by Marion Nestle

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Jun 28 2010

Dietary Guidelines Advisory Committee: The Politics

I’ve heard rumors that some members of the Dietary Guidelines Advisory Committee (DGAC) believe that commentators did not give a fair shake to their recently released report (see previous post).

I complained that the DGAC report is difficult to read because its pieces are presented online in a great many individual pdf files that must be downloaded separately.  Fortunately, Cornell student Daniel Green created a single Web-based file.

I have now read the report, or at least browsed through its 699 pages, and I agree that it is better than it first appeared and deserves a revisit (which I am doing in two parts, the second tomorrow).

As with previous Dietary Guidelines, both politics and science underlie this report.  The science components of this report are stunning—as good as such things get—and make this document an invaluable resource.

Why did everyone, including me, miss this?  Politics, of course.  The politics appear unchanged from previous versions (for that, see Food Politics).

The science in this report gives clear guidance for action.  But the report obfuscates its most important messages.

The Executive Summary makes the advice seem dull. The Summary is the part everyone reads first and often the only part anyone reads.  Try this:

The 2010 DGAC report concludes that good health and optimal functionality across the life span are achievable goals but require a lifestyle approach including a total diet that is energy balanced and nutrient dense…SoFAS (added sugars and solid fats) contribute approximately 35 percent of calories to the American diet….Reducing the intake of SoFAS can lead to a badly needed reduction in energy intake and inclusion of more healthful foods into the total diet.

Obesity, it says, is a big problem.  The food environment is a big problem.  What to do about them?  SoFAS.

The report introduces a new euphemism, SoFAS (Solid Fats and Added Sugars).  The meaning of added sugars is obvious.  But what are solid fats?  For that, you must wait until page 183 (on the Daniel Green file):

Solid fats are fats that are solid at room temperature. Solid fats come from many animal foods and can be made from vegetable oils through hydrogenation. Some common solid fats are butter, beef tallow (tallow, suet), chicken fat, pork fat (lard), stick margarine, and shortening. Foods high in solid fats include many cheeses, creams, ice cream, well-marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked goods (such as cookies, crackers, donuts, pastries, and croissants).

Earlier (p. 24), the report listed the principal food sources of SoFAS:

Solid fats (percent of solid fat intake)

  • Grain-based desserts, including cakes, cookies, pies, doughnuts, and granola bars (10.9%)
  • Regular cheese (7.7%)
  • Sausage, franks, bacon, and ribs (7.1%)
  • Pizza (5.9%)
  • Fried white potatoes, including French fries and hash browns (5.5%)
  • Dairy-based desserts, such as ice cream (5.1%)

Added sugars (percent of added sugars intake)

  • Soda (36.6%)
  • Grain-based desserts (11.7%)
  • Fruit drinks (11.5%)
  • Dairy-based desserts (6.4%)
  • Candy (6.2%)

The report does not say to eat less of these foods; it talks about nutrientsIn various places in the report, the report says [with my comments in brackets]:

  • Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium. [Nutrients, not foods].
  • Eat less of these: calories from SoFAS, added sugars, solid fats, refined grains, sodium, saturated fat. [Ditto]
  • Significantly lower excessive calorie intake from added sugars, solid fats, and some refined grain products. [Ditto]
  • Strategies to prevent childhood obesity should include efforts to reduce surplus energy intake, especially energy from foods and beverages that provide empty calories from added sugars and solid fats. [Ditto]
  • Intake of caloric beverages, including SSB [sugar-sweetened beverages], sweetened coffee and tea, energy drinks, and other drinks high in calories and low in nutrients should be reduced in consumers needing to lower body weight.  [Only overweight people need to worry about these foods?]

Only once does the report say the clear and simple: “Avoid sugar-sweetened beverages” (p. 65).  Nowhere does it explicitly say to eat less steak, hamburger, French fries, pizza, cookies, or ice cream.

Like previous editions of the Dietary Guidelines, this one talks about foods in the context of eat more (fruits and vegetables).  For eat less advice, it switches to nutrients.  I’d call this obfuscation (and politics).

