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Tag: industry influence

  • The Stroke Risk of Vegetarians  | NutritionFacts.org

    The Stroke Risk of Vegetarians  | NutritionFacts.org

    The first study in history on the incidence of stroke in vegetarians and vegans suggests they may be at higher risk.

    “When ranked in order of importance, among the interventions available to prevent stroke, the three most important are probably diet, smoking cessation, and blood pressure control.” Most of us these days are doing pretty good about not smoking, but less than half of us exercise enough. And, according to the American Heart Association, only 1 in 1,000 Americans is eating a healthy diet and less than 1 in 10 is even eating a moderately healthy diet, as you can see in the graph below and at 0:41 in my video Do Vegetarians Really Have Higher Stroke Risk?. Why does it matter? It matters because “diet is an important part of stroke prevention. Reducing sodium intake, avoiding egg yolks, limiting the intake of animal flesh (particularly red meat), and increasing the intake of whole grains, fruits, vegetables, and lentils….Like the sugar industry, the meat and egg industries spend hundreds of millions of dollars on propaganda, unfortunately with great success.” 

    The paper goes on to say, “Box 1 provides links to information about the issue.” I was excited to click on the hyperlink for “Box 1” and was so honored to see four links to my videos on egg industry propaganda, as you can see below and at 1:08 in my video. 

    The strongest evidence for stroke protection lies in increasing fruit and vegetable intake, with more uncertainty regarding “the role of whole grains, animal products, and dietary patterns,” such as vegetarian diets. One would expect meat-free diets would do great. Meta-analyses have found that vegetarian diets lower cholesterol and blood pressure, as well as enhance weight loss and blood sugar control, and vegan diets may work even better. All the key biomarkers are going in the right direction. Given this, you may be surprised to learn that there hadn’t been any studies on the incidence of stroke in vegetarians and vegans until now. And if you think that is surprising, wait until you hear the results. 

    “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up: Results from the Prospective EPIC-Oxford Study”: There was less heart disease among vegetarians (by which the researchers meant vegetarians and vegans combined). No surprise. Been there, done that. But there was more stroke, as you can see below, and at 2:14 in my video. 

    An understandable knee-jerk reaction might be: Wait a second, who did this study? Was there a conflict of interest? This is EPIC-Oxford, world-class researchers whose conflicts of interest may be more likely to read: “I am a member of the Vegan Society.”

    What about overadjustment? When the numbers over ten years were crunched, the researchers found 15 strokes for every 1,000 meat eaters, compared to only 9 strokes for every 1,000 vegetarians and vegans, as you can see below and at 2:41 in my video. In that case, how can they say there were more strokes in the vegetarians? This was after adjusting for a variety of factors. The vegetarians were less likely to smoke, for example, so you’d want to cancel that out by adjusting for smoking to effectively compare the stroke risk of nonsmoking vegetarians to nonsmoking meat eaters. If you want to know how a vegetarian diet itself affects stroke rates, you want to cancel out these non-diet-related factors. Sometimes, though, you can overadjust. 

    The sugar industry does this all the time. This is how it works: Imagine you just got a grant from the soda industry to study the effect of soda on the childhood obesity epidemic. What could you possibly do after putting all the studies together to conclude that there was a “near zero” effect of sugary beverage consumption on body weight? Well, since you know that drinking liquid candy can lead to excess calories that can lead to obesity, if you control for calories, if you control for a factor that’s in the causal chain, effectively only comparing soda drinkers who take in the same number of calories as non-soda-drinkers, then you could undermine the soda-to-obesity effect, and that’s exactly what they did. That introduces “over adjustment bias.” Instead of just controlling for some unrelated factor, you control for an intermediate variable on the cause-and-effect pathway between exposure and outcome.

    Overadjustment is how meat and dairy industry-funded researchers have been accused of “obscuring true associations” between saturated fat and cardiovascular disease. We know that saturated fat increases cholesterol, which increases heart disease risk. Therefore, if you control for cholesterol, effectively only comparing saturated fat eaters with the same cholesterol levels as non-saturated-fat eaters, that could undermine the saturated fat-to-heart disease effect.

    Let’s get back to the EPIC-Oxford study. Since vegetarian eating lowers blood pressure and a lowered blood pressure leads to less stroke, controlling for blood pressure would be an overadjustment, effectively only comparing vegetarians to meat eaters with the same low blood pressure. That’s not fair, since lower blood pressure is one of the benefits of vegetarian eating, not some unrelated factor like smoking. So, that would undermine the afforded protection. Did the researchers do that? No. They only adjusted for unrelated factors, like education, socioeconomic class, smoking, exercise, and alcohol. That’s what you want. You want to tease out the effects of a vegetarian diet on stroke risk. You want to try to equalize everything else to tease out the effects of just the dietary choice. And, since the meat eaters in the study were an average of ten years older than the vegetarians, you can see how vegetarians could come out worse after adjusting for that. Since stroke risk can increase exponentially with age, you can see how 9 strokes among 1,000 vegetarians in their 40s could be worse than 15 strokes among 1,000 meat-eaters in their 50s. 

    The fact that vegetarians had greater stroke risk despite their lower blood pressure suggests there’s something about meat-free diets that so increases stroke risk it’s enough to cancel out the blood pressure benefits. But, even if that’s true, you would still want to eat that way. As you can see in the graph below and at 6:16 in my video, stroke is our fifth leading cause of death, whereas heart disease is number one. 

    So, yes, in the study, there were more cases of stroke in vegetarians, but there were fewer cases of heart disease, as you can see below and at 6:29. If there is something increasing stroke risk in vegetarians, it would be nice to know what it is in hopes of figuring out how to get the best of both worlds. This is the question we will turn to next. 

    I called it 21 years ago. There’s an old video of me on YouTube where I air my concerns about stroke risk in vegetarians and vegans. (You can tell it’s from 2003 by my cutting-edge use of advanced whiteboard technology and the fact that I still had hair.) The good news is that I think there’s an easy fix.

    This is the third in a 12-video series on stroke risk. Links to the others are in the related posts below.

    Michael Greger M.D. FACLM

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  • Obesity and a Toxic Food Environment  | NutritionFacts.org

    Obesity and a Toxic Food Environment  | NutritionFacts.org

    Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth. 

    When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

    It’s the food.

    Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

    It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

    The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

    Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

    However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

    If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

    What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate. 

    Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating. 

    As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

    But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

    Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

    If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

    This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below. 

    Michael Greger M.D. FACLM

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  • Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Like the tobacco industry adding extra nicotine to cigarettes, the food industry employs taste engineers to accomplish a similar goal of maximizing the irresistibility of its products. 

    The plague of tobacco deaths wasn’t due just to the mass manufacturing and marketing of cheap cigarettes. Tobacco companies actively sought to make their products even more crave-able by spraying sheets of tobacco with nicotine and additives like ammonia to provide “a bigger nicotine ‘kick.’” Similarly, taste engineers are hired by the food industry to maximize product irresistibility.

    Taste is the leading factor in food choice. “Sugar, fat, and salt have been called the three points of the compass” to produce “superstimulating” and “hyper palatability” to tempt people into impulsive buys and compulsive consumption. Foods are intentionally designed to hook into our evolutionary triggers and breach whatever biological barriers help “keep consumption within reasonable limits.”

    Big Food is big business. The processed food industry alone brings in more than $2 trillion a year. That affords them the economic might to manipulate not only taste profiles, but public policy and scientific inquiry, too. The food, alcohol, and tobacco industries have all used similar unsavory tactics: blocking health regulations, co-opting professional organizations, creating front groups, and distorting the science. The common “corporate playbook” shouldn’t be surprising, given the common corporate threads. At one time, for example, tobacco giant Philip Morris owned both Kraft and Miller Brewing.

    As you can see below and at 1:45 in my video The Role of Corporate Influence in the Obesity Epidemic, in a single year, the food industry spent more than $50 million to hire hundreds of lobbyists to influence legislation. Most of these lobbyists were “revolvers,” former federal employees in the revolving door between industry and its regulators, who could push corporate interests from the inside, only to be rewarded with cushy lobbying jobs after their “public service.” In the following year, the industry acquired a new weapon—a stick to go along with all those carrots. On January 21, 2010, the Supreme Court’s five-to-four Citizen’s United ruling permitted corporations to spend unlimited amounts of money on campaign ads to trash anyone who dared stand against them. No wonder our elected officials have so thoroughly shrunk from the fight, leaving us largely with a government of Big Food, by Big Food, and for Big Food. 

