by Marion Nestle

Currently browsing posts about: Dietary-Guidelines

Jul 17 2023

Industry-influenced study of the week: Ultra-processed foods are good for you!

I am devoting this week to the pushback against advice to reduce consumption of ultra-processed foods.  It is coming from the food industry, of course, government agencies with ties to the food industry, and nutritionists who focus on  the benefits of nutrients, without contextualizing the foods and diets they come from (“nutritionism”).

For the record, ultra-processed foods are :

  • Industrially produced
  • Bear little resemblance to the foods they were derived from
  • Typically contain additives for color, flavor, and texture
  • Cannot be made in home kitchens,
  • Are formulated to be irresistable,
  • Are associated with excessive calorie intake and poor health
  • Are extremely profitable to their makers
  • Cannot be made in home kitchens (a brief operating definition)

Ultra-processed food pushback #1: A study from the USDA and authors with conflicted interests

The USDA’s Agricultural Research Service is so proud of this study that it sent out a press release.

Scientists at the USDA Agricultural Research Service’s (ARS) Grand Forks Human Nutrition Research Center led a study that demonstrates it is possible to build a healthy diet with 91 percent of the calories coming from ultra-processed foods (as classified using the NOVA scale) while still following the recommendations from the 2020-2025 Dietary Guidelines for Americans (DGA). The study highlights the versatility of using DGA recommendations in constructing healthy menus.

The Study: Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.  Julie M. Hess, Madeline E. Comeau, Shanon Casperson, Joanne L. Slavin, Guy H. Johnson, Mark Messina, Susan Raatz, Angela J. Scheett, Anne Bodensteiner, Daniel G. Palmer.  The Journal of Nutrition, 2023.  https://doi.org/10.1016/j.tjnut.2023.06.028.

Purpose: “The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.”

Method: “we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).”

Results: “In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points.”

Conclusions: “Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.”

 Conflicts of Interest: “MM serves as the Director of Nutrition Science and Research for the Soy Nutrition Institute (SNI) Global. The SNI Global receives funding from soybean farmers via the soybean national checkoff program and via membership dues from companies involved in manufacturing and/or selling soy ingredients and/or soyfoods. GHJ serves as Senior Advisor to the McCormick Science Institute. JLS serves on advisory/consultant boards for Simply Good Foods, Quality Carbohydrates Coalition, and the Sustainable Nutrition Scientific Board and has received funding from the National Institutes of Health, Taiyo, Barilla Foods, and the USDA in the past 12 mo. The other authors report no conflicts of interest.”

Funding: This work was supported by USDA Agricultural Research Service project grant #3062-51000-057-00D.

Comment:  I can think of only one reason for doing a study like this: to cast doubt on the concept of ultra-processed foods (UPF) and all the research showing that UPF diets induce people to eat more calories (see the study by Kevin Hall et al) and are strongly associated in hundreds of studies with poor health, evidence that by this time is overwhelming and incontrovertible.  Why now?  Because the 2025-2030 Dietary Guidelines Advisory Committee has been charged with examining the relationship of UPF to heart disease risk.

The first rule of the ‘Playbook” is to cast doubt on the research, which is what we are seeing here.  The message to reduce consumption of ultra-processed foods makes good sense for health reasons.  But such advice is very bad for the profits of food companies making junk foods.

The USDA’s Agricultural Research Service is a marketing arm of the food industry,.  It is heavily conflicted.

For one thing, the Healthy Eating Index is not useful for this purpose; it is strictly nutrient-based, which is not the issue here.  And the Dietary Guidelines are careful to leave plenty of room for eating junk foods and to say not one word about UPF.

I think the UPF concept is so solidly backed up by evidence that it is here to stay.  But it is so threatening to food companies making UPF products, and the USDA is so captured by the food industry (checkoff programs, anyone?) that it is understandable why they are so eager to cast doubt.

