The American Heart Association (AHA) has just issued its latest set of dietary guidelines aimed at preventing the leading cause of death in the United States: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Because AHA guidelines apply not only to coronary heart disease but also to all other chronic disease conditions—and sustainability issues—influenced by dietary practices, they deserve special attention.

Most of these repeat and reinforce the 2020-2025 Dietary Guidelines for Americans.

The two big differences in the recommendations:

• Clarifying protein recommendations: these include all sources but emphasize plant sources (#4)
• Including a new one: minimize ultra-processed foods (#6)

These recommendations are way ahead of the US Dietary Guidelines in recognizing how much ultra-processed foods contribute to poor health, and how important it is to minimize their intake.

Also unlike the US guidelines, these are unambiguous and easily summarized.

The statement is worth reading for its emphasis on two other points.

• This dietary pattern addresses problems caused by other chronic conditions and also has a low environmental impact.
• Following this dietary pattern requires much more than personal responsibility for food choices.  It requires societal changes as well.

The press release summarizes the problems in society that make following healthy diets so difficult, if not impossible:

• Widespread dietary misinformation from the Internet;
• A lack of nutrition education in grade schools and medical schools;
• Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
• Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
• Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

As the statement concludes: “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”

Amen to that.

Comment: From my perspective, this statement thoroughly supersedes the 2020-2025 Dietary Guidelines for Americans, which—because they say nothing about ultra-processed foods , differential protein sources, sustainability, or doing anything to counter societal determinants of poor diets—were out of date the instant they appeared.

Some of the details of the AHA statement will be debated but its overall approach should not be.

The committee that put these guidelines together deserves much praise for basing its advice on today’s research and most pressing societal needs.

Additional AHA Resources:

• Spanish news release 
• Available multimedia is on right column of release link: https://newsroom.heart.org/news/new-look-at-nutrition-research-identifies-10-features-of-a-heart-healthy-eating-pattern?preview=288ef57763869cab946e725d341dbb63
• After Nov. 2, 2021, view the manuscript online.
• What kind of diet helps heart health?
• Eating walnuts daily lowered bad cholesterol and may reduce cardiovascular disease risk
• Eating more plant foods may lower heart disease risk in young adults, older women
• Sugar 101
• Follow AHA/ASA news on Twitter @HeartNews

I learned about this study from an article in FoodNavigator.com, “Baobab industry welcomes study linking the fruit to good gut health.”

The title raised the question, “Who funded this?”  Bingo, as it turns out.

Baobabs are enormous African trees that produce a highly fibrous fruit.

I can’t say it looks particularly yummy.  In fact, it is described as “floury, dry, and powdery” and works best as a powdered ingredient.

But the baobab industry?  Who knew such an entity existed?

It does.  Hence this study:

The study: A Pectin-Rich, Baobab Fruit Pulp Powder Exerts Prebiotic Potential on the Human Gut Microbiome In Vitro.  Martin Foltz, Alicia Christin Zahradnik, Pieter Van den Abbeele, Jonas Ghyselinck, Massimo Marzorati.  Microorganisms. 2021 Sep 17;9(9):1981.

Methods: Test tube mixing of baobab powder with colonic bacteria.

Results: Baobab fruit pulp powder boosted colonic acidification across three simulated human adult donors due to the significant stimulation of health-related metabolites.

Conclusions: Overall, Baobab fruit pulp powder fermentation displayed features of selective utilization by host microorganisms and, thus, has promising prebiotic potential.

Funding: The studies described in this manuscript were performed at the request of and were funded by Döhler, 94295 Darmstadt, Germany  Surprise!  This company makes baobab powder.

Conflict of interest:  M.F. and A.C.Z. are employees of Döhler. While M.F. participated in the design of the study, the interpretation of the data, and the revision of the manuscript, M.F. did not participate in the collection and analyses of data.

Comment: No food, product, or ingredient is too obscure to avoid industry attempts to demonstrate that it can be marketed as a “superfood” (see, for example, this product).

Reference: For a summary of research on the “funding effect”—the observation that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests but that recipients of industry funding typically do not recognize its influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Priya Fielding-Singh.  How the Other Half Eats: The Untold Story of Food and Inequality in America.  Little, Brown Spark, 2021.

