by Marion Nestle

Search results: dietary guidelines

Dec 13 2021

Industry-funded study of the week: whole-fat dairy

I’m kind of a dairy agnostic.  If you like dairy foods, fine; if not, don’t eat them.

But the arguments about them are fierce, and the current Dietary Guidelines for Americans advise choosing low-fat alternatives.

So when I saw the title of this study, I wondered whether it had been funded by the dairy industry.  It was not, although some of the investigators have dairy industry ties.

The study: Whole-fat dairy products do not adversely affect adiposity or cardiometabolic risk factors in children in the Milky Way Study: a double-blind randomized controlled pilot study.  Analise Nicholl, Kane E Deering, Kate Evelegh, Philippa Lyons-Wall, David Lawrence, Trevor A Mori, Mario Kratz, Therese A O’Sullivan.  The American Journal of Clinical Nutrition, Volume 114, Issue 6, December 2021, Pages 2025–2042, https://doi.org/10.1093/ajcn/nqab288

Conclusions: Our results suggest that although changing from whole-fat to reduced-fat dairy products does reduce dairy fat intake, it does not result in changes to markers of adiposity or cardiometabolic disease risk in healthy children.

Acknowledgments: …The Principal Investigator, TAOS, was awarded funding in 2011 for a previous study from the Dairy Health and Nutrition Consortium. MK has received honoraria and reimbursements for travel as well as a research grant from several dairy-related organizations, including National Dairy Council/Dairy Management Inc., Dairy Farmers of Canada, the Dutch Dairy Association (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Interbranch Organization (CNIEL). All other authors report no conflicts of interest.

Notes: …No funding body played any role in the Milky Way Study design, implementation, analysis or interpretation of the data, or publication. The Milky Way Study received no funding from any dairy or food industry organization or affiliation toward study research, dairy product purchase or provision, child assessments, project personnel, or publication.

Comment: No funding body needed to be involved in this study to raise questions of conflicted interests; two of the authors report financial ties to dairy companies.  At the very least, these ties give the appearance of conflict of interest.  Are dairy foods good, bad, or indifferent for health?  My guess is that like pretty much everything else in the diet, it depends on everything else you are eating (unless you are lactose or dairy protein intolerant, in which case you know to avoid dairy foods).  The underlying purpose of this study is to encourage sales of full-fat dairy products to children.   Is that a good idea?  You decide.

Reference: For a summary of research on the “funding effect”—the observation that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests, but that recipients of industry funding typically do not recognize its influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Nov 18 2021

What about 100% fruit juice?

An additional observation in the fruit drink study I recently discussed was a reduction in purchases of 100% juice, probably because it is so hard to tell the difference without careful scrutiny of labels (hint: look for 100%).

100% juice is a better option than fruit drinks because it has a better balance of nutrients and no added sugars. But it is still sugary because so many pieces of fruit go into it [really, fruit is the best option].

The orange juice industry is worried about decreasing sales.

The worldwide market for juices is increasing.

The juice industry would like it to grow even faster.

I was interested to see juice marketing materials emailed to dietitians.

Want to take a guess as to who paid for these messages?

Hot summer temperatures combined with a population eager to get outside and get moving means risk of dehydration is high. In addition to water, consider including 100% juice as a healthy, nutrient dense beverage option. In addition to rehydration and increasing fruit intake, two new studies show 100% juice has many other health benefits.

  1. A recent UK study published in Nutrients found moderate consumption of 100% fruit juice, which aligns with the US Dietary Guidelines, does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycemic control. Furthermore, regular daily consumption of 100% juice, may confer health benefits related to vascular function and reduced blood pressure. Emerging evidence shows there may even be a positive impact on cognitive health. [Funding: This research was funded by an unrestricted grant from the Fruit Juice Science Centre].
    [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].
  1. A second review study, published in Frontiers in Immunology, found that citrus juice, contains key nutrients and bioactive substances that help our immune system to work efficiently and reduce inflammation. [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

And how do we know this is all about marketing?  Try this Infographic:  Squeeze More Profits From Juices.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Nov 17 2021

Juice drinks: it’s all about the marketing

Fruit drinks, as opposed to 100% fruit juice, are a no-brainer.  They are heavily sugar-sweetened, and best consumed in very small amounts or not at all.

They are difficult to distinguish from 100% fruit juice.  Their labels make them look fruity and juicy.

