A Cal-Berkeley journalism professor, writing in yesterday's New York Times Magazine, has crafted a devastating critique of political correctness in dietary guidance. Michael Pollan's "Unhappy Meals " argues that replacement of advice to select a politically-correct (though ever-changing) balance of nutrients in lieu of basing a healthy diet on food choices has led to "cognitive dissonance" among shoppers and a deterioration of food choices -- all in the name of good science. It may be the best analysis of nutrition policy since Gary Taubes, whom Pollan cites reverently.
He laments "the rise of nutritionism":
The first thing to understand about nutritionism -- I first encountered the terms in the work of an Australian sociologist of science names Gyorgy Scrinis -- is that it is not quite the same as nutrition. As the "ism" suggests, it is not a scientific subject but an ideology. Ideologies are ways of organizing large swaths of life and experience under a set of shared but unexamined assumptions. This quality makes an ideology particularly hard to see, at least while it's exerting its hold on your culture.
But the problem is not confined to the consumer: "... if nutritionism leads to a kind of false consciousness in the mind of the eater, the ideology can just as easily mislead the scientist," says Pollan crediting anti-agribusiness activist and New York University nutrition professor Marion Nestle with the insight that "The problem with nutrient-by-nutrient nutrition science is that it takes the nutrient out of the context of food, the food out of the context of the diet and the diet out of the context of lifestyle."
Why? Because what is the the "soul" of a particular food -- even if one head of broccoli is presumed identical to all others of its genus -- is unknown, perhaps unknowable. Looking where the light is brightest, scientists study nutrients, substances they can isolate and measure. The process of considering them in isolation, however, Pollan faults with producing dangerously misleading science. He offers this example: societies that eat a lot of meat have more coronary heart disease and cancers. Perhaps that's because their substitution of lots of fruits and vegetables leaves little room in their diet for meats rather than the nutritionism conclusion that there is something inherently unsafe about the meat itself. That, he posits, is why the Women's Health Initiative failed to discover a relationship between reducing fat intake and reducing heart disease and cancer. He also lambasts use of dietary recall as garbage-in, garbage-out data.
No one likes to admit that his or her best efforts at understanding and solving a problem have actually made the problem worse, but that's exactly what has happened in the case of nutritionism. Scientists operating with the best of intentions, using the best tools at their disposal, have taught us to look at food in a way that has diminished our pleasure in eating it while doing little or nothing to improve our health. Perhaps what we need now is a broader, less reductive view of what food is, one that is at once more ecological and cultural. (emphasis added)
Moving towards a prescriptive conclusion, Pollan continues:
Looking at eating through this ecological lens opens a whole new perspective on exactly what the Western diet is: a radical and rapid change not just in our foodstuffs over the course of the 20th century but also in our food relationships, all the way from the soil to the meal. the ideology of nutritionism it itself part of that change.
He identifies four large-scale changes: 1) moving from whole foods to refined, 2) simplification of the food chain through standardization of seeds and fertilizers, 3) shifting from eating leaves to seeds, and 4) the shift caused by agri-business industrialization which has displaced "traditional food cultures."
Moving "beyond nutritionism," Pollan observes that "To medicalize the diet problem is of course perfectly consistent with nutritionism." He misses a great opportunity to identify government-mandated nutrition labels on food as a prime culprit (with one exception -- stay tuned). His nine rules of better eating: 1) "Don't eat anything your great-great-grandmother wouldn't recognize as food" (moms are hopelessly contaminated), 2) "Avoid even those food products that come bearing health claims" (there, the exception!) -- here he notes disapprovingly that "The American Heart Association charges food makers for their endorsement", 3) "Especially avoid food products containing ingredietns that are a) unfamiliar, b) unpronounceable c) more htan five in number -- or that contain high-fructose corn syrup", 4) shop at farmers' markets, not supermarkets, 5) "Pay more, eat less," 6) "Eat mostly plants, especially leaves," 7) "Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do....", 8) Cook and, if possible, plant a garden, and 9) "Eat like an omnivore" by adding new foods for a more varied diet.
Regular consumers of McDonald's Happy Meals won't find a lot of comfort, but, then, that's part of our problem in making nutrition policy: to allow nutritionism's ideologists to define as good science anything that takes an easy shot at popular whipping boys like fast food. We deserve better. We need to demand more rigorous and encompassing dietary guidelines. We need to eat what our grandmothers told us was healthy. They were right.
