How Kind Bars Are Helping Push the FDA to Reconsider What ‘Healthy’ Means
Most people have a basic understanding of what healthy food is—and is not. Public health campaigns, the old food pyramid and the new MyPlate and parental admonitions to “eat your veggies" have all contributed to a population that can identify a salad as being healthier than a deep-fried Oreo.
But the days of “good" and “bad" foods may be coming to an end. Nutritional advice—including the most recent federal dietary guidelines—is now more concerned with a person's overall diet than with avoiding any one thing. Now the Food and Drug Administration (FDA) is reconsidering the definition of “healthy" as it's used on package labeling, a further sign of this change.
Photo credit: Yelp Inc. / Flickr
Defining “healthy" as a government regulator is far more difficult than picking between salad and deep-fried cookies. Since the 1990s, the FDA has only allowed a “healthy" label on vitamin-rich foods that are low in fat, saturated fat, cholesterol and sodium. These requirements nearly make sense—but note that sugar content is not included in this list. As a result, sugary fortified cereals or low-fat toaster pastries or puddings could be considered healthy and can use that claim on their packaging with the full backing of the FDA. Yet the standards for “healthy" prohibit foods such as avocados, nuts or fatty fish from receiving the label. So a product like Kind snack bars, which are filled with almonds and other fatty nuts, cannot label its products “healthy," as the FDA made clear in 2015 when it told the company to stop using the labeling language.
That's all changing thanks to a request made in last month's appropriations bill from the House of Representatives and a citizen petition started by Kind. “In light of evolving nutrition research, forthcoming Nutrition Facts Labeling final rules and a citizen petition, we believe now is an opportune time to reevaluate regulations concerning nutrient content claims, generally, including the term 'healthy,'" wrote FDA Press Officer Lauren Kotwicki in an email. (Kind is now allowed to use the word on its packaging as part of corporate philosophy, not a nutritional claim).
“The FDA is decades behind the science on this issue," said Michele Simon, a public health lawyer who runs the Plant-Based Foods Association, an industry trade group. She regularly has to tell people who make healthy foods that they aren't allowed to use the word on their label. Not all fats are bad for you, she said, adding that she would like to see mono- and polyunsaturated fats no longer count against otherwise healthy foods. Sugar content, in her opinion, should also be taken into consideration “so that sugary Kind bars don't get to be called healthy," she said.
It's too early to tell what the new definition of “healthy" might be—after all, it took six years to finalize requirements around “gluten-free" foods—but it will undoubtedly reflect current nutritional knowledge. In the 1990s, nutritionists vilified fats and paid little attention to sugar, which led to the FDA's current definition of the term. Many experts now believe that the war on fats may have led to the current obesity crisis.
“One of the most unfortunate unintended consequences of the fat-free crusade was the idea that if it wasn't fat, it wouldn't make you fat," Walter Willett, a professor of epidemiology and nutrition at the Harvard School of Public Health, told Frontline. “I even had colleagues who were telling the public that you can't get fat eating carbohydrates."
Since then, multiple studies have suggested fats in general aren't to blame for heart disease and other dietary ills. If some sources of saturated fat (whole milk) are good for us and other sources (fast-food hamburgers) are not, perhaps it's the food—not the fat—that people need to worry about.
The FDA's approach to food reflects what food-policy expert Marion Nestle calls “nutritionism" in which the amount and type of nutrients in a food are used to determine whether it's healthy or not. She disagrees with the mentality that nutrient content alone can tell you whether a food is healthy, regardless of what's written on the label. “Most of the labeling requirements were designed to deal with processed food products, not foods," said Nestle. “They don't work well for whole foods."
Today's research shows a more nuanced view of nutrition and government regulations are beginning to reflect that shift. The new dietary guidelines have moved away from telling people to get however many grams of protein and consume less than this many teaspoons of salt—to focus on overall dietary patterns instead. “People do not eat food groups and nutrients in isolation but rather in combination," the executive summary states. It's a person's overall diet, not how much fat or vitamin C a food has, that determines one's health.
If the FDA takes the new research under consideration, it may be difficult to come up with a one-size-fits-all definition of words like “healthy." Maybe the days of ticking off nutrient levels to proudly claim something is “healthy" or has “50 percent less calories" are coming to an end.
