For the food industry, it is essential to have coherent federal leadership on dietary and environmental issues together

For the food industry -- and also for meeting important public interest goals -- it would be beneficial for the U.S. federal government to consider environmental sustainability along with nutrition science in the Dietary Guidelines for Americans (DGA).

In 2013, the Food Forum of the National Academies organized a workshop on sustainable dietary guidelines (covered previously). At the time, we had little hope the topic would be included in the actual guidelines. Then, in 2015, hopes were raised when the Dietary Guidelines Advisory Committee (DGAC) included scientific literature on sustainability in its report, which serves as an important input to the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS), which then jointly produce the official dietary guidelines once every five years. That year, former Deputy Secretary of Agriculture Kathleen Merrigan, several other colleagues, and I argued in an opinion column for Science that the federal agencies should use this material on sustainability in the official report. However, the agencies excluded all mention of sustainability in the end. Since then, the National Academies has continued to organize fascinating workshops on this topic (see video presentations and proceedings), but we have little indication of progress in the federal guidelines.

The Menus of Change initiative, a collaboration between the Harvard TH Chan School of Public Health and the Culinary Institute of America encourages the restaurant industry in particular to explore new ways of providing healthy and sustainable food in a profitable way. I have served on the Scientific and Technical Advisory Committee for several years. The experience clearly shows that major food industry sectors see the need to address complex consumer expectations for environmental and nutrition issues together. From a practical standpoint, it would be impossible for business executives to separate the issues.

For the new 2020-2025 Dietary Guidelines for Americans, an advisory committee report is expected later this spring, and then the official report will come out a few months later. This week, the Union of Concerned Scientists (UCS) released a policy brief (.pdf) encouraging the federal government once again to favorably consider including sustainability in the official report.

A growing body of research shows that shifting what we eat could improve the health of the population and the planet. However, the US government has declined to incorporate this evidence into federal food policies. As government agencies develop the 2020-2025 Dietary Guidelines for Americans, a review of recent studies on dietary patterns and sustainability by the Union of Concerned Scientists and colleagues shows that current US dietary advice may not support the long-term environmental sustainability of the food system. This policy brief outlines key actions and recommendations for federal agencies and policymakers to help protect public health and food security for generations to come.

The policy brief draws on a literature review published this week [updated March 16] in Advances in Nutrition, by UCS researchers and several Friedman School community members, including Rebecca Boehm (alum), Nicole Tichenor Blackstone (faculty), and Naglaa El-Abbadi and Salima Taylor (students).

I hope the government does include sustainability. Just as the dietary guidelines help consumers and government agencies understand the connections between diet and health, by providing a steady and sober summary of the balance of evidence in a complex literature, it would be valuable to do likewise for environmental sustainability. This is not a mere digression into a side topic. In the 2020-2030 decade, the climate emergency will be central to almost all policy debate on major social and economic decisions, including decisions about the food system. If political pressure from selected agricultural industries causes these issues to be excluded from the dietary guidelines, federal food and nutrition policy will be hampered for years to come.

Dietary guidelines, processed meat, and risk of cancer

In a public comment submitted today, my colleagues Fang Fang Zhang, Jennifer Pomeranz, and I encourage the 2020-2025 Dietary Guidelines Advisory Committee (DGAC) to evaluate the entire scientific literature on processed meat and colon cancer risk.

The DGAC is the external committee that summarizes the scientific evidence on nutrition and health, which two federal departments, USDA and DHHS, then use in writing the actual Dietary Guidelines for Americans, an influential document in U.S. nutrition policy.

USDA and DHHS have determined that the 2020-2025 DGAC may only address topics that were explicitly given in a list of questions by the departments.

One of the questions is: "What is the relationship between dietary patterns consumed and risk of certain types of cancer?"

Our public comment today recommends that the DGAC include the entire scientific literature on processed meat and cancer risk, as part of its systematic review of evidence on dietary patterns and cancer.

Why is this even in doubt?

As our recent article in the Milbank Quarterly recounts, in the previous 2015-2020 Dietary Guidelines for Americans, the federal government muddled its message on processed meat and cancer.

On the one hand, it included lower intake of processed meat in a list of characteristics of healthy eating patterns: "Lower intakes of meats, including processed meats; processed poultry; sugar-sweetened foods, particularly beverages; and refined grains have often been identified as characteristics of healthy eating patterns."

On the other hand, it said that processed meats can be recommended as long as sodium, saturated fats, added sugars, and total calories are within limits. This latter favorable comment in the official policy document from USDA and DHHS had no basis in the earlier independent scientific report from the 2015-2020 DGAC.

Even though it is not responsible for the final DGA report, we think the 2015-2020 DGAC report may have overlooked some of the important research on processed meat and colon cancer, by interpreting the words "dietary patterns" too strictly, screening out some research on processed meat merely because this one food category is not a "dietary pattern."

