Search results: dietary guidelines

The Center for Food As Medicine and the Hunter College NYC Food Policy Center have released their first-ever academic narrative review and report of the food-as-medicine movement: Food as medicine review and report: how food and diet impact the treatment of disease.

As the press release puts it,

Food has always been a part of medical practice, going back millennia; however, as medical procedures and treatments became more sophisticated, modern societies began to disregard the role of food in the treatment of disease. Using food to treat disease was viewed as an uncivilized approach. This led to a gap between modern medicine and the use of food to treat disease, and a lack of acceptance of food-based interventions in modern treatment plans.

the report has five parts:

1. Background information on the history of using food to treat disease,
2. Modern challenges to widespread use and acceptance of food as medicine practices,
3. Current evidence about contemporary food as medicine practices (such as medically tailored meals, produce prescriptions, and functional foods),
4. Literature review of food as treatment for specific disease states, and
5. Recommendations to stakeholders (including policymakers, health care professionals, and academics) to contribute to a healthier, more equitable health care system.

Here are the report’s key findings (my paraphrase)

• Medical schools do not often require nutrition instruction.
• Social media makes food as medicine appear pseudoscientific.
• Websites confuse the public about role of food in disease prevention and treatment.
• Supplements cause confusion.
• Dietary Guidelines are influenced by food companies and do not always reflect current science.
• The FDA allows misleading marketing and health claims on packaged foods.
• Research funded by food companies misleads the public.
• Nutrition incentive programs (e.g., NYC’s Health Bucks) can help combat food and nutrition insecurity.
• The government should support food as medicine interventions such as medically tailored meals and produce prescription programs.

See Food Tank: 22 Global Medical Professionals Practicing Food as Medicine

Here are 22 medical professionals working to use food as a critical tool for treating, controlling, and healing from illness and maintaining health.

Along those lines, The Rockefeller Foundation Commits USD 105M to Making Healthy and Sustainable Foods More Accessible Around the World.

Today The Rockefeller Foundation launched its new Good Food Strategy, which will invest USD 105 million over three years to increase access to healthy and sustainable foods for 40 million underserved people around the globe. The program will support a shift in public and private spending toward foods that are nutritious, regenerate the environment, and create equitable economic opportunity for people at every step of the food supply chain.

And here is Dr. David Katz on this theme.

We could transition from the dual costs of medication to fix only partly all the parts of us food keeps breaking. Food as the medicine long ago invoked by Hippocrates could save lives, vitality, biodiversity — and a vast fortune into the bargain. The drumbeat tolls of necessity in the guise of diabetes, heart disease, obesity, cancer, dementia, climate change — and the acutely calamitous toll of COVID, as well. We may, whenever so inclined, invoke the will to invent the better way.

And let’s not forget the Food is Medicine Initiative from the Aspen Institute. which I wrote about previously here.

Comment: I prefer to think of food as food (a pleasure) and medicine as medicine (a pain) and not conflate them, but there s no question that eating healthfully is a good health habit along with being active, getting enough sleep, and not smoking, or overdoing on alcohol or recreational drugs.  If food-as-medicine initiatives help people eat more healthfully, it’s hard to argue with them, and I won’t.

Remember the fight over setting standards for reimbursible meals and a la carte products offered to kids in schools?

Michelle Obama’s Let’s Move! campaign set healthier standards for school foods.   Although you might think that serving healthy food to kids in schools would get lots of bipartisan support (who could possibly be against it), the standards got lots of pushback (too hard to implement, kids won’t like the food, too much food waste, too much nanny state).

Some aspects of the standards—less salt and more fruits, vegetables, and whole grains—survived, but “relaxed” during the Trump administration.  Recall USDA Secretary Sonny Perdue’s “Make School Meals Great Again”

That was then and this is now with pandemic-induced obesity rates rising among children, and supply chains making it hard for schools to feed kids in any way.

That has not stopped the Center for Science in the Public Interest, the American Heart Association, and the American Public Health Association from petitioning the USDA to put a limit on added sugars in school meals, to bring them into compliance with the Dietary Guidelines.  By law, the USDA must have school meals follow the guidelines, but this means rulemaking, and rulemaking takes time—lots of it.

