Sunday, October 23, 2011

Harvard Food Law Society "Forum on Food Policy" TEDx Conference

Last Friday, it was my pleasure to attended and present at the Harvard Food Law Society's TEDx conference, Forum on Food Policy.  I had never been to Cambridge or Boston before, and I was struck by how European they feel compared to Seattle.  The conference was a great success, thanks to the dedicated efforts of the Food Law Society's presidents Nate Rosenberg, Krista DeBoer, and many other volunteers. 

Dr. Robert Lustig gave a keynote address on Thursday evening, which I unfortunately wasn't able to attend due to my flight schedule.  From what I heard, he focused on practical solutions for reducing national sugar consumption, such as instituting a sugar tax.  Dr. Lustig was a major presence at the conference, and perhaps partially due to his efforts, sugar was a central focus throughout the day.  Nearly everyone agrees that added sugar is harmful to the nation's health at current intakes, so the question kept coming up "how long is it going to take us to do something about it?"  As Dr. David Ludwig said, "...the obesity epidemic can be viewed as a disease of technology with a simple, but politically difficult solution".


Taxes/regulations are vigorously opposed by the processed food industry, and also (more understandably) by people who don't want to have their food choices legislated.  Children in particular should be federally protected from predatory food industry practices.  Personally, I'm in favor of legislation that de-incentivizes added sugar consumption.  What if we had a sugar tax that paid for some of the obesity and diabetes-related expenditures that taxpayers currently shoulder through Medicare and Medicaid?  That would simply balance the "externalized" cost of health problems that are caused by sugar in the first place.   

The first panel of speakers on Friday was on nutrition and health, and set the tone for the rest of the conference, which was focused on policy.  Dr. Walter Willett was the first speaker.  Dr. Willett is the chair of the Harvard Nutrition department and the second most cited scientist in clinical medicine.  He reviewed the evidence from his observational studies supporting his vision of nutrition and health.  His optimal diet focuses on whole grains, vegetables and fruit, legumes, fish and poultry, unsaturated fats from nuts and seed oils, limited whole eggs, and avoids refined carbohydrate/sugar, red meat, and replaces saturated fats with unsaturated fats.  He suggests that a fat intake of ~40% of calories is healthy as long as the fat is unsaturated. 

I spoke second, giving a talk titled "The American Diet: a Historical Perspective".  The talk was about the US diet, so apologies to non-US residents of North and South America for the imprecise terminology.  The talk began by describing briefly how certain aspects of health have changed in the US over the last 120 years (increased obesity, diabetes, heart attacks, and other "diseases of civilization"), then focused on the major changes in diet over the last 200 years or so.  The main point I kept coming back to is that the diet has shifted dramatically from simple, home-cooked food to commercially prepared food, although I covered many other aspects of dietary change as well.  I think it was an informative talk, and it was well received.  Volunteers told me it will be freely available on the TED website, as well as their Food Law Society website, within 2-3 weeks. 

Dr. David Ludwig spoke third.  He's an accomplished researcher at Harvard and Boston Children's hospital who focuses on childhood obesity.  His talk focused on the danger of excessively processed/refined food and I thought it dovetailed nicely with what I presented.  He started out with a perspective on the evolution of the human diet from early hominid times-- it's nice to see this line of thinking become more prevalent, although his concept of the Paleolithic diet was not entirely consistent with the evidence I've seen.  I thought one of the most memorable moments of the conference was when he showed a picture and described a meal marketed to children called "Mess With Your Mouth Tacos".  He must have bought one of these and carefully laid out and photographed everything the box contained, which included various "pastes and concoctions", refined tortilla shells, a Capri Sun sweetened beverage, and Nerds (candy).  Whether or not the Nerds go inside the tacos wasn't clear.  The point is that when you stop and think about it, the idea that this stuff is food and should be eaten by children is so ironic it had us snickering in our seats.  They should rename it "Mess With Your Pancreas Tacos".  The talk ended with Dr. Ludwig recommending a "Mediterranean"-type diet for health.  Although it was largely crafted by American nutrition researchers and does not adhere very closely to actual traditional Mediterranean diets (it's loosely based around the traditional diet of Crete), I nevertheless believe it is far superior to the typical American diet.

