by Marion Nestle

Search results: a life in food

Jul 5 2017

Thinking about: potatoes!

The American Journal of Clinical Nutrition has a new study with a startling conclusion: “frequent consumption of fried potatoes appears to be associated with an increased mortality risk” (here’s a news report about it).

For lovers of French fries, this is unhappy news.  Or is it?

The study looked at potato intake (fried and unfried) reported by 4440 participants aged 45–79 y at baseline for 8 years, as part of a study on osteoarthritis.  Participants with the highest consumption of potatoes had the same mortality as those consuming the lowest amount.

But when they looked at the subgroup consuming fried potatoes 2–3 times per week, the risk of mortality doubled.

It’s not potatoes that might be a problem; it’s just those that are fried.  Even so,

  • The study is based on intake reported in food frequency questionnaires
  • The results are not cleanly dose-related; mortality rates were higher among people reporting fried potatoes twice a week than those reporting more
  • People who eat lots of fried potatoes are likely to indulge in other unhealthful dietary or lifestyle practices.

But this is not the first study to report health problems among frequent eaters of fried potatoes.  See:

This is a lot to blame on one food.  I vote for lifestyle confounding.

Put French fries in your once-in-awhile category.  I’m saving my allotment for the Belgian ones.

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Apr 3 2017

The U.K.’s efforts to reduce sugar intake

The British government is serious about reducing sugars, especially in the diets of children.  Its agency, Public Health England (PHE), has been hard at work for several years.

In 2014, it issued a report announcing plans for initiatives to reduce overall sugar intake: Sugar Reduction: Responding to the Challenge.

In 2015, its report provided evidence for why eating less sugar is necesssary: Sugar Reduction: The Evidence for Action.

The Scientific Advisory Committee on Nutrition (SACN) has concluded that the recommended average population maximum intake of sugar should be halved: it should not exceed 5% of total dietary energy. SACN also recommended that consumption of sugar sweetened drinks should be minimized by both adults and children. By meeting these recommendations within 10 years we would not only improve an individual’s quality of life but could save the NHS, based on a conservative assessment, around £500 m every year.

In 2016, a different agency of the UK government issued a plan for action to reduce childhood obesity. Among other recommendations, the plan called for taxes on soft drinks, but it also challenged the food and beverage industries to reduce sugars in products aimed at children by at least 20% by 2020, including a 5% reduction in the first year.  It said companies could do this by reducing sugar levels in products, reducing portion size, or shifting purchases to lower sugar alternatives.

In 2017, Public Health England set targets: Sugar Reduction: Achieving the 20%.

The role for Public Health England (PHE) is to advise government on setting the sugar reduction guidelines per 100 g of product and the calorie or portion size guidelines for specific single serving products. PHE is committed to publishing the category-specific guidelines for the nine initial categories of food in March 2017 and this report fulfills that commitment.

The guidelines are quite precise:

The good news: everyone has to do this so it will be an across-the-board reduction.

The not-so-good news: the reports say not one word about enforcement.

Public Health England plans follow-up reports.  Stay tuned.

Dec 22 2016

More on the industry-funded sugar guideline paper

The Associated Press reporter Candice Choi has a special interest in industry-funded research (as I do) and has been using emails obtained through FOIA requests to document connections between funders and researchers that otherwise would not come to light.

Yesterday, she reported some follow up on the article I was surprised to see published in the Annals of Internal Medicine—the one I wrote about in my last post.

