A reader, Effie Schultz, sent this one, with a comment that it comes with the longest conflict of interest statement she had ever seen (I’ve noted one that was two pages long in the first item in a post in 2015).

Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis.  McGlynn ND, and 20 other authors.  JAMA Network Open, March 14, 2022. 2022;5(3):e222092.  doi:10.1001/jamanetworkopen.2022.2092

The research question: Are low- and no-calorie sweetened beverages (LNCSBs) as the intended substitute for sugar-sweetened beverages (SSBs) associated with improved body weight and cardiometabolic risk factors similar to water replacement?

The conclusion: This systematic review and meta-analysis found that using LNCSBs as an intended substitute for SSBs was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution. The evidence supports the use of LNCSBs as an alternative replacement strategy for SSBs over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.

Comment: Research on artificial sweeteners remains controversial.  I think we will be arguing forever about their safety and efficacy in helping people lose weight.  Studies with conflict of interest disclosures like the excessively extensive one here do not help resolve the research questions.

I strongly support revealing conflicted interests that might influence any aspect of research design, conduct, and interpretation.  For this study, I would be interested in financial ties or arrangements with companies that might either gain or lose sales or marketing advantages from results showing artificial sweeteners or diet drinks to be harmless or beneficial, as these do.  At issue here is whether financial ties to companies with corporate interests in the outcome of such research bias results or interpretation, consciously or unconsciously.

You have to search through this mess of unnecessary and distracting disclosures to find the ones that matter.  They are there.  You have to search for them.

Much of what is disclosed is irrelevant and, therefore, not helpful.

You may well disagree with that assessment.  Judge for yourself.

Conflict of Interest Disclosures: Ms McGlynn reported receiving a Canadian Institutes of Health Research (CIHR)-Masters Award during the conduct of the study and being a former employee of Loblaws Companies Limited outside the submitted work. Dr Khan reported receiving grants from CIHR, International Life Science Institute, and National Honey Board outside the submitted work. Dr Chiavaroli reported being a Mitacs Elevate postdoctoral fellow and receiving joint funding from the Government of Canada and the Canadian Sugar Institute. Mr Au-Yeung reported receiving personal fees from Inquis Clinical Research outside the submitted work. Ms Lee reported receiving graduate scholarship from CIHR and the Banting & Best Diabetes Centre at the University of Toronto outside the submitted work. Dr Comelli reported being the Lawson Family Chair in Microbiome Nutrition Research at the Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, during the conduct of the study and receiving nonfinancial support from Lallemand Health Solutions, donation to research program from Lallemand Health Solutions, personal fees from Danone, sponsored research and collaboration agreement from Ocean Spray, and nonfinancial support from Ocean Spray outside the submitted work. Ms Ahmed reported receiving scholarship from the Toronto Diet, Digestive tract, and Disease Centre (3D) outside the submitted work. Dr Malik reported receiving personal fees from the City and County of San Francisco, Kaplan Fox & Kilsheimer LLP, and World Health Organization outside the submitted work and support from the Canada Research Chairs Program. Dr Hill reported receiving personal fees from General Mills and McCormick Science Institute. Dr Rahelić reported receiving personal fees from the International Sweeteners Association, Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Merck, MSD, Salvus, and Sanofi outside the submitted work. Dr Salas-Salvadó reported receiving personal fees from Instituto Danone Spain, nonfinancial support from Danone Institute International, personal fees as director of the World Forum for Nutrition Research and Dissemination from the International Nut and Dried Fruit Council Foundation, financial support to the institution from Fundación Eroski, and financial support to the institution from Danone outside the submitted work. Dr Kendall reported receiving grants and/or in-kind support from Advanced Food Materials Network, Agriculture and Agri-Food Canada, CIHR, Almond Board of California, Barilla, Canola Council of Canada, International Nut and Dried Fruit Council, Peanut Institute, Pulse Canada, Tate and Lyle Nutritional Research Fund at the University of Toronto, and Unilever; receiving nonfinancial support from General Mills, Kellogg, Loblaw Brands Limited, Oldways Preservation Trust, Quaker Oats (Pepsi-Co), Sun-Maid, White Wave Foods/Danone, International Pasta Organization, California Walnut Commission, Primo, Unico, International Carbohydrate Quality Consortium (ICQC), and Toronto Diet, Digestive tract, and Disease Centre (3D) outside the submitted work; receiving personal fees from McCormick Science Institute and Lantmannen; and being a member of the Diabetes and Nutrition Study Group (DNSG) Executive Board and Dietary Guidelines, a member of the expert committee of the DNSG Clinical Practice Guidelines for Nutrition Therapy, a member of the scientific advisory board of the McCormick Science Institute, a scientific advisor for the International Pasta Organization and Oldways Preservation Trust, a member of the ICQC, an executive board member of the DNSG, and being the director of the Toronto Diet, Digestive tract, and Disease Centre (3D) Knowledge Synthesis and Clinical Trials Foundation. Dr Sievenpiper reported receiving nonfinancial support from DNSG of the European Association for the Study of Diabetes (EASD), grants from CIHR through the Canada-wide Human Nutrition Trialists’ Network (NTN), PSI Graham Farquharson Knowledge Translation Fellowship, Diabetes Canada Clinician Scientist Award, CIHR Institute of Nutrition, Metabolism and Diabetes and the Canadian Nutrition Society (INMD/CNS) New Investigator Partnership Prize, and Banting & Best Diabetes Centre Sun Life Financial New Investigator Award during the conduct of the study; receiving grants from American Society for Nutrition, International Nut and Dried Fruit Council Foundation, National Honey Board (the US Department of Agriculture [USDA] honey checkoff program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America), Pulse Canada, Quaker Oats Center of Excellence, United Soybean Board (the USDA soy checkoff program), Tate and Lyle Nutritional Research Fund at the University of Toronto, Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council); receiving personal fees from Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Abbott, General Mills, American Society for Nutrition, INC Nutrition Research and Education Foundation, European Food Safety Authority, Nutrition Communications, International Food Information Council, Calorie Control Council, Comité Européen des Fabricants de Sucre, International Glutamate Technical Committee, Perkins Coie LLP, Tate and Lyle Nutritional Research Fund at the University of Toronto, Danone, Inquis Clinical Research, Soy Nutrition Institute, and European Fruit Juice Association outside the submitted work; serving on the clinical practice guidelines expert committees of Diabetes Canada, EASD, Canadian Cardiovascular Society, and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons; being an unpaid scientific advisor for the Food, Nutrition, and Safety Program and the Technical Committee on Carbohydrates of IAFNS; being a member of the ICQC, executive board member of the DNSG of the EASD, and director of the Toronto Diet, Digestive tract, and Disease Centre (3D) Knowledge Synthesis and Clinical Trials Foundation; his spouse is an employee of AB InBev. No other disclosures were reported.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

