Currently browsing posts about: Diets

Several readers wrote suggesting I take a look at the conflicts of interest statement on this paper.

It comes from the Harvard TH Chan School of Public Health, which issued a press release: Harvard study: ‘Portfolio diet’ may decrease risk of heart disease, stroke.

The portfolio diet—a plant-based diet designed to lower unhealthy cholesterol, emphasizing plant proteins (legumes), phytosterols (nuts and seeds), viscous fiber (oats, barley, berries, apples), and plant-based monounsaturated fatty acids (avocado)—may lower the risk of heart disease and stroke, according to a new study co-authored by researchers at Harvard T.H. Chan School of Public Health.

The study was published in Circulation, which also sent out a press release: Ever heard of the portfolio diet? It may lower risk for heart disease and stroke.

The study itself, Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies, produced results that should be expected from eating healthier diets.

Background: The plant-based Portfolio dietary pattern includes recognized cholesterol-lowering foods (ie, plant protein, nuts, viscous fiber, phytosterols, and plant monounsaturated fats) shown to improve several cardiovascular disease (CVD) risk factors in randomized controlled trials.

Objective: to examine the relationship between the Portfolio Diet Score (PDS) and the risk of total CVD, coronary heart disease (CHD), and stroke.

Methods: We prospectively followed 73924 women in the Nurses’ Health Study (1984–2016), 92346 women in the Nurses’ Health Study II (1991–2017), and 43970 men in the Health Professionals Follow-up Study (1986–2016) without CVD or cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every 4 years using a PDS that positively ranks plant protein (legumes), nuts and seeds, viscous fiber sources, phytosterols (mg/day), and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and cholesterol.

Conclusions: The PDS was associated with a lower risk of CVD, including CHD and stroke, and a more favorable blood lipid and inflammatory profile, in 3 large prospective cohorts.

This report was funded by Canadian and U.S. government research agencies.

Comment: The reason readers sent this to me had to do with the authors’ reported conflicts of interest.  These take up the equivalent of an entire page in the journal and refer to a curious mixture of financial support or connections, paid and unpaid, with government agencies and foundations, authors’ and sometimes their spouses’—in addition to long lists of financial ties to food trade associations for one or another plant food included in the Portfolio diet.

Muddying up disclosure statements like this is inappropriate.  Many connections listed do not in any way imply conflicted interests.  Mixing them up with those that do takes the focus away from financial ties that could have influenced the design or interpretation of the study.

Financial connections to food companies raise questions of credibility in nutrition research.  At the very least, they give the appearance of industry influence.

Disclosure lists like these either reflect ignorance of the significance and harm causes by conflicts of interest or deliberate disdain for its meanings.  If Circulation is requiring this mix of disclosures, it should reevaluate its policy.

Just because these disclosures come in a study from Harvard does not make them OK.

The Government Accountability Office has produced a “snapshot” on Healthy Eating: Government-wide solutions for promoting healthy diets, food safety, and food security.  It’s only two pages; take a look.

As of July 2022, many of our recommendations for developing strategies on healthy eating have not yet been addressed.

1. Strategy Needed to Address Diet-Related Chronic Health Conditions
Three diet-related chronic health conditions (cardiovascular diseases, diabetes, and cancer) were among the 10 leading causes of death in 2018, according to CDC. Men, Black or African Americans, and people living in southern states had disproportionately higher mortality rates from diet related conditions. Dietary changes could have prevented some of these deaths.

Additionally, in 2018, about three in four adults in the U.S. had excess weight, which can be associated with poor diet and lead to cardiovascular diseases, diabetes, and cancer.

The GAO recommends that the federal government establish leadership for strategies:

• On diet-related efforts
• Food-safety oversight
• Nutrition assistance programs to respond to emergencies

Excellent suggestions.  If only they could be implemented.

Here are three announcements I received this week.

I.  Pringles shoots for spider history.  The Kidney Garden Spider bears an uncanny resemblance to the Pringles logo – sparking a mission to get the arachnid community to officially recognise it as the Pringles Spider…. Read more

II.  Milk cows listening to music are more relaxed.  Musical enrichment of the environment was done using recorded-tape of flute and sitar was played in yamen raga at 40-60 (dB) decibel intensity.   [Thanks to Stephan van Vliet for this one].

III.  Dating for diet followers: The Filteroff dating app is hosting an online speed dating event for followers of the Paleo and Keto diets.  You can learn more about the speed dating event (and sign up if single) here.  [Thanks to Michelle Miller of Filteroff for the emailed invitation].