Ms. Choi came up with these delicious tidbits:

  • Mars Inc., which is one of the companies that funds ILSI (the International Life Sciences Institute, which funded the study in the Annals charging that dietary guidelines for sugar are based on weak evidence), is now denouncing the study on the grounds that “the paper undermines the work of public health officials and makes all industry-funded research look bad…[and] creates more doubt for consumers rather than helping them make better choices.”
  • Mars is saying this even though emails show that two Mars executives knew about the study last year.
  • Mars now said it will make clear to ILSI hat it does not support such work.
  • ILSI’s executive director says ILSI devised the concept for the study, but the paper originally said that the authors wrote the protocol and conducted the study independently from the funder. Oops.  When confronted with the Associated Press emails “showing the group sent the authors ‘requested revisions’ on the proposal last year,” the journal corrected that statement to make clear that ILSI “reviewed and approved” the protocol.
  • One of the authors did not fully disclose her consulting and research agreements with companies that make high-sugar foods.  The AP had emails demonstrating this author’s financial ties to Coca-Cola and to ILSI for a previous grant on the same topic.  The Annals now show a more complete disclosure statement.

The point of all this is that when food companies sponsor research, they sometimes are much more involved in it than they would like to let on.

Mars is right.  These kinds of incidents make all industry-funded research look bad.  Mars should know.  It funds research to make chocolate look like a health food.

Dec 20 2016

Industry-funded study says advice to eat less sugar is based on bad science (surprise)

I haven’t posted an industry-funded study for a while, but here’s a good one.  This is a systematic review published in the Annals of Internal Medicine attacking dietary advice to eat less sugar on the grounds that such advice is not scientifically justified.

This one doesn’t pass the laugh test.

What are dietary guidelines supposed to do?  Tell people to eat more sugar?

This review is particularly peculiar:

  • It was funded by the International Life Sciences Institute (ILSI), a food-industry front group.
  • Two of the four authors consult for ILSI, and one of the two is on the scientific advisory board of Tate & Lyle, the British sugar company.
  • The authors admit that “given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.”  No kidding.
  • It was published by a prestigious medical journal.  Why?
  • It is accompanied by an editorial that thoroughly demolishes every single one of the authors’ arguments.

I can understand why ILSI wanted this review.  Many of its funders make sugary foods and drinks.  They would like to:

  • Cast doubt on the vast amounts of research linking excessive sugar intake to poor health.
  • Discredit dietary guidelines aimed at reducing sugar consumption.
  • Head off regulatory attempts to tax or label added sugars.

In funding this study, ILSI is following the tobacco industry playbook to the letter.  Strategy #1 is to cast doubt on the science.

When the 2015 Dietary Guidelines came out with a recommendation to restrict sugar intake to 10% of calories or less, the Sugar Association called it“agenda-based, not science-based.”  The Annals review says international sugar guidelines do not “meet criteria for trustworthy recommendations and are based on low-quality evidence.”

I detect a theme here.

But I ask again: what are dietary guidelines supposed to do?  We cannot lock up large numbers of people and feed them controlled amounts of sugar for decades and see what happens.  Short of that, we have to do the best we can with observational and intervention studies, none of which can ever meet rigorous standards for proof.  So this review is stating the obvious.

Take a look at the accompanying editorial.  After destroying each of the flawed premises of this review, it concludes:

Industry documents show that the F&B [Food & Beverage] industry has manipulated research on sugars for public relations purposes….Accordingly, high quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome. In summary, our concerns about the funding source and methods of the current review preclude us from accepting its conclusion that recommendations to limit added sugar consumption to less than 10% of calories are not trustworthy. Policymakers, when confronted with claims that sugar guidelines are based on “junk science,” should consider whether “junk food” was the source.

I don’t ever remember seeing a paper accompanied by an invited editorial that trashes it, as this one did, but this incident suggests a useful caution.

Whenever you hear that something isn’t “science-based,” look carefully to see who is paying for it.

The press coverage

Dec 5 2016

Farewell Steve Clapp, and thank you for your legacy

On Friday December 2 I posted Steve Clapp’s Fixing the Food System in my series on Weekend Reading.  His daughter has just written to tell me that Steve died on December 1 of acute leukemia, which he learned he had just six weeks earlier.

I so hope that he was able to see his book, hold it in his hands, and celebrate its arrival.

