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A reader who wishes to remain anonymous sent me an account of the development of the new Nordic Nutrition Recommendations, pointing out what they do not contain: a recommendation to reduce ultra-processed foods [Note: this is an updated and slightly corrected version of what was first posted on July 9].

Indeed, on pages 253-255 (this is a long report), you will find this statement:

The backstory here is one of effective food industry lobbying.

The Nordic Nutrition Recommendations do not say:  reduce consumption of ultra-processed foods.

The story begins with two authors who were asked to sum up the health effects of ultra-processed foods, and to advise the committee writing the recommendations.  They did so.  Their initial background paper concluded with these recommendations:

(1) Limit the consumption of ultra-processed foods.

(2) Choose less processed form of foods within each food group when possible.

(3) Cook at home and choose freshly prepared foods when eating out.

The committee revised the background paper.  It omitted the three recommendations but concluded:

Recommendations to limit ultra-processed foods, and choose foods of lower processing level, when possible, may enhance and support several of the existing FBDGs [food-based dietary guidelines] and help individuals select more healthful foods that align with the overall NNR2022 [last years Nordic Nutrition Recommendations] guidelines within each food category. For example, such advice would support choosing plain, unsweetened yoghurt instead of flavored, sweet yoghurt; choosing oatmeal or muesli based on grains, nuts, and dried fruits over sweetened, refined breakfast cereals; and choosing chicken breast/thighs over chicken nuggets.

The revised document was opened for public comment and a hearing.  A great many representatives of food companies objected to saying anything negative about ultra-processed foods.  This Excel spreadsheet lists the 60 people who commented and their main objections.

After the hearing, the committee preparing the recommendations wrote a draft report based on the comments.  The section on ultra-processed foods is on pages 152-153.  It begins:

There is currently no consensus on classification of processing of foods, including UPFs. The dominating UPF classification (NOVA classification group 4) contains a variety of unhealthy foods, but also a number of foods with beneficial health effects.

It also says:

Health effects. Regular intake of UPF encourages over-eating and intake of foods in the UPF category of the NOVA classification has been suggested associated with increased risk of obesity, cardiovascular disease, type 2 diabetes, cancer, depression, and premature mortality …However, no qSRs [qualified systematic reviews] support these suggestions.

These negative views of the UPF concept differ from the views of the background document (however politely stated) and clearly were influenced by the overwhelmingly negative views of food industry representatives.

The draft report also was opened for public comment.  These comments also are listed in an Excel document. Some favor the changes benefiting the food industry; others—but many fewer—object to them (these last are summarized in yet another document).

The final Nordic Nutrition Recommendations are somewhat of a compromise between public health and food industry views, but generally favor the food industry position.  The new Nordic Nutrition Recommendations are less critical of the UPF concept, but do not say “reduce consumption of ultra-processed foods.”

The NOVA food classification system, which first defined ultra-processed foods, was published by Carlos Monteiro, a professor of public health at the University of São Paulo, and his colleagues in 2009.*  About the Nordic recommendations, my informant writes:

I have come to realize that this is not at all about evidence. It’s about power, and who gets to define what’s important in nutrition science. “The establishment” refuses to accept that someone from Brazil, a country they regard as inferior, should be allowed to tell them they have been wrong in their nutritionism-approach. They claim NOVA is based on ideology, not science….And now this is getting in the way of public health.

My take-home lesson:  The food industry came out in force on this issue and greatly overwhelmed the few comments of public health advocates.  The message here seems clear: public support for reduction of ultra-processed food needs to be widespread, clear, and forceful.

*Definition of ultra-processed foods

• Industrially produced
• Bearing no evident relationship to the foods from which they were derived
• Formulated to be irresistably delicious (if not addictive)
• Usually containing color, flavor, and texture additives
• Often high in salt, sugar, and fat (but these are culinary ingredients that do not in themselves make foods ultra-processed)
• Cannot be made in home kitchens (because they are industrially produced and contain ingredients unavailable to home cooks)

Addition

An additional document was sent to me after this post and the response from nutritionists involved in the NNR, which I posted the following week.  It is from the authors of the background document expressing their concerns about the changes made.

Poisoned: The Dirty Truth About Your Food, a Netflix documentary about food safety in the U.S., premiered at the Tribeca Film Festival and I got to go.

It’s based on the book by Jeff Benedict about the Jack in the Box E. coli O157:H7 poisonings in 1993, and features Bill Marler, the lawyer who represented the families of kids who got sick or died from eating undercooked hanburgers contaminated with that especially toxic form of E. coli.  

I got to go to the premier because I’m in it—one of the many talking heads.

