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Last week, I posted information and links to documents sent to me anonymously suggesting that the new Nordic Nutrition Recommendations (NNR) had been influenced by the food industry to omit a statement in an earlier draft to reduce consumption of ultra-processed foods.

I have no first hand personal experience with these recommendations and do not want to get in the middle of a dispute over the development of these guidelines.

I do feel strongly that the concept of ultra-processed is an enormous step forward in understanding how to eat more healthfully, backed up as it is by hundreds of observational studies and one extraordinarily well controlled clinical trial (Kevin Hall’s at NIH).  I think enough evidence exists, and the concept is well enough defined, to advise the public to eat less of highly processed food products.

Shortly after my post went online, I received the following letter from Norwegian researchers involved in the NNR process asking me to correct and clarify what I had posted.  I reproduce the letter here with their permission, and with thanks for our correspondence over this issue.  Read what they say and last week’s post, and decide for yourself.

July 12^th 2023

Dear Marion Nestle,

This email is from the Norwegian researchers involved with the recently published Nordic Nutrition Recommendations (NNR2023), including the head of the working group.

We have read your books, followed your daily blogposts for years, and always appreciated your informative and thoughtful letters. However, your post Monday 10th July on NNR2023 and the chapter on ultra-processed foods (UPF) is misinformed, and we believe that your informant has misled you. We would appreciate the opportunity to answer the claims, one by one.

• You: “The backstory here is one of effective food industry lobbying”.
  • This is 100 % untrue. The committee has not been subject to any form of lobbying unless one considers responses to the public hearing as lobbying. In the public hearing, which you have a link to, you cite that we received 60 responses (or to be correct: 58 responses when subtracting the heading and an empty entry) to the UPF chapter, but as the same institution could have several entries, there were 39 unique responses. Of these, 27 represented industry or commercial interests in one way or the other, while 12 responses were from academia.
  • If you read the responses carefully, you will see that absolutely ALL the academic institutions argue that it is premature to give public advice on UPFs. The academic responses came from the following institutions: Lund University, Nofima (a food research institute), Natural Resources Institute of Finland, Norwegian University of Technology and Science (NTNU), Technical Research Centre of Finland, SINTEF Ocean (Norway), RISE Research Institute of Sweden, Norwegian University of Life Sciences, Chalmers Technical College, Sweden’s Agricultural University (SLU), Karolinska, University of Helsinki, University of Lund, Swedish Food Agency, University of Gothenburg, and University of Umeå. (There are more than 12 institutions because several of them merged their responses into one entry).
  • You do not mention that there were three independent peer-reviewers of the UPF review paper, none of which has ties to the food industry
  • It is first and foremost careful listening to the input from the peer-reviewers and the scientific inputs from the public consultation, combined with our own evaluation of the totality of the evidence, that made us land on not having a specific recommendation on UPFs.
    • The arguments against having a recommendation on UPF are nicely summed up in this input to the public hearing (jointly signed by a number of scientists from Sweden): “In summary, the chapter introduces an unspecific concept that is controversial without a detailed discussion about its benefits and limitations. It is questionable whether the concept UPF adds anything beyond existing measures of diet quality since it is merely a proxy that includes both diet (nutrient) quality aspects, additives and processes. It is of outermost importance that NNR is based on solid scientific data and avoids speculations based on model studies and poorly defined exposures to maintain trust and credibility among the public and the research community. As researchers, we consider UPFs as an unspecific and non-scientifically defined concept that will make it difficult to study mechanisms and unravel causality. Instead, we suggest using existing and more well-defined and studied measures of diet quality and make efforts to come up with better ways of measuring food processing per see to allow a scientific evaluation of its potential implications for human health. This could be reflected in a narrative chapter that introduces and discuss the concept of UPF and food processing and their benefits and limitations in a balanced way as well as identifies scientific gaps in our understanding of the role of different processing and additives for health”.
    • As an example, whole-grain bread does not become unhealthy just because it is placed in the UPF group.
• You: “These negative views of the UPF concept differ from the views of the background document (however politely stated) and clearly were influenced by the overwhelmingly negative views of food industry representatives”.
  • Yes, the food industry representatives were negative, but as explained in the previous comment, so were absolutely ALL the Nordic scientists who responded in the public hearing. The result would have been the same regardless of the comments from industry.
• You refer to a summary in English available on online: https://docs.google.com/document/d/10Kf4kuaD1wZNkQJyrdOHdQPvsDqY6O6pytizzBxfpRA/edit?lctg=102461686&pli=1 This is an anonymous summary, but likely written by the same person who is your informant
• You cite your informant who states the following: “I have come to realize that this is not at all about evidence. It’s about power, and who gets to define what’s important in nutrition science. “The establishment” refuses to accept that someone from Brazil, a country they regard as inferior, should be allowed to tell them they have been wrong in their nutritionism-approach. They claim NOVA is based on ideology, not science….And now this is getting in the way of public health”.

