“No sugar added” candy lists sugar as first ingredient

sugar free

No sugar added?

Add this to the #facepalm files.

I took the above photo at a convenience store in Charlottetown this summer.  As you can see on the package, the candy is proudly advertised as “no sugar added”.  The package also announces that the candy is sweetened “only with maltose”.  This seemed somewhat surprising to me, because (as you may have guessed), maltose is a form of sugar.  The Canadian Food Inspection Agency defines sugar as “all mono- and disaccharides, including sucrose, fructose, glucose, glucose-fructose, maltose, etc”.  For that reason, foods that contain added maltose cannot be advertised as “no sugar added”.

As you might expect, a quick look at the ingredients showed that these candies were basically just maltose with a bit of added flavoring.  This whole episode is another reminder of how “no added sugar” is a meaningless concept.

I did email the company, and it appears that this was a mistake made out of ignorance rather than a deliberate attempt to mislead. Here is the response from the company (emphasis mine):

It might be something that is outdated, as I have looked over and only found old bags that state “no sugar added.”

Although if it helps your questioning any, Maltose [is] a very complex carbohydrate that dissolves slower than cane sugar.  It means you have less of a spike effect from the sugars.

As noted above, maltose is a sugar (coincidentally, it’s very important for brewing beer), and has a higher glycemic index than table sugar.  All of which highlights the fact that you should not take nutrition advice from candy manufacturers, and most foods that sport front-of-package health labels are probably bad for you. 


Category: Miscellaneous, News, nutrition | Tagged | 1 Comment

Lancet editorial misses the boat

Just came across an interesting editorial in Lancet Diabetes & Endocrinology via @Dr_Burr and @Skeila on Twitter. The article focuses on physical activity and dietary guidelines, but takes a moment to critique the recent Canadian Society for Exercise Physiology position stand on the risks and benefits of promoting activity in kids (full disclosure: I’m a CSEP member, and have collaborated with/studied under several of the authors of the position stand, although I had nothing to do with the article itself).

Here’s the critique from Lancet Diabetes & Endocrinology (emphasis mine):

Disappointing, then, is the position statement on the benefits and risks of exercise in children that was released by the Canadian Society of Exercise Physiology in August, 2014. Although the society acknowledges the great benefits of physical activity for physical and mental health in children, they strongly suggest that the risks should not be ignored. They advise against promotion of physical activity in children unless information about potential activity limitations is available. Lead author Pat Longmuir (Children’s Hospital of Eastern Ontario Research Institute) said that “[vigorous activity] might precipitate a cardiac arrest due to an unrecognised cardiac condition”. With the substantial gains being made in recent years—reversing the trend of ever-increasing childhood obesity rates—this scaremongering report seems a step in the wrong direction. The only result can be defensive, with schools, sports coaches, or other professionals who should be promoting activity practising caution for fear that any child could have a rare heart condition. The onus should be on parents to tell coaches and schools if their child has a heart condition and whether they are therefore fit to exercise, not on these professionals.

I was surprised that these particular authors would argue that we shouldn’t promote activity unless info about limitations is available, because that seems pretty onerous.  And it would probably have a negative impact on physical activity, as the Lancet editorial authors suggest.

So I checked out the position stand,  and I think the Lancet may have grossly over-reacted. Here are the most relevant recommendations from the CSEP position stand (emphasis mine):

The experts convened in June 2012 to consider an appropriate approach to promoting increased physical activity in children. They recommended that given the limitations of current evidence, the following question be used for the purpose of determining whether children less than 15 years of age are apparently healthy: “Has your healthcare provider ever told you that your child should not do some types of physical activity?”

Taken together, the goal of these question(s) would be to identify children at increased risk during physical activity without falsely identifying children who are not at risk and to indicate whether a child should be referred to a physician before engaging in increased physical activity. The expert group also recognized that it is typically not feasible to collect background information for unstructured physical activity (e.g., children swimming in a local pool or playing in a local park). Therefore, the use of these questions is recommended only for structured settings and organized programs. Primary healthcare provider-prescribed activity restrictions, conveyed directly from the healthcare provider or by the parent/guardian, must always be respected by the physical activity leader. The need to inquire about healthcare provider-prescribed activity limitations or other relevant information (e.g., allergies, special needs, medical history) is the same for high-intensity and more sedentary pursuits, and regardless of the setting (e.g., competitive, recreational, research)

Parents and professionals should encourage all children to accumulate at least 60 min of physical activity daily.

