Currently browsing posts about: Conflicts-of-interest

To continue the thene of yesterday’s post, check out this report from the Global Health Advocacy Incubator (an international organization that supports advocacy).

The report documents the food industry’s strategies to defeat warning labels on ultra-processed food products (UPP).

1. Protect the UPP industry’s reputation and brands through corporate washing;
2. Influence policies through multilateral bodies to delay implementation and threaten countries with legal and economic concerns;
3. Divert attention from its corporate responsibility on the damage to environmental and human health to blame individuals for their behaviors;
4. Imply that their products contribute to health, the environment, and society while blocking the development and implementation of healthy food policies; and
5. Seek loopholes in regulations to continue promoting ultraprocessed products.

For example, here is how strategy #5 was implemented in Mexico:

Here, also for example, is image #27:

What should civil society organizations be doing to counter industry tactics?

• Monitor and unmask industry practices
• Use legal strategies
• Avoid loopholes, gaps, and ambiguities when developing labeling  policies
• Demand transparency and no conflicts of interest

This report is exceptionally well documented, covers an enormous range of countries, and gives a quick but compelling overview of how the food industry operates internationally to product product sales.

• Full report click here.
• Executive Summary
• Report’s microsite:  advocacy examples recommendetions.
• Webinar: English, Spanish, Portuguese

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.

Two studies of the role of nuts in health.

I.  This one comes from ObesityandEnergetics.org’s “Headline vs. Study.”

Headline: Maximum Wellness: Walnuts are a Life-Extension Food:  “Looks like your [sic] nuts not to include walnuts in your diet. For more information and to read this study…go to maxwellnutrition.com, where you can find top wellness and nutrition products made in the United States – shipped to your door.”  [Comment: Clearly, we are dealing here with marketing]

Study: Association of Self-Reported Walnut Consumption with Total and Cause-Specific Mortality and Life Expectancy in U.S. Adults. Maximum Wellness nor Causation Necessarily Established.  Liu, X.; Guasch-Ferré, M.; Tobias, D.K.; Li, Y.  Nutrients 2021, 13, 2699. https://doi.org/ 10.3390/nu13082699

Conclusion: A greater life expectancy at age 60 (1.30 years in women and 1.26 years in men) was observed among those who consumed walnuts more than 5 servings/week compared to non-consumers.  Higher walnut consumption was associated with a lower risk of total and CVD mortality and a greater gained life expectancy among U.S. elder adults.  [Comment: association, not causation, and the difference is small].

Conflict of interest: The last (senior?) author reports having received research support from California Walnut Commission, but states that ” The funder has no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or in the decision to publish the results.”  [Comment: That’s what they all say, but research often demonstrates otherwise, as I review in my book Unsavory Truth].

And now for the second:

II.  Association of nut consumption with risk of total cancer and 5 specific cancers: evidence from 3 large prospective cohort studies.  Zhe Fang, You Wu, Yanping Li, Xuehong Zhang, Walter C Willett, A Heather Eliassen,1Bernard Rosner,
Mingyang Song, Lorelei A Mucci,and Edward L Giovannucci.  The American Journal of Clinical Nutrition, Volume 114, Issue 6, December 2021, Pages 1925–1935, https://doi.org/10.1093/ajcn/nqab295

Conclusion: In 3 large prospective cohorts, frequent nut consumption was not associated with risk of total cancer and common individual cancers.  [Comment: What? An industry-funded study that finds no benefuts?]

Funding: Supported by the California Walnut Commission and Swiss Re Management Ltd (to YL),… and NIH grants U01 CA167552 (to LAM and the Health Professionals Follow-up Study), UM1 CA186107 and P01 CA87969 (to the Nurses’ Health Study), and U01 CA176726 (to AHE and the Nurses’ Health Study II). The funding sources did not participate in the study design; or
collection, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

Here’s how the authors explain their highly unusual no-benefit result:

Given the scarcity of available high-quality data, our findings add to current evidence to more precisely determine the relation between nut consumption and cancer risk. So far, the population based evidence has not been strong enough to conclude that nut consumption is protective against total cancer and these 5 common cancers. Future studies on other cancer sites are still needed to examine the benefits of nuts on cancer development.

Really?  Why?  Do the authors not believe their own data?  Their findings ought to settle the matter and encourage the authors to move on to more significant research.  “More research needed” keeps the California Walnut Commission busy.

Research funded by food companies always requires a degree of skepticism, no matter what the results.

My thanks go to New Zealand reader Kirsten for sending this one.

The study: Exploring the Links between Diet and Inflammation: Dairy Foods as Case Studies. Julie M Hess, Charles B Stephensen, Mario Kratz, Bradley W Bolling.  Advances in Nutrition, Volume 12, Issue Supplement_1, October 2021, Pages 1S–13S,

Note: This article was intended as a review article based on presentations made by CBS, MK, and BWB at the American Society for Nutrition 2020 LIVE ONLINE Conference 7–10 June 2020.

