Health Journal Online

Category: Nutrition

  • How Heavy Is Your Food’s Carbon Footprint? 

    How Heavy Is Your Food’s Carbon Footprint? 

    How much greenhouse gas does the production of different foods cause, measured in miles driven or lightbulb hour equivalents?

    “Our eating habits are making us and the planet increasingly unhealthy—it’s a lose-lose situation.” “A global transformation of the food system is urgently needed.”

    “In consideration of the mounting evidence regarding the environmental effects of foods, in 2015, the [U.S.] Dietary Guidelines Advisory Committee included for the first time a chapter focused on food safety and sustainability.” It concluded that “a dietary pattern that is higher in plant­based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal­based foods is more health promoting and is associated with lesser environmental impact than is the current average US diet.” However, unsurprisingly, “despite unprecedented public support, this and other sustainability language were not included in the final 2015–20 Dietary Guidelines published by the US Department of Health and Human Services and the US Department of Agriculture.”

    The U.S. Dietary Guidelines didn’t even sufficiently stick to the science of healthy eating either. “Many national dietary guidelines do not reflect this evidence on healthy eating and include no or too lax limits for animal-source foods, particularly meat and dairy, despite an opposing evidence base.” Even if it completely ignored planetary health and just stuck to the latest evidence on healthy eating, it would have knock-on environmental benefits. Replacing animal-sourced foods with plant-based ones would not only improve nutrition and help people live longer, but it could reduce greenhouse gas emissions by up to 84 percent.

    In general, “plant-based foods cause fewer adverse environmental effects” by nearly any measure. In terms of carbon footprint, all the foods that are the equivalent of driving more than a mile (1.6 km) per 4 ounces (113 g) served are animal products, as you can see below and at 1:44 in my video Which Foods Have the Lowest Carbon Footprint?.

    Below and at 2:05 in my video, you can see the greenhouse gas emissions from various foods. Even though something like a lamb chop or farmed fish may be the worst, eating chicken causes about five times the global warming than tropical fruit, for instance. What are the climate superstars? Legumes—beans, split peas, chickpeas, and lentils. 

    “For example, in the United States, substituting beans for beef at the national level could deliver up to 75% of the 2020 GHG [greenhouse gas] reduction target and spare an area of land 1.5 times the size of California,” not to mention health benefits. And it isn’t just greenhouse gases. “To produce 1 kg [2.2 lbs] of protein from kidney beans required approximately eighteen times less land, ten times less water, nine times less fuel, twelve times less fertilizer and ten times less pesticide in comparison to producing 1 kg [2.2 lbs] of protein from beef.”

    So, yes, according to the prestigious EAT-Lancet Commission, more plant-based may be better, but even “a shift towards a dietary pattern emphasizing whole grains, fruits, vegetables, nuts, and legumes without necessarily becoming a strict vegan, will be beneficial.” In Europe, for example, researchers found that just “halving the consumption of meat, dairy products, and eggs in the European Union would achieve a 40% reduction in nitrogen emissions, 25–40% reduction in greenhouse gas emissions and 23% per capita less use of cropland for food production. In addition, the dietary changes would also lower health risks,” reducing cardiovascular mortality, which is Europe’s leading cause of death.

    “However, minimizing environmental impacts does not necessarily maximize human health.” Yes, as you can see below and at 3:33 in my video, animal products, including dairy, eggs, fish, and other meat, release significantly more greenhouse gas per serving than foods from plants, but eating added sugar and oil won’t do your own body any favors. 

    In California, including more animal products in your diet requires an additional 10,000 quarts/liters of water each week. So, that’s like taking 150 more showers in seven days. As you can see below and at 4:00 in my video, skipping meat just on weekdays could conserve thousands of gallons of water a week, compared to eating meat every day, as well as cut your daily carbon footprint and total ecological footprint by about 40 percent. 

    Some countries are actually doing something about it. For example, the “Chinese government has outlined a plan to reduce its citizens’ meat consumption by 50%,” whereas much of the rest of the world appears to be doing the complete opposite, pumping billions of taxpayer dollars into subsidizing the meat, dairy, and egg industries, as you can see below and at 4:15 in my video. 

    We can certainly all try to do our part. However, an obstacle to dietary change may be that “consumers underestimate” the environmental impacts of different types of food. Labeling may help. For example, imagine picking up a can of beef noodle soup and seeing the image below, shown at 4:38 in my video.

    The carbon footprint of a single half-cup serving of beef noodle soup is like leaving on a light for 39 hours straight—and not an eco-bulb, but an old-school, 100-watt incandescent bulb. Compare that to eating a meat-free vegetable soup. Between the two, there’s a difference of 34 light-bulb hours, as you can see below and at 4:50 in my video. You can imagine someone getting on your case for unnecessarily leaving on a light for 34 minutes, but this is 34 hours wasted just from eating half a cup (120 ml) of a meaty soup rather than a meat-free vegetable soup. 

