I am devoting this week to the pushback against advice to reduce consumption of ultra-processed foods.  It is coming from the food industry, of course, government agencies with ties to the food industry, and nutritionists who focus on  the benefits of nutrients, without contextualizing the foods and diets they come from (“nutritionism”).

For the record, ultra-processed foods are :

• Industrially produced
• Bear little resemblance to the foods they were derived from
• Typically contain additives for color, flavor, and texture
• Cannot be made in home kitchens,
• Are formulated to be irresistable,
• Are associated with excessive calorie intake and poor health
• Are extremely profitable to their makers
• Cannot be made in home kitchens (a brief operating definition)

Ultra-processed food pushback #1: A study from the USDA and authors with conflicted interests

The USDA’s Agricultural Research Service is so proud of this study that it sent out a press release.

Scientists at the USDA Agricultural Research Service’s (ARS) Grand Forks Human Nutrition Research Center led a study that demonstrates it is possible to build a healthy diet with 91 percent of the calories coming from ultra-processed foods (as classified using the NOVA scale) while still following the recommendations from the 2020-2025 Dietary Guidelines for Americans (DGA). The study highlights the versatility of using DGA recommendations in constructing healthy menus.

The Study: Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.  Julie M. Hess, Madeline E. Comeau, Shanon Casperson, Joanne L. Slavin, Guy H. Johnson, Mark Messina, Susan Raatz, Angela J. Scheett, Anne Bodensteiner, Daniel G. Palmer.  The Journal of Nutrition, 2023.  https://doi.org/10.1016/j.tjnut.2023.06.028.

Purpose: “The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.”

Method: “we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).”

Results: “In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points.”

Conclusions: “Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.”

 Conflicts of Interest: “MM serves as the Director of Nutrition Science and Research for the Soy Nutrition Institute (SNI) Global. The SNI Global receives funding from soybean farmers via the soybean national checkoff program and via membership dues from companies involved in manufacturing and/or selling soy ingredients and/or soyfoods. GHJ serves as Senior Advisor to the McCormick Science Institute. JLS serves on advisory/consultant boards for Simply Good Foods, Quality Carbohydrates Coalition, and the Sustainable Nutrition Scientific Board and has received funding from the National Institutes of Health, Taiyo, Barilla Foods, and the USDA in the past 12 mo. The other authors report no conflicts of interest.”

Funding: This work was supported by USDA Agricultural Research Service project grant #3062-51000-057-00D.

Comment:  I can think of only one reason for doing a study like this: to cast doubt on the concept of ultra-processed foods (UPF) and all the research showing that UPF diets induce people to eat more calories (see the study by Kevin Hall et al) and are strongly associated in hundreds of studies with poor health, evidence that by this time is overwhelming and incontrovertible.  Why now?  Because the 2025-2030 Dietary Guidelines Advisory Committee has been charged with examining the relationship of UPF to heart disease risk.

The first rule of the ‘Playbook” is to cast doubt on the research, which is what we are seeing here.  The message to reduce consumption of ultra-processed foods makes good sense for health reasons.  But such advice is very bad for the profits of food companies making junk foods.

The USDA’s Agricultural Research Service is a marketing arm of the food industry,.  It is heavily conflicted.

For one thing, the Healthy Eating Index is not useful for this purpose; it is strictly nutrient-based, which is not the issue here.  And the Dietary Guidelines are careful to leave plenty of room for eating junk foods and to say not one word about UPF.

I think the UPF concept is so solidly backed up by evidence that it is here to stay.  But it is so threatening to food companies making UPF products, and the USDA is so captured by the food industry (checkoff programs, anyone?) that it is understandable why they are so eager to cast doubt.

Thanks to the half dozen or so readers who sent this one to me, to Ted Kyle for calling it “oxymoronic healthy eating,” and  Kevin Hall for pointing out that the healthfulness of this diet is assumed, not tested:

The long-awaited report on aspartame from the International Agency for Research on Cancer and the WHO and FAO Joint Expert Committee on Food Additives (JECFA) are now out.  These agencies jointly issued two documents.

