As always, I am indebted to Bill Marler for staying on top of the latest food safety scandals.  This one is even more complicated than most.  According to the CDC, 187 people in 39 states have become ill from Salmonella Montevideo (for some reason, I’m unable to get into the CDC site today although the map of the distribution of cases is available and Marler has yesterday’s version posted in full on his site).

Here’s what I find especially interesting about this one:

• Cases have been reported at a relatively steady rate since the beginning of July – more than six months ago.

• Athough the food source is still questionable, a company in Rhode Island, Daniele International, recalled 1.24 million pounds of pepper-coated salami.

• In January (did they not do any of this earlier?), the CDC conducted a study to compare foods eaten by 39 sick and 39 healthy people.  Among those who were sick, 51% said they were more likely to have eaten Daniele salami than people who were not sick (15 percent).  In addition, 11 other people said they bought Daniele salami before they became ill.

• These kinds of studies are really hard to do.  As William Keene, senior Oregon epidemiologist explained (quoted on the Marler blog), people “were questioned left and right and they were asked about salami and very few of them said yes….Investigators re-interviewed people who were thought to be part of the outbreak, such as members of a hunting party from the South who had been to the Great Plains and responded to new questions with answers such as, “Now that you mention it, we did stop at a Wal-Mart in South Dakota and buy some salami.”

• Daniele issued the recall because a private testing lab identified Salmonella in one of its salami products.  But that Salmonella strain was not Montevideo.  Could multiple strains be involved?

• Daniele did the recall anyway and mentioned that pepper might be the source of the Salmonella.  Was it?  If so, this is by no means the first time that Salmonella has been associated with pepper, as Marler explains.

• The public relations firm that has attempted damage control on previous food outbreaks is doing this one too.

Is this salami or pepper, Daniele salami or not?  So far, we still are dealing with guilt by association, but public relations?  How about just producing safe food in the first place?

And in more food safety news, let’s all congratulate President Obama for finally appointing someone to lead food safety efforts in USDA – Dr. Elizabeth Hagen.  Dr. Hagen has been at USDA and knows how that organization works.  Let’s hope she starts making waves today!

Congress: now it’s your turn.  Pass that food safety bill!

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.

The current issue of the New England Journal of Medicine has an article from investigators at the University of California San Francisco School of Medicine (where I worked from 1976 to 1986) and Columbia using computer models to predict the effect of relatively small reductions in salt intake on health.  Their conclusion:

Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.

The article also is discussed in an accompanying editorial, and was the topic of a long discussion in the New York Times.

I never know what to make of computer models, but one thing is clear: many people consume two or three times the amount of salt recommended.  It’s hard to avoid doing so.  Australian investigators surveyed processed foods and found more than 60% of them to contain salt above recommended levels.  Ours are unlikely to be any different.

While we are on the subject of salt in processed foods:  Juli Mandel Sloves of Campbell Soup correctly points out that my observation that the company’s kids’ soups contain 480 mg sodium per 4 ounce serving is incorrect.  A serving of soup is 8 ounces, not 4.  I see how I made this mistake.  The label states that a serving is half a cup (4 ounces) and that one serving contains 480 mg sodium.   But you are supposed to dilute what’s in the can with another can of water.  That makes it 480 mg sodium per 8 ounces, the same amount of salt but diluted.  The confusing serving sizes are another good reason to rethink and redesign the Nutrition Facts label.

What is likely to be the effect of yesterday’s Supreme Court decision on food politics?  Nothing good.

The decision to overturn limits on corporate campaign contributions will affect every aspect of society, food included.  I have long argued that campaign contributions are one of two major sources of corruption in government (the other is the way Wall Street requires corporations to report growth every 90 days).

If we want our congressional representatives to make decisions in the public interest, their election campaigns must be publicly funded.  When corporations fund campaigns, representatives make decisions in the corporate interest.   It’s that simple.

