Thanks to Bradley Flansbaum for sending this one from a journal not on my usual reading list: “In persons with constipation or IBS-C, kiwifruit vs. psyllium increased spontaneous bowel movements.”

I like the way this press release gets right to the point.

An industry-funded randomized trial assessed the effect of daily consumption of kiwifruit versus psyllium on GI function and comfort in 184 adults who were healthy, had functional constipation (FC), or met Rome III diagnostic criteria for constipation-predominant irritable bowel syndrome (IBS-C).

The study: Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort—Results of an International Multicenter Randomized Controlled Trial.  The American Journal of Gastroenterology ():10.14309/ajg.0000000000002124, January 9, 2023. | DOI: 10.14309/ajg.0000000000002124.

Authors: Gearry, Richard MD, PhD; Fukudo, Shin MD, PhD; Barbara, Giovanni MD; Kuhn-Sherlock, Barbara PhD; Ansell, Juliet PhD; Blatchford, Paul PhD; Eady, Sarah MSc; Wallace, Alison PhD; Butts, Christine PhD; Cremon, Cesare MD; Barbaro, Maria Raffaella PhD; Pagano, Isabella MD; Okawa, Yohei PhD; Muratubaki, Tomohiko PhD; Okamoto, Tomoko PhD; Fuda, Mikiko MS; Endo, Yuka MD; Kano, Michiko MD, PhD; Kanazawa, Motoyori MD, PhD; Nakaya, Naoki PhD; Nakaya, Kumi PhD; Drummond, Lynley BTech (Hons)

Summary of the study

Methods: Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week.

Results: Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001).

Conclusion: This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.

Financial support: Zespri International Ltd. was the principal sponsor and reviewed, approved, and funded the study design. The New Zealand study center trial was jointly funded by a grant from the New Zealand government (Contract C11X1312) and the sponsor company, Zespri International Ltd. In Italy and Japan, Zespri International Ltd. was the sole funder for each study center trial. The funder did not contribute to the study design or data analysis.

Potential competing interests: J.A. and P.B. are employed by Zespri International who part-funded the study. R.G. and L.D. sit on the Science Advisory Board, have received travel and research grants from Zespri International. SF and GB have received research travel grants from Zespri International.

Comment:  Can you guess what Zespri International sells?  Go on.  Take a wild guess.  I’ll admit it.  I’d go for kiwi over psyllium every time.  But we are talking here about an average improvement of 1.5 bowel movements a week, which may or may not be clinically meaningful..  I do give the authors credit for claiming a benefit for “fresh whole fruit,” not specifically kiwifruit.  The study didn’t compare kiwi to other fruits (and why would it, given the kiwi fruit sponsor).  But overall, this is yet another study done for marketing far more than scientific purposes.

Welcome to New York City ‘s new “Eat A Whole Lot More Plants” campaign “to put scrumptious sprouts and piquant produce on New Yorkers’ menus.”

The Health Department launched a new campaign that urges New Yorkers to put plants on their plates and adopt a healthy balanced diet full of whole foods. Whole and minimally processed plant foods like fruits, vegetables, whole grains, beans, and nuts are good for health as they are high in fiber, vitamins, and minerals and don’t come packaged with high amounts of sodium, added sugar, or unhealthy fats. The campaign titled “Eat A Whole Lot More Plants” highlights how eating a diet with lots of plants is one way to improve health and can help manage and reduce risk of type 2 diabetes.

The campaign begins with video ads.

It includes  ideas to increase intake of tasty shrub grub, like fruits, vegetables, beans, nuts, and whole grains.

It “builds on the Mayor’s commitment to improve the food environment and combat climate change throughout New York City. ”

The campaign includes:

• Plant-powered Fridays in public schools.
• Updated NYC Food Standards for Meals and Snacks Purchased and Served and for Food, Vending Machines on City Property.
• Plant-based meals in public hospitals.
• Commitment to reduce absolute carbon emissions from food purchases across city agencies by 33% by 2030.
• A new partnership with the American College of Lifestyle Medicine (ACLM) to provide every New York City health care practitioner with free introductory training in lifestyle medicine with a special focus on plant-based nutrition.
• An expansion of NYC Health + Hospitals’ (H+H) groundbreaking lifestyle medicine services at six new sites across all five boroughs to provide patients living with chronic diseases such as type 2 diabetes and high blood pressure the tools, support, and guidance to treat and prevent common conditions using lifestyle interventions including a plant-predominant eating pattern.

I hope it also includes an evaluation.  Let’s try it and see if it works!

There’s a lot of new product development going on in the plant-forward arena: chocolate, cheese, and anything else you can think of.

Which of these products will survive?  You get to decide that one.