A press release

Citing “limited evidence” for carcinogenicity in humans, IARC classified aspartame as possibly carcinogenic to humans (IARC Group 2B) and JECFA reaffirmed the acceptable daily intake of 40 mg/kg body weight.

A summary of the findings

• The [IARC] working group classified aspartame as possibly carcinogenic to humans (Group 2B) based on limited evidence for cancer in humans (for hepatocellular carcinoma, a type of liver cancer)…There was also limited evidence for cancer in experimental animals…In addition, there was limited mechanistic evidence that aspartame exhibits key characteristics of carcinogens, based on consistent and coherent evidence that aspartame induces oxidative stress in experimental systems and suggestive evidence that aspartame induces chronic inflammation and alters cell proliferation, cell death and nutrient supply in experimental systems.
• The [JEFCA] Committee concluded that the data evaluated during the meeting indicated no reason to change the previously established acceptable daily intake (ADI) of 0–40 mg/kg body weight for aspartame. The Committee therefore reaffirmed the ADI of 0–40 mg/kg body weight for aspartame…Based on the results of the oral carcinogenicity studies of aspartame, the absence of evidence of genotoxicity, and a lack of evidence on a mechanism by which oral exposure to aspartame could induce cancer, the Committee concluded that it is not possible to establish a link between aspartame exposure in animals and the appearance of cancer.

If this feels crazy-making, I’m with you.

For starters, I’ve never seen a scientific report released this way—essentially by leakage and press release before the research is published where it can be reviewed independently.

To summarize the chronology:

• June 29: Reuters releases leaked information that aspartame is soon to be declared a carcinogen (I wrote about this in a post on July 6)
• June 29: American Beverage Association releases statement: “There is a broad consensus in the scientific and regulatory community that aspartame is safe.”
• July 1: Vox publishes a an article with the provocative title, “The WHO is about to declare aspartame can cause cancer. Here’s why you should listen.”
• July 12: Reporters tell me that they participated in a press conference with WHO and IARC to discuss what the reports will say when they are released at 12:30 a.m. ET on July 14.
• July 12: Anahad O’Connor writes in the Washington Post: “Does aspartame pose a health risk? Here’s what the science says” (I’m quoted in it).
• July 12 and 13: The agencies send reporters copies of press releases on embargo (see above), but not the published data.
• July 13: Reporters get copies of a statement from the FDA disagreeing with IARC.
• July 14:  Everything comes off embargo, including these four pieces:

1. Research article in Lancet Oncology:  Carcinogenicity of aspartame, isoeugenol, and methyleugenol 
2. Infographic
3. Q & A
4. Featured News page on the evaluation of aspartame

Here’s what I think of all this: if aspartame is a carcinogen, it’s a weak one.

But it is artificial and off my dietary radar.  It’s not essential in human diets.  I don’t like its taste and I don’t like all the iffy questions about how it is metabolized.  I avoid it.

You don’t want to avoid it?  JEFCA says you can have 9 to 14 cans of diet soda a day without exceeding tolerable limits.  If you want one once in a while, it is highly unlikely to hurt you.

But a much better idea is getting out of the sweetened-drinks habit.  If you must have something sweet to drink, try adding fruit juice to water.

The World Health Organization has just come out with a new report on protecting children from the harms of marketing unhealthy food to kids.

Some conclusions from research on the effects of marketing unhealthy foods to kids:

• Across studies, the most frequently marketed food categories were fast food, sugar-sweetened beverages, chocolate and confectionery, salty and savoury snacks, sweet bakery items and snacks, breakfast cereals, and desserts.
• Reductions in children’s exposure to food marketing were more often found with: mandatory policies; policies designed to restrict food marketing to children, including those older than 12 years; and policies that used a government-led nutrient profile model to determine the foods for which marketing was to be restricted.
• Reductions in the power of food marketing were more often found with: mandatory policies; and policies designed to restrict food marketing to children, including those older than 12 years.
• Policies to protect children from the harmful impacts of food marketing would be highly cost-effective or cost-saving.
• Policies to protect children from the harmful impacts of food marketing can be expected to reduce health inequities.
• In HICs [high-income countries], policies to protect children from the harmful impact of food marketing are largely acceptable to
  the public, but industry has generally opposed government-led restrictions.
• Some countries have successfully implemented policies, demonstrating that policies are acceptable to government and policy-makers and feasible to implement.