    This is the second in a three-video series. If you missed the first one, check out Friday Favorites: Win-Win Dietary Solutions to the Climate Crisis. Stay tuned for Which Diets Have the Lowest Carbon Footprint?. Also check: Friday Favorites: Which Foods and Diets Have the Lowest Carbon Footprint?.

    For more, see my older video Diet and Climate Change: Cooking Up a Storm and a [digital download] on using plant-based or cultivated meat as a climate (and pandemic) mitigation strategy. 



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  • Gut Health Month 2025 | Dietitian Connection

    Gut Health Month 2025 | Dietitian Connection

    Inside Your Complete Guide to Gut Health Month, you’ll find everything you need to dive into this year’s campaign, plus a full set of practical gut health resources for your practice.

    More information and resources are on the way, so keep an eye out for updates!

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  • Eating to Fight the Climate Crisis 

    Eating to Fight the Climate Crisis 

    The EAT-Lancet Commission lays out the best diet for human and planetary health.

    “Scientists have a moral obligation to clearly warn humanity of any catastrophic threat and to ‘tell it like it is.’” In November 2019, more than 11,000 scientists from 150 countries declared “clearly and unequivocally that planet Earth is facing a climate emergency.” As you can see in a series of graphs starting at 0:33 in my video Win-Win Dietary Solutions to the Climate Crisis, CO2 levels are rising and the glaciers are melting, as is Antarctica. The oceans are getting hotter, and more acidic. Sea levels are rising, and extreme weather events are escalating. Yes, the use of fossil fuels is going up, for air travel, for example, but so is per capita meat consumption. In fact, one of the solutions offered by scientists to help the climate crisis is “eating mostly plant-based foods while reducing the global consumption of animal products….”

    What makes “designing a sustainable diet” so easy is that “the dietary advice is the same: eat less meat.” It’s good for our personal health (by reducing the risk of our number one killer, for instance), as well as planetary health. As you can see below and at 1:24 in my video, the least healthy foods also cause the worst environmental impact. 

    Indeed, the foods with the most nutrition just so happen to be the foods that cause the lowest greenhouse gas emissions, as shown below and at 1:31 in my video, so the effect is a win-win. 

    Let’s put it all together. If we are to “redesign the global food system for human and planetary health,” which is to say human health, planetary health, and future human health, what would it look like? Enter the EAT-Lancet Commission. What was the “result of more than 2 years of collaboration between 37 experts from 16 countries”? Suggesting a cut in total meat consumption down to no more than an ounce a day (28 g), which is around the weight of a single chicken nugget, and, concurrently, a dramatic increase in our intakes of legumes (beans, split peas, chickpeas, and lentils), vegetables, nuts, and fruits. We aren’t only in a climate crisis, but a health crisis, too. “Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined.” But we can address both crises at the same time by “increasing consumption of plant-based foods and substantially reducing our consumption of animal source foods.”

    Eating such a diet could save the lives of more than 10 million people a year. It may also help save the world. The Paris Agreement had set out a boundary condition, an aspirational goal for a carbon budget to help prevent catastrophic impacts. “Staying within the boundary for climate change can be achieved by consuming plant-based diets.”

    What’s more, “the economic value of the health benefits associated with more plant-based diets is comparable with, or exceeds, the value of the environmental benefits….” Just the healthcare benefits alone of a healthy global diet that’s predominantly plant-based, vegetarian, or vegan could exceed the price of the carbon saved, as you can see below and at 3:11 in my video. We’re talking up to $30 trillion a year saved from just the health benefits of more healthful eating. 

    Now, if the health of yourself, the planet, and your loved ones doesn’t quite motivate you, consider you may also be facing threats to the global beer supply. The title of the paper tells the story: “Decreases in Global Beer Supply Due to Extreme Drought and Heat.”

    And healthier diets don’t just reduce greenhouse gas emissions. “Livestock production is the single largest driver of habitat loss,” so reducing meat consumption is also the key to biodiversity conservation. Researchers “suggest…reducing demand for animal-based food products and increasing proportions of plant-based foods in diets, the latter ideally to a global average of 90% of food consumed.” As well, “livestock production is also a leading cause of climate change, soil loss, and water and nutrient pollution,” yet it appears to be “a blind spot in water policy.” “Despite the fact that animal products form the single most important factor in humanity’s WF [water footprint], water managers never talk about meat or dairy.”

    It isn’t only animal products, though. Yes, at least 80 percent of the deforestation in the Amazon is to raise cattle and grow feed crops like soybeans to export to other farm animals, but it’s also to make vegetable oil, mostly from palm and soy. Both crops have been expanding, “resulting in massive deforestation accompanied by declines in biodiversity and the release of sequestered carbon into the atmosphere…It will be particularly egregious if that deforestation takes place for the sake of junk food….”

    Not everyone agrees that we should be moving to healthier diets, though. The World Health Organization actually pulled out of the EAT-Lancet Commission that “promotes global move to plant-based foods.” See, if we “focused on promoting predominantly plant-based foods, and excluding foods deemed unhealthy, including meat and other animal-based foods,” such a diet could save 10 million lives a year and $30 trillion in healthcare costs, and help save the entire planet, but it “could lead to the loss of…jobs linked to animal husbandry and the production of ‘unhealthy’ foods….”

