by Marion Nestle

Search results: dietary guidelines

Oct 22 2010

The latest salvos in the sodium debates

Scientific debates about the role of sodium in high blood pressure go on and on.  Committees of scientists reviewing the research invariably conclude that people would be healthier if they ate less salt (salt is sodium chloride).  The 2010 Dietary Guidelines Advisory Committee is only the most recent group to urge population-wide reductions in sodium intake.

The Institute of Medicine has just issued a new report on reducing sodium.  Its Report in Brief gives a quick summary

As its primary strategy for sodium reduction, the committee recommends that the FDA set mandatory national standards for the sodium content in foods…beginning the process of reducing excess sodium in processed foods and menu items to a safer level. It is important that the reduction in sodium content of foods be carried out gradually…Evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products if it is done in a stepwise process that systematically and gradually lowers sodium levels across the food supply.

But wait!  Hypertension rates have been increasing for years without any change in sodium excretion, says a report in FoodNavigator.com.  The report refers to new study in this month’s American Journal of Clinical Nutrition reviewing trends in sodium excretion from 1957 to 2003.

Sodium excretion, a precise reflection of intake, say Adam Bernstein and Walter Willett of the Harvard School of Public Health, has not changed in the last half century, despite rising rates of high blood pressure.   Instead, they suggest that rising rates of obesity might be the cause.

The accompanying editorial, by David McCarron and his colleagues, takes the argument even further as can be seen just from its title: “Science trumps politics: urinary sodium data challenge US dietary sodium guideline.

The editorial says that this new study provides:

plausible, scientific evidence of a “normal” range of dietary sodium intake in humans that is consistent with our understanding of the established physiology of sodium regulation in humans. This scientific evidence, not political expediency, should be the foundation of future government policies….Guidance for sodium intake should target specific populations for whom a lower sodium intake is possibly beneficial. Such an approach would avoid broad proscriptive guidelines for the general population for whom the safety and efficacy are not yet defined.

Is this review likely to change the Dietary Guidelines due out later this year?  The Advisory Committee was convinced that the preponderance of evidence favors the importance of sodium as a causative agent in high blood pressure.

Because so much is at stake for the processed food industry, this argument is not likely to be resolved quickly.  Stay tuned.

Oct 7 2010

New York City says no to using Food Stamps for sodas

New York City is serious about trying to reduce rates of obesity and the expensive and debilitating conditions for which obesity raises risks.  Its latest move?  It is asking the USDA for a Food Stamp waiver for two years during which recipients would not be allowed to use their benefit cards to buy sodas.

I hardly know where to begin on this one.  I learned about this from the front page of this morning’s New York Times and from reading the accompanying op-ed by city Health Commissioner Tom Farley and New York State Health Commissioner Richard Daines.

This is an old, old idea that has been consistently rejected by USDA and by public health advocates for the poor.  It is based on the commonly held notion—never conclusively demonstrated by independent data—that recipients of Food Stamps (now called SNAP, the Supplemental Nutrition Assistance Program)–make worse food choices than everyone else.

New York City, according to the Times account, has 1.7 million people who receive SNAP benefits.  The rationale for banning soda purchases?

City statistics released last month showed that nearly 40 percent of public-school children in kindergarten through eighth grade were overweight or obese, and that obesity rates were substantially higher in poor neighborhoods. City studies show that consumption of sugared beverages is consistently higher in those neighborhoods….Anticipating such criticism, Dr. Farley and Dr. Daines said that the food-stamp program already prohibited the use of benefits to buy cigarettes, beer, wine, liquor or prepared foods.

The op-ed points out:

Every year, tens of millions of federal dollars are spent on sweetened beverages in New York City through the food stamp program — far more than is spent on obesity prevention. This amounts to an enormous subsidy to the sweetened beverage industry.

I asked for data on soda purchases by New York City SNAP recipients, and was sent the city’s waiver request to USDA:

An estimated $75 to $135 million dollars of SNAP funds were spent on sweetened beverages in New York City (NYC) alone in 2009 [Based on Nielsen beverage market data for 2009, the prevalence of SNAP participants in NYC, and prior studies of SNAP purchasing behavior].   This use of federal funds to purchase a group of products that are leading contributors to the diabetes and obesity epidemics (and whose extensive consumption contradicts the USDA’s own recommended dietary guidelines) far outstrips current federal funding for prevention of these health problems.