I did a blurb for this book (some of it ended up on the cover)

How the Other Half Eats is a must-read for anyone who has ever wondered why Americans don’t eat more healthfully. Fielding-Singh achieved something remarkable in gaining the trust of families who then let her observe their daily food choices. Her book is a thoughtful, riveting, compassionate, and utterly compelling account of why eating healthfully is so difficult, especially for the poor. What’s more, she offers a superb example of why on-the-ground field research is invaluable for gaining a deep and nuanced understanding of the ways that our industry-driven and highly inequitable food environment affects real people on a daily basis.

What I found so amazing about this book was that Fielding-Singh actually talked to people about how they feel about their diets—and listened.  Her analysis is exceptionally thoughtful.  Some examples:

From page 253

It is one thing to be able to find and afford a head of cauliflower.  But it is another to want to buy that cauliflower, to choose to spend one’s money on that cauliflower (at the expense of other purchases), to have the time and tradition to cook that cauliflower, and to possess the patience to weather one’d child’s complaints and pleas for macaroni and cheese and soldier on to feed that cauliflower to one’s child.  Only a handful of parents I met had all of these things.

From page 255

Personal responsibility has never solved a public health problem or remedied an inequity.  Food is no exception…Many of the families I met had either done so or were trying to figure out how to eat more nutritiously with the resources they had.  But, largely due to the structures implemented by the food industry and federal government, most felt like they were fighting an uphill battle—and losing.

Page 259

Banning marketing to kids would give moms a fighting chance of being able to feed their kids what they want rather than what corporations push on them.  Currently, only those families with the most money, time, and bandwidth have a shot at prevailing against the industry—and even those families often struggle and even fail.  Protection from the food industry should be right granted to all families, not a privilege reserved for the few.

FAO says the world food price index is higher than it’s been in years, due to reduced harvests, fuel prices, climate change, and Covid-19.

According to the New York Times, the prices of foods in the U.S. are also up—and by 15 percent since early 2020.

Steak, ground beef for hamburger, and turkey are especially costly.

The increases are due to supply chain shortages and higher labor costs and there is little relief in sight. In fact, some economists think prices could rise even more, given the increase in energy prices.

These increases may be hard on consumers, but they are also hard on food banks.

A case of peanut butter that was $13 to $14 before the pandemic now costs $16 to $19…Green beans that used to retail for $9 a case now sell for $14.

BUT, the New York Times also reports:

Despite higher prices, McDonald’s, Kraft Heinz and Coca-Cola post solid earnings.

The Coca-Cola Company, McDonald’s and Kraft Heinz all reported quarterly earnings on Wednesday that were better than expected, despite continuing challenges with the global supply chain and pandemic restrictions in many parts of the world. The enormous scale of each business, as well as their ability to pass on price increases to consumers, appears to have helped them during a time of uncertainty.

Ironic, no?

I am not a litigious person and much prefer to stay out of the legal system.

But I am a big fan of Bill Marler, who represents victims of food poisonings, not least because his lawsuits against companies with sloppy food safety procedures should encourage them to clean up their processes.

I’m not sure what to think of NPR’s account of Spencer Sheehan’s 400 or so lawsuits against food companies for misleading labeling.

The one that triggered off the article is on behalf of a woman suing Kellogg over the number of strawberries in Strawberry Pop-Tarts.

Enriched flour (wheat flour, niacin, reduced iron, vitamin B1 [thiamin mononitrate], vitamin B2 [riboflavin], folic acid), corn syrup, high fructose corn syrup, dextrose, soybean and palm oil (with TBHQ for freshness), sugar, bleached wheat flour. Contains 2% or less of wheat starch, salt, dried strawberries, dried pears, dried apples, leavening (baking soda, sodium acid pyrophosphate, monocalcium phosphate), citric acid, gelatin, modified wheat starch, yellow corn flour, caramel color, xanthan gum, cornstarch, turmeric extract color, soy lecithin, red 40, yellow 6, blue 1, color added.

Some of his other cases:

Keebler and Betty Crocker and others over “fudge” cookies and baking mixes that contained no milkfat.

Frito-Lay alleging it didn’t use enough real lime juice in its “hint of lime” Tostitos.

Coors suggesting its pineapple-and-mango-flavored Vizzy Hard Seltzers are sources of Vitamin C “nutritionally-equivalent” to actual pineapples and mangos.

Snack Pack pudding — advertised as “made with real milk” — actually made with fat-free skim milk.

