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Thanks to Andy Bellatti for noticing this at his local Las Vegas Whole Foods.

This reminds me so much of the Low-Carb craze way back in 2005.

Oh well.  Whatever works.

Let me start with a reminder that since mid-March I’ve been collecting examples of studies funded by food companies or trade associations that come up with results favorable to the sponsor’s interests.  I post them five at a time.  I am having a hard time finding industry-funded studies that do not favor the sponsor’s interests.  If you run across any, please send.  Here’s the latest collection.

Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial.  Estefanía Toledo, MD, MPH, PhD; Jordi Salas-Salvadó, MD, PhD; Carolina Donat-Vargas, PharmD; et al.  JAMA Intern Med. Published online September 14, 2015. doi:10.1001/jamainternmed.2015.4838

• Conclusions and Relevance  This is the first randomized trial finding an effect of a long-term dietary intervention on breast cancer incidence. Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer.
• Conflict of Interest Disclosures: Dr Salas-Salvadó received grants from Instituto de Salud Carlos III and the International Nut and Dried Fruit Foundation during the conduct of the study and has received consultancy fees from Danone Research and Eroski outside the present work; he is also a nonpaid member of the Scientific Committee of the International Nut and Dried Fruit Foundation. Dr Estruch, outside the present work, has received grants from the California Walnut Commission, nonfinancial support from Patrimonio Comunal Olivarero (Spain), La Morella Nuts (Spain), and Borges SA (Spain) and grants from Novartis Farmaceutica SA, Cerveceros De España, Sanofi, FIVIN-Spain, Instituto Cervantes Albuquerque, the Harvard School of Public Health, the Culinary Institute of America, the International Family Doctors Association, and Instituto Cervantes (Milan, Italy). Dr Ros, during the conduct of the study, received grants from Instituto de Salud Carlos III and nonfinancial support from the California Walnut Commission, Patrimonio Comunal Olivarero, La Morella Nuts, and Borges SA. Dr Ros, outside the present work, has received grants from the California Walnut Commission and nonfinancial support from Nuts for Life, La Asturiana SA, the International Nut and Dried Fruit Council, and the California Walnut Commission and personal fees and other compensation from Nuts for Life and La Asturiana SA. Dr Hu, outside the present work, has received grants from the California Walnut Commission and Metagenics. Dr Fitó, outside the present work, has received personal fees from Menarini and AstraZeneca. No other disclosures are reported.
• Funding/Support: Although most funding support came from government agencies, “The supplemental foods used in the study were generously donated by Patrimonio Comunal Olivarero and Hojiblanca, Spain (EVOO); the California Walnut Commission, Sacramento, California (walnuts); and Borges SA (almonds) and La Morella Nuts (hazelnuts), both from Reus, Spain.”

Evaluation of 4-methylimidazole, in the Ames/Salmonella test using induced rodent liver and lung S9 Carol Beevers^1,* and Richard H. Adamson.  Environ. Mol. Mutagen., Article first published online: 10 SEP 2015.  DOI: 10.1002/em.21968.   

• Conclusions: No induction of mutation (as measured by an increase in revertant colonies) was observed and it was concluded that 4-MeI was not mutagenic in S. typhimurium using either rodent liver or lung S9 for exogenous metabolism.
• Conflicts of Interest: The work described in this publication…was funded entirely by the American Beverage Association. ABA had no direct involvement in the study design, collection, analysis or interpretation of the data. ABA were not involved in the writing of this manuscript or the decision to submit the manuscript for publication. Richard H Adamson has received fees for serving as a consultant for the American Beverage Association. He was an observer for the International Technical Caramel Association for IARC Monograph- volume 101 and acted as Study Monitor for the work described in this manuscript. Carol Beevers is an employee of Covance Laboratories Ltd and acted as GLP Study Director for the work described in this manuscript.
• Comment: 4-MEI is a chemical produced during the Maillard (browning) reaction and found as a component of caramel coloring in diet sodas.  It is listed as a probable carcinogen under California’s proposition 65 rules, and CSPI has petitioned the FDA to require companies to remove it.

Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder.  Dienke J Bos, Bob Oranje, E Sanne Veerhoek, Rosanne M Van Diepen, Juliette MH Weusten, Hans Demmelmair, Berthold Koletzko, Monique GM de Sain-van der Velden, Ans Eilander, Marco Hoeksma, and Sarah Durston.  Neuropsychopharmacology. 2015 Sep; 40(10): 2298–2306.  Published online 2015 Apr 22.  doi:  10.1038/npp.2015.73.

