Paula Young Lee.  Deer Hunting in Paris: A Memoir of God, Guns, and Game Meat.  How a Preacher’s Daughter Refuses to Get Married, Travels the World, and Learns to Shoot.  Solas House, 2013.

The topic of this cross-cultural memoir—game hunting—would not ordinarily interest me but once I starting flipping through its pages I found myself reading it cover to cover.  For one thing, Paula Lee sounds like someone anyone would enjoy having as a friend. She’s easy to be with as she tells the story of her Korean-American background as a Maine preacher’s daughter, and her partnership with a stuffy but warm-sounding guy in Wellesley, Massachusetts who spends every free moment hunting on his family’s property in Maine.  Paula, a trained chef,* cooks what they shoot.    She also casts an affectionate eye on the backwoods hunting culture.  I can’t say it’s a culture I’d care to adopt (I’m not much for killing animals and Maine winters are cold), but I was fascinated to learn about it from a companion who writes well and tells a good story.

*Addition: Paula informs me that she is not, in fact, a trained chef.  She “just cooks” [I’d say she writes about food like a trained chef].  She says she “started out as an academic historian, migrated into the cultural history of meat via a study of slaughterhouses…and am now mostly a food writer focusing on wild meat.”

The American Society of Nutrition (ASN) is not the only nutrition society raising issues of conflict of interest (see yesterday’s post).  The Academy of Nutrition and Dietetics (AND) is the subject of two recent analyses of this problem.

• The Food Ties that Bind
• And Now a Word From Our Sponsors

FoodNavigator-USA interviewed a number of people, including me, about the implications of these reports.  Opinions differ, to say the least.

But here’s what I said:

Sponsorship perverts science

However, Dr Marion Nestle, Paulette Goddard professor of nutrition, food studies, and public health at New York University, said it was wishful thinking to assume that companies that make their money selling soda and chips as well as water, juice and oatmeal could provide a “full” picture.

The issue, she said, was not whether FNCE delegates were capable of distinguishing facts from sponsored spin in conference handouts.

She told us: “That’s not the right question. Most people are unaware of how such things influence their opinions. Substantial research on sponsorship by tobacco, drug, and chemical companies provides such evidence. There is not yet as much research on the effects of food industry sponsorship but the few studies that exist are completely consistent with research on other industries.”

It’s stunningly easy to design studies that accomplish these goals

Asked whether it was unfair to automatically dismiss industry-funded research and information rather than judging it on its merits, Nestle said: “In my opinion, agriculture, food, nutrition, and health professionals should dismiss industry-sponsored research out of hand, and journals should not accept industry-sponsored papers. 

“There is only one reason for food companies to sponsor research—so they can use the results in their own interests. 

“Sponsorship perverts science.  Sponsored research is not about seeking truth or adding to public knowledge.  It is about obtaining evidence to defend or sell the sponsor’s product, to undermine research that might suggest that a product is unhealthy, to head off regulation, and to allow the product to be marketed with health claims. 

“It’s stunningly easy to design studies that accomplish these goals and to conduct them in ways that meet the scientific criteria of peer-reviewers.”

She added: “Peer reviewers, journal editors, and readers ought to be asking: Why did the sponsor fund this study?  Was the research question designed to permit an answer that might not meet the sponsor’s goal?  Was the study conducted in a way that permitted an answer against the sponsor’s interest?  Sponsored studies almost always fail these tests of independence.”

I think corporate sponsorship poses huge problems for the credibility of nutrition researchers and nutritionists in general.  The issue requires much more discussion than it has received to date.

Let the debates begin!

I am a member of the American Society for Nutrition (ASN), the organization that publishes the American Journal of Clinical Nutrition (AJCN) and the Journal of Nutrition.

I’ve become increasingly worried about food company influence on ASN.  Food companies fund sessions at ASN annual meetings.

But I’m even more concerned about food company sponsorship of scientific studies published in AJCN.

The results of sponsored studies almost invariably benefit the sponsor.  Exceptions are scarce.

The conflicts are so blatant that I can often guess from reading an abstract who the study’s sponsor must be.

A look at the conflicts of interest disclosed by the editorial board of AJCN suggests why this problem is occurring.

Of the 12 members of the editorial board, only 3 disclose no corporate conflicts of interest, and 2 others disclose minor conflicts.

But the majority—7 of the 12—list major corporate affiliations.  The list of food companies for which they consult or advise is too long to reproduce but it includes Coca-Cola, PepsiCo, The Sugar Association, The National Restaurant Association, ConAgra, McDonald’s, Kellogg, Mars, and many others.

This raises uncomfortable questions: How does this editorial board deal with papers suggesting harm to health from consuming products from these companies?  How does it deal with sponsored papers suggesting benefits of the products?