So do their ingredient lists:

But these are juice concentrates and require translation: added sugars.  In this case, 11 out of the 13 grams per serving.

Public health advocates want to discourage parents from buying sugary beverages for their kids.  Here are the results of one such attempt.

As the accompanying editorial, Warning: Don’t Let the Beverage Industry Harm Your Kids, explains, 

Unlike general social marketing or other communications campaigns, countermarketing is designed “to reduce the demand for unhealthy products by exposing the motives of their producers and portraying their marketing activities as outside the boundaries of civilized corporate behavior”…Let’s put this good news to use by placing responsibility at the feet of the platforms and companies profiting from directly and incessantly targeting children with marketing the food and drink they should avoid.

If you would like to know how this works, here’s a toolkit for campaigns against fruit drinks.

One additional observation was a reduction in purchases of 100% juice, probably because it is so hard to tell the difference without careful scrutiny of labels (hint: look for 100%).

100% juice is a better option than fruit drinks (fruit is the best option), but still sugary because so many pieces of fruit go into it.

The juice industry is plenty worried about decreasing sales.  Marketing materials sent to dietitians reveal the concerns.  Guess who paid for these messages—and the studies.

Hot summer temperatures combined with a population eager to get outside and get moving means risk of dehydration is high. In addition to water, consider including 100% juice as a healthy, nutrient dense beverage option. In addition to rehydration and increasing fruit intake, two new studies show 100% juice has many other health benefits.

  1. A recent UK study published in Nutrients found moderate consumption of 100% fruit juice, which aligns with the US Dietary Guidelines, does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycemic control. Furthermore, regular daily consumption of 100% juice, may confer health benefits related to vascular function and reduced blood pressure. Emerging evidence shows there may even be a positive impact on cognitive health. [Funding: This research was funded by an unrestricted grant from the Fruit Juice Science Centre].
    [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].
  1. A second review study, published in Frontiers in Immunology, found that citrus juice, contains key nutrients and bioactive substances that help our immune system to work efficiently and reduce inflammation. [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

And how do we know this is all about marketing?  Try this Infographic: Squeeze More Profits From Juices.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Oct 19 2021

Big news: FDA finally issues guidance on sodium reduction

On October 13, the FDA finally got around to finalizing its guidance for the food industry for voluntary, short-term (2.5 year) sodium reduction targets for lots of processed, packaged and prepared foods.

In a statement, the FDA says its new guidance

provides voluntary, short-term sodium reduction targets for food manufacturers, restaurants, and food service operators for approximately 160 categories of processed, packaged and prepared foods. The targets seek to decrease average sodium intake from approximately 3,400 milligrams (mg) to 3,000 mg per day—about a 12% reduction—over the next 2.5 years.

Reducing sodium has been on the FDA agenda for years.  It issued draft guidance in 2016.  On this, it received about 200 comments.  

The FDA’s idea for this first target is to reduce average daily sodium intake by about 12%—from approximately 3,400 milligrams (mg) to 3,000 mg per day—in 2.5 years.

This is still higher than the recommended 2300 mg.  Why so limited?

Politics, of course.

The FDA believes

  • These targets are feasible.
  • Gradual reduction will accustom people to lower sodium intake.
  • Food companies might be willing to do this.

A quick review of the basics:

  • Salt is 40% sodium (2300 mg sodium means about 6 grams of salt or 1.5 teaspoons).
  • High salt diets are strongly associated with high blood pressure and stroke.
  • We require less than 500 mg sodium a day; average diets are greatly in excess.
  • Most salt in the diet comes from pre-prepared foods (70%); 20% is added at the table; 10% is innate in foods.
  • The taste for high-salt is acquired; the more salt you eat, the more salt it takes to make foods taste right.
  • For people used to high-salt diets, low-salt makes food taste bland.  It takes about three weeks to get used to low-salt.
  • Once accustomed to low-salt, typical levels of salt make food taste too salty.

Thus, the FDA’s strategy is to gradually accustom people to lower salt intake.

The guidance is voluntary: “This voluntary, iterative approach is similar to approaches successfully implemented in other countries.”

By other countries, the FDA must mean Great Britain.  The UK did a big voluntary salt reduction campaign some years ago and got enough buy in from food companies to see a real difference in salt intake and blood pressure.

