WIC at the Crossroads of the Opioid Epidemic

by Danièle Todorov

The complexity and pervasiveness of the opioid epidemic has forced government agencies to be innovative with their resources. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in a prime position to care for pregnant women affected by the epidemic and has stepped up to the plate.

In January of 2016, then Secretary of Agriculture Tom Vilsack was appointed by President Obama to lead an interagency taskforce to address the opioid epidemic in rural America. Secretary Vilsack, who’s been outspoken about his own mother’s struggle with prescription drug addiction, knew that compassion and collaboration would be vital. His agency, the USDA, has unique resources and relationships in rural areas, putting it in a prime position to address the epidemic.

Addressing the epidemic is no simple task. According to the CDC, 91 Americans died daily from opioid overdose in 2015. Nearly half of these deaths involved a prescription opioid, used in the treatment of pain. In a town hall meeting in Missouri last July, Secretary Vilsack stated that due to “the devastating toll that opioid misuse has taken on our communities, and particularly rural areas, I have tasked USDA with creatively using all of the resources at our disposal to stem the tide of this epidemic” [1]. Interestingly, Secretary Vilsack highlighted WIC as a resource that could be creatively used. “For many women”, he stated, “WIC is their first point of entry into the healthcare system, and we have an opportunity to intercept and potentially prevent dangerous health outcomes for both the mother and the child” [1].

Pain management is an important part of pregnancy care. The prescription of opioids for pain in pregnancy is increasingly common; 1 in 5 Medicaid-enrolled women were prescribed an opioid at some point during their pregnancy in 2014 [2]. However, the effect of opioids on birth outcomes is understudied. In utero opioid exposure may be associated with preterm delivery and low birth weight [3]. Exposed neonates may develop withdrawal symptoms, a condition known as neonatal abstinence syndrome, which is associated with increased risk of seizures and breathing difficulties [3]. Similarly understudied are the rates of opioid abuse during pregnancy. We do know that pregnant women with substance abuse problems are particularly vulnerable to food and job insecurities and unstable housing, which exacerbate potential health complications [4].

The healthcare system often stigmatizes and underserves pregnant women with substance abuse problems. However, WIC is increasing its ability to engage them in care. WIC’s mission is to promote the health of low-income women and their children by providing nutritious food, health education, and referrals. Starting in 2014, WIC agencies have increased staff training surrounding substance abuse [1]. Staff are better equipped to notice potential substance abuse, to educate WIC participants about the dangers of substance abuse during pregnancy and breastfeeding, and to connect them with local resources. These expanded roles align with WIC’s mission, not only because they aim to protect the health of the women they serve, but because WIC “acknowledges that substance use is incompatible with good nutrition” [5].

WIC is forming relationships with women at a promising point in time in their lives. In their staff training guide, WIC cites a study showing that women are “more motivated to improve their lifestyle and health habits during periods when they make the transition from one life situation or role to another… WIC participants are a natural target audience for substance use information because they are, by definition, in the life transition stage of pregnancy and new motherhood” [5].

WIC is playing an important part in the collaborative response to the epidemic. As the director of the USDA, Secretary Vilsack understood that a holistic response was the only effective solution and embraced President Obama’s mandate. “This disease isn’t a personal choice,” says Secretary Vilsack, “and it can’t be cured by willpower alone. It requires responses from whole communities, access to medical treatment, and an incredible amount of support. To me, our mandate is clear: don’t judge, just help” [6]. Secretary Vilsack’s endorsement of his replacement as Secretary of Agriculture, nominee Sonny Perdue, gives hope that the USDA will continue this vital endeavor.

Sources

  1. Agriculture Secretary Vilsack Announces Substance Misuse Prevention Resources for Low Income Pregnant Women and Mothers In Order to Battle the Opioid Epidemic, U. Office of Communications, Editor. 2016.
  2. Desai, R.J., et al., Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetrics and gynecology, 2014. 123(5): p. 997.
  3. Patrick, S.W., et al., Prescription opioid epidemic and infant outcomes. Pediatrics, 2015. 135(5): p. 842-850.
  4. Sutter, M.B., S. Gopman, and L. Leeman, Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence. Obstetrics and Gynecology Clinics of North America, 2017. 44(1): p. 95-107.
  5. Substance Use Prevention: Screening, Education, and Referral Resource Guide for Local WIC Agencies, F.a.N.S. U.S. Department of Agriculture, Editor. 2013.
  6. USDA. Addressing the Heroin and Prescription Opioid Epidemic. 2016 02/17/17].

Danièle Todorov is a first-year nutritional epidemiology student with a focus on pregnancy nutrition and birth outcomes.

 

Can I Eat An Engineered Apple, Please?

by Delphine Van Roosebeke

The days of throwing your half-eaten apple away because it turned brown are over. Shiny non-browning apples are about to hit the consumer market in a few months. And this time, it’s not a fairy tale. Read on.

Cartoon from Pinterest

Cartoon from Pinterest

In 1812, the German Grimm Brothers created the shiny red apple in Snow White, featuring it as the symbol of evil given to Snow White by the witch on behalf of the jealous queen. The story was told to children to teach them not to trust strangers. Two hundred years later, it is the shiny green Arctic® Apple that brings people together to tell stories. This time, Okanagan Specialty Fruits Inc., a Canadian agriculture biotech company that creates new varieties of apples, has replaced the jealous queen. Don’t get me wrong, you won’t get poisoned as Snow White did, but you may be surprised by sliced apples that won’t brown for two weeks.

