Yesterday, the fabulous Representative Rosa DeLauro (Dem_CT) introduced the Sugar-Sweetened Beverages Tax Act of 2014 (SWEET Act).  Here’s a quick summary of the bill. The SWEET Act (you have to love the name) would put an excise tax of one cent per teaspoon of sugars (a teaspoon is about 4 grams). The bill is clearly aimed at sugary drinks, which account for about half of total sugar intake.  According to the 2010 Dietary Guidelines (page 29),

• Sodas, energy, and sports drinks account for 35.7% of total sugars
• Fruit drinks—a category that does not include 100% juices—account for another 10.5%.
• Sugar-sweetened teas account for 3.5%.

The tax ought to raise about $10 billion a year, and is earmarked for programs to combat soda-related disease. It also ought to further reduce consumption of sugary drinks, as is already happening in Mexico. If you would like to endorse this legislation, contact Kelly.Horton@mail.house.gov in Representative DeLauro’s office. References

• DeLauro Press Release
• CSPI’s Press Release
• Mark Bittman’s July 30 discussion of the bill in the New York Times
• The Prevention Institute’s endorsement
• Reuters’ report
• Food-Navigator.com’s report
• The Hill’s story plus video
• The American Beverage Association statement

The big surprise in Michael Moss’s tough look at health claims on coconut water in today’s New York Times—worth looking at online for the terrific video—is this:

One Last Comparison

These days, coconut water’s big rival may be plain old water. How do they compare? Scientists are still wrestling with the question, and while their findings vary, water is starting to look just fine for most people. A 2012 study (funded by Vita Coco) in the Journal of the International Society of Sports Nutrition found that neither coconut water nor sports drinks were better than water in hydrating young men after hourlong workouts.

Really?  An industry-funded study that comes to a conclusion against the interest of the funder?

This requires a look at the original paper.

So a round of applause please for the authors who did this funded study, “Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men,” and nevertheless came to this conclusion:

Our data indicate that both coconut water (natural, concentrated and not from concentrate) and bottled water provide similar rehydrating effects as compared to a carbohydrate-electrolyte sports drink.  Moreover, none of the beverages impacted treadmill exercise performance differently during the rehydration period.

Lest there be any ambiguity about what this means, their data clearly show that VitaCoco, a sports drink (not named but I’d bet on Gatorade), and coconut water from concentrate all rehydrated men who spent 60 minutes on a treadmill to the same extent.

In other words: for rehydration, water works just as well as coconut water or sports drinks.   No surprise, really.

VitaCoco must be disappointed, but it still has one thing going for it: coconut water tastes really good.

August 1 is the deadline for filing comments on FDA’s food label proposals.

Two were released yesterday, one for and one against.

The Union of Concerned Scientists (UCS) organized a statement in support of listing added sugars signed by 280 scientists, physicians, and public health officials (including me).

The press release says:

In a letter submitted as a public comment for the agency’s first label update since 1994, the signatories point out that sugar overconsumption contributes to diabetes, cardiovascular disease and other ailments….Many food and beverage manufacturers add excessive amounts of sugar to their products, including those that they market as healthy options. In our current food environment, many people are unknowingly and unavoidably consuming excess sugar. Given our soaring rates of chronic diseases and the link between sugar and these diseases, citizens have a right to know how much sugar has been added to their foods.

People who signed the letter include many from Healthy Food Action, a national network of health professionals founded by Dr. David Wallinga.  I am a co-author of the statement with UCS staff and Dr. Robert Lustig.

In contrast, the American Society for Nutrition (ASN), an organization of nutrition scientists to which I belong, produced a strong statement against labeling added sugars.

ASN also has concerns that the inclusion of added sugars on the label may divert attention away from total calories and other important contributors to weight gain. The inclusion of added sugars on the label may confuse consumers and create the perception that naturally occurring sugars are somehow more beneficial because they are “natural” and do not have health effects similar to added sugars…There is no supporting evidence that indicates that the inclusion of added sugars on the food label will translate into the American public reducing caloric intake from added or total sugars or total energy intake…it is important to consider potential unintended consequences of  reformulation as well. When sugar is removed from a solid food product…The replacement is often fat and/or starch which could lead to a product with higher calories per serving. ASN encourages FDA to carefully consider potential adverse consequences of this proposed determination, including gaining input from food scientists…An investment in consumer education… is likely to be most productive for consumer understanding relative to added sugars, and would assure that consumers do not experience increased confusion, which they may encounter if added sugars are declared on the Nutrition Facts label.