A recent report in Nature caught my eye:

It begins with the problem:

More than 2 billion people are overweight or obese, mostly in the Western world. At the same time, 811 million people are not getting enough calories or nutrition, mostly in low- and middle-income nations. Unhealthy diets contributed to more deaths globally in 2017 than any other factor, including smoking². As the world’s population continues to rise and more people start to eat like Westerners do, the production of meat, dairy and eggs will need to rise by about 44% by 2050, according to the UN Food and Agriculture Organization (FAO).

That poses an environmental problem alongside the health concerns. Our current industrialized food system already emits about one-quarter of the world’s greenhouse-gas emissions. It also accounts for 70% of freshwater use and 40% of land coverage, and relies on fertilizers that disrupt the cycling of nitrogen and phosphorus and are responsible for much of the pollution in rivers and coasts³.

It talks about dietary recommendations for human and planetary health:

And it discusses the practicalities of achieving that kind of diet.

In fact, for the average person to eat the diet in 2011 — the most recent data set available on food prices — would have cost a global average of $2.84 per day, about 1.6 times higher on average than the cost of a basic nutritious meal¹².

Despite the lack of more recent data, the ideas here demand consideration.  Nature readers don’t get to see things like this too often and these issues deserve attention and solutions.

Melissa Fuster.  Caribeños at the Table: How Migration, Health, and Race Intersect in New York City.  University of North Carolina Press, 2021.

My former NYU colleague, Melissa Fuster, now at Tulane, has written a book length report on her research investigating the eating preferences of immigrants to New York from Puerto Rico, the Domincan Republic, and Cuba.

She used qualitative methods—interviews—to come to some reality-based conclusions about immigrant foodways.  She did not find deep longings for traditional Caribbean diets.  Instead, she also identified class, race, and gender as major influences on dietary preferences.

 Hence, with this work I aim to change ongoing scholarly conversations on the immigrant food experience and health outcomes in the United States, which tend to overemphasize the importance of culture when addressing immigrant communities.  This overemphasis on culture dimishes the role of the structural factors (class, race, gender) that intersect to shape the experiences of these communities, overstates the uniqueness of specific cultural groups, and risks blaming culture for the health inequities observed in these communities. (p. 5)

She has interesting things to say about how dietitians view the traditional diets of the Caribbean—as unhealthy and unsophisticated.

These racialized descriptions of comidas, including those made in nutri-speak [talking about foods strictly in terms of nutrient content]…are laden with meanings that reflect the cuisines roots in slavery and colonization—institutions that are built on oppression through racialization.  Despite the stigma attached to foods that emerged out of slave and colonial foodways, these foods traveled with their communities from the Caribbean to the United States.  (p. 96)

And she urges us to think about migrant eating patterns in the broader context of everyone’s eating patterns:

The prevalent focus on culture in the food and migration scholarship minimizes the struggles immigrants face in the home-making process and the political forces surrounding such processes…Moreover, this emphasis often carries an implicit assumption that traditional foods are  important for immigrant or ethnic communities, and that these foods are always healthier than the “new’ American foods.  We must also rethink this dichotomy.  All diets have a range of healthfulness, and in migration contexts, this depends on the interpretation of what traditional comidas are, and how frequently they are consumed.  As found in other studies, migrant communities engage in both healthful and unhealthful dietary practices upon moving.  (p. 128)

I am indebted to Bill Tonelli who took this photo on October 10 in Viterbo, Italy, about an hour outside of Rome.

The shop, he reports, sells American snacks—candy, chips, soda—with no pretense of worry about health or sustainability.

He sent me to the store’s website:

Benvenuti nel regno degli snack americani (Welcome to the kingdom of American snacks)

Tantissimi snack e bevande made in USA come Hershey’s, Reese’s, Monster Energy, Doritos, Cheetos, Dr. Pepper e tantissimi altri ti aspettano ! (And many others are waiting for you!)

I’m always interested in how the food industry tries to sell products to specific groups.  Here’s one of FoodNavigator’s Special Editions (collections of articles) on products the food industry is designing and trying to sell for older adults.

Special Edition: Healthy ageing: Food for an older population

Europe is ageing. By 2050 the population of over 65s is expected to reach almost 150m in the region. Gains are expected for products that cater to this older demographic by boosting immunity, as well as bone, joint, muscle, cognitive, heart, skin, eye and digestive health. FoodNavigator looks at some of the innovation strategies food makers are developing to meet the needs of older people.