    Globally, a similar dynamic exists. Weak tea calls from the public health community for voluntary standards are met not only with vicious fights against meaningful change but also massive transnational trade and foreign investment deals that “cement the protection of their [food industry] profits” into the laws of the lands.

    The corrupting commercial influence extends to medical associations. Reminiscent of the “just what the doctor ordered” cigarette ads of yesteryear, as you can see below and at 3:05 in my video, the American Academy of Family Physicians accepted millions from The Coca-Cola Company to “develop consumer education content on beverages and sweeteners.” 

    On the front line, fake grassroots “Astroturf” groups are used to mask the corporate message. RJ Reynolds created Get Government Off Our Back (memorably acronymed GGOOB), “a front group created by the tobacco industry to fight regulation,” for instance. Americans Against Food Taxes may as just as well be called “Food Industry Against Food Taxes.” The power of front group formation is enough to bind bitter corporate rivals; the Sugar Association and the Corn Refiners Association linked arms with the National Confectioners Association to partner with Americans for Food and Beverage Choice.

    Using another tried-and-true tobacco tactic, research front groups can be used to subvert the scientific process by shaping or suppressing the science that deviates from the corporate agenda. Take the trans fat story. Food manufacturers have not only “long denied that trans fats were associated with disease,” but actively “worked to limit research on trans fats” and “discredit potentially damaging findings.”

    At what cost? The global death toll from foods high in trans fat, saturated fat, salt, and sugar is at 14 million lost lives every year. The inability of countries around the world to turn the tide on obesity “is not a failure of individual will-power. This is a failure of political will to take on big business,” said the Director-General of the World Health Organization. “It is a failure of political will to take on the powerful food and soda industries.” She ended her keynote address before the National Academy of Medicine entitled “Obesity and Diabetes: The Slow-Motion Disaster” with these words: “The interests of the public must be prioritized over those of corporations.”

    Are you mad yet? To sum up my answer to the question underlying my What Triggered the Obesity Epidemic? webinar, it’s the food. I close next with my wrap-up video: The Role of the Toxic Food Environment in the Obesity Epidemic. 

    This was part of an 11-part series. See the related posts below.

    If the political angle interests you, check out: 

    Michael Greger M.D. FACLM

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  • Are Food Ads Making Us Obese?  | NutritionFacts.org

    Are Food Ads Making Us Obese?  | NutritionFacts.org

    We all like to think we make important life decisions, like what to eat, consciously and rationally, but if that were the case, we wouldn’t be in the midst of an obesity epidemic.

    The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Certainly, there is a “large number of well-conducted randomized experiments” I could go through with you that “have shown that exposure to marketing—especially, but not only, advertising—changes people’s eating behavior. Marketing causes people to choose to eat more.” But, what do you need to know beyond the fact that the industry spends tens of billions of dollars a year on it? To get people to drink its brown sugar water, do you think Coca-Cola would spend a penny more than it thought it had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work. 

    To give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in the world’s leading scientific journal: “In-Store Music Affects Product Choice” documented an experiment in which French accordion music or German Bierkeller music was played on alternate days in the wine section of a grocery store. As you can see below and at 1:27 in my video The Role of Food Advertisements in the Obesity Epidemic, on the days the French music played in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. And it wasn’t a difference of just a few percent; it was a complete three-fold reversal. Despite the dramatic effect, when shoppers were approached afterward, the vast majority of them denied the music had influence on their choice. 

    Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations, even if we’d like to think that were the case. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we are “under stress, tired, or preoccupied. This unconscious part of our brain is estimated to function and guide our behaviors at least 95% of the time.” This is the arena where marketing manipulations do most of their dirty work. 

    The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process more than 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

    Before calls could be made at the touch of a button or the sound of our voice, the seven-digit span of phone numbers in the United States was based in part on the longest sequence most people can recall on the fly. We only seem to be able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. The study’s setup: Randomize people to memorize either a seven-digit number or a two-digit number to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy and presumably takes few cognitive resources. As you can see in the graph below and at 3:52 in my video, under the two-digit condition, most study participants chose fruit salad. Faced with the same decision, most of those trying to keep seven digits in their heads just went for the cake. 

    This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks compared to those exposed to non-food ads. Or maybe that is a surprise. We all like to think we’re in control and not so easily manipulated. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two-digit or seven-digit memorization task during the TV show, and the snack-attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background or multi-task during commercial breaks? Research suggests that may make us even more impressionable to the subversion of our better judgment. 

    There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that, given the dire health consequences of our unhealthy eating habits, “the marketing techniques of which we are unaware should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

    Given the role marketing can play even when we least suspect it, what is the role of personal responsibility in the obesity epidemic? That’s the subject of my next video.

    We are winding down this series on obesity, with three videos remaining: 

     If you missed any of the previous videos, see the related posts below. 

    Michael Greger M.D. FACLM

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  • Marketing Takes Off and Obesity Soars  | NutritionFacts.org

    Marketing Takes Off and Obesity Soars  | NutritionFacts.org

    The unprecedented rise in the power, scope, and sophistication of food marketing starting around 1980 aligns well with the blastoff slope of the obesity epidemic.

    In the 1970s, the U.S. government went from just subsidizing some of the worst foods to paying companies to make more of them: “Congress passed laws reversing long-standing farm policies aimed at protecting prices by limiting production” and started giving payouts in proportion to output. Extra calories started pouring into the food supply.

    Then Jack Welch gave a speech. In 1981, the CEO of General Electric effectively launched the “shareholder value movement,” reorienting the primary goal of corporations towards maximizing short-term returns for investors. This placed extraordinary pressure from Wall Street on food companies to post increasing profit growth every quarter to boost their share price. There was already a glut of calories on the market and now they had to sell even more.

    This placed food and beverage CEOs in an impossible bind. It’s not like they’re rubbing their sticky hands together at the thought of luring more Hansels and Gretels to their doom in their houses of candy. Food giants couldn’t do the right thing even if they wanted. They are beholden to investors. If they stopped marketing to kids or tried to sell healthier food or did anything else that could jeopardize their quarterly profit growth, Wall Street would demand a change in management. Healthy eating is bad for business. It’s not some grand conspiracy; it’s not even anyone’s fault. It’s just how the system works.

    As I discuss in my video The Role of Marketing in the Obesity Epidemic, given the constant demands for corporate growth and rapid returns in an already oversaturated marketplace, the food industry needed to get people to eat more. Like the tobacco industry before them, it turned to the ad makers. The food industry spends about $10 billion a year on advertising and around another $20 billion on other forms of marketing, such as trade shows, consumer promotions, incentives, and supermarket “slotting fees.” Food and beverage companies purchase shelf space from supermarkets to prominently display their most profitable products. They pay supermarkets. The practice is also known as “cliffing,” because companies “force suppliers to bid against each other for shelf space with the loser pushed ‘over the cliff.’” With slotting fees costing up to $20,000 per item, per retailer, and per city, you can imagine what types of foods get the special treatment. Hint: It ain’t broccoli.

    To get a sense of what kind of products merit prime shelf real estate, look no further than the checkout aisle. “Merchandising the power categories on every lane is critical,” reads a trade publication on the “best practices for superior checkout merchandising.” It was referring to candy bars and beverages. Just a 1 percent power category boost in sales could earn a store an extra $15,000 a year. It’s not that publicly traded companies don’t care about their customers’ health. They might, but like most of the leading grocery store chains, their “primary fiduciary responsibility is to increase profits” above other considerations.

    For instance, tens of millions of dollars are spent annually advertising a single brand of candy bar. McDonald’s alone may spend billions a year. Now, “the food industry is the biggest spender on advertising of any major sector of the economy.”

    “Reagan-era deregulatory policies removed limits on television marketing of food products to children.” Now, the average child may see more than 10,000 TV food ads a year, and that’s on top of “the marketing content online, in print, at school, at the movies, in video games, or at school,” or even on their phones. “Nearly all food marketing to children worldwide promotes products that can adversely affect their health.”