After our talks, Drs. Willett, Ludwig, Lustig and I participated in a panel discussion about nutrition and health, moderated by Corby Kummer, an accomplished food writer and senior editor at The Atlantic.  We covered many topics, including various aspects of sugar consumption (which were not particularly controversial), meat, and the glycemic index.  I wasn't able to participate as much as I would have liked, due to the assertiveness of the other panelists and the fact that the moderator essentially ignored me.  But I got a few points in related to red meat consumption and traditional grain processing.

Dr. Willett made a few remarks that I wasn't able to address effectively at the time but that I think are worth discussing further.  One of the first things he did was express his dim view of diet-health information on the Internet.  I actually agree with that to some extent.  The Internet has democratized information, for better and worse.  On the positive side, it has given people unprecedented access to information that has allowed them to self-experiment and connect with interesting new ideas, which has often been helpful.  On the other hand, it had allowed the proliferation of "instant experts" who are long on advice and short on rigor, and who manage to convince others to adopt dietary changes that aren't necessarily in their best interest.  But these people existed in the popular press long before the Internet went mainstream. 

Another topic that came up, but which I wasn't able to comment on was the glycemic index.  Support for the importance of this concept comes almost entirely from observational studies, where people who eat high-glycemic foods tend to have worse health outcomes (fat gain, diabetes) than those who eat lower-glycemic foods.  I have three difficulties with this idea: 1) the highest-glycemic foods in the US diet are white flour products and sugar, so how do we know the glycemic index is the relevant factor?  2) controlled trials lasting from 10 weeks to 18 months overall have shown no meaningful effects of glycemic index on total food intake, fat gain, insulin sensitivity or any other marker of health in non-diabetics (1, 2), 3) many non-industrial cultures eat diets that rely heavily on high glycemic carbohydrate such as cassava, taro, partially milled rice, and milled millet and corn, and they generally don't become overweight, diabetic or have heart attacks (3).  I readily admit that could also have to do with other lifestyle factors such as exercise, sleep, etc., but that is true of any ancestral lifestyle.

This brings us to another thing Dr. Willett seems to have a dim view of, which is historical diet-health evidence.  I partially agreed with him, in that this kind of evidence is the least well controlled, and just because we were doing something 100 years ago and weren't fat, doesn't mean everything about our diet and lifestyle was optimal.  However, what it gives us is an archetype for a diet/lifestyle that does not lead to a high chronic disease burden over generations, which is valuable.  I was disappointed to hear Dr. Willett deploy the "people didn't live past 50" argument that is often used to hastily discredit historical/anthropological evidence.  I wasn't able to get this point in, but the fact is that we have age-adjusted data from the US, the UK, and a number of non-industrial cultures, suggesting that at the same age, the chronic disease burden for certain diseases was very low compared with today.  Furthermore, if you compare disease precursors that are present in young people in our society, such as obesity and high blood pressure, the prevalence of these is often radically lower as well.

Another point that I didn't make is that each form of evidence has its limitations.  While historical/anthopological evidence is the least well controlled, the second least well controlled is observational evidence.  Its principal limitations are 1) it is intrinsically incapable of identifying cause and effect relationships; 2) it often suffers from substantial inaccuracy in food assessment (such as that inherent in food frequency questionnaires), which is unevenly distributed across food groups (4); 3) one can never measure and adjust for all relevant confounding factors, and people who live a healthy overall lifestyle will differ from those who don't in ways that are probably relevant to health but can't be corrected for, and this injects a significant risk of spurious results into observational studies, particularly when they're studying factors that carry a cultural stigma and tend to be avoided by health-conscious people (e.g., red meat, 5, 6).  For these reasons, observational studies shouldn't be used as the sole basis for public health recommendations.  A better approach is to look broadly at historical/anthropological evidence, observational evidence, controlled trials, and basic science/mechanism, and see if a coherent pattern emerges.  That allows us to increase our degree of confidence, since the strengths of each method will buttress the weaknesses of the others.  

The rest of the conference focused on food policy from a health, susctainability and marketing perspective.  There were some great speakers, whose talks will be available online shortly.  Policy isn't my specialty so I'm not going to comment on these much, but it was good for me to be exposed to the ideas.  One interesting point that came up is the fact that children don't have the ability to determine persuasive intent in advertising-- i.e., they can't tell when someone is trying to convince them of something that isn't necessarily in their best interest.  They take things that people tell them as fact.  Therefore, marketing to children is inherently deceptive.  One of the highlights of the conference was the quote (I'm paraphrasing) "we need to de-normalize the fact that a clown is telling our children how to eat".  Apologies to the author of that quote whose name I don't recall.  

