While I was visiting Cuba, formerly the largest supplier of sugar to the United States and now blocked from selling anything to us, I missed several stories about sugar.  It’s time to catch up with them.

• The Mexican Nutritional Health Alliance announces a 6% reduction in purchase of sugary beverages since implementation of the peso-per-liter tax.
• Johns Hopkins issued a case study on Mexico’s soda tax, explaining why it worked.
• The New York City Department of Health and Mental Hygiene has a new advertising campaign on the health risks of sugary drinks for children.  You can view the ads here.
• Canada has decided against requiring labeling of added sugars, but instead plans to institute a Daily Value for total sugars of 100 grams and to group all sugars on the ingredient list.  Note: 100 grams is 20% of total calories for people on 2000-calorie diets, and is twice what is recommended by most health authorities these days.
• The Washington Post says it’s great to get rid of trans fats, but what about sugars?
• The Washington Post also discusses the war between the Corn Refiners (makers of high fructose corn syrup) and sugar trade associations, this time over federal protections of the sugar industry.  I’ve discussed sugar policy in previous posts (see this one, for example).

On this last item the Post explains:

While other crop subsidies have withered, Washington’s taste for sugar has been constant. The sugar program, which has existed in various forms since the 1930s, uses an elaborate system of import quotas, price floors and taxpayer-backed loans to prop up domestic growers, which number fewer than 4,500.

Sugar’s protected status is largely explained by the sophistication and clout of a small but wealthy interest group that includes beet farmers in the Upper Midwest, cane growers in the South and the politically connected Fanjul family of Florida, who control a substantial part of the world sugar market.

Attempts to get rid of the sugar program have been constant, at least since the 1970s when I first started teaching about it, but to no avail.  Why not?  Because outrageous as the program is, it only costs the average American $10 per year—not enough to generate widespread opposition, apparently.

The bottom line on all this: eating less sugar is always a good idea.

I’ve been posting summaries of studies funded by food companies or trade groups, all of which come up with results that the sponsor can use for marketing purposes.

In each of these posts, I ask for examples of industry-funded studies that produce results contrary to the interests of the funder.

In response, I received this comment from Mickey Rubin, Vice President for Nutrition Research, National Dairy Council.

He gave me permission to reproduce his letter: 

Dear Marion,

By way of introduction, my name is Mickey Rubin and I am a scientist at the National Dairy Council. I understand that you know Greg Miller, and I asked him for your contact information so I could write to you directly after reading with great interest your most recent post on industry-funded nutrition research, in which you selected a sample of 5 studies/papers sponsored by industry all showing favorable outcomes. Although none of the papers you selected were sponsored by the organization I represent (although there is one dairy industry sponsored review paper in the list), what struck me is your focus on the favorable vs. unfavorable dichotomy, rather than the reality of what much nutrition science research results in: null findings.

It seems that there are fewer and fewer nutrition studies published that report the null, or find no effect. I agree with you that the reason we don’t see more of these studies in the literature has to do with bias, but I suspect that it is publication bias as much as any other bias. From my interactions with nutrition researchers, I gather it is quite difficult and sometimes impossible to get a study with no significant effects published regardless of funding source, to say nothing of allegiance bias by some researchers hesitant to publish findings that may go against their own hypotheses. Dr. Dennis Bier of Baylor College of Medicine and editor in chief of the American Journal of Clinical Nutrition has presented eloquently on this issue previously. You may also be aware of David Allison’s papers on other types of bias. So I think it is important to discuss all types of bias, and not just industry bias. You of course wouldn’t want your discussion on bias to be biased to just one type.

At National Dairy Council we have an extensive program of nutrition research that we sponsor at universities both nationally and internationally. While I can’t speak for all of industry, we strongly encourage the investigators of all of our sponsored studies to publish the findings, no matter the results. Thus, we would expect our sponsored studies to have a similar “success” rate as those sponsored by the National Institutes of Health. In fact, that is exactly what one recent analysis – not sponsored by the dairy industry – found, reporting that there was no evidence that dairy industry funded projects were more likely to support an obesity prevention benefit from dairy consumption than studies sponsored by NIH.

We feel this transparency is not only critical to the credibility of the research we sponsor, but we also feel it is important that our research contributes to nutrition science knowledge as a whole. We hope that other scientists take the findings from studies we sponsor and build upon them, and if it is by using research dollars from other sources, even better! I’ll be the first to stand up and say that one favorable study on milk, as an example, does not close the books on the subject. We need many studies in many different labs sponsored by multiple agencies in order to produce a portfolio of knowledge. I suspect that is certainly an example of where you and I are in agreement.

