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OK, so “begging” isn’t quite the right word.  The FTC (Federal Trade Commission) has issued subpoenas to 48 food companies demanding information about their marketing practices aimed at children.

The FTC tried this once before and issued a report in 2008 based on the information it received.  But companies were not exactly forthcoming with the data.  In the present political climate, they will foot-drag this time too.

According to ThePacker.com, the FTC is asking for asked for nutritional data on the companies’ products as well as marketing information by December 1.

The FTC is quoted as saying that none of this is expected to lead to new regulations.  I guess the FTC is trying to do what it can under challenging circumstances.

But let me ask again: where is the FTC’s long-awaited report on nutrition standards for marketing products to kids?  If it can’t even get that report out, can the new subpoenas do any good?

Yesterday’s Science section of the New York Times carried a story by Denise Grady summarizing the present status of the arguments over the safety of the estrogen-disrupting chemical in plastics, bisphenol A (BPA).

Who knew that supposedly scientific decisions about whether BPA is safe or not would be mired in deadlocked partisan politics of the Republican vs. Democrats type?  As Grady explains,

Environmental groups and many Democrats want BPA banned, blaming it for an array of ills that includes cancer, obesity, infertility and behavior problems….Many Republicans, anti-regulation activists and the food-packaging and chemical industries insist that BPA is harmless and all but indispensable to keeping canned food safe by sealing the cans and preventing corrosion, and to producing many other products at reasonable prices.

Dianne Feinstein (Dem-CA) tried to get a ban on BPA inserted into the pending food safety bill.  Her plan

to ban BPA from baby bottles, sippy cups, baby food and formula was blocked by partisan battling. She had hoped that the ban would be included in the food safety bill, not merely in an amendment to be considered separately. But after months of wrangling, she gave up. The food industry, mostly supportive of the food bill, threatened to oppose it if the BPA provision got in. So did many Republican senators.

The scientific questions about BPA safety are complicated and difficult to answer, mainly because the doses are so low.  Here too, politics intervenes.  The article quotes Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences.  She and other scientists say that

studies by university labs tended to find low-dose effects, and studies by government regulatory agencies and industry tended not to find them. The split occurs in part because the studies are done differently. Universities, Dr. Birnbaum said, “have moved rapidly ahead with advances in science,” while regulators have used “older methods.” Some researchers consider the regulatory studies more reliable because they generally use much larger numbers of animals and adhere to formal guidelines called “good laboratory practices,” but Dr. Birnbaum described those practices as “good record-keeping” and said, “That doesn’t mean the right questions were being asked.”

In the absence of firm science, regulators have two choices: exercise caution and ban the chemical until it can be proven safe (the precautionary principle) or approve it until it can be proven harmful.   In this case, I’m in favor of caution (see previous posts), not least because alternatives to BPA are available.

Your preference?

FoodProductionDaily.com has done an analysis of who does what under the new UK scheme for dividing food responsibilities and taking power away from the pesky Food Standards Agency, which had the nerve to actually try to regulate the food industry.

At a time when it is increasingly obvious that food regulations would be better served if under the authority of a single food agency, the UK is doing just the opposite.

Here in America, we have enough problems with food regulations divided between FDA and USDA.  The UK has done us one better.    It now has three agencies in charge.  See if you can make sense of any of these new responsibilities:

The Food Standards Agency

• Scientific advice on the food safety aspects of date marking
• Assessment and labeling of ingredients/foods with food safety implications (e.g. allergens, glycols, high caffeine, high glycyrrhizinic acid)
• Food safety aspects of organic food and of foods controlled by compositional standards
• Treatments and conditions of use with food safety implications (e.g. quick frozen foods, raw drinking milk and pasteurization, food contact materials)
• GM and novel foods (including use of nanotechnology)
• EU General Food Law regulation, including traceability of food
• Codex Committees on Food Hygiene, Methods of Analysis and Sampling, Food Additives, Contaminants in Foods

Department for Environment, Food and Rural Affairs (a mix of our FDA, USDA, and EPA)

• General lead on food labeling legislation and relevant EU negotiations
• Lead on the EU Food Information proposal
• Country of origin labeling
• Food composition standards and labeling such as fruit juice and fruit nectars, jams and bottled water
• Technical advice on compositional standards for food without specific legislation, such as soft drinks and cereal products
• Fish labeling
• Use of marketing terms e.g. natural, fresh, clear labeling, vegan and vegetarian labeling
• Food authenticity program
• Codex Committees for: Food Labeling, Processed Fruits and Vegetables, Fresh Fruits and Vegetables, Fats and Oils, Fish and Fishery Products, Europe, General Principles
• Lead on Codex Alimentarius Commission, General Principles and Coordinating Committee for Europe

