While I was visiting Cuba, formerly the largest supplier of sugar to the United States and now blocked from selling anything to us, I missed several stories about sugar. It’s time to catch up with them.
The New York City Department of Health and Mental Hygiene has a new advertising campaign on the health risks of sugary drinks for children. You can view the ads here.
Canada has decided against requiring labeling of added sugars, but instead plans to institute a Daily Value for total sugars of 100 grams and to group all sugars on the ingredient list. Note: 100 grams is 20% of total calories for people on 2000-calorie diets, and is twice what is recommended by most health authorities these days.
The Washington Post says it’s great to get rid of trans fats, but what about sugars?
The Washington Post also discusses the war between the Corn Refiners (makers of high fructose corn syrup) and sugar trade associations, this time over federal protections of the sugar industry. I’ve discussed sugar policy in previous posts (see this one, for example).
On this last item the Post explains:
While other crop subsidies have withered, Washington’s taste for sugar has been constant. The sugar program, which has existed in various forms since the 1930s, uses an elaborate system of import quotas, price floors and taxpayer-backed loans to prop up domestic growers, which number fewer than 4,500.
Sugar’s protected status is largely explained by the sophistication and clout of a small but wealthy interest group that includes beet farmers in the Upper Midwest, cane growers in the South and the politically connected Fanjul family of Florida, who control a substantial part of the world sugar market.
Attempts to get rid of the sugar program have been constant, at least since the 1970s when I first started teaching about it, but to no avail. Why not? Because outrageous as the program is, it only costs the average American $10 per year—not enough to generate widespread opposition, apparently.
The bottom line on all this: eating less sugar is always a good idea.
I’ve been posting summaries of studies funded by food companies or trade groups, all of which come up with results that the sponsor can use for marketing purposes.
In each of these posts, I ask for examples of industry-funded studies that produce results contrary to the interests of the funder.
In response, I received this comment from Mickey Rubin, Vice President for Nutrition Research, National Dairy Council.
He gave me permission to reproduce his letter:
Dear Marion,
By way of introduction, my name is Mickey Rubin and I am a scientist at the National Dairy Council. I understand that you know Greg Miller, and I asked him for your contact information so I could write to you directly after reading with great interest your most recent post on industry-funded nutrition research, in which you selected a sample of 5 studies/papers sponsored by industry all showing favorable outcomes. Although none of the papers you selected were sponsored by the organization I represent (although there is one dairy industry sponsored review paper in the list), what struck me is your focus on the favorable vs. unfavorable dichotomy, rather than the reality of what much nutrition science research results in: null findings.
It seems that there are fewer and fewer nutrition studies published that report the null, or find no effect. I agree with you that the reason we don’t see more of these studies in the literature has to do with bias, but I suspect that it is publication bias as much as any other bias. From my interactions with nutrition researchers, I gather it is quite difficult and sometimes impossible to get a study with no significant effects published regardless of funding source, to say nothing of allegiance bias by some researchers hesitant to publish findings that may go against their own hypotheses. Dr. Dennis Bier of Baylor College of Medicine and editor in chief of the American Journal of Clinical Nutrition has presented eloquently on this issue previously. You may also be aware of David Allison’s papers on other types of bias. So I think it is important to discuss all types of bias, and not just industry bias. You of course wouldn’t want your discussion on bias to be biased to just one type.
At National Dairy Council we have an extensive program of nutrition research that we sponsor at universities both nationally and internationally. While I can’t speak for all of industry, we strongly encourage the investigators of all of our sponsored studies to publish the findings, no matter the results. Thus, we would expect our sponsored studies to have a similar “success” rate as those sponsored by the National Institutes of Health. In fact, that is exactly what one recent analysis – not sponsored by the dairy industry – found, reporting that there was no evidence that dairy industry funded projects were more likely to support an obesity prevention benefit from dairy consumption than studies sponsored by NIH.
We feel this transparency is not only critical to the credibility of the research we sponsor, but we also feel it is important that our research contributes to nutrition science knowledge as a whole. We hope that other scientists take the findings from studies we sponsor and build upon them, and if it is by using research dollars from other sources, even better! I’ll be the first to stand up and say that one favorable study on milk, as an example, does not close the books on the subject. We need many studies in many different labs sponsored by multiple agencies in order to produce a portfolio of knowledge. I suspect that is certainly an example of where you and I are in agreement.
That all said, please allow me to provide some examples of studies the National Dairy Council has sponsored that are published and, rather than showing a clear benefit, do not refute the null hypothesis. These are all studies published within the last 4 years. It’s not meant to be comprehensive, but rather just a sample similar to what you provided. I could also provide you a list of studies we have sponsored that have shown favorable results for dairy, but you seem to have that covered, and I’ll instead wait until one of our sponsored studies appears in a subsequent blog post J.
