by Marion Nestle

Search results: dietary guidelines

May 22 2023

Industry-funded study of the week: Exercise!

My thanks to Arun Gupta for sending this one from a newspaper in India.

The clipping refers to this article.

  • The study: Ostendorf, D.M., Schmiege, S.J., Conroy, D.E. et al.Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis.Int J Behav Nutr Phys Act18, 158 (2021). https://doi.org/10.1186/s12966-021-01225-5.
  • First sentence : “High levels of moderate-to-vigorous physical activity (MVPA) are strongly associated with sustained weight loss [12], and current guidelines recommend high levels of PA for weight management .”
  • Methods: Participants were asked to follow a weight-loss diet and to do 300 minutes per week of exercise.  The investigators lstudies participants’ motivation levels.
  • Conclusion: once exercise supervision and support was removed, adults in the high autonomous motivational profile were protected against the standard attenuation in MVPA following removal of support/supervision.
  • Competing interests: “The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DC reports consulting income from Gelesis, Inc., a company that has developed a weight loss device.  SP has a grant from WW International [formerly, Weight Watchers] unrelated to this work.”

Comment: As far as I can tell, the paper says nothing about exercise being more important than diet.  The study didn’t find any differences in weight among people with different levels of motivation.  We can’t blame the authors for the press account.    But anything that minimizes the need for dietary changes gets pounced on.  Alas.

Apr 26 2023

The latest sugar recommendation

The latest review of sugars and health has created quite a stir.

  • The study:  Dietary sugar consumption and health: umbrella review.  BMJ 2023381 doi: https://doi.org/10.1136/bmj-2022-071609 (Published 05 April 2023).
  • Method:  The authors evaluated 73 meta-analyses that included 8601 studies, most of them observational (meaning they indicate associations but not necessarily causation).
  • Findings: Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected.
  • Implications: Low-quality evidence linked each additional serving of a sugar-sweetened beverage per week with a 4% higher risk of gout. Each extra cup per day of a sugar-sweetened drink was associated with a 17% and a 4% higher risk of coronary heart disease and all-cause mortality, respectively.
  • Recommendations: (1) Reduce the consumption of free sugars or added sugars to below 25 g/day (this translates to about 6 teaspoons daily). (2) Limit sugar-sweetened beverages to less than 1 a week.

Here’s the headline about the stir:

Experts recommend 6-teapsoon limit to added sugar following BMJ review, industry weighs in:  Recently published research in The BMJ is providing fresh concerns about sugar consumption levels, as some industry stakeholders disagree with the conclusion and CPG brand look to innovate in the low- and no-sugar space…. Read more

And one of the quotes from an industry representative:

…This is a review of existing evidence, and even a well-executed systematic review is only as good as the studies that are inputted. Essentially, garbage in equals garbage out, and it is known that added sugars literature suffers from significant variability when it comes to definitions, intake measurements and control of energy and other diet and lifestyle variables.

Comment: The six-teaspoon recommendation is consistent with World Health Organization guidelines to reduce daily intake of free sugar to less than 10% of their total energy intake, and preferably 5 percent.  The authors admit the evidence is not strong.  But there’s just so much of it, and it’s not going away.

When it comes to sugars, less is better, alas.

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

 

Jan 9 2023

Industry funded study of the week: ultra-processed foods are OK, really

Jim Krieger of Healthy Food America sent me this Food Navigator article titled “Can ultra-processed packaged food play a role in healthy, sustainable diets of the future.”

Uh oh.  Another attack on the concept of ultra-processed foods.  These, you will recall, are strongly associated in observational studies with poor health outcome, and one clinical trial demonstrates them to cause people to eat more calories.

The makers of highly processed foods are understandably worried that the word will get out and people will stop eating them.

Clif Bar to the rescue.