• Keto for healthy ageing: F&B brands tap into ketone production with older generations in mind:  How are brands responding to growing demand for keto-friendly food and drink that supports healthy ageing?.. Read
• Nut supplier Importaco cracking the healthy ageing market: ‘Everybody is targeting older people’:  Nut and dried fruit supplier Importaco is leveraging innovation and deep consumer insight to build a portfolio of products targeting older people. We spoke to Teresa Cercós (PhD), Director General of Quality, Environment and Innovation, to learn more about the company’s long-term ambition to develop ingredients that support healthy ageing… Read
• Food for ageing populations: What, how and where will the elderly be eating in 2030?  What will the everyday diets of elderly people living at home in 2030 look like? Where and when will they consume their meals? And how will it reach their plates?.. Read
• ‘The narrative on ageing needs to evolve’: Barclays sees innovation opportunity in healthy ageing:  The food industry should do more to meet the nutritional needs of the ageing population, according to new research out from Barclays. This is, after all, a demographic that is only going to grow… Read
• Ajinomoto talks ‘nutrition without compromise’ and ‘first mover advantage’ in healthy ageing:  Ajinomoto has launched a nutrition strategy that the company believes will enable it to leverage its unique expertise in amino acids to deliver solutions that meet its two global strategic priorities: salt reduction and optimal protein intake for the ageing population… Read
• The role of citrus in brain health: ‘Citrus bioactive compounds improve general cognition’:  Eating citrus fruit and drinking citrus juices can have a positive impact on brain health, particularly during ageing, according to new research… Read
• Study finds microbiome ‘signature’ associated with healthy aging:  A large set of longitudinal data revealed a distinct gut microbiome signature that is associated with healthy aging and survival in the latest decades of life… Read
• Ketogenic drink boosts brain in cognitively impaired, says Nestlé study:  A Nestlé-produced ketogenic (kMCT) drink could improve cognitive function in individuals suffering from Mild Cognitive Impairment (MCI), the firm’s study suggests, as the product is set to be launched in Europe by the end of the year… Read

Saray Stancic.  What’s Missing From Medicine: Six Lifestyle Changes to Overcome Chronic Illness.  Hierophant Publishing, 2021.

I don’t usually recommend books about topics other than food politics, but this one has dietary changes at its core and although I have never met the author, I greatly admire her and her work.

I first heard about Dr. Stancic, who has a practice in New Jersey, when I was invited to watch a documentary film about her, Code Blue.   I was interested to see it because I was told I appeared in it, which I did for about 10 seconds.  I don’t remember meeting her or filming it (I tend not to remember such things), but the film is impressive and well worth seeing.

It tells her personal story of how she was able to get control of her formerly debilitating multiple sclerosis with a plant-based diet and exercise—good advice for everyone.  The film goes beyond the personal and talks about why she never understood the importance of diet: lack of nutrition education in medical schools, media confusion, inadequate government policies, and the overwhelming influence of drug, food, and beverage companies.   The film moves quickly and I thought it was much better than most documentaries of this type.

What made it work for me is Stancic, who comes across as committed, but sane and likable.  I would send anyone who has MS to see her in a shot.  She’s my kind of doctor—one who listens to patients and works with them.  The film’s message leans toward veganism, but without ideology and pushed only softly even by the strongest proponents she interviewed.

The book makes the same points.  It’s great strength is that it makes lifestyle changes seem possible for anyone.

Here’s what drove her to healthier eating:

My physicians warned me that it was irresponsble to wean myself off of the ten to twelve medications I was taking daily (and that were making my life unbearable) and solely manage my MS with an “unproven lifestyle change” [i.e., diet]…I adoped a whole foods, plant-based diet becasue the overwhelming body of scientific literature pointed to those foods as the best diet for optimal health for all people.  At that point, I knew I could not face a lifetime of living as I was—with a huge pillbox, cane, diapers, and the other physical and psychological burdens of MS [p. 36].

Her advice about how to eat more plant foods is sensible and easy to follow.  I particularly like her lack of dogmatism.  In a section on common food myths, she has two about meat:

Myth 1: We need to eat meat and dairy to be healthy.  FALSE [p. 57].

Myth 2. Eating animal products of any kind is bad for your health.  FALSE [p. 59]

Most of the book is about other changes that  can help everyone cope with chronic disease: movement, stress management, sleep, avoiding substances, human connections.  All of these messages are aimed at giving us the power to control our own health, and to make doing so seem entirely possible.

I found the book inspiring.  Her wish for us:

May we eat well, relish physical and mental challenges, enjoy restorative sleep, and connect deeply with others [p. xxxiii].

This is good advice for all of us these days.