by Marion Nestle

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Oct 9 2024

Some thoughts about the current state of nutrition I: Medical Education

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 DMCole AMaile EJ, et al. Proposed Nutrition Competencies for Medical Students and Physician TraineesA 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.

Oct 8 2024

The Farm Bill Expired: Now What?

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:

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:

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.

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Oct 7 2024

Industry-funded opinion of the week: Forget about ultra-processed

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.

Oct 4 2024

Weekend reading: food philosophy

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

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Oct 3 2024

Edibles: a roundup of items

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

THE MARKETING POTENTIAL

THE REGULATORY GAP

ONE CASE OF REAL RISK: MUSHROOM EDIBLES

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Oct 2 2024

Make America Healthy Again (MAHA): Strange Bedfellows Indeed

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.

Oct 1 2024

The PCAST report: a timid step forward

PCAST, the President’s Council of Advisors on Science and Technology, has released its REPORT TO THE PRESIDENT A Vision for Advancing Nutrition Science in the United States.

I learned about the report from a Tweet (X)

I wrote about an earlier draft of the report in a previous post: The federal vision for chronic disease prevention: individual behavior, not the environment.  I called for the report to take on the need for fundamental improvements in the food environment aimed at preventing obesity-influenced chronic diseases.

If you read the fine print, the report has indeed done some of that.  It now mentions ultra-processed foods, for example,

people’s food selections are complex, influenced by various factors in a multifaceted U.S. (and global) food ecosystem, with many of these factors beyond an individual’s control, e.g., increased production and availability of ultraprocessed foods which are associated with overconsumption and obesity. In addition to widespread availability of inexpensive ultra-processed foods, the U.S. food environment has undergone huge changes in recent decades, including easy access to low-cost fast food and eating away-from-home becoming much more common…in the era of widespread internet and digital technology access and use, people’s food habits increasingly are influenced by advertising and social media, which are sources of both facts and misinformation. Acknowledging and understanding these factors and their intersections is critical to addressing nutrition-related health disparities.

It also says useful things like these:

  • new emphasis must be placed on nutrition research that can equitably and effectively help all Americans achieve better health.
  • [needed is an] equity focus that particularly considers those who are disproportionately affected—racially, ethnically, and socially minoritized groups—due to long-standing and structural inequities which make it hard for many people to eat healthy and be physically active.
  • For such a highly developed nation, the U.S. has distressingly high rates of food insecurity, imbalanced nutrition, and inequities in food access, all further exacerbated by the pandemic.  With diet-related disease rates increasing, we have responded by focusing resources on costly medical treatments, further widening disparities and directing efforts away from prevention or addressing social determinants of health and a food environment that for too many Americans does not provide or promote good nutrition. The only way to reverse these trends and achieve robust health for our nation is to focus on prevention, which will require significant modifications of our overall food environment and must be informed by improved nutrition research.
  • Preventing diet-related chronic diseases is among the most urgent public health challenges facing the nation.

Despite these statements, its two recommendations say nothing beyond the need for coordination aimed at addressing that challenge.

1. The Administration should implement a coordinated and sustained federal interagency effort, co-led by HHS and USDA, to strengthen the nutrition science base for current and future public and private sector actions to reduce the burden of diet-related chronic disease and maintain momentum toward the President’s 2030 goal.

2. To ensure equitable access to the benefits of nutrition research, federal agencies should prioritize equity in nutrition research, focus research on improving program delivery, continue efforts to diversify the nutrition science and dietetics workforce and engage the academic and private sectors in multisector research and intervention initiatives.

Yes, coordination would be a big help.  Nutrition research is all over the place at the federal level.  So would increased funding for nutrition research aimed at improving the food environment to prevent chronic disease.  Only a tiny fraction of the NIH budget goes for this purpose.  NIH’s main nutrition focus is “precision nutrition” aimed at individuals, not public health.  And much of the USDA’s nutrition funding goes to the kinds of industry-funded studies I post here on Mondays.

The report mentions what’s needed in theory; it ducks dealing with the tough politics of chronic disease prevention.

And alas, it did not cite my suggestions for what is needed (which I had sent to the committee).

So where is leadership for chronic disease prevention at the federal level?  It’s in an odd place at the moment, as I will discuss tomorrow.

Sep 30 2024

Industry-funded study of the week: Krill oil

I read about this one in NutraIngredients.  To its credit, it identified the funder right in the headline:

Krill oil may boost skin health measures, say two new RCTs from Aker BioMarine: Krill oil supplementation may strengthen skin barrier function and improves hydration and elasticity of the skin in healthy adults, according to data from two new pilot studies.

I went right to the study: Krill oil supplementation improves transepidermal water loss, hydration and elasticity of the skin in healthy adults: Results from two randomized, double-blind, placebo-controlled, dose-finding pilot studies.  Katina Handeland PhD, Mike Wakeman MSc, MRPharmS, Lena Burri PhD.  J Cosmetic Dermatology.  https://doi.org/10.1111/jocd.16513

Purpose: to see whether krill oil, which contains omega-3 fatty acids, improves skin hydration and elasticity.

Methods: in two randomized, double-blind, placebo-controlled, pilot studies, participants consumed 1 or 2 g of krill oil or placebo daily.  The outcomes were assessed at baseline, 6 and 12 weeks.

Results: the group supplemented with krill oil did better.

Conclusions: “Daily oral supplementation with 1 and 2 g of krill oil showed significant and dose-dependent improvements in skin TEWL, hydration, and elasticity compared to placebo that correlated with changes in the omega-3 index.

Conflicts of interest: “KH and LB are employees of Aker BioMarine Human Ingredients AS that has provided the krill and placebo oil and funded the study.”

Comment: Krill oil?  That’s a new one for me.  Krill are crustaceans, plankton, at the bottom of the marine food chain; they are a primary food source for baleen whales.  I quickly found krill oil supplements to be widely available (“dynamic,” “antarctic,” “help to reduce heart disease, strokes, inflammation”) at impressive cost.  Despite claims for a vast array of benefits, I’m dubious about the value of getting omega-3s from supplements.  The manufacturer of these supplements did this study to back up another sales pitch.  As I keep saying, these kinds of studies are primarily about marketing, not science.