‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: Shut your pie hole or, in this case: Put less in your pie hole.

Wednesday, August 16, 2017

4 Things to Wrap Your Sugar-Addicted Brain Around

You may have seen the memes floating around about sugar being addictive, don't worry if you haven't, I have one below! Although the thought of sugar addiction isn't new, it is, however, a gross oversimplification and misunderstanding of human biology and neurobiology. Humans are complicated, and science helps us appreciate just how complex the human body, brain, and psychology are.

Let's chow down and break down the science in relation to sugar and addiction.

First of all, addiction to a substance requires diagnosis by a certified professional using a standard set of diagnostic criteria outlined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (the DSM-IV). That's a mouthful, and possibly a risky opening paragraph... If you're still with me, thanks, it gets better.

Here are a few sweet spoonfuls of science to swallow:
  1. Neural reward pathways light up in response to eating... As they do in response to sex, drugs, and a good workout
    • It is actually the act, the behaviour of eating that lights up these pathways, not a substance (eg: sugar)
    • So no, you cannot extrapolate and say that sugar lights up the same pathways as drugs, and therefore sugar is addictive. Again, it's the act of eating a food (not a specific nutrient) that lights up the pathway, and as you'll read in #3 below, addiction and dependence elicit a number of symptoms upon withdrawal that do not occur with sugar
  2. Addiction is a highly complex chronic disease involving brain reward, motivation, memory, and related circuitry, as well as neurochemistry dysfunction... The American Society of Addiction Medicine says so
    • If addiction were a person, its relationship status would be: it's complicated
  3. Opiate withdrawal syndrome in relation to sudden opiate abstinence involves symptoms including hot and cold flashes, nausea, diarrhea, anxiety, restlessness, insomnia.... and then several others you've probably never heard of, so have fun google-ing these: piloerection, diaphoresis, myalgia, arthralgia, emesis, dysphoria, lacrimation, tachypnea, tachycardia, rhinorrhea, and hypertension
    • These withdrawal symptoms are similar for addictions to alcohol, stimulants, and sedatives... But not sugar, you dig?
  4. People often report "cravings" for foods (specifically, kinds of foods that are highly delicious, like chocolate, sweet desserts, or fried food)
    • BUT these people rarely limit their diets to specific nutrients or substances (eg: only eating sugar or fat)
    • AND these cravings are not as intense, frequent, and/or persistent in duration, unlike drug cravings
    • FURTHER, people restricting their intake of desirable foods (eg: chocolate) makes the forbidden food (eg: chocolate) ever so preoccupying. This is often interpreted as a craving and therefore an addiction, but really, collectively it may very well be part of normal eating behaviour. Basically, don't overthink it and make a mountain out of a molehill
Perhaps you're rethinking the sugar addiction thing a little... Maybe? In reality, your addiction might be to social media and sensationalist soundbites.

Back to point #1 about reward centers lighting up when eating, to reiterate: this is in the act, the behaviour of eating. Not in response to the substance or specific nutrient (eg: fat or sugar). Basically, if you really love the food you're eating, this reward system is activated. In my case, the act of eating peanut butter or chocolate, or both.

An offending meme: It looks legit and everything, it uses complex words like "insulin" and "dopamine"...
But there is no scientific link between sugar and addiction. Blood glucose levels dropping after eating any food with carbohydrates is not indicative of addiction, it's indicative of digestion and your body working correctly. 
In my research of this topic, I came across several points I wanted to share with anyone pedalling the idea of sugar addiction:
  • Calling certain foods or nutrients "addictive" implies they possess an inherent property making a susceptible individual addicted to it (which is the case for chemical substance abuse), NOT the case for sugar or fat
    • You are therefore giving food (or a particular nutrient) a "power" it does not have
  • Calling overeating "food addiction" neither explains overeating nor offers strategies for successfully reducing it
    • There is simply not enough evidence to validate or reject "food addiction"
    • Categorising a "food addiction" now, while evidence is insufficient to do so, risks trivialising serious and validated addictions
Just so you know, in recent years the amount of added sugar Americans eat has significantly decreased, mostly because soda consumption has decreased (yay!) BUT, the average American is still eating more sugar than is recommended. And FYI,  <10% of your daily calories should come from sugar, read more on that here.

In summary:
  • There is insufficient evidence of "food addiction" in humans, this includes substances and nutrients in foods like sugar or fat (1, 2, 3, 4, 5, 6)
  • The more correct notion is that people enjoy eating specific kinds of food that are often high in fat and sugar, and that the behaviour stimulates reward centers in the brain
  • These conclusions are not a green light to eat lots of sugary and fatty foods, because there is an mountain of evidence linking excess consumption of these to all manner of chronic diseases and death... just not by way of addiction
  • I love memes as much as the next guy, but they are unscientific sound bites, not facts!
If you're still reading, I've used this meme in other articles and I love it...
But not because it's true.

Wednesday, July 12, 2017

Cocoa and Coffee: Convincingly Cracking Consumables

If you like coffee or chocolate, you'll want to devour this article! We're doing a crossover episode combining two of the most popular consumables in the world into one considerably charming article for your consumption.

It's pretty good news for both the coffee and cocoa lovers, with a couple of minor caveats.

