Saturday Stories

A wonderful interview with Marion Nestle on how Big Food hijacked nutrition.

Colby Vorland on conflicts of interest and the American Dietetic Association.

The New York Times on whether or not science should be a prerequisite for medical school.

Steven Novella of Neurologica explains why you might want to stop taking your calcium supplement!

Babies like watermelons!

Sadly my baby's probably too big to recreate this Funny Friday's now viral YouTube video.

Have a great weekend!

Breaking News: Canada's Sodium Working Group's Recommendations

It's not often I'm thrilled with something the government's had a hand in but today I'm thrilled with the recommendations that have come from Canada's Sodium Working Group.

CSPI posts the highlight reel which includes:

Reducing the Nutrition Facts table’s “daily value” for sodium from 2,400 mg to 1,500 mg, mandate standardized serving sizes as the basis for reporting nutrition information, and retrofit labels to facilitate improved consumer understanding after the US Institute of Medicine’s report on front-of-pack food labelling is published in 2011

Mandate prominent placement of sodium and calorie information at chain restaurants serving standardized fare;

Ensure regulatory standards for products using protected names like cheese and pickles to permit the use of low-sodium salt substitutes;

Include sensible sodium limits in government food-service policies and procurement contracts (e.g., for schools, hospitals, and the military);

Retrofit advice in Canada’s Food Guide on caloric intake and sodium.

But please folks, don't hold your breath until these get done. Not to be a killjoy but I can't help but think of the wonderful recommendations that came out of Canada's 2006 Trans-fat Task Force which have yet to be acted upon.

England's health officials continue to prove they're among the dumbest in the world.

Hat tip to my friend and colleague Arya Sharma for his tweet which pointed me to the latest from across the pond.

Apparently Anne Milton (pictured up above) the British parliamentary under-secretary of state for health, has called upon GPs to start calling their patients "fat" so as to "inspire" them to take, "personal responsibility" for their weight.

Of course the notion that obesity is a disease of the individual, of "personal responsibility" and not a disease of a toxic, obesogenic environment is one near and dear to the food industry's so-called heart.

As I've reported this week on my blog, the messages the food industry want shouted from the rooftops include:

- There's no such thing as a bad food.
- Obesity is caused by inactivity and treated through exercise.
- It's about "balancing" energy in vs. energy out.
- It's about taking "personal responsibility".

And lately British health officials have been singing all four.

I know I have some British readers and wondering if you folks might know - is there a transparent means whereby money spent by the food industry lobby on your politicians can be tracked? Given what's come out of the mouths of your officials these past 2 years, I'd be willing to wager tens of millions of pounds are involved.

To add to Anne's crystal clear clarion call of stupidity, here's a quick recap of what were once only the wet dreams of British food marketers yet now are their daily realities:

Jan. 2009 - England's government launches 3 year "Change4Life", food industry funded and government overseen program replete with useless messages of the, "Eat less, exercise more" camp with emphasis on the "exercise more".

June 2010 - England's Health Minister Andrew Lansley slams Jamie Oliver inspired school lunches campaign that led to the removal of processed garbage from middle schools.

July 2010 - England's Health Minister Andrew Lansley spews the food industry party lines of, "there's no such thing as a bad food", to the Faculty of Public Health in London while informing them of the British government's divestment of any involvement in Change4Life. He then tells them he's turning over direct control of Change4Life to the food industry and in return for their continued funding he's promised not to regulate them.

July 2010 - England strips their Food Standards Agency (FSA) of their food labeling responsibilities because they had been pressing for the adoption of front-of-package traffic light labeling. Now that labeling's been formally returned to the hands of industry's best friend Andrew Lansley, guess what? No traffic lights.

All I can say is good thing they've no longer got an exclusively socialized medical system over there for so long as the likes of Anne Milton and Andrew Lansley are at their health system's helm, that system's in big trouble.

Can extremely low fat diets lead to obscene conflicts of interest? (Dean Ornish edition)

That's certainly the question I'd love to ask Dr. Dean Ornish.