USDA has now taken Step #1: transitional standards for milk, whole grains, and salt.

• Milk: Schools and child care providers serving participants ages six and older may offer flavored low-fat (1%) milk in addition to nonfat flavored milk and nonfat or low-fat unflavored milk;
• Whole Grains: At least 80% of the grains served in school lunch and breakfast each week must be whole grain-rich; and
• Sodium: The weekly sodium limit for school lunch and breakfast will remain at the current level in SY 2022-2023. For school lunch only, there will be a 10% decrease in the limit in SY 2023-2024. This aligns with the U.S Food and Drug Administration’s recently released guidance that establishes voluntary sodium reduction targets for processed, packaged, and prepared foods in the U.S.

The next steps:

• Stakeholder briefing today: 11:45am-12:30 pm ET.  Register to attend here. 
• USDA will start working on standards that bring the meals into full compliance with the Dietary Guidelines.

Call for Comments:  The USDA invites comments on these transitional standards and on the next steps.

• Federal eRulemaking Portal: Go to http://www.regulations.gov. Follow the online instructions for submitting comments.
• Mail: Send comments to Tina Namian, Chief, School Programs Branch, Policy and Program Development Division—4th Floor, Food and Nutrition Service, 1320 Braddock Place, Alexandria, VA 22314; telephone: 703-305-2590.

Resources

• Press release
• USDA’s website on school meals 
• Federal Register: Child Nutrition Programs: Transitional Standards for Milk, Whole Grains, and Sodium
• Webpage: Building Back Better with School Meals
• Fact Sheet: Child Nutrition Programs: Transitional Standards for Milk, Whole Grains, and Sodium
• Infographic: The Road Ahead: Building Back Better with School Meals 
• Infographic: Ten Reasons to Build Back Even Better with School Meals!

Last week was a busy time for high-level thinking about nutrition.

I’ll start with this from Chef José Andrés.

A message from @WCKitchen's @chefjoseandres on child #nutrition: Child nutrition programs play an essential role in ensuring food and nutrition security for the nation's youth. pic.twitter.com/kZ4i7JGYVK

— Bipartisan Policy Center (@BPC_Bipartisan) January 27, 2022

For the rest, I am indebted to Politico Morning Ag for gathering all this in one place.

Nutrition research: Last week, Sens. Cory Booker (D-N.J.) and John Cornyn (R-Texas) appeared at an event focused on “sustainable nutrition science” hosted by the Union of Concerned Scientists and Tufts University’s Friedman School of Nutrition Science and Policy.  The are sponsors of the Food and Nutrition Education in Schools Act.  I watched Booker’s remarkably inspiring talk and wish I could find a video or transcript of it.

Booker held hearings on nutrition last year.  I have a transcript of his opening remarks.  Here is an excerpt:

Now let’s be clear about something: the majority of our food system is controlled by a handful of big multinational companies. These big food companies carefully formulate and market nutrient-poor, addictive, ultra-processed foods — ultra-processed foods which now comprise 2/3 of the calories in children and teen diets in the U.S — and then these companies want us to believe that diet related diseases such as obesity and diabetes are somehow a moral failing, that they represent a lack of willpower or a failure to exercise enough.
That is a lie.
It is not a moral failing, it is a policy failure.

Food is Medicine: Food and Society at the Aspen Institute and Harvard’s Center for Health Law and Policy Innovation released a Food is Medicine Research Action Plan, a lengthy report detailing recommendations for how to bolster nutrition interventions in health care.

Food is the leading cause of poor health in the United States. Over half of American adults suffering from at least one chronic, diet-related disease. This health crisis has devastating effects for individuals and their and families and places an immense burden on our health system and economy. Though food is the culprit, it can also be the cure. Food and nutrition interventions can aid in prevention and management, and even reverse chronic disease. Introduced at large scale, proven interventions could save millions of lives and billions in healthcare costs each year.