But the report—for the first time—emphasizes environmental influences on obesity:

The 2010 DGAC recognizes that the current food environment does not adequately facilitate the ability of Americans to follow the evidence-based recommendations outlined in the 2010 DGAC Report. Population growth, availability of fresh water, arable land constraints, climate change, current policies, and business practices are among some of the major challenges that need to be addressed in order to ensure that these recommendations can be implemented nationally.

What business practices?  It doesn’t say.  It does, however, recommend:

  • Improve foods sold and served in schools, including school breakfast, lunch, and afterschool meals and competitive foods so that they meet the recommendations of the IOM report on school meals….
  • Increase comprehensive health, nutrition, and physical education programs and curricula in US schools and preschools, including food preparation, food safety, cooking, and physical education classes and improved quality of recess….
  • Remove sugar-sweetened beverages and high-calorie snacks from schools, recreation facilities, and other places where children gather.
  • Develop and enforce responsible zoning policies for the location of fast food restaurants near schools and places where children play….

This is excellent advice.  But how about some suggestions about what individuals might do about it?

The report says little about food marketing.  Beyond “Develop and enforce effective policies regarding marketing of food and beverage products to children…,” the report says virtually nothing about the well documented impact of food marketing on children’s food choices, dietary intake, and health.  Unless I missed it someplace, the research review does not cite the Institute of Medicine’s 2006 landmark report, Food Marketing to Children and Youth: Threat or Opportunity.

It buries the need for policy changes in long wordy lists.  It states the needs for low-income Americans to have access to and afford healthier foods; to produce fruits, vegetables, and grains sustainably; to ensure household food security; to promote sustainable aquaculture; and to encourage the food service industry to serve healthier foods and smaller portions.  It does not—and perhaps cannot—recommend policy changes to achieve these important goals.

Overall, the report contains plenty of material for food, nutrition, and health advocates to work with, but you have to read between the lines to find it.

Recall the process.  This committee’s report is advisory. From 1980 through 2000,  dietary guidelines advisory committees actually wrote the final Dietary Guidelines.   No more.  Since 2005, the sponsoring agencies decide what the Dietary Guidelines will say.

The report is open for public comment until July 8.  If you think the Dietary Guidelines should provide clear, unambiguous advice about how people should eat to avoid obesity and how we can create a healthier food environment, now would be a good time to express your opinion.  Here’s how.

Tomorrow: The reason why this report is an invaluable resource—its science review.

May 27 2010

The Bisphenol A saga heats up

A coalition of public health and environmental groups, collectively known as the National Workgroup for Safe Markets, has produced a report on the amounts of Bisphenol A (BPA) in canned foods: No Silver Lining: An Investigation into Bisphenol A in Canned Foods.

What did it find?  BPA in 92% of the foods sampled.  Most canned foods are lined with BPA plastic, and it leaches into the foods.

I’ve discussed concerns about the health effects of BPA in previous posts.  Here is an update on attempts to get rid of it.

To put all this in context, take a look at Jerome Groopman’s New Yorker article, The Plastic Panic: How Worried Should We Be About Everyday Chemicals? He isn’t exactly sure, but points out how difficult it is to test the health effects of any one of many chemicals in our environment–flame retardants and plastics among them–and how far regulation lags in dealing with this problem.  He concludes:

How do we go forward? Flame retardants surely serve a purpose, just as BPA and phthalates have made for better and stronger plastics. Still, while the evidence of these chemicals’ health consequences may be far from conclusive, safer alternatives need to be sought. More important, policymakers must create a better system for making decisions about when to ban these types of substances, and must invest in the research that will inform those decisions. There’s no guarantee that we’ll always be right, but protecting those at the greatest risk shouldn’t be deferred.

Given the evidence brought forth to date on BPA, I’d call this an understatement.

Apr 21 2010

FDA to regulate salt? If not now, when?

The Washington Post reported yesterday that the FDA is about to launch an initiative to get food companies to reduce the amount of sodium in their foods.

If true, this would be a major big deal.  But by late afternoon, the FDA had issued a press release denying the Washington Post’s report (and see note below):

A story in today’s Washington Post leaves a mistaken impression that the FDA has begun the process of regulating the amount of sodium in foods. The FDA is not currently working on regulations nor has it made a decision to regulate sodium content in foods at this time.