It is widely recognized that apparently healthy children should perform at least 60 min of daily physical activity that is of at least moderate intensity, and that exceeding 60 min per day offers even greater benefit (Tremblay and Haskell 2012). Vigorous-intensity activity and muscle and bone strengthening activities are recommended at least 3 days per week (CSEP 2012). What may not be recognized is that the same physical activity recommendations apply to children with disabilities or who have conditions that require primary healthcare provider physical activity restrictions. Modifications or restrictions to the frequency, intensity, duration, or type of physical activity permitted can enable physical activity that is appropriate to each child’s condition (Bar-Or and Rowland 2004b).

So they are not proposing that we only allow kids to participate in activity if they have info on their health risk.  Instead, the question is meant to simply identify kids who have already been identified as being at high risk.  I know this, because I used this specific question as a means of screening participants in a previous study.  Here’s how it was worded on the consent form:

Pre-Participation Health Screening

Please answer the questions:

1.  Has a doctor ever told you that there are some types of exercise or physical activity that you should not do? (please circle)

Yes / No

2.  If you answered yes, please describe the types of exercise or physical activity that you cannot do at this time:

Not surprisingly, almost no one answers yes to these questions (especially among kids who are involved in organized sport). But if there was a reason that someone shouldn’t be exercising, or a specific limitation, it would be helpful to know.  In fact, not asking seems almost negligent.  The whole reason we used this question in our study was specifically because we wanted a way to identify the kids who were known to be at high risk (which is a reasonable requirement of most research ethics boards), without accidentally screening out a bunch of healthy kids, or subjecting them to unnecessary screening.  In other words, this question is meant to avoid the scenario that is described in the Lancet editorial.  In my experience, this question is a good way to quickly assess whether a child has any known risk factors for adverse events during exercise, without any real negative consequences.

Obviously I have some inherent biases at play here, so I’m curious to hear what others think.  And I realize that this may seem like a pretty minor issue, but since the Lancet literally called people out by name (and accused them of “scaremongering”), I thought it was worth pointing out that they seem to be mistaken.


Category: News | 1 Comment

Participants Needed: Standing desk edition

Exciting news – researchers at the University of PEI (myself included) are beginning a study on the impact of standing desks.  If you live in the Charlottetown area (or know someone who does) and work a desk job, we’d love to hear from you.

To get involved email upeiexerciselab (at) gmail (dot) com, and Brittany will be in touch.

Category: News | 3 Comments

Time is of the essence: How to best spend 30 minutes for your health

Today’s post comes from Jonathan Kurka and Matthew Buman, discussing a recent paper that they published in the American Journal of Epidemiology.  Below is a video of Dr Buman explaining the main findings of his study, which was recorded in the fall of 2012.  More on Mr Kurka and Dr Buman can be found at the bottom of this post.

It seems there is never enough time in the day, and this is often the reason people tend not to exercise even if they know they should. There are only 24 hours in a day and all of our daily behaviors can be broken down into three basic categories. Sedentary behaviors include any activity in which you aren’t active, such as sitting while watching TV, sitting while at a computer at work, driving your car, or lying down without sleeping. Active behaviors include walking, jogging, exercising, or even performing household chores such as cleaning, cooking, and vacuuming. Sleeping behaviors include naps and your nightly rest period.

Note: in research, we often break activity behaviors up, based on intensity, into light intensity (LIPA; activities that don’t require a lot of effort, but are still active, such as walking and cleaning) and moderate-to-vigorous (MVPA; activities that really make you sweat!) physical activity.