When the government changed and laid off the pressure, companies put back most of the salt (not all though). That history is here.

So this could work if food companies cooperate.  Presumably, the FDA will assess the results of this voluntary effort in 2.5 years.

The stick?  The implied threat of mandatory reductions if the voluntary ones don’t work.

2.5 years is a long time to wait for voluntary compliance.

My view

  • These should have been mandatory to begin with.
  • The target levels should be lower.
  • The time scale should be faster.

Other than that, the FDA’s plan could be a useful first step.  We shall see.

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Sep 6 2021

Industry-funded study of the week: full-fat dairy

The study: Impact of low-fat and full-fat dairy foods on fasting lipid profile and blood pressure: exploratory endpoints of a randomized controlled trial.  Kelsey A Schmidt, et al. The American Journal of Clinical Nutrition, nqab131, https://doi.org/10.1093/ajcn/nqab131.  Published: 13 July 2021

Background: “Dietary guidelines traditionally recommend low-fat dairy because dairy’s high saturated fat content is thought to promote cardiovascular disease (CVD). However, emerging evidence indicates that dairy fat may not negatively impact CVD risk factors when consumed in foods with a complex matrix.”

Method: “Participants were then randomly assigned to 1 of 3 diets, either continuing the limited-dairy diet or switching to a diet containing 3.3 servings/d of either low-fat or full-fat milk, yogurt, and cheese for 12 wk.”

Conclusions: “In men and women with metabolic syndrome, a diet rich in full-fat dairy had no effects on fasting lipid profile or blood pressure compared with diets limited in dairy or rich in low-fat dairy. Therefore, dairy fat, when consumed as part of complex whole foods, does not adversely impact these classic CVD risk factors.”

Funding: “National Dairy Council, Dairy Farmers of Canada, Dutch Dairy Association (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Dairy Interbranch Organization (CNIEL),” and NIH and others.

Conflict of interest: “This study was initiated by the principal investigator (MK). The dairy-related funding organizations suggested changes to details of the study design prior to the conduct of the study, some of which were implemented. Otherwise, the funding organizations had no impact on the design or conduct of the trial or the analysis and interpretation of study data.”

Comment: Let’s give these investigators high marks for disclosing that the dairy funders influenced the design of the study, which, as we know from the data of Lisa Bero and her colleagues, is the place where biases caused by industry funding most typically show up.  Food companies that fund research are looking for benefits; they won’t risk study designs that might yield inconvenient results.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Aug 23 2021

Industry-funded studies of the week: One Potato, Two Potato

One Potato

Thanks to David Ludwig for alerting me to an e-mail from the Alliance for Potato Research & Education (APRE), a trade association “dedicated to advancing the scientific understanding of the role potatoes play in promoting the health of all people.”

A new APRE-funded study published in Nutrients investigated the effect of increased dietary potassium from a whole food source – baked/boiled potatoes and baked French fries – or a potassium supplement on blood pressure and other cardiovascular disease risk factors compared to a ‘typical American’ control diet (lower potassium intake) among 30 pre-hypertensive-to-hypertensive men and women.

Results showed that baked/boiled potato consumption had the greatest benefit on reducing sodium retention, even more than the supplement, and resulted in a greater reduction in systolic blood pressure (SBP) compared to the control diet.

Further, despite commonly held misbeliefs about French fries and their role in heart-healthy lifestyles, the authors observed that a 330-calorie serving of baked French fries, when eaten as part of a ‘typical American’ diet, had no adverse effect on blood pressure or blood vessel function.

The study concludes:

This was the first controlled feeding study of potassium from food and supplements on BP and CVD outcomes in an unhealthy population…Of public health relevance is our observation that French fries in amounts typical of a large serving in a fast food restaurant has no adverse effect on blood pressure or endothelial function.

It discloses the funding source: “This research was funded by Alliance for Potato Research and Education.”

Comment: Because some (but not all) observational studies have linked potatoes, and especially French fries, to poor health outcomes, the potato industry wants research to give these foods a healthier image.  This study says that potatoes are high in potassium and a high potassium-to-sodium ratio is good for blood pressure and heart disease.  I could have told them that on the basis of food composition data alone: 100 grams of French fries contains 435 mg potassium versus 295 of sodium.  Does that make French fries a health food?  No, alas, it does not.

Once more for the record: industry-funded research is about marketing, not public health.