What are non-browning apples?

No matter how you slice, bruise or bite your apple, every apple turns brown eventually. When the apple’s flesh is cut, the oxygen in the air interacts with chemicals in the flesh of the apple. An enzyme called polyphenol oxidase, or PPO, makes melanin, an iron-containing compound that gives apple cells a brown tinge. The same type of ‘oxidative’ browning happens in the browning of tea, coffee and mushrooms. Within five minutes of slicing, browning can alter an apple’s taste and make it less aesthetically pleasing, but it doesn’t mean the apple is old or rotten.

To prevent this oxidative browning, Okanagan developed proprietary technologies to engineer genetically modified (GM) apples. The apples, called Arctic® Apples, produce reduced amounts of PPO. To achieve this, small gene fragments, called silencing RNAs, were injected into the apple seeds using bacteria. Such an insertion with gene fragments is a red flag for the apple cell, as it resembles the first step of viral attack. As a response, it chops up every sequence of DNA that looks like the suspicious fragment, and thus the PPO gene gets decimated. Because the PPO production is reduced to less than 10% compared to regular apples, the Arctic® Apple, even when sliced, will stay clear of browning for about two weeks. That’s roughly the same extended life span as apple slices from McDonald’s and Burger King, which use lemon juice and calcium ascorbate to prevent browning. Indeed, lemon juice and calcium ascorbate have a similar cosmetic effect to the silencing fragments inserted into the Arctic® Apples.

A regular apple, on the left, shows brown spots, while an Arctic® Apple has a clearer appearance. Photo by Okanagan Specialty Fruits

A regular apple, on the left, shows brown spots, while an Arctic® Apple has a clearer appearance. Photo by Okanagan Specialty Fruits

 Why do we need non-browning apples?

Is the world waiting for a non-browning apple or is this just another ‘we-can, so-we-do-it’ product that eventually may threaten the ecosystem or our bodies? Well, according to Okanagan, very few fresh-cut apples are available on fruit plates, in salads, in cafeterias, or on airplanes, primarily due to the browning issue. Anti-browning treatments are costly and often add an off-taste, the company says. But these treatments are not needed for Arctic® Apples, which is why Okanagan hopes to get their apples available in more places. Consumer research has suggested that apple products, such as bagged apple slices, are the number one produce item that customers would like to see more packaged versions of. Since apple slices are arguably easier to eat than whole fruits, this innovation could propel apple sales. Indeed, the simple convenience of baby carrots doubled carrot consumption, and Okanagan is endeavoring to achieve the same results with apples.

Another argument for bringing engineered non-browning apples to the consumer market is the reduction of food waste. According to the company, apples are among the most wasted foods on the planet, with around 30 to 40 percent of the apples produced never being consumed because of superficial bruising and browning. Given that 52 percent of fresh produce goes to waste in the U.S. alone, consumption of non-browning apples, such as the Artic® Apple, may be one small step in the right direction to shrink this enormous mountain of food waste.

When will you be able to eat them?
Cartoon from Pinterest

Cartoon from Pinterest

Non-browning apples have gotten the green light to get on the market, as both the USDA and FDA approved Arctic® Apples for consumption. According to Okanagan, the first commercial Arctic® Apple orchards were planted in 2015, but it takes a few years for newly-planted apple trees to produce much fruit. They expect small test market quantities from the 2016 harvest, followed by a gradual commercial launch starting in 2017 with increasing availability each year thereafter. The first two varieties that will be available to consumers will be the Arctic® Granny and the Arctic® Golden. Currently, Arctic® Fuji is next in line with others planned to follow!

Although Neil Carter, the president and founder of Okanagan Specialty Fruits, has expressed in the New York Times that the apples will be labeled as Arctic®, they will not explicitly label their apples as GMO. Unlike other genetically engineered crops, Arctic® Apples do not contain foreign DNA but silencing RNAs to reduce the expression of the PPO gene. Therefore, Arctic® Apples are not effectively captured by the current regulatory structure on GMO labeling. According to the company, the label Arctic® is sufficient to create transparency and let the consumers decide whether they want GM apples that don’t brown.

Food for thought on non-browning apples

Despite the millions of dollars and more than 20 years of research that went into the development of non-browning apples, not everyone welcomes the new shiny green Arctic® Apples from Canada. Since we already have hybrid ‘low browning’ varieties, such as the Cortland apple, and successful preservative treatments, some people wonder whether we really need a genetically engineered apple that doesn’t brown. In fact, with the advent of the non-browning apple, the food industry has departed from the premise that GM foods are meant to increase productivity. Indeed, the Arctic® Apple is one of the few GM products that is developed to improve the product cosmetically, to match the media-driven image of a perfect apple rather than improving the crop’s yield or nutritional performance. However, despite the maintenance of a fresher look, the preservability of non-browning apples is similar to conventional apples as Arctic® Apples will eventually still brown due to the rotting process by bacteria and fungi.