It sponsored a small session to establish guidelines for making highly processed foods healthier: “Making Healthy, Sustainable Diets Accessible and Achievable: A New Framework for Assessing the Nutrition, Environmental, and Equity Impacts of Packaged Foods

The publication emphasizes flaws in the concept of “ultra-processed,” an approach it says

lacks the nuance needed to holistically evaluate packaged foods within recommended dietary patterns. Additionally, there is considerable diversity of opinion within the literature on these topics, especially on how best to improve nutrition security in populations most at risk of diet-related chronic disease. In support of addressing these challenges, 8 sustainability and nutrition experts were convened by Clif Bar & Company for a facilitated discussion on the urgent need to drive adoption of healthy, sustainable diets; the crucial role that certain packaged foods can play in helping make such diets achievable and accessible; and the need for actionable guidance around how to recommend and choose packaged foods that consider human, societal, and planetary health.

Acknowledgments: “Staff at Clif Bar & Company developed the meeting agenda, synthesized all prework inputs, participated as observers in the workshop, and assisted in the gathering of the materials used to prepare this manuscript.”

Here is an ingredient list for an oatmeal raisin walnut Clif Bar:

ORGANIC ROLLED OATS, ORGANIC BROWN RICE SYRUP, SOY RICE CRISPS (SOY PROTEIN ISOLATE, RICE FLOUR, BARLEY MALT EXTRACT), ORGANIC ROASTED SOYBEANS, ORGANIC TAPIOCA SYRUP, ORGANIC CANE SYRUP, ORGANIC RAISINS, CHICORY FIBER, ORGANIC SOY FLOUR, WALNUTS, SUNFLOWER AND/OR SOYBEAN OIL, NATURAL FLAVORS, SALT, ORGANIC CINNAMON, MIXED TOCOPHEROLS (ANTIOXIDANT).

My definition of ultra-processed is that you can’t make it in your home kitchen because the ingredients are industrially produced and not available in supermarkets.  By this definition, the soy rice crisps are ultra-processed and maybe chicory fiber, but that’s about it.

The Clif people must be worried that they will be viewed in the same category as seriously ultra-processed snack foods.

Let’s give them and their parent company, Mondelez, credit for full disclosure.

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

Apr 5 2022

Good news: Another White House Conference on Food

If you are plenty old, or up on your history of US nutrition policy, you might remember the 1969 White House Conference on Food, Nutrition, and Health.

Tufts held a 50th anniversary conference at which I spoke (videos of the talks are here–I was on Panel 3 starting at about 17 minutes in).

In early December 1969, President Richard M. Nixon convened the first and only White House Conference on Food, Nutrition and Health to “put an end to hunger in America for all time” and improve the nutritional well-being of all Americans at a time when malnutrition was of urgent national concern. The agenda of the Conference was to draft recommendations that could be implemented by a bipartisan coalition into national nutrition policy.

The conference was notable for Nixon’s amazing speech kicking off the conference.

We see, then, that the problem of hunger and malnutrition is, really, two separate problems. One is to insure that everyone is able to obtain an adequate diet. The second is to insure that people actually are properly fed, where they have the ability to obtain the adequate diet.

On the one hand, we are dealing with problems of income distribution. On the other hand, with problems of education, habit, taste, behavior, personal preferences-the whole complex of things that lead people to act the way they do, to make the choices they do.

Look at what Nixon was proposing:

For the first time–Mr. Moynihan [Counsellor to the President] please notice–for the first time, this new family assistance plan would give every American family a basic income, wherever in America that family may live. For the first time, it would put cash into the hands of families because they are poor, rather than because they fit certain categories. When enacted, this measure alone will either supplement the incomes or provide the basis for the incomes of 25 million American men, women, and children.

The conference was also notable for its hundreds of recommendations—among them, free food stamps, cash income supports, transfer of food assistance out of the USDA.  We didn’t get the Universal Basic Income but we did get food stamps (now SNAP), school meals,and other useful policies.

The Tufts program kicked off demands for another White House Conference, and it looks like we may actually get that.

Congress allotted $2.5 million for a White House Conference on Food, Nutrition, Health, and Hunger in the FY22 omnibus spending package (see page 112), as part of efforts to end hunger.