This is an outrageous claim and we wonder how anyone can accuse us of something like this. We have the deepest respect for Carlos Monteiro and have followed his research on UPF since he first published his hypothesis in 2009. Like him, we are deeply concerned about the rise of overweight and obesity worldwide and like him, we work on disentangling the causes. We find the UPF concept intriguing scientifically, but it’s premature to use the concept in public advice until it has been refined and better defined.

We are also surprised that you do not mention the large proportion of comments coming from the meat industry and farmer’s organizations regarding both health and sustainability aspects of meat consumption. They have of course been fervently opposed the science advice to reduce meat consumption to maximum 350 grams red meat/week, generating significant media attention and engaging with politicians to dismiss the report. This would itself certainly be an interesting case study. However, the committee again adhered to the science and did not succumb to lobbyism. The same goes for sugars, alcohol and other hot topics. This is contrary to the accusations that the recommendations were influenced by the food industry.

We regret to note that you have shared a letter containing misleading allegations regarding the NNR2023 results on UPFs. The unfounded accusations of NNR2023 seem to come mainly from persons who are also in opposition to the NNR2023 advice on reducing red meat intake, thus being in opposition to a more environmentally sustainable diet. Nonetheless, we do hope that you will look more closely into the final NNR2023 report (not the draft) and modify the damaging and untruthful assertions about the process.

Yours sincerely

Helle Margrete Meltzer, member of the NNR2023 committee, former research director at the Norwegian Institute of Public Health

Rune Blomhoff, head of the NNR2023 committee, professor at the University of Oslo

Jacob Juel Christensen, member of the NNR2023 committee, postdoc at the University of Oslo

Erik Kristoffer Arnesen, advisor to the NNR2023 committee, PhD student at the University of Oslo

I learned about this one as I often do from reading NutraIngredients’ daily newsletter:  RCT: Grape and blueberry extract improves cognitive health in ageing consumers.

This sounds great!  I went right to the article.

The study:  Effects of a polyphenol-rich grape and blueberry extract (Memophenol™) on cognitive function in older adults with mild cognitive impairment: A randomized, double-blind, placebo-controlled study   Adrian L. Lopresti, Stephen J. Smith, Camille Pouchieu Line Pourtau, David Gaudout, Véronique Pallet⁴ and Peter D. Drummond.  Front. Psychol., 29 March 2023.  Volume 14 – 2023 | https://doi.org/10.3389/fpsyg.2023.1144231

Background: Polyphenols are naturally occurring organic compounds found in plants. Research suggests that their intake reduces the risk of cognitive decline and related dementias. Grapes and blueberries are polyphenol-rich foods that have attracted attention for their potential cognitive-enhancing effects.

Purpose: Examine the effects of supplementation with a standardized and patented polyphenol-rich grape and blueberry extract (Memophenol™) on cognitive function in older adults with mild cognitive impairment.

Study design: Two-arm, 6 month, parallel-group, randomized, double-blind, placebo-controlled trial.

Methods: One hundred and forty-three volunteers aged 60 to 80 years with mild cognitive impairment were supplemented with either 150 mg of Memophenol™, twice daily or a placebo. Outcome measures included computer-based cognitive tasks, the Behavior Rating Inventory of Executive Function (BRIEF-A), the Cognitive Failures Questionnaire, and the CASP-19.

Results: Compared to the placebo, Memophenol™ supplementation was associated with greater improvements in the speed of information processing (p = 0.020), visuospatial learning (p = 0.012), and the BRIEF-A global score (p = 0.046). However, there were no other statistically significant between-group differences in the performance of other assessed cognitive tests or self-report questionnaires. Memophenol™ supplementation was well-tolerated with no reports of significant adverse reactions.

Conclusion: The promising results from this trial suggest that 6-months of supplementation with Memophenol™ may improve aspects of cognitive function in adults with mild cognitive impairment. Further research will be important to expand on the current findings and identify the potential mechanisms of action associated with the intake of this polyphenol-rich extract.

Funding: This study received funding from Activ’Inside. The funder was not involved in data collection, interpretation of data, or the decision to submit it for publication.

Conflict of interest: AL is the managing director of Clinical Research Australia, a contract research organization that has received research funding from nutraceutical companies. AL has also received presentation honoraria from nutraceutical companies. SS is an employee of Clinical Research Australia and declares no other conflicts of interest. PD and VP declare no conflicts of interest. DG, CP, and LP are employed at Activ’Inside and provided the Memophenol™ and placebo capsules.

