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Weight Bias in Health Care

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Please note: This blog and its accompanying video discuss the important and troubling issue of weight bias and discrimination, which may be a sensitive topic for some readers. How common is weight stigmatization in health care? Described as the last “acceptable” form of bias, weight stigma is the rampant discrimination and stereotyping of overweight individuals. Fifty overweight women were asked to keep a diary of all the times they felt they were being stigmatized for their weight. Over a single week, more than a thousand instances were recorded. An overweight woman may expect to be harassed (such as being called names or insulted), run into physical barriers (like being unable to fit into public seats), or discriminated against (such as receiving perceived poorer service at restaurants or stores) on average about three times a day. Obese men report three times less discrimination than women of the same size, so it may be only a daily occurrence for them. They’re not just being ...
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Nuts, Meat, and the Flaw in Nutrition Studies

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Do people who eat nuts live longer simply because they replace protein from animals with protein from plants? The American Journal of Clinical Nutrition “ is the highest-ranked peer-reviewed scientific journal in nutrition and dietetics.” That should tell you a lot about the field, since it’s published by the American Society of Nutrition, whose sustaining partners include The Sugar Association, soda companies, and the meat, dairy, and egg industries. This is the highest-ranked nutrition journal! The fact that the National Cattlemen’s Beef Association is a sustaining partner may help explain its publication of an article that claimed eating red meat “does not negatively influence cardiovascular disease risk factors.” Imagine you’re in the pocket of Big Beef and Big Pork. How could you possibly pull off a meta-analysis of randomized controlled trials purporting to show that eating more versus less red meat does not influence cholesterol or blood pressure? Drs. Neal Barnard and Wal...
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Micromorts: Putting Risk Into Perspective

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A micromort, a unit for comparing and communicating risk to patients, is equivalent to a one-in-a-million chance of dying. Hundreds of millions of operations are performed every year, and the risk of death is typically around half a percent, to which patients might say things like, “I could die just as easily crossing the road,” making it clear they really don’t understand the difference in magnitude of risk. One way to communicate risk is by analogy. For example, just going under anesthesia carries about a 1-in-100,000 chance you won’t wake up. How much is that? Well, that’s about the same risk as an expert sky dive. But that still may be kind of tough to wrap your head around. It’s hard to think in terms of small numbers. Can you imagine a 0.0017 mile by 0.00227 mile rug? How big (or small) is that? We need more digestible units. Enter the micromort as a unit for comparing and communicating risk. A micromort (mM) is a unit equivalent to a one-in-a-million chance of dying. That...
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What Foods Help Hair Growth?

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Hot peppers, soy foods, and pumpkin seeds may help with hair loss. Androgenic or androgenetic alopecia is one of the most common chronic problems seen by dermatologists. In men, it’s called male pattern hair loss, and in women, it’s called female pattern hair loss. It’s characterized by progressive hair loss, mostly of the central scalp. I’ve talked about hair-loss supplements and hair-loss drugs; what about foods for hair loss? What role might diet play in the treatment of hair loss? Human experiments with fecal transplants offer a clue to how powerful our microbiome is, with reports of improvements in hair loss after a “fecal slurry made from freshly passed stools” from a donor was administered into another person’s colon. These weren’t just subtle improvements. As you can see below and at 1:14 in my video Food for Hair Growth , a totally bald guy started growing back hair a few months after a fecal transplant. A little more than a year later, his hair had completely regrow...
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The Benefits and Risks of Hair Loss Drugs

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What are the pros and cons of Propecia and Rogaine for hair loss? “Any consumer looking on the Internet for a treatment for hair loss is exposed to a multitude of remedies.” However, we only have good evidence for efficacy for drugs approved by the U.S. Food and Drug Administration: finasteride (sold as Propecia) and minoxidil (sold as Rogaine). It’s considered a myth that all the patented hair-loss supplements on the market will increase hair growth. And they may actually be more expensive, with over-the-counter supplement regimens costing up to more than $1,000 a year, whereas the drugs may cost between $100 and $300 annually. The drugs can help but can cause side effects. Propecia can diminish libido and cause sexual dysfunction, while the topical minoxidil can cause itching. Below and at 1:12 in my video Pills for Hair Growth , you can see a list of some of the more common side effects of these FDA-approved drugs. To understand why there are so many hormonal side effects f...
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Do Hair Growth Supplements Work?

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Might biotin or zinc supplements prevent hair loss in men and women? By the time we’re 50, about half of us, men and women, will experience hair loss. No, it’s not caused by washing your hair too much or, for that matter, brushing it too much either—two of the many myths out there. Researchers found that the majority of hair loss with age is genetic for both women and men. And, based on studying twins, researchers discovered that the heritability of baldness in men is 79%, meaning about 80% of the differences in hair loss between men are genetically determined. But that still leaves some wiggle room. Even when it comes to identical twins—in one case, identical twin sisters with the same DNA—one can have more hair loss than the other, thanks to increased stress, increased smoking, having more children, or having a history of high blood pressure or cancer. Check out the two identical twin brothers below and at 1:24 in my video Supplements for Hair Growth . They have the same genes...
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The Protein Debate: Why Source Matters More Than Amount

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I discuss a public health case for modernizing the definition of protein quality. In 2019, Dr. David Katz and colleagues, including one of my favorite researchers, David Jenkins, published a “public health case for modernizing the definition of protein quality.” The prevailing definition seems to have more to do with biochemistry than the overall effects on human health. The common belief that protein is “good,” and the more the better, combined with a definition of protein quality that favors animal protein, gives the impression that eating more meat, eggs, and dairy is desirable and preferable. But this is directly opposed to nutrition guidelines that are instead trying to push more plants. Although protein malnutrition is still common in many areas of the world, it is extremely rare in the industrialized world, where “the most formidable public health threats…are from chronic diseases,” not something like kwashiorkor, severe protein and calorie malnutrition. In 2016, a landmark stu...
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