Over the coming weeks, the FDA will more thoroughly review the recommendations of the IOM report and build plans for how the FDA can continue to work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply.

The FDA is referring to a report also issued yesterday by the Institute of Medicine: Strategies to Reduce Sodium Intake in the United States. According to the IOM Summary, voluntary efforts by the food industry to reduce sodium intake have failed.  The report’s first recommendation is for the government to set standards for the sodium content of packaged foods.  And that sounds like what the Washington Post thought the FDA was about to do.

The idea is to get all companies to start reducing sodium.  USA Today quotes Jane Henney, the previous FDA Commissioner who chaired the IOM committee: “The best way to accomplish this is to provide companies the level playing field they need so they are able to work across the board to reduce salt in the food supply.”

The IOM is doing a public briefing on the report at 10:00 a.m. today, at the National Press Club in Washington DC.  You can listen to it via audio webcast at www.nas.edu.

The Center for Science in the Public Interest (CSPI) first asked the FDA to start regulating salt in processed foods in 1978.  Its press release and report, Shaving Salt, Saving Lives, explain why the FDA’s action would be such good news for public health.

Salt is as controversial as any nutrition issue can get.  I expect plenty of pushback from the Salt Institute and other industry trade groups if there is any hint that FDA might be about to regulate salt content.  Could the FDA’s denial be the result of industry pressure?  It would be interesting to find out.

Some basic facts: Recall that sodium is 40% of table salt (sodium chloride).  Too much raises the risk of high blood pressure and stroke.  Nearly 80% of salt is in processed and pre-prepared foods that are salted before they get to you.

The recommended maximum for adults is 2300 mg or about a teaspoon a day.  If you are at risk for high blood pressure, the maximum is just 1500 mg, or two-thirds of a teaspoon.  Americans consume more than twice that much on average.

Note added April 20: the FDA has produced a Q and A on its salt regulatory policy.

Additions April 21: Here’s the New York Times story on the IOM report.  The LA Times reports on the amounts of sodium in fast food restaurant meals.  Impressive.

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Apr 4 2010

Mrs. Obama’s anti-obesity campaign

Today is Easter Sunday and my monthly San Francisco Chronicle column appears today.  It deals with Michelle Obama’s campaign against childhood obesity.  Enjoy!

Kudos for first lady’s anti-obesity campaign

Nutrition and public policy expert Marion Nestle answers readers’ questions in this monthly column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.

Q: What do you think of Mrs. Obama’s “Let’s Move” campaign against childhood obesity? It doesn’t say much about junk food or food marketing. Isn’t this a cop-out?

A: Skeptic that I usually am, I have nothing but applause for Michelle Obama’s decision to adopt childhood obesity as the first lady’s official cause. Lady Bird Johnson’s legacy is the flowers that bloom throughout the nation’s capital. Obama must want hers to be the flowering of better health for our nation’s children.

Yes, Obama is sensitive to political realities. She calls her campaign “Let’s Move” rather than “Let’s Eat Less Junk Food.” But its goals are crystal clear. Her campaign aims to improve food in schools and eliminate “food desert” areas without access to healthier foods.

The White House organic garden is an integral part of this effort. It is no accident that Will Allen, the charismatic head of Growing Power, the group that runs urban farms in Milwaukee and Chicago, spoke at the campaign news conference. Good food, he said, is about social justice. Every child should have access to good food.

This campaign reveals real leadership on a desperately important issue. Obama brings diverse groups to this table. She presses government agencies to take action. She exacts promises from Congress to make it easier for kids to eat low-cost meals in schools. She got her husband to create a task force to tackle ways to prevent childhood obesity.

In addition, she is asking professional and business groups to do more to help kids eat better. I’m particularly impressed by her speech to the Grocery Manufacturers Association, which represents the makers of processed foods and beverages.

With masterful tact, Obama nonetheless insisted that the association “entirely rethink the products that you’re offering, the information that you provide about these products, and how you market those products to our children.” We parents, she said, want assurance that food companies will stop “teaching kids that it’s good to have salty, sugary food and snacks every day.”

