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The Framingham Heart Study has just released new results suggesting that people who drink one or more 12-ounce sodas a day have a greater chance of developing “multiple metabolic risk factors” such as obesity, high blood pressure (hypertension), high blood sugar (diabetes), or low HDL-cholesterol (the good kind). The story made headlines in USA Today and other publications because diet sodas–which have no calories–were associated with the same level of risk as that of sodas made with corn sweeteners. As might be expected, soda industry officials find this result ridiculous but I think it makes sense if you think of sodas–diet and not–as an indicator of poor dietary habits. Plenty of evidence suggests that many (although certainly not all) people who habitually drink sodas of any kind consume more calories, have worse diets, and are more likely to be overweight than people who do not. For some individuals, using artificial sweeteners helps maintain weight. But on a population basis, the huge increase in use of artificial sweeteners since the early 1980s has occurred precisely in parallel with rising rates of obesity. So lots of people must be making up for the calories they save in diet sodas by eating other junk foods. When it comes to food, I don’t care for anything artificial so I try to avoid artificial sweeteners as much as I can. And you?

A reader just posted an interesting comment about marketing foods to children in school, but also has this to say about the farm bill: “…I’m concerned with the vast amount of money that is spent on promotion of corn and obesity with the corn subsidies in the Farm Bill…Dr. Nestle, what do you think can be done so that America has a Farm Bill more appropriate for public health before the current one is reissued for 2008-2012?
My response: Well, something certainly needs to be done about the Farm Bill, especially this year when it’s up for renewal. The Farm Bill (food bill, really) has everything to do with our food and agriculture system, good and bad. But the issues it concerns are mind-numbingly complex. Dan Imhoff’s book, Food Fight, is a good place to start figuring out what they mean, and he has a terrific short summary of his book at the Center for Ecoliteracy. The Institute for Agriculture and Trade Policy in Minneapolis is another great source of information–check out their reports, particularly the one called Food Without Thought about how current farm policies promote obesity. Now is the time to let congressional representatives know how you think about the issues. It could not be easier to find and contact them. Maybe they will listen if enough people let them know that farm policies should promote health–for people and the environment. Don’t you think it’s worth a try?

Today’s question is one I often get about my 15 seconds of fame in Morgan Spurlock’s film, SuperSize Me! (you can view the clip on my food politics website). A student in Great Britain writes: “…I would like to comment on your description of a calorie….You described it as “the amount of energy required to heat 1 litre of water by 1 degree Celsius.” Whereas I would argue that a calorie is the quantity of thermal energy required to raise 1g / 1cm3 by 1 degree Celsius, from an initial temperature of 15 degrees Celsius or 252 Kelvin. May I suggest that what you meant was a kilocalorie, and although this may seem pedantic, this is a gross difference and an inaccurate education for those watching. Especially after the number of people that were demonstrated to have no real understanding of the calorie…this was disappointing.”

My comment: Oh dear. It’s great that students are learning their basic chemistry but what I defined in SuperSize Me! was a Calorie (spelled with a capital C)–the kind used on food labels. This, of course, is really a kilocalorie. The calorie/Calorie/kilocalorie confusion is why I devote an entire chapter of What to Eat to explaining what calories are and why they matter.

The New York Times business reporter, Andrew Martin, starts a new column on the food and beverage industries today with an article on McDonald’s Portion Sizes and the introduction of Hugo drinks to temporarily replace the company’s phased-out Supersize portions. Mr. Martin’s article draws on a study on McDonald’s promises versus actions that I did in collaboration with my former doctoral student, Dr. Lisa Young, just published in the Journal of Public Health Policy. If you look at the comments to my previous entry on Hugo drinks, people do love getting 42-ounce drinks for as little as 69 cents. And, of course, they can fill those cups with water if they like.

At last the FDA is going to take a look at those confusing symbols on food packages purporting to tell you how healthy the products must be. PepsiCo uses green “Smart Spots.” Kraft uses green “Sensible Solutions.” Just about every breakfast cereal sports symbols indicating that they are low in fat, lactose-free, high in fiber, containing whole grains, and so forth. These are unregulated health claims, although the companies would argue that they are just providing information. As the FDA politely puts the matter, “Although each symbol intends to indicate that the food product bearing the symbol is a healthful choice, each symbol program has different nutrient requirements.” Indeed. The FDA will hold hearings on this topic on September 10 and 11 to solicit information and comments. If you have thoughts on whether companies should be allowed to use these symbols or scoring systems, or whether the FDA needs to establish firm criteria for their use, now might be a good time to let the agency know.

The Senate Agricultural Appropriations Committee has just announced that it will give the FDA an extra $48 million to fund food safety oversight. In federal terms, this is chump change but at least it’s an admission that the FDA is not adequately funded to meet its regulatory obligations. Why so little? Note that the money comes from agricultural appropriations, not health appropriations. This is the result of an historical anomaly; the FDA used to be part of the Department of Agriculture. When it was split off and eventually joined to the Department of Health and Human Services, its appropriations stayed with Agriculture. This, of course, is precisely the wrong place for it and helps explain why the FDA is so badly underfunded for what it has to do to protect the public from unsafe food. This is also part of the reason why the Government Accountability Office has been calling for creating a separately funded food safety agency that would take politics out of the food aspects of public health. If you think the present situation makes no sense, this is a good time to contact your congressional representatives.

Oh that nutrition and health were that simple. The The WHEL trial results appeared yesterday in JAMA. The sadly disappointing results of that trial showed no difference in rates of breast cancer recurrence among women who typically ate 5 servings of fruits and vegetables every day as compared to those who ate nearly twice that amount. I served on the data management committee for this trial and was involved with it for more than 10 years–a fascinating experience and a long saga.  I thought the trial was exceptionally well done. The investigators monitored fruit and vegetable intake by measuring the amounts of carotenes and other nutrients in the blood of the participants. Although there was some convergence of dietary patterns over the 8 years of study, the patterns were distinct enough to show benefits from eating more fruits and vegetables if that had been the case. An accompanying editorial explains why sorting out diet and cancer risk is so complicated. In the meantime, what to do? We know that people who habitually eat fruits and vegetables are healthier than those who don’t. The old “five-a-day” is a reasonable goal and it’s too bad that the promoters of that message messed it up by turning it into “fruits & vegetables: more matters.” As with most things in nutrition, enough is enough and more is not necessarily better.

The New York City Health Department ruling that certain fast food places must post the calorie content of their products in some prominent place was supposed to go into effect in July but has been postponed as a result of litigation. An impressive group of public interest organizations–among them, Center for Science in the Public Interest, Public Citizen, and the American Public Health Association–has jointly filed the Waxman-Kessler et al Amicus Curiae Brief in the case. According to Assistant Commissioner Lynn Silver, Subways and Auntie Anne’s have already posted calories on menu boards. I think calorie labeling is worth a try. Most people do not have an intuitive feel for the number of calories in foods or the number they need, and are especially unable to predict the number of calories in larger size portions. Check it out and see if it makes a difference in what you choose.