Department of Health

• Nutrition related aspects of the EU food information regulation
• Front of pack labeling
• Food for particular nutritional uses (PARNUTS)
• Infant formula and follow on formula
• Health and nutrition claims
• Food supplements
• Calorie information in catering establishments
• Codex Committee on Nutrition and Foods for Special Dietary Uses

This sounds to me like an ironclad guarantee that nothing will ever get accomplished.  But that, of course, was very point of taking so many responsibilities away from the Food Standards Agency.  That agency, alas, was actually trying to regulate the food industry, something no conservative government is willing to tolerate.

Let’s hope our FDA pays no attention.

This month’s San Francisco Chronicle column evolved in answer to a question from a former colleague at the UCSF School of Medicine.

Q: What do you think doctors should be telling patients about how best to care for themselves and their families, nutritionally?

A: I had my chance when, long ago, I ran a nutrition education program for medical and other health professions students and practitioners at UCSF.

Then, as now, it was obvious that just about every patient who landed in the hospital needed nutrition intervention. Practically everyone who visited the outpatient clinic either wanted or needed nutrition advice.

Then, as now, few doctors were taught anything about nutrition, let alone the details of what they needed to know to help patients address dietary concerns.

In today’s health care environment, even doctors with advanced nutrition training do not have time to use it. Blame this on how our health care system systematically rewards doctors for treatment of disease, not its prevention.

What doctors need to tell patients about nutrition depends on who the patients are. If people are sick, doctors need to talk to them about how dietary changes and improvements will help them recover and prevent further illness.

But I’m guessing that your question refers to healthy patients who want to stay that way. With these people, what doctors do and say can have profound effects. Doctors are authority figures and their advice is taken seriously.

As a standard part of patient care, doctors routinely ask about drugs, cigarettes and alcohol. Even if they only have a minute, adding one more question about diet can do much good. If nothing else, it conveys that diet matters to health.

Given the reality of time constraints, my wish list for what to do next is necessarily short.

Tell patients that healthy eating simply means three things: variety, minimal processing and moderation.

Variety means choosing many different kinds of foods from the various food groups: meat, dairy, fruits, vegetables, grains. It counts because foods vary in nutrient content. Varying foods within and among food groups takes care of needs for nutrients without having to think about them. People who consume adequate amounts of varied diets rarely exhibit nutrient deficiencies. It’s the most restrictive diets that are likely to be deficient in one or another nutrient.

Minimal processing means that the foods should be as close as possible to how they came from the animal or plant. The greater the level of processing, the less the foods resemble their origins, the less nutritious they may be, and the more salt, sugar and calories get added to disguise the changes.

Minimal processing excludes foods high in salt and sugars and low in fiber, as well as sugary sodas and juice drinks, those popularly known as junk foods.

My definition of minimal processing is only slightly facetious: Don’t eat anything with more than five ingredients or an ingredient you can’t pronounce.

Moderation is about balancing calorie intake with expenditure and maintaining a healthy weight through food choices and physical activity.

These are general principles. Beyond them, nutrition advice must be personalized to the particular individual or family. To do that quickly:

• Ask patients what they and their children eat. You can start with a waiting-room questionnaire that probes typical intake of foods and supplements.
• Screen the responses for variety, minimal processing, moderation and excessive or unusual supplement use. Note whether body weights are within healthy ranges.
• Reassure patients whose diets are varied, minimally balanced and moderate that they are doing wonderful things for their health and should keep doing what they are doing.
• Refer observations that need further discussion to a nutritionist.

Doctors: You don’t have to do it all. Making it clear that diet matters is often enough to encourage patients to make better dietary choices. Use the services of a nutritionist. Nutritionists are professionally trained to answer patients’ questions about diet and health and to counsel them on dietary interventions.

Patients (meaning everybody): Tell your doctors that you want their advice about diet and health and expect them to know something about it.

The New York Times Magazine has a long article this week about Plumpy’nut,  the peanut butter-based product designed to feed malnourished kids in emergency situations.  The product is made and patented by Nutriset, a French company.

You might think that a food product aimed at saving the lives of starving kids would be uncontroversial, but not when patents are involved.  Nutriset holds intellectual property rights to this product and defends them to the hilt.   The company extends its patent to line extensions of the product, as well.

