Sent to me from a Cracker Barrel in Florida.

Yum.

I am an advisor to the American Society of Nutrition’s Early Career Nutrition group and was asked to address this question for its spring/summer newsletter (my piece starts on page 9).  Here’s what I said:

As a newly appointed advisor to ASN’s Early Career Nutrition (ECN) group, I am pleased to be asked to explain why I do not think it a good idea for nutrition scientists, practitioners, and societies to be funded by food, beverage, and supplement companies (collectively, the food industry) for research that is in any way related to their products. If we do, we run the risk of appearing as if our interests are conflicted. More than that, we risk being conflicted—influenced to be less critical or silent about nutrition issues related to the donor’s products. There is no getting around it: whatever the reality of the relationship, taking money from a for-profit food company makes us appear to be supporters of whatever products the company sells.

I worry a lot that financial ties between food companies and ASN tarnish its reputation and ours. It troubles me when critics outside our profession view us as “on the take” and publish reports exposing ASN’s financial ties to companies that have a marketing stake in what we study or say about their products. When ASN meetings are sponsored by food companies, it makes these financial ties seem normal. ASN provides a platform for industry-sponsored sessions such as the one this year on the benefits of Stevia, but you can bet they don’t include speakers who might say anything critical. Sponsorship excludes that possibility.

Most of what we know about the effects of sponsorship comes from a very large body of research on funding by the cigarette, chemical, pharmaceutical, and medical device industries. The results of this research are remarkably consistent: they demonstrate that industry funding influences the design, interpretation, and outcome of research. Nutrition is late to this type of investigation, but several recent studies show that studies funded by the food industry almost invariably favor the interests of the sponsor. Publication bias against negative studies explains only a small part of these findings.

Industry funding of nutrition research is an important issue where there are diverse opinions. ASN is a welcoming place encouraging discussion from members with all perspectives on topics including this one. ASN members share a common unifying goal of advancing nutrition science to promote the public welfare. Working together we can and we will continue to disclose potential conflicts of interest and advance the field for the public benefit. Dr. Mary Ann Johnson, ASN President
Investigators who take such funding insist that it has no effect on the design, conduct, interpretation, or publication of their research. This insistence is consistent with another large body of research demonstrating that gifts have a profound influence on attitudes, behavior, and action–but that recipients are blind to these effects. The medical literature shows that even small gifts—pens and pads—are enough to influence prescription practices, and that larger gifts have even greater effects. But the influence occurs below the radar of critical thinking. It is unintentional, unconscious, and unrecognized.

What most troubles me is the lack of questioning of industry penetration into our societies and research. I think we should be raising questions about ASN’s involvement with companies whose profits might be affected by our opinions or research results. Should ASN have competed to manage the industry-funded Smart Choices program that ended up putting a seal of approval on Froot Loops? Does it make sense for ASN to endorse public policy statements promoting the benefits of processed foods or opposing “added sugars” on food labels? Is it reasonable for ASN to argue on social media that it is inappropriate to question industry funding of research? Must ECN sessions at the annual meeting really be funded by companies such as PepsiCo (last year) or Abbott Laboratories? These actions send the message that ASN is an arm of the food industry and that we uncritically support what it makes, sells, or does.

But let’s turn to a more immediate concern: research funding. As early investigators, you face intense pressures to bring in external grants to pay for your studies, overhead, and maybe even your salaries. Government funding for many areas of nutrition research is declining. These pressures are real. But just as real are the effects of industry funding on research.
From March 2015 to March 2016, I posted summaries of industry-funded studies on my blog. During that year, I collected 168 studies. Of these, 156 yielded results favoring the sponsor’s interests. I only could find 12 studies that did not. This was a casually collected convenience sample but it did allow one conclusion: it is easier to find industry-funded studies with positive results than those with negative results. Nevertheless, recent systematic studies come to the same conclusion. Studies funded by Coca-Cola, for example, are far more likely to conclude that its products have no effect on obesity or type 2 diabetes than do studies funded by government or foundations.

