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Christina Leffel, a public health nutritionist in Florida, sent this one, which with both find amusing.

The study: Effects of Adding Lean Red Meat to a U.S.-Style Healthy Vegetarian Dietary Pattern on Gut Microbiota and Cardiovascular Risk Factors in Young Adults: a Crossover Randomized Controlled Trial – The Journal of Nutrition.  VOLUME 153, ISSUE 5, P1439-1452, MAY 2023, https://doi.org/10.1016/j.tjnut.2023.03.013

Method:  19 participants consumed 3 study diets in random order: 1) healthy lacto-ovo vegetarian diet (LOV); 2) LOV plus 3 ounces/d of cooked unprocessed lean red meat (URM); and 3) LOV plus 3 ounces/d of cooked processed lean red meat (PRM). Measures: Fecal and fasting blood samples.

Results: The addition of unprocessed or processed lean red meats to a LOV HDP did not influence short-term changes in bacterial taxonomic composition.  When the data from all three diets were combined, “changes in some bacteria were associated with improvements in TC, LDL-C, triglycerides, and HDL-C concentrations, and TC/HDL-C ratio.”

Conclusions:  Healthy young adults who adopt an HDP that may be vegetarian or omnivorous, including lean red meat, experience short-term changes in gut microbial composition, which associate with improvements in multiple lipid-related cardiovascular risk factors.

Funding: “The study was cofunded by the Pork Checkoff, North Dakota Beef Commission, Beef Checkoff, and Foundation for Meat and Poultry Research and Education. The supporting sources had no role in study design; collection, analysis, and interpretation of data; writing of the report; or submission of the report for publication.

Author disclosures: “During the time this review was conducted, WWC received funding for research grants, travel or honoraria for scientific presentations, or consulting services from the following organizations: U.S. National Institutes of Health, U.S. Department of Agriculture (Hatch Funding), Pork Checkoff, National Pork Board, Beef Checkoff, North Dakota Beef Commission, National Cattlemen’s Beef Association, Foundation for Meat and Poultry Research and Education, American Egg Board, Whey Protein Research Consortium, National Dairy Council, Barilla Group, Mushroom Council, and the National Chicken Council. Additionally, SRL received funding for research grants, travel or honoraria for scientific presentations, or consulting services from the following organizations: U.S. National Institutes of Health, U.S. Department of Agriculture, National Science Foundation, Showalter Research Trust, Grain Foods Foundation, CP Kelco US, OLIPOP, Inc, Council for Responsible Nutrition. YW, T-WLC, MT, and CMC declare no conflict of interest. The funder and these other organizations had no role in the design and conduct of the study, analysis, interpretation of the results, and writing of the manuscript.”

Comment: This is yet another industry-funded study in which the funder claims no role–a statement that always makes me laugh.  That’s what they all say, despite much evidence that the funding influence in such situations can be considerable, although unrecognized.  For details, see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

The meat industry, apparently, is trying to convince vegetarians that they can eat any kind of meat they want and not affect their cardiovascular risk.  This, of course, contradicts tons of other evidence, including associations with cancer risk.  These risks may not be mediated through the microbiome, however.  What this study says is that if you are worried about the risks of meat, you don’t have to worry that it changes your microbiome much, at least under the conditions of this study.

This absolutely superb—informative, eminently readable, compelling—book makes the strongest possible case for the benefits of not eating ultra-processed foods.

These, you may recall, are produced by industrial means, loaded with unfamiliar and questionable food additives, unable to be made in home kitchens, and designed deliberately to be irresistibly delicious, if not addictive, so as to make profits for food companies.

They also encourage people to eat more than they realize, and are consistently associated with poor health.

Van Tulleken is a British physician, scientist, and television star with his twin brother Xand.

Although I am thoroughly familiar with just about everything in this book having written extensively about these topics myself, I still found it to be a great read.

Van Tulleken tells stories really well.  I was hooked on page 30 with the description of Lyra, his 3-year-old daughter’s first encounter with a breakfast cereal aimed at kids.  He had decided to do a Morgan Spurlock  (Super Size Me!) experiment on himself and eat mainly ultra-processed foods for as long as he could stand it.  He began with a breakfast of Coco Pops cereal.

I had assumed that, having never tried Coco Pops, she [Lyra] wouldn’t have any interest in them.  But Kellogg’s had got her hooked before she’d had a mouthful.  She knew that here was a product designed with a three-year-old in mind.  Again, I told her no, so she collapsed on the floor crying and screaming with rage…My lingering doubts [about this cereal] were irrelevant ….Lyra had crawled out from under the table, filled her bowl and started to eat great fistfuls of dry Coco Pops, wide-eyed and ecstatic.  Defeated, I poured out the milk, and read the ingredients…Lyra put her ear to the bowl and shut her eyes, entranced. She then began to eat again.