Given that PPO is involved in the plant’s defense mechanism, it has been speculated that the mutation in non-browning apples could make the plant more susceptible to insect and microbial pest damage, thus increasing farmers’ reliance on pesticides. Although more pesticides might be needed to maintain productivity of the crops, if non-browning apples actually do reduce food waste, growing fewer acres of non-browning apples may be adequate to meet the market demand. Also, the primary market of the Arctic® Apple is sliced apples, which is a subset of all apples consumed. However, as sliced non-browning apples find their way into more products, demand could increase from, say, parents wanting to use these apples as a convenient and healthy snack in their picky eater’s lunch box. This may eventually drive the need for increased production. Given these market dynamics, the cost-benefit of non-browning apples for the society is elusive and it remains to be seen to what extent the Arctic® Apple puts a burden on the natural environment.

Delphine Van Roosebeke is a rising Biochemical and Molecular Nutrition graduate with a background in biochemical engineering. When she is not thinking about dark Belgian chocolate, she’s eating it! Delphine has a crush on nutrients and the magic they perform in our body, and loves to share her knowledge with anyone who wants to hear it in a fun and approachable way! 

 

 

Coming to a Presidential Candidate’s Plate Near You

by Carla Curle

With the presidential race narrowing down and the delegate counts ratcheting up for the top candidates, it still seems that food and agriculture policy are missing in the stump speeches and media interviews.

Even as the candidates campaigned in top agricultural states such as Iowa, Nebraska, and Illinois, the discussion of national food policy initiatives never seemed to make it to the forefront of the discussions. Instead, the Renewable Fuel Standard loomed large as a top issue for many agriculture voters in these states, so much so that fuel-based agriculture was one topic they were grilled on.

This is unfortunate, not only for Friedman School students, but for the entire country, which is plagued by rising rates of diet-related disease, proliferation of non-sustainable farming practices, and limited access to healthful foods. Grassroots efforts at local and regional levels such as Food Policy Councils and Farm to School activities are popping up all around the country, signifying a growing desire for positive changes to our food system. And according to a recent nationwide poll by the Johns Hopkins Center for a Livable Future, public support for food sustainability is high and crosses party lines. Of the 800 respondents, 92% believe that producing food in a sustainable way is a high priority and 79% want scientists — not politicians — to set the dietary guidelines.potu

In order to highlight this broken food system in the presidential race, the Plate of the Union Initiative was launched through a collaboration by the Union of Concerned Scientists, Food Policy Action, and the HEAL Food Alliance. This initiative includes a petition to our next president that can be signed by anyone with access to the Internet and an interest in the American food system, and includes the following statement:

Our food system is out of balance, and it’s time to take action. Current food policies prioritize corporate interests at the expense of our health, the environment, and working families. This has led to spikes in obesity and type-2 diabetes, costing taxpayers billions of dollars each year.

If you are elected president, I urge you to take bold steps to reform our food system to make sure every American has equal access to healthy, affordable food that is fair to workers, good for the environment, and keeps farmers on the land.

The Plate of the Union Initiative also includes an Activist Toolkit (coming soon), which will allow users to download a toolkit with resources and ideas to help individuals get involved in reforming our current food system.

The Obama Administration has made significant strides in improving American nutrition, thanks largely in part to First Lady Michelle Obama. Over the past 8 years, changes to nutrition policy have been met by Republican opposition and significant industry pushback. Despite all of the hurdles, there have been meaningful improvements made to the school lunch program and WIC through the Healthy, Hunger-Free Kids Act. The next administration must build on these successes and continue to address the numerous food system issues that exist in this country.

Where do the current five candidates stand on food and farm policy?

Democratic Candidates:

Secretary Hillary Clinton’s policies focus on strengthening rural economies by investing in infrastructure and expanding access to credit, promoting clean energy and stewardship of the land, and increasing agricultural production and profitability for family farms. During her time as a senator from New York, Clinton worked to connect and bridge the divide between her lower-income urban constituents with upstate farmers through her “Farm to Fork” program.

Senator Bernie Sanders’ rural economy policy platform focuses on expanding support for young and beginning farmers, producing a nutritious and abundant food supply, and encouraging farmers to act as partners in promoting conservation and combating climate change. Sanders has also endorsed local food production and is worried about the “dangerous concentration of ownership that exists in agriculture and the food industry.”

Republican Candidates:

Senator Ted Cruz’s food policy positions stem from his belief in limited government. Cruz voted against the 2014 Farm Bill, mainly because of its food stamp provisions and issues with the crop insurance program that he felt needed reform. He believes that agricultural subsidies should be focused on smaller and lower income farmers rather than “large conglomerate agricultural operations.”

The Ohio Farm Bureau named Governor John Kasich a “Friend of Agriculture” in 2014 for his support of the public policy goals that align with maintaining Ohio’s agricultural economy. Kasich has worked with environmental organizations and farmers to pass legislation to reduce nutrient runoff from agricultural operations. Kasich is the only Republican candidate who believes that humans contribute to climate change, but he does not want to end the use of fossil fuels entirely.

Little is known about Donald Trump’s stance on food or agriculture policy, but a few enlightening moments on the campaign trail may offer us some information. He doesn’t believe in climate change, calling it a “hoax” on multiple occasions, which doesn’t bode well for the mitigation and adaption that world leaders are calling for. In terms of food stamps, he believes something is “clearly wrong” when half of food stamp recipients have been receiving benefits for almost a decade.

