Search results: a life in food

As Food Navigator-USA puts it, “No, wheat does not make people fat and sick.”

Bread lover that I am, I consider recent research to be giving us good news.

Food Navigator is referring to a review of research on whole wheat and health just published in the Journal of Cereal Science of all places.  The authors conclude that unless you have celiac disease or wheat allergies, eating whole-wheat foods is good for you.

In fact, foods containing whole-wheat, which have been prepared in customary ways (such as baked or extruded), and eaten in recommended amounts, have been associated with significant reductions in risks for type 2 diabetes, heart disease, and a more favourable long term weight management. Nevertheless, individuals that have a genetic predisposition for developing celiac disease, or who are sensitive or allergic to wheat proteins, will benefit from avoiding wheat and other cereals that contain proteins related to gluten, including primitive wheat species (einkorn, emmer, spelt) and varieties, rye and barley…Based on the available evidence, we conclude that whole-wheat consumption cannot be linked to increased prevalence of obesity in the general population.

The authors find little evidence in support of popular myths:

• Proliferation of wheat products parallels obesity and is causally related.  No, it does not.
• Wheat starch differs from starches in other foods in especially undesirable ways.  No, it does not.
• Whole wheat bread has a higher glycemic index than sugar.  No, it does not.
• Wheat contains opioids that make people addictive. No, they do not.

In the meantime, the FDA has been working on updating its 2006 guidance to industry about how to label statements about whole grains. The agency has been conducting research on how consumers judge:

• Food products, including nutritional attributes, overall healthiness, and health benefits.
• Labeling statements in terms of their credibility, helpfulness, and other attributes.
• Terms and statements such as “Made with Whole Grain”, “Multi-Grain”, and “100% Whole Wheat.”
• Whole grain statements beyond the scope of the statements themselves (i.e., halo effects).
• How whole grain statements influence consumer use of the Nutrition Facts.

Can’t wait to see the results.  They ought to be out soon.

I was in Washington DC last week when the FDA announced  that it was taking significant steps to address antibiotic resistance, a problem caused by overuse in raising animals for food.

The FDA called on makers of animal antibiotics to:

• Voluntarily stop labeling medical important antibiotics as usable for promoting animal growth or feed efficiency (in essence, banning antibiotics from these uses).
• Voluntarily notify the FDA of their intent to sign on to these strategies within the next three months.
• Voluntarily put the new guidance into effect within 3 years.
• Agree to a proposed rule to require a veterinarian’s prescription to use antibiotics that are presently sold over the counter (the proposal is open for public comment for 90 days at www.regulations.gov.   Docket FDA-2010-N-0155).

Voluntary is, of course, a red flag and the Washington Post quoted critics saying that the new guidance falls far short of what really is needed—a flat-out ban on use of antibiotics as growth promoters.

• Consumers Union is concerned about the long delay caused by the 3-year window.
• CSPI is worried about all the loopholes.
• NRDC thinks the FDA is pretending to do more than it’s really doing and “kicks the can significantly down the road.”
• Mother Jones points out that the meat industry can still “claim it’s using antibiotics ‘preventively,’ continuing to reap the benefits of growth promotion and continue to generate resistant bacteria.”
• Civil Eats reminds us that the Pew Commission on Industrial Farm Animal Production (on which I served) recommended a ban on nontherapeutic use of all antibiotics.

Yes, the loopholes are real, but I view the FDA’s guidance as a major big deal.  The agency is explicitly taking on the antibiotic problem.  It is sending a clear signal to industrial farm animal  producers that sooner or later they will have to:

• Stop using antibiotics as growth promoters.
• Stop using antibiotics indiscriminately, even for disease treatment.

I think the FDA is dead serious about the antibiotic problem.  If the FDA seems to be doing this in some convoluted fashion, I’m guessing it’s because it has to.  The FDA must not have been able to find any other politically viable way to get at the antibiotics problem.

I see this as a first step on the road to banning antibiotics for any use in animals other than the occasional treatment of specific illnesses.

As the New York Times puts it,

This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.

Still not convinced antibiotics are worth banning for promoting growth?