The conference should be developed using a whole-of-government approach- in partnership with the Executive Office of the President, the Department of Agriculture, and other Federal agencies-and in consultation with State, territories, local, and Tribal officials, and a diverse group of interested parties from across the country, including anti-hunger, nutrition, and health experts; the private sector; and people with lived experience of hunger and nutrition insecurity. The conference should examine why hunger and nutrition insecurity persist and how they affect health, including their role in the high prevalence of chronic disease. It should also review existing and crossdepartmental strategies and consider new approaches to improve health by eliminating hunger, reducing the prevalence of chronic disease, and improving access to and consumption of nutritious foods in accordance with Dietary
Guidelines for Americans.

The conference was called for in bills S. 3064 sponsored by Senator Cory Booker (D, NJ) and Mike Braun (R, IN) and H.R. 5724 sponsored by House Rules Chair Jim McGovern (D, MA) and Jackie Walorski (R, IN).

HHS is to work with other federal agencies to “report initial findings” to the Hill about conference plans probably by late July.

This is great news.  Can’t wait to see how this develops.

Apr 19 2021

Industry-funded study of the week: avocados again and again

You might not think that avocados need any special sales efforts, but the Haas Avocado marketers are particularly aggressive in funding research to demonstrate the health benefits of this food.

I’ve written about Haas-funded avocado research previously (most recently, here and here) but here’s yet another, this time initiated by a tweet:

I think avocados are fine foods, love them, but wish their marketers would not do this.  Here’s the Good News Network headline: “An Avocado a Day May Keep Your Gut Microbes Happy, Study Shows.”  As always, the operative word is “may.”  The headline would be equally correct saying “may not.”

The study: Avocado Consumption Alters Gastrointestinal Bacteria Abundance and Microbial Metabolite Concentrations among Adults with Overweight or Obesity: A Randomized Controlled Trial. Sharon V Thompson, Melisa A Bailey, Andrew M Taylor, Jennifer L Kaczmarek, Annemarie R Mysonhimer, Caitlyn G Edwards, Ginger E Reeser, Nicholas A Burd, Naiman A Khan, Hannah D Holscher.  The Journal of Nutrition, Volume 151, Issue 4, April 2021, Pages 753–762.

Conclusions: “Daily avocado consumption resulted in lower fecal bile acid concentrations, greater fecal fatty acid and SCFAs, and greater relative abundances of bacteria capable of fiber fermentation, providing evidence that this nutrient-dense food affects digestive physiology, as well as the composition and metabolic functions of the intestinal microbiota.”

Funding: Support for this research was provided by the Hass Avocado Board and the USDA National Institute of Food and Agriculture, Hatch project 1009249.

Author disclosures: NAB, NAK, and HDH received grant funding from the Hass Avocado Board.

Comment: All fruits and vegetables provide nutritional value and the best way to get the nutrients you need is by eating a variety of them.  If you like avocados, include them in that variety.  If not, don’t.

The Haas marketers want you to think that avocados are a superfood.  Alas, there is no such thing.  All fruits and vegetables provide nutritional value.  By that criterion, all fruits and vegetables are superfoods.

Here’s an example of how Haas advertises:

Did you know fresh avocados can be part of the MyPlate food guide?

  • Make half your plate fruits and vegetables.

Avocados are a nutrient-dense fruit with naturally good fats and are easily incorporated into various meals and snacks. One serving (50g or one-third of a medium avocado) has only 80 calories and contributes nearly 20 vitamins, minerals, and phytonutrients along with dietary fiber.

The same could be said for most other fruits and vegetables, although most will be lower in calories.

Jan 25 2021

Conflicts of interest in nutrition research: this week’s example

Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. David JA Jenkins, David Kitts, Edward L Giovannucci, Sandhya Sahye-Pudaruth, Melanie Paquette, Sonia Blanco Mejia, Darshna Patel, Meaghan Kavanagh, Tom Tsirakis, Cyril WC Kendall, Sathish C Pichika, and John L Sievenpiper.  The American Journal of Clinical Nutrition, Volume 112, Issue 6, December 2020, Pages 1642–1652

Background: “Antioxidants have been promoted for cardiovascular disease (CVD) risk reduction and for the prevention of cancer. Our preliminary analysis suggested that only when selenium was present were antioxidant mixtures associated with reduced all-cause mortality.”