Why is the cancer risk from processed meat important?

The issue is important because the best available systematic literature reviews concluded that consuming processed meat increases the risk of colon cancer. In particular, see authoritative reports from the International Agency for Research on Cancer and the World Cancer Research Fund and American Institute of Cancer Research.

Luxian Zeng, Fang Fang Zhang, other colleagues, and I recently reported in the Journal of the Academy of Nutrition and Dietetics (JAND) on trends in processed meat intake based on data from the Nutrition and Health Examination Survey (NHANES). While red meat declined, processed meat held steady in recent years. This issue is big enough to matter for national nutrition policy.

What are the policy implications of ignoring this issue?

Currently, far from encouraging reductions in processed meat intake, the federal government supports advertising and marketing programs to increase consumption. The semi-public checkoff programs have been covered previously in this blog. Just to give one current illustration, here is advertising from the federal government's pork checkoff program for bacon and ice cream. If the Dietary Guidelines for Americans were based on a full evaluation of the scientific literature about processed meat and colon cancer, it might facilitate policies to encourage reductions, or at the very least a halt to these advertising programs encouraging yet more processed meat consumption.

National Pork Board advertising endorsed by USDA.

Preventing chronic disease (evidence versus Google's featured snippets)

Scientifically dubious information may sometimes appear in Google's "featured snippets."

An online search -- in Google of course -- turns up all sorts of scammy sites offering advice on how to optimize web content so that it appears in these featured snippets.

When we Google "preventing Parkinson's", we get advice to consume the co-enzyme CoQ10, but research in the journal Neurological Science found no benefit.

Similarly, when we Google "preventing colon cancer," we get a featured snippet with advice from Mayo Clinic (a reputable source):

Make lifestyle changes to reduce your risk
You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:

• Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
• Stop smoking. Talk to your doctor about ways to quit that may work for you.
• Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.

That is mostly good advice, with one big omission. Authoritative research summaries from the World Cancer Research Fund (WCRF) and American Cancer Society (ACS) recommend lowering risk of colorectal cancer by eating less processed meats (such as bacon and sausage).

These authoritative sources appear further down the list of Google results for "preventing colon cancer," overshadowed by the incomplete information in the featured snippet.

Gershoff Symposium, April 27

The 2018 Gershoff Symposium, on April 27, will feature 4 presentations:

• "Food Labeling Chaos" (Keynote). Kathleen Merrigan, Executive Director of Sustainability and Professor of Public Policy at George Washington University. Merrigan was Deputy Secretary of Agriculture in the Obama administration. She led a fascinating workshop on sustainability in dietary guidance in 2014, leading to a 2015 commentary in Science (whose co-authors included my Tufts colleague Tim Griffin and myself), which was part of the discussion and debate around sustainability issues in the 2015 Dietary Guidelines for Americans. 
• "Deal or No Deal, What Do You See in a Label?" John Bernard, Professor, Department of Applied Economics & Statistics, University of Delaware. John is an old friend from graduate school at Cornell. His recent research addresses fascinating topics in food labeling, including (a) one article in Food Policy anticipating what will type of mess will happen if cloned meat and dairy products enter the marketplace without labeling rules, and (b) another article in Food Quality & Preference with amusing results about how much more highly consumers rate the taste of equivalent food products when they are labeled organic compared to when they are not labeled.
• "State of the Evidence: Organic vs. Non-Organic." Qi Sun, Associate Professor of Medicine, Brigham and Women's Hospital and Harvard Medical School.
• "Creating a Sustainable Food System: What Matters and What Counts?" Amanda Beal, President and Chief Executive Officer, Maine Farmland Trust. Beal is a Tufts Friedman School alum and a great source of insight about local farming and fisheries in Maine.

A registration link and more information about this annual symposium, in honor of former dean Stanley Gershoff, are here.

U.S. Food Policy: An Introduction (Second Edition)

The book Food Policy in the United States: An Introduction, whose second edition has just been released in the Earthscan Food and Agriculture Series (Routledge), prepares readers to make their own distinctive contribution to a lively conversation about our food system.

There is no reason why food policy debate should continue to mirror the current dysfunctional state of our national political debate. We can do better.

The first in a series of related videos asks: Who should study U.S. food policy?

Routledge provides a free sample chapter on the author Q&A page.

Are checkoff programs good for nutrition? (#AAEA2016)

Harry Kaiser (Cornell University) and I have enjoyed putting together a lively session later today, discussing the question: Are checkoff programs good for nutrition?

In a friendly debate, Harry will argue "yea" and I will argue "nay" (though in fact we agree on many aspects of these programs). John Crespi from Iowa State will be independent discussant, and Kristin Kiesel of UC Davis will moderate.

The session takes place in the Berkeley room 2:45pm today, Aug 2, at the conference site for the Agricultural and Applied Economics Association (AAEA) here in Boston.