Thanks to the half dozen or so readers who sent this one to me, to Ted Kyle for calling it “oxymoronic healthy eating,” and  Kevin Hall for pointing out that the healthfulness of this diet is assumed, not tested:

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Jul 10 2023

Nordic Nutrition Recommendations: influenced by industry?

A reader who wishes to remain anonymous sent me an account of the development of the new Nordic Nutrition Recommendations, pointing out what they do not contain: a recommendation to reduce ultra-processed foods [Note: this is an updated and slightly corrected version of what was first posted on July 9].

Indeed, on pages 253-255 (this is a long report), you will find this statement:

The backstory here is one of effective food industry lobbying.

The Nordic Nutrition Recommendations do not say:  reduce consumption of ultra-processed foods.

The story begins with two authors who were asked to sum up the health effects of ultra-processed foods, and to advise the committee writing the recommendations.  They did so.  Their initial background paper concluded with these recommendations:

(1) Limit the consumption of ultra-processed foods.

(2) Choose less processed form of foods within each food group when possible.

(3) Cook at home and choose freshly prepared foods when eating out.

The committee revised the background paper.  It omitted the three recommendations but concluded:

Recommendations to limit ultra-processed foods, and choose foods of lower processing level, when possible, may enhance and support several of the existing FBDGs [food-based dietary guidelines] and help individuals select more healthful foods that align with the overall NNR2022 [last years Nordic Nutrition Recommendations] guidelines within each food category. For example, such advice would support choosing plain, unsweetened yoghurt instead of flavored, sweet yoghurt; choosing oatmeal or muesli based on grains, nuts, and dried fruits over sweetened, refined breakfast cereals; and choosing chicken breast/thighs over chicken nuggets.

The revised document was opened for public comment and a hearing.  A great many representatives of food companies objected to saying anything negative about ultra-processed foods.  This Excel spreadsheet lists the 60 people who commented and their main objections.

After the hearing, the committee preparing the recommendations wrote a draft report based on the comments.  The section on ultra-processed foods is on pages 152-153.  It begins:

There is currently no consensus on classification of processing of foods, including UPFs. The dominating UPF classification (NOVA classification group 4) contains a variety of unhealthy foods, but also a number of foods with beneficial health effects.

It also says:

Health effects. Regular intake of UPF encourages over-eating and intake of foods in the UPF category of the NOVA classification has been suggested associated with increased risk of obesity, cardiovascular disease, type 2 diabetes, cancer, depression, and premature mortality …However, no qSRs [qualified systematic reviews] support these suggestions.

These negative views of the UPF concept differ from the views of the background document (however politely stated) and clearly were influenced by the overwhelmingly negative views of food industry representatives.

The draft report also was opened for public comment.  These comments also are listed in an Excel document. Some favor the changes benefiting the food industry; others—but many fewer—object to them (these last are summarized in yet another document).

The final Nordic Nutrition Recommendations are somewhat of a compromise between public health and food industry views, but generally favor the food industry position.  The new Nordic Nutrition Recommendations are less critical of the UPF concept, but do not say “reduce consumption of ultra-processed foods.”

The NOVA food classification system, which first defined ultra-processed foods, was published by Carlos Monteiro, a professor of public health at the University of São Paulo, and his colleagues in 2009.*  About the Nordic recommendations, my informant writes:

I have come to realize that this is not at all about evidence. It’s about power, and who gets to define what’s important in nutrition science. “The establishment” refuses to accept that someone from Brazil, a country they regard as inferior, should be allowed to tell them they have been wrong in their nutritionism-approach. They claim NOVA is based on ideology, not science….And now this is getting in the way of public health.

My take-home lesson:  The food industry came out in force on this issue and greatly overwhelmed the few comments of public health advocates.  The message here seems clear: public support for reduction of ultra-processed food needs to be widespread, clear, and forceful.

