Currently browsing posts about: Sponsored-research

On July 19, I did a post on a recent study comparing the nutrient composition of plant-based meat alternatives to that of grass-fed beef.  I was not surprised that the study found nutritional differences; they are to be expected.

I was surprised that “From the abstract and conclusion, the study appears to suggest that meat is nutritionally better,” but the authors said the two types “could be viewed as complementary in terms of provided nutrients. It cannot be determined from our data if either source is healthier to consume.”   That confused me.  I also was confused by the authors’ reported conflicts of interest and said so.

One reader wrote to say that I was being unfair to the authors, who are excellent scientists.

Indeed, the authors followed up with an explanation, which I offered to post here without further comment.  They agreed to that.

Dear Dr. Nestle,

Many thanks for posting about our work. We have the utmost respect for your work and we have cited your work in our papers and books (e.g., Provenza’s Nourishment). You are an influential and well-respected person, and as you noted, your followers wanted you to inform them about this paper. When reading the post about our work, we were particularly surprised that you didn’t send us an email to fact-check your points, especially since we were introduced by email on 7/7 that noted: “I’ve copied two of the researchers involved Stephan van Vliet and Fred Provenza. That way if you have any further questions, you can pose those to the researchers directly.” If you disagree, c’est la vie, but at least that would have enabled you to write an informed critique, rather than one that is speculative and, at times, incorrect.

An off-hand and speculative statement such as this one: “maybe the vegetarian was responsible for the hedging comments?” would easily have been addressed by simply sending us an email inquiring about this. We would have gladly told you that it was three of the omnivores (SVV, FDP, SK) who were particularly concerned that people would over extrapolate the data. We were especially concerned that people would interpret our data as beef being “better”. That is not what the data indicate (more on what the data does indicate below). Hence our clear and repeated statement: “It cannot be determined from our data if either source is healthier to consume.”

We are writing you this friendly note to put some context to the points that you made. We hope that you will take them as our attempt to reinforce points that we were careful to develop so our paper was not one-sided.

“So, they’re framing everything with the baseline that animal meat is “proper nutrition” which seems like a pretty obvious bias right out of the gate…”

The two words you quoted are from a much more nuanced sentence, which reads: “This has raised questions of whether plant-based meat alternatives represent proper nutritional replacements to animal meat”. This statement refers to a number of papers by different research groups (see our paper for citations) who pose that very question, which we were interested in exploring. This is much more nuanced statement than what you suggest in the blogpost, which simply states animal meat is “proper nutrition”, which, to us, feels like a twisting of our carefully chosen words.

That we are not framing meat as “proper nutrition” is further illustrated by the stated goal of this work at the end of the introduction: “Given the scientific and commercial interest in plant-based meat alternatives, the goal of our study was to use untargeted metabolomics to provide an in-depth comparison of the metabolite profiles of grass-fed ground beef and a popular plant-based meat alternative, both of which are sometimes considered as healthier and more environmentally friendly sources of “beef”.

Furthermore, we also have to be realistic here and not dance around the obvious; the goal of plant-based meat alternatives is to provide a sensory and nutritional replacement for meat, as illustrated in press releases such as Impossible’s “We are Meat”. If one were to add carotenoids and fiber to a meat sausage (see Arby’s Marrot https://www.foodandwine.com/news/arbys-meat-carrots) and consider this a replacement to a carrot…. We would ask the same question: to what extent do a carrot and a meat-based carrot alternative differ nutritionally? It would be reasonable to take the carrot as the benchmark. All in all, we argue that our framing of the research question is much more nuanced than you suggested in your blogpost. “

To the question of nutritional differences, duh, indeed. Why would anyone not expect nutritional differences? From the abstract and conclusion, the study appears to suggest that meat is nutritionally better.”

