"EAT"ing my banoffee pie

I had the pleasure of launching the EAT Lancet Commission report in beautiful Cork Ireland at the University of Cork College, hosted by Nick Chisholm at the Center for Global Development. It was a really great event attended by a diverse set of individuals including those from the livestock sector and dairy farmers, advocates, students, professors and researchers.

I presented the overall findings from the EAT Lancet Commission report but I also gave two additional perspectives. The first was my personal view on what I thought the EAT Lancet did not cover adequately or ignored, but should not have. The second was the Ireland perspective - what does the EAT Lancet mean for the future of Ireland’s food system? My slides are here.

On what I thought the EAT Lancet did not adequately do. It did not:

1. Address the confused space of sustainable diets and the epidemiology and science to support it. This was the most contentious aspect of the report and continues to be questioned. I don’t think the report cleared up the debate of what are considered sustainable diets and may have made things more contentious and perplexing.

Inequities in meat consumption

2. Tackle the inequities in food systems. The report did not at all go into how people experience difficulties in accessing healthy foods and the inequities in which they bring. It is easy to say eat less meat, but it really depends on where you are in the world, who you are, how contexts and situations can be more or less vulnerable, and what you can afford and access.

3. Take on the entirety of food systems. The EAT Lancet Commission just covered food production and consumption — the head and the tail of the food system — but we know there is this whole middle piece that drives health, sustainable and economies: food supply chains, food environments and drivers of food system transition. The EAT fell short in covering the full scope of food systems but if we did, the report would be 500 pages, not the current 50, in which still, no one read…

4. Focus on who will feed us and their livelihoods. The report did not at all go into the impacts of this type of diet and earth system change on food producers and their livelihoods, ways of life, and traditions. Nor did it go into women producers, small and medium sized producers or rural development/impacts.

5. Examine the actors, especially, consumers and behavior change. The diet really looked at supply side changes and not much on how consumers can take on such a diet, how behavior change is needed and what nudges should be put into place.

6. Consider the local social determinants, and the trade-offs. The report was lofty, ambitious and global. But local nuance, decision making and context is needed, and the report just didn’t have the bandwidth to take on local to global perspectives.

On Ireland. It was fascinating to launch the report in Ireland for a few reasons. I took the train from Dublin to Cork and the landscape was riddled with black and white cows and green rolling hills. I knew the launch could be tough…Was I entering a snake pit?

Bountiful beef cows!

First, the cattle and dairy industry is strong here. And for good reason. The agriculture sector contributes significantly to the GDP of the country. The Irish beef sector currently accounts for over 30% of the value of Irish agricultural output at producer prices. Number of cattle heads here. The beef output of Irish farming provides the key input to the Irish meat processing industry. In 2014 the Irish meat processing employed over 13,000 people. Irish agriculture is dominated by family-owned farms.  There are almost 140,000 farms, with an average land holding of 32.5 hectares.  Pasture-based farm enterprises dominate, and as a result, Irish output is dominated by dairy and livestock, especially beef.  Dairy and beef account for two-thirds of gross agricultural output and similar proportions of agri-food exports. Ireland is currently one of the world’s fastest-growing dairy producers and exporters.

Second, the impacts on climate change should not be taken lightly. They have seen a 25% and 9% increase in dairy and cattle head numbers. As a result, their agriculture sector contributes 33% of GHGe in Ireland. Methane is 64% of that. Nitrous oxide from N fertilizer application and excretion of manure is 31%. Energy contributes less - 20% and transport 19% of GHGe. GHGe have been increasing 3.5% every year since 2015 in Ireland. Ireland can play a lead role in fulfilling the “sustainable intensification” goal but so far, they are falling short on the climate agenda. Irish farmers are aware of the need to produce more from less and are addressing their carbon footprint. There is a lot more to do. A Teagasc blueprint on how to make Irish farming carbon neutral is a roadmap, but stakeholders have not signed up to the necessary timelines which will cause them to be fined 600 million for not adhering to the targets set out during the Paris COP agreement. 

The insanely delicious banoffee pie

Third, we know that the traditional Irish diet is not sustainable. Some of the top risk factors of death and disease in Ireland are related to diet. And have you ever had banoffee pie? Enough said.

While I was there, there were a lot of the questions about the “hangover” of the report. More of the questions asked by media were about the political backlash of the report findings, why WHO pulled their consensus of the report, and what it means for Ireland’s livestock industry. I found myself defending a report that while I feel fully responsible for what it says, I too find not helpful when we get into the nitty gritties, the realities and the nuance needed to make such transformational changes.

I have never been in something so high profile that I have had to defend but don’t have complete ownership over its content. I am glad to take the fall on things that I believe in or that I have been solely responsible for. But this is a different beast.

FOOD BYTES: WEEKLY NIBBLES FROM APR 5 - 21

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

After all the chaos of the Mueller report and sanctuary cities here in the U.S., I found much joy in tuning out, and instead reading about our fellow friend, the coyote’s diet. Turns out, they eat a lot of cats. Not so much roadrunner. Talk about the new urban hunter! The researchers who investigated the scat of these stealthy creatures also found that their diets consisted of “baseballs, shoes, furniture, and bedazzled jewels.” Hide your pets…

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National Academy of Sciences, Engineering and Medicine report: Sustainable Diets, Food and Nutrition

The National Academy of Sciences, Engineering and Medicine held a a public workshop in Washington, DC, in mid 2018 on sustainable diets, food, and nutrition. Workshop participants reviewed current and emerging knowledge on the concept of sustainable diets within the field of food and nutrition; explored sustainable diets and relevant impacts for cross-sector partnerships, policy, and research; and discussed how sustainable diets influence dietary patterns, the food system, and population and public health. This publication summarizes the presentations and discussions from the workshop.

