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Thanks to Jim Krieger of Healthy Food America for this one.

Substituting Refined Sugars With Maple Syrup Decreases Key Cardiometabolic Risk Factors in Individuals With Mild Metabolic Alterations: A Randomized, Double-Blind, Controlled Crossover Trial. Arianne Morissette, Anne-Laure Agrinier, Théo Gignac, Lamia Ramadan, Khoudia Diop, Julie Marois, Thibault V Varin, Geneviève Pilon, Serge Simard, Éric Larose, Claudia Gagnon, Benoit J Arsenault, Jean-Pierre Després, Anne-Marie Carreau, Marie-Claude Vohl, André Marette.  The Journal of Nutrition, Volume 154, Issue 10, 2024, Pages 2963-2975.  https://doi.org/10.1016/j.tjnut.2024.08.014.

Methods: In a randomized, double-blind, controlled crossover trial with 42 overweight adults with mild cardiometabolic alterations, participants were instructed to substitute 5% of their total caloric intake from added sugars with either maple syrup or an artificially flavored sucrose syrup for 8 wk.

Results: Replacing refined sugars with maple syrup over 8 wk decreased the glucose area under the curve when compared with substituting refined sugars with sucrose syrup, as determined during the oral glucose tolerance test, leading to a significant difference between the intervention arms.

Conclusions: Substituting refined sugars with maple syrup in individuals with mild metabolic alterations result in a significantly greater reduction of key cardiometabolic risk factors compared with substitution with sucrose syrup, in association with specific changes in gut microbiota.

Funding: This study was funded by the Producteurs et productrices acéricoles du Québec (PPAQ) and the Ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec (MAPAQ). The sponsors had no role in study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Marianna Chilton.  The Painful Truth about Hunger in America: Why We Must Unlearn Everything We Think We Know—and Start Again.  MIT Press, 2024. 366 pages.

MIT Press asked me to do a back-cover blurb for this book, which I was pleased to do.

Marianna Chilton’s uncompromising book cuts to the heart of what’s wrong with America’s “safety net” for poverty and hunger.  Her tough analysis derives from the lived experience of people dependent on this system despite its demonstrable inadequacies, inequities, and indignities.

This is one tough book to read, as Chilton warns us right from the start.  Accepting food and financial assistance is a deeply humiliating experience.  Worse, it is intended to be so, right from the start.

Chilton’s work is highly unusual.  She gains the trust of participants in this system by listening closely when they tell her what it is really like for them, and how they feel about it.

This system is so bad and self-sustaining that nothing short of  a complete overhaul can fix it.  We could, should, must do better.

She says:

Poverty costs the United States at least $1.03 trillion a year.  For every dollar spent on reducing childhood poverty, the country would save at least $7 in government spending to address the health and social problems that arise from poverty…To fix this, we need to spend more money to help people avoid poverty; we need to fix the tax code, wage structures, and many other policies that exclude and exploit people who are poor so the wealthy will stop profiting off them.

Chilton recommends the universals:

• Universal health care
• Universal Basic Income
• Universal school meals
• Universal child care

Anything short of that keeps the current system in place.

Late in September, the British government issued guidance about reducing intake of foods high in fat, salt, and sugar, collectively HFSS.

The guidance is based on  the provisions of the Food (Promotion and Placement) (England) Regulations of 2021.

The regulations provide for restrictions on the promotions and placement in retail stores and their online equivalents of certain foods and drinks that are high in fat, salt or sugar (HFSS) or ‘less healthy’.

The regulations have led to a flurry of product reformulations to get the fat, sugar, and salt below the cut point for the restrictions.

According to one report, “reformulation is rife in F&B but consumers aren’t sold yet: Brands are reformulating to improve nutritional value and reduce or remove ‘unhealthy’ ingredient levels. But this is not always a vote winner with customers. Why?… Read more”

In fact, just this week, food and beverage giant, PepsiCo, announced the reformulation of one of its flagship brands, Doritos. The US multinational said in the statement that, in addition to making its famous crisp ‘crunchier’, it was also cutting salt by 24% and fat by 15%, making it HFSS compliant…And while there are a variety of reasons for brands to reformulate their products, including the rising cost of commodities such as sugar, the primary reason is HFSS compliance.