That all said, please allow me to provide some examples of studies the National Dairy Council has sponsored that are published and, rather than showing a clear benefit, do not refute the null hypothesis. These are all studies published within the last 4 years. It’s not meant to be comprehensive, but rather just a sample similar to what you provided. I could also provide you a list of studies we have sponsored that have shown favorable results for dairy, but you seem to have that covered, and I’ll instead wait until one of our sponsored studies appears in a subsequent blog post J.

Thanks for taking the time to read. I appreciate the dialogue.

Here’s his list of papers:

Studies with null finding:

Bendtsen et al. 2014: http://www.ncbi.nlm.nih.gov/pubmed/24168904

• No unique benefit of dairy protein over other proteins for weight maintenance

Maki et al. 2013: http://www.ncbi.nlm.nih.gov/pubmed/23901280

• No effect of three servings of dairy on blood pressure

Chale et al. 2013: http://www.ncbi.nlm.nih.gov/pubmed/23114462

• Whey protein supplementation offered no additional benefit over resistance training alone in older individuals

Lambourne et al. 2013: http://www.ncbi.nlm.nih.gov/pubmed/23239680

• No change in body weight or composition in adolescents performing resistance training and supplemented with milk, juice, or control

Van Loan et al. 2011: http://www.ncbi.nlm.nih.gov/pubmed/21941636

• Recommended dairy servings offered no additional weight loss benefit over calorie restriction without dairy servings 

Studies with mixed findings (some outcomes changed, others null):

Maki et al. 2015: http://www.ncbi.nlm.nih.gov/pubmed/25733460

• The main finding from the study was that dairy intake had no effect on glucose control whereas sugar sweetened product consumption contributed to a worsening of glucose control in at-risk adults.

Dugan et al. 2014: http://www.ncbi.nlm.nih.gov/pubmed/24236646

• Waist circumference and BMI were lower in women after consuming the dairy diet as compared to the control diet. Fasting glucose was lower in men following the dairy diet as compared to the control diet. There were no differences in blood pressure, serum lipids, fasting insulin, or insulin resistance between the treatments.

Here’s what I wrote in response:

I am familiar with charges of bias against independently funded researchers (“White-hat Bias”), which equates industry biases with biases that result from career objectives and other goals.  I do not view the biases as equivalent.  Industry-sponsored research has only one purpose: to be used in marketing to sell products.   As I have said repeatedly, it is easy to design studies that produce desired answers.

When I was in graduate school in molecular biology, we were taught—no, had beaten into us—to do everything we could to control for biases introduced by wishful thinking.  I don’t see that level of critical thinking in most studies funded by food companies.

You may be correct about the influence of publication bias with respect to dairy studies, but how do you explain the situation with sugar-sweetened beverages?  Studies funded by government and foundations typically indicate strong correlations between habitual consumption of sugary beverages and metabolic problems, whereas studies funded by the soda industry most definitely do not.   The percentages are too high to be due to chance: 90% of independently funded studies show health effects of soda consumption whereas 90% of studies funded by soda companies do not.  This is troubling.

We’ve seen the results of studies funded by tobacco and drug companies.  Are food-industry studies different?  I don’t think so.   What seems clear is that industry-induced biases are not recognized by funding recipients, a problem in itself.

That’s why I’m posting these studies as they come in and begging for examples of industry-funded studies that do not favor the interests of the donor.

Thanks to Mickey Rubin for writing and for permission to reproduce his letter.

Let the discussion continue!

Politico Morning Agriculture reports today on an unprecedented move by the 2015 Dietary Guidelines Advisory Committee (DGAC).  The committee sent a letter to members of Congress to protest legislative interference with its scientific process.

Recall: The DGAC’s research report alarmed meat producers when it said that sustainability needed to be considered in developing dietary guidelines.

Of course sustainability should be considered in developing dietary guidelines.  Agricultural policy needs to be linked to health policy, and it’s high time we did so.

But industry protests and letters from Congress induced USDA Secretary Tom Vilsack to assure Congress that the 2015 guidelines will focus only on nutrition.

That was not enough.  Industry groups induced the House of Representatives to put this rider in the 2016 Agricultural Appropriations bill:

SEC. 734. None of the funds made available by this Act may be used to release or implement the final version of the eighth edition of the Dietary Guidelines for Americans, revised pursuant to section 301 of the National Nutrition Monitoring and Related Research Act of 1990 (7 20 U.S.C. 5341), unless the Secretary of Agriculture and the Secretary of Health and Human Services comply with each of the following requirements:

(1) Each revision to any nutritional or dietary information or guideline contained in the 2010 edition of the Dietary Guidelines for Americans and any new nutritional or dietary information or guideline to be included in the eighth edition of the Dietary Guidelines for Americans shall be based on

(A) scientific evidence that has been rated ‘‘Grade I: Strong’’ by the grading rubric developed by the Nutrition Evidence Library of the Department of Agriculture; and

(B) shall be limited in scope to only matters of diet and nutrient intake.