From left to right: Alexa Ginsburg, Associate Producer; Kristen Lazure, Producer; Bill Marler, food safety lawyer and Poisoned star; Ross Dinerstein, Producer; Jeff Benedict, Author of Poisoned; Christine Haughney, Journalist; Sarah Sorscher, CSPI; Me; Darin Detwiler, father of boy who died from eating a Jack in the Box hamburger and food safety advocate; Stephanie Soechtig, Director.

My interview for this was so long ago—prepandemic?—that I had forgotten all about it.  I may be prejudiced but I think the film is terrific.

It really lays out what’s wrong with our food safety system and what needs to be done to fix it.  I thought I knew this stuff pretty well—see my book Safe Food: The Politics of Food Safety—but I learned a lot from it, partly because the photography is so well done.

Some images are unforgettable (spoiler alert):

• The children hooked up to tubes in hospitals.
• Their grieving parents.
• Vast confined animal feeding operations (CAFOs) right next to fields of vegetables.
• Representatives of the USDA and FDA: “the US has the safest food supply in the world.”
• Bill Marler saying that he no longer has cases of people sick from eating hamburger since the USDA declared E. coli O157:H7 an adulterant.

It’s really worth seeing.

While waiting for Netflix to schedule it, Marler explains how you can see it on Tribeca at Home.

At Home Virtual Screenings will take place June 19 – July 2

• WAYS TO WATCH:
  • Browser: watch.tribecafilm.com
    • Members can use their login credentials (email & password) to access the At Home portal.
    • Single ticket holders can redeem their 9-digit voucher code for their screening. This code can be found in the confirmation email.
  • App: “Tribeca At Home”/ Available on Apple TV, Fire TV, Roku
  • TV:
    • Download the OTT app for Apple TV (Gen4 and above), Fire TV, or Roku
    • Chromecast [3rd generation or later Chromecast stick] from a computer using the Chrome browser or an Android device to your TV.
    • Airplay from a computer, iPhone or iPad to your Apple TV (Gen 4 and above) or to any Smart TV bearing the “AirPlay” badge.
    • Connect your laptop to your TV via HDMI, VGA, or DVI cables.
  • Computer:
    • PCs running Windows 7+ [Browsers: Google Chrome, Firefox, Microsoft Edge, Opera]
    • Intel-based Macs running macOS 10.12+  [Browsers: Google Chrome, Firefox, Safari, Opera]
    • *Internet Explorer is not supported
  • iPhone / iPad / Android:
    • Android: use Chrome on Android 6.0 or later
    • iPhone/iPad: use Safari on iOS 11.2 or later

It will get to Netflix evenually.  Watch out for it.

Thanks to Bill Marler for keeping us all up to date on the Daily Harvest saga.  He keeps up with the literature and writes, Is the Tara mystery closer to being solved?

My most recent post on this mystery was almost a year ago.

To review: Daily Harvest is a company that makes and ships preprepared vegan frozen meals, one of which, French Lentil + Leek Crumbles, has been recalled after several hundred people who ate it developed serious problems with their livers and gall bladders.

This was no trivial incident.  The FDA reported “As of 10/18/2022, there were 393 adverse illness reports in 39 states with 133 hospitalization and 0 deaths.”  But it could not detrmine the specific cause or route of contamination.

My post had breaking news:

The ingredient that caused the illnesses among people who consumed Daily Harvest’s French Lentil + Leek Crumbles has been identified, sort of.  As suspected, it’s the tara flour.  But what’s the toxin in the tara flour?  That, we still don’t know.

Now we have a new study: Is Baikiain in Tara Flour a Causative Agent for the Adverse Events Associated with the Recalled Frozen French Lentil & Leek Crumbles Food Product? A Working Hypothesis. 

In summary, the results of these initial studies support a working hypothesis that the adverse events reported by individuals consuming the Daily Harvest Crumbles product originate from the tara flour ingredient and are due, at least in part, to high levels of nonprotein amino acids (e.g., baikiain). It is further hypothesized that in vivo metabolism of metabolically unstable baikiain results in a toxic metabolite(s) that depletes glutathione and/or is an irreversible enzyme inhibitor (for L-pipecolate oxidase), resulting in adverse events which are dependent on the dose consumed and potentially exacerbated for individuals that have specific genetic predispositions.

Baikiain, which I had never heard of, is an analog of the amino acid proline.  In bacteria, it catalyzes proline destruction.  If it does this in humans, it also might account for the liver toxicity experienced by people who ate the Daily Harvest frozen meals containing tara.

The authors of the tara flour study identified baikiain in the flour.  They gave baikiain to mice, who did not fare well with it.

The hypothesis here is that some people are more susceptible to the toxic effects of baikiain than others.  The French Lentil + Leek Crumbles were sent to 26,000 customers, of which 400 or so got sick, more than 100 of them badly enough to have to be hospitalized; some required surgery.

