Search results: david ludwig

Just because all of the major nutrition professional organizations partner with food companies, does not make it a good idea.  If nothing else, partnerships with food companies raise reputational risks.  They give the appearance of conflicted interests, as David Ludwig and I warned in 2008.  I have also written about the hazards of food industry sponsorship of professional organizations in Food Politics, Soda Politics, and Unsavory Truth.  Here’s what they are doing now.

Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association)  OOPS.  My error.  This should be the American Diabetes Association (even worse).  Abject apologies.  This is what I get for not reading more carefully.  Apologies again.

If I seem to be picking on AND, it’s because it is bigger and gets into more trouble than other nutrition professional societies.

The latest example: According to Reuters, a former AND officer, Elizabeth Hanna, has sued the organzation for “firing her for objecting to what she called a “pay to play” scheme to promote the no-calorie sweetener Splenda.

In its 2022 annual report, the ADA said Splenda was one of a group of “elite” supporters that had given more than $1 million, along with Bayer Healthcare, Blue Cross Blue Shield of Illinois, Helmsley Charitable Trust and others.

On its website, Splenda publishes “diabetes-friendly recipes,” endorsed by the ADA. Hanna, a registered dietitian nutritionist, said she refused to approve the endorsement of several of these recipes in July.

…The U.S. Centers for Disease Control and Prevention states on its website that some studies have found possible health risks associated with the sweeteners, but that more research is needed.

American Society for Nutrition (ASN)

I am a member of this society and raise objections every time I get something like this in my e-mail.

Sponsored Webinar: Oral Health and Nutrition: Imperative for Healthy People 2030 and US Dietary Guidelines   Sponsored By: Mars Wrigley and the Oral Health Alliance.  The 2020-2025 Dietary Guidelines (DGA) identified dental caries as a major diet-related chronic disease of public health concern….

Doing this sort of thing risks reputation.

Evidence:  In a video on ultra-processed foods, the Financial Times identifies the ASN as “food industry advocacy group.”

The ASN’s executive director assures me they will ask for a correction.

Society for Nutrition Education and Behavior

Et tu?

It just announced a webinar, “Latinos love affair with Mangos: Maintaining Generational Food Traditions to Improve Health Outcomes.”

This is “a webinar sponsored by the National Mango Board, SNEB Organizational Member.”

The mango is…one of the world’s most popular fruits, and a staple food across Spanish speaking countries of North America, South America, and the Caribbean. Beyond its culinary popularity, an expanding body of research shows associations with mangos and risk reductions for inflammation and metabolically- based chronic disease, many of which disproportionately impact Hispanic American populations.

Mangos as opposed to any other fruit?

I am also a member of this society.

Overall comment

Are the reputational risks—and the loss of integrity—worth the money?  I don’t think so.

It’s a sad sign of the times that the CDC has found it necessary to revise its standard growth charts for boys and girls in order to expand Body Mass Index ranges to include current weights.

The 2000 CDC BMI-for-age growth charts, based on data from 1963-1980 for most children, do not extend beyond the 97th percentile. So, CDC developed new percentiles to monitor very high BMI values. These extended percentiles are based on data for children and adolescents with obesity – including from 1988-2016 – thus increasing the data available in the reference population. See the report on alternative BMI metrics for more information.

Here’s what the comparison looks like (thanks to David Ludwig):

The comparison for girls extends to a BMI of 56.

What are we to make of this?  In revising the growth charts, the CDC is recognizing reality: children weigh more than they used to, and sometimes a lot more.

Why: the quick-and-dirty answer:  junk food (more calories consumed) and electronic media plus imprisonment (fewer calories expended).

The world has changed.  When I was a kid, and when my kids were kids, we didn’t eat a lot of junk food (more politely, ultra-processed), we weren’t allowed to snack all day, and we were free—required!—to walk to school and play outdoors unaccompanied.

Shouldn’t the CDC be engaging in campaigns to promote healthier eating and more activity among children?

One can wish.

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The study:  Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies.  Glenn A.Gaesser.  Trends in Cardiovascular Medicine, Available online 6 September 2022.  https://doi.org/10.1016/j.tcm.2022.08.002

Conclusions:  Meta-analyses of prospective cohort studies demonstrate that refined grain intake is not associated with risk of CVD, stroke, or heart failure. This conclusion holds for studies that restricted analyses to staple grain foods only, as well as for studies that included both staple and indulgent grain foods as a single refined grains category. Although refined grains are included as a component of the Western dietary pattern, the present findings suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

Declaration of Competing Interest:  The author is a scientific advisory board member of the Grain Foods Foundation and the Wheat Foods Council.

Funding: Preparation of this manuscript was supported in part by a grant from the Grain Foods Foundation.