Yes, she avoids saying anything about soda taxes or other measures that might make it easier for kids and parents to make better food choices, but she is bringing childhood obesity to public attention in a fresh, new way.

Consider what her campaign is up against. Preventing obesity means eating less, often a lot less, of processed fast-food, snacks and sodas. This puts the makers of such foods in an impossible bind. Eating less is not good for business.

Short of going out of business, what can such companies do to help? They can reformulate their products to make them a little healthier. They can stop marketing their products directly to children. But this, too, is bad for business – unless it can be used for public relations.

Indeed, food and beverage companies are falling all over themselves – with much fanfare – to reformulate and to promise to restrict marketing that targets kids.

PepsiCo, the maker of soft drinks and Frito-Lay snacks, says it will stop pushing sales of full-sugar soft drinks to primary and secondary schools worldwide by 2012. The new policy is voluntary, encourages rather than mandates, and assures school districts in the United States and abroad that the company will not tell them what to supply.

It keeps vending machines in schools and allows for continued sales of branded sugary drinks such as Gatorade, juice drinks, and sweetened milk.

Kraft Foods says it will reduce the sodium in its foods by 10 percent, also by 2012. This sounds good, but has a long way to go. Kraft’s Macaroni & Cheese (the SpongeBob package) contains 580 mg sodium per serving and two servings per package. A 10 percent reduction takes 1,160 mg sodium down to 1,050 mg. Salt is 40 percent sodium, so this brings salt down to 2.6 grams – about half a day’s upper limit for adults.

Still, these are steps in the right direction. Are they meaningful? You decide.

In the meantime, the Center for Responsive Politics, a nonprofit research group focused on the effect of money on public policy, says soda companies have increased by ten-fold the amount of money they spend on lobbying – no doubt to counter the threat of soda taxes.

What are we to make of these responses? They raise my favorite philosophical question: “Is a slightly better-for-you processed food necessarily a good choice?”

What would be better for preventing childhood obesity would be to make eating real foods the default. These, as defined by Oakland’s Prevention Institute, are relatively unprocessed foods that contain nothing artificial. And they are produced in ways that are good for farmworkers, farm animals and the environment, and are available and affordable to all.

Getting to that point requires policy as well as voluntary actions. Perhaps I’m reading too much into Obama’s campaign, but that’s how I interpret it. I’m supporting it. How about you?

Mar 9 2010

Sugar politics: not so sweet

I got a comment this morning from Eric who asks whether I had seen the article in yesterday’s New York Times about Florida’s bailout of Big Sugar in the Everglades.  I could hardly miss it.  The story starts on the front page and continues over two full inside pages.

Titled “Deal to save Everglades may help sugar firm,” the article explains how Florida politicians engineered a taxpayer-supported buyout of United States Sugar for nearly $2 billion in 2008, ostensibly to restore a waterway through the Everglades.  Now, it seems, the restoration projects have stopped for lack of money and U.S. Sugar gets to keep using the land.

U.S. Sugar is or was the largest sugar producer in Florida.  Founded by Charles Stewart Mott in 1931, it owned mills and a railroad as well as land.

Sugar policy, as I explained in a post last September, is special.  Alone among commodities, it is supported by an arcane system of quotas and tariffs designed to ensure that domestic sugar producers get prices for their crops that are higher than values on the world market.  The result?  Taxpayers pay more for sugar than they should.

I suppose I could argue that higher prices for sugar are a good thing.  High prices discourage consumption.   Fortunately or unfortunately (depending on how you look at it), sugar prices are not high enough to do that.

So chalk this one up to politics in action, replete with lobbyists, lawyers, and corporate heads with cozy ties to government officials.   As is all too often the case, the corporation came out ahead.  Whether the Everglades will ever benefit remains to be seen.

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Mar 7 2010

Tools for promoting soda taxes

I’ve been collecting information about soda taxes.  If you think they are worth a try, as I do, and want to help get the New York bill (the Duane Bill) passed, plenty of background information and tools are available.