    Besides the massive early exposure and ubiquity, food marketing has become “highly sophisticated. With the help of child psychologists, companies began to understand the factors that unconsciously influenced sales. They found out, for example, how to influence children and get them to manipulate their parents.” Packaging was designed to best attract a child’s attention, and then those products are placed at their eye level in the store. You know those mirrored bubbles in the ceilings of supermarkets? They aren’t just for shoplifters. Closed-circuit cameras and GPS-like devices on shopping carts are used to strategize how best to guide shoppers toward the market’s most profitable products. Behavioral psychology is widely applied to increase impulse buying, and eye movement tracking technologies are utilized.

    The “unprecedented expansion in the scope, power, and ubiquity of food marketing…coincided with an unprecedented expansion in food consumption in predictable ways.” Some techniques have “skyrocket[ed] from essentially zero to multi-billion-dollar industries” since the 1980s, including “product placement, in-school advertising, event sponsorships.” This led one noted economist to conclude that “the most compelling single interpretation of the admittedly incomplete data we have is that the large increase in obesity is due to marketing.” Yes, innovations in manufacturing and political maneuvering led to a food supply bursting at the seams with close to 4,000 calories a day for us all, but it’s the advances in marketing manipulations that try to peddle that surplus into our mouths. 

    I think the natural reaction to the suggestion of the power of marketing is: I’m too smart to fall for that. Marketing works on other people, but I can see through it. But that’s what everyone thinks! For a splash of cold water to shake us all out of this delusion, I next bring you some data: The Role of Food Advertisements in the Obesity Epidemic. 

    Also, for both the role of marketing and food advertisements, check out Friday Favorites: The Role of Marketing and Food Advertisements in the Obesity Epidemic.

    This is the seventh in an 11-video series. If you missed any of the first six, check out the related posts below. 

    Michael Greger M.D. FACLM

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  • Processed Foods and Obesity  | NutritionFacts.org

    Processed Foods and Obesity  | NutritionFacts.org

    The rise in the U.S. calorie supply responsible for the obesity epidemic wasn’t just about more food, but a different kind of food.

    The rise in the number of calories provided by the food supply since the 1970s “is more than sufficient to explain the US epidemic of obesity.” Similar spikes in calorie surplus were noted in developed countries around the world in parallel with and presumed to be primarily responsible for, the expanding waistlines of their populations. After taking exports into account, by the year 2000, the United States was producing 3,900 calories for every man, woman, and child—nearly twice as much as many people need. 

    It wasn’t always this way. The number of calories in the food supply actually declined over the first half of the twentieth century and only started its upward climb to unprecedented heights in the 1970s. The drop in the first half of the century was attributed to the reduction in hard manual labor. The population had decreased energy needs, so they ate decreased energy diets. They didn’t need all the extra calories. But then the “energy balance flipping point” occurred, when the “move less, stay lean phase” that existed throughout most of the century turned into the “eat more, gain weight phase” that plagues us to this day. So, what changed?

    As I discuss in my video The Role of Processed Foods in the Obesity Epidemic, what happened in the 1970s was a revolution in the food industry. In the 1960s, most food was prepared and cooked in the home. The typical “married female, not working” spent hours a day cooking and cleaning up after meals. (The “married male, non-working spouse” averaged nine minutes, as you can see below and at 1:34 in my video.) But then a mixed-blessing transformation took place. Technological advances in food preservation and packaging enabled manufacturers to mass prepare and distribute food for ready consumption. The metamorphosis has been compared to what happened a century before with the mass production and supply of manufactured goods during the Industrial Revolution. But this time, they were just mass-producing food. Using new preservatives, artificial flavors, and techniques, such as deep freezing and vacuum packaging, food corporations could take advantage of economies of scale to mass produce “very durable, palatable, and ready-to-consume” edibles that offer “an enormous commercial advantage over fresh and perishable whole or minimally processed foods.” 

    Think ye of the Twinkie. With enough time and effort, “ambitious cooks” could create a cream-filled cake, but now they are available around every corner for less than a dollar. If every time someone wanted a Twinkie, they had to bake it themselves, they’d probably eat a lot fewer Twinkies. The packaged food sector is now a multitrillion-dollar industry.

    Consider the humble potato. We’ve long been a nation of potato eaters, but we usually baked or boiled them. Anyone who’s made fries from scratch knows what a pain it is, with all the peeling, cutting, and splattering of oil. But with sophisticated machinations of mechanization, production became centralized and fries could be shipped at -40°F to any fast-food deep-fat fryer or frozen food section in the country to become “America’s favorite vegetable.” Nearly all the increase in potato consumption in recent decades has been in the form of french fries and potato chips. 

    Cigarette production offers a compelling parallel. Up until automated rolling machines were invented, cigarettes had to be rolled by hand. It took 50 workers to produce the same number of cigarettes a machine could make in a minute. The price plunged and production leapt into the billions. Cigarette smoking went from being “relatively uncommon” to being almost everywhere. In the 20th century, the average per capita cigarette consumption rose from 54 cigarettes a year to 4,345 cigarettes “just before the first landmark Surgeon General’s Report” in 1964. The average American went from smoking about one cigarette a week to half a pack a day.

    Tobacco itself was just as addictive before and after mass marketing. What changed was cheap, easy access. French fries have always been tasty, but they went from being rare, even in restaurants, to being accessible around each and every corner (likely next to the gas station where you can get your Twinkies and cigarettes).

    The first Twinkie dates back to 1930, though, and Ore-Ida started selling frozen french fries in the 1950s. There has to be more to the story than just technological innovation, and we’ll explore that next.

    This explosion of processed junk was aided and abetted by Big Government at the behest of Big Food, which I explore in my video The Role of Taxpayer Subsidies in the Obesity Epidemic.

    This is the fifth video in an 11-part series. Here are the first four: 

    Videos still to come are listed in the related videos below.

    Michael Greger M.D. FACLM

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  • Cutting the Calorie-Rich-And-Processed Foods  | NutritionFacts.org

    Cutting the Calorie-Rich-And-Processed Foods  | NutritionFacts.org

    We have an uncanny ability to pick out the subtle distinctions in calorie density of foods, but only within the natural range.

    The traditional medical view on obesity, as summed up nearly a century ago: “All obese persons are, alike in one fundamental respect,—they literally overeat.” While this may be true in a technical sense, it is in reference to overeating calories, not food. Our primitive urge to overindulge is selective. People don’t tend to lust for lettuce. We have a natural inborn preference for sweet, starchy, or fatty foods because that’s where the calories are concentrated.

    Think about hunting and gathering efficiency. We used to have to work hard for our food. Prehistorically, it didn’t make sense to spend all day collecting types of food that on average don’t provide at least a day’s worth of calories. You would have been better off staying back at the cave. So, we evolved to crave foods with the biggest caloric bang for their buck.

    If you were able to steadily forage a pound of food an hour and it had 250 calories per pound, it might take you ten hours just to break even on your calories for the day. But if you were gathering something with 500 calories a pound, you could be done in five hours and spend the next five working on your cave paintings. So, the greater the energy density—that is, the more calories per pound—the more efficient the foraging. We developed an acute ability to discriminate foods based on calorie density and to instinctively desire the densest.

    If you study the fruit and vegetable preferences of four-year-old children, what they like correlates with calorie density. As you can see in the graph below and at 1:52 in my video Friday Favorites: Cut the Calorie-Rich-And-Processed Foods, they prefer bananas over berries and carrots over cucumbers. Isn’t that just a preference for sweetness? No, they also prefer potatoes over peaches and green beans over melon, just like monkeys prefer avocados over bananas. We appear to have an inborn drive to maximize calories per mouthful. 

    All the foods the researchers tested in the study with four-year-old kids naturally had less than 500 calories per pound. (Bananas topped the chart at about 400.) Something funny happens when you start going above that: We lose our ability to differentiate. Over the natural range of calorie densities, we have an uncanny aptitude to pick out the subtle distinctions. However, once you start heading towards bacon, cheese, and chocolate territory, which can reach thousands of calories per pound, our perceptions become relatively numb to the differences. It’s no wonder since these foods were unknown to our prehistoric brains. It’s like the dodo bird failing to evolve a fear response because they had no natural predators—and we all know how that turned out—or sea turtle hatchlings crawling in the wrong direction towards artificial light rather than the moon. It is aberrant behavior explained by an “evolutionary mismatch.”