Nestle said if she were in charge of redefining the word, she would only allow the “healthy" label to be used on “real foods, minimally processed." But in an ideal world, she would “try to get rid of health claims—all health claims—on foods and food products." Considering how often these claims are found on processed products such as canned produce or low-fat foods while their whole counterparts go unlabeled, it's about time.
“I guess it's fortunate for food-industry marketers that I don't work for the FDA," Nestle said.
This article was reposted with permission from our media associate TakePart.
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Fish exposed to endocrine-disrupting compounds pass on health problems to future generations, including deformities, reduced survival, and reproductive problems, according to a new study.
Low Levels Lead to Generational Impacts<p>Researchers exposed inland silverside fish to bifenthrin, levonorgestrel, ethinylestradiol, and trenbolone to levels currently found in waterways.</p><p>"Our concentrations were actually on the low end" of what is found in the wild, DeCourten said, adding that it was low amounts of chemicals in parts per trillion.</p><p>Bifenthrin is a pesticide; levonorgestrel and ethinylestradiol are synthetic hormones used in birth controls; and trenbolone is a synthetic steroid often given to cattle to bulk them up.</p><p>Such endocrine-disruptors have already been linked to a variety of health problems in directly exposed fish including altered growth, reduced survival, lowered egg production, skewed sex ratios, and negative impacts to immune systems. But what remains less clear is how the exposure may impact future generations.</p><p>For their study, DeCourten and colleagues started the exposure when the fish were embryos and continued it for 21 days.</p><p>They then tracked effects on the exposed fish, and the next two generations.</p>
Inherited Problems<p>DeCourten said the altered DNA methylation is one of the plausible ways that future generations would experience health impacts from previous generations' exposure. Hormone-disrupting compounds have been shown to impact DNA methylation, which is an important marker of how an organism will develop.</p><p>"Methyl groups are added to specific sites on the genome, [the exposure] is not changing the genome itself, but rather how the genome is expressed," she said. "And that can be inherited throughout generations."</p><p>In addition, Brander said there are essentially different "tags" that exist on DNA molecules, which tell genes how to turn on and off. She said the exposure to different compounds may be "influencing which methyl tags get taken on or off as you proceed through generations."</p><p>The researchers said the study should prompt future toxics testing to consider impacts on future generations.</p><p>"The results … throw a wrench in the current approach to regulating chemicals, where it's often short-term testing looking at simple things like growth, survival, and maybe gene expression," Brander said.</p><p>"These findings are telling us we really at least need to consider" the next two generations, she added.</p>
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Consumers have long turned to vitamins and herbs to try to protect themselves from disease. This pandemic is no different — especially with headlines that scream "This supplement could save you from coronavirus."
Vitamin D<p><strong>What it is: </strong>Called "the sunshine vitamin" because the body makes it naturally in the presence of ultraviolet light, <a href="https://www.sciencenews.org/article/vitamin-d-supplements-lose-luster" target="_blank">Vitamin D is one of the most heavily studied</a> supplements (<em>SN: 1/27/19</em>). <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-12/" target="_blank">Certain foods</a>, including fish and fortified milk products, are also high in the vitamin.</p><p><strong>Why it might help: </strong>Vitamin D is a hormone building block that helps strengthen the immune system.</p><p><strong>How it works for other infections:</strong> In 2017, the <em>British Medical Journal</em> published a meta-analysis that suggested a daily vitamin D supplement <a href="https://www.bmj.com/content/356/bmj.i6583" target="_blank">might help prevent respiratory infections</a>, particularly in people who are deficient in the vitamin.</p><p>But one key word here is <em>deficient. </em>That risk is highest during dark winters at high latitudes and among people with more color in their skin (melanin, a pigment that's higher in darker skin, inhibits the production of vitamin D).</p><p>"If you have enough vitamin D in your body, the evidence doesn't stack up to say that giving you more will make a real difference," says Susan Lanham-New, head of the Nutritional Sciences Department at the University of Surrey in England.</p><p>And taking too much can create new health problems, stressing certain internal organs and leading to a dangerously high calcium buildup in the blood. The recommended daily allowance for adults is 600 to 800 International Units per day, and the upper limit is considered to be 4,000 IUs per day.</p><p><strong>What we know about Vitamin D and COVID-19:</strong> Few studies have looked directly at whether vitamin D makes a difference in COVID.</p>