Overall, an excellent conference.  Thanks to everyone who made it happen.

37 comments:

  1. I'm glad the conference was a success. I have some issues with the idea of taxing specific ingredients, namely that regardless of whether or not there is a price increase, there will be certain people who eat the ingredient, and certain people who abstain, and certain people who eat in moderation. I don't think it would be a stretch to posit that this has been the case with all foods available to man from the beginning of eating. (I have met people who spent rent money on cigarettes, regardless of the exorbitant price for a pack/carton in the US, and there are many smokers in European countries I visited, despite graphic depictions of charred lungs, damaged babies, and a large sign that says "Smoking Kills".) People have a responsibility to sort through the information that is presented to them, and to determine which is true, and not true, and whether they care. If they make the wrong choice, it is ultimately their choice! It is my opinion that it is a dangerous and misguided policy that assumes the inadequacy of the human mind to use reason.

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  2. Wow, congratulations Stephan! Standing up to Willett and his mega-cohorts is a tough job indeed, especially for those who are more mild-mannered. I wish I would have come down that day to see you talk. Funny enough, Meir Stampfer, another Harvard nutritional epi guy, is the most widely cited author on Medline.

    From my limited experience, every nutritional epi prof I've ever talked to knows approximately zilch about ancestral nutrition. Granted, they know a lot about their specific subject areas. But breadth of knowledge into other fields and other time periods is sorely lacking. When did they lose their sense of curiosity? Maybe they just haven't been exposed to paleo stuff yet, or maybe job security dictates a little covering your ears and closing your eyes.

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  3. Sorry, but this was a bad idea.

    I can feel the pain as you wrote this, Stephan. I have a BS in nutrition and have recently passed the California bar exam. So I am a nutrition major with a law degree.

    Those who try to shape public health policy as applied to nutrition have minimal to no knowledge of biochemistry, nutritional science, or the most basic biological functions,

    Thus, you get ideas such as taxes on sugar, corn, beef, milk blah blah blah. It's been tried before (alcohol - prohibition?) and did not work.

    However these types of "think tanks" and policy propounders are typical of law schools. A lot of thinkers with little thought that is actually meaningful.

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  4. It doesn't surprise me that the editor from the Atlantic was biased. Their own food summit on sustainability was sponsored by Conagra and Coca-Cola:
    http://www.baycitizen.org/blogs/culturefeed/food-politics-bloggers-challenge-food/

    I think we don't need to address any Pigouvian taxes yet because we still have subsidies. Let's stop the government from buying sugar-laden food and serving it in schools. That seems like worthy low-hanging fruit.

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  5. I think it's time to conclude that the libertarian stance on public health as regards to food taxation is shaky at best. It works fine in a perfect world where everyone is rational and there are few if any externalities, but I think it's time we realized the massive effect exerted by folks who simply won't stop consuming sugar/PUFAs/other obesogenic foods.

    As salfredston said, "there will be certain people who abstain, and certain people who eat in moderation," whether or not you tax it. That's kind of the point. Those that still continue to consume these products exert a heavy toll on the rest of society that we all pick up the tab on through Medicare/Medi-cal when they almost inevitably keel over with diabetes/heart disease/cancer. It sounds to me like the tax would not serve as a deterrent so much as a way to quantify their toll on society and provide an alternate source of funding to pay it. Whether or not you trust your government to use that wisely (I don't) is a different question, but I think it's clear that in the current way our system is set up in the US in regards to the welfare state, it's a logical step that needs to be considered seriously.

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  6. Strange world we live in when one considers our highly subsidized agriculture sector and the resulting State-reinforced behaviors to be "libertarian". Equally strange the idea of the human right to eat what you like being considered "libertarian". I though it was just human.

    Melissa already covered this. Its absurd to start regulating a distorted market instead of first removing the distortions.

    Additionally, "public health" is an oxymoron. Individuals have health, collectives don't. But, the notions of what "public health" means held by the food police, is a great argument against forcibly collectivized health services.

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  7. I sure hope you got to take in some of the Head of the Charles while you were there!

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  8. I rather like Pigovian taxes, but I fear having the government do so for nutrition save for the most egregious artificial ingredients; i.e., trans fats. This is less out of any principled libertarian sentiment than the fact that science does not have a solid consensus on the subject. Even if Lustig is absolutely right about fructose, keep in mind that the government types also would like to tax saturated fats as well. Not sure that replacing saturated fats with seed oils would be an improvement.

