Search results: "dietary guidelines"

This is a deep personal as well as professional loss.  Here’s the obituary from the New York Times. which quotes me.

Marion Nestle, a nutritionist and public health advocate, said that Ms. Gussow “was enormously ahead of her time,” adding, “Every time I thought I was on to something and breaking new ground and seeing something no one had seen before, I’d find out that Joan had written about it 10 years earlier.”

“She was a food systems thinker before anyone knew what a food system was,” Ms. Nestle said, referring to the process of producing and consuming food, including the economic, environmental and health effects. “What she caught on to was that you couldn’t understand why people eat the way they do and why nutrition works the way it does unless you understand how agriculture production works. She was a profound thinker.”

I first met Joan in the late 1970s when I heard her give a talk in the Bay Area when I was first teaching at the University of California San Francisco School of Medicine.  I had never heard anyone talk about the need to link agricultural production to nutrition and health—food systems, we now call that—and it felt revelatory.

Soon after, her publisher sent me the manuscript of what became The Feeding Web: Issues in Nutritional Ecology, asking whether he should take it.  My reader’s report praised it to the skies, but I worried that it was so critical of mainstream nutrition that students would find it nihilistic.  She added a brilliant and utterly inspiring conclusion.

I am not alone in being inspired by her work.  I have followed it with great admiration.

Ahead of her time?  Absolutely.

You have discovered that the food industry influences food choices?  Try Joan’s Who Pays the Piper from 1980.

You think food systems should be sustainable?  See Joan’s “Dietary Guidelines for Sustainability,” written with Kate Clancy in 1986.

Her students at Columbia were so lucky to be in her orbit.

I learned so much from her about how to think about food issues.

I am beyond sad at her loss.

If you want a better idea of her contribution, take a look at Brian Halweil’s 2010 profile of Joan for Edible Manhattan (I’m quoted).

Pam Koch at Columbia invites people to share memories, photos, or comments on what Joan meant to you at this link.

So much is happening on the alcohol frontier these days that it is getting hard to keep up.  Let’s start with the multiplicity of reports on alcohol and health arriving one after another.  I’ve written about the NASEM and Surgeon General’s reports recently.  I’ve also written recently about their implications for the forthcoming Dietary Guidelines.

I.  The ICCPUD report.  Now we have yet a third report from the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).  This one says:

• Males and females who consumed 1 drink per day had an increased risk of liver cirrhosis, esophageal cancer, oral cancer, and injuries, but a lower risk for ischemic stroke…females had a higher risk for liver cancer and a lower risk for diabetes mellitus when they drank 1 drink per day…even infrequent high per-occasion drinking may eliminate the lower levels of risk for ischemic stroke.
• Alcohol use is associated with increased mortality for seven types of cancer (colorectal, female breast, liver, oral cavity, pharynx, larynx, esophagus [squamous cell type]). Increased risk for these cancers begins with any alcohol use and increases with higher levels of use. Women experience a much greater risk of an alcohol-attributable cancer per drink consumed.

II.  The Alcohol industry’s reaction to the ICCPUD report. The reaction to this from a group of National Agriculture, Beverage and Hospitality Associations is pretty tough.  In an email and press release titled “New U.S. Alcohol Report Tainted by Bias, Conflicts,” its representative said:

The controversial report, which is based on observational studies rather than any randomized controlled trials, is blatantly biased, with many panel members failing to disclose conflicts of interest, including affiliations with and funding from anti-alcohol and international temperance organizations…it’s essential to consider the findings of the recent Congressionally-mandated report from the National Academies of Science, Engineering and Health (NASEM), which found moderate drinking may be healthier than teetotaling (Axios).

Its recommendation

We urge the Secretaries of Agriculture and Health & Human Services to uphold the integrity of the DGAs to promote informed and responsible decision-making around alcohol. The agencies should disregard the ICCPUD report in their final assessments for the 2025-2030 Dietary Guidelines.

III.  Call for public comment on the NASEM and ICCPUD reports

From the HHS Office of Disease Prevention and Health Promotion (I am an alum)

HHS and USDA will invite the public to provide input on two separate but complementary reports [ICCPUDand NASEM] on the relationship between alcohol and health starting January 15. These reports and the public comments received will be considered by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) as the two departments collaborate to develop the next edition of the Dietary Guidelines for Americans. The comment period will close on February 14, 2025. Additional details on this public comment opportunity are available on DietaryGudelines.gov.

