The Long Angry Arm of Coca-Cola

Not Actually a Photo of Dr. Isra Levy

First some brief background.

This May Ottawa's Public Health (OPH) department released their, Healthy Eating, Active Living Strategy which outlines some of the steps and recommendations OPH believes will further the health of Ottawans.

One of the items identified as an unhealthy behaviour is the consumption of sugar-sweetened beverages and the strategy made the following singular recommendation therein:

"Launch social marketing campaigns focusing on walking and sugar sweetened beverages."

Oh the horror!

How dare OPH suggest that we launch a social media campaign that both champions walking and cautions against the consumption of sugar sweetened beverages?

What's amazing too is that here we are in late August and suddenly a strategy report released in May saw 117 news headlines about it show up last week.

Where did all this outrage come from?

The long angry arm of Coca-Cola.

And it's an amazing story too as it clearly demonstrates that those boys from Atlanta know what they're doing when it comes to commanding spin.

What'd they do?

First they launched a letter writing campaign. According to OPH no less than 14 identical copies of an angry letter (signed by 14 different local Coca-Cola executives) were circulated to various City Councillors and the Mayor.

Next they literally flew in a ringer Coca-Cola suit from Atlanta to chew out Dr. Isra Levy the City's Chief Medical Officer.

More importantly though they changed the message.

Suddenly the issue was no longer about whether or not we consume too many sugar-sweetened beverages and whether or not there's anything we can do to help reduce their unhealthy consumption (especially by our children). Nope, now the issue was our "civil liberties" and the bad guy was no longer sugared soda, it was Dr. Isra Levy.

And what insanity does Dr. Levy condone? Putting aside that all he's ever actually recommended is a social media campaign and that he once admitted under questioning that regulation was theoretically part of the city's toolkit (why let facts get in the way of a great narrative?) let's say media letter writers, news columnists, the internet's angry commentators and Coca-Cola were all right! That Dr. Levy instead has some master plan to ban the sale of sugar-sweetened beverages in publicly funded institutions? That suddenly you found yourself unable to buy Coca-Cola in your local city funded arena, community center or workplace?! I mean that'd be just steps away from full on fascism, no? You'd sure think so if you read the truly laugh-out-loud alarmist piece in the Ottawa Sun by Anthony Furey entitled, "Back Off Pop Police: Tell Ottawa's Top Doc He Has No Right to Ban Your Liberties Along with Drinks" and where he invites readers to write Dr. Levy to tell him what they think about his nefarious plans.

What's really telling about all of this though is that by creating such a big stink Coca-Cola's showing their cards. They're scared. If the specter of a social media campaign in a single line in an Ottawa, Ontario, Canada Public Health report is enough to launch a letter writing campaign and fly muscle in from Atlanta clearly they feel they've got a huge public relations problem on their hands and while they certainly did succeed in changing the subject here in Ottawa the way this all went down - it's actually quite heartening.

All that said, Dr. Levy's had a rough ride. If you're reading this and think that perhaps his identification of sugar-sweetened beverages as problematic is a fair one, why not drop him a line and let him know you support his efforts.

Justin Sherwood, Refreshments Canada President, Defends Sugar

I don't envy the food industry spin doctors their jobs, as at least some of them must realize how ridiculous their arguments are to folks who take the time to critically appraise them.

Take for instance Justin Sherwood. Mr. Sherwood is the President of the Canadian Beverage Association and just this week he was tasked with defending sugar as a contributor to obesity, diabetes and heart disease.

Let's review Mr. Sherwood's letter, but seen through the lens of Kelly Brownell and Kenneth Warner's Big Tobacco Playbook - whereby they came up with a list of plays that the food industry has co-opted from the early days of the fight to prove tobacco harmful:

Focus on personal responsibility as the cause of the nation’s unhealthy diet.

"The Canadian beverage sector is committed as an industry to providing a variety of products for every lifestyle and occasion through our expanding portfolio of low-and no-calorie beverages, smaller package sizes and through our voluntary, national industry calorie label initiative, Clear on Calories, that provides clear calories information on front of pack to enable informed purchasing decisions and consumption"

Raise fears that government action usurps personal freedom.

Mr. Sherwood failed to make this play (though he did make it here)

Vilify critics with totalitarian language, characterizing them as the food police, leaders of a nanny state, and even “food fascists,” and accuse them of desiring to strip people of their civil liberties.

Mr. Sherwood failed to make this play (though he did make it here)

Criticize studies that hurt industry as “junk science.”

"Contrary to the vast amounts of nutritional science available, the article, based on one controversial study, inaccurately tries to paint the consumption of sugar-sweetened beverages as a direct contributor to obesity, heart disease and diabetes."

Emphasize physical activity over diet.

Mr. Sherwood failed to make this play (though he did make it here)

State there are no good or bad foods; hence no food or food type (soft drinks, fast foods, etc.) should be targeted for change.

"Research shows that no one single food or beverage can be linked to obesity, and scientific evidence does not support that sugar, in any of its various forms, is a unique cause of any health condition."

"No one single food or beverage alone is responsible for people being overweight or obese. All calories count from whatever food or beverage they come from."

Plant doubt when concerns are raised about the industry.

Mr. Sherwood failed to make this play (though he did make it here)

So is Mr. Sherwood right? Is there only a single study out there linking sugared soda as a primary contributor to rising rates of obesity, heart disease and diabetes?

Of course not.

For a brief summary of literature, here's one from Harvard's Frank Hu.

I'm not sure how much money Mr. Sherwood takes home each year but I sure hope it's a great deal. It'd have to be in order to make up for the impact his statements must have on how folks might perceive him as a person.

