My thanks to Arun Gupta for sending this one from a newspaper in India.

The clipping refers to this article.

• The study: Ostendorf, D.M., Schmiege, S.J., Conroy, D.E. et al.Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis.Int J Behav Nutr Phys Act18, 158 (2021). https://doi.org/10.1186/s12966-021-01225-5.
• First sentence : “High levels of moderate-to-vigorous physical activity (MVPA) are strongly associated with sustained weight loss [1, 2], and current guidelines recommend high levels of PA for weight management .”
• Methods: Participants were asked to follow a weight-loss diet and to do 300 minutes per week of exercise.  The investigators lstudies participants’ motivation levels.
• Conclusion: once exercise supervision and support was removed, adults in the high autonomous motivational profile were protected against the standard attenuation in MVPA following removal of support/supervision.
• Competing interests: “The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DC reports consulting income from Gelesis, Inc., a company that has developed a weight loss device.  SP has a grant from WW International [formerly, Weight Watchers] unrelated to this work.”

Comment: As far as I can tell, the paper says nothing about exercise being more important than diet.  The study didn’t find any differences in weight among people with different levels of motivation.  We can’t blame the authors for the press account.    But anything that minimizes the need for dietary changes gets pounced on.  Alas.

A press release from the World Health Organization announces recommendations on the use of artificial, non-nutritive (meaning no-calorie) sweeteners: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that use of NSS does not confer any long-term benefit in reducing body fat in adults or children. Results of the review also suggest that there may be potential undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The recommendation not to use artificial sweeteners for weight control or chronic disease prevention applies to:

all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars. Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

The guideline document notes:

The recommendation in this guideline was made based on evidence that suggests that there may be health effects associated with NSS use irrespective of which NSS is being used – that is, NSS as a class of compounds, despite individual NSS having different chemical structures, may have an impact on health…individual NSS have different sweetness intensities and organoleptic properties, and are processed differently by the body. Although limited  evidence suggests that individual NSS may also differ in some of their physiological effects in humans, the evidence is currently insufficient to make
recommendations for individual NSS.

Overall, the evidence summarized in the document shows benefits from short-term studies but not ones that last longer than three months or so.  After that, use of non-nutritive sweeteners is associated with potential harm.

At issue, of course, is the mechanism.  These remain speculative: calorie compensation? mainenance of taste preference?  microbiome?

Much of the research into biological mechanisms has been carried out in in vitro and rodent models, and further research is needed to determine whether observations in non-human models translate to humans.  Although there are as yet no conclusive mechanistic links between NSS use and many of the associations observed in prospective cohort studies, that plausible mechanisms have been identified, tested and in some cases validated (albeit mostly in non-human models) reinforces the seriousness with which the associations observed in prospective cohort studies should be considered and highlights the need for further exploration of possible mechanisms with additional research.

Until then, it seems best to avoid them (I don’t like their taste anyway).

• View the press release here
• Access the guideline here

Questions?

• Please email any questions to: NFS@who.int 

To the surprise of everyone as far as I can tell, the Supreme Court has upheld California’s ban on pork from states that allow pork producers to confine pregnant sows in gestation crates.

California, which consumes 13% of U.S. pork but imports 99% of it, said it would only permit import of pork from producers who give pregnant sows at least 24 square feet of space.

Gestation crates confine pregnant sows so tightly that all they can do is stand up and lie down.

I would not call myself an animal rights advocate, but having been pregnant myself a couple of times, I found myself deeply upset when I saw sows confined like that.

At the time, I was on the Pew Commission on Industrial Farm Animal Production.

We asked why they were doing this.  Answer: To keep the sow from crushing her piglets—and to make it easier to feed and clean the animals.

Fortunately, Bill Niman was also on the commission and whisked us off to one of the Niman Ranch farms where we could see sows, each in her own hoop tent, happily tending to piglets and rolling in mud when she felt like it.

Did the sows crush their piglets?  Not when they had ample room to move around ard were not stressed.  Yes, they didn’t produce quite as many piglets, but the meat tasted a lot better.

So I’m happy to see the pig crates disappear, which they will have to if anyone wants to sell pork in California.

This case is not really about animal rights though.  It is about states’ rights to make laws like this one.

The pork producers challenged California’s law.  But Justice Neil Gorsuch writing for the majority said:

California voters overwhelmingly endorsed the “ethical pork” law in 2018 and have the right to decide what products appear on store shelves…Companies that choose to sell products in various States must normally comply with the laws of those various States, “While the Constitution addresses many weighty issues, the type of pork chops California merchants may sell is not on that list.”

It’s amazing to have something good come out of this court.  Maybe pig crates will set a precedent.

A committee of the American Heart Association has just published a position paper looking at how well popular weight-loss and other diets meet AHA standards.  The standards are worth a look.

When ranked against these standards, the diets come out in this order:

• Tier 1: Mediterranean, DASH, Pescetarian, Ovo/Lacto Vegetarian
• Tier 2: Vegan, Low-fat
• Tier 3: Very Low-Fat and Low-Carbohydrate
• Tier 4: Paleo and Keto

Proponents of full-fat diets will object that Paleo and Keto diets can be healthy, as well they may be depending on how much and what else their followers are eating.

Nearly any diet can be healthy if it does not include excess calories or too much junk food, but includes plants and is based on a wide variety of foods.

And they can all be delicious, and have no excuse not to be.

Enjoy!

In a strange partnership, the Nutrition Coalition and the Center for Science in the Public Interest (CSPI) are jointly complaining about the way the USDA and HHS have “disclosed” conflicts of interest among members of the 2025-2030 Dietary Guidelines Advisory Committee.