Two Potato

Last week, I received an emailed notification from APRE, the Alliance for Potato Research & Education announcing a new study.

For decades, people have often associated higher intakes of carbohydrate-containing foods with less healthy lifestyles. Yet, evidence suggests this view is overly simplistic, and it is instead the type and quality of carbohydrate foods that matter most for supporting health…In a newly published perspective in Nutrients, a group of nutrition researchers, who collectively make up the Quality Carbohydrate Coalition-Scientific Advisory Council (QCC-SAC), outline the opportunity for a stronger, more evidence-based approach to defining quality carbohydrate foods to support overall health and provide clearer dietary guidance.

The study: Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report.  Kevin B. Comerford, Yanni Papanikolaou,  Julie Miller Jones, Judith Rodriguez. Joanne Slavin,  Siddhartha Angadi.  and Adam Drewnowski.  Nutrients202113(8), 2667.

Conclusion: The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans. 

Funding:  This work was supported by the Quality Carbohydrate Coalition (QCC), which is funded by Potatoes USA. The QCC was not involved in the expert panel discussions, manuscript preparation, or the decision to submit the manuscript for publication.Conflicts of Interest: All authors are invited members of the Quality Carbohydrate Coalition’s Scientific Advisory Council (QCC-SAC). A.D. is the developer of the Nutrient Rich Food (NRF) index, a nutrient profiling model, and has received grants, contracts, and honoraria from entities, both public and private, with an interest in nutrient density of foods, complex meals, and the total diet. Y.P. is the president of Nutritional Strategies, collaborates on NHANES analyses and provides food, nutrition, and regulatory affairs consulting services for food/beverage companies and food-related associations. S.A. and J.M.J. advise the Grain Foods Foundation. J.S. has current grants from Taiyo and Barilla in the area of dietary fiber, and also serves on the Scientific Advisory Boards for Tate and Lyle and Atkins Nutritionals. J.R. has no conflicts of interest. K.B.C. is employed by FoodMinds, which provides science communications consulting services to various food and nutrition entities, including Potatoes USA and the Alliance for Potato Research and Education (APRE).
Comment: This is a successful effort by the potato industry to engage academics in support of the value of potatoes in healthful diets.  The role of potatoes in health is a contentious issue in the nutrition research community (see, for example, this FrontLine interview with Walter Willett).  The potato industry is fighting back by funding research (see above and also a previous post) and now engaging sympathetic academics.  I think potatoes are fine, in moderation.  But I wish academics would stay out of conflicted situations like this one.Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Aug 13 2021

Weekend reading: A call to the UN Food Systems Summit: Ultra-processed foods

I am a co-author on a paper published recently by BMJ Global Health 2021;6:e006885.  The need to reshape global food processing: a call to the United Nations Food Systems Summit.  Authors: Carlos Augusto Monteiro, Mark Lawrence, Christopher Millett, Marion Nestle, Barry M Popkin, Gyorgy Scrinis, Boyd Swinburn.

Because this paper is open access, I reproduce its text below.  The link is to the pdf.

Summary box

  • In the modern, globalised food system, useful types of industrial food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by food ultra-processing.

  • The main purpose of food ultra-processing is to increase profits by creating hyperpalatable and convenient food products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals.

  • In the last decades, obesity, type 2 diabetes and related diseases have become global epidemics, leading the health systems of many countries to or beyond breaking point.

  • Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity, type 2 diabetes and related diseases.

  • The 2021 UN Food System has a unique opportunity to urge countries to implement policy interventions required to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Introduction

The UN Food Systems Summit is taking place later this year at a crucial time. Food systems are manifestly failing to enhance human health, social equity or environmental protection. One symptom is the pandemic of obesity and related non-communicable diseases with their vast consequences. As we show here, one of the main drivers of this pandemic is the transformation in food processing. In the modern, globalised food system, useful types of food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by deleterious types of processing whose main purpose is to increase profits by creating hyperpalatable and convenient products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals. The Summit has a unique opportunity to confront this calamitous change, and to recommend effective policies and actions to UN agencies and member states.