Pollan's article should be required reading for every member of the next Dietary Guidelines Advisory Committee.
Nothing in nutrition is more politically correct today than a preoccupying focus on the "obesity epidemic." Predictably, anti-salt zealots have chimed-in that one step towards eliminating overweight is to curtail salt consumption. Of course, salt is non-caloric, but few question lumping out-of-favor nutrients in the ukase to remove salt from the diet. The Salt Institute has just published the latest issue of its e-newsletter, Salt and Health, examining the question: "Is salt implicated in our obesity epidemic? " The article documents its conclusion that:
"... the evidence exhonerates salt and even assigns it a postive role in encouraging an increase in pursuit of healthy physical fitness. In the vast majority of cases, overweight and obesity result from energy input exceeding energy output."
Let's not take these scurrilous attacks lying down; exercise your opportunities to insist on sound science!
The global anti-obesity frenzy accelerates as politically-correct legislators from city councils (New York City and Chicago, for example) to the European Parliament weigh into the "consensus" that some foods are bad and governments should discourage (or even ban, e.g. trans fat) them.
Good nutrition is in danger of being converted from a worthy health objective to a food safety imperative like e coli or mad cow disease.
This rhetorical esacalation has an eerie similarity to the US-led multi-national effort to overthrow Saddam Hussein and erect stable self-government in Iraq. People understand that food choices influence good health; they understood that Saddam had butchered his people and thumbed his nose at UN resolutions condemning his actions. Unleashing massive efforts of public awareness has produced dietary changes, but the underlying problem of diet-related chronic disease continues, forcing consideration of a "surge" of government intervention into food processing decisions to "protect" the public from making wrong food choices. Whether improved food choices can be compared to peace and freedom in Iraq, the similarity is that failure of largely voluntary measures (food labeling or UN resolutions) is followed by more draconian interventions that invite the observation that policy-makers may have "bitten off more than they can chew" and risk not only failure, but undermine the credibility of their sponsors.
No one doubts the validity of the objectives of healthy diets or Mideast peace. The consensus breaks down in interpreting the intelligence (medical studies of health outcomes of dietary interventions or whether Saddam's government in fact trained, encouraged and exported terrorists to supplement his internal barbarities) and developing effective strategies (improving overall dietary quality versus "good food/bad food" demonization or the role of the US and its allies in preventing inter-factional blood-letting among Iraq's Kurds, Sunnis and Shiites).
In February, the European Parliament expects to vote on an anti-obesity measure that declares excess body weight a "chronic disease" and would call on the European Commission to push for rules to end the promotion of foods high in fat, salt and sugar to children. Whether you believe Saddam ever had weapons of mass destruction, you should be concerned about the "intelligence" linking non-caloric salt to obesity; there's no science behind this. And whether expanded food nanny interventionism will be more successful than "boots on the ground" along the Tigres and Euphrates should give strategists pause.
Increasing speed if you're on the wrong road won't get you where you want to go.
The (British) Salt Manufacturers' Association (SMA) has developed a questionnaire on its Salt Sense website, seeking individuals whose health has been affected by consuming either too much or too little salt. SMA wants to use this information in 's effort to persuade the UK Government to undertake much-needed research and risk assessments.
SMA has been concerned for some time that the dangers of dietary salt reduction have not been given due attention. Medical and nutrition experts from around the world have come forward over recent years to warn that older people, pregnant women and those who exercise, in particular, could be at risk from following blanket advice to reduce salt, SMA has called for balance.
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Stephen Daniells , the Food Science Reporter for NutraIngredients.com, writing for AP-Food Technology.com echoes a theme often voiced in our blog: that a proper concern is with the science in studies of nutrtition and health, not whether they are funded by governments or private parties. Says Daniells:
It is important to have an independent watchdog for both industry and academia, but the statements of subtle bias, or insinuations of industry meddling merely serve to undermine scientific integrity, industrial sponsors, and consumer confidence.
He goes on with regard to a recent example:
After starting with 538 articles, the reviewers, from the Children's Hospital Boston and the Center for Science in the Public Interest (CSPI), whittled this down to 206 according to their specific inclusion/ exclusion criteria. Of these, only 111 declared financial sponsorship - 22 per cent were funded entirely by industry, 47 per cent had no industry funding, and 32 per cent had mixed funding.