Why strange?  Because the Nutrition Coalition has long urged relaxations on advice about dietary fat, whereas CSPI has long urged restrictions.

Why “disclosed” in quotes?  Because the agencies’ disclosure statement lists the combined conflicts for the entire group, not for individual members of the committee.

Here’s the committee, courtesy of a tweet from Christopher Gardner.

Dietary Guidelines Advisory Committee

2nd in person meeting of DGAC this week.
Committee members are a pleasure to work with – thoughtful, critical, informed group.

HHS/USDA staff supporting the effort are an incredible resource! Wow!

2-year process is off to a great start! pic.twitter.com/6Cx5npxJcH

— Christopher Gardner (@GardnerPhD) May 13, 2023

Here is a small part of what the disclosure list looks like.

 

 

 

 

 

 

 

 

Because these are all jumbled together, you have to look hard to pull out the genuine conflicts—-relationships of committee members with food companies with vested interests in the outcome of the guidelines.

The Nutrition Coalition points out that USDA and HHS are failing to:

• Comply with a National Academies of Science report calling for publicly posting financial and nonfinancial biases and conflicts of interest of committee members.
• Fully adopt the National Academies’ 11 recommendations.
• Recognize the significance of the first-ever systematic review of a DGAC’s financial ties. This review found 95% of the 2020 DGAC members had at least one tie with a food or pharmaceutical company and half had 30 such ties or more.

In its statement, CSPI says that it, the Coalition, and 13 other groups are calling on the federal government to disclose potential financial conflicts of interest, including sources of research funding, speakers’ fees, and other relationships.

Press coverage, the statement says, “has already uncovered one 2025 Dietary Guidelines Advisory Committee member with a conflict of interest that seems relevant to their role.”

Comment:  I agree that the credibility of the committee and the guidelines depends on transparency, but it’s hard to know how much of a problem this is.

I wanted to compare the disclosure list to the research questions set by the agencies for the committee, but I can no longer find them online.

This reminds me that’s it’s hard to know how much influence the committee will have, in any case, now that the agencies set the research questions and write the actual guidelines.

The advisory committee is just that, advisory.  The agencies do not have to take its advice.

I will be following this closely.  Stay tuned.

Additions, May 17 (thanks to Jerry Mande)

• The original list of Proposed Scientific Questions
• The list as posted on the current website: Step 3: Advisory Committee Reviews Scientific Evidence

 

Thanks to reader Maira Bes-Rastrollo at the University of Navarra in Spain (and whose work I greatly admire) for this one.

The Relationship of Ready-to-eat Cereal Intake and Body Weight in Adults: A Systematic Review of Observational Studies and Controlled Trials.   Lisa M Sanders, Mary R. Dicklin, Yong Zhu, Kevin C. Maki.  Advances in Nutrition https://doi.org/10.1016/j.advnut.2023.05.001

Center for Science in the Public Interest is campaigning for mandatory front-of-package labeling—like these.

Here’s what you need to know about the campaign:

• Comment from CSPI responding, point-by-point, to industry arguments opposing mandatory front-of-package labeling
• Sign-on comment filed in support of CSPI’s front-of-package labeling petition
  • Signatories include American Heart Association, American Cancer Society Cancer Action Network, American Public Health Association, Consumer Federation of America, Consumer Reports, and more
• Comment filed in response to FDA’s proposal to conduct quantitative research on front-of-package labeling
• Factsheet summarizing the importance of mandatory front-of-package labeling in the U.S. (from January)
• Factsheet summarizing findings of a public opinion poll commissioned by CSPI in March (we found widespread support for mandatory front-of-package labeling)

Guess what!  The food industry opposes this kind of labeling.  A lot.

Why?  Because it might discourage purchase of ultra-processed junk foods.  That, after all, is its point.

I was fascinated to see this article in Ag Funder News (to which I am now subscribing):  FDA warns molecular farming startups of risks if food allergens are not properly managed.  

If companies are putting the genes for animal proteins into crops, they need to be super careful not to introduce proteins known or likely to be allergenic.

The FDA’s  warning letter reminds companies to:

• Consider the food safety risks posed by allergens
• Plan early in development to manage the risks
• Label products properly
• Pay attention to legal requirements and food safety responsibilities

This took me right back to 1996 when I wrote an editorial for the New England Journal of Medicine about one such incident (scroll down to the third editorial in the pdf).

Investigators thought it would be clever to add a Brazil nut protein to soybeans to enrich the beans—used for chicken feed—in sulfur-containing amino acids especially needed by chickens for feather formation.  Unfortunately, some people are allergic to that protein.

The investigators were especially diligent about checking the allergenicity of the transferred protein.  By a truly remarkable coincidence, everything they needed to establish allergenicity was available.  The soybeans were withdrawn from the market, but all of this was somewhat of a miracle.

As I concluded,

This situation illustrates the pressing need to expand basic and clinical research on food allergies. More information about incidence, prevalence, dietary exposure, antigenicity, immune responses, diagnosis, and treatment would help researchers, regulators, and biotechnology companies predict whether transgenic proteins are likely to cause harm. In the special case of transgenic soybeans, the donor species was known to be allergenic, serum samples from persons allergic to the donor species were available for testing, and the product was withdrawn. The next case could be less ideal, and the public less fortunate. It is in everyone’s best interest to develop regulatory policies for transgenic foods that include premarketing notification and labeling. Industry benefits when the public is convinced that transgenic foods are safe, and stronger federal regulations would encourage such public confidence.

That was in 1996.  I could have written it yesterday.  No wonder the FDA is worried.