Wonder of wonders, the FDA at last has issued its Final Guidance on Menu Labeling to go into effect a year from now.

Why astonishment?  New York City has had menu labeling since 2008. The national process started in 2010.

Here’s the chronology:

Happily, the rules will cover:

bakeries, cafeterias, coffee shops, convenience stores, delicatessens, food service facilities and concession stands located within entertainment venues (such as amusement parks, bowling alleys, and movie theatres), food service vendors (such as ice cream shops and mall cookie counters), food takeout or delivery establishments (such as pizza takeout and delivery establishments), grocery stores, retail confectionary stores, superstores, quick service restaurants and table service restaurants.

Center for Science in the Public Interest has produced celebratory graphics:

It’s too bad we have to wait yet another year, but menu labels are worth the wait.

The FDA documents:

• Final Guidance for Industry: A Labeling Guide for Restaurants and Retail Establishments Selling Away-From-Home Foods – Part II (Menu Labeling Requirements in Accordance with 21 CFR 101.11)
• Guidance for Industry: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments: Small Entity Compliance Guide
• Final Rule: Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments

I did an interview last year with Rebecca Straus of Organic Life about books of interest to the magazine’s readers.  I never heard what happened to it but learned from a recent tweet that it is now available online.  So consider this a late catch up.

Marion Nestle’s Favorite Organic Books: Eight reads to get you thinking about where your food is coming from.  Organic Life, September 11, 2015.

Food advocate Marion Nestle, a professor of nutrition and food studies at New York University, has long been outspoken in her support of organic farming and opposition to GMO crops. Her books and articles on how science, marketing, and society impact food choices and obesity have influenced everyone from Michelle Obama to Michael Pollen, who named her the second most powerful foodie in America.  Her new book Soda Politics: Taking on Big Soda (and Winning), comes out in October. But even when she’s busy writing, Nestle takes time to review other recent titles on her popular blog, Food Politics. “I’m overwhelmed by the avalanche of outstanding books that I run across or that get sent to me,” she says. But when forced to choose, she settled on these eight as some of the best writing and original research in the bunch, adding, “They deserve much more attention than they’ve received.”

Food, Farms, and Community: Exploring Food Systems by Lisa Chase and Vern Grubinger

“Many people don’t understand what food systems  are, and it’s very hard to explain, so this book is a terrific introduction. The authors take a big-picture approach to explain how our food gets from production to consumption,.They also focus on how we can create food and farming systems that promote the health of people and planet. It’s very readable.”

The End of Plenty: The Race to Feed a Crowded World by Joel K. Bourne, Jr.

“This book takes a look at industrial farming and discusses how food production must change to meet the world’s demands. But if you think the title sounds depressing, you shouldn’t.  The food situation is so much better than it was 20 years ago. There’s so much more organic, local, and seasonal growing. Students are interested in these issues, and that’s inspiring to me. You can make progress without overturning the whole system. My personal measure is that when we started food studies at NYU in 1996, we were the only program like that in the country. Now every university offers food studies and has an organic garden.”

From Field to Fork: Food Ethics for Everyone by Paul Thompson

“Ethical dilemmas impact the way we shop for food. Should we buy orancic or local? Should we care how farm animals are raised? For people who aren’t trained in ethics, it’s sometimes hard to think about these things, and this book can help you delve into them.”

Organic Struggle: The Movement for Sustainable Agriculture in the United States by Brian K. Obach

“For me, the discussion of the development of the organic standards is the most interesting part of this book. It explains why it’s so important to maintain strict organic standards, and why there’s such intense conflict about them. In fact, the biggest issue facing the organic industry is confidence in the standards.”

Afro-Vegan: Farm-Fresh African, Caribbean & Southern Flavors Remixed by Bryant Terry

“Terry is an extraordinary cook. He’s really concerned about the health of African Americans, who tend to have much higher levels of chronic disease, so he sets out to demonstrate that it’s possible to cook a healthier, vegan diet using the ingredients of traditional African cuisine, like collards, grits, and okra. I’ve never seen a book like this before.”

Lentil Underground: Renegade Farmers and the Future of Food in America by Liz Carlisle

“Carlisle is an incredible author (and Michael Pollan’s protégé). To write the book, she simply went to talk to farmers in Montana to find out what they were doing. It’s very lively. I attended her book tour, and she actually brought the farmers with her – it was clear she was really passionate. Everyone is always talking about how farmers are failing, but this is a success story. It’s inspiring.”