This week, climate change was on the minds of many, with young people marching in the streets and young, but wise Greta Thunberg showing her courage in the fight, hence being honored by Time magazine as one of the 100 most influential people.

We at Johns Hopkins hosted an event on food and water security in the era of climate change. We had some really fantastic experts speaking at the event. I was hoping for a sold out house, but no such luck. We had good attendance but I guess people don’t care that much about the changing climate. I have no other explanation. Here is what the event was about:

The media headlines in the last two weeks showing Nebraska and Mozambique underwater are tragic glimpses of a new era - the era of climate-related natural disasters. Climate change is and will continue to impact the lives of everyone, and will have significant ramifications on both water and food security globally. Climate-related impacts affect water availability in regions that are already water-stressed, as well as the productivity of both irrigated and rain-fed agriculture. Rising temperatures translate into increased crop water demand and have consequences for food availability, and potentially, the nutritional content and quality of crops. Likewise, insufficient and compromised food access and utilization influence households and individuals ability to access healthy diets and drinking water, which can have detrimental health outcomes. No one is immune — both the livelihoods of rural communities and food security of urban populations are at risk of water insecurity linked to climate variability. The rural poor, in particular, are disproportionately affected by climate effects. It is likely that climate variability and change will continue to exacerbate food insecurity in areas currently vulnerable to hunger and undernutrition. There is an immediate need for considerable investment in adaptation and mitigation actions toward “climate-smart agriculture, water and food systems” that are resilient to climate-related shocks. This seminar will delve into water and food security in the midst of a changing climate and what we can do as a global community to adapt and mitigate.

Speaking of climate change, I really liked this piece by Richard Waite and Janet Ranganathan of the World Resources Institute (a speaker at our event) on beef and climate. They unpack 6 common questions about the contentious topic of the sustainability of beef production systems and climate change. Here they are:

1. Q: How does beef production cause greenhouse gas emissions? A: Through the agricultural production process and through land-use change.

2. Q: Is beef more resource-intensive than other foods? A:Yes.

3. Q: Why are some people saying beef production is only a small contributor to emissions? A: Such estimates commonly leave out land-use impacts, such as cutting down forests to establish new pastureland. I think it is politics and some denial there too…

4. Q: Can beef be produced more sustainably? A: Yes, although beef will always be resource-intensive to produce.

5. Q: Do we all need to stop eating beef in order to curb climate change? A: No.

6. Q: Would eating less beef be bad for jobs in the food and agriculture sector? A: Not necessarily

If you want to read their long responses, check out the article! They also have a ton of solutions in their Creating Sustainable Food Futures report and in the figure below.

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World Resources Institute’s Menu of Options from their most recent report: Creating Sustainable Food Futures

And climate change is definitely real. Farmers are feeling the effects. A NYT article looked at Honduran coffee farmers are being hit hard. Estimates suggest that least 1.4 million people will flee their homes in Mexico and Central America and migrate during the next three decades. But if Trump has his way, they will be met with a Game of Throne like wall…

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Johns Hopkins Global Food Ethics and Policy Program newsletter

Last but not least, there is a lot of talk about cultural appropriation around food these days. A restaurant opened in New York called “Lucky Lee's”, a new Chinese restaurant, not run by Chinese but a Jewish American couple who wanted to have a Chinese restaurant that served “clean” food that was healthy. Not sure what the hell they were thinking. You can’t really mess with food particularly because it is so deep rooted in people’s culture and tradition. It holds a special place in society and it gets quickly politicized when you remove it from its core identity.

And last, last but not least, the Global Food Ethics and Policy Program at the Berman Institute of Bioethics at the Johns Hopkins University puts out a weekly newsletter on interesting articles in the food space, much like this one. It is curated by Claire Davis at the Berman, and I find it to be a rich source of information on ethics and politics of food and nutrition. I encourage you to sign up for it. It is also in the Food Archive resources section.

Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

• Why do we still have hunger & undernutrition?

• Why are we not seeing improvements? And in some cases reversals of progress?

• How did we get to this place of paradox: hunger & obesity?

• What can we do about it?

I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

• Limited resources and lack of access to healthy, affordable foods

• Cycles of food deprivation and overeating

• High levels of stress, anxiety and depression

• Limited access to health care

• Fewer opportunities for physical activity

• Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

3. Consider the situation a “Syndemic” and take on triple duty actions.

4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused…

10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Food Bytes: Weekly Nibbles from Mar 25 - Apr 4

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

This week’s food bytes focuses on the complications of understanding what is a healthy diet because there seems to be much havoc and confusion in the space. The more havoc, the more people want to dissect the havoc or relish in it. And we seemed to be inundated these last two weeks with diet news.