Because we are generally unconscious of the influence of financial ties, it is easy for us to deny the influence or argue that nonfinancial interests—preferences for hypotheses and desires for career advancement–are just as biasing. Yes they may be biasing, but all scientists have them. In contrast to financial ties to industry, it is not possible to eliminate nonfinancial biases and still do science.

I am often asked whether there is a way to take money from food companies and maintain intellectual independence and professional reputation. I regret that I cannot think of any viable way to do that. The ASN has appointed a “Truth” commission to examine this issue and I look forward to its report. In the meantime, I am hoping that you will give thought to the potential conflict of interest and reputational loss that you risk with food industry ties. You must figure out for yourself whether you think the risks are worth taking.

If you do decide to engage with industry, you will need to disclose it. Most journals now require authors to reveal who pays for their work, but even when done diligently, disclosure is not sufficient to alert readers to the extent to which industry funding influences research outcome and professional opinion. Yes, disclosure is uncomfortable, perhaps explaining why so many studies identify frequent lapses. It is likely to become more uncomfortable. In response to a petition from the Center for Science in the Public Interest (which I co-signed), the National Library of Medicine has announced that it will henceforth add funding disclosures and conflict-of-interest statements to PubMed abstracts.

It is only fair to tell you how I handle these issues. My disclosure statement says:

Dr. Nestle’s salary from NYU supports her research, manuscript preparation, Website, and blog at https://foodpolitics.com. She also earns royalties from books and honoraria from lectures to university and health professional groups about matters relevant to this topic.” I also on occasion speak to food industry groups. When I do, I accept reimbursements for travel expenses but ask that honoraria be donated to the NYU library’s food studies collection.

This policy, imperfect as it may be, is the best I can do. I ask only that you think seriously about these issues and figure out for yourself how best to deal with them. I am happy to discuss these matters and am most easily reached at marion.nestle@nyu.edu.

References

• Nestle M. Food company sponsorship of nutrition research and professional activities: A conflict of interest? Public Health Nutrition 2001;4:1015-22.
• Nestle M. Corporate funding of food and nutrition research: science or marketing? JAMA Internal Medicine 2016;176(1):13-4.
• Krimsky S. Science in the Private Interest: Has the Lure of Profits Corrupted Medical Research. Rowman and Littlefield, 2004.
• Lo B, Field MJ, eds. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
• Simon M. Nutrition Scientists on the Take from Big Food. Eat Drink Politics and the Alliance for Natural Health, Jun 2015.

BakeryandSnacks.com is another industry newsletter I subscribe to for keeping me up to date on what’s happening with baked goods and snacks.

Special Edition: Is grain-free the new gluten-free?

Grain-free may still be niche but it’s gaining traction among consumers who perceive it as the next step to better health. ‘Going completely grainless’ is becoming increasingly popular among consumers who are moving away from processed foods and incorporating natural ingredients, such as nuts, legumes and pulses, into their diets that boost their intake of proteins and minerals. The grain-free trend is an extension of the gluten-free trend, which is predicted to reach $4.35b by 2013 in the US, according to MicroMarketMonitor.

• Promise Gluten Free sells majority stake to UK private equity firm: Mayfair Equity Partners (MEP) has bought a majority stake in the Donegal-headquartered Promise Gluten Free for an undisclosed amount… Read
• Grain-free trend just sprouting in bakery, but may overtake gluten-freeMany bakery industry professionals believe the grain-free trend will catch on – drive by a demand for more natural, less processed ingredients – and will eventually supersede gluten-free… Read
• Rice-based enzyme will bring gluten-free bread to the next level, says DSMDSM has unveiled a rice-based baker’s enzyme which boosts the softness and moistness of gluten-free bread, allowing it to compete with wheat-based breads in texture, it says… Read
• Witte dryers safeguard gluten-free foods from cross-contaminationThe Witte Company has developed a range of dryers and coolers that eliminate the need for a dedicated, gluten-free drying system… Read

And just for fun, I’m adding this fascinating one from the B&S daily feed:

• Prehistoric grains identified in Swiss Alps lunch box:
  Scientists have discovered a 4,000-year-old ‘lunch box’ – obviously lost by a plucky primitive traveler crossing the Swiss mountains – contains microscopic traces of ancient wheat and rye… Read

The International Panel of Experts on Sustainable Food Systems (IPES) has issued a new report with five case studies on successful urban food policy.  lead authors are Corinna Hawkes and Jess Halliday.

the five:

• Belo Horizonte—food security
• Nairobi—urban agriculture
• Amsterdam—healthy weight
• Golden Horseshoe (Ontario, Canada)—food and farming
• Detroit—urban agriculture

It’s wonderfully written and illustrated.

