Last week, a Feedback comment from a reader, Judith Rice-Jones, inspired me to try to understand what’s going on with the new heart disease prevention guidelines (I can’t say I’m succeeding very well).

Looking forward to your response to the recent recommendations for more people to take statins. Don’t see anything in the new recommendations about changing lifestyle or diet to reduce risks of stroke or heart attack.

Yes, there are lifestyle recommendations.   But lifestyle changes do not make money for drug companies, and they don’t get press attention.

The American College of Cardiology (ACC) and American Heart Association (AHA) issued four sets of guidelines:

1. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
2. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
3. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
4. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

These organizations say:

AHA and ACC are pleased to announce a series of new cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults. These guidelines are based on rigorous, comprehensive, systematic evidence reviews originally sponsored by the NHLBI. The ACC and AHA collaborated with professional organizations to finalize these AHA/ACC cardiovascular prevention guidelines, and stakeholder organizations were invited to review and endorse the final documents.

So these guidelines are a major big deal.  The New York Times said you need to know three things about them:

• You don’t need to know your cholesterol number (unless it is very high).
• You do need to know your risk (for this you need to use the risk calculator and, therefore, to know your LDL and HDL levels and blood pressure).
• If you are at risk, take a statin (most, at least, are generics).

But wait!

As the New York Times also suggested, the new guidelines have taken many by surprise.

This is an understatement.

Problem #1: Authoritative clinicians say more patients should not be taking statins

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.

This opinion piece points out that members of the group writing the recommendations have financial ties to drug makers, as do both the AHA and ACC.

The guidelines might make sense, they say, if statins

actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case…as shown in a recent BMJ article co-written by one of us.

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease…80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

Problem #2: The risk calculator greatly overestimates risk

The lead article in today’s Times summarizes studies to be published in The Lancet tomorrow concluding that the risk calculator makes the risks seem greater than they really are.

It will lead many doctors to prescribe statin drugs to people who do not need to take them (from the standpoint of drug companies, that’s the point).

The calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

What to do?

• Best to discuss this one with your doctor.
• For sure, eat your veggies and be active.
• If you still smoke cigarettes, stop.
• Stay tuned for further developments.

Just for fun

Let’s let Brian McFadden (Sunday’s New York Times Week in Review) have the last word for today.

I’ve gotten announcements about two films in the making.  Both are worth a look.

Gleason Ranch: Risking Everything.  This is about

a family struggling to salvage their relationships and their 150 year-old, 5th-generation family ranch in Bodega, California. The project began four years ago with the intention of documenting the everyday difficulties of maintaining a family farm. Now, however, it has turned into a much larger, much more personal story of loss, life, pain, and resilience.

What Does 48 Million Hungry People Look Like?

This is a 78-second animated video aimed at getting people energized about ending hunger in America.  It’s a follow-up to A Place at the Table and an introduction to the faces and stories of SNAP alumni.  I’m guessing a longer version will follow soon.  In the meantime, have a look.

It’s not a good time for the makers of herbal and vitamin supplements.  The better the research, the fewer benefits it shows.

Herbal supplements

DNA testing is demonstrating what many of us have long suspected: herbal supplements are not necessarily what they say they are.

As the New York Times reports, a recent study shows that many products purporting to be herbal supplements, actually contain rice, corn, or wheat (gluten-sensitive folks beware):

I would feel sorry for supplement manufacturers, if they hadn’t brought this on themselves.

First, they lobbied to get Congress to pass the Dietary Supplement Health and Education Act of 1994 (DSHEA).  This lets them advertise the benefits of supplements without much in the way of scientific substantiation.  It also excused the FDA from doing much regulation.

But DSHEA also required research.  Oops.   Although the point of asking for research was to demonstrate the benefits of supplements, things haven’t worked out that way.  Most of the research shows no benefit and, sometimes, harm.

And investigations like this one show what many have long suspected.  Without federal oversight, some supplement manufacturers will do whatever they can get away with.

Fortunately, rice substituted for St. John’s Wort is harmless and hardly matters, since St. John’s Wort doesn’t seem to do much anyway.