These comments, which read as though written by sugar trade association groups, were signed by the president of ASN.  Although the statement letter gives no indication of the process by which these comments were developed, I’m told it was prepared by ASN’s public policy committee.

If so, it would help to know whether members of the committee have financial ties to the sugar industry or to food companies that use sugar in their products.

I wonder how much of the ASN membership agrees with this position on Added Sugars.   I certainly don’t.

The FDA is taking comments on its proposals to revamp the food label through August 1, 2014 (instructions are at bottom of post).

I’ve already filed comments on Added Sugars and on whether Vitamin D should be added to food labels.

And I just filed further comments on the FDA’s proposals for the Nutrition and Supplement Facts Labels.  If you would like to read what I said, click here.

I’ve also filed comments on the FDA’s Serving Size proposals.

These proposals are highly technical and tough to slog through, so I tried to deal with the big picture.

July 27, 2014

TO:                  FDA

FROM:           Marion Nestle, Professor of Nutrition, Food Studies and Public Health, New York University

RE:                  Comments: Serving size proposals, Docket No. FDA-2004-N-0258

In addressing the question of how to change serving size designations on food labels, FDA is faced with an impossible dilemma .  Serving sizes, which are supposed to be based on amounts typically consumed from packaged products, are invariably perceived as recommendations for dietary intake.

To comment on each of the bold-face, italicized points:

• Typically consumed:  This information derives from dietary intake surveys which invariably underestimate actual intake, often by 30% to 40%.

• Packaged foods: Food labels only appear on packaged foods.  RACC amounts on packaged foods are often much lower than amounts served in restaurants or fast-food places (pizza is an obvious example).  It is unclear whether amounts reported as consumed are from packages (with Nutrition Facts labels) or are from restaurants or fast-food places where portion sizes can be much higher than those for foods in packages.

• Recommendation:  Substantial anecdotal information suggests that people view labeled serving sizes as what they should be eating.  They view the serving sizes as meaningless compared to the portion sizes of foods they are accustomed to eating.

What is well established is that overall calorie intake has increased since RACCs were established in 1993 and marketplace portion sizes have also increased.

Therefore, any increase in RACC runs the risk of being interpreted as a validation of current portion sizes and as a recommendation to eat more.

On the other hand, larger portions have more calories.  These must appear on the label.

To address this dilemma, FDA should:

• Make dual-column labeling mandatory for all food and beverage packages likely to be consumed in one sitting.
• Require total calories in the package to be displayed on the front of the package.
• Include a footnote explaining that the serving size is not meant as a recommendation

INSTRUCTIONS FOR FILING COMMENTS

The FDA 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

The role of specific nutrients in brain health isn’t something I think about much.  I’m of the opinion that a reasonably healthy diet takes care of health.  Stop worrying, be happy.

But I’m always interested in what the food industry is cooking up based on current research, and here’s a good sampling to ponder.

For this Special Edition, NutraIngredients-USA has a long hard think about cognitive health…

Cognition spans the lifetime, from development in the womb right through to old age. So, which ingredients have the best science? How are companies approaching this sector and what claims can they make? What’s all this about the gut-brain axis? And what’s happening with botanicals in this space?

• Gallery: The top ingredients for cognitive health: Memory, attention and focus, development, mood; there are numerous ways that a nutrient or ingredient can affect cognitive health. But which have the most science, how do they work, and how are they performing in the market. Check out our gallery of the top ingredients for cognitive health. .. Display
• Cognitive health claims range from sublime to ridiculous, experts say: When it comes to what’s an allowable claim in the realm of cognitive health, ignorance and confusion abound, experts say… Read
• ‘The eye and the brain are connected, so it’s no surprise lutein is important for brain health,’ says Kemin: Lutein and zeaxanthin are well-established in the realm of eye health, but ever emerging science shows the importance of the carotenoids in brain health. And that comes as no surprise to Kemin, with ‘eye health and brain health are coming together as one’… Read 
• Evidence of gut/brain connection piles up, but actual products are a ways off, researcher says: The gut is teeming with bacteria, good and bad, and these organisms and their cousins living elsewhere on and in the body outnumber the body’s own cells by an order of magnitude.  It is only recently that the notion has come to the fore that these microorganisms are doing something other than helping us digest food or aiding in keeping nefarious colonies at bay.  Now researchers are beginning to realize that there is a feedback loop at work between the brain and the gut, with one influencing the other… Read
• Botanical ingredients step up to battle cognitive decline: Botanical ingredients for cognitive health indications abound, and the scientific backing for these ingredients is abundant, too, if you are willing to look, experts said… Read
• NIU’s Cognitive Health Forum: ‘The key is to not have ingredients that stimulate other areas of the body that are not needed for performance’:  Cognitive health formulations must be driven by mechanisms of action, and with cognition being a lifelong issue with many aspects to consider the possibilities are impressive and continually developing, according to experts at the NutraIngredients-USA Cognitive Health Forum… Read
• Fish oil linked to structural changes in the brain: Human data:  Fish oil supplements may produce beneficial structural changes in the brain, according to a new study from Brown University and Rhode Island Hospital… Read