• Conclusion: this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD [Attention deficit/hyperactivity disorder].
• Funding: This study was financially supported by Unilever Research & Development, Vlaardingen, The Netherlands. Unilever Research & Development was involved in the conception and design of the study. They provided financial support for research staff to run the study and provided the intervention product.  Marco Hoeksma and Ans Eilander are employees of Unilever.

Milk Modulates Campylobacter Invasion into Caco-2 Intestinal Epithelial Cells. Rogier Louwen, R. J. Joost van Neerven.  European Journal of Microbiology and Immunology 5 (2015) 3, pp. 1–7 2015.  doi:10.1556/1886.2015.00019.

• Conclusions: We found that all milk products modulated the invasion of Campylobacter species into the Caco-2 cells in a dose-dependent manner…This in vitro study shows for the first time that pasteurized and formula milk affect the invasion of Campylobacter… Industrially made milk-based formulas…specifically reduced the invasion of the C. coli and C. fetus strain into the Caco-2 cells.
• Funding: “Part of this study was supported by FrieslandCampina by paying material costs, but FrieslandCampina was not involved in study design or data analysis.”
• Comment: FrieslandCampina makes dairy-based beverages, infant nutrition, cheese and desserts, and sells them in Europe, Asia, and Africa.  The study results suggest that even pasteurized milk contains substances that reduce pathogenic bacteria, at least in cell cultures.

Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12^®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial.   Dorte Eskesen, Lillian Jespersen, Birgit Michelsen, Peter J. Whorwell, Stefan Müller-Lissner and Cathrine M. Morberg. British Journal of Nutrition. DOI: http://dx.doi.org/10.1017/S0007114515003347 , 9 pages. Published online: 18 September 2015.

• Conclusions: Overall, 4 weeks’ supplementation with the probiotic strain BB-12® resulted in a clinically relevant benefit on defecation frequency. The results suggest that consumption of BB-12® improves the GI health of individuals whose symptoms are not sufficiently severe to consult a doctor.
• Funding: Design, conduct, analysis and reporting of the study, as well as writing of this manuscript, were funded in full by Chr. Hansen…S. M.-L. and P. J. W. perform consultancy work for Chr. Hansen A/S. L. J., D. E., C. M. M. and B. M. are employees of Chr. Hansen A/S.
• Comment: Chr. Hansen develops and produces cultures, enzymes and probiotics for the dairy industry in particular as well as products for dietary supplements, pharmaceuticals and infant formula.

Sunday’s New York Times carried this full-page advertisement.

The ad is from Cocoa Via, a company owned by Mars.  It quotes a dietitian stating that cocoa flavanols “support healthy blood flow…which allows oxygen and nutrients to get to your heart more easily.”

The ad directs you to the full story at nytinmes.com/cocoavia (where you see more ads).

I posted the science behind this ad earlier this month in my collection of industry-funded studies with results favorable to the sponsor’s interests.  To repeat:

Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study.  Roberto Sansone, Ana Rodriguez-Mateos , Jan Heuel, David Falk, Dominik Schuler, Rabea Wagstaff, Gunter G. C. Kuhnle, Jeremy P. E. Spencer, Hagen Schroeter, Marc W. Merx, Malte Kelm and Christian Heiss for the Flaviola Consortium, European Union 7th Framework Program.  British Journal of Nutrition, September 9, 2015. doi:10.1017/S0007114515002822.

• Conclusion: In healthy individuals, regular CF [cocoa flavanol] intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.
• Funding: Additional funding was provided…through an unrestricted grant by MARS Inc. MARS Inc. also provided the standardised test drinks used in this investigation… H. S. provided test drinks on behalf of Mars Inc… H. S. is employed by MARS Inc., a member of the Flaviola research consortium and a company engaged in flavanol research and flavanol-related commercial activities. [The conflict statement also discloses that MARS employee H.S. shared responsibility for designing the study, writing the paper, and approving the final content].
• Comment: Lest the “eat more chocolate” message of these studies be missed, Mars sent out a press release: “Cocoa flavanols lower blood pressure and increase blood vessel function in healthy people.”

Now we have a full-page ad in the New York Times.