Tamar Haspel is a fantastic food columnist for the Washington Post. There was a lot of twittering and conversation, which she does not shy away from, about her recent article entitled “Here’s what the government’s dietary guidelines should really say.” She hauls the science of nutrition over the coals leaving no one left standing. In her article, she presents two main criticisms. Her first issue is the flawed nature of nutritional sciences. Errors abound in the way diet data is collected, the way observational studies assess impacts of those diets on outcomes, and the ways in which confounding factors are taken into account. Her second issue is the conflicts of interest in nutritional science. She highlights not just perverse industry-funded research, but also, the nutrition experts’ often ideological world views, or “fanatical opinions that abound in nutrition” which shape interpretations of the data in misleading ways. These two issues, the imperfect science and the conflicts of interest, interact and influence each other.

Following her merciless critique, Haspel concludes that “In the two decades I’ve been writing about nutrition, my confidence in what we know about food and health has eroded.” She is not alone. Many people are very confused about what is healthy and what is not. What will kill you and what will keep you alive. What is sustainable, and what will ruin the planet. She is left feeling certain about three simple things: (1) eat a wide variety of foods with their nutrients intact; (2) keep your weight down; and (3) get some exercise. Sounds about right.

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Timeline of the nutrition science field

Do former New York Times writer Mark Bittman and Yale Professor David Katz agree with these sentiments? Largely yes. They argue, “eating well remains difficult not because it’s complicated but because the choices are hard even when they’re clear.” But they have answers. Lots of them. They thought of every question imaginable about diets and health and tried to answer them. Many of the answers are a bit “take my word for it,” but I give them the benefit of the doubt. Although some could wonder why we trust Bittman over credible scientists, but I digress. They argue that future conversations are no longer needed. Yeah, if it were only that easy boys…

Katz also delves deep into why we are eating as if we know less about food than ever before. He argues that humans have been bamboozled by prominent ideologues in the field of nutrition who have built careers defending just one point of view. Similar sentiments to what Haspel highlighted. He argues:

“Where humans practice any reasonable variant on the theme of wholesome foods, mostly plants, in a balanced, time-honored assembly; wherever they eat mostly vegetables, fruits, whole grains, beans, lentils, nuts and seeds, and drink mostly water, they tend to live long, prosper with vitality, and go late and gentle into that good night.  It is not the job of “science” to tear down this established foundation: It is the job of science to build upon it.”

I think what Katz is getting at is that the science of nutrition has come a long way, and there is lot of agreement about the science, but we need to build further on that evidence base. At least, I hope that is what he means. Well-respected Dariush Mozaffarian (Dean and Jean Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy) and colleagues have shown a timeline of the nutrition field and how far the science has come. In the final piece of their timeline - the future - they argue, “Public health future nutrition policy must unite modern scientific advances on dietary priorities with creative new approaches for trusted public communication and modern evidence on effective systems level behavior change.” Trusted public communication. Sounds quite similar to what is being argued by Katz and Haspel. The question is, how do we ensure the science and the way it is communicated by scientists, media and journalists, is trustworthy?

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Global Burden of Disease Lancet study: impact of diets on mortality

But the chug and churn of nutritional sciences continues amidst the havoc. Here are three studies published these past two weeks that show the impact of diets on health, at three different levels: at the dietary pattern/whole diet level, the food group level and the individual nutrient level.

1. The Global Burden of Disease project out of the University of Washington just published a Lancet paper on the impact of suboptimal diet on noncommunicable disease mortality and morbidity (Full discloser: The Food Archive archiver is an author on this paper). The estimates (and modeled data) show that 11 million deaths and 255 million disability adjusted life years (DALYs) were attributable to dietary risk factors. High intake of sodium (3 million deaths and 70 million DALYs), low intake of whole grains (3 million deaths and 83 million DALYs), and low intake of fruits (2 million deaths and 65 million DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries.  

2. Sabrina Schlesinger and authors published a systematic review looking at the impact of food groups on risk of overweight, obesity and weight gain. They found that increased consumption of whole-grains, fruits, nuts, legumes and fish consumption had a negative association with overweight and obesity. Positive associations were found for refined grains, red meat, and and sugar sweetened beverages and overweight, obesity and weight gain. 

3. And last, a Nature paper examined the impact of carbohydrate, a macronutrient, quality on health. They argue that the quality of carbohydrate-rich foods (high in fiber and whole grains) rather than quantity has the strongest effect on decreased mortality and reduced incidence of cardiovascular diseases, type 2 diabetes mellitus and colorectal cancer.

Still confused? Everyone is sort of saying the same thing that Michael Pollan said so simply a decade ago, now a mantra for many: Eat food, mostly plants and not too much.

Soda, Celebrities and Sell Outs

I wrote this piece two years ago on my urwhatueat blog, but I feel it needed to be updated and resurfaced.  So here it is.

A few years ago, Mark Bittman wrote: “Why Do Stars Think It’s O.K. to Sell Soda?” This was in response to Beyonce’s TV ad selling Pepsi to the masses. I couldn’t agree more. It is maddening actually. With the current culture being so obsessed with all-things celebrity, you would think that actors, musicians, and athletes would use that position, an enormously powerful one, to make positive change in the world. I was really surprised and disappointed to see one of my favorite actors, Steve Carell (with Cardi B and others), doing a Pepsi commercial during the 2019 Super Bowl yelling that Pepsi is “okay!” But is it Steve?

One out of every 4 people are overweight or obese globally – approximately 2.1 billion people. This “globesity” pandemic touches everyone including young children and teenagers. Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years and now more than one third of children and adolescents were overweight or obese.