The American Journal of Public Health has just published a first look—ahead of its print in June—at my most recent article, Regulating the Food Industry: An Aspirational Agenda [if you are not a member of the American Public Health Association, this will be behind a paywall, alas].

It begins:

I end it with policy recommendations for:

• Dietary guidelines
• Mass media campaigns
• Taxes
• Warning labels
• Marketing restrictions
• Portion size restrictions
• Farm subsidies

Hence, aspirational.

And, I say,

While we are thinking in aspirational terms, let us not forget root causes. We must also demand policies that link agriculture to public health, keep corporate money out of politics, reduce corporate concentration, and require Wall Street evaluate corporations on the basis of social as well as fiscal responsibility.  In comparison with those challenges, takin gon the food industry should be easy.

Let’s get to work.

In response to my post last week about problems at the FDA, I received an emailed note from Jerry Mande, whom I met years ago when he was at USDA, and is now a visiting fellow at the Harvard School of Public Health.

Terrific piece today, but you should have called for the need for FDA to focus much more on the chronic disease risks of food. It’s catastrophic that they have taken only one truly regulatory action (banning trans fat) to improve diet and health…Commissioner Califf needs to put the F back in FDA only 7% of CFSAN’s budget is used for improving diet quality and nutrition, which accounts for 99%+ of food related poor health…The bottom line, as you know better than anyone, is there are more deaths every day due to poor quality diets than in a year due to acute illnesses…I urge you to consider that when you write more on this topic. You could start by featuring our op-ed in your blog. Thx!

The op-ed is indeed worth a read.

But, in fact, this topic has been on my mind since Politico’s Helena Bottemiller Evich wrote Diet-related diseases pose a major risk for Covid-19.  But the U.S. overlooks them, back in October.

