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.

The ever curious Kerry Trueman, Eating Liberally’s kat, wants to hear more about Bloomberg’s salt assault.  And well she might.  Today’s New York Times has a bunch of letters weighing in from all points of view.    Here’s how our conversation went:

(With a click of her mouse, EatingLiberally’s kat corners Dr. Marion Nestle, NYU professor of nutrition and author of Pet Food Politics, What to Eat and Food Politics🙂

Kat: New York City’s new initiative to persuade food manufacturers and restaurants to voluntarily reduce the salt in their foods by 25% over the next five years is eliciting the usual outrage from the “nanny state” naysayers, for whom excess salt consumption is yet another matter of personal responsibility.

But as you noted last Monday, “nearly 80% of salt in American diets is already in packaged and restaurant foods and if you eat them at all you have no choice about the amount of salt you are getting.” Many Americans consume more than double the daily recommended intake of sodium, contributing to thousands of deaths and billions in medical costs annually.

Mayor Bloomberg equates the food industry’s overuse of salt to such health hazards as asbestos. But Mark Kurlansky, author of Salt: A World History, insisted to WNYC’s Amy Eddings that this analogy is false because “we could reduce our salt intake on our own, if we wanted to.”

Technically, this is true, if you’re willing and able to eliminate packaged foods from your diet, stop eating out, and start cooking all your meals from scratch. Unfortunately, the percentage of folks who have the time, inclination, and resources to do this is roughly on a par with those who think that Wall Street’s robber barons earned those big bonuses.

The food industry maintains that it would gladly reduce the sodium in its products–and some are doing so surreptitiously–if only consumers conditioned to crave super salty foods would be more willing to accept reduced sodium products.

The “invisible hand” of the market can’t seem to let go of the salt shaker. Mayor Bloomberg’s proposal is a step in the right direction, but do you think it will achieve meaningful reductions, or will we ultimately end up having to regulate salt?

Dr. Nestle: I love nanny-state accusations. Whenever I hear them, I know either that food industry self-interest is involved or that the accuser really doesn’t understand that our food system already is government-regulated as can be. These kinds of actions are just tweaking of existing policy, in this case to promote better health.

At issue is the default. Right now, companies have free rein to add as much salt to their processed or prepared foods as they like. The makers of processed foods do focus-group testing to see how consumers like the taste of their products. They invariably find that below a certain level of salt–the “bliss” point—their study subjects say they don’t like it. Soups are a good example. A measly half-cup portion of the most popular Campbell’s soups contains 480 mg of sodium or more than a full gram of salt (4 grams to a teaspoon).

To someone like me who has been trying to reduce my salt intake for years, those soups taste like salt water. That’s because the taste of salt depends on how much you are eating. If you eat a lot, you need more to taste salty. If you are like me, practically all processed and restaurant foods taste unpleasantly salty.

So what to do? I say this is indeed a matter of personal choice and right now I don’t have one. If I want to eat out at all, I know I’m going to feel oversalted by the time I get home.

I want the default choice to be lower in salt. Nobody is stopping anyone from salting food. You don’t think your food tastes salty enough? Get out the salt shaker.

But let me make two other comments. One is that the amount of salt we eat is so far in excess of what we need that asking food makers and sellers to cut down can hardly make a dent in taste. A new Swedish study just out says that young men consume at least twice the salt they need and the authors are calling on government to require food makers to start cutting down.

And yes, the science is controversial and not everyone has blood pressure that goes through the roof when they eat something salty. But lots of people do. And almost everyone has blood pressure that goes up with age. As a population, we would be better off exposed to less salt in our diets.

Some food makers are already gradually cutting down on salt, but quietly so nobody notices. If every food company were required to do that, everyone would get used to a less salty taste and we all might be able to better appreciate the subtle tastes of food.

My guess is that Bloomberg has started a movement and we will be seeing much more effort to lower the salt intake of Americans. As I see it, this is about giving people a real choice about what they eat.

Correction, January 22:  Juli Mandel Sloves of Campbell Soup correctly points out that I am in error.  A serving of soup is 8 ounces, not 4, even though the label says that a serving is half a cup.  How come?  Because the can is to be diluted with another can of water, making it 21 ounces divided by 2.5 servings per can, or about 8 ounces.    Complicated, no?  But this means the sodium content is 480 mg per cup, not half cup, despite what the label says.   I apologize for the error.  But here is an excellent reason to redesign the Nutrition Facts label, alas.

The FDA now says it has concerns about BPA and intends to join other federal agencies in a review of the chemical’s safety.   As readers of this blog may recall from previous posts, the FDA has a long-awaited report on BPA sitting in a drawer someplace.  The report was due at the end of November.  Now we can guess the reason for the delay.  The report must have given BPA a pass even though studies seem to be coming in daily suggesting harm.  BPA may not be immediately deadly, but it does not seem good for human health.

The most recent study, this one  from England, looked at dietary intake data in the U.S.   It concluded that BPA is a risk factor for heart disease.  The industry, of course, disagrees.  They think the British study isn’t scientific enough.

Faced with increasing evidence of harm, the FDA is doing the right thing to take this one on.  The problem will be getting rid of BPA.  We can all do our part by avoiding hard plastic bottles, but what about the linings of canned foods?  The canning industry says it doesn’t have a safe substitute.  Until they find one, you will have to add canned foods to the list of foods to avoid.