Food Politics

by Marion Nestle
Apr 30 2014

The never-ending fish dilemmas

Mal Nesheim and I have an editorial in a recent issue of the American Journal of Clinical Nutrition: “Advice for fish consumption: challenging dilemmas.”

We commented on a research article evaluating blood mercury levels in adults eating seafood.

In it, we point out that

the 2010 Dietary Guidelines for Americans advise Americans to consume 8 ounces (227 g) of seafood per week to reach an average intake of 250 mg/d of the omega-3 fatty acids EPA and DHA.

This recommendation represents a substantial increase over current consumption amounts of ∼3.5 oz/wk. It is based on “moderate, consistent evidence” that the health benefits of increased seafood consumption outweigh the risks associated with methylmercury, a toxic contaminant of large predatory food fish (tilefish, shark, swordfish, king mackerel) and, to a lesser extent, albacore (white) tuna.

To avoid this toxin, the guidelines advise eating seafood typically found to be low in methylmercury, such as salmon, anchovies, sardines, and trout.

Such advice, however, leads to at least 3 dilemmas. Eating more fish might raise methylmercury intake above safe amounts. Pressures to consume more fish might place impossible demands on an already threatened seafood supply. And the obvious solution—fish farming—raises concerns about what farmed fish are fed and how farmed fish affects the environment.

We urge the 2015 Dietary Guidelines committee to take all this into consideration when making recommendations about fish consumption: “We hope that its advice for seafood consumption will help a confused public resolve some of these dilemmas and make wise seafood choices.”

Wise seafood choices may be an oxymoron, alas.

Apr 29 2014

The Bloomberg soda cap rule: not over yet

Yesterday, Health Commissioner Mary Bassett announced that the National Alliance for Hispanic health and nine other New York City organizations had filed an amicus—”friend of the court”—brief in support of the ban on sales of sodas larger than 16 ounces (the “soda cap rule”).

The amicus brief filed today…is a reminder of what this rule is about: protecting the health of New Yorkers. Corporate lawsuits and well-financed marketing campaigns do not change the documented scientific fact that there is an obesity and diabetes epidemic in our city, with the epicenter in our poorest neighborhoods. We must protect New Yorkers from corporate practices that value profits at the expense of their customers’ health.

The Alliance issued its own statement.

“The beverage industry has pursued a strategy of legal obstruction and put profits over the health of its customers,” said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health, the nation’s leading science-based advocate for Hispanic health.

The amici brief concludes:

The problem that the Rule addresses – the impact of sugary drinks in contributing to obesity and other diet-related chronic disease – is an issue of importance and urgency  for millions of New Yorkers. The crisis calls for action – including the incremental action of reducing the portion sizes of sugary drinks in restaurants. For the one of every three children born in 2000 who will develop type 2 diabetes, and for the one of every two African-American and Hispanic girls who will get the disease, the question is not whether the Rule was justified but rather “What else is being done?”  It is for their sake that the Rule was adopted. It is for their sake that the Board concluded thaqt the inconvenience to the thirsty of having to order another soda was worth it.  It is for their sake that amici urge this Court to uphold the Rule.

The soda cap rule is on appeal to the State Supreme Court.  According to the Associated Press, a hearing is scheduled for June 4.

Congratulations to the new Commissioner for keeping this idea alive.

 

Apr 28 2014

Act now: support USDA’s wellness policies for schools

Now is the time to tell USDA you support its proposed guidelines for nutrition education, physical activity, and junk food marketing in schools:

The bipartisan Healthy, Hunger-Free Kids Act of 2010 mandated that the USDA set guidelines for what needed to be included in local school wellness policies in areas such as setting goals for nutrition education and physical activity, informing parents about content of the policy and implementation, and periodically assessing progress and sharing updates as appropriate. As part of local school wellness policies, the proposed guidelines would ensure that foods and beverages marketed to children in schools are consistent with the recently-released Smart Snacks in School standards. Ensuring that unhealthy food is not marketed to children is one of the First Lady’s top priorities; that is why it is so important for schools to reinforce the importance of healthy choices and eliminate marketing of unhealthy products.

Here are two easy ways to make sure USDA follows through on the guidelines:

Center for Science in the Public Interest (CSPI) has a website set up for quick letters:

While many schools have adopted policies over the past few years to support healthy eating and physical activity, implementation has not been uniformly strong. USDA’s proposed updates will strengthen implementation, help parents be better informed about the policies, and provide schools with more tools and resources.

The Campaign for a Commercial-Free Childhood (CCFC) asks for signatures on a letter urging the USDA to ban all advertising in schools:

The USDA is urging schools only to limit junk food marketing. By attempting to set a ceiling that prohibits advertising for unhealthy foods, the USDA may set a floor that opens the floodgates for many other types of marketing in schools, setting a dangerous precedent that goes far beyond food.

Now is the time….

 

Apr 24 2014

Vermont’s GMO labeling bill: the first domino?

