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My post yesterday about the increase in sugars in certain Stonyfield yogurts elicited this e-mail from Stonyfield’s Vice President for Communications and Social Media. I’m posting it here with her permission:

Hi Marion,

Alice Markowitz here…I read your blog post today–and wanted to give you an update on our yogurt and company.

Happy to say, that as Chairman of the Stonyfield Board, Gary [Hirshberg] is still wholeheartedly and irrepressibly involved with the company and our direction. Likewise, Stonyfield is actively engaged in the labeling issue, as we continually try to communicate the importance of knowing where your food comes from and how it’s produced.

I also wanted to clarify that we’ve shared the parent company Groupe Danone with Dannon since 2003, and we’ve always operated our company independently. That includes making our own decisions about the recipes we use for our yogurts.

In 2011, we replaced some of the sugar in our Smooth and Creamy style nonfat yogurts with organic stevia. Our fans didn’t like the switch, so we went back to using just organic sugar with our new Blends. So, while there’s more sugar in those yogurts now than when we used stevia, the amount is about the same as our pre-stevia recipe. In fact, the slight increase is due primarily to an increase in milk in the product, resulting in more protein, more milk sugar.   As with many of our products, Blends has a mix of naturally-occurring sugars from milk and fruit and some added sugars.

We are concerned about the amount of sugar in our yogurts. In fact, almost half of the sugar listed in the nutritional info is what’s found naturally in the milk and fruit – which is why you see different sugar amounts in different flavors. The sugar we do add is organic sugar used to create the flavors that our yogurt lovers prefer the most.

Ultimately though we offer the choice to the consumer, and offer 98 different organic products. If yogurt eaters prefer to restrict their sugar intake, we offer plain versions of our nonfat, lowfat, whole milk and Greek yogurt without any added sugar. Turns out we’re also the only company that offers a plain yogurt for babies (with naturally-occurring milk sugars only) so parents have a choice if they prefer no sugar.

Probably more info than you ever wanted but hope this clarifies things a bit.

All the best,

Alice

A coalition of consumer, health, food safety and fishing groups behind the “Campaign for Genetically Engineered (GE)-Free Seafood” is recruiting grocery store chains to agree not to sell genetically engineered seafood even if the FDA allows it to be sold.  The campaign is aimed at the genetically modified AquaBounty salmon, which the FDA has had under consideration for ages, with no decision in sight.

The stores that have pledged not to sell GM salmon include Trader Joe’s (367 stores), Aldi (1,230 stores), Whole Foods (346 stores in U.S.), Marsh Supermarkets (93 stores in Indiana and Ohio), and PCC Natural Markets (9 stores in Washington State) and co-ops in Minnesota, New York, California, and Kansas.

This is a big deal because other GM seafood are in the research pipeline.  Large percentages of Americans say they oppose GM seafood and that the FDA should not allow it to be marketed.

And if the FDA does approve it, the agency is highly unlikely to require any special kind of labeling.

This reminds me of what happened to genetically modified tomato paste in the U.K.  Supermarket chains were selling the cans with labels clearly indicating that they were “produced from genetically modified tomatoes.”  The stores priced them favorably, and customers bought them — until Monsanto shipped unlabeled corn to Great Britain and caused a furor.

Retailers decided that they had plenty of tomato paste, didn’t need upset customers, and refused to continue selling the GM varieties.

Retailers call the shots in this situation.

I think much of the public distress over GM foods is because of lack of transparency.  Without labels, customers cannot exercise freedom of choice.

Just label it!

Here’s another one of those occasional queries from Kerry Trueman.  This one, posted at Huffington, is about FDA regulations for labeling sugars.

Trueman: I’ve just begun to sink my teeth into Michael Moss’s extraordinary food industry exposé, Salt Sugar Fat: How the Food Giants Hooked Us, a book you’ve rightly lauded as a “breathtaking feat of reporting.” As Moss points out, the FDA is happy to give us guidelines on how much salt and fat to include in our daily diets, but–as a glance at any nutritional label shows–they’ve declined to make any recommendation at all about sugar.

Does this mean that:

(a) It’s OK to eat as much sugar as you like, or:

(b) There may be an unsafe level of sugar consumption, but the FDA just doesn’t have the resources to figure out what that level is, or:

(c) The FDA knows how much sugar we can eat without harming our health, but the food industry won’t let them tell us.