Kelly D. Brownell, & Kenneth E. Warner (2009). Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? The Milbank Quarterly, 87 (1), 259-294 PMID: 19298423

[For those interested, I've posted Mr. Sherwood's remarks below in their entirety as I couldn't seem to find a way to link. They were published in the London Free Press on April 10th, 2012 and a hat tip to blog reader Gay for sending my way]

"I read with interest the article, "Sugar can be found in unexpected places (April 9 2012)" in The London Free Press. Contrary to the vast amounts of nutritional science available, the article, based on one controversial study, inaccurately tries to paint the consumption of sugar-sweetened beverages as a direct contributor to obesity, heart disease and diabetes.

The Canadian Beverage Association would like to provide scientific facts on the consumption of sugar-sweetened beverages.

Research shows that no one single food or beverage can be linked to obesity, and scientific evidence does not support that sugar, in any of its various forms, is a unique cause of any health condition.

Statistics Canada's own data indicates that, full calorie soft drink consumption has declined by 30 per cent in the past 11 years but obesity continues to rise-these numbers alone show that there is no link between the two.

The international scientific community disagrees with the direct association of sugar consumption as the cause of health issues. For example; & From the Canadian Sugar Institute; "Through scientific reviews such as the Institute of Medicine Dietary Reference Intakes (DRI) report, does not support the view that sugar is "toxic" and a cause of non-communicable diseases"[1] <#_ftn1> & The Dietitians Association of Australia (DAA) "believes it is simplistic and unhelpful to blame sugar alone for rising obesity rates and other related health problems across the world"[2] <#_ftn2> & British Nutrition Foundation: "Current evidence does not support the dramatic claims about the association between sugar and health" [3] <#_ftn3> No one single food or beverage alone is responsible for people being overweight or obese. All calories count from whatever food or beverage they come from. The Canadian beverage sector is committed as an industry to providing a variety of products for every lifestyle and occasion through our expanding portfolio of low-and no-calorie beverages, smaller package sizes and through our voluntary, national industry calorie label initiative, Clear on Calories, that provides clear calories information on front of pack to enable informed purchasing decisions and consumption. "

Coca Cola's spins arms length relationships into "corporate social responsibility"

I'm guessing that not to many people have had the chance to read Coca Cola's 2009-2010 corporate social responsibility report.

It's quite the feel good tome and it covers all the wonderful things Coca Cola has done for the world - from improving our health to saving the earth, and while undoubtedly Coca Cola will strive to make a positive impact on the world, it will only do so when and where such efforts are able to translate into more sales. This isn't in my mind evil behaviour, it's just the nature of being a public company - ultimately it's all about shareholder equity - if Coca Cola spends money recklessly on do-good efforts without returns on investments, the shareholders have a case to sue.

So reading through the report I came across the section on Corporate Responsibility and Sustainability. According to Coca Cola, by virtue of the 2010 Olympics they,

"engaged stakeholders at all levels, particularly those related to healthy active living and the environment."

Sounds pretty great, no?

So who'd they engage?

Well according to the report among others they "engaged": the College of Family Physicians of Canada, the Canadian Obesity Network, the Ontario Medical Association, the Alberta Medical Association, the BC Medical Association and the Canadian Medical Association.

I was curious what "engaged" meant so I contacted my friends and colleagues at both the Ontario Medical Association and the Canadian Obesity Network.

Did they have sit downs with Coca Cola?

Nope.

Did they advise them about anything health related?

Nope.

Did they review their corporate social responsibility plans?

Nope.

So what the heck did they do that landed them as bragging trophies for Coca Cola?

Well apparently they provided the Olympic Torch Relay committee with names of members for consideration of inclusion in the relay.

The same Olympic Torch Relay sponsored by Coca Cola.

That's the "engagement".

Oh, and in case you were wondering why Coca Cola wanted to sponsor the relay/Olympics?

CBC Says Eggos aren't products while Kellogg's breaks committment not to product place!

Readers will likely remember just a few days ago when I commented on product placement by Kellogg's on CBC Kids' morning shows with Yamma Mamma talking about healthy breakfasts while the camera provided multiple plate and product shots of an Eggo Waffle.

Comments on the blog were mixed. Some thought I was out to lunch, some thought I was bang on, while one person demonstrated incredible ignorance by invoking Godwin's Law by suggesting that my depiction of product placement was at a level comparable to how I might complain about Nazi propaganda.

The CBC wrote me back and while they didn't suggest I was on a Nazi witch hunt, they certainly didn't agree that the Eggo shots were in fact product placement,

"At no time are brand-name products promoted. In the example cited, we focus on the importance of a complete, balanced breakfast even within the time, cost or other constraints faced by many people.

In other words, a waffle matched with fresh fruit, nuts, yogurt and/or milk and juice represents a nutritious, enticing choice for kids."

But isn't that what product placement is? Not mentioning a product by name but placing it in the show - in this case a round, commercially produced, breakfast waffle product into a show that explicitly suggests it's a healthy choice?

A new and interesting twist to all of this came by way of Dr. Brain Cook.

Brian's a researcher for Toronto Public Health and his area of expertise is advertising to children. When he read my blog piece he wrote to inform me of Kellogg's commitment to the Children’s Food and Beverage Advertising Initiative.

The initiative very clearly states,

"Kellogg will implement the Product Placement principle by not paying for or seeking out promotional product placement (i.e., embedding our products within program/editorial content, as distinguished from sponsorship of programming) for our products in any medium directed primarily to children under 12. Kellogg does not currently engage in this type of marketing directed to children under 12."

I've written to Johanne Trudeau, the Director of Nutrition Marketing for Kellogg's Canada for comment and will keep you posted.

The whole thing seems pretty clear to me.