Vitamin Supplements

The latest review of the benefits—or lack thereof—of vitamin supplements for prevention of heart disease or cancer comes to cautious conclusions.

Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

Borderline significance?  Not impressive.

The Natural Products Association, which represents supplement makers, issued a response:

• Multivitamin supplements should not be expected, without the combination of a healthy lifestyle, to prevent chronic disease.
• Dietary supplements are used by more than 150 million Americans on a daily basis. Research has shown that when taken in combination with other healthy lifestyle practices, such as consuming a wholesome diet and exercising regularly, people can benefit from dietary supplements.

Translation: if you consume a wholesome diet and exercise regularly, you really don’t need supplements.  And if you are not doing those things, supplements won’t do any good.

As for the 150 million Americans who take supplements: the ones I know tell me that they don’t care what the science says; they feel better when they take the pills.

Let’s hear it for placebo effects!

As always, I am indebted to Bill Marler for keeping me up to date on the latest outbreaks of foodborne illness.

The most recent—26 illnesses, 6 hospitalizations—seems caused by E. coli 0157:H7 contaminating grilled chicken salads sold by Trader Joe’s in California, Washington and Arizona.  According to the CDC:

Epidemiologic and traceback investigations conducted by local, state, and federal officials indicate that consumption of two ready-to-eat salads, Field Fresh Chopped Salad with Grilled Chicken and Mexicali Salad with Chili Lime Chicken, produced by Glass Onion Catering and sold at Trader Joe’s grocery store locations, are one likely source of this outbreak of STEC O157:H7 infections.

These are multiple ingredient products.  What could be the source of the toxic E. coli?

Marler provides some labels:

The contaminated ingredient could be Israeli couscous, something I can’t read (currents?), asiago cheese & toasted pecans with sweet basil dressing (first label), or white chicken meat, mixed greens, corn, peppers, sun-dried tomatoes, pepitas and asiago cheese with a jalapeno Caesar dressing (second label).

This will be hard to figure out.  There are lots of possibilities.  Likely candidates are mixed greens and jalapenos—this would not be the first time—but others could also have gotten contaminated along the way.

Marler also took the trouble to go to the website of Glass Onion Catering.  You will be happy to learn that this company’s “ salads, sandwiches, wraps and treats are crafted to the client’s specific recommendation. We only use the freshest, most natural ingredients to promote a healthy lifestyle,” and that the products are

• Trans fat free
• No artificial colors or flavorings
• No preservatives or additives
• No genetically modified ingredients
• Locally grown produce used (when possible)

Too bad they aren’t also free of this nasty form of E. coli.

Everyone who prepares or produces food needs to know how to follow standard food safety procedures.

You should not have to worry about buying foods at Trader Joe’s that make you sick.

To keep up with this is not so easy.  Because the products have meat (chicken) and vegetables (mixed greens, etc), they are regulated by two agencies: FDA and USDA.  This means three agencies are involved:

• CDC information 
• FDA information (and more FDA) 
• USDA information

Wouldn’t it make more sense to have one food safety agency?  Just asking.

This gem comes courtesy of DairyReporter.com.

It got my attention, for sure.

Recall that Got Milk! ads are funded by a USDA-sponsored research and promotion (a.k.a “checkoff”) program, this one, appropriately, for fluid milk.

Will this ad help reverse the long-term trend in declining milk sales let alone consumption?

Um.  Why don’t I think so.

I am indebted to Farm Futures for the heads up about the USDA’s just-published request for public input on what it calls “enhancing agricultural coexistence.”

Agricultural coexistence, the USDA says,

refers to the concurrent cultivation of crops produced through diverse agricultural systems, including traditionally produced, organic, identity preserved (IP), and genetically engineered crops.  As the complexity and diversity of U.S. agriculture increases, so does the importance of managing issues that affect agricultural coexistence, such as seed purity, gene flow, post-harvest mixing, identity testing, and market requirements.

My translation: The USDA wants producers of traditional crops and organic foods to stop complaining that GMOs are contaminating their crops, and producers of GMO crops to stop complaining that they get prosecuted if they try to save seeds from year to year.