    So Which Foods Have the Lowest Carbon Footprint? Find out next, then stay tuned for Which Diets Have the Lowest Carbon Footprint?.

    Before this video, I think the only global warming video I had to date was Diet and Climate Change: Cooking Up a Storm. I’m pleased I could add to this important topic.

    One way to reduce the climate impact of meat is to switch to plant-based or cultivated meat. I did a webinar on it, and you can get the digital download here.



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  • Confidence and storytelling in science

    Confidence and storytelling in science

    How can dietitians effectively communicate ever-evolving nutrition science and guidelines while maintaining public trust? In this episode, food and nutrition scientist Dr Emma Beckett unpacks the art of communication, emphasising the importance of ‘sticky stories’ to make complex scientific concepts relatable and easy to understand. Using the humble egg as a case study for storytelling, Emma highlights strategies for addressing common misconceptions, including concerns about fat content, cholesterol and pregnancy safety, without triggering the ‘backfire effect’. We also explore how dietitians can effectively cut through misinformation on social media to empower clients with engaging evidence-based guidance.​​

    Hosted by Brooke Delfino

    Biography

    Known as the “Dynamic Foodie” at FOODiQ Global, Dr Emma Beckett combines her diverse education and experience across food, nutrition, biomedical sciences, epidemiology, academia, industry and science communication to drive positive changes in the world through food. Her aim is to empower people to interpret food and nutrition information so that they can make informed choices without fear or judgment, and to empower health professionals to use the evidence-base to diversify and update their toolkits for use on the same mission. She has won several research and communications awards, including being named as a NSW Young Tall Poppy in 2017.

    In this episode, we discuss:

    • Why it’s important to acknowledge the journey of changing science​
    • How storytelling can make communicating scientific facts more effective ​
    • Using anecdotes for their power of persuasion​
    • The backfire effect (and how to avoid it) ​
    • The importance of starting new nutrition conversations ​
    • Tips for better translating up-to-date nutrition science for better translating up-to-date nutrition science

    Additional resources

    Sign up here for research updates and resources from Australian Eggs, shared straight to your inbox every two months.​

    Supported by

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.

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  • Junk Food in Hospitals 

    Junk Food in Hospitals 

    Why is hospital food so unhealthy?

    “Put in stark terms, CVD [cardiovascular disease] claims 1 American life every 39 seconds and is responsible for more deaths annually than cancer, chronic lower respiratory disease, and accidents combined.” For most heart attack deaths, you just keel over. Sudden cardiac death “is the first manifestation of CHD [coronary heart disease] for the majority of individuals, particularly among women.” So, “for many of these sudden death victims, their demise was the first indication of the presence of coronary heart disease.” They didn’t even know they had heart disease. That’s why an ounce of prevention is worth way more than a pound of cure—because there is no cure for death.

    That’s also why the prevention of sudden cardiac death “remains a major public health challenge” because most people don’t even know they’re at risk. However, we’ve known for more than half a century, when we first started autopsying young servicemen who died during the Korean War, that coronary artery disease begins in our youth, even among young children. So, “business as usual…simply is not going to yield the improvements necessary to radically improve the CV [cardiovascular] health of the United States” and around the world.

    There is good news, though. A “low-risk lifestyle (not smoking, exercising regularly, having a prudent diet, and maintaining a healthy weight)” may be able to eliminate the vast majority of the risk for sudden cardiac death. “The time is now long overdue to start aggressive preventive cardiovascular disease programs in our schools, our homes, and our worksites.” How about starting in our hospitals?

    As I discuss in my video Hospitals Profit on Junk Food, a significant percentage of hospitals surveyed had fast-food restaurants inside them, with Krispy Kreme topping the list. Brilliant marketing, given that “families surveyed at the hospital with McDonald’s were…twice as likely to think McDonald’s was healthy, as compared to families at the hospitals without McDonald’s.” After all, McDonald’s was in the hospital.

    What about food served in hospital cafeterias? Any better? Researchers analyzed 384 entrees from 14 children’s hospitals in California, and only 7 percent “were classified as healthy.” And, just in case someone chose the rare healthy option, 81 percent of eating venues in children’s hospitals had junky “high-calorie impulse items, such as ice cream freezers, cookies, and candy, at or near the checkout register” and 38 percent “had signs encouraging unhealthy eating.” Why would they do that?

    If you ask hospital cafeteria managers, “less than a quarter (4 of 17) of respondents reported that the hospital followed nutrition standards for food offered in the cafeteria.” “Nutrition is not a top priority.” It’s the same reason unhealthy food is sold anywhere else: “pressure on food service departments for cafeterias to generate profit.”

    “Increased emphasis…[is] placed on running a hospital foodservice department as a profit center”—a bigger and “bigger profit center,” that is. It’s such a metaphor for our sickness-care system in general, where healthy, treat-the-cause approaches are eclipsed by the pills and procedures that bring in the most money.