Processing and industry

The key issue here is the nature, purpose and extent of food processing. It is not processing as such. General criticism of food processing is too unspecific to be helpful. Most foods are processed in some way, and culinary preparations of fresh foods are usually made using processed ingredients. Some types of food processing contribute to healthful diets, but others do the opposite.1

At one extreme are minimal processes which mostly preserve or enhance whole foods, such as drying grains, pulses and nuts, grinding grains into flour and pasta, chilling or freezing fruits and vegetables, pasteurising milk and fermenting milk into yoghurt.

At the other extreme are industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives into generally cheap to make, long duration substitutes to minimally processed foods and freshly prepared dishes and meals. The result is brand-named sugary, fatty and/or salty food and drink products which typically contain little or no whole food, are designed to be ready-to-consume anytime, anywhere and are highly attractive to the senses or even quasi-addictive. These products, including sweet and flavoured drinks, sweet or savoury snacks, reconstituted meat products and shelf-stable or frozen ready meals and desserts, are identified as ultra-processed foods.2

Criticisms of the food industry as a whole are also a mistake. Most of the very many millions of food farming, growing, rearing, making, distributing, selling and catering businesses throughout the world, notably in Asia, Africa and Latin America, deal solely or largely in fresh and minimally processed foods. These businesses and the foods they produce need to be encouraged, defended and supported.

By contrast, ultra-processed foods are mostly enabled, produced and sold by a small number of transnational corporations, some of whose turnovers exceed the revenues of many countries and make annual profits of US$ billions.3 These corporations use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide.4

These corporations shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods.5 They also exercise political power by intensive lobbying, donations and sponsorships, and until now have dissuaded most governments from adequately regulating their products and practices.6

Time-series food sales data indicate the explosive growth in manufacturing and consumption of ultra-processed foods worldwide.7 National dietary surveys show that ultra-processed foods already make up 50% or more of total dietary energy intake8 in high-income countries, with even higher consumption among children and adolescents.9 In middle-income countries, they now represent between 15% and 30% of total energy intake8 but sales of ultra-processed foods are increasing fastest in these countries.10

The pandemic of obesity and related diseases and its link with ultra-processing

According to WHO, worldwide prevalence of obesity has nearly tripled since the mid-1970s, and now over 650 million adults are obese, and 1.9 billion adults and over 370 million children and adolescents are overweight or obese (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). No country has yet reversed these increases. Closely driven by the increase in obesity is a doubling of worldwide type 2 diabetes prevalence since 1980, now affecting about 420 million people (https://www.who.int/news-room/fact-sheets/detail/diabetes). Obesity, type 2 diabetes and related non-communicable diseases, including cardiovascular diseases and some common cancers, have become pandemics. Pre-COVID-19, health systems in most countries did not have the capacity to effectively treat diet-influenced diseases. Now, many health systems are at or beyond breaking point struggling with COVID-19, the severity of which is significantly higher in people with obesity and related diseases.

Evidence of the general healthfulness of dietary patterns based on fresh and minimally processed foods and culinary preparations, and their protection against all forms of malnutrition, ‘is noteworthy for its breadth, depth, diversity of methods, and consistency of findings’.11

But only in the last decade, with the advent of the NOVA food classification system that distinguishes ultra-processed foods from minimally processed or processed foods,1 has the link between changes in types of food processing and the pandemic of obesity and related diseases been revealed. Evidence here includes:

  • Three meta-analyses of findings from epidemiological studies, including large, long-duration, carefully conducted cohort studies, show dose-response associations between consumption of ultra-processed foods and obesity, abdominal obesity, type 2 diabetes, dyslipidaemias, metabolic syndrome, depression, cardio and cerebrovascular diseases and all-cause mortality.12–14

  • Analysis of national dietary or food purchase surveys in middle-income or high-income countries shows that the higher the dietary share of ultra-processed foods, the higher the obesogenic dietary nutrient profiles. These are characterised by higher energy density, free sugars, unhealthy fats and sodium, and lower protein and dietary fibre.8

  • Epidemiological and experimental studies indicate that ultra-processed foods may increase risks for obesity and related diseases in other ways beyond their nutritional composition. These include structural and physical properties that blunt satiety signalling, organoleptic characteristics associated with higher energy intake rate, neo-formed substances and migrated packaging materials that are endocrine disruptors, additives that promote pro-inflammatory microbiome, and reduced thermic effect that decreases total energy expenditures.12–14

