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I keep getting asked what I think about the Child Nutrition Act wending its way through Congress.  Kerry Trueman of Eating Liberally posed this as a Q and A:

Let’s Ask Marion: Does The USDA Stand for Ultra Silly Dietary Agenda?

It’s almost impossible to keep up with what’s being written about childhood obesity.  The papers and commentary pour in.  Much of this is well worth reading.  If you want to keep up on the latest thinking about the issue, here are some places to start:

1.  Health Affairs: Thanks to Matt Gruenberg for alerting me to the issue of Health Affairs devoted entirely to obesity topics.  Here’s the Table of  Contents.

The Robert Wood Johnson Foundation had a hand in this and discusses some of the papers on its website.

Even better, Health Affairs has produced a series of “issue briefs” to go with the journal articles.  These are available on the Health Affairs blog. They cover:

• Overview: The State Of Childhood Obesity In America
• The Role Of Agriculture Policy In Reducing Childhood Obesity
• Food Marketing And Distribution’s Role In The Fight Against Childhood Obesity
• Speeding Up Progress In Fighting Obesity In Schools
• Lessons From States On Fighting Childhood Obesity
• The Pervasive Effects Of Environments On Childhood Obesity

2.  FoodNavigator.com has a “special issue” on childhood obesity from the business standpoint:

Giving children the best nutritional start: With childhood obesity rates apparently sky rocketing around the world, celebrity chefs redesigning school meals, and international initiatives to influence what our children eat, now is an interesting time for child nutrition.

Kids’ food trends in the spotlight: Some major trends in children’s eating habits could change as the economy recovers – but foods marketed as natural and healthful are here to stay, according to a senior analyst at Mintel. 

How characters can help children eat healthily: From Disney to Tony the Tiger, consumer groups have been campaigning hard to break the links between childhood icons and unhealthy foods. But furry friends and super-heroes are now putting in more of an appearance on healthy products.

Kids’ TV food commercials down, but cross-promotions soar: Cross-promotions on food packaging targeted at children increased by 78 percent between 2006 and 2008, according to a study from Yale’s Rudd Center for Food Policy.

3.  Michelle Obama’s campaign:USA Today reports on Mrs. Obama’s talk to the school nutrition association, the organization of people who work in school lunchrooms – those who Jamie Oliver refers to as “lunch ladies.”  Check out the coverage and see the video.

What is one to make of all this?  Childhood obesity is a huge public health issue and deserves the attention it is getting.  Let’s hope some of it works.

I can’t resist dealing with the questions just asked by Elliot and Johannes.  From Elliot:

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease (see: American Journal of Clinical Nutrition, January 13, 2010)…[but] in his book, Good Calories Bad Calories, Gary Taubes clearly attributes most of our chronic disease problems — including heart disease — to carbohydrates (see page 454).  In contrast, Colin Campbell in his book The China Study (pages 113-133) forcefully argues that animal proteins contribute to CVD.  Yet, Dr. David Katz in his book Nutrition in Clinical Practice (pages 130, 133) asserts that to prevent heart disease, “saturated and trans fat should be restricted to below 7% (or even 5%) of total calories . . . .”  Who’s right?  We badly need your unbiased wisdom on this topic.

Joannes says that according to the Weston A Price Foundation,

it seems as if (naturally-occurring) saturated fats are almost better for you than the unsaturated fats we get fed these days, which mainly consist of rancid oils which more than anything contribute to heart disease, whereas many saturated fats are actually quite beneficial.

OK.  Here’s my “unbiased wisdom” (if such a thing exists).  I like to ask: What do saturated fats, sugars, and animal proteins have in common as factors in the development of heart disease?   Answer: They are all single nutrients.

Recall that nutrition research is difficult to do because diets contain many foods, foods contain many nutrients and other chemicals that affect health, and other behavioral, socioeconomic, and genetic factors influence heart disease.  Studies of single nutrients take these chemicals out of their food, dietary, caloric, and lifestyle contexts and are, therefore, reductive.

Such studies tend to produce ambiguous results that demonstrate small differences, if any.  Small differences create situations ripe for interpretation.  Interpretation depends on the viewpoint of the interpreter.  That is why it helps to know who is doing the interpreting and who sponsored the studies.

Short of that, you would have to read every study cited by these authors and come to your own decision about how to interpret them – a daunting task.

My approach to conflicting research?  I look for points of agreement. The authors cited here do not disagree about the basic principles of healthful diets: variety in food intake, moderation in calories, largely plant-based (although not necessarily exclusively), and minimally processed.  Eat according to those principles and you do not have to worry about nutritional details.

All of that boils down to the advice I propose in What to Eat: eat less, move more, eat plenty of fruits and vegetables, and don’t eat too much junk food.

Let the scientists and their interpreters fight it out over single nutrients.  Eat food and enjoy your dinner.