Harry was one of my professors in graduate school at Cornell in the 1990s, and he is a leading economist in the evaluation of generic advertising effects on food consumption. This recent infographic from the beef checkoff program highlights his work (click for full size).

Food policy in Brazil emphasizes enjoyment of meals and criticizes overprocessed foods

The Food and Environment Reporting Network (FERN) and the Nation have an in-depth article by Bridget Huber this week on national food policy in Brazil, led by Carlos Monteiro and colleagues. Dietary guidelines in Brazil bluntly criticize highly processed foods while simultaneously communicating a healthy enjoyment of food more generally.

Monteiro came to believe that nutritionists’ traditional focus on food groups and nutrients like fat, sugar, and protein had become obsolete. The more meaningful distinction, he started to argue, is in how the food is made. Monteiro is most concerned with the “ultraprocessed products”—those that are manufactured largely from industrial ingredients like palm oil, corn syrup, and artificial flavorings and typically replace foods that are eaten fresh or cooked. Even by traditional nutritionists’ criteria, these sorts of products are considered unhealthy—they tend to be high in fat, sugar, and salt. But Monteiro argues that ultraprocessed foods have other things in common: They encourage overeating, both because they are engineered by food scientists to induce cravings and because manufacturers spend lavishly on marketing.

This blog has previously discussed the way Brazilian dietary guidelines combine nutrition and sustainability issues, in a manner that is not done in the United States. I helped colleagues at George Washington University organize a conference on sustainability issues in dietary guidance in 2014, at which Monteiro was a speaker, and the Brazilian experience has influenced my sense of what might be possible in the United States.

Regarding enjoyment of healthy meals, Huber writes:

Pleasure is an essential part of the new guide, which frames cooking as a time to enjoy with family and friends, not a burden. And instead of sterile prescriptions for the number of grams of fat and fiber to eat each day, the guide focuses on meals. Sample meals were created by looking at the food habits of Brazilians who eat the lowest amount of ultraprocessed foods. One dinner option is a vegetable soup followed by a bowl of acai pulp with cassava flour, as one might eat in the Amazon region. Another plate, more typical of São Paulo, is spaghetti, chicken, and salad. If these seem like ordinary meals, that would be the point, one of the researchers said: They wanted to counteract the idea that a “healthy” diet is one full of unfamiliar and even unpleasant foods.

Exercise, weight loss, and the food environment

A clear and effective video from Vox explains why exercise is not directly a cure for overweight. The video's message -- rightly -- is that we should pay close attention to food intake and the quality of the food environment.

The video does note that physical activity has strong direct effects on health. Nonetheless, I would have emphasized the benefits of physical activity even more strongly than the video does.

My first reason for giving physical activity yet more credit is a bit geeky. Much of the research literature uses regression models where a weight measure is the outcome variable and physical activity or exercise is the main explanatory variable. To make sure the analysis really reflects the "effect" of exercise, the studies include additional control variables such as food intake and general health. Yet, when we step up our physical activity, we may experience improvements in health, mood, and feelings of self-efficacy. Including explanatory variables for food intake and health status may risk "over-controlling" for other factors. We may eat healthier when our mood is good. We may avoid periods of poor health and inactivity that lead to weight gain. Perhaps stepping up our physical activity deserves some of the credit for improvements in weight that are being picked up by the control variables.

My second reason for giving physical activity yet more credit is more superficial. For some people who seek to lose weight, the ultimate goal is to look better. I have mixed feelings about whether this is good psychology, but it does seem to be common. Stepping up physical activity may affect posture, muscle tone, and confidence, making people look better in ways that the scale may not register.

But the video certainly is right that researchers in recent years have become more careful about not over-promising physical activity as a complete weight loss program on its own.

 

Debating the role of government and markets in food policy

Politico's Agenda today has a special issue on food policy.

It prominently highlights the great work of my Friedman School colleagues Miriam Nelson and Christina Economos:

Miriam Nelson got the call while she was rock climbing in Canada: It was the White House assistant chef, of all people, summoning her to a closed-door meeting with the new first lady of the United States. It was 2009, Nelson was one of the nation’s top experts on nutrition and exercise, a Tufts University professor at the time, and she wasn’t the only one: a half-dozen more got the same surprise invitation....

With Democrats holding control of Congress, Nelson and the others realized, the East Wing was formulating a big policy push that would use all available levers of the federal government to improve how Americans eat. They wanted a new law to make school lunches healthier; they saw ways to deploy federal stimulus dollars on new cooking equipment in public school cafeterias and to use government financing to get grocery stores into poor communities where fresh food wasn’t readily available. They wanted to overhaul the federal nutrition label so it confronted shoppers more directly with calorie counts. Even the more symbolic side of American food policy was coming under the microscope: A reboot of the decades-old “food pyramid” that told families how to balance a meal.