Comment: Guess what Activ’Inside makes.  This study is not only funded by the maker of the supplement, but three of the authors work for the company.  This is contract research.  How can they say the funder was not involved?  The authors may not recognize it, but the funder was involved, and deeply.  How could it not be if the authors work for the company?

I could hardly believe this ad in the New York Times last Friday.

Cattle as a promoter of biodiversity?

My usual question: Who paid for this?

The only clue was the little checkmark and in tiny letters “Funded by beef farmers and ranchers.”

I did the thing with the QR code and went straight to www.beefitswhatsfordinner.com, the website of the Cattlemen’s Beef Board and the National Cattlemen’s Beef Association, organizations paid for by per-animal levies imposed by USDA-sponsored checkoff programs.

The beef checkoff

acts as a catalyst for change and is designed to stimulate beef sales and consumption through a combination of initiatives including consumer advertising, research, public relations and new-product development.

The ad says:

Almost a third of U.S. land is too rocky or dry to be used for growing food crops.  But cattle can graze on and regenerate that land, naturally protecting open space and conserving precious habitats and ecosystems.

Yes, they can, but participants in the Beef checkoff generally raise cattle in CAFOs (factory feedlots), the antithesis of grazing on and regenerating land.

The beef industry is under siege these days from people who care about health and the environment.

Instead of doing all it can to promote regenerative grazing, it uses public relations to deflect attention from how it really raises cattle.

Butterflies?  Not a chance.

CORRECTION:  Several readers have written to complain that I obviously know nothing about how cattle are raised.  “You idiot,” they say (or imply), “cattle are raised on grass until the last few months of their lives.”  Not only that, says one reader, but their grazing on grass produces ecological miracles (see, for example, this video.)  That, however, still leaves them with months of finishing off on grains in feedlots, somehow not mentioned in the Beef Checkoff ad.  It may be, as one reader tells me, that beef producers hate this system and hate paying for it with checkoff funds, but that’s how it works.  Advocacy, anyone?  In any case, I apologize for not including this iinformation n my original post.

A press release from the World Health Organization announces recommendations on the use of artificial, non-nutritive (meaning no-calorie) sweeteners: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that use of NSS does not confer any long-term benefit in reducing body fat in adults or children. Results of the review also suggest that there may be potential undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The recommendation not to use artificial sweeteners for weight control or chronic disease prevention applies to:

all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars. Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

The guideline document notes:

The recommendation in this guideline was made based on evidence that suggests that there may be health effects associated with NSS use irrespective of which NSS is being used – that is, NSS as a class of compounds, despite individual NSS having different chemical structures, may have an impact on health…individual NSS have different sweetness intensities and organoleptic properties, and are processed differently by the body. Although limited  evidence suggests that individual NSS may also differ in some of their physiological effects in humans, the evidence is currently insufficient to make
recommendations for individual NSS.

Overall, the evidence summarized in the document shows benefits from short-term studies but not ones that last longer than three months or so.  After that, use of non-nutritive sweeteners is associated with potential harm.

At issue, of course, is the mechanism.  These remain speculative: calorie compensation? mainenance of taste preference?  microbiome?

Much of the research into biological mechanisms has been carried out in in vitro and rodent models, and further research is needed to determine whether observations in non-human models translate to humans.  Although there are as yet no conclusive mechanistic links between NSS use and many of the associations observed in prospective cohort studies, that plausible mechanisms have been identified, tested and in some cases validated (albeit mostly in non-human models) reinforces the seriousness with which the associations observed in prospective cohort studies should be considered and highlights the need for further exploration of possible mechanisms with additional research.

Until then, it seems best to avoid them (I don’t like their taste anyway).

• View the press release here
• Access the guideline here

Questions?

• Please email any questions to: NFS@who.int 

I’ve had so many requests to comment on Michelle Obama’s new PLEZi food business—reduced sugar but ultraprocessed artificially sweetened drinks for kids—that I feel obliged to write about them, unhappy as I am as having to consider this enterprise so ill advised.

In case you missed it, the former First Lady—a public health hero of mine for her efforts to improve school food and feed kids more healthfully—announced these drinks as having 75% less sugar than Coke and Pepsi.

The press materials say PLEZi’s mission is:

to create higher standards for how the U.S. makes and markets food and beverages for kids, leading with nutrition, taste, and truth…PLEZi Nutrition was created to give parents a helping hand by offering healthier, great-tasting products that parents can feel good about giving their kids and that kids actually want. The company is focused on lowering sugar content and lowering sweetness to help adjust kids’ palates to crave less sweetness overall. In addition to reducing the sugar and sweetness, they are adding in nutrients kids need, all with the aim to replace sugary drinks and snacks.