If PepsiCo can do this in England, it surely can do this here.

Apparently, it takes government action to get companies to do these things…

I am late getting to this report but am finally ready to take it on.

This is the annual report from FAO, which always tries to put as positive a spin on its findings as it can.

The press release says:

Hunger numbers stubbornly high for three consecutive years as global crises deepen: UN report

1 in 11 people worldwide faced hunger in 2023, 1 in 5 in Africa

Rio de Janeiro – Around 733 million people faced hunger in 2023, equivalent to one in eleven people globally and one in five in Africa, according to the latest State of Food Security and Nutrition in the World (SOFI) report published today by five United Nations specialized agencies.

Each of these reports tries to do something different, and this one is about financing.  It talks about the cost of a health diet (CoHD).

The CoHD has risen worldwide since 2017 (the first year for which FAO disseminates estimates) and continued to rise in 2022, peaking at an average of 3.96 PPP dollars per person per day in 2022. This represents a surge in the global average CoHD, from a 6 percent increase between 2020 and 2021 to an 11 percent increase the following year…Despite the increase in the CoHD, the number of people in the world unable to afford a healthy diet fell for two consecutive years, from 2020 to 2022. Worldwide, an estimated 35.5 percent of people in the world (2.83 billion) were unable to afford a healthy diet in 2022, compared with 36.5 percent (2.88 billion) in 2021.

So the good news is that the percentage of people who can’t afford to eat healthfully dropped by 1%.

That’s still a third of people in the world.

Impossible.  Unacceptable.  And tragic and frustrating beyond belief.

Resources

• The FAO home page for these reports
• The 2024 report
• The press conference
• Press materials and video

I attended a meeting at Cornell last week at which FDA Commissioner Robert Califf answered questions from faculty and staff.

He started out by remarking on the poor health status of Americans, despite our spending twice as much on health as any other country.  He noted the disparities in health status, particularly singling out the declining health of rural Americans.

In answer to questions from panel members and, later, from the audience, he said (my notes and paraphrase, unless in quotes):

• We have real health problems on the ground right now.
• The  big issue is chronic disease, on which we are “doing terribly.”
• We have to deal with the marketing of ultra-processed foods designed to make you hungry for more.
• On tradeoffs in trying to discourage ultra-processed foods: This isn’t like drugs with clear risk/benefit calculations.  Food research has big confidence intervals and less rigorous estimates. The FDA has lots of bosses.  The executive branch and Congress can overrule anything it does.
• One Health (the movement to treat human and animal health issues as parts of a whole) is essential to the future of humanity.
• Climate change has moved pathogens into areas where they didn’t used to be.
• Action on animal antibiotics stagnated as a result of the pandemic: “We are all sinners in this regard.”
• We need a global strategy; infectious diseases do not respect borders.
• ”There is a lot of rhetoric about food safety, but the systems do not come together as they should.
• There is too much financial influence on policy.  “Policy is everyone’s job.”
• A lot of people are making a lot of money on our food and health systems, but it’s not spent on the right things.
• On the Supreme Court’s overturn of Chevron: the FDA cannot extend its rulings beyond what Congress intended.  It will slow things down.
• “We should reserve most of our energy to do our jobs well.”
• Courage is important: we must have courage to do things differently.

Comment

I was impressed by his knowledge, thoughtfulness, and concern about public health issues, especially those around food, as well as his understanding of the current political barriers against using expertise and regulation to improve food systems and public health.

He used the occasion to encourage students to consider careers in the FDA and noted the remarkably low turnover of permanent staff.

Jerry Mande sent me a link to a report of remarks the Commisioner made in December: America has a life expectancy crisis. But it’s not a political priority (Washington Post), and also to Helena Bottemiller Evich’s report, FDA Commissioner says ultra-processed foods drive addictive behavior.