    The food industry exploits our innate biological vulnerabilities by stripping crops down into almost pure calories—straight sugar, oil (which is pretty much pure fat), and white flour (which is mostly refined starch). It also removes the fiber, because that effectively has zero calories. Run brown rice through a mill to make white rice, and you lose about two-thirds of the fiber. Turn whole-wheat flour into white flour, and lose 75 percent. Or you can run crops through animals (to make meat, dairy, and eggs) and remove 100 percent of the fiber. What you’re left with is CRAP—an acronym used by one of my favorite dieticians, Jeff Novick, for Calorie-Rich And Processed food.

    Calories are condensed in the same way plants are turned into addictive drugs like opiates and cocaine: “distillation, crystallization, concentration, and extraction.” They even appear to activate the same reward pathways in the brain. Put people with “food addiction” in an MRI scanner and show them a picture of a chocolate milkshake, and the areas that light up in their brains (as you can see below and at 4:15 in my video) are the same as when cocaine addicts are shown a video of crack smoking. (See those images below and at 4:18 in my video.) 

    “Food addiction” is a misnomer. People don’t suffer out-of-control eating behaviors to food in general. We don’t tend to compulsively crave carrots. Milkshakes are packed with sugar and fat, two of the signals to our brain of calorie density. When people are asked to rate different foods in terms of cravings and loss of control, most incriminated was a load of CRAP—highly processed foods like donuts, along with cheese and meat. Those least related to problematic eating behaviors? Fruits and vegetables. Calorie density may be the reason people don’t get up in the middle of the night and binge on broccoli.

    Animals don’t tend to get fat when they are eating the foods they were designed to eat. There is a confirmed report of free-living primates becoming obese, but that was a troop of baboons who stumbled across the garbage dump at a tourist lodge. The garbage-feeding animals weighed 50 percent more than their wild-feeding counterparts. Sadly, we can suffer the same mismatched fate and become obese by eating garbage, too. For millions of years, before we learned how to hunt, our biology evolved largely on “leaves, roots, fruits, and nuts.” Maybe it would help if we went back to our roots and cut out the CRAP. 

    A key insight I want to emphasize here is the concept of animal products as the ultimate processed food. Basically, all nutrition grows from the ground: seeds, sunlight, and soil. That’s where all our vitamins come from, all our minerals, all the protein, all the essential amino acids. The only reason there are essential amino acids in a steak is because the cow ate them all from plants. Those amino acids are essential—no animals can make them, including us. We have to eat plants to get them. But we can cut out the middlemoo and get nutrition directly from the Earth, and, in doing so, get all the phytonutrients and fiber that are lost when plants are processed through animals. Even ultraprocessed junk foods may have a tiny bit of fiber remaining, but all is lost when plants are ultra-ultraprocessed through animals.

    Having said that, there was also a big jump in what one would traditionally think of as processed foods, and that’s the video we turn to next: The Role of Processed Foods in the Obesity Epidemic.

    We’re making our way through a series on the cause of the obesity epidemic. So far, we’ve looked at exercise (The Role of Diet vs. Exercise in the Obesity Epidemic) and genes (The Role of Genes in the Obesity Epidemic and The Thrifty Gene Theory: Survival of the Fattest), but, really, it’s the food.

    If you’re familiar with my work, you know that I recommend eating a variety of whole plant foods, as close as possible to the way nature intended. I capture this in my Daily Dozen, which you can download for free here or get the free app (iTunes and Android). On the app, you’ll see that there’s also an option for those looking to lose weight: my 21 Tweaks. But before you go checking them off, be sure to read about the science behind the checklist in my book How Not to Diet. Get it for free at your local public library. If you choose to buy a copy, note that all proceeds from all of my books go to charity. 

    Michael Greger M.D. FACLM

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  • What Should We Eat?  | NutritionFacts.org

    What Should We Eat?  | NutritionFacts.org

    Here is a review of reviews on the health effects of animal foods versus plant foods.

    Instead of looking only at individual studies or individual reviews of studies, what if you looked at a review of reviews? In my last video, I covered beverages. As you can see below and at 0:20 in my video Friday Favorites: What Are the Best Foods?, the majority of reviews found some effects either way, finding at least some benefits to tea, coffee, wine, and milk, but not for sweetened beverages, such as soda. As I explored in depth, this approach isn’t perfect. It doesn’t take into account such issues as conflicts of interest and industry funding of studies, but it can offer an interesting bird’s-eye view of what’s out in the medical literature. So, what did the data show for food groups? 

    You’ll note the first thing the authors did was divide everything into plant-based foods or animal-based foods. For the broadest takeaway, we can look at the totals. The vast majority of reviews on whole plant foods show protective or, at the very least, neutral effects, whereas most reviews of animal-based foods identified deleterious health effects or, at best, neutral effects, as you can see at 1:14 in my video. 

    Let’s break these down. As you can see in the graph below and at 1:23, the plant foods consistently rate uniformly well, reflecting the total, but the animal foods vary considerably. If it weren’t for dairy and fish, the total for animal foods would swing almost entirely neutral or negative. 

    I talked about the effects of funding by the dairy industry in my last blog, as well as substitution effects. For instance, those who drink milk may be less likely to drink soda, a beverage even more universally condemned than dairy, so the protective effects may be relative. They may arise not necessarily from what is being consumed, but rather from what is being avoided. This may best explain the fish findings. After all, the prototypical choice is between chicken and fish, not chicken and chickpeas.

    Not a single review found a single protective effect of poultry consumption. Even the soda industry could come up with 14 percent protective effects! But, despite all of the funding from the National Chicken Council and the American Egg Board, chicken, and eggs got big fat goose eggs, as you can see below and at 2:20 in my video. 

    Also, like the calcium in dairy, there are healthful components of fish, such as the long-chain omega-3 fatty acids. Not for heart health, though. In “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” increasing intake of fish oil fats had little or no effect on cardiovascular health. If anything, it was the plant-based omega-3s found in flaxseeds and walnuts that were protective. The long-chain omega-3s are important for brain health. Thankfully, just like there are best-of-both-worlds non-dairy sources of calcium, there are pollutant-free sources of the long-chain omega-3s, EPA, and DHA, as well.

    The bottom line, as you can see below and at 3:04 in my video, is that when it comes to diet-related diseases, such as obesity, type 2 diabetes, mental health, bone health, cardiovascular disease, and cancers, even if you lump together all the animal foods, ignore any industry-funding effects, and just take the existing body of evidence at face value, nine out of ten study compilations show that whole plant foods are, in the very least, not bad.

    However, about eight out of ten of the reviews on animal products show them to be not good, as shown in the graph below and at 3:24 in my video.

    This reminds me of my Flashback Friday: What Are the Healthiest Foods? video, which you may find to be helpful for some broad takeaways.

    If you missed my previous video, check out Friday Favorites: What Are the Best Beverages?.

    The omega-3s video I mentioned is Should Vegans Take DHA to Preserve Brain Function?.

    For more on eggs, see here.

    On fish, go here.

    And, for poultry, see related posts below. 

    Michael Greger M.D. FACLM

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  • What Should We Drink?  | NutritionFacts.org

    What Should We Drink?  | NutritionFacts.org

    Here is a review of reviews on the health effects of tea, coffee, milk, wine, and soda.

    If you’ve watched my videos or read my books, you’ve heard me say, time and again, the best available balance of evidence. What does that mean? When making decisions as life-or-death important as what to feed ourselves and our families, it matters less what a single study says, but rather what the totality of peer-reviewed science has to say.

    Individual studies can lead to headlines like “Study Finds No Link Between Secondhand Smoke and Cancer,” but to know if there is a link between secondhand smoke and lung cancer, it would be better to look at a review or meta-analysis that compiles multiple studies. The problem is that some reviews say one thing—for instance, “breathing other people’s tobacco smoke is a cause of lung cancer”—and other reviews say another—such as, the effects of secondhand smoke are insignificant and further such talk may “foster irrational fears.” And, while we’re at it, you can indulge in “active smoking of some 4-5 cigarettes per day” without really worrying about it, so light up!

