Tom Farley, MD.  Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives.  Norton, 2015.

Dr. Farley is the former New York City Health Commissioner under Mayor Michael Bloomberg, the second Tom in that position (the first was Tom Frieden, now head of the CDC).

He has produced a wonderfully written, personal, eye-witness, in-the-trenches account of how the New York City Department of Health and Mental Hygiene led the nation in creating public health interventions to reduce smoking, get rid of trans fats. put calorie labels on restaurant menus, and reduce soda consumption—with impressive improvements in the health of New Yorkers.

His book also covers the Department’s failures to convince the USDA to allow a pilot project to get sodas out of SNAP and the courts to support the city’s proposal to cap the sizes of sugary drinks at 16 ounces.

For me, a New York City resident  who lived through these events and wrote about some of them in Soda Politics, this book was fun, even gossipy, and disclosed things I hadn’t known.  It has much to teach anyone about how the politics of city public health agencies, how to get things done in complicated city institutions, and how to treasure even the smallest successes.

This particular health department had three things going for it: courageous health commissioners, huge city health problems that desperately needed to be addressed, and a mayor fearless (and rich) enough to take on the challenges.

Farley ends the book with a quote from Bloomberg:

While government action is not sufficient alone, it is nevertheless absolutely essential.  There are powers only governments can exercise, policies only governments can mandate and enforce, and results only governments can achieve.  To halt the worldwide epidemic of noncommunicable diseases, governments at all levels must make healthy solutions the default social option.

That is, ultimately, government’s highest duty.

Amen.

Every now and then something reminds me about food nanotechnology, the use of molecular size nanoparticles to whiten or improve the safety or shelf life of processed foods (see previous posts on the topic).

What brought this on is a recent report from Australia that sounds all too familiar.  Friends of the Earth commissioned tests and found “nanoparticles of titanium dioxide and silica in 14 popular products, including Mars’ M&Ms, Woolworths white sauce and Praise salad dressing.”  Australian regulators, however, have denied that nanoparticles are in use “because no company had applied for approval.”

Last year, Friends of the Earth did the same in America.  Its report, “Tiny Ingredients Big Risks,” documents nanomaterials in more than 90 food products, among them Jet Puffed Marshmallows, Trix Cereal and Nestle Original Coffee Creamer.

Nanoparticles are really small (10^-9 meters, or one millionth of a millimeter).  How they work and what they might do to the human body is greatly in need of research.

The FDA’s guidance to industry—nonbinding and, in my opinion, not particularly helpful—says nanoparticles are safe in foods but that companies using them should let the FDA know about it.

It is prudent practice for you to do so, particularly when the manufacturing process change involves emerging technologies, such as nanotechnology…The consequences (to consumers and to the food industry) of broadly distributing a food substance that is later recognized to present a safety concern have the potential to be significant…FDA does not categorically judge all products containing nanomaterials or otherwise involving application of nanotechnology as intrinsically benign or harmful. Rather, for nanotechnology-derived and conventionally-manufactured food products alike, FDA considers the characteristics of the finished product and the safety of its intended use.

Are they really safe?  Nobody knows, leaving much room for unease, as Twilight Greenaway pointed out in Grist in 2012.  Her Grist colleague Tom Philpott wrote about this question even earlier—in 2010: “The strategy seems to be: release into the food supply en masse first; assess risks later (if ever).”

This is not reassuring

Web MD suggests that “while researchers are still sorting it out, avoid heavily processed foods, and read labels if you’re concerned.”

Good advice, and another reason to avoid heavily processed foods.

Politico Morning Agriculture (behind a firewall, unfortunately) reported this morning that Bruce Silverglade has filed a letter on behalf of The Sugar Association objecting to the FDA’s proposal to put Added Sugars on food labels.

The objection is on procedural grounds.  The Sugar Association opposes the FDA’s labeling proposal and wants the agency to allow more time for public comment (and, of course, additional time for lobbying against the measure).