Act Now:

It’s up to voters to demand answers from the candidates on the issues that matter to all of us: sustainable agriculture, improved animal welfare, access to healthy and affordable food, and fair working conditions. What can you as a food voter do? Sign the petition, research the candidates’ positions and voting records, and make sure you vote in the primaries and the general election in November.

Carla Curle is a second-year AFE student. She is also involved in the interdisciplinary Water: Systems, Science and Society (WSSS) program and is a firm believer that systems approaches to addressing problems will be the wave of the future. Also a co-chair of Slow Foods Tufts, you can find Carla nerding out over coffee, fermented items of any kind, and locally grown veggies. You can contact Carla at carla.curle@tufts.edu.

2015-2020 Dietary Guidelines for Americans: Process & Politics

by Connie Ray

On January 7, the US Department of Health and Human Services (HSS) and the US Department of Agriculture (USDA) released the highly-anticipated Dietary Guidelines for Americans for the years 2015-2020. The guidelines, released every five years, always brew up some controversy among food and nutrition professionals, but this year’s may be the most hotly debated in history.

The Process

The process of developing the Dietary Guidelines is a complex one, involving health and nutrition professionals, public input, lobbyists, the HHS, and the USDA. The general timeline is as follows:

 

  1. A Dietary Guidelines Advisory Committee (DGAC) is formed, made up of nutrition, health, and medical researchers. This year’s DGAC included 14 professionals (2 from Friedman: Alice Lichtenstein, DSc, Committee Vice Chair, and Miriam Nelson, PhD). Of those 14 members, here is a breakdown of the specialties of members of the committee:

Screen Shot 2016-01-30 at 4.57.08 PM

The Committee reviews current scientific evidence on the relationships between diet and health, including original systematic reviews (analyzing and grading evidence based on its strength); a review of existing systematic reviews, meta-analyses, and reports by scientific organizations (reviewed for quality); data analyses gleaned from national data from federal agencies; and food pattern modeling analyses.

  1. The DGAC submits its report to the Secretaries of the HHS and USDA. The recommendations are made public and are open to commentary for 45 days. The committee report is subject to further analysis by both federal and nonfederal nutrition and health experts. Ultimately, the document is approved by the HHS and USDA Secretaries.
  1. Referencing the previous edition of the Dietary Guidelines, the DGAC Report, and public and federal agency comments, the HHS and USDA develop a new edition of the Dietary Guidelines.

The Politics

As previously mentioned, this version of the Dietary Guidelines has been a controversial one from the very beginning. What follows is a brief summary of some of the major debates and controversies along the way.

The House Appropriations Bill

Congress got involved in the formation of the Dietary Guidelines this time around when the House of Representatives passed the Agricultural Appropriations Bill in July 2015, with a few pointed and controversial riders. These amendments aimed to directly impact the 2015 Guidelines, imposing an impossibly high evidentiary standard (i.e., only evidence that can receive a Grade 1: Strong Evidence grade by the Nutrition Evidence Library). This would disallow the inclusion of any recommendations with “Moderate” evidence, including recommendations to select a diet rich in fruits, vegetables, and whole grains; to decrease sodium intake for individuals with high blood pressure; and to limit sugar to help prevent dental caries, all of which receive a grade of “Moderate.” It would also prevent any mention of physical exercise, food safety, or sustainability, limiting the Guidelines exclusively to diet and nutrient intake.

Many leading health and nutrition groups strongly opposed these riders and accordingly wrote to the House Appropriations Committee in protest. The Academy of Nutrition and Dietetics, American Diabetes Association, American Heart Association, American Academy of Pediatrics, CSPI, Friends of the Earth, the American Public Health Association, and others cosigned a letter disagreeing with the Bill. In an unprecedented move, the Dietary Guidelines Advisory Committee sent its own letter delineating the detrimental effects that the Bill would have on the Dietary Guidelines.

Although the Dietary Guidelines were due to be released by the end of 2015, they were further delayed. In December 2015, the omnibus spending bill passed and made into law along with a further provision allocating $1 million to fund an investigation of the Dietary Guidelines process by the Academy of Medicine to search for scientific bias.

Ultimately, the 2015-2020 Guidelines skated by; they were already completed by December and were released January 7, 2016 before any of these provisions could affect them. It is unlikely, however, that the next Dietary Guidelines will escape these newly imposed congressional regulations.

Issues of Sustainability

USDA and HHS announced earlier last year that, despite inclusion of recommendations in the DGAC report, the official Dietary Guidelines would not include recommendations based on sustainability. Their press release stated that sustainability is beyond “the scope of our mandate.” The issue was further highlighted by the aforementioned rider attached to the 2016 spending bill, limiting the Guidelines in scope to nutrition/dietary recommendations only. Many leading experts believe the decision to exclude sustainability was made in response to meat industry lobbyists who were outraged that the DGAC concluded a sustainable diet is one that limits animal products

Lobbyist Fights

During the typically allotted 45-day public commentary period, comments on the DGAC can be submitted for consideration. These include comments by lay people, academics, lobbyists, and businesses. That period was extended to 75 days this time around. A group of 30 senators, led by Sen. John Thune (R-SD), requested the extension, concerned that the committee’s report “greatly exceeded their scope in developing recommendations.” Thune specifically discussed concern about the recommendations to limit red meat as well as the commentary on sustainability. Indeed, a large percentage of the public comments submitted expressed concern or outrage about one or both of these issues.

