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The FDA is taking comments on label proposals until August 1 (see info at end of post).  Here’s mine on voluntary vitamin D labeling.

July 17, 2014

TO:  FDA

FROM:  Marion Nestle, Professor, New York University

RE:  Proposed revision to Nutrition Facts Panel: VITAMIN D

This is to argue against permitting food companies to voluntarily label added “Vitamin” D on the Nutrition Facts panel.  Doing so will not promote—and may possibly harm–public health.

Rationale

• “Vitamin” D is not a vitamin; it is a hormone synthesized by the action of sunlight on skin.  For this reason alone, it does not belong on the food label.
• Vitamin D fortification must be understood as a form of hormone replacement therapy.   As such, it raises questions about efficacy, dose, and side effects that should be asked about all such therapies.
• Fortification and supplementation provide hormone Vitamin D by the oral route.  This is not physiological.  Active vitamin D is synthesized in the body through a series of reactions that begin with the action of sunlight on skin.  Sunlight on skin produces ample Vitamin D, is regulated to promote synthesis as needed and avoid toxicity, and may lead to synthesis of other useful biological components; the unphysiologic oral route does not produce the same benefits.[i]
• As a hormone, Vitamin D is found naturally in very few foods (e.g., fish); in them, it is present in small amounts.  It is present in most foods as a result of fortification.
• Permitting Vitamin D to be listed on food labels will encourage fortification, undoubtedly of foods that would not otherwise necessarily be recommended.  To cite just one example: Yum Bunny Caramel Milk Spread fortified with vitamin D at 10% of the DV.  This product is half sugars by weight, marketed as “a good source of calcium and vitamin D,” and clearly aimed at children. See: http://www.yumbunny.com/about-us.   Whether such products should be considered “good sources” also deserves scrutiny.
• The U.S. Preventive Services Task Force concludes that evidence is insufficient to determine how Vitamin D supplementation (and, therefore, fortification) affects fracture incidence.[ii]^,[iii],[iv] 
• Data from the Women’s Health Initiative also are consistent with largely inconclusive findings about hormone Vitamin D supplements and bone health.[v]
• The Institute of Medicine (IOM) does not consider deficiency of Vitamin D to be a serious problem in the United States, except among certain population groups.  Instead, because of widespread fortification and supplementation, it is concerned about the possibility of adverse consequences from overconsumption through supplementation or fortification.[vi]
• Many scientific debates about hormone Vitamin D are as yet unresolved.[vii]^,[viii]  
• The lack of compelling research has permitted Vitamin D to become “trendy.”  It is advertised on boxes of fortified cereals, has its own pro-supplement advocacy group, and generates millions in annual supplement sales.[ix]

In the absence of stronger evidence for benefit from fortification, and some evidence for possible adverse consequences, the FDA should not contribute to further commercialization of this misnamed hormone by permitting it to be listed on food labels.

References

[i] Wacker M, Holick MF.  Sunlight and Vitamin D: A global perspective for health. Dermato-Endocrinology 2013;5(1):51–108.

[ii] Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, et al.  Effectiveness and safety of vitamin D in relation to bone health. Evidence Report/Technology Assessment No. 158. Rockville, MD: Agency for Healthcare Research and Quality. 2007.  http://www.ncbi.nlm.nih.gov/books/NBK38410. Accessed February 5, 2013.

[iii] Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al  Vitamin D and calcium: a systematic review of health outcomes. Evidence Report/Technology Assessment No. 183. Rockville, MD: Agency for Healthcare Research and Quality. 2009.  http://www.ncbi.nlm.nih.gov/books/NBK32603/. Accessed February 5, 2013.

[iv] Chung M, Lee J, Terasawa T, Lau J, Trikalinos T. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(12):827-38.

[v] Prentice RL, Pettinger MB, Jackson RD, Wactawski-Wende J, LaCroix AZ, Anderson GL, et al.  Health risks and benefits from calcium and vitamin D supplementation: Women’s Health Initiative clinical trial and cohort study.  Osteoporosis Int.  2013;24(2):567-580.