Memorial service: January 28 at Wakefield Country Day School, Flint Hill, VA, 2:00 p.m. with reception following.  Doors open at 1:00.

In sadness, I am repeating the post in honor of his memory.

Steve Clapp.  Fixing the Food System: Changing How We Produce and Consume Food.  Praeger/ABC-Clio, 2017  (but published November 30).

I wrote the Foreword to this book.  Here’s what I said:

In this welcome addition to my library of books about food policy and politics, Steve Clapp’s Fixing the Food System reviews the past and current history of calls for a national food policy, the most contentious controversies over food and nutrition issues that have impeded development of such a policy, and the work of advocates to achieve one.   As this book makes clear, this history began decades ago.

I first became aware of the importance of federal food policies in the early 1980s when I was teaching nutrition to medical students at the University of California San Francisco (UCSF).  First-year students were eager to learn about nutrition, but for personal more than for professional reasons.  They wanted to know what they—and the patients whose health problems they were learning to treat—should eat.  But by the time they were residents, I could see their dietary concerns vanish under the daily demands of patient care.  Trying to advise about diets was too difficult, time-consuming, and financially unrewarding to be worth the trouble.  It seemed unreasonable to expect doctors to take the time needed to counsel individual patients about the prevention of diet-related conditions—heart disease, type 2 diabetes, cancer, and the like.  If nutritionists like me wanted to focus on disease prevention rather than treatment, we would have to advocate to change the food environment to make healthful food choices the easy choices—even better, the preferred choices.  This meant we would have to advocate for food and nutrition policies aimed at promoting public health.

In 1983, I co-authored an article with UCSF colleagues on the need for such policies.[i]  It began:

The U.S. government helps to assure an adequate food supply for Americans by sponsoring a wide variety of food, nutrition, and agricultural support programs.  These federal activities were developed in the absence of a clearly articulated national policy, a situation that has resulted in the fragmentation of government programs and their wide disbursement among numerous agencies and departments.

Our article quoted the earliest calls we could find for a national policy to address these problems.  In 1974, long before the term “food system” came into common use, the National Nutrition Consortium of four leading nutrition and food science societies[ii] argued for a national nutrition policy that would:

  • Assure an adequate, wholesome food supply, at reasonable cost, to meet the needs of all segments of the population.
  • Maintain food resources sufficient to meet emergency needs and to fulfill a responsible role as a nation in meeting world food needs.
  • Develop a level of sound public knowledge and responsible understanding of nutrition and foods that will promote maximal nutritional health.
  • Maintain a system of quality and safety control that justifies public confidence in its food supply.
  • Support research and education in foods and nutrition with adequate resources and reasoned priorities to solve important current problems and to permit exploratory basic research.

Whether offered as nutrition or food policies, these were and remain highly appropriate goals for an abundant, healthy, safe, and effective food system.

My co-authors and I went on to identify the constraints that then limited government action to achieve such goals.  Despite an emerging consensus on the basic elements of healthful diets—fruits and vegetables, balanced calories, not too much junk food (as Michael Pollan put it more recently, “eat food, not too much, mostly plants”[iii])—the greatest impediment to policy development was the controversy over the science of diet and health.  As our article understated this issue,

The effect on the nation’s health of food processing and other changes in the U.S. diet is controversial.  Salt, sugar, fiber, saturated fats, alcohol, caffeine, calories, vitamins, and food additives all elicit vigorous debate.

Today, more than 30 years later, we are still arguing about that science, and the scientific arguments still impede policy development.  In Fixing the Food System, Steve Clapp brings us up to the minute on federal progress (or the lack thereof) toward achieving a clearly articulated national food policy.  He begins and ends his book with the most recent policy proposals from leading food advocates Michael Pollan, of course, but also Mark Bittman, Olivier de Schutter, and Ricardo Salvador.  Their recent suggestions for improving our current food system reflect the many changes in agricultural production and food consumption that have taken place since 1974 but retain the basic elements of those earlier proposals.  Fixing the Food System explains why a national food policy is so badly needed and matters so much.