So what does obesity have to do with soda? Well…the evidence is pretty cut and dry at this point. Some would argue, and are often “paid” to do so, that soda doesn’t make a dent as a contributor to our waistlines but that is just hogwash. Much of the deleterious effects are due to the high content of sugar in these products. One single 12-ounce can of soda contains three-quarters of the daily added sugar the World Health Organization deems as safe. We know three things about soda and other sugar-sweetened beverages (SSBs such as soda, energy, sports drinks, sweetened teas):

1. Serving sizes have increased: Before the 1950s, standard soft-drink bottles were 6.5 ounces. Now, 20-ounce to 42 ounce bottles are the norm.

2. People everywhere are drinking more soda: In one decade, calories from sugary beverages increased by 60% in children ages 6 to 11, and sugary drinks (soda, energy, sports drinks) are the top calorie source in teens’ diets.

3. Soda does contribute to obesity and diabetes: Frank Hu at Harvard outlined the studies that make the case. Recent meta-analyses show that higher intake of SSBs among children was associated with 55% higher risk of being overweight or obese; A meta-analysis showed that one to two servings per day of SSB intake was associated with a 26% greater risk of developing type 2 diabetes compared with occasional intake (less than one serving per month); Two large randomized control trials showed that reducing consumption of SSBs significantly decreases weight gain and adiposity in children and adolescents.

Convinced yet? Unfortunately, some of the top-selling artists and athletes are clearly not convinced or just don’t care. Instead, they have sold their souls to the soda companies. Not that some scientists are any better. This whole fiasco of soda companies funding science and pushing the product in emerging economies is just beyond me. With all the commoditization of everything on the planet, isn’t there anything that remains pure and of sound truth? Science should remain untouched, un-monetized: an “immuno-priveleged” place where you just don’t tamper with evidence. Marion Nestle, professor at NYU, has written a whole book on the poltics of soda aptly entitled “Soda Politics” highlighting the perverse tactics used by soda industries to fund and push their products on the public. But I digress…

Selling products with saccharin-sweet pop music is so ubiquitous in our culture that you can even take quizzes on which celebrity sold Coke or Pepsi. Not sure the point of that but indeed a good time waster.

The 1980s saw pop music come to life (and further exploited) through our TV, not just our record players (cassette tapes in those days) thanks in large part to MTV. Commercials or mini videos followed. As an 80s teenager, the first massive star I remember selling soda was Michael Jackson and he took a pretty decent pop song, Billy Jean, and changed its lyrics from “Billy Jean is not my lover” to “You’re the Pepsi generation.” Swell. But it all didn’t work out so well for Mike. Remember the hair catching fire incident not to mention other controversies…Next up. Madonna aka self-proclaimed #rebelheart. Dancing in lingerie in front of burning, Catholic crosses and kissing a black Jesus proved to be a bit too racy for Pepsi in which her ad was banned. Mamma mia.

With each decade, the hits and the soda sales just escalated. Britney Spears, Beyonce, One Direction for both Pepsi and Coke (isn't that a conflict of interest?), Selena Gomez (sipping the slurpy stuff from a Coke bottle with a straw got over 7 million likes!) and Taylor Swift, to name a few. But Taylor is okay because she promotes diet soda. Taylor – don’t you know about the implications of diet soda on the profile of the microbiome? Sigh…

Biggie in da Bronx

CSPI, a DC nutrition watchdog, published a list of celebrities, what they promote, and twitter feeds like Pittbull’s elegant tweets of poetry: “Hanging out at Club23 with Dr. Pepper.”  Nas and Drake for Sprite – Obey your thirst. In the ridiculous video, showing lots of young African American men drinking soda, Drake actually credits Sprite with his success. Maybe he should give himself more credit instead of belittling his talent to something so nutritionally deficient. Even the dead cannot RIP. I saw the below ad in the Bronx. Who gave Sprite permission to use Biggie’s image? His estate? Is that even legal?

Kendall Jenner, one of the Kardashians, did a Pepsi ad last year, that infuriated the #blacklivesmatter (BLM) movement. At the end of the commercial, Kendall walks to the front of the protest line, and hands a police officer a Pepsi. There is an exchange of peace, love and understanding. The crowd cheers on Kendall, who has saved the day, ending any resentment and policy brutality. Indeed art imitates life with this ad taking inspiration from a photo of a specific black woman, Leisha Evans, bravely standing up to riot gear adorned police at a BLM protest in Baton Rouge.  Live bolder, live louder, live for now. "Pepsi was trying to project a global message of unity, peace and understanding. Clearly, we missed the mark and apologize." Um…yah.

What makes this so infuriating is that they are targeting young, African Americans. But African Americans are not untouched by the obesity epidemic and often, suffer significantly more than other races due to poor access to healthy foods, poverty and inequity. Some stats in case you don't believe me:

• African American adults are nearly 1.5 times as likely to be obese compared with White adults.

• 47.8% of African Americans are obese compared with 32.6% of Whites

• More than 75% of African Americans are overweight or obese compared with 67.2% of Whites

• 35.1% of African American children ages 2 to 19 were overweight, compared with 28.5% percent of White children

#BlackLivesMatter – indeed they do. And if we continue to push junk food and soda on populations, racial health inequities will continue to persist.

On one hand, I understand the pull of profit. Celebrities make bank with these commercials. We could equally criticize all the sports players who promote equally unhealthy sugar sweetened beverages (Gatorade etc) and movie stars promoting fine Japanese whiskey (for a relaxing time, make it Santori time), but picking on pop stars is fun. And they earn so much money already. One Direction, a British pop boy band, was the highest grossing band in 2017 due to touring, which of course is always sponsored by somebody. Do they need to sell Toyota, Coke, and everything else that comes along, to sell their songs and get teenagers to come to their concerts?

I am not judging them. Well, maybe I am. I bet they are all great human beings and many have promoted important causes. One Direction is pushing Action 1 which is getting the young generation to take action and raise their voices to what future they want in the post 2015 development agenda. Commendable. Taylor Swift in her own right is empowering young women #GirlPower! The millennial generation, which Taylor and others are 'labeled' as, is impressive. I know. I teach them every day. What bothers me is the selling of their songs – their “art” – to sell soda. Why? They should really start thinking about their fans. If they want them to continue buying their records, going to their movies, and going to their shows, they should want their pre-pubescent and adolescent fans to be healthy. Especially our girls who are particularly vulnerable to obesity, with life-long repercussions.

We know celebrities care about their own health. They gotta look good with 25million+ Twitter and Instagram followers watching their every move. Most popstars are on special diets, have brutal trainers, do yoga and soul cycle. They probably don’t drink soda or for that matter, consume any sugar. Because well, that is what their personal nutritionist advised them to do…And advice given by "nutritionists to the stars" is ALWAYS of sound scientific evidence (Think Beyonce + Cleanse).

One could argue that there are efforts underway to counter these ads - companies are reformulating sodas to get the sugar content down or using alternative sweeteners, and national and municipal governments are taxing soda at the point of sale. Is this enough? I will write on these topics in some detail at a later date.

And maybe it is all just a bit unethical to be pushing soda on children? Marketing junk food and soda to children is generally considered pretty immoral in some circles, and wreaks of the same tactics used by tobacco to get kids to smoke. Check out this Coke 2018 ad called The Wonder of Us that promotes “the diversity of youth” and “there is a different coke for all of us.” Rafael Acevedo, the group director for Diet Coke in North America said “Millennials are now thirstier than ever for adventures and new experiences, and we want to be right by their side. We're making the brand more relatable and more authentic.”

Maybe celebrities need to be held accountable to what they are selling and to who?Young popstars should take a page from the songbook of Neil Young. Or at least watch "This Notes for You" and his rip on the commercialism of rock and roll.

 Ain't singin' for Pepsi


Ain't singin' for Coke


I don't sing for nobody


Makes me look like a joke


This note's for you.

Well sung Neil Young.          

Food Bytes: Weekly Nibbles from Mar 4 - 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Chicago Council on Global Affairs released their annual report. This year focuses on water: From Scarcity to Security: Managing Water for a Nutritious Food Future. There are lots of nuggets on the links of water to food and nutrition. Definitely worth a read.

IFPRI has also launched a new book: Agriculture for improved nutrition: Seizing the momentum. I contributed a chapter on biodiversity and its importance for food and nutrition security.

I always like what Bee Wilson writes. She recently wrote a great piece in the Guardian on how modern food is killing us. The grape story is an interesting analogy of how our food system has changed.

I just can’t help myself, but the EAT Lancet continues to get press. This article hones in on how it spurred a global debate. Great. It did its job. Keep debating! The Guardian is going a bit nuts on the diet side. They also published a recent piece on “peak beef.” And the Hopkins HUB, published an article on proteins of the future where they warn us to “get ready for a menu of lab-grown steaks, "bleeding" plant burgers, and cricket smoothies!”

Speaking of animal source foods, eggs seem to be bad for us once again. The nutrition science field is just one big teeter totter. This JAMA study shows that eggs increase cholesterol and cardiovascular mortality.

If Africa doesn’t have it tough enough these days, my heart goes out to Mozambique with the cyclone devastation, the armyworm seems to be eating its way across the continent destroying staple crops like maize. Let’s hope R & D can be ramped up quickly with solutions.

I am a closet Chipotle lover and Tamar Haspel outlines the woes the chain has been dealing with.

Two other interesting papers came out last week. One is unpacking stunting - faltering of linear growth in children. The other is a paper in the journal I edit, Global Food Security, on the use and interpretation of dietary diversity indicators in nutrition-sensitive agriculture literature.

In the world of food ethics, with colleagues at Hopkins and Columbia University, we published two papers. The first is in the Oxford Handbook of Public Health Ethics. The chapter focuses on three key ethical challenges in the nutrition public health sphere: the prioritization of key actions to address the multiple burdens of malnutrition, intergenerational justice issues of nutrition-impacted epigenetics, and the consequences of people’s diet choices, not only for humanity but also for the planet. In the second paper, we unpack the meaning of nutrition and demonstrate that a standalone right to adequate nutrition does indeed exist in international human rights law as a sum of other rights. This right to nutrition is, essentially, the sum of the human rights to food, health, education, water and sanitation, a healthy environment, information, political participation, and social security, along with rights ensuring adequate protection of and nondiscrimination against specific groups, such as women, children, and indigenous peoples.

Nutrition and Agriculture Research: Some Thoughts

I recently was asked to provide some commentary at the International Food Policy Research Institute (IFPRI) at the ARENA-II (Advancing Research on Nutrition and Agriculture) project policy seminar. I thought I would post my speaking notes on what I think is a really fascinating set of research findings stemming from the project. The seminar presented new research on food markets and nutrition including cross-country studies of the costs of nutritious foods and nutritious diets as a whole, and case studies of fish, dairy, and poultry products. The event can be watched here.

ARENA is trying to understand markets in low-income contexts. Markets play a key role in delivering food and nutrition, even for poor and remote rural households. But nutrient-rich foods, especially animal-sourced foods, are very expensive in poor countries, suggesting that markets for perishable but nutritious foods are not functioning well. Both scientific research and real-world programs have largely focused on farm-level interventions to diversify household production and consumption, not recognizing the important role of market purchases.

The major findings coming out of ARENA:

1. Nutritious foods are typically very expensive sources of calories in low income countries, although there are exceptions.

2. Consumption patterns are strongly associated with prices - price variations explains a LOT of the gap between low and high consumers.

3. Indirect evidence that non-price factors (also implicit price factors) matter a lot: e.g. refrigeration and water quality.

4. No single solution for improving affordability or increasing consumption:

• Eggs: domestic productivity is key, often improving feed sectors (maize, soybean, fishmeal).

• Dairy: production in some countries, but trade in others. Markets work incredibly badly in rural areas.

• Fish: cheap and nutritious but under-appreciated by consumers.

• Domestic and international value chains very important, but also important to think about industrial policy: e.g. How do we create a viable modern dairy industry that delivers affordable safe milk to both rural and urban consumers?

My talking points:

Diets are significant risk factors of morbidity, disability and mortality

The Global Burden of Disease based out of the University of Washington in Seattle has recently assessed the burden of malnutrition in all its forms for the Syndemic commission report in the Lancet. Globally and in the lower income countries, malnutrition in all its forms (shown as the contributions of undernutrition, high. body-mass index, and dietary risks) contributes as much disease burden as high blood pressure, tobacco, high fasting blood glucose and water, sanitation and hygiene combined. For countries with a low Socio-demographic Index, undernutrition incurs a much higher burden both in absolute terms and relative to the other leading contributors. The recognition that undernutrition and obesity are both due to poor diet quality and a low variety of healthy foods is a more helpful perspective to resolve nutrition problems collectively.

Our knowledge of diets is still a black box

Understanding what people are eating is important to shape food system and nutrition policies, including dietary guidelines. However, determining what people are eating, remains somewhat of a black box. We don’t know key questions such as, what are people actually eating? Where do they get their food from and how much do they pay, or are willing to pay for food? What influences their dietary choices? Does health or even the environment factor into their decision making? Data on diets and their sourcing and costs are developing with better use of metrics and surveys that feed into larger databases. We are learning more and more with each passing year. We still have significant gaps in low-income settings on many of these questions.

Diets are inequitable

We are really living in a time of haves and have nots. Globally, there is a significant debate going on about the impacts of animal source foods (mainly large ruminants) on climate change, the environment and on human health. Clearly, this debate sits with high-income countries and those countries which produce and consume vast quantities of meat that do not align with the sustainable development goals. However, we know that the production and consumption practices of some, will impact the many living in low-income countries who do not have the resources to adapt and change rapidly and are limited in their options. The inequities are staggering - the rural, the poor, the geographically isolated struggle to get enough animal source foods that are important, particularly for young children who are growing and developing and need nutrient-rich foods high in iron, zinc, protein, D, B12 etc. The ARENA study advances are understanding of the challenges that rural populations face in getting access to these critical foods – eggs, dairy and fish, rich in important nutrients and other health promoting properties – through both informal and formal markets. While the evidence is growing on the impacts of on-farm production to dietary diversity of households, we know rural peoples, smallholder farming families and day labor workers are net buyers of food and they need market that work.

 My questions

I know the ARENA is meant to of course shed and shine a light but it is also meant to set out a research and policy agenda. Here are some of my questions that I was left wondering about for future research:

• Infrastructure is so important. Not just roads but technology and innovation along supply chains. What would be the role of the private sector or PPPs to accelerate action and get over the barriers to access?

• We cannot think about commodities as stand alone. They interact (the ARENA shows how important feed sectors (maize, soybean, fishmeal) are critical for the growth of animal source foods). How do we grapple this with land use changes?

• The enabling environment is key. What should policies focus on? Subsidies? Trade?

• Changing food environments or markets. How shall we measure changes and rapid shifts that we are seeing in many rural places, with the encroachment and influence of urban hubs? I would be keen to see how processed, packaged foods are changing the diets and market landscape in rural places.

• Many consumers all over the world are driven by the same issues - price, convenience, taste. Other factors matter too like reliability and safety. How do we get consumers to care more about nutrition or is that completely unrealistic? What are the trade-offs?

• Eggs: Can these rural areas shift from scavenging systems to intensive systems? How realistic is that? How much does that cost? Is there infrastructure and investment to do this? There is new evidence showing eggs increase cholesterol and heart disease risk - once again, eggs are deemed to not be god for us. Should we be worried about future burdens if we are promoting these foods to children to improve nutrition?