Many cases targeting vanilla products — soda, soy milk, yogurt, ice cream — that use synthetic vanilla or other flavors alongside or in place of the more expensive natural vanilla.

NPR says

Most of Sheehan’s suits, including the strawberry Pop-Tart cases, allege damages based on the so-called “price premium theory,” which says that products are sold at higher prices than they would have otherwise commanded had the companies marketed them honestly.

Are these cases frivolous or in the public interest?

I’m for anything that gets the makers of ultra-processed foods to advertise them for what they are, not for what they aspire to be.

Hat tip to Lisa Young for sending this one.

Last week, I ran across three items related to plastics in our food system.  The big issues: waste, pollution, and harmful chemicals.

(1) Fortunately, Civil Eats has done all the work and produced this must-read compendium of articles.

Of all the issues we cover, one in particular has all of us at Civil Eats deeply concerned: the widespread overuse of plastic in food and agriculture. From the myth of recycling and the millions of tons of plastic in the oceans, to the abundance of “forever chemicals” and microplastics making their way into our food and our soil, plastics are contaminating the food chain, polluting the environment, and making us sick. And while there are important ways individuals can address the problem, they often feel like a drop in the bucket when compared to the ways industry is shaping the narrative, increasing the amount of plastic being produced, and stalling or opposing regulation.

First Look: The Future of Plastic-Free Grocery Shopping

The Follow-Up

• The End of the Line for PFAS?
• Sustainable Dairy: Packaging, the Final Frontier
• Emerging Research on Microplastics in Soil

The Check-In: A Conversation with the Peak Plastic Foundation

A Roadmap to Plastic-Free Grocery Shopping

What We’re Reading

(2) I also ran across this notice from Food Dive:  “Coca-Cola, Unilever among top plastic polluters, report says.”  This excellent summary refers to The #BrandAudit2021Report from the group, Break Free From Plastic.

The report points out that this is the fourth year in a row Coca-Cola is the #1 plastic polluter.  Here are the report’s top ten.

(3)  Phthlates.  In her Technically Food newsletter, Larissa Zimberoff talks about potentially harmful chemicals that leach into food from plastics, particularly plastic gloves.

The study found that pthalates (an industrial chemical) were found in food samples taken from chains including McDonald’s, Pizza Hut and Chipotle. These included DnBP, which has been linked to a heightened risk for asthma, and DEHP, which has been linked to an increased risk of reproductive problems. Other problems: disruption to the endocrine system (yes, that’s where diabetes comes from) and behavioral disorders in children…The main source of pthalates in food are the ubiquitous plastic gloves worn in food handling, but also in packaging and processing equipment. 

And a new study looks at phthlates in fast food.  Here’s what the Washington Post says about it:

A new study out Tuesday reportsthat far too often, small amounts of industrial chemicals called phthalates (pronounced THA-lates), which are used to make plastics soft, have been found in samples of food from popular outlets including McDonald’s, Pizza Hut and Chipotle….The study found harmful chemicals in a majority of samples collected. Phthalates are linked to health problems, including disruption to the endocrine system, and fertility and reproductive problems, as well as increased risk for learning, attention and behavioral disorders in children.

I have a long-standing interest in pet food (see Feed Your Pet Right, and Pet Food Politics: The Chihuahua in the Coal Mine) and in conflicts of interest in research (see Unsavory Truth: How Food Companies Skew the Science of What We Eat).  Knowing of both, a reader, Teresa Reinhardt, alerted me to this one.

The study:  Investigation of diets associated with dilated cardiomyopathy in dogs using foodomics analysis.  Caren E. Smith, Laurence D. Parnell, Chao-Qiang Lai, John E. Rush & Lisa M. Freeman.  Scientific Reports volume 11, Article number: 15881 (2021).

Purpose: to identify specific pet food ingredients associated with Dilated Cardiomyopathy (DCM) in dogs.

Methods: Metabolomic profiling of 25 diets associated with canine DCM and 9 diets not associated with DCM.

Results: “Four diet ingredients distinguished the two diet groups (peas, lentils, chicken/turkey, and rice). Of these ingredients, peas showed the greatest association with higher concentrations of compounds in 3P/FDA diets [the ones associated with DCM].“

Funding:  “This work was funded in part by Nestlé Purina PetCare and the Barkley Fund. This work was funded in part by United States Department of Agriculture project number 8050-51000-107-00D, and this entity had no part in the design of the experiments, in the collection, analysis and interpretation of data, nor in composing the manuscript.”