Here’s what’s good about all this.

• Michelle Obama is eloquent on the need for kids to eat more healthfully.
• PLEZi is established as a benefit corporation meaning that its stockholders have agreed to have social values as part of its mission, not just profits (although those count too, evidently).
• It has donated $1 million to Food Corps, which teaches school kids about food—a cause well worth supporting.
• It has a distinguished “kitchen cabinet” advisory committee of people who care about kids’ health.

Why my dismay? 

Take a look at the PLEZi Blueberry Blast drink’s nutrition information and ingredient list.

This product has a lot less sugar than Coke or Pepsi and contains zero added sugars, but it has five sweeteners:

• Apple juice concentrate (Translation: sugar derived from apples)
• Watermelon juice concentrate (ditto from watermelons)
• Blueberry juice concentrate (ditto from blueberries)
• Stevia leaf extract
• Monk fruit extract

These, plus “natural flavors” (don’t get me started) and some of the other ingredients put this squarely in the category of ultraprocessed products, now strongly associated with poor health and promotion of excessive calorie intake.

These drinks do not meet my idea of a “higher standard,” alas.

Instead, I see PLEZi as a direct competitor of existing drinks—Kraft’s Capri Sun and Kool-Aid Jammers among them—both with less sugar than Coke or Pepsi, and neither what I would consider a health food.

I found PLEZi shelved right with other sweetened drinks aimed at kids  at the Target in Ithaca, New York.

PLEZi’s cost

Target has PLEZi,on special sale at for $3.50 for 32 ounces (four 8-ounce bottles).  This makes it almost twice as expensive as Capri Sun ($3.19 for 60 ounces—ten 6-ounce pouches).

The competition

PLEZi’s nutritional profile isn’t all that different from that of “half the sugar” Capri Sun.  Here’s Capri Sun Strawberry Kiwi:

Capri Sun has the same kinds of ingredients as PLEZi, but less fruit juice, and a little more overall sugar.  To me, they don’t look all that different.

What about taste?

I bought packages of PLEZi Blueberry Blast, Orange Smash, and Capri Sun ‘s “half the sugar” Strawberry Kiwi.

OK, I  am not these products’ core customer.   They are not aimed at me.  I thought the PLEZi drinks were oddly colored and watery, and had undistinguishable flavors and the slight off-taste of monk fruit sweetener.

Capri Sun is noticably sweeter, which is not surprising: it has 7 grams of sugar in 6 ounces, whereas PLEZi has 6 grams of sugar in 8 ounces.

But all of these drinks raise the same question: Is a somewhat less sugary, sweetened, “better-for-you” drink necessarily a good choice?

Many healthier drinks are available for kids.

I would like to know:

• Why anyone would think kids need another drink like this.
• Why someone didn’t identify PLEZi drinks as ultraprocessed.
• Why someone didn’t intervene to protect Mrs. Obama from getting involved in this dubious enterprise.

My business and health questions:

• Will PLEZi sell?
• Will it cut into sales of Kool-Aid Jammers and Capri Sun, let alone Coke and Pepsi?
• Will it accustom kids to less sweet tastes?
• Will it encourage kids to eat more healthfully?

I sure hope the Kitchen Cabinet insists on a serious evaluation.

I’m working on a new edition of What to Eat and am spending a lot of time in grocery stores seeing what’s new and different since 2006—vastly more than I thought when I signed up to do this project, which is why it is taking a long time to do.

One change is in the number of products displaying Non-GMO labels.  The Non-GMO Project says it has certified 60,000 products, and I believe it.

On the other hand, don’t expect to see labels on foods that are genetically modified even though they are required.  With much searching, I found a few on shipping boxes but not on grocery shelf labels.

So I’m interested to see what the FDA is saying about genetically modified foods.

It sent out a press release recently.

Today, the U.S. Food and Drug Administration (FDA) released new “Feed Your Mind” educational materials to provide science-based information on genetically modified organisms (GMOs). “Feed Your Mind” is an education initiative launched in 2020 to help increase consumer understanding of GMOs and was developed in partnership with the U.S. Department of Agriculture and the U.S. Environmental Protection Agency.