Because the total time in one day equals the sum of sleep, sedentary behavior, LIPA, and MVPA, if you increase time in one behavior, you’ll have to decrease time in another. So if we were able to add a 30 minute jog (that’s MVPA) to our day, what other behavior would we be doing 30 minutes less of? Would that jog replace watching a TV show (sedentary)? Or cleaning the kitchen (LIPA)? Or perhaps going to bed 30 minutes earlier (sleep)?

We know for many years of previous research that MVPA is associated with markers of cardiovascular disease (e.g. waist circumference, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, insulin levels, glucose, and C-reactive protein). It turns out that sleep duration is also related to many of these same biomarkers. Most recently, we have come to realize that sedentary behavior, independent of MVPA, is uniquely associated with these biomarkers as well. But how do all these behaviors fit together? What are the trade-offs, one behavior for another? This was the focus of our analyses. We sought to explore the effects of re-allocating 30 minutes/day from one behavior to another on markers for cardiovascular disease.

To do this we conducted isotemporal substitution models using data from the National Health and Nutrition Examination Survey (NHANES). NHANES is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The program includes an in-person home interview and a laboratory examination in a mobile examination center. By incorporating a complex sampling strategy and weighting system (details can be found on the Centers for Disease Control and Prevention website), a sample that is statistically representative of the entire U.S. population can be created. After removing ineligible persons, 2,185 remained with data for waist circumference and HDL and 923 remained with data for triglycerides and insulin.

We used a statistical technique called isotemporal substitution modeling. These types of models have more commonly been used in studies involving food intake, but we applied this technique to the context of daily behaviors. These models estimate the “substitution association” of reallocating 30 minutes/day from one behavior to another (e.g., reallocating 30 minutes/day of sedentary behavior to 30 minutes/day of MVPA). We also controlled for several other variables to make sure any results were due to the re-allocation of behaviors and not due to the sex, ethnicity, marital status, education, work status, ratio of family income to poverty level, smoking, depressive symptoms, intake of total energy, saturated fat, caffeine, and alcohol; general health rating; previous diagnosis of cancer or malignancy, diagnosis of CVD or diabetes, or current use of diabetic, antihypertensive, lipidemic, or other CVD medication.

What did we find?

We’ve provided a graph that highlights our findings. Briefly, a relative risk < 1 (a marker to the left of the vertical line) indicates that by reallocating 30 minutes/day of one behavior to the other reduced the value  for that cardiovascular risk factor. A marker to the right of the vertical line indicates an increased  value in that risk factor from the reallocation of 30 minutes/day of one behavior to the other.

Impact of 30-minute reallocation of time (Source)

Impact of 30-minute reallocation of time (Source)

It is pretty clear from this graph that by reallocating 30 minutes/day of either sleep, sedentary, or LIPA behaviors to MVPA decreases waist circumference risk (that’s a good thing, as larger waist circumference indicates obesity), increases HDL cholesterol risk (that’s a good thing, because HDL is the “good” cholesterol), decreases triglycerides (that’s a good thing because triglycerides increase risk for obesity), and decreases insulin risk (that’s a good thing, as this is an indicator for diabetes). All good things!

Another interesting finding is that it doesn’t take MVPA to improve health. By reallocating sedentary behavior to LIPA, there was a 1.9% reduction in triglycerides and a 1.4% reduction in insulin levels and reallocating sedentary behavior to sleep resulted in a 2.4% reduction in insulin.

What’s the take home message?
Continue reading »

Category: News, Obesity Research, Peer Reviewed Research, Physical Activity, Sedentary Behaviour | 1 Comment

On due dates (Or: why confidence intervals are often better than means)

A very pregnant woman (not my wife). Image by Nina Matthews.

A very pregnant woman (not my wife). Image by Nina Matthews.

As regular readers will know, my wife is pregnant.  In fact, today is the due date.  As of this writing (2:30 EST), labour has yet to commence.

Throughout the pregnancy, my wife and I have constantly reminded ourselves that the due date is a gross over-simplification.  It’s pretty obvious that it’s a ball-park estimate at best.  And yet, providing a precise date creates some weird psychological tension, even when you know that it shouldn’t be taken too seriously.