Who's he?

Well he's perhaps the most famous low-fat diet guru of all time and the founder and President of the non-profit Preventive Medicine Research Institute in Sausalito, California.

His career has been exceedingly illustrious. Ornish is a best-selling author, a world-class researcher, an award-winning physician and he was voted "one of the most interesting people of 1996" by People magazine, one of the "TIME 100" in integrative medicine, one of LIFE magazine's "fifty most influential members of their generation" and one of Forbes magazine's "seven most powerful teachers in the world."

Pretty lofty stuff.

So what does one of the most powerful teachers in the world and one of the most influential members of their generation want to teach you?

Usually it's how to eat an almost insanely low-fat diet but not when he's working for the Mars chocolate, confectionery and beverage conglomerate. When he's working for Mars he wants to help feed you Big Food's party line that,

Feeling good is all about balance. It’s important to balance work life with time spent with loved ones, it’s important to find a balance between what we eat and how much we exercise

He also wants to feed you the other Big Food party line that there's no such thing as a "bad food", something I blogged about a ways back.

Now I don't disagree entirely with Ornish in that a sustainable lifestyle does need to include such things as chocolate bars, but I'm not about to start selling them for Mars Inc.

Not so with Dr. Ornish. His message, that joy is a powerful medicine, when grabbed hold of by Mars' marketers gets spun into this message taken directly from their website,

"At Mars, our products provide opportunities for people across the world to practice pleasure in balance every day. Mars chocolate products should be enjoyed in moderation as part of a healthy and well-balanced lifestyle – and bring people small moments of joy in the process. In fact, our vision is to make more moments of joy in more places, bringing more smiles into the world. We’re in the business of making people feel good, and that means being a part of a balanced and healthy lifestyle that supports your physical and emotional well-being. .

We love being a part of many different kinds of chocolate moments.

• A child sharing a treat with a friend.
• Parents enjoying a quiet moment together at the end of a busy day.
• A small celebration after a successful meeting.
• Sweet memories from holidays, parties and gatherings.

More Moments. More Places. More Smiles."

Not less chocolate - more.

More chocolate in more places.

How many joyful chocolate moments is Ornish helping to sell? Again, according to the Mars website,

"At Mars, we're responsible for more than 500 million chocolate moments each day! And our vision is to make more moments of joy in more places - bringing more smiles into the world."

And now Dr. Dean Ornish, one of our generation and world's most influential teachers, lends (sells) his powerful voice to that vision, a vision that can be summarized as.

More, not less; there is no such thing as a "bad food"; and really all you need is a balanced active lifestyle.

Shameful is too soft a word to describe Dr. Ornish's cozy conflict of interest with Mars.

That said I probably shouldn't be surprised. After all, before Dean Ornish was using his world class influence and teaching abilities to sell chocolate bars, he was using it to sell Big Macs.

"Exercise is Medicine" (and a great smokescreen for Big Food)

Further to my post from yesterday regarding the innocence by association test for conflicts of interest comes "Exercise is Medicine".

Exercise is Medicine is a laudable organization whose aims are,

"To make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States.

and,

"For physical activity to be considered by all health care providers as a vital sign in every patient visit, and that patients are effectively counseled and referred as to their physical activity and health needs, thus leading to overall improvement in the public's health and long-term reduction in health care cost."

It has great buy-in too with a massive list of supporters that include the who's who in health promotion.

So why am I knocking it?

It's not so much that I'm knocking it, more I'm questioning its role, as Big Food conspiracist that I am, I see a dual role for Exercise is Medicine.

On the one hand its role is to encourage exercise for health - a true, valuable and important endeavour.

But on the other hand, its other role is to serve its founding sponsor Coca-Cola, in the promotion of the assertion that the best means to deal with our current obesity epidemic is to ensure that people exercise. Or to put it another way, that sugary soda's not a bad thing so long as you live an active lifestyle.