According to The Hill, “In March, 71 GOP representatives and 30 Republican senators signed letters critical of the Advisory Committee Report, specifically attacking the recommendations against eating less red meat and lowering sodium on behalf of the cattle and restaurant industries, among others. Those same politicians received more than $3 million in donations from food-related donors from 2013 to 2014 alone. Senators who signed the letter received almost half a million dollars just from the beef and cattle industries, according to campaign contribution records from OpenSecrets.com.”

The sheer number of comments submitted is indicative of the level of controversy and outrage. Compared to the just over 2,000 comments submitted in 2010, there were over 28,000 comments submitted this time around.

And many people believe the actions of meat industry lobbyists paid off. Not only was sustainability not mentioned in the final Dietary Guidelines, but neither was the DGAC’s recommendation to limit red and processed meat.

The wording from the DGAC report reads (emphasis added):

A healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and drinks and refined grains.

Rather than recommending a diet lower in red and processed meat as did the DGAC report, the final Dietary Guidelines state that a healthy eating pattern includes: “A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products” and limits “Saturated fats and trans fats, added sugars, and sodium.”

Much of the nutrition community is certainly in an uproar over this change. Rafael Perez-Escamilla, a Yale epidemiologist and member of the 2015 DGAC, attributes this change in wording to the effectiveness of meat industry lobbyists and calls it “a major gap.” Dr. Walter Willett, head of the nutrition department at the Harvard School of Public Health, goes so far as to call the exclusion of the recommendation to lower red meat “censorship.”

The American Cancer Society is also disappointed. “The science on the link between cancer and diet is extensive. By omitting specific diet recommendations, such as eating less red and processed meat, these guidelines miss a critical and significant opportunity to reduce suffering and death from cancer,” said Dr. Richard Wender.

However, as usual, not everyone is in agreement. The Academy of Nutrition and Dietetics sent out a press release praising the Dietary Guidelines for their science-based approach, claiming that they will “provide a solid basis for federal nutrition policy, identify future research needs and equip health professionals and employers with the tools necessary to benefit the public.”

Tufts’ own Dr. Alice Lichtenstein, vice chair of the DGAC, describes the Guidelines as a “very good document. I think it’s a big step forward from the 2010 Guidelines. It isn’t written exactly as I would have done it, but from a public health perspective, focusing on the negative and sidestepping the positive is not particularly useful to anyone. If you follow the basic guidance that’s given in terms of eating patterns, you will end up consuming a healthy diet.”

Referencing criticisms of the Guidelines’ wording, she offers the opinion: “These are centered in minor points, not major points.”

In Summary

For better or for worse, the 2015 Dietary Guidelines are here to stay for the next five years. If nothing else, the complicated road we’ve traveled to get to this point has proven that releasing a national document with a federal agency’s stamp of approval is anything but simple. When there are so many with vested interests, it will certainly be interesting to see what the 2020 process has in store.

Connie Ray is a first year MNSP student at the Friedman School. She currently lives in Virginia, where she raises her two sons and teaches yoga.

2015-2020 Dietary Guidelines for Americans: Content & Controversies

by Emily Finnan

With the next five years of Americans’ nutritional recommendations at stake, a hot debate surrounding the Dietary Guidelines is a guarantee!

As you’re probably well aware, the 2015-2020 Dietary Guidelines (DG) for Americans were released! Every five years, this report, a joint venture of Department of Health and Human Services and the United States Department of Agriculture (USDA), aims to provide food and beverage recommendations to promote health, prevent chronic disease, and help people reach and maintain a healthy weight.

The final Dietary Guidelines aren’t just lofty recommendations. They’re the basis of food/nutrition policy and federal nutrition programs like WIC, national school meals, meal programs for the elderly, and others. Organizations, industry, health professionals, and individuals all use these guidelines.

The guidelines were formed over a long, two-in-half-year process detailed in this month’s Sprout article by Connie Ray, the “Process & Politics,” of the DG. A team of scientists starts the process with the Scientific Report of the Dietary Guidelines Advisory Committee (DGAC) that aims to inform the DG.

The Dietary Guidelines are a pretty big deal. We can expect contention. This edition seemed to generate even more disputes, however, starting with the release of the DGAC report. Debates even took to the congressional floor! Ray’s article explores the congressional controversy that happened before the guidelines were even released.

It is important to note that the DG actually don’t change much with each new edition despite a media portrayal of fickle nutrition recommendations (remember when one day kale was a “superfood,” the next filled with toxic thallium?). Overall, what we know to be a healthy diet, and what dietary changes Americans should make, holds true.

We still need to eat more vegetables and fruits (especially whole fruits). We fall way behind on the recommendation to make “half your grains whole.” The majority of us aren’t meeting dairy goals with most of the dairy we eat being saturated fat-rich cheese versus low-fat milk and yogurt. Most of us are way over the recommended maximum 2,300 milligram of sodium a day.