Affiliations with food companies may or may not lead to publication bias, but at the very least they give the appearance of serious conflicted interest.  This affects opinion not only of sponsored studies, but also of the overall credibility of research published in the journal.

For the results of papers published in the AJCN to be considered credible, the editorial board should:

• List the editor responsible for review of published papers in the conflict disclosures.
• Recuse individual members with conflicts from reviewing papers in their area of conflict.
• Phase out conflicted editors as quickly as possible.
• Appoint editors who have minimal or no conflicts.
• Give special editorial scrutiny to papers sponsored by food and beverage companies.

ASN is not the only nutrition society raising doubts about its conflicts of interest with food company sponsorship.  The Academy of Nutrition and Dietetics (AND) is the subject of two recent reports analyzing its conflicts of interest.

• The Food Ties that Bind
• And Now a Word From Our Sponsors

I will say more about these reports tomorrow, but it looks like a similar report could be written about ASN, alas.

FoodNavigator-USA.com has a special edition on “Tackling Diabetes: Formulating for Healthy Blood Sugar.”

We’ve been telling people to lose weight, eat more complex carbs and do more exercise for years to get their blood sugar under control, but the number of Americans with type two diabetes continues to rise at an alarming rate. So how can the food industry help? In this FoodNavigator-USA special edition we explore the growing number of tools in the formulator’s toolbox to help promote healthy blood sugar. We also look at what messages resonate with consumers, from the glycemic index to healthy blood sugar, plus what you can, and can’t, say about diabetes on a food label.

Here are the articles in this series:

• How can the food industry address the ticking time bomb of type 2 diabetes?
• FDA permits qualified health claim about whole grains and type 2 diabetes, but is the wording so qualified no one will use it?
• Food marketers have narrow field to play in when making blood sugar management claims
• Pharmachem: The potential market for products addressing excess sugar consumption is huge
• Glucose management ingredient gets UAE distribution, ‘needs to be in food supply,’ founder says
• Focus on energy balance could jumpstart mainstream appeal of resistant starch beyond diabetes
• HORN prepares to launch cinnamon-extract for reducing blood sugar response to starchy meals
• Type 2 diabetes a ‘mismatch disease’ for our Paleolithic bodies

It’s always interesting to look at such issues from the food industry’s perspective.  And FoodNavigator reporters do an especially good job of putting the issues in context.

Last week, a Feedback comment from a reader, Judith Rice-Jones, inspired me to try to understand what’s going on with the new heart disease prevention guidelines (I can’t say I’m succeeding very well).

Looking forward to your response to the recent recommendations for more people to take statins. Don’t see anything in the new recommendations about changing lifestyle or diet to reduce risks of stroke or heart attack.

Yes, there are lifestyle recommendations.   But lifestyle changes do not make money for drug companies, and they don’t get press attention.

The American College of Cardiology (ACC) and American Heart Association (AHA) issued four sets of guidelines:

1. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
2. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
3. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
4. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

These organizations say:

AHA and ACC are pleased to announce a series of new cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults. These guidelines are based on rigorous, comprehensive, systematic evidence reviews originally sponsored by the NHLBI. The ACC and AHA collaborated with professional organizations to finalize these AHA/ACC cardiovascular prevention guidelines, and stakeholder organizations were invited to review and endorse the final documents.

So these guidelines are a major big deal.  The New York Times said you need to know three things about them:

• You don’t need to know your cholesterol number (unless it is very high).
• You do need to know your risk (for this you need to use the risk calculator and, therefore, to know your LDL and HDL levels and blood pressure).
• If you are at risk, take a statin (most, at least, are generics).

But wait!

As the New York Times also suggested, the new guidelines have taken many by surprise.

This is an understatement.

Problem #1: Authoritative clinicians say more patients should not be taking statins

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.

This opinion piece points out that members of the group writing the recommendations have financial ties to drug makers, as do both the AHA and ACC.

The guidelines might make sense, they say, if statins

actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case…as shown in a recent BMJ article co-written by one of us.

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease…80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

Problem #2: The risk calculator greatly overestimates risk

The lead article in today’s Times summarizes studies to be published in The Lancet tomorrow concluding that the risk calculator makes the risks seem greater than they really are.

It will lead many doctors to prescribe statin drugs to people who do not need to take them (from the standpoint of drug companies, that’s the point).

The calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

What to do?

• Best to discuss this one with your doctor.
• For sure, eat your veggies and be active.
• If you still smoke cigarettes, stop.
• Stay tuned for further developments.

Just for fun

Let’s let Brian McFadden (Sunday’s New York Times Week in Review) have the last word for today.

I’ve gotten announcements about two films in the making.  Both are worth a look.