The "obesity can be treated effectively through exercise alone" message, crucial to the purveyors of high calorie foods everywhere, is indeed spread by Exercise is Medicine,

"This is just the beginning. Hopefully, the insurance and medical communities will soon realize that the most effective way to treat and prevent a wide variety of obesity-related conditions is through exercise."

- Press release from Exercise is Medicine founding partner Anytime Fitness, June 28th, 2010

"As a whole, people are significantly less active today, even compared to just 20 years ago. When we look at the data that shows how diseases like obesity and diabetes are rapidly increasing, there's an obvious correlation to the decline in physical activity.

Even though everyone has heard it before, something as simple as taking the steps instead of an elevator can make a big difference. It's too easy to consume a massive amount of calories and sit at a desk all day - both of which have negative consequences to our health. We need to remember to take breaks during the day to take a ten minute walk. Any bit of activity is better than being sedentary."

- Press release for Exercise is Medicine quoting Sandra Billinger, PT, PhD, FAHA, research assistant professor in the KU Physical Therapy and Rehabilitation Science department, June 9th, 2010

"Dr. Sallis poses this question to health-care providers: "What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly."

Well, there is one prescription available to you that will do just that. It's called exercise."

- Dr. Robert Sarlis, past President of the American College of Sports Medicine (a founding partner of Exercise is Medicine) to Charleston's Sunday Gazette-Mail, March 7th, 2010

"The International Health, Racquet & Sportsclub Association (IHRSA) announced today their partnership with the Institute of Lifestyle Medicine (ILM); a division of Harvard Medical School's Department of Physical Medicine and Rehabilitation and of Spaulding Rehabilitation Hospital. IHRSA and ILM join together to fight the global obesity epidemic by working to improve physician knowledge of the science and benefits of physical activity, and to increase the practice of physician-prescribed exercise."

- Press release from Active Doctors, an organization whose President is part of Exercise is Medicine's Task Force, May 19th, 2009

"In an effort to decrease the prevalence of childhood obesity and promote physical activity to children, the American College of Sports Medicine (ACSM) has announced a partnership with the Youth Fitness Coalition (YFC). This partnership will feature ACSM's Exercise is Medicine(TM) initiative, designed to encourage America's patients to incorporate physical activity and exercise into their daily routine, and YFC's signature program, Project ACES (All Children Exercise Simultaneously)."

- Press release from the American College of Sports Medicine, March 10th, 2009

The message that obesity can be prevented or treated with exercise is an important one to the food industry as it shifts the blame for obesity from the consumption of their calorific products to a decline in fitness, a link which at best is described as debatable and at worst, inconsequential. It also fuels Big Food's ability to preach about what Coca-Cola refers to as, "an active, balanced lifestyle", McDonald's a, "balanced, active lifestyle" and "it's what i eat and what i do ... i'm lovin' it" campaign, Pepsi a, "balanced lifestyle", Unilever a, "balanced diet and lifestyle", Mars a "well-balanced lifestyle", and Nestlé' a, "balanced lifestyle".

That the message is being spread by Exercise is Medicine and sometimes directly and other times by extension by the exceedingly reputable organizations included in Exercise is Medicine 397 signatory partners helps embolden the purveyors of calorific foods to make statements like Pepsi CEO's Indra Nooyi's,

"If all consumers exercised, did what they had to do, the problem of obesity wouldn't exist."

And Coca-Cola's President Sandy Douglas',

"And we're for active lifestyles, with more than 6 billion Diet Coke packages helping the National Heart, Lung and Blood Institute remind women about the importance of staying active and maintaining a healthy weight, and our support of physical activity initiatives like Exercise Is Medicine."

Ultimately, while exercise is indeed medicine, Exercise is Medicine again illustrates the risks and inherent conflicts of interest consequent to Big Food partnerships, and I would argue these risks and conflicts shouldn't come as a big surprise.

Why?