How is the average American supposed to interpret this absence of information?

Nestle: Whoa. Slow down. Let’s back up a minute. The FDA sets nutritional standards for food labels, but the Institute of Medicine (IOM) sets nutritional standards for dietary intake. To understand what’s happening with the FDA and food labels, we have to talk about what the IOM used to call the Recommended Dietary Allowances (RDAs) but now calls Dietary Reference Intakes (which, confusingly, include RDAs and other standards, such as Upper Limits).

In 2002, the IOM set standards for total carbohydrates–sugars and starches (which are converted to sugars in the body). In its review of the evidence, the IOM set the RDA for total carbohydrates at 130 grams a day (roughly 4 ounces) to meet the needs of the brain for fuel. This amount is much less than typically consumed by adults.

As for sugars, the IOM noted that the average intake of sugars among adolescent males was 143 grams per day, and that the heaviest users were consuming 208 grams per day–much more than the amount of total carbohydrate needed.

Since sugars are not required nutrients, the IOM could not set an RDA. And although it did not have enough evidence to set an Upper Limit, the IOM suggested that the maximum level of intake of added sugars (as opposed to those naturally present in foods) should be a whopping 25% or less of calories.

Americans typically consume around 20% of calories from added sugars. Taken at face value, the IOM suggestion made it sound as if current intake levels were just fine. The sugar industry happily viewed 25% as a recommendation, not a maximum.

Before the sugar industry got after them, many countries recommended an upper level of sugar intake at 10% of calories. That’s what the U.S. Pyramid did in 1992.

The sugar industry does not like the 10% recommendation. It means, for example, that just one of Mayor Bloomberg’s 16-ounce sodas takes care of recommended sugar intake for the day.

Robert Lustig, who is largely concerned about what too much fructose does to us, thinks that 50 grams of sugar (sucrose or HFCS) is a reasonable Upper Limit for most people. This would provide 25 grams of fructose, which the body can handle with relative ease. What’s interesting about his cut point is that it means 200 calories a day, or 10% of calories for a 2000 calorie diet. So there we are at 10% of calories again.

If the FDA wanted to be helpful, it could do two things.

1. Require companies to list added sugars under the carbohydrate category on food labels.

2. Set a DV for sugars at 50 grams.

In the meantime, everyone would be healthier eating less sugar. 

Malden Nesheim and I wrote an editorial for the Annals of Internal Medicine that has just gone online, and is likely to elicit plenty of discussion.  We comment on the highly conservative, evidence-based recommendations of the U.S. Preventive Services Task Force for taking supplements of calcium and vitamin D as a means to prevent osteoporosis.

Our commentary: “To Supplement or Not to Supplement: U.S. Preventive Services Task Force Recommendations on Calcium and Vitamin D.”  Here’s what we said:

In this issue, the U.S. Preventive Services Task Force (USPSTF) plunges headlong into ongoing debates about whether healthy adults—those who show no signs of vitamin D deficiency or osteoporosis—should be advised to take combined supplements of calcium and vitamin D to prevent bone fractures and, if so, at what level (1).

In terse statements unlikely to settle the debates, the Task Force states first that insufficient evidence makes it impossible to determine how supplementation affects fracture incidence in men or premenopausal women. Next, it deals with postmenopausal women. For this group, the Task Force says that evidence is insufficient to assess the effects of daily supplementation with greater than 400 IU of vitamin D₃ and greater than 1000 mg of calcium. The Task Force’s unambiguous conclusion: Supplementation at or below those levels does not prevent fractures. Because supplementation at or below 400 IU of vitamin D₃ and 1000 mg of calcium seems to convey a slightly increased risk for renal stones, the USPSTF recommendation for postmenopausal women is also unambiguous: “do not supplement.”

The Task Force based these decisions on 2 commissioned evidence reviews and a meta-analysis  (2 – 4). More recent data from the Women’s Health Initiative also are consistent with inconclusive findings, except among a subgroup of long-adherent supplement recipients who experienced a reduced risk for hip—but not total—fractures (5).

The Task Force’s recommendations must be interpreted in the light of ongoing disputes about the most effective method for assessing vitamin D deficiency, whether calcium and vitamin D supplements are needed by a large portion of the population, and what level of supplementation might best maximize benefits and minimize risks.