Breadlines Knee-Deep in Wheat: Food Assistance in the Great Depression by Janet Poppendieck

“I have special interest in this one – I wrote the foreword. The author is fabulous, and this book is particularly well done. Anyone who wants to really understand the Farm Bill and the fight about food stamps needs to read this book. We’re seeing enormous congressional fighting over SNAP right now, and those same issues were there from the very beginning.”

Lethal but Legal: Corporations, Consumption, and Protecting Public Health by Nick Freudenberg

“This book is compelling because it draws out the parallels between food issues and things like cigarettes, guns, and alcohol. Food producers use the same corporate strategies as these other industries to enrich themselves at the expense of public health. I believe advocacy is the only way to beat the system, and Freudenberg writes about ways for organizing against coporate power to create a healthier environment.  organize against corporate power for a healthier, more sustainable environment.”

I mentioned yesterday that whenever something comes out saying that “everything you thought you knew about nutrition is wrong,” it’s a sign that some skepticism may be in order.

Here is another example: The article on the “sugar conspiracy“ by Ian Leslie published in The Guardian.  This strongly criticizes the work of Ancel Keys, whose work was largely but by no means exclusively responsible for the diet-heart hypothesis linking excessive intake of animal fats to heart disease risk.

I love conspiracy theories as much as anyone else and appreciated how the author made his case for this one.  My sense of his article was that it had grains of truth (Gary Taubes and Cristin Kearns, for example, report that Keys had funding from the sugar industry).  But the overall thrust of the article seemed excessively hyperbolic and based on selective picking of the data (cherry-picking).

Going through the piece line by line to identify errors and misinterpretations was not something I thought worth the trouble.

Fortunately, someone else did.

Katherine Docimo Pett, a master’s degree candidate in biochemical and molecular nutrition at Tufts University, who blogs as Nutrition Wonk, sent me her detailed critique of the paper.  She explains:

So I decided to look into the Seven Countries Study and I found a number of occasions where “The Sugar Conspiracy” misinterprets the evidence.  So buckle yourselves up, conspiracy theorists, because in this post, I’m going to cover the history of the diet-heart hypothesis – namely The Seven Countries Study and the subsequent research mentioned in “The Sugar Conspiracy.”

If you can wade through her lengthy analysis, you will be hard pressed to disagree with her conclusion:

In “The Sugar Conspiracy,” the author makes a lot of assumptions about intent, the usefulness of epidemiology, and even the conclusions of papers.  However, upon closer inspection, a lot of his evidence doesn’t hold up under scrutiny.

The idea that Keys claimed in his Seven Countries Study that correlation proved causation is false.  Keys just said that cholesterol is a mediator for heart disease and that saturated fat raises cholesterol, both of which later turned out to be true.  The Menotti “reanalysis” did not find that sugar is more closely correlated with heart disease than fat, and even if it did, it is a simple regression – it controlled for zero confounders, way fewer than were controlled for in the original Seven Countries Study.  Finally, there is plenty of evidence to suggest that substituting saturated fatty foods in favor of unsaturated fats is a good idea [Clarification: she must mean substituting unsaturated for saturated].

It is absolutely worthwhile to debate the merits of all scientific findings or even the merits of an entire field, like epidemiology.  Scientists, even nutrition scientists, do this all the time.  The problem, though, is that if basic facts are actually based on misinformation, you can’t build a real case for or against anything.

Amen.

Footnote: Sarah Tracy, an historian at the University of Oklahoma, has been working on a biography of Ancel Keys for quite some time.  I can’t wait for her to get it done (she probably can’t either), as it is likely to give us a thoughtful, balanced account of the significance of his work.

A couple of weeks ago, I mentioned several new studies that elicited much media attention.  I am now getting around to them.

Let’s start with the article in the BMJ about newly discovered data from the Minnesota Heart Study purportedly casting doubt on the risks of saturated fat (here’s what the Washington Post said about it).

The BMJ article concluded:

Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

I’ve been at this game long enough to guess that any statement suggesting that everything you thought you knew about nutrition is wrong ought to raise red flags and call for more than the usual degree of skepticism.

