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The FDA Announces Qualified Health Claim for Yogurt and Reduced Risk of Type 2 Diabetes.

FDA intends to consider exercising its enforcement discretion for the following qualified health claims:

“Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes. FDA has concluded that there is limited information supporting this claim.”

“Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes according to limited scientific evidence.”

FDA intends to consider exercising enforcement discretion for the above qualified health claims for when all other factors for enforcement discretion identified in Section IV of this letter are met.

All I can do is laugh.  As I told CNN,

Qualified Health Claims are ridiculous on their face.

Why would any sensible person think that all you have to do to prevent type 2 diabetes is eat 2 cups of yogurt a week?…All we can hope is that the yogurt is at least unsweetened, but since it’s really hard to find unsweetened yogurt [in small cups], this is telling people who want to avoid type 2 diabetes that sweetened yogurts are good for them…According to the FDA’s review of the studies, the amount of sugar in the yogurt made no difference to the results…Therefore, according to the FDA, sugar is a non-issue.”

The reason for my amusement?  Limited evidence.  Translation: if you want to believe this, go ahead, but it’s not on the basis of compelling evidence.

Take a look at the Danone petition.  The company asked for—and got—the qualified claim on the basis of observational evidence along with consumption data indicating that Americans currently do not eat much yogurt.

Given this low consumption, such a QHC is important to encourage food companies to increase yogurt in the food supply and inform consumers of current evidence in order to help them make informed choices.

It’s not that the FDA is ignoring the sugar issue despite its allowing the claim no matter how much sugar the yogurt contains.  In its letter of acceptance of Danone’s petition, the FDA said,

we are concerned that the use of a qualified health claim on yogurts that contain a significant amount of added sugars could contribute empty calories to the diet. The Dietary Guidelines for Americans, 2020-2025 recommend limiting added sugars to less than 10 percent of total calories and note that added sugars account on average for almost 270 calories, or more than 13 percent of total calories per day in the U.S. population.

…Consequently, while there is currently no disqualifying level for added sugars, given that Americans are exceeding recommended limits on added sugars, and some yogurts on the market are high in added sugars, FDA encourages careful consideration of whether to use the claim on products that could contribute significant amounts of added sugars to the diet.

Is this a warning to Danone to avoid using the claim on sugary yogurts?  We shall have to wait and see.

In the meantime, Danone is delighted: Danone North America Announces the FDA’s Decision on Their Petition for the First-Ever Qualified Health Claim for Yogurt, Linking This Dairy Aisle Staple to a Reduced Risk of Type 2 Diabetes

In response to efforts led by Danone North America, the new claim states that “eating yogurt regularly, at least 2 cups (3 servings) per week” may reduce the risk of developing type 2 diabetes, a condition 1.4 million Americans are diagnosed with every year.

Qualified Health Claims are about selling food products, not science.

Since it’s Monday when I post industry-funded studies anyway, I will add one more of these to last week’s collection.

This one comes from an articles in The Conversation: Big companies, like Nestlé, are funding health research in South Africa – why this is wrong.

At the time a group of more than 200 senior academics wrote an open letter, about conflicts of interest. Nestlé’s portfolio of foods, by its own admission, includes more than 60% that don’t meet the definition of healthy products.

In December last year, the same centre announced it had signed a memorandum of understanding with Nestlé. It signalled their intent to “forge a transformative partnership” to shape “the future of food and nutrition research and education” and transform “Africa’s food systems”.

Dr Katie Pereira-Kotze, a part time Senior Nutritionist at First Steps Nutrition Trust wrote me to ask if I might comment on the conflicts of interest displayed at a conference sponsored by the British Journal of Midwifery (BJM).  This journal accepts sponsorship for its annual conference from breastmilk substitute companies (Nutricia, Kendamil, Nestle).

Groups concerned about the historic role of infant formula compnanies in discouraging breastfeeding in new mothers, have asked the BJM not to permit this funding.

For example, the Baby Feeding Law Group UK wrote a letter to the conference organisers in 2022.

We would also like to share with you our perceptions of the motivations of companies such as Kendamil and Nutricia for sponsoring events such as your conference. It is against the law in many countries including the UK for companies to promote infant formula. By partnering with organisations or sponsoring events, these companies avoid workplace controls on advertising and gain direct access to health care workers, including in the case of the BJM conference, midwives, and in doing so create a valuable link to pregnant and post-partum women.