Comment: Refining of grains removes the outer bran and germ and most of the fiber and nutrients along with them, leaving some nutrients along with teh starch and protein.  Refined starch is quickly digested to sugars and rapidly absorbed.  The Wheat Foods Council wants to reassure you that you can eat as much refined grain as you like without raising disease risk.  Much independently funded research argues otherwise, alas.  If nothing else, refined grains contribute calories relatively low in nutrients and constitute major components of ultra-processed foods.  This study did not look at dietary patterns.

And thanks to David Ludwig for alerting me to this one.

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The publication date is tomorrow!

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

I am indebted to David Ludwig for passing along this bit of nutritional history.

The study: PROLONGED MEAT DIETS WITH A STUDY OF KIDNEY FUNCTION AND KETOSIS.*
BY WALTERS. McCLELLAN AND EUGENE F. Du BOIS.  Journal of Biological Chemistry Volume 87, Issue 3, 1 July 1930, Pages 651-668
Method:  Several men agreed to eat nothing but meat for a year.  The meats included beef, lamb, veal, pork, and chicken, in various parts.  This was a high-fat, low-carb diet.  The men lived at home mostly.

Conclusion: In these trained subjects, the clinical observations and laboratory studies gave no evidence that any ill effects had occurred from the prolonged use of the exclusive meat diet.

Funder: These studies were supported in part by a research grant from the Institute of American Meat Packers.

Comment: I did not realize that industry sponsorship of favorable studies went back that far.  I’ll bet there are lots more.  Researchers: start digging!

One Potato

Thanks to David Ludwig for alerting me to an e-mail from the Alliance for Potato Research & Education (APRE), a trade association “dedicated to advancing the scientific understanding of the role potatoes play in promoting the health of all people.”

A new APRE-funded study published in Nutrients investigated the effect of increased dietary potassium from a whole food source – baked/boiled potatoes and baked French fries – or a potassium supplement on blood pressure and other cardiovascular disease risk factors compared to a ‘typical American’ control diet (lower potassium intake) among 30 pre-hypertensive-to-hypertensive men and women.

Results showed that baked/boiled potato consumption had the greatest benefit on reducing sodium retention, even more than the supplement, and resulted in a greater reduction in systolic blood pressure (SBP) compared to the control diet.

Further, despite commonly held misbeliefs about French fries and their role in heart-healthy lifestyles, the authors observed that a 330-calorie serving of baked French fries, when eaten as part of a ‘typical American’ diet, had no adverse effect on blood pressure or blood vessel function.

The study concludes:

This was the first controlled feeding study of potassium from food and supplements on BP and CVD outcomes in an unhealthy population…Of public health relevance is our observation that French fries in amounts typical of a large serving in a fast food restaurant has no adverse effect on blood pressure or endothelial function.

It discloses the funding source: “This research was funded by Alliance for Potato Research and Education.”

Comment: Because some (but not all) observational studies have linked potatoes, and especially French fries, to poor health outcomes, the potato industry wants research to give these foods a healthier image.  This study says that potatoes are high in potassium and a high potassium-to-sodium ratio is good for blood pressure and heart disease.  I could have told them that on the basis of food composition data alone: 100 grams of French fries contains 435 mg potassium versus 295 of sodium.  Does that make French fries a health food?  No, alas, it does not.

Once more for the record: industry-funded research is about marketing, not public health.

Two Potato

Last week, I received an emailed notification from APRE, the Alliance for Potato Research & Education announcing a new study.

For decades, people have often associated higher intakes of carbohydrate-containing foods with less healthy lifestyles. Yet, evidence suggests this view is overly simplistic, and it is instead the type and quality of carbohydrate foods that matter most for supporting health…In a newly published perspective in Nutrients, a group of nutrition researchers, who collectively make up the Quality Carbohydrate Coalition-Scientific Advisory Council (QCC-SAC), outline the opportunity for a stronger, more evidence-based approach to defining quality carbohydrate foods to support overall health and provide clearer dietary guidance.

The study: Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report.  Kevin B. Comerford, Yanni Papanikolaou,  Julie Miller Jones, Judith Rodriguez. Joanne Slavin,  Siddhartha Angadi.  and Adam Drewnowski.  Nutrients2021, 13(8), 2667.

Conclusion: The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans. 

Yesterday I explained why “butter is back” is not useful dietary advice, even when studies show that eating butter has little or no effect on disease risk (the total diet and calories are what matter).  Now I can say the same thing about low-carbohydrate diets.

The debate about whether fat or carbohydrate is responsible for obesity has passionate advocates on both sides, although those for carbohydrates predominate in the press these days.

As explained by Julia Belluz of Vox,

The main scientific model behind the low-carb approach is the “carbohydrate-insulin hypothesis,” which journalist Gary Taubes, Harvard professor David Ludwig, and others have extensively promoted. It suggests that a diet heavy in carbohydrates (especially refined grains and sugars) leads to weight gain because of a specific mechanism: Carbs drive up insulin in the body, causing the body to hold on to fat and suppress calorie burn.

