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III.  Personalized, as opposed to Public Health, Nutrition

Stephanie Rogus, a former doctoral studentt in my NYU department, and Peter Lurie, director of the Center for Science in the Public Interest, have a new paper out: Personalized nutrition: aligning science, regulation, and marketing. Health Affairs Scholar, Volume 2, Issue 9, September 2024, qxae107, https://doi.org/10.1093/haschl/qxae107

Proponents of personalized nutrition assert that population-based approaches to dietary recommendations have had limited impact because they have failed to take interindividual differences into account. Proponents argue that increasing or reducing consumption of particular foods in response to the results of a survey or diagnostic test allows for the development of more personalized and, it is argued, more effective recommendations.

Their paper does not deal with the flaws in individualized approached to nutritional health—“precision” nutrition: the cost, the difficulty, the lack of support, the inability to reach those who most need support, etc.  Instead, it focuses on the commercialization of personalized nutrition:

regulatory gaps have led to market growth of products with unknown efficacy that are making bold, and possibly unsubstantiated, claims. As personalized nutrition products and related treatments continue to enter the market without regulation, unreliable products may cause consumers financial, psychological, and physical harm. Stronger regulation will help engender trust in these products among consumers and ensure their safety and effectiveness.

Hard to argue with that.  Glad they wrote it.

II.  The need for nutrition science leadership in promoting policies to prevent and treat disease

Three-quarters of American adults are overweight or obese and at increased chronic disease risk, yet nobody is screaming much about it (except for the MAHA people).

As the Government Accountability Office put it in 2021,  “federal strategy needed to coordinate diet-related efforts.”

Chronic health conditions (like heart disease, diabetes, cancer, and obesity) are costly and deadly—causing over half of U.S. deaths in 2018. They also exacerbated the pandemic: Americans with such conditions were 12 times more likely to die after contracting COVID, according to the CDC.

Yet chronic conditions are largely preventable with a healthy diet and other behaviors like exercise. The federal government leads 200 different efforts, spread across 21 agencies, to improve Americans’ diets. But agency efforts are fragmented and there are gaps in key scientific research, including for children. A strategy for working together could help.

In its recommendations, the GAO says:

Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans’ risk of chronic health conditions.

The GAO comments:

The White House sponsored a conference on Hunger, Nutrition, and Health on September 28, 2022. In advance of that event, the White House released a national strategy aimed at ending hunger in America and increasing healthy eating and physical activity by 2030. [Note: I wrote about these events extensively.  For example, here]

However, we do not believe the White House strategy satisfies our matter because it does not contain the necessary information about outcomes and accountability, resources, and leadership. In particular, without designated leadership, it may be difficult to sustain the strategy over time. Therefore, as of March 2024, the matter remains open.

In October 2024, it still remains open.  I see this as an urgent priority.

Tomorrow: Personalized nutrition

Some comments on three recent developments in the field of nurition.

I.  Nutrition in medical education

I’ve been teaching , researching, and writing about nutrition since 1976 when I was on the faculty at Brandeis and assigned my first class.  I then went to the USCF School of Medicine where I taught nutrition to health professions student for the next ten years.

While there, I wrote my first book, Nutrition in Clinical Practice, in which I briefly summarized what all of us at the time thought medical students needed to know.  The book was published in 1985, and is long out of print.  In 2020, a used copy was available on Amazon for $930 (even more surprising, it is no longer on that site).

Consequently, I was amazed to see: Eisenberg DM, Cole A, Maile EJ, et al. Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement. JAMA Netw Open. 2024;7(9):e2435425. doi:10.1001/jamanetworkopen.2024.35425

As one of the authors , Emily Broad Leib, wrote in a Tweet (X), “This article shares the consensus of 37 medical education leaders on what all physicians-in-training should know about nutrition. With this start, I hope we can achieve a future where all drs. are armed with this knowledge!”

Well, wouldn’t that be nice.  When I arrived at UCSF in 1976, it was already nearly 20 years since the first conference on nutrition in medical education called for more nutrition instruction.  It has now been 70 years since then, with little change.

The structural barriers are insurmountable, apparently.