I wish I could answer all of the questions that come into Feedback or Comments, but I cannot except occasionally.  It’s a rainy day in New York and today seems to be one of those occasions.

Q: Does the caloric value of a food change when it’s cooked?  In his latest book, “Catching Fire: How Cooking Made us Human,” Harvard Primatologist Richard Wrangham argues that cooking foods changes the available nutrient content and actually raises the available calories.

A:  The rules of physical chemistry tell us that matter cannot be destroyed or created so the number of calories available in a food does not change with temperature.  What can change is our ability to use (digest, absorb) the calories that are there as well as our desire to eat the foods.  Cooking makes the calories in potato starch more available, for example, but has hardly any effect on the calories in meat.  Both, in my opinion at least, taste better cooked.    But cooked or not, the calorie differences will be small and unlikely to account significantly for weight change.

The nutrient situation is also complicated.  Cooking destroys some nutrients (vitamin C is a good example) but makes others more available (beta-carotene).  This is another reason why nutritionists are always advising variety in food intake.  Variety applies to cooked and raw, as well.

Q.  Can you please explain what benefits, if any, there are in using a “natural” sweetener, e.g. agave, over regular sugar?  Are there any differences in terms of glucose/fructose makeup?

A.  Agave is more expensive so you probably won’t use as much of it.  Beyond that, it is higher in fructose than table sugar or honey.  This is because agave contains inulin, a polymer of fructose, which must be hydrolyzed (broken down by heat or enzymes) to fructose to make the sweetener.  It’s a processed sweetener requiring one hydrolysis step, requiring more processing than honey and less than high fructose corn syrup.  It has the same number of calories as any other sugar, about 4 per gram or 16 per teaspoon.

Q.  Also, you’ve written on a prior blog that fructose is “preferentially” metabolized into fat by the body.  Can you explain in more detail what that means?

A.  More and more evidence suggests that high amounts of fructose in the diet are not good for health.  Fructose occurs naturally in fruit and nobody worries about that because fruits don’t contain all that much and the sugar is accompanies by vitamins, minerals, and fiber that are well worth eating.  Honey, table sugar, and high fructose corn syrup (a misnomer) are about 50% each glucose and fructose.  Glucose and fructose are metabolized differently and some investigators believe that excessive amounts of fructose stress metabolism in ways that encourage fat deposition.  Eating a lot of sugars of any kind is not a great idea, which is why there are so many concerns about soft drinks these days.

Q.  I would appreciate some comments about the “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.

A.  The study concludes:  

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [coronary heart disease] or CVD [cardiovascular disease]. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

This is a review of previous epidemiological studies (not clinical trials).  These fail to find a correlation between consumption of saturated fat and heart disease.  This could be because there is no correlation or there is one but they can’t find it.  My interpretation: even if there is one, it is likely to be small.

I am increasingly convinced that studies of single nutrients – sugar, fructose, saturated fat, or even omega-3s – will give complicated results when removed from their dietary context.  People who eat foods containing a lot of sugars or animal fats eat and behave differently than people who do not, but not so differently that health differences will show up in the kinds of studies scientists are currently able to do.

Keep in mind: nutrition science is exceedingly difficult to do because there are so many factors in foods that affect health and so many behavioral, economic, and social factors that affect what people eat.

All of this is why I find nutrition so interesting but I can understand why others might find it frustrating.

I’ve been fretting about the immunity and brain claims on Nestlé’s Juicy Juice for quite some time now, but completely missed the FDA’s December 4 warning letter about them.  Thanks to Hemi Weingarten at Fooducate for keeping track of such things.

If you give these products a moment’s thought, you can quickly figure out that feeding DHA- or antioxidant-fortified juice drinks to kids is unlikely to have much effect on how smart they are or whether they can resist colds or swine flu.  But never underestimate the power of food marketers.   Adding a little DHA or a few antioxidants to juices sells products.  Health claims, as I keep pointing out, are about marketing, not health.

In warning the company to cease and desist, however, The FDA did not take on the health issues.  Instead, it invoked labeling regulations:

The Food and Drug Administration (FDA) has reviewed the labeling for several Nestlé Juicy Juice products…Based on our review, we have concluded that these products are misbranded…. because [their] labeling includes unauthorized nutrient content claims. Except for statements that describe the percentage of a vitamin or mineral in relation to a Reference Daily Intake (RDI), a nutrient content claim cannot be made for a food intended for use by infants and children less than 2 years of age….On October 30, 2009. we also reviewed your website….The labeling found on your website makes an additional unauthorized nutrient content claim, which further misbrands the product. The website claims that Juicy Juice Brain Development Fruit Juice Beverage is “naturally lower in sugar”…[but] no nutrient content claims can be made for a food intended specifically for use by infants and children less than 2 years of age unless specifically permitted by FDA regulations.