“You really got the sense that this is something that she was likely to take on,” recalled Nelson, who was asked for advice on nutrition and exercise programs that worked. “It was very exciting.”

I also enjoyed Danny Vinik's interesting poll of food policy experts. It seems revealing that most of the respondents would have supported stronger language in the Dietary Guidelines encouraging Americans to consume less meat (after all, that was the view of the more independent scientific Dietary Guidelines Advisory Committee), limits on healthy food marketing to kids, and state or local initiatives to tax soda. Separately, the majority also supported greater efforts to reduce hunger. But, the majority did not support mandatory GMO labeling. I was included in the sample, and, in each case, I voted with the majority.

A brief digression on survey sampling: The poll is not a scientific survey of observations randomly sampled from a larger population of food policy experts in general. Instead, it is a tabulation of responses from a particular sample of researchers and writers on food policy topics. As such, it seems important to let readers know who was sampled -- which is exactly what Vinik does in a list at the bottom of the article. That seems to me a completely legitimate reporting approach. Also, it is fun to try to guess which of my colleagues gave which answers.

The new Dietary Guidelines are broad and respectful of diverse views

The federal government's Dietary Guidelines for Americans 2015 were released this morning. This official publication of the Departments of Agriculture and Health and Human Services will offend nobody. Certainly, any student of food policy can appreciate why its authors made the decisions they made. The departments are under intense pressure from Congress, and an official document of this type necessarily reflects a broad and inclusive area of common ground.

The Washington Post headline says the new guidelines mean, "go ahead and have some eggs." Marion Nestle observes that the guidelines use "protein" as a euphemism for "meat" and "added sugars" as a euphemism for soda. Although the guidelines do include a phrase about "decreasing intakes of meats, poultry, and eggs," especially for men and teen boys, they exclude all mention of environmental sustainability, thereby avoiding considerable controversy. The Washington Post article gives the final word not to a nutrition scientist but to Nina Teicholz, a journalist and low-carb author who is on the board of the Nutrition Coalition, which lobbies for changes to federal dietary guidance. The coalition will have little to complain about in the official 2015 guidelines.

If you place less value on political common ground and more value on sharpness, detail, and authority of scientific evidence review, breadth of topic coverage, and basic writing with vigor, don't be distressed that official departmental guidelines are not really the place to find such virtues. You may continue to read and cite the earlier unofficial external Dietary Guidelines Advisory Committee report for years to come.

The new official guidelines retain the outer shell of the Advisory Committee's interest in food policy and economics topics. Chapter Three sets up a framework for considering a wealth of approaches to improving diets in every possible setting: homes, schools, worksites, communities, and food retail settings. The official recommendations have a mild character, suggesting quite rightly that somebody should do something, but without assigning specific difficult tasks to particular actors. For example, this chapter's strategies include:

Expand access to healthy, safe, and affordable food choices that align with the Dietary Guidelines and provide opportunities for engaging in physical activity.

In addition to that sound recommendation in the official guidelines, I will continue to read a related passage from the unofficial Dietary Guidelines Advisory Committee report.

Moderate to strong evidence shows that targeted environmental and policy changes and standards are effective in changing diet and physical activity behaviors and achieving positive health impact in children, adolescents, and adults....

It will take concerted, bold action on the part of individuals, families, communities, industry, and government to achieve and maintain healthy dietary patterns and the levels of physical activity needed to promote a healthy U.S. population.This will entail dramatic paradigm shifts in which population health is a national priority and individuals, communities, and the public and private sectors seek together to achieve a population-wide “culture of health” through which healthy lifestyle choices are easy, accessible, affordable and normative—both at home and away from home.

In such a culture, preventing diet- and physical activity-related diseases and health problems would be much more highly valued, the resources and services needed to achieve and maintain health would become a realized human right across all population strata, the needs and preferences of the individual would be seriously considered, and individuals and their families/households would be actively engaged in promoting their personal health and managing their preventive health services and activities. Health care and public health professionals would embrace a new leadership role in prevention, convey the importance of lifestyle behavior change to their patients/clients, set model standards for prevention-oriented activities and client/employee services in their own facilities, and manage patient/client referrals to evidence-based nutrition and comprehensive lifestyle services and programs. Communities and relevant sectors of our economy, including food, agriculture, private business, health care (as well as insurance), public health and education, would seek common ground and collaborations in promoting population health. Initiatives would be incentivized to engage communities and health care systems to create integrated and comprehensive approaches to preventing chronic diseases and for weight management.

The new official guidelines are quite nice, but, in addition, the 2015 Dietary Guidelines Advisory Committee report will retain a place on my syllabus.

KIND Snacks petitions FDA to change the definition of "healthy"

In early 2015, FDA wrote a warning letter to KIND Snacks, calling out the company for using the term "healthy" on nut-filled snacks that -- among other things -- had a level of total fat level exceeding the official standards for "healthy" foods.