For example:

  • If today is the “due date”, does that mean that tomorrow the baby is “over due”?
  • Can the baby spoil, like over due milk?
  • Does it mean there is something wrong with the baby?
  • Seriously: when is this baby going to come out??!?!
  • Etc.

These are all questions that are naturally raised by pronouncing a specific due date, and by repeating it at every appointment over a 9 month period (and by being asked about the due date every time you pass someone in the street).

due dates

Image via spacefem.

This is especially annoying given than only ~10% of women give birth on their actual due date (which is actually quite impressive, given that it’s calculated 6+ months in advance). For a visual representation of what this looks like, check out the above figure compiled from a survey by spacefem (the original figure is interactive, so it’s worth clicking through). While births are most likely right around the due date, that is in no way guaranteed (another very cool interactive figure at spacefem shows that roughly 60% of women give birth within a week of their due date, yet only ~10% give birth on the due date itself)   So everyone knows that the due date is a radical oversimplification, and yet we stick with it.

There is another way

Consider if instead of providing a specific date, a pregnant woman was provided instead with a range of dates.  So rather than giving us a due date of August 19, the doctor could have instead said that there is a 60% chance that the baby will be born between August 12 and 26th.  Or that there is a 95% chance the baby will be born between July 19 and September 19.  You could easily create a figure like the one above, with the actual dates plugged in.

The nerds among us will recognize that I’m suggesting that instead of providing women with a due date in the form of a mean (e.g. one specific date), I’m suggesting they be provided with a 60% or 95% confidence interval.  I personally think it would be much more useful (and more accurate) information, while being arguably more intuitive than the due date, which always seems a bit random and arbitrary to  me.

So if there are any healthcare providers out there, I strongly urge you to try presenting the due date in a different way.  You could even do some A/B testing to see which format women prefer.

And seriously, when is this baby going to come out!??!?


Category: News | 5 Comments

You should workout in jeans (I do)

Appropriate workout clothes (image by Per Ljung)

Appropriate workout clothes (image by Per Ljung)

At various points over the past few years, I have been fortunate to basically have a gym as my office.  I’ve worked near treadmills, exercise bikes, light free weights, and a bunch of machines (bench press, leg press, a chin-up bar, etc).  The gyms have always been for research and data collection, but there were plenty of opportunities for those of us working in the lab to pop out and do a quick set almost anytime we liked.  And it was awesome.

During my time in the lab I would often take a short break to do a set of bench press, chin-ups, or leg press.  And when I had to do some reading (which, as a researcher, is pretty often), I would do it while riding one of the exercise bikes. Most of the time I did all these exercises while wearing my work clothes (typically jeans and a dress shirt or polo shirt).   It felt a bit strange to do bench press while wearing a dress shirt, but it saved soooooo much time.  By the end of the day it was great to know that I didn’t have to spend another 45 minutes working out, as I’d already done a full workout spread throughout the day.  And after an hour or two staring at a computer screen, it feels really good to do something physical for a change.

Why can’t every workplace be like this?  Aside from the obvious fact that most of us don’t work in a gym.  But it wouldn’t be that hard to place a few weight machines within an office building.  Like one of those outdoor gyms you sometime see in parks, but in the break room.  I now work in a traditional office, which is conveniently located in a building beside a gym.  And yet I already do WAY less weight training than I have done in other work environments where workout equipment was never more than a few feet away.

Wouldn’t it be great to walk down the hall and see someone riding a bike while wearing high heels, or doing bench press in a polo shirt?  Wouldn’t you feel better if you could workout during the day, rather than sitting the whole time?  And think of the time it would save (or the extra workouts you would get in).

I realize this is a bit of a pipe dream.  So, for now, I’m saving up all my reading so that I can do it all in batches while I ride the bike at the gym.  And I will close my office door to do push-ups every once in a while without people thinking I’m a weirdo.  Maybe I can fit a chin-up bar behind the door?  Next time you’re bored at work consider trying a little resistance training (assuming it’s safe, of course). I bet you will be glad you did.


Category: Miscellaneous, News | 12 Comments