Though not everyone agrees on even those unchanging recommendations, they were largely accepted without major controversy. Scientists and organizations were quick to sound off within hours of the release on what did change—or, alternatively, did not change—in the 2015 DG.

For cholesterol there isn’t a new or different recommendation, but rather a lack of a recommendation in the 2015 DG. It was removed from the list of nutrients to limit. In 2010, Americans were over-consuming the recommended 300-milligram limit on cholesterol.

Per the 2015 DG, “Adequate evidence is not available for a quantitative limit for dietary cholesterol.” The guidelines confusingly add, “but this change does not suggest that dietary cholesterol is no longer important…individuals should eat as little dietary cholesterol as possible.” The DG go on to cite the high saturated fat content of many cholesterol-containing foods. Eggs and shellfish get special mention for being high in cholesterol but low in saturated fat.

It seems most media outlets took the lack of cholesterol recommendation as vindication, concluding that cholesterol is not the artery-clogging nutrient it was once thought of. The Physicians Committee for Responsible Medicine, a group that advocates for vegan diets, filed a lawsuit against the DG (they also did this in 2011 with the 2010 DG). They questioned if a conflict of interest from the egg industry led to the deletion of a cholesterol limit. However, overall, the group praised the guidelines, focusing on the “eat as little as possible” phrasing.

And despite some heavy media coverage and significant controversy, butter is NOT back. The recommendation to eat less than 10% of total calories from saturated fat remained, with continued encouragement to replace solid, saturated fats with unsaturated plant oils.

We are still eating too much added sugar. We are down from on average 16% of total calories to 13%, with most of that added sugar still coming from beverages. New in this version of the Dietary Guidelines is a calorie limit on added sugar: less than 10% of total calories. By distinguishing added sugar from sugar naturally present in food, the sugar in fruit and milk gets a pass. The proposed re-vamped nutrition facts panel would have added sugars listed separately, with a corresponding daily value, making this recommendation easier for individuals to implement.

It seems most were happy with the “sugar cap.” The World Health Organization has said since 1989 to keep added sugars less than 10% of total calories. More recently in 2015, a further reduction was recommended for dental health: keep sugars to less than 5% of total calories. Unsurprisingly, The Sugar Association rejects the sugar limit, describing it as an, “agenda based, not science based” recommendation, claiming a lack of scientific evidence to justify the cap.

Nutritionist and food industry critic Dr. Marion Nestle criticized the DG for not outright recommending to “drink less soda.” Indeed, just one 16-ounce soda can put a person over the recommended sugar limit. Nestle and quite a few others, including Friedman Dean Dr. Dariush Mozaffarian, note the DG switch from talking about food (i.e., eat more green leafy vegetables), to talking about nutrients when they want us to eat less of something (i.e. eat less sugar, instead of drink less soda). Nestle blames “food politics.”

The DG do suggest cutting down on sugar by drinking no-added sugar beverages, but do not recommend diet drinks. In fact, this was the first time the DG mentioned diet drinks: “Replacing added sugars with high-intensity sweeteners may reduce calorie intake in the short-term, yet questions remain about their effectiveness as a long-term weight management strategy.” Caffeine also gets a first time mention. Moderate caffeine consumption is OK, but if you don’t drink caffeine, there’s no reason to start.

For the first time, the scientific report considered sustainability. The DGAC recommended a diet that limited animal products. This drew intense industry criticism and even a Change.org petition, titled “Hands Off My Hot Dog.” The Secretaries of Health and Human Services and Agriculture decided not to include sustainability in the DG. Ray’s article further explores the controversy behind the influence industry had on the exclusion.

The scientific report’s main finding—what constitutes a healthy diet—is as follows: “higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat.” This pescatarian-esque diet recommendation drew harsh criticism from the North American Meat Institute, which called removal of “lean meat” as part of a healthy diet “arbitrary and capricious,” publicly questioning the scientific rigor and transparency of the DGAC.

The 2015 DG recognized the scientific evidence regarding meat and health, stating, “Strong evidence…has shown that eating patterns that include lower intake of meats as well as processed meats and processed poultry are associated with reduced risk of CVD in adults. Moderate evidence indicates that these eating patterns are associated with reduced risk of obesity, type 2 diabetes, and some types of cancer in adults.”

However, the recommendation to eat, per week, 26-ounce equivalents of meat, poultry, and egg goes unchanged from 2010. The 2015 DG do sort of recommend you eat less meat, particularly red and processed meat, if you read between the lines.

For protein, the big take home is to increase variety. Since Americans get most of their protein from poultry, meat, and eggs, the recommendation to increase variety by eating more seafood, nuts/seeds, and legumes can be interpreted as “eat less meat.” Teen and adult men generally overconsume protein, so it is recommended they decrease protein intake by eating less of the common protein foods like meat, chicken, and eggs. Recommendations to limit saturated fat can lead someone to eat less red meat, and recommendations to eat less sodium could lead someone away from typically high-sodium processed meat. The DG do green light lean, low-sodium processed meats.

The tiptoeing around processed and red meat yielded perhaps the largest criticism of the Dietary Guidelines. In an interview with NPR, Mozaffarian said, “A challenge here is that the Dietary Guidelines come from USDA, which is inherently conflicted. It wants to improve the health of Americans yet it also wants to promote farming and food industry.”