The lesson here is that food ingredients need better testing.   Whoever makes tara must consider it GRAS (generally recognized as safe) for human consumption.

As Tom Neltner writes,

Tara flour is yet another example of how FDA’s GRAS program is broken—putting the health of Americans at unnecessary risk. FDA should use its big food reboot to fix the program so that we can have confidence in the safety of our food. The agency should also work with members of Congress who have introduced bills intended to fix GRAS and to have FDA reevaluate old food safety decisions in light of new science.

Amen to that.

Thanks to Bradley Flansbaum for sending this one from a journal not on my usual reading list: “In persons with constipation or IBS-C, kiwifruit vs. psyllium increased spontaneous bowel movements.”

I like the way this press release gets right to the point.

An industry-funded randomized trial assessed the effect of daily consumption of kiwifruit versus psyllium on GI function and comfort in 184 adults who were healthy, had functional constipation (FC), or met Rome III diagnostic criteria for constipation-predominant irritable bowel syndrome (IBS-C).

The study: Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort—Results of an International Multicenter Randomized Controlled Trial.  The American Journal of Gastroenterology ():10.14309/ajg.0000000000002124, January 9, 2023. | DOI: 10.14309/ajg.0000000000002124.

Authors: Gearry, Richard MD, PhD; Fukudo, Shin MD, PhD; Barbara, Giovanni MD; Kuhn-Sherlock, Barbara PhD; Ansell, Juliet PhD; Blatchford, Paul PhD; Eady, Sarah MSc; Wallace, Alison PhD; Butts, Christine PhD; Cremon, Cesare MD; Barbaro, Maria Raffaella PhD; Pagano, Isabella MD; Okawa, Yohei PhD; Muratubaki, Tomohiko PhD; Okamoto, Tomoko PhD; Fuda, Mikiko MS; Endo, Yuka MD; Kano, Michiko MD, PhD; Kanazawa, Motoyori MD, PhD; Nakaya, Naoki PhD; Nakaya, Kumi PhD; Drummond, Lynley BTech (Hons)

Summary of the study

Methods: Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week.

Results: Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001).

Conclusion: This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.

Financial support: Zespri International Ltd. was the principal sponsor and reviewed, approved, and funded the study design. The New Zealand study center trial was jointly funded by a grant from the New Zealand government (Contract C11X1312) and the sponsor company, Zespri International Ltd. In Italy and Japan, Zespri International Ltd. was the sole funder for each study center trial. The funder did not contribute to the study design or data analysis.

Potential competing interests: J.A. and P.B. are employed by Zespri International who part-funded the study. R.G. and L.D. sit on the Science Advisory Board, have received travel and research grants from Zespri International. SF and GB have received research travel grants from Zespri International.

Comment:  Can you guess what Zespri International sells?  Go on.  Take a wild guess.  I’ll admit it.  I’d go for kiwi over psyllium every time.  But we are talking here about an average improvement of 1.5 bowel movements a week, which may or may not be clinically meaningful..  I do give the authors credit for claiming a benefit for “fresh whole fruit,” not specifically kiwifruit.  The study didn’t compare kiwi to other fruits (and why would it, given the kiwi fruit sponsor).  But overall, this is yet another study done for marketing far more than scientific purposes.

To the surprise of everyone as far as I can tell, the Supreme Court has upheld California’s ban on pork from states that allow pork producers to confine pregnant sows in gestation crates.

California, which consumes 13% of U.S. pork but imports 99% of it, said it would only permit import of pork from producers who give pregnant sows at least 24 square feet of space.

Gestation crates confine pregnant sows so tightly that all they can do is stand up and lie down.

I would not call myself an animal rights advocate, but having been pregnant myself a couple of times, I found myself deeply upset when I saw sows confined like that.

At the time, I was on the Pew Commission on Industrial Farm Animal Production.

We asked why they were doing this.  Answer: To keep the sow from crushing her piglets—and to make it easier to feed and clean the animals.

Fortunately, Bill Niman was also on the commission and whisked us off to one of the Niman Ranch farms where we could see sows, each in her own hoop tent, happily tending to piglets and rolling in mud when she felt like it.

Did the sows crush their piglets?  Not when they had ample room to move around ard were not stressed.  Yes, they didn’t produce quite as many piglets, but the meat tasted a lot better.

So I’m happy to see the pig crates disappear, which they will have to if anyone wants to sell pork in California.

This case is not really about animal rights though.  It is about states’ rights to make laws like this one.

The pork producers challenged California’s law.  But Justice Neil Gorsuch writing for the majority said:

California voters overwhelmingly endorsed the “ethical pork” law in 2018 and have the right to decide what products appear on store shelves…Companies that choose to sell products in various States must normally comply with the laws of those various States, “While the Constitution addresses many weighty issues, the type of pork chops California merchants may sell is not on that list.”

