by Marion Nestle

Search results: the corporation not me

May 31 2016

Why trade issues matter: the still-to-be-ratified Trans Pacific Partnership (TPP)

Every now and then I like to try to catch up with the arcane topic of trade agreements (see last week’s post).  Today, I’ll deal with the other one still in play, the Trans Pacific Partnership (TPP).  The U.S. Trade Representative’s Office states the administration’s position on the TPP.  Ballotpedia.org has a helpful summary of where we are on it.

For this one, should you be at all interested, the full text of the TPP is available online.  Like all trade agreements in which the U.S. participates, the TPP is about reducing and eliminating tariffs.  In principle, this is supposed to foster competition and create business opportunities and, as the Trade Representative’s Office says, “leveling the playing field for American workers & American businesses.”

The TPP was signed by the U.S. and the 11 other participating countries in February.  But for us to participate in it, Congress has to ratify the agreement.  It has not yet done so, not least because the TPP is caught up in election-year politics.

Contributing to slow approval is the weak endorsement of the International Trade Commission, which was required to report on the agreement’s economic effects.  Its conclusion: TPP would improve the economy by 2032 (the target year, apparently)—but by less than 1%.  The report gives examples of the increased percentage over baseline in 2032:

  • Annual real income: $57.3 billion (0.23 %)
  • Real GDP: $42.7 billion (0.15 %)
  • Employment would be 0.07 %
  • Exports: $27.2 billion (1.0 %)
  • Imports: $48.9 billion (1.1 %)
  • Agriculture and food output: $10.0 billion (0.5 %)

So TPP has an upside, but a small one.

What about the downside?

For starters, see the letter filed in January by 1500 groups opposing the agreement, and this BMJ paper, just out, about the TPP’s potential to block public health policies such as front-of-package food labels.

Public Citizen also has concerns.  These include, among others, that the TPP would:

  • Make it easier for corporations to offshore American jobs.
  • Push down domestic wages.
  • Flood the U.S. with unsafe imported food.
  • Permit big pharmaceutical corporations to keep lower cost generic drugs off the market.
  • Tacitly permit human rights violations in partner countries (the agreement does not mention “human rights”).

The Institute for Agriculture and Trade Policy (IATP) has problems with the “fast-track” rules passed by Congress earlier this year.  Under these rules, Congress is only allowed to vote yes or no on the agreement.  It cannot amend it. The IATP says:

Provisions in the chapter on Sanitary and Phytosanitary Standards, for example, would reduce the food safety inspection capacity of food imports, and relegate controversies over GMOs to questions of market access rather than public or environmental health. The inclusion of investor state rules would give foreign corporations new ways to challenge a wide range of environmental and consumer laws around the world for alleged loss of anticipated profits. New rules on patent protections would limit farmers’ ability to save seeds. The agreement fails to acknowledge climate change while expanding an extractive mode of globalization. Like previous failed trade agreements, there are a lot of promises to help farmers that will likely result in the accelerated loss of family farms.

Should you want to do some advocacy on this issue, the IATP has produced a timeline for urging Congress to say no to the TPP, and a handy form for doing so.

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May 18 2016

New report on GMOs: safe but “more research needed” (sigh)

The National Academies of Science has just released its long-awaited report “Genetically Engineered Crops: Experiences and Prospects.”

I was a reviewer on this report months ago and as far as I can tell it hasn’t changed much from when I sent in my comments.  Here’s what I said:

In light of public polarization of opinion of GE foods, this report tries to do something quite difficult—to come to evidence-based opinions about the risks and benefits of these foods now and in the future.  The report makes it clear that the committee listened carefully to a wide variety of opinions about risks and benefits and tried to make sense of the varying viewpoints based on available evidence.  This was not easy, given the inadequacy of much of the evidence.

I give the report high marks for its neutral tone and cautious interpretations.  The report clearly reveals how little is known about the effects of GE foods, how much GE is about crops fed to animals and how little is about food for people (except indirectly), and how minimally the promises of food biotechnology have been realized, except as they benefit large agricultural producers.