    Why do review articles on the health effects of secondhand smoke reach such different conclusions? As you can imagine, about 90 percent of reviews written by researchers affiliated with the tobacco industry said it was not harmful, whereas you get the opposite number with independent reviews, as you can see below and at 1:18 in my video Friday Favorites: What Are the Best Beverages?. Reviews written by the tobacco industry–affiliated researchers had 88 times the odds of concluding that secondhand smoke was harmless. It was all part of “a deliberate strategy to use scientific consultants to discredit the science…” In other words, “the strategic and long run antidote to the passive smoking issue…is developing and widely publicizing clear-cut, credible, medical evidence that passive smoking [secondhand smoke] is not harmful to the non-smoker’s health.”

    Can’t we just stick to the independent reviews? The problem is that industry-funded researchers have all sorts of sneaky ways to get out of declaring conflicts of interest, so it can be hard to follow the money. For instance, it was found that “77% failed to disclose the sources of funding” for their research. But, even without knowing who funded what, the majority of reviews still concluded that secondhand smoke was harmful. So, just as a single study may not be as helpful as looking at a compilation of studies on a topic, a single review may not be as useful as a compilation of reviews. In that case, looking at a review of reviews can give us a better sense of where the best available balance of evidence may lie. When it comes to secondhand smoke, it’s probably best not to inhale, as you can see in the graph below and at 2:30 in my video. 

    Wouldn’t it be cool if there were reviews of reviews for different foods and drinks? Voila! Enter “Associations Between Food and Beverage Groups and Major Diet-Related Chronic Diseases: An Exhaustive Review of Pooled/Meta-Analyses and Systematic Reviews.” Let’s start with the drinks. As you can see below and at 2:51 in my video, the findings were classified into three categories: protective, neutral, or deleterious.

    First up: tea versus coffee. As you can see in the graph below and at 2:58, most reviews found both beverages to be protective for whichever condition they were studying, but you can see how this supports my recommendation for tea over coffee. Every cup of coffee is a lost opportunity to drink a cup of green tea, which is even healthier. 

    It’s no surprise that soda sinks to the bottom, as you can see below and at 3:20 in my video, but 14 percent of reviews mentioned the protective effects of drinking soda. What?! Well, most were references to papers like “High Intake of Added Sugar Among Norwegian Children and Adolescents,” a cross-sectional study that found that eighth-grade girls who drank more soda were thinner than girls who drank less. Okay, but that was just a snapshot in time. What do you think is more likely? That the heavier girls were heavier because they drank less soda, or that they drank less sugary soda because they were heavier? Soda abstention may therefore be a consequence of obesity, rather than a cause, yet it gets marked down as having a protective association. 

    Study design flaws may also account for wine numbers, as seen below and at 4:07 in my video. This review of reviews was published in 2014, before the revolution in our understanding of “alcohol’s evaporating health benefits,” suggesting that the “presumed health benefits from ‘moderate’ alcohol use [may have] finally collapsed”—thanks in part to a systematic error of misclassifying former drinkers as if they were lifelong abstainers, as I revealed in a deep dive in a video series on the subject.  

    Sometimes there are unexplainable associations. For example, one of the soft drink studies found that increased soda consumption was associated with a lower risk of certain types of esophageal cancers. Don’t tell me. Was the study funded by Coca-Cola? Indeed. Does that help explain the positive milk studies, as you can see in the graph below and at 5:02 in my video? Were they all just funded by the National Dairy Council? 

    As shown below and at 5:06, even more conflicts of interest have been found among milk studies than soda studies, with industry-funded studies of all such beverages “approximately four to eight times more likely to be favorable to the financial interests of the [study] sponsors than articles without industry-related funding.”

    Funding bias aside, though, there could be legitimate reasons for the protective effects associated with milk consumption. After all, those who drink more milk may drink less soda, which is even worse, so they may come out ahead. It may be more than just relative benefits, though. The soda-cancer link seems a little tenuous and not just because of the study’s financial connection to The Coca-Cola Company. It’s hard to imagine a biologically plausible mechanism, whereas even something as universally condemned as tobacco isn’t universally bad. As I’ve explored before, more than 50 studies have consistently found a protective association between nicotine and Parkinson’s disease. Even secondhand smoke may be protective. Of course, you’d still want to avoid it. Passive secondhand smoke may decrease the risk of Parkinson’s, but it increases the risk of stroke, an even deadlier brain disease, not to mention lung cancer and heart disease, which has killed off millions of Americans since the first Surgeon General’s report was released, as you can see below and at 6:20 in my video. 

    Thankfully, by eating certain vegetables, we may be able to get some of the benefits without the risks, and the same may be true of dairy. As I’ve described before, the consumption of milk is associated with an increased risk of prostate cancer, leading to recommendations suggesting that men may want to cut down or minimize their intake, but milk consumption is also associated with decreased colorectal cancer risk. This appears to be a calcium effect. Thankfully, we may be able to get the best of both worlds by eating high-calcium plant foods, such as greens and beans.  

    What does our review-of-reviews study conclude about such plant-based foods, in comparison to animal-based foods? We’ll find out next.

    Stay tuned for the exhaustive review of meta-analyses and systematic reviews on major diet-related chronic diseases found for food groups in What Are the Best Foods?.

    The alcohol video I mentioned is Is It Better to Drink a Little Alcohol Than None at All?, and the Parkinson’s video is Pepper’s and Parkinson’s: The Benefits of Smoking Without the Risks. I also mentioned my Dairy and Cancer video. 

    What about diet soda? See related posts below. 

    What’s so bad about alcohol? Check out Can Alcohol Cause Cancer? and Do Any Benefits of Alcohol Outweigh the Risks? for more. 

    I’ve also got tons of milk. Check here.

    My recommendations for the best beverages are water, green tea, and hibiscus herbal tea. Learn more in the related posts below.

    Michael Greger M.D. FACLM

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  • Children’s Cereals: Candy for Breakfast?  | NutritionFacts.org

    Children’s Cereals: Candy for Breakfast?  | NutritionFacts.org

    Plastering front-of-package nutrient claims on cereal boxes is an attempt to distract us from the incongruity of feeding our children multicolored marshmallows for breakfast.

    The American Medical Association started warning people about excess sugar consumption more than 75 years ago, based in part on our understanding that “sugar supplies nothing in nutrition but calories, and the vitamins provided by other foods are sapped by sugar to liberate these calories.” So, added sugars aren’t just empty calories, but negative nutrition. “Thus, the more added sugars one consumes, the more nutritionally depleted one may become.”

    Given the “totality of publicly available scientific evidence,” the Food and Drug Administration (FDA) decided to make processed food manufacturers declare “added sugars” on their nutrition labels. The National Yogurt Association was livid and said it “continues to oppose the ‘added sugars’ declaration,” since it needed “‘added sugars’ to increase palatability” of its products. The junk food association questioned the science, whereas the ice cream folks seemed to imply that consumers are too stupid to “understand or know how to use the added sugar declaration,” so it’s better just to leave it off. The world’s biggest cereal company, Kellogg’s, took a similar tact, opposing it so as not “to confuse consumers.” Should the FDA proceed with such labeling against Kellogg’s objections, the cereal giant pressed that “an added sugars declaration…should be communicated as a footnote.” It claimed that its “goal is to provide consumers with useful information so they can make informed choices.” This is from a company that describes its Froot Loops as “packed with delicious fruity taste, fruity aroma, and bright colors.” Keep in mind that Froot Loops has more sugar than a Krispy Kreme doughnut, as you can see in the graph below and at 1:46 in my video Friday Favorites: Kids’ Breakfast Cereals as Nutritional Façade. 

    Froot Loops is more than 40 percent sugar by weight! You can see the cereal box’s Nutrition Facts label below and at 1:50 in my video. 

    The tobacco industry used similar terms, such as “light,” “low,” and “mild” to make its products appear healthier—before it was barred from doing so. “Now sugar interests are fighting similar battles over whether their terminology, including ‘healthy,’ ‘natural,’ ‘naturally sweetened,’ and even ‘lightly sweetened,’ is deceptive to consumers.”