[vi] Institute of Medicine.  Dietary Reference Intakes: Calcium, Vitamin D.  Washington, DC: National Academies Press, 2011.

[vii] Rosen, Clifford J,  Abrams, Steven A,  Aloia John F. et al.  IOM Committee members respond to endocrine society vitamin D guideline. J Clin Endocrinol Metab. 2012;97:1146-1152.

[viii] Holick, Michael F,  Brinkley Neil C, Heike, A et al  Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited.  J Clin Endocrinol Metab. 2012;97:1153-1158.

[ix] Much growth in vitamin sales driven by vitamin D.  Nutr Business J. 2009;14(6/7):5.

Here’s how to file comments:

The proposed revisions are to:

• Nutrition and Supplement Facts Labels
• Serving Sizes 

The FDA makes it very easy to file comments. It provides:

• All necessary information in one place.
• A short guide and checklist

File comments here

• Nutrition and Supplement Facts Label: Docket FDA-2012-N-1210  Comment here now
• Serving Sizes: Docket FDA-2004-N-0258  Comment here now

Hoping to cash in on the current protein craze, General Mills has come up with this (thanks to Kasandra Griffin of  Upstream Public Health in Portland, OR,  for sending):

Cheerios Protein has 7 grams of protein per serving.  But it also has 17 grams of sugars.

I use sugars, plural, for good reason.  Here’s the ingredient list:

In case you can’t read this: Whole grain oats, cluster (whole grain oats, brown sugar, soy protein, lentils, sugar, corn syrup, natural flavor, molasses, rice starch, caramel (sugar, caramelized sugar syrup), salt, calcium carbonate, baking soda, color added, BHT added to preserve freshness), sugar, corn starch, honey, salt, refiner’s syrup, tripotassium phosphate, rice bran and/or canola oil, color added, natural flabor, brown sugar, vitamin E (mixed tocopherols) and BHT added to preserve freshness.

A trip to the supermarket also turned up these:

This one has 16 grams of sugars.

And here’s another.  This one only has 7 grams of sugar per serving.  How come?  Sucralose!

Really, you can’t make this stuff up.

And just a reminder about protein: American consume roughly twice as much as needed.  Protein is not an issue in U.S. diets.

This is about marketing, not health.

I guess Cheerios SUGARS, Fiber One SUGARS, or Special K SUGARS PLUS ARTIFICIAL SWEETENERS wouldn’t go over nearly as well.

This ad was in last Sunday’s New York Times.  It appears again today with blurbs added.

Full disclosure: I’m one of the many people interviewed for the film and appear in three 10-second clips.

Fed Up! is a stunningly hard-hitting exposé of the food industry’s role in promoting unhealthy diets and childhood obesity.  It spares nothing in showing the devastating effects of obesity on kids (I found those parts painful to watch).

The film’s main message is that the food industry, in collaboration with government, is responsible for creating a food environment that promotes poor health.

It is especially tough on food company marketing and industry-sponsored research.

It is also—I think, unfortunately—tough on Michelle Obama and her Let’s Move! campaign.

Mrs. Obama is not the problem.  The food industry’s marketing and co-opting practices are the problem.

We can debate whether it was wise or useful for Let’s Move! to partner with the food industry, but the campaign has done much to bring issues of childhood obesity to public attention.

It’s ironic that the accomplishments of Let’s Move!—the White House garden, the Healthy Hunger-Free Act of 2010, the new school food nutrition standards, the new nutrition standards for WIC, and the new food label, for example—are at this very moment under fierce attack by food companies, their trade associations, and their friends in Congress.

With that said, the film is well worth seeing.  Don’t miss it.  Get your friends to see it.  Let the debates begin.

How to see Fed Up!

• Watch the trailer here.
• Find out where it’s playing here.
• Share it on social media here.
• See Katie Couric’s excellent ABC News interview here.
• Read the New York Times review here.