In trying to be fair, the committee will please nobody.  Proponents will be distressed that the benefits are not more strongly celebrated.  Critics will be upset that the report treats many of their concerns pejoratively (“activism”).  Both sides will find plenty in the report to buttress their views.  The overall conclusion, “more research needed,” makes sense but is not helpful in bringing the two sides together.

Some examples:

The Environmental Working Group, for example, likes:

  • The implied call for mandatory GMO labeling: “Mandatory labeling provides the opportunity for consumers to make their own personal risk-benefit decisions.”
  • The recommendations to fix the GMO regulatory system, including putting in some limits on “GMO crops and the chemicals used with them.”
  • The confirmation that “GMO crops have not, to date, increased actual yields and should not be exclusively relied upon to meet long-term food security needs.”

But Food & Water Watch issued a statement and a position paper claiming that the Academies and committee members have ties to the biotechnology industry and agricultural corporations.  The group says that Monsanto, DuPont and Dow Chemical Company each donated between $1 million and $5 million to the Academies in 2014, citing a treasurer’s report, and that the report is conflicted from the get go.

Today’s New York Times has a good summary of diverse reactions to the report, and points out:

Perhaps because of the sensitivity and complexity of the issue, many of the document’s conclusions are hedged by caveats.

“We received impassioned requests to give the public a simple, general, authoritative answer about G.E. crops,” Fred Gould, a professor of entomology at North Carolina State University and chairman of the committee that compiled the report, wrote in the preface. “Given the complexity of G.E. issues, we did not see that as appropriate.”

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Mar 12 2016

“Superannuated Chardonnay Socialist!” Moi?

The Australian Broadcasting Corporation’s Sarah Whyte of ABC 7:30 interviewed me and others for a 6-minute segment on Coca-Cola’s funding of health researchers.  Here’s an excerpt from the transcript:

TIM OLDS, UNI. OF SOUTH AUSTRALIA: I’ve got about $26 million worth of funding, and of that, probably less than $2 million would have come from industry sources. Most of it comes from government schemes such as the NHMRC and the ARC, a lot from government departments.

SARAH WHYTE: So when you take that funding, do you get other academics saying you shouldn’t be taking funding from that?

TIM OLDS: We get a lot of academics saying that.

SARAH WHYTE: He disagrees with people like Marion Nestle who says his work is compromised.

TIM OLDS: I think frankly this is an example old-style, superannuated chardonnay socialism.

Oh.

Here’s what he’s referring to (the dates are Australian).

February 17  Marcus Strom, a business reporter with the Sydney Morning Herald, invites me to lunch to discuss issues related to Soda Politics.

February 24  Strom publishes an article based on our conversation: “What Coca-Cola isn’t telling you about its health funding in Australia” (the video tells the story).

February 26  The Sydney Morning Herald publishes Strom’s account of our lunch interview.

March 1  I give a lecture on Soda Politics at the University of Sydney.

March 3  In response to my remarks, the director of Coca-Cola Amatil makes this statement: “one can [of soda] a week not unhealthy.”

March 10  Coca-Cola publishes a preliminary version of its “commitment to transparency,” listing some of the community organizations it funds.

March 10  Strom writes an analysis of the transparency list—$1.7 million in support of research over five years—noting several key omissions.

March 10  ABC 7:30 runs its video (and see transcript).

March 10  A blogger publishes a list of individuals funded by Coca-Cola during that period.

March 11  Coca-Cola releases the complete version of its transparency list, including the names of individuals.

March 11  I receive an e-mail message from a Coca-Cola official stating the company’s commitment to transparency.

We are continuing to progress on our commitment to enhance our transparency in markets across the globe. Today, in Australia and New Zealand, we launched country-specific websites listing our health and well-being partnerships, research and health professionals and scientific experts that have received financial support from Coca-Cola from 2010-2015. In December 2015, we launched sites with this information in Great Britain, Germany, France, Ireland, Denmark, Finland, Belgium, Sweden, Norway and the Netherlands.  We will publish the six-month update for the U.S. later this month.

March 11  Strom attempts to interview the 14 health experts on Coca-Cola’s list; most don’t return his calls.