    The case for trans fats is less to stop people who want to eat them from doing so than to keep restaurants from substituting them for more expensive natural fats. I have lost count of the number of times a waitress has referred to margarine as butter in my presence.

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  9. Congrats, Stephan, for just being a member of a pretty highly regarded panel. You deserve it.

    Really great take-home pieces from this post:

    “the diet has shifted dramatically from simple, home-cooked food to commercially prepared food”
    “just because we were doing something 100 years ago and weren't fat, doesn't mean everything about our diet and lifestyle was optimal”

    “if you compare disease precursors that are present in young people in our society, such as obesity and high blood pressure, the prevalence of these is often radically lower as well”

    I too am coming to the realization that the libertarian stance is not sufficient for the current US society's problems. I am coming around to the "Yeah we're all libertarians in a perfect world - but we live in the US 2011. Far fom that."

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  10. All these guys are just government shills preaching there dogma to the choir. I'm sure its the sucrose making these kids fat and not the toxic vegetable oils, biggest load of crap I've ever read.

    These guys are not real scientist, they are government puppets pushing some weird government diet agenda to make us all slaves and tax every food we eat. They ignore real science in the name of DOGMA!

    How come lustig never talks about the studies where they feed sucrose in the absence of fat and the animals stay lean? Or what about 811ers who eat nothing but fruit in massive quantities and become anorexic skinny?

    These shills don't even do real experiments, they setup "controlled trials" designed to prove there hypothesis...

    Sorry for the rant but this whole tax sugar thing really gets me going, its a load of BS.

    I suggest anyone and everyone listen to this http://www.radio4all.net/index.php/program/47094 before you believe there lies.

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  11. If the goal is to minimize the cost of the "eternality" of socialized medical costs, the government ought to be nudging and taxing people and non-smokers, they ultimately cost more money according to this study (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029)

    "Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions."

    So the utilitarian argument for Pigou taxes, even those on cigarettes breaks down, regardless whether one thinks (as I do) that the government has no business regulating people eat, nor what they think nor what I say. And don't even get me started on so-called predatory advertising. My kid lives in a dictatorship and the "predatory" advertisements for junk food might make my job a little tougher but that's my problem. I'd prefer the clown that represents McD to try and tell my kid what to eat than the clowns who wrote the Food Pyramid.

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  12. "The government ought to be nudging and taxing people and non-smokers"

    Meh, *thin* people.

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  13. I'd like to respond as a parent of impressionable children. I have 3 kids, ages 7, 5, and 3. They haven't been effected by McDonald's marketing (or any other company), because they only watch an hour of PBS a week, with no ads. Turn off the TV, and the marketing is virtually gone. The kids figure out how to entertain themselves.

    Parents are fully capable of moderating the child's environment, and you don't have to be a recluse to do it.

    Our friends are relatively health conscious, so I don't have to worry about snacks on play dates. There is more sugar at their school than I'd like, but I don't want to make them dysfunctional around sugar by my prohibiting it. Overall sugar consumption for them is pretty low.

    I do recognize that I have the means to afford unprocessed foods, the time to cook it, and enough education to recognize crap when I see it. I realize not everyone is in the same position. While I don't feel the need to change laws regarding marketing to children, I can see that it might make a positive difference to other families.

    I am already frustrated by laws regarding what I can and cannot eat (raw milk, for example). I would not be in favor of more laws regarding what foods should be available.

    I would, however, like to see the Farm Bill changed so that processed foods aren't artificially cheap.

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  14. Carl,

    "keep in mind that the government types also would like to tax saturated fats as well"...

    (That's just i was about to say before reading your comment - with a small addition:)
    ...as they did in Denmark where all foods with SFA content > 2,3% are now taxed and each kilo of pure saturated fat costs about 3$ more.
    Anyway, I wouldn't rely on goverment regulations in and around health, especially seeing that they are working in an opposite direction (S510 in US, C-36 in Canada, THMPD in EU and so on).

    As for restaurants, even if we assume keeping them from substituting fats is possible, they're cheating with other stuff as well and there are not so many healthy dishes in the menu anyway.
    Last time when ate in a restaurant was abot five years ago. Having no access to home-made food, I'd better go buy myself some bananas.

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  15. It's more efficient and reasonable to change entitlement program directives than laws relating to the general public as a whole.

    Was that discussed?