As we acknowledge in the abstract “Important nutritional differences may exist between beef and novel plant-based alternatives; however, this has not been thoroughly assessed.” Please give us some credit. One of us (Fred Provenza) has studied plants and animals for over 50 years. Of course, we expected meat from a cow to differ from meat from soybeans, but the extent to which this may be the case had not been studied. Nor is this clear to the consumer who is simply looking at Nutrition Facts panels, another very important reason why we did the research. Another issue is that foods are often considered equivalent simply based on their protein content (even in dietary guidelines), but “protein foods” can be vastly different in terms of the non-protein nutrients they provide. We recommend Dr. Courtney-Martin’s editorial in AJCN titled “Is a peanut really an egg”. (https://academic.oup.com/jn/article/151/5/1055/6217441). She discusses these issues in such an elegant way.

We do not suggest that meat is nutritionally better, we clearly state the following in the abstract (something you cite in your blogpost): “Amongst identified metabolites were various nutrients (amino acids, phenols, vitamins, unsaturated fatty acids, and dipeptides) with potentially important physiological, anti-inflammatory, and/or immunomodulatory roles—many of which remained absent in the plant-based meat alternative when compared to beef and vice versa. Our data indicates that these products should not be viewed as nutritionally interchangeable, but could be viewed as complementary in terms of provided nutrients. It cannot be determined from our data if either source is healthier to consume.”

The italicized portions are key: we state that some nutrients are not found in the plant-based meat alternative and some nutrients are not found in the meat. Nothing more and nothing less. We also clearly state that we cannot determine from this metabolomics analysis if one is healthier than the other. We intend to pursue that question in research with people, but based on current research we also have to be realistic and we, therefore, highlight the following: “Further work is needed to inform these discussions; however, we consider it important to not lose sight of the “bigger picture” in these discussions, which is the overall dietary pattern in which individual foods are consumed. That is arguably the predominant factor dictating health outcomes to individual foods. Of note is a recent 8-week randomized controlled trial that found that a “flexitarian approach” (swapping moderate amounts of meat with novel plant-based alternatives as part of an omnivorous diet) may have positive benefits in terms of weight control and lipoprotein profiles (e.g., LDL-cholesterol).” (https://doi.org/10.1093/ajcn/nqaa203).

We are not particularly touting the superiority of meat in the discussion. We mention many of the potential health benefits of the compounds found in plant-based meat alternatives such as phytosterols, tocopherols, and other phenolic anti-oxidants, which were more abundant or exclusively found in the plant-based meat alternative.

“Really? If they can’t figure out which is better, why do this study?”

It is not a question of which one is better. It is about understanding potential similarities and differences. Is an almond better than an orange? That depends on the types of nutrients you are looking to get. If you want Vitamin C, an orange is preferred over an almond. If you want Vitamin E, consume the almonds. But there is also nutritional overlap, because both provide fiber and they have complementary phytonutrient profiles. A silly example perhaps when you put it like that, but that’s analogues to what we are stating in the paper.

“As for the conflicted interests: My first reaction to seeing this study was to ask: “Who paid for this?”

No funding was received for this work. The cost of the meat and plant-based meat alternatives (~$600) was paid with my [Dr. Stephan van Vliet] personal credit card (I am a post-doc and had no grant or start-up funds when I first arrived at Duke). The cost of metabolomics (~$200 per sample) was waived by Duke Molecular Physiology Institute’s Metabolomics Core. This was generously done to provide an early career investigator like myself to generate pilot data for a publication and grants.

The North Dakota Beef Association grant that I am the PI on [Dr. Stephan van Vliet] is $135k (not a very big grant) and supports a 4-week RCT that studies cardiovascular risk biomarkers and metabolome profiles in response to eating beef as part of a traditional (whole food) vs standard American diet. Various epidemiological studies suggest that when red meat is consumed as part of a whole foods diet, the associated risk with CVD becomes neutral, whereas eating red meat as part of a standard American diet is associated with increased disease risk. We are testing/falsifying this hypothesis prospectively in a short-term RCT and are exploring potential mechanisms by which this may or may not be the case. This work has nothing to do with plant-based meat alternatives.