Silverglade is now an attorney at Olsson Frank Weeda Terman Matz.  He joined this firm after resigning from the Center for Science in the Public Interest (CSPI), where he had worked as director of legal affairs for more than 25 years.

CSPI has advocated for policies to reduce sugar intake for many years, and favors putting Added Sugars on labels (as I explained in a previous post).

The “Revolving Door”—-exchange of positions between the food industry and government—often raises uncomfortable questions.

This example, a move from a food advocacy group to The Sugar Association, is unusual.  And sad.

Last month, the New York City Board of Health voted to require chain restaurants to publish warnings when menu items contain more than the recommended daily limit for sodium, thus taking the lead on regulating the amount of salt in foods.

Salt, says the city health department, is a leading cause of cardiovascular disease but also a leading driver of health disparities: blood pressure levels are higher in African-American populations.

The rule, which takes effect December 1, says that chains with 15 or more locations in New York City must display a warning symbol — a salt shaker inside a triangle — if the item has more than 2,300 milligrams of salt.

The policy does not restrict choice or limit how much sodium can be in food.

The New York State Restaurant Association (NRA) called the new rule “burdensome.”

It issued a statement:

This is just the latest in a long litany of superfluous hoops that restaurants here in New York must jump through…Every one of these cumbersome new laws makes it tougher and tougher for restaurants to find success.

The health department estimates the regulation will apply to 10 percent of all menu items.  Some examplesof affected products (For the record, 40% of salt is sodium; for grams of salt multiply by 2.5):

• Panera Bread Smokehouse Turkey Panini (2,590 mg),                  “
• TGI Friday’s sesame jack chicken strips (2,700 mg)
• Regular-size Applebee’s Grilled Shrimp ‘n Spinach Salad (2,990 mg)
• Subway footlong spicy Italian sub (2,980 mg)
• Red Robin monster-size salted caramel milkshake (3,400 mg)

But the Salt Institute, a salt producers’ trade group, called the policy “misguided”:

This is another example of the government creating policy based on outdated, incorrect sodium guidelines that have been refuted by ten years of research. Research shows Americans already eat within the safe range of sodium consumption and population-wide sodium reduction strategies are unnecessary and could be harmful,” said Lori Roman, President of the Salt Institute.

The consumer group Center for Science in the Public Interest said the proposed warnings “will prompt restaurants to use less salt and will help consumers reduce their risk of stroke or heart attack.”

This one will be interesting to watch.  Will people pay attention?  Will chain restaurants take steps to reduce sodium levels?  Will hypertension levels decline?  I hope researchers are hard at work collecting baseline data.

Do sugar-sweetened beverages increase the risk of high blood pressure?

Yes, says this study, which was conducted by investigators who accept research funding from Coca-Cola and the Calorie Control Council (a trade association for companies that make or use artificial sweeteners).  But the study itself was funded by independent government agencies or health associations in Canada.

I’m counting it in the category of studies with results unfavorable to the food industry sponsors.

This brings the score to 70 industry-funded studies since mid-March with results favorable to the sponsor, to 6 with unfavorable results.

Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts.  Viranda H Jayalath, Russell J de Souza, Vanessa Ha, Arash Mirrahimi, Sonia Blanco-Mejia, Marco Di Buono, Alexandra L Jenkins, Lawrence A Leiter, Thomas MS Wolever, Joseph Beyene, Cyril WC Kendall, David JA Jenkins, and John L Sievenpiper.  Am J Clin Nutr 2015; 102:914-921 doi:10.3945/ajcn.115.107243.

• Conclusions: SSBs were associated with a modest risk of developing hypertension in 6 cohorts. There is a need for high-quality randomized trials to assess the role of SSBs in the development of hypertension and its complications.
• Funding: “The Canadian Institutes of Health Research…through the Canada-wide Human Nutrition Trialists’ Network and by the Diet, Digestive Tract, and Disease (3D) Centre, which is funded through the Canada Foundation for Innovation.  The Ministry of Research and Innovation’s Ontario Research Fund provided the infrastructure for the conduct of this project.”  Some of the investigators also received funds from Canadian government agencies or health associations.
• Authors’ funding disclosures: RJdS has received research support from the Calorie Control Council and the Coca-Cola Company…ALJ is a part owner, vice president, and director of research of Glycemic Index Laboratories, Toronto, Canada….JB has received research support from the Calorie Control Council and The Coca-Cola Company…CWCK has received research support from the Calorie Control Council, the Coca-Cola Company (investigator initiated, unrestricted grant), Hain Celestial, Kellogg, Kraft, Loblaw Companies Ltd., Solae, and Unilever…DJAJ has received research grants from Loblaw Companies Ltd., Unilever, the Coca-Cola Company… JLS has received research support from the Calorie Control Council and the Coca-Cola Company…travel funding, speaker fees, or honoraria from the Calorie Control Council, the Canadian Sugar Institute, World Sugar Research Organization, White Wave Foods, Abbott Laboratories, Dairy Farmers of Canada, Dr. Pepper Snapple Group, The Coca-Cola Company, and the Corn Refiners Association….

Comment

This is an exception that proves the rule.  In this study, a group of investigators, some—but not all— of whom typically receive funding from food companies, participated in a study funded by Canadian government and health agencies.

One possible explanation is that when investigators typically funded by soda companies are funded independently,  they design and conduct independent research.

If nothing else, this study is evidence for the need for and value of independent funding of nutrition research.

Forrest Pritchard.  Growing tomorrow: A Farm-to-Table Journey in Photos and Recipes.  The Experiment, 2015.

I did a blurb for this book:

Who says that nobody is going into farming these days or that you can’t make a living growing foods organically and sustainably?  Certainly not the 18 pioneers described in this lovely, inspiring book.  Forrest Pritchard chose farmers of diverse crops—mushrooms, honey, lobsters, avocados, grain, beef, and more—and tells the personal stories of how they created lives of deep productivity and satisfaction.  Any aspiring farmer or consumer of freshly farmed products will get great pleasure from reading this book and admiring its photos.

A reminder that since mid-March I’ve been collecting studies funding by food companies.  These greatly tend to produce results favorable to the sponsor’s interests.  Today’s group makes 70.  I have an ongoing call out for sponsored studies that don’t.  So far I’ve found 5 .  If you run across either kind, please send.

Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age. Jamie I Baum, Michelle Gray, and Ashley Binns.  J Nutr 2015;145:2229–35.

• Conclusion: This study indicates that breakfast macronutrient composition affects postprandial responses in both NW [normal weight] and OW [overweight] children. A PRO [high protein breakfast] increases postprandial EE [energy expenditure] and fat oxidation, reduces hunger, and increases satiety when compared with a carbohydrate-based breakfast.
• Funding: Supported by a grant from the Egg Nutrition Center/American Egg Board, Chicago, IL.
• Added note: this one is a repeat of one posted earlier.

Dietary Whey and Casein Differentially Affect Energy Balance, Gut Hormones, Glucose Metabolism, and Taste Preference in Diet-Induced Obese Rats.  Adel Pezeshki, Andrew Fahim, and Prasanth K Chelikani. J. Nutr. 2015; 145:2236-2244 doi:10.3945/jn.115.213843

• Conclusion: Together, these data demonstrate that in obese rats, whey, casein, and their combination improve energy balance through differential effects on food intake, taste preference, energy expenditure, glucose tolerance, and gut hormone secretion.
• Funding: Supported by operating grants from the Alberta Livestock and Meat Agency, Alberta Innovates Bio-Solutions, Alberta Milk…Whey protein isolate for this study was donated by Agropur Dairy Cooperative (Canada).

Consumption of Yogurt, Low-Fat Milk, and Other Low-Fat Dairy Products Is Associated with Lower Risk of Metabolic Syndrome Incidence in an Elderly Mediterranean Population.  Nancy Babio, Nerea Becerra-Tomás, Miguel Ángel Martínez-González, Dolores Corella, Ramon Estruch, Emilio Ros, Carmen Sayón-Orea, Montserrat Fitó, Lluís Serra-Majem, Fernando Arós, Rosa M Lamuela-Raventós, José Lapetra, Enrique Gómez-Gracia, Miguel Fiol, Andrés Díaz-López, José V Sorlí, J Alfredo Martínez, Jordi Salas-Salvadó, on behalf of the PREDIMED Investigators.  J. Nutr. 2015; 145:2308-2316 doi:10.3945/jn.115.214593

• Conclusions: Higher consumption of low-fat dairy products, yogurt (total, low-fat, and whole-fat yogurt) and low-fat milk was associated with a reduced risk of MetS [metabolic syndrome] in individuals at high cardiovascular disease risk from a Mediterranean population. Conversely, higher consumption of cheese was related to a higher risk of MetS.
• Funding: This study was funded in part by the Spanish Ministry of Health…Thematic Network…the European Regional Development Fund, and the Catalan Nutrition Center of the Institute of Catalan Studies.
• Author disclosures: N Babio received consulting fees from Danone. R Estruch served on the board of, and received lecture fees from, the Research Foundation on Wine and Nutrition…E Ros served on the board of, and received travel support and grant support through his institution from the California Walnut Commission; served on the board of the Flora Foundation (Unilever)… L Serra-Majem is a member of the Scientific Advisory Board and received consulting fees and grant support from the European Hydratation Institute, received lecture fees from the International Nut Council, and received travel support from Nestle. F Arós received payment for the development of educational presentations from Menarini and Astra Zeneca. RM Lamuela-Raventós serves on the board of, and received lecture fees from, the Research Foundation on Wine and Nutrition; received lecture fees from Cerveceros de España; and received lecture fees and travel support from PepsiCo. J Salas-Salvadó served on the board of, and received grant support through his institution from the International Nut and Dried Fruit Council; received consulting fees from Danone; and received grant support through his institution from Eroski and Nestlé. N Becerra-Tomás, MÁ Martínez-González, D Corella, C Sayón-Orea, M Fitó, J Lapetra, E Gómez-Gracia, M Fiol, A Díaz-López, JV Sorlí, and JA Martínez, no conflicts of interest.
• Comment: This study was funded by independent agencies but the authors report many financial connections to food companies.

Type and amount of dietary protein in the treatment of metabolic syndrome: a randomized controlled trial.  Alison M Hill, Kristina A Harris Jackson, Michael A Roussell, Sheila G West, and Penny M Kris-Etherton.  Am J Clin Nutr 2015; 102:757-770 doi:10.3945/ajcn.114.104026

• Conclusions: Weight loss was the primary modifier of MetS [metabolic syndrome] resolution in our study population regardless of protein source or amount. Our findings demonstrate that heart-healthy weight-loss dietary patterns that emphasize either animal or plant protein improve MetS criteria similarly.
• Funding: Supported by The Beef Checkoff and the General Clinical Research Center, The Pennsylvania State University.
• Comment: The point of this study was to demonstrate that animal protein is not harmful.

