Food Politics

by Marion Nestle
Mar 28 2023

The Lancet series on commercial determinants of health (and, therefore, nutrition)

Executive Summary

Commercial actors can contribute positively to health and society, and many do, providing essential products and services. However, a substantial group of commercial actors are escalating avoidable levels of ill health, planetary damage, and inequity—the commercial determinants of health. While policy solutions are available, they are not currently being implemented, and the costs of harm caused by some products and practices are coming at a great cost to individuals and society.

A new Lancet Series on the commercial determinants of health provides recommendations and frameworks to foster a better understanding of the diversity of the commercial world, potential pathways to health harms or benefits, and the need for regulatory action and investment in enterprises that advance health, wellbeing, equity, and society.

  • Defining and conceptualising the commercial determinants of health: Anna B Gilmore, Alice Fabbri, Fran Baum, Adam Bertscher, Krista Bondy, Ha-Joon Chang, Sandro Demaio, Agnes Erzse, Nicholas Freudenberg, Sharon Friel, Karen J Hofman, Paula Johns, Safura Abdool Karim, Jennifer Lacy-Nichols, Camila Maranha Paes de Carvalho, Robert Marten, Martin McKee, Mark Petticrew, Lindsay Robertson, Viroj Tangcharoensathien, Anne Marie Thow

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors—notably the largest transnational corporations—are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so….

Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods….Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them…Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health—the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

Comment
Perspectives
Viewpoint

Infographics

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Mar 27 2023

Industry-funded study of the week: Strawberries

It feels like spring (at last!) in New York so I’m thinking about strawberries.

Last September, Lisa Young sent me a copy of an email she had received from a public relations agency.

Good Morning –

Today is World Alzheimer’s Day and a new study has found that eating Strawberries may reduce the risk of Alzheimer’s Disease and related dementias.

In fact, the compounds that give strawberries their beautiful red color may have several health benefits, such as lowering the risk of heart disease and some cancers and improving blood sugar control. And now researchers have found that one of those compounds, known as pelargonidin, may slow or prevent the development of Alzheimer’s Disease by lowering the number of twisted fibers inside the brain that contain a protein called tau. These twisted fibers are a hallmark of Alzheimer’s Disease.

The new study, which was supported by the National Institute of Aging and the California Strawberry Commission, was conducted postmortem on the brains of participants of the Rush Memory and Aging Project (MAP). Participants with the highest level of pelargonidin intake prior to their death also had less buildup in the brain of protein fragments called amyloid beta plaques – another hallmark of Alzheimers Disease. Pelargonidin is primarily found in berries. In this study, strawberries were the principal source of pelargonidin….

The study: Agarwal P, Holland TM, James BD, Cherian LJ, Aggarwal NT, Leurgans SE, Bennett DA, Schneider JA. Pelargonidin and Berry Intake Association with Alzheimer’s Disease Neuropathology: A Community-Based Study. J Alzheimers Dis. 2022;88(2):653-661. doi: 10.3233/JAD-215600. PMID: 35694918.

Results: “participants in the highest quartile of pelargonidin intake when compared to those in the lowest quartile, had less amyloid-β load (β (SE) = -0.293 (0.14), p = 0.038), and fewer phosphorylated tau tangles…”

Conclusion: “Higher intake of pelargonidin, a bioactive present in strawberries, is associated with less AD neuropathology, primarily phosphorylated tau tangles.”

Comment: I love strawberries and grow them in pots on my terrace.  But this study?  It looks at one chemical among many in strawberries and associates it with improved symptoms.  Association, alas, does not indicate causation.  If you give this a moment’s thought, could you believe that eating a few strawberries every day would help you prevent Alzheimer’s?  I’m all for plant-based diets.  And I’m all for eating strawberries.  But to imply that strawberries alone can control hunger, be good for your heart, especially if they come from California (as the Commission says on its website), seems a bit much.

Are strawberries demonstrably better for Alzheimer’s than any other berry or fruit?  The California Strawberry Commission is not interested in asking comparative questions.  It just wants you to buy more strawberries.

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Mar 24 2023

Weekend reading: pesticides on produce

The Environmental Working Group has just published its annual lists of Dirty Dozen and Clean Fifteen.