Let's cover coffee first. Two large-scale, long-term studies came out this week. Collectively, they ground... I mean, found:
  • People consuming one cup of coffee/day were 12% less likely to die compared to non-coffee drinkers
  • People drinking two cups of coffee/day were 18% less likely to die compared to non-coffee drinkers
  • People drinking the most coffee had the lowest risk of dying from any disease
  • The ethnically diverse study found the coffee-consuming crowd, whether decaf or regular, had similar positive health effects
  • An inverse association exists between coffee consumption and deaths caused by heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease
    • Meaning, more coffee = lower chance of dying from the above diseases
Here are the coffee caveats that are cause for concern, tamp down your expectations:
  • Paying attention to how hot your brewed beverage is... Scoffing your scorching blend can lead to esophageal cancer
  • Much previous research into coffee found high coffee consumption wasn't actually beneficial for disease prevention and that moderation really was key
  • Akin to deep-frying a vegetable, saucing your coffee with cream, sugar, and syrups won't help your health due to the many side effects of too much sugar and too many calories
Now, onto my favourite... Chocolate. A day that goes by without eating a good quality, dark chocolate is a day wasted (that's my motto.) Okay, okay, I'll tell you about the cocoa hype, but first a little background.

It's long been known that cocoa is rich in flavonoids, particularly the sub-class called flavanols, and more specifically epicatechins and catechins. These flavanols exert cardiovascular benefits including lowering blood pressure and improving blood flow. More recently, we're learning about their neuroprotective effects.

Flavonoids and their metabolites can cross the blood brain barrier and have been found in areas associated with learning and memory such as the hippocampus, cerebral cortex, cerebellum, and striatum. New research found:
  • Consuming a daily high-flavonol drink enhanced cognitive performance in both older people with and without early memory decline
  • Higher flavanol levels also improved blood pressure and insulin resistance
  • Within hours of consuming a high-flavanol beverage, enhanced performance on various cognitive tasks significantly increased
  • Cocoa flavanols were also able to counteract cognitive impairment induced by sleep deprivation in healthy women... Something most mothers of young babies might rejoice about
Cocoa caveats to unwrap include:
  • Research into chocolate and cocoa on human cognition is still young
  • Dose, timing, and kind of flavanol requires further investigation
  • Similar to consuming a deep-fried vegetable, to get the benefit of cocoa flavanols, quality is key
    • The above research used a beverage with about 900mg of cocoa flavanols
    • Flavanol content is largely based on chocolate brand and processing, you can read more on that here and here
  • Choose dark chocolate over milk or white chocolate (let's be honest, if it's not even brown, it's not chocolate)
  • Select unsweetened cocoa powder when making your brownies or hot chocolate rather than presweetened powders like Ovaltine and Swiss Miss, this not only boosts flavanols but also slashes sugar (it's cheaper too)
  • Writing articles about chocolate and coffee increases the writer's consumption of both products
Cheers to you, coffee for decreasing death. And melt mindfully in your mouth, chocolate for marvelous mental mastery.

Thursday, June 15, 2017

The Critical Connection Between Gluten-Free and Eating Disorders

Since the gluten-free craze is still going strong and people are still really excited about it, I thought it was time for another gluten-related article. And yes, this one too is a spirit-crushing, shoulder shaking, face slap for those on the diet for an undiagnosed, non-medically necessary reason.

Let me preface this with the usual disclaimer that people who have been objectively biopsied and have true celiac disease should indeed follow a gluten-free diet. For the rest of you, and particularly other medical professionals, some interesting new research came across my desk recently about the association between celiac disease (CD) and anorexia nervosa (AN).

I know, right? Not what you were expecting. I'll do my best to lighten things up, but this article is on the serious side... Eating disorders aren't funny, but being on an unnecessary restrictive diet is a bit amusing.

Ok, so as it turns out, it appears there is a bidirectional association between celiac disease and anorexia nervosa. Well, what the heck does that mean?
  • A positive relationship between CD and AN, both before and after (bidirectional) CD diagnosis exists
    • Positive in this case ≠ a good thing, positive in this case means CD diagnosis and AN diagnosis increased together (this is a correlation)  
  • CD is associated with a significant two-to-threefold increase in diagnosis of AN and vice versa
    • Meaning having either CD or AN increases the chance of diagnosis with the other condition
Why might this be? The researchers offered several factors that could contribute to this relationship:
  1. Diseases that require dietary restrictions have been associated with AN (like food allergies and type 1 diabetes)
  2. Diseases or self-imposed "diets" can trigger obsessive eating patterns and/or diets with a long-term energy imbalance
  3. The positive association between CD and AN before and after CD diagnosis could be:
    • Because of a misdiagnosis with the other condition
    • Due to a genetic susceptibility - genomewide association studies of AN show genetic regions shared with type 1 diabetes and other autoimmune diseases
What's important here?
  • 1 in 5 Americans restricts gluten daily as a means to "eat healthier", the number is even higher in young females (who are already at a higher risk of eating disorders)
    • These people have no evidence (biopsy) to objectively evaluate the presence of true CD, meaning they are self-diagnosed, or just on the trendy bandwagon
  • Eating disorders often begin with well-meaning, self-imposed diets or attempts to eat healthy
    • This often includes banishing "bad" or "unhealthy" foods
    • Think about your social media channels... how many friends do you have posting about being on this diet, that "cleanse", or this "food challenge" (like no sugar for 30 days)?
      • Read more about these diets and make up your own mind here, here, and here
    • Orthorexia nervosa is the unhealthy obsession with eating healthy foods, see link below to read more
  • CD (or a medically-unnecessary gluten-free diet) requires dietary restriction that could easily become obsessive in susceptible individuals
  • Medical professionals would benefit to understand this association during screenings for patients with either AN or CD
For the rest of you on the gluten-free bandwagon without a medical diagnosis by a proper small intestinal biopsy (having followed the gluten-loading protocol) you might want to consider jumping ship and focus your efforts on just eating a healthier diet all around. Need some eating healthy help and resources? You can get some tips and info here, here, here, and here.

More on eating disorders here.
Read about orthorexia nervosa here.
Read more about gluten-free diets by yours truly:
- Gluten-free and microbiome health (or not)
-Gluten-free eating for the gluten-intolerant
-Why gluten-free doesn't = guilt-free