Background: Systemic chronic inflammation may be a contributing factor to many noncommunicable diseases, including diabetes, cardiovascular disease, and obesity. An emerging body of evidence indicates that consuming certain foods, including dairy foods like milk, cheese, and yogurt, may be linked to a decreased risk for inflammation.

Method: Review of research on dairy foods and inflammation.

Conclusion: While there is currently insufficient evidence to prove an “anti-inflammatory” effect of dairy foods, the substantial body of clinical research discussed in this review indicates that dairy foods do not increase concentrations of biomarkers of chronic systemic inflammation.

Funding: The ASN Nutrition 2020 session that this article is based on was supported by the National Dairy Council. This support included honoraria for MK and BWB. The authors reported no funding received for this study.

Author disclosures: JMH was an employee of the National Dairy Council at the time this article was written. MK has received honoraria and reimbursements of travel costs as well as research funding from dairy-related organizations, including the National Dairy Council, Dairy Management, Inc., Dairy Farmers of Canada, the Dutch Dairy Organization (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Dairy Interbranch Organization (CNIEL). BWB has received research funding for dairy-related projects from University of Wisconsin Dairy Innovation Hub, the National Dairy Council, and USDA National Institute of Food and Agriculture (NIFA) HATCH WIS02094. The other author reports no conflicts of interest.

Comment: This is a study by dairy-funded authors with an interesting spin.  The research review found no anti-inflammatory effect of dairy foods but concludes that they have a benefit: they don’t make inflammation worse.  I realize that dairy foods have a bad reputation among some eaters, but I wish the dairy industry didn’t sponsor research so blatantly in its self-interest.  I also wish we could get away from one-food research.  One food cannot possibly make a substantial difference in the diets of reasonably healthy people who eat a variety of foods.  I am all for eating dairy foods if you like them, especially from well-treated animals.  They have a place in healthful diets—or not ,if you don’t like or want to eat them.

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

A reader in Norway, Marit Kolby, sent me this one.

First, the press release: “Mushroom consumption may lower risk of depression.”

New research led by Penn State College of Medicine also reveals that these superfoods may benefit a person’s mental health.  Penn State researchers used data on diet and mental health collected from more than 24,000 U.S. adults between 2005 and 2016. They found that people who ate mushrooms had lower odds of having depression.

The study: Mushroom intake and depression: A population-based study using data from the US National Health and Nutrition Examination Survey (NHANES), 2005–2016.  Djibril M.Ba. XiangGao, LailaAl-Shaar, Joshua, E.Muscat, Robert B.Beelman, John P.Richie.  Journal of Affective Disorders, Volume 294, 1 November 2021, Pages 686-692.

Hypothesis: “We hypothesized that mushroom consumption is associated with a lower risk of depression in American adults.”

Method: Analysis of dietary recall data from NHANES vs. self-reported depression.

Conclusion: “Mushroom consumers had a lower odd of depression. However, we did not observe a dose-response relationship.”

Funding: none.

Declaration of competing interest: none.

Comment: Ordinarily, beyond noting the conditional “may be linked” (which also could be “may not”  and the lack of dose-response, I would not bother to comment on this study except that Marit Kolby wrote:

As usual, the health effects (this time from mushrooms) are greatly exaggerated, especially given the study type and the lack of a dose-response relationship.  One compound in mushrooms suggested to explain the association is ergothioneine. The authors list no conflicts of interest.  But look at the patent list of the author Beelman.

This called for a look at the patent list.  Beelman does indeed hold several patents related to ergothioneine from mushrooms, but most of them are assigned to the Penn State Research Foundation.   This is not unusual for universities, but called for a look at Penn’s State’s policy on faculty intellectual property.

Penn State’s policy on patents requires research faculty to negotiate patent income according to a formula.

1. PSRF [the foundation]: 40%
   Inventor(s): 40%
   Administrative Unit of College: 20%
2. The inventors’ portions of the income are divided according to the contribution percentage that the inventors establish. A memo to establish the percentages to be paid to each invention will be sent to the Inventors before making payment .

Without knowing the details of Beelman’s arrangement with the university, it is difficult to be sure that a conflict of interest exists (he might have turned all the proceeds over to the university), but this situation clearly gives the appearance of a conflict, and an undisclosed one at that.

If professor Beelman is entitled to any percentage of profits from the patents, he has a competing interest and should have disclosed it.

Regardless, his declaration should have acknowledged his patent ownerships, as should the university’s press release.

Are mushrooms a “superfood” as the press release maintains?