IV.  Treasury Department proposes new and more informative labeling of alcohol drinks, also with a call for public comment  

TTB Proposes Mandatory Disclosures of Major Food Allergens and Alcohol Facts in the Labeling of Wines, Distilled Spirits, and Malt Beverages.

Allergens: In Notice No. 238, we propose to require a label disclosure of all major food allergens used in the production of alcohol beverages…labels must declare milk, eggs, fish, Crustacean shellfish, tree nuts, wheat, peanuts, soybeans, and sesame, as well as ingredients that contain protein derived from these foods, if used in the production of the alcohol beverage.

Alcohol Facts: In Notice No. 237, we propose to require Alcohol Facts label disclosures for alcohol beverages subject to TTB’s regulatory authority under the Federal Alcohol Administration Act. This disclosure would include the serving size of the product; the number of servings per container; alcohol content as a percentage of alcohol by volume; the number of fluid ounces of pure ethyl alcohol per serving; the number of calories per serving; and the number, in grams per serving, of carbohydrates, fat, and protein.

Wow!  This has been a long time coming.

To comment:

• For Allergens see Notice No. 238 and/orDocket No. TTB–2025–0003 at Regulations.gov and this comment form. 
• For Alcohol Facts see Notice No. 237 and/or Docket No. TTB–2025–0002 at regulations.gov and this comment form.

Electronic comments submitted via Regulations.gov are due by 11:59 p.m. ET on April 17, 2025, and comments submitted by postal mail must be postmarked by that date.

In its scientific report, the 2025-2030 Dietary Guidelines Advisory Committee recommends substituting plant proteins for animal proteins.

The Committee recommends that the proposed Eat Healthy Your Way Dietary Pattern emphasizes dietary intakes of beans, peas, and lentils while reducing intakes of red and processed meats….The Committee also proposes reorganizing the order of the Protein Foods Group to list Beans, Peas, and Lentils first, followed by Nuts, Seeds, and Soy products, then Seafood, and finally Meats, Poultry, and Eggs.

It did not take long for the meat industry to respond: Animal vs. Plant Protein: New Research Suggests That These Protein Sources Are Not Nutritionally Equivalent.

As is my habit, I went right to the study.

The study: Connolly G, Hudson JL, Bergia RE, Davis EM, Hartman AS, Zhu W, Carroll CC, Campbell WW. Effects of Consuming Ounce-Equivalent Portions of Animal- vs. Plant-Based Protein Foods, as Defined by the Dietary Guidelines for Americans on Essential Amino Acids Bioavailability in Young and Older Adults: Two Cross-Over Randomized Controlled Trials. Nutrients. 2023; 15(13):2870. https://doi.org/10.3390/nu15132870

Conclusions: “The same “oz-eq” portions of animal- and plant-based protein foods do not provide equivalent EAA content and postprandial bioavailability for protein anabolism in young and older adults.”

Funding: “This research was funded by the Pork Checkoff and the American Egg Board—Egg Nutrition Center. The supporting sources had no role in study design; collection, analysis, and interpretation of data; writing of the report; or submission of the report for publication.”

Conflicts of Interest: “When this research was conducted, W.W.C. received research funding from the following organizations: American Egg Board’s Egg Nutrition Center, Beef Checkoff, Pork Checkoff, North Dakota Beef Commission, Barilla Group, Mushroom Council, and the National Chicken Council. C.C.C. received funding from the Beef Checkoff. R.E.B. is currently employed by Archer-Daniels-Midland (ADM); the research presented in this article was conducted in a former role and has no connection with ADM. G.C., J.L.H., E.M.D., A.S.H. and W.Z. declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.”

Comment: Amino acids, the building blocks of protein, are the same whether they come from plants or animals (or us).  Food animals are closer to us evolutionarily than are plants; the animo acid composition of their proteins is more like ours than the amino acid composition of food plants.  That is why protein complementarity matters; mix and match the plants you eat and their amino acid compositions will complement each other and fill in the gaps.  This doesn’t even have to be done at every meal.  Overall, it’s easier to get the needed amino acids from animal foods but it’s not all that hard to get them from plants as long as they are varied and you eat enough of them.  So the study isn’t wrong; it’s just not telling the whole story.

Thanks to Kevin Mitchell for sending this one.

I.  Darius Mozaffarian, a nutrition professor at Tufts University, has an editorial in the American Journal of Clinical Nutrition:“The Dietary Guidelines for Americans—is the evidence bar too low or too high?”