• The focus on treatment, not prevention
• Lack of qualified instructors
• Time in the curriculum
• Time in office visits (anyone seen a doctor lately for more than 15 minutes)
• The complexity of the field

Still, let’s hear applause for this consensus effort, starting with recommendation #1:

Provides evidence-based, culturally sensitive nutrition and food recommendations to patients for the prevention and treatment of disease.

Tomorrow: The need for leadership on precisely that point.

Our hopelessly dysfunctional Congress did not pass a new Farm Bill in 2023, but granted a one-year extension to the 2018 bill.  It has since been unable to pass a new one.  The old one expired on October 1.

So what?   For explanations, see:

• Market Intel:  Here’s What Happens When the Farm Bill Expires.
• Congressional Research Service: Expiration of the 2018 Farm Bill and Extension for 2024.

The Farm Bill is a collection of a huge number of programs, each with its own funding authority and rules. (and lobbyists).

Its termination affects some programs , others not so much.

Market Intel lists programs shut down on October 1.

• International programs, such as the Market Access and Foreign Market Development Cooperator trade promotion programs and Food for Progress
• The Biobased Markets Program and Bioenergy Program for Advanced Biofuels
• Several  animal health programs
• Programs for socially disadvantaged, veteran, young and beginning farmers
• The Specialty Crops Block Grants program
• The National Organic Certification Cost-Share program

Programs with permanent funding can pretty much continue.  These include:

• Crop insurance
• SNAP
• Some disaster programs
• Some commodity support programs

The big problem is with dairy and a few other commodity support programs.  I know this seems unbelievable, but as of January 1, 2025, they revert back to “permanent law,” which means the 1938 and 1949 farm billls (!).

I have no idea why, but the permanent law makes the government pay a lot more for milk, honey, corn, and wheat than current support prices.

For example, the price for milk per hundredweight.

• July 2024: $22.80
• Parity: $65.90
• Permanent (75% of parity): $49.43

Market Intel says:

Purchasing cheese, butter and nonfat dry milk at multiples of the market price would be severely disruptive to markets, would badly distort pricing under the federal milk marketing order system and would undermine demand at home and abroad in return for very uneven benefits to farmers over a limited time. And the release of USDA stocks when permanent law is suspended again would depress markets for months.

Weird, no?

As I am on record as saying, the farm bill drives me insane.

A reader, Bart Peuchot, writes:

I would be very interested to have your view on this new publication for Nature.

As you taught me, I checked the competing interests and it seems to be a perfect industry-funded publication.

And then ,I ran across this Tweet (X) from @Stuart Gillespie:

New paper concluding “more research needed”
…brought to you by Nutrition Foundation of Italy…
…which in turn is brought to you by
…..@Nestle @McDonalds @CocaCola Ferrero, Barilla, Danone et al…

Well.  What  is this about?

I went right to the paper: Visioli, F., Del Rio, D., Fogliano, V. et al. Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01515-8

Aha! Another attack on the concept of ultra-processed foods.  The article concludes

the available evidence on how different UPFs have been associated with health, as well as the results of studies examining specific food additives, call into question the possibility that ultra-processing per se is the real culprit. It is possible that other unaccounted for confounding factors play an important role. Future, urgently needed studies will clarify this issue.

The Italian food industry has been especially active in opposing NutriScore labels and anything else that might discourage sales of foods high in sugar, salt, and saturated fat.

But it is not alone in pushing back against the concept of  ultra-processed foods—an existential threat to junk food manufacturers.

Here, for example, is Hank Cardello,  the Executive Director of Leadership Solutions for Health + Prosperity at Georgetown’s Business School writing in Forbes:: New Report Highlights The Sweet Side Of Ultra-Processed Foods.

With ultra-processed foods (UPFs) replacing “junk food” as the new bogeyman for public health advocates, a new study published by  the Georgetown University Business for Impact Center (full disclosure: I am one of the authors) reveals that all UPFs are not created equal. The report spotlighted that candy in particular was the exception, since that category contributes only 6.4% of added sugars and less than 2% of our calories. The most surprising discovery is that the “healthiest of the healthiest” consumer cohort in the study purchased candy 26% more frequently than the general population.

The report: New Consumer Insights on Ultra-Processed Indulgent Foods: How Confectionery Products Are Different.