So the Commissioner is giving serious thought to these issues.  So are others: see Announcement below.

The big question: who at FDA will take the lead on all this?

The FDA has just undergone a major reorganization.

As of October 1, the Human Foods Program looks like this.

The big question: who will head the new Nutrition Center of Excellence?

My big hope: Califf will appoint someone to that position who shares his committment to reducing diet-associated chronic disease.  Fingers crossed.

Announcement

Senator Bernie Sanders (I-Vt.), announced that his Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing on the urgent need for the FDA to “adequately protect Americans – especially children – from unhealthy foods that are pushed on consumers by the food and beverage industry.”  Here is his invitation letter to Commissioner Califf and Deputy Commissioner Jim Jones, who heads the FDA’s Human Foods Program.

When: 10:00 a.m. ET, Thursday, December 5, 2024
Where: Room 562 Dirksen Senate Office Building. The hearing will also be livestreamed on the HELP Committee’s website and Sanders’ socials.

Potatoes, a source of rapidly absorbable starch, have such a bad reputation that some nutritionists advise against eating them.  I am not one of them.  I enjoy eating potatoes and think their blood sugar-raising effects depend on how they are prepared and how muh of them you eat.

The potato industry, alarmed about advice not to eat potatoes, funds research to prove they are healthy, or at least do no harm.  Hence:

Djousse L, Zhou X, Lim J, Kim E, Sesso HD, Lee IM, Buring JE, McClelland RL, Gaziano JM, Steffen LM, Manson JE. Potato Consumption and Risk of Type 2 Diabetes Mellitus: A Harmonized Analysis of 7 Prospective Cohorts. J Nutr. 2024 Oct;154(10):3079-3087. doi: 10.1016/j.tjnut.2024.07.020.

• Results: In the primary analysis, total potato intake was not associated with T2D risk:…In secondary analyses, consumption of combined baked, boiled, and mashed potatoes was not associated with T2D risk, whereas fried potato consumption was positively associated with T2D risk:.
• Conclusions: Although consumption of total potato is not associated with T2D risk, a modest elevated risk of T2D is observed with fried potato consumption.
• Conflict of interest: LD received investigator-initiated grant from the Alliance for Potato Research and Education (as principal investigator).
• Funding: This project was supported by a grant from the Alliance Potato Research and Education (principal investigator: LD).  A lengthy list of other funders, including NIH and Mars Edge, follows.

Comment: This potato industry-funded study did not find potatoes to be associated with type 2 diabetes, which must be a huge relief to this industry. But the study did find a weak association (barely statistically significant) beween fried potatoes and type 2 diabetes.  The Potato Alliance ought to be delighted with this result.   I’m guessing the result is real (it’s what I would have predicted), but I’d be happier with it if it had been conducted by investigators independent of industry funding.  As it is, it looks like the potato industry got what it paid for.

Ronnie Cummins and André Leu.  The Regenerative Agriculture Solution: A Revolutionary Approach to Building Soil, Creating Climate Resilience, and Supporting Human and Planetary Health.  Chelsea Green, 2024.

I was asked to do a blurb for this one, and did:

This book is a testament to the vision of the late Ronnie Cummins.  His friend, André Leu, memorializes Cummins’ lifelong work with this overview of the demonstrable benefits of regenerative agriculture for everything in the book’s subtitle, and more.  Cummins’ case study on agave illustrates these benefits perfectly, making this book a useful as well as touching tribute.

This short book is a touchingly sentimental project.  It started out as Ronnie Cummins’ account of how to use agave fronds (which otherwise would be wasted), ground to the consistency of cole slaw and then fermented, for sustainable animal feed.

But Cummins died after writing only two chapters.  The publisher thought agave was too narrow a topic to make book length; it advised broadening the scope to regenerative agriculture with agave as a case study.  Leu, an old friend of Cummins’, took this on.