Results: No association of selenium alone or antioxidants was seen with CVD and all-cause mortality. However, a decreased risk with antioxidant mixtures was seen for CVD and all-cause mortality when selenium was part of the mix.

Conclusion: The addition of selenium should be considered for supplements containing antioxidant mixtures if they are to be associated with CVD and all-cause mortality risk reduction.

Comment: The results are statistically significant, but not by much (RR: 0.90; 95% CI: 0.82, 0.98; P = 0.02); the Confidence Interval reaches 0.98, which is very close to 1.00, which would show no difference.  But that’s not the real reason for my interest in this one.  The real reason in this astounding conflicts-of-interest statement and the disclaimer that follows it.

Conflicts of interest

DJAJ has received research grants from Loblaw Companies Ltd, the Almond Board of California, Soy Nutrition Institute (SNI), and the Canadian Institutes of Health Research (CIHR). He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speakers’ panel, served on the scientific advisory board, and/or received travel support and/or honoraria from the Loblaw Companies Ltd, Diet Quality Photo Navigation (DQPN), Better Therapeutics (FareWell), Verywell, True Health Initiative (THI), Heali AI Corp, Institute of Food Technologists (IFT), Soy Nutrition Institure (SNI), Herbalife Nutrition Institute (HNI), Herbalife International, Pacific Health Laboratories, Nutritional Fundamentals for Health (NFH), the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), and the American Society of Nutrition (ASN). He received an honorarium from the USDA to present the 2013 W. O. Atwater Memorial Lecture. He is a member of the International Carbohydrate Quality Consortium (ICQC). His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry; his 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the plant foods advocated here, The Portfolio Diet for Cardiovascular Risk Reduction; and his sister, Caroline Brydson, received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada (AAFC), Almond Board of California, American Peanut Council, Barilla, Canadian Institutes of Health Research (CIHR), Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, American Peanut Council, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Quaker (PepsiCo), Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the American Peanut Council, Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Loblaw Brands Ltd, Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and White Wave Foods/Danone. He has served on the scientific advisory board for the International Tree Nut Council, International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a member of the International Carbohydrate Quality Consortium (ICQC), is Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and a director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of Health Research (CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), INC International Nut and Dried Fruit Council Foundation, National Dried Fruit Trade Association, The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and the Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received in-kind food donations to support a randomized controlled trial from the Almond Board of California, California Walnut Commission, American Peanut Council, Barilla, Unilever, Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods, and Nutrartis. He has received travel support, speaker fees, and/or honoraria from Diabetes Canada, Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Pulse Canada, Canadian Society for Endocrinology and Metabolism (CSEM), GI Foundation, Abbott, Biofortis, ASN, Northern Ontario School of Medicine, INC Nutrition Research & Education Foundation, European Food Safety Authority (EFSA), Comité Européen des Fabricants de Sucre (CEFS), and Physicians Committee for Responsible Medicine. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Wirtschaftliche Vereinigung Zucker e.V., and Inquis Clinical Research. He is a member of the European Fruit Juice Association Scientific Expert Panel and Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the Study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada. He serves or has served as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), executive board member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of AB InBev. DK, ELG, SS-P, MP, SBM, DP, MK, TT, and SCP have no conflicts of interest to declare.

Disclaimer: The authors have no relevant conflicts of interest over the past 4 y. DJAJ has received funds for dietary studies from Loblaws, which, during the course of his funding, acquired Shopper’s Drugmart, which is a pharmaceutical company that also sells supplements.

Comment: Here’s one reason why I am not a fan of dietary supplements.  Most independently funded studies show no significant benefit when they are given to healthy people.  The industry needs studies like these for marketing purposes.  I’m not, but if you are worried about selenium, try food.