Her article, which focused on the lack of government attention to the risks posed by obesity for chronic disease and COVID-19, inspired me to write an editorial for the American Journal of Public Health.  I’m told it’s going online tonight (if it does, I will post it tomorrow).

The James Beard Foundation has justifiably given its Humanitarian-of-the-Year award to Grace Young, the fabulous cookbook writer who has also become, as she puts it, “The accidental voice of Chinatown.”

Since January 2020, my beloved Chinatown here in New York has been under siege. Due to the ongoing pandemic, a multitude of restaurants and businesses have closed permanently, while others struggle to remain open. Most eateries and shops that have survived have still not returned to pre-COVID business, and this is not sustainable. Over the last two years, as I watched this tragedy unfold, I realized Chinatown (actually Chinatowns everywhere) was in dire need of someone to speak for this treasured ethnic community wavering on the brink of extinction. It needed an advocate, a dedicated voice to rally the press and public to this crisis. I became one of those voices, along with many others who have since responded to the need.

The foundation is supporting her call to #LoveAAPI:

Now, we’re joining Grace Young and Poster House on a new campaign, #LoveAAPI. The expansion of this effort is a nationwide social media campaign to support Asian Americans and Pacific Islanders (AAPI) and Chinatowns everywhere!

As Grace said in an email to me in response to my congratulatory note:

The idea is to fight the anti-Asian hate with Love. Post a photo or video of your favorite AAPI restaurant, grocer or shop and tell us what you’re eating or buying. Why you love the business and use the hashtag #LoveAAPI.

More than that, support your local Chinatown restaurants and food stores, particularly the mom-and-pop outfits.

I was in San Francisco recently and walked the entire Chinatown corridor on Grant Street, dismayed by the closed shops but even more dismayed by reports of violence against Asian-American residents.  Here’s a situation where you can help, just by going out to dinner, looking around, and recognizing what a wonderful contribution Chinatowns make to American life.  Enjoy!

I can hardly believe it but we are going to have to endure another round of dietary guidelines, these for 2025-2030.

Why endure?

Because they have basically said the same things since 1980:

• Eat more fruits and vegetables
• Balance calories
• Don’t eat too much of foods high in saturated fat, salt, and sugar

As I am fond of quoting Michael Pollan: “Eat food.  Not too much.  Mostly plants.”

The wording changes from edition to edition.  The editions get longer and longer.  And the basic problems—nutrients as euphemisms for the foods that contain them, more and more obfuscation–stay the same.

But maybe not this time?

ODPHP, the Health and Human Service Office of Disease Prevention and Health Promotion (of which I am an alum) has just announced “Proposed Scientific Questions to Inform the Development of the Dietary Guidelines for Americans, 2025-2030: Available for Public Comment April 15 to May 16!”

The questions whose answers will form the research basic of the forthcoming guidelines are listed here.

Several break new or necessary ground:

• What is the relationship between consumption of dietary patterns with varying amounts of ultra-processed foods and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: This was one of my big criticisms of the 2020-2025 guidelines; the word “ultraprocessed” was never mentioned, yet I consider it the most important nutrition concept to come along in decades.  So this is a big step forward.
• What is the relationship between beverage consumption (beverage patterns, dairy milk and milk alternatives, 100% juice, low- or no-calorie sweetened beverages, sugar-sweetened beverages, coffee, tea, water) and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance? risk of type 2 diabetes?  Comment: it will be good to have this clarified.
• What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?  Comment: This is an old issue but one under attack as being irrelevant.  Let’s get it settled, if that is possible.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: With luck, this will resolve the diet wars over low-carb v. low-fat, etc.  My prediction: they all work for some people.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment:  Finally, an unambiguous demand for research on diet and obesity (as opposed to euphemisms).

What’s missing here?  I think they should have a question on meat, since evidence on risk/benefit is also controversail.  OK, saturated fat is a euphemism for meat, but let’s stop using euphemisms.

What’s being ducked, at least in the guidelines?

There are two topics not on the list of questions to be examined by the 2025 Dietary Guidelines Advisory Committee that will be addressed in separate processes.