Politics in action!

As I told Politico Morning Agriculture, I’ve never heard of a DGAC writing directly to Congress.  But I understand its frustration.  The committee was asked by USDA and HHS to review and consider the science of diet and health and did so. It reported what its members believe the science says. Some segments of the food industry don’t like the science so they are using the political system to fight back. The idea that some members of Congress would go along with this is shameful.

CSPI has organized a letter-writing campaign to defeat the rider and provides these tools:

• Fact Sheet
• Talking points
• Memo
• Sign on letter

Let’s keep Congress out of the dietary guidelines process.  The process may not be perfect but scientific committees do the best they can to advice the public about dietary practices that are best for health—and, at long last, the environment.

Political interference with this process is not in the best interest of public health, and should be strongly discouraged.  If you agree with this view, CSPI makes it easy for you to say so.  Sign on now.

Update, June 25: Politico Morning Agriculture reports today that the Senate bill reads: “None of the funds appropriated in this Act may be used to issue, promulgate, or otherwise implement the 2015 Dietary Guidelines for Americans edition unless the information and guidelines in the report are solely nutritional and dietary in nature; and based only on a preponderance of nutritional and dietary scientific evidence and not extraneous information.”

I’m catching up with events I missed while offline in Cuba.  Here’s one: Michele Simon’s new report:

The American Society for Nutrition (ASN) is the leading organization for physicians and scientists who conduct nutrition research.  I’ve been a member for years and have long fretted about the ASN’s too-cozy relationships with food company sponsors (for example, see my posts on the ill-fated Smart Choices campaign and on a recent ASN annual meeting).

Simon has now done for the ASN what she previously did for the American Academy of Dietetics.

A few of her findings:

• Of the 34 scientific sessions at ASN’s annual meeting, 6 were supported by PepsiCo, and others were supported by the Egg Nutrition Center, Kellogg, DuPont Nutrition and Health, Ajinomoto, and the National Dairy Council.

• The International Life Sciences Institute (a front group for Big Food and Big Pharma) sponsored a session on low-calorie sweeteners; speakers included a scientific consultant for Ajinomoto, which produces aspartame.

• For $35,000, junk food companies can sponsor the hospitality suite at the annual meeting, where corporate executives socialize with nutrition researchers.

• ASN published an 18- page defense of processed food that consists of numerous talking points for the junk food industry, such as “There are no differences between the processing of foods at home or at a factory.”

• ASN opposes an FDA proposed policy to include added sugars on the Nutrition Facts panel, at a time when excessive sugar consumption is causing a national public health epidemic.

I’m quoted in the report:

I think it’s important that professional societies like ASN promote rigorous science and maintain the highest possible standards of scientific integrity. Research and education about food and nutrition are easily influenced by funding from food companies but such influence often goes unrecognized. This means that special efforts must be taken to avoid, account for, and counter food industry influence, and organizations like ASN should take the lead in doing so.

The report has been well covered by the media:

• Leading U.S. Nutrition Scientists Forge Cozy Relationships With Major Food Companies and Lobbying Groups, Report Charges, International Business Times
• Is the Leading Nutrition Science Group in Big Food’s Pocket? Mother Jones
• Do big food companies have too much sway over nutrition research? WBEZ Radio
• Report Questions Nutrition Group’s Ties to Food Companies, Food Manufacturing
• Food companies, nutrition researchers getting too friendly: report, FoodDive
• And see the lengthy online rebuttal

Relations between nutrition scientists and food companies worry me.  Here’s another example: Portuguese nutritionists have produced an e-book extolling the virtues of cereal-based drinks.  The book is sponsored by Nestlé (the company, not me).  Nestlé, no surprise, is the market leader for these products in Portugal.  I thank Vladimir Pekic of BeverageDaily.com for finding this one.

I’ve been in Cuba for the past week on a food sovereignty agricultural tour sponsored by Food First.

I will have more to say about this trip, but I’ll start with my obsession with sodas (because of my forthcoming book, Soda Politics): Does the U.S. embargo prevent sales of Coke and Pepsi in Cuba?

Based on research for the book, I know that Cuba is one of the last remaining countries in which Coke and Pepsi cannot be marketed.  North Korea is another.  Myanmar used to be in that category, but came out of it a couple of years ago.

So I was fascinated to see this street cart in Old Havana (Coke hecho en Mexico):

And in a small market near the Hotel Nacional (Pepsi bottled in El Salvador):

And in a suburban supermercado outside of Havana (3-liter Cokes from Mexico):

As for soda marketing, it’s only collectors’ items.  These are on the wall of Paladar San Cristóbal, in Central Havana:

As I’ll discuss in later posts, these are harbingers of marketing to come.

