by Marion Nestle

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Jun 27 2016

Israel’s solution to peanut allergies

While in Israel, I kept hearing that peanut allergies are virtually unknown in that country.  Nobody I met knows anyone with problems with peanuts—not Jews, Arabs, children, nor adults.

The explanation?

Bamba (and its Arabic equivalent).

These things are peanut puffs.

Because they melt in the mouth, they are often fed to babies as a first food.  Apparently, babies love them.

How do they taste?  Just as you might expect (peanut-flavored straw?  peanut-flavored Cheetos?).  They are sold everywhere as a snack and I met adults who love them too.

Do they really prevent peanut allergies?  Indeed, there might be something to this idea.

Introduction of peanut products into the diets of infants at high risk of developing peanut allergy was safe and led to an 81 percent reduction in the subsequent development of the allergy, a clinical trial has found…Researchers led by Gideon Lack, M.D., of King’s College London, designed a study called Learning Early About Peanut Allergy (LEAP), based on observations that Israeli children have lower rates of peanut allergy compared to Jewish children of similar ancestry residing in the United Kingdom. Unlike children in the UK, Israeli children begin consuming peanut-containing foods early in life.

Translation:  Bamba.

These researchers also found that allergic reactions did not return even if the children in that trial stopped eating Bamba for a year.

Their studies were funded mainly by NIH and the UK Department of Health, but the researchers also report that their clinical trials unit was supported by the National Peanut Board, Atlanta, and that the manufacturer of Bamba supplied the products.  The lead author, Gideon Lack, reports holding stock in DBV Technologies, the maker of Viaskin Peanut, a product that helps people with peanut allergies tolerate exposure to peanuts.

I’d like to see these studies repeated by fully independent researchers.

In the meantime, pediatric allergists are advising parents to let their babies eat peanut butter (but not peanuts because babies can choke on them).

These allergists—and the authors of the Bamba studies—participated in an American Academy of Pediatrics consensus statement:

There is now scientific evidence (Level 1 evidence from a randomized controlled trial) that health care providers should recommend introducing peanut-containing products into the diets of ‘‘high-risk’’ infants early on in life (between 4 and 11 months of age) in countries where peanut allergy is prevalent because delaying the introduction of peanut can be associated with an increased risk of peanut allergy.

If these studies are right, introducing babies to the widest possible variety of foods as soon as they can handle solid foods (usually at 4 to 5 months) may well help prevent allergies later on.

Addition

A reader just sent another paper from the same authors, this one a randomized trial of six allergenic foods given to breastfed babies at 3 or 6 months of age.  By one analysis, allergies developed 1 to 3 years later in 7.1% of the later-introduction group and 5.6% of the earlier-introduction group—a result that was not statistically significant.  By another, allergies were much lower in the early-introduction group (2.4% vs 7.3%), especially with respect to peanut and milk allergies.  

Jun 15 2016

Seafood politics: Catfish? Really?

The Senate just voted to reverse a decision of Congress last year to remove catfish inspection from the FDA (which is usually in charge of regulating seafood) and give it to the USDA (which usually regulates meat and poultry).

Why did the 2008 and 2012 farm bills say that catfish inspection should be given to USDA?

It depends on whom you ask.

  • Defenders say it’s because USDA has the resources to protect us against unsafe Vietnamese catfish.
  • Critics said it’s to protect the Mississippi catfish industry against the food safety hazards of cheap imported catfish from Vietnam.

Indeed, the USDA inspection program is finding antibiotics and other unapproved carcinogens in catfish imported from Vietnam.

This issue, however, is a sticking point in US negotiations with Vietnam over the Trans Pacific Partnership trade agreement.

Vietnam wants the USDA catfish inspection removed as an unfair barrier to trade.

As I wrote about this issue in 2013,

What is this about?  Not fish safety, really.  It’s about protecting catfish farmers in the South and setting up “more rigorous” safety criteria that will exclude competitive foreign catfish imports, especially from Vietnam.

Food retailers and retail trade associations are for reverting inspection to FDA. They say USDA’s catfish inspection program will take years to allow imports from Vietnam, thereby causing the cost of domestic catfish to rise.