• Dairy: Lactose intolerance. The expression of lactase which digests lactose from milk in humans is generally lost after weaning, but selected mutations influencing the promoter of the lactase gene have spread into the human populations. This is considered a classical example of gene-culture co-evolution, and several studies suggested that the lactase gene has been under strong directional evolutionary selective pressure in the past 5000 to 10,000 years. These data indicate that a combination of socio-economic, ethnic and evolutionary factors converged to shape the genetic structure of lactase persistence in East African populations. A Lancet systematic review study in 2017 showed that lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. 63% (54–72) in sub-Saharan Africa. Lactose malabsorption was also widespread in Africa. including northern Africa (53–84%) and sub-Saharan Africa (77–100%), with the exception of Niger (13%), Kenya (39%), Sudan (55%), and Tanzania (45%) - pastoralist populations. I am keen to learn more about this?

• Fish: What would be the strategies to improve the status of fish among consumers as they get wealthier? What role does aquaculture play in these areas and ensuring feed is affordable and more sustainable? What about alternative feeds?

• Are there gender links to any of these commodities as they become commercialized and how does that change household intake of these foods?

• How do we ensure these rural places thrive? Someone needs to feed this growing urban population. Who will it be and how if rural places struggle to feed themselves?

Food Bytes: Weekly Nibbles from Feb 25 - Mar 3

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Let’s look to the future but learn from the past of the American dietary guidelines. The 2020 USDA dietary guidelines are now in the works. Politico has unpacked who will serve on the Dietary Guidelines Advisory Committee, a panel of experts that “wields considerable influence over the guidelines.” Some are tied to the food and beverage industry. Tamar Haspel, one of my favorite journalists who writes on food for the Washington Post re-opened a can of worms about how the dietary guidelines have made Americans fatter, as opposed to promoting healthier diets. The argument goes: When the dietary guidelines decreased their recommendation on fat intake, Americans replaced those fats with added sugars and refined grains. Parallel to this, obesity increased. But Haspel points out that dietary guidelines always advised to limit sugar, and delves into the reasons why - was it calories? was it lower carb diets? She argues the guidelines are not the culprit. Thereafter a twitter war ensued.

Speaking of inducing obesity, taxes on soda have been adopted by many cities and countries now, and the question still remains, do they work? A study done on the soda tax in Berkeley showed a 52% reduction in self reported consumption of soda. Key words: SELF REPORTED, which we all know can bring about some skepticism of quality data. In Philadelphia, there was a 46% decrease in sales of soda, but just right outside the city, there was an increase in sales, insinuating that maybe people are driving outside the city to get cheaper soda. And people don’t want to call it crack…

The issues of unhealthy diets and their contributions to obesity and undernutrition are getting some mainstream press these days. Let food be thy medicine is a mantra that has some teeth. TIME magazine published an article about how health practitioners are starting to include healthy food and diets as part of the medical care they provide to patients. Cure no but maybe a miracle… This infographic from Tufts shows how the medical profession can take action. I also edited a special issue of the AMA Journal of Ethics in which David Katz explores “barriers to dietary counseling, strategies for improving medical education and clinical practice with respect to nutrition, and the ethical importance of sharing dietary information with patients.” He also did a great podcast on the ethical implications of NOT considering diets as part of medical care here.

Dan Glickman and colleagues are arguing that America needs an institute devoted to research on the top cause of poor health - that being nutrition. It would be called the National Institute of Nutrition, and it would be part of the National Institutes of Health. The institute will facilitate and help coordinate incisive research into nutrients, foods and their relationships to better health. They give some details in this NYT article. I could definitely be on board with that. Time for science to take nutrition seriously.

On the opposite end of the malnutrition spectrum, a new report published by the United Nations’ Food and Agriculture Organization (FAO) and the World Food Programme (WFP), show that 60% of the world’s hungry live in just 8 countries. They are: Yemen, the DRC, Afghanistan, South Sudan, Syria, the Lake Chad Basin, The Central African Republic, and Somalia. What do these countries have in common? Man-made conflict. Sadly hunger and sometimes starvation is used a tool to fuel civil wars. Very tragic and very preventable.

Another war being fought is to protect and conserve the biodiversity on the planet. An epic, FAO report on biodiversity for food security and agriculture was released last week along with 91 country & 27 organization reports. No time to read 576 pages? The digital short read can be found here. Crux: Biodiversity is under severe threat which means we are too.

The EAT Lancet saga continues, and I speak to eating healthy, sustainable diets for Australia’s ABC radio new show here. We also did an Let’s Rethink Food podcast on the future of food production

Food bytes: Weekly nibbles from Feb 18 - Feb 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Since the publication of the Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems,” there have been some thoughtful critiques on the paper. Lawrence Haddad of GAIN and some other GAIN colleagues published what they felt were omissions but also the opportunities for more research, dialogue and debate. Over at the New Food Economy, Sam Bloch tried to eat the planetary health diet for one week. He struggled. He cooked almost all his meals, and he found the diet more expensive. I think he was a bit extreme, forgoing coffee and spices, which is not really recommended, but A effort in at least trying to take the lofty goals of the report and giving some practical insights into whether one can consume this diet on a daily basis. But don’t throw the baby out with the bathwater just yet. There are many attempts to ensure plant-based diets and vegan cuisine are tasty to our picky palates. Restaurants and food companies are trying new recipes and using new technology to ensure that vegetables make our mouths water just as much as those pavlov-dog-drooling juicy steaks do.