The American Institute of Cancer Research had some harsh feedback: “We are dismayed to see that the Dietary Guidelines have allowed lobbying efforts to supersede the scientific evidence, when it comes to meat and cancer risk.” The American Cancer Society Cancer Action Network echoed this sentiment, calling the DG a “missed opportunity to reduce death and suffering.”

It will be interesting to see if the discord surrounding the 2015 DG fizzles out or creates serious change in how the Dietary Guidelines are created and disseminated. But, if you are unhappy with the guidelines, sit tight. Only five more years and we can debate once again!

Emily Finnan is a second-year Biochemical and Molecular Nutrition MS student and registered dietitian. When she’s not reading lengthy government documents, she’s tweeting: follow her @emilyyfin.

Chipotle in the News

by Shannon Dubois

Chipotle is a very popular restaurant, with more than 1,500 locations across the US, Canada, France, Germany, and the UK. Chipotle claims fame for its quick and casual service of touted healthy foods and the catchphrase, “Food with Integrity.” However, in the past six months, Chipotle has been under fire, as many different foodborne illness outbreaks have been reported all across the US.

In August 2015, 64 people became ill when tomatoes served at a Minnesota Chipotle were associated with a salmonella outbreak. In the same month, a norovirus outbreak occurred in California, sickening 235 customers and leading to a civil lawsuit seeking class-action status. The lawsuit claims that the restaurant tried to cover up the incident by disposing of and bleach-cleaning away evidence before the health officials could inspect to determine the source. Allegedly, the restaurant closed for cleaning on August 20 but only notified health officials of the illness on August 21.

Then, in October, an E. coli outbreak affected 52 people in Washington and Oregon. In November, E. coli sickened five people in Kansas, North Dakota, and Oklahoma. The most recent outbreak connected to Chipotle occurred in December, when a host of Boston College students became ill with the classic nausea, vomiting, and diarrhea symptoms of norovirus. The alleged cause of the norovirus outbreaks? Employees continuing to work while ill, thereby spreading the virus on cutting boards, your utensils, the napkin you wipe your mouth with, and beyond.

(AP Photo/Steven Senne)

(AP Photo/Steven Senne)

Foodborne illnesses contracted at restaurants are certainly not unheard of, especially in fast-food chains. For example, a Wendy’s Restaurant was linked to foodborne illness in 2006 and Taco Bell in 2008. Employees may be undertrained and rushed to work as quickly as possible, but the number of outbreaks associated with Chipotle in this short amount of time is alarming. It only takes working in foodservice for even a brief amount of time to know that, while the rulebook may say you technically can call in sick, it may not be the smartest idea if you want to keep your preferred shifts and your job. Also, it’s called fast foodnot meticulously hygienic foodso speed is definitely the goal, especially during a lunch or dinner rush.

The question remaining is this: With a similar culture across the board for fast food restaurants, why is Chipotle’s current track record so much worse than other restaurants of similar style and menu? It’s hard to say, but Chipotle suggested that it may be due to their use of fresh produce and meat, instead of frozen. In the wake of these outbreaks and lawsuits, they are pledging to increase food safety measures, such as modifying food testing and altering food preparation.

Will this be enough to save their reputation? Will their newly implemented food safety measures quell these outbreaks? Let’s hope so, but only time will tell.

Shannon Dubois is a second-year Master’s student studying Biochemical and Molecular Nutrition.

Edible Seaweed: An Ancient Vegetable from the Sea

by Nusheen Orandi

We call it an exotic “health food” now, but edible seaweed became part of the world’s cuisine thousands of years ago and still remains a normal kitchen ingredient in many parts of the world. Why should we pay more attention to the stuff that gets stuck in between our toes at the beach? While western chefs and foodies play catch-up to the rest of the world by switching up their vegetable dishes, nutrition scientists say seaweed offers health benefits. Perhaps both contribute to why U.S markets are starting to make room for this sea vegetable on grocery shelves.

The health benefits of edible seaweed

Edible seaweed can be a good source of vitamins, minerals, and other nutrients and hosts many health benefits that can add value to our diets. The nutrient content of seaweed can depend on the variety. People harvest green, red, and brown seaweed in Japan, China, Korea, the Philippines, India, New Zealand, and many other parts of the world. There are over 30 commonly eaten seaweeds.

Seaweed is rich in complex carbohydrates and protein, with red seaweed containing the most protein. Seaweed also contains omega-3-fatty acids, which have been shown to promote heart health by lowering triglyceride levels (bad fat) in the blood. Seaweed is comprised of fiber as well. About a ¼ cup serving of fresh seaweed, or a couple tablespoons of dried seaweed (like nori), has approximately one gram of fiber.

As an antioxidant-rich vegetable, seaweed provides us with some of the immune-boosting vitamins such as vitamin A, C, and E. A single serving of seaweed (about two tablespoons) also gives about a fifth of the daily recommended amount of vitamin K, which plays an important blood clotting role in the body and helps maintain bone health. But, it is the vitamin B12 in seaweed that may really pack a nutritional punch. Dr. Jeffrey Blumberg, director of the Antioxidant Laboratory at the USDA’s Human Nutrition Center on Aging at Tufts University, explained why: “It’s not just important to look at the nutrients present in a food, but how readily those nutrients are released once you eat it.”