Oct 27 2020

Vitamin D and Coronavirus: Panacea or sign of good health?

Evidence is pouring in that people with adequate vitamin D status seem to be better protected against harmful effects of Covid-19.

This is not surprising; people who practice healthful lifestyles—eating well, being active, getting out in the fresh air, maintaining a healthy weight, not smoking, not drinking too much—generally survive this infection more easily.

Vitamin D, I must remind you, is not really a vitamin.  It is a hormone induced by the effects of sunlight on skin.

Sunlight is by far the most effective way to get it.   Foods provide much less.

As for supplements, it’s hard to say.  They are under investigation.

I’ve been collecting items:

  • An account of a clinical trial in Italy published in Medium: “Among the 26 hospitalized people who received standard care alone, fully half went on to the intensive care unit (ICU) because their disease had worsened. Two of them died. But among the 50 people who received the vitamin D treatment on top of standard care, only one person ended up in the ICU. None died.”  The study itself concludes: “…administration of a high dose of Calcifediol or 25-hydroxyvitamin D…significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.”
  • Medium’s discussion of what is known about Vitamin D supplements and Covid-19: “If we ask the question “Does vitamin D prevent/treat COVID-19?” the only real answer is “How could you possibly know?””
  • Consumer Reports on whether you should be taking vitamin D supplements: its not-particularly-helpful conclusion: “Ultimately, whether to get tested or take a supplement and how to do it comes down to having a discussion with your doctor.”

As always with supplements, a market is involved.  This one is not trivial, even in the UK.

An obesity newsletter I subscribe to—Obesity and Energetics Offerings—provides items suggesting that conflicts of interest may be involved.

  • Vitamin D deficiency linked to 54% higher SARS-CoV-2 positivity rate: Study: The associations between vitamin D status and COVID-19 risk continue to strengthen, with new data from Quest Diagnostics and Boston University indicating that people with deficiency in the sunshine vitamin may have a significantly higher positivity rate for SARS-CoV-2, the coronavirus that causes COVID-19.
  • The study in question, Evidence That Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths, reports conflicted interests: “W.B.G receives funding from Bio-Tech Pharmacal, Inc. (Fayetteville, AR). H.L. sells vitamin D supplements. GrassrootsHealth works with various supplement suppliers to test the efficacy of their products in various custom projects. These suppliers may be listed as sponsors of GrassrootsHealth.”   Basically, it’s industry-funded.
  • One letter in response to the study points out that “the efficacy of high-dose supplementation of vitamin D3 in reducing risk of COVID-19 infection is mere extrapolation of currently available evidence, which is often conflicting, on the effectiveness of vitamin D3 in reducing risk of other respiratory tract infections.”
  • To this, the authors have a lengthy rebuttal.

My bottom line at the moment: the science is still unfolding.  What to do while waiting for further research?  I like these Considerations for Obesity, Vitamin D, and Physical Activity Amid the COVID-19 Pandemic:

Until further breakthroughs emerge, we should remember that modifiable lifestyle factors such as diet and physical activity should not be marginalized. Decades of empirical evidence have supported both as key factors promoting health and wellness. In times of crisis, whether it be real or perceived, there is something to be said about the benefits of empowering people to actively preserve their own health.

Get outside, move around, expose some skin to sunlight.  Even in winter.

 

Mar 24 2020

Coronavirus and food: this week’s update

From the New York Times

Does food transmit Coronavirus?  

Keeping up Coronoavirus  

How to survive working at home (watch out for junk food) 

How to take action

Advice for the food industry

  • US lays out new COVID-19 guidelines for food industry  The Trump Administration released a set of coronavirus guidelines for all Americans, with special provisions for critical infrastructure industries like food and beverage. Brands have been adapting this week to the new reality, while keeping employee safety a top priority…. Read more

What’s happening with supermarkets and supply chains?

What to avoid: dubious schemes for immune boosting

Who profits from this?

What else?