    What do you expect from the private sector? Public hospitals don’t seem to be much better. A 2019 analysis of veterans’ hospitals found that “all VA Hospitals contain vending machines providing a majority of soda, candy, and junk foods that directly conflict with healthy food choice recommendations from US governing health bodies,” such that, ironically, “hospital visits could theoretically promote worse health….An important question that should be posed is why are any soda or candy machines available at our VA hospitals? Are we trading the health of our veterans for profits?”

    Maybe it’s time to ban junk food on hospital premises. “On daily rounds, it is appalling to see patients…gorging on crisps [potato chips], confectionery [candy], sports drinks, and cola—the very food items that may have contributed to their admission in the first place…It is obscene that many hospitals continue to have…fast food franchises on site, as well as corridors littered with vending machines selling junk food. Such practice legitimizes the acceptability and consumption of such foods in the daily diet…The obesity epidemic represents a public health crisis, but it is a public health scandal that by legitimizing junk food hospitals have themselves become a risk factor for diet-related disease by perpetuating the revolving door of healthcare…It’s time to stop selling sickness on the hospital grounds.”

    What message do residents receive when they are fed pizza and soda at grand rounds? We need a healthcare system with “more Hippocrates, less hypocrisy.”

    For more on how the profit motive is degrading our health, see related posts below.



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  • Dietitian to Dietitian | Dietitian Connection

    Introducing Dietitian to Dietitian– our accredited webinar series hosted by Joy Bauer, NBC’s Today Show nutrition and health expert, where we delve into different ideas and perspectives on some of the hottest topics in dietetics.

     

    US dietitians: 1.0 CPEU from CDR per episode (see individual pages for details).

    CPD/CEU hours are applicable for Australia and New Zealand dietitians. Check your local country requirements to see if you can claim for continuing education. 

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  • Celebrating Native American Cuisine with Chef Lois Ellen Frank, Ph.D.

    Celebrating Native American Cuisine with Chef Lois Ellen Frank, Ph.D.

    Meet Chef Lois Ellen Frank, Ph.D. We had the pleasure of talking with Dr. Frank about her work, food, and Native American cuisine. Read on and enjoy her recipe for Delicious Pinto Bean and Spinach Tacos.

     

    Please tell us a little about yourself and your work.

    My name is Lois Ellen Frank, and I am a Santa Fe, New Mexico-based chef cooking alongside Chef Walter Whitewater at Red Mesa Cuisine, LLC, a small catering company specializing in Native American cuisine. We focus on Indigenous Cuisine and Cultural Education, and work on the revitalization of ancestral Native American cuisine. We incorporate a modern twist and prepare foods using ingredients focused on health and wellness. Together, we have been working with communities in the Southwest for more than 30 years. Our newest cookbook, Seed to Plate, Soil to Sky: Modern Plant Based Recipes Using Native American Ingredients, was released in the fall of 2023 and focuses on The Magic Eight, eight plants that Native Peoples shared with the world. We also work with the Physicians Committee for Responsible Medicine (PCRM) on The Power to Heal Diabetes: Food for Life in Indian Country program, which uses the ancestral Native American diet for health and wellness in Native American communities throughout the United States to re-indigenize, revitalize, and re-introduce healthy ancestral foods back the diet. (Learn more at www.nativepowerplate.org.)

    Can you please discuss the re-indigenizing food movement in the Native American community? How can this promote better health and wellness?

    By using healthy foods from the ancestral past, including The Magic Eight (corn, beans, squash, chiles, tomatoes, potatoes, vanilla, and cacao), and increasing the amount of plant-based foods in the current Standard American Diet (SAD), the Native American foods movement works towards reclaiming ancestral foods for wellness; revitalizing traditional cooking techniques and recipes associated with them; educating and teaching children, teens, college students, and adults about the importance of traditional foods and the role they play in health and wellness; developing well-rounded culinary professionals in both the theory and technique of cuisine; developing specialized workshops tailored toward individual and group needs that include (but are not limited to) health, nutrition, team-building, youth development, and technical skill enhancement, as well as other social and professional development; creating an awareness of traditional and contemporary Native American culinary customs and technologies that include concepts of sustainable agriculture, health, and nutrition; and emphasizing how the health benefits of an ancestral plant-based diet can improve health and connect community members to healthy ancestral foods.

    Can you please tell us about The Magic Eight? What are they, and what is the history of these foods? 

    The Magic Eight are eight plants that Native Peoples gave to the world: corn, beans, squash, chiles, tomatoes, potatoes, vanilla, and cacao. Prior to 1492, these plants existed only in the Americas. Once these plants were introduced to cultures of the world outside of the Americas, their cuisines were changed forever. And these eight plants, now found in almost every cuisine all over the world, are inherently Native American, an important part of our cuisine, and the foundation to the foods we cook at Red Mesa Cuisine. Think about this: The Italians didn’t have the tomato until after 1492. The Irish didn’t have the potato. In Britain, they had fish, but no chips. The Russians didn’t have the potato, nor did they have distilled spirits from the potato. There were no chiles in any East Indian cuisine dishes, including curries, and no chiles existed in any Asian cuisines at all. As a matter of fact, chiles weren’t introduced into South Asia until the 1500s when they would come to dominate the world spice trade in the sixteenth century. Vanilla and cacao weren’t used in any confection dishes prior to 1492. The world cuisines as we know them today were completely different!