The Turner Institute of Ecoagriculture ($27.5k) and the Dixon Foundation ($12.5k) are pilot grants to run metabolomics on grass-fed vs grain-fed bison and beef, respectively. The USDA-NIFA-SARE grant is collecting both plant (crops + fruit) and animal (eggs + beef) food samples from farms that use agroecological principles such as integrated crop-livestock systems. Here we are asking the question: How do practices that potentially stimulate soil health and plant diversity impact the healthfulness of animal and plant foods for human consumption? To be clear, we are also studying crop samples (soy, corn, and peas) some of which may go into alternative protein production.

My [Stephan van Vliet] conflict-of-interest policy is also essentially similar to yours: I accept funding for travel, hotels, meals, and meeting registrations, but I do not accept personal honoraria, consulting fees, or any other financial payments from such groups. A simple email could have cleared that up, but I will make sure that I state this more clearly in future papers.

Of course, we understand the public suspicion about research funding and undue influence. If a certain funding agency doesn’t like the data or the proposal and they don’t want to fund any of our projects then that is what it is, but we would not risk our reputation and career for a few research dollars or to please the funding agency. That’s why we are pushing back on this. Fred Provenza, especially, has been critical of the way beef is produced in confinement feeding operations (e.g., see recent paper https://doi.org/10.3389/fsufs.2021.547822), so the suggestion that we are beef industry defendants rather than independent scientists does sting a bit.

At the same time, we would also be lying if we didn’t think about where funding comes from. However, the harsh reality is that without foundation/commodity funds for scientific research, there would be much less research, much of which has also proven valuable over time. Even with our USDA grant, one could argue that the reason we are funded is because we wrote a good proposal, but also because our proposed work can presumably benefit the US Farm Bill. Is that true independence? All we know is that we should be transparent (hence our detailed competing interest statement) and let the data speak for itself (hence we attached our full data set as supplementary materials and deposited raw data files on metabolomics workbench), which is what we aimed to do in our Sci Rep paper.

We appreciate your concerns. We will certainly take these into account as we move forward and continue to be critical of our work. We hope you also consider our concerns and are willing to keep an open and friendly dialogue.

Sincerely,

Stephan van Vliet

Fred Provenza

Scott Kronberg

Jessi Silverman, a policy associate at the Center for Science in the Public Interest, sent me this one with a note that it might be fodder for my blog.  It most definitely is.

I have long argued that industry sponsorship of nutrition research is not about science; it is about marketing.   The beef industry explains how this works.

Nutrition Research Improves Public Perception of Beef

As the Beef Checkoff celebrates its 35th anniversary, the National Cattlemen’s Beef Association (NCBA), a contractor to the Beef Checkoff, is shining a light on the successful promotion and research programs that drive the demand for beef. Consumers today are more open to the nutritional benefits of beef than at any other time since the Checkoff began more than three decades ago but getting here was not easy and required consistent long-term investment in nutrition research to turn the tide [my emphasis].

And what research did the Beef Checkoff fund?

Two landmark studies reinforce that beef not only fits heart healthy diets but may also help decrease risk of cardiovascular disease when included in heart healthy diets. The Beef in an Optimal Lean Diet (BOLD) study found that people can enjoy 4-5½ ounces of lean beef daily, as part of a heart healthy lifestyle to lower blood pressure and improve cholesterol levels.3  The Mediterranean-style eating pattern study found that eating a Mediterranean diet that included 7-18 ounces of lean red meat per week can improve cardiometabolic disease risk factor profiles.4

Although citations 3 and 4 appeared in the text, no reference list is given, and I could not find references 3 and 4 on the Beef Research site.

I had better luck with Google.  The BOLD study dates from 2012.  It discloses support from the Beef Checkoff Program and the General Clinical Research Center, Pennsylvania State University.  For the record, Checkoff programs are sponsored by the USDA.