Coca-Cola deserves much praise for following through on its transparency commitments.  The aftermath continues.

Additions: New Zealand transparency and more from Australia

March 3: Coke: One can a week ‘not unhealthy’

March 11:  Coca-Cola cash went to NZ health organisations and research

March 11: Coca-Cola funds research in NZ, NZ Herald

March 13: Three Kiwi health professionals took money from Coca-Cola

March 14:  Gary Moorhead, past CEO of Sports Medicine Australia argues that shaming researchers does no good

March 15: NZ Dominion Post editorial says dentists should not take money from Coca-Cola

March 16: The Press, New Zealand, editorial on whether Coca-Cola should be paying scientists

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Feb 11 2016

A rare industry-negative study brings the score to 119/12

Short-term studies of DHA ( docosahexaenoic acid, a long-chain omega-3 fatty acid) have suggested that DHA supplements promote the visual acuity of infants born prematurely.  This study, for which supplement and formula companies donated products, and in which some of the investigators had connections to those and other companies with a vested interest in the results, could not find measurable benefits of DHA supplementation by the time children reached school age.

This is a rare example of a study supported by food companies with results that must have caused much disappointment.

How rare?  Since last March, I’ve unsystematically collected 119 industry-supported studies with results that favor the sponsor’s interest (industry-positive) but have only run across or been sent 12 that do not.

Long-term effect of high-dose supplementation with DHA on visual function at school age in children born at 33 wk gestational age: results from a follow up of a randomized controlled trial. Carly S Molloy, Sacha Stokes, Maria Makrides, Carmel T Collins, Peter J Anderson, and Lex W Doyle.  Am J Clin Nutr 2016; 103:268-275 doi:10.3945/ajcn.115.114710.

  • Conclusion: Supplementing human milk with DHA at a dose of ~1% of total fatty acids given in the first months of life to very preterm infants does not appear to confer any long-term benefit for visual processing at school age.
  • Funding: Treatment and placebo capsules for the original trial were donated by Clover Corporation, and infant formula was donated by Mead Johnson Nutrition and Nutricia Australasia.
  • Authors’ disclosures: CTC and MM have received nonfinancial support from Clover Corporation and Nestlé Nutrition for research outside that of the submitted work. MM serves on scientific advisory boards for Nestlé, Fonterra, and Nutricia. Associated honoraria for MM are paid to her institutions to support conference travel and continuing education for postgraduate students and early-career researchers. MM, through the Women’s and Children’s Health Research Institute, has a patent pending “Methods and compositions for promoting the neurological development of an infant.” None of the other authors declared a conflict of interest.
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Jan 6 2016

Viewpoint: Food-industry Funding of Food and Nutrition Research

My latest Viewpoint, “Corporate funding of food and nutrition research: science or marketing,” was published yesterday in JAMA Internal Medicine 2016;176 (1):13-14.  doi:10.1001/jamainternmed.2015.6667.

The longstanding influence of food industry funding on nutrition research, researchers, and professional societies1 threatens the credibility of nutrition science. So much research is sponsored by industry that health professionals and the public may lose confidence in basic dietary advice. Although most journals now require authors to disclose who pays for their work, disclosure—even done diligently—is not sufficient to alert readers to the extent to which industry funding influences research results and professional opinion. As is well established from experimental and observational research, drug company gifts and grants can have substantial effects. To recipients, however, these effects are almost always unconscious, unintentional, and unrecognized, making them especially difficult to prevent.

Medical schools and medical journals have increased efforts to minimize and manage conflicts of interest with industry. But from my observations, nutrition researchers, journals, and professional societies, like medical researchers, often fail to realize that food-industry funding may affect their work and its credibility.

Two recent investigative articles in the New York Times illustrate the concerns about biases introduced by industry funding. The first3 described the support by Coca-Cola of academic researchers who founded a new organization, the Global Energy Balance Network, to promote physical activity as a more effective method than calorie control (eg, from avoiding sugary sodas) for preventing obesity. The second4 analyzed emails obtained through open-records requests to document how Monsanto, the multinational agricultural biotechnology corporation, on the one hand, and the organic food industry, on the other, recruited professors to lobby, write, and testify to Congress on their behalf.