They then calculated that the 22 per cent declaring an industry-only source of funding were four to eight times likely to report favourable conclusions for the sponsors than studies with no industry funding.
And this led to the researchers to imply: Bias! Industry meddling! Company heavyweights leaning on the little academic!
Let's just think about this for a moment.
First of all, the studies used in the review were all published in peer-review journals, meaning independent and anonymous reviewers had already passed their expert eyes over the studies.
Undoubtedly, the studies fitted in with other results - in vitro research, and in vivo animal studies, as well as other human studies. I have never seen an article published without supporting references - have you? Some of the studies were clinical interventions.
Everything looks ok, so far…
Next up is the role of industry in funding a study. As was stated in an insightful, balanced, and levelheaded editorial by Martijn Katan from the Vrije Universiteit in Amsterdam that accompanied the review, when industry plans to fund a study, it is natural that it would select a product with a potentially favourable nutritional profile.
Finally, some sense!
You'll want to read it all .
Stephen Daniells , the Food Science Reporter for NutraIngredients.com, writing for AP-Food Technology.com echoes a theme often voiced in our blog: that a proper concern is with the science in studies of nutrtiion and health, not whether they are funded by governments or private parties. Says Daniells:
It is important to have an independent watchdog for both industry and academia, but the statements of subtle bias, or insinuations of industry meddling merely serve to undermine scientific integrity, industrial sponsors, and consumer confidence.
He goes on with regard to a recent example:
After starting with 538 articles, the reviewers, from the Children's Hospital Boston and the Center for Science in the Public Interest (CSPI), whittled this down to 206 according to their specific inclusion/ exclusion criteria. Of these, only 111 declared financial sponsorship - 22 per cent were funded entirely by industry, 47 per cent had no industry funding, and 32 per cent had mixed funding.
They then calculated that the 22 per cent declaring an industry-only source of funding were four to eight times likely to report favourable conclusions for the sponsors than studies with no industry funding.
And this led to the researchers to imply: Bias! Industry meddling! Company heavyweights leaning on the little academic!
Let's just think about this for a moment.
First of all, the studies used in the review were all published in peer-review journals, meaning independent and anonymous reviewers had already passed their expert eyes over the studies.
Undoubtedly, the studies fitted in with other results - in vitro research, and in vivo animal studies, as well as other human studies. I have never seen an article published without supporting references - have you? Some of the studies were clinical interventions.
Everything looks ok, so far…
Next up is the role of industry in funding a study. As was stated in an insightful, balanced, and levelheaded editorial by Martijn Katan from the Vrije Universiteit in Amsterdam that accompanied the review, when industry plans to fund a study, it is natural that it would select a product with a potentially favourable nutritional profile.
Finally, some sense!
You'll want to read it all .
According to the latest research at the University of Haifa , low birth weight babies born with low sodium (salt) in their blood serum are likely to consume large quantities of dietary sodium later in life. Taken together with other recent findings, this information confirms that very low serum sodium in pre-term and new born infants may be a significant contributing factor for long-term sodium intake.
The researchers reported that dietary sodium consumption in childhood (ages 8-15) was predicted by neonatal lowest serum sodium (NLS). The children with the most severe NLS serum sodium ate double the number of salty snacks and their dietary sodium intake was substantially higher than their peers. It was as if they were trying to make up for their previous history of salt deprivation. There was no relationship found between NLS and a preference for salt per se, but rather for the foods that contained salt.
This work provides a good deal of food for thought regarding our innate preference and requirements for salt and should give expectant mothers and parents of newborns pause to think before they severely limit their child's salt intake.
As with everything else in life, balance is the byword.
On January 15, 2007, a 28-year-old mother of three died from water intoxication (hyponatremia) hours after competing in a Sacramento radio station contest to see which contestant could drink the most water without urinating. The winner of the contest reportedly won a new video game system - the Nintendo Wii. The contest organizers obviously thought it very clever to have a contest called "Hold Your Wee for a Wii."
They may have been clever in thinking up contest names, but were not quite as clever in knowing the consequences of excess consumption of anything - including water.
Water intoxication - also known as hyponatremia - is more commonly seen among athletes, usually extreme athletes, although it can happen to anyone who consumes too much water, causing a critical loss of sodium. Dick Hanneman made a point of blogging this issue back in September, 2006 .