At the time, media sources included quotes from leading national figures in nutrition policy, who pointed out that recent editions of dietary guidelines do not come down hard on total fats (instead focusing on the types of fats). For example, NPR quoted Walter Willett.

Willett says that the FDA's letter to Kind is based on outdated guidelines, at least when it comes to nuts. The government updates its Dietary Guidelines for Americans every five years, and the latest report from the advisory committee for those guidelines does indeed point to research supporting the inclusion of nuts in a healthful diet.

But the FDA seems to be lagging, in part because the agency doesn't revise its guidelines as frequently. "I think there's wide consensus that nuts are a healthy food," Willett says.

Last week KIND Snacks petitioned FDA, asking for a change in the definition of "healthy." Here is part of the firm's publicity in support of that petition, making the rhetorical point that current rules focus too much on fat content and not enough on processing or sugar content. 

What do you think?

A couple complications:

1. This post was spurred by an email from a food policy student, who also has worked for KIND Snacks. I think I would have chosen this topic anyway, but introspection cannot quite confirm that. 
2. Some KIND Snacks are sweetened, and, in any case they are packaged manufactured foods, not quite so simple as the nuts in the image above.

Food policy is never simple.

Neurosurgeon and presidential candidate Ben Carson is asked about his endorsement of dubious Mannatech supplement company

Presidential candidate Ben Carson was asked during debate this week about his ties to Mannatech, maker of a dubious nutrition supplement based on "glycoscience."

Carson responded:

I didn’t have an involvement with them. That is total propaganda, and this is what happens in our society. Total propaganda. I did a couple of speeches for them, I do speeches for other people.

Jim Geraghty, who thoroughly covered these ties already last January in the National Review, yesterday pointed out that Carson's response appears to be untrue, or in Geraghty's words, "bald-faced lies." Geraghty explains how the paid speeches were compensated highly enough that reasonable people will recognize this as a paid sponsorship arrangement.

Indeed, that point becomes obvious with even a brief look at Carson's video about Mannatech, in which he praises the company for "trying to find a way to restore the natural diet as a medicine, as a mechanism for maintaining health." Carson says:

The wonderful thing about a company like Mannatech is that they recognize that when God made us, he gave us the right fuel, and that fuel was the right kind of healthy food.

Geraghty describes the company's "long, checkered past" in the National Review.

Science commentary: It makes sense to include sustainability in dietary guidelines

In a commentary today for the journal Science, several colleagues and I explain why we think it is fine to include considerations of environmental sustainability within the scope of the U.S. Dietary Guidelines for Americans (DGA).

The challenge is how to produce the most healthful foods in a way that sustains employment in the agricultural sector and minimizes adverse impacts on the environment. All major constituencies concerned with food security and health must wrestle with sustainability and dietary choices together. It is right and proper for the DGA process to lead the way.

The commentary, which may be gated (sigh), grew out of a fall 2014 workshop initiated by the first author, Kathleen Merrigan, who was until 2013 the Deputy Secretary of Agriculture, and who now leads the sustainability program at George Washington University. Other authors include Tim Griffin, myself, Kim Robien, Jeanne Goldberg, and William Dietz. This issue also had been the focus of an earlier workshop, to which I contributed, for the Food Forum of the Institute of Medicine in 2013.

In an era of global climate change, the issue of sustainability is so important to the food system as a whole that policy-makers and the general public will inevitably find themselves considering environmental issues as part of almost any discussion of food choices. See for example the recent article in Nature by David Tilman and Michael Clark.

There is no way for the U.S. government to avoid having people talk about sustainability and dietary guidance jointly. That matter is already settled. The only question on the table is whether we will all need to struggle to compile multiple authoritative sources on these issues or instead whether -- as seems more sensible -- both issues will be addressed together in the same coherent federal guidance document.

Other countries include sustainability issues in their dietary guidance. For example, dietary guidelines in Brazil and the Netherlands take a comprehensive approach.

The U.S. Dietary Guidelines Advisory Committee (DGAC), whose report provides the scientific basis for the upcoming release of the 2015 Dietary Guidelines for Americans, already discusses sustainability in a sober and moderate way. It seems wise for the actual Dietary Guidelines to do likewise.

Unfortunately, some in Congress have taken steps to instruct federal agencies to limit the scope of the guidelines to "diet and nutrient intake" only. It would be absurd to limit guidelines to just those two topics. Along with preventing discussion of sustainability, the proposed language from Congress would prevent the guidelines from discussing physical activity. Yet, we all recognize that food and physical activity should be discussed together.

It is already within the mandate of the Dietary Guidelines to consider food security -- access by all people at all times to enough food. Far from being a loose cannon, the Dietary Guidelines Advisory Committee recognized environmental sustainability as sufficiently important to food security to deserve at least a brief and restrained mention. It would be silly to reverse that persuasive and sensible approach.