As for the debate, please enjoy:

• The Grocery Manufacturers Association statement about Fed Up! and its Q and A in response to the film
• International Food Information Council review
• The National Confectioners Association statement

Additions

• Jerry Hagstrom on the lack of “policy muscle”
• Nancy Huenegarth’s review in Food Safety News
• The food industry’s stealth campaign against the film
• Michele Simon’s take on the film.
• IFIC’s new point-by-point rebuttal of scientific statements in the film.
• Mark Bittman on the most important movie ever made.
• Food Policy Action — Real Fed Up Facts (in response to GMA)

You might think that the Supreme Court of the United States would have more important things to do than to weigh in on which of two beverage companies puts less misleading labels on its products, but apparently not.

The highest court in the land takes POM Wonderful’s accusation against Coca-Cola seriously.  Coke’s Minute Maid juice, POM says, is advertised in ways that mislead the public.

POM should know.   It’s been under fire from the Federal Trade Commission for equally absurd label claims.

Here’s the Coca-Cola product at issue.

And here’s what the label says, in case you can’t read it (with emphasis added):

Enhanced Juice/Minute Maid/100% Fruit Juice Blend

Omega-3/DHA/HELP NOURISH YOUR BRAIN

5 Nutrients to Support Brain and Body

Pomegranate  Blueberry Flavored Blend of 5 Juices

From concentrate with added ingredients and other natural flavors

Never mind the nutritional quality or the ridiculous structure/function claims on this particular product (here’s Fooducate’s analysis from 2009—it has 29 grams of sugars, among other things).

POM doesn’t want Coke getting away with selling cheap grape and apple juices as pomengranate juice and undercutting their prices.  Coke’s drink is 99% apple and grape juice; it contains less than 1% pomegranate or blueberry juice.  You would never know that from looking at the label.

Why is the court interested?  The Minute Maid label is legal by FDA standards.  Therefore, can the label be considered misleading?

Coca-Cola won in the lower court, but the Supreme Court seems sympathetic to POM (here’s the transcript of the hearing).

The New York Times account has the best quotes:

Kathleen M. Sullivan, a lawyer for Coca-Cola, said consumers were not misled.

“We don’t think that consumers are quite as unintelligent as Pom must think they are,” she said. “They know when something is a flavored blend of five juices and the nonpredominant juices are just a flavor.”

Justice Kennedy frowned. “Don’t make me feel bad,” he said, “because I thought that this was pomegranate juice.”

It also quotes from Justice Alito:

You don’t think there are a lot of people who buy pomegranate juice because they think it has health benefits, and they would be very surprised to find when they bring home this bottle that’s got a big picture of a pomegranate on it, and it says ‘pomegranate’ on it, that it is — what is it — less than one half of 1 percent pomegranate juice?”

Where is the FDA on all this?  Blame its inaction on the Dietary Supplement Health and Education Act of 1994, which allowed ridiculous health claims on food labels and forced the FDA to keep hands off.

This outcome of this case, silly as it is, will be fun to watch.

I read about General Mills’s introduction of non-GMO Cheerios back in January, but didn’t get around to looking for them until this weekend.

I was expecting to see something like this (thanks Fooducate):

Instead, the information is tucked into a side panel. 

This may explain why General Mills is complaining that the non-GMO is not doing a thing to boost sales of Cheerios.  If anything, sales are “down somewhat.”

And here’s a good one: According to one professor, the non-GMO Grape Nuts and Cheerios are going to be less nutritious than the GMO versions.

Post Foods’ new non-GMO Grape Nuts (click here ) no longer include Vitamin A, vitamin D, vitamin B12 or vitamin B2 (Riboflavin)*, while the new non-GMO Original Cheerios no longer have Riboflavin on the ingredients list (the old version has 25% of the daily value in a 28 g serving while the new version has 2% of the DV).

How come?  It’s hard to find non-GMO vitamins (who knew?).  Vitamins, it seems are often produced from genetically engineered microorganisms, or from microbes growing in fermentation tanks that are fed a nutrient mix that contains ingredients from GM sugar beets or corn.

Should we be worried about nutritional deprivation among Cheerios eaters?

Cheerios are essentially a vitamin pill wrapped in rapidly absorbable starch.

