by Marion Nestle

Search results: dietary guidelines

Jul 15 2019

Industry-funded studies: The Sugar Association’s view

You may think, as I do, that everyone would be better off eating less sugar, but that’s not how The Sugar Association sees it.  This trade association for sugar producers funds research to demonstrate that eating sugar is a good thing and not harmful.

Here’s what The Sugar Association says:

The Sugar Association is committed to transparent engagement with researchers, external partners and consumers to address knowledge gaps and support independent, peer-reviewed science. Recent literature suggests this framework, rooted in transparency and communication and reflected in our Operating Principles, leads to increased public confidence in industry-funded research,* a goal the organization is working to achieve.

The asterisk refers to Achieving a transparent, actionable framework for public-private partnerships for food and nutrition research, a consensus report written by, among others, representatives of the International Life Sciences Institute, a well known front group for the food industry, and other organizations with ties to food companies.

The Sugar Association lists some of its recent publications [you can’t make this stuff up]:

Nutrition Today Supplement: Sweet Taste Perception and Feeding Toddlers. March/April 2017 – Volume 52 [The Sugar Association funded the conference that resulted in this supplement, which it also funded].

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Jul 9 2019

An exchange with Ray Goldberg about sponsorship and trust

Ray Goldberg, Harvard Business School Professor of Agribusiness, Emeritus, but still running a seminar that I have attended annually for about 25 years, often challenges me to think more constructively about how food businesses should respond to pressures from public health advocates. His 2018 book, Food Citizenship (for which I was interviewed and videotaped) illustrates some of the back-and-forth we have had over the years.

Recently, in response to my “industry-funded study of the week” posts, he sent me several thought-provoking questions, which I respond to here with his permission.

RG: How can the private sector support nutrition research without being accused of a conflict of interest?

MN: With great difficulty. Industry-sponsored research is inherently conflicted when research questions are designed for marketing purposes, which much—if not most—industry-sponsored research now is. Such research almost invariably produces results that favor the sponsor’s interests. As I explain in Unsavory Truth, I get letters all the time from trade associations requesting proposals for research projects to demonstrate the benefits of the products they represent. There is a big difference between designing a study to demonstrate benefits (a marketing question) and one asking an open-ended what-happens question (basic research). If companies want to fund basic research, they could contribute to a common pool administered by an independent third party such as the NIH. But food companies don’t want to take the risk of paying for research that might come out with inconvenient results. In my book, I suggest taxing food companies to create a research fund that would be administered independently. That’s the only way I can think of that would work.

RG: How does the consumer end up having confidence in the statements of those in the food system who really do have integrity and who really care about their customers and society and the environment? I trust the Wegmans because I know them personally. How does the Food System build back trust?

MN: It’s interesting that you mention Wegmans (I often shop in the one in Ithaca). It is a family-owned business, not publicly traded. I recall hearing Danny Wegman explain the advantage of family ownership at one of your seminars. It’s not that family members don’t want to make money; it’s that they don’t have to be greedy .  They can do things for their customers that publicly traded supermarkets cannot. As long as Wall Street expects food companies to make a profit and to grow their profits every 90 days, companies must respond by pushing their most highly profitable products every way they can, regardless of whether poor health is collateral damage. If companies want the public to trust them, they have to be trustworthy.  But investors don’t reward integrity; they reward profits.

RG: The food system needs people who care about the health of people, plants, animals and our environment but who is providing the leadership that you and others want in that system?

MN: If they want to sell products, large food product companies (Big Food) has to appeal to public demands for health and sustainability.  They are trying to move the Titanic as quickly as they can and still maintain the same profit margins. Big Ag is way behind. I’m seeing a worldwide consensus that we need food system approaches to solve world food problems.  These firmly link agricultural policy to health and environmental policy so as to address hunger, obesity, and climate change. at the same time.  A largely, but not necessarily exclusively, plant-based diet does that and it’s what all food policies should promote.  At the moment, American agriculture and dietary guidelines are outliers in ignoring those linkages. We badly need to catch up.  I see international leadership on this issue, but not here.  Is Harvard training food business leaders to address these needs?  You tell me where the American leadership is. I don’t see it coming from the top.  It has to be bottom up.  Fortunately, lots of young people are interested in food issues and the leadership is going to have to come from them.

 

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Jul 1 2019

Industry-funded study of the week: grains exonerated!

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association? Glenn A Gaesser.  Adv Nutr. 2019 May 1;10(3):361-371.

Conclusion: This literature analysis illustrates a pitfall of attributing health risks to specific food groups based primarily on analysis of dietary patterns. With regard to refined grains, a large and consistent body of evidence from meta-analyses of prospective cohort studies suggests that the assumed health risks are largely a consequence of guilt by association with other foods within the Western dietary pattern, and not to refined grains per se.

Funding: Preparation of this manuscript was supported in part by a grant from the Wheat Foods Council and Grain Foods Foundation. Author disclosure: GAG is a member of the scientific advisory boards of the Grain Foods Foundation, the Wheat Foods Council, and Ardent Mills.

Comment:  The author set out to counter a recommendation of the 2015 Dietary Guidelines Advisory Committee that to improve dietary quality, it’s better to replace most refined grains with whole grains.  Refining whole grains removes the great majority of their vitamins, minerals, and fiber (fortified flour replaces some of the nutrients, but not all).  Furthermore, refined grains are the main ingredients in many ultra-processed junk foods that promote overeating calories and raise risks for chronic disease.  Wheat per se may not be the problem, but what about the foods made from it?  I keep thinking: “grain-based desserts,” the number one contributor to calories in the American diet, according to the Dietary Guidelines.

Why do studies like this?  So the Texas Wheat Association can issue this headline: “New study exonerates refined grains.”

Want details and references on these contentions?  I provide them at length in Unsavory Truth.

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Jun 11 2019

My latest publication: food and nutrition policy primer

This is an invited comment on a series of papers on food policy in the American Journal of Public Health, Vol. 109, No. 7 (July): 985-986.

Primer on US Food and Nutrition Policy and Public Health: Marion Nestle Comments

Marion Nestle PhD, MPH

Accepted: April 12, 2019
Published Online: June 05, 2019
The profound influence of food policies on public health is best illustrated by the vast number of people affected by these policies. All three of the most prevalent problems in worldwide public health—undernutrition, overnutrition, and climate change—have roots in dysfunctional food systems. Hunger and malnutrition affect more than 800 million people,1 more than two billion people are overweight and at risk for chronic disease,2 and all of us are subject to the impact of food production on climate change.3

How the US food system affects public health is a matter of intense current interest. “Food system” means the totality of processes through which food is produced, transported, sold, prepared, consumed, and wasted.4 Policies governing these processes emerged piecemeal over the past century in response to specific problems as they arose, with regulatory authority assigned to whatever agency seemed most appropriate at the time.5 Today, multiple federal agencies oversee food policies. For some policy areas, oversight is split among several agencies—the antithesis of a systems approach.

US food policies deal with eight distinct purposes, all of them directly relevant to public health:

  • Agricultural support: Overseen by the US Department of Agriculture (USDA), agricultural support polices are governed by farm bills passed every five years or so. These bills determine what crops are raised and grown, how sustainably, and the extent to which production methods contribute to pollution and greenhouse gas emissions.
  • Food assistance: The USDA also administers food assistance for low-income Americans through programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the Women, Infants, and Children program, and school meals.
  • Nutrition education: This policy is set forth in dietary guidelines revised every five years since 1980 (overseen jointly by the USDA and the US Department of Health and Human Services) and in the MyPlate food guide (USDA).
  • Food and nutrition research: The National Institutes of Health and the USDA fund studies of diet and disease risk.
  • Nutrition monitoring: The USDA and the Centers for Disease Control and Prevention are responsible for keeping track of the quantity and quality of the foods we eat and how diet affects our health.
  • Food product regulation: Rules about food labels, health claims, and product contents are overseen by three agencies: the USDA for meat and poultry; the Food and Drug Administration (FDA) for other foods, beverages, and dietary supplements; and the Federal Trade Commission for advertising.
  • Food safety: Regulation of food safety is split between the USDA for meat and poultry and the FDA for other foods.
  • Food trade: More than 20 federal agencies are involved in regulating the export and import of food commodities and products, among them are the FDA, the USDA, and the Department of Homeland Security.

This list alone explains why advocates call for a coordinated national food policy.6

The food policy primers in this issue of AJPH address the critical links between agricultural policies and health (Miller et al., p. 986) and key components of food assistance policies: direct food aid to the poor (Brownell et al., p. 988) and nutrition standards for school food (Schwartz et al., p. 989). Their authors are well-established policy experts whose thoughtful comments on the political opposition these programs face make it clear why food system approaches to addressing hunger, obesity, and climate change are essential.

Politics stands in the way of rational policy development, as the editorial by Franckle et al. (p. 992) suggests. Although its authors found substantial bipartisan support for introducing incentives to improve the nutritional quality of foods purchased by SNAP participants, congressional interest in this program remains focused almost entirely on reducing enrollments and costs. Please note that for a special issue of AJPH next year, I am guest editing a series of articles on SNAP that will provide deeper analyses of that program’s history, achievements, needs for improvement, and politics. Stay tuned.

In the meantime, how can US public health advocates achieve a systems approach to oversight of the eight food and nutrition policy areas? A recent report in the Lancet suggests a roadmap for action. It urges adoption of “triple-duty” policies that address hunger, obesity, and the effects of agricultural production on climate change simultaneously.7 For example, a largely—but not necessarily exclusively—plant-based diet serves all three purposes, and all federal food policies and programs, including SNAP, should support it. The primers and editorial should get us thinking about how to advocate a range of food system policies that do a better job of promoting public health. Read on.

CONFLICTS OF INTEREST: The author’s work is supported by New York University retirement funds, book royalties, and honoraria for lectures about matters relevant to this comment.

REFERENCES
1. IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World. Rome, Italy: Food and Agriculture Organization of the United Nations; 2018. Google Scholar
2. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. Crossref, Medline, Google Scholar
3. Vermeulen SJ, Campbell BM, Ingram JSI. Climate change and food systems. Annu Rev Environ Resour. 2012;37:195–222. Crossref, Google Scholar
4. Institute of Medicine; National Research Council; Nesheim MC, Oria M, Yih PT, eds. A Framework for Assessing Effects of the Food System. Washington, DC: National Academies Press; 2015. Google Scholar
5. Nestle M, Lee PR, Baron RB. Nutrition policy update. In: Weininger J, Briggs GM, eds. Nutrition Update. Vol 1. New York, NY: Wiley; 1983:285–313. Google Scholar
6. Bittman M, Pollan M, Salvador R, De Schutter O. A national food policy for the 21st century. 2015. Available at: https://medium.com/food-is-the-new-internet/a-national-food-policy-for-the-21st-century-7d323ee7c65f. Accessed March 17, 2019. Google Scholar
7. Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791–846. Crossref, Medline, Google Scholar
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Apr 23 2019

What’s up with cheese in China?

I was in Beijing last week, reading the English-language, government-issued China Daily in my hotel, and ran across this article about China’s “growing appetite for cheese,”

Cheese has never been part of traditional Chinese cuisines, and the Chinese still do not eat much.

Currently, annual per capita consumption of cheese in China is only 0.1 kilogram, far below 2.4 kg in Japan, 2.8 kg in South Korea, 15 kg in the United States and 18.6 kg in Europe where France, Germany and the Netherlands take the top three spots, according to the China Dairy Industry Association.

But there is a big push to encourage dairy consumption.  Chinese dietary guidelines advise adults to consume 300 grams of dairy a day.

The annual per capita consumption of dairy products in China has reached 36 kg now, much higher than the 6 kg recorded two decades ago, but the volume is still less than half that of Asia and less than a third of the world average.

This all seems odd to me.  Asian populations tend to be lactose intolerant, making dairy products difficult to digest.  But dairy foods are believed to promote faster growth and taller heights in children, which the government deems desirable.  Many people can handle dairy foods, especially yogurt and other fermented varieties.

I went to a large supermarket in an area where many foreign embassies are located and was impressed by the size of the dairy aisle.

But on an Untour Food Tour to Beijing’s lower income alleys (hutongs), I was taken to a tiny store devoted exclusively to dairy products.

Most of the products were milk or yogurt.  The cheese in both places was mostly slices, Kraft and the like.

But in an indoor farmers’ market, I visited Le Fromager de Pekin stall and did some tasting.  At the moment, French cheese makers (or American, for that matter) have nothing to fear from Chinese competition.   I will be interested to see how cheesemaking progresses.

In the meantime, I’m not the only one fascinated by the very thought of cheese in China.  DairyReporter.com notes:

Three decades after most consumers had tried their first cheese slice or milk shake, fortunes have changed dramatically for dairy in China.The country is now the world’s biggest importer of dairy products, with a younger, more mobile generation ravenous for cheeses from overseas. With a market value of US$12bn today, cheese sales are expected to grow by US$4bn over the next year, according to Mintel. In just two years the number of Chinese cheese-eaters has grown from 15% to 17% in 2017, with the market researcher anticipating further rises of 13% annually until 2021.

As for dairy use, the unanticipated consequences are already emerging, not least the environmental impact of the transition from sheep to dairy cows in New Zealand.

A massive rise in the country’s dairy herd over the last 20 years has had a devastating impact on the country’s freshwater quality, a key area being targeted by the government for improvement….groundwater failed standards at 59% of wells owing to the presence of E coli, and at 13% of the wells owing to nitrates. Some 57% of monitored lakes registered poor water quality, and 76% of native freshwater fish are at risk of or threatened with extinction…the main culprits for worsening freshwater quality were the intensive use of fertilisers, irrigation and cows.