    How were these Magic Eight foods used in Native American cuisine historically versus in modern-day cuisine?

    These foods were used in a variety of ways. Corn, beans, and squash were (and still are) often served together. Chef Walter thinks of them as a family. They are grown together and eaten together. Chiles, tomatoes, and potatoes were also often used together in the past, as they are today, as their flavors work well together and they are nightshade plants. Vanilla and cacao are considered to be the sweet sisters and are often paired together. In our cookbook Seed to Plate, Soil to Sky, we have shared some very traditional ancestral recipes featuring these eight amazing plants and introduced some new and creative ways to eat them in both savory and sweet dishes.

    Is there a way that local food systems can be better supported so more of these plants can become cultivated and accessible?

    We are very blessed in New Mexico. There are lots of farmers in Northern New Mexico where I live, and they grow many varieties of corn, beans, squashes, chiles, tomatoes, and potatoes, so it is easy for someone living here to purchase many of these plants and incorporate them into their diets. It’s also easy to grow your own garden here, even in a small space. Buying from the local Santa Fe farmers market helps to support the farmers and perpetuate the growing of these important crops. And, more and more Native American communities are implementing gardens for their community members and growing traditional varieties of these amazing plants, making these foods accessible and affordable to those who really need them. Programs such as WIC, SNAP-Ed, and FDPIR are including New Mexico-grown produce as part of their distribution programs, and Chef Walter and I are working hard to teach people how to use the plants in delicious and nutritious dishes.

    Are there other lesser-known plants that are used in Native American cuisine that you would like to highlight?

    Native American cuisine is regional, so a plant that is common to one community in one region of the United States might not be common in another. It also depends on what grows in each region. For instance, wild rice grows in the lake regions and is a very important and sacred food to the communities living there. Where I live, wild plant foods play an important part of the diet. I love to eat wild lettuces and spinach, wild purslane, and edible flowers. There are many herbs from this region that play an important part in this cuisine––both wild and cultivated plants. I think the more plants, the better. I love plants, and Chef Walter and I try to honor the plants and eat seasonally when they are available. We also use culinary ash to increase the nutrients and minerals in some of our corn dishes.

    What does Native American Heritage Month mean to you?

    That’s a tough question. Food to me is medicine. I try to practice gratefulness and appreciation for the bounty of foods and plants in my life everyday––not just one month a year. But, if people can appreciate the plants that Native Americans shared with the world and honor the Native American contribution to the foods we eat every day, then that makes me happy. Many people are unaware of the contribution Native Peoples have made to the foods we eat each day, including corn, beans, squash, chiles, tomatoes, potatoes, vanilla, and cacao. When these foods are prepared in a healthy way and the Traditional Ecological knowledge (TEK) surrounding these plants is revitalized, then so is everything associated with them. And when people are fed these foods, they are nurtured, and the knowledge and importance of this ancestral knowledge is honored.

    Delicious Pinto Bean and Spinach Tacos

    This recipe, adapted from Seed to Plate, Soil to Sky, is a wonderful combination of fresh spinach greens sautéed with cooked beans. It is easy to make for a healthy and nutritious meal. I use organic spinach, which is now readily available, and if I don’t want to cook a whole pot of fresh beans, organic canned pinto beans from the grocery store.

    • 2 teaspoons of Roasted Garlic (approximately 8 cloves)
    • 3 medium Roma tomatoes, diced (approximately 1 cup)
    • ½ large white onion, diced (approximately 2/3 cup)
    • 3 cups coarsely chopped fresh spinach
    • 1½ cups cooked pinto beans or one 15.5 oz can
    • Pinch of freshly ground black pepper

     

    Heat a small cast iron skillet over high heat until hot. 

    Prepare the Roasted Garlic. 

    Heat a medium- to large-sized cast iron pan over medium-high heat until it is hot, then add the Roasted Garlic, tomatoes, and onion, and cook for 2 to 3 minutes, stirring constantly to prevent burning. Add the spinach, and cook for another 2 minutes. Then, add the pinto beans and a pinch of black pepper, and cook for 2 minutes, stirring constantly to prevent burning.

    Serve in your favorite corn or flour tortillas. (I like this dish with either corn tortillas or gordita-sized flour tortillas.)

    Top with freshly made pico de gallo salsa and homemade guacamole, if desired. Serve immediately.

    Makes 6 tacos.

    You can find Chef Lois Ellen Frank here.

     



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  • Cannabis and Cars 

    Cannabis and Cars 

    Did traffic fatalities increase or decrease after cannabis legalization?

    Is cannabis-impaired driving a public health and safety concern? Well, the number of tickets for cannabis-impaired driving went up in Washington State after legalization, as did the proportion of drivers in fatal car crashes in Colorado who tested positive for marijuana use. But, in both cases, this “may simply reflect a general increase in marijuana use” overall. It doesn’t mean that cannabis is causing the crashes, as I discuss in my video The Effects of Marijuana on Car Accidents.