And eat.  And eat.  As I watched her, it seemed she wasn’t fully in control…Lyra had hardly taken a breath.  I normally have to do a little cajoling at mealtimes, but the first bowl of Coco Pops had simply disappeared.  When I tried to suggest that one bowl was enough, the idea was immediately dismissed.  It felt like advising a smoker to stick to one cigarette.  Her eating wasn’t just mindless: it was trancelike.

This is just what ultra-processed foods are supposed to do.

Van Tulleken calls for government policies to be made without food company involvement, and for policies to restrict the marketing of such foods.

Yes!

The book is published today by Norton. I thought it was a great read.

Is anyone else as upset as I am about the Debt Limit bill just passed by the House and Senate and signed by the President?

Senator Bernie Sanders, maybe.  Here’s why he voted against it.

Yes, the bill:

• Averted a default on the debt which everyone agrees would have been catastrophic (but the crisis should have been prevented in the first place)
• Will probably not cut SNAP benefits by much if at all (if you believe the Congressional Budget Office)
• Could have been a lot worse (a very low bar)
• Is considered a big win by the White House (oh dear)

But, and it’s a big but:

• It proved that bullying works.

The bullies know it, and are exulting.

The Farm Bill is next.  Watch what the bullies do to it.

What ever happened to government of the people, by the people, for the people?

Existential angst, anyone?  I’ve got plenty.

Here’s another one that several readers have asked me about: Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial.  Authors: Lok-Kin Yeung, Daniel M. Alschuler, Melanie Wall, Howard D. Sesso, JoAnn E. Manson, Adam M. Brickman.  American Journal of Clinical Nutrition. DOI:https://doi.org/10.1016/j.ajcnut.2023.05.011

The study: “Participants were randomly assigned to a daily multivitamin supplement (Centrum Silver) or placebo and evaluated annually with an Internet-based battery of neuropsychological tests for 3 y.”  Primary outcome measure: change in episodic memory (immediate recall performance on the ModRey test, after 1 y of intervention).  Secondary outcome measures: changes in episodic memory over 3 y of follow-up,  and in performance on neuropsychological tasks of novel object recognition and executive function over 3 y.

Results: “Compared with placebo, participants randomly assigned to multivitamin supplementation had significantly better ModRey immediate recall at 1 y, the primary endpoint (t(5889) = 2.25, P = 0.025), as well as across the 3 y of follow-up on average (t(5889) = 2.54, P = 0.011). Multivitamin supplementation had no significant effects on secondary outcomes…we estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 y of age-related memory change.”

Conflict of interest: HDS, JEM, and AMB received investigator-initiated grant support to their institutions from Mars Edge. Pfizer Consumer Healthcare (now Haleon) provided support through the partial provision of study pills and packaging. HDS received investigator-initiated grants from Pure Encapsulations and Pfizer Inc and honoraria and/or travel for lectures from the Council for Responsible Nutrition, BASF, NIH, and the
American Society of Nutrition during the conduct of the study. No funding sources had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Funding: This work was supported by an investigator-initiated grant from Mars Edge, a segment of Mars Inc dedicated to nutrition research. Pfizer Consumer Healthcare (now Haleon) provided support through the
partial provision of study pills and packaging.

Comment:  This study continues to surprise me.  As I’ve written before, it is part of the COSMOS trial, which is also supported by grants from NIH and a private foundation.  In my previous post on it, I noted that despite being funded by Pfizer (which makes Centrum Silver multivitamin supplements), the study did not show benefits of the supplement for prevention of cardiovascular disease or cancer—a rare exception to the rule that industry-funded studies tend to favor the sponsor’s interests.  But here we go again, this time with an equally surprising result but for a different reason: most multivitamin studies have shown no benefits whereas this one says if you take Centrum Silver, it will give you another three years of no loss in memory.  Wow!  I’ll be Pfizer is thrilled.

Here’s what the NIH National Center for Complementary and Integrative Health says about multivitamins:

I’m just getting to this report from Food and Water Watch: The Economic Cost of Food Monopolies: Dirty Dairy Racket

Food & Water Watch took a look at what’s happening to the U.S. dairy industry.  Its conclusions are not surprising if you have been following these trends.

• Big dairies have driven out small.  Only about 30 percent of all U.S. milk is produced on family-scale farms.
• Dairy is not profitable.  “Thanks to the gutting of federal supply management policy,” overproduction and increased production costs gave caysed milk prices to plummet.
• Consolidation doesn’t help.  Three dairy coops control 83 percent of milk sales: DFA (Dairy Farmers of America), Land O’ Lakes, and California Dairies, Inc.).

Here’s one comparison: Dairy association CEP salaries as compared to dairy farmer income.

The next Farm Bill could help fix some of this by:

• Restoring supply management
• Stopping proliferation of factory dairy farms
• Reforming the farm safety net
• Setting fair prices

Ultra-processed foods—defined operationally as industrially produced foods formulated to be irresistably delicious that can’t be made in home kitchens (because you don’t have the machinery or the ingredients—are by now well established to be associated with weight gain and weight-related chronic diseases.

