by Marion Nestle

Search results: dietary guidelines

Sep 30 2019

Eat as much meat as you like? Really?

The press release from the Annals of Internal Medicine arrived last week under embargo, sent to me by several reporters: “New guidelines: No need to reduce red or processed meat consumption for good health.”

The press announcement was accompanied by 5 review papers, a sixth with this recommendation, and an editorial.  These are posted on the website of their publisher, the American College of Physicians, implying this organization’s endorsement of this guideline.

Collectively, these papers challenge dietary advice to eat less processed meat and red meat on the grounds of inadequate science.

These papers argue:

  • Eliminating processed and red meat from the diet may reduce disease risks but the effects are small and evidence for them is of low quality and low certainty.
  • Omnivores are unwilling to eat less meat.
  • If you continue to think eating meat is bad for you in the face of this evidence, you are a victim of the “the less you know, the more you hold to your beliefs” syndrome.
  • You can ignore dietary guidelines (regardless of source) and continuing eating meat as you always have.

This is a good example of what I call nutritional nihilism, an approach that insists that because observational studies are based on self-reported information and necessarily flawed, their conclusions are unscientific and should be discounted.  Therefore, because we can’t do more rigorous studies, we should not advise the public about diets best for health or the environment.

I have several concerns about all this:

  • Yes, the effects are small but that is true of nutrition studies in general.  The small effects show benefits from eating less meat.  The authors could easily have interpreted their work as suggesting that eating less meat might be useful.  This is an example of interpretation bias.
  • The authors took a strictly science-based approach to a problem strongly affected by social, economic, and political factors and values.
  • The studies look at previous studies that compared people who eat meat to those who eat less. The authors excluded studies of vegetarians compared to meat-eaters.
  • They look at meat outside its context of calories.
  • The authors did not look at the totality of the evidence; they excluded laboratory and animal studies that can be more closely controlled.
  • They excluded studies of environmental impact, which has a significant bearing on human dietary practices (meat production adds more greenhouse gases than vegetable production).
  • The conclusions fall into the category of “everything you thought you knew about nutrition is wrong.”  This rarely happens.  Science usually works incrementally, not in one enormous reversal like this.

Do the authors really believe that all those other committees and commissions urging less meat were wrong and continue to be wrong?   Their strictly science-based approach seems unrealistic.

The papers come across to me as a concerted attack on dietary guidelines (national and international), on nutrition science in general, and on nutritional epidemiology in particular.

The meat industry and its supporters will love them.

Attacks on the quality of nutrition research have been coming from many sources lately: the food industry, of course, but also statisticians (John Ioannidis at Stanford is making a career of this), and some scientists (usually with ties to food companies).  The criticisms themselves are not new.

What is new is the vehemence and level of effort to discredit observational studies, particularly those based on self-reports of dietary intake.  Yes, nutritional epidemiology has flaws, but the methods have been useful in many instances, as argued convincingly by two of its leading practitioners.

In looking at nutrition research, I think it is essential to evaluate the totality of information available: laboratory, animal, human epidemiology and clinical studies—and to do this in the context of what people actually eat and the number of calories they consume, as well as adding in a hefty dose of common sense.

Common sense is what’s missing in these studies.  Do the authors really believe that:

  • Meat eaters are healthier than vegetarians?
  • Eating more meat is better for health?
  • Meat eaters are less obese and have less heart disease and cancer than those who eat less?

If not, the conclusions make no sense.

Most of the authors report no financial ties to the food industry.  I would love to know the back story about why they chose to do these studies and to interpret them in this way.

Reactions (I will be adding to this list as they come in)

Sep 30 2019

Industry-funded studies of the week: Yogurt

These three papers were part of a supplement to Advances in Nutrition published in September 2019: Supplement—6th Yogurt in Nutrition Initiative (YINI) Summit / More than the Sum of Its Parts, sponsored by Danone Institutes International. Publication costs for this supplement were defrayed in part by the payment of page charges.

I.  Introduction to the Sixth Global Summit on the Health Effects of Yogurt: Yogurt, More than the Sum of Its Parts.  Sharon M Donovan ; Olivier Goulet. Advances in Nutrition, Volume 10, Issue 5, September 2019, Pages 913S–916S.