1. Kellogg's paid for segments involving Yamma Mamma and healthy breakfasts on CBC Kids.
2. The segments included Eggo product placement (and perhaps other Kellogg's products, I'm only aware of the one example).
3. According to Kellogg's, product placement in kids shows is an advertising modality that they themselves report voluntarily avoiding.
4. The CBC disagrees with Kellogg's in that according to the CBC who report explicitly banning advertising on Kids shows, product placement isn't an advertising modality.

Can't wait to hear what Kellogg's has to say.

Sara Lee takes the cake on outlandish omega-3 claims

Here's a great example of why front-of-package health claims should be banned entirely - Sara Lee's Soft and Smooth Plus DHA bread. According to the press release per slice there's 6mg of DHA.

Sara Lee Soft and Smooth Plus' marketers try to gussy up the importance of 6mg by noting 2 slices worth is,

"is at least 10 percent of the Institute of Medicine’s suggested daily amount for kids, depending on age, ranging from 1-13 years old"

Sounds like a fair bit, no?

Except for one thing, the Institute of Medicine doesn't have a suggested daily amount of DHA for kids.

Page 469 of the very reference that Sara Lee Soft and Smooth Plus' marketers point to as proof states,

"Because of a lack of evidence for determining the requirement for n-3 fatty acids during childhood, an AI is set based on the median intake of α-linolenic acid in the United States where a deficiency is basically nonexistent in non-institutionalized populations (Appendix Table E-11), and rounding."

Translation? There isn't enough evidence to recommend a particular DHA intake in kids so instead the Institute of Medicine has created an arbitrary number for what they're calling an "adequate intake" based on the average intake of α-linolenic acid in the population. Sara Lee's Soft and Smooth marketers then took 10% of that arbitrary number and claimed that it was the Institute of Medicine's "Kids Suggested Daily Amount".

Soft and smooth marketing? I'd say. Slippery too.

Looking at the front of the bag of bread one can see a cartoon head replete with brain beside the bag's DHA announcement and I imagine the back of the bag has some quotes about DHA and childhood brain development.

Looking at Sara Lee's Soft and Smooth Plus product partner's website (Disney), you'll learn,

"With New Sara Lee® Soft & Smooth® Plus, moms can enjoy knowing they are serving a great tasting, soft textured made with whole grain bread their little ones will love, plus providing DHA Omega-3 which helps to support healthy brain development.

DHA is important for brain and eye development particularly during the first two years of life and early childhood. It is important that children consume adequate amounts of DHA in their diet to support brain and eye growth and development during the early years of rapid development. DHA ensures that cells in the brain, retina, heart and other parts of the nervous system develop and function properly."

To help push their message even harder, Sara Lee's Soft and Smooth Plus marketers even purchased their own MD spokesperson in one Dr. Alanna Levine.

According to Alanna Levine's homepage, not only is she a designated spokesperson for the American Academy of Pediatrics, she's also a member of the National Association of Medical Communicators, and a member of the American Academy of Pediatrics’ Council on Communications and Media. Oh, and she's also a self-professed, "Parenting Expert".

She sounds great. She's is a pediatrician, an "expert parent" and someone incredibly well versed in medical communication and public speaking with exposure on shows like Fox News, the Tyra Banks Show and CBC's Early Show. Someone like that would never steer you wrong, would they?

For the sake of discussion let's ignore the fact that Sara Lee's Soft and Smooth Plus' marketers took soft and smooth liberties with the Institute of Medicine's report on DHA requirements. Instead let's take a quick look at those 6mg of DHA per slice and compare them to what you might find in let's say salmon.

So how many slices of bread would your child need to eat to consume the equivalent amount of DHA as you might find in let's say a child sized, 2.5oz serving of salmon? An astounding 13.5 loaves or 268 slices.

And how much salmon would you need to convince your child to eat to consume the 6mg that a slice of Sara Lee Soft and Smooth Plus contains? My calculations peg that as a piece of salmon roughly 1/12th the size of a single, solitary, lonely pea.

So tell me Dr. Alanna Levine, MD, pediatrician to the stars, brilliant spokesperson and expert parent - don't you think that suggesting that Sara Lee Soft and Smooth Plus bread is a useful means to help your child consume more DHA is more than a touch disingenuous?

Me? I would imagine "parenting experts" and pediatricians would be much more interested and capable of helping find ways for parents to actually feed their children fish, a pea sized serving of which would have the DHA equivalent of 12 slices of Sara Lee Soft and Smooth Plus bread, than push bread with significantly less DHA per slice than you'd find in a single flake of fish.

It's cases like these that are exactly what's wrong with front-of-package nutrition claims and as far as doctors go, I would have thought we make a good enough living on our own than to sell our good names for the promotion of products of questionable benefit.

[BTW - I tried to contact Dr. Alanna Levine, MD for comment but never did hear back from her.]

Coca Cola's Amy Laski explains why Coke is great!

What a heart warming story.

In a response to Dan Gardner's excellent column that called out Olympic sponsorships like Coca Cola and McDonald's as an anathema to the spirit of healthy living, Coca Cola's Canadian Communication Manager Amy Laski wrote a letter to the editor that detailed why Coke is great and why Coca Cola couldn't possibly be a player in obesity.

Her first argument? Coca Cola has been sponsoring the Olympics since 1928 but obesity rates really only started their spectacular rise in the very early 70s. Clearly if Coke's sponsorship of the Olympics had an impact on obesity, we should have seen obesity rates rise in the 30s and onwards.

Now that's a brilliant argument isn't it? I've actually never heard that one. Bravo Amy! Because people drank just as much Coca Cola back in 1928 as they do now, right? No? They didn't drink as much Coca Cola as now? Would that matter? I wonder what that graph up above would think about your argument?