But today, Politico Morning Agriculture reports that more than 100 House Republicans are urging repeal of the USDA’s catfish inspection program, pointing out that

The Government Accountability Office (GAO) has 10 times stated that this program is “duplicative” and at “high risk” for fraud, waste, abuse, and mismanagement…This is not a food safety issue.  USDA acknowledges that catfish, regardless of where it comes from, is considered a “low risk food.”

When I wrote this issue previously, I got comments that I needed to better appreciate the superiority of USDA’s import safety program.  As I said in response:

It’s not surprising if USDA’s import safety system is better than the FDA’s.  USDA gets $14 million a year to run its currently non-operating catfish inspection system.  The FDA gets $700,000 and, according to the Government Accountability Office, has managed pretty well with it.

My conclusion then and now:

If the political fuss over catfish inspection reveals anything, it is why we so badly need a single food safety agency—one that combines and integrates the food safety functions of USDA and FDA—to ensure the safety of the American food supply.

Documents

Jun 9 2016

CSPI and Public Citizen sue the FDA over absurd delays in regulating the safety of—oysters!

The Center for Science in the Public Interest (CSPI) has sued the FDA for ignoring its 2012 petition to prevent illnesses and deaths caused by eating raw oysters from the Gulf of Mexico contaminated with toxic Vibrio vulnificus.

The lawsuit, filed jointly with Public Citizen, asks the FDA to set standards to make sure these bacteria are “nondetectable in oysters and other molluscan shellfish sold for raw consumption.”

The FDA is supposed to respond to the complaint by July 25.

This issue goes back a long way.  I wrote about it in 2011 in the context of a Government Accountability Office (GAO) report, Food Safety: FDA Needs to Reassess Its Approach to Reducing an Illness Caused by Eating Raw Oysters.

Vibrio vulnificus bacteria are considered “flesh-eating;” they kill half the 30 or so people who eat contaminated raw oysters.   Treating the raw oysters before allowing them to be sold kills the bacteria.  California requires this and nobody eating California oysters gets sick from Vibrio.  As I wrote in 2011:

In 2001, the oyster industry trade association, the Interstate Shellfish Sanitation Conference (ISSC), promised the FDA that this industry would substantially reduce Vibrio infections in oysters within seven years through a program of voluntary self-regulation and education aimed at high-risk groups. If this program failed to reduce the infection rate, the ISSC agreed that the FDA could require oysters to be treated after harvesting to kill pathogenic Vibrio.

So what happened?  Late in 2009, the FDA said it would issue rules, but backed off under pressure from the oyster industry and friendly state officials.

Despite years of warnings and promises that it obviously has no intention of meeting, the Gulf oyster industry has been able to stave off FDA regulations for 15 years at the cost of about 15 preventable deaths a year.

CSPI and Public Citizen are trying the legal route.  I hope it works.

Jun 8 2016

Where are we on Golden Rice?

Golden Rice, genetically engineered to contain beta carotene, has long been the poster child for the benefits of GMOs—as witnessed by this Time Magazine cover of July 31, 2000.Golden Rice on Time cover

Beta-carotene is a precursor of vitamin A and the idea behind this rice was that it could—a conditional word expressing uncertainty—help prevent blindness due to vitamin A deficiency in areas of the world where this deficiency is rampant.

But vitamin A deficiency is a social problem.  Fruits and vegetables containing beta-carotene are widely available in such areas, but are not grown or consumed as a result of cultural or economic issues.  If they are consumed, people cannot absorb the beta-carotene cannot be absorbed because of poor diets, diarrheal diseases, or worms.

Here we are, 16 years after the Time cover, and Golden Rice is still not on the market.

I predicted its current problems in my book, Safe Food: The Politics of Food Safety, first published in 2003.  In Table 12 (page 158) I outlined the many basic research studies and research on production, consumer acceptance and use, and clinical effectiveness that would have to be done before Golden Rice could be shown to achieve its intended purpose.  Much of this research has now been done but plenty more still needs doing on getting it produced and into the mouths of people who most need its beta-carotene.