• Alcoholic beverages remain a high priority topic, but because it requires significant, specific expertise and has unique considerations, it will be examined in a separate effort led by HHS Agencies that support work on this topic.
• Sustainability and the complex relationship between nutrition and climate change is an important, cross-cutting, and high priority topic that also requires specific expertise. HHS and USDA will address this topic separate from the Committee’s process to inform work across the Departments.

Want to weigh in on this (please do!):  here’s how (read and follow the directions carefully to have maximum impact)

As usual ConscienHealth has interesting things to say about all this.  I particularly enjoyed:

So it’s both unsurprising and unimpressive to hear that people with strong views about nutrition believe the process is rife with conflicts of interest. A group that is disenchanted with the last output from this process lays it out with a new paper in Public Health Nutrition. But Tamar Haspel made the same point much more efficiently in a recent tweet:

“I think they should just let me write the Dietary Guidelines and call it a day.”

This also reminds me about the need to select a scientific committee as free of conflicted interests as possible.  The last committee was rife with them.  HHS/USDA ought to be starting the committee selection process fairly soon.  Stay tuned.

The study:  A 12-Week Randomized Double-Blind Placebo-Controlled Clinical Trial, Evaluating the Effect of Supplementation with a Spinach Extract on Skeletal Muscle Fitness in Adults Older Than 50 Years of Age. Pérez-Piñero, S.; Ávila-Gandía, V.; Rubio Arias, J.A.; Muñoz-Carrillo, J.C.; Losada-Zafrilla, P.; López-Román, F.J. Nutrients 2021, 13, 4373. https:// doi.org/10.3390/nu13124373

Purpose: to assess the effect of daily supplementation with a natural extract of Spinacia oleracea L. (4 × 500 mg capsules/day; total 2 g per day) combined with a moderate-intensity training program (1 h session/3 times a week) on skeletal muscle fitness in adults over 50 years of age.

Conclusion: In subjects over 50 years of age, moderate-intensity strength training combined with daily supplementation for 12 weeks with a natural extract of Spinacia oleracea L. improved muscle-related variables and muscle quality. Maintaining muscle health is a key component of healthy aging

Comment: Muscle function improved significantly at the end of the study as compared with baseline both in the experimental and the placebo groups, but the magnitude of improvements was higher in the experimental group.

Really?  The paper doesn’t even mention Popeye.  I consider this an egregious oversight.

According to a Popeye fan site (yes, such things exist)

In most media featuring Popeye, it is used as a last-minute device in which the hero, in danger, pulls out a can of spinach from his shirt or otherwise acquires the vegetable and eats it. This gives his already extraordinary strength a tremendous boost, helping him withstand his enemies’ attacks and all kinds of adverse situations.

Eat your spinach, everyone.

The Center for Food As Medicine and the Hunter College NYC Food Policy Center have released their first-ever academic narrative review and report of the food-as-medicine movement: Food as medicine review and report: how food and diet impact the treatment of disease.

As the press release puts it,

Food has always been a part of medical practice, going back millennia; however, as medical procedures and treatments became more sophisticated, modern societies began to disregard the role of food in the treatment of disease. Using food to treat disease was viewed as an uncivilized approach. This led to a gap between modern medicine and the use of food to treat disease, and a lack of acceptance of food-based interventions in modern treatment plans.

the report has five parts:

1. Background information on the history of using food to treat disease,
2. Modern challenges to widespread use and acceptance of food as medicine practices,
3. Current evidence about contemporary food as medicine practices (such as medically tailored meals, produce prescriptions, and functional foods),
4. Literature review of food as treatment for specific disease states, and
5. Recommendations to stakeholders (including policymakers, health care professionals, and academics) to contribute to a healthier, more equitable health care system.

Here are the report’s key findings (my paraphrase)

• Medical schools do not often require nutrition instruction.
• Social media makes food as medicine appear pseudoscientific.
• Websites confuse the public about role of food in disease prevention and treatment.
• Supplements cause confusion.
• Dietary Guidelines are influenced by food companies and do not always reflect current science.
• The FDA allows misleading marketing and health claims on packaged foods.
• Research funded by food companies misleads the public.
• Nutrition incentive programs (e.g., NYC’s Health Bucks) can help combat food and nutrition insecurity.
• The government should support food as medicine interventions such as medically tailored meals and produce prescription programs.