The ingredients: whole grain oats, corn starch, sugar, salt, tripotassium phosphate, wheat starch.

Everything else is added vitamins.

Personally, I prefer my cereals with no added vitamins (they taste bad).  And I doubt they make much difference to health.

Whether non-GMO will have a noticeable effect on sales of Cheerios remains to be seen.

If General Mills doesn’t advertise the change, it can’t expect non-GMO to boost sales.

Curious, no?

Rumors are flying that Let’s Move! will announce significant accomplishments this week.

From what I can piece together from ProPolitico and press conference announcements, they go on all week.

• Tuesday: School wellness policies
• Wednesday: Food assistance programs other than SNAP
• Thursday:  The Nutrition Facts label

These promise to be more useful than Mrs. Obama’s visit to the New Museum in New York to celebrate a pop-up exhibit organized by WAT-AAH!, a company that makes bottled water—marketed specifically to kids.

The company is a supporter of Let’s Move!’s Drink Up! campaign.

Its bottled waters are “functional,” meaning ostensibly nutritionally enhanced in some way.

For example, its “Power” product says it is:

Ultra pure water!

Bone-building magnesium!

Absolutely NO SUGAR!

Taste like pure clean water!

Sounds like plain, ordinary water to me (unless the amount of magnesium is substantial, which seems unlikely—I can’t find a Nutrition Facts label for it).

The idea here is to get kids who won’t drink water to drink bottled water aimed specifically at them—at $1.50 a pop.

This was great publicity for the company, but I sure wish Drink Up! would emphasize how terrific tap water is, especially in New York City, where it really is terrific.

Added comments:  A reader points out that WAT-AAH!’s health claims are difficult to substantiate (e.g., boosted oxygen level, brain function), and are just the kinds of claims that concern the FTC.  

And, despite Drink Up!’s public stance on how tap water is just fine, WAT-AAH! puts down tap water.  To check both the claims and the put down, go to the website, click on WAT-AAH! Drinks!, then on Just the Facts, and scroll on down.  

You will find plenty of highly iffy health claims, along with this:

OK, so this is about marketing so what’s the big deal?  I can think of several reasons for concern:

• It’s marketing bottled water.
• It’s marketing directly to kids.
• It’s marketed with absurd health claims.
• It claims to be substantially better for kids than tap water.
• It’s endorsed by the First Lady.

The FTC has gone after health claims just like these.  Can it go after WAT-AAH!’s claims and, thereby, take on the First Lady?

This is what happens—all too often—when health programs try to partner with private industry.  The private industry invariably wins, and the health partner loses credibility.

It’s the first Sunday of the month and time for my monthly Food Matters column in the San Francisco Chronicle.  In this one, I deal with the annoying “natural” on food labels, a term that the FDA prefers not to define.

Q: I am doing legislative research on food policy for one of my state’s senators on the definition of “natural.” As things stand, it’s difficult for consumers to understand what “natural” means on food labels. How should the FDA define this term so it is accurate and not misleading?

A: I was traveling in New England when your question arrived, and it sent me right to the nearest Hannaford supermarket. Hannaford makes this research easy. Sections everywhere in the store are labeled “organic and natural.”

Organic is no problem. Certified organic products must be made with ingredients raised or grown without artificial fertilizers, pesticides, hormones, antibiotics, irradiation, sewage sludge or genetic modification.

But what are we to make of Honey BBQ All Natural Potato Chips containing 20 ingredients, among them monosodium glutamate, yellow food color, and undoubtedly genetically modified corn and soy, but “no hydrogenated fats and gluten free”? Or Healthy Natural Dog Food containing meat by-products and other such things but “no artificial preservatives, colors or fillers”?

The Food and Drug Administration is not much help. Its answer: “From a food science perspective, it is difficult to define a food product that is ‘natural’ because the food has probably been processed and is no longer the product of the earth. That said, FDA … has not objected to the use of the term if the food does not contain added color, artificial flavors or synthetic substances.”

