead to poor absorption of these things, and can cause significant nutritional deficiencies. Patients with celiac disease often have unexplained weight loss and diarrhea. Other common symptoms include abdominal pain, gas, bloating, low energy/fatigue and unexplained anemia or low iron levels.

These are considered to be “classic” symptoms. There are also many “non-classic” symptoms that actually account for the majority of symptoms in patients with celiac disease. These include unexplained constipation, dental problems, weak bones (osteoporosis), heartburn, nausea/vomiting, skin rash, joint and muscle aches and pains, migraine headaches, fertility problems…just to name a few. It is important to emphasize that many patient with celiac disease have NO SYMPTOMS. These patients usually come to medical attention when a family member is diagnosed with celiac disease and, consequently, they are screened for this condition with blood testing.

The treatment of celiac disease is complete, 100% avoidance of gluten for life.

The symptoms discussed above are not unique to celiac disease and can occur with other conditions. However, if you think you might have celiac disease, recognize any of the symptoms described above or have any symptoms that concern you, please speak with your doctor and consider getting tested.

Testing is simple and involves a blood test to start. If you think you might have celiac disease, do not start a gluten free diet until you have consulted with your doctor. Going gluten free before testing usually makes it difficult to interpret the test results. Early diagnosis of this condition and effective treatment can get you back on the right track towards health and improved quality of life.

The post What’s All the Fuss About Gluten? Celiac Disease 101 appeared first on Talia Zenlea.

“Food For Thought” is a recurring column on bellyblog.ca, where we will share a well-curated collection of high quality, thought-provoking pieces, usually about food, diet, nutrition, and the gut.

EXCERPT: Toward the end of the Second World War, researchers at the University of Minnesota began a legendary experiment on the psychology and physiology of human starvation — and, thus, on hunger. The subjects were 36 conscientious objectors, some lean, some not.

Read the Full Article

Diet Advice That Ignores Hunger, By Gary Taubes, New York Times

The post Diet Advice That Ignores Hunger appeared first on Talia Zenlea.

“Food For Thought” is a recurring column on bellyblog.ca, where we will share a well-curated collection of high quality, thought-provoking pieces, usually about food, diet, nutrition, and the gut.

If there is one health myth that will not die, it is this: You should drink eight glasses of water a day.

It’s just not true. There is no science behind it.

READ THE FULL ARTICLE

There is no formal recommendation for a daily amount of water people need. Credit Todd Heisler/The New York Times

The post Do You Really Need 8 Glasses of Water per Day? appeared first on Talia Zenlea.