I mentioned yesterday that whenever something comes out saying that “everything you thought you knew about nutrition is wrong,” it’s a sign that some skepticism may be in order.
Here is another example: The article on the “sugar conspiracy“ by Ian Leslie published in The Guardian. This strongly criticizes the work of Ancel Keys, whose work was largely but by no means exclusively responsible for the diet-heart hypothesis linking excessive intake of animal fats to heart disease risk.
I love conspiracy theories as much as anyone else and appreciated how the author made his case for this one. My sense of his article was that it had grains of truth (Gary Taubes and Cristin Kearns, for example, report that Keys had funding from the sugar industry). But the overall thrust of the article seemed excessively hyperbolic and based on selective picking of the data (cherry-picking).
Going through the piece line by line to identify errors and misinterpretations was not something I thought worth the trouble.
Fortunately, someone else did.
Katherine Docimo Pett, a master’s degree candidate in biochemical and molecular nutrition at Tufts University, who blogs as Nutrition Wonk, sent me her detailed critique of the paper. She explains:
So I decided to look into the Seven Countries Study and I found a number of occasions where “The Sugar Conspiracy” misinterprets the evidence. So buckle yourselves up, conspiracy theorists, because in this post, I’m going to cover the history of the diet-heart hypothesis – namely The Seven Countries Study and the subsequent research mentioned in “The Sugar Conspiracy.”
If you can wade through her lengthy analysis, you will be hard pressed to disagree with her conclusion:
In “The Sugar Conspiracy,” the author makes a lot of assumptions about intent, the usefulness of epidemiology, and even the conclusions of papers. However, upon closer inspection, a lot of his evidence doesn’t hold up under scrutiny.
The idea that Keys claimed in his Seven Countries Study that correlation proved causation is false. Keys just said that cholesterol is a mediator for heart disease and that saturated fat raises cholesterol, both of which later turned out to be true. The Menotti “reanalysis” did not find that sugar is more closely correlated with heart disease than fat, and even if it did, it is a simple regression – it controlled for zero confounders, way fewer than were controlled for in the original Seven Countries Study. Finally, there is plenty of evidence to suggest that substituting saturated fatty foods in favor of unsaturated fats is a good idea [Clarification: she must mean substituting unsaturated for saturated].
It is absolutely worthwhile to debate the merits of all scientific findings or even the merits of an entire field, like epidemiology. Scientists, even nutrition scientists, do this all the time. The problem, though, is that if basic facts are actually based on misinformation, you can’t build a real case for or against anything.
Footnote: Sarah Tracy, an historian at the University of Oklahoma, has been working on a biography of Ancel Keys for quite some time. I can’t wait for her to get it done (she probably can’t either), as it is likely to give us a thoughtful, balanced account of the significance of his work.
A couple of weeks ago, I mentioned several new studies that elicited much media attention. I am now getting around to them.
Let’s start with the article in the BMJ about newly discovered data from the Minnesota Heart Study purportedly casting doubt on the risks of saturated fat (here’s what the Washington Post said about it).
The BMJ article concluded:
Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.
I’ve been at this game long enough to guess that any statement suggesting that everything you thought you knew about nutrition is wrong ought to raise red flags and call for more than the usual degree of skepticism.
Here are some sensible and, yes, skeptical comments about this study:
From Julia Belluz of Vox
But there were a few major problems with the research. The study involved men and women of an average age of 52 who had been admitted to a nursing home and six state mental health hospitals because they were sick. The researchers who conducted the meta-analysis note the “results are not necessarily generalizable to populations without mental illnesses or living outside nursing homes.”
Another issue: The study followed 9,423 women and men, but only a quarter of the participants followed the diets for more than a year. Altering one’s diet for a short period of time — especially in old age — would not necessarily affect one’s long-term health risks….
…Some of the biggest controversies surround saturated fats. Scientists disagree about the extent to which saturated fats contribute to important health outcomes like heart disease, stroke, and cancer. The available research does suggest, however, that there are health benefits from replacing saturated fats with unsaturated fats in the diet, and that eating lots of nutrient-poor carbs (like sugary cereals, soda, and white bread) instead of fat is a bad idea.
From David Katz, to whom I am often grateful for taking on such things, writes that this study
tested something that nobody expert in nutrition is recommending: an extremely high dose of omega-6, linoleic acid…we already got the memo that this is a dubious proposition.
With all due respect to the BMJ authors, I personally found it a bit odd that they stated the following: “A key component of dietary guidelines has long been to replace saturated fat with oils rich in linoleic acid…” The current Dietary Guidelines for Americans, let alone the far better 2015 Dietary Guidelines Advisory Committee Report, make no such recommendation. Searching for any mention of linoleic acid, I found it only in the appendices in the context of descriptions and definitions, not in any of the actionable guidance. While the current Dietary Guidelines do recommend limiting saturated fat intake, the replacement encouraged is a balance of healthful oils, such as olive, and the fats found natively in, as noted, nuts, seeds, avocado, and fish.