Those of us who care about creating a good, clean, fair, and sustainable food system will have to work harder now.  But I can’t think of any more important work to do to protect our democratic institutions.

Addition: here’s my interview with Helena Bottemiller of Food Safety News on the topic.

I keep saying that you don’t need complicated theories to explain childhood obesity.  Just read the newspapers!  Yesterday’s New York Times carried two stories that fully account for kids’ caloric balance these days.

The first (front page) describes a Kaiser Family Foundation study that counted the number of hours kids spend online each day.  The bottom line: “practically every waking minute.”  Here’s the link to the actual study.

The second is a food section story documenting the astonishing rise in snacking among kids to the point where parents are harassed beyond belief  about having to supply snacks for every activity.  And you should see what goes on in schools.   The bottom line: also practically every waking minute.

No wonder kids are gaining weight.

The question, of course, is what to do about it.   Dealing with the snacks will be easier and that’s a great place to start, no?

Tomorrow: I will comment on the new study on salt, discussed in today’s paper.

Thanks to Sodium Girl (see comments under Feedback) for giving me a chance to talk about one of my favorite nutrition topics: how do we know what’s in food.  Her question:

I am on a very low sodium diet…I am beginning to have less and less faith in the nutritional labels – who is regulating them and what process/research do they use to define the amounts? And it is not just produced goods. I find it hard to know what information to trust when it comes to whole foods as well. I know that the USDA reports nutritional values which are the standard. Even with their documents though, a raw egg is 70 mg of sodium while a boiled egg is upwards of 120 mg of sodium – are they taking salted water into account?

This comment sent me straight to the USDA’s nutrient composition data base.  Despite the daunting home page, it’s a lot of fun to use once you get the hang of it.  Start with where it says Search the data base online.  Type in Egg (not Eggs) at Keyword.  Click on Dairy and Egg where it says Select Food Group, pick what you are looking for (I checked “egg, whole, raw;” on the next round, I checked “egg, whole, cooked, hard boiled”), click on Submit, and then decide how you want the data presented.  I chose one large egg.  Bingo.

USDA reports large eggs as 50 grams.  A 50-gram raw egg has 70 mg sodium and a cooked one has 62.  My interpretation: no significant difference.

Here’s the deal on food composition tables: you have to consider these numbers as ballpark figures, not as something engraved in stone.

• Foods grown and raised in different places under different circumstances have different nutrient compositions, so the food you are eating is unlikely to be identical to the ones tested by USDA.

• Nutrient amounts depend on weight; if your egg is a little bit bigger or smaller, the nutrient numbers change accordingly.

So you need to interpret food composition numbers leaving a lot of wiggle room.  That’s why I think reporting calories the nearest calorie is silly.  A 50-gram hard-cooked egg is 78 calories?  Plus or minus 10 maybe.

The USDA figures are the most authoritative available.  The office in charge of the nutrient composition data base is an unsung treasure of American government.  The scientists who work there are first rate, but they struggle daily with two problems: (1) not enough money to do their own testing, and (2) food companies know quite well what is in their products but they won’t give the USDA any information about nutrient composition beyond what is on the food label; they consider that information “proprietary” and don’t have to.

When it comes to sodium, which we eat in gram amounts per day, the difference between 70 and 62 mg is trivial.  I use the USDA figures as ballpark estimates and don’t pay any attention to small differences.

Sodium Girl: unprocessed foods like eggs are all relatively low in sodium so you don’t have to worry about it if that’s what you routinely eat.   Things start getting salty when you eat foods like cheese, pickles, and soy sauce, or anything commercially processed or prepared for you by others.  That’s why I’m for getting food companies and restaurants to cut down on salt so it will be easier for you to follow your doctor’s orders.