If you have made it through all the not’s in this non-definition, you can begin to understand how the FDA can allow high-fructose corn syrup to be “natural.” Even though enzymes, synthetic or not, are required to convert cornstarch to this mixture of glucose and fructose, it does not contain artificial colors or flavors.

But the products I mentioned do. Yellow No. 5 is an artificial color. You must assume that the corn or soy in any “natural” product is genetically modified unless the label says GMO-free or Certified Organic. You may be someone who has a hard time considering GMO ingredients “natural.”

In the last decade, new products marketed with “natural” claims have proliferated, and it’s easy to understand why. Marketers love the term. “Natural” sells products, not the least because consumers consider it a synonym for healthful and, often, for organic. Anyone would rather buy “100 percent natural seltzer water” – “calorie-free, no sugar, no sodium, gluten-free” (things never found in water) – than plain seltzer.

While “natural” does not necessarily mean “healthy” or even “healthier,” it works splendidly as a marketing term and explains why many junk-food manufacturers are switching from expensive organic ingredients to those they can market as “natural.”

The FDA isn’t fixing this situation because, according to a statement in response to a petition by Center for Science in the Public Interest, it’s “not an enforcement priority.”

Manufacturers of highly processed foods could not be happier with this nondecision.

In the absence of regulation, enter litigation. In recent years, advocacy groups have filed dozens of lawsuits seeking to ban “natural” claims on foods containing ingredients that seem unnatural, especially those genetically modified. Judges tend to say it’s the FDA’s problem and are calling on the agency to define the term.

The U.S. Department of Agriculture, which is responsible for meat and dairy products, has attempted to clarify what it means by “natural.” Its Food Safety and Inspection Service says meat and poultry can be labeled “natural” when they are minimally processed and have no artificial flavorings, colorings or preservatives. USDA’s Agricultural Marketing Service says “naturally raised” means the meat must come from animals produced with no hormone growth promoters, no antibiotics and no animal by-products.

How about all of the above? And if the public really can’t tell the difference between “natural” and “organic,” the closer the definition of “natural” is to that of “organic,” the less confused they will be.

Perhaps you could advise the senator to begin with the organic standards. And then toss in working definitions that exclude anything synthetic, artificial and more than minimally processed.

You should expect food industry lobbying against this idea to be fierce. But the public will be better served if the compromises in defining “natural” come at the end of the negotiations rather than at the beginning.

Marion Nestle is the author of “Why Calories Count: From Science to Politics,” “Food Politics” and “What to Eat,” among other books. She is a professor in the nutrition, food studies and public health department at New York University, and blogs at www.foodpolitics.com. E-mail:food@sfchronicle.com

Can something like this be nutritionally revolutionary?

Kellogg has just launched this cereal with just 6 grams of sugars per serving—half of what’s in most other cereals aimed at kids.

It’s also lower in sodium, but everything else about it looks pretty much the same:

Will Kellogg put money behind this cereal and market it with the millions it spends to market Froot Loops?   Will it reduce the sugars in its other cereals?  Will other cereal companies do the same?

Or will Scooby Doo suffer the fate of Post’s no-added-sugar and otherwise unsweetened Alpha Bits introduced in around 2005?

Post put no money into marketing the cereal and dropped it after just a few months (Alpha Bits now has 6 grams of sugars per serving).

Let’s give Kellogg some credit for giving this a try.   I’ve looked for Scooby Doo in grocery stores but haven’t been able to find it.

I will watch its fate with great interest.

Update: Thanks to Cara for pointing out that with Scooby Doo, Kellogg adds a cereal to its portfolio that meets requirements of the WIC (USDA’s Women, Infants, and Children’s nutritional support program).  As Jessica, a Kellogg rep explains, “The benefit of this cereal is that it’s WIC eligible and boosts several vitamins and minerals, is low in fat, is a good source of fiber and vitamin D and an excellent source of iron.”

And thanks to an anonymous writer for pointing out that Scooby Doo is directly competing with General Mills’ Dora Explorer cereal for the lucrative WIC market, one that should amount to nearly $7 billion in 2013.  WIC specifies what the benefits can be used to buy.  Cereal companies want to be sure they are in that market.