Proponents of the benefits of Golden Rice, however, complain that anti-GMO activists are responsible for keeping the rice off the market.

Not so, says an article in the Source, a publication of Washington University in St. Louis.  Based on what some of its researchers have just published in an article in Agriculture and Human Values, the Source quotes one of its authors:

The rice simply has not been successful in test plots of the rice breeding institutes in the Philippines, where the leading research is being done,” Stone said. “It has not even been submitted for approval to the regulatory agency, the Philippine Bureau of Plant Industry (BPI)…The simple fact is that after 24 years of research and breeding, Golden Rice is still years away from being ready for release.”

As I learned long ago, even the slightest skepticism about Golden Rice is perceived by uncritical proponents of GMOs as an attack on science and the entire food biotechnology enterprise.  If you publicly express doubt that Golden Rice can solve the vitamin A problem, you will be accused, as I have been, of responsibility for the illnesses and deaths of millions of children.

As the table in Safe Food makes clear, Golden Rice is a highly technical approach to solving a nutritional problem resulting from cultural and socioeconomic factors.

Such solutions do occasionally succeed.  The best examples I can think of are iodized salt to prevent goiter and water fluoridation to prevent tooth decay.  But both of these interventions address geographical mineral deficiencies, not deficiencies resulting from cultural prohibitions or poverty.

Is Golden Rice worth a try?  Sure it is.  But not when it is used to demonstrate that GMO foods are good for the public as well as the owners of seed and pesticide companies.

Jun 7 2016

World Resources Institute report

The World Resources Institute has a new paper out: Shifting Diets for a Sustainable Food Future.

This is the most recent item in its series: World Resources Report: Creating a Sustainable Food Future.

The paper is about how food choices affect land, water and climate change.  It provides further evidence that eating less meat and dairy would be more sustainable.

Resources:

Jun 6 2016

The Senate’s (mostly unfunded) agenda for the FDA

Food Chemical News reports that the Senate Appropriations bill comes with report language instructing the FDA to:

  • Conduct a risk assessment to see how harmful it really is to eat Listeria-tainted frozen vegetables [these, presumably, would be cooked before eating].  CRF Frozen Foods had to recall of 358 organic products after 7 people became ill.
  • Release no sodium guidelines before the National Academies of Science has a chance to update the Daily Reference Intake (DRI) for sodium [which will take years].  The report says “it is “imperative that any guidance be issued using the latest sound science…based upon an updated DRI report.”  House directives said the same thing.  [The FDA has just released voluntary sodium guidelines for public comment].
  • Release its overdue report on food traceability systems: “The Committee directs the FDA to collaborate with science-based international and industry-led food traceability initiatives of the type recommended by the pilot projects…[and] to make publicly available information on FDA’s efforts to encourage…traceability initiatives.”
  • Reconsider its E. coli standard.  The Senate views this standard as too stringent and disruptive of raw milk cheese businesses.
  • Actively engage stakeholders in best practice standards for medical foods. “They should work together on “forming a framework for a distinct regulatory pathway for medical foods that does not encumber its progress towards approval for patient use.”
  • Better enforce standards for antibiotics in shrimp imports.
  • Sample olive oil bottles at retail to determine if they are adulterated, and report findings to Congress.
  • Report on efforts to implement regulations for the growing commercial human milk industry.

Some of these directives would improve food safety, but some would not.

All make more work for the FDA.

Does the Senate also plan to appropriate sufficient funds for the FDA to do all this in addition to what it is already doing?  Want to take bets?

Jun 3 2016

Weekend reading: Science & Nutrition Research

I’ve just started getting a new Science and Research newsletter from William Reed: Informing Business Growth.

Some of the listings focus on dietary patterns or emerging microbiome research:

But most of them focus on single nutrients, ingredients, or foods—suggesting that they are about marketing those ingredients, not necessary health (people don’t eat single foods exclusively; we eat meals and mixtures).

These are a lot of fun.  They raise the possibility of magic bullets (if only).

But watch out for the weasel words “may,” “could,” “might”.  These mean “may or may not,” “could or could not,” “might or might not.”