Oral Vitamin D Supplements Increase Serum 25-Hydroxyvitamin D in Postmenopausal Women and Reduce Bone Calcium Flux Measured by ⁴¹Ca Skeletal Labeling.  Andreas Schild, Isabelle Herter-Aeberli, Karin Fattinger, Sarah Anderegg, Tim Schulze-König, Christof Vockenhuber, Hans-Arno Synal, Heike Bischoff-Ferrari, Peter Weber, Arnold von Eckardstein, and Michael B Zimmermann.  J. Nutr. 2015; 145:2333-2340 doi:10.3945/jn.115.215004

• Conclusion: In healthy postmenopausal women, increasing serum 25(OH)D primarily affects calcium transfer from the central compartment to a fast exchanging compartment…A serum 25(OH)D concentration of ∼40 μg/L achieves ∼90% of the expected maximal effect on this transfer rate.
• Funding: This study was supported by DSM Nutritional Products Ltd. and the ETH Zurich, Switzerland.
• Author disclosures: P Weber is employed by DSM Nutritional Products.
• Comment: Although this study addresses a basic research question, its results favor the use of vitamin D supplements and, therefore, the interests of this supplement company.

Two events yesterday:

#1.  USDA and HHS announce that sustainability will not be part of the Dietary Guidelines.

This year, we will release the 2015 edition, and though the guidelines have yet to be finalized, we know they will be similar in many key respects to those of past years. Fruits and vegetables, low-fat dairy, whole grains and lean meats and other proteins, and limited amounts of saturated fats, added sugars and sodium remain the building blocks of a healthy lifestyle.

…In terms of the 2015 Dietary Guidelines for Americans (DGAs), we will remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (NNMRRA), which is to provide “nutritional and dietary information and guidelines”… “based on the preponderance of the scientific and medical knowledge.”  The final 2015 Guidelines are still being drafted, but because this is a matter of scope, we do not believe that the 2015 DGAs are the appropriate vehicle for this important policy conversation about sustainability.

OK, but see Michele Simon’s analysis of the legal issues related to sustainability in the guidelines, and My Plate My Planet’s analysis of the comments filed on the sustainability question.

As my analysis shows, the USDA and HHS would be well within its legal authority to include sustainability. In summary:

• A plain reading of the statute does not preclude sustainability;
• The Congressional intent was to further a broad agenda on health;
• Previous DGA versions included issues beyond “nutrition and diet”.

And also see Kathleen Merrigan et al’s argument in favor of sustainable dietary guidelines in Science Magazine.

So this is about politics, not science.

#2.  A coalition of critics of the Dietary Guidelines is attempting to block their release.

Yesterday’s Hagstrom Report and, later, Politico (both behind paywalls) reported that this group is calling on  USDA and HHS to turn over the guidelines to a committee of the National Academy of Sciences Food and Nutrition Board for reexamination before releasing them to the public.

The issues?  The meat and beverage recommendations.

The group is funded by philanthropists Laura and John D. Arnold, who fund Nina Teicholz’s work.

Teicholz is on the board of the group as is Cheryl Achterberg, dean of the Ohio State University College of Education, and John Billings, who directs the Wagner School’s Health Policy and Management Program at NYU (why they agreed to do this is beyond me).

Hagstrom notes that coordinating support is coming from Beth Johnson, a former undersecretary for food safety at USDA who has her own consulting firm with clients apparently including the National Restaurant Association and the National Cattlemen’s Beef Association.

Other members of the advisory board include several scientists who do research funded by food companies.

The Coalition’s website is here.

This morning’s Politico Pro Agriculture has a long piece on the funding behind the coalition.

In the lead up to congressional hearings on the proposed 2015 dietary guidelines, the Arnolds are spending an initial $200,000 to communicate that critique and to advocate for changes that they say would improve the process. They have funded the new political action group, called The Nutrition Coalition, whose well-placed lobbyists have helped Teicholz score face-to-face meetings with top officials in Congress and the White House to push for an independent review of the guideline process. The team helped persuade lawmakers to insert language in the fiscal 2016 House agriculture spending bill to direct the National Academy of Medicine to conduct such a review.

Really? Eating fruits and vegetables and not overeating calories requires this level of lobbying?

This too is about politics.

The mind boggles.

Addition

The Hagstrom Report is keeping track of the testimony at today’s congressional hearing on the guidelines.

• Agriculture Secretary Tom Vilsack
• Health and Human Services Secretary Sylvia Burwell