Universal free school meals: The Bipartisan Policy Center released recommendations from its Food and Nutrition Security Task Force.   The report has recommendations for strengthening nutrition education and security in and out of school.  For example:

• Ensure all children, regardless of household income, have access to nutritious foods to allow them to learn and grow by providing school breakfast, school lunch, afterschool meals, and summer meals to all students at no cost.
• Make Summer EBT a permanent program and allow students to access EBT benefits during school breaks, holidays, closures, and other emergencies.
• Maintain and, if possible, strengthen nutrition standards for all programs to better align them with the latest Dietary Guidelines for Americans.

Pandemic EBT program: The Government Accountability Office recommended that USDA do a better job on nutrition assistance during emergencies and of implement the Pandemic-EBT program, which was supposed to give eligible school children charge cards for buying foods, but never worked well.

I’m kind of a dairy agnostic.  If you like dairy foods, fine; if not, don’t eat them.

But the arguments about them are fierce, and the current Dietary Guidelines for Americans advise choosing low-fat alternatives.

So when I saw the title of this study, I wondered whether it had been funded by the dairy industry.  It was not, although some of the investigators have dairy industry ties.

The study: Whole-fat dairy products do not adversely affect adiposity or cardiometabolic risk factors in children in the Milky Way Study: a double-blind randomized controlled pilot study.  Analise Nicholl, Kane E Deering, Kate Evelegh, Philippa Lyons-Wall, David Lawrence, Trevor A Mori, Mario Kratz, Therese A O’Sullivan.  The American Journal of Clinical Nutrition, Volume 114, Issue 6, December 2021, Pages 2025–2042, https://doi.org/10.1093/ajcn/nqab288

Conclusions: Our results suggest that although changing from whole-fat to reduced-fat dairy products does reduce dairy fat intake, it does not result in changes to markers of adiposity or cardiometabolic disease risk in healthy children.

Acknowledgments: …The Principal Investigator, TAOS, was awarded funding in 2011 for a previous study from the Dairy Health and Nutrition Consortium. MK has received honoraria and reimbursements for travel as well as a research grant from several dairy-related organizations, including National Dairy Council/Dairy Management Inc., Dairy Farmers of Canada, the Dutch Dairy Association (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Interbranch Organization (CNIEL). All other authors report no conflicts of interest.

Notes: …No funding body played any role in the Milky Way Study design, implementation, analysis or interpretation of the data, or publication. The Milky Way Study received no funding from any dairy or food industry organization or affiliation toward study research, dairy product purchase or provision, child assessments, project personnel, or publication.

Comment: No funding body needed to be involved in this study to raise questions of conflicted interests; two of the authors report financial ties to dairy companies.  At the very least, these ties give the appearance of conflict of interest.  Are dairy foods good, bad, or indifferent for health?  My guess is that like pretty much everything else in the diet, it depends on everything else you are eating (unless you are lactose or dairy protein intolerant, in which case you know to avoid dairy foods).  The underlying purpose of this study is to encourage sales of full-fat dairy products to children.   Is that a good idea?  You decide.

Reference: For a summary of research on the “funding effect”—the observation that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests, but that recipients of industry funding typically do not recognize its influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

An additional observation in the fruit drink study I recently discussed was a reduction in purchases of 100% juice, probably because it is so hard to tell the difference without careful scrutiny of labels (hint: look for 100%).

100% juice is a better option than fruit drinks because it has a better balance of nutrients and no added sugars. But it is still sugary because so many pieces of fruit go into it [really, fruit is the best option].

The orange juice industry is worried about decreasing sales.

The worldwide market for juices is increasing.

The juice industry would like it to grow even faster.

I was interested to see juice marketing materials emailed to dietitians.

Want to take a guess as to who paid for these messages?

Hot summer temperatures combined with a population eager to get outside and get moving means risk of dehydration is high. In addition to water, consider including 100% juice as a healthy, nutrient dense beverage option. In addition to rehydration and increasing fruit intake, two new studies show 100% juice has many other health benefits.