  • A randomised controlled cross-over trial shows that consuming a high ultra-processed diet causes a highly significant increase in ad libitum calorie intake and consequent weight gain. Over a 2-week period, 20 young adults following a diet with 83% of energy from ultra-processed foods consumed approximately 500 more kcal per day than when they followed a diet with no ultra-processed foods. Participants gained 0.9 kg at the end of the 2 weeks with the ultra-processed diet and lost 0.9 kg at the end of the non ultra-processed diet, mostly of body fat.15

  • A longitudinal ecological study of 80 countries from 2002 to 2016 shows a direct association between changes in annual per capita volume sales of ultra-processed foods and corresponding changes in population adult body mass index.16

Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity and related diseases. There is also mounting evidence of the harmful effects of the ultra-processed food industry on the planet, through its global demand for cheap ingredients that destroy forests and savannah, its displacement of sustainable farming, and its resource-intensive manufacturing and packaging.17

Policy responses

To begin with, the UN Food Systems Summit should urge international and national health and food and nutrition authorities to review their dietary guidelines to emphasise preference for fresh or minimally processed foods and avoidance of ultra-processed foods, in line with guidelines developed, for example, by the WHO/Pan American Health Organization,18 and issued in several Latino-American countries, and now also in France, Belgium, and Israel.

At the same time, national governments should be urged to use fiscal measures, marketing regulations, bold mandatory front-of-pack labelling schemes and food procurement policies, all designed to promote the production, accessibility and consumption of a rich variety of fresh or minimally processed foods, and to discourage the production, distribution and consumption of ultra-processed foods, as now done in several countries.19

Current food and nutrition policies are mostly intended to encourage food manufacturers to reformulate their products by reducing the use of salt, sugar or unhealthy fats. There is a role for strong regulations that effectively limit the levels of these components, but reformulation alone will not turn ultra-processed products into healthy foods,20 as in effect recently acknowledged in one internal document from one leading ultra-processed food corporation – “some of our categories and products will never be ‘healthy’ no matter how much we renovate” (https://www.ft.com/content/4c98d410-38b1-4be8-95b2-d029e054f492). Policies should instead stimulate the entire manufacturing industry to maintain, develop or improve processing methods that prolong the duration of whole foods, enhance their sensory properties and make their culinary preparation easier and more diverse. Ultra-processed foods should be replaced by processed foods with limited levels or absence of added salt, sugar or unhealthy fats or, preferably, by minimally processed foods.20

Conclusions

Food systems are failing. This is most clearly shown by what are now the pandemics of obesity and type 2 diabetes, of which ultra-processed food is a main contributor. The UN Food Systems Summit should urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Acknowledgments

This paper expands a one-page submission made by the authors to the UN Food Systems Summit within Solution Cluster 2.2.1 (food environment).

References

 

Footnotes

  • Twitter @CMonteiro_USP

  • Contributors All authors contributed to the ideas presented in the manuscript. CAM wrote the manuscript. All authors contributed to redrafting and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Aug 5 2021

Response to my conflicts-of-interest post on July 19

On July 19, I did a post on a recent study comparing the nutrient composition of plant-based meat alternatives to that of grass-fed beef.  I was not surprised that the study found nutritional differences; they are to be expected.

I was surprised that “From the abstract and conclusion, the study appears to suggest that meat is nutritionally better,” but the authors said the two types “could be viewed as complementary in terms of provided nutrients. It cannot be determined from our data if either source is healthier to consume.”   That confused me.  I also was confused by the authors’ reported conflicts of interest and said so.

One reader wrote to say that I was being unfair to the authors, who are excellent scientists.

Indeed, the authors followed up with an explanation, which I offered to post here without further comment.  They agreed to that.

Dear Dr. Nestle,

Many thanks for posting about our work. We have the utmost respect for your work and we have cited your work in our papers and books (e.g., Provenza’s Nourishment). You are an influential and well-respected person, and as you noted, your followers wanted you to inform them about this paper. When reading the post about our work, we were particularly surprised that you didn’t send us an email to fact-check your points, especially since we were introduced by email on 7/7 that noted: “I’ve copied two of the researchers involved Stephan van Vliet and Fred Provenza. That way if you have any further questions, you can pose those to the researchers directly.” If you disagree, c’est la vie, but at least that would have enabled you to write an informed critique, rather than one that is speculative and, at times, incorrect.