Thanks for taking the time to read. I appreciate the dialogue.
The main finding from the study was that dairy intake had no effect on glucose control whereas sugar sweetened product consumption contributed to a worsening of glucose control in at-risk adults.
Waist circumference and BMI were lower in women after consuming the dairy diet as compared to the control diet. Fasting glucose was lower in men following the dairy diet as compared to the control diet. There were no differences in blood pressure, serum lipids, fasting insulin, or insulin resistance between the treatments.
Here’s what I wrote in response:
I am familiar with charges of bias against independently funded researchers (“White-hat Bias”), which equates industry biases with biases that result from career objectives and other goals. I do not view the biases as equivalent. Industry-sponsored research has only one purpose: to be used in marketing to sell products. As I have said repeatedly, it is easy to design studies that produce desired answers.
When I was in graduate school in molecular biology, we were taught—no, had beaten into us—to do everything we could to control for biases introduced by wishful thinking. I don’t see that level of critical thinking in most studies funded by food companies.
You may be correct about the influence of publication bias with respect to dairy studies, but how do you explain the situation with sugar-sweetened beverages? Studies funded by government and foundations typically indicate strong correlations between habitual consumption of sugary beverages and metabolic problems, whereas studies funded by the soda industry most definitely do not. The percentages are too high to be due to chance: 90% of independently funded studies show health effects of soda consumption whereas 90% of studies funded by soda companies do not. This is troubling.
We’ve seen the results of studies funded by tobacco and drug companies. Are food-industry studies different? I don’t think so. What seems clear is that industry-induced biases are not recognized by funding recipients, a problem in itself.
That’s why I’m posting these studies as they come in and begging for examples of industry-funded studies that do not favor the interests of the donor.
Thanks to Mickey Rubin for writing and for permission to reproduce his letter.
Of course sustainability should be considered in developing dietary guidelines. Agricultural policy needs to be linked to health policy, and it’s high time we did so.
But industry protests and letters from Congress induced USDA Secretary Tom Vilsack to assure Congress that the 2015 guidelines will focus only on nutrition.
SEC. 734. None of the funds made available by this Act may be used to release or implement the final version of the eighth edition of the Dietary Guidelines for Americans, revised pursuant to section 301 of the National Nutrition Monitoring and Related Research Act of 1990 (7 20 U.S.C. 5341), unless the Secretary of Agriculture and the Secretary of Health and Human Services comply with each of the following requirements:
(1) Each revision to any nutritional or dietary information or guideline contained in the 2010 edition of the Dietary Guidelines for Americans and any new nutritional or dietary information or guideline to be included in the eighth edition of the Dietary Guidelines for Americans shall be based on
(A) scientific evidence that has been rated ‘‘Grade I: Strong’’ by the grading rubric developed by the Nutrition Evidence Library of the Department of Agriculture; and
(B) shall be limited in scope to only matters of diet and nutrient intake.
Politics in action!
As I told Politico Morning Agriculture, I’ve never heard of a DGAC writing directly to Congress. But I understand its frustration. The committee was asked by USDA and HHS to review and consider the science of diet and health and did so. It reported what its members believe the science says. Some segments of the food industry don’t like the science so they are using the political system to fight back. The idea that some members of Congress would go along with this is shameful.
Let’s keep Congress out of the dietary guidelines process. The process may not be perfect but scientific committees do the best they can to advice the public about dietary practices that are best for health—and, at long last, the environment.
Political interference with this process is not in the best interest of public health, and should be strongly discouraged. If you agree with this view, CSPI makes it easy for you to say so. Sign on now.
Update, June 25: Politico Morning Agriculture reports today that the Senate bill reads: “None of the funds appropriated in this Act may be used to issue, promulgate, or otherwise implement the 2015 Dietary Guidelines for Americans edition unless the information and guidelines in the report are solely nutritional and dietary in nature; and based only on a preponderance of nutritional and dietary scientific evidence and not extraneous information.”
Use and enjoy the list of media resources—links to videos, audios, songs, movies, infographics, commercials—keyed to illustrate the text.
This book:
Answers the question, how did what is essentially flavored sugar-water come to mean so much and to have such devastating health and food policy consequences?