Evidence now suggests the association is causal.  Ultra-processed diets induce people to eat more calories without realizing it.

Alas for food companies.  Ultra-processed products are among their most profitable.

The British Nutrition Foundation to the rescue!

• It has issued a position statement on ultra-processed foods.   It complains that:
• The classification system omits foods the Foundation considers healthy.
• It implies that expensive artisanal products are superior for health (advice to reduce UPF raises questions of equity).
• The research is largely observational.
• The food environment is a key driver of poor health.
• Making products that are not ultra-processed may have unintended consequences.
• Demonizing ultra-processed foods could foster feelings of guilt and stigma.
• Messages to avoid UPF might discourage industry from reformulation.
• Food processing plays a releant role in food system sustainability and food security.

When I read things like this, I have the usual question: Who paid for this?

The British Nutrition Foundation says:

BNF’s funding comes from: membership subscriptions; donations and project grants from food producers and manufacturers, retailers and food service companies; contracts with government departments; conferences, publications and training; overseas projects; funding from grant providing bodies, trusts and other charities.

If it lists its corporate sponsors, I can’t find it.

But PowerBase says:

The British Nutrition Foundation (BNF) is the key food industry front group in the UK. The BNF promotes itself as a source of impartial information, but it does not always make its links with industry clear.

The BNF is hard at work on behalf of food companies who wish the entire UPF concept would just disappear.  See, for example, “How do we differentiate not demonise –Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event” published in the Nutrition Bulletin.  The themes that emerged from the conference:

• problems with the use of definitions for UPF,
• the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes,
• advice that may result in consumer confusion.
• misalignment of UPF foods with dietary guidelines
• unintended consequences for vulnerable groups

Comment: 

OK, the food industry is fighting back.  I think it’s a losing battle.  The UPF concept has so much evidence backing up its usefulness.  But I will say one thing about the point about unintended consequences.   It’s OK for rich people to avoid UPF but OK for poor people to eat them?  I think the food industry is in trouble on this one.  It has gotten away with pushing junk food for way too long.  The British Nutrition Foundation would be much more crredible if it put public health first.

Thanks to Bradley Flansbaum for sending this one from a journal not on my usual reading list: “In persons with constipation or IBS-C, kiwifruit vs. psyllium increased spontaneous bowel movements.”

I like the way this press release gets right to the point.

An industry-funded randomized trial assessed the effect of daily consumption of kiwifruit versus psyllium on GI function and comfort in 184 adults who were healthy, had functional constipation (FC), or met Rome III diagnostic criteria for constipation-predominant irritable bowel syndrome (IBS-C).

The study: Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort—Results of an International Multicenter Randomized Controlled Trial.  The American Journal of Gastroenterology ():10.14309/ajg.0000000000002124, January 9, 2023. | DOI: 10.14309/ajg.0000000000002124.

Authors: Gearry, Richard MD, PhD; Fukudo, Shin MD, PhD; Barbara, Giovanni MD; Kuhn-Sherlock, Barbara PhD; Ansell, Juliet PhD; Blatchford, Paul PhD; Eady, Sarah MSc; Wallace, Alison PhD; Butts, Christine PhD; Cremon, Cesare MD; Barbaro, Maria Raffaella PhD; Pagano, Isabella MD; Okawa, Yohei PhD; Muratubaki, Tomohiko PhD; Okamoto, Tomoko PhD; Fuda, Mikiko MS; Endo, Yuka MD; Kano, Michiko MD, PhD; Kanazawa, Motoyori MD, PhD; Nakaya, Naoki PhD; Nakaya, Kumi PhD; Drummond, Lynley BTech (Hons)

Summary of the study

Methods: Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week.

Results: Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001).

Conclusion: This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.

Financial support: Zespri International Ltd. was the principal sponsor and reviewed, approved, and funded the study design. The New Zealand study center trial was jointly funded by a grant from the New Zealand government (Contract C11X1312) and the sponsor company, Zespri International Ltd. In Italy and Japan, Zespri International Ltd. was the sole funder for each study center trial. The funder did not contribute to the study design or data analysis.

Potential competing interests: J.A. and P.B. are employed by Zespri International who part-funded the study. R.G. and L.D. sit on the Science Advisory Board, have received travel and research grants from Zespri International. SF and GB have received research travel grants from Zespri International.

Comment:  Can you guess what Zespri International sells?  Go on.  Take a wild guess.  I’ll admit it.  I’d go for kiwi over psyllium every time.  But we are talking here about an average improvement of 1.5 bowel movements a week, which may or may not be clinically meaningful..  I do give the authors credit for claiming a benefit for “fresh whole fruit,” not specifically kiwifruit.  The study didn’t compare kiwi to other fruits (and why would it, given the kiwi fruit sponsor).  But overall, this is yet another study done for marketing far more than scientific purposes.

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 [1, 2], 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.