Conflicts of interest: “In the last 3 years, Dr. Freeman has received research funding from, given sponsored lectures for, and/or provided professional services to Aratana Therapeutics, Elanco, Hill’s Pet Nutrition, Nestlé Purina PetCare, P&G Pet Care (now Mars), and Royal Canin. In the last 3 years, Dr. Rush has received research funding from, given sponsored lectures for, and/or provided professional services to Aratana Therapeutics, Boehringer Ingelheim, Elanco, IDEXX, Nestlé Purina PetCare, and Royal Canin. None of the other authors has any competing interests to declare.”

Comment:  DCM is a common heart disease affecting dogs, with a prevalence that exceeds 50% in some breeds (e.g., Doberman Pinschers). More than 1100 cases have been reported to the FDA.

Despite endless speculation, its cause is unknown.  Much attention has focused on one or another dietary deficiencies or specific components (e.g., grains).  As the authors explain:

The diets reported to be associated with DCM often are marketed as “grain-free” and often contain certain ingredients that became part of commercial foods relatively recently (e.g., pulses, potatoes, and sweet potatoes) and lack others (such as rice or corn). Most of the ingredients that are included in the associated diets are also found in human diets, but dogs often eat them in even higher quantities because most dogs eat a single commercial pet food, rather than a variable mixture of multiple foods as humans do.

I think there three issues need further discussion.

(1)  Grains. Some pet owners believe that dogs should not eat grains. They buy pet foods that do not contain them.  This study identified grains only in the pet foods that were not associated with DCM.  Ms. Reinhardt also sent a link to a commentary from someone who questions this finding and raises other critical points about the study.  Dogs are fully capable of digesting grains and grains have been used safely in pet foods for decades.  The FDA describes the association of DCM with on its website.  What’s needed to resolve the peas question is a long-term (years, not months) trial of diets with and without peas.  The pet food industry has no incentive to pay for something like that.

(2)  The funding effect.  Nestlé Purina PetCare [no relation] paid for the study, and two of the authors consult widely for pet food companies.  Grains are inexpensive pet food ingredients and it is to Nestlé’s interest to have evidence demonstrating that grains do no harm.  How much influence did this company have over the research?  The conflict of interest statement is oddly worded.  The USDA funder is stated to have stayed out of the study, but the statement does not seem to apply to Nestlé, suggesting company influence.

(3)  Pet food research funding in general.  This study had some USDA funding, but government funding for pet food research is rare.  Most pet food research is funded by pet food companies, and most focuses on taste preferences.  Remarkably little research is designed to answer questions about which diets are better than others—a big issue because most pets eat commerical pet foods designed to take care of their complete nutritional needs.

This study identified peas as most strongly associated with DCM.  Pea protein is a main ingredient in plant-based meat alternatives.  It would be good to know more about the dietary effects of peas and pea proteins.

If nothing else this study demonstrates why pet food research matters.  We only have one food system, and pet food is very much a part of that system.

Ana Eliza Port Lourenço & Priscila Vieira Pontes. Eating at School: Reflections from Brazil.  Editora CRV, 2021.

To the ever expanding library of books on school food, this one is a welcome addition.  It aims to improve school food in Brazil, but has plenty of information relevant to everywhere else.

The book is short—just 88 pages—but covers diet and kids’ health, regulation of school food, barriers to eating healthfully in school, and what to do to overcome them in short chapters.  These have important information in boxes like this one.

Imagine!  Brazil has laws governing sales and use of junk food in schools.

The reality, however, is a challenge.

I heard about this book when I was asked to do a blurb (endorsement) for it.  I was happy to.  Here’s what I said:

For anyone who has kids in school or who cares about what kids eat, Eating at School is essential reading.  It is a warm, reality-based, and entirely practical guide to why school food should set a healthy example, and how to approach fixing it when it doesn’t.   The authors understand what schools and caretakers are up against and provide all the evidence anyone needs to make healthy school food a priority.

Addition, 11-8-21

At some point, this book will be listed on Amazon.com.  In the meantime, if you would like to order it but get stuck on the website, contact this address for help: logistica@editoracrv.com.br