Here are some sensible and, yes, skeptical comments about this study:

From Julia Belluz of Vox

But there were a few major problems with the research. The study involved men and women of an average age of 52 who had been admitted to a nursing home and six state mental health hospitals because they were sick. The researchers who conducted the meta-analysis note the “results are not necessarily generalizable to populations without mental illnesses or living outside nursing homes.”

Another issue: The study followed 9,423 women and men, but only a quarter of the participants followed the diets for more than a year. Altering one’s diet for a short period of time — especially in old age — would not necessarily affect one’s long-term health risks….

…Some of the biggest controversies surround saturated fats. Scientists disagree about the extent to which saturated fats contribute to important health outcomes like heart disease, stroke, and cancer. The available research does suggest, however, that there are health benefits from replacing saturated fats with unsaturated fats in the diet, and that eating lots of nutrient-poor carbs (like sugary cereals, soda, and white bread) instead of fat is a bad idea.

From David Katz, to whom I am often grateful for taking on such things, writes that this study

tested something that nobody expert in nutrition is recommending: an extremely high dose of omega-6, linoleic acid…we already got the memo that this is a dubious proposition.

With all due respect to the BMJ authors, I personally found it a bit odd that they stated the following: “A key component of dietary guidelines has long been to replace saturated fat with oils rich in linoleic acid…” The current Dietary Guidelines for Americans, let alone the far better 2015 Dietary Guidelines Advisory Committee Report, make no such recommendation. Searching for any mention of linoleic acid, I found it only in the appendices in the context of descriptions and definitions, not in any of the actionable guidance. While the current Dietary Guidelines do recommend limiting saturated fat intake, the replacement encouraged is a balance of healthful oils, such as olive, and the fats found natively in, as noted, nuts, seeds, avocado, and fish.

From Martijn Katan, the Dutch lipid biochemist who did the original work demonstrating the cholesterol-raising effects of trans fats, writes in an e-mail:

I have not had time to study the BMJ article on the Minnesota Heart Study in detail. However, some of my colleagues did, and I think that their conclusions are correct:

1. The randomized trial itself showed no effect on disease or death
2. This was to be expected because most subjects were on the diet for less than 1 year. This was due to the change in regime for psychiatric patients that took place during that period, which essentially caused the trial to fail. Lowering cholesterol by 14% for one year does not noticably affect CVD risk.
3. The relation of a larger fall in cholesterol with a larger risk of mortality did not emerge from the randomized study; subjects were not randomized to various levels of cholesterol lowering. It is an observational association. The question than arises which causes which. Various occult diseases, notably cancer, cause cholesterol to fall as the disease progresses. This also explains the association seen in observational studies between low cholesterol and cancer. That observation led me to think up in 1985 the technique now known as ‘Mendelian Randomization’ [1]. Application of that technique showed that the association of low cholesterol and cancer is indeed spurious [2].

The only new thing about the present study is that they revived the long disproved hypothesis that lowering cholesterol causes various diseases. Hundreds of thousands of patients in statin trials have proven this wrong….

[1] Katan, M.B., 1986. Apolipoprotein E isoforms, serum cholesterol, and cancer. Lancet 1, 507–8.

[2] Trompet, S.,et al ., 2009. Apolipoprotein E genotype, plasma cholesterol, and cancer: a Mendelian randomization study. Am J Epidemiol 170, 1415–21.

My bottom line on this one

It confirms the value of basic dietary advice: Eat a variety of relatively unprocessed foods, mostly plants (fruits, vegetables, grains, beans, nuts), balance calories, and enjoy what you eat!

Do this and food fatty acids will balance out too and you won’t need to give them another thought.

The moral

Whenever you read a headline suggesting that everything you know about nutrition is wrong, roll your eyes, eat something delicious, and wait for confirming studies to come along before deciding to ignore that basic advice.

Talk about soda politics! I can hardly believe it but soda taxes have become an issue in the Democratic primary campaign.

This started when Hillary Clinton came out in favor of Philadelphia Mayor Jim Kenney’s proposed soda tax.

I’m very supportive of the mayor’s proposal to tax soda to get universal pre-school for kids. I mean, we need universal pre-school. And if that’s a way to do it, that’s how we should do it.

Given the Clinton Foundation’s long-standing relationship with Coca-Cola, this was unexpected.