He writes about an analysis of the systematic literature reviews SRs) that form the basis of science-based decisions in the guidelines.  His comments gives an insight into the Dietary Guidelines process worth seeing.

For the 2025–2030 DGAC, I served as a peer reviewer for the SR on UPFs…I felt that the SR’s question, design, and planned methods were appropriate, but that its implementation and conclusions were weakened by important deviations from these standards. For example, contradicting its stated eligibility criteria, the SR included numerous studies that did not appropriately or adequately define or assess UPF. Following inclusion of such heterogeneous studies, the SR concluded that the scientific evidence on UPF was limited due to many studies having serious concerns around exposure misclassification as well as evaluating dietary patterns not directly varying in amounts of UPF. This demonstrated a circular and dismaying reasoning: the SR included studies it should not have that had heterogeneous and poorly characterized assessments of UPF, and then concluded that heterogeneous and poorly characterized assessments of UPF limited the strength of the evidence.

He observes:

Most importantly, the DGA and SR requirements make clear that guiding Americans toward a healthier diet is an unfair fight from the start. The food industry can do almost anything it wishes to our food, combining diverse ingredients, additives, and processing methods with virtually no oversight or required evidence for long-term safety  In contrast, the DGAs and other federal agencies can only make recommendations to avoid certain foods or limit certain manufacturing methods when there is extensive, robust, and consistent evidence for harm. In this severely imbalanced playing field, industry wins again and again.

II.  Senator Bernie Sanders posted on Facebook Sanders Statement on How to Make America Healthy Again.  Among other issues, he’s taking on the food industry.

Reform the food industry. Large food corporations should not make record-breaking profits addicting children to the processed foods which make them overweight and prone to diabetes and other diseases. As a start, we must ban junk food ads targeted to kids and put strong warning labels on products high in sugar, salt and saturated fat. Longer term, we can rebuild rural America with family farms that are producing healthy, nutritious food.

III.  California Governor Gavin Newsom “issues executive order to crack down on ultra-processed foods and further investigate food dyes.”

The food we eat shouldn’t make us sick with disease or lead to lifelong consequences. California has been a leader for years in creating healthy and delicious school meals, and removing harmful ingredients and chemicals from food. We’re going to work with the industry, consumers and experts to crack down on ultra-processed foods, and create a healthier future for every Californian.

Comment

Mozaffarian offers these opinions despite disclosing financial ties to food companies.  Sanders is a welcome addition to the handful of legislators concerned about food issues.  Newsom is making it easier for other states to take similar steps.

Maybe there’s a glimmer of hope for coalition building among advocates for healthier food systems.  Maybe this really is a movement!

How’s that for a cheery thought for 2025.  Happy new year everyone!

Here’s what the FDA says about Use of the Term Healthy on Food Labeling.

To meet the updated criteria for the claim, a food product needs to

1. contain a certain amount of food from at least one of the food groups or subgroups (such as fruit, vegetables, grains, fat-free and low-fat dairy and protein foods) recommended by the Dietary Guidelines for Americans, and
2. meet specific limits for added sugars, saturated fat and sodium.

To qualify, a breakfast cereal, bread, or any other grain food would need to have 3/4 ounce of whole grains, and have less than 10% of the Daily Value for added sugars (5 grams per serving), less than 10% for sodium (230 mg per serving), and less that 1 gram of saturated fat (5% DV).

On this basis, kids cereals won’t qualify.

Oh.  And the FDA is still working on the symbol.

Resources

• Use of the Term Healthy on Food Labeling | FDA
• FDA Finalizes Updated “Healthy” Nutrient Content Claim | FDA
• Constituent update
• FDA’s Updated “Healthy” Claim Definition: Fact Sheet
• Federal Register: https://public-inspection.federalregister.gov/2024-29957.pdf
• New York Times: What Are ‘Healthy’ Foods? The F.D.A. Updates the Labeling Terms
• The Hill: FDA updates definition of ‘healthy’ on food labels for first time in 30 years

What are we to make of this?

The National Academies of Sciences, Engineering, and Medicine’s Review of Evidence on Alcohol and Health says moderate drinking

• Reduces all-cause mortality (moderate certainty)
• Reduces the risk of cardiovascular disease (moderate certainty)
• Increases the risk of breast and colorectal cancer (but can’t decide about others)

The Surgeon General, Vivek Murthy, says in his Advisory on Alcohol and Cancer Risk

• Consuming alcohol increases the risk of developing at least 7 types of cancer.
• The causal relationship between alcohol consumption and cancer is firmly established.