Wouldn’t you rather eat chocolate than beets?  That’s what such studies are about.  And I wonder how many of them are funded by the makers of the products.  Want to take a look?

Jun 2 2016

Open for comment: the FDA’s new guidance for voluntary salt reduction

Yesterday, the FDA opened for public comment its long-awaited guidance for industry about reducing salt in processed food products.  The guidance affects about 150 products.  It gives baseline data for those products and sets targets for salt reduction.

Please note that I am using the word salt, not sodium.  The targets are for sodium reduction.  Most dietary sodium comes from salt added to processed foods and pre-prepared foods.  Salt is 40% sodium.  The target dietary intake of 2300 mg sodium comes to just under 6 grams of salt a day, which is not particularly low.  It is, however, lower than current intake levels.

In a blog post, FDA official Susan Mayne said the link between sodium intake and blood pressure is “strong and well documented,” but

In fact, it’s very difficult in the current marketplace NOT to consume too much sodium. The average intake today is over 3,400 milligrams—significantly more than the 2,300 milligram limit recommended by federal guidelines. And it’s not just adults who are eating too much sodium: Children and teens consume more than is recommended.

Vox, for example, provides a terrific chart on the amounts of sodium in foods.  It starts with this:

Susan Mayne goes on to explain that

the FDA assessed the sodium content of thousands of products in the marketplace and engaged with experts in industry, academia, and government to get the best available scientific and technical input. We know that sodium has important functions in many foods, such as taste, texture, and microbial safety… Our approach encourages gradually reducing sodium in the majority of foods that contain it…Moreover, our draft targets apply to processed and prepared foods that are eaten both at home and outside the home.

Despite the voluntary nature of the guidance and the lengthy timeline (up to ten years) for implementation, the makers of processed foods are sure to object.  At their urging, the House committee on appropriations, in draft report language, urged the FDA to postpone guidance on salt until the CDC and Institute of Medicine update the Dietary Reference Intake standards for sodium intake.

The Salt Institute, the trade association for the salt industry, issued a press release charging malpractice:

The issuance today of new “voluntary” sodium reduction mandates by the FDA is tantamount to malpractice and inexcusable in the face of years of scientific evidence showing that population-wide sodium reduction strategies are unnecessary and could be harmful. This effort will limit the food choices of Americans, not increase them as the FDA claims. It will make our food less safe and endanger public health.

In JAMA, CDC Director Thomas Frieden rebuts the scientific arguments point by point and, in my view, demolishes them.  He explains how important this initiative is to public health:

Thirty-nine countries have established sodium targets for foods and meals, with 36 of those adopting voluntary approaches. Setting targets helps create a level playing field for the food industry, supporting reductions already begun by companies such as Walmart, Darden, Unilever, PespsiCo, General Mills, Mars, Nestlé, and others. The United Kingdom set voluntary sodium reduction targets in 2003; from 2003 to 2011 sodium intake decreased 15%. During this same period, average blood pressure decreased, and, following no change in prior years, deaths from ischemic heart disease and stroke decreased by approximately 40% [the reference for this last statement is BMJ Open. 2014;4(4):e004549].

Most people would be healthier cutting down on salt intake.  Food company executives know this.  Politico Morning Agriculture points out that some Big Food companies have joined the public health community in supporting the FDA’s proposal.

The band of strange bedfellows – the American Heart Association, Mars, Academy of Nutrition and Dietetics, Nestlé, PepsiCo, American Public Health Association, Unilever and the Center for Science in the Public Interest – all signed on to a letter last month to Senate Appropriations ag subcommittee Chairman Jerry Moran and ranking member Jeff Merkley to support the FDA on sodium. Find that here.

From a public health perspective, the FDA initiative is a step in the right direction but could go further.  It should have required mandatory salt reduction.  Judging from the Salt Institute’s reaction, this is still a big step.  The New York Times quotes Michael Jacobson:

“The F.D.A. found a sweet spot between doing nothing and regulating…This will at least give the public benchmarks against which we can gauge sodium content of foods.”

FDA resources:  

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