I am, as readers of this blog well know, no fan of sodas.   If people want to do something about controlling body weight, the best place to begin is by cutting out sodas.  Soft drinks contain sugars and, therefore, calories, but nothing else.  As the Center for Science in the Public Interest has long maintained, sodas are liquid candy.   And I am on record as favoring soda taxes (see previous posts) as a strategy to discourage use, especially among young people.

But if I were in charge of Food Stamps, I would much prefer incentives: make the benefit worth twice as much when spent for fresh (or single-ingredient frozen) fruits and vegetables.

How far will the city get with this request?  I can’t wait to find out.  If you want to watch lobbying in action, keep an eye on this one, as I certainly will.

As for this proposal?

Oct 6 2010

Today’s oxymoron: Alcohol companies support breast cancer research

I can’t quite get my head around this one.  According to USA Today (October 5), some makers of alcohol drinks have joined the “pink” campaigns to raise awareness of breast cancer and more research.

Chambord’s website notes that its Pink Your Drink campaign has raised more than $50,000 in donations for the Breast Cancer Network of Strength and other patient groups.

Mike’s Hard Lemonade has given $500,000 over the past two years to the Breast Cancer Research Foundation, company President Phil O’Neil says. The company was inspired by the loss of an employee named Jacqueline who died after a long battle with breast cancer.

But alcohol is clearly implicated as a cause of breast cancer.  USA Today discusses that connection—to imbibe or not—in another article in the same issue.

Alcohol raises complicated public health issues for women.  On the one hand, moderate drinking reduces the risk of heart disease.  On the other, it raises the risk of breast cancer.

That is why dietary guidelines suggest no more than one drink a day for women, with a drink defined as 5 ounces of wine, 12 ounces of beer, and 1.5 ounces of hard liquor.

But alcohol companies using donations to pink causes as marketing?  Could we expect breast cancer research sponsored by alcohol companies to focus on the relationship of alcohol to breast cancer?  Is this any different than cigarette companies paying for lung cancer research?

Ethics, anyone?

Aug 2 2010

Why the FDA must act on health claims

On July 30, Center for Science in the Public Interest (CSPI)—in collaboration with representatives of a long list of distinguished health and consumer organizations (see below)–wrote Martha Coven of the Domestic Policy Council and Ezekiel Emanuel of the Office of Management and Budget urging them to encourage the FDA to take more vigorous enforcement action against misleading health claims on food packages.

Their petition responds to comments by the FDA’s Michael Taylor (discussed in a previous post) in a July 19 article for the Atlantic Food Channel, titled “How the FDA is picking its food battles.”   In explaining why the FDA is backing off from doing anything about unsubstantiated health claims on food products, Taylor said:

FDA must pick its battles—and set its priorities—in a way that will best benefit the public health….We have no pre-market review authority over such claims, and, under prevailing legal doctrines concerning “commercial free speech,” the evidentiary requirements placed on FDA to prove that such claims are misleading are significant and costly to meet. Moreover, meeting them requires tapping the same team of nutritionists, labeling experts, and lawyers who are working on our other nutrition initiatives.

We’re also conscious of the cleverness of marketing folks, who, once we prove today’s claim is misleading, can readily come up with another one tomorrow. Going after them one-by-one with the legal and resource restraints we work under is a little like playing Whac-a-Mole, with one hand tied behind your back.

So, we must make choices….especially considering the other high-priority nutrition and food safety initiatives that compete for FDA’s finite resources. We’ll consider all possibilities, but, in the meantime, we call on the food industry to exercise restraint, and we welcome the scrutiny CSPI and the media give to this issue.

Clearly, I was not the only one dismayed by this statement, which appears to be an open invitation to food companies to do whatever they like with health claims.  Indeed, Taylor’s statement reminded me of the Bush Administration’s FDA which, in 2003, announced that it had lost so many first amendment  health claims cases in court that it no longer intended to fight them.