Conclusion: “Ultimately, the inclusion of fermented dairy products in food-based dietary guidelines, not only as a dairy option, but as a significant source of viable bacteria and fermentation products, could contribute to improved public health and should be considered.”

Author disclosures: “The guest editor of the supplement has the following conflict of interest: SMD co-chairs the Yogurt in Nutrition Initiative. She received reimbursement for travel expenses and an honorarium from Danone Institutes International for chairing the Sixth International Yogurt in Nutrition Summit at the Nutrition 2018 meeting in June 2018 in Boston, MA….SMD and OG are co-chairs of the Yogurt in Nutrition Initiative. Travel expenses and an honorarium were paid to SMD and OG by Danone Institutes International for chairing the Sixth International Yogurt in Nutrition Summit at the Nutrition 2018 meeting in June 2018 in Boston, MA. OG is also the Chair of Danone Institutes International.

II.  Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix Compared with Single Nutrients.  Dariush Mozaffarian.  Advances in Nutrition, Volume 10, Issue 5, September 2019, Pages 917S–923S,

Conclusion: “The present evidence suggests that whole-fat dairy foods do not cause weight gain, that overall dairy consumption increases lean body mass and reduces body fat, that yogurt consumption and probiotics reduce weight gain, that fermented dairy consumption including cheese is linked to lower CVD risk, and that yogurt, cheese, and even dairy fat may protect against type 2 diabetes. Based on the current science, dairy consumption is part of a healthy diet, without strong evidence to favor reduced-fat products; while intakes of probiotic-containing unsweetened and fermented dairy products such as yogurt and cheese appear especially beneficial.”

Disclosures: “DM received an honorarium from the American Society of Nutrition for the preparation of this manuscript. A freelance science writer, Denise Webb, was supported by Danone Institute International to prepare an initial draft of this manuscript for DM based on a recording of his talk and slides at the American Society of Nutrition 2018 Congress. The final manuscript was edited in detail and approved by DM. The funders had no role in the design, analysis, interpretation, review, or final approval of the manuscript for publication…DM reports research funding from the NIH and the Gates Foundation; personal fees from GOED, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, and America’s Test Kitchen; scientific advisory board, Elysium Health (with stock options), Omada Health, and DayTwo; and chapter royalties from UpToDate; all outside the submitted work.”

III.  Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts.  Arne Astrup; Nina Rica Wium Geiker; Faidon Magkos.  Advances in Nutrition, Volume 10, Issue 5, September 2019, Pages 917S–923S.

Conclusion: “Although more research is warranted to adjust for possible confounding factors and to better understand the mechanisms of action of dairy products on health outcomes, it becomes increasingly clear that the recommendation to restrict dietary saturated fat to reduce risk of cardiometabolic disease is getting outdated. Therefore, the suggestion to restrict or eliminate full-fat dairy from the diet may not be the optimal strategy for reducing cardiometabolic disease risk and should be re-evaluated in light of recent evidence.”

Disclosures.  “NRWG and FM, no conflicts of interest. AA is a member of advisory boards/consultant for BioCare Copenhagen, Denmark; Dutch Beer Institute, Netherlands; Gelesis, United States; Groupe Éthique et Santé, France; McCain Foods Limited, United States; Novo Nordisk, Denmark; Pfizer, United States; Saniona, Denmark; and Weight Watchers, United States. AA has received travel grants and honoraria as a speaker for a wide range of Danish and international consortia. AA is co-owner and member of the board of the consultancy company Dentacom Aps, Denmark; cofounder and co-owner of UCPH spin-outs Mobile Fitness A/S, Flaxslim ApS, and Personalized Weight Management Research Consortium ApS (Gluco-diet.dk). He is coinventor of a number of patents owned by the University of Copenhagen, in accordance with Danish law. He is coauthor of a number of diet and cookery books, including books on personalized diet approaches. AA is not an advocate or activist for specific diets and is not strongly committed to any specific diet.”

Comment

These papers aim to dispute the idea that full-fat dairy products but have negative health effects. This is a legitimate scientific question that deserves investigation and analysis, preferably by studies funded by independent sources.  Industry-funded studies and opinion pieces are well known to produce results and conclusions favorable to the sponsor’s interest, as is the case here.