Here’s what the ad does not say:

• CocoaVia is owned by MARS, Inc (this appears nowhere in the ad).
• Flavanols are usually destroyed during normal cocoa processing.
• Most chocolate contains few flavanols; CocoaVia’s process preserves some of the flavonols in very dark chocolate.
• Flavonol-rich or not, chocolate candy is not a health food.

Like most conflicted research, this is about marketing—hence, the ad—not science.

Really, the Dietary Guidelines Advisory Committee’s (DGAC) report shouldn’t be this controversial and shouldn’t be controversial at all (as I’ve said before).  But lots of people—the food industry, of course, but also some scientists and journalists—seem to have exceptionally intense opinions about the fat recommendations [Recall:  The DGAC report does not constitute the Dietary Guidelines; these are written by USDA and HHS and are not due out until the end of this year].

Now, we have the journalist Nina Teicholz, author of The Big Fat Surprise, repeating the themes of her book in the BMJ: The scientific report guiding the US dietary guidelines: is it scientific?.

The BMJ has also found that the committee’s report used weak scientific standards, reversing recent efforts by the government to strengthen the scientific review process. This backsliding seems to have made the report vulnerable to internal bias as well as outside agendas.

Teicholz’s interpretation of the science relating dietary fat to health has been thoroughly critiqued (see end of post).   The way I see it, these arguments are difficult to resolve outside the context of dietary patterns as a whole.

My hypothesis (note: hypothesis) is that for people who balance calorie intake with expenditure, the type of fat—or carbohydrate—matters much less than it does for people who overeat calories.  This hypothesis needs testing to confirm it.

What troubles me about Teicholz’s work is the certainty with which she presents her ideas.  She comes across as utterly convinced she is right, even in the face of substantial and substantive criticism of her statements and interpretations.

At least one error

Here, for example, is one statement in the BMJ article that I know from personal experience cannot be correct.

Much has been written about how industries try to influence nutrition policy, so it is surprising that unlike authors in most major medical journals, guideline committee members are not required to list their potential conflicts of interest.

I was a member of the 1995 DGAC and I was required to declare conflicts of interest.  So were members of the committees in 2000, 2005, and 2010, as shown in this excellent short video.

Later, discussing conflicts of interest among DGAC members, Teicholz says:

Still, it’s important to note that in a field where public research dollars are scarce, nearly all nutrition scientists accept funding from industry. [Nearly all?  I don’t, and I doubt this is correct].  Of far greater influence is likely to be bias in favor of an institutionalized hypothesis as well as a “white hat” bias to distort information for what is perceived as righteous ends.

The “white hat bias” comment refers to a paper by authors who themselves report food-industry funding:

Competing Interests. Drs. Allison and Cope have received grants, honoraria, donations, and consulting fees from numerous food, beverage, dietary supplement, pharmaceutical companies, litigators, and other commercial, government, and nonprofit entities with interests in obesity and nutrition including in interests in breastfeeding and NSBs. Dr. Cope has recently accepted a position with The Solae Company (St Louis, MO.).

Responses to the BMJ article

The DGAC wrote a rebuttal to Teicholz.  It is published on the BMJ website.

HHS also published a statement, reproduced by Mother Jones.

The British Medical Journal’s decision to publish this article is unfortunate given the prevalence of factual errors. HHS and USDA required the 2015 Dietary Guidelines Advisory Committee to conduct a rigorous, systematic and transparent review of the current body of nutrition science. Following an 19-month open process, documented for the public on DietaryGuidelines.gov, the external expert committee submitted its report to the Secretaries of HHS and USDA. HHS and USDA are considering the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, along with comments from the public and input from federal agencies, as we develop the 2015 Dietary Guidelines for Americans to be released later this year.

Yoni Freedhoff’s Weighty Matters blog provides a handy summary of additional responses to the BMJ article.

• BMJ Publishes Error-Laden Attack on Dietary Guidelines Report – CSPI
• Medical journal’s bogus investigation could derail better dietary guidelines – The Verge
• Expert is as expert does: in defence of US dietary guidelines – The Conversation
• The DGAC’s official response to Teicholz’ accusations – The BMJ
• An Open Letter to the BMJ Regarding US Dietary Guidance – Dr. David Katz
• British Medical Journal (BMJ) gives low-carb journalist Nina Teicholz an outlet to blast the Dietary Guidelines Advisory Committee (DGAC) – U.S. Food Policy Blog
• Call for The BMJ to retract Teicholz article on Dietary Guidelines Committee and Science – Evelyn (CarbSane)

Scientific analysis of The Big Fat Surprise

Many of the scientific claims in this book seemed so far-fetched that they induced a nutritionist, Seth Yoder, to go over it line by line, read the references, and point out discrepancies.   These are posted on his website in two parts.