The British Medical Journal (BMJ) also commented on these conflicted interests: Midwifery conference is criticised over formula milk sponsors.

Three companies that market formula milk (Aptamil, Kendamil, and Nestlé) are sponsoring the conference and have each been given a 40 minute slot during the one day conference programme.

This journal contrasted its own position on infant formula complany sponsorship with that of the midwifery jounral:

In 2019 The BMJ announced that it would no longer carry advertisements for breastmilk substitutes,4 and after pressure from clinicians and campaigners the Royal College of Paediatrics and Child Health also said that it would stop accepting funding from formula milk companies. Robert Boyle, a clinical reader in paediatric allergy at Imperial College London, told The BMJ, “Formula company marketing aims to disrupt breastfeeding, their main competitor, so that the companies can sell more formula.

Comment: The role of the commercial infant formula industry in pushing its products and discouraging breastfeeding has been well documented for decades, most recently in a series of Lancet Commission reports.  Conferences are expensive to run and the  British Journal of Midwifery undoubtedly can use the infant formula company money—but at some cost to its reputation.  The optics do not look good.  Sometimes, the money isn’t worth it.  Infant formula companies have joined cigarette and opioid companies in being viewed as producing products with great capability of doing more harm than good.  The sooner the BJM stops taking their funding, the better.

Two examples of  beef-industry attempted influence:

I.  Science teachers

This one comes from Wired: Inside the Beef Industry’s Campaign to Influence Kids

Big Beef is wooing science teachers with webinars and lesson plans in an attempt to change kids’ perceptions of the industry.

A beef industry group is running a campaign to influence science teachers and other educators in the US. Over the past eight years, the American Farm Bureau Foundation for Agriculture (AFBFA) has produced industry-backed lesson plans, learning resources, in-person events, and webinars as part of a program to boost the cattle industry’s reputation.

What is the AFBFA?

The AFBFA is a contractor to Beef Checkoff, a US-wide program in which beef producers and importers pay a per-animal fee that funds programs to boost beef demand in the US and abroad. In 2024, Beef Checkoff has approximately $42 million to disperse across its initiatives, and a funding request reveals that the AFBFA’s campaign for 2024 is projected to cost $800,000. The allocation of Beef Checkoff funding to programs like this is approved by members of the Cattlemen’s Beef Board and the Federation of State Beef Councils, two groups that represent the cattle industry in the US.

What does this program teach?

One lesson plan provided as part of the program directs students to beef industry resources to help devise a school menu. In another lesson plan students are directed to create a presentation for a conservation agency regarding the introduction of cattle into their ecological preserve. A worksheet aimed at younger students has them practice their sums by adding up the acreage of cow pastures. Another worksheet based around a bingo game aimed at 8- to 11-year-olds asks teachers to “remind students that lean beef is a nutritions source of protein that can be incorporated in daily meals.”

As for the answer to my question yesterday about whether this kind of training works:

According to survey data included in these documents, educators who attended at least one of the AFBFA’s programs were 8 percent more likely to trust positive statements about the beef industry. Some 82 percent of educators who participated in a program had a positive perception of how cattle are raised, and 85 percent believed that the beef industry is “very important” to society.

Again, this is a USDA-sponsored checkoff program.  The US Dietary Guidelines on beef call for it to be lean and unprocessed.  The checkoff does not.

II.  Public health professionals

I received this e-mailed message from a reader who wishes to remain anonymous.

I am a member of the Kentucky Public Health Association and so receive their email newsletters. The Beef Council promotion is fairly new. It is interesting to watch an industry PR campaign with health professionals happen in real time. I’ve also just realized that I don’t believe the Association has policies around sponsorships, something I had not worried about until the past few months.

She forwarded two messages sent to her from the Kentucky Public Health Association.  These are announcements from the Kentucky Beef Council: “Happy Nationl Nutrition Month,” and “Fueling Tween and Teens with Strong Minds and Bodies.”

The second is labeled as an advertisement; the first is not.

Both encourage visits to the Beef Nutrition Education Hub to get free continuing education credits and other resources.