But Taylor’s statement is also an open invitation to food advocates to get busy, as CSPI and the other signers of this letter have now done. The letter, dated July 30, 2010, is a follow up to a June 11 meeting on FDA/USDA Food Labeling Reform Efforts:

At Zeke’s suggestion, we are attaching a Priority List/Timetable Chart that provides an overview of the recommendations we made at our meeting and delineates how those recommendations intersect. As we discussed:

• We commend the Food and Drug Administration (FDA) for increasing the number of enforcement actions it has taken against misleading food labeling, and we urge the agency to increase those efforts. We also commend the FDA’s initiative to develop a system for disclosing key nutrition information on the fronts of food labels. However, we emphasize that the existing Nutrition Facts panel must also be modernized. In particular, nutrition information must be based on up-to-date serving sizes, a Daily Value for added sugars must be established and added to the existing Nutrition Facts panel, and “Calories per serving” must be displayed more prominently. Revisions to the Nutrition Facts panel and the development of a front-of-pack disclosure system are closely intertwined and should be developed concurrently.

• We urge the Domestic Policy Council to ask the FDA to ensure that any front-of-pack labeling scheme is not undercut by deceptive health-related claims on the fronts of food packages. Such claims, if unabated, will divert attention from any front-of-pack scheme the FDA develops. Since our meeting, the Federal Trade Commission (FTC) issued a consent order prohibiting claims that a food product could strengthen immunity because the claim lacked sufficient clinical evidence. Such claims are called “structure/function” claims by the FDA. The FDA should take a consistent position regarding the use of those claims. In addition, the FDA should address claims exaggerating the presence of healthy ingredients stressed in the U.S. Dietary Guidelines such as whole grains, fruits, and vegetables. For example, failure to remedy claims such as “Made with real fruit” on products that contain little fruit will detract from a declaration of sugar content that the FDA may specify in a front-of-pack labeling scheme, thus frustrating the Administration’s attempts to reduce childhood obesity.

• One way to remedy exaggerated claims for healthy ingredients (other than prohibiting them completely) is for the FDA to revise the ingredient list to require that the percentage of key ingredients such as fruit be disclosed in a clear, easily readable manner. FDA could also require that ingredient lists group all sources of added sugars to provide consumers with a clearer indication of the amount of added sugar in a product. The First Lady has recognized that ingredient labeling reform is an integral part of the Administration’s broader efforts to combat childhood obesity. The U.S. Department of Agriculture (USDA) is already working on new formats for ingredient labeling. We support those efforts and request the Council to encourage the FDA to follow USDA’s approach.

• In regard to a timetable, the recommendations we have made are closely intertwined with efforts already ongoing at the FDA. In some cases, they are necessary to ensure that those ongoing efforts by FDA succeed. We, therefore, urge the Council to recommend that the FDA expand its food labeling reform initiatives to include these additional issues and address them concurrently. Additional efforts that complement existing FDA labeling reform initiatives should commence as soon as the first set of initiatives is published in the Federal Register. All initiatives should be finalized by October 2012. This request is based on the fact that the FDA implemented the Nutrition Labeling and Education Act of 1990 in two years. The reform efforts we request are more limited than the requirements of the 1990 Act, and the FDA should be able to accomplish them by 2012 based on the agency’s previous performance on such matters.

• Rep. DeLauro, Chair of the House Agriculture Appropriations Subcommittee, asked the FDA how many FTEs the agency would need to issue regulations to revise the Nutrition Facts panel, increase the prominence of calories per serving, require caffeine labeling, and establish a daily value for added sugars, as well as other issues. The FDA stated that approximately “10-12” additional FTE’s would be necessary to address such concerns. Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations for 2005: Hearings Before a Subcomm. of the House Comm. on Appropriations, 108th Cong. 2d Sess. 323 (2004). While the FDA’s response at the time involved some issues not covered by our current requests, we believe that the FDA’s estimate is still reasonable, and we urge the Council and the Office of Management and Budget to work with the FDA to ensure that the FDA devotes additional resources to this effort.

We welcome the opportunity to assist the Administration and look forward to continuing our dialogue.

The letter is signed by Bruce Silverglade, Director of Legal Affairs, CSPI and representatives of Consumers Union, American Public Health Association, American Medical Association,  American Cancer Society Cancer Action Network, American Heart Association,  American Society of Bariatric Physicians, American Diabetes Association,  American Dietetic Association, Alliance for Retired Americans, Society for Nutrition Education, American Institute for Cancer Research, and Directors of Health Promotion and Education.

