I’m trying to keep up with what’s happening with Cannabis edibles and drinkables, still with borderline legality in most places, but gradually working their way to supermarkets near you.

Here’s what’s come up lately.

• The FDA is calling a public hearing on May 31 and asking for comments on Cannabis products.
• The Washington Post discusses the messy regulatory situation.
• Cannabidiol (CBD), extracted from hemp, does not have the psychoactive properties of marijuana.
• The 2018 Farm Bill legalized the raising of hemp, which contains CBD.
• On the local level: regulators in different agencies view regulation in different ways.
• On the global level: different countries are handling regulation of these products in different ways.
• CVS will be selling CBD products as over-the-counter drugs.
• As for edibles, CBD-infused water is predicted to be the big seller.
• The Sacramento Bee reported what happens when kids get into their parents’ marijuana edibles; it called for childproof packaging.
• A video from Fresno County shows unlicensed marijuana edibles, some of which look like candies aimed at children.
• The FDA will hold a public hearing on the safety, manufacturing, quality, marketing, labeling, and sale of Cannabis products on May 31.

And then there are the health claims.  As early as 2017, the FDA sent out warning letters to makers of CBD products; they were marketing their products as drugs not supplements or foods.

For example, the FDA sent a letter to That’s Natural, complaining that the company published testimonials saying things like this:

• “Scientific research by doctors have shown it actually kills cancer cells and provides a protective coating around our brain cells.”
• “as a Type 1 diabetic, my blood sugars have noticeably leveled off.”
• “My blood pressure and heart rate have also significantly improved as well.”

The FDA also sent a letter to Green Roads of Florida objecting to claims like these:

• “CBD .[has] anti-proliferative properties that inhibit cell division and growth in certain types of cancer, not allowing the tumor to grow.”
• “Almost all studies recognize CBD’s potential in preventing both cancer spread and growth…”
• “The following are some of the many ailments CBD oil can potentially be therapeutic for:  asthma, Alzheimer’s disease, arthritis, autism, bipolar disorder, various types of cancer….

Food, medicine, supplement, or snake oil?  We shall see.

I am occasionally asked to comment on new studies that appear.  Practice Update: Diabetes asked for a comment on this study:

VS Malik, et al.  Long-Term Consumption of Sugar Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139:00–00. DOI: 10.1161/CIRCULATIONAHA.118.037401

The study concluded: “Consumption of SSBs [sugar-sweetened beverages] was positively associated with mortality primarily through CVD [cardiovascular disease] mortality and showed a graded association with dose. The positive association between high intake levels of ASBs [artificially sweetened beverages] and total and CVD mortality observed among women requires further confirmation.”

Here’s what I said:

This study is based on analyses of data from two remarkably large and long-standing investigations of diet and disease risk. The investigators looked for correlations between mortality and consumption of sugar-sweetened beverages (SSB) and found them. More than two SSB servings a day was associated with higher mortality, particularly from cardiovascular disease, and, to a lesser extent, cancer.

Thus, this study adds to the increasing body of evidence associating SSBs with poor health. SSBs provide calories, but nothing of nutritional value. Other studies correlate SSBs with obesity, type 2 diabetes, and heart disease. A further correlation with increased mortality is not surprising, but it is good to have it confirmed.

These results associate high intake of SSBs with disease risk, but cannot prove that SSBs causedisease. Epidemiological studies like these, based on self-reported dietary data, require careful interpretation. In part, this is because intake of SSBs tracks closely with other lifestyle characteristics. Heavy SSB users tend to be more sedentary, more likely to smoke, to consume more meat and calories, but to eat fewer vegetables than light users—overall, to have less healthy dietary habits in general. Still, reducing or eliminating SSB intake is harmless and could well improve health.

This is one of an ongoing series of examples of how industry funding skews, or to be more precise, is strongly associated with skewing, of research and opinion about matters of diet and health.

This example is an analysis of the scientific rigor of dietary approaches to controlling type 2 diabetes through diet.  The authors looked at the evidence for efficacy of the DASH, Mediterranean, Plant-Based, and Low-Carb diets.