Let me try some context.

That alcohol is a risk factor for cancer has been known since the 1980s.

The Surgeon General’s conclusion is especially noteworthy for its lack of ambiguity.  He says flat out: alcohol causes cancer, and 7 kinds no less.

In contrast, the NASEM report talks about low and moderate certainty for its conclusions.

Presumably, both reports were based on the same data.

Here’s what this is about.

At issue: what the 2025-2030 Dietary Guidelines will say about how much alcohol is safe to drink (if any).

Since 1990, Dietary Guidelines have said two standard drinks a day for men and one for women could be considered low risk.

But the 2020-2025 Dietary Guidelines Advisory Committee, based on recent research indicating harm from any level of alcohol intake, said only one drink a day for both men and women was probably OK.

This alarmed the alcohol industry and other industries that profit from drinking.  They convinced Congress and federal agencies to revisit the effects of moderate drinking.

Yet another report on moderate drinking and health, this one from federal agencies, is expected any day now.

The bottom line

While all this is going on, the moral is pretty clear: the less alcohol, the better.

Resources

NASEM report press release

Industry pressure to make sure Dietary Guidelines to not toughen alcohol restrictions

New York Times: What is Moderate Drinking?

Example of alcohol industry pressure on Dietary Guidelines

Rani Rabin has been right on top of this fuss.  See, for example

• Surgeon General calls for cancer warnings on alcohol
• The battle over what to tell Americans about drinking
• US diet panel adds another researcher with alcohol industry ties
• Major study of drinking will be shut down

The Dietary Guidelines Advisory Committee may not think there is much to ultra-processed foods (UPF), but companies making them have just been served with a lawuit.

I learned about this from a tweet (x) from Carlos Monteiro, the Brazilian public health professor who coined the UPF term.

CMonteiro_USP (@Carlos A. Monteiro) posted: A first-of-its-kind lawsuit against 11 UPF industries alleging they engineer their UPF products to be addictive with details on the actions taken to target children including internal memos, meetings & the research conducted to create addictive substances.

The lawsuit, filed by several law firms, is aimed at Big Food: Kraft, Mondelez, Post, Coca-Cola, PepsiCo, General Mills, Nestle, Kellanova, WK Kellogg, Mars, and Conagra.

The suit charges that these firms, through their deliberate marketing, are making people sick.

Due to Defendants’ conduct, Plaintiff regularly, frequently, and chronically ingested their UPF, which caused him to contract Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease Plaintiff is now suffering from these devastating diseases, and will continue to suffer for the rest of his life.

The suit makes interesting reading.

Some examples:

• Big Tobacco companies intentionally designed UPF to hack the physiological structures of our brains.  These formulation strategies were quickly adopted throughout the UPF industry, with the goal of driving consumption, and defendants’ profits, at all costs.
• The same MRI machines used by scientific researchers to study potential cures for addiction are used by UPF companies to engineer their products to be ever more addictive.
• Big Tobacco repurposed marketing strategies designed to sell cigarettes to children and minorities, and aggressively marketed UPF to these groups.
• The UPF industry now spends about $2 billion each year marketing UPF to children.
• UPF increase the risks of disease because they are ultra-processed, not because of how many grams of certain nutrients they contain or how much weight gain they cause. Therefore, even attempts to eat healthfully are undermined by the ultra-processed nature of UPF. One cannot evade the risks caused by UPF simply by selecting UPF with lower calories, fat, salt, sugar, carbohydrates, or other nutrients.
• The UPF industry is well aware of the harms they are causing and has known it for decades. But they continue to inflict massive harm on society in a reckless pursuit of profits.

Can’t wait to see what happens with this one.  Stay tuned.

Resources

Consumer Federation of America: “Ultra-processed Foods: Why They Matter and What to Do About It.”

With government officials reluctant to issue advice on ultra-processed foods (UPFs), Consumer Federation of America aims to raise awareness about research on UPFs, explain the leading theories of how they harm health, and build support for public policies to reduce harms from UPFs in our diet.