And much of this is driven by China’s purchases of New Zealand’s dairy production.

Kiwi companies sold $4b worth of dairy products in China. Milk powder, butter and cheese mainly. The success of dairy companies Fonterra and A2 is largely underpinned by exports to China. Fonterra [a New Zealand company] accounts for 36 per cent of all dairy imports into China…11 per cent of China’s total dairy consumption was produced by Fonterra, and 26 per cent of Fonterra’s output was shipped to China.

It’s hard to believe that any of this is good for the health of people or the envirornment.

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Mar 12 2019

RIP The Salt Institute

I never thought I would live to see this day, but the Salt Institute announced that it is ending operations at the end of this month.

I first learned about the Institute in the late 1980s when I was Senior Policy Advisor to the Office of Disease Prevention and Health Promotion (ODPHP) editing the 1988 Surgeon General’s Report on Nutrition and Health.  The Institute visited us regularly to try to discourage the report from advising “eat less salt.”

Since then, the Salt Institute has been relentless in following the industry playbook to:

  • Cast doubt on science linking high salt intake to disease risk
  • Argue that the current high levels of salt intake are just fine for health
  • Maintain that only a small portion of the population is salt-sensitive
  • Promote science arguing that low salt intake is harmful

The Institute has a lot to answer for.  It has been responsible for confusing the science and creating a most peculiar situation: noisy public debate about salt science while every expert committee examining the relationship of salt to health concludes that we should be consuming much less.

It can hardly be a coincidence that the most recent and most authoritative review of salt and health came out just a few days before the Institute’s announcement .  That review by the National Academies of Science, Engineering, and Medicine reaffirmed what Dietary Guidelines have been saying for years: the upper recommended limit of sodium intake is 2300 milligrams per day, or about 6 grams of salt (a bit more than a teaspoon).

On average, Americans consume much more and, as the Center for Science in the Public Interest (CSPI) has demonstrated for years, single restaurant meals easily exceed that much.

CSPI’s former director, Michael Jacobson, issued a statement.

It might seem the stuff of satire that there is a trade association devoted to defending the amount of salt in our food supply—which contributes to hypertension and cardiovascular disease—and on our roads.  Or at least there was: the Salt Institute will close its doors at the end of this month. And it will not be missed.

Rest in peace.

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Jan 25 2019

Weekend reading: The Lancet / EAT Forum report on healthy and sustainable diets

I’ve saved this for Weekend Reading because it will take a weekend to get through it.  The report is a blockbuster: 37 authors, 47 pages, 357 references.

The Lancet commissioned this report from the EAT Forum, which brought together international experts on diet and health (most of whom I do not know) to define unifying dietary principles that best promote will promote the health of people and the planet.

Fortunately, the diet that is best for health is the same diet as is best for the planet.  The report defines it on page 5.

To summarize:

This report has many strengths:

  • It is researched in depth and is now the reference source for information about needed dietary changes.
  • It firmly links dietary health to environmental sustainability.
  • Its findings are consistent with many previous reports on diet and health, including that of the 2015 Dietary Guidelines Advisory Committee DGAC).
  • Its messages are unambiguous.
  • The summary report is a big help
  • The timing  is excellent; the 2020 Dietary Guidelines advisory committee, if it ever gets appointed, will have to pay close attention to the science reviewed in this report.
  • It focuses on food, not nutrients (these meals meet the standards of recommended diets).

Does this report settle the questions?  Hardly.  Remember the fuss over sustainability (the “S-word?”) in the 2015 report of the DGAC?

There is lots to read and think about here.  Enjoy!

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Jan 23 2019

Canada’s new food guide: a better version of MyPlate?

Here’s Canada’s new food guide:

Doesn’t this look a lot like the USDA’s MyPlate?

Actually, the Canadian guide is better.  Even though it retains the annoying “Protein” section (we don’t eat protein; we eat foods containing protein and lots of other nutrients), it drops the dairy requirement.  Even better, it comes with mostly useful suggestions: [my comments]:

  • Be mindful of your eating habits
  • Cook more often
  • Enjoy your food [Yes!]
  • Eat meals with others
  • Use food labels
  • Limit foods high in sodium, sugars or saturated fat [alas, the usual switch from foods to nutrients when talking about eating less]
  • Be aware of food marketing [yes, but lots more on this please]

I can see why this has been greeted with some enthusiasm and less criticism than usual:

The documents

 

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