Let’s hope the FDA pays attention and gets busy on these issues.

Jul 21 2010

Be green and healthy: eat less meat?

How can food producers become more sustainable? Use less meat in their products.

Rita Jane Gabbett writes today on Meatingplace.com, a meat industry site, about a talk given by Cheryl Baldwin of Green Seal at a recent meeting of the Institute for Food Technologists.

She told Meatingplace that meat producers should better understand “the production methods used to feed and raise animals, making sure they are treated humanely and looking for ways to reduce the carbon footprint of processing methods.” She also said that “grass-fed animals created a lower carbon footprint than those that were grain fed.”

One can only imagine the reaction of meat producers to her comments.

Meatingplace noted:

Earlier this year, however, a study by the University of New South Wales published in the journal Environmental Science and Technology indicated beef produced in feedlots had a slightly smaller carbon footprint than meat raised exclusively on pastures. (See Feedlot beef could be “greener” than grass-fed: study on Meatingplace, Feb. 8, 2010.)

More recently, Washington State University scientists concluded that improvements in U.S. beef industry productivity have reduced the environmental impact of beef production over the past decade. (See Better beef industry practices have reduced carbon footprint on Meatingplace July 15, 2010.

This follows soon after the Dietary Guidelines Advisory Committee report’s advice to:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

To the meat industry, advice about health and sustainability must come as a serious challenge. Keep an eye on the “eat less meat” theme. My guess is that we will be hearing a lot more about it.

Jul 4 2010

San Francisco Chronicle column: low-acid diets

My monthly Food Matters column in the San Francisco Chronicle answers readers’ questions and these tend to be about nutrition rather than food politics.   Today’s column is about diets aimed at controlling the amount of acid excreted in urine:

Low acid diet may not prevent bone loss

Q: I’ve just read “Building Bone Vitality: A Revolutionary Plan to Prevent Bone Loss and Reverse Osteoporosis,” by Amy Lanou and Michael Castleman.

The writers contend that a high acid diet causes bone loss and other negative health outcomes. The book is so well documented and the theory so logically explained that I find it compelling.

However, I am not a scientist and would appreciate your opinion.

A: Ordinarily I would not bother to read a book with the word “Revolutionary” in its title. In diet books, “revolutionary” invariably means using a grain of scientific truth to construct a dietary theory that contradicts current thinking but cannot be proven by current research.

But two readers asked about this book and I was curious about it for another reason. Last year, I gave a talk at a spa where I was seated at dinner next to a couple who announced that they were following a low-acid diet. To my amazement, they excused themselves during the meal to measure the pH of their urine.

Stay with me: pH is a measure of acidity or hydrogen ion concentration. pH 7 is neutral. Above 7 is basic or alkaline. Below 7 is acidic.

I could not believe that anyone would bother to measure urine pH, let alone leave dinner to do so. The pH of blood is tightly regulated and must stay within a slightly alkaline range of 7.36 to 7.4. Bicarbonate buffering systems keep it that way, and excreting excess acid is exactly what the kidney is supposed to do.

The authors are proponents of vegan diets. Here, they argue that small increases in blood acidity cause calcium to be leached from bones to help neutralize it. Over time, these small losses weaken bones and lead to osteoporosis.

Adding calcium to the diet, they claim, is not enough to replace the losses. They parse the results of 1,200 research studies to argue that dairy foods cannot protect against osteoporosis. Instead, low acidity – meaning too much meat – provides the best current explanation for worldwide rates of osteoporosis.

The authors provide an entertaining list of the acid-producing potential of more than 100 foods. As they put it, “flesh foods”- beef, chicken and fish – produce the most acid, with grains coming in second.

Dairy, oddly, is low-acid, except for cheeses. They produce the most. Four ounces of Parmesan, for example, yield 34 milliequivalents (mEq). Compare this to 4 ounces of trout (11 mEq), beef (8), cornflakes (6) or yogurt (1).

Acidity depends largely, but not exclusively, on protein content. All proteins form acid, but “flesh” proteins yield more. They contain more sulfurous amino acids than do plant proteins. Meat and grains also have more acid-forming phosphates.