• • Hershey debuts plant-based Reese’s and chocolate bar: The confections, which will hit shelves in March and April, are made with oats. This will be the first time the company offers permanent products in the category.<
  • Inside Lovo’s quest to rethink plant-based milk chocolate:  The new brand from the founders of Pascha makes almond, oat, coconut and hazelnut milk the star ingredients, leaning into what consumers love about the popular alternatives.
  • ‘We were told this was impossible’: Meet FÆRM, the start-up that plans to revolutionize plant-based cheese:  The Danish company says it’s among the first to successfully adapt traditional cheesemaking techniques in the manufacture of plant-based cheese. Now, FÆRM has joined the Venture Lab accelerator program in a bid to commercialize its patented technology…. Read more
  • Cargill embraces ‘smarter’ fats to perk up plant-based options in Europe: The ingredients supplier has joined forces with Spanish food tech start-up Cubiq Foods aimed at accelerating healthier, more sustainable and better-tasting plant-based food solutions…. Read more
  • Dairy alternatives: “We have to be realistic about the growth outlook,” warns Rabobank analyst:  The plant-based dairy market may be reaching maturity while the cell-based and precision fermentation dairy segments are just getting started…. Read more
  • 23 New Plant-Based Foods Coming to Market in 2023: Even if they don’t go fully vegan or vegetarian, research indicates a growing number of people are adding more plant-based foods to their diet.
  • 14 Best Vegan Products to Try in 2023: Vegans these days have it easy thanks to the brave souls that paved the way before us: Early vegans drank rice milk and ate soy patties so that we could enjoy JUST Eggs and Impossible burgers. There’s a new wave of veganism and consumers have put out a cry for tastier options.

I could hardly believe this ad in the New York Times last Friday.

Cattle as a promoter of biodiversity?

My usual question: Who paid for this?

The only clue was the little checkmark and in tiny letters “Funded by beef farmers and ranchers.”

I did the thing with the QR code and went straight to www.beefitswhatsfordinner.com, the website of the Cattlemen’s Beef Board and the National Cattlemen’s Beef Association, organizations paid for by per-animal levies imposed by USDA-sponsored checkoff programs.

The beef checkoff

acts as a catalyst for change and is designed to stimulate beef sales and consumption through a combination of initiatives including consumer advertising, research, public relations and new-product development.

The ad says:

Almost a third of U.S. land is too rocky or dry to be used for growing food crops.  But cattle can graze on and regenerate that land, naturally protecting open space and conserving precious habitats and ecosystems.

Yes, they can, but participants in the Beef checkoff generally raise cattle in CAFOs (factory feedlots), the antithesis of grazing on and regenerating land.

The beef industry is under siege these days from people who care about health and the environment.

Instead of doing all it can to promote regenerative grazing, it uses public relations to deflect attention from how it really raises cattle.

Butterflies?  Not a chance.

CORRECTION:  Several readers have written to complain that I obviously know nothing about how cattle are raised.  “You idiot,” they say (or imply), “cattle are raised on grass until the last few months of their lives.”  Not only that, says one reader, but their grazing on grass produces ecological miracles (see, for example, this video.)  That, however, still leaves them with months of finishing off on grains in feedlots, somehow not mentioned in the Beef Checkoff ad.  It may be, as one reader tells me, that beef producers hate this system and hate paying for it with checkoff funds, but that’s how it works.  Advocacy, anyone?  In any case, I apologize for not including this iinformation n my original post.

Here’s one of the most important—and alarming—papers I’ve seen in a long time.

Critical data at the crossroads: the National Health and Nutrition Examination Survey [NHANES] faces growing challenges

In summary, NHANES is at crossroads. Its many past successes are impressive, given the ambition of its goals and the complex nature of the data it has been designed to collect. However, the effect of years of inflation on the survey’s stagnant budget has undercut activities to meet the future, and the potentially game-changing nature of newer challenges cannot be avoided. A NASEM study to set the stage for the future of NHANES—that is, to provide an actionable framework—is a critical and prudent step forward. Certainly, maintaining the status quo and failing to adapt to emerging challenges cannot be an option for a survey vital to the nation’s health.

The National Nutrition Monitoring and Related Research Act of 1990 established a system for tracking diet and health in the United States.  Its passage was a long time coming and a terrific step forward.

The Act legally established the National Nutrition Monitoring and Related Research Program and numerous activities including development and implementation of a Ten-Year Comprehensive Plan and formation of the Interagency Board for Nutrition Monitoring and Related Research. Both requirements serve as the basis for planning and coordinating the activities of 22 Federal agencies that either conduct nutrition monitoring surveys and surveillance activities or are major users of nutrition monitoring data.

It set up the data collection system for What We Eat in America and the National Health and Nutrition Examination Survey (NHANES), Originally, the surveys were done by separate agencies, but they are now integrated under the CDC. 

It’s hard to overstate their importance.  Here’s a short list of how what the data are used for:

Everything we know about diet and health—and trends—in the U.S. comes from these surveys.

The report makes it clear that:

• The CDC has been letting the surveys slide.
• They are badly underfunded.
• Nobody is paying attention to them.
• They are not able to collect the data they need.
• They are not being revised or modernized to collect new kinds of data.
• They do not have champions in the public or in government.

I remember what it took to get the 1990 act: concerted efforts from advocacy groups and government nutrition personnel, and a series of reports over a ten-year period.  

Do we need to go through all that again?  It sure looks that way.