The best explanation is the Washington Post’s handy guide to the antibiotic-perplexed.  Here, for example, is its timeline of development of microbial resistance to antibiotics.  The bottom line: the more widespread the use of antibiotics, the greater the onset and prevalence of resistance.  And it takes practically no time for bacteria to develop resistance to antibiotic drugs.

Resources from FDA

• Consumer Update: Phasing Out Animal Antibiotics
• FAQ on today’s action
• Final Non-Binding Guidance for Industry 213
• Veterinary Feed Directive
• Final Non-Binding Guidance for Industry 209

As we head into the holiday season, I’m going to catch up on books that might make welcome gifts for the people in your life who think that food is about more than just eating.  Here’s one for food-worried parents:

Dina Rose.  It’s Not About the Broccoli: Three Habits to Teach Your Kids for a Lifetime of Healthy Eating.  Perigree, 2014

I blurbed this one:

I am constantly hearing from parents that they have no idea what their kids are supposed to eat or whether their kids are eating ‘right.’ [It’s Not About the Broccoli] provides just what parents need to feed kids properly, stop worrying, and start enjoying mealtimes with kids. Dina Rose looks at feeding kids from a sociologist’s perspective. When the feeding behavior goes well, kids will get all the nutrients they need. This book ought to reassure parents that following a few simple principles will get their kids fed just fine.

Last week, a Feedback comment from a reader, Judith Rice-Jones, inspired me to try to understand what’s going on with the new heart disease prevention guidelines (I can’t say I’m succeeding very well).

Looking forward to your response to the recent recommendations for more people to take statins. Don’t see anything in the new recommendations about changing lifestyle or diet to reduce risks of stroke or heart attack.

Yes, there are lifestyle recommendations.   But lifestyle changes do not make money for drug companies, and they don’t get press attention.

The American College of Cardiology (ACC) and American Heart Association (AHA) issued four sets of guidelines:

1. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
2. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
3. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
4. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

These organizations say:

AHA and ACC are pleased to announce a series of new cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults. These guidelines are based on rigorous, comprehensive, systematic evidence reviews originally sponsored by the NHLBI. The ACC and AHA collaborated with professional organizations to finalize these AHA/ACC cardiovascular prevention guidelines, and stakeholder organizations were invited to review and endorse the final documents.

So these guidelines are a major big deal.  The New York Times said you need to know three things about them:

• You don’t need to know your cholesterol number (unless it is very high).
• You do need to know your risk (for this you need to use the risk calculator and, therefore, to know your LDL and HDL levels and blood pressure).
• If you are at risk, take a statin (most, at least, are generics).

But wait!

As the New York Times also suggested, the new guidelines have taken many by surprise.

This is an understatement.

Problem #1: Authoritative clinicians say more patients should not be taking statins

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.

This opinion piece points out that members of the group writing the recommendations have financial ties to drug makers, as do both the AHA and ACC.

The guidelines might make sense, they say, if statins

actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case…as shown in a recent BMJ article co-written by one of us.

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease…80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

Problem #2: The risk calculator greatly overestimates risk

The lead article in today’s Times summarizes studies to be published in The Lancet tomorrow concluding that the risk calculator makes the risks seem greater than they really are.

It will lead many doctors to prescribe statin drugs to people who do not need to take them (from the standpoint of drug companies, that’s the point).

The calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

What to do?

• Best to discuss this one with your doctor.
• For sure, eat your veggies and be active.
• If you still smoke cigarettes, stop.
• Stay tuned for further developments.

Just for fun

Let’s let Brian McFadden (Sunday’s New York Times Week in Review) have the last word for today.

My monthly first Sunday Food Matters column in the San Francisco Chronicle:

Q: I hear that the Mexican government wants to increase taxes on sodas as a way to fight diabetes. The soda industry persuaded voters to defeat soda taxes in Richmond and El Monte last year. Won’t it do the same in Mexico?

A: It might. I’m just back from a lecture trip to Mexico City where I heard plenty about the proposed soda tax and the industry’s response to it.

Last month, the Mexican government proposed an additional soda tax of one peso (about 8 cents) per liter. The idea is to raise $1.5 million per year while discouraging soda consumption, thereby helping to reduce the country’s high prevalence of obesity and Type 2 diabetes.

