by Marion Nestle

Search results: dietary guidelines

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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Nov 20 2018

Healthy diets: Variety?

I was surprised to read a recent paper in the American Heart Association journal arguing that dietary diversity may not be good for health:

“Eat a variety of foods,” or dietary diversity, is a widely
accepted recommendation to promote a healthy, nutritionally adequate
diet and to reduce the risk of major chronic diseases. However, recent
evidence from observational studies suggests that greater dietary diversity is associated with suboptimal eating patterns, that is, higher intakes of processed foods, refined grains, and sugar-sweetened beverages and lower intakes of minimally processed foods, such as fish, fruits, and vegetables, and may be associated with weight gain and obesity in adult populations.

Obviously, eating a variety of junk food is unlikely to improve health.  But the variety recommendation has never been intended to include junk food.

Here’s a summary of the variety recommendations of the Dietary Guidelines from 1980 to 2015:

These have increasingly specified healthy foods.

Eat your veggies!  Enjoy!

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Aug 2 2018

Eat meat and reduce carbon emissions. How? Feed cattle on grass.

In response to my post last week about a new report on the effects of meat production on climate change and the need to eat less meat, Ridge Shinn, a producer of 100% grass-fed beef reminded me that meat has a place in the diet and raising cattle does not have to harm the planet.

The whole point of cattle raising is to graze the animals on land that cannot be used to produce food for people and let them turn grass into edible meat.  Raising cattle on grass, sustainably, regenerates the land and reduces carbon emissions.

Shinn summarizes the evidence in comments that he and other sustainable livestock farmers submitted to the 2015 Dietary Guidelines Advisory Committee.

As ranchers and farmers who produce 100% grass-fed beef, we submit that the research on our product is already in. We are already employing techniques that soil scientists have validated since the 1990s. We know that corn is bad for cattle and that corn-fed meat is unhealthy for humans. Therefore we raise our beef on grass and pasture alone. We are managing our pastures and our herds to foster the soil microbes that science has shown to be critical to producing healthy meat, sequestering carbon, restoring soil fertility, and retaining water.

He also sent other useful resources on this issue.

A 2016 scientific paper by WR Teague et al in the Journal of Soil and Water Conservation on the role of ruminant animals in reducing carbon footprints.

Incorporating forages and ruminants into regeneratively managed agroecosystems can elevate soil organic C, improve soil ecological function by minimizing the damage of tillage and inorganic fertilizers and biocides, and enhance biodiversity and wildlife habitat. We conclude that to ensure longterm sustainability and ecological resilience of agroecosystems, agricultural production should be guided by policies and regenerative management protocols that include ruminant grazing.

A 2010 essay by Tara Kelly in Time Magazine based on a book review.

in his new book, Meat: A Benign Extravagance, Simon Fairlie, a British farmer and former editor of the Ecologist magazine, tears apart the theory that being carnivorous is bad for the planet — and says that eating moderate amounts of meat could be greener than going vegan.

A 2010 article by the journalist Lisa Abend, also in Time Magazine.

Environmentalists have been giving cows a bad rap in recent years. Between what bovines eat and what they excrete, cattle production emits a lot of greenhouse gas. But if fed solely grass, cows could play a key role in reversing climate change.

I think the arguments are compelling.  Animals have a place in human diets when they are raised sustainably and as humanely as possible.

Raising animals this way means fewer of them.  We still have to eat less meat—and eat meat of better environmental quality.

We could do this….

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Jun 19 2018

What’s up with the retracted Mediterranean diet study?

In a most unusual action, the New England Journal of Medicine has retracted a 2013 study of Mediterranean diets and published a new version of it at the same time.

The studies asked participants to consume one of three diets: (1) a Mediterranean diet supplemented with extra-virgin olive oil, (2) a Mediterranean diet supplemented with mixed nuts, and (3) a control diet with advice to reduce dietary fat.

The authors describe Mediterranean diets as containing a

high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.

The conclusion of the original, widely publicized, but now retracted study:

In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet.

The conclusion of the newly analyzed version:

In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet.

Looks the same, no?

The most thorough analysis of the study that I have seen comes from Hilda Bastian at PLoS Blogs.

Even for the full group, there was no statistically significant difference on myocardial infarction or CVD mortality – just for stroke. And in the supplementary information, there wasn’t a difference in the Kaplan Meier analysis for stroke either.

What are we to make of all this?

Diet trials are notoriously difficult to conduct and interpret and the Mediterranean diet—largely vegetarian with olive oil as the principal fat—was associated with great health and longevity based on studies of people who lived on the island of Crete immediately after the Second World War; they did not have much food to eat and were highly physically active.

And then there’s the matter of who paid for the study.  The retracted study and its revision were funded independently.  But a study published on June 13 concludes:

Adults who are overweight or moderately obese may improve multiple cardiometabolic disease risk factors by adopting a Mediterranean-style eating pattern with or without reductions in red meat intake when red meats are lean and unprocessed.

The funder?  The Beef Checkoff and the National Pork Board.

Overall, the 2015-2020 Dietary Guidelines for Americans recommends Mediterranean dietary patterns for their health benefits, defines what goes into them in Table 1.2 (p. 35), and provides more details in Appendix 4 (starting on p. 83).

Mediterranean diets are delicious.  While the scientists are arguing about exactly how healthy they might be, enjoy!

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