From Martijn Katan, the Dutch lipid biochemist who did the original work demonstrating the cholesterol-raising effects of trans fats, writes in an e-mail:
I have not had time to study the BMJ article on the Minnesota Heart Study in detail. However, some of my colleagues did, and I think that their conclusions are correct:
The only new thing about the present study is that they revived the long disproved hypothesis that lowering cholesterol causes various diseases. Hundreds of thousands of patients in statin trials have proven this wrong….
 Katan, M.B., 1986. Apolipoprotein E isoforms, serum cholesterol, and cancer. Lancet 1, 507–8.
 Trompet, S.,et al ., 2009. Apolipoprotein E genotype, plasma cholesterol, and cancer: a Mendelian randomization study. Am J Epidemiol 170, 1415–21.
My bottom line on this one
It confirms the value of basic dietary advice: Eat a variety of relatively unprocessed foods, mostly plants (fruits, vegetables, grains, beans, nuts), balance calories, and enjoy what you eat!
Do this and food fatty acids will balance out too and you won’t need to give them another thought.
Whenever you read a headline suggesting that everything you know about nutrition is wrong, roll your eyes, eat something delicious, and wait for confirming studies to come along before deciding to ignore that basic advice.
Talk about soda politics! I can hardly believe it but soda taxes have become an issue in the Democratic primary campaign.
This started when Hillary Clinton came out in favor of Philadelphia Mayor Jim Kenney’s proposed soda tax.
I’m very supportive of the mayor’s proposal to tax soda to get universal pre-school for kids. I mean, we need universal pre-school. And if that’s a way to do it, that’s how we should do it.
Given the Clinton Foundation’s long-standing relationship with Coca-Cola, this was unexpected.
In short order, Bernie Sanders distanced himself from her position:
I do not support Mayor Kenney’s plan to pay for this program with a regressive grocery tax that would disproportionately affect low-income and middle-class Americans. I was especially surprised to hear Hillary Clinton say that she is “very supportive” of this proposal. Secretary Clinton has vowed not to raises taxes on anyone making less than $250,000 per year. For reasons that are not clear, she has chosen to abandon her pledge by embracing a tax that targets the poor and the middle class while going easy on the wealthy. That approach is wrong for Philadelphia, and wrong for the country.
This, in turn, induced Paul Krugman, who seems to have little love for Sanders anyway, to weigh in:
It does seem worth pointing out that progressivity of taxes is not the most important thing, even when your concern is inequality. Notably, Nordic countries — very much including Denmark, which Sanders has praised as a model — rely heavily on the VAT, which is a regressive tax; but they use that revenue to pay for a strong social safety net, which is much more important.
If we add in the reality that heavy soda consumption really is destructive, with the consequences falling most heavily on low-income children, I’d say that Sanders is very much on the wrong side here. In fact, I very much doubt that he’d be raising the issue at all if he weren’t still hoping to pull off some kind of political Hail Mary pass.
Soda tax proponents wish that Sanders had better understanding of the health issues.
Proponents say Diabetes is regressive.
Here’s information from the table from Soda Politics on framing the soda-tax debate (see page 385).OPPONENTS SAY ADVOCATES SAY Taxes are a blunt instrument of government intervention. Taxes can encourage healthier food choices while generating needed revenue. No compelling evidence links sodas to obesity or other health problems. Research sponsored by independent agencies, not soda companies, clearly links soda consumption to overweight and poor health. Soda taxes are regressive. They disproportionately hurt poor people. Diabetes is regressive. Obesity and diabetes disproportionately hurt poor people. Governments should stay out of personal choice. Governments should protect the health of citizens. Soda choice is a matter of personal responsibility. Taxpayers fund health care costs. Obesity and diabetes are matters of social responsibility. Soda companies are already making healthful changes to their products. Soda companies heavily market sugary beverages. Soda sales have declined while obesity rates remain high; Sodas cannot be responsible for obesity. Obesity rates are stabilizing as soda sales decline. Sales of some other sweetened beverages are increasing. All should be taxed. Sodas are not cigarettes or alcohol; They do not cause the same level of harm. The health effects of sodas increase health care costs for everyone. Soda taxes lead to unintended consequences; Decreases in consumption will be offset by other sources of calories. Cigarette taxes decreased smoking; Let’s try taxing sodas and see whether it works. Everyone opposes nanny-state soda taxes. Soda taxes linked to health programs have strong bipartisan support from public health organizations, city officials, and policy centers.
Mars, the very same company that has been trying for years to position chocolate as a health food, appears to be joining the food movement, and big time.
Take a look at its GMO disclosure statement on the back of this package of M&Ms.
If it’s too small to read, the statement is in between MARS and the green Facts Up Front labels)
PARTIALLY PRODUCED WITH
And this is before Vermont’s GMO labeling rules come into effect in July.