*Definition of ultra-processed foods

  • Industrially produced
  • Bearing no evident relationship to the foods from which they were derived
  • Formulated to be irresistably delicious (if not addictive)
  • Usually containing color, flavor, and texture additives
  • Often high in salt, sugar, and fat (but these are culinary ingredients that do not in themselves make foods ultra-processed)
  • Cannot be made in home kitchens (because they are industrially produced and contain ingredients unavailable to home cooks)

Addition

An additional document was sent to me after this post and the response from nutritionists involved in the NNR, which I posted the following week.  It is from the authors of the background document expressing their concerns about the changes made.

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Jun 21 2023

MyPlate in song?

I am not a big fan of the MyPlate food guide.

  • It was created without doing consumer research to find out how well people understand it.
  • Pie charts are harder to understand than pyramids (the old pyramid, despite its flaws, conveyed the what-you-should-eat messages much better).
  • The Protein section makes no nutritional sense; grains and dairy are also excellent sources of protein, and beans, which are high in protein, are vegetables.

Never mind.  We have to live with it.

It appeared in 2010.  Now the USDA is trying to sell it, and with a catchy music video no less.

Will this sell kids on eating their veggies?

I hope the USDA has an evaluation in the works.

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May 30 2023

Mexico’s terrific new dietary guidelines. Yes!

Mexico has issued new dietary guidelines.

https://www.gob.mx/cms/uploads/attachment/file/826673/Gui_as_Alimentarias_2023_para_la_poblacio_n_mexicana.pdf

  1. Breastfeed babies for the first 6 months and then continue until age 2 along with other nutritious foods.
  2.  Eat more vegetables and fruits.
  3. Eat beans.
  4. Choose whole grains.
  5. Eat less beef and processed meats.
  6. Avoid ultra-processed foods.
  7. Drink water.
  8. Avoid alcohol.
  9. Be physically active.
  10. Enjoy meals with family and friends.

I’m looking forward to reading a case study on how the public health institute got these through the political process.

If people follow these guidelines, these industries will be in trouble:

  • Infant formula
  • Beef
  • Processed meats
  • Ultra-processed foods
  • Sugar-sweetened beverages
  • Alcohol

People will be healthier!  These industries will also be in trouble.

  • Pharmaceutical drugs
  • Private medicine
  • Insurance companies? (you might think they would benefit, but they make so much money on illness—this one is complicated)

I hope the new U.S. Dietary Guidelines will find these inspiring.

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May 17 2023

American Heart Association weighs in on healthy diet plans

A committee of the American Heart Association has just published a position paper looking at how well popular weight-loss and other diets meet AHA standards.  The standards are worth a look.

When ranked against these standards, the diets come out in this order:

  • Tier 1: Mediterranean, DASH, Pescetarian, Ovo/Lacto Vegetarian
  • Tier 2: Vegan, Low-fat
  • Tier 3: Very Low-Fat and Low-Carbohydrate
  • Tier 4: Paleo and Keto

Proponents of full-fat diets will object that Paleo and Keto diets can be healthy, as well they may be depending on how much and what else their followers are eating.

Nearly any diet can be healthy if it does not include excess calories or too much junk food, but includes plants and is based on a wide variety of foods.

And they can all be delicious, and have no excuse not to be.

Enjoy!

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May 16 2023

Dietary Guidelines Advisory Committee: conflict of interest disclosed, sort of

In a strange partnership, the Nutrition Coalition and the Center for Science in the Public Interest (CSPI) are jointly complaining about the way the USDA and HHS have “disclosed” conflicts of interest among members of the 2025-2030 Dietary Guidelines Advisory Committee.

Why strange?  Because the Nutrition Coalition has long urged relaxations on advice about dietary fat, whereas CSPI has long urged restrictions.

Why “disclosed” in quotes?  Because the agencies’ disclosure statement lists the combined conflicts for the entire group, not for individual members of the committee.

Here’s the committee, courtesy of a tweet from Christopher Gardner.

Here is a small part of what the disclosure list looks like.