Candy behaves differently from other ultraprocessed indulgent products. New NMI and NHANES data re-confirm that candy is different and should not be lumped together with other indulgent products. Consumers do not overconsume  chocolate and candy, so targeting these foods will not impact obesity. An approach that focuses on product categories that consumers with the highest BMIs eat and drink the most will be more effective.

OK, readers: Take a guess at who paid for this.

Funding for this paper was provided by the National Confectioners Association.

As I keep saying, you can’t make this stuff up.

Julian Baggini.  How the World Eats: A Global Food Philosophy. Granta, 2024.  443 pages.

I did a blurb for this one:

How the World Eats is an enormously wide overview of how people throughout the entire world–from hunter-gatherers to NASA astronauts–view, exist within, manage, and try to improve their food systems.  Baggini’s philosophy makes sense.  We need sustainable food systems to feed the world.

When I say “enormously wide,” I’m not kidding.  Baggini has interviewed an amazing number of people, including me.  I do not remember our interview (I don’t keep track of interviews), but he quotes me extensively—and my book Food Politics—especially in the chapter titled “The Big Business of Food.”

The book is long, not least because Baggini lets his interviews speak for themselves, regardless of their opinions on controversial food issues.  He does not use the book to argue with the people he interviewed.  If you want to know what everyone, everywhere thinks about food, from every side of an issue, this is a good starting place.

Eventually, Bagggini comes out in favor of food systems that are, in his words, “holistic, circular, pluralistic, foodcentric, resourceful, compassionate, and equitable.”

If we were to adopt the principles of Holism, Circularity, Pluralism, Foodcentrism, Resourcefulness, Compassion, and Equitability, many of the desiderata we have for the food world would come along for the ride. Everyone is in favour of sustainability, and that is what we would get if we followed these seven principles.  Similarly, a circular, plural and resourceful food system is also an efficient ne.  When the main things people want flow naturally from a set of principles, that is a good sign that those principles are the right ones.  p. 361

Cannabinoid (CBD, THC, psychedelics) and other edibles are now widely available—in stores on every block near where I live in Manhattan. legal and not.  Much remains to be learned about the products.  One thing for sure: keep them away from kids and pets (use them to treat pets at your risk).

THE [PURPORTED] BENEFITS

• CBD boosts sleep quality and immune function: StudyLow-dose CBD supports healthy sleep in healthy participants and increases immune cell expression, according to a recent study published in the journal Nutrients… Read
• Review highlights cannabinoids’ therapeutic potential in gastrointestinal dysfunction: A new Polish review of how endocannabinoids and phytocannabinoids affect gastrointestinal (GIT) functions underscores their therapeutic potential… Read
• CBD boosts sleep quality and immune function: StudyLow-dose CBD supports healthy sleep in healthy participants and increases immune cell expression, according to a recent study published in the journal Nutrients…. Read more

THE MARKETING POTENTIAL

• Can cannabis beverages make their mark in bars and restaurants?  Cannabis beverages are most frequently consumed at home. But much has been made of their potential to replace alcohol – with important channels for alcohol including bars, restaurants and other on-premise locations. How can cannabis beverages succeed in the on-trade?… Read more

THE REGULATORY GAP

• CBD inspection highlights significant mislabelling in Portuguese market: A study of CBD products available in Portugal reveals significant discrepancies between label claims and actual cannabinoid compositions, highlighting the need for “stringent regulation and standardised testing protocols”… Read