The healthfulness of a food depends on how much of a nutrient is released once we eat it (its bioaccessibility) and how much of that nutrient our body can take up (its bioavailability). So, nutrients in a food are only useful if the body can take them up in the first place. This makes seaweed curious because most plants do not contain bioavailable vitamin B12. Research conflicts with whether the vitamin B12 in seaweed really is bioavailable or not. For example, it has been shown to be bioavailable in the red seaweed known as purple laver, which is usually sold dried. But it is not clear if other edible seaweeds have bioavailable sources of vitamin B12. However, this potential source could benefit people trying to include more plants in their diet. It would also suit vegetarians, who usually have few food sources of vitamin B12. Animal foods, such as red meat, act as the main source of vitamin B12, however nutrition professionals recommend that most healthy diets should consist of less red meat.

What gives seaweed its high mineral content? Some scientists suspect it is the exposure to ocean minerals. Seaweed has plenty of minerals like calcium, potassium, magnesium, iron, iodine, zinc, selenium, and copper, which have diverse functions in the body. A single serving of seaweed (particularly green or brown seaweed) provides over half of the daily-recommended amount of calcium. In fact, the calcium found in seaweed (calcium phosphate) is more bioavailable and useful to our body than the calcium found in milk (calcium carbonate). Seaweed is a major source of iodine. Brown seaweed contains the most iodine, while green and red seaweed contain less. The other primary source of iodine is iodized salt. But, as Dr. Blumberg noted, “If people are being told to decrease salt intake in their diet, then that means that they are also taking in less iodine in their diets.” This especially applies to heart patients on low-salt diets that may be at risk of iodine deficiency.

The health risks of edible seaweed

Seaweed can pose risks for some people. For example, people with thyroid health problems would do best to avoid large amounts of brown algae because of its high iodine content. A person with kidney problems could also be at risk because red seaweed, such as dulse, is very high in potassium and could present a risk of potassium toxicity.

What makes seaweed any better than the usual green veggies, like broccoli and lettuce? It’s not so much that it’s superior to other vegetables, but that it can add variety to a healthy diet that, as Dr. Blumberg said, should lean in a plant-based direction.

“I would argue that one of the things we need people to do is to eat more plant food. And, that can be done with one of the principles of nutrition: diversity of the diet. A healthful food doesn’t have to be a ‘superfood,’ just a good, nutrient-dense food,” he said.

So edible seaweed is full of good things. But, how are we supposed to eat this mildewy-looking green stuff? Cooking with seaweed may seem like a high dive, but you can actually easily work it into any meal or snack.

Cooking with edible algae

You don’t need to learn how to roll sushi in order to cook with seaweed. Different types of seaweed, fresh or dried, add unique flavors to soups, meats, salads, and snacks.

Kelp is a popular form of seaweed, usually dried, that people cook with. Kombu, a brown kelp, is one of the most common types. It comes in dried sheets in most grocery stores. You can rehydrate it by adding water to be used in salad, stir fries, or with fish. You can even add it dried to soups or rice dishes for flavor. As it gets cold out there, try out this Seared Salmon with Winter Vegetables and Kombu Broth recipe.

Did you know you could add a vegetable to your popcorn? Well, with red seaweed, you can! Dulse, red seaweed, is sold in the form of dried flakes, which gives it the nickname “sea lettuce flakes.” It has a naturally salty flavor and chewiness that dresses up your popcorn nicely. Just add about ¼ cup of dulse flakes to your favorite bag of popcorn kernels, and let it pop!

If you try a seaweed salad in a Japanese restaurant, its main ingredient is probably wakame. You buy wakame dried, but once you add water to it, it turns into a dark green and slightly crunchy vegetable. Cucumbers and sesame seeds complement wakame in a salad, such as this easy Sunomono (Cucumber Salad) recipe.

The most well known seaweed is probably nori, a dark green seaweed. It’s often seen as sushi’s belt and adds a salty and vinegar flavor to seafood. You find nori as dried sheets, just like kombu. You can break it up and add it to your trail mix, or cut it up into strips and use it as a healthy cracker substitute for an appetizer. Get fancy with this Tuna Tartare and Nori Chips recipe.

Arame is a funky, dark brown kelp that comes in dried, long strands. It actually tastes slightly sweeter than other kelps and adds flavor to an assortment of dishes. Arame brings a blend of texture to a dish, such as in this Arame and Edamame Salad, where you get creamy and crunchy all in one bite.

Remember when trendy kale chips swept through Whole Foods? Seaweed chips naturally have lots of flavor and also provide a healthy alternative to even our guiltiest snack cravings. Roast 3-4 cups of seaweed with a teaspoon each of salt and pepper and a dash of lemon juice.

If the vegetable drawer of your refrigerator tires you out, adding this flexible and flavorful sea vegetable to your meals could benefit both your health and your palate.

Nusheen Orandi is a second-year student from California in the Nutrition Communication program with a concentration in Agriculture, Food and Environment. She likes to spend her time tea-shop hunting, breakfasting, tensely watching the Tottenham Hotspurs, and cooking and eating with friends and family.