Both say:

Thank you to our 38,000 Kentucky Beef Farmers! Fun Fact: Kentucky is the largest beef-producing state East of the Mississippi River

This email was sent on behalf of KY Beef Council and the content within shall be attributed to the sponsor. This email shall not indicate an endorsement on behalf of KPHA.

Copyright © 2023  Kentucky Public Health Association

Comment:  The Kentucky Beef Checkoff at work!   Regardless of the Kentucky Public Health Association’s protestations, these messages give the appearance of endorsement.  It should not be doing this.

This one is about activities of the National Pork Board, a USDA-sponsored checkoff program recipient (see comment at end).  It comes from a reader, Lily Doher, reproduced with her permission.

I receive emails from the National CACFP [Child and Adult Care Food Program] Sponsors Association and occasionally click to see what free trainings they’re offering providers. I was encouraged by a training that described how providers play a pivotal role in developing childrens’ food habits and preferences and how providers can create positive food environments that support healthy eating. I clicked on the link and was surprised to see the training was sponsored and presented by the National Pork Board, and even more surprised to see the egregious industry influence throughout the training. Hosted by a registered dietitian nonetheless.

• “Empowering children to explore new foods, like lean pork, is key to addressing nutritional challenges faced by children.”
• “…pork has a huge role to play in discussions around food choice, exposure, language, and acceptance in children.”
• “Dr. Hicks-Roof then shed light on the crucial role of pork in shaping children’s food preferences and dietary habits…”
• “She also shared the science behind hunger and satiety, emphasizing the pivotal role of protein intake and importance of lean pork in informing conditional satiety.”
• ” Additionally, she shed light on pork’s affordability, nutrition and cultural significance as pork is a widely consumed meat globally.”
• “Dr. Hicks-Roof clarified that pork is the ultimate carrier food for busting through food neophobia in children, unlocking a new world of varied food exposures, and supporting opportunities to use positive, inclusive language during conversations about food with children.”

While this training is being highlighted by National CACFP, this type of industry influence is ultimately what led me to leave the Academy of Nutrition and Dietetics, and I am disheartened to once again see a fellow registered dietitian be the puppet for Big Food. Our children, and the providers that care for them, deserve better.

Comment: CACFP is the USDA’s Child and Adult Care Food Program.  It provides reimbursements to providers of meals at child care centers, day care homes, and adult day care centers.  I wrote about it most recently in a previous “weekend reading” post.  Of course the National Pork Board, which runs the USDA-sponsored checkoff program, wants to encourage dietitians to promote pork.  It must welcome the opportunity to provide free continuing education credits.  Dietitians are required to complete 75 such credits every five years.  As I’ve written previously, they can easily do that with free industry-sponsored coursses.

Do those courses influence what dietitians tell clients?  Perhaps the Pork Board can answer that question (I wonder if it ever did before-and-after surveys).  I’m guessing it must view the expense as worthwhile.

In my Monday postings of industry-funded studies of the week, I mostly have stopped listing the names of authors because I view industry influence as a systemic problem, not something to be blamed on individuals.

But a recent article on meat industry influence on climate change science, sent to me by one of its authors, focuses on two individual recipients of meat industry funding.

The study: Morris, V., Jacquet, J. The animal agriculture industry, US universities, and the obstruction of climate understanding and policy. Climatic Change 177, 41 (2024). https://doi.org/10.1007/s10584-024-03690-w

The 2006 United Nations report “Livestock’s Long Shadow” provided the first global estimate of the livestock sector’s contribution to anthropogenic climate change and warned of dire environmental consequences if business as usual continued. In the subsequent 17 years, numerous studies have attributed significant climate change impacts to livestock. In the USA, one of the largest consumers and producers of meat and dairy products, livestock greenhouse gas emissions remain effectively unregulated. What might explain this? Similar to fossil fuel companies, US animal agriculture companies responded to evidence that their products cause climate change by minimizing their role in the climate crisis and shaping policymaking in their favor. Here, we show that the industry has done so with the help of university experts….Here, we traced how these efforts have downplayed the livestock sector’s contributions to the climate crisis, minimized the need for emission regulations and other policies aimed at internalizing the costs of the industry’s emissions, and promoted industry-led climate “solutions” that maintain production.