Additionally, we have reviewed the labeling of your Nestle Juicy Juice All Natural 100% Juice Orange Tangerine and Nestle Juicy Juice All Natural 100% Juice Grape products. These products are misbranded…because their labels are misleading. The label of the Orange Tangerine product is designed to imply that the product is 100% orange/tangerine juice, and the label of the Grape product is designed to imply that product is 100% grape juice…neither orange/tangerine juice nor grape juice is the predominant juice in the products….

Nestlé (alas, no relation) is the largest food company in the world with $102 billion in sales last year.  It should know better.

Just for the record, the misbranded products are still displayed on the Juicy Juice website.

The FDA also warned Nestlé that its Boost Kids Essentials products are misbranded. Why?  Because their labeling does not follow the rules for medical foods, those aimed at alleviating specific conditions – in this case “failure to thrive.”   Oops.  The Boost Kids Essentials website is now under revision.

I greatly admire the work of Jared Diamond.  His book, Guns, Germs, and Steel: The Fate of Human Societies, is as clear an explanation as you will ever get of how the inequitable distribution of favorable geography, climate, and natural resources affects the development and maintenance of human societies.

But here he is, incredibly, in the Sunday New York Times writing a fan letter to corporate social responsibility for protecting those favorable environments.  He writes:

There is a widespread view, particularly among environmentalists and liberals, that big businesses are environmentally destructive, greedy, evil and driven by short-term profits. I know — because I used to share that view.  But today I have more nuanced feelings…I’ve discovered that while some businesses are indeed as destructive as many suspect, others are among the world’s strongest positive forces for environmental sustainability.

And which corporations does he include as “strongest positive forces?”  Chevron, Walmart, and Coca-Cola.   I’ll leave discussion of Chevron and Walmart to others, but Coca-Cola?

Coca-Cola, Diamond says, is protecting the world’s water supplies.  The company needs clean water in the 200 countries in which it operates.  This, says Diamond:

compels it to be deeply concerned with problems of water scarcity, energy, climate change and agriculture. One company goal is to make its plants water-neutral, returning to the environment water in quantities equal to the amount used in beverages and their production. Another goal is to work on the conservation of seven of the world’s river basins, including the Rio Grande, Yangtze, Mekong and Danube — all of them sites of major environmental concerns besides supplying water for Coca-Cola. These long-term goals are in addition to Coca-Cola’s short-term cost-saving environmental practices, like recycling plastic bottles, replacing petroleum-based plastic in bottles with organic material, reducing energy consumption and increasing sales volume while decreasing water use.

Please note the future tense.  These are things Coke says it plans to do.  As for what the company is doing now, Diamond does not say.  His piece does not mention Coke’s negotiating with officials in developing countries to buy water at rates significantly below those charged to local communities, a topic under much discussion when I was in India last year.  It does not mention campaigns in India to hold Coke accountable for its abuse of local water rights or any of the similar campaigns in other countries.

Diamond’s piece does not talk about the efforts Coke puts into selling bottled water at the expense of local water supplies.  As described by Elizabeth Royte in her book, Bottlemania, companies like Coke exhibit every one of of the characteristics formerly deplored by Diamond in attempting to secure plentiful and reliable sources of cheap local water: in his words, “environmentally destructive, greedy, evil and driven by short-term profits.”

Diamond says he sits along side and has gotten to know and appreciate the motives of many corporate executives.  Me too.  Personally, many of them mean well and wish that they could do more to be socially responsible.  But they work for businesses that are required, by law, to make short-term profit their reason for existence.  This means that corporate social responsibility is necessarily limited to actions that bring visible – and immediate – returns on investment.

We need some critical thinking here.  If Diamond gave any thought at all to what Coca-Cola produces – bottled water and sodas – he would surely have to agree that less of both would be good for our own health and that of the planet.

The British Medical Journal has a new meta-analysis of 13 studies of the health effects of high salt intake.  Its conclusion:

High salt intake is associated with significantly increased risk of stroke and total cardiovascular disease. Because of imprecision in measurement of salt intake, these effect sizes are likely to be underestimated. These results support the role of a substantial population reduction in salt intake for the prevention of cardiovascular disease.

In commentary, the authors insist that regulation is needed.  The effects of salt are large:

a 5 g reduction in salt intake at the population is associated with a 23 per cent difference in stroke rates, and a 17 per cent difference in total cardiovascular disease….eating less salt could avert 1.25 million deaths from stroke and almost 3m deaths from cardiovascular disease – and these projections are…conservative because of imprecision in assessing salt intake.

Why regulation?  Because nearly 80% of salt enters the diet through processed and pre-prepared foods.  The rest is about equally divided between naturally occurring salt in foods and salt added at the table.   To reduce salt, food manufacturers and restaurants need to cut down, and all of them have to do it.