British Medical Journal (BMJ) gives low-carb journalist Nina Teicholz an outlet to blast the Dietary Guidelines Advisory Committee (DGAC)

The British Medical Journal (BMJ) this week published an article/editorial by journalist Nina Teicholz blasting the Dietary Guidelines Advisory Committee (DGAC) for recommending diets with less saturated fat, red meat, and salt. In it, Teicholz offers a powerful stew of selective scientific evidence and blistering attacks on the integrity of opponents.

Teicholz is a journalist and author of The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. Her disclosure statement in the BMJ mentions honorariums for medical, restaurant, financial, meat, and dairy industries. She slams DGAC committee members for conflicts of interest with vegetable oil producers and, in one case, some funding from the California Walnut Commission. This tit-for-tat focus on conflicts might come out in Teicholz' favor ... if we lived in some upside-down universe where walnut growers and vegetable oil manufacturers controlled U.S. agriculture policy and the meat and dairy industries were oppressed and powerless minions.

Teicholz is most upset with the DGAC for "not only deleting meat from the list of foods recommended as part of its healthy diets, but also actively counseling reductions in 'red and processed meats.'" But the Dietary Guidelines Advisory Committee never has and never would recommend deleting meat. I have no idea what passage of the report she thinks recommended deleting meat.

As for eating less meat, the context for the DGAC recommendation is that per capita annual meat consumption in the United States is a remarkable 120 kg, far higher than the average amounts consumed globally (42 kg) or in other rich countries that have lower rates of chronic disease than we do, such as Japan (46 kg). The United States has plenty of room to improve healthy diets without eating as much meat as we currently do.

Teicholz never mentions why leading health authorities recommend moderating our consumption of red meat and processed meat in particular. For example, the American Institute of Cancer Research (AICR) advises less processed meat because of concern about colon cancer. Teicholz mentions "heart disease" 11 times, but ignores cancer (the two occurrences of the word "cancer" are later off-hand dismissals of concerns about saturated fat). It's not that Teicholz disputes the evidence, she simply never mentions it.

Teicholz offers rich and sanctimonious criticism of the DGAC for sometimes using its own best summary of the evidence without the formality of a systematic review. A systematic review is a process through which a research team with relevant expertise carefully defines the diet-health relationship under study, prepares a written protocol in advance for choosing eligible research articles, and systematically classifies and reports the results. The striking thing about the DGAC is that -- more than with any other such work that I know -- it is usually easy to trace the committee's reasoning from its conclusions, back to systematic reviews in the government's free online Nutrition Evidence Library (NEL) and other authoritative research associations, such as the American Heart Association (AHA). But, wow, does Teicholz really hate the AHA, describing the respected association as mere pawns of, once again, the vegetable oil industry.

The contrast between DGAC and Teicholz in transparency of selecting and reporting evidence is striking. A systematic review is precisely the opposite of what Teicholz does in her own work, as a journalist deep-diving willy-nilly into idiosyncratically selected sub-sections of a vast and complex literature, choosing those studies that support her argument and agree with the conclusions of her best-selling book.

Others have already prepared a line-by-line evisceration of the Teicholz article, and committee members submitted a response to the BMJ online site. Here, more broadly, for your comparison with Teicholz' article in BMJ, consider the reasonableness of the approach and conclusions used by the DGAC.

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat; and low in sugar sweetened foods and drinks and refined grains.

That won't sell so many books, but it makes sense to me. I hope it earns a more fair reading from you than it has from Teicholz.

Friedman School Student Research Conference on "The Future of Food and Nutrition" (April 11)

The Friedman School's graduate student-organized research conference on "The Future of Food and Nutrition" will take place here in Boston on April 11 (registration here).

In addition to the excellent student research program, this annual event has particularly notable speakers this year. The topic is especially timely in light of the new Dietary Guidelines Advisory Committee report, which for the first time discussed sustainability issues along with nutrition issues.

I look forward to moderating the plenary discussion panel:

We are excited to announce that this year’s keynote speaker is Angie Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at USDA. Her talk is titled “Nutrition Policy at a Crossroads: Application and Evolution of the Dietary Guidelines for Americans”. We will also have a panel discussionfocused on sustainable diets and implications for dietary guidance in the US. Our panelists include Dr. Miriam Nelson (Member, 2015 DGAC), Dr. Andrew Rosenberg (Director, Center for Science and Democracy, Union of Concerned Scientists) and Julia Pon (Director, Double Value Coupon Program, Wholesome Wave).

Even the beef checkoff program links environmental sustainability and dietary guidance

Should the Dietary Guidelines for Americans address environmental sustainability issues?

The Dietary Guidelines Advisory Committee (DGAC) report earlier this year included these issues in its executive summary, giving them far higher profile than they ever previously have had in the nation's most august dietary guidance process. The federal government uses this DGAC report as one input into the official guidelines, which will be released later this year.