The authors describe the ways the meat industry interacts with the work of two university researchers.  Both researchers, they report:

• have received significant research funding from industry groups
• lead university centers that receive funding from industry groups
• have been employed by an industry group as consultants
• have received awards or travel from industry groups
• have failed to disclose industry funding in instances where it is the norm to do so
• have presented to policymakers at an industry-sponsored event
• have produced work referenced in public comments submitted by industry groups to regulatory agencies
• have co-authored publications with industry employees
• have published repeatedly in industry-funded journals
• have been referenced by industry groups in industry advertisements
• have published traditional and social media in support of industry interests
• have minimized the industry’s role in climate change
• have challenged the need for regulations or promoted policy changes in ways that are favorable to industry

And there’s more:

Nicholas Carter sent me a copy of his and the Freedom Food Alliance’s report on meat industry efforts to deflect its role in climate change: Harvesting Denial, Distractions, & Deception: Understanding Animal Agriculture’s Disinformation Strategies and Exploring Solutions.

This analysis focuses on key strategies, including tactics to deny, derail, delay, deflect and distract6 meaningful discussion of the key issues, as well as methods that generally are intended to confuse and create doubt in the minds of policymakers and the general public.  It is common for the animal agriculture industry to challenge the necessity to shift to a plant-based food system, question causation, dispute the messenger, and contest suggested proplant-based policies.

Carter also sent an article about this study from DeSmog: Meat industry using “misinformation: to block dietary change, report finds.

He notes: “Relevant to all this to is the ironic timing of $4 million more just rewarded (announced yesterday) to Mitloehner and the CLEAR center.”

His comments on this irony:

Yes, feed swaps & quicker fattening can lower some methane, albeit with tradeoffs, but this ignores the far bigger opp. for shifts in demand & supply away from the highest methane-polluting practice.

Comment: In partnerships of this type, the sponsoring industry typically wins.  Much research shows that individual recipients of industry funding do not believe it influences the design, conduct, or interpretation of their studies, despite substantial evidence that it does. The role of beef methane emissions is an existential threat to beef sales.  The industry, understandably, is doing all it can to undermine concerns about its role in climate change.

Lately, I have been asked repeatedly to explain just how the food industry exerts influence to protect and promote product sales.  This week’s posts address that question, starting with the usual Monday industry-funded study of the week, in this case an opinion piece sponsored by the potato industry.

Potato trade associations work hard to overcome concerns about this food’s rapidly absorbable starch content.

I received an email from the Alliance for Potato Research & Education telling me that if I don’t eat potatoes, I might become nutritionally deficient.

New publication alert: swapping out starchy vegetables may lead to unintended nutrition consequences.

A new perspective paper published in Frontiers in Nutrition underscores starchy vegetables are more than just carbs – they’re a vital vehicle for essential nutrients. Yet, as confusion around “good versus bad carbs” persists among consumers, there is a risk of starchy vegetable avoidance in favor of other carbohydrate foods perceived as equally or more nutritious – or even carbohydrate avoidance all together.

The press release cited a paper with this conclusion:

Replacing starchy vegetables with grain-based alternatives, including whole-grain foods, for one day led to a 21% decrease in potassium, a 17% decrease in vitamin B6, an 11% drop in vitamin C and a 10% reduction in fiber.

This called for a look at the actual paper.

The paper: Carbohydrate confusion and dietary patterns: unintended public health consequences of “food swapping.”   Ayoob, K.  Front. Nutr., 28 September 2023. Volume 10 – 2023 |

Rationale: “Nutrient-dense dietary patterns include both grain foods and starchy vegetables. These food groups are currently considered separately [by the Dietary Guidelines for Americana], and they must remain separate to ensure people are encouraged to consume complementary nutrients from each of these food groups.”

Conclusion: “Using complex carbohydrate foods, specifically starchy vegetables (e.g., potatoes) and grains, interchangeably is at best, not a useful strategy, but at worst, may increase the risk of micronutrient inadequacy and/or dietary imbalances.”

Funding: “The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Funding for this perspective was provided by Potatoes USA.”