Tomorrow, March 8, The New York Academy of Medicine, the New York State Healthy Eating and Physical Activity Alliance, and the New York State Public Health Association invite you to a symposium:

TAKING ACTION AGAINST OBESITY:
A Sugar-Sweetened Beverage Tax for New York State

Monday, March 8 2010 from 2:00 pm to 3:30 pm
Blue Room, 2nd Floor, Capitol Building, Albany, NY

Speakers include NYS Health Commissioner Dr. Richard Daines, New York City Health Commissioner Dr. Tom Farley, and Dr. Kelly Brownell from the Yale Rudd Center for Food Policy. The event is free.  RSVP to tsanders@malkinross.com

Here’s more than you ever wanted to know about why these taxes are likely to do some good and are worth passing:

Convinced?  Want to help?

And just for fun, here is testimony from an official of PepsiCola opposing the taxes and a rebuttal from some group (sorry, I don’t know which).

Finally, the Los Angeles Times (February 21) had a terrific graph of the recent sharp increase in lobbying expenditures (in the rebuttal).  Given the mess in Albany, it will be interesting to see how all this goes.  Act now!

Jan 17 2010

Eating Liberally asks about salt

The ever curious Kerry Trueman, Eating Liberally’s kat, wants to hear more about Bloomberg’s salt assault.  And well she might.  Today’s New York Times has a bunch of letters weighing in from all points of view.    Here’s how our conversation went:

(With a click of her mouse, EatingLiberally’s kat corners Dr. Marion Nestle, NYU professor of nutrition and author of Pet Food Politics, What to Eat and Food Politics🙂

Kat: New York City’s new initiative to persuade food manufacturers and restaurants to voluntarily reduce the salt in their foods by 25% over the next five years is eliciting the usual outrage from the “nanny state” naysayers, for whom excess salt consumption is yet another matter of personal responsibility.

But as you noted last Monday, “nearly 80% of salt in American diets is already in packaged and restaurant foods and if you eat them at all you have no choice about the amount of salt you are getting.” Many Americans consume more than double the daily recommended intake of sodium, contributing to thousands of deaths and billions in medical costs annually.

Mayor Bloomberg equates the food industry’s overuse of salt to such health hazards as asbestos. But Mark Kurlansky, author of Salt: A World History, insisted to WNYC’s Amy Eddings that this analogy is false because “we could reduce our salt intake on our own, if we wanted to.”

Technically, this is true, if you’re willing and able to eliminate packaged foods from your diet, stop eating out, and start cooking all your meals from scratch. Unfortunately, the percentage of folks who have the time, inclination, and resources to do this is roughly on a par with those who think that Wall Street’s robber barons earned those big bonuses.

The food industry maintains that it would gladly reduce the sodium in its products–and some are doing so surreptitiously–if only consumers conditioned to crave super salty foods would be more willing to accept reduced sodium products.

The “invisible hand” of the market can’t seem to let go of the salt shaker. Mayor Bloomberg’s proposal is a step in the right direction, but do you think it will achieve meaningful reductions, or will we ultimately end up having to regulate salt?

Dr. Nestle: I love nanny-state accusations. Whenever I hear them, I know either that food industry self-interest is involved or that the accuser really doesn’t understand that our food system already is government-regulated as can be. These kinds of actions are just tweaking of existing policy, in this case to promote better health.

At issue is the default. Right now, companies have free rein to add as much salt to their processed or prepared foods as they like. The makers of processed foods do focus-group testing to see how consumers like the taste of their products. They invariably find that below a certain level of salt–the “bliss” point—their study subjects say they don’t like it. Soups are a good example. A measly half-cup portion of the most popular Campbell’s soups contains 480 mg of sodium or more than a full gram of salt (4 grams to a teaspoon).

To someone like me who has been trying to reduce my salt intake for years, those soups taste like salt water. That’s because the taste of salt depends on how much you are eating. If you eat a lot, you need more to taste salty. If you are like me, practically all processed and restaurant foods taste unpleasantly salty.

So what to do? I say this is indeed a matter of personal choice and right now I don’t have one. If I want to eat out at all, I know I’m going to feel oversalted by the time I get home.

I want the default choice to be lower in salt. Nobody is stopping anyone from salting food. You don’t think your food tastes salty enough? Get out the salt shaker.

But let me make two other comments. One is that the amount of salt we eat is so far in excess of what we need that asking food makers and sellers to cut down can hardly make a dent in taste. A new Swedish study just out says that young men consume at least twice the salt they need and the authors are calling on government to require food makers to start cutting down.