Here is the sober and sensible passage of the DGAC report that generates all the fuss:

The major findings regarding sustainable diets were that a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet. This pattern of eating can be achieved through a variety of dietary patterns, including the Healthy U.S.-style Pattern, the Healthy Mediterranean-style Pattern, and the Healthy Vegetarian Pattern. All of these dietary patterns are aligned with lower environmental impacts and provide options that can be adopted by the U.S. population. Current evidence shows that the average U.S. diet has a larger environmental impact in terms of increased greenhouse gas emissions, land use, water use, and energy use, compared to the above dietary patterns. This is because the current U.S. population intake of animal-based foods is higher and plant-based foods are lower, than proposed in these three dietary patterns. Of note is that no food groups need to be eliminated completely to improve sustainability outcomes over the current status.

As Dan Charles reported for NPR in December, many in Congress are furious. More recently, Mike Hamm from Michigan State, who served as a consultant to the DGAC, summarized much of the controversy after the report's release.

One of the great things about the U.S. process of developing dietary guidelines is that the public comments are transparent. The DGAC report is generating thousands of comments from supporters and opponents alike.

For example, here is an excerpt from comment #1234, enraged about the inclusion of sustainability issues:

Are you crazy? This is supposed to be a free America - now you want to tell us what to eat, how to eat, how much tv to watch (what about the case of my husband who is disabled - television gives him something to do, yet you want to limit that??

I believe this goes too, too far, especially where you want us to limit meat due to climate sustainability. Climate change, global warming - whatever you have been told to call it so that low-info Americans believe whatever garbage you feed them - is made up. We all know it. Even the UN admitted it is for economic reasons to get rid of a capitalistic society and become socialist which has been proven time and time again to NOT work.

But, is it really so crazy to link sustainability and dietary guidance?

Here is part of comment #3359 from Kim Stackhouse with the federal government's beef checkoff program (the semi-public producer board that promotes increased beef consumption):

Ensuring a sustainable food supply is undoubtedly one of the greatest societal challenges we face. By 2050, we will need to produce 70 percent more food than we do today in order to feed the growing population.

Ensuring a sustainable food supply requires balancing efficient agricultural production with environmental, social and economic impacts. Only by looking holistically at food production practices can our food systems meet demand and minimize unintended consequences. The beef industry recognizes the important role it plays to produce food in a more sustainable manner and has committed to a journey toward more sustainable beef.

Setting aside the selective summary of the actual environmental evidence, these public comments are striking. Even the beef checkoff program acknowledges the value of "looking holistically at food production practices."

There is no doubt that Americans will be discussing environmental sustainability and dietary guidance together -- jointly -- for decades to come. In writing the Dietary Guidelines for Americans, the federal health and agriculture departments may help clarify the evidence, or they may ignore the issue that everybody is thinking about. If they stick their heads in the sand, the public will just turn elsewhere for dietary guidance information that rightly considers the future of the environment.

U.S. food supply inconsistent with dietary guidance

The U.S. food supply is far out of balance with dietary recommendations. A new study in the Journal of the Academy of Nutrition and Dietetics quantifies the gaps. In brief, the U.S. food supply was quite unhealthy already by the 1970s and has not improved noticeably since then.

The authors -- Paige Miller, Jill Reedy, Sharon Kirkpatrick, and Susan Krebs-Smith -- use a measure more commonly applied to individual survey data, called the Healthy Eating Index. Getting this measure to fit national food supply data from USDA requires a bit of shoe-horning, but nonetheless the results are persuasive about the basic picture. As the video below illustrates, for example, Americans have for decades had all the protein we could possibly need, but the food supply for vegetables falls much short of recommendations.

The video -- from the National Collaborative on Childhood Obesity Research (NCCOR) -- generally thinks of the food supply as "upstream" and food consumers as "downstream." A possible implication is that policies should alter the food supply so that downstream consumers could eat more healthfully. It should be noted that people in the food business, and perhaps most agricultural economists too, give greater weight to consumer preferences for unhealthy food as a key driver of the gap the study describes. Economists may suggest that the food supply would provide plenty of healthy food if that's what consumers actually would buy.

Still, nutrition scientists and agricultural economists have in recent years been doing better than ever at listening to each other's perspectives on these big questions. For example, in an accompanying article, which calls on dietitians to get involved in designing federal policies such as the Farm Bill, Claire Zizza reviews agricultural economics perspectives as well as public health perspectives on how such policies should be evaluated. It all makes a lively conversation.

 

Independent analysis of the Healthy Weight Commitment Foundation trillion calorie pledge

An independent evaluation reported today that the Healthy Weight Commitment Foundation succeeded in removing more than a trillion calories from the U.S. food supply, as originally pledged.