In 2011, after reviewing more than 1000 studies, the Institute of Medicine (IOM) concluded that vitamin D and calcium are indeed critical to bone health but their role in other diseases—cancer, heart disease, diabetes, immune function, and reproductive health, for example—remains uncertain. The IOM did not consider deficiencies of either calcium or vitamin D to be serious problems in the United States, except among certain population groups. Instead, because of widespread fortification and supplementation, the IOM was concerned about the possibility of adverse consequences from oversupplementation (6).

With risks as well as benefits in mind, the IOM established the average adult daily requirement for calcium at 800 to 1000 mg depending on age, the Recommended Dietary Allowance (the amount needed to meet the needs of about 97% of the population) at 1000 to 1200 mg, and the safe upper level of intake at 2000 to 2500 mg. Its corresponding recommendations for vitamin D were 400 IU, 600 IU (800 IU for older adults), and 4000 IU, respectively. The IOM viewed these levels as sufficient to maintain blood levels of 25-hydroxyvitamin D at or above 20 ng/mL, a level it considered adequate to meet population-based needs regardless of amounts synthesized as a result of sun exposure.

Vitamin D, of course, is not a vitamin in the usual sense. It is a hormone produced in response to the action of sunlight on skin. Like other hormones, vitamin D has multiple roles in the body, not all of them well-understood. Vitamin D supplementation, therefore, must be considered a form of hormone replacement therapy. As such, it raises all of the questions about efficacy, dose, and side effects currently asked of such therapies.

In that light, the 2011 recommendations of the Endocrine Society deserve special scrutiny (7). The Society approaches questions about vitamin D from a standpoint quite different from that of the IOM. It appointed its own task force to make recommendations based on the premise that vitamin D deficiencies are common among all age groups. The Society prefers 30 ng/mL of 25-hydroxyvitamin D as the target level for maximum benefits. By that criterion, virtually all U.S., Canadian, and European adults are deficient in hormone vitamin D and require daily supplements of 1500 to 2000 IU. For adults with demonstrated deficiency, the Society recommends treatment with 50 000 IU of the hormone once a week or daily supplementation of 6000 IU for 8 weeks, followed by 1500 to 2000 IU for maintenance.

This clinical endocrinology perspective differs from the nutrition science perspective of the IOM committee, whose members tend to interpret studies of single nutrients within the context of the diet as a whole. From this standpoint, the amount of hormone generated by the action of sunlight on skin (which ought to be more than adequate for people who spend time outdoors in latitudes as far north as Boston) is crucial to decisions about supplementation. The IOM and Endocrine Society debated their conflicting perspectives in an exchange published in 2012 (8 – 9). The insufficiency of research to resolve such arguments has permitted vitamin D to become “trendy.” It is advertised on boxes of fortified cereals, has its own prosupplement advocacy group, and generates millions in annual supplement sales (10).

The USPSTF’s recommendations can be understood as an attempt to clarify the present situation with respect to one specific outcome of supplementation. In doing so, its recommendations have a substantial advantage. They depend on hard end points—fractures—rather than on blood levels of 25-hydroxyvitamin D, at best an indirect measure of vitamin D adequacy. The USPSTF uses the same precautionary approach as did the IOM. In the absence of compelling evidence for benefit, taking supplements is not worth any risk, however small.

A previous attempt to sort through the various claims for vitamin D noted an urgent need for further research to answer fundamental questions about the risks and benefits of sun exposure, fortification, and supplements, and the hormone’s role in body functions beyond bone mineralization (11). The USPSTF plans to publish further recommendations on the role of vitamin D in cancer prevention. When it does, we hope it will keep in mind the value of making a single recommendation about vitamin D and calcium supplementation that will encompass all potential benefits and risks. Multiple recommendations by condition confuse practitioners and the public. While we wait for the results of further research, the USPSTF’s cautious, evidence-based advice should encourage clinicians to think carefully before advising calcium and vitamin D supplementation for healthy individuals.