Next Amy tells us that between 1999 and 2008 people consumed fewer soft drinks while at the same time physical activity dropped and so it couldn't be soft drinks and it must be inactivity that's led to rising obesity rates, right? Because really the only two variables in obesity are the amount of Coca Cola you drink and how active you are? And obesity only became a problem in and around 1999?

Amy also points out, in an argument reminiscent of the bad old days when doctors helped Big Tobacco in their attempts to convince the public cigarettes weren't bad, that Coca Cola created a "red ribbon panel" partnering up with the Heart and Stroke Foundation, ParticipACTION and the Canadian Diabetes Association and holds that out seemingly as proof of their great intentions (and at the same time highlighting just exactly why these organizations shouldn't be making deals with Big Food devils). I mean really, how could Coca Cola and soft drinks be bad if the Heart and Stroke Foundation, the Canadian Diabetes Association and ParticipACTION have teamed up with them? It's innocence by association don't you know?

Lastly Amy notes that soft drinks contribute 2.5% of total daily Canadian calories and then tries to slough that off as nothing.

2.5% of total daily calories consumed by Canadians come from soft drinks? That ain't nothing! The average Canadian currently consumes 2,400 calories. Now that's probably a very lowball figure as it's based off of always overly conservative dietary recall data. But even using that lowball figure that means each and every Canadian consumes 60 calories or two thirds of a can of a soft drink like Coca Cola daily. But of course not everyone consumes soft drinks. I bet between young children and folks who are watching their health or their weight it wouldn't be too much of a stretch to suggest that 33% of the population almost never drink soft drinks which means then that average soft-drinking Canadian consumes a can daily.

What happens if you drink a can of Coke daily for a year? Well you'd end up slurping up 32,850 calories along with nearly 40 cups of sugar. Drink a Coke a day for a decade and that'd translate to 94 pounds worth of Coca Cola calories and 400 cups (>200lbs!) of sugar.

Yeah, 2.5% of total daily calories is nearly nothing.

Reading her letter led me to wonder - is Amy Laski stupid, or does she just think we are?

A pea sized bite of salmon has 3x the DHA of Dairyland's Li'L Ones yogurt with DHA!

"A Li'L Story
by Li'L Ones
Once upon a time there were Big Ones who had Little Ones. The Big Ones wanted the Little Ones to be healthy and strong, so they said to the Little Ones, "You must always eat all your meat and all your vegetables."

The Little Ones wanted to be healthy and strong too, so they told the Big Ones, "We won't always eat all our meat and all our vegetables, but we'll always eat all our Li'L Ones yogurt."

So the Big Ones read the label on the Li'L Ones yogurt, and they saw that the Little Ones were very smart indeed, which wasn't surprising because Li'L Ones has DHA. Plus it's made with whole milk to keep them healthy and strong.

So the Big Ones bought their Little Ones lots of Li'L Ones yogurt and they all lived happily every always."

Hmmmmmm.

So this Big One decided to read the label on the Li'L Ones yogurt, and this Big One decided to read the whole label, not just the front of the package, or the cute storybook on their website (as seen below).





Want to know what this Big One found?

This Big One found that the nutrition facts panel on Li'L Ones yogurt, the one the Little Ones "will always eat", the one whose website states was developed with the help of dietitians and shouts is,

"FORTIFIED WITH DHA FOR HEALTHY BRAINS, EYES AND NERVES"

Well that very same yogurt's nutrition facts panel reports that while there are nearly 4 teaspoons of sugar per serving of Li'L Ones, there are 0g of Omega-3 Polyunsaturates.


Wait a sec', isn't DHA an Omega-3 polyunsaturated fat?

So this Big One called up Dairyland customer service to ask about DHA and was told that the amount of DHA that's added to Li'L Ones yogurt is so low that labeling laws in Canada forbid them from reporting any! All told per serving there's only 25mg of DHA, an amount so small that were your toddler to eat a single pea sized serving of salmon they'd be eating the equivalent nearly 3 Li'L Ones worth of DHA! And if you managed to convince your toddler to eat a small 2.5 ounce serving of salmon they'd be getting the DHA equivalent of 64.4 Li'L Ones.

So what does Dairyland's RD have to say about her company's incredibly sugary product, that as far as Health Canada's concerned has 0g of DHA yet markets itself as brain, eye and nerve food for toddlers?

"Toddlers need sufficient intake of the omega-3 fat called DHA, which supports the normal development of the brain, eyes and nerves. It can be found in salmon, trout, enriched eggs and Dairy-Oh! Milk and Li’L Ones yogurt."

Gee thanks - great job promoting your company's product at the expense of properly interpreting a nutrition facts panel for the public.

Conflicts of interest in professional dietetics

According to my friends over at Fooducate, at this week's American Dietetic Association (ADA) conference there was a talk regarding whether or not we can trust industry sponsored nutrition research. The reason that's in question is because sadly right now there are no guidelines in place to help expose conflict of interest in dietetics. It was the absence of such guidelines which led Marion Nestle in 2001 to write a fascinating journal article about how food company sponsorship impacts on the profession's credibility. Ultimately it led Marion to resign her ADA membership. According to Fooducate,the lecture was not a popular one at the ADA conference and was very poorly attended.

Of course it's not just research articles that demonstrate conflicts and bias, we can see non-evidence based industry bias in a far more dangerous place - the mainstream media.

Case in point?

Yesterday there was a CBC report about an Ipsos-Reid survey which according to the CBC was, "conducted on behalf of Dietitians of Canada" (DC). What the CBC article later reported was that the survey was cosponsored by the Dairy Farmers of Canada. The DC and Dairy Farmers of Canada joint press release on the survey drew these 4 conclusions (highlighting is mine, not theirs):

"1. Consumption of all four food groups is far below recommended levels;

2. A significant number of Canadian adults had not consumed any milk and alternatives or any vegetables and fruit on the day prior to the survey.