The paper calls for a deep investigation of the nutrition monitoring system.

the single most effective action at this time would be an overall and integrated examination of NHANES in the context of its future. Without a well-informed and defined set of goals and recommendations, there cannot be meaningful progress. Such a study would need to not only carry the gravitas of diverse experts with experience and knowledge related to health surveys and to health and nutrition data collection but also provide an independent and consensus-driven report.

That seems like a bare minimum.  Let’s get to it right away.

My thanks to Arun Gupta for sending this one from a newspaper in India.

The clipping refers to this article.

• The study: Ostendorf, D.M., Schmiege, S.J., Conroy, D.E. et al.Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis.Int J Behav Nutr Phys Act18, 158 (2021). https://doi.org/10.1186/s12966-021-01225-5.
• First sentence : “High levels of moderate-to-vigorous physical activity (MVPA) are strongly associated with sustained weight loss [1, 2], and current guidelines recommend high levels of PA for weight management .”
• Methods: Participants were asked to follow a weight-loss diet and to do 300 minutes per week of exercise.  The investigators lstudies participants’ motivation levels.
• Conclusion: once exercise supervision and support was removed, adults in the high autonomous motivational profile were protected against the standard attenuation in MVPA following removal of support/supervision.
• Competing interests: “The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DC reports consulting income from Gelesis, Inc., a company that has developed a weight loss device.  SP has a grant from WW International [formerly, Weight Watchers] unrelated to this work.”

Comment: As far as I can tell, the paper says nothing about exercise being more important than diet.  The study didn’t find any differences in weight among people with different levels of motivation.  We can’t blame the authors for the press account.    But anything that minimizes the need for dietary changes gets pounced on.  Alas.

A press release from the World Health Organization announces recommendations on the use of artificial, non-nutritive (meaning no-calorie) sweeteners: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that use of NSS does not confer any long-term benefit in reducing body fat in adults or children. Results of the review also suggest that there may be potential undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The recommendation not to use artificial sweeteners for weight control or chronic disease prevention applies to:

all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars. Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

The guideline document notes:

The recommendation in this guideline was made based on evidence that suggests that there may be health effects associated with NSS use irrespective of which NSS is being used – that is, NSS as a class of compounds, despite individual NSS having different chemical structures, may have an impact on health…individual NSS have different sweetness intensities and organoleptic properties, and are processed differently by the body. Although limited  evidence suggests that individual NSS may also differ in some of their physiological effects in humans, the evidence is currently insufficient to make
recommendations for individual NSS.

Overall, the evidence summarized in the document shows benefits from short-term studies but not ones that last longer than three months or so.  After that, use of non-nutritive sweeteners is associated with potential harm.

At issue, of course, is the mechanism.  These remain speculative: calorie compensation? mainenance of taste preference?  microbiome?

Much of the research into biological mechanisms has been carried out in in vitro and rodent models, and further research is needed to determine whether observations in non-human models translate to humans.  Although there are as yet no conclusive mechanistic links between NSS use and many of the associations observed in prospective cohort studies, that plausible mechanisms have been identified, tested and in some cases validated (albeit mostly in non-human models) reinforces the seriousness with which the associations observed in prospective cohort studies should be considered and highlights the need for further exploration of possible mechanisms with additional research.

Until then, it seems best to avoid them (I don’t like their taste anyway).

• View the press release here
• Access the guideline here

Questions?

• Please email any questions to: NFS@who.int 

To the surprise of everyone as far as I can tell, the Supreme Court has upheld California’s ban on pork from states that allow pork producers to confine pregnant sows in gestation crates.

California, which consumes 13% of U.S. pork but imports 99% of it, said it would only permit import of pork from producers who give pregnant sows at least 24 square feet of space.

Gestation crates confine pregnant sows so tightly that all they can do is stand up and lie down.

I would not call myself an animal rights advocate, but having been pregnant myself a couple of times, I found myself deeply upset when I saw sows confined like that.

At the time, I was on the Pew Commission on Industrial Farm Animal Production.

We asked why they were doing this.  Answer: To keep the sow from crushing her piglets—and to make it easier to feed and clean the animals.

Fortunately, Bill Niman was also on the commission and whisked us off to one of the Niman Ranch farms where we could see sows, each in her own hoop tent, happily tending to piglets and rolling in mud when she felt like it.

Did the sows crush their piglets?  Not when they had ample room to move around ard were not stressed.  Yes, they didn’t produce quite as many piglets, but the meat tasted a lot better.

So I’m happy to see the pig crates disappear, which they will have to if anyone wants to sell pork in California.

This case is not really about animal rights though.  It is about states’ rights to make laws like this one.

The pork producers challenged California’s law.  But Justice Neil Gorsuch writing for the majority said:

California voters overwhelmingly endorsed the “ethical pork” law in 2018 and have the right to decide what products appear on store shelves…Companies that choose to sell products in various States must normally comply with the laws of those various States, “While the Constitution addresses many weighty issues, the type of pork chops California merchants may sell is not on that list.”

It’s amazing to have something good come out of this court.  Maybe pig crates will set a precedent.