 

Sep 20 2019

Weekend reading: the state of obesity

Trust for America’s Health has just published its annual report on obesity, state by state.

As the home page puts it, “U.S. Obesity Rates Reach Historic Highs – Racial, Ethnic, Gender and Geographic Discrepancies Continue to Persist.”

The press release has an even more pointed headline: “U.S. Obesity Rates at Historic Highs – Nine States Reach Adult Obesity Rates of 35 Percent or More.”

The report highlights that obesity levels are closely tied to social and economic conditions and that individuals with lower incomes are more at risk. People of color, who are more likely to live in neighborhoods with few options for healthy foods and physical activity, and, are the target of widespread marketing of unhealthy foods, are at elevated risk.

What to do?

The report calls for sugary drink taxes, expanded SNAP and WIC Nutrition support programs and a built environment that encourages physical activity.

Buried in the report are suggestions for curbing food-industry marketing and other efforts to undermine public health initiatives.

  • Keep industry out of dietary guidelines.
  • Consider regulating food-industry marketing.
  • Stop industry from preempting state public health laws.
  • Reduce unhealthy food marketing to children.

Lots of good stuff here and well worth a read.

Sep 11 2019

USDA’s Nutrition Education programs

I was astounded to learn that the USDA spends more than $900 million a year on nutrition education since I can hardly recall seeing any of it.

But now we have a Government Accountability Office (GAO) analysis of USDA’s expenditures on nutrition education.

The GAO says that USDA does not:

  • Coordinate its nutrition education efforts
  • Use the expertise of USDA nutritionists
  • Make nutrition education a priority
  • Have leadership with responsibility for nutrition education
  • Share information across sub-agencies and avoid duplicating efforts
  • Assign nutrition education experts to appropriate sub-agencies

No big surprise here—I’ve been hearing such complaints since I worked for the government in the late 1980s—but it’s good to see them documented.

Most of the report is about nutrition education for participants in WIC, SNAP, and other nutrition assistance programs.

Note that there is no line budget for promotion of the Dietary Guidelines for Americans, a statement of of federal nutrition policy, or for MyPlate, a food guide directed at the general public.  Funds to promote these documents have to be authorized by Congress.

Note also that while $900 million seems like a lot of money, it is considerably below what companies like McDonald’s and Coca-Cola each spend on advertising every year.

Aug 6 2019

The true purpose of moving the ERS out of DC: “Drain the Swamp”

Really, you can’t make this stuff up.

The Washington Examiner reports on a speech given by Mick Mulvaney, Trump’s acting chief of staff and current budget head, on why the administration chose to move the Economic Research Service from Washington DC to Kansas City:, causing 70 to 80 percent of its researchers to resign:

What a wonderful way to sort of streamline government and do what we haven’t been able to do for a long time…It’s really, really hard to drain the swamp, but we’re working at it…Guess what happened? More than half the people quit. Now, it’s nearly impossible to fire a federal worker. I know that because a lot of them work for me, and I’ve tried. You can’t do it.  By simply saying to people, ‘You know what, we’re going to take you outside the bubble, outside the Beltway, outside this liberal haven of Washington, D.C., and move you out to the real part of the country,’ and they quit.  What a wonderful way to sort of streamline government and do what we haven’t been able to do for a long time…even that was difficult to do.

From my standpoint, the destruction of the ERS—now a done deal—is nothing less than an American tragedy.

The ERS was an apolitical research organization, producing carefully done and highly vetted studies on all aspects of USDA’s food programs—agricultural supports, GMOs, pesticides, crop insurance, conservation, trade, food insecurity, food assistance programs, dietary guidelines.

Sometimes their studies produced inconvenient results.  Sometimes truth is inconvenient.

I’ve always viewed the ERS as a national treasure.  I used to think it was Washington’s best kept secret.

Somehow, somebody in this administration found out about it.   It was a tiny agency and must have looked easy to get rid of.

A tragedy indeed.

Some of my previous posts on this topic.  I wish they had done some good.

And this just in:

USDA’s inspector general says the department may well have violated laws by moving ERS without congressional permission.

 

Tags:
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].

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.

 

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.