The young Sacramento mother was simply trying to secure the Wii game console for her children.
Contestants were asked to sign a waiver before taking part in the competition, but the winner of the game said participants were never alerted to the dangers.
A listener - apparently a nurse - called the show and warned the deejays of the risks of the game, but to no avail.
Yesterday, the radio station fired the morning disc jockeys and seven other employees involved in setting up the contest
Hyponatremia is a disorder of fluid and electrolyte balance characterized by an excess of body water relative to body sodium content (specifically a serum sodium concentration less than 135 mEq/L). It is the most common electrolyte disorder encountered in clinical medicine and is associated with negative outcomes in many chronic diseases. Yet, most people don't understand the significance of drinking water to excess without taking supplementary electrolytes, such as salt.
Although most hyponatremia victims may appear to be asymptomatic, severe hyponatremia is a medical emergency that calls for immediate treatment. Complications can include seizures, coma, brain-stem herniation, respiratory arrest, permanent brain damage, and death.
Two years ago, a 21-year-old student died of water intoxication during a hazing incident at Chico State University. He had been forced to drink from a five-gallon jug of water that was repeatedly refilled. He soon collapsed and had a seizure. Fraternity members didn't initially call an ambulance. By the time they did, it was too late. He was pronounced dead a few hours later.
It difficult to understand why we mindlessly continue to amuse ourselves with challenges that subject our bodies to physiological extremes, but if we do so, everyone should know the risks and consequences.
There's been a lot of chatter in the U.S. and the U.K. in recent weeks about food labels.
In the U.K., European Food Information Council (EUFIC) director general Josephine Wills presented her views to the CIAA on research on consumer response to nutrition information on food labels in Europe. She noted that although nutrition labeling has been a major instrument for consumer health and nutrition education, research shows consumers don't understand the information and likely misuse it in actual consumer purchasing decisions. The UK labeling debate divides consumer activists advocating a stoplight (red-yellow-green) "good food/bad food" label from the Food and Drink Federation (FDF) and many food manufacturers who advocate "Guideline Daily Amounts" (GDAs) for four key nutrients (calories, protein, carbohydrates and fats). Including salt is optional. FDF launched a 4m pound campaign last week to promote GDAs. The food industry effort has prompted two government agencies to proclaim a joint "independent" panel to provide an evidence-based resolution of the issues. For their side, perhaps the food companies can also agree on their own "independent" panel.
The same issues separate U.S. food manufacturers and "consumer" groups like the Center for Science in the Public Interest (CSPI). CSPI has agitated for many years for a "good food/bad food" stoplight label while the GMA/FPA and Food Marketing Institute announced last week its "Take a Peak" promotion campaign for the government's Food Guide Pyramid. The food manufacturers' campaign is the largest of a series of "private" label/education efforts which include commercial endorsement logos sold by the American Heart Association and grocers like Hanaford Brothers with their own "stars" labels. Predictably, CSPI objected to the new GMA/FPA-FMI promotion, having earlier sued FDA to require its preferred red-yellow-green stoplight. CSPI president Michael Jacbson complained to the Washington Post : "What's a consumer to do if one product has the Take a Peak logo and right next to it is a product that gets the American Heart Association logo for being a healthy food?"
Our suggestion: use evidence-based procedures to evaluate both the relationship of the claimed health benefits to quantities of nutrients ingested as well as objective measures of how consumers use food labels. There's a lot more heat than light on these issues at present.
The media is generating a mountain of coverage alleging bias based on the funding source for scientific studies, most particularly, recently, when that funding source is "industry." Presumably disinterested funding partners like the federal government, universities and even, in one recent case, the "consumer" interest group the Center for Science in the Public Interest (CSPI), get a free pass. That study , released earlier this week alleged that food industry funding biased conclusions of research studies on the healthfulness of fruit juice, milk and soft drinks. All the authors claimed they were free from bias -- including CSPI. CSPI is an advocacy group whose primary mantra is that the food industry is trying to poison its customers. Unbiased? Still, it's not an "industry" group (unless fear-mongering is an industry), so no one thinks to ask if having an author who is part and parcel of an advocacy group with a dog in this fight might somehow bias the study.
Worse, the matter of potential author bias entirely escaped media attention (or at least my monitoring of the coverage which focused on pointing with alarm to "industry money.")