Improving the Scientific Rigor of Nutritional Recommendations for Adults with Diabetes: A Comprehensive Review of the American Diabetes Association Guidelines Recommended Eating Patterns.  Hallberg S, Dockter NE, Kushner J, Athinarayanan S.  Preprints 2019.  Online March 5.  doi: 10.20944/preprints201812.0187.v2

Conclusion: “Our review of the current Standards and Recommendations finds significant shortcomings regarding scientific review methodologies, which are likely to translate to suboptimal clinical care decisions for patients with T2D.”  The study dismisses most studies of the DASH, Mediterranean, and Plant-based diets as poorly done or otherwise inappropriate for their review.  For the DASH diet, it says more research is needed.  It calls for more research on whether the benefits of Mediterranean diets are due to low carb or healthy fats, and suggests that the benefits of plant-based diets may be due to weight loss.  The best evidence supports the Low-Carb diet: “Evidence from 30 trials and 10 follow-up studies demonstrates that a low-carbohydrate diet is an effective dietary approach for addressing dyslipidemia.”

Conflict of Interest Statement:  SJH is an employee and shareholder of Virta Health, a for-profit company that provides remote diabetes care using a low-carbohydrate nutrition intervention, and serves as an advisor for Atkins Corp.  NED is a paid consultant for Virta Health.  JAK serves as medical director of McNair Interests, a private equity group with investments in type 1 diabetes and other chronic illnesses, and is also an advisor for Sanofi and Lexicon.

Comment:    All authors are employed by or consult for a company that uses low-carb dietary approaches in its for-profit business.  As I explain in Unsavory Truth, the influence of industry funding is often unconscious, unintentional, and unrecognized.  Nevertheless, the opinions of the authors can be predicted from their financial connections to Virta Health.

The George Institute in Australia (see clarification below) publishes an annual index holding the ten largest U.S. food and beverage corporations accountable for how they addrss nutrition challenges.

The 2018 Index ranks corporations on their governance, products, accessability, marketing, lifestyle, labeling, and engagement.  Here’s what it looks like.

Here’s how this is explained:

Seven out of ten companies claim to focus on improving health and nutrition (all except Coca-Cola, Dr Pepper Snapple and Kraft Heinz), as expressed in their mission statements or corporate growth strategies, the objectives they defined related to health and wellness are mostly limited to product development, product reformulation and responsible marketing. Only two companies (Nestlé and Unilever) have defined a more comprehensive set of objectives within their nutrition strategy.

To remind you: food corporations are not social service or public health agencies.  They have stockholders to please as their first priority.  The conflicts of interest with public health approaches are obvious.  That’s why none of them does particularly well on this Index.

Clarification from a reader

I believe you are referring to the US Spotlight Index, a product of the Access to Nutrition Foundation, an independent nonprofit in the Netherlands.  (https://www.accesstonutrition.org).  The George Institute provided research support for the US Spotlight index. RWJF [Robert Wood Johnson Foundation] was a major funder.  The Foundation has also published an India Spotlight Index (2016) and a Global Index (latest in 2018).  Shiriki Kumanyika chairs the Expert Group.

The British Parliament has just rejected the plan for Brexit for the third time, and the EU has just extended the exit deadline until October 31.i

The British food industry is understandably worried about what Brexit, whenever it happens, will mean for supply chains and sales.  Large percentages of British food are imported from the EU, something likely to become more difficult and expensive after Britain’s withdrawal.

I’ve been collecting items on the topic from Food-Navigator.com and other sources.

• • • Food sector slams ‘confusing and complex’ no-deal Brexit tariffs: Food makers have hit out at the tariff system the UK government has said it will adopt in the event of a no-deal Brexit as “confusing and complex”. Read more
    • No-deal Brexit threat: Gove admits ‘no absolute guarantee’ food trade with EU will continue: The UK has said it will extend the deadline on some food policy consultations as Environment Secretary Michael Gove admits a no-deal exit from the EU could see an immediate halt to food trade with the bloc. Read more
    • Concerns remain over ‘hassle and extra cost’ following UK no-deal Brexit labelling advice:  The UK has issued guidance to food businesses on what they will need to include on labels if the UK leaves the EU without a withdrawal agreement on 29 March. Read more
    •  No-deal Brexit and food prices: How much will it push up the average basket?  There is broad agreement that a no-deal Brexit will result in higher UK food prices – but what does this mean for the average family? Read more  
    • Brexit: The best and worst-case scenarios: The fresh food sector may well be the hardest hit when the UK withdraws from the EU, with a no-deal Brexit potentially costing the UK food industry €1.3bn, according to market research provider, Euromonitor International… Watch now
    • Withdrawal agreement defeat leading to catastrophic Brexit: The defeat of the Prime Minister’s withdrawal agreement in parliament last week could be leading the UK toward a catastrophic exit from the EU, warned the head of the National Farmers Union… Read
    • Meat industry issues Brexit warnings: The British Poultry Council (BPC) has called on the Government to ensure that the population continues to have access to quality food once the UK leaves the EU… Read
    • Europe is ready for food safety, post Brexit. The European Commission has said it is prepared for the impact a no deal scenario in the Brexit negotiations would have on food safety. The United Kingdom held a referendum in June 2016 and voted to leave the European Union, a move that became known as Brexit. This was supposed to happen at the end… Continue Reading