Gleason Ranch: Risking Everything.  This is about

a family struggling to salvage their relationships and their 150 year-old, 5th-generation family ranch in Bodega, California. The project began four years ago with the intention of documenting the everyday difficulties of maintaining a family farm. Now, however, it has turned into a much larger, much more personal story of loss, life, pain, and resilience.

What Does 48 Million Hungry People Look Like?

This is a 78-second animated video aimed at getting people energized about ending hunger in America.  It’s a follow-up to A Place at the Table and an introduction to the faces and stories of SNAP alumni.  I’m guessing a longer version will follow soon.  In the meantime, have a look.

It’s not a good time for the makers of herbal and vitamin supplements.  The better the research, the fewer benefits it shows.

Herbal supplements

DNA testing is demonstrating what many of us have long suspected: herbal supplements are not necessarily what they say they are.

As the New York Times reports, a recent study shows that many products purporting to be herbal supplements, actually contain rice, corn, or wheat (gluten-sensitive folks beware):

I would feel sorry for supplement manufacturers, if they hadn’t brought this on themselves.

First, they lobbied to get Congress to pass the Dietary Supplement Health and Education Act of 1994 (DSHEA).  This lets them advertise the benefits of supplements without much in the way of scientific substantiation.  It also excused the FDA from doing much regulation.

But DSHEA also required research.  Oops.   Although the point of asking for research was to demonstrate the benefits of supplements, things haven’t worked out that way.  Most of the research shows no benefit and, sometimes, harm.

And investigations like this one show what many have long suspected.  Without federal oversight, some supplement manufacturers will do whatever they can get away with.

Fortunately, rice substituted for St. John’s Wort is harmless and hardly matters, since St. John’s Wort doesn’t seem to do much anyway.

Vitamin Supplements

The latest review of the benefits—or lack thereof—of vitamin supplements for prevention of heart disease or cancer comes to cautious conclusions.

Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

Borderline significance?  Not impressive.

The Natural Products Association, which represents supplement makers, issued a response:

• Multivitamin supplements should not be expected, without the combination of a healthy lifestyle, to prevent chronic disease.
• Dietary supplements are used by more than 150 million Americans on a daily basis. Research has shown that when taken in combination with other healthy lifestyle practices, such as consuming a wholesome diet and exercising regularly, people can benefit from dietary supplements.

Translation: if you consume a wholesome diet and exercise regularly, you really don’t need supplements.  And if you are not doing those things, supplements won’t do any good.

As for the 150 million Americans who take supplements: the ones I know tell me that they don’t care what the science says; they feel better when they take the pills.

Let’s hear it for placebo effects!

As always, I am indebted to Bill Marler for keeping me up to date on the latest outbreaks of foodborne illness.

The most recent—26 illnesses, 6 hospitalizations—seems caused by E. coli 0157:H7 contaminating grilled chicken salads sold by Trader Joe’s in California, Washington and Arizona.  According to the CDC:

Epidemiologic and traceback investigations conducted by local, state, and federal officials indicate that consumption of two ready-to-eat salads, Field Fresh Chopped Salad with Grilled Chicken and Mexicali Salad with Chili Lime Chicken, produced by Glass Onion Catering and sold at Trader Joe’s grocery store locations, are one likely source of this outbreak of STEC O157:H7 infections.

These are multiple ingredient products.  What could be the source of the toxic E. coli?

Marler provides some labels:

The contaminated ingredient could be Israeli couscous, something I can’t read (currents?), asiago cheese & toasted pecans with sweet basil dressing (first label), or white chicken meat, mixed greens, corn, peppers, sun-dried tomatoes, pepitas and asiago cheese with a jalapeno Caesar dressing (second label).

This will be hard to figure out.  There are lots of possibilities.  Likely candidates are mixed greens and jalapenos—this would not be the first time—but others could also have gotten contaminated along the way.

Marler also took the trouble to go to the website of Glass Onion Catering.  You will be happy to learn that this company’s “ salads, sandwiches, wraps and treats are crafted to the client’s specific recommendation. We only use the freshest, most natural ingredients to promote a healthy lifestyle,” and that the products are

• Trans fat free
• No artificial colors or flavorings
• No preservatives or additives
• No genetically modified ingredients
• Locally grown produce used (when possible)

Too bad they aren’t also free of this nasty form of E. coli.

Everyone who prepares or produces food needs to know how to follow standard food safety procedures.

You should not have to worry about buying foods at Trader Joe’s that make you sick.

To keep up with this is not so easy.  Because the products have meat (chicken) and vegetables (mixed greens, etc), they are regulated by two agencies: FDA and USDA.  This means three agencies are involved:

• CDC information 
• FDA information (and more FDA) 
• USDA information

Wouldn’t it make more sense to have one food safety agency?  Just asking.