Let's face it: every research project has a funding source and that funding source has a theory of what they hope science will confirm. Every funding agency has a "bias;" they want to confirm their hypothesis. That doesn't invalidate the study. The key thing is the quality of the science itself.
The ludicrous extreme of the current uncritical condemnation of industry-funded research and equally uncritical endorsement of studies funded by universities, "public interest" groups and governments is that the "white hat" scientists are credible while the "black hat" researchers employed or funded by industry find their motives examined more than the science they produce.
There's a name for the clear political agenda at play here: socialism. If socialism is government ownership of the means of production, then de-legitimizing privately-funded research is outright socialism. It is destroying the private production of science in favor of government-funded studies because only government can "protect" citizens from the rapacious, unconscionable private sector.
Medical research can be an expensive undertaking. None of the published studies at the heart of the salt and health debate have had salt industry funding support. Most are studies of government data. Most of the analysts are government-funded. Having the government gathering the data and then interpreting it weakens individual citizens. And when government goes that still-further step of denying independent scientists access to its own data, the problem moves from concern to alarm (a problem supposedly addressed by the Data Quality Act).
A good start to redress this disturbing imbalance and dangerous trend is to insist on more rigorous examination of the science itself -- study design and conformance with transparent, replicable analytic techniques. After all, if we play political games with the "evidence," it really doesn't change anything physiologically -- neither politicians nor bureaucrats can amend the laws of nature. If we head down the wrong road we don't just waste tax dollars, we "kill" people who would survive if we'd had an accurate read on the science.
The Salt Institute tries to correct the subtle distortions of our defense of the healthfulness of dietary salt. One common slander is that the Institute sued the federal government challenging the validity of the DASH-Sodium study. Regular readers will recall that the government claimed that the study proved that "every American" would be healthier if they reduced salt intake. While we strongly dispute this conclusion, we don't actually challenge the study; it seems of high quality -- only the interpretation of the findings. This is a small distinction with an important difference. Let me illustrate the way the case was put today by unbossed.com by repeating our response (also posted on unbossed.com):
As the president of the Salt Institute, which you mention as the plaintiff for the DQA test case, I feel I must correct an error incorporated into your blog. You repeat Chris Mooney's erroneous statement that the lawsuit challenges "a National Institutes of Health study on diet" that is "state-of-the-art scientific work."
Actually, we agree that the study is "state of the art" -- and vitally important. But our lawsuit did not challenge the study at all. The lawsuit challenged the fact that the government had not made the data available for independent experts to validate its "insider" interpretation of the data as required by the DQA. We asked, specifically, that the beginning blood pressure and the standard deviations of the subgroup analyses be disclosed; they have not been published and it is impossible to determine the accuracy of the conclusions being drawn without these statistics that could be provided in a millisecond from the data of the study's authors. The data are fine, but incompletely divulged and we asked only a tiny bit of information. As it is, published data by the authors have already confirmed that the agency has mischaracterized the findings. The government says the health of "all Americans" would be helped by cutting back on salt. Not only does this study not address that question at all (it is confined to blood pressure, not the net health effects of salt reduction) but in six of the eight reported subgroups -- representing the vast majority of Americans -- even blood pressure lowering is not statistically significant. This says nothing of the adverse impacts on glucose metabolism and the heart attack-stimulating production of the kidney hormone renin.
So, to set the record straight: we challenged the agency's application of its own DQA guidelines, not the study which seems to be first-rate (if not fully understood).
Dick HannemanPresidentSalt Institute
The half-truth allegation (we DID, after all, sue the government), if unchallenged, would have the effect of undermining the credibility of our argument; if people believe the DASH-Sodium study is a quality study, they would be less willing to listen to our complaint about the twisting of its findings. And if you're in the knowledge business as we are, your credibility is a huge factor in your effectiveness. Ignore the little things and you lose the ability to influence the big things. It's like the policing strategy adopted in New York City by "America's mayor," Rudy Giuliani. Mayor Giuliani started enforcing against breaking windows and painting grafitti on buildings and it helped unravel the hopelessness the public felt about obeying the law and led quickly to a dramatic fall in violent street crime. Same principle.
Sometimes we all get so busy that challenging the distortions pales in importance with the urgent priorities we all face, but responding not only preserves our credibility as salt industry advocates, but helps erode less-informed or even malicious distorters of the facts. Take time to become informed and speak out!