The USDA explains that it is doing this in response to recommendations from its Advisory Committee on Biotechnology & 21st Century Agriculture.  This committee recommended actions to promote agricultural coexistence in five areas:

1. Potential compensation mechanisms
2. Stewardship
3. Education and outreach
4. Research
5. Seed quality

How come the USDA is collecting input on #3 rather than the far-more-likely-to-be-controversial #1 and #2?

Early in 2011, I wrote about USDA Secretary Tom Vilsack’s use of Cold War rhetoric to promote détente between growers of organic and GMO foods.  I pointed out that while the USDA had no intention of backing down on support of GM agriculture, it was at least recognizing the threat to organic production.

I noted that the USDA was unlikely to get very far with this initiative because so many farm groups representing industrial agriculture so strongly objected to Vilsack’s coexistence proposal.  The groups argued that coexistence could “adversely impact all producers of biotech crops, as well as the integrity of the American agriculture system.”

If you can’t do anything about underlying structural problems, try communication.

Have something to say about what it will take to support all systems of agricultural production?  Now is a good time to weigh in.

 

The Yale Rudd Center, in collaboration with the Robert Wood Johnson Foundation, has just released its 2013 report on fast food marketing to kids.

This report takes a look at what, if anything, the top 18 fast food restaurant chains have done to improve the nutritional quality of menu items since the last report in 2010.

Quick summary: not much.

It also analyzes changes in marketing to children and teens on TV, the internet, and social and mobile media.

Quick summary: getting worse and increasingly focused on minorities.

Check it out:

• The full report (PDF) 
• The report summary(PDF) 
• The video
• The press release 
• The Q and A with lead author Jennifer Harris 
• A fact sheet on food marketing to kids
• An account of it in Advertising Age

The FDA has just announced a proposal to withdraw GRAS (Generally Recognized As Safe) status for trans-fat.

My first reaction: Isn’t trans-fat already out of the food supply?  Hasn’t this been one of the food industry’s greatest public health achievements?

Once the FDA started to require trans-fat to be listed on food labels, food companies quickly stopped using partially hydrogenated oils (the source of trans-fat) and found healthier substitutes.  That’s why most food labels list zero grams trans-fat.

But the FDA allows food labels to say zero trans-fat if its amount is below 0.5 gram per serving.

Some manufacturers are still using a little.  This new initiative will encourage them to get rid of those last little bits.

Contrary to the New York Times headline, this is not exactly a ban on trans-fat.  If trans-fat is no longer GRAS, manufacturers can still file a food additive petition to continue using partially hydrogenated oils.

The Federal Register notice asks for input for the next 60 days.

I say congratulations to all:

• To food companies who worked hard to find ways to substitute healthier fats for trans-fats.
• To the FDA for finally taking care of the trans-fat 0.5-gram loophole.
• To Center for Science in the Public Interest for bringing health problems with trans-fat to public attention.
• To all of the researchers who did the science linking trans-fat to higher LDL-cholesterol levels and to heart disease risk.
• To the New York City health department for banning trans-fats from use in city restaurants.

Americans will be healthier as a result of all of your efforts.

Resources

At the moment, the FDA has not yet posted its Federal Register notice on the GRAS status of trans-fat. When it does, the notice should be available here.

CSPI’s home page on trans fat

The FDA trans-fat home page

FDA consumer materials

• Talking About Trans Fat: What You Need to Know
• What are the different types of fat that a food can contain? How are they different?
• Trans Fat Now Listed With Saturated Fat and Cholesterol (Including Examples of Nutrition Labels)

FDA guidance for industry

• Guidance for Industry: Trans Fatty Acids in Nutrition Labeling, Nutrient Content Claims, Health Claims; Small Entity Compliance Guide
• Federal Register – 2003 Food Labeling rule on trans-fat (68 FR 41434)
• Health Claim Notification for Saturated Fat, Cholesterol, and Trans Fat, and Reduced Risk of Heart Disease

Research

• FDA Health and Diet Survey – 2004 Supplement – Fats and Carbs – A Snapshot of Consumer Knowledge from a Recent FDA Survey
• Trans Fat Basics (CDC)
• Updated Estimate of Trans Fat intake by the U.S. population, 2012