  • The Dirty Dozen—those with the highest levels of harmful pesticides:  Strawberries, spinach, kale/collards/mustard greens, peaches, pears, nectarines, apples, grapes, peppers, cherries, blueberries, green beans.
  • The Clean Fifteen—those with the lowest levels of harmful pesticides: Avocados, sweet corn, pineapple, onions,papaya, sweet peas (frozen), asparagus, honeydew melon, kiwi, cabbage, mushrooms, mangoes, sweet potatoes, watermelon, carrots

What always interests me about these lists is how nobody except the EWG wants to deal with pesticides on produce, and how much pushback the EWG gets from industry.

IFIC, the International Food Information Council (an industry front group), criticizes the EWG for promoting “organic produce as being safer and healthier than conventional produce.”  It says (my paraphrase except for direct quotes):

  1. You don’t need to avoid any kind of produce.
  2. Regulators ensure all foods are safe.
  3. Regulators inspect and monitor all foods.
  4. Residues are on all foods but “they are not to be feared.”
  5. “Giving elite status to organic produce is detrimental to people’s health.”
  6. Everybody agrees people need to eat more produce.
  7. “Shelf-stable foods, organic or conventional, present relatiable and healthy foods for all of us.”

My translation: Don’t bother with organics, ultra-processed foods are fine.

The Alliance for Food and Farming (a produce industry trade group) says:

Despite peer reviewed research showing it is scientifically unsupportable and negatively impacts consumers, the so-called “dirty dozen” list will be released soon  This list was developed to invoke misplaced safety fears about fruits and vegetables – the food group we are encouraged to eat more of every day to improve physical and mental health, prevent illness and increase lifespan.

This group says the “Dirty Dozen” recommendations are “unsupportable” and “negatively impact consumers and produce consumption.”

It says,

  • Just wash it! According to the FDA, washing produce under running tap water can reduce and often eliminate pesticide residues, if they are present at all.
  • A farmer’s first consumer is their own family so food safety is always their priority.

Comment: We use a lot of pesticides, more than 400 in the US alone, and more than 2.5 million metric tons annualy, worldwide.

We can debate the degree of harm caused to individuals, especially children, but there is no question they are bad for soil and the environment, and I’ve never heard anything suggesting they are good for us.

We would be better off eating fewer of them and producing food in ways that use less of them.

If EWG pushing farming in that direction, it needs it.

Choose organics as a means to encourage more sustainable production practices (vote with your fork).

Advocate for policies to reduce pesticide use (vote with your vote).

And thank EWG for holding industry’s feet to the fire.

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Mar 23 2023

Milk Marketing Orders: an attempt to understand the system

According to USDA,

Federal Milk Marketing Orders (FMMOs) establish certain provisions under which dairy processors purchase fresh milk from dairy farmers supplying a marketing area. ..A marketing area is generally defined as a geographic area where handlers compete for packaged fluid milk sales…Federal orders serve to maintain stable marketing relationships for all handlers and producers supplying marketing areas, thus facilitating the complex process of marketing fresh milk.

USDA has a brochure on how the program works.

FMMOs establish monthly uniform prices paid to farmers by first classifying milk by its end use. The FMMO then pools the value of that milk and shares that value among the farmers participating on that marketing order. Pooling allows farmers to receive the uniform price of all milk in the pool regardless of what end product their milk was used for. In this way, pooling makes a farmer’s payment independent of how the milk was used.

Got that?

Here are the current milk marketing regions:

I have to confess that Milk Marketing Orders are beyond me, but I am trying .  I understand the basics.  They are supposed to do three things: (1) establish minimum prices paid to dairy farmers, (2) ensure payments are accurate and timely, and (3) provide market information.

To try to understand how this works, I subscribe to AgriPulse News (“Providing balanced coverage of the food, fuel, feed, and fiber industries”).

From AgriPulse, I learned:

After more than two years of discussion and more than 130 meetings, the National Milk Producers Federation Board of Directors unanimously endorsed a comprehensive plan to correct shortcomings exacerbated during the pandemic regarding pricing regulations for milk.

Among the proposed changes, NMPF called for a return to the “higher of” Class 1 mover that was changed in the last farm bill.
NMPF also recommended that USDA update make allowances and review them every two years. Make allowances are based on estimates of what it costs to convert a hundredweight of raw milk into commodity dairy products such as cheese, butter, whey and nonfat dry milk.

NMPF plans to submit its proposal to USDA for a hearing and a potential producer referendum on the order’s modernization yet this year. The International Dairy Foods Association previously said it would request a hearing only on the make allowances request.