An off-hand and speculative statement such as this one: “maybe the vegetarian was responsible for the hedging comments?” would easily have been addressed by simply sending us an email inquiring about this. We would have gladly told you that it was three of the omnivores (SVV, FDP, SK) who were particularly concerned that people would over extrapolate the data. We were especially concerned that people would interpret our data as beef being “better”. That is not what the data indicate (more on what the data does indicate below). Hence our clear and repeated statement: “It cannot be determined from our data if either source is healthier to consume.”

We are writing you this friendly note to put some context to the points that you made. We hope that you will take them as our attempt to reinforce points that we were careful to develop so our paper was not one-sided.

“So, they’re framing everything with the baseline that animal meat is “proper nutrition” which seems like a pretty obvious bias right out of the gate…”

The two words you quoted are from a much more nuanced sentence, which reads: “This has raised questions of whether plant-based meat alternatives represent proper nutritional replacements to animal meat”. This statement refers to a number of papers by different research groups (see our paper for citations) who pose that very question, which we were interested in exploring. This is much more nuanced statement than what you suggest in the blogpost, which simply states animal meat is “proper nutrition”, which, to us, feels like a twisting of our carefully chosen words.

That we are not framing meat as “proper nutrition” is further illustrated by the stated goal of this work at the end of the introduction: “Given the scientific and commercial interest in plant-based meat alternatives, the goal of our study was to use untargeted metabolomics to provide an in-depth comparison of the metabolite profiles of grass-fed ground beef and a popular plant-based meat alternative, both of which are sometimes considered as healthier and more environmentally friendly sources of “beef”.

Furthermore, we also have to be realistic here and not dance around the obvious; the goal of plant-based meat alternatives is to provide a sensory and nutritional replacement for meat, as illustrated in press releases such as Impossible’s “We are Meat”. If one were to add carotenoids and fiber to a meat sausage (see Arby’s Marrot https://www.foodandwine.com/news/arbys-meat-carrots) and consider this a replacement to a carrot…. We would ask the same question: to what extent do a carrot and a meat-based carrot alternative differ nutritionally? It would be reasonable to take the carrot as the benchmark. All in all, we argue that our framing of the research question is much more nuanced than you suggested in your blogpost. “

To the question of nutritional differences, duh, indeed. Why would anyone not expect nutritional differences? From the abstract and conclusion, the study appears to suggest that meat is nutritionally better.”

As we acknowledge in the abstract “Important nutritional differences may exist between beef and novel plant-based alternatives; however, this has not been thoroughly assessed.” Please give us some credit. One of us (Fred Provenza) has studied plants and animals for over 50 years. Of course, we expected meat from a cow to differ from meat from soybeans, but the extent to which this may be the case had not been studied. Nor is this clear to the consumer who is simply looking at Nutrition Facts panels, another very important reason why we did the research. Another issue is that foods are often considered equivalent simply based on their protein content (even in dietary guidelines), but “protein foods” can be vastly different in terms of the non-protein nutrients they provide. We recommend Dr. Courtney-Martin’s editorial in AJCN titled “Is a peanut really an egg”. (https://academic.oup.com/jn/article/151/5/1055/6217441). She discusses these issues in such an elegant way.

We do not suggest that meat is nutritionally better, we clearly state the following in the abstract (something you cite in your blogpost): “Amongst identified metabolites were various nutrients (amino acids, phenols, vitamins, unsaturated fatty acids, and dipeptides) with potentially important physiological, anti-inflammatory, and/or immunomodulatory roles—many of which remained absent in the plant-based meat alternative when compared to beef and vice versa. Our data indicates that these products should not be viewed as nutritionally interchangeable, but could be viewed as complementary in terms of provided nutrients. It cannot be determined from our data if either source is healthier to consume.

The italicized portions are key: we state that some nutrients are not found in the plant-based meat alternative and some nutrients are not found in the meat. Nothing more and nothing less. We also clearly state that we cannot determine from this metabolomics analysis if one is healthier than the other. We intend to pursue that question in research with people, but based on current research we also have to be realistic and we, therefore, highlight the following: “Further work is needed to inform these discussions; however, we consider it important to not lose sight of the “bigger picture” in these discussions, which is the overall dietary pattern in which individual foods are consumed. That is arguably the predominant factor dictating health outcomes to individual foods. Of note is a recent 8-week randomized controlled trial that found that a “flexitarian approach” (swapping moderate amounts of meat with novel plant-based alternatives as part of an omnivorous diet) may have positive benefits in terms of weight control and lipoprotein profiles (e.g., LDL-cholesterol).” (https://doi.org/10.1093/ajcn/nqaa203).

