Search results: a life in food

In 2008, in response to a petition by Cargill, the FDA authorized a health claim for beta-glucan extracted from barley.  Beta-glucan is a form of soluble fiber similar to that from oats, psyllium, and other grains or from the cell walls of yeast.  It can help lower blood cholesterol levels and, therefore, the risk of coronary heart disease.

Cargill must think that beta-glucan will create another oat bran craze such as the one that occurred in the late 1980s.  Or at least that’s the impression given by the latest news from the U.K.: “Cargill says EFSA health claim will transform beverage fibre fortunes.”

The deal with beta-glucan is that it can be added to drinks (presumably sugary).  If so, the drinks can carry the claim:

3 grams per day of barley beta-glucan, as part of a diet low in saturated fat, and a healthy lifestyle, can help manage normal blood cholesterol (my emphasis).

Beta-glucan is a “functional” ingredient, meaning that it is something added to a food ostensibly to boost its health value.  But the entire point of functional ingredients is to be able to make health claims for them.  Health claims sell food products when nobody bothers to read the fine print.

Thanks to my NYU Medical Center colleague, Dr. Melissa Bender for the alert about the blogosphere fuss over Cascadian Farm Purely O’s cereals.  Apparently, Cascadian Farm, now owned by Big Food General Mills:

quietly changed the recipe for its “Purely O’s” cereal — previously an unsweetened favorite among children/toddlers – to include three times the sugar, as well as new fillers/sweeteners such as corn meal and tapioca syrup. They did this with no announcement on the label, taking advantage of those who trusted the brand for its previous simplicity. Loyal customers, particularly parents who had chosen this product because it was one of the few unsweetened options available, are outraged by this secretive yet major reformulation. Many discovered the change when their children spat out the cereal (myself included).

Her note sent me right to the largest of the three Whole Foods stores within walking distance of my Manhattan apartment.  Purely O’s: 3 grams of sugars, 3 grams of fiber, and 160 mg sodium per serving.

Oops: low-sugar, yes, but only medium-fiber and high in sodium.  Even with 0 grams of sugar, it’s not all that great.  Neither, for that matter, is its non-organic analog Cheerios (1 gram sugar, 3 grams fiber, 190 mg sodium).

At 3 grams of sugar per serving, Purely O’s is still lower in sugar than practically every other cereal in Whole Foods.  Whole Foods does not sell Big Food non-organics, so it does not carry Cheerios.  I had to look hard to find the only cereal lower in sugar than the reformulated Purely O’s: Arrowhead Mills Shredded Wheat, Bite Size (2 grams of sugar, 6 grams of fiber, and only 5 mg sodium).  That one, it seems to me, is a much better choice to begin with, pretty much in the same category as oatmeal (1 gram of sugar, 4 of fiber, and 0 mg sodium).  When it comes to cereal, more fiber the better.  Fiber is the point of breakfast cereal.

So I can’t get too upset about the reformulation of Purely O’s.  It’s simply a business decision, entirely to be expected from Big Food.  Cascadian Farms started out with “humble beginnings” as a maker of organic products, none of them cereals.  It was successful enough to be bought first by Small Planet Foods, and later by General Mills, which wanted to get in on the organic market.  Hence: organic Purely O’s.

General Mills is in business to sell cereal, and Purely O’s just didn’t make it past focus groups, as reported in the Boston Globe earlier this year.  General Mills must think there are too few of its deeply loyal customers to matter.  According to a business school case study, it has a history along these lines.  So chalk this one up to corporate imperatives.

Dr. Bender wrote to General Mills and received a reply that said as much:

Our goal is to give consumers quality products at a good value. Prior to introducing any product, extensive consumer testing is done. We conduct market research and product testing continuously to obtain consumer reaction to existing products and to changes being considered. Only when we feel confident that a product change will broaden its appeal will we alter a product’s formulation. We are sorry that you do not agree that the recent change in Cascadian Farm organic Purely O’s cereal was for the better.

If the bloggers are looking for a replacement, try oatmeal or those cute little bite-sized shredded wheat things.

For years, some people – not me – have been saying that eating one extra 50-calorie cookie a day can make you put on 5 pounds per year.  This calculation comes from basic math: if about 3500 extra calories make you put on a pound of body fat, then 50 times 365 is 18,250 extra calories which, divided by 3500,  equals about 5 pounds.

This never made sense to me.  It is impossible to know how much you are eating each day within 50 calories let alone how many calories you are using in daily activities.  Yet people used to be able to keep their weight steady without thinking about calories at all.

This is because the body regulates weight and can easily compensate for such small changes in calorie intake or output with small changes in metabolic rate.  It takes more calories to move heavier bodies, and fewer to move lighter ones.