ONE CASE OF REAL RISK: MUSHROOM EDIBLES

• CDC: Severe Illness Potentially Associated with Consuming Diamond ShruumzTM Brand Chocolate Bars, Cones, and Gummies.  CDC, the U.S. Food and Drug Administration (FDA), America’s Poison Centers, and state and local partners are investigating reports of severe acute illnesses potentially associated with consuming Diamond Shruumz^TM brand chocolate bars, cones, and gummies marketed as containing a proprietary blend of mushrooms.  [As of September 18: Cases = 169, Hospitalizations = 66, Deaths =2].
• FDA: Investigation of Illnesses: Diamond Shruumz-Brand Chocolate Bars, Cones, & Gummies: Do not eat, sell, or serve any flavor of Diamond Shruumz- Brand Products. FDA’s investigation is ongoing.
• June 19: The outbreak linked to micro-dosing candies more than doubles; company refuses to recall: Despite the number of illnesses having more than doubled since an outbreak announcement this past week, a company that sells microdosing candy continues to refuse to issue a recall. The Food and Drug Administration has issued a public warning about the products sold under the Diamond Shruumz brand. Implicated products… Continue Reading
• July 22: Second person dies in edibles outbreak; recall initiated but products still available: Another person has died in the outbreak of illnesses tied to Diamond Shruumz edibles, which are sold nationwide. As of July 22, 2024, a total of 74 illnesses had been reported from 28 states. Sixty-two of the 74 people have reported seeking medical care, 38 have been hospitalized, and there… Continue Reading
• July 31: More sick in outbreak linked to edibles; FDA posts list of retailers: More people have been stuck ill from eating Diamond Shruumz brand edibles. The FDA has posted a list of hundreds of stores and online outlets selling the products. As of July 29, a total of 78 illnesses have been reported in 28 states. Sixty-five of the 78 people have reported… Continue Reading 
• August 22: More patients added to toll in deadly outbreak traced to Diamond Shruumz edibles:  The patient count in a deadly outbreak traced to edibles continues to increase with 145 patients having developed symptoms since the previous update this past week. The Food and Drug Administration continues investigating Diamond Shruumz brand chocolate bars, gummies, and cones. The outbreak has spread across 29 states, with 59… Continue Reading

Politics, as they say, makes strange bedfellows and I cannot get my head around the MAHA hearings last week.

Sen. Ron Johnson, R-Wis., has posted a video of the health and nutrition roundtable he held Monday with Robert F. Kennedy Jr., the former presidential candidate now supporting former President Trump, and others including Vani Hari, the “Food Babe.”  He listed participants in a press release.

Vani Hari posted her own video on Twitter (X): “American food companies are making a fool out of us. They are knowingly poisoning us. It’s time for this to stop. Our movement is growing like I have never seen before. It’s going to be historic! This is a clip from my Senate testimony in Washington DC yesterday, watch the whole thing.”

Another Tweet pointed to testimony by Jillian Michaels: “This is one of the best overviews I’ve ever witnessed on how the whole system has been rigged, in what is essentially a ‘bad health by design’ framework As Jillian Michaels says emphatically – People have been ‘sacrificed at the alter of corporate greed.”

This is amazing!

What I find most remarkable is the lack of mainstream nutrition science in this lineup.  The speakers are mainly influencers and not among the most recognized nutrition scientists.  Nearly all havie some decidedly non-mainstream interpretations of nutrition research and the history of federal nutrition policy.

BUT: They are calling for fixing the food system, doing something to coordinate and address diet-related chronic diseases, stopping corporate power, eliminating conflicts of interest between industry and government, getting toxic chemicals out of the food supply, and doing everything possible to refocus the food environment and dietary advice on health.

Try this: “Ultra-processed foods are the new cigarette for my generation,” said Grace Price, described as an 18-year-old social media influencer.

These are things I’ve been writing about here for years.  It’s hard to argue with any of this and I won’t.

But where are my nutrition scientist colleagues?

As Jerry Mande wrote to me, referring to the PCAST report I talked about yesterday:

How did it come to this? We have the nation’s top nutrition scientists afraid to demand action and Senators turning to nutrition influencers for advice. I must admit the influencers did a better job than the WH science advisors stating the urgency of the problem and demanding action.

In Food Fix, Helena Bottemiller Evich described the experience as “rather disorienting.”

I’ve been covering food policy in Washington for 15 years, and I would have never expected this cast of characters to be together in the Senate – and hosted by Republicans, no less. (It was hosted by Johnson, but Sen. Mike Crapo (R-Idaho) also attended. Both said they’d changed their diets to improve their health.)  As I noted recently, there is a political realignment happening here. Many of the concerns discussed during this roundtable – lack of food chemical regulation, metabolic dysfunction, pesticide exposure, lack of focus on nutrition in medical school, etc. – were previously common policy fare on the left. That’s all been shaken up by Johnson’s office.

Could it be that we are heading for bipartisan support for addressing epidemic obesity and diet-related chronic disease?

If so, it’s about time and I”m all for it.

But the mind boggles.