Vermont’s governor, Peter Shumlin, says he will sign Vermont’s GMO labeling bill.  The bill, (H112), which passed by a majority of 114 to 30:

  • Requires food manufacturers to label GMO products sold in Vermont starting July 1, 2016 (Meat, dairy, liquor and prepared foods sold in restaurants are exempt).
  • Will allow labels to say “partially produced with genetic engineering,” “may be produced with genetic engineering,” or “produced with genetic engineering.”
  • Says foods containing GMO ingredients cannot be marketed as “natural.”
  • Sets aside $1.5 million to pay for the inevitable lawsuits.

As always, the Grocery Manufacturers of America can be counted on to give the industry position.  H112

is critically flawed and not in the best interests of consumers.  It sets the nation on a costly and misguided path toward a 50-state patchwork of GMO labeling policies that will do nothing to advance the safety of consumer.

…The FDA, World Health Organization, American Medical Association and U.S. National Academy of Science have all found that foods and beverages that contain GM ingredients are safe and materially no different than conventionally produced products. Consumers who prefer to avoid GM ingredients have the option to choose from an array of products already in the marketplace labeled ‘certified organic.’

Translation: if GMO’s are safe, they are OK.  Never mind all the other reasons it would be good to label them.

GMOs are the best thing that ever happened to organics.

The lawsuits will, no doubt, invoke the First Amendment.  One attorney, Jonathan Emord, says the bill should be able to withstand the challenge.

Will Vermont’s action lead to a domino effect?  Nearly 30 other states are considering such bills.

Recall that the first company to produce GMO tomatoes intended to label them (I have copies of the label in my files).  But the biotechnology industry put an end to that idea in the early 1990s.

Now it’s paying the price for a bad decision 20 years ago.  I’m surprised this took so long.

More information from FoodNavigator-USA:

Apr 23 2014

POM v. Coca-Cola at the Supreme Court: The Mind Boggles

You might think that the Supreme Court of the United States would have more important things to do than to weigh in on which of two beverage companies puts less misleading labels on its products, but apparently not.

The highest court in the land takes POM Wonderful’s accusation against Coca-Cola seriously.  Coke’s Minute Maid juice, POM says, is advertised in ways that mislead the public.

POM should know.   It’s been under fire from the Federal Trade Commission for equally absurd label claims.

Here’s the Coca-Cola product at issue.

And here’s what the label says, in case you can’t read it (with emphasis added):

Enhanced Juice/Minute Maid/100% Fruit Juice Blend

Omega-3/DHA/HELP NOURISH YOUR BRAIN

5 Nutrients to Support Brain and Body

Pomegranate  Blueberry Flavored Blend of 5 Juices

From concentrate with added ingredients and other natural flavors

Never mind the nutritional quality or the ridiculous structure/function claims on this particular product (here’s Fooducate’s analysis from 2009—it has 29 grams of sugars, among other things).

POM doesn’t want Coke getting away with selling cheap grape and apple juices as pomengranate juice and undercutting their prices.  Coke’s drink is 99% apple and grape juice; it contains less than 1% pomegranate or blueberry juice.  You would never know that from looking at the label.

Why is the court interested?  The Minute Maid label is legal by FDA standards.  Therefore, can the label be considered misleading?

Coca-Cola won in the lower court, but the Supreme Court seems sympathetic to POM (here’s the transcript of the hearing).

The New York Times account has the best quotes:

Kathleen M. Sullivan, a lawyer for Coca-Cola, said consumers were not misled.

“We don’t think that consumers are quite as unintelligent as Pom must think they are,” she said. “They know when something is a flavored blend of five juices and the nonpredominant juices are just a flavor.”

Justice Kennedy frowned. “Don’t make me feel bad,” he said, “because I thought that this was pomegranate juice.”

It also quotes from Justice Alito:

You don’t think there are a lot of people who buy pomegranate juice because they think it has health benefits, and they would be very surprised to find when they bring home this bottle that’s got a big picture of a pomegranate on it, and it says ‘pomegranate’ on it, that it is — what is it — less than one half of 1 percent pomegranate juice?”

Where is the FDA on all this?  Blame its inaction on the Dietary Supplement Health and Education Act of 1994, which allowed ridiculous health claims on food labels and forced the FDA to keep hands off.

This outcome of this case, silly as it is, will be fun to watch.

Apr 21 2014

No nutrition in medical education? An old story that might be changing.

JAMA Internal Medicine invited me to comment on an article about the lack of nutrition education in medical schools.  This was written by Nathanial Morris, a second-year medical student at Harvard, who complains about the paucity of nutrition instruction in his curriculum.

Yet the course spanned just 3 afternoons, for a total of 9 hours of instruction…The course directors told us it would be the only time for dedicated nutrition education during our 4 years as medical students. There were no examinations nor interactions with patients. The 1 lecture on obesity lasted 45 minutes…As a medical student, I cannot fathom why medical schools continue to neglect nutrition education.