For years, I’ve been thinking that it must take a lot more than 50 extra calories a day – I guessed hundreds –  to make people gain weight.  I thought this for two reasons:

First reason: Portion sizes have increased greatly in recent years, and larger portions have more calories.  Sometimes, they have a lot more.  Foods eaten outside the home often have more calories in them than anyone suspects.

That’s why calorie labeling matters.  Labeling may underestimate the actual calories present in a food according to Tufts researchers (see this week’s Time for commentary and also see the industry response).  But even so, a new study shows that labeling encourages people to cut down on food intake, at least at Starbucks.  Make that two new studies: one from the Rudd Center at Yale comes to the same conclusion.

Second reason: I keep hearing from pediatricians who treat overweight kids that they have kids in their practices who drink from 1,000 to 2,000 calories a day from sodas alone.  I can’t judge whether these figures are correct or not, but several different kinds of studies suggest that many people today are eating a lot more calories than their counterparts of 25 years ago.

Now Martin Katan and David Ludwig have done the actual calculations in a paper in this week’s JAMA titled “Extra calories cause weight gain–but how much?”  Their conservative estimate is that it would take an excess of 370 calories to gain 35 pounds in 28 years.   To become obese in 25 years, you would need to eat 680 calories a day more than you expended.

To become 58 pounds overweight at age 17, they predict that a child would need to overconsume 700 to 1,000 calories a day from the age of 5 or so.

These figures are quite consistent with what those pediatricians were telling me.  By other estimates, average caloric intake has increased by 200-500 calories a day since the early 1980s, along with a 700 calorie-a-day rise in the availability of energy in the food supply (from 3,200 to 3,900 per day per capita).

As Katan and Ludwig conclude:

small changes in lifestyle would have a minor effect on obesity prevention.  Walking an extra mile a day expends, roughly an additional 60 kcal compared with resting – equal to the energy in a small cookie.  Physiological considerations suggest that the apparent energy imbalance for much of the US population is 5- to 10-fold greater, far beyond the ability of most individuals to address on a personal level.  Rather, an effective public health approach to obesity prevention will require fundamental changes in the food supply and the social infrastructure.

This is because on the personal level, prevention of weight gain means eating hundreds of calories a day less.  Moving more, useful as it is, will not do the trick unless people eat less as well.

On the societal level, we need measures to make it easier for people to eat less.

I can think of a bunch of examples.  You?

Remember last year’s scandal about the 300,000 Chinese infants who developed kidney disease after being fed infant formula laced with melamine?  That anyone would put melamine into infant formula was shocking on its own (although the previous year’s scandal over melamine in pet food ought to have been fair warning, as I explained in my book, Pet Food Politics).

Even more shocking is that the Sanlu infant formula company knew about problems with its milk long before it issued a recall, in part because it did not want to embarrass the country just prior to the start of the Olympic games in Beijing.

Now, Chinese authorities have executed two men deemed responsible for adding melamine to the milk powder sold to Sanlu.  The Sanlu manager was given a life jail sentence, and 18 others involved with the Sanlu company also have been jailed for up to 15 years.

One can always debate whether the punishment fits the crime but a BBC press account quotes a lawyer who laid the blame on

an inadequate regulatory system…It’s hard to understand why these people are give such harsh punishment because generally speaking… there is a lack of monitoring and regulation…It’s the food supervision and inspection authorities that are responsible for this.

Congress, take notice: pass that food safety bill now!

The Connecticut Attorney General, Richard Blumenthal, announced yesterday that all eight food companies involved in the Smart Choices program have agreed to drop out pending his investigation and the FDA’s decision about front-of-package labeling.  Says Blumenthal:

Food manufacturers now realize that continued use of the logo would only mislead and compound consumer confusion. Other food labels richly deserve the same scrutiny — which we will give them with relish.

My investigation into Smart Choices, now supported by the FDA, continues to seek any scientific research or evidence behind a program that promotes mayonnaise, sugar-loaded cereal and ice cream as Smart Choices.

Many in the food and beverage industry have sugarcoated their labels — diverting and distracting consumers from nutrition truth, and pushing them toward obesity and disease. Self responsibility and good parenting are key to healthy lifestyles, but impossible when food manufacturers misguide them.

Our initiative should send a message to other food manufacturers that labeling must be completely truthful and accurate without hype or spin, especially when appealing to children. I am strongly encouraged by interest in our investigation by other attorneys general who can form a powerful coalition against misleading or deceptive food labeling.

Keep an eye out for what other city and state attorneys will be doing about food labels.   FDA: get busy!

Yesterday, 20 family physicians in Contra Costa County, California, ripped up their membership cards in the American Academy of Family Physicians in protest over the AAFP’s partnership with Coca-Cola.

The director of the Contra Costa Department of Health Services, Dr. William Walker, announced that he was resigning his 25-year membership in AAFP.  In his statement, Dr. Walker said:

…I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death.