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  16. I agree with Cliff, the biggest problem with a sugar tax is that the evidence that sugar is harmful is simply pretty weak.

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  17. Given the unconventionality of the views that are held by many in the "ancestral health" community, it's surprising that there is at least some support here for govt dietary nudging.

    I don't think low carbers are likely to be happy with a meat tax

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  18. Your emerging prominence is well-deserved. It is amazing to see how the internet has helped quicken the rise of the cream. I found WholeHealthSource about sixteen months ago. Without the internet it would have been a few more years before I would have had any chance of running into a book or article you might have written.

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  19. One simple policy solution might be to eliminate the tariffs on imported sugar and eliminating sugar and corn subsidies. Sugar and corn sweeteners are two of the most subsidized commodities on the planet thanks to our industrial agricultural policies. In fact, we should get rid of all agricultural subsidies (and every other subsidy as well, but I digress). That would be a great start.

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  20. Stephan,

    Congrats on being invited to a panel with such heavy-hitters.

    As to Dr. Willett's PUFA recommendations, what are your thoughts on his lumping n-6s and n-3s together into the generic 'PUFAs' category as he seems to do? I'm thinking of the work of Ramsden and Hibbeln that teased out the details regarding dietary PUFAs (n3 vs. n6)and came to a different conclusion than Willett, Mozaffarian, et al.

    Do you agree with Dr. Willett that n6's do not contribute to inflammation?

    Finally, was there any discussion as to the recent papers suggesting saturated fats are relatively benign? Is the "saturated fats are bad" mantra still alive and well in those circles?

    Thanks for any thoughts.

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  21. Hi Caira,

    Yes, parents can mostly control what their children eat, but the fact is, advertising to children causes children to eat more junk food, otherwise the food companies wouldn't waste their money. It works because kids request it from their parents, and not all parents are as resolute or as educated about food as you are.

    Hi David,

    Thanks for he kind words.

    Hi Garry,

    There was general agreement that saturated fat is not much of an issue. Willett recommends replacing it with PUFA, but that's because he thinks PUFA are protective, not that SFA are particularly harmful. I can't say I find that line of reasoning very compelling myself.

    I have a high regard for Chris Ramsden's work on the n-6/3 PUFA distinction in clinical trials. Willett seems to pay little attention to the n-3/6 distinction, simply recommending increased PUFA intake.

    He is probably right that n-6 PUFA don't simply increase inflammation as part of normal dietary patterns, at least not to any large degree. However, they do change inflammatory signaling pathways in a complex manner, interfere with n-3 pathways and increase oxidative stress when consumed excessively. Not only that, but in the form of refined seed oils, they are stripped of their natural protective compounds, and form unhealthy oxidized by-products when used in cooking.

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  22. Good points raised re: pigovian taxes and "public health". I think I'll reconsider my position on it.

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  23. In the conference there was some high points on vegetarian lifestyle you can catch these points on the ted websites!!


    Dr Clark

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  24. I was a physics major in college. There were some history of science classes. We were taught that new evidence didn't change the minds of the elders in a field. Instead, younger generations would be swayed. Then, as the elders retired, the beliefs of the next generation would come to dominate the field.

    As long as Willet maintains political power, his beliefs will carry weight, and he is unlikely to change his beliefs. We can only hope that the next generation is exposed to better data and analysis, and is ready to fill the power vacuum when the old guard steps down.

    It's heartening that Dr Stephan participated in this conference, it's a sign of the succession path. Stephan, you'll need to practice your assertiveness if you want to be infuential. I imagine that it is contrary to your core philosophies to try and dominate others, but you need that type of strength to not be dominated by others. You have a duty to get your perspective out there to help the rest of us.

    Thank your for your service.

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  25. Not a fan of taxing sugar. I am, however, a fan of subsidizing fruits and vegetables instead of corn and soy. This would make the price of whole foods drop while adjusting the price of meats to what is actually more reasonable (meat is way too cheap in this country IMHP).

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  26. Stephan,
    Were you able to ask Willet what he thinks about evidence linking PUFAs (especially omega 6) to cancer. In humans, there's the Lyon Diet Heart trial and the Veterans trial (Pearce). Lots of evidence in rats, mice, other animals. Decent (but conflicting) epidemiological evidence, especially from places, like outside of the United States, where the saturated fat = death message wasn't broadcast so loudly. All together, it's very compelling evidence in my opinion.