Marit Kolby thinks it is more likely that mushrooms are an indicator of usual consumption of whole rather than ultra-processed foods, and points out that a couple of studies have linked ultra-processed foods themselves to depression.

I learned about this study from an article in FoodNavigator.com, “Baobab industry welcomes study linking the fruit to good gut health.”

The title raised the question, “Who funded this?”  Bingo, as it turns out.

Baobabs are enormous African trees that produce a highly fibrous fruit.

I can’t say it looks particularly yummy.  In fact, it is described as “floury, dry, and powdery” and works best as a powdered ingredient.

But the baobab industry?  Who knew such an entity existed?

It does.  Hence this study:

The study: A Pectin-Rich, Baobab Fruit Pulp Powder Exerts Prebiotic Potential on the Human Gut Microbiome In Vitro.  Martin Foltz, Alicia Christin Zahradnik, Pieter Van den Abbeele, Jonas Ghyselinck, Massimo Marzorati.  Microorganisms. 2021 Sep 17;9(9):1981.

Methods: Test tube mixing of baobab powder with colonic bacteria.

Results: Baobab fruit pulp powder boosted colonic acidification across three simulated human adult donors due to the significant stimulation of health-related metabolites.

Conclusions: Overall, Baobab fruit pulp powder fermentation displayed features of selective utilization by host microorganisms and, thus, has promising prebiotic potential.

Funding: The studies described in this manuscript were performed at the request of and were funded by Döhler, 94295 Darmstadt, Germany  Surprise!  This company makes baobab powder.

Conflict of interest:  M.F. and A.C.Z. are employees of Döhler. While M.F. participated in the design of the study, the interpretation of the data, and the revision of the manuscript, M.F. did not participate in the collection and analyses of data.

Comment: No food, product, or ingredient is too obscure to avoid industry attempts to demonstrate that it can be marketed as a “superfood” (see, for example, this product).

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

Jackfruit?  No, I’m not kidding.

For one thing, it’s JSTOR Daily’s Plant of the Month: “The newly hot alternative to meat has a long history.”

Jackfruit is not new in South Asia and its surrounding regions, where it has been a culturally significant foodstuff for centuries. Nor is jackfruit new in the West. Rather, it has a long and disquieting history: British imperialists wielded jackfruit as a tool to provide cheap nutrition to enslaved and coerced laborers throughout their empire.

Here’s what it looks like on the tree:

And off:

If you are in the business of selling Jackfruit, or products made from it, you will want research demonstrating health benefits.

Voila!

The study: Efficacy of green jackfruit flour as a medical nutrition therapy replacing rice or wheat in patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled study  Gopal Rao, K. Sunil Naik, A. G. Unnikrishnan & James Joseph.  Nutrition & Diabetes volume 11, Article number: 18 (2021)

Methods: This was a randomized, double-blind, placebo-controlled study of patients with type-2 diabetes who were being treated with oral antihyperglycemic agents.  They were either given jackfruit flour 30 g/day (Group A) or placebo flour (Group B) for 12 weeks.

Results: Patients from Group A had a better reduction in glycosylated hemoglobin, fasting plasma glucose, and postprandial plasma glucose than patients in Group B.

Conclusion: This study demonstrates the efficacy of jackfruit flour in glycemic control as medical nutrition therapy replacing an equal volume of rice or wheat flour in daily meal.

Funding: Diet Fibre 365 Food Products Pvt Ltd, India.

Acknowledgment: “The authors would like to acknowledge Abiogenesis Clinpharm Pvt Ltd, Hyderabad, for medical writing assistance funded by Diet Fibre 365 Food Products Pvt Ltd, Mumbai, India.”

Competing interests: JJ is the inventor of Jackfruit 365™ Green Jackfruit Flour with a pending patent and CEO of God’s Own Food Solutions Pvt Ltd which along with its subsidiary Diet Fibre 365 Food Products Pvt Ltd manufactures and markets the product. AGR, KSN, and UAG have no conflict of interest to declare.

Comment: This is a classic example of the funding effect in nutrition research.  The author owns the Jackfruit flour and the company that markets it, and the funder wrote (OK, helped to write) the paper.  The results were predictable.

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

Thanks to Tufts Professor Sheldon Krimsky for sending me this gem.

Residues of glyphosate in food and dietary exposure.  John L. Vicini,Pamela K. Jensen,Bruce M. Young,John T. Swarthout, Comprehensive Reviews in Food Science and Food Safety.  First published: 16 August 2021.

The study: A review of existing data on amounts of glyphosate residues in foods as compared to maximum limits or tolerances set by European or American regulatory agencies.  The study also reviewed data on levels of glyphosate in urine samples.

Conclusion: “Exposures to glyphosate from food are well below the amount that can be ingested daily over a lifetime with a reasonable certainty of no harm.”