Patents mean that people in developing countries who want to produce their own product based on local ingredients can’t do it.  It also means that anyone making the product has to follow the formula, even if ingredients are expensive and not locally available.

In September 2007, I wrote about Plumpy’nut, describing how peanut butter had become the basis of a “ready-to-use therapeutic food” (RUTF) for aiding recovery of severely malnourished children in Africa.

The study itself is published in Maternal and Child Nutrition and the authors make the point that people administering this RUTF do not need to be medically trained so this therapy can be used at home. I’m always amazed when researchers discover that feeding malnourished children helps them to recover. Peanut butter is highly concentrated in calories and the investigators mixed in some vitamins along with it, so I guess it can be considered a superfood.

Since then, much has been written about the controversy over this product, particularly about its formula, cost, and sustainability.

Its formula includes:

• Peanut Butter
• Dry Skim Milk
• Vegetable oil
• Powdered sugar
• Minerals & vitamins

It contains about 500 calories in a 92-gram foil package.

Of these calories, one-quarter to one-third are from the added sugar.  No wonder kids like it!

What about its cost? A recent article about local production of Plumpy’ nut in Niger illustrates this particular problem.

UNICEF pays US$60 to purchase and ship a box of 150 packets from the main producer and patent holder of Plumpy’nut, Nutriset, in France. It costs $65 in Niger. The difference adds up to an extra $15,000 for the 3,000 boxes purchased in Niamey every week.

“The luxury of having no production delays and not fully depending on an external provider is a price we are willing to pay,” UNICEF’s nutrition manager, Eric-Alain Ategbo, told IRIN. Ategbo said it took at least eight weeks for the nutritious peanut butter-like paste to arrive from France.

Here are some other cost concerns:

Electricity is expensive, taxes are high and money is expensive as interest rates are high. It would be cheaper if the products we use were bought locally, but they are not available.  Peanuts are the only ingredient from Niger. Others, such as milk, sugar and oil, are purchased internationally. We also have the obligation to buy specific products [such as micronutrients and packaging] from Nutriset in order to respect the formula.

As for its sustainability:

• Who is going to pay for these products?  And for how long?
• Does it make sense to promote a peanut-based product in countries that do not grow peanuts?
• Is it a good idea to give packaged, sweetened products to kids whose families cannot continue to provide such things once the crisis is over?
• Is it a good idea to give kids the idea that sweet things in packages are what they supposed to eat?
• Will products like this pave the way for other sweetened products in packages—soft drinks, for example?

These are all complicated issues.  Read the article and ponder.

The FDA has scheduled meetings September 19-21 to hear advice about whether the agency should approve GM (genetically modified) salmon.

These, you may recall are Atlantic salmon bioengineered by AquaBounty Technologies.   Atlantic salmon only grow for a few months per year; they do not produce growth hormone in non-growth months.  AquaBounty scientists combined growth hormone genes from an unrelated Pacific salmon with DNA from the anti-freeze genes of an eelpout fish.

The result is that the GM salmon produce growth hormone throughout the year and grow at twice the rate of non-GM salmon.

In preparation for these hearings, a coalition of 31 advocacy groups issued a statement urging the FDA not to approve the fish.

Each year millions of farmed salmon escape from open-water net pens, outcompeting wild populations for resources and straining ecosystems…We believe any approval of GE salmon would represent a serious threat to the survival of native salmon populations, many of which have already suffered severe declines related to salmon farms and other man-made impacts….FDA’s decision to go ahead with this approval process is misguided and dangerous, and is made worse by its complete lack of data to review…FDA has been sitting on this application for 10 years and yet it has chosen not to disclose any data about its decision until just a few days before the public meeting.

According to press accounts, salmon are only the first in a long line of potential GM fish and animals.  AquaBounty also raises GM trout and tilapia.  Other companies are working on GM pigs and cows.

AquaBounty lost no time in responding to the Coalition’s objections:

This press release is inaccurate, deliberately misleading, and intended to create fear and misunderstanding. AquAdvantage salmon are, quite literally, the most studied fish in the world. In addition, the U.S. Food and Drug Administration has spent the last fifteen years creating a robust regulatory process to ensure these fish and other transgenic animal applications are appropriately evaluated and regulated.