We are not particularly touting the superiority of meat in the discussion. We mention many of the potential health benefits of the compounds found in plant-based meat alternatives such as phytosterols, tocopherols, and other phenolic anti-oxidants, which were more abundant or exclusively found in the plant-based meat alternative.

“Really? If they can’t figure out which is better, why do this study?”

It is not a question of which one is better. It is about understanding potential similarities and differences. Is an almond better than an orange? That depends on the types of nutrients you are looking to get. If you want Vitamin C, an orange is preferred over an almond. If you want Vitamin E, consume the almonds. But there is also nutritional overlap, because both provide fiber and they have complementary phytonutrient profiles. A silly example perhaps when you put it like that, but that’s analogues to what we are stating in the paper.

“As for the conflicted interests: My first reaction to seeing this study was to ask: “Who paid for this?”

No funding was received for this work. The cost of the meat and plant-based meat alternatives (~$600) was paid with my [Dr. Stephan van Vliet] personal credit card (I am a post-doc and had no grant or start-up funds when I first arrived at Duke). The cost of metabolomics (~$200 per sample) was waived by Duke Molecular Physiology Institute’s Metabolomics Core. This was generously done to provide an early career investigator like myself to generate pilot data for a publication and grants.

The North Dakota Beef Association grant that I am the PI on [Dr. Stephan van Vliet] is $135k (not a very big grant) and supports a 4-week RCT that studies cardiovascular risk biomarkers and metabolome profiles in response to eating beef as part of a traditional (whole food) vs standard American diet. Various epidemiological studies suggest that when red meat is consumed as part of a whole foods diet, the associated risk with CVD becomes neutral, whereas eating red meat as part of a standard American diet is associated with increased disease risk. We are testing/falsifying this hypothesis prospectively in a short-term RCT and are exploring potential mechanisms by which this may or may not be the case. This work has nothing to do with plant-based meat alternatives.

The Turner Institute of Ecoagriculture ($27.5k) and the Dixon Foundation ($12.5k) are pilot grants to run metabolomics on grass-fed vs grain-fed bison and beef, respectively. The USDA-NIFA-SARE grant is collecting both plant (crops + fruit) and animal (eggs + beef) food samples from farms that use agroecological principles such as integrated crop-livestock systems. Here we are asking the question: How do practices that potentially stimulate soil health and plant diversity impact the healthfulness of animal and plant foods for human consumption? To be clear, we are also studying crop samples (soy, corn, and peas) some of which may go into alternative protein production.

My [Stephan van Vliet] conflict-of-interest policy is also essentially similar to yours: I accept funding for travel, hotels, meals, and meeting registrations, but I do not accept personal honoraria, consulting fees, or any other financial payments from such groups. A simple email could have cleared that up, but I will make sure that I state this more clearly in future papers.

Of course, we understand the public suspicion about research funding and undue influence. If a certain funding agency doesn’t like the data or the proposal and they don’t want to fund any of our projects then that is what it is, but we would not risk our reputation and career for a few research dollars or to please the funding agency. That’s why we are pushing back on this. Fred Provenza, especially, has been critical of the way beef is produced in confinement feeding operations (e.g., see recent paper https://doi.org/10.3389/fsufs.2021.547822), so the suggestion that we are beef industry defendants rather than independent scientists does sting a bit.

At the same time, we would also be lying if we didn’t think about where funding comes from. However, the harsh reality is that without foundation/commodity funds for scientific research, there would be much less research, much of which has also proven valuable over time. Even with our USDA grant, one could argue that the reason we are funded is because we wrote a good proposal, but also because our proposed work can presumably benefit the US Farm Bill. Is that true independence? All we know is that we should be transparent (hence our detailed competing interest statement) and let the data speak for itself (hence we attached our full data set as supplementary materials and deposited raw data files on metabolomics workbench), which is what we aimed to do in our Sci Rep paper.

We appreciate your concerns. We will certainly take these into account as we move forward and continue to be critical of our work. We hope you also consider our concerns and are willing to keep an open and friendly dialogue.

Sincerely,

Stephan van Vliet

Fred Provenza

Scott Kronberg