According to this hypothesis, to lose weight you reduce the amount of carb calories you eat and replace them with fat calories. This is supposed to drive down insulin levels, boost calorie burn, and help fat melt away…instead of just cutting calories, you’re supposed to change the kinds of calories in your diet to lose weight.

To his great credit, Gary Taubes was willing to put this hypothesis to the test.  He organized the Nutrition Science Initiative (NuSI) to fund studies that he must have hoped would demonstrate the benefits of low-carb diets.

To its great credit, NuSI recruited highly experienced and respected obesity investigators to design and conduct the studies.

The first of these studies has just been published.   It fully discloses the role of NuSI.

Supported by the Nutrition Sciences Initiative…Nutrition Sciences Initiative (NuSI) convened the research team, helped formulate the hypothesis, and provided partial funding. NuSI and its scientific advisors were given the opportunity to comment on the study design and the manuscript, but the investigators retained full editorial control.

In this case, because I am familiar with the work of some of the investigators, I’m inclined to take these statements at face value.

Here’s what they did.  They put 17 overweight or obese men in a metabolic ward and fed them a very low carbohydrate diet, so low that it would induce fat breakdown and ketosis.  The calories were supposed to be sufficient to maintain weight, but were not.  The men lost weight from water excretion and breakdown of body protein as well as of fat, as is typical of what happens during partial starvation.  Energy expenditure did not increase to the level anticipated from the carbohydrate-insulin model.

The Abstract concluded:

The isocaloric KD [ketogenic, very low carbohydrate diet] was not accompanied by increased body fat loss but was associated with relatively small increases in EE [energy expenditure] that were near the limits of detection [translation: barely detectable] with the use of state-of-the-art technology.

The Discussion concluded:

Therefore, our data do not support the carbohydrate–insulin model predictions of physiologically relevant increases in EE or greater body fat loss in response to an isocaloric KD. However, it is possible that dietary carbohydrate restriction might result in decreased ad libitum energy intake—a prediction of the carbohydrate-insulin model that was not tested in the current study but deserves further investigation.

In other words, restricting carbohydrate does not increase body fat loss or energy expenditure but might help you eat fewer calories.

This result confirms some of the results of a previous study from the first NuSI author. That one, funded by NIH, concluded:

Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was unchanged by fat restriction, leading to 89 ± 6 g/day of fat loss, and was significantly greater than carbohydrate restriction (p = 0.002).

Taken together, these studies show that both low-carbohydrate and low-fat diets cause weight loss when calories are restricted, but low-fat diets cause greater losses in body fat content than do low-carbohydrate diets.

In my book with Malden Nesheim, Why Calories Count: From Science to Politics, we review a 1964 study that put obese patients in a metabolic ward and fed them low-calorie diets of widely varied composition.  They lost weight at the same rate on diets ranging from 3% to 60% carbohydrate and from 13% to 83% fat.  They titled the study “Calories Do Count.”  The NuSI studies confirm the benefits of reducing calories from any source to lose weight.

Bottom line:

• With regard to weight loss, calories count and the relative proportions of fat, protein, and carbohydrate do not matter much (although low-carb diets may help with eating less).
• With regard to health, the food sources of calories matter very much indeed, and nearly everyone would be better off eating less sugar—at the very least because sugars provide calories, but no nutrients.

*Note: this version corrects an error in the version originally posted.  Hall et al.’s 2015 study was funded by NIH, not NuSI.  Apologies.

Readers have filed corrections to previous postings on industry-funded studies (see here and here).  I am most grateful for their sharp eyes.  No excuses, but I’m having a hard time keeping them straight because there are so many, some are published first online and then again in print, and sometimes I just get them wrong.  Apologies.

The corrections reduce the count to 132/12.  But here are three more to bring it back up to 135/12.

Management of obesity.  George A Bray, Gema Frühbeck, Donna H Ryan, John P H Wilding.  The Lancet.  Published online February 8, 2016 http://dx.doi.org/10.1016/S0140-6736(16)00271-3.