This is because the taste for salt depends on how much is eaten.  On a low salt diet, even lightly salted foods taste salty.  But if you are used to eating a lot of salt, it takes even more to taste salty.  So the object needs to be to reduce salt in the diet across the board.

I’m hearing a lot these days about how federal agencies are getting interested in the salt issue.  Stay tuned on this one.

And have a safe, healthy, delicious, and lightly salted thanksgiving!

My Sunday (September 20) column in the San Francisco Chronicle deals with the sugar “crisis” I discussed here a few weeks ago:

Q: I saw you on “The Colbert Report” (Aug. 19) talking about sugar policy. Explain, please. I don’t understand why sugar policy is a topic for Comedy Central.

A: Neither did I until I saw Stephen Colbert douse himself with 5 pounds of sugar over the impending “crisis.” We have a sugar crisis? According to processed food manufacturers, we are about to run out of sugar. Horrors!

Earlier in August, Kraft and other food processors asked the U.S. Department of Agriculture to raise the quota on sugar imports. Sugar availability, they complained, is the lowest in years and it’s the USDA’s fault.

The USDA firmly controls amounts of sugar (sucrose) produced by American cane and beet growers through quotas. It even more firmly controls sugar imported from other sugar-growing countries through quotas and tariffs. And as corn is increasingly diverted to biofuels, less high-fructose corn syrup (HFCS) is around to make up the shortfall.

Should we worry?

The shortage is no crisis. At worst, it is temporary and will end as soon as the 2009 harvest is in. But processed food makers are right about one thing: Sugar is the most absurdly protected agricultural commodity in America.

For decades, no matter what it cost on the world market, quotas and tariffs ensured that Americans paid two or three times as much for sugar. High sugar prices cost American consumers about $3 billion a year. But because this works out “only” to about $10 per year per capita, nobody much cared.

If you think of $10 as trivial, you won’t give sugar protectionism another thought. But if you look at this system as an unnecessary transfer of $3 billion a year from 350 million Americans to a few thousand sugar growers and processors, you can understand why sugar policy is ripe for satire.

Here’s how the system works:

Quotas allow U.S. producers to grow only specified amounts of sugar cane and sugar beets each year, for which the USDA guarantees a higher-than-market price. Beets get 55 percent of the quota; cane gets 45 percent. The quotas are fixed. If you want to grow sugar beets in your backyard and sell the sugar to USDA at the favorable support price, too bad for you. You only get a quota if you already have a quota.

As for tariffs, the 2008 Farm Bill requires 85 percent of total sugar in the United States to be produced domestically, and allows only 15 percent to be imported. That 15 percent is distributed through quotas awarded to about 20 countries.

Above and beyond the quotas, imported sugar is subject to high tariffs. Mexico is an exception. Under NAFTA, Mexico gets to sell us as much sugar as it wants at the favored price. However, few countries in Africa hold quotas. What if you are an African cane-growing country and want the high quota price for your sugar? Not a chance.

Imports are never supposed to top 15 percent, so the USDA can’t increase the percentage. But we participate in the World Trade Organization, which obligates us to take world market sugar. Oops. These policies don’t match. Processed food makers must think the contradictions will allow the USDA to let in more sugar. Maybe, but the legalities are not yet decided.

Mind you, sugar producers and processors love this system. They argue that it keeps jobs in rural America and eliminates dependence on foreign sugar imports. To make sure nobody scrutinizes the system too carefully, they formed cooperatives to avoid antitrust laws.

Sugar producers are among the most generous and equal-opportunity contributors to congressional election campaigns, giving to both Democrats and Republicans. For decades, administrations of both parties have tried to end sugar supports. No such luck.

A shift’s brewing

Policies may change, because the gap between the prices for domestic and world market sugar – and for high fructose corn syrup – has narrowed recently. Sugar is now at war with HFCS. As HFCS is increasingly known as a key junk food ingredient, manufacturers are rushing to replace it with sucrose, which they can tout as “natural and unprocessed.”

Other sugar issues are also ripe for comedy. Most sugar beets are now genetically modified, leading many companies to avoid using beet sugar. In the South, sugar cane production pollutes the Everglades, which is costing billions of dollars to clean up. Investigative reporters are riveted by the feudalistic labor practices of sugar plantations.

And then there’s Cuba. Until the Castro revolution, that’s where we got most of our imported sugar. When relations improve, will Cuba get a sugar quota?

If sugar is responsible for any true crisis, it is because of its role as an ingredient in processed foods. Cheap sugar reduces the cost of candy and soft drinks. Cheap junk foods are highly profitable. Otherwise, our sugar policies make no sense in today’s global marketplace.

But we would be healthier eating less sugar, anyway. So here’s my solution to the non-crisis: Eat less sugar!