In short order, Bernie Sanders distanced himself from her position:

I do not support Mayor Kenney’s plan to pay for this program with a regressive grocery tax that would disproportionately affect low-income and middle-class Americans. I was especially surprised to hear Hillary Clinton say that she is “very supportive” of this proposal. Secretary Clinton has vowed not to raises taxes on anyone making less than $250,000 per year. For reasons that are not clear, she has chosen to abandon her pledge by embracing a tax that targets the poor and the middle class while going easy on the wealthy. That approach is wrong for Philadelphia, and wrong for the country.

This, in turn, induced Paul Krugman, who seems to have little love for Sanders anyway, to weigh in:

It does seem worth pointing out that progressivity of taxes is not the most important thing, even when your concern is inequality. Notably, Nordic countries — very much including Denmark, which Sanders has praised as a model — rely heavily on the VAT, which is a regressive tax; but they use that revenue to pay for a strong social safety net, which is much more important.

If we add in the reality that heavy soda consumption really is destructive, with the consequences falling most heavily on low-income children, I’d say that Sanders is very much on the wrong side here. In fact, I very much doubt that he’d be raising the issue at all if he weren’t still hoping to pull off some kind of political Hail Mary pass.

Soda tax proponents wish that Sanders had better understanding of the health issues.

• Laurie David points out that “there’s nothing populist about soda” and expands on that in HuffPo
• Nancy Huehnergarth says “Senator Sanders is wrong: A soda tax is progressive, not regressive.”
• Margot Sanger-Katz in the New York Times

Proponents say Diabetes is regressive.

Here’s information from the table from Soda Politics on framing the soda-tax debate (see page 385).

Mars, the very same company that has been trying for years to position chocolate as a health food, appears to be joining the food movement, and big time.

Take a look at its GMO disclosure statement on the back of this package of M&Ms.

If it’s too small to read, the statement is in between MARS and the green Facts Up Front labels)

PARTIALLY PRODUCED WITH

GENETIC ENGINEERING

And this is before Vermont’s GMO labeling rules come into effect in July.

Mars also has come out in support of the FDA’s proposals on voluntary sodium reduction.  The company explains that through its “new global Health and Wellbeing Ambition,

Mars Food will help consumers differentiate and choose between “everyday” and “occasional” options. To maintain the authentic nature of the recipe, some Mars Food products are higher in salt, added sugar or fat. As these products are not intended to be eaten daily, Mars Food will provide guidance to consumers on-pack and on its website regarding how often these meal offerings should be consumed within a balanced diet. The Mars Food website will be updated within the next few months with a list of “occasional” products – those to be enjoyed once per week – and a list of “everyday” products – including those to be reformulated over the next five years to reduce sodium, sugar, or fat.

Last year, the company supported the FDA’s proposal to require added sugars labeling with a Daily Value percentage on the Nutrition Facts panel.

It also said it would stop using artificial dyes in its candies.

How to interpret these actions?  I’m guessing they mean that the movement for good, clean, fair food has gained enough traction to put long-established food brands on notice: make your products healthier for people and the environment, or else.

Jennifer Clapp.  Food, 2^nd ed.  Polity, 2016.

I did a blurb for the first edition of this book, and also for this second edition:

The global food economy may seem remote from daily experience, but Jennifer Clapp explains how it affects every aspect of what we eat and, therefore, our health and welfare.  From the standpoint of globalization, food is no longer merely a source of nourishment or a mark of culture but a fungible commodity in the global food economy.  Food unpacks and clarifies the mind-numbing complexities of today’s global food marketplace, international trade, transnational corporations, and financial markets.  It provides the information and tools advocates can use to redesign the global food economy to promote fair trade, food justice, and food sovereignty.

My friend and colleague Maya Joseph submits this entry for the category Annals of American “Healthy” Dining:

I was at an Olive Garden last night and, while I greatly appreciated the calorie labeling, which prevented me from ordering the 1,480 calorie entree I was hankering after, I was unsettled by the promotional materials urging us to order two entrees for the price of one (you’re supposed to take one home…).

She includes this link to the two-for-one offer (Oops.  It’s no longer available.  Whew).

Comment: OK, they offered customers a choice.

But unlimited breadsticks and two Fettucine Alfredos?

The mind boggles.