The new materials for consumers include:

• A factsheet about how scientists use genome editing to develop food crops that address the needs of a growing global population and adapt to a changing environment:
  • Genome Editing in Agricultural Biotechnology
• Infographics about how growing GMOs can have environmental benefits and benefit the lives of farmers and consumers:
  • GMOs and the Environment
  • GMOs Outside the U.S.: A Closer Look at Bt Eggplant
• Videos featuring how GMOs are regulated in the U.S. and experts who grow them:
  • Talk About GMOs: Experts Who Know Them and Grow Them
  • GMOs: Government Regulation and Your Safety

…Funding for the “Feed Your Mind” initiative was provided by Congress in the Consolidated Appropriations Act of 2017 to conduct “consumer outreach and education regarding agricultural biotechnology and biotechnology derived food products and animal feed, including through publication and distribution of science-based educational information on the environmental, nutritional, food safety, economic, and humanitarian impacts of such biotechnology, food products, and feed.” More funds were provided through 2018 and 2019 Appropriations bills.

For More Information

• Feed Your Mind – Agricultural Biotechnology Initiative
• Resources for Healthcare Professionals
• FDA Releases New “Feed Your Mind” Education Materials on GMOs for Consumers, Health Educators, and Health Care Providers (August 2022)
• FDA Releases New “Feed Your Mind” Consumer Education Materials (September 2020)

The last time I wrote about the FDA’s GMO initiatives, I titled the post “The FDA’s new pro GMO propaganda.”  I pointed out that the FDA’s materials stick with limited issues, and say nothing about:

• Corporate control of commodity agriculture
• Glyphosate, the herbicide used with GMOs and considered carcinogenic by international health agencies and US courts
• How pesticides used on GMO crops contaminate organic production
• The ways GMO companies harrass independent farmers by enforcing intellectual property rights
• How the Farm Bill subsidizes GMO corn and soybeans, causing them to be overproduced and corn to be used for ethanol
• The lack of labeling of the few GMO foods on the market.

No wonder sales of organic foods are booming and so many people look for Non-GMO labels on food products.

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Tove Danovich.  Under the Henfluence: Inside the World of Backyard Chickens and the People Who Love Them.  Agate, 2023 (223 pages).

I’ve followed Tove Danovich’s career with great interest, not least because she took a course with me in the Food Studies master’s program at NYU some years ago.

This is her first book, a nonfiction account of the chickens she raises, each named and identified, the contrast between the welfare of chickens raised in backyards as opposed to industrial batteries, and her love for chickens in general and hers in particular.

During the first year of the pandemic, chicken watching became my main hobby. (Not that there were many other options.)  When the news got to be too overwhelming, watching the chickens was how I reset  Obviously, I’m not the first one to discover the therapeutic power of chickens..Some people pour themselves a glass of wine; others stare at chickens. (p. 107)

She adopts two checkens rescued from factory farms and names them Thelma and Louise.

Some of Thelma’s and Louise’s natural behaviors came back as soon as they were given the chance to express them—dust bathing, foraging, laying in the sun—but their bodies and minds took longer to heal  A year after they were rescued, the hens’ feathers were almost completely regrown with the exception of their still sparse tail feathers.  Some things won’t change.  They will probabl always sleep on the floor of the coop.  Their beaks will never grow back.  But they’ve found a place for themselves in the flock and with me.  (p. 193)

The book has plenty to say about the political, economic, and animal-welfare aspects of factory farmed chicken raising, but mostly it’s a personal account of her enjoyment of raising backyard chickens.

She eats their eggs.  She does not eat the hens.

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If you thought yesterday’s post about blueberries as a means to reduce hypertension in menopausal women seemed far-fetched, you are missing the point.

The food industry views menopause as a marketing opportunity.

‘We need the food industry to recognise this opportunity and step up to the plate’: Campaigner urges more NPD to embrace the menopause: The menopause represents a significant untapped opportunity for food and beverage brands, FoodNavigator’s Positive Nutrition Summit hears…. Read more

The menopause hits at a life stage when many women are particularly busy and time-poor and it is, at best, an inconvenience…This audience is now demanding more from brands – they don’t want to have to struggle and search to find items that support their symptoms. GenM research shows that 78% of women would be happy to shop for products labelled as menopause-friendly, while a further 90% of menopausal women want brands to be more inclusive to menopause. We need the food industry to recognise this opportunity and step up to the plate.

And then there’s this one:

Marketing sports nutrition products for menopausal women:  A variety of products are geared toward youth and seniors, but where do women in their 50s fit?… Watch now

Alexis Collins, director of product and brand strategy, Stratum, said one ingredient stands out to her most: NEM, the company’s flagship, branded eggshell membrane. Our ingredient is natural eggshell membrane also known as NEM and NEM is a joint health ingredient that has been specifically clinically researched in postmenopausal women to show fast exercise recovery.

Eggshell membrane.  Why didn’t I think of that?

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