Is the first to focus on the history, politics, nutrition, and health of soda, integrating public health science with historical and cultural research
Helps readers understand how we created this food system, what its problems are, and what we can do to fix these problems
Is illustrated with 70 figures and 50 tables
Comes with a Foreword by Mark Bittman, food journalist and columnist for The New York Times
Comes with an Afterword by Dr. Neal Baer, pediatrician and television writer and producer
Here are the book’s blurbs:
“The soda industry is a powerful economic operator. Economic power readily translates into political power. Soda Politics is exactly the kind of carefully-researched investigative reporting needed to open the eyes of the public and parliamentarians to the health hazards of what is, as the author rightly notes, essentially liquid candy in a bottle.” –Dr. Margaret Chan, Director-General, World Health Organization
“No book in history has so completely laid bare the soda scourge that touches every corner of the world. Marion Nestle shows how this happened, its impact on human health and well-being, who the players are, and, most importantly, what might be done. This is the right book at the right time.” –Dr. Kelly Brownell, Dean, Sanford School of Public Policy, Duke University
“Marion Nestle is one of the greatest muckrakers of our time, and what she does is vitally important-for our health, our environment, and for future generations. Here, she wages war against the soda titans with such piercing clarity and so many irrefutable truths that all other arguments crumble.” –Alice Waters, Founder and Proprietor of Chez Panisse
“Comprehensive and well-written, this book will help frame a thoughtful public policy debate about nutrition and the societal impacts and costs of obesity.” –Ann M. Veneman, Former US Secretary of Agriculture and Former Executive Director of UNICEF
“What happens when the food industry’s most insightful critic turns her sights on soda? This razor-sharp, fun to read, plan-of-battle for one of the greatest public health fights of our time. Big soda may have all the money, but those who would enter this fray, as we all should, now have their champion.” –Michael Moss, Author of Salt Sugar Fat: How the Food Giants Hooked Us
“For decades, soda companies have amassed fortunes off drinks that are making us sick. It took someone like Marion Nestle to cut through the spin and uncover the high cost of cheap sodas.” –Robert Kenner, Director/Producer, Food Inc. and Merchants of Doubt
“Long recognized as an important and informed voice in our national and international discussions on nutrition and health, Marion Nestle has written another book that will keep us talking. With an impressive combination of scholarship and advocacy, Dr Nestle takes an unflinching look at the soda industry, its products and the impact on health. Soda Politics deserves the attention of the public and policy makers, and should make us all think more carefully about choices we can make to improve health and well-being.”–Margaret Hamburg, M.D., Former Commissioner, U.S. Food and Drug Administration
REVIEWS
Here’s the first review from the August 2015 Library Journal:
Nestle (nutrition, New York Univ.) once again exposes the dark side of the food business. As in her 2007 Food Politics: How the Food Industry Influences Nutrition and Health, the author examines the soft drink industry, demonstrating how products that are basically flavored water with added sugar contribute to obesity, type-2 diabetes, and metabolic syndrome. She discusses the composition and production of soda, the adverse effects of excess sugar consumption, and product marketing. The companies’ targeting of children, low-income, and minority communities; lobbying of Congress to prevent legislation that would impact profits; funding of research to produce results that obscure the facts about soda; and donations to health organizations and charities in order to be portrayed as socially responsible corporations make it difficult for citizens to act. Nestle reveals what can be done and how to do it, providing relevant data, analyzing that information, and illustrating its difficulties. She then advocates for smaller portions, taxing sugary drinks, and excluding soda from the Supplemental Nutrition Assistance Program (SNAP) and provides examples of successful campaigns, a list of groups advocating for healthy beverage choices, and extensive notes. VERDICT An outstanding manual for health educators, activists, and anyone seeking information about the soda industry and its impact on health.— Barbara Bibel, formerly Oakland P.L.
For me, the single most stunning and appalling revelation comes in the section about environmental impact and industry responses to it. It is that between 340 and 620 litres of water are used for every litre of soft drink produced, about 20% of that related to packaging. Despite such disturbing revelations,Soda Politics is not discouraging…Throughout the book, Nestle provides tactics for practical, local advocacy, such as working with school wellness committees and engaging local policymakers. And since 2002, the proportion of US citizens who say that they avoid soft drinks has risen by 20%, reaching nearly two-thirds of the population…For public health to prevail over soda politics as usual, we have miles to go. This book is the richly drawn map of how to get there, from here.
The standard operating practices of companies like Coca-Cola and PepsiCo demand the same level of scrutiny as cigarette companies, and for many of the same reasons, argues Marion Nestle in the introduction of her new book, Soda Politics. What follows is a thorough and unflinching look at the soft-drink industry’s role in promoting the consumption of sugary drinks despite growing evidence that they are detrimental to our health. The book begins with a basic primer of the range of health problems that have been linked to soda consumption, from tooth decay to obesity and diabetes, hitting its stride with an eviscerating assessment of the industry’s marketing and advocacy practices.