 

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

Living in New York as I do, I miss the fun in Washington, DC, of which there was much yesterday related to the First Lady’s “Drink Up” campaign with the Partnership for a Healthier America.   Here’s one of ObamaFoodorama’s tweets on the event.

Listen to what the First Lady is saying in these selected quotes, some of which deal with the current furor over school meals:

• When the Drink Up campaign was launched last year, it had one simple goal – to get kids and families excited about drinking water.
• As Drink Up encourages more people to drink more water, we also want to help make choosing water an easier choice…water for more people wherever they are, whenever they want it, however they want it – be it tap, filtered or bottled.
• In a number of school districts, participation in the lunch program has actually risen. And there’s a simple reason for that: It’s because those districts actually put some effort into marketing the new meals to the kids. They didn’t just sit back and say, well, the kids like junk food so let’s just give them junk food.
• Instead, they embraced higher standards and more nutritious options, and they worked hard to get the kids excited about them. They did taste tests. They came up with new recipes. They did everything they could to make healthy eating fun.
• Today, we’re seeing the results, especially among younger kids…They’re getting used to healthier food, and they’re developing healthy habits early on that will stay with them for the rest of their lives. And that’s our job as adults… And no matter what, we don’t give up on our kids. And we don’t give up on their health and their futures.
• We need to keep pushing to market healthy products to children and families. We need to keep working together within industries and across industries to help our kids lead healthier lives.

Even better, The California Endowment announced that it will increase community access to water in South Kern County and the Eastern Coachella Valley by installing hundreds of taps and dispensers to fill reusable water bottles in schools and public places.

Let’s have more tap-water initiatives, please.

The more people drink tap water, the greater will be public support for maintaining the quality of municipal water supplies.

Addition, July 24:  The School Nutrition Association wrote the First Lady to complain that it found her remarks offensive.

The Times’ obituary for Dr. Albert J. (“Mickey”) Stunkard, who died last week at the age of 92, describes his work on the genetics of obesity and quotes Dr. Walter Willett’s comment that genetics accounts for only a small part of the “legions of the obese.”

Stunkard was writing about the lifestyle and environmental determinants of weight gain, long before most of us had a clue.

I learned this in 2000 when Michael Jacobson and I were writing a paper on public health policy approaches to obesity prevention.[i]   We were arguing that policies aimed at preventing weight gain focused almost entirely on personal behavior but needed to focus on fixing the environment of food choice.

A peer reviewer scolded us for missing Stunkard’s work.

At last, we discovered Stunkard’s groundbreaking work.  In the published paper, we wrote:

The most notable exception [to the focus on personal responsibility] was the report of a 1977 conference organized by the National Institutes of Health (NIH) to review research and develop recommendations for obesity prevention and management.

In one paper, A.J. Stunkard thoroughly reviewed social and environmental influences on obesity.[ii]  As a result, the conference report included an extraordinarily broad list of proposals for federal, community, and private actions to foster dietary improvements and more active lifestyles.

These ranged from coordinated health education and model school programs to changes in regulations for grades of meat, advertising, taxes, and insurance premiums. Some of the proposals cut right to the core of the matter: “Propose that any national health insurance program…recognize obesity as a disease and include within its benefits coverage for the treatment of it.” “Make nutrition counseling reimbursable under Medicare.” And “Fund demonstration projects at the worksite.”[iii]

He was far ahead of his time and will be greatly missed.

References

[i] Nestle M, Jacobson MF.  Halting the obesity epidemic: A public health policy approach.  Public Health Reports 2000;115:12-24.

[ii] Stunkard AJ. Obesity and the social environment: current status, future

prospects. In: Bray GA, editor. Obesity in America. Washington:

Department of Health, Education, and Welfare (US); 1979. NIH Pub.

No.: 79-359.

[iii] Stunkard A. The social environment and the control of obesity. In:

Stunkard AJ, editor. Obesity. Philadelphia: WB Saunders; 1980. p. 438-