Therefore, WHO recommends that policies:

• Be mandatory
• Protect children of all ages
• Use a government-led nutrient profile model to classify foods to be restricted from marketing;
• Be sufficiently comprehensive to minimize the risk of migration of marketing to other media, to other spaces within the same medium or to other age groups
• Restrict the power of food marketing to persuade.

Yes!

WHO has just given governments a mandate to take action.  Go for it!

My distant (but dearly loved) cousin, the food package designer Michael Kravit, thought I would enjoy seeing this example of first-rate food marketing—and of a healthy product yet.

First, open the box.

Cut. Scoop. Enjoy!

You aren’t sure how?  The company even supplies a video.

I’d like to see more like this.

Well here’s a big surprise.  The USDA is taking a look at concentration in agribusiness.

TODAY: Webinar at 1:00 p.m. ET.  Register here.

Here’s what this is about:

This report details issues surrounding market concentration in agribusiness, particularly in three agribusiness sectors where concentration has increased over time: seeds, meatpacking, and food retail. Market concentration and its impact on competition have attracted growing public scrutiny. Critics argue that many industries have grown too concentrated, with fewer firms competing with one another and a consequent weakening of competition. The report covers the consolidation in each of these industries, explains the driving forces behind increased concentration, and examines public policies aimed at encouraging competition, focusing on the implementation of merger policy.

This report has lots of interesting tidbits about those three industries.

• Two firms, DuPont Pioneer and Monsanto, control 71.6% of U.S. corn and 65.9% of U.S. soybeans.
• Four U.S. meat firms (not necessarily the same ones) control 85% of steers and heifers, 67% of hogs, 55% of turkeys, and 53% of chickens.

But what is shocking to me about this report is what it does not say.

It does not refer to or even cite Phil Howard’s book: Concentration and Power in the Food System: Who Controls What We Eat?

I wrote about Howard’s book when it came out in a new edition.

How could the USDA’s economists fail to mention Howard’s analysis of the global seed industry (since updated).

It’s great the USDA is taking this on.  But if you really want to know what’s going on in industry concentration, read Phil Howard’s book first.

A reader who wishes to remain anonymous sent me an account of the development of the new Nordic Nutrition Recommendations, pointing out what they do not contain: a recommendation to reduce ultra-processed foods [Note: this is an updated and slightly corrected version of what was first posted on July 9].

Indeed, on pages 253-255 (this is a long report), you will find this statement:

The backstory here is one of effective food industry lobbying.

The Nordic Nutrition Recommendations do not say:  reduce consumption of ultra-processed foods.

The story begins with two authors who were asked to sum up the health effects of ultra-processed foods, and to advise the committee writing the recommendations.  They did so.  Their initial background paper concluded with these recommendations:

(1) Limit the consumption of ultra-processed foods.

(2) Choose less processed form of foods within each food group when possible.

(3) Cook at home and choose freshly prepared foods when eating out.

The committee revised the background paper.  It omitted the three recommendations but concluded:

Recommendations to limit ultra-processed foods, and choose foods of lower processing level, when possible, may enhance and support several of the existing FBDGs [food-based dietary guidelines] and help individuals select more healthful foods that align with the overall NNR2022 [last years Nordic Nutrition Recommendations] guidelines within each food category. For example, such advice would support choosing plain, unsweetened yoghurt instead of flavored, sweet yoghurt; choosing oatmeal or muesli based on grains, nuts, and dried fruits over sweetened, refined breakfast cereals; and choosing chicken breast/thighs over chicken nuggets.

The revised document was opened for public comment and a hearing.  A great many representatives of food companies objected to saying anything negative about ultra-processed foods.  This Excel spreadsheet lists the 60 people who commented and their main objections.