Both articles3,4 quoted the researchers named in these reports as denying an influence of industry funding and lamenting the paucity of university research funds and the competitiveness of federal grants. Despite leaving their organizations open to accusations that they have sold out to industry,5 officers of nutrition research societies tell me that they cannot function without industry funding of journals and conferences. They have a point. Although the investment by federal agencies in food and nutrition research has increased steadily since the early 1990s, US Department of Agriculture grants are diminishing, and the National Institutes of Health are funding fewer researchers at state agricultural colleges. Investigators have a hard time obtaining grants for projects related to food composition, food technology, nutrients, and nutrient metabolism as federal agencies have understandably shifted priorities toward research on obesity, genetics, and chronic diseases.6

Food companies, such as Quaker Oats, used to support basic research conducted by in-house scientists, but Unilever and Nestlé (no relation) are among the very few companies that continue to do so. Instead, food companies outsource research, much of which can appear as designed for marketing purposes. Recently, in preparation for what I intend to be a more systematic analysis of corporate funding of nutrition research, I began collecting a convenience sample of studies funded by food and beverage companies or trade associations as they appear in journals I happen to be reading. I sort them by whether their results do or do not favor the interests of the sponsor, and post examples online at my blog, https://foodpolitics.com.7

Between March and October 2015, I identified 76 industry-funded studies. Of these, 70 reported results favorable to the sponsor’s interest. Despite ongoing requests to readers of my blog to help me identify funded studies reporting results contrary to a funder’s interest, I have found only 6.  [Note: Since writing this, the score has gone to 90:9.] This discrepancy is consistent with the results of systematic investigations of industry sponsorship, such as one on the role of sugar-sweetened beverages in obesity.8 In general, independently funded studies find correlations between sugary drinks and poor health, whereas those supported by the soda industry do not.9 In the studies I collected, companies or trade associations promoting soft drinks, dairy foods, eggs, breakfast cereals, pork, beef, soy products, dietary supplements, juices, cranberries, nuts, and chocolates supported the study itself, the investigators, or both. These studies all found significant health benefits or lack of harm from consuming the foods investigated, results that can be useful for deflecting criticism of a company or promoting its products.

Mars Inc, for example, the maker of chocolate candies such as M&Ms, funds studies on the effects of cocoa flavanols on arterial function and blood pressure. One such study, published in September 2015,10(p1246)concluded that these compounds “improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.” The study investigators,10 one of whom is employed by Mars, followed well-established scientific protocols in conducting the research. Science is not the issue here. Marketing is the issue. The question is why Mars would fund a study like this and assign one of its employees to help design and write it. In this instance, the answer is obvious. Mars issued a press release “Cocoa flavanols lower blood pressure and increase blood vessel function in healthy people,” and noted these results in a full-page advertisement in the New York Times on September 27, 2015, Neither the press release nor advertisement explained that cocoa flavanols are largely destroyed during all but the most careful processing of chocolate, nor did they mention chocolate at all. They didn’t have to. Uncritical readers are likely to interpret the statements as evidence that chocolate is good for them and that its sugar and calories can be ignored.

The second New York Times article4 raised more insidious concerns about industry involvement with scientists, using Monsanto and organic food companies as cases in point. Although both industries recruit scientists to speak on their behalf, Monsanto has far greater resources. In 1994, I was a member of the Food Advisory Committee to the US Food and Drug Administration (FDA) when that agency approved genetically modified (GM) foods. I observed how Monsanto-funded scientists convinced the FDA that labeling GM foods would be misleading.