    There is a lot of evidence correlating marijuana use with car accidents, but who uses marijuana? Mostly young people and males. And guess who has a higher crash risk regardless of what they smoke? Young people and males. However, even taking that into account, it does seem that “roughly 20–30% of traffic crashes involving cannabis use occur because of the cannabis use.” But, to put that in perspective, that number is more like 85 percent when it comes to alcohol.

    Aren’t cannabis crashes low-velocity fender-benders from an impaired driver going like five miles an hour? “After a systematic review of the literature,” a compilation of studies “examining acute cannabis consumption and motor vehicle collisions…found a near doubling of the risk of a driver being involved in a motor vehicle collision resulting in serious injury or death.” So, that’s pretty serious, but alcohol is even worse. Cannabis may double or triple the risk of car crashes, but alcohol may multiply the risk 6- to 15-fold. The combination may be even worse—25 times the odds of a fatal car crash involvement when testing positive for both cannabis and alcohol.

    The “safety consequence of increased incidence of cannabis intoxication” when driving is listed as one of the “three primary reasons for concern about legalized cannabis….” Well, what happened in the U.S. states where marijuana was legalized? How much did traffic fatalities go up? They didn’t. In fact, they went down. What? “Why does legalizing medical marijuana reduce traffic fatalities?” Because of reduced alcohol consumption. It was found that “the legalization of medical marijuana is associated with reduced alcohol consumption, especially among young adults.” So, there was more drugged driving, but less drunk driving—and drunk driving is so much worse that fatalities went down overall.

    So, perhaps we’d also see less liver disease and less alcohol-induced brain damage, as cannabis substitutes for some of the alcohol use. Indeed, researchers argued that “cannabis was unlikely to produce as much harm as alcohol because, unlike alcohol, cannabis did not cause liver and other gastrointestinal diseases, it was not fatal in overdoses, it did not appear to be as neurotoxic as alcohol, and it was not as potent a cause of car crashes as alcohol.”

    “The health problems reported by cannabis dependent persons—e.g. bronchitis and impaired memory—are much less serious on average than those reported by persons who are alcohol dependent (e.g. delirium, liver disease, gastritis) but this does not mean that cannabis dependence is a minor problem.” When public health authorities bring that up, though, they may be criticized. In the 1940s and 1950s in the United States, for instance, after the repeal of Prohibition, we needed to warn people about the problems of heavy drinking, liver cirrhosis, and alcoholism, but some dismissed the concerns as if they were just “temperance propaganda.” We now see a similar situation, where the public health profession wants to educate people about the adverse health effects of cannabis but is dismissed as “reefer madness” hysterics.

    Still, it’s important to put these adverse health effects in perspective. How does the safety of cannabis stack up against alcohol and tobacco? According to the Centers for Disease Control and Prevention (CDC), “alcohol is linked to approximately 88,000 deaths per year,” whereas “there are no reported deaths due to cannabis.” (They’re from things like car accidents.) What’s more, they even go down when more people smoke pot because alcohol is so much worse. “With hindsight, we can clearly see the enormous problems that have been caused to many individuals and to society by tobacco and alcohol”—both legal drugs. “If asked to decide today which psychoactive drugs should be legal, cannabis (which rarely kills people) might well be judged as being comparatively benign” and may be much higher on the list.

    I have many other videos on cannabis if you’re interested. Check out the related posts below.

    I first released these videos in a webinar, and you can find them all on a digital download here.



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  • A Look at Bariatric Surgery

    A Look at Bariatric Surgery

    Obesity isn’t new, but the obesity epidemic is. We went from a few corpulent queens and kings, like Henry VIII and Louis VI (known as Louis le Gros, or “Louis the Fat”), to a pandemic of obesity, now considered to be perhaps the direst and most poorly contained public health threat of our time. Today, 71 percent of American adults are overweight and 40 percent of men and women appear to have so much body fat that they can be classified as obese, and there’s no end in sight.

    In 2013, the American Medical Association voted to classify obesity as a disease against the advice of its own Council on Science and Public Health. Disease implies dysfunction, but bariatric drugs and surgery are not fixing physiological malfunction. Our bodies are just doing what they were designed to do in the face of excess calories. Rather than some sort of disorder, weight gain may largely be a normal response, by normal people, to an abnormal situation. And with more than 70 percent of Americans now overweight, it’s literally normal.

     

    What Is Bariatric Surgery?

    Bariatric surgeries involve changing our digestive system to facilitate weight loss. As discuss in my video The Mortality Rate of Bariatric Weight Loss Surgery, the use of bariatric surgery has exploded from about 40,000 procedures, noted in the first international survey in 1998, to now hundreds of thousands performed every year in the United States alone. The first technique developed, the intestinal bypass, involved carving out about 19 feet of intestines.

    The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of stomach is left, so as to restrict how much food can be eaten at any one time. Bariatric surgery can be thought of as a form of internal jaw wiring.

    Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging our anatomy to bypass the first part of our small intestine. It appears to be more effective than just cutting out most of the stomach. It results in a loss of about 63 percent of excess weight, compared to 53 percent with a gastric sleeve.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure.

     

    Is Weight Loss Sustainable After Bariatric Surgery?

    As discussed in my video How Sustainable Is the Weight Loss After Bariatric Surgery, bariatric surgery may result in weight loss, but most patients end up regaining some of the fat they lose over the first year or two after surgery, but five years later, three-quarters maintain at least a 20 percent weight loss.

    The typical trajectory for someone who starts out obese at 285 pounds, for example, would be to drop to an overweight 178 pounds two years after bariatric surgery, but then regain back up to an obese 207 pounds. This has been chalked up to “grazing” behavior, where compulsive eaters may shift from bingeing, which becomes more difficult post-surgery, to eating smaller amounts constantly throughout the day. Eight years out, about half of gastric bypass patients continue to describe episodes of disordered eating. As one pediatric obesity specialist described, “I have seen many patients who put chocolate bars into a blender with some cream, just to pass technically installed obstacles” [like a gastric band].

     

    Does Bariatric Surgery Cure Diabetes?

    As I discuss in my video Bariatric Surgery vs. Diet to Reverse Diabetes, after bariatric surgery, about 50 percent of individuals with diabetes and obesity, as well as 75 percent with diabetes and super-obesity, go into remission, meaning they have normal blood sugars on a regular diet off all diabetes medications. Are we sure it was the surgery, though?

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to first undergo an identical period of caloric restriction, but without the surgery. They were placed in the hospital and put on the same diet they would be on immediately before and after the surgery for ten days, averaging less than 500 calories a day to mimic the surgical situation. Then, the researchers waited a few months so the patients would gain back the weight and then put them through the actual surgery, matched day-for-day to the diets they were on before. So, the same patients and the same diets, just with or without the actual surgery.

    If there were some sort of metabolic benefit to the anatomical rearrangement, they would have done better after the actual surgery, but in some ways they actually did worse. The caloric restriction alone resulted in similar improvements in blood sugar, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. So, the surgery seemed to put them at a metabolic disadvantage.

    The caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver, which then spills over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it causes insulin resistance. The liver attempts to offload some of the fat, which then gets stuck in the pancreas, and can kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough negative caloric balance can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the liver stops spitting out fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal intake and still keep your diabetes at bay. The bottom line is that type 2 diabetes is reversible with weight loss, if you catch it early enough.

     

    Reasons Not to Have Bariatric Surgery

    More than 30,000 intestinal bypass operations were performed before “catastrophic,” “disastrous outcomes” were recognized. This included protein deficiency-induced liver disease, which often progressed to liver failure and death. This inauspicious start is remembered as “one of the dark blots in the history of surgery.”

    Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to 1 in 500 patients. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new surgical procedures don’t require premarket testing or, in the United States, for instance, Food and Drug Administration approval, and they are largely exempt from rigorous regulatory scrutiny.

    What’s more, up to 25 percent of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery, as discussed in my video The Complications of Bariatric Weight-Loss Surgery. And re-operations are riskier, carrying around ten times the mortality rate, and offer no guarantee of success. Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Complications risk plateaus after about 500 cases, with the lowest risk found among surgeons who’ve performed more than 600 bypasses. The risk of not making it out alive may be double under the knife of those who’ve done less than 75, compared to more than 450. So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. This includes more than a little anemia, osteoporosis, or hair loss, but full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage, which can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is on purpose for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories, but at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Indeed, vomiting is reported by up to 60 percent of patients after bariatric surgery due to “inappropriate” eating behaviors (in other words, trying to eat normally). The vomiting helps with weight loss similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods as they bypass your stomach and dump straight into the intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.”

    Colorectal cancer appears to be the only malignancy for which the risk goes up after obesity surgery. After bariatric surgery, the rate of rectal cancer death may triple. The rearrangement of anatomy involved in one of the most common surgeries—gastric bypass—is thought to increase bile acid exposure along the intestinal lining. This causes sustained pro-inflammatory changes even years after the procedure, which are thought to be responsible for the increased cancer risk. In contrast, losing weight by dietary means has the potential to decrease obesity-related cancer risk across the board.

     

    Bariatric Surgery and Mental Health

    As you can imagine, weight regain after surgery can have devastating psychological effects, as patients may feel they failed their last resort. This may explain why bariatric surgery patients are at a high risk of depression and suicide.

    Now, severe obesity alone may increase risk of suicidal depression, but even at the same weight, those going through surgery appear to be at higher risk. At the same BMI, age, and gender, bariatric surgery recipients have nearly four times the odds of suicide compared with counterparts not undergoing the procedure. Most convincingly, before-and-after mirror-image analyses show the risk of serious self-harm increases post-surgery among the same individuals.