I looked at the comprehensive plan.  Here are NMPF’s requested changes to the Federal Milk Marketing Order System:

  • Returning to the “higher of” Class I mover;
  • Discontinuing the use of barrel cheese in the protein component price formula;
  • Extending the current 30-day reporting limit to 45 days on forward priced sales on nonfat dry milk and dry whey to capture more exports sales in the USDA product price reporting;
  • Updating milk component factors for protein, other solids and nonfat solids in the Class III and Class IV skim milk price formulas;
  • Developing a process to ensure make-allowances are reviewed more frequently through legislation directing USDA to conduct mandatory plant-cost studies every two years;
  • Updating dairy product manufacturing allowances contained in the USDA milk price formulas; and
  • Updating the Class I differential price system to reflect changes in the cost of delivering bulk milk to fluid processing plants.

For starters, what is a “Class I mover?”  For this, I need help.

The USDA classifies milk into four categories:

CLASS I – Milk used for beverages including eggnog and ultra-high temperature (UHT) milk.

CLASS II – Milk used for soft products. This includes cottage cheese, ricotta cheese, pot cheese, Creole cheese, milk shake and ice milk mixes, frozen desserts, aerated cream, frozen cream, sour cream, half-n-half, yogurt, custards, puddings, pancake mixes, batter, buttermilk biscuit mixes, infant or dietary formulas packaged in hermetically sealed containers, candy, soup and bakery products for general distribution to the public including sweetened condensed milk used for manufacture of aforesaid products, and fluid cream or any product containing artificial fat or fat substitutes that resemble fluid cream.

CLASS III – Milk used in the manufacture of cream cheese and other spreadable cheeses, and hard cheese of types that may be shredded, grated, or crumbled. It also includes plastic cream, anhydrous milkfat, and butteroil.

CLASS IV – Milk used to produce butter, any milk product in dry form and evaporated or sweetened condensed milk in a consumer-type package.

But a Class I mover?  I cannot find a definition, although I can easily find examples of how it’s used.

The Federal Milk Marketing Order (FMMO) advanced Class I base price hit another eight-year high in March, but the change in the Class I mover formula implemented in 2019 reduced what might have been an even higher price paid to producers.

Announced by the USDA’s Agricultural Marketing Service on Feb. 16, the March I base price is $22.88 per hundredweight (cwt), up $1.24 from February 2022 and $7.68 more than March 2021. It’s also the highest since November 2014.

At $3.12 per cwt, the difference between the advanced Class III skim milk pricing factor ($10.59 per cwt) and the advanced Class IV skim milk pricing factor ($13.71 per cwt) grew substantially. That means producers will see a negative impact using the “average-of plus 74 cents” Class I mover compared to the old “higher-of” formula.

Based on Progressive Dairy calculations, the Class I mover calculated under the higher-of formula would have resulted in a Class I base price of $23.67 per cwt, 79 cents more than the price determined using the average-of plus 74 cents formula. That difference is up from 51 cents per cwt in February.

I give up.  If anyone can explain this to me, please do.

This is what you are up against if you want to understand why milk prices are rising at grocery stores.

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Mar 22 2023

Lunchables (OK, reformulated versions) are heading for a school near you

My email inbox last week was full of notes from people  who did not want me to miss the latest school food news: Lunchables—the prototypical ultra-processed meals, some made for kids—can now be sold and fed in schools (thanks Will Rosenzweig).

Starting this year, school administrators will be able to buy two different Lunchables offerings for the 2023-2024 school year: Turkey and Cheddar Cracker Stacker and Extra Cheesy Pizza, Kraft Heinz spokesperson Jenna Thornton told NBC News…the two Lunchables now meet National School Lunch Program guidelines and “have a specialized recipe that incorporates more protein and whole grains,” “reduced saturated fat and sodium, and an increased serving size.”

Supposedly, the meals have been modified—heIngredient list regular Lunchables cheese pizzare’s what Lunchables Turkey & Cheddar looks like—to meet USDA standards for school meals.

According to the accountof this  in The Guardian,

Kraft Heinz executive vice-president Carlos Abrams-Rivera said the company has produced two new varieties of specially formulated Lunchables containing “improved nutrition” so that they can become part of the National School Lunch program, which provides lunch daily to nearly 30 million students across the US.