Steve Clapp is in a unique position to comment on food policy issues.  He’s been at the policy game for a long time.  I don’t remember when I first met him but I have been reading his work since he reported for the Community Nutrition Institute’s newsletter, Nutrition Week.  For those of us outside the Beltway in those pre-Internet days, Nutrition Week was a lifeline to the ins and outs of food politics in Washington, DC.   Later, when Steve moved to Food Chemical News, also—and still—a lifeline, I continued to read his reporting.  I often ran across him at meetings and hearings in Washington, DC and found it instructive to read what he wrote about those deliberations, not least because he got it right.

I say all this because he has been a keen observer of the food politics scene in Washington for decades and I can’t think of anyone who ought to know it better.  Fixing the Food System reviews the major debates he witnessed—the Dietary Guidelines, of course, but also attempts to set policy for food safety, marketing to children, hunger in America, and humane treatment of farm animals, among others.

Over the years, he also observed the work of policy advocates, and this book includes profiles of many individuals engaged in this work, some likely to be familiar to readers, whereas others may not.  Impossible as it is for me to judge whatever impact my own writing and advocacy might have, I am honored to be included among those whose work he presents.

Fixing the Food System describes political arguments over the kind of food system we ought to have and what an ideal system should accomplish.  But it is also about the importance of personal and political advocacy for a better food policies, those aimed squarely at promoting public health and environmental sustainability.

Advocacy makes a difference.  Advocates are scoring successes in improving one after another aspect of the food system.  In comparison to the 1970s or 1980s, we now have better food in supermarkets, more organic foods, more farmers’ markets, more nutritious food in schools, and impressive declines in consumption of sugary drinks.  My personal favorite among indicators of advocacy success—the change that makes me most optimistic—is the increasing number of college students who care deeply about food issues.  They are demanding local, seasonal, organic, and sustainably produced food in their cafeterias, and campus vegetable gardens.  And they are demanding and getting food studies courses and programs like the ones we started at New York University in 1996 that teach about how food is produced and consumed and the practical and symbolic meanings of food in modern culture and societies.  Today’s students are tomorrow’s advocates for healthier and more sustainable diets for everyone, everywhere, and for fixing what needs fixing in our food systems.  This book is a great starting place for this work.

–Marion Nestle, New York, June 2016

[i] Nestle M, Lee PR, Baron RB.  Nutrition policy update.  In: Weininger J, Briggs GM, eds.  Nutrition Update, Vol. 1.  New York: John Wiley and Sons, 1983:285-313.

[ii] National Nutrition Consortium, Inc.  Guidelines for a national nutrition policy.  Nutrition Reviews 1974;32(5):1253-157.  The Consortium included the American Institute of Nutrition, the American Society for Clinical Nutrition, the American Dietetic Association, and the Institute of Food Technology.

[iii] Pollan M.  In Defense of Food: An Eater’s Manifesto.  Food Rules: An Eater’s Manual.  Penguin Press, 2008.

Oct 24 2016

Rethinking nutrition policy in developing countries

I recently coauthored an editorial on international development.  It appeared first in French, and now in English in Ideas for Development, a blog coordinated by the French Agency for Development.

Rethinking nutritional policies in developing countries taking into account the double burden of malnutrition

By , Marion Nestle, and

The world now experiences two forms of malnutrition which may seem contradictory: “undernutrition” (which includes micronutrient deficiencies) and “overnutrition” (obesity and its health consequences).The problem of malnutrition in developing countries is approached by most aid bodies (donors, international organisations and NGOs) and governments solely from the angle of undernutrition. And yet in these countries, the complex and multi-faceted challenge which malnutrition now presents can justifiably be called the double burden of malnutrition. In addition to the continuing problem of undernutrition there are now major issues linked to overnutrition and its associated illnesses.