Because Big Food doesn't care about your health; they don't care about your well-being; and they don't care if you exercise. All Big Food cares about is whether or not you'll buy their products, and certainly every single dollar they spend on programs such as Exercise is Medicine are earmarked to further that goal. A goal Coca-Cola's certainly meeting as last week they reported North American sales volume growth for the first time in two years which led Coca-Cola CEO Muhtar Kent to proclaim,

"We firmly believe that North America with be a growth market of great opportunity for the next 10 years and beyond"

So while the notion of Big Food capitalizing on their investments in programs such as Exercise is Medicine to fuel sales isn't in and of itself surprising, what is surprising to me is the fact that well intentioned individuals, along with top-notch medical and public health organizations, don't seem to realize it, or simply don't care.

[For some further reading on what I think about "balanced, active lifestyles", please have a read of the article I co-authored this year, Running Away with the Facts on Food and Fitness, published in the journal Public Health Nutrition]

Expanding the Definition of Conflict of Interest - Big Food Edition

This month the Annals of Family Medicine published a point/counterpoint discussion of last year's awful decision by the American Academy of Family Physicians (AAFP) to partner up with Coca-Cola.

Howard Brody, arguing that the AAFP's deal was clearly a conflict of interest, explains that by definition a conflict of interest,

"arises when individuals or organizations enter into a set of arrangements which under usual circumstances would lead to the reasonable presumption that they will be tempted to put aside their primary interests in favor of a secondary set of interests."

and that,

"It is true that where a conflict of interest exists, no actual unethical behavior has necessarily arisen."

Meaning that simply having the opportunity for a conflict of interest is in and of itself a conflict, and certainly having Coca Cola fund and/or write educational materials on beverage consumption for the AAFP in return for $600,000 sure smells like a conflict of interest waiting to happen.

Howard then does a fine job of describing the most common arguments against perceived conflicts which include:

Premature accusations: How can you accuse the AAFP of having a conflict? You haven't even seen the educational materials yet!

The other party's not evil: There's no conflict - just because Coca-Cola contributes to obesity doesn't make their parent company evil.

It'd be wrong not to engage: Conflict or not, it'd be wrong not to enter into a partnership with Coca-Cola because we'd be missing out on an opportunity to influence their behaviour for the good.

Counterpoint was delivered by Lori Heim, current President of the AAFP (I interviewed her about the Coca-Cola partnership when it went down).

Basically Lori's argument boils down to Howard's premature accusations piece as she notes,

"Integral to this discussion is the transparency of the interaction, the rules governing the interaction, and the outcome of the agreement. Examined only in a philosophical vacuum, issues of conflict of interest and the underlying ethics governing behavior become an ideological straitjacket."

She then goes on to talk about the AAFP's great core values, the scourge of obesity in society and finally how great the educational materials are on the AAFP site and cites two statements that explicitly call for a reduction in sugar sweetened beverages.

You know, I agree with Lori - you can't examine the partnership in a philosophical vacuum, nor a practical one. What do I mean? Well while the duelling Annals pieces were an interesting read, I think they're rather beside the point as I'd argue there's a further litmus test for a conflict of interest, one that a philosophical or practical vacuum would ignore. I'm calling it the, "innocence by association" test.

Here's the basic premise: If your partnership with a corporation, regardless of the details or outcomes of that partnership, provides that corporation with the ability to use your partnership as a means to defend products, practices or positions that in turn are contrary to your or your organization's primary obligations, then partnership with said corporation should rightly be described as a conflict of interest.

In this case, if Coca Cola can or does use their partnership with the AAFP, an organization whose obligations lie with the betterment and protection of public health, to defend products, practices or positions which in turn are harmful to public health, then AAFP's partnership with Coca-Cola should be considered a conflict of interest.

So can or do they?

Let's ask Sandy Douglas, President of Coca-Cola North America.

Here's Sandy on April 6th 2010 in the Atlanta Journal-Constitution citing Coca-Cola's partnership with AAFP as part of his case for why soda taxes aren't necessary or appropriate,

"We're for education, through support for organizations such as the American Academy of Family Physicians, which is providing consumers science-based information about sweeteners."

Want to see another similar type example?