Through this pledge, leading food and beverage manufacturers had promised to reduce total food energy sold by 1 trillion calories, from a 2007 baseline through 2012.

Using Nielsen scanner data from supermarket electronic cash registers and from a random sample of consumer households, Shu Wen Ng, Meghan M. Slining, and Barry M. Popkin estimated calorie trends and reported the results today in the American Journal of Preventive Medicine.

To some extent, the accomplishment simply reflects downward trends in the packaged food and beverage sector, which is losing market share over time -- mostly to the restaurant industry but perhaps partly to healthier food options. In an accompanying editorial in the same journal, Dariush Mozaffarian asks whether the pledge is a "marketing ploy."

As a rule, nutritional targets -- and other quantitative information intended for general audiences -- should be stated in easily explained per-capita terms. Who knows what a trillion calories in aggregate even means?

It reminds me of silly infographics that take a common-sense concept and convert it to some obscure immense quantity. For example, in my in-box this month, I have an infographic from Guiding Stars, which aims to report the amount of running required to burn off the average American's sugar consumption. Sugar is estimated at 3 pounds per week (a sensible way of explaining the quantity), while the amount of running is stated as 2.7 times around the globe over a lifetime (an irrelevant quantity designed merely to appear large to easily-impressed readers).

Today's study by Ng, Slining, and Popkin nicely goes beyond its assessment of the original trillion calorie pledge and also reports the modest but non-negligible resulting calorie changes on a per-capita basis. To the extent that the results reflect improvements in particular categories, such as sugar sweetened beverages, the findings are still reasonably upbeat.

The Healthy Weight Commitment Foundation -- and the companies that made pledges -- will be delighted by today's coverage in major media outlets such as U.S. News and World Report, which states the good news broadly: "Obesity continues to plague the country, but it appears as though food companies are beginning to take strides in helping alleviate the problem."

Dariush Mozaffarian: to address chronic disease, we should focus on food patterns rather than nutrients

In my school's latest Wednesday seminar, the epidemiologist and cardiologist Dariush Mozaffarian methodically builds the scientific case for amending our traditional obsession with total fat (as a culprit in obesity) and saturated fat (as a culprit in heart disease).

Then, from about minute 47:30 to 50:30 in the video, he drops the hammer. Summarizing this large body of research, he argues that federal dietary guidance to address chronic disease should focus on food patterns rather than nutrients. In sharp criticism of the "Go, Slow, Whoa" guidance that still appears on the website of the National Heart, Lung, and Blood Institute, Mozaffarian concludes, "This is insane!."

The speech implies big changes afoot. And I don't just mean for federal dietary guidance. This summer, Mozaffarian took the helm as the fourth dean of my school, the Friedman School of Nutrition Science and Policy at Tufts University.

Dean Dariush Mozaffarian, MD DrPH-Global Dietary Priorities and Policies to Improve Cardiometabolic Health from Tufts Friedman School on Vimeo.

Patent office okays patent for "Diane's Manna"

The federal government last December allowed a patent (U.S. patent 8,609,158) for "Diane's Manna," a supplement that is ...

so potent that it removes or alleviates depression, mood disorders, Attention Disorder symptoms, thought disorder, mental illness, pain, right lip retardation symptoms, physical problems, Lymph Node cancer and many other illness symptoms. 

Yes, that's quite a trick, but there's more:

It is extremely strong or potent and can be made weak to make your little Attention deficit child normal. It is an incredible mood stabilizer and reduces psychosis. Use it for cancer patient and for people with pain issues. It works.

According to the patent, the supplement is "made from distinctly and uniquely combined and processed interchangeable seed and seed derivatives."

The inventor, Diane Elizabeth Brooks of Sandy, Oregon, has an unusual background, as the patent explains:

I am a minister who has prayed my way through this medicine. 

The inventor provides extensive evidence of effectiveness based on her own personal experience.

I have used all of the ingredients listed. These all are used for the claims. Please know that these are continual medicines and are very good if you take them and make sure your body is filled with these before you ever stop or halt using them. 

This drug is to be used by all people who hate going to the Pharmaceutical companies or going to doctors who have a great problem in diagnosing our illnesses. It is for the people to judge. I am very ill. When I get sick, it is imperative to make myself a large dose of this recipe and take a large dose for many days. It causes a mild psychosis in me during this phase. I have to endure that to get to the right dose. I always lower the dose to my needs, but only after I have flooded my body with enough of the medicine to create this continuum. 

The primary examiner at the U.S. Patent and Trademark Office (USPTO) was Michael Meller.

This patent was recognized this week by the Electronic Frontier Foundation as the "Stupid Patent of the Month." I heard about it on BoingBoing. The EFF points out that the patent should have been rejected on any number of grounds, "including enablement, indefiniteness, and utility."

I think awarding such a foolish patent undermines the government's credibility as an authority that can help consumers sort through conflicting evidence on diet and health claims.