It’s amazing to have something good come out of this court.  Maybe pig crates will set a precedent.

My email inbox last week was full of notes from people  who did not want me to miss the latest school food news: Lunchables—the prototypical ultra-processed meals, some made for kids—can now be sold and fed in schools (thanks Will Rosenzweig).

Starting this year, school administrators will be able to buy two different Lunchables offerings for the 2023-2024 school year: Turkey and Cheddar Cracker Stacker and Extra Cheesy Pizza, Kraft Heinz spokesperson Jenna Thornton told NBC News…the two Lunchables now meet National School Lunch Program guidelines and “have a specialized recipe that incorporates more protein and whole grains,” “reduced saturated fat and sodium, and an increased serving size.”

Supposedly, the meals have been modified—heIngredient list regular Lunchables cheese pizzare’s what Lunchables Turkey & Cheddar looks like—to meet USDA standards for school meals.

According to the accountof this  in The Guardian,

Kraft Heinz executive vice-president Carlos Abrams-Rivera said the company has produced two new varieties of specially formulated Lunchables containing “improved nutrition” so that they can become part of the National School Lunch program, which provides lunch daily to nearly 30 million students across the US.

I wanted to see an ingredient list.  Do they meet the NEW nutrition standards recently proposed by the USDA?

• I searched for Nutrition Facts and ingredient lists for these products but could not find them online.
• I called the consumer hotline at Kraft/Heinz.  After about 20 minutes of searching, the representative told me she did not have that information and I would have to get it from a school food salesperson.
• Calls to the USDA’s Food and Nutrition Service also did not turn up the basic nutition information (thanks Jerry Mande).
• Neither did calls to New York City’s school food people (thanks Pam Koch).

But then a reader sent me the Kraft/Heinz “sell sheet” (thanks Alexina Cather):

She then followed up by sending me these documents (thanks Alexina)

• Ingredient list regular Lunchables cheese pizza
• Product reformulation for the school lunch cheese pizza
• Ingredient list regular Lunchables turkey & cheddar
• Product reformulation for the school lunch turkey & cheddar

That reader also sent Nutrition Facts panels for the school lunch cheese pizza (330 calories) and the school lunch turkey & cheddar (270 calories).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gulp.  Nutritionism in action: if it meets standards for salt and sugar, it’s OK?  I don’t think so.

It’s still ultra-processed.  How about serving kids real food?

School-based Lunchables raise the question: is a slightly better-for-you product necessarily a good choice?

Not in this case.

The entire idea of reformulated branded products is just plain wrong.

Why?  Because these products are advertisements for the brand’s regular offerings.  Nobody explains this better than Michael Moss in this short video.

 

 

Thanks again to Will Rosenzweig, Jerry Mande, Alexina Cather, Pam Koch, and Michael Moss for all the help with this.

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For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

 

 

 

The Lancet has just published its commissioned series on breastfeeding, vs the commercial formula industry: three papers, an editorial, and a comment.

Breastfeeding has proven health benefits for both mothers and babies in high-income and low-income settings alike. Yet, less than 50% of babies worldwide are breastfed according to WHO recommendations. For decades, the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business—generating revenues of about $55 billion each year.

Editorial: Unveiling the predatory tactics of the formula milk industry

For decades, the commercial milk formula (CMF) industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business. The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced.

Breastfeeding: crucially important, but increasingly challenged in a market-driven world. R Pérez-Escamilla,, et al.

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding.

Marketing of commercial milk formula: a system to capture parents, communities, science, and policy.  N Rollins et al.

We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress.  P Baker, et al.

First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support.

Comment: Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding, by Tanya Doherty et al.

One of the striking messages of the Lancet Breastfeeding Series is that the consumption of commercial milk formula (CMF) by infants and young children has been normalised. More children are consuming CMF than ever before. Only 48% of the world’s infants and young children are breastfed as recommended, despite the huge body of evidence on the lifelong benefits of breastfeeding. This situation reflects the stranglehold the CMF industry has on governments, health professionals, academic institutions, and increasingly on caregivers and families through pervasive social media.

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I received an emailed announcement alerting me to today’s big event: It’s National Peanut Brittle Day, “a day dedicated to honoring one of our favorite uniquely American treats.”

Who knew?

The press release continues with some not-so-sweet news:  peanut brittle is yet another victim of inflation.

The chart shows the cost of the raw ingredients in peanut brittle has increased by nearly 18% — from just under $0.38 per pound in early 2021 to nearly $0.46 cents today.

Other cost increases: transportation, energy, labor add up to “a recipe for expensive candy!”

A strange press release, but an interesting commentary on what’s happening with prices.

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