1. A recent UK study published in Nutrients found moderate consumption of 100% fruit juice, which aligns with the US Dietary Guidelines, does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycemic control. Furthermore, regular daily consumption of 100% juice, may confer health benefits related to vascular function and reduced blood pressure. Emerging evidence shows there may even be a positive impact on cognitive health. [Funding: This research was funded by an unrestricted grant from the Fruit Juice Science Centre].
   [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

2. A second review study, published in Frontiers in Immunology, found that citrus juice, contains key nutrients and bioactive substances that help our immune system to work efficiently and reduce inflammation. [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

And how do we know this is all about marketing?  Try this Infographic:  Squeeze More Profits From Juices.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Fruit drinks, as opposed to 100% fruit juice, are a no-brainer.  They are heavily sugar-sweetened, and best consumed in very small amounts or not at all.

They are difficult to distinguish from 100% fruit juice.  Their labels make them look fruity and juicy.

So do their ingredient lists:

But these are juice concentrates and require translation: added sugars.  In this case, 11 out of the 13 grams per serving.

Public health advocates want to discourage parents from buying sugary beverages for their kids.  Here are the results of one such attempt.

• The study:  Countermarketing About Fruit Drinks, Alone or With Water Promotion: A 2019 Randomized Controlled Trial in Latinx Parents.  James Krieger, Taehoon Kwon, Rudy Ruiz, Lina Pinero Walkinshaw, Jiali Yan and Christina A. Roberto.  American Journal of Public Health, 28 Oct 2021.
• Method: Online messaging via Facebook groups using “countermarketing”—focusing on industry strategies rather than health messages.
• Result: A nearly 14% reduction in choosing fruit drinks.

As the accompanying editorial, Warning: Don’t Let the Beverage Industry Harm Your Kids, explains, 

Unlike general social marketing or other communications campaigns, countermarketing is designed “to reduce the demand for unhealthy products by exposing the motives of their producers and portraying their marketing activities as outside the boundaries of civilized corporate behavior”…Let’s put this good news to use by placing responsibility at the feet of the platforms and companies profiting from directly and incessantly targeting children with marketing the food and drink they should avoid.

If you would like to know how this works, here’s a toolkit for campaigns against fruit drinks.

One additional observation was a reduction in purchases of 100% juice, probably because it is so hard to tell the difference without careful scrutiny of labels (hint: look for 100%).

100% juice is a better option than fruit drinks (fruit is the best option), but still sugary because so many pieces of fruit go into it.

The juice industry is plenty worried about decreasing sales.  Marketing materials sent to dietitians reveal the concerns.  Guess who paid for these messages—and the studies.

Hot summer temperatures combined with a population eager to get outside and get moving means risk of dehydration is high. In addition to water, consider including 100% juice as a healthy, nutrient dense beverage option. In addition to rehydration and increasing fruit intake, two new studies show 100% juice has many other health benefits.

1. A recent UK study published in Nutrients found moderate consumption of 100% fruit juice, which aligns with the US Dietary Guidelines, does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycemic control. Furthermore, regular daily consumption of 100% juice, may confer health benefits related to vascular function and reduced blood pressure. Emerging evidence shows there may even be a positive impact on cognitive health. [Funding: This research was funded by an unrestricted grant from the Fruit Juice Science Centre].
   [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

2. A second review study, published in Frontiers in Immunology, found that citrus juice, contains key nutrients and bioactive substances that help our immune system to work efficiently and reduce inflammation. [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

And how do we know this is all about marketing?  Try this Infographic: Squeeze More Profits From Juices.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

On October 13, the FDA finally got around to finalizing its guidance for the food industry for voluntary, short-term (2.5 year) sodium reduction targets for lots of processed, packaged and prepared foods.

In a statement, the FDA says its new guidance

provides voluntary, short-term sodium reduction targets for food manufacturers, restaurants, and food service operators for approximately 160 categories of processed, packaged and prepared foods. The targets seek to decrease average sodium intake from approximately 3,400 milligrams (mg) to 3,000 mg per day—about a 12% reduction—over the next 2.5 years.

Reducing sodium has been on the FDA agenda for years.  It issued draft guidance in 2016.  On this, it received about 200 comments.  