    But if you look at the side of a cereal box, as shown below and at 2:13 in my video, you can see all those vitamins and minerals that have been added. That was one of the ways the cereal companies responded to calls for banning sugary cereals. General Mills defended the likes of Franken Berry, Trix, and Lucky Charms for being fortified with essential vitamins. 

    Sir Grapefellow, I learned, was a “grape-flavored oat cereal” complete with “sweet grape star bits”—that is, marshmallows. Don’t worry. It was “vitamin charged!” You can see that cereal box below and at 2:31 in my video. 

    Sugary breakfast cereals, said Dr. Jean Mayer from Harvard, “are not a complete food even if fortified with eight or 10 vitamins.” Senator McGovern replied, “I think your point is well taken that these products may be mislabeled or more correctly called candy vitamins than cereals.” 

    Plastering nutrient claims on cereal boxes can create “a ‘nutritional façade’ around a product, acting to distract attention away” from unsavory qualities, such as excess sugar content. Researchers found that the “majority of parents misinterpreted the meaning of claims commonly used on children’s cereals,” raising significant public health concerns. Ironically, cereal boxes bearing low-calorie claims were found to have more calories on average than those without such a claim. The cereal doth protest too much. 

    Even candy bar companies are getting in on the action, bragging about protein content because of some peanuts. Like the Baby Ruth, a candy bar that has 50 grams of sugar. Froot Loops could be considered breakfast candy, as the same serving would have 40 sugar grams, as you can see below and at 3:45 in my video. 

    Given that “research suggests that consumers believe front-of-package claims, perceive them to be government-endorsed, and use them to ignore the Nutrition Facts Panel,” there’s been a call from nutrition professionals to consider “an outright ban on all front-of-package claims.” The industry’s short-lived “Smart Choices” label, as you can see below and at 4:13 in my video, was met with disbelief when it was found adorning qualifying cereals like Froot Loops and Cookie Crisp. The processed food industry spent more than a billion dollars lobbying against the adoption of more informative labeling (a traffic-light approach), “opposing most aggressively the use of a red light suggesting that any food was too high in anything.” 

    I was invited to testify as an expert witness in a case against sugary cereal companies. (I donated my fee, of course.) Check out the related posts below for a video series and blogs that are a result of some of the research I did. 

    You may also be interested in videos and blogs on the food industry; see related posts below.

    Michael Greger M.D. FACLM

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  • How Much Added Sugar Is Okay?  | NutritionFacts.org

    How Much Added Sugar Is Okay?  | NutritionFacts.org

    Public health authorities continue to lower the upper tolerable limit of daily added sugar intake.

    Dating back to the original “Dietary Goals for the United States” in 1977, also known as the so-called McGovern Report, leading nutrition scientists didn’t only call for a reduction in meat and other sources of saturated fat and cholesterol, such as dairy and eggs, but also sugar. The goal was to reduce America’s sugar intake to no more than 10 percent of our daily diet.

    “The conclusions would hang sugar,” reported the president of the Sugar Association. “The McGovern Report has to be neutralized.” The National Cattlemen’s Association was on its side and, just like Big Sugar, appealed to the Senate Select Committee to withdraw the report.

    “The Sugar Industry Empire Strikes Back”—and it appeared to work. When the official U.S. Dietary Guidelines were released in 1980 and again in 1985, it was without a specific limit, like 10 percent. It “said, simply, and in just four words, ‘Avoid too much sugar.’” (Whatever that means.) “In 1990, it went to five words, ‘Use sugars only in moderation,’ and in 1995 to six: ‘Choose a diet moderate in sugars.’” In 2000, it at least went back to limiting intake—specifically, “‘Choose beverages and foods to limit your intake of sugars’ (ten words), but even that was too strong. Under pressure from sugar lobbyists, the government agencies substituted the word ‘moderate’ for ‘limit’ so it read ‘Choose beverages and foods to moderate your intake of sugars.’” Then, the 2005 guidelines committee dropped the s-word completely, encouraging Americans to “Choose carbohydrates wisely…” Again, what does that mean? If only there were a dietary guidelines committee that could guide us….

    The Sugar Association expressed optimism about that 2005 Committee. In its Sugar E-News, it wrote that Sugar Association Incorporated (SAI) “is committed to the protection and promotion of sucrose [table sugar] consumption. Any disparagement of sugar will be met with forceful, strategic public comments”—and it wasn’t kidding. “In 2003, [the World Health Organization] WHO released a joint report with the Food and Agriculture Organization entitled Diet, nutrition and the prevention of chronic diseases which, for the first time [since the McGovern Report], called for a reduction in sugar intake to under 10% of total dietary energy [caloric] consumption.” The Sugar Association responded by threatening to get the United States to withdraw all funding from the WHO. You can see it yourself in black and white at 2:22 in my video Friday Favorites: The Recommended Daily Added Sugar Intake. The Sugar Association threatened to pressure Congress to withdraw funding from the World Health Organization—polio vaccinations and AIDS medications be damned! Don’t mess with the candy man. The threat was described as “tantamount to blackmail and worse than any pressure exerted by the tobacco lobby.” 

    Fifteen years later and 40 years after the first proposed McGovern Report, the 2015 to 2020 Dietary Guidelines for Americans lays out the 10 percent limit as a key recommendation: “Consume less than 10 percent of calories per day from added sugars.” This is currently exceeded by every age bracket in the United States starting at age one, as you can see in the graph below and at 2:58 in my video, with adolescents averaging 87 grams of sugar a day. That means the average teen is effectively eating 29 sugar packets a day. 

    The Sugar Association describes the 10 percent limit as “extremely low.” Well, I mean, it is only up to about a dozen spoonsful a day. Of course, there is no dietary requirement for added sugar at all, and every single calorie we get from added sugar is a wasted opportunity to get calories from sources that provide nutrition. To the American Heart Association’s credit, it went further by trying to push added sugar intake down to about 6 percent of calories, for which a single can of soda could send you over the limit. That’s an added sugar limit exceeded by 90 percent of Americans.

    In 2017, the American Heart Association (AHA) released its guidelines for children, recommending they get no more than about six teaspoons per day. In that case, a single serving of nearly a hundred cereals on the U.S. market would exceed the entire recommended daily limit. The AHA recommends no added sugars at all for children under the age of two, a recommendation that’s violated in up to 80 percent of toddlers, as you can see below and at 4:20 in my video. 

    In the United States, “at least 65 countries have implemented dietary guidelines or public health policies to curb sugar consumption to encourage maintenance of healthy body weight.” In the United Kingdom, the Scientific Advisory Committee on Nutrition made new recommendations to reduce added sugars down to 5 percent, which is also the direction the World Health Organization is headed. The WHO always seems to be ahead of the curve. Why? Because its policy-making process is at least partially protected “against industry influence.” Unlike governments, which may have competing interests in commerce and trade, “WHO is exclusively concerned with health.”

    I spoke at a hearing of the 2020 Dietary Guidelines Committee. Watch the highlights and my speech here: Highlights from the 2020 Dietary Guidelines Hearing.

    The sugar industry keeps pretty busy, as you’ll see from my recent videos, Friday Favorites: Are Fortified Kids’ Breakfast Cereals Healthy or Just Candy? and Flashback Friday: Sugar Industry Attempts to Manipulate the Science.

    Check the related posts below for my other popular videos and blogs on sugar.

    Michael Greger M.D. FACLM

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  • Milk Hormones and Female Infertility  | NutritionFacts.org

    Milk Hormones and Female Infertility  | NutritionFacts.org

    Dairy consumption is associated with years of advanced ovarian aging, thought to be due to the steroid hormones or endocrine-disrupting chemicals in cow’s milk.
     
    When it comes to the amount of steroid hormones we are exposed to in the food supply, dairy “milk products supply about 60–80% of ingested female sex steroids.” I’ve talked about the effects of these estrogens and progesterone in men and prepubescent children, and how milk intake can spike estrogen levels within hours of consumption. You can see graphs illustrating these points from 0:25 in my video The Effects of Hormones in Milk on Infertility in Women. In terms of effects on women, I’ve discussed the increased endometrial cancer risk in postmenopausal women. What about reproductive-age women? Might dairy hormones affect reproduction? 
     