3. Many Canadian adults report they have barriers to healthy eating.

4. A majority of Canadian adults are not aware of the many health benefits of milk and alternatives and vegetables and fruit including their role in reducing the risk of some cancers, hypertension and other chronic diseases.

5. When made aware of these important health benefits, Canadians report they are motivated to increase their intake of foods from these food groups."

Well last week we covered how milk doesn't appear to actually have a benefit on hypertension and that calcium supplementation alone impacted on cancer risk while dairy might in fact up the risk of prostate cancer and given milk's failure in preventing osteoporotic fracture and in weight loss, I'm not sure what magic milk is meant to do.

Looking at the actual survey the bias is obvious. The only specific questions regarding choices and healthfulness have to do with either "dairy and alternatives" or "fruits and vegetables" and of the 5 conclusions of the press release, 3 directly relate back to dairy (2, 4 & 5). Absent was information regarding the health benefits of whole grains, nuts, legumes or fish.

The thing is I get it. I fully understand why the Dairy Farmers crafted the survey - it was designed to report that Canadians don't drink enough milk; that there are umpteen-million magical "benefits" to milk consumption; that milk's as healthy and important as fruit and vegetables; and that if we just teach people more about unbelievably healthy milk they'll drink more of it, but the question I've got is why do you think the Dietitians of Canada decided to lend their name and credibility to a survey that ignored multiple food groups and is basically a milk advertisement?

Unfortunately the media certainly treated it like more than simply a milk ad and they ran with it prominently featuring DC's involvement. Had the poll simply been one from the Dairy Farmers of Canada I imagine the coverage of the report, if any, would likely have been very different. As well in this case, the media also oiled the slippery slope of corporate dietetic collaboration by failing to identify quoting dietitian Kathy Furgala's corporate allegiances referring to her instead as a "Toronto-based dietitian". Frankly it was in fact Kathy's quote from the CBC story that got me riled up enough to write this post and explore the survey in the first place. She was quoted as saying,

"For people who say, 'I don't want to worry about the food groups,' just look at your plate, and see if you can't throw in one veggie or some cheese"

Yup, the two most important things you could ever add to your plate if you don't want to "worry about the food groups" - a single vegetable or of course, some cheese.

I'm not sure what's worse. DC signing off on a milk ad disguised as a national eating survey, a dietitian who would give the advice that all your plate needs for your meal to be healthy is one lonely vegetable or a hunk of cheese, or a reporter who chooses to identify that dietitian as a "Toronto area dietitian" while omitting the fact that she's in fact a nutrition educator for the Dairy Farmers of Canada in an article whose focus is on increasing dairy based on the results of a survey paid for by the Dairy Farmers of Canada.

[Oh, and in case you noticed - the survey found that "consumption of all 4 food groups is far below recommended levels". Strange in a country where over 65% are already overweight or obese. Could it be that the recommended levels recommend too much? Tune in tomorrow for more discussion.]

Nestle, M. (2007). Food company sponsorship of nutrition research and professional activities: a conflict of interest? Public Health Nutrition, 4 (05) DOI: 10.1079/PHN2001253

Big Milk RD wants kids to drink 1/2 cup of sugar daily

Meet Shannon Crocker.

She's a registered dietitian who runs her own nutritional consulting company whose clients include Gaylea foods (a dairy company) and Dairy Farmers of Canada.

On her personal website S. Crocker Consulting, Shannon recommends,

"when seeking life advice to go to people who are required by law to get their information from the most credible sources and held accountable for the information they dispense"

I couldn't agree more - so let's talk about the information you recently dispensed.

In a recent advertisement gussied up as a pretend newspaper article with the lead recommendation of,

"Research shows that two to three servings of milk products each day, included as part of a balanced diet and active lifestyle, are vital in maintaining our families’ health."

Shannon is quoted as stating,

"I personally am a great lover of chocolate milk. It has a bit of added sugar to it but all those essential health benefits are there and as long as it is part of a healthy diet, that extra sugar should not do children who shy away from ordinary milk any harm.”

A "bit" of added sugar Shannon? Per cup of your client Gaylea's 1% chocolate milk there are nearly 5 teaspoons of added sugar. If unsuspecting parents followed your advertisement's advice to give their children a "harmless" 3 glasses of chocolate milk a day that's now 15 teaspoons of added sugar, not to mention the sugar already in the milk. In total those children will be consuming 23 1/4 teaspoons of sugar a day - 3/4 of a teaspoon shy of half a cup.

Want to know what else they'd be drinking Shannon? They'll also be drinking 600mg of sodium (who would have thunk chocolate milk had so much sodium - um, maybe a dietitian working for the company who makes the product?), or a full 1/2 of the total recommended daily maximum for kids under 8 and 40% of total recommended daily adult maximums.

But wait, there's more. They'd also be downing 540, not satiating, liquid calories a day, or roughly the same amount they'd get if they were chugging 1.5 daily litres of Coke.

Doing the math - a year's worth Shannon's advice would have your kids drinking just over 90 pounds of sugar, that's eighteen 5lb bags, as well as 2 full cups of salt and 54lbs worth of calories.

Fantastic advice Shannon. So glad we've got "credible sources" of information like you to help us navigate as you put it on your website, "the incredible amount of myth and misinformation", because surely it's just a myth that chocolate milk is an unhealthy choice, and advertisements dressed up as newspaper articles with quotes from registered dietitians stating that magic nutrients in milk make the daily consumption of 1/2 a cup of liquid sugar and far too much sodium and calories a-ok, are meant to help, not misinform.