Zinc<p><strong>What it is: </strong>Zinc, a mineral found in cells all over the body, is found naturally in certain meats, beans and oysters.</p><p><strong>Why it might help: </strong>It plays several supportive roles in the immune system, which is why zinc lozenges are always hot sellers in cold and flu season. Zinc also helps with cell division and growth.</p><p><strong>How it works for other infections: </strong><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457799/" target="_blank" rel="noopener noreferrer">Studies of using zinc for colds</a> — which are frequently caused by coronaviruses — suggest that using a supplement right after symptoms start might make them go away quicker. That said, a clinical trial from researchers in Finland and the United Kingdom, published in January in <em>BMJ Open</em> <a href="https://bmjopen.bmj.com/content/10/1/e031662" target="_blank" rel="noopener noreferrer">did not find any value for zinc lozenges</a> for the treatment of colds. Some researchers have theorized that inconsistencies in data for colds may be explained by varying amounts of zinc released in different lozenges.</p><p><strong>What we know about zinc and COVID-19:</strong> The mineral is promising enough that it was added to some early studies of hydroxychloroquine, a drug tested early in the pandemic. (Studies have since shown that <a href="https://www.sciencenews.org/article/covid-19-coronavirus-hydroxychloroquine-no-evidence-treatment" target="_blank">hydroxychloroquine can't prevent or treat COVID-19</a> (<em>SN: 8/2/20</em>).)</p>
Vitamin C<p><strong>What it is: </strong>Also called L-ascorbic acid, vitamin C has a long list of roles in the body. It's found naturally in fruits and vegetables, especially citrus, peppers and tomatoes.</p><p><strong>Why it might help:</strong> It's a potent antioxidant that's important for a healthy immune system and preventing inflammation.</p><p><strong>How it works for other infections: </strong>Thomas cautions that the data on vitamin C are often contradictory. One review from Chinese researchers, published in February in the <em>Journal of Medical Virolog</em>y, looked at <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25707" target="_blank">what is already known about vitamin C</a> and other supplements that might have a role in COVID-19 treatment. Among other encouraging signs, human studies find a lower incidence of pneumonia among people taking vitamin C, "suggesting that vitamin C might prevent the susceptibility to lower respiratory tract infections under certain conditions."</p><p>But for preventing colds, a 2013 Cochrane review of 29 studies <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000980.pub4/full" target="_blank" rel="noopener noreferrer">didn't support the idea</a> that vitamin C supplements could help in the general population. However, the authors wrote, given that vitamin C is cheap and safe, "it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial."</p><p><strong>What we know about Vitamin C and COVID-19: </strong>About a dozen studies are under way or planned to examine whether vitamin C added to coronavirus treatment helps with symptoms or survival, including Thomas' study at the Cleveland Clinic.</p><p>In a review published online in July in <em>Nutrition</em>, researchers from KU Leuven in Belgium concluded that the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000980.pub4/full" target="_blank" rel="noopener noreferrer">vitamin may help prevent infection</a> and tamp down the dangerous inflammatory reaction that can cause severe symptoms, based on what is known about how the nutrient works in the body.</p><p>Melissa Badowski, a pharmacist who specializes in viral infections at the University of Illinois at Chicago College of Pharmacy and colleague Sarah Michienzi published an extensive look at all supplements that might be useful in the coronavirus epidemic. There's <a href="https://www.drugsincontext.com/can-vitamins-and-or-supplements-provide-hope-against-coronavirus/" target="_blank" rel="noopener noreferrer">still not enough evidence to know whether they are helpful</a>, the pair concluded in July in <em>Drugs in Context</em>. "It's not really clear if it's going to benefit patients," Badowski says.</p><p>And while supplements are generally safe, she adds that nothing is risk free. The best way to avoid infection, she says, is still to follow the advice of epidemiologists and public health experts: "Wash your hands, wear a mask, stay six feet apart."</p>
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