Conflict of interest: “This study received funding from Potatoes USA. The funder had the following involvement with the study: composition and data analysis of the menu modeling. KA was compensated by Potatoes USA for preparation and revision of the manuscript.  The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.”

Comment: I like potatoes, think they have nutritional value (especially when baked rather than fried), and do not view them as poison.  But: this paper is an opinion piece commissioned, developed, and paid for by a potato trade association.  And sent to me in a press release.

Anne Mendelson.  Spoiled: The Myth of Milk as Superfood.  Columbia University Press, 2023 (396 pages).

I am an admirer of Anne Mendelson’s books and did a blurb for her Chow Chop Suey.  But this one is over the top—original, compelling, brilliantly written.

Driving this book is a question I’ve not heard asked before, at least not so directly: Why and how did the consumption of fresh liquid milk (“drinking-milk”)—as opposed to fermented dairy products—become framed as a nutritional necessity?

Her question derives from some basic facts about cow’s milk and its industrial production:

• Once cow’s milk leaves the udder, it is easily contaminated with pathogenic bacteria.
• Most adults have stopped making the enzyme that digests the sugar lactose in milk and can’t drink it without getting unpleasant digestive systems.
• To produce milk safely requires complicated and expensive industrial processes.
• The cost of milk production exceeds the price people are willing to pay for it; dairy farming is a losing proposition even with taxpayer subsidies.
• Industrial milk production is hard on cows and pollutes the environment.

Why are we even doing this?  For this, she blames 19th and 20th century European and American doctors who thought the ability to digest lactose normal, nutritionists (calcium!), and the USDA (3 servings a day!).

She is not against eating dairy foods when they are fermented.  These, yogurt and the like, are much safer.  Friendly bacteria split the lactose along with producing acid that destroys pathogens.

You don’t have to agree with all her points to appreciate how well they are argued.

To wit:

[The book] argues that influential nutritional theories about fresh and fermented milk took a disastrously wrong turn in the eighteenth century.  The reason is that the founders of modern Western medicine had no way of understanding the genetic fluke that allowed them, unlike most of the world’s peoples, to digest lactose from babyhood to old age.  In other words, today’s mega-industry stemmed from a lack of scientific perspective.  That lack turned the one form of milk that is most fragile, perishable, difficult to produce on a commercial scale, and economically pitfall-strewn into a supposed daily necessity for children and, to a lesser extent, adults.  [pp x, xi].

No other food product is as staggeringly difficult and expensive to get from source (in this case, a cow) to destination (milk glass on table) in something loosely approximating its first condition.  If one existed, it would be treated as an astounding luxury. [p. 1].

Mendelson takes deep dives into the history of dairy use, dietary recommendations, industrial production, and government dairy policy.  In attempting to teach about the Farm Bill, I was defeated by Milk Marketing Orders, the formulas used by the government to set price support levels required to be paid by “handlers” (milk processors) to dairy producers in different areas of the country.  I could not find anything about this in the index, alas, but I loved what she says about them on page 205.

These formulas gradually became as abstruse, and as unintelligible to anyone outside a small charmed circle, as anything in the bad old days before the federal government stepped in.  Far from abolishing the buyer’s market, they trapped farmers selling fluid milk within the marketing order system in endless struggles to wring enough out of handlers to recoup production costs….What I do understand is that as the postwar era advanced, the sheer incomprehensibility of producer-handler milk price schemes again became an endless frustration to dairy farmers, above all those trying to make a living within the marketing order system for drinking-milk.

One final irony:

Nothing is going to dislodge supermarket drinking-milk from its towering economic importance.  It is certain to continue along the track of expansion, consolidation, and increasingly complex technological infrastructure that it has pursued for almost three quarters of a century.  Big Milk is going to become Bigger Milk.  Its absurdities are also sure to become more entrenched.  The greatest of these is the plain fact that Americans are drinking less milk while dairy farms are producing more of it.

A personal comment: The book triggered a memory.  I once visited a school lunch program in Barrow (now Utqiaġvik), Alaska.  Inuit children were served the standard USDA lunch, which requires half-pint cartons of milk.  I did not see any of them drinking it.  The untouched cartons were discarded.  The milk was not only culturally inappropriate, but wasteful.  All food in that part of North Alaska has to be flown in on airplanes.