Parents, think of a glass of chocolate milk like a liquid chocolate bar. If you think giving your kids a Hershey's bar with each meal is a good plan, well then you and Shannon would probably get along great. If not, consider it a sometimes food.

Big Milk PhD bares her bias

Meet Dr. Susan Barr.

Dr. Barr is a professor of nutrition at the University of British Columbia and she has had a truly illustrious career, having published dozens of peer reviewed articles. She's also been a workhorse for the milk industry serving as a member of the Medical Advisory Board of the Milk Processors' Education Program, the Medical Advisory Board for the International Dairy Foods Association and speaking and writing regularly for the Dairy Farmers of Canada.

So what's got my knickers in a knot about Dr. Barr? It's her quotes from the recent "article" published in CanWest papers across the country last week where she tries to make the case that increased dietary dairy consumption reduces blood pressure. I put the word article in quotations because CanWest reports that the articles are "a joint venture with Dairy Farmers of Canada"and refer to them as a "special advertising feature".

Dr. Barr's case for dairy's role in reduction of blood pressure rests on a famous study from 1997, the Dietary Approaches to Stop Hypertension Study which resulted in what's now known as the DASH diet. Dr. Barr reports,

"The findings showed that those on the fruit and vegetable rich diet experienced a significant reduction in blood pressure. Those on the diet with milk products as well showed an even more significant reduction."

A true statement, except of course it omits the fact that the study was not designed to examine the specific effects of dairy on blood pressure and more importantly omits the fact that the diet with dairy had other differences from the fruit and vegetable rich diet including lower overall saturated fat, lower total fat and lower cholesterol.

Looking at the last 15 years of clinical trials research I was able to find only a handful of studies that were specifically designed to investigate the effects of dairy on blood pressure, and of those none were large or robust enough to draw firm conclusions.

Thankfully I was able to find a recent review article published in the Journal of the American College of Clinical Nutrition which summarized the most pertinent studies detailing dairy's effects on blood pressure. The review reported that a few studies indeed showed decreases in blood pressure with increased dairy, another showed increases in blood pressure with yogurt but not cheese, and many showed no dairy/blood pressure relationship at all. Regarding the DASH study the review specifically concluded,

"The greater reductions in BP seen with the DASH diet compared to the high fruits and vegetable diet cannot be ascribed to dairy products per se"

and the review goes on to conclude that there are certainly some plausible mechanisms by which dairy might improve blood pressure and that further research is warranted.

Fair enough, and really that's it? That's what's got me hot and bothered? The fact that Dr. Barr perhaps misconstrued the DASH study and overblew the preliminary suggestion that maybe blood pressure and dairy have a connection?

Nope.

It was this. The review article summarized the only studies that have ever been published that were designed specifically to address whether or not an intervention involving increasing dairy would have a positive impact on blood pressure, all 5 of them. According to the review none of those studies showed significant improvements to diastolic blood pressure while 3 showed minor improvements to systolic pressure, the greatest of which was 5mm Hg.

Again, so? So why are you so pissy you're actually devoting an entire post to Dr. Barr and suggesting she's "bared her bias", yeah it doesn't look like there's much data to conclusively recommend increasing dairy for blood pressure benefit, but so what, at least there's some?

It was this. Included in those 5 studies was this one,

"Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults"

This study, conducted in the year 2000, followed 204 healthy, middle aged men and women and tracked what happened to their blood pressure and their weight following randomization to either stick with their current diets (low in dairy) or to add 3 glasses per day of milk to their diets for 12 weeks. At the end of 12 weeks researchers found that the increased dairy group did not see any statistically significant reduction in their blood pressures (nor did the subgroup of pre-existing hypertensives in the sample), but they did see statistically significant increases in weight, triglycerides and blood sugar - not exactly healthful results.

Want to know who the lead author of this study, one of only 5 studies ever published which was actually designed to determine the effect of increasing dietary dairy consumption on blood pressure, the results of which showed increasing milk not only failed to have a positive effect on blood pressure but rather, significantly worsened weight, triglycerides and blood sugar? You guessed it, Dr. Susan Barr.

Ain't it funny (and by funny I mean awful) that she didn't mention the paucity of conclusive research linking increased dairy with decreased blood pressure along with her own study's negative and potentially harmful results while misrepresenting the findings of the DASH study in the "article", I mean "joint venture", I mean "special advertising feature" meant to sell more milk?

Kris-Etherton PM, Grieger JA, Hilpert KF, & West SG (2009). Milk products, dietary patterns and blood pressure management. Journal of the American College of Nutrition, 28 Suppl 1 PMID: 19571168

BARR, S. (2000). Effects of Increased Consumption of Fluid Milk on Energy and Nutrient Intake, Body Weight, and Cardiovascular Risk Factors in Healthy Older Adults Journal of the American Dietetic Association, 100 (7), 810-817 DOI: 10.1016/S0002-8223(00)00236-4

Appel, L. (1997). A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure New England Journal of Medicine, 336 (16), 1117-1124 DOI: 10.1056/NEJM199704173361601

Spin Doctoring: Popcorn

So last week I was contacted by a spin doctor - a representative from Ketchum, a fancy shmancy PR firm whose client list includes giants like IBM, Ikea, and apparently, Orville Redenbacher. She wanted me to know (and write) about a fantastic new study conducted by a Dr. James Rippe from the Rippe Lifestyle Institute - a place where Big Food meets science as evidenced from their partners page that includes the likes of PepsiCo, Tropicana, Quaker, and ConAgra.

So what of this earth shattering study?

Well they took 35 whole people and then divided them up into 4 groups. One group had water before an all you could eat lunch, the next 1 cup of Orville Redenbacher Smart Pop! popcorn, the next 6 cups (100 calories) of Orville Redenbacher's Smart Pop! popcorn and the last 150 calories of potato chips.