I wanted to see an ingredient list.  Do they meet the NEW nutrition standards recently proposed by the USDA?

  • I searched for Nutrition Facts and ingredient lists for these products but could not find them online.
  • I called the consumer hotline at Kraft/Heinz.  After about 20 minutes of searching, the representative told me she did not have that information and I would have to get it from a school food salesperson.
  • Calls to the USDA’s Food and Nutrition Service also did not turn up the basic nutition information (thanks Jerry Mande).
  • Neither did calls to New York City’s school food people (thanks Pam Koch).

But then a reader sent me the Kraft/Heinz “sell sheet” (thanks Alexina Cather):

She then followed up by sending me these documents (thanks Alexina)

That reader also sent Nutrition Facts panels for the school lunch cheese pizza (330 calories) and the school lunch turkey & cheddar (270 calories).

Product reformulation for the school lunch cheese pizza

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gulp.  Nutritionism in action: if it meets standards for salt and sugar, it’s OK?  I don’t think so.

It’s still ultra-processed.  How about serving kids real food?

School-based Lunchables raise the question: is a slightly better-for-you product necessarily a good choice?

Not in this case.

The entire idea of reformulated branded products is just plain wrong.

Why?  Because these products are advertisements for the brand’s regular offerings.  Nobody explains this better than Michael Moss in this short video.

 

 

Thanks again to Will Rosenzweig, Jerry Mande, Alexina Cather, Pam Koch, and Michael Moss for all the help with this.

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Mar 21 2023

The FDA responds

My post last week on the FDA’s lack of action on ensuring the safety of infant formula elicited this response from Taryn WebbHealth Communications Specialist at CFSAN/FDA:

Hi Marion,

In your article below, “Alarming (in)action from the FDA,” you assert that “If FSMA did not require companies to notify the FDA when they found contamination, the FDA should be going to Congress to get that authority to announce its rulemaking to get that authority.” These statements could mislead readers to believe that the agency has not taken action to obtain this authority from Congress. In fact, the FDA is specifically seeking new authority to compel reporting of product positive test results for relevant pathogens (see FY 24 FDA Legislative Proposal titled, “Product Testing Requirements for Foods Marketed for Consumption by Infants and Young Children,” available at: https://www.fda.gov/about-fda/reports/budgets). Furthermore, the statement “FDA should…announce its rulemaking to get that authority,” is factually incorrect as without statutory authority, we are not in the position to undertake rulemaking to require such reporting. To reiterate what appears to be a point of confusion, the FDA cannot create authorities that we do not have through rulemaking. We did notice that you later updated your article at the very bottom to note that FDA did request such authority. However, your initial article and email distribution to readers contained incorrect information.

We are seeing a troubling pattern of articles with erroneous information that then get amplified. In the future, we would appreciate it if you contacted us before publishing articles that are solely about FDA so that we can provide you with the most up-to-date, correct information. You can reach out to our communications staff, which include myself and Jen Dooren (copied here) or by emailing CFSANTradepress@fda.hhs.gov.

As I see it, the “troubling pattern” here is FDA’s responses to advocates like me who want to support this agency’s role in making sure food companies in general—and infant formula companies in particular—do not produce unsafe food.  I want to encourage the FDA  to put public health as its first and immediate priority, as it is supposed to as an agency of the US Public Health Service.

I did not know about the FDA’s request to Congress.  The agency did not publicly announce it was asking for that authority.  I only learned about it from Helena Bottemiller Evich’s Food Fix newsletter, to which I subscribe.  I corrected my post as soon as I could.

Evich has her own issues with the FDA.  In her Food Fix letter last Friday, she said:

I updated last week’s post on FDA asking (not telling) infant formula makers to disclose contamination to clarify that the agency has determined it doesn’t have the authority to require this disclosure.  It’s perfectly normal for an agency to seek a clarification on something, as FDA did here, and I was happy to update the post – no problem. What I did take issue with, however, is FDA Commissioner Robert Califf characterizing the coverage as “misinformation” on Twitter.

…As I reported in Tuesday’s newsletter, FDA asked Congress last week for this test reporting authority in a budget document. This is notable, but it raises another critical question: Why didn’t the agency formally make this request earlier? It wasn’t in the agency’s budget request last year. It’s been more than a year since the massive Abbott Nutrition infant formula recall, and we’ve seen a handful of smaller recalls over Cronobacter concerns in recent months. And infant formula shortages and disruptions continue in many parts of the country.