References

1  Moyer VA; U.S. Preventive Services Task Force.  Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013. [Epub ahead of print]

2  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. Evid Rep Technol Assess (Full Rep). 2007:1-235. [PMID: 18088161]

3 Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al.  Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep). 2009:1-420. [PMID: 20629479]

4 Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA.  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;155:827-38. [PMID: 22184690]

5 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. Osteoporos Int. 2013;24:567-80. [PMID: 23208074]

6 Institute of Medicine.  Dietary Reference Intakes: Calcium, Vitamin D. Washington, DC: National Academies Pr; 2011.

7 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al; Endocrine Society.  Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30. [PMID: 21646368]

8 Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, et al.  IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012;97:1146-52. [PMID: 22442278]

9 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al.  Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012;97:1153-8. [PMID: 22442274]

10 Supplements stand out as 2008 sales bright spot for U.S. nutrition industry. Vitamins: D still shines. Nutrition Business Journal. 2009;14(6/7):5. Accessed athttp://newhope360.com/research-and-insights/supplements-stand-out-2008-sales-bright-spot-us-nutrition-industry on 15 February 2013.

11 Brannon PM, Yetley EA, Bailey RL, Picciano MF.  Overview of the conference “Vitamin D and Health in the 21st Century: an Update”. Am J Clin Nutr. 2008;88:483S-490S. [PMID: 18689388]  

Here’s the first objection:

• From the Natural Products Association

At long last, the USDA announced that it has released its proposed rules governing the nutritional content of snacks, sodas, and meals sold in competition with federally subsidized school breakfasts and lunches.

As soon as the rules get published in the Federal Register, which is supposed to happen this week, people will have 60 days to file comments.  Although USDA has not said when it will issue final rules, it did say that it will give schools another year to implement them.

The rules apply to foods sold outside the school meals in vending machines and a la carte lines.  They will not apply to fundraisers.  They set minimum standards.  States and localities that want stricter standards may do so.  A recent CDC analysis says states are already doing this (see Competitive Foods and Beverages in U.S. Schools: A State Policy Analysis).

Under the proposed rules, schools must provide:

• Potable water at no charge [this alone is cause for celebration].
• Real foods that are either something recognizable as a food or something that naturally contains 10% of the Daily Value in calcium, potassium, vitamin D, or fiber.
• Snacks with less than 200 mg sodium per serving.
• Desserts with less than 35% of calories from sugars or less than 35% of weight as sugars.
• Beverages with no more than 40 or 50 calories per 8-ounce serving.

There are plenty of exceptions.   I can only guess that the exemption for sweetened yogurt—30 grams of sugars in 8 ounces—has something to do with dairy lobbying.

My immediate reaction: these rules are a big improvement and deserve much support.

Applause to USDA for this one!

I was unfamiliar with the Leanwashing Index, but am delighted to learn about it.  EnviroMedia launched it in 2012 to discourage advertisers from using absurdities to push products.

EnviroMedia explains the inspiration for the Index: the appearance of the word “Superfood” on Lake Superior State University’s 38th annual List of Words to be Banished.

Here’s the 2013 Leanwashing list:

• Natural
• Made With
• Whole Grains
• Light
• 100 Calorie

Away with all of them!  (I can think of plenty more.  Send your suggestions to the site.)

Here’s a prime example:

And while we are on the subject of whole grains, you might want to take a look at Colbert’s latest “Thought for Food.”

Enjoy the weekend!

For my monthly (first Sunday) Food Matters column in the San Francisco Chronicle, I devote the one in January every year to predictions.  Last year I got them all pretty much on target.  It didn’t take much genius to figure out that election-year politics would bring things to a standstill.  This year’s column was much harder to do, not least because the FDA was releasing blocked initiatives right up to the printing deadline.

 Q: I just looked at your 2012 crystal ball column. Your predictions were spot on. But what about 2013? Any possibility for good news in food politics?

A: Food issues are invariably controversial and anyone could see that nothing would get done about them during an election year. With the election over, the big question is whether and when the stalled actions will be released.

The Food and Drug Administration has already unblocked one pending decision. In December, it released the draft environmental assessment on genetically modified salmon – dated May 4, 2012. Here comes my first prediction:

The FDA will approve production of genetically modified salmon: Because these salmon are raised in Canada and Panama with safeguards against escape, the FDA finds they have no environmental impact on the United States. The decision is now open for public comment. Unless responses force the FDA to seek further delays, expect to see genetically modified salmon in production by the end of the year.