I’m guessing the second study is this recent one:  Effect of varying quantities of lean beef as part of a Mediterranean-style dietary pattern on lipids and lipoproteins: a randomized crossover controlled feeding trial.  “This study was funded by the Beef Checkoff. This study also was supported by the USDA, ARS, and the Penn State Clinical and Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award, and NIH/National Center for Advancing Translational Sciences grant no. UL1TR000127.”

Here’s a clip from a press release for the second study:

Eating red meat may have a bad reputation for being bad for the heart, but new research found that lean beef may have a place in healthy diets, after all.

The Beef Checkoff takes full credit for sponsoring this kind of research.  It gets what it pays for.

The beef industry is under enormous pressure.  More and more people understand that the health of humans and the planet would be a lot better with eating less beef.

Sponsoring research is an effective way to counter such pressures.

I read about this one in NutraIngredients.com.

While previous animal studies have suggested a significant impact of the gut microbiota on the development and maturation of brain networks that underlie emotional behaviour, fewer studies have been conducted on humans. Intake of a galacto-oligosaccharides (GOS) prebiotic over 3 weeks has been shown to lower the secretion of the stress hormone cortisol and emotional processing in healthy adults, suggesting that GOS intake may be useful in modifying anxiety-related psychological mechanisms. However, reviews and meta-analyses on the efficacy of prebiotics for reducing anxiety symptomology are mixed, calling for further well controlled trials in human participants.

I am always curious to know who pays for this kind of research, so I looked up the study.

Anxiolytic effects of a galacto-oligosaccharides prebiotic in healthy females (18-25 years) with corresponding changes in gut bacterial composition.  Nicola Johnstone , Chiara Milesi , Olivia Burn, Bartholomeus van den Bogert, Arjen Nauta , Kathryn Hart , Paul Sowden, Philip W J Burnet, Kathrin Cohen Kadosh.   Sci Rep 2021 Apr 15;11(1):8302.

The study: “We examined multiple indices of mood and well-being in 64 healthy females in a 4-week double blind, placebo controlled galacto-oligosaccharides (GOS) prebiotic supplement intervention and obtained stool samples at baseline and follow-up for gut microbiota sequencing and analyses. We report effects of the GOS intervention on self-reported high trait anxiety, attentional bias, and bacterial abundance, suggesting that dietary supplementation with a GOS prebiotic may improve indices of pre-clinical anxiety.”

Conflict of interest statement: AN is an employee of FrieslandCampina, Amersfoort, The Netherlands. BvdB reports co-ownership of MyMicroZoo, Leiden, The Netherlands with no financial benefit from contributions to this manuscript. NJ, CM, OB, KH, PS, PWJB and KCK declared no financial or potential conflicts of interest.

Comment:  Probiotics are microorganisms that maintain a healthy microbiome.   They are typically found in fermented foods like yogurt.  Prebiotics are substances in food—or, in this case, supplements—that feed probiotic microbes.  This prebiotic supplement is GOS, a complicated chain of sugar molecules that is found in milk.

Why would an employee of FrieslandCampina want to do this study?  “Milk is the foundation of everything we do at FrieslandCampina.”

Why would a co-owner of MyMicroZoo be interested?  “The MyMicroZoo analysis shows the composition of your microbiota, and gives insight into how to improve your vitality.”

I’m all for eating yogurt (but watch out for the added sugars).  But GOS supplements?  Pardon my industry-induced skepticism.

By this time, a great many research studies have associated eating nuts—of any kind—with good health.  Nuts have fats and, therefore, calories (150-200 per ounce).

The nut industry would like to minimize concerns about fats and calories.  It funds research to demonstrate that nut fats are healthy (which they are) and that you don’t have to worry about the calories (which you do, depending on what else you eat).  Hence:

The study: Almond Bioaccessibility in a Randomized Crossover Trial: Is a Calorie a Calorie?  Nishi SK, et al.  Mayo Clinic Proceedings, 2021;nn(n):1-12, Published April 11, 2021.

Methods: This is a clinical trial in which subjects with hyperlipidemia consumed about 1 or 2 ounces a day of almonds versus muffins with equivalent calories.