After the hearing, the committee preparing the recommendations wrote a draft report based on the comments.  The section on ultra-processed foods is on pages 152-153.  It begins:

There is currently no consensus on classification of processing of foods, including UPFs. The dominating UPF classification (NOVA classification group 4) contains a variety of unhealthy foods, but also a number of foods with beneficial health effects.

It also says:

Health effects. Regular intake of UPF encourages over-eating and intake of foods in the UPF category of the NOVA classification has been suggested associated with increased risk of obesity, cardiovascular disease, type 2 diabetes, cancer, depression, and premature mortality …However, no qSRs [qualified systematic reviews] support these suggestions.

These negative views of the UPF concept differ from the views of the background document (however politely stated) and clearly were influenced by the overwhelmingly negative views of food industry representatives.

The draft report also was opened for public comment.  These comments also are listed in an Excel document. Some favor the changes benefiting the food industry; others—but many fewer—object to them (these last are summarized in yet another document).

The final Nordic Nutrition Recommendations are somewhat of a compromise between public health and food industry views, but generally favor the food industry position.  The new Nordic Nutrition Recommendations are less critical of the UPF concept, but do not say “reduce consumption of ultra-processed foods.”

The NOVA food classification system, which first defined ultra-processed foods, was published by Carlos Monteiro, a professor of public health at the University of São Paulo, and his colleagues in 2009.*  About the Nordic recommendations, my informant writes:

I have come to realize that this is not at all about evidence. It’s about power, and who gets to define what’s important in nutrition science. “The establishment” refuses to accept that someone from Brazil, a country they regard as inferior, should be allowed to tell them they have been wrong in their nutritionism-approach. They claim NOVA is based on ideology, not science….And now this is getting in the way of public health.

My take-home lesson:  The food industry came out in force on this issue and greatly overwhelmed the few comments of public health advocates.  The message here seems clear: public support for reduction of ultra-processed food needs to be widespread, clear, and forceful.

*Definition of ultra-processed foods

• Industrially produced
• Bearing no evident relationship to the foods from which they were derived
• Formulated to be irresistably delicious (if not addictive)
• Usually containing color, flavor, and texture additives
• Often high in salt, sugar, and fat (but these are culinary ingredients that do not in themselves make foods ultra-processed)
• Cannot be made in home kitchens (because they are industrially produced and contain ingredients unavailable to home cooks)

Addition

An additional document was sent to me after this post and the response from nutritionists involved in the NNR, which I posted the following week.  It is from the authors of the background document expressing their concerns about the changes made.

UNICEF does not want its statements to be compromised by conflicted interests with food and beverage companies that make formula or foods for children.

Here’s how UNICEF will be dealing with the food and beverage interests.

This publication explains just how UNICEF intends to avoid conflicts of interest with companies making products that do not promote childrens’ health.

The practices and products of a subset of the F&B industry whose primary business is the production, distribution, marketing and retailing of ultra-processed foods and beverages (UPF) pose particular concern. The companies producing these unhealthy, nutrient-poor UPF – rich in sugar, salt, trans-fats and food additives and preservatives – are major drivers of today’s broken food system and the global epidemic of childhood overweight and obesity and diet-related non-communicable diseases…It is now widely accepted that the practices and products of the UPF industry harm children’s and adolescents’ lives and have become the main commercial determinant of childhood malnutrition and disease.

Evidence shows that direct partnering with the UPF industry (i.e., working with) and voluntary UPF industry initiatives do not translate into large-scale sustainable results in transforming food systems for children. Further, direct funding engagements with UPF industry stakeholders pose a significant reputational risk to the credibility of UNICEF programming and independence as governments’ trusted advisor for policy formulation, normative guidance and programme scale-up for children and adolescents.

UNICEF says it will, among other measures (my emphasis):

• Continue to advocate for the F&B industry not to be included in public policy making.
• Continue avoiding all partnerships with F&B industries that violate the Code.
• Avoid all partnerships with ultra-processed food and beverage (UPF) industries.
• Exclude Code violators and UPF industries in UNICEF-led business platforms.
• Engage responsibly with the F&B industry in humanitarian response.