Here's Coca-Cola Canada's Amy Laski defending Coca-Cola's sponsorship of the 2010 Winter Olympics (sorry the article itself isn't linkable),

"We formed a red ribbon panel of experts from organizations such as the Heart and Stroke Foundation and the Canadian Diabetes Association to nominate torchbearers for Coca-Cola who committed to leading more active lifestyles and encouraging others to do the same."

Maybe I'm just a simple man, but to me it seems pretty black and white. If you enter into a partnership with an organization whose products are anathema to you or your organization's aims it's a conflict of interest. The fact that the AAFP doesn't admit to that in the case of Coca-Cola is shameful and disingenuous and frankly I'd have preferred it if they simply came out and admitted the truth - yes, it's a terrifically unsavory conflict of interest, but hey, we needed the money.

Brody, H. (2010). Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues The Annals of Family Medicine, 8 (4), 354-358 DOI: 10.1370/afm.1140

Heim, L. (2010). Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics The Annals of Family Medicine, 8 (4), 359-361 DOI: 10.1370/afm.1146

Saturday Stories

Bad Science's Ben Goldace on how he was slandered by an incompetent millionaire.

A touching love story from Auschwitz.

Good, Bad, and Bogus explains why small studies aren't all that exciting.

Dan Gardner talks politics, privacy and governmental hypocrisy.

The dumbfoundingly eloquent Dr. David Katz doesn't disappoint with his take on the next generation of weight loss drugs.

Stormtroopers invade the NYC subway.

How badly do I wish I was part of this Funny Friday's video making?

Once a Star Wars nerd, always a Star Wars nerd.

Have a great weekend!

Health Halos and Kellogg's new FiberPlus Antioxidants Cereals

Brian Wansink coined the term, "Health Halo" when he was studying consumer behaviours when faced with healthier sounding front of package statements and restaurants perceived as healthier.

Words like, "low fat", "low carb", while not formal health claims in terms of function, still have strong influence on consumer perception, ingestion and likely purchase.

I couldn't help but think of Dr. Wansink's work yesterday when I read an article in the Big Food e-tradezine Food Navigator. The article detailed Kellogg's new cereal brand that they claim, "makes no health claims".

One of my favourite blogs, Fooducate, covered this cereal a few days ago, but when I saw that, "makes no health claims" piece, I had to weigh in myself.

The cereals, will be part of Kellogg's new FiberPlus Antioxidants Cereals and their launch comes right on the heels of the Federal Trade Commission's slap for Kellogg's suggesting their cereals improved, "Immunity".

Want to take a guess at how many ingredients there are in their Kellogg's FiberPlus Antioxidants Berry Yogurt Crunch? I guarantee you'll be wrong.

82!

Here they are in all their splendor with the 12 different sugar sources highlighted for good measure.

