Posts dated: January2013

Nutrition Facts panels on food labels are notoriously confusing.  People who use them usually look for only one item such as fat or calories.

As I’ve discussed previously. the label is so difficult to interpret that the FDA devotes pages on its website to explaining it.  When the FDA did the original research in the early 1990s, it tested a large number of formats.  When it became clear that people did not understand any of them very well, the FDA chose the least worst—the one that was understood least poorly.

Two decades later, the FDA is revisiting the Nutrition Facts panel to make it easier to understand in the light of today’s concerns about calories and obesity.  Once again, it is testing multiple formats.  The results of the first round of research have just been published in the Journal of the Academy of Nutrition and Dietetics (JAND), and reporters are trying to make sense of them.

FDA researchers tested 10 formats differing in number of servings and columns (1 or 2, each), font size, and wording.  They asked respondents for opinions about the healthfulness of the product, number of calories and nutrients per serving, perceptions of the label, and the ability to choose healthier products and those with fewer calories.  This, like the research in the early 1990s, is complicated.

The result:

For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices.

Here’s an example of one of the formats that may help:

Soda companies are already doing something like this, but a 20-ounce soda has more than 2 servings.  Serving size is what confuses.  If it’s 100 calories per serving, those calories have to be multiplied by the number of servings per container.

The Institute of Medicine produced two reports for the FDA on front-of-package labels and also suggested a way to integrate its ideas into the Nutrition Facts label.

Is the FDA testing this idea?  I hope so.

What is there to say about Girl Scout cookies.  Everybody loves them (or is forced to).

But now, if you worried that promoting cookies maybe wasn’t the best public health strategy, ABC Bakers, the company that makes them, has solved your problem.

Girl Scout cookies are now health foods.  How?

NutriFusion.

Translation: “major vitamins.”

As the company explains, NutriFusion is delicious made nutritious.

These crunchy vanilla and coconut cookies with a mango-flavored crème filling have all the nutrient benefits of eating cranberries, pomegranates, oranges, grapes, and strawberries.

As I keep saying, you can’t make this stuff up.

I’m teaching a course on food advocacy this semester at NYU and am always looking for instructive examples.  Here’s a good one.

PepsiCo announced that it would remove Brominated Vegetable Oil (BVO) from Gatorade and replace it with something less potentially harmful.

BVO, a flame retardant, keeps keep flavor oils in suspension and prevents a cloudy appearance in soft drinks.

According to the account in the New York Times, PepsiCo’s action followed soon after a 15-year-old activist in Mississippi, Sarah Kavanagh, filed a petition on Change.org to remove BVO.

The petition attracted more than 200,000 signatures, and this week, Ms. Kavanagh was in New York City to tape a segment for “The Dr. Oz Show.” She visited The New York Times on Wednesday and while there said, “I just don’t understand why they can’t use something else instead of B.V.O.”

…a spokesman for PepsiCo…said in an e-mail, “We appreciate Sarah as a fan of Gatorade, and her concern has been heard.”

…”Kudos to PepsiCo for doing the responsible thing on its own and not waiting for the F.D.A. to force it to,” said Michael Jacobson, executive director of the Center for Science in the Public Interest [CSPI].

Mr. Jacobson has championed the removal of brominated vegetable oil from foods and beverages for the last several decades, but the F.D.A. has left it in a sort of limbo, citing budgetary constraints that it says keep it from going through the process needed to formally ban the chemical or declare it safe once and for all.

I love Ms. Kavanagh’s response to BVO’s removal, as quoted in Beverage Daily:

I thought I might get a lot of support because no-one wants to gulp down flame retardant, especially from a drink they associate with being healthy. But with Gatorade being as big as they are, sometimes it was hard to know if we’d ever win. This is so, so awesome.

A teenager with social media skills accomplished what CSPI has been trying to do for decades. 

The FDA removed BVO from its list of ingredients Generally Recognized As Safe in 1970, but in 1977 allowed companies to use it on an “interim” basis.  It says getting rid of it is “not a priority.”

Animal studies show it causes lesions in the liver and impairs growth and behavior.   The medical literature contains occasional case reports of bromine toxicity in individuals who abuse brominated cola drinks.

Getting rid of it is good news.

But, as CSPI’s Michael Jacobson points out:

Gatorade without BVO is nutritionally no better than with it.  A typical 20oz (591ml) bottle has 130 calories, all from its 34 g of refined sugars.

NutraIngredients.com reports frequently on current research and opinion on dietary supplements.  Lots of people take these products and swear by them, but proving that they do much good is another matter.  It has been hard to find evidence that they make healthy people—those who take them most often—any healthier.

Here are some recent NutraIngredient reports on this topic, largely reflecting views of the supplement industry.

• Multivitamins: ‘The cheapest health insurance a person will ever buy
• Multivitamin supplements may cut cancer risk: JAMA paper
• Multivitamin Study: Making Lemons Out of Lemonade
• Multivitamins may not benefit heart disease risk, but ‘don’t forget the aim and other potential benefits of supplements’
• U.S. supplement use remains strong, CRN survey says
• Vitamin Shoppe: US supplement user confidence soars to 93% as usage increases
• Multivitamin Supplements Boost Brain Function, say U.K. Researchers
• Looking forward: The emerging evidence for vitamins and health
• Global population demands, ‘confusing’ media coverage and the 100 year old vitamin [Vitamin A]
• Multivitamins – They Won’t Wash the Windows or Change the Oil Either!
• Multivitamins may not benefit heart disease risk, but ‘don’t forget the aim and other potential benefits of supplements

Who knew that Wednesday’s New York State Supreme Court hearing on the lawsuit filed against New York City’s cap on sodas larger than 16 ounces would turn out to be a debate about race relations?

Let’s be clear.  This lawsuit is about only one thing and one thing only: to protect the profits of Big Soda—mainly, Coca-Cola and PepsiCo.  The lawsuit is funded by their trade association, the American Beverage Association (ABA), at what must be astronomical expense.

But to shift attention away from profit as a motive, the ABA enlisted two organizations of underrepresented groups—the NAACP and Hispanic Federation—to file an amicus brief on behalf of the soda companies.  The brief argues that the soda cap discriminates against citizens and small-business owners in African-American and Hispanic communities.  But it neglects to mention  that both “friends of the court” received funding from soda companies.

The financial arrangements between Big Soda and such groups demand further examination. Fortunately, we have Michael Grynbaum at the New York Times, who explains that:

The obesity rate for African-Americans in New York City is higher than the city average, and city health department officials say minority neighborhoods would be among the key beneficiaries of a rule that would limit the sale of super-size, calorie-laden beverages.

But the N.A.A.C.P. has close ties to big soft-drink companies, particularly Coca-Cola, whose longtime Atlanta law firm, King & Spalding, wrote the amicus brief filed by the civil rights group in support of a lawsuit aimed at blocking Mr. Bloomberg’s soda rules…Coca-Cola has also donated tens of thousands of dollars to a health education program, Project HELP, developed by the National Association for the Advancement of Colored People. The brief describes that program, but not the financial contributions of the beverage company. The brief was filed jointly with another organization, the Hispanic Federation, whose former president, Lillian Rodríguez López, recently took a job at Coca-Cola.

Soda companies have a long history of targeting their marketing efforts to Blacks and Hispanics, as shown in at least one book (and described in one of its reviews).

Last fall, the East Bay Express exposed how the soda industry exploited race issues and used them to divide and conquer in defeating the Measure N soda tax initiative in Richmond, California.

The No on Measure N workers’ paychecks were signed by political consultant Barnes Mosher Whitehurst Lauter & Partners (BMWL), which had been hired by the American Beverage Association….By the time that Big Soda had arrived, the issue of race was already a factor in the campaign. Some opponents of the tax had alleged that it was racist, arguing that it would unfairly harm low-income residents in the city. And the No on Measure N campaign…nurtured that sentiment. Indeed, there is evidence that the beverage association helped keep race at the forefront of the campaign as part of a strategy that exploited Richmond’s existing tensions.

…the beverage industry discovered a winning formula in Richmond last year that it might be able to replicate elsewhere…And if that were to happen, it could drive a wedge through traditional Democratic constituencies in many communities, with blacks and Latinos opposing their longtime political allies — progressives and environmentalists — just like they did in Richmond.

Is a cap on soda sizes discriminatory?  Quite the contrary.

Public health measures like this are about removing health disparities and giving everyone equal access to good nutrition and health.  This makes public health—and initiatives like the soda cap—democratic, inclusive, and anything but elitist.

But I can’t think of anything more elitist, less inclusive, and more undemocratic than suing New York City over the soda cap.

In funding this suit, the soda industry has made it clear that it will go to any lengths at any cost to protect its profitability—even to the point of dragging along with it the very groups that would most benefit from the initiative.

If the American Beverage Association and its corporate members really cared about Black and Hispanic groups, it would stop target marketing,  stop marketing to children, and stop pretending that sugar-sweetened beverages are an important part of active, healthy lifestyles.  It certainly would stop wasting these groups’ time and credibility on anti-public health lawsuits.

My post yesterday about Michele Simon’s report on food company sponsorship of the Academy of Nutrition and Dietetics (AND) elicited a wealth of thoughtful comments.  These are well worth careful consideration.

Many express disappointment that I would suggest that corporate sponsorship might influence their thinking or practice, that other nutrition professionals have equal or better education, that I singled out AND when other nutrition and health organizations also accept food industry funds, or that I am unsympathetic to their plight (they are required to be AND members whether or not they agree with its policies).

Let me clarify:

On the effects of corporate sponsorship: I don’t know a single individual who thinks that taking money from food companies influences personal opinion or practice, but research on the effects of drug—and food—company sponsorship demonstrates otherwise.    At the very least, sponsorship gives the appearance of conflict of interest.  Individuals and organizations who accept sponsorship from soda companies, for example, can hardly be expected to advise the public to drink less soda.

On education: my point here is not that dietetic education is inadequate but that other nutritionists without such training may be equally qualified to advise the public about diet and health.

On other organizations:  That other nutrition and health organizations accept funds from food companies has long been a point of discussion on this blog (click on Partnerships).  I am especially concerned  about the practices of the American Society of Nutrition, to which I belong.  Its embarrassing role in the Smart Choices fiasco was an example of why nutrition professional organizations should avoid getting involved in such alliances.

On sympathy: I have plenty.  Food company sponsorships create painful dilemmas for nutrition professionals and each of us must figure out our own way to deal with them.  I have written about my own struggles with this issue in Food Politics and elsewhere.

I especially appreciate the comments from those of you engaged in your own struggles with this issue within AND.  You have your work cut out for you.  Here, for example, is the response of your president, Dr. Ethan Bergman, to Simon’s report. He writes [and see addition below]:

There is one indisputable fact in the report about the Academy’s sponsorship program: We have one. And for the record, I support the Academy’s sponsorship program, as does the Board of Directors and our members.

Let me make it clear that the Academy does not tailor our messages or programs in any way due to influence by corporate sponsors and this report does not provide evidence to the contrary.

…As members of a science-based organization, I encourage you to not take all information you see at face value, always consider the source (in this case, an advocate who has previously shown her predisposition to find fault with the Academy) and seek out the facts.

My interpretation: ignore the message because the messenger is not one of us.

As nutrition professionals, we ignore such messages at our peril.  If we want the public to trust what we say, our views cannot be perceived as compromised by financial ties to food companies.

What you can do.  If, as some of you noted, you oppose corporate sponsorship and would like to do something about it, here are a few suggestions:

• Let your voice be heard: write letters, post blogs, send tweets.
• Make it clear to colleagues and clients that you oppose current policies on corporate sponsorship.
• Provide evidence that your organization can do just fine without the money.
• Join committees and groups within your organization; say what you think.
• Organize petition campaigns.
• Run for office; run a slate for office.

If you want the policy to change, work for it.

But don’t be discouraged if nothing much happens right away.  Change takes time.  Keep at it.

Thanks to all of you for taking this issue so seriously.  Let’s keep working together to find ways to keep food company money out of our professional lives.

Addition, January 25: a reader, Craig, points out that Coca-Cola gave Dr. Bergman the opportunity to carry the torch at last summer’s Olympic games.  A news story about this event quotes Dr. Bergman on the Academy’s partnership:

I think the philosophy that Coca Cola has through its Live Positively campaign, and our philosophy at the academy, is about trying to improve the nation’s health through better nutrition and fitness so this fits in well with our cause.

 

Michele Simon, president of Eat, Drink, Politics, an industry watchdog consulting group, has just published an exposé of the close financial relationships between food and beverage companies and the Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association).

Her hard-hitting report, And Now a Word from Our Sponsors: Are America’s Nutrition Professionals in the Pocket of Big Food? provides ample evidence that partnerships and alliances with Big Food make it impossible for AND members to convey clear and accurate messages about nutrition and health.

When she talks about nutrition professionals, she doesn’t mean me.  I have a PhD (in molecular biology, although long lapsed) and a master’s in Public Health Nutrition.  She means AND members.  AND represents more than 70,000 individuals who mostly hold credentials as Registered Dietitians (RDs).

To qualify, they had to complete a bachelor’s degree that included a specified set of courses and a 6-month clinical internship.  I once tried to get credentialed as an RD after I completed a qualifying internship but I had never had a practical course in food service management.  That lack was a deal breaker.

Never mind.  Here’s what Simon’s report is about:

And here are a small selection of her observations and conclusions:

• AND collected $1.85 million in sponsorship funds in 2011, a relatively small percentage of its $34 million income.
• Companies such as Coca-Cola, Kraft, Nestlé, and PepsiCo offer approved continuing education courses to AND members.
• Two of the messages conveyed by one of Coca-Cola’s courses: sugar is not harmful to children, and federal nutrition standards for school meals are too restrictive.
• More than 20% of speakers at AND’s annual meeting have financial ties to Big Food companies, although most were not disclosed.
• A survey found 80% of members to believe that sponsorship implies an AND endorsement of the sponsor’s products.
• A majority of AND members believe that three current sponsors are unacceptable: Coca-Cola, Mars, and PepsiCo.

If you want to see how sponsorship plays out in practice, take a look at her photographs of the exhibit hall at the 2012 AND annual meeting.  She also provides photos taken elsewhere at the meeting.  And here’s the New York Times’ take on it.

As a trade association for Registered Dietitians, AND—as I discussed in Food Politics—has as its primary goal to position RDs as the leading source of nutrition information for patients, clients, and the public.

As you might imagine, I’ve always had a bit of trouble with that goal.

For one thing, nutritionists with master’s and doctoral degrees are likely to know more than RDs about nutrition science and to think more critically about it.

For another, that self-interested goal creates an image problem.  RDs might be accepted as more credible sources if their primary goal was to improve the nutritional health of the American people.

Their advice also would be more credible if AND were not so heavily linked to food and beverage corporations, especially those whose products contribute to poor health.

Let’s hope this new report gets AND members talking about how to change some current AND policies.

I am an avid follower of NutraIngredients-USA.com, a daily newsletter for the food industry.  Today, it collects its recent articles on energy drinks in one place.

• Monster Beverage Corporation: Alarmist DAWN report is highly misleading
• Legislators seek info from energy drink manufacturers
• Shot in the arm: The secret to success in shots… without going head to head with 5-Hour Energy…
• Majority of caffeine-containing supplements have inaccurate labels, claims study
• New Canadian caffeine limits part of growing pressure on energy drink sector
• Monster hit with another suit over advertising, caffeine content
• Senators tilt at Red Bull as FDA hints at energy action
• Durbin seeks meeting with FDA following 5-Hour adverse events news
• 5-Hour Energy: Adverse event reports do not prove that our shots caused 13 deaths
• New lawsuit targets Monster and its ‘dangerous and potentially lethal’ ingredient: EGCG
• Third time’s the charm: Durbin, Blumenthal call on FDA to investigate energy drinks
• Lawyer urges FDA to ban energy drink sales to minors after US teen death
• California company looking to create ‘synergy’ beverages category

The makers of energy drinks have managed to get away with positioning these products as healthier alternatives to regular soft drinks.

They also have gotten away with being able to add vitamins and minerals to them that the FDA would not permit in regular Coke or Pepsi.

Unfortunately for them, some manufacturers upped the caffeine to the point where it might be making people sick.  Illnesses among energy drink users have focused attention on these products.

Are energy drinks the new frontier for food advocacy?  I think so, and I’m guessing NutraIngredients-USA does too.