Comment: In the early 1990s, I was one of four consumer representatives on the FDA’s 30-member Food Advisory Committee.  This was the time when the FDA was considering approval of the first GM crops.   All four of us voted to delay the decision until more information became available or to make sure that GM foods were labeled as such.  Obviously, the FDA did not listen to our excellent advice.

Indeed, when our term on the committee was up, the head of the FDA’s Center for Food Safety and Applied Nutrition explained to us that our committee had not really been advisory.  The FDA had already decided the issues that it brought to the committee for discussion.  All the agency wanted from the committee was some indication of the kind of public reaction its decisions might raise.

Is this still the case with FDA advisory hearings?  I really don’t know, but I hope the FDA will listen carefully to concerns about these fish.

If the most important risk factor for chronic malnutrition is poverty, natural disaster is surely the most important for acute malnutrition.   Nutrition problems created by natural disasters usually can be alleviated by effective government action and, when necessary, international aid.

But the flood disaster in Pakistan is so huge, and affects so many people over such a large area, that it has become an object lesson in the consequences of international disinterest.  What aid has been forthcoming has been slow to arrive and not much of it comes from the United States.

One result is illustrated in today’s Guardian (UK):

Children at roadside shelter, Northwest Pakistan. Photo: Mohammad Sajjad/AP

The photo was forwarded to me by Patty Rundall, policy coordinator of Baby Milk Action.

It was sent to her by UNICEF, which has produced guidelines on infant feeding and a call for appropriate support for feeding young children in Pakistan.  Bottle feeding in unsterile environments is not healthy for infants.

The Washington Post points out that helping to alleviate this disaster is the right thing to do.  But it is also very much in America’s strategic interest.

If strategic interest is what it takes to get our government and others to move on this, let’s use it.

The FDA has just posted the “483” reports from inspectors who examined the Iowa egg factories responsible for the recent Salmonella outbreak and recalls.  These, as the New York Times puts it, go into “nose-pinching detail.”

I happen to have a strong stomach for these kinds of things, perhaps because I have had children. Birds, like babies, produce waste. Babies create some smelly sanitation issues.  But tens of thousands of birds in one place create waste on an entirely different scale—for the birds themselves, for the workers who handle them, and for people who eat their eggs.

The FDA reports make interesting reading. The inspection violations at the Hillandale facility ranged from the seemingly trivial (unsigned forms) to the disturbing (rodent holes) to the alarming (leaky manure) to the utterly damning (egg wash water testing positive for Salmonella enteriditis).

The comments on the Wright Egg facility sometimes approach the poetic (these are direct quotes):

• Approximately 2×6 inch wood board was observed on the ground with approximately 8 frogs living underneath.
• Layer 3 -House 8 had a bird’s nest and birds were observed under the edges of metal siding on the south wall.
• The outside access door to the manure pits at these locations had been pushed out by the weight of the manure, leaving open access to wildlife or domesticated animals.
• Dark liquid which appeared to be manure was observed seeping through the concrete foundation to the outside of the laying houses.
• Uncaged birds (chickens having escaped) were observed in the egg laying operation…The uncaged birds were using the manure, which was approximately 8 feet high, to access the egg laying area.
• There were between 2 to 5 live mice observed inside the egg laying houses.
• Live and dead flies too numerous to count were observed…inside the egg laying houses.
• Birds were observed roosting and flying, chicks heard chirping in the storage and milling facility. In addition, nesting material was observed in the feed mill closed mixing system, ingredient storage and truck filling areas.

Take home lesson: If you just have a few chickens, waste is not a problem. If you have millions of chickens in one place, you have a disaster in waiting.

Let’s put concentration in the egg industry in some historical context. My partner, Dr. Malden Nesheim, trained originally as a poultry scientist. He points out that according to the USDA about 450 egg facilities in the United States house more than 100,000 egg laying hens, and these account for nearly 80% of all egg production.

Just for fun, he looked up the figures in his 1966 textbook, Poultry Production (10th edition).  A table in the first chapter lists more than 100,000 poultry farms in 1959.

The change may be more efficient, but it is certainly not healthier for anyone concerned.

Clarification, September 1: In 1959, there were more than 100,000 farms for which poultry products constituted the main source of income—50% or more. In 2007, 146,000 farms reported to USDA that they had laying hens. But 125,000 of these farms had less than 50 hens. Only 3,360 farms accounted for 97% of the total laying hens. For the vast majority of farms reporting laying hens, eggs do not account for much of the income. The same is true for broilers. The data illustrate the massive concentration in the poultry industry that has occurred in the last half century.