 

 

 

 

 

 

 

 

Because these are all jumbled together, you have to look hard to pull out the genuine conflicts—-relationships of committee members with food companies with vested interests in the outcome of the guidelines.

The Nutrition Coalition points out that USDA and HHS are failing to:

  • Comply with a National Academies of Science report calling for publicly posting financial and nonfinancial biases and conflicts of interest of committee members.
  • Fully adopt the National Academies’ 11 recommendations.
  • Recognize the significance of the first-ever systematic review of a DGAC’s financial ties. This review found 95% of the 2020 DGAC members had at least one tie with a food or pharmaceutical company and half had 30 such ties or more.

In its statement, CSPI says that it, the Coalition, and 13 other groups are calling on the federal government to disclose potential financial conflicts of interest, including sources of research funding, speakers’ fees, and other relationships.

Press coverage, the statement says, “has already uncovered one 2025 Dietary Guidelines Advisory Committee member with a conflict of interest that seems relevant to their role.”

Comment:  I agree that the credibility of the committee and the guidelines depends on transparency, but it’s hard to know how much of a problem this is.

I wanted to compare the disclosure list to the research questions set by the agencies for the committee, but I can no longer find them online.

This reminds me that’s it’s hard to know how much influence the committee will have, in any case, now that the agencies set the research questions and write the actual guidelines.

The advisory committee is just that, advisory.  The agencies do not have to take its advice.

I will be following this closely.  Stay tuned.

Additions, May 17 (thanks to Jerry Mande)

 

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May 3 2023

The 2025-2030 Dietary Guidelines: an update

Personally, I can’t believe we are going through this again since the result will certainly not differ much from previous versions, except in details (see my previous post on this).
But here we are, so let’s get to it.

ODPHP must be in charge this round (leadership passes back and forth between ODPHP and USDA’s nutrition policy office).  It says:

You can get involved by:

  • Attending virtual meetings: View the recording of the first meeting held in February 2023, and register to view the livestream of the second meeting on May 10th on DietaryGuidelines.gov.
  • Providing public comments: Comments may be submitted online.
  • Subscribing to email updates: Stay informed on each step of the process by registering for updates.

More details on the Dietary Guidelines development process can be found at DietaryGuidelines.gov.

What to expect?

  • Investigative reports on conflicts of interest among members of the Dietary Guidelines Advisory Committee (members must report conflicted interests but the agencies do not make the reports public)
  • Nothing about sustainability (Off the table; the agencies said there will be a separate report on that.  When?)
  • Nothing about meat (Off the table)
  • Debates about the significance of ultra-processed foods (but only with respect to heart disease)
  • Other issues, surely

My prediction: after an enormous amount of work, the guidelines will say, as they mostly do:

  • Balance calorie intake with expenditure
  • Eat more plant foods (foods)
  • Don’t eat too much salt, sugar, saturated fat (nutrients)
  • And, if we are lucky, minimize or avoid ultra-processed foods

Stay tuned.

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Jan 10 2023

Chile’s new dietary guidelines

Twitter still has its uses.  It’s how I found out about about Chile’s new dietary guidelines.

Even without speaking Spanish, you can see what they do that the US Dietary Guidelines do not.  They emphasize:

  • Sustainability (the forbidden word in the 2020-2025 US Guideines)
  • Fresh, minimally processed foods–“Avoid products ultra-processed and labeled as “high in” (“ultra-processed is not mentioned in the US Guidelines)
  • Home cooking
  • Respect for traditional cultural values
  • Farmers’ markets
  • Recycling

One odd message: “Consume làcteos en todas las etapas de la vida,” which I translate as “Consume dairy foods through all stages of life.”

I’m wondering how that got in there and guessing that Chile must have a powerful dairy industry.

But I hope the new, soon to be appointed, I’m told, 2025-2030 Dietary Guidelines Advisory Committee will pay attention to Chile’s version.  It has much to teach us.

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