The report pushes back on arguments that researchers have not consistently defined UPFs, or that the categorization lacks scientific rigor. In fact, researchers have operationalized the “Nova classification” system behind UPFs in a largely consistent manner, defining foods based on whether they contain ingredients that are “industrial formulations” or “rarely used in home kitchens,” with little serious disagreement about which ingredients should be considered “ultra processed.” Consumers can take CFA’s online quiz to test their knowledge of which ingredients are markers of “ultra processing.”

New research: Trends in Adults’ Intake of Un-processed/Minimally Processed, and Ultra-processed foods at Home and Away from Home in the United States from 2003–2018.  J Nutr 2024, https://doi.org/10.1016/j.tjnut.2024.10.048.  The data show that 50% or more of calories are consumed from UPF at home, away from home, and by pretty much everyone.

New research: Hagerman CJ, Hong AE, Jennings E, Butryn ML. A Pilot Study of a Novel Dietary Intervention Targeting Ultra-Processed Food Intake. Obes Sci Pract. 2024 Dec 8;10(6):e70029. doi: 10.1002/osp4.70029.  Behavioral interventions to reduce UPF intake cut calories by about 600 calories per day.

My post summarizing the three studies demonstrating that diets high in UPF induce intake of an excess of 500, 800, and 1000 calories per day.

Charlotte Bilekoff.  Real Food, Real Facts: Processed Food and the Politics of Knowledge.  University of California Press, 2024.  267 pages.

Food processing is a big issue these days (witness RFK Jr’s pledge to get ultra-processed foods out of school meals) and I was interested to see what food studies scholar Charlotte Biltekoff had to say about it.

Her thesis: When people say they want to eat “real food” rather than highly processed food, the food industry responds with “real facts,” science-based discussions of the benefits of food processing (“food scientism”).

The industry’s response is based on the idea that if you could only correct public ignorance and misperceptions, you could sell your products more easily.

But public concerns are about politics, not science.  And food scientism is a form of antipolitics.

She cites as an example, the FDA’s ongoing inability to define the term “natural.”

Concerned about health, sustainability, and risk and wanting change in the food system, the public sought to act on its values and aspirations in the marketplace.  Narrowly reframing those concerns as demands that could be met through product reformulations and new approaches to marketing—but without serious, systemic engagement with the broader issues they reflected—the food industry produced products that appeared to be more natural, less processed, and therefore better…articles in the industry press and comments to the FDA show that many perceived the consumers of “real food” as irrational and misinformed.  Seen through the lens of food scientism of the Real Facts frame, consumer perceptions of processing and what “natural” meant, or should mean, were further proof that the public lacked the skills and understanding to meaningfully participate in the regulatory processess, let alone act as knowledgeable participants in the governance of technology and the shaping of the food system. (p. 143)

What Biltekoff has done here is to translate the classic two-culture risk communication problem to food.

Her book made me go back and look at what I wrote about the two-culture problem in Safe Food: The Politics of Food Safety.  The book contrasts the differing perceptions of industry and the public about the potential harm of microbial foodborne illness versus GMOs.

These differences in approaching questions of risk were understood long before anyone invented the techniques for genetically modifying foods. In 1959, for example, the scientist and writer C. P. Snow characterized the ways in which people trained in science tend to think about the world—as opposed to those without such training—as representing two distinct cultures separated from one another by a “gulf of mutual incomprehension” [1]. Much more recently, the anthropologist Clifford Geertz wrote, “The ways in which we try to understand and deal with the physical world and those in which we try to understand and deal with the social one are not altogether the same. The methods of research, the aims of inquiry, and the standards of judgment all differ, and nothing but confusion, scorn, and accusation—relativism! Platonism! reductionism! verbalism!—results from failing to see this” [2].  [1. Snow CP. Two Cultures and the Scientific Revolution: The Rede Lecture. London: Cambridge University Press, 1959; 2. Geertz C. Empowering Aristotle (book review). Science 2001;293:53].

Science-based approaches to food safety, I pointed out, count cases and estimate costs, whereas what I called “value-based” approaches, are about feelings of dread and outrage.

Biltekoff’s analysis applies the two-culture framework to public responses to food processing and to the ways the food industry deals with those responses.

Her analysis explains much about the current pushback against the concept of ultra-processed foods from the food industry and some nutritionists.  If you want to understand why the Dietary Guidelines Advisory Committee has chosen not to recommend reducing intake of ulra-processed foods, read this book.

And, amazingly, the book is available as open source.  Read the book online here.

Read Charlotte Biltekoff’s interview with UC Press here.