Rapid nutrition transition

The stereotyped image of skeletal young children with protruding bellies saved by souls of goodwill in sub-Saharan Africa is still too widespread. Severe acute malnutrition still persists of course, especially among the victims of extreme poverty, natural catastrophes and wars. Naturally, this deadly disease must continue to be addressed and treated, as numerous NGOs are doing.

The treatment of malnutrition should focus not only on severe malnutrition in children. Less severe malnutrition, going back to life in the foetus and resulting from malnutrition in women even prior to their pregnancy, continues to contribute to stunting, which affects 23.8% of all children under the age of 5 throughout the world.

In parallel with acute and chronic undernutrition, the “nutrition transition” in low-income countries, driven by globalisation, urbanisation and technological progress and linked to “overnutrition,” leads to a swift increase in obesity and other chronic diseases – mainly diabetes and cardiovascular diseases. Nutrition transition is the term used to describe the progressive Westernisation of eating patterns, typified by a sharp increase in the consumption of animal fats and processed foods all over the world, combined with an increasingly sedentary lifestyle. It is easy to see how this transition encourages the increase in overweight and obesity.

Today, undernutrition alone is not the major issue; the greatest problem is the double burden of undernutrition and overnutrition. According to estimates from 129 countries with available data, 57 experience serious problems of both undernutrition in children and overweight in adults[i]. And Africa is not exempt from this double burden where undernutrition and overweight are undeniably linked. In West Africa, 50% of women of child-bearing age are anemic while at the same time 38% are overweight and 15% are obese. For the whole of sub-Saharan Africa, 40% of children have stunted growth characteristic of chronic undernutrition, while 7.5% of adults suffer from obesity. Malnutrition early in life increases the subsequent risk of chronic diseases in places where obesity is encouraged by the environment. Obesity is now on the increase among children in all developing countries. The World Health Organization (WHO) reports that between 1990 and 2015 the number of overweight or obese African children doubled from 5 to 10 million. 

The responsibilities of the industrial food system

It is often said that communication aimed at changing food habits is the best way to prevent obesity, a problem reserved for rich people in low-income countries. This cliché contains three errors:

  • The first is the claim that preventing nutrition-related chronic relies entirely on the capacity of individuals to make appropriate choices regarding food, physical activity or lifestyle. This claim ignores the well-documented effects of the food system and the socio-cultural factors which play a determining role and which influence the choice of individuals.
  • The second error is to believe that significant changes cannot be made to the eating practices of limited-income groups in the absence of an increase in resources. Yet several studies show the opposite, whether they are about exclusive breastfeeding for the first six months of life and improved complementary feeding, or else hygiene measures and supplies of drinking water.
  • The third error is to consider that obesity continues to be only a problem of the rich in low-income countries. Obesity is escalating and affecting growing numbers of not so well-off people, particularly in cities.

When analysing the impact of the food system, it is necessary to account for the agri-food industry (Big Food). On a world-wide scale Big Food is primarily responsible for the nutrition transition” towards processed food. “Globalised” industrial food is gradually replacing traditional cooking and locally produced foods, with ultra-processed foods’ (food-like substances as Michael Pollan calls some of them) undeniable appeal for city-dwellers and young people as these products are strongly associated with Western-style fast food and heavily promoted by the media. This appeal is reflected in profound changes in consumption trends in developing countries. Global sales of highly processed foods increased by 44% from 2000 to 2013, but only by 2% in North America as opposed to 48% in Latin America and 71% in Africa and the Middle East.

So what is the problem? Industrial food products (and drinks) are often a nutritional disaster: rich in calories, sugar, fat and salt, but low in essential nutrients and fiber. Even more, these products are relatively inexpensive, often less expensive than more nourishing local food products.

Changing the food environment

What is the explanation for the popularity of these “globalized” food products? Part of the answer lies in extremely effective advertising. Anyone travelling in Africa, for example, will see campaigns to promote salty stock cubes to replace traditional spices and vegetables. “Social marketing” efforts to change eating behaviour must be as forceful as these adverts, with commensurate budgets.