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  27. I think a sugar tax is a really bad idea. It's a slippery slope - what will prevent a saturated fat tax, a cholesterol tax, an animal product tax? Certainly not science. We all know that the government doesn't understand nutrition, and I think looking to the government for solutions is counterproductive.

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  28. Daniel,

    As Kamal said, "...maybe job security dictates a little covering your ears and closing your eyes..." I'm pretty sure Willet would offer little insight to any well-rounded nutrition researcher or even hobbyist.

    Raza,

    Yes, but France knows what's up. Melissa of Huntgatherlove linked to an article about France requiring meat in school lunches.

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  29. "There were some history of science classes. We were taught that new evidence didn't change the minds of the elders in a field. Instead, younger generations would be swayed."

    It's off the subject not just of this post but of this blog...but it's too beautiful not to share. See:

    http://www.itroodon.com/2011/10/nobel-prize-chemistry/

    for a superb example of the progress of science that exhibits both the openness and the closedness of minds.

    It also illustrates the foolishness of efforts to predict in advance the "the promise of broader impacts" of proposed work on the practical world, as NSF currently asks grant proposals to do.

    The article is from Science magazine, but membership in AAAS is required to access it on their site.

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  30. You have some interesting thoughts! Perhaps we should contemplate about attempting this myself.

    CCTV Karachi

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    ReplyDelete
  32. To tempt a few people to actually take a look, here’s a gist of the story at the link I gave a couple days ago.

    Man observes something in lab experiment that “can’t happen”. He believes it anyway and confirms it for himself. When he tells colleagues about it, he’s laughed at and asked to leave his research group.

    Struggling on, he publishes 2½ years later. Since it IS a simple experiment that others can carry out in a few days, “all hell breaks loose”.

    Note that we are not talking medical/nutritional research, riven with vague definitions, squishy data, hordes of confounding variables, and seen through a thick statistical filter. This is simple, lab-bench physical chemistry. Still, X-ray crystallographers refused to believe it until, three years later, they could use their preferred technology to check it out. Double Nobel laureate Linus Pauling never does accept it.

    Much earlier a few mathematicians playing around with some completely useless geometric ideas came up with structures that some theoretical chemists had used to make models of peculiar substances that didn’t exist...until they did. The new kind of materials is subsequently found both in nature and in some man-made things. A diversity of innovative practical applications are in the works.

    Final result: Science recognizes a new state of matter, and the original guy gets a Nobel Prize in chemistry.

    The linked site has a nice picture.

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  33. Stephan,

    Have you seen this article by Ludwig and Willet from New England Journal of Medicine. They seem to be pretty clear about their views on saturated fat.

    http://www.nejm.org/doi/full/10.1056/NEJMp1107075?query=TOC

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  34. Stephan, In case you or anyone else is interested, the speaker who made the clown comment and discussed issues relating to marketing food to children is Jennifer Pomeranz from the Yale Rudd Center. Her info is here:

    http://www.yaleruddcenter.org/who_we_are.aspx?id=333

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  35. http://blog.cholesterol-and-health.com/2011/10/denmark-came-for-your-sugar-and-trans.html

    Denmark Came For Your Sugar and Trans Fats, Now They Are Coming For Your Saturated Fat. When They Come for You, Will There Be Any Macronutrient Left to Object on Your Behalf?

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  36. >>> how long is it going to take us to do something about it?

    it is not theirs to do. There is a special place in hell, right next to the ovens, for these do-gooder nanny-state Stalinists.

    First thing to be done is to cut off all tax dollars going to them.

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  37. Congratulations on being on the panel.

    Let me just say that I'm a little disappointed that you, the person I consider to be probably the most reasonable and probably the most important voice in the nutrition debate, didn't challenge some of the things I know you disagree with. Having said that, I now that it was partly due to the moderator's ignorance, as well as the inappropriate behavior of Dr. Lustig, who interrupted you at least twice by stealing your mic. I sincerily hope that next time you will act less passively in this sort of situation, because I believe your opinions and analysis should be heard for the good of everyone.

    At one point in the discussion Dr Willet said (49:25 -> http://www.youtube.com/watch?v=xaLbq1H958s): "I'm absolutely, 100% sure - if you replace red meat with the combination of nuts and legumes you will reduce your heart disease risk". Although I know it is a really unscientific thing to say, I would like to ask you if there is any evidence supporting this assumption that you know of.

    Thank you for the incredible work you're doing here and good luck in the future.



    Thanks

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