NOTE: FoodPolitics.com is going offline.  Will return June 21

Soda Politics is in press.

It comes out from Oxford University Press on October 1.

It has a Foreword by Mark Bittman and an Afterward by Neal Baer (my grateful thanks to both).

For information about Soda Politics, go to:

• The Oxford University Press website
• The book’s page on Amazon.com
• My Amazon author’s page
• The page for it on this site
• The Table of Contents

Enjoy!

The San Francisco Board of Supervisors has approved three measures to deal with sugary drinks:

1.  Put warning labels on all print and billboard ads for sodas and sugary drinks sold in the city (those with more than 25 calories per 12 ounces).

2.  Ban soda ads on city property

3.  Prohibit the use of city funds for the purchase of soda or sugary beverages

Will the mayor sign the measure?

Will the city’s famous freeway sign look like this?

Here is my latest roundup of industry-sponsored research producing results or opinions that favor the sponsor’s commercial interests.

Sugars and obesity: Is it the sugars or the calories?  Choo FL, Ha V, Sievenpiper JL.  Nutrition Bulletin, May 19, 2015.  DOI: 10.1111/nbu.12137

Conclusion: The higher level evidence reviewed in this report does not support concerns linking fructose-containing sugars with overweight and obesity.

Conflicts of interest: All three authors report scholarship or research support from such entities as the Canadian
Sugar Institute, PepsiCo, Coca-Cola, Dr Pepper Sapple, Corn Refiners Association, World Sugar Research Organization.

Cranberry Juice Consumption Lowers Markers of Cardiometabolic Risk, Including Blood Pressure and Circulating C-Reactive Protein, Triglyceride, and Glucose Concentrations in Adults.  Janet A Novotny, David J Baer, Christina Khoo, Sarah K Gebauer, and Craig S Charron. J. Nutr. 2015; 145:1185-1193 doi:10.3945/jn.114.203190.

Conclusion: LCCJ [low-calorie cranberry juice] can improve several risk factors of CVD [cardiovascular disease] in adults, including circulating TGs [triglycerides], CRP (c-reactive protein], and glucose, insulin resistance, and diastolic BP [blood pressure].

Sponsor: Ocean Spray Cranberries, Inc. and the USDA.  JA Novotny received funding from  and C Khoo is employed by Ocean Spray Cranberries, Inc.

Effect of cheese consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Janette de Goede, Johanna M. Geleijnse, Eric L. Ding, and Sabita S. Soedamah-Muthu

Conclusion: Despite the similar P/S ratios of hard cheese and butter, consumption of hard cheese lowers LDL-C and HDL-C when compared with consumption of butter.

Funding. The senior author received unrestricted research grants from the Global Dairy Platform, the Dairy Research Institute, and Dairy Australia for the present meta-analysis. One other author, E.L.D., has consulted for the Dairy Research Institute.

Protein Summit 2.0: Evaluating the Role of Protein in Public Health: Proceedings of a conference held in Washington, DC, October 2, 2013.  American Journal of Clinical Nutrition, June 2015 Supplement.

Program organizer: Shalene McNeill, National Cattlemen’s Beef Association, and a Contractor to The Beef Checkoff.

Sponsors: The Beef Checkoff, Dairy Research Institute, Egg Nutrition Center, Global Dairy Platform, Hillshire Brands, National Pork Board

My comment: Journal supplements are typically paid for by outside parties—government agencies, foundations, private organizations, or food companies.  The papers in this supplement discuss various aspects of protein and health.  All emphasize the benefits of animal protein in human diets, as might be expected, given the sponsors.

Two examples:

Commonly consumed protein foods contribute to nutrient intake, diet quality, and nutrient adequacy.  Stuart M Phillips, Victor L Fulgoni III, Robert P Heaney, Theresa A Nicklas, Joanne L Slavin, and Connie M Weaver.  Am J Clin Nutr June 2015 vol. 101 no. 6 1346S-1352S.

Conclusion: dietary recommendations to reduce intakes of saturated fat and solid fats may result in dietary guidance to reduce intakes of commonly consumed food sources of protein, in particular animal-based protein.

The role of protein in weight loss and maintenance.  Heather J Leidy, Peter M Clifton, Arne Astrup, Thomas P Wycherley, Margriet S Westerterp-Plantenga, Natalie D Luscombe-Marsh, Stephen C Woods, and Richard D Mattes.

Conclusion:  Collectively, these data suggest that higher-protein diets…provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes.

For the record: Industry sponsorship does not necessarily mean that the reported conclusions are wrong.  It just means that the papers require even more than the usual level of critical analysis.

I am happy to post industry-sponsored studies that do not produce results that can be used to market the sponsor’s products.  Please send if you find any.