And it is highly instructive about what has to be in place to put these policies in action (the report calls them enablers).

You want a food policy in your town?  This will help.

Last Sunday’s New York Times had a front-page story on Coca-Cola’s relationship to the current nominee for director of the CDC.  I’m quoted in it and soon got this request:

Good morning, Marion:

I saw this Times news coverage in which you’re quoted.

Given this news about reversing the CDC’s position on aligning with the private sector on sugar sweetened beverages, I’m wondering if you’d be game to elaborate on this and provide your perspective on it.

Sure.  Happy to.

The New York Times story on Coca-Cola’s connections to Brenda Fitzgerald, President Trump’s nominee to head the CDC, goes right into the book I’m writing.  The book is about food, beverage, and supplement industry funding of nutrition research and practice and with luck will be published by Basic Books late in 2018.

Fitzgerald was health commissioner for the state of Georgia and at first glance looks well qualified to head the CDC.  But a health advocacy group, US Right to Know, has had a long-standing interest in Coca-Cola’s cozy relationships with CDC—both Coke and CDC are in Atlanta, after all—and at some point obtained emails through FOIA that explain just how cozy.

Here’s what especially got my attention in the Times article :

• While she was health commissioner, Fitzgerald accepted a million-dollar grant from Coca-Cola for an obesity program focused exclusively on physical activity—for sure, not on the health benefits of drinking less Coke (focusing on physical activity has long been a deliberate strategy of this company).
• People associated with the activity program said “Coke had no influence over the program.”  Of course that’s what they think.  Much research shows that recipients of industry funding do not recognize the influence.  Such influence is unintentional, unconscious, and invariably denied.
• When the previous CDC director, Tom Frieden, canceled Coca-Cola’s funding of obesity programs (he said it was unjustifiable “to have Coca-Cola run an obesity campaign that had an exclusive focus on physical activity), he asked company officials if they would be willing to fund something in “neutral space” like transportation or water programs.  Not a chance.

Food, beverage, and supplement companies are happy to fund research with a high probability of supporting marketing objectives.   Industry-funded research almost invariably comes out with results favorable to the sponsor’s commercial interests.

It’s unreasonable to expect otherwise.  Food companies are not public health agencies; they are businesses expected to generate profits and returns to shareholders—that is their #1 priority.

The moral for public health: don’t take the money.

First cantaloupe, now papayas.

The CDC has opened up a homepage on Salmonella infections associated with eating Yellow Maradol Papayas.

Here’s the count so far:

• 47 Cases
• 12 States
• 12 Hospitalizations
• 1 Deaths

Food Safety News has the story.  And provides the label you had best avoid.

As usual, by the time the CDC finds out about outbreaks, cases have slowed down (it takes time to find them).

This one is affecting people in states all over the country.

Papayas grow on trees.  Salmonella are animal bacteria.  Monkeys?  Arboreal sloths?

A more likely explanation is that the fruit came in contact with human waste or dirty hands sometime during collection, transport, or processing.

What to do?

Bacteria are on the rind.  They get on the fruit itself when you cut through it.  You can try scrubbing the outside before you peel the papaya.  The CDC recommends discarding it and cleaning your kitchen carefully.

Better preventive controls?  They are on the books (the FDA Food Safety Modernization Act).

Enforcement?  Not unless Congress appropriates the funds.

Why won’t it?  FDA appropriations go through agricultural appropriations, not health.  Do ag committees care about food safety?

I wish.

Addition:  Food Safety News reports that the distributor of the papayas has started recalling them, but not publicly.

A reporter asks:

I was wondering if you could share your thoughts with me about the new study finding phthalates in boxed Mac & Cheese.  Should consumers be afraid of just Mac & Cheese, considering phthalates are ubiquitous and found in almost every food we consume? What are your recommendations?