In contrast, fruits and vegetables contain loads of alkali-producing potassium and magnesium. They have minus numbers: apples (-2 mEq), potatoes and cauliflower (-4), and avocados (-8), with the alkali prize going to raisins (-21).

To prove this theory, research must demonstrate four things: foods have differential effects on urine pH, acid-producing diets cause calcium to be excreted, calcium excretion reflects loss of calcium from bones, and acid-induced calcium losses lead to osteoporosis.

Research easily confirms that animal foods and grains produce more acid than do fruits and vegetables and cause calcium to be excreted in urine. Evidence for everything else, however, is much less certain. Although some studies find bone losses with high-acid diets, a recent “meta-analysis” published in the Journal of Bone Mineral Research concluded that urine calcium does not reflect bone calcium. It found little justification for the idea that alkaline foods prevent bone calcium losses.

Kidney specialists agree. I asked Dr. Jerome Lowenstein, author of “Acids and Basics: A Guide to Understanding Acid-Base Disorders,” for comment. He says bone calcium is involved in maintaining normal blood pH, but so are many other factors.

Normal kidneys maintain normal blood pH over a very wide range of diets. Diet may affect acid-base balance in people with damaged or diseased kidneys, but matters less to people with normal kidneys. Bone losses do occur in kidney disease but not because bone serves as an acid buffer.

“If it did, patients with advanced kidney disease would become invertebrate within a couple of years,” he says.

How to make sense of this? To prevent osteoporosis, the authors promote a vegan diet based on low-acid fruits, vegetables and beans, with no or minimal acid-producing meat, poultry, fish, eggs, cheese and grains.

Revolutionary? Hardly.

Last month’s report from the 2010 Dietary Guidelines Advisory Committee called for a shift in food intake patterns to a more plant-based diet, one with more vegetables, beans, fruits, whole grains, nuts, seeds, seafood and low-fat milk products, and only moderate amounts of lean meats, poultry and eggs.

Eat healthfully, and you automatically eat low-acid.

So: eat vegetables with your meat, forget about pH testing, and enjoy your dinner.

Jul 2 2010

The latest on salt for the 4th of July

In preparation for eating over the 4th of July weekend, here’s what’s happening on the salt frontier.

The CDC says fewer than 10% of Americans meet sodium recommendations. Only 5.5% of adults who should be consuming low sodium diets(≤1,500 mg/day) actually do so.  Less than 20% of adults consume the amount currently recommended for healthy adults, ≤2,300 mg/day. Overall, only 9.6% of adults met their applicable recommended limit.

The British Food Standards Agency (FSA) says the U.K. is making great progress on reducing salt consumption. Even though UK salt intakes are still above the target of 6g/day after seven years of campaigning, FSA is happy about what the campaign achieved: a 10% reduction in average daily intakes from 9.5g/day to 8.6g/day.  This is substantial progress, given “the complexity of the task and the FSA’s modest budget.”

The New York Times explains part of the complexity: food industry resistance.  In an article titled, “The hard sell on salt” (May 29), the Times interviews food company executives who talk about why they must, must use salt and lots of it in processed foods.

The Salt Institute attacks the Dietary Guidelines Advisory Committee report. The report recommends a limit of 1,500 mg/day sodium because 70% of the U.S. population is at risk of high blood pressure. According to Food Chemical News (June 16), the Salt Institute claims that reducing salt intake to recommended levels would only make the obesity epidemic worse: “Most nutritionists agree that reduced sodium in food preparations will very likely increase the obesity crisis because individuals will consume more calories just to satisfy their innate sodium appetite.”

Most?  I don’t think so.  Because 77% of salt (sodium chloride) is in processed and restaurant foods, I see the salt issue as one of consumer choice.  Consumers can always add salt to foods.  They cannot take it out.

Enjoy a happy, healthy, safe, and lower salt 4th of July!

Tags:
Jun 21 2010

Wild Alaskan salmon: food politics in action

On a tour arranged and paid for by the Alaskan Seafood Marketing Institute (see Note below),  I spent last week observing salmon fishing and processing in Anchorage and at remote places 600 miles to the southwest.