Confronted with increasing public support for labeling foods that are produced with GM ingredients, the biotechnology industry supported—and the House of Representatives passed—H.R. 1599 in July 2015. This bill, expected to be considered by the Senate before the end of 2015, has the Orwellian title, “The Safe and Accurate Food Labeling Act,” but some critics call it the “Denying Americans the Right to Know (DARK) Act.” Proposed by Representative Mike Pompeo (Kansas) on the basis that GM foods are safe and, therefore, acceptable, the act would block states from enacting labeling laws (as Vermont has already done) and permit GM foods to be labeled as “natural.” Opponents question the safety of GM foods. But they also raise additional reasons for full transparency in labeling—patents, control of seed stocks, the widespread application of chemical herbicides to GM crops, and the increasingly widespread resistance of weeds to those herbicides. When evaluating conflicting scientific and policy arguments about GM foods, it is useful to know who funds the researchers and their studies.

Should nutrition researchers and professional societies accept funding from food companies? Not without careful thinking. It’s time that food and nutrition researchers and societies recognize the influence of food-industry sponsorship, take steps to control its effects, and ensure that sponsored studies promote public health, not the marketing of food products. Journal editors should ensure that editors and members of editorial boards are free of industry conflicts, require peer reviewers to note food-industry funding in manuscript evaluations, and be wary of accepting industry-funded publications with evident commercial implications. If food companies and trade associations want to fund research, they should consider pooling resources and setting up an independent foundation to administer the grants. Everyone involved in this system should be doing everything possible to advocate for more research funds from federal granting agencies. Nothing less than the credibility of nutrition research and advice is at stake.

REFERENCES

1 Nestle  M. Food Politics: How the Food Industry Influences Nutrition and Health.3rd ed. Berkeley: University of California Press; 2013.
2 Lo  B, Field  MJ, eds. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
3 O’Connor  A. Coca-Cola funds scientists who shift blame for obesity away from bad diets. New York Times. August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/?_r=0. Accessed October 22, 2015.
4 Lipton  E. Food industry enlisted academics in G.M.O. lobbying war, emails show. New York Times. September 5, 2015. http://www.nytimes.com/2015/09/06/us/food-industry-enlisted-academics-in-gmo-lobbying-war-emails-show.html. Accessed October 22, 2015.
5 Simon  M. Nutrition scientists on the take from Big Food: has the American Society for Nutrition lost all credibility? June 2015. http://www.eatdrinkpolitics.com/wp-content/uploads/ASNReportFinal.pdf. Accessed October 22, 2015.
6 Toole  AA, Kuchler  F. Improving health through nutrition research: an overview of the U.S. nutrition research system. Econ Res Rep No. 182. January 2015.http://www.ers.usda.gov/media/1760111/err-182.pdf. Accessed October 27, 2015.
7 Nestle  M. Food Politics blog. https://foodpolitics.com. Accessed October 27, 2015.
8 Lesser  LI, Ebbeling  CB, Goozner  M, Wypij  D, Ludwig  DS.  Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med. 2007;4(1):e5. PubMed   |  Link to Article
9 Massougbodji  J, Le Bodo  Y, Fratu  R, De Wals  P.  Reviews examining sugar-sweetened beverages and body weight: correlates of their quality and conclusions. Am J Clin Nutr. 2014;99(5):1096-1104. PubMed   |  Link to Article
10 Sansone  R, Rodriguez-Mateos  A, Heuel  J,  et al; Flaviola Consortium, European Union 7th Framework Program.  Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study. Br J Nutr. 2015;114(8):1246-1255. doi:10.1017/S0007114515002822. PubMed   |  Link to Article

ARTICLE INFORMATION

Corresponding Author: Marion Nestle, PhD, MPH, Department of Nutrition, Food Studies, and Public Health, New York University, 411 Lafayette, Fifth Floor, New York, NY 10003-7035 (marion.nestle@nyu.edu).

Published Online: November 23, 2015. doi:10.1001/jamainternmed.2015.6667.

Conflict of Interest Disclosures: Dr Nestle’s salary from New York University supports her research, manuscript preparation, website, and blog at https://foodpolitics.com. She also earns royalties from books and honoraria from lectures to university and health professional groups about matters relevant to this Viewpoint.