Another Lancet journal commission report was published last week on the “Global Syndemic of Obesity, Undernutrition, and Climate Change.” What is a syndemic one might ask? It is a synergy of pandemics that co-occur in time and place, interact with each other, and share common underlying societal drivers. Oh. Sounds serious. Well, in this case, it is. The pandemics are climate change and malnutrition - that being undernutrition and obesity. All three affect most people in every country. They give this example:

“Food systems not only drive the obesity and undernutrition pandemics but also generate 25-30% of greenhouse gas emissions (GHGs), and cattle production accounts for over half of those. Car-dominated transportation systems support sedentary lifestyles and generate between 14-25% of GHGs. Underpinning all of these are weak political governance systems, the unchallenged economic pursuit of GDP growth, and the powerful commercial engineering of overconsumption. The outcomes of obesity, undernutrition, and climate change interact. For example, climate change will increase undernutrition through increased food insecurity from extreme weather events, droughts, and shifts in agriculture. Likewise, fetal and infant undernutrition increases the risk of adult obesity. The effects of climate change on obesity and vice versa are currently uncertain.”

The Commissioners argue that double and triple duty actions are necessary to address The Global Syndemic. This figure below shows some options of triple duty actions. Some are very similar to what was recommended in the EAT Lancet Commission like reducing meat consumption and more sustainable dietary guidelines. Seems, most scientists are somewhat on a similar page on these recommendations. They do rip into both governments and food and beverage industries for not governing and not having public health concerns in mind respectively.

Triple duty actions to address the “global syndemic”

Dark cuisine. Copyright: NYT

Of course, as part of these global conversations is the issue of meat production and consumption and the potential future technologies that could save the planet, animals and humanity. One report just released argues that lab-grown meat could accelerate climate change, more so than current cattle production. Shwoops. Not sure about the authors assumptions, but they do acknowledge the limitations of their modeling of different types of gases and the energy calculations to come up with such a sweeping conclusion. The podcast Freakonomics breaks down the potential future of meat - weighing the pros and cons. It is worth a listen. One thing they discuss in the podcast that I had not heard of is “finless foods” - where fish are produced from stem cells. With 33% of fish stocks overly fished, this could be a game changer. That is, if people want to eat cultured meats and seafoods….

And speaking of weird science, and the future of food, ever heard of stargazy pie? It is a pie made up of herring, half buried in the pie with their heads and eyes peaking up from the buttery crust. Underneath is the rest of their bodies “leaching their brine in a rich custard, larded with bacon and hard boiled eggs.” Yummmm. Welcome to the world of ugly food and “dark cuisine.” These ugly food concoctions are highlighted in the New York Times Fashion section no less.

Food Bytes: Weekly Nibbles from Jan 21 - 27

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Environmental effects per serving of food produced

The EAT Lancet Commission report entitled: “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems” came out this week. It was both praised and demonized but regardless, it made a big splash across many media outlets. I was part of the Commission and I must say, I felt pretty worn out with interviews and podcasts after the first week of its release. So what is the report? It was made up of 37 scientists that came together to do three things: The first was to quantitively describes a universal healthy reference diet that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals. The second was to define six scientific boundaries for food systems that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet. The third outlined five strategies needed for the “Great Food Transformation.” Establishing targets has its benefits but it also breeds controversy. I will write in some detail on the politics of the report at a later date, but for now, the link above has all the deets including a podcast I did with Professor Tim Lang.

On the same week as the EAT Lancet, a paper was quietly published in the New England Journal of Medicine by Andy Haines urging for a renewed focus on climate and health. The authors argue that “climate change is expected to alter…climate-sensitive health outcomes and to affect the functioning of public health and health care systems.” One could argue, we know this, but the fact that it was in a clinical medical journal shows the breadth of how climate change will impact all facets and medical professionals need to be thinking about how this will impact their patient populations, particularly the more vulnerable.

What wasn’t discussed much in the EAT Lancet were “food environments.” These are the places where consumers make a decision about what to buy, order or have delivered. Food environments are markets or cafeterias, or restaurants or food trucks. They look different everywhere. My colleague, Shauna Downs and I published an article in Public Health Nutrition looking at consumers’ perceptions of their food environments and their food consumption patterns and preferences in urban and rural Myanmar. The study shows that the availability of diverse foods had increased over time, while the quality of foods had decreased. Most consumers greatest concern about the foods available was the safety. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities.

One food environment that could improve is the office. A study done by the CDC shows that nearly a quarter of respondents ate food obtained directly at their office. And the foods they ate were not necessarily healthy. Think the leftover pizza, the corporate snack bar, the candy in the jar, the cake for someone’s birthday. The study found that what they officemates ate during work hours was “high in empty calories, sodium, and refined grains, and low in whole grains and fruit.” Shocker? Not really but I do think work places need to stop making it so hard for their colleagues to eat healthy.

Enough with the studies! How about a podcast? A great one has just been started by our friends at NPR. It is called Life Kit and they “help you cut through all the nutrition noise” and provide guidance on how to eat healthy. And there is indeed a lot of noise out there. I listened to three of their podcasts - only about 20 minutes long - and they had some stellar nutrition experts including Dary Mozaffarrian who is the Dean of Tufts Friedman School and Doctors David Katz and David Ludwig. They are great, and I think provide sound advice on nutrition and what to eat. Listen to them on your way to work or even better, while exercising!

And speaking of eating healthy, here is an old video of Andy Warhol, eating a hamburger. Took him about 4 minutes.