Mexicans drink lots of soda. By some estimates, average per capita consumption is 50 gallons a year, the highest in the world. It’s no coincidence that more than 70 percent of Mexicans are overweight or obese, and around 15 percent have Type 2 diabetes, a prevalence that terrifies health officials. This type of diabetes, if undiagnosed and untreated, can lead to blindness or foot amputations.

‘Nutrition transition’

Mexico is a classic example of a country in “nutrition transition.” As the economy improves, people increasingly buy high-calorie ready-made foods, put on weight, and raise their risk for diabetes. Meanwhile, the poorer segments of the population continue to experience high levels of stunting, iron-deficiency anemia and vitamin A deficiency.

This makes obesity a relatively new problem in Mexico, one widely understood to result from the introduction of processed foods – especially sodas – into the Mexican food market.

I could easily see how deeply sodas are embedded in Mexico’s food culture. Sodas were advertised and available everywhere. And they come in enormous three-liter bottles that cost less than the price of bottled water – only 17 pesos ($1.35) each. Clean water is not always available, making sodas the easy choice.

Sodas are cheap because Mexico grows its own sugarcane and sells it at market prices. We, however, artificially support the higher price of U.S. sugar through tariffs and quotas. That’s why our sodas are made with high fructose corn syrup. We subsidize corn production so corn syprup costs less than sugar.

Some people think cane sugar tastes better than high fructose corn syrup, although controlled taste tests don’t always back this up. It’s ironic that U.S. supermarkets now carry, at highly inflated prices, Mexican Coca-Cola sweetened with cane sugar.

Industry efforts to defeat the Mexican soda tax have been ferocious, just as they were in Richmond and El Monte last year. Producers argue that if the tax really does decrease consumption, it will cause hundreds of thousands of jobs to be lost.

I saw a newspaper advertisement from the Mexican Beverage Association that not only attacked the science relating soft drinks to obesity, but extolled the health benefits of sodas: “Sugar is nutritious; it’s a carbohydrate. Carbohydrates are essential for life. Sugar is indispensable for the brain. Soft drinks hydrate and bring energy.”

An ad from the sugarcane industry also threatened job losses – “The tax will generate unemployment and discourage productivity and investment” – and noted that workers and the poor will bear most of its burden.

The big questions

As with any such initiative, the big questions are whether the tax is likely to reduce soda consumption, obesity and diabetes, and whether the revenue will be used for widely beneficial public health purposes. Mexico’s Congress will have to address these questions when it votes on the tax in the weeks ahead.

In the meantime, a coalition of consumer and health groups, in part funded by Bloomberg Philanthropies, has been putting posters in subway stations that illustrate the amounts of sugar in soft drinks. The groups are actively advocating for the soda tax and for using its funds to provide free potable water in schools – something that does not now exist. But TV stations have refused to carry their ads for fear of losing soda advertisers.

Like their U.S. colleagues, Mexican public health authorities are searching for effective ways to reverse obesity trends. Sugary drinks are an easy target. Taxing them might happen despite industry opposition – especially if the funds are earmarked for clean water.

Editor’s notes: Marion Nestle will discuss her new book, “Eat, Drink, Vote: An Illustrated Guide to Food Politics,” with Narsai David at the Commonwealth Club on Oct. 15 at 6 p.m., and at Book Passage in Corte Madera on Oct. 19 at 11 a.m.

She is also receiving the James Beard Foundation Leadership Award for her writing about how science and public policy influence what we eat. The award ceremonies are Oct. 21 at the Hearst Tower in New York.

Marion Nestle is the author of “Eat, Drink, Vote,” “Why Calories Count: From Science to Politics,” “Food Politics” and “What to Eat,” among other books. She is a professor in the nutrition, food studies and public health department at New York University, and blogs at www.foodpolitics.com. E-mail: food@sfchronicle.com

Michele Obama’s Let’s Move! campaign to end childhood obesity within a generation has taken on a new angle: Drink Up.  It issued a press release yesterday urging Americans to drink more water.

The “Drink Up: You Are What You Drink” website explains:

Let me be absolutely clear: I am totally in favor of encouraging kids to drink water.