So there are really two books here, on two topics, by two different authors, in two distinct voices.  Even so, it works as a basic introduction to the benefits of regenerative agriculture for sustainability.

I think the agave example would be better as a monograph, but Cummins hadn’t done enough on it.  Too bad.  He was really excited about its possibilities.  Agave stores moisture from air and does not need much water to grow.

So I projected, if you could grow enough plants, in this case billions of agaves and companion trees, grow them large enough, and interplant them on millions and millions of acres of the world’s currently decarbonized and unproductive rangelands, you could conceivably draw down a critical mass of excess carbon from the atmosphere (where too much CO₂ contributes to climate change) and put in into the plants and trees aboveground, and into the soil belowground, where it belongs.  By greening the desert and the drylands you could dramatically increase soil fertility, retain and store rainfall, restore landscapes and biodiversity, reforest semi-desert areas, regenerate rural livelihoods, and eventually restabilize the climate.  I could hardly fall asleep.

This book is Cummins’ living memorial.

t foods are typically made from the by-products of human food production.  These, like offals, are plenty nutritious; we just don’t happen to want to eat them.  Pet foods therefore, reduces food waste.

A reader and friend, Patricia Gadsby, sent me this note:

Never occurred to me to ask this question before. But when the idea occurred I thought of you. What percentage of greenhouse gases are attributable to pet food? I found this.

Here’s the article she refers to:

Pedrinelli, V., Teixeira, F.A., Queiroz, M.R. et al. Environmental impact of diets for dogs and cats. Sci Rep 12, 18510 (2022). https://doi.org/10.1038/s41598-022-22631-0

The chief findings of this analysis of Brazilian pet foodss:

• Pet food has a high environmental impact.
• Wet diets have the highest.
• Dry diets have the least .
• The more animal protein, the higher the impact.
• The more calories, the greater the impact.

Like all environmental impact studies, this one depends on assumptions and tradeoffs.   The analysis does not consider the role of food waste., although the authors discuss this issue.

Several ingredients used in pet food are considered by-products, and this could be considered as a factor that reduces the impact of these foods…approximately 38% of beef, 20% of pork, and 19% of chicken is viscera or blood that is not used for human consumption31. Of all the by-products produced in Brazil, 12.8% are used in the pet food segment, and the rest is used for animal production, biodiesel, hygiene, and
cleaning, among other uses…In the present study, all types of diets contained by-products such as ofal or meat meals, although
dry and wet diets presented by-products more often than homemade diets.

I’m waiting for consensus on the assumptions.

In the meantime, two other items on pet food sustainability:

• Insect protein is a key solution to a sustainable pet food industry:  Government interest and funding are increasing for using insects to help meet climate goals.  .Read more

• Research reveals vegan diets can improve dog health: A study lead by Professor Andrew Knight at the University of Winchester in the UK found fewer cases of health disorders overall in dogs fed vegan diets. [Paid for by ProVeg International and conducted by authors linked to it and other animal welfare organizations—the full study is here].

Comment

Thanks to Phyllis Entis, author of TAINTED. From Farm Gate to Dinner Plate, Fifty Years of Food Safety Failures and TOXIC. From Factory to Food Bowl, Pet Food Is a Risky Business for the vegan diet item.  Vegan diets may be more environmentally sustainable, but are they best for a dog or cat’s health?  That question involves assumptions and tradeoffs about health and environmental impact.

The health impact would be easier to address if researchers were studying such questions.  But, as I discussed in my co-authored book about pet food issues, Feed Your Pet Right, remarkably little research is being done on dog and cat diets.  I think there are three reasons for the lack of research:

1. Pet owners do not approve of experimentation on companion animals.
2. The government does not want to bother to invest in research on pet food.
3. No pet food company wants to pay for diet studies that might not help sell pet food.

Personally, I would like to see studies examining the effects of high- and low-end commercial foods on health and sustainability.  Without them, we are left with assumptions and tradeoffs, and personal beliefs about what’s best for our beloved animals.