I thought this was an April Fool joke, but apparently it’s for real.  According to The Guardian (and many other sources), Burger King will be serving this plant-based meat alternative.

Much has been said in favor of and opposed to the Impossible Burger.

I give Tamar Haspel credit for the most cogent comment:

The latest issue of World Nutrition, the online journal of the World Public Health Nutrition Association, contains tributes to Elisabet Helsing, the Norwegian nutritionist and breastfeeding advocate who died in January of the effects of Parkinson’s disease.

Here’s my contribution.

I met Elisabet in the late 1980s when she was living in Copenhagen, heading up nutrition activities at WHO’s regional office for Europe.  At that time, I did not have much international nutrition experience so I said yes right away when she asked me to go to Mauritius and report on its efforts to prevent childhood malnutrition.  In the month I spent there—January 1990—it became clear that I had landed in the middle of the nutrition transition, as we now call it.  Type 2 diabetes and heart disease were increasing rapidly  right along with persistent undernutrition in some segments of the population. With observations complete, I went to Copenhagen to work with Elisabet on my report.  There, I got to see her in action, and impressive it was.  She was right on top of every nutrition policy in each of the 30 or so countries then part of the region, knew all the key players in government and public health by name, and spoke on the phone to each of them in their own languages.  I had never met anyone so stunningly beautiful, accomplished, forward thinking–and courageous.  Not long after, she was diagnosed with Parkinson’s—Mr. P., as she called it.  She spent the rest of her years keeping Mr. P. at bay as best she could, while continuing her policy and breastfeeding work.  She inspired me, all the way to the end.  I could say more about the later times I saw her in New York or Oslo, but it’s too heartbreaking.  I took this photo at a meeting of the European Nutrition Society in Vienna in 1995, and that’s how I want to remember her.

This is one of my ongoing updates of industry-funded studies such as those discussed in my most recent book, Unsavory Truth.

Here’s this week’s example:

Funding sources and outcomes of dairy consumption research – a meta-analysis of cohort studies: The case of type-2 diabetes and cardiovascular diseases.  Moshe Mishali, Mirit Kisner,Tova Avrech.  International Dairy Journal, accepted and in press 2019.

The study: The authors asked whether the source of funding was associated with the results of studies examining the association of dairy food intake with the risk of type 2 diabetes or heart disease.

Conclusion:  “This meta-analysis found that the funding source (i.e., food industry sponsorship versus neutral organisations sponsorship) did not affect the findings of studies in terms of the association between dairy consumption and the risk of developing type-2 diabetes and cardiovascular diseases…This meta-analysis suggests that research funded by the dairy industry might not deserve the same dismissive treatment that other industry-funded studies might merit.”

Funder: “This work was supported by the Israel Dairy Board Research – Fund (DBRF). Declaration of interest Moshe Mishali is a consultant for the Israel Dairy Board; Mirit Kisner was paid for her work by the Israel Dairy Board; Tova Avrech is Chief Health Officer at the Israel Dairy Board.”

Comment: This study was commissioned by the Israel Dairy Board specifically to address “The radicalised discourse that emerged in recent years [which] sees industry-funded research as inherently biased due to the obvious vested interests of any industry that initiates and funds certain studies…We sought to check if the suspicion is warranted when it comes to the dairy industry.”

These conclusions are consistent with those of Wilde et al (2012), although that study found that independently funded research included the only studies with results unfavorable to dairy (3 out of 16), whereas the industry-funded research came out 100% in favor of dairy products.

I would find the arguments about the benefits of dairy food more convincing if they were funded and conducted by investigators with no skin in the game.