I could not help thinking about federal dietary guidelines.  The 2010 Dietary Guidelines Advisory Committee has just filed its report.  It recommends consuming two 4-ounce servings of seafood per week, preferably fatty fish rich in omega-3 fatty acids.

Develop safe, effective, and sustainable practices to expand aquaculture and increase the availability of seafood to all segments of the population. Enhance access to… information that helps consumers make informed seafood choices.

This, among other fish, means salmon, particularly wild Alaskan salmon because they have higher levels of omega-3 fats than the farmed fish and because Alaska is working hard to maintain the sustainability of its wild fish.

Wild Alaskan salmon caught 6-19-10. Top to bottom: King (Chinook), Red (Sockeye), Chum (Keta), Pink

To be sustainable, fish have to remain in the sea and steams long enough to reproduce. This means controlling the number of people who are allowed to catch fish (through licenses and permits) as well as the number of fish they catch (through restrictions on fishing methods and times and places).

The Alaskan system for doing this works fairly well but is under constant pressure.  Commercial fishers want to be able to catch all the salmon they can with no restrictions. Communities that have always depended on salmon for sustenance want to be able to continue doing so, and do not want fish caught before they get to community spawning streams.  Hence: salmon politics.

Here are some thoughts about what I observed:

Labor conditions in the processing plants: workers were imported from the Philippines or Eastern Europe, and worked 12 to 16 hour days, 6 or 7 days a week, for months at a time.

The amount of hand labor involved: Fishermen haul nets and sort fish by hand, and processing plant workers remove heads and guts, fillet fish, trip fillets, and debone by hand. In canneries, they weigh cans and clean the contents by hand. Some of this work is highly skilled and so meticulously done that it qualifies as artisanal. All of it is hard and repetitive

Peter Pan salmon cannery, King Cove, Alaska, 6-20-10

The huge numbers of fish that can be caught by commercial fishers: Alaska regulates how fish can be caught (boat size, types of nets), but even so a purse seine picks up thousands of pounds of fish at one time. It is hard to imagine how such fisheries can be sustainable, even when tightly regulated.

Purse seine bringing in the catch

The waste in the system: Some plants had arrangements to supply fish heads, guts, backbones, belly fat, skin, tails, and other parts to be used for pet food or fish meal, but some just ground up the leftovers and flushed them into the water system or back into the ocean. If the wrong fish get into nets, they get tossed back into the sea.

The cold chain (temperature controls): fish stay fresher longer if they are held temperatures just above freezing throughout every step of processing. The tenders (collecting boats) do “RSW,” hold fish in a tank filled with Refrigerated Sea Water. High quality fish are sampled at arrival at plants to make sure their flesh is below 35 degrees. Two of the three plants we visited were careful with temperature controls. The third, however, allowed fish to sit in holding tanks for days or to remain on stopped processing lines at room temperature while workers went to lunch.

The role of science: Geneticists are madly working on methods to identify salmon by stream of origin as a means to settle arguments about who gets to catch which fish. This, of course, could backfire if the salmon turn out to be from Russia or Canada.

The love of fishermen for what they do: The ones we met love their work and have been doing it for decades. They just wish they got treated better by processors and paid better for the fish they catch.

As fish eaters, we don’t need to consider where fish comes from or how it gets to us. I will be looking at fresh, frozen, and canned salmon in grocery stores and fish markets with new appreciation for what it takes to get them to us.

I haven’t said anything about methylmercury and PCBs, fish safety, international disputes over fishing rights, or issues about organic or farmed fish. For these topics, see the five chapters on fish in What to Eat.

If we want to continue to have fish to eat, we must pay attention to such issues, uncomfortable as they may be to contemplate.

Note: The Alaskan Seafood Marketing Institute is a trade association supported by the seafood processing industry:

The Alaska Seafood Marketing Institute (ASMI) was created over twenty years ago as a cooperative partnership between the Alaska seafood industry and state government to advance the mutually beneficial goal of a stable seafood industry in Alaska. It is Alaska’s “official seafood marketing agency”, and is established under state law as a public corporation…[It] is divided into three distinct marketing programs: international, foodservice and retail. All three programs are designed to enhance the appeal and popularity of Alaska Seafood. The international program operates in the European Union, China, and Japan, while the retail and foodservice programs conduct their activities in the U.S.

Tags: