Adam Drewnowski and his colleagues at the University of Washington have been doing a series of papers on the cost of food per calorie.  The latest is a research brief answering the question, “Can low-income Americans afford a healthy diet?”  Not really, they say.  Federal food assistance assumes that low-income people spend 30% of their income on food but that assumption was based on figures from an era when housing, transportation, and health care costs were much less.  As Drewnowski has shown repeatedly, healthier foods cost more, and sometimes a lot more, when you look at them on a per-calorie basis.

Last week, I posted correspondence regarding the American Society of Nutrition’s (ASN) partnership with the industry-sponsored Smart Choices program.  This program places a check mark on food products that meet its nutrient standards.  I am concerned about ASN’s involvement in this project as it puts the society in conflict of interest.  Several other food rating systems are under development, among them the traffic-light system used in Great Britain.  How can the ASN objectively evaluate the relative merits of these systems if it is paid for administering – and, therefore, endorsing – Smart Choices?  I much prefer the traffic light system, have concerns about the entire approach, and think some of the standards overly generous, particularly the upper limits of 25% of calories from added sugars and 480 mg sodium per serving.  Several people who commented on my post asked to see the ASN’s response.  Here it is:

From: John E. Courtney, Ph.D., Executive Officer, American Society of Nutrition
Sent: Tuesday, May 12, 2009 10:24 AM
Subject: Sunday, May 10, 2009 10:36 AM email to Katrina Dunn

Importance: High

Dear Dr. Nestle,

Thank you for your comments on ASN and the Smart Choices program. We value feedback from our members and I’d like to take this opportunity to address some of your concerns and amend a few of the points you made. First, The Smart Choices Program is not an industry-initiated plan. The Smart Choices idea was facilitated by the Keystone Center, which works with a broad array of stakeholders to develop solutions to complex health and social problems. The Smart Choices front-of-pack symbol was developed through a series of plenary meetings over two years and intensive work groups with academics, food manufacturers, public health organizations, and with observers from federal agencies.  This unique process with a broad array of stakeholders along with the fact that the program is completely transparent sets it apart from other programs that have been developed. In the fall of 2008, Keystone Center issued a RFP for organizations interested in administering the program. The ASN Executive Board was briefed on the program, discussed and evaluated it, and approved moving forward. ASN partnered with NSF to administer the program and was selected. ASN’s role will primarily be one of oversight and facilitation of the program governance, and the Society will be responsible for maintaining the scientific integrity in the Smart Choices program. This program was discussed at the ASN Volunteer Member Leadership Summit in January and most recently at the ASN Scientific Sessions and Annual Meeting at Experimental Biology in New Orleans, LA in April, 2009.

Perhaps most exciting for the Society and consistent with its mission is that ASN will be coordinating a rigorous evaluation of the program as well as consumer research to determine the effectiveness of the program. Perhaps most importantly, ASN neither “owns” the program nor are we making any profit from the program. The funds generated from company participants will be reinvested into the program.  ASN is the pre-eminent society for nutrition researchers and practitioners and encourages scientific debate and transparency and is looking forward to evaluating the effectiveness of this program in helping consumers.

Thank you again for your comments and for your commitment to advancing nutrition research and practice.

I’ll bet that a study published by the American Association of Wine Economists will be a top candidate for this year’s IgNobel Prize (the prize given for “research that makes you laugh and then think”).  Investigators somehow convinced a bunch of volunteers to undergo a blind taste test of liver pâtés and dog food.  Participants knew that one of the samples was dog food, but not which one.  They gave the dog food the lowest marks on taste, but only 17% identified it as dog food.  Everyone else thought it was just bad pâté.  This must say something about the average American palate, alas.  To address that question, Stephen Colbert  did his own taste trial on camera.  Too salty, he says.  Indeed.

Or so says ConAgra, apparently.  The New York Times reports that ConAgra, unable to locate the source of Salmonella in its frozen dinners (oops), deals with the problem by telling you to heat the dinner to 165 degrees and use a thermometer to make sure you do.  The Times tried this.  Not so easy.  Oops again.

Mind you, it makes sense for everyone to follow standard food safety procedures at home.  These, you may recall, involve doing four things in your kitchen: CLEAN – wash hands and preparation surfaces frequently and thoroughly, SEPARATE cooked from uncooked foods so they don’t get cross-contaminated, COOK food to appropriate temperature to kill harmful microbes, and promptly CHILL foods in the refrigerator to retard bacterial growth.

Shouldn’t we expect ConAgra and everyone else to produce safe food in the first place?  And don’t we need some regulation to make sure companies do?  I think so.  Now.

The appointment of Tom Friedan to head the CDC should help.  Let’s hope Margaret Hamburg’s appointment to head the FDA moves quickly through the glacial congressional approval process.

If the FDA is now going after health claims (see yesterday’s post), will it also start going after dietary supplements?  These, as I explained in my most recent column in the San Francisco Chronicle, get to make all kinds of unsubstantiated claims without the FDA being able to do much about them.  More and more evidence is coming in suggesting that supplements can be harmful as well as ineffective.   The latest example: antioxidant supplements are said to interfere with the beneficial effects of physical activity.    Will such studies encourage the FDA to insist that manufacturers demonstrate safety and efficacy before they put supplements on the market?  That would be a refreshing change, no?

It looks like the FDA is finally getting around to looking at the absurd health claims on boxes of breakfast cereals.  And about time too, I’d say.  For starters, the FDA picked on General Mills’ Cheerios.  Cheerios boxes display banners claiming that if you eat this cereal, you will reduce your cholesterol by 4% is 6 weeks (see previous post on this).  This, General Mills says, is “clinically proven.”  Yes, but the trial on which General Mills bases this claim substitutes one serving of Cheerios for each of two meals a day.  Hey – that ought to work!

In its warning letter, the FDA says that if Cheerios lowers cholesterol, it is claiming to work like a statin drug.  If Cheerios acts like a drug, it has to be treated like a drug.  Cheerios, says the FDA, “is not generally recognized as safe and effective for use in preventing or treating hypercholesterolemia or coronary heart disease. Therefore…it may not be legally marketed with the above claims in the United States without an approved new drug application.”

So what’s going on here?  I collect cereal boxes and I’m guessing that I bought the one shown here at least two years ago.  The boxes have changed since then but similar claims appear on the Cheerios website.  Maybe in this new administration the FDA can get a grip on silly and misleading health claims.  Let’s hope.

Update May 18: Advertising Age advises marketers about how to avoid FDA interference: know the rules, don’t assume that breaking them is OK even if you have done so for a long time, follow the rules.  Seems like good advice.

Update May 25: Europeans applaud this FDA action. They think we have gone much too far with health claims.

Update January 18, 2010: At a visit to the FDA last week, I saw a more recent Cheerios box that I somehow missed – lower your cholesterol by 10% in one month.  This one disappeared quickly, but I found a good description of what happened on the Consumer World Mouse Print site.  General Mills sponsored a study and rushed the box into print.

I’m still in awe of Melissa Clark’s “mature and restrained” recipe for Almond Birthday Cake with Sherry-Lemon Butter Cream. She says the recipe yields 8 servings.  But she surely must mean 24.

I used the USDA’s handy food composition data base to add up the calories: 1,060 per slice!

Yum.

Over the weekend, I received a letter from the American Society of Nutrition (ASN) nominating me to join the Board of Directors of the Smart Choices program.  Smart Choices, you may recall from my previous posts on this program as well as on other such systems, is a food industry-initiated plan to put a check mark – a stamp of approval – on processed food products that meet certain nutritional criteria.  Apparently, the ASN Board agreed to administer (and, implicitly, endorse) this program without discussing the matter with the membership.  I think involvement of independent nutrition researchers with Smart Choices represents a conflict of interest and the ASN should not be involved in this effort.  Here is what I told Katrina Dunn, the ASN Program Coordinator:

Dear Katrina—

Thank you for inviting me to join the Board of Directors of the Smart Choices program.  I regret that I cannot accept.  Participating in Smart Choices represents a serious conflict of interest for nutrition educators who wish to maintain independence from the influence of the food industry on nutrition advice.

But participation also represents a serious conflict of interest for the American Society of Nutrition (ASN).  I am dismayed that the ASN—an organization devoted to the highest standards of nutrition research–is involved in this project.  I think the ASN should reconsider this involvement and withdraw immediately.

The ostensible purpose of Smart Choices is to guide the public to select more healthful foods.  I am unaware of a research basis indicating that the program is likely to succeed in this goal.

Evidence does, however, support two additional goals of the program.  The first is to provide a basis for marketing highly processed food products.  I think we would all agree that highly processed foods are, in general, demonstrably nutritionally inferior to whole or minimally processed foods.

The second is to stave off federal regulations requiring a traffic-light food rating system such as that in use in the United Kingdom.   Preliminary research indicates that consumers prefer this system to numerical scores and understand the colors to mean that they should choose green-lighted foods and avoid red-lighted foods.

The cut points selected for the Smart Choices program may meet criteria of the Dietary Guidelines, but their health benefits are debatable (the sodium cut point is particularly generous).  Surely, a great deal more research is needed before ASN directly or indirectly endorses specific processed foods simply because they meet arbitrary nutrient cut points.

These concerns all address questions of intellectual conflict of interest.  But I am also concerned about financial conflicts of interest.  If ASN receives payment for its endorsement and administration of this program, the organization—and its members—risk losing intellectual independence.

I appreciate the invitation but I believe the entire program is ill advised and I urge ASN to extricate as quickly as possible.

Sincerely yours,

Marion Nestle
Paulette Goddard Professor of Nutrition, Food Studies, and Public Health
New York University