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Nov 25 2015

A retraction and apology

The Journal of Public Health Policy (JPHP) will soon announce the retraction of a Viewpoint—an opinion piece—I co-authored with a Guatemalan physician, Dr. Joaquin Barnoya, “The food industry and conflicts of interest in nutrition research: A Latin American perspective.” Because of factual errors in the piece, and in response to valid objections about the errors from its subjects, they and we requested its retraction and JPHP is doing so.

I believe it is useful to explain how this happened.  In late summer, Dr. Barnoya brought to my attention an advertorial, a sponsored news account, published in el Periódico and other Guatemalan newspapers announcing an alliance among the Central American Bottling Corporation (cbc), the largest beverage distributor in Guatemala and bottler for PepsiCo; the Guatemala-based Institute of Nutrition of Central America and Panama (INCAP); and the U.S.-based Shalom Christian Foundation to distribute a supplemental food product, Mani+, to chronically malnourished children in rural areas (here is a translation of the advertorial).  Mani+ is a sweetened, peanut-based, nutrient-fortified supplemental food made from local ingredients in Guatemala, used to prevent malnutrition in young children.  The advertorial displayed a photograph of the directors of the three organizations holding the agreement.  It also displayed statements from all three directors emphasizing the alliance’s importance in addressing childhood malnutrition.

As readers of this blog should know, I have long been concerned about the conflicts of interest that arise when food companies—especially soda companies—enter into alliances with public health organizations.   The New York Times made the consequences of such alliances clear in its recent revelations of Coca-Cola sponsorship of the Global Energy Balance Network and the fallout from those revelations.  The announced alliance between cbc and INCAP raises similar concerns, particularly in the light of more general food industry partnerships with research and health institutions in Latin America.  Our intention in writing the Viewpoint was to question the appropriateness of this alliance, as well as of other such partnerships and alliances.

We should, however, have exercised more care.  Shortly after publication of the Viewpoint, Carolina Siu Bermúdez, the director of INCAP who appears in the advertorial, wrote to object that our piece incorrectly implied a financial relationship with cbc, and that Dr. Barnoya had failed to disclose that INCAP paid a substantial portion of his salary via a grant from yet another organization.  We also received letters from Dr. Edward Fischer, the founder of NutriPlus/Mani+, Professor of Anthropology and Director of the Center for Latin American Studies at Vanderbilt University, objecting to our statement that the alliance was responsible for manufacturing (rather than just distributing) the product.   Both asked us to retract the Viewpoint.

Upon investigation, we realized their objections had merit.  Indeed, further investigation by us and by the editors of the JPHP exposed additional errors.  Together, these include the following clarifications and corrections:

  • The alliance is involved only in the distribution of Mani+, not its manufacture (as we had asserted).
  • The actual nature of the alliance between cbc, INCAP, and the Shalom Christian Foundation—who does what—is, in fact, unclear. The Viewpoint should have characterized the relationship with less certainty and specified that cbc has no financial relationship with either INCAP or the Foundation.
  • Dr. Barnoya should have disclosed his financial relationship with INCAP, and I should have insisted that he do so.
  • The Viewpoint was triggered by the advertorial, and we should have made this connection more explicit.
  • The reference in the Viewpoint to the advertorial is incorrect. It is listed as (2015) cbc co. Unidos contra la desnutricion. INCAP, cbc y Fundacion Crisitiana Shalom Firman Convenio 23(July): 9.  The correct reference is Alianza Contra la Desnutricion. elPeriódico. July 23, 2015;Advertorial: 9.

To correct and clarify these issues, we would need to revise the Viewpoint.  Doing so, however, is not possible once a paper is published.  That left us no choice but to request a retraction, which I believe is the right course of action in this situation.

In my books and other writing, I try as hard as I can to be precise and accurate.  This incident is a lapse that I regret deeply, for which I take responsibility, and for which I apologize to Carolina Siu Bermúdez, to Dr. Fischer, and to my readers.  I also apologize to Phyllis Freeman and Anthony Robbins, the editors of JPHP, and to Lucy Wheeler of Palgrave, who have set an exemplary standard of ethics and integrity throughout these investigations and discussions.

As for lessons learned: Although I fully intend to continue to write critically about alliances between food companies and public health organizations, I also intend to use this experience to recommit myself to accountability and to diligence in checking and double-checking facts and disclosures going forward.   Again, my deepest apologies.