The unbelievably, amazing results?

The groups that had water or popcorn before lunch consumed 717 calories between the snack and the lunch while the group that had the 150 calories of chips consumed 803 calories combined.

The spin?

According to the email I received,

"The new research shows a snack of low-fat popcorn before a meal can help curb hunger without increasing total calorie intake at the subsequent meal"

Really?

To me the research shows that people tend to eat around 717 calories for lunch with the popcorn serving as a first course rather than a snack (snacks to me occur hours before the meal).

As to why did they eat more with the chips? Probably because chips are highly energy dense. Had they been offered a higher calorie popcorn likely they'd have the same result.

Oh, and with each group having an average of 9 people in it, this is a very far cry from a powerful study.

So did the spin work?

I couldn't find a single news article, so I'd call it a spectacular fail.

Oh, and 717 calories for lunch? Dr. Rippe is quoted in his press release as saying,

"Our findings suggest that some snack foods, such as low-fat popcorn, can be a satisfying and effective way to manage calories."

717 calories is an awful lot of calories for lunch so I'd call that a spectacular fail too - if eating popcorn as an appetizer for your meal still leads you to have 717 calories per meal it's certainly not doing much for "managing" calories.

Sorry popcorn, you're not magic.

Spin Doctoring: Juice

Today's going to be the launch of a new feature on Weighty Matters - Spin Doctoring. Spin Doctoring posts will detail the efforts of the media or Big Food in spinning the conclusions of a study into a dramatically overblown or misleading message.

First up? Juice.

The spin doctor? A website likely paid for by Big Juice called Fruit Juice Facts.

So what'd they do?

Apparently there was a paper or an abstract presented at the 2009 Experimental Biology conference that detailed some epidemiological data on 5 years of juice consumption as documented through the National Health and Nutrition Examination Survey (NHANES) 1999-2004.

The headline to detail the findings?

"Drinking 100% Fruit Juice is Associated with Lower Risk of Obesity and Metabolic Syndrome"

The report goes on to explain how juice drinkers

"had lower mean Body Mass Index (BMI), smaller waist circumference and lower insulin resistance"

They then concluded,

"Based on the analysis, risk for obesity was 22% lower among 100% juice drinkers, while risk for metabolic syndrome (defined as the presence of three or more of the following: central obesity, elevated blood glucose, elevated fasting triglycerides, low HDL-cholesterol, elevated blood pressure) was 15% lower compared to non-consumers."

In keeping with the juice is miraculous theme the presenting author was quoted as saying,

"One-half cup of 100% fruit juice counts as a serving of fruit and, based on our analysis, 100% juice consumption is associated with some of these same benefits"

So where's the spin?

Well read a bit more and you'll find out that maybe it wasn't actually the juice after all,

"juice consumers had higher physical activity levels and more favorable dietary intake patterns (including: lower fat intakes, higher fiber intakes, lower added sugar intakes). After taking these lifestyle factors into account, the inverse relationship between 100% fruit juice consumption and metabolic syndrome was no longer statistically significant."

But apparently juice magically lowered the risk of obesity by 14% "even after the adjustment".

Yup, sugar water plus vitamins is a sure fire way to combat obesity.

So did the spin work? I could only find two articles:

Fruit Juice Lowers Obesity, Stroke Risk - Times of India

Drink to Juice - The Brisbane Times

I'd call that a fizzle.

Better luck next time Big Juice.

Think About Your Drink - a New Milk Info-Udy

If you haven't heard it yet, you'll hear it soon, the new mantra of milk ads, "Think about your drink". They have a website, a "study", and already ample media attention.

So why did I put the word study in quotations?

Because this report is to studies what infomercials are to commercials. I'll call it an info-udy

The info-udy is called, "What America Drinks: How Beverages Relate to Nutrient Intakes and Body Weight".

The first tip-off that something's up is the fact that this info-udy was not actually published in a medical journal but rather was,

"commissioned by the Milk Processor Education Program. What America Drinks is a component of an education campaign called Think About Your Drink."

The rest of the tip-offs come from the content. How's this line for objective empirical conclusions?

"The results of this study show that beverages make significant contributions to calorie and nutrient intakes of Americans. Milk provided Americans with a substantial portion of essential nutrients, while other types of beverages tended to contribute substantially to calories and added sugar intakes but provided few nutrients other than vitamin C, potassium and some folate"

Looking at their data, depending on the age group, milk actually is the second highest contributor of liquid calories to most diets, but of course, it's not spun that way.

Here's another oddity. The info-udy did something I've never seen before. They took their data, divided folks by age and sex and then subdivided by beverage intake, with two categories. The first category was "High Milk/Low Sweetened Beverage" consumers and the second was, "Low Milk/High Sweetened Beverage Consumers". They then drew conclusions from the body mass indices of these groups and concluded that folks who drank more milk weighed less that folks who drank more sugared beverages. Big problem here - they didn't bother controlling for anything else!

What if the folks who drank more milk did so because they were trying to live what they thought were healthier lifestyles (after all, milk's done a bang up job of marketing itself as a healthy choice)? Perhaps they were more active? Perhaps their dietary choices as a whole were lower in calories? The info-udy tries to suggest that they controlled for calorie intake, but with a dietary recall study, that's pretty much impossible.

Bottom line, when you hear the call to action, "Think About What you Drink", I'd advise you to, "Think About Where you Heard it".

So what's not in the report? How about the fact that higher dairy consumption has been shown to be linked with increased risks of ovarian cancer and increased severity of prostate cancer? How about the fact that higher dairy consumption has not been shown to minimize the risk of osteoperosis?