    About 1 in 50 bariatric surgery patients end up killing themselves or being hospitalized for self-harm or attempted suicide, and this only includes confirmed suicides, excluding masked attempts such as overdoses of “undetermined intention.” Bariatric surgery patients also have an elevated risk of accidental death, though some of this may be due to changes in alcohol metabolism. Give gastric bypass patients two shots of vodka, and because of their altered anatomy, their blood alcohol level shoots up past the legal driving limit within minutes. It’s unclear whether this plays a role in the 25 percent increase in prevalence of alcohol problems noted during the second postoperative year.

    Even those who successfully lose their excess weight and keep it off appear to have a hard time coping. Ten years out, although physical health-related quality-of-life improves, general mental health tends to significantly deteriorate, compared to pre-surgical levels even among the biggest losers. Ironically, there’s a common notion that bariatric surgery is for “cheaters” who take the easy way out by choosing the “low-effort” method of weight loss.

    Shedding the pounds may not shed the stigma of even prior obesity. Studies suggest that in the eyes of others, knowing someone was fat in the past leads them to always be treated more like a fat person. And there’s a strong anti-surgery bias on top of that, such that those who choose the scalpel to lose weight are rated most negatively (for example, being considered less physically attractive). One can imagine how remaining a target of prejudice even after joining the “in-group” could potentially undercut psychological well-being.

     

    Who Is a Good Candidate for Bariatric Surgery?

    A body gaining weight when excess calories are available for consumption is behaving as it should. Efforts to curtail such weight gain with drugs or surgery are not efforts to correct an anomaly in human physiology but rather to deconstruct and reconstruct its normal operations at the core. Critics have pointed out this irony of surgically altering healthy organs to make them dysfunctional (“malabsorptive”) on purpose, especially when it comes to operating on children. Bariatric surgery for kids and teens is becoming widespread and performed on children as young as five years old. Surgeons defend the practice by arguing that growing up fat can leave emotional scars and “lifelong social retardation.”

    Promoters of preventive medicine argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, a proponent of pediatric bariatric surgery said, “It is often pointed out that we should focus on prevention. Of course, I agree. However, if someone is drowning, I don’t tell them, ‘You should learn how to swim’; no, I rescue them.”

    A strong case can be made that the benefits of bariatric surgery far outweigh the risks if the alternative is remaining morbidly obese, which is estimated to shave off up to 13 years of one’s life. Although there are no data from randomized trials yet to back it up, compared to obese individuals who hadn’t been operated on, those getting bariatric surgery would be expected to live significantly longer on average. It’s no wonder surgeons consistently frame the elective surgery as a life-or-death necessity, but the benefits only outweigh the risks if there are no other alternatives.

     

    False Advertising

    Bariatric surgery advertising is filled with happily-ever-after fairytale narratives of cherry-picked outcomes offering, as one ad analysis put it, “the full Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they’ll lose with the procedure and underestimate the difficulty of the recovery process. Surgery forces profound changes in eating habits, requiring slow, thoroughly chewed, small bites. Your stomach goes from the volume of two softballs down to the size of half a tennis ball in stomach stapling, and half a ping-pong ball in the case of gastric bypass or banding.

    “Even if surgery proves sustainably effective,” wrote the founding director of Yale University’s Prevention Research Center, “the need to rely on the rearrangement of our natural gastrointestinal anatomy as an alternative to better use of feet and forks”—that is, exercise and diet—“seems a societal travesty.”

    Might there be a way to lose weight healthfully without resorting to the operating table? Yes, a whole food, plant-based diet.



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  • Clinical dietetics to aged care leadership

    Clinical dietetics to aged care leadership


    Charlene Grosse is a WA-based dietitian whose impressive career journey has taken her from clinical roles to senior leadership in aged care. Now, as General Manager of Residential Care, Charlene is focused on improving the quality of care in aged care settings, with expertise in service development, team leadership and regulatory compliance. In this episode, she shares her career evolution, the challenges of stepping into leadership, and and how she sees the recent aged care reforms affecting the day-to-day role of dietitians in this space. Whether you’re considering a career change or looking to navigate the evolving aged care landscape, Charlene’s story will offer plenty of inspiration and practical takeaways.

    Hosted by Rebecca Sparrowhawk

    Biography

    Charlene Grosse is a dedicated healthcare leader who has an impressive path in the health sector since her graduation as a dietitian in 2001. Beginning her career in clinical dietetics within a large private hospital, Charlene quickly advanced to allied health service development overseeing a variety of allied health services. With a wealth of leadership and management experience, she has successfully built and led high-performing teams, navigated complex health funding structures, managed patient length-of-stay, and ensured compliance with quality accreditation standards. Charlene holds a Master’s in Healthcare Management and is nearing completion of her PhD research, focusing on inflammatory bowel disease (IBD). Recently, she took on a new challenge as General Manager in residential aged care, where her commitment to growth and development, driving positive change, and making a difference in the lives of others reflects her dedication to quality care.

     

    In this episode, we discuss:​

    • The key skills that have supported Charlene’s transition into senior roles
    • How transitioning from hospitals to aged care shifted Charlene’s approach to patient care
    • Insights into the latest aged care reforms and how they will impact dietitians​​

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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