WHOLE GRAIN WHEAT, SUGAR, RICE, CHICORY ROOT FIBER, MIXED BERRY FLAVORED CLUSTERS (ROLLED OATS, SUGAR, OAT FIBER, CORN BRAN, CORN SYRUP, WHEAT STARCH, HONEY, YELLOW CORN FLOUR, CORN CEREAL, CANOLA OIL, NATURAL AND ARTIFICIAL FLAVORS, FRUCTOOLIGOSACCHARIDES, MODIFIED CORN STARCH, SOYBEAN OIL, SALT, CARAMEL COLOR, MALT EXTRACT, STRAWBERRY POWDER, CITRIC ACID, GLYCERIN, BHT [PRESERVATIVE], RED #40, BLUE #2, CELLULOSE GUM, GREEN #3, BLUE #1, RED #40 LAKE, BLUE #2 LAKE), MODIFIED WHEAT STARCH, SOLUBLE CORN FIBER, MALT FLAVORING, SALT, ROLLED OATS, FRACTIONATED PALM KERNEL OIL, INULIN, OAT FIBER, NONFAT DRY MILK, CORN BRAN, MODIFIED CORN STARCH, GLYCERIN, WHEAT STARCH, CORN SYRUP, HONEY, APPLE PUREE CONCENTRATE, YELLOW CORN FLOUR, STRAWBERRIES, BLUEBERRIES, VITAMIN A PALMITATE, NATURAL AND ARTIFICIAL FLAVORS, KIWI JUICE CONCENTRATE, WHEY, MONOGLYCERIDES, SOY LECITHIN, CORN STARCH, NONFAT YOGURT POWDER (HEAT TREATED AFTER CULTURING), CANOLA OIL, INVERT SUGAR, STRAWBERRY JUICE CONCENTRATE, ASCORBIC ACID (VITAMIN C), CINNAMON, FRUCTOOLIGOSACCHARIDES, RED RASPBERRY JUICE CONCENTRATE, GUAR GUM, BLUEBERRY JUICE CONCENTRATE, NIACINAMIDE, MALT EXTRACT, CARAMEL COLOR, CITRIC ACID, VITAMIN D, ALPHA TOCOPHEROL ACETATE (VITAMIN E), BHT (PRESERVATIVE), PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), RIBOFLAVIN (VITAMIN B2), THIAMIN HYDROCHLORIDE (VITAMIN B1), BETA CAROTENE (SOURCE OF VITAMIN A), FOLIC ACID, VITAMIN B12.

So what does 82 ingredients including not 1, not 2, not 3, not 4, not 5, but 6 different artificial colours (including one that now has to have a warning label slapped on it in the EU) buy you nutritionally?

170 calories per cup dry (not wonderful for a cereal)
200mg of sodium (meh)
10g of fibre (holy crap - no pun intended)
12g of sugar (3 teaspoons worth)
And a smattering of vitamins including some "antioxidants"

Kellogg's of course isn't stupid. They're simply expecting consumers who don't take the time to think about what they're eating and read food labels to be saying, "you had me at antioxidants" when they walk down the cereal aisle.

Sure, there's no formal health claim, but that doesn't change the fact that this Frankencereal is banking on the words "FiberPlus" and "Antioxidants" to serve a health halos whose job it is to dupe you into thinking that what's in the box is good for you, which it probably is.....if you're a shareholder.

A rose may be a rose but perhaps a calorie's not a calorie

File this one under cool data!

Simple study published in Food and Nutrition Research to look at the differences between whole foods and processed foods and the calories the body utilizes to metabolize them (something called diet induced thermogenesis and also known as the thermic effect of food).

18 subjects were enrolled in a cross-over study (meaning they each ate both test meals) whereby the thermic effect of food was measured following the ingestion of two different cheese sandwiches.

One cheese sandwich was made with cheddar cheese and a multi-grain bread containing whole sunflower seeds and whole-grain kernels, while the other cheese sandwich was made with white bread and processed cheese.

Both sandwiches contained the same number of calories.

The results?

While subjects reported that the whole food sandwich was tastier, both sandwiches conferred equal levels of satiety, and in a not completely surprising, but ultimately fascinating result, eating the whole food sandwich led to roughly double the thermic effect of food than the processed sandwich and that effect lasted nearly an hour longer than the processed meals.

Why wasn't this surprising?

Whole grains take longer to digest due to the protective fibrous sheath that processing removes. We also would expect the whole grain sandwich to have more protein and fat (which it did) which in turn delays the speed with which the body is able to break down its accompanying carbohydrates.

Calorically what does this mean?

It takes more energy to release the nutrients of the whole food sandwich with the differences between meals resulting in a 9.7% increase in the net energy gain of the processed food meal.

Translation?

Eat processed crap and you're effectively consuming 10% more calories than you would be were you eating healthier whole food alternatives.

Now this is a small study and certainly it's too soon to extrapolate this across the board, but were it to be true for all processed foods, given their viral spread across the developed world these past 30 years, and given that a 10% net energy gain is huge, this might be another great reason to ditch the Wonder bread and Velveeta.

Barr, S., & Wright, J. (2010). Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure Food & Nutrition Research, 53 DOI: 10.3402/fnr.v54i0.5144