The FDA’s idea for this first target is to reduce average daily sodium intake by about 12%—from approximately 3,400 milligrams (mg) to 3,000 mg per day—in 2.5 years.

This is still higher than the recommended 2300 mg.  Why so limited?

Politics, of course.

The FDA believes

• These targets are feasible.
• Gradual reduction will accustom people to lower sodium intake.
• Food companies might be willing to do this.

A quick review of the basics:

• Salt is 40% sodium (2300 mg sodium means about 6 grams of salt or 1.5 teaspoons).
• High salt diets are strongly associated with high blood pressure and stroke.
• We require less than 500 mg sodium a day; average diets are greatly in excess.
• Most salt in the diet comes from pre-prepared foods (70%); 20% is added at the table; 10% is innate in foods.
• The taste for high-salt is acquired; the more salt you eat, the more salt it takes to make foods taste right.
• For people used to high-salt diets, low-salt makes food taste bland.  It takes about three weeks to get used to low-salt.
• Once accustomed to low-salt, typical levels of salt make food taste too salty.

Thus, the FDA’s strategy is to gradually accustom people to lower salt intake.

The guidance is voluntary: “This voluntary, iterative approach is similar to approaches successfully implemented in other countries.”

By other countries, the FDA must mean Great Britain.  The UK did a big voluntary salt reduction campaign some years ago and got enough buy in from food companies to see a real difference in salt intake and blood pressure.

When the government changed and laid off the pressure, companies put back most of the salt (not all though). That history is here.

So this could work if food companies cooperate.  Presumably, the FDA will assess the results of this voluntary effort in 2.5 years.

The stick?  The implied threat of mandatory reductions if the voluntary ones don’t work.

2.5 years is a long time to wait for voluntary compliance.

My view

• These should have been mandatory to begin with.
• The target levels should be lower.
• The time scale should be faster.

Other than that, the FDA’s plan could be a useful first step.  We shall see.

Statements

• From FDA officials
• The American Heart Association  
• Center for Science in the Public Interest

Documents

• The FDA constituent update on sodium is available here.
• An FDA web page, “Sodium Reduction,” is available here.
• The FDA guidance for industry is available here.
• Dietary Guidelines for Americans  fact sheet on sodium
• A paper in JAMA from FDA officials on reducing sodium in the US

The study: Impact of low-fat and full-fat dairy foods on fasting lipid profile and blood pressure: exploratory endpoints of a randomized controlled trial.  Kelsey A Schmidt, et al. The American Journal of Clinical Nutrition, nqab131, https://doi.org/10.1093/ajcn/nqab131.  Published: 13 July 2021

Background: “Dietary guidelines traditionally recommend low-fat dairy because dairy’s high saturated fat content is thought to promote cardiovascular disease (CVD). However, emerging evidence indicates that dairy fat may not negatively impact CVD risk factors when consumed in foods with a complex matrix.”

Method: “Participants were then randomly assigned to 1 of 3 diets, either continuing the limited-dairy diet or switching to a diet containing 3.3 servings/d of either low-fat or full-fat milk, yogurt, and cheese for 12 wk.”

Conclusions: “In men and women with metabolic syndrome, a diet rich in full-fat dairy had no effects on fasting lipid profile or blood pressure compared with diets limited in dairy or rich in low-fat dairy. Therefore, dairy fat, when consumed as part of complex whole foods, does not adversely impact these classic CVD risk factors.”

Funding: “National Dairy Council, Dairy Farmers of Canada, Dutch Dairy Association (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Dairy Interbranch Organization (CNIEL),” and NIH and others.

Conflict of interest: “This study was initiated by the principal investigator (MK). The dairy-related funding organizations suggested changes to details of the study design prior to the conduct of the study, some of which were implemented. Otherwise, the funding organizations had no impact on the design or conduct of the trial or the analysis and interpretation of study data.”

Comment: Let’s give these investigators high marks for disclosing that the dairy funders influenced the design of the study, which, as we know from the data of Lisa Bero and her colleagues, is the place where biases caused by industry funding most typically show up.  Food companies that fund research are looking for benefits; they won’t risk study designs that might yield inconvenient results.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.