• Conclusion: For patients who struggle with weight loss and who would receive health benefit from weight loss, management of medications that are contributing to weight gain and use of approved medications for chronic weight management along with lifestyle changes are appropriate. Medications approved in the USA or European Union are orlistat, naltrexone/bupropion, and liraglutide; in the USA, lorcaserin and phentermine/topiramate are also available. Surgical management (gastric banding, sleeve gastrectomy, and Roux-en Y gastric bypass) can produce remarkable health improvement and reduce mortality for patients with severe obesity.
• Declaration of interests GAB is a consultant to Herbalife International and Medifast; a member of the Speakers Bureau for Novo Nordisk Pharmaceuticals and Takeda Pharmaceuticals; and receives royalties from Up-to-Date and Handbook of Obesity. GF is a consultant to Novo Nordisk Pharmaceuticals. DHR is a consultant to Novo Nordisk Pharmaceuticals, Takeda Pharmaceuticals, Eisai Pharmaceuticals, Vivus Pharmaceuticals, Janssen Pharmaceuticals, Amgen Pharmaceuticals, Real Appeal, Gila Therapeutics, Tulip Medical, and Scientific Intake; is on the speakers’ bureau for Novo Nordisk Pharmaceuticals, Takeda Pharmaceuticals, Eisai Pharmaceuticals, and Vivus Pharmaceuticals; and has equity ownership in Scientifi c Intake. JPHW received grant funding from Novo Nordisk and AstraZeneca, and is a consultant to Novo Nordisk, Janssen Pharmaceuticals, AstraZeneca Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, and Pfi zer Pharmaceuticals.

The effects of potatoes and other carbohydrate side dishes consumed with meat on food intake, glycemia and satiety response in children.  R Akilen, N Deljoomanesh, S Hunschede, CE Smith, MU Arshad, R Kubant and GH Anderson.  Nutrition & Diabetes (2016) 6, e195; doi:10.1038/nutd.2016.1

• Conclusions: The physiological functions of CHO foods consumed ad libitum at meal time on food intake, appetite, BG, insulin and gut hormone responses in children is not predicted by the GI [glycemic index].
• Acknowledgements: This study was supported by the Alliance for Potato Research and Education (APRE).
• Comment: David Ludwig, M.D., PhD says: “Potatoes are at the top of the list for weight gain according to the best epidemiological research studies. A small new study claimed that potatoes actually had beneficial effects on appetite. There’s just one thing: The study was fully funded by the Alliance for Potato Research and Education, whose mission is to ‘recognize the role of all forms of the potato in promoting health for all age groups.’”  Here’s the press release from the Alliance for Potato Research & Education.

Nutrient Intakes and Vegetable and White Potato Consumption by Children Aged 1 to 3 Years.  Maureen L Storey and Patricia A Anderson.  doi: 10.3945/​an.115.008656.  Adv Nutr January 2016 Adv Nutr vol. 7: 241S-246S, 2016.

• Conclusion: The consumption of all vegetables, particularly those that are excellent sources of potassium and DF, such as potatoes, should be encouraged.
• Funding: Presented at the Roundtable on Science and Policy: Adopting a Fruitful Vegetable Encounter for Our Children. The roundtable was sponsored by the USDA/Agricultural Research Service Children’s Nutrition Research Center, Baylor College of Medicine, and was held in Chicago, IL, 10–11 November 2014. The roundtable and supplement publication were supported by an unrestricted grant from the Alliance for Potato Research and Education. The roundtable speakers received travel funding and an honorarium for participation in the meeting and manuscript preparation. Author disclosures: ML Storey is a paid employee of the Alliance for Potato Research and Education; PA Anderson is a paid consultant for the Alliance for Potato Research and Education.
• Comment: Potato trade associations must be really worried about views like those of Dr. Ludwig.  Personally, I love potatoes and think they are delicious but should be eaten in moderation of course, and not in the form of French fries.  Speculation: I wonder if frequent consumption of French fries could be a marker of unhealthful diets in general?

It is always interesting to watch the food industry deal with criticism.  One common strategy is to discredit critics through personal attacks. Most companies are too embarrassed to do this publicly.  Instead, they pay public relations firms—in this case, the Center for Consumer Freedom—to do this for them.

What is this group?  See Center for Consumer Freedom Exposed and follow the links to see lists of the food industry donors it keeps secret.

If you have been reading this blog for a while, you know that I am an occasional target of this group, as can be seen from  the piece it posted yesterday:

Marion Nestle, Food Fascist

Sound harsh? After our latest check-in with everyone’s favorite anti-pleasure nutritionist, we think it’s completely appropriate. Marion Nestle published an article on her blog today quoting a law professor named Timothy Lytton, who insists that trampling on anyone’s First Amendment rights is a no-no. That prompted Nestle and fellow obesity warrior Dr. David Ludwig to fire off an astonishing letter.

The post goes on to quote extensively from my comments earlier this week.  It also points out:

At the end of the day, there’s no high-minded Constitutional principle in play here. This is about Marion Nestle attacking businesses she doesn’t like. This is the same professor who delivered a speech at an event sponsored by the “Socialist Conference” of the American Public Health Association. Nestle also addressed the “Socialist Scholars Conference” in 2003.

These kinds of strategies speak for themselves.

The corporations that hire the Center to do things like this should be ashamed of themselves.