For those readers who share Nestle’s critical perspective on the food industry, it is obvious that this book would be informative. But here is the greater surprise: this solid book is by far the best source on this topic for any reader, with any perspective on economics or politics. If I worked for a trade association, or an industry front group, or an esteemed professional association that relies on soda industry funding, or the House Agriculture Committee, or a sugar manufacturer, or a high-powered corporate law firm, I might store this book in my desk drawer rather than my book shelf … yet I would read it word for word.
In Soda Politics (OUP, £19.90), Dr Marion Nestle does us all a great service by spelling out clearly and authoritatively the dreadful price we are paying for guzzling gallons of sugared water – Coke and Pepsi by any other name. Big Soda, as Dr Nestle calls the billion-dollar corporate giants behind this poison, know exactly how bad their products are for us but are so powerful no one takes them on. Rise up and rebel, Nestlé urges.
Nestle writes like an investigator hunting every possible scrap of damning material for a prosecutorial brief, which will no doubt make her book an excellent resource for activists and reformers seeking remedies in Washington, in the courts, and, perhaps, in the aisles of the local supermarket.
Fortunately, so does Marion Nestle. The nutrition professor, advocate and investigator best known for “Food Politics” profiles the soft drink industry in her expansive, superbly researched new book, “Soda Politics: Taking On Big Soda (and Winning).” It isn’t so much a narrative as a well-organized barrage of facts, some eye-popping (the world’s soda companies produce nearly two trillion 12-ounce servings annually), others banally incriminating. They come off the page like jabs in a sustained pummeling lasting more than 400 pages. Even if Nestle is only half right, it’s still a total knockout.
Nestle is foremost an educator and an activist, and Soda Politics is worth its price alone for the chapters on advocacy, from recruiting public health leaders and working from within to protecting public water resources…In other words, we can change things, one Big Gulp at a time.
Sabnavis M. Bitter fizz. Financial Express (India), March 20, 2016: A book that exposes that there’s more ill in a cola bottle than mere sugar—environment costs, high water use and pure politics.
Conclusion: The higher level evidence reviewed in this report does not support concerns linking fructose-containing sugars with overweight and obesity.
Conflicts of interest: All three authors report scholarship or research support from such entities as the Canadian
Sugar Institute, PepsiCo, Coca-Cola, Dr Pepper Sapple, Corn Refiners Association, World Sugar Research Organization.
Conclusion: LCCJ [low-calorie cranberry juice] can improve several risk factors of CVD [cardiovascular disease] in adults, including circulating TGs [triglycerides], CRP (c-reactive protein], and glucose, insulin resistance, and diastolic BP [blood pressure].
Sponsor: Ocean Spray Cranberries, Inc. and the USDA. JA Novotny received funding from and C Khoo is employed by Ocean Spray Cranberries, Inc.
Conclusion: Despite the similar P/S ratios of hard cheese and butter, consumption of hard cheese lowers LDL-C and HDL-C when compared with consumption of butter.
Funding. The senior author received unrestricted research grants from the Global Dairy Platform, the Dairy Research Institute, and Dairy Australia for the present meta-analysis. One other author, E.L.D., has consulted for the Dairy Research Institute.
Program organizer: Shalene McNeill, National Cattlemen’s Beef Association, and a Contractor to The Beef Checkoff.
Sponsors: The Beef Checkoff, Dairy Research Institute, Egg Nutrition Center, Global Dairy Platform, Hillshire Brands, National Pork Board
My comment: Journal supplements are typically paid for by outside parties—government agencies, foundations, private organizations, or food companies. The papers in this supplement discuss various aspects of protein and health. All emphasize the benefits of animal protein in human diets, as might be expected, given the sponsors.
Conclusion: dietary recommendations to reduce intakes of saturated fat and solid fats may result in dietary guidance to reduce intakes of commonly consumed food sources of protein, in particular animal-based protein.
The role of protein in weight loss and maintenance. Heather J Leidy, Peter M Clifton, Arne Astrup, Thomas P Wycherley, Margriet S Westerterp-Plantenga, Natalie D Luscombe-Marsh, Stephen C Woods, and Richard D Mattes.
Conclusion: Collectively, these data suggest that higher-protein diets…provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes.
For the record: Industry sponsorship does not necessarily mean that the reported conclusions are wrong. It just means that the papers require even more than the usual level of critical analysis.