…The AAFP is supposed to be an organization that works to protect the health of children not put them at risk. Their decision to take soda money is all the more unconscionable because, unlike doctors in the 40s, they well know the negative health impact of soda. There is no shortage of documentation that soda is a major contributor to our nation’s obesity epidemic.

…Let me be clear about something: as disappointed as I am with the American Academy of Family Physicians for being duped into thinking that Coca Cola wants to help promote health, the real problem here is our children are being put at risk.

Companies like Coca Cola are polluting our communities with deceptive advertising promoting products that put our children’s health at risk.

…as a family practice doctor and the Health Officer for Contra Costa, I do have a prescription for every parent, teacher, community leader and student:

Look beyond the glitzy advertising that makes you think pouring liquid containing sugar into your body is healthy. Read the label. Look at the ingredients. I’m not suggesting that you boycott sugared drinks, but please make an informed decision about what you are consuming.

I’m calling on every city and neighborhood in our County to fight back against the industry that pushes these harmful products. I ask the American Academy of Family Physicians to end this unhealthy partnership and to join us in leading this important campaign to take back the health of our residents and end the obesity epidemic.

Strong words, indeed.  I hope that the AAFP – and other health and nutrition organizations that might consider food industry partnerships – pay close attention to these words.

* The event was covered in the Contra Costa Times. The Health Department’s website includes the press release and also a video and podcast.

Addendum:

Big news!  According to an AP report today, the group that runs the Smart Choices program has announced that it will “postpone” active recruitment of new products and will not encourage use of the logo while the FDA is in the process of examining front-of-package labeling issues.

Who says the FDA does not have any power?  I think it does.  And let’s welcome it back on the job.

As for my nutrition colleagues in the American Society of Nutrition, the group that competed to manage the program and has been defending it ever since, here’s what they now say:

Dear ASN Member,

Today the Smart Choices Program announced the decision to voluntarily postpone active operations and not encourage wider use of the Smart Choices Program logo. This move follows an announcement by FDA Commissioner, Margaret Hamburg, M.D. on Oct. 20, 2009, which said that the agency intends to develop standardized criteria on which future front-of-package (FOP) nutrition or shelf labeling will be based. In a letter captioned, “Guidance for Industry” and posted on its website, the FDA stated: “We want to work with the food industry − retailers and manufacturers alike − as well as nutrition and design experts and the Institute of Medicine, to develop an optimal, common approach to nutrition-related FOP and shelf labeling that all Americans can trust and use to build better diets and improve their health.”

ASN commends the FDA on its announcement of intent to develop standardized criteria on which front-of-pack nutrition and shelf labeling could be based. In addition, ASN fully supports the decision of the Smart Choices Program Board of Directors to postpone their active operations as FDA works to address both front-of-pack and on shelf labeling.  “ASN will continue to provide nutrition science expertise within the dialogue on front-of-pack labeling in order to best serve the interests of the health of Americans,” said ASN President Jim Hill in a statement to media.

Sincerely,

ASN Executive Board

As I have explained in previous posts about Smart Choices, the ASN should never have gotten involved in this dubious enterprise in the first place.  The organization was lucky to get out of this so easily.  I hope it does not make the same mistake again.

The press had a field day with the Smart Choices logo on Froot Loops.  As Rebecca Ruiz at Forbes puts it, “the uproar over the program has conveyed a definitive message to industry: Don’t try to disguise a nutritional sin with a stamp of approval.”

On October 6, the American Academy of Family Physicians (AAFP) announced its new partnership with Coca-Cola.  What does AAFP get from this?  A grant “to develop consumer education content on beverages and sweeteners for FamilyDoctor.org.”

The AAFP, says its president, looks forward to

working with The Coca-Cola Company, and other companies in the future, on the development of educational materials to teach consumers how to make the right choices and incorporate the products they love into a balanced diet and a healthy lifestyle.

Coca-Cola must be thrilled with this.  As its CEO explains in an op-ed in yesterday’s Wall Street Journal, soft drinks are entirely benign and have nothing to do with obesity.  Obesity is due to lack of physical activity and eating too much of other foods, not Coke.  His view of the situation is entirely predictable.

But what about the AAFP?  Family practice doctors have been telling me for years that it is not unusual for them to see overweight kids and adults in their practices who consume 1,000 to 2,000 calories a day from soft drinks alone.  The first piece of advice to give any overweight person is to stop drinking soft drinks (or other sugary drinks).

This partnership places the AAFP in embarrassing conflict of interest.  I gather that members were not consulted.  They need to make their voices heard.  I hope AAFP members decide that no matter what Coke paid for this partnership, their loss of credibility is not worth the price.

Addendum: Here’s what a Chicago Tribune blogger has to say about this.

Further addendum, October 10: As noted in the comments, AAFP members were consulted, more or less.  Apparently, they decided Big Food was less of a problem than Big Pharm.  Really?  How about selling out to neither?