One idea is to impose a tax on soft drinks or other highly processed foods and use the revenues to finance cutting-edge nutrition education campaigns. This is what the United Kingdom has recently decided to do by taxing soft drinks.

It is especially important to rethink the nutrition programs created by NGOs and financed by international aid. Correcting the nutrition of malnourished mothers or children is only part of the problem.

A wider vision is needed to recognize the threat to world health posed by nutrition-related chronic diseases.

To cope with this new challenge, it will be important to address many determinants of health – education, social disparities, housing, and culture – as well as the food environment. The latest report on global nutrition1 points out the excellent return on investment of nutrition interventions (16 for 1), and challenges governments and decision-makers to identify and implement strategies that target the double burden of malnutrition. If this is not done, it will be difficult to reach the nutrition objectives set by the WHO for 2025 (see below). Solutions do exist, however, as can be seen from places such as Ghana, Brazil, or the state of Maharashtra in India, which have had encouraging results in fighting malnutrition in all its forms.

Global nutrition targets for 2025

  • Reduce the number of children with stunted growth by 40%
  • Reduce and keep the prevalence of acute malnutrition in under-five children (low weight) under 5%
  • Avoid any increase of overweight in children
  • Reduce the prevalence of anemia in women of child-bearing age by 50%
  • Increase exclusive breastfeeding for babies less than 6 months old by 50%
  • Reduce low birth weights by 30%
  • Avoid any increase in the prevalence of overweight, obesity and diabetes in adults.

The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.

[i] Global Nutrition Report 2016 www.globalnutritionreport.org
Sep 19 2016

Farewell Dorothy Cann Hamilton. Rest in peace.

The International Culinary Center announced yesterday that its president and founder, Dorothy Cann Hamilton, died in a car accident.  I’ve heard that the accident was in Nova Scotia, but cannot find details.

Dorothy was a star in New York’s food world.   Her Wikipedia entry tells some of the story.

But I knew her best as someone who dreamed big and made the dreams come true.

I met her in the early days of the French Culinary Institute when we met to work out a partnership—her idea—with NYU’s newly launched food studies programs.

That worked.  So did much else.

She turned ICC into a go-to place for programs as well as culinary arts.  I was privileged to participate in those programs occasionally.

I was even more privileged to be part of her occasional Ladies Who Lunch group at L’Ecole.

I watched her handle ambassadors and dignitaries at Food Expo in Milan.  Back in New York, I saw her receive high honors from the French government.

I have no doubt the press will have much to say about all she accomplished.

To me she will always be the girl from Queens who longed for Manhattan, got there, and made many wonderful things happen.

I cannot believe she is gone.  I will miss her.

Obituaries, September 20

Sep 16 2016

Weekend reading: Conservation Heroes of the Heartland

Miriam Horn.  Rancher, Farmer Fisherman: Conservation Heroes of the American Heartland.  WW Norton, 2016.

Actually, this book should be titled “Rancher, Farmer, Riverman, Shrimper, Fisherman: Conservation of Life around the Mississippi River.” It consists of deep interviews with one person in each category who is working hard to protect some part of the environment.

My favorite is the shrimper, the truly remarkable woman who is devoting her life to saving the livelihoods of the people engaged in Louisiana’s highly endangered—by hurricanes, floods, oil spills, and regulators—shrimp-fishing industry.

Each of the people highlighted in this book is doing something for conservation, not always in the ways you and I might choose.  As Miriam Horn explains in her introduction,

Which is not to say they have found the perfect way to fish or farm; they would be the first to acknowledge that there is no such ideal.  Rather, their heroism lied in the depth of their commitment to consider the largest implications of what they do, across geographic and generational lines; to forever listen more intently, weight each choice for the impact it will have on their neighbors and all of life, challenge themselves to do better as they understand more and the world changes around them.