A summary quote from Part 1:

What makes this particular book interesting is not so much that it is bad (which it is) or that it is extravagantly biased (which it also is). No, what really fascinates me about this book is that the author excessively and shamelessly lifts other people’s material.

And a quote from Part 2

The Big Fat Surprise (BFS) by Nina Teicholz is yet another book in a long line of books that informs the reader that everything you thought you knew about nutrition is wrong: saturated fat from animals is actually quite good for you, cholesterol isn’t really important, the government lied to you, nutritionists and dietitians lied to you, the American Heart Association lied to you, etc… Leaving aside that the concept of that kind of a conspiracy actually existing is really absurd, what I’m surprised about is that publishers can keep churning out books like this and people are gullible enough to keep buying them.

Caveat emptor.

Additions: 

• The Conversation, Australia: In defence of the US Dietary Guidelines
• New research published in the J Am College of Cardiology. “Conclusions:  Our findings indicate that unsaturated fats, especially PUFAs, and/or high-quality carbohydrates can be used to replace saturated fats to reduce CHD risk.”
• The Verge on the BMJ’s backtracking on the Teicholz piece

Here’s a sweet conclusion to this week’s sugar theme (#5):

How do bakeries do this?  I have no idea.

But this particular bakery at first refused to make the cake.

It worried about potential copyright violation (I’m not kidding).

Well, it’s too late to sue.  The evidence has been consumed.

This week’s post about sugars #4:

Sugar politics is in the news and I’ve been collecting items about it.

• U.K. consumers say sugar is their #1 food issue, beating out waste and salt.
• The Florida sugar industry is giving generously to Republican presidential candidates.
• Australian sugar growers are pushing for greater access to the U.S. sugar market through the Trans Pacific Partnership agreement, and are in part responsible for the impasse in signing it (this is not necessarily a bad thing).
• U.S. candy makers are not happy about the suspension agreements brought against Mexican sugar imports.  These, they say, have raised the price of sugar.  Ordinarily, under NAFTA, Mexico is allowed to ship as much sugar to the U.S. as it likes, with no tariffs.  But Mexico agreed to new trade caps in return for not having to deal with antidumping investigations (isn’t trade fun?).
• The Washington Post has a good summary of where we are on putting Added Sugars on food labels.
• The FDA will take comments specifically on its Nutrition Facts panel studies, including controversial research on how well consumers would understand an added sugars label, the agency announced in a Federal Register notice.  The comment period is extended to October 15.
• The FDA’s move follows a letter from law firm Olsson Frank Weeda Terman Matz that criticized the agency for not taking comments on its consumer research.

This week’s sugar item #3

John Downs, the president of the National Confectioners Association has an editorial (note: sponsored) in Politico announcing the NCA’s new campaign to convince Americans of the benefits of eating candy.

Candy is a special treat that has played an important role in cultural traditions, seasonal celebrations and family occasions here in the U.S. and around the world. But some consumers might not know that there is much more that goes into this honest, affordable, fun and transparent treat.

What more?  The economic benefits, of course.  Here’s the Infographic:

The press release highlights the benefits.

The confectionery industry directly employs 55,000 people in the United States, and more than 400,000 jobs in agriculture, retail, transportation and other industries rely in part on the sale of confections for their livelihood.  For every job that is created in confectionery another seven are supported in related industries, which means that candy drives a multiplier effect of 1:7 or an impact of 700 percent.

Sugar?  Calories?  Tooth decay?  Obesity?

Never mind.

Sugars item #2 for this week (about half of the sugars in US diets come from sugar-sweetened beverages)

As promised in his op-ed in the Wall Street Journal in August, Muhtar Kent, the CEO of Coca-Cola, is making its funding transparent.  He said he “directed Sandy Douglas, president of Coca-Cola North America, to”

Publish on our website a list of our efforts to reduce calories and market responsibly, along with a list of health and well-being partnerships and research activities we have funded in the past five years, which we will continue to update every six months.

True to his word, here is Coca-Cola’s commitment to transparency:

• The company’s transparency website
• A list of the organizations it funds
• A list of the scientific experts and researchers it funds (but some declined to be listed)
• Answers to frequently asked questions

This makes interesting reading, to say the least.  Enjoy!