Addition, December 14: The actual retraction notice is published here.  The discussion on Retraction Watch is here.

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Nov 4 2015

Does eating eggs raise blood cholesterol levels?

The Physicans Committee for Responsible Medicine (PCRM), a group advocating against use of animals in research but for vegetarian and vegan diets, has started a campaign to restore egg-and-cholesterol recommendations to the Dietary Guidelines for Americans.

Eggs are the largest source of cholesterol in American diets.

The campaign involves billboards like this one, in six locations in Texas:

egg-facts

It also involves a new organization (truthaboutegg.org) with an interactive website on a dozen issues related to egg production and consumption.

The one that particularly caught my eye was #5.

A 2013 review suggested that high-cholesterol foods have only a modest effect on blood cholesterol. Of the 12 studies it relied on, 11 were industry-funded.

In a letter to Congressman K. Michael Conaway (Rep-TX), Dr. Neal Barnard, PCRM’s president, wrote:

This week, billboards near your Texas offices will alert you to the dangers Americans face if cholesterol warnings are removed…Eggs are the leading source of cholesterol in the American diet.  A report (which I’ve included for your review) in the autumn 2015 Good Medicine magazine finds that this recommendation may have been influenced by egg-industry-funded cholesterol research. America’s heart disease and diabetes epidemics will continue unabated if the egg industry succeeds in its efforts to get cholesterol warnings out of the guidelines.

The 2015 Dietary Guidelines Advisory Committee (DGAC) said this about dietary cholesterol.

Cholesterol. Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report.2,35.  Cholesterol is not a nutrient of concern for overconsumption.

The DGAC based its unconcern about dietary cholesterol on two references:

2.  Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99. PMID: 24222015. Its conclusion:

There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL–C.

35.  Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(1):146-59. PMID: 23676423. This study, which was also independently funded, concluded:

compared with those who never consume eggs, those who eat 1 egg per day or more are 42% more likely to develop type 2 diabetes. Among diabetic patients, frequent egg consumers (ie, > 1 egg/d) are 69% more likely to have CVD comorbidity…This meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population. However, egg consumption may be associated with an increased incidence of type 2 diabetes among the general population and CVD comorbidity among diabetic patients.

Were these references based largely on studies funded by the egg industry?  If so, PCRM is correct in arguing that the question of egg consumption and blood cholesterol levels merits much closer scrutiny and analysis than it is currently receiving.

What does a study funded by the egg industry look like?  Here are two one from my recent collection:

The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study—a 3-mo randomized controlled trial, by Nicholas R Fuller, Ian D Caterson, Amanda Sainsbury, Gareth Denyer, Mackenzie Fong, James Gerofi, Katherine Baqleh, Kathryn H Williams, Namson S Lau, and Tania P Markovic.  Am J Clin Nutr 2015; 101:705-713.

  • Conclusion: High egg consumption did not have an adverse effect on the lipid profile of people with T2D [type 2 diabetes] in the context of increased MUFA [monounsaturated fatty acid] and PUFA [polyunsaturated fatty acid] consumption. This study suggests that a high-egg diet can be included safely as part of the dietary management of T2D, and it may provide greater satiety.
  • Sponsor: Australian Egg Corporation

Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Berger, S., Raman, G., Vishwanathan, R., Jacques, P.F., Johnson, E.J., 2015. Am J Clin Nutr ajcn100305. doi:10.3945/ajcn.114.100305.  Am J Clin Nutr August 2015
vol. 102 no. 2 276-294

  • Conclusion: Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk.  [Implication: suggestions that eggs might raise cardiovascular risk are unwarranted]
  • Sponsor: Supported by USDA agreement 1950-51000-073 and the American Egg Board, Egg Nutrition Center.  The funders did not have a role in the study selection, quality assessment, data synthesis, or manuscript preparation.
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Aug 14 2015

Let’s Ask Marion: Can Exercise Balance Out Soda Drinking?