Pressures to label genetically modified foods will increase: If approval of the genetically modified salmon does nothing else, it will intensify efforts to push states and the FDA to require GM labeling.

Whatever Congress does with the farm bill will reflect no fundamental change in policy: Unwilling to stand up to Southern farm lobbies, Congress extended the worst parts of the 2008 farm bill until September. Don’t count on this Congress to do what’s most needed in 2013: restructure agricultural policy to promote health and sustainability.

The FDA will start the formal rule-making process for more effective food safety regulations: President Obama signed the Food Safety Modernization Act in January 2011. Two years later, despite the FDA’s best efforts, its regulations – held up by the White House – have just been released for public comment. Lives are at stake on this one.

The FDA will issue rules for menu labels: The Affordable Care Act of 2010 required calorie information to be posted by fast-food and chain restaurants and vending machines. The FDA’s draft applied to foods served by movie theaters, lunch wagons, bowling alleys, trains and airlines, but lobbying led the FDA to propose rules that no longer covered those venues. Will its final rules at least apply to movie theaters? Fingers crossed.

The U.S. Department of Agriculture will delay issuing nutrition standards for competitive foods: When the USDA issued nutrition standards for school meals in January 2012, the rules elicited unexpected levels of opposition. Congress intervened and forced the tomato sauce on pizza to count as a vegetable serving. The USDA, reeling, agreed to give schools greater flexibility. Still to come are nutrition standards for snacks and sodas sold in competition with school meals. Unhappy prediction: an uproar from food companies defending their “right” to sell junk foods to kids in schools and more congressional micromanagement.

The FDA will delay revising food labels: Late in 2009, the FDA began research on the understanding of food labels and listed more relevant labels as a goal in its strategic plan for 2012-16. Although the Institute of Medicine produced two reports on how to deal with front-of-package labeling and advised the FDA to allow only four items – calories, saturated and trans fat, sodium and sugars – in such labels, food companies jumped the gun. They started using Facts Up Front labels that include “good” nutrients as well as “bad.”

Will the FDA insist on labels that actually help consumers make better choices? Will it require added sugars to be listed, define “natural” or clarify rules for whole-grain claims? I’m not holding my breath.

Supplemental Nutrition Assistance Program participation will increase, but so will pressure to cut benefits: Demands on Snap – food stamps – reached record levels in 2012 and show no sign of decline. Antihunger advocates will be working hard to retain the program’s benefits, while antiobesity advocates work to transform the benefits to promote purchases of healthier foods. My dream: The groups will join forces to do both.

Sugar-sweetened beverages will continue to be the flash point for efforts to counter childhood obesity: The defeat of soda tax initiatives in Richmond and El Monte (Los Angeles County) will inspire other communities to try their own versions of soda tax and size-cap initiatives. As research increasingly links sugary drinks to poor diets and health, soda companies will find it difficult to oppose such initiatives.

Grassroots efforts will have greater impact: Because so little progress can be expected from government these days, I’m predicting bigger and noisier grassroots efforts to create systems of food production and consumption that are healthier for people and the planet. Much work needs to be done. This is the year to do it.

And a personal note: In 2013, I’m looking forward to publication of the 10th anniversary edition of “Food Politics” and, in September, my new editorial cartoon book with Rodale Press: “Eat, Drink, Vote: An Illustrated Guide to Food Politics.”

If you happen to be in Washington DC, take a look at FOOD: Transforming the American Table 1950–2000 at the Smithsonian National Museum of American History.

Julia Child’s kitchen is the featured exhibit, but the history of the industrialization of the U.S. food supply is well worth a look.

I especially like quirky collections of food objects.  Here’s one from the exhibit:

If you are in New York City, you can see Our Global Kitchen: Food, Nature, Culture at the American Museum of Natural History and check out the New York Times review so you know what to look for.

Also in New York is Lunch Hour at the New York Public Library.  If you can’t get there, the library has an online version of the exhibition.

If you happen to be in Switzerland and anywhere near Lake Geneva, Nestlé’s Alimentarium in Vevey has a special display of quirky collections: sardine cans, sugar cubes, and fruit wrappers, for example.  You can find it easily from its fork stuck into Lake Geneva.

Food exhibits seem to be the current Big Thing.  I’m trying to take advantage of them while they are around.  You too?