Results: “Almond-related energy bioaccessibility was 78.5%±3.1%, with an average energy loss of 21.2%±3.1% (40.6 kcal/d in the full-dose almond phase).”

Conclusion:  “Energy content of almonds may not be as bioaccessible in individuals with hyperlipidemia as predicted by Atwater factors, as suggested by the increased fat excretion with almond intake compared with the control.”

Comment #1: The authors went to a lot of expensive trouble to demonstrate what has been known for a long time: almonds as typically consumed have only about 80% of the calories listed in standard tables.  This is because some of the fat is excreted rather than absorbed.  Chewing is not as efficient as machine grinding in separating fat from fiber.  When nuts are machine ground, their fats are more fully released and their calories similar to values obtained in calorimeters.

So guess who paid for this?

Grant Support: …the Almond Board of California…[and several other sources].

Potential competing interests: Where to begin?  The list takes three full columns of printed page.  Several of the authors report grants or consulting arrangements with entities such as the Almond Board of California, American Peanut Council, International Nut & Dried Fruit Council (INC), International Tree Nut Council Research and Education Foundation, California Walnut Commission, Peanut Institute, and the International Tree Nut Council.  But authors also report funding relationships that seem irrelevant to this study, such as the Dairy Farmers of Canada, Ocean Spray, the Saskatchewan & Alberta Pulse Growers Associations, and Beyer Consumer Care.  Even odder are reports of an honorarium from the USDA for a lecture; travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association (CDA); and, most unnecessarily, a book about vegetarian diets published by the daughters of one of the authors.

Comment #2:  I think disclosure statements like these are disrespectful of the disclosure requirement.  In this case, because several of the authors have so many financial relationships with food and drug companies, a listing of the nut-industry connections would have sufficed.  These alone would make it clear that these authors have conflicted interests that might deserve consideration in interpreting the study results.

The review:  Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting .  Yanni Papanikolaou, Joanne L Slavin, Roger Clemens, J Thomas Brenna, Dayle Hayes, Glenn A Gaesser, Victor L Fulgoni, III.  Current Developments in Nutrition, Volume 4, Issue 10, October 2020, nzaa125.

Method: “A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes.

Results: 

1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns,

2) whole and refined grain foods contribute nutrient density,

3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet,

4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and

5) gaps exist in the scientific literature with regard to grain foods and health.“

Supported by the Grain Foods Foundation.  The sponsors (Grain Foods Foundation) had no role in the design of the study or in the collection, analyses, or interpretation of the data.

Author disclosures: YP, as President of Nutritional Strategies, provides food, nutrition, and regulatory affairs consulting services for food and beverage companies and food-related associations and collaborates with VLF on NHANES analyses. VLF, as Senior Vice President of Nutrition Impact, provides food and nutrition consulting services for food and beverage companies. VLF also conducts analyses of NHANES data for members of the food industry. JLS, RC, JTB, DH, and GAG all received an honorarium and travel expenses in the current scientific collaboration.

Comment: The Grain Foods Foundation commissioned the panel and paid the panel participants for their service and travel.  For the authors, this was a paid gig.  The Foundation got what it paid for.  About results #1, 2, and 5, there can be no argument.  #1 and #2 are obvious and did not require a scientific panel to come to those conclusions: even refined grains have nutritional value, not least because they are fortified with several key nutrients.   That’s why these authors consider fortification and enrichment to be “vital.”

What this really is about is to demonstrat that refined grains are healthy and do no harm (#4).  But refined grains are major components of ultra-processed foods, which cause people who eat them to take in more calories than they recognize or need (see Hall et al, 2019) and are strongly associated with higher levels of obesity, chronic disease, and mortality.  Despite dozens of studies consistently linking ultra-processed foods to these conditions, this industry-sponsored panel says the evidence is inconclusive.

The underlying purpose of this study, therefore, is to cast doubt on the connection between refined grains, ultra-processed foods, and weight gain.

With independently funded research, even by biased researchers, the underlying purpose is usually explicit.