This is the latest in a series of Q & A’s written by .   It appeared on Civil Eats, August 12, 2015.  And please note references added at the end.

Civil Eats: Your next book, Soda Politics: Taking on Big Soda (and Winning), documents the history of how this sugary beverage gave rise to some of our most powerful corporations and has lately become Public Enemy Number One in the war on obesity.

With sales on the decline, the New York Times recently reported that Coca-Cola is pouring millions of dollars into a ‘science-based’ campaign to convince the public that the secret to achieving and maintaining a healthy weight is not avoiding excess calories, but getting more exercise. What’s the science on more exercise versus fewer calories?

Marion Nestle: When it comes to studies about the health effects of sugary drinks, the science, alas, depends on who pays for it. Studies paid for by government or private health foundations show that if you want to prevent obesity, [a combination of] eating less and moving more works every time.

You can lose weight by eating less on its own. But you will have a much harder time doing that by increasing physical activity. This is because it takes lots of effort to compensate for excess calories. Eat two little Oreo cookies—100 calories—and you have to walk a mile to work them off. Drink a 20-ounce soda and you need to cover nearly three miles. This was the point of the New York City health department’s subway current poster campaign, which shows that you need to walk from Union Square in Manhattan to downtown Brooklyn to burn off 275 calories.

The soda industry would love you to believe that the principal cause of obesity is lack of physical activity, and they put tons of money into research to discourage other ideas. They much prefer you to believe that all of their products can be part of an active, healthy lifestyle that includes balanced diets, proper hydration, and regular physical activity. I call the idea the “physical activity diversion.” It deflects attention from what really counts in obesity prevention: not eating huge amounts of junk foods, snack foods, and sodas.

Mind you, I’m greatly in favor of physical activity for its many benefits: physiological, social, psychological, and health. But there is a good reason for the outraged reaction to Coca-Cola’s video seemingly suggesting that all you have to do to burn off the 140 “happy calories” in a 12-ounce soft drink is to laugh out loud for 75 seconds. This is so far from the reality of calorie balance that several countries actually banned the commercial [in 2013].

Soda companies promote the primacy of physical activity in other clever ways. The Coca-Cola Foundation says that about one-third of its philanthropic contributions go to organizations working to counter obesity, especially through promotion of physical activity.

Both Coca-Cola and PepsiCo invest heavily in sponsorship of international sports teams. They put fortunes into recruiting sports celebrities as spokespersons. These investments accomplish two purposes: they influence fans to buy the products and shift the focus to physical activity. Obesity, these imply, is about what you do, not what you eat or drink. Public health advocates complain about how frequently young people—especially those of color or in low-income families—are exposed to advertising by professional athletes. The sponsored programs and celebrities never suggest that drinking less soda might be a useful health-promotion strategy.

As a nutritionist and co-author of a book titled Why Calories Count, I thoroughly agree that balance, variety, and moderation are fundamental principles of healthful diets, and that weight gain is a result of calorie imbalance.

But soda companies distort these principles to distract from their marketing of sugary drinks and how overconsumption of these drinks overrides normal physiological controls of hunger and satiety. Independently funded research makes it abundantly clear that avoiding sodas is one of the best things you can do for your health.

Sponsorship of research or research investigators by Coca-Cola or the American Beverage Association is reason alone for skepticism.

References: I am grateful to Richard Cooper for forwarding his paper on the relative contributions to obesity of diet and exercise.  From his review of the literature, you must reduce calories to lose weight.

He also pointed me to rebuttals by  Blair and Hill, the investigators featured in the New York Times article cited above.

The rebuttal by Steven Blair and colleagues.

  • Funding: Drs. Blair, Archer, and Hand are funded via unrestricted research grants from The Coca-Cola Company for analyses of dietary trends and for an energy balance study.
  • Conflict of interest: None declared [Evidently, these investigators do not perceive funding by Coca-Cola as a conflict]

The rebuttal from James Hill and John Peters:

  • Conflict of interest: J.H. receives research grants from the American Beverage Association and serves on advisory boards for McDonalds, General Mills and McCormicks. J.P. receives research funding from the American Beverage Association.

 

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