Mars Food will help consumers differentiate and choose between “everyday” and “occasional” options. To maintain the authentic nature of the recipe, some Mars Food products are higher in salt, added sugar or fat. As these products are not intended to be eaten daily, Mars Food will provide guidance to consumers on-pack and on its website regarding how often these meal offerings should be consumed within a balanced diet. The Mars Food website will be updated within the next few months with a list of “occasional” products – those to be enjoyed once per week – and a list of “everyday” products – including those to be reformulated over the next five years to reduce sodium, sugar, or fat.
Last year, the company supported the FDA’s proposal to require added sugars labeling with a Daily Value percentage on the Nutrition Facts panel.
It also said it would stop using artificial dyes in its candies.
How to interpret these actions? I’m guessing they mean that the movement for good, clean, fair food has gained enough traction to put long-established food brands on notice: make your products healthier for people and the environment, or else.
I did a blurb for the first edition of this book, and also for this second edition:
The global food economy may seem remote from daily experience, but Jennifer Clapp explains how it affects every aspect of what we eat and, therefore, our health and welfare. From the standpoint of globalization, food is no longer merely a source of nourishment or a mark of culture but a fungible commodity in the global food economy. Food unpacks and clarifies the mind-numbing complexities of today’s global food marketplace, international trade, transnational corporations, and financial markets. It provides the information and tools advocates can use to redesign the global food economy to promote fair trade, food justice, and food sovereignty.
My friend and colleague Maya Joseph submits this entry for the category Annals of American “Healthy” Dining:
I was at an Olive Garden last night and, while I greatly appreciated the calorie labeling, which prevented me from ordering the 1,480 calorie entree I was hankering after, I was unsettled by the promotional materials urging us to order two entrees for the price of one (you’re supposed to take one home…).
She includes this link to the two-for-one offer (Oops. It’s no longer available. Whew).
Comment: OK, they offered customers a choice.
But unlimited breadsticks and two Fettucine Alfredos?
The mind boggles.
Yesterday, the House Appropriations Committee passed the 2017 Agriculture-FDA spending bill.
As Politico explains (behind a paywall, unfortunately)
The bill would boost funding for rural development to $2.9 billion and allocate an additional $33 million over fiscal 2016 levels for the FDA to carry out the requirements of the Food Safety Modernization Act.
This isn’t nearly enough to permit FDA to carry out its functions.
The committee also passed amendments to:
Can someone please explain to me why agricultural appropriations committees have jurisdiction over FDA and FDA spending is linked to agriculture spending? OK, this is an historical anomaly; the FDA used to be part of USDA, but that was nearly a century ago.
Today’s FDA is part of the public health service, along with the CDC.
Shouldn’t health committees decide how much funding should go to FDA’s mandate to protect public health?
The USDA has just done a write up on a study it funded in collaboration with the National Honey Board: Consumption of Honey, Sucrose, and High-Fructose Corn Syrup Produces Similar Metabolic Effects in Glucose-Tolerant and -Intolerant Individuals.
This was one of the 12 industry-negative studies I posted to my collection of 168 industry-funded studies from March 2015 to March 2016.
The USDA article explains:
Controversy exists over whether all sweeteners produce the same metabolic effects in consumers despite the sweeteners’ chemical similarities. A study conducted by U.S. Department of Agriculture (USDA) researchers indicates that consuming lower amounts of added sugars is a more effective approach to health than finding a sugar that is more neutral in terms of its health effects…Volunteers [consuming honey, white cane sugar, or HFCS] did not show any differences in blood sugar levels based on the dietary sugar source. In addition, blood levels of triglyceride, an indicator of blood fat concentrations (a marker for heart disease risk), increased in response to all three sugars tested.
White cane sugar is 50% glucose and 50% fructose, linked together (but quickly separated in the body). Honey and High Fructose Corn Syrup are glucose and fructose, already separated, but with slightly higher percentages of fructose. Biochemically, they are not all that different.
So the results of this study, disappointing as they may have been to the Honey Board, were predictable on the basis of basic sugar biochemistry.
A reader, Eddie Pugsley, sends this photo taken at the Walgreens on Nepperhan Avenue, Yonkers, NY. His comment: “I guess, if you buy the Coke & Pepsi specials you’ll be happy about their diabetic supply savings..?”
I’m in Mexico City doing talks for El Poder del Consumidor, the advocacy group in part responsible for Mexico’s soda tax. I had some time to be a tourist yesterday afternoon and got to see the Diego Rivera murals at the Palacio Nacional.
These are enormous, and stunning. They deal with the history of Mexico in conflict and in peace. Look closely, and you see Rivera’s deep respect for Mexico’s traditional food culture.
Along the corridor flanking the main mural, for example, is a painting above a plaque listing what the world owes Mexico—corn, obviously—but also beans, tobacco (oops), chocolate, hemp, and tomatoes.
Other panels also deal with corn—in this one, production.
Another shows how corn is used.
The corner panel at the end of the corridor is devoted to chocolate.
Along the way, quieter panels display the harvest of fruits and vegetables.
Leave the Palacio, cross the Zócolo, and you come to the Coca-Cola bar and toy store.
A brief look at Mexico’s food culture, then and now.