Oh, and if this type of info-udy and its reporting bothers you, if you feel that there's an obvious lack of objectivity, if you feel that the scientists involve should not be selling their good names for such clearly spun data, it might also bother you to learn that Susan Barr, the scientist who according to the report itself, "provided invaluable input on the design of the study and the analysis of the results" is a member of the 12-member advisory board to the revisions to the Canada's Food Guide - interestingly her official Food Guide bio doesn't mention her ties with Big Milk (she's a member of the medical advisory board for the International Dairy Foods Association)

No, our upcoming Food Guide couldn't possibly be influenced by conflicts of interest (please note the non-veiled sarcasm).

Chalk up another win for the marketing machine that is Big Milk!

Enviga - Burn your Money....I mean your Calories

Coca Cola and Nestle, a match made in marketing heaven, are about to release Enviga, which according to Dr. Rhona Applebaum, the chief scientist of the Coca Cola company (that's what the press release calls her anyhow), the "perfect partnership of science and nature".

So what does this perfect partnership entail? A crap load of caffeine (3x the caffeine of a can of Coca Cola), and a component of green tea lovingly named epigallocatechin gallate, or EGCG. And EGCG, what does it do? According to Dr. Hilary Green, corporate shill and sell-out scientist for Nestle, it "speeds up metabolism and increases energy use, especially when combined with caffeine". Put this all together and Coca Cola and Nestle's marketing campaign tells us that if we drink 3 cans of this stuff a day, we'll lose weight!

Can you say ka-ching?

So first, let's ask how much weight we're talking here. According to the companies', an extra 60-100 calories a day or 6-10lbs per year. Remember that number, I'll come back to it.

So how much do we have to pay for the privilege of losing an extra 6lbs in a year? Roughly $1500 given that each can costs on average $1.39 and you'll have to drink over 1,100 of them a year.

Marketing in the test market of New York is fierce with billboards stating, "Burning Calories is now officially delicious", and "Be Positive, Drink Negative".

The science by the way, surprise surprise, is lacking to say the least, but I'm not even going to bother getting into it.

I know, you've been reading my blog and are baffled by the fact I'm resisting an opportunity to provide references.

Here's a case where I don't need references, but if you want some, feel free to turn to the Center for Science in the Public Interest who 3 days ago sent a cease and desist letter to the Enviga folks.

Why don't I need references? Let's go back to that 60-100 calories burned. Let's even assume it's true. What else burns 60-100 calories - drinking 8 glasses of fridge cold water a day or really drinking 8 glasses of any cold zero-calorie beverage a day (because it takes energy to raise the temperature of the cold liquid) or taking just three extra 5 minute walks a day.

Any zero-calorie beverage marketers reading my blog? If so, take the wind out of this Frankenfood's sales by starting your own drink negative campaign!

So what would you rather do? Drink 8 glasses of cold water a day, go for three 5 minute walks a day, drink 4 glasses of cold water and take one 7.5 minute walk a day, go for three 10 minute walks a day, or would you rather spend $1500/year and in so doing help pay the salary of a clear researcher of the night who actually put her name behind the statement calling Enviga a "perfect partnership of science and nature"?

Shame on Dr. Rhona Applebaum selling her name that way, shame on Dr. Hilary Green for promoting shaky science as fact, and shame on you if you buy into this incredibly stupid campaign.

(Looking for the Food Guide series? It can be found if you click here.)

Food Industry Spin Doctors

Yesterday I was given the honour of speaking in front of the Canadian House of Commons Standing Committee on Health on the subject of childhood obesity.

The panel I was on included one other clinician (a dietitian from London), an indigenous person's nutritional advocate, and then 3 corporate spokespersons representing a diverse range of companies from the restaurants, to Coca Cola, to Kentucky Fried Chicken.

Amazingly, but entirely not surprisingly, the industry spokespeople did their best to spin things in their favour.

The party line of course is that because obesity is so complex and multifactorial, to pick on any one thing as a cause would be inappropriate. I actually agree with that statement to a degree, but have a difficult time with the conclusion of all of these industry reps that therefore we should not pick on any of the various and multiple factors.

The Restaurant Industry's spokesperson tried to explain how mandatory labeling on menus of calories would be impossible due to supply chain variety. Amazingly she did that in the same breath that she mentioned the 42% of restaurant chains who voluntarily carry nutrition information in brochure form. I highly doubt that these brochures change with the supply chain.

She also questioned the value of putting calories on menus and stated that there has never been any evidence to suggest that calories on labels help. In fact that's not true. In a study available online, a high school, without providing any extra classes on the subject, simply posted calories on their cafeteria's menuboard. Immediately they noticed students choosing lower calorie options.

Certainly it would not take a degree in dietetics to know that the 2900 calorie Aussie Fries appetizer at the Outback steakhouse might be a poor choice.

Next was the beverage industry where there was much bragging about how they voluntarily took pop out of schools and replaced it with fruit drinks, juice and sports drinks. The spokesperson even bragged about the size of their containers: 250ml (8oz) containers for elementary schools, 300ml (10oz) for middle schools and 355ml (12oz) for high schools.

I of course had to point out that the expert advisory panel for the American Academy of Pediatrics with representatives from the Canadian Pediatric Society recommend that for children between 1-6 years old juice intake should be limited to 125-175mls (4-6oz) and from 7-18 years old limited to 250-355mls) and therefore every child through grade 9, with a single serving from the vending machine, actually exceeds daily recommended intake of juice. I would also like to note here that the daily recommended intake of fruit "drinks" and sports drinks is 0ml.

Remember drop per drop there are more calories in orange juice than Coke.

Now I don't blame the industry at all. They're doing their job. It's just a shame that more often than not, there's not someone there to unspin them.