    We’ve known that “dairy food intake has been associated with infertility; however, little is known with regard to associations with reproductive hormones or anovulation.” How might dairy do it? By affecting how the uterus prepares, or by affecting the ovary itself? Researchers found that women who ate yogurt or cream had about twice the risk of sporadic anovulation, meaning failure of ovulation, so some months there was no egg to fertilize at all. Now, we know most yogurt is packed with sugar these days. Even plain Greek yogurt can have more sugar than a double chocolate glazed cake donut, but the researchers controlled for that and the results remained after adjusting for the sugar content, “which suggests that the risk of anovulation was independent of the sugar content included in many flavored yogurt products.” We don’t know if this was just a fluke or exactly what the mechanism might be, but if women skip ovulation here and there throughout their lives, might they end up with a larger ovarian reserve of eggs? 
     
    Women are starting to have their first baby later in life. As you can see in the graph below and at 2:02 in my video, there’s been a rise in women having babies when they’re in their late 30s and 40s.

    We used to think that women’s ovarian reserve of eggs stayed relatively stable until a rapid decline at about age 37, but now we know it appears to be more of a gradual loss of eggs over time. The graph below and at 2:22 in my video charts a steady loss starting at peak fertility in one’s 20s.

    This measures “antral follicle count,” which is an ultrasound test where you can count the number of “next batter up” eggs in the ovaries, as you can see below and at 2:31 in my video. It is probably the best reflection of true reproductive age. It’s a measure of ovarian reserve—how many eggs a woman has left.

    What does this have to do with diet? Researchers at Harvard looked at the association of various protein intakes with ovarian antral follicle counts among women having trouble getting pregnant. “Even though diminished ovarian reserve is one of the major causes of female infertility, the process leading to reproductive senescence [deterioration with age] currently is poorly understood. In light of emerging population trends towards delayed pregnancy, the identification of reversible factors (including diet) that affect the individual rates of reproductive decline might be of significant clinical value.”

    The researchers performed ultrasounds on all the women, studied their diets, and concluded that higher intake of dairy protein was associated with lower antral follicle counts—in other words, accelerated ovarian aging. The graph below and at 3:39 in my video shows what counts look like in nonsmokers: Significantly lower ovarian reserve (12.7 antral follicle counts) at the highest dairy intake, which would be like three ounces of cheese a day, compared to the lowest dairy intake (16.9 antral follicle counts).

    What do these numbers mean in terms of biological age? Is 16.9 down to 12.7 really that much of a difference? As you can see below and at 3:58 in my video, when you look at women with really robust ovaries, a follicle count of 16.9 is what you might see in a 36- or 37-year-old, whereas 12.7, which is what you can see in women eating the most dairy, is what you might see in a really fertile 50-year-old. So, we’re talking year’s worth of ovarian aging between the highest and lowest dairy consumers.

    While it wasn’t possible for the researchers to “identify the underlying mechanism linking higher dairy protein intake to lower AFC,” antral follicle count, they had educated guesses. (1) It could be the steroid hormones and growth factors or (2) “the contamination of milk products by pesticides and endocrine disrupting chemicals that may negatively impact” the development of these ovarian follicles and egg competence.

    “Regarding the former [the hormones], studies suggest that commercial milk (derived from both pregnant and non-pregnant animals) contains large amounts of estrogens, progesterone, and other placental hormones that are eventually released into the human food chain, with dairy intake accounting for 60–80% of the estrogens consumed. Dairy estrogens overcome [survive] processing, appear in raw whole cow’s and commercial milk products, are found in substantially higher concentrations with increasing amounts of milk fat, with no apparent difference between organic and conventional dairy products…” Hormones are just naturally in cows’ bodies, so they aren’t just in the ones injected with growth hormones. And, once these bovine hormones are inside the human body, they get converted to estrone and estradiol, the main active human estrogens. Following absorption, bovine steroids may then affect reproductive outcomes.

    The researchers asserted that further studies are needed and that “it is imperative that these findings are reproduced in prospective studies designed to clarify the biology underlying the observed associations. The latter might be crucial given that consumption of another species’ milk by humans is an evolutionary novel dietary behavior that has the potential to alter reproductive parameters and may have long-term adverse health effects.”

    The video I mentioned about the effects of these estrogens and progesterone in men and prepubescent children is The Effects of Hormones in Dairy Milk on Cancer.

    I talk about the effect of dairy estrogen on male fertility in Dairy Estrogen and Male Fertility.

    How else might diet affect fertility? See related posts below. 

    Michael Greger M.D. FACLM

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  • Are Fortified Children’s Breakfast Cereals Just Candy?  | NutritionFacts.org

    Are Fortified Children’s Breakfast Cereals Just Candy?  | NutritionFacts.org

    The industry responds to the charge that breakfast cereals are too sugary.

    In 1941, the American Medical Association’s Council on Foods and Nutrition was presented with a new product, Vi-Chocolin, a vitamin-fortified chocolate bar, “offered ostensibly as a specialty product of high nutritive value and of some use in medicine, but in reality intended for promotion to the public as a general purpose confection, a vitaminized candy.” Surely, something like that couldn’t happen today, right? Unfortunately, that’s the sugary cereal industry’s business model.

    As I discuss in my video Are Fortified Kids’ Breakfast Cereals Healthy or Just Candy?, nutrients are added to breakfast cereals “as a marketing gimmick to “create an aura of healthfulness…If those nutrients were added to soft drinks or candy, would we encourage kids to consume them more often?” Would we feed our kids Coke and Snickers for breakfast? We might as well spray cotton candy with vitamins, too. As one medical journal editorial read, “Adding vitamins and minerals to sugary cereals…is worse than useless. The subtle message accompanying such products is that it is safe to eat more.”

    General Mills’ “Grow up strong with Big G kids’ cereals” ad campaign featured products like Lucky Charms, Trix, and Cocoa Puffs. That’s like the dairy industry promoting ice cream as a way to get your calcium. Kids who eat presweetened breakfast cereals may get more than 20 percent of their daily calories from added sugar, as you can see below and at 1:28 in my video. 

    Most sugar in the American diet comes from beverages like soda, but breakfast cereals represent the third largest food source of added sugars in the diets of children and adolescents, wedged between candy and ice cream. On a per-serving basis, there is more added sugar in a cereal like Frosted Flakes than there is in frosted chocolate cake, a brownie, or even a frosted donut, as you can see below and at 1:48 in my video. 

    Kellogg’s and General Mills argue that breakfast cereals only contribute a “relatively small amount” of sugar to the diets of children, less than soda, for example. “This is a perfect example of the social psychology phenomenon of ‘diffusion of responsibility.’ This behavior is analogous to each restaurant in the country arguing that it should not be required to ban smoking because it alone contributes only a tiny fraction to Americans’ exposure to secondhand smoke.” In fact, “each source of added sugar…should be reduced.”

    The industry argues that most of their cereals have less than 10 grams of sugar per serving, but when Consumer Reports measured how much cereal youngsters actually poured for themselves, they were found to serve themselves about 50 percent more than the suggested serving size for most of the tested cereals. The average portion of Frosted Flakes they poured for themselves contained 18 grams of sugar, which is 4½ teaspoons or 6 sugar packets’ worth. It’s been estimated that a “child eating one serving per day of a children’s cereal containing the average amount of sugar would consume nearly 1,000 teaspoons of sugar in a year.”

    General Mills offers the “Mary Poppins defense,” arguing that those spoonsful of sugar can “help the medicine go down” and explaining that “if sugar is removed from bran cereal, it would have the consistency of sawdust.” As you can see below and at 3:17 in my video, a General Mills representative wrote that the company is presented “with an untenable choice between making our healthful foods unpalatable or refraining from advertising them.” If it can’t add sugar to its cereals, they would be unpalatable? If one has to add sugar to a product to make it edible, that should tell us something. That’s a characteristic of so-called ultra-processed foods, where you have to pack them full of things like sugar, salt, and flavorings “to give flavor to foods that have had their [natural] intrinsic flavors processed out of them and to mask any unpleasant flavors in the final product.” 