But:

• Water deficiency is not a public health problem in the United States.  Childhood obesity is the problem.
• Drinking water will only help to counter childhood obesity if it substitutes for sugary sodas.

• Bottled water companies such as Dasani (owned by Coca-Cola) and Aquafina (PepsiCo), and their trade group The American Beverage Association (ABA), are the main supporters of this initiative.
• This makes the message sounds like “drink bottled water,” without much attention to environmental implications.

The ABA’s congratulatory press release says:

Staying hydrated is important to staying in balance, and bottled water provides people with a convenient and popular choice. By supporting this new initiative, our industry is once again leading with meaningful ways to achieve a balanced lifestyle.”

Hydrated?  Not an issue for most people (exceptions—elite athletes, people at high altitude, the elderly).

Bottled water?  In places with decent municipal water supplies, tap water is a much better choice; it’s inexpensive, non-polluting, and generates political support for preserving the quality of municipal water supplies.  See, for example, what Food and Water Watch has to say about bottled water.

James Hamblin’s critical account  in The Atlantic indicates that the press conference must have been tough going.  Sam Kass, White House chef and executive director of Let’s Move! took the questions.

Another reporter: Are we talking about replacing sugary drinks and sodas with water?”

Lawrence Soler, president and CEO of Partnership for a Healthier America, fielded that one. “It’s less a public health campaign than a campaign to encourage drinking more water. To that end, we’re being completely positive. Only encouraging people to drink water; not being negative about other drinks. “

I consider Let’s Move! to be a public health campaign, and a very important one.

Hamblin concludes:

I know we’re just trying to “keep things positive,” but missing the opportunity to use this campaign’s massive platform to clearly talk down soda or do something otherwise more productive is lamentable. Public health campaigns of this magnitude don’t come around every day…Keeping things positive and making an important point are not mutually exclusive, you fools.

My interpretation

Let’s Move! staff have stated repeatedly that they must and will work with the food industry to make progress on childhood obesity.  I’m guessing this is the best they can do. Messages to “drink less soda” (or even “drink tap water”) will not go over well with Coke, Pepsi, and the ABA; sales of sugary sodas are already declining in this country.

I’m thinking that the White House must have cut a deal with the soda industry along the lines of “we won’t say one word about soda if you will help us promote water, which you bottle under lots of brands.”   A win-win.

Isn’t drinking water better than drinking soda?  Of course it is.

But this campaign could have clarified the issues a bit better.  Jeff Cronin, communications director of the Center for Science in the Public Interest circulated a poster created by Rudy Ruiz (of the communications firm Interlex) for a public health campaign in San Antonio:

Public health partnerships with food and beverage companies—especially soda companies—are fraught with peril.   Let’s hope this one conveys the unstated message like the one in San Antonio: My balance is less soda and more tap water.

Other resources

As always, Eddie Gehman Kohan writing at ObamaFoodorama provides a clear, detailed summary of the relevant details along with transcripts of Michele Obama’s remarks at the launch in Watertown, Wisconsin (site of a Pepsi bottling plant, among other things).

Amanda Chin has a good piece in the Huffington Post (I’m quoted).

As an undergraduate at Berkeley, I majored in Bacteriology.  I haven’t worked in that field for decades, but the training makes me appreciate the terrific job the Centers for Disease Control and Prevention (CDC) does in providing education about food safety microbiology.

The CDC website is always a good place to start (another is food safety lawyer Bill Marler’s blog).

I thought of this as I was trying to find out what’s going on with the latest big outbreak of foodborne illness, this time due to Cyclospora.

The CDC’s Cyclospora website, updated frequently, keeps track of the numbers of cases—in this case, 641 as of September 3, with 41 hospitalizations—from 24 states.

Investigators traced cases in Iowa and Nebraska to a salad mix produced by Taylor Farms de Mexico.  But this mix is not linked to cases in Texas, which complicates the investigations.

As for the biology of Cyclospora: it’s a parasitic protozoa transmitted through feces.  The CDC provides this handy diagram of its life cycle:

What are you supposed to do to prevent getting sick from Cyclospora?  The CDC says unhelpfully: “Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.”

Everyone, it says, should follow safe produce handling recommendations.

Translation: Wash your veggies!