Thanks to my NYU Medical Center colleague, Dr. Melissa Bender for the alert about the blogosphere fuss over Cascadian Farm Purely O’s cereals.  Apparently, Cascadian Farm, now owned by Big Food General Mills:

quietly changed the recipe for its “Purely O’s” cereal — previously an unsweetened favorite among children/toddlers – to include three times the sugar, as well as new fillers/sweeteners such as corn meal and tapioca syrup. They did this with no announcement on the label, taking advantage of those who trusted the brand for its previous simplicity. Loyal customers, particularly parents who had chosen this product because it was one of the few unsweetened options available, are outraged by this secretive yet major reformulation. Many discovered the change when their children spat out the cereal (myself included).

Her note sent me right to the largest of the three Whole Foods stores within walking distance of my Manhattan apartment.  Purely O’s: 3 grams of sugars, 3 grams of fiber, and 160 mg sodium per serving.

Oops: low-sugar, yes, but only medium-fiber and high in sodium.  Even with 0 grams of sugar, it’s not all that great.  Neither, for that matter, is its non-organic analog Cheerios (1 gram sugar, 3 grams fiber, 190 mg sodium).

At 3 grams of sugar per serving, Purely O’s is still lower in sugar than practically every other cereal in Whole Foods.  Whole Foods does not sell Big Food non-organics, so it does not carry Cheerios.  I had to look hard to find the only cereal lower in sugar than the reformulated Purely O’s: Arrowhead Mills Shredded Wheat, Bite Size (2 grams of sugar, 6 grams of fiber, and only 5 mg sodium).  That one, it seems to me, is a much better choice to begin with, pretty much in the same category as oatmeal (1 gram of sugar, 4 of fiber, and 0 mg sodium).  When it comes to cereal, more fiber the better.  Fiber is the point of breakfast cereal.

So I can’t get too upset about the reformulation of Purely O’s.  It’s simply a business decision, entirely to be expected from Big Food.  Cascadian Farms started out with “humble beginnings” as a maker of organic products, none of them cereals.  It was successful enough to be bought first by Small Planet Foods, and later by General Mills, which wanted to get in on the organic market.  Hence: organic Purely O’s.

General Mills is in business to sell cereal, and Purely O’s just didn’t make it past focus groups, as reported in the Boston Globe earlier this year.  General Mills must think there are too few of its deeply loyal customers to matter.  According to a business school case study, it has a history along these lines.  So chalk this one up to corporate imperatives.

Dr. Bender wrote to General Mills and received a reply that said as much:

Our goal is to give consumers quality products at a good value. Prior to introducing any product, extensive consumer testing is done. We conduct market research and product testing continuously to obtain consumer reaction to existing products and to changes being considered. Only when we feel confident that a product change will broaden its appeal will we alter a product’s formulation. We are sorry that you do not agree that the recent change in Cascadian Farm organic Purely O’s cereal was for the better.

If the bloggers are looking for a replacement, try oatmeal or those cute little bite-sized shredded wheat things.

The FDA’s recently stated concerns about the health effects of bisphenol A did not go unnoticed.

The European Food Safety Authority is keeping a close eye on the FDA action because the two agencies have an agreement to cooperate.   But the U.K.’s Food Standards Agency continues to maintain that BPA is safe at current levels of exposure:

a 3-month-old bottle-fed baby weighing around 6 kg would need to consume more than four times the usual number of bottles of baby formula a day before it would reach the tolerable daily intake set by EFSA in 2006.

It is amusing to read the predictable responses of stakeholders who have a vested interest in demonstrating that BPA is safe – the chemical, plastics, and grocery manufacturers, for example.   In contrast, the Environmental Working Group said that the reversal of the FDA’s position is likely to be:

the Waterloo [that ends] nearly a decade of agency collusion with BPA manufacturers… It represents a victory for parents and children, and validation of the hundreds of independent studies linking BPA to numerous and serious health problems.

How harmful is BPA?  I have no idea.  I wish the FDA would release its review of the research.  But even without it there is now enough evidence questioning the safety of BPA to invoke the “precautionary principle:” don’t use it until it is proven safe.

Are BPA plastics essential in our food supply?  Clearly not.