–Thanks to Lisa Young for alerting me to this one.

Conclusion: “Addition of mushrooms to USDA Food Patterns increased several micronutrients including shortfall nutrients (such as potassium, vitamin D and choline), and had a minimal or no impact on overall calories, sodium or saturated fat.”

US and UK Consumer Adoption of Cultivated Meat: A Segmentation Study.  Keri Szejda, Christopher J. Bryant, Tessa Urbanovich.  Foods 2021, 10(5), 1050.

Background: “Despite growing evidence of the environmental and public health threats posed by today’s intensive animal production, consumers in the west remain largely attached to meat. Cultivated meat offers a way to grow meat directly from cells, circumventing these issues as well as the use of animals altogether.”

Purpose: “The aim of this study was to assess the overall consumer markets and a range of preferences around cultivated meat in the US and the UK relating to nomenclature, genetic modification, health enhancements, and other features.”

Conclusion: “there are solid consumer markets for cultivated meat in the UK and the US, despite an overall lack of familiarity with the product. Younger generations are the most open to trying cultivated meat, and government seals of approval are considered important. Consumers tend to prefer non-GM cultivated meat, and while nutritional enhancements do not add much to consumer appeal overall, they may be an effective way to provide tangible benefits to more skeptical consumers.”

Funding: “This work was supported by Aleph Farms. Aleph Farms participated in the study design, but not other aspects of the project.”

Conflicts of interest: “The authors report no conflicts of interest.”

Comment: Aleph Farms produces cell-based meat substitutes: “We’re paving a new way forward in the field of cultivated meat, growing delicious, real beef steaks from the cells of cows, eliminating the need for slaughtering animals or harming the environment.”

The company paid for consumer research to find out how to sell its product.   The authors perceive no conflicted interests in this kind of paid research.  The biases induced by paid research are often unconscious and unrecognized.  The result of this study is an implied suggestion to add nutrients to cell-based meat products as a means to convince people to buy them.

This is marketing research.

Thanks to Michele Simon for sending a query about this paper.

I recently received an email from the Soyfoods Council: “If You’re Confused About Endocrine Disruptors, Here’s Why Soy Isn’t One.”

The email explained that “the Soyfoods Council is a non-profit organization, created and funded by Iowa soybean farmers, providing a complete resource to increase awareness of soyfoods, educate and inform media, healthcare professionals, consumers and the retail and foodservice markets about the many benefits of soyfoods.  Iowa is the country’s number one grower of soybeans and is the Soyfoods Capital of the world.”

The email referred to a just-published paper

The Study: Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data, by Mark Messina,Sonia Blanco Mejia,Aedin Cassidy,Alison Duncan,Mindy Kurzer,Chisato Nagato, et al.  Critical Reviews in Food Science and Nutrition, published online: 27 Mar 2021.

Conclusion: After extensive [my emphasis] review, the evidence does not support classifying isoflavones as endocrine disruptors.

Funding: “Funds were provided by the Soy Nutrition Institute and the European Plant-based Food Association to MM and the Toronto 3D Knowledge Synthesis & Clinical Trials Foundation for work related to the development and writing of this paper.”

Disclosures: Mark John Messina receives funding from the Soy Nutrition Institute as its Executive Director. Both Mindy Kurzer and John Sievenpiper are on the advisory board of the Soy Nutrition Institute. Ian Rowland is on the advisory board of the European Plant-based Foods Association. I have disclosed those interests fully to Taylor & Francis, and have in place an approved plan for managing any potential conflicts arising from these positions.

Comment: “Extensive” is an understatement; the paper has 688 references.  This may be overkill, but its purpose is to put to rest any concerns that soybeans might act as endocrine disrupters and, therefore, should be avoided.  The Soy Foods Council, obviously, wants you to stop worrying about this and paid for this review for that purpose.

I’m not particularly worried about soybeans.  As I wrote in What to Eat, I view soy as neither poison nor panacea.  But there is plenty of evidence on both sides.  That’s why paid reviews are not helpful.