These commitments are a major public health advance.  Let’s hope UNICEF sticks with them.

I was deluged with interview requests last week over the rumor that the World Health Organization will soon release reports stating that the artificial sweetener aspartame is “possibly” carcinogenic.

I say rumor, because the reports will not be released until July 14.

According to Reuters—Exclusive: WHO’s cancer research agency to say aspartame sweetener a possible carcinogen -sources—two sources leaked the conclusion.

Aspartame, used in products from Coca-Cola diet sodas to Mars’ Extra chewing gum and some Snapple drinks, will be listed in July as “possibly carcinogenic to humans” for the first time by the International Agency for Research on Cancer (IARC), the World Health Organization’s (WHO) cancer research arm, the sources told Reuters…. Last month, the WHO published guidelines advising consumers not to use non-sugar sweeteners for weight control. The guidelines caused a furore in the food industry, which argues they can be helpful for consumers wanting to reduce the amount of sugar in their diet.

From what I hear from my own sources, everyone involved in the forthcoming reports is bound by confidentiality agreements.  They suspect that food industry representatives did the leaking.

This gives the industry plenty of time to complain and lobby.  As one report has it, “Industry experts and trade groups are decrying the World Health Organization’s International Agency for Research on Cancer’s pending addition of aspartame to a list of possible carcinogens for humans as unscientific and politically motivated.”

Aspartame has been under scrutiny for its potential harm to health practically from the time it first appeared. (see Laura Reiley in the Washington Post on how aspartame has come under scrutiny lately).

Center for Science in the Public Interest has long said of aspartame, Avoid.

Aspartame (sometimes marketed under the brand names Equal, NutraSweet, or AminoSweet) is a chemical combination of two amino acids and methanol. Questions of cancer and neurological problems, such as dizziness or hallucinations, have swirled around aspartame for decades…In 2005, researchers at the Ramazzini Foundation in Bologna, Italy…found that rats exposed to aspartame starting at eight weeks of age and continuing through their entire lifetimes developed lymphomas, leukemias, and other tumors, including kidney tumors, which are extremely rare in the strain of rat used. In 2007, the same researchers published a follow-up study that exposed rats to aspartame beginning in the womb and continuing through their entire lifetimes. That study, too, found that aspartame caused leukemias/lymphomas, as well as mammary (breast) cancer. Then in 2010, they published a study that exposed mice to aspartame, starting in the womb and continuing throughout their entire lifetimes. That third study found that aspartame caused liver and lung cancer in male mice.

US Right to Know says of Aspartame, “Decades of Science Point to Serious Health Risks.”

But the FDA says “aspartame is safe for the general population when made under good manufacturing practices and used under the approved conditions of use.”

And the American Cancer Society says you would have to drink 36 cans of diet soda a day to excede the Acceptable Daily Intake level.

Rumors and concerns about aspartame causing a number of health problems, including cancer, have been around for many years. Some of the concerns about cancer stem from the results of studies in rats published by a group of Italian researchers, which suggested aspartame might increase the risk of some blood-related cancers (leukemias and lymphomas). However, later reviews of the data from these studies have called these results into question. The results of epidemiologic studies (studies of groups of people) of possible links between aspartame and cancer (including blood-related cancers) have not been consistent.

A recent review says “The consumption of ASBs [artifically sweetened beverages] was associated with a higher risk of obesity, type 2 diabetes, all-cause mortality, hypertension, and cardiovascular disease incidence.”

As I mentioned a month or so ago, artificial sweeteners are taking a big hit these days and it looks like they are about to take another one.

In my intereviews, I pointed out that what’s news here is the level of authority.  It’s a big deal that WHO is saying this.

Two other points.

• Aspartame is not essential in the diet.  Nobody (except soft drink companies) need it.
• It and other artificial sweeteners are artificial and, therefore, ultra-processed.
• I’m already seeing “no aspartame” labels on soft drinks and food products.

I am looking forward to seeing the data when the reports are published.