I am happy to post industry-sponsored studies that do not produce results that can be used to market the sponsor’s products. Please send if you find any.
I was interested to read Michael Taylor’s comments on the recall of Blue Bell ice cream contaminated with Listeria. Mr. Taylor is Deputy FDA Commissioner for food safety.
This was an outbreak in which 10 people were hospitalized and three died. The best place to begin on this is on the CDC website for the Blue Bell outbreak. It provides excellent graphics summarizing the number of cases and where they occurred:
This outbreak was particularly awful because inspections had found severe violations of standard food safety procedures, yet the company ignored them. The result: people died.
Mr. Taylor asks if this outbreak could have been prevented with better FDA regulation. In 2010, Congress passed the FDA Food Safety Modernization Act (FSMA) but it’s taken time for the implementation. Taylor says:
the preventive controls for human food rule, if finalized as proposed, would require that companies like Blue Bell have a written food safety plan, based on an analysis of likely hazards, and companies would have to show us that plan during inspections.Listeria monocytogenes is a classic example of a hazard that a company should be controlling. Under the proposed standards, companies would be required to have the right controls in place to minimize hazards and would have to verify that their controls are working.
But, he says, to implement the law, the FDA needs funding: “If we do not get the funding, we will lose momentum, and implementation will be badly disrupted.”
Congress, no doubt, will continue to keep the FDA on a short string. No industry likes being regulated and the food industry fights regulation in every way it can.
The FDA needs to do more to ensure food safety but can’t without inspectors.
That leaves legal approaches. For these, I go right to the websites of the Marler-Clark law firm, which specializes in food safety cases.
Here’s what Bill Marler and his colleagues have had to say about the Blue Bell case (most recent first and I may be missing some):
Every time I collect five, I’m posting studies sponsored by food companies or trade associations that show benefits of the sponsor’s products.
I would love to be able to post industry-sponsored studies with results contrary to the sponsor’s interest, but I’m just not finding any. If you run across some, please send.
Here’s this week’s batch, with comments on the last two:
Conclusion: These results suggest that probiotic supplementation may be useful in the prevention of diet-induced metabolic diseases such as type 2 diabetes.
Sponsor: The present study…was financially supported by industry funds. The cost of consumables for the study was covered by an educational grant from Yakult UK Limited.
Conclusion: Given cultured dairy products’ long history of safe use, and whey protein’s overall efficacy in clinical studies so far, these dairy products appear to have great potential to assist with the management of T2DM in millions of people worldwide, in an inexpensive and easily implementable manner.
Sponsor: California Dairy Research Foundation. G Pasin is the executive director of the California Dairy Research Foundation. KB Comerford is a paid consultant for the California Dairy Research Foundation.
Conclusions: When compared to an oatmeal breakfast, one egg per day did not result in changes in plasma glucose, our primary end point…[and other markers] indicating that eggs can be consumed without any detrimental changes in lipoprotein or glucose metabolism in this population. The most interesting finding, however, was that eggs—possibly due to their content of highly bioavailable lutein and zeaxanthin—reduced inflammation in diabetic subjects when compared to oatmeal intake.
Conclusions: This is the first known study to investigate acute EEG effects of consuming chocolate and suggests a potential attention-enhancing effect… there is clearly the possibility of an application of this combination of L-theanine and cacao in the treatment of hypertension.
Sponsor: “Chocolate products for this study were provided by a generous grant in supplies from The Hershey Company…Grateful appreciation is expressed to Dr. Debra Miller and to the staff at The Hershey Company for their guidance and support throughout this project and for their careful review of this manuscript prior to submission.”
Conclusion: “In men and women at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events.”
Conflicts reported: The CTT Collaboration reports funding by various British and Australian research councils and foundations, “and not by the pharmaceutical industry.” But, it says, most of trials covered by its analysis were supported by the drug industry, and numerous members of the CTT report fees, grants, consultancies, or honoraria from various companies making cholesterol-lowering drugs.
Note: drug companies have a vested interest in promoting drug, rather than dietary, approaches to LDL-lowering.
Comment: Conflicts of interest do not necessarily mean that the results of the study were manipulated or wrong. They do mean that the methods and results require more than the usual level of scrutiny. Sponsored studies almost invariably produce results consistent with the sponsor’s economic or marketing interests.
It’s likely that some industry-sponsored studies produce conclusions contrary to the sponsor’s interest. If you know of any, please send.
I’m moderating: Chop Fry Watch Learn: Fu Pei-mei and the Making of Modern Chinese Food with author Michelle T. King. Arcchstatus Books is at 164 Huron, Greenpoint. 6:00 p.m. Information is here.