See Food Tank: 22 Global Medical Professionals Practicing Food as Medicine

Here are 22 medical professionals working to use food as a critical tool for treating, controlling, and healing from illness and maintaining health.

Along those lines, The Rockefeller Foundation Commits USD 105M to Making Healthy and Sustainable Foods More Accessible Around the World.

Today The Rockefeller Foundation launched its new Good Food Strategy, which will invest USD 105 million over three years to increase access to healthy and sustainable foods for 40 million underserved people around the globe. The program will support a shift in public and private spending toward foods that are nutritious, regenerate the environment, and create equitable economic opportunity for people at every step of the food supply chain.

And here is Dr. David Katz on this theme.

We could transition from the dual costs of medication to fix only partly all the parts of us food keeps breaking. Food as the medicine long ago invoked by Hippocrates could save lives, vitality, biodiversity — and a vast fortune into the bargain. The drumbeat tolls of necessity in the guise of diabetes, heart disease, obesity, cancer, dementia, climate change — and the acutely calamitous toll of COVID, as well. We may, whenever so inclined, invoke the will to invent the better way.

And let’s not forget the Food is Medicine Initiative from the Aspen Institute. which I wrote about previously here.

Comment: I prefer to think of food as food (a pleasure) and medicine as medicine (a pain) and not conflate them, but there s no question that eating healthfully is a good health habit along with being active, getting enough sleep, and not smoking, or overdoing on alcohol or recreational drugs.  If food-as-medicine initiatives help people eat more healthfully, it’s hard to argue with them, and I won’t.

As far as I can tell, the plan-based trend is all about marketing.  Whether it has anything to do with health and the environment remains to be seen.

When I hear about doom and gloom for this sector, I know that it has to do with investment issues.  To wit:

• RIP Plant-based Meat Mania:  “Plant-based meat, egg, and dairy companies received $2.1 billion in investments in 2020 — the most capital raised in any single year in the industry’s history and more than three times the $667 million raised in 2019. Plant-based meat, egg, and dairy companies have raised $4.4 billion in investments in the past decade (2010–2020). Almost half, or $2.1 billion, was raised in 2020 alone. This included Impossible Foods’ record $700 million funding haul.”  Like with any emerging trend, what matters is not the absolute size of the plant-based category relative to plant-fed meat….what matters is the growth rate.  But if the growth rate is slowing, and more emerging brands are popping up then suddenly the category is crowded and competing on price and suddenly the whole category is much less interesting to investors.
• McPlant not setting the world on fire at McDonald’s, claims analyst: ‘A wide-scale launch seems a ways off at this point…’  Despite promising test results in small-scale trials last year, the pea-protein-fueled McPlant burger – developed with Beyond Meat – is not setting the world on fire in tests at a broader selection of McDonald’s locations, according to analyst Peter Saleh at BTIG…. Read more
• Plant-based foods sales: Plant-based meat sales stall while eggs, yogurt, and cheese gain ground, GFI, SPINS, PBFA :  The overall plant-based foods sector reported a significant slowdown (but still positive) growth for 2021 vs. 2020 with plant-based meat sales seeing flat growth while other categories grew by single-digits for the year, according to new data released by The Plant Based Foods Association, The Good Food Institute, and SPINS…. Read more

Not everyone agrees:

• Plant-based price parity will lead to exponential growth, study finds:  Alternative proteins could have a 22% market share in meat once the analogs cost the same, Kearney’s study found.

And none of this is stopping start-up innovations.

• Beyond Meat and PepsiCo launch plant-based jerky: The first product under the companies’ Planet Partnership joint venture is made of ingredients like peas and mung beans, and will be available in stores nationwide.
• How plant-based Skinny Butcher aims to capture both retail and foodservice markets: The new brand is supported by the manufacturing might of Golden West Food Group, the ghost kitchen reach of Wow Bao, a $10 million VC investment for marketing and the enthusiasm of CEO Dave Zilko.
• The future of meat: The tobacco plant? Israeli start-up BioBetter is repurposing tobacco plants in attempt to overcome the greatest hurdle currently facing the budding cultivated meat industry: scaled production…. Read more

As for the public:

• Vegan Fridays for All? More Schools Offer Plant-Based Meals: Despite many challenges, schools are focusing on equity and nutrition in an effort to feed kids more options.