And yes, the science is controversial and not everyone has blood pressure that goes through the roof when they eat something salty. But lots of people do. And almost everyone has blood pressure that goes up with age. As a population, we would be better off exposed to less salt in our diets.

Some food makers are already gradually cutting down on salt, but quietly so nobody notices. If every food company were required to do that, everyone would get used to a less salty taste and we all might be able to better appreciate the subtle tastes of food.

My guess is that Bloomberg has started a movement and we will be seeing much more effort to lower the salt intake of Americans. As I see it, this is about giving people a real choice about what they eat.

Correction, January 22:  Juli Mandel Sloves of Campbell Soup correctly points out that I am in error.  A serving of soup is 8 ounces, not 4, even though the label says that a serving is half a cup.  How come?  Because the can is to be diluted with another can of water, making it 21 ounces divided by 2.5 servings per can, or about 8 ounces.    Complicated, no?  But this means the sodium content is 480 mg per cup, not half cup, despite what the label says.   I apologize for the error.  But here is an excellent reason to redesign the Nutrition Facts label, alas.

Nov 16 2009

Uh oh. Industry forces FDA to drop oyster safety plan

On November 13, the FDA announced indefinite postponement of rules requiring raw oysters from the Gulf of Mexico to undergo postharvest processing to destroy their content of Vibrio vulnificus, a particularly nasty “flesh-eating” bacterium.  According to accounts in the New York Times and in industry newsletters,  the FDA caved under pressure from the oyster industry and members of Congress representing oyster-harvesting regions in the Gulf.

The FDA has been trying for years to get the oyster industry to clean up its act and use post-harvest technologies to sterilize oysters in order to prevent the 15 or so deaths they cause every year.  The technologies include quick freezing, frozen storage, high hydrostatic pressure, mild heat, and low dose gamma irradiation.  When used, the methods reduce bacteria to undectable levels and deaths from Vibrio vulnificus infections to zero.  As the FDA puts it, “seldom is the evidence on a food safety problem and solution so unambiguous.”

The FDA took action on October 16.  It wrote a letter to the industry announcing the new rules.  It would expect oyster producers to use the techniques, especially on oysters harvested in summer months when bacteria levels are higher.  It also issued a background paper on why the techniques are needed, a fact sheet on oyster hazards, and a Q and A on the new policy.

On October 17, FDA official Michael Taylor gave a speech to the oyster industry outlining the policy.

Oops.  The oyster industry did not take well to the idea and went into organized action.

Now, the proposed rules are history.  As the FDA explains:

Since making its initial announcement, the FDA has heard from Gulf Coast oyster harvesters, state officials, and elected representatives from across the region about the feasibility of implementing post-harvest processing or other equivalent controls by the summer of 2011.  These are legitimate concerns.

It is clear to the FDA from our discussions to date that there is a need to further examine both the process and timing for large and small oyster harvesters to gain access to processing facilities or equivalent controls in order to address this important public health goal.  Therefore, before proceeding, we will conduct an independent study to assess how post-harvest processing or other equivalent controls can be feasibly implemented in the Gulf Coast in the fastest, safest and most economical way.

My interpretation: 15 or more preventable deaths a year, every year, from oyster Vibrio must not be enough to elicit industry responsibility or FDA action.  That the FDA was forced to back down so quickly is not reassuring about this administration’s commitment to food safety.  Make no mistake.  This is a major setback to developing a strong food safety system.

One of the ironies here is that the FDA’s approach to oyster safety mirrored the approach taken by the very same Michael Taylor when he worked for the USDA in the mid-1990s.  Then, the administration backed him up on requiring science-based food safety procedures for meat and poulty producers.  This time, it looks like the administration pulled the rug out from under him and forced the FDA to back down.

Note: Thanks to Mike Taylor, safety rules are in place for meat and poultry.  Unfortunately, the current USDA isn’t enforcing them.  I will have more to say on that point in tomorrow’s post.

Another note: Center for Science in the Public Interest, which has been pushing for oyster safety for years, has organized a protest campaign.  Sign up here.