If she didn’t know that FDA had asked Congress for test-reporting authority, it’s because the FDA wasn’t screaming for it as it should have been doing from the moment the infant formula crisis began.

The lives of infants are at stake.

Here what I wish the FDA had said from the beginning of the infant formula crisis and would still say:

“Marion, we are devastated by what has happened with infant formulas.  We can’t sleep for worrying about how we can protect infants from harm.  We are doing everything in our power to force formula producers to make sure their prevention controls are in place and monitored.  We never want this to happen again and won’t stop pushing them until we are sure infant formula is safe.”

I apologize for my error.  But I stand by my concerns.  FDA: If you want the troubling pattern to go away, fix the problem.

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Mar 20 2023

Industry-funded studies: null results!

I’m often saying that industry-funded studies tend to produce results that favor the funder’s commercial interests.  This is true, but there are occasional exceptions.

Here, for example, are two studies based on grants from the American Pistachio Growers to the same group of investigators.  Both are randomized clinical trials with results that must have disappointed the funder.

I. Effects of short-term pistachio consumption before and throughout recovery from an intense exercise bout on cardiometabolic markers

Results: Two weeks of pistachio consumption failed to elicit changes in any biomarker (p < .05).. .Overall, in healthy young men with normal blood lipid and glucose metabolism, little effect of either pistachios or intense exercise on cardiometabolic risk indicators was detected.

II. Influence of pistachios on force production, subjective ratings of pain, and oxidative stress following exercise-induced muscle damage in moderately trained athletes: A randomized, crossover trial.

Results: Creatine kinase, myoglobin, and C-reactive protein increased over time following exercise (p < 0.05); however, there were no advantages following pistachio consumption. No significant changes in vertical jump or superoxide dismutase were elicited during any trial.

Comment:  The second paper put a positive spin on the basically null results: “This study demonstrates that 3.0 oz/d of pistachios can reduce delayed onset of muscle soreness and maintain muscle strength, potentially promoting exercise tolerance and training adaptations.”  My question is why anyone would think that pistachios would make any difference anyway.  They are one food in the diets of people who eat many othere kinds of foods.  I’m all for eating pistachios, if you like them, along with lots of other healthy foods.  There is only one reason to do this kind of one-food research—for marketing purposes.

You don’t believe this?  Check out the nutrition and health section of the Pistachio Growers website.  You can’t make this stuff up.

Hey.  If that’s all it takes, give it a try (I guess).

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Mar 17 2023

Weekend reading: IPES Food

If you aren’t familiar with IPES Food, here is your chance.

IPES-Food – the International Panel of Experts on Sustainable Food Systems – is a diverse and independent panel of experts guided by new ways of thinking about research, sustainability, and food systems. Since 2015, IPES-Food has uniquely shaped the debate on global food systems reform, through policy-oriented research and direct engagement with policy processes.

The IPES Food panel is an impressive bunch, starting with its co-chairs, Olivier De Schutter, currently UN Special Rapporteur on extreme poverty and human rights, and Maryam Rahmanian, independent expert on agriculture and food.

Their two most recent reports:

I.  Smoke & Mirrors: Examining competing framings of food system sustainability 

This comes with a background report: Agroecology, Regenerative Agriculture, and Nature-Based Solutions: Competing framings of food system sustainability in global policy and funding spaces.

Together, these cover those key terms, their emergence and evolution, and the ways they are used in global policy and funding.

The report favors use of Agroecology:

Agroecology, and in some uses regenerative agriculture, offer a more inclusive and comprehensive pathway toward food system transformation because they connect social
and environmental aspects of sustainability, address the whole food system, is attentive to power inequalities, and draws from a plurality of knowledges emphasizing the inclusion of marginalized voices.

II.  Special Report: Debt & Food Crisis: Breaking the Cycle of Unsustainable Food Systems, Hunger and Debt

Unsustainable food systems, this says, are major drivers of “the debt crisis. Import dependencies, extractive financial flows, boom-bust commodity cycles,” leaving countries exposed to shocks and unable to invest in climate-resilient food production and food security.

The IPES panel calls for:

  • Debt relief and development finance
  • Reparation of historical food system injustices and the return of resources to the Global South.
  • Putting the interests of the world’s poorest countries and marginalized populations first.

The documents

IPES Food deals with Big Picture issues.  What they say is worth attention.