Here’s what I said:

The moral of this story is to eat a healthy diet and you don’t have to worry about things like phthalates.  What is a healthy diet?  It’s one in which most of the calories come from relatively unprocessed fruits, vegetables, and grains, and heavily processed foods—like boxed Mac & Cheese—are kept to a minimum.  The phthalate-in-Mac-and-Cheese problem is a processing issue.  Phthalates leach in during processing.  You love Mac and Cheese?  Great.  Make your own.

What’s going on here?

For starters, I love Mac & Cheese, although not so much for the kind in boxes.

In case you don’t know much about this dish, check out the Hartman group’s useful historical Infographic.

As for phthalates:

• These are plasticizers in packaging with effects as endocrine disrupters.
• They have been associated with male infertility.
• The EPA is concerned about their toxicity and widespread environmental exposure.
• Researchers are worried about phthalates in fast food because of all the packaging and handling.

So why am I not more upset about them?  They are easy to avoid.  Just don’t eat foods in boxes.

David Katz has an excellent piece that puts phthalates in a wider dietary context:

This whole topic represents risk distortion, and it’s something we tend to do all the time. We all know, or certainly should, that a dietary pattern of wholesome, whole foods, mostly plants, is monumentally good for us. Such a diet not only minimizes bad chemicals in the food we eat, it – more importantly- minimizes bad food in the food we eat!

Remember menu labeling?  The idea started in New York City in 2008.  Here is one of my early posts on it.  My point in mentioning this: if you care about such things, menu labeling is useful, fun, and effective if you pay attention to it.

Despite a lot of research suggesting otherwise, menu labeling must work.  How else to explain industry’s ferocious and unrelenting opposition to it?

The latest is a lawsuit filed by the Food Marketing Institute and the National Association of Convenience Stores against New York City, which announced that it plans to enforce the regulations it has had in effect for nine years—even though the FDA has delayed national implementation once again until 2018.

To get some idea of what fast-food places are upset about, it helps to check in with the American Pizza Community, the friendly-sounding, but actually highly aggressive trade association for fast-food pizza places.

Here, for example, is its congratulatory statement to the FDA for delaying compliance with the law for another year:

The American Pizza Community welcomes the important step by the Food and Drug Administration toward applying common sense to federal menu labeling regulations…The previous approach threatened to impose excessive burdens on thousands of small businesses without achieving meaningful improvements in educating consumers. The American Pizza Community commends the Administration’s decision to extend the compliance date to May 7, 2018 and its request to collect comments for reducing the regulatory burden and increasing flexibility in implementation methods.  We support menu labeling and look forward to working with policy makers to implement a permanent solution that provides consumers with information and enables small business owners to comply with flexibility while continuing to thrive and create jobs.

By “support,” the pizza folks mean the “Common Sense Nutrition Disclosure Act of 2017.”

Instead of requiring calories to be posted next to the menu item, this bill would allow nutrition information to be available “solely by a remote-access menu (e.g., an Internet menu) for food establishments where the majority of orders are placed by customers who are off-premises.”

Also, “an establishment’s nutrient content disclosures may vary from actual nutrient content if the disclosures comply with current standards for reasonable basis.

The pizza industry has the Wall Street Journal on its side.

The Food and Drug Administration can’t possibly fulfill all of the responsibilities it claims to have, and here’s one way the Trump Administration can set better priorities: Direct the agency to end its effort to inform Americans that pizza contains calories.

I guess the hope is that if they delay long enough, menu labeling will quietly disappear.

CSPI, however, has other ideas.  It filed a lawsuit to force the FDA to implement the regulations.

This lawsuit asserts that the delay of the menu labeling requirement—published without prior notice or an opportunity for comment, one day before the menu labeling rule was supposed to take effect—is illegal and must be vacated.  Since the regulated industry was ready to comply before the delay, it can promptly comply with the menu labeling rule once reinstated and, thus, begin to provide this important health information to the public without delay, according to the complaint.

Recall that menu labeling was authorized by Congress as part of the Affordable Care Act in 2010.  No wonder CSPI wants the rules implemented right away.

The ACA is still with us—so far.