When I read his article, I didn’t know whether to laugh or cry.  I wrote almost identical articles in the 1980s based on my experience at UCSF (here’s one).

I asked a former UCSF colleague, Dr. Robert Baron, to co-author the commentary with me: Nutrition in Medical Education:  From Counting Hours to Measuring Competence.

Our interest in this issue started nearly 40 years ago, when we were both at the University of California, San Francisco (UCSF), School of Medicine. In 1976, one of us (R.B.B.) was, like Mr Morris, a medical student advocating for nutrition instruction, while the other (M.N.) was a lecturer newly recruited to provide that instruction. For the next decade, we worked together to create “NutritionUCSF,” a comprehensive program of nutrition training that at its peak encompassed 16 hours of preclinical instruction; regular lectures and ward rounds in several clinical rotations; an intensive, 1-month fourth-year clinical elective; an ongoing lecture series for the health professions community; and postgraduate continuing education courses.

In addition to our youthful interest and enthusiasm, we were able to achieve all this for a simple reason: we had funding. Funding came first from a curriculum development grant from the Health Resources Administration and later from a private foundation. These grants allowed us to pay faculty for a small portion of their time and leverage nutrition hours into the curriculum.

Our article explains how at UCSF and some other institutions, nutrition instruction is becoming integrated into overall reform of medical education:

Today’s medical education reform movement must respond to this call by including a broad competency-based approach to improving the nutrition-related skills of physicians. When it does, we may finally have the opportunity to include advice about healthful eating as a routine part of 21st century medical practice.

Some help from Congress?

It is interesting in this context that various members of Congress are introducing bills to improve nutrition education for medical professionals, for example, the EAT for Health Act and the ENRICH Act.  Thanks to Jamie Berger for alerting me to this legislation and for sending some fact sheets about the bills: EAT for Health / ENRICH.

It’s been nearly 40 years since my involvement in this issue.  Ever optimistic, I’m happy to see some progress at last.

And this just in.

The current issue of the American Journal of Clinical Nutrition has papers from a symposium on nutrition in medical education.  The first was in 1962, so the half-century saga continues.

  • Title page, program participants, and TOC:  Am J Clin Nutr 2014;99 1145S-1149S
  • Introduction to Nutrition Education in Training Medical and Other Health Care Professionals. Penny M Kris-Etherton, Charlotte A Pratt, Edward Saltzman, and Linda Van Horn. Am J Clin Nutr 2014;99 1151S-1152S
  • The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Penny M Kris-Etherton, Sharon R Akabas, Connie W Bales, Bruce Bistrian, Lynne Braun, Marilyn S Edwards, Celia Laur, Carine M Lenders, Matthew D Levy, Carole A Palmer, Charlotte A Pratt, Sumantra Ray, Cheryl L Rock, Edward Saltzman, Douglas L Seidner, and Linda Van Horn. Am J Clin Nutr 2014;99 1153S-1166S
  • Nutrition education in medical school: a time of opportunity. Robert F Kushner, Linda Van Horn, Cheryl L Rock, Marilyn S Edwards, Connie W Bales, Martin Kohlmeier, and Sharon R Akabas. Am J Clin Nutr 2014;99 1167S-1173S
  • Residency and specialties training in nutrition: a call for action. Carine M Lenders, Darwin D Deen, Bruce Bistrian, Marilyn S Edwards, Douglas L Seidner, M Molly McMahon, Martin Kohlmeier, and Nancy F Krebs. Am J Clin Nutr 2014;99 1174S-1183S 
  • Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Rose Ann DiMaria-Ghalili, Jay M Mirtallo, Brian W Tobin, Lisa Hark, Linda Van Horn, and Carole A Palmer. Am J Clin Nutr 2014;99 1184S-1193S
  • Policy approach to nutrition and physical activity education in health care professional training. Matthew D Levy, Lisel Loy, and Laura Y Zatz.  Am J Clin Nutr 2014;99 1194S-1201S.
Apr 18 2014

CDC’s food safety report card: no happy news

The CDC has just issued its latest report on foodborne illness and food safety progress from 2006 to 2013.

It’s report has a couple of frowny faces—Campylobacter and Vibrio cases are up—and nothing else has changed.

Nothing to smile about.

Laboratory diagnoses of other foodborne microbial illnesses are also rising.

Figure: Changes in incidence of laboratory-confirmed bacterial infections, United States, 2013 compared with 2006-2008 (data are preliminary). Yersinia = 7% decrease, Vibrio = 32% increase, STEC Non-O157  = 8% increase, STEC O157 = 16% increase, Shigella = 14% decrease, Salmonella = 9% decrease, Listeria = 3% decrease, Campylobacter = 2% increase

The food industry needs to do a better job of producing safe food.

Let’s hope the new food safety rules go into effect soon and get followed.

Apr 17 2014

Is Big Food the new Tobacco?

Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”

Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.

From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.

…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”

… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.

The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food: 

There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.

Sounds like the message is getting across loud and clear.

Thoughts?

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