    The president of the Cereal Institute argued that without sugary cereals, kids might not eat breakfast at all. (This is similar to dairy industry arguments that removing chocolate milk from school cafeterias may lead to students “no longer purchasing school lunch.”) He also stressed we must consider the alternatives. As Kellogg’s director of nutrition once put it: “I would suggest that Fruit [sic] Loops as a snack are much better than potato chips or a sweet roll.” You know there’s a problem when the only way to make your product look good is to compare it to Pringles and Cinnabon.

    Want a healthier option? Check out my video Which Is a Better Breakfast: Cereal or Oatmeal?.

    For more on the effects of sugar on the body and if you like these more politically charged videos see the related posts below.

    Finally, for some additional videos on cereal, see Kids’ Breakfast Cereals as Nutritional Façade and Ochratoxin in Breakfast Cereals.

    Michael Greger M.D. FACLM

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  • Sugar and Gaining Weight  | NutritionFacts.org

    Sugar and Gaining Weight  | NutritionFacts.org

    The sugar industry responds to evidence implicating sweeteners in the obesity epidemic. 
     
    In terms of excess body fat, the “well-documented obesity epidemic may merely be the tip of the overfat iceberg.” It’s been estimated that 91 percent of adults—nine out of ten of us—and 69 percent of children in the United States are overfat, a condition defined as having “excess body fat sufficient to impair health.” This can occur even in individuals who are “normal-weight and non-obese, often due to excess abdominal fat.” The way to tell if you’re overfat is if your waist circumference is more than half your height. What’s causing this epidemic? As I discuss in my video Does Sugar Lead to Weight Gain?, one primary cause may be all the added sugars we’re eating. 
     
    A century ago, sugar was heralded as one of the cheapest forms of calories in the diet. Just ten cents’ worth of sugar could furnish thousands of calories. Dr. Fredrick Stare, “Harvard’s sugar-pushing nutritionist,” bristled at the term “empty calories,” writing that the calories in sugar were “not empty but full of energy”—in other words, full of calories, which we are now getting too much of. The excess bodyweight of the U.S. population corresponds to about a daily 350- to 500-calorie excess on average. So, “to revert the obesity epidemic,” that’s how many calories we have to reduce, but which calories should we cut? As you can see below and at 1:33 in my video, the majority of Americans who fail to meet the Dietary Guidelines’ sugar limit get about that many calories in added sugars every day: Twenty-five teaspoons’ worth of added sugars is about 400 calories. 

    There are die-hard sugar defenders. James Rippe, for example, was reportedly paid $40,000 a month by the high fructose corn syrup industry—and that was on top of the $10 million it paid for his research. Even Dr. Rippe considers it “undisputable that sugars…contribute to obesity. It is also undisputable that sugar reduction…should be part of any weight loss program.” And, of all sources of calories to limit, since sugar is just empty calories and contains no essential nutrients, “reducing sugar consumption is obviously the place to start.” And, again, this is what the researchers funded by the likes of Dr. Pepper and Coca-Cola are saying. The primary author of “Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?…,” Richard Kahn, is infamous for his defense of the American Beverage Association—the soda industry—and he was the chief science officer at the American Diabetes Association when it signed a million-dollar sponsorship deal with the world’s largest candy company. “Maybe the American Diabetes Association should rename itself the American Junk Food Association,” said the director of a consumer advocacy group. What do you expect from an organization that was started with drug industry funding? 
     
    The bottom line is that “randomised controlled trials show that increasing sugars intake increases energy [calorie] intake” and “increasing sugar intake leads to body weight gain in adults, and…sugar reduction leads to body weight loss in children.” For example, when researchers randomized individuals to either increase or decrease their intake of table sugar, the added sugar group gained about three and a half pounds over ten weeks, whereas the reduced sugar group lost about two and a half pounds. A systematic review and meta-analysis of all such ad libitum diet studies—real-life studies where sugar levels were changed but people could otherwise eat whatever they wanted—found that reduced intake of dietary sugars resulted in a decrease in body weight, whereas “increased sugars intake was associated with a comparable weight increase.” The researchers found that, “considering the rapid weight gain that occurs after an increased intake of sugars, it seems reasonable to conclude that advice relating to sugars intake is a relevant component of a strategy to reduce the high risk of overweight and obesity in most countries.” That is, it’s reasonable to advise people to cut down on their sugar consumption. 
     
    Findings from observational studies have been “more ambiguous,” though, with an association found between obesity and intake of sweetened beverages, but failing to show consistent correlations with consumption of sugary foods. Most such studies rely on self-reported data, however, and “it is likely that this has introduced bias, especially as underreporting of diet has been found to be more prevalent among obese people and it is sugar-rich foods that are most commonly underreported.” However, one can measure trace sucrose levels in the urine, which gives an objective measure of actual sugar intake and also excludes contributions from other sweeteners such as high fructose corn syrup. When researchers did this, they discovered that, indeed, sugar intake is not only associated with greater odds of obesity and greater waist circumference on a snapshot-in-time cross-sectional basis, but that was also seen in a prospective cohort study over time. “Using urinary sucrose as the measure of sucrose intake,” researchers found that “participants in the highest v. the lowest quintile [fifth] for sucrose intake had 54% greater risk of being overweight or obese.” 
     
    “Denying evidence that sugars are harmful to health has always been at the heart of the sugar industry’s defense.” But when the evidence is undeniable, like the link between sugar and cavities, it switches from denial to deflection, like trying to pull attention away from restricting intake to coming up with some kind of “vaccine against tooth decay.” We seem to have reached a similar point with obesity, with the likes of the Sugar Bureau switching from denial to deflection by commissioning research suggesting that obese individuals would not benefit from losing weight, a stance contradicted by hundreds of studies across four continents involving more than ten million participants. 
     
    For more on Big Sugar’s influence, check out Sugar Industry Attempts to Manipulate the Science. 
     
    You may also be interested in some of my other popular videos on sugar. See related videos below.

    Michael Greger M.D. FACLM

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  • Can You Lose Weight with Pills?  | NutritionFacts.org

    Can You Lose Weight with Pills?  | NutritionFacts.org

    Studies show that many doctors either tend to overestimate the amount of weight that can be lost with obesity drugs or are simply clueless.

    Current options for weight-loss medications include the ridiculously named Qsymia, a combination of phentermine (the phen in fen-phen) and topiramate, a drug that can cause seizures if you stop it abruptly. Qsymia was “explicitly rejected” multiple times for safety reasons in Europe “because of concerns about the medicine’s long-term effects on the heart and blood vessels” but, at the time of making my video Are Weight Loss Pills Effective?, remains available for sale in the United States. Belviq is in a similar boat—allowed in the United States but not in Europe due to “concerns about possible cancers, psychiatric disorders, and heart valve problems…”  

    Belviq is sold in the United States for about $200 a month. If you think that’s a lot, there’s Saxenda, which requires daily injections and is listed at the low, low price of only $1,281.96 for a 30-day supply. It carries a black box warning, the FDA’s strictest caution about potentially life-threatening hazards, for thyroid cancer risk. Paid consultants and employees of the company that makes it argue the greater number of breast tumors found among drug recipients may be due to “enhanced ascertainment,” meaning easier breast cancer detection just due to the drug’s effectiveness. 

    Contrave is another option if you ignore its black box warning about a potential increase in suicidal thoughts. Then there’s Alli, the drug that causes fat malabsorption, thereby resulting in side effects “including fecal urgency, oily stool, flatus with discharge, and fecal incontinence”—Alli can be your ally in anal leakage. The drug evidently “forces the patient to use diapers and to know the location of all the bathrooms in the neighborhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.” A Freedom of Information Act exposé found that although company-sponsored studies claimed that “all adverse events were recorded,” one trial apparently conveniently failed to mention 1,318 of them. 

    What’s a little bowel leakage, though, compared to the ravages of obesity? As with anything in life, it’s all about risks versus benefits. However, in an analysis of more than a hundred clinical trials of anti-obesity medications that lasted up to 47 weeks, drug-induced weight loss never exceeded more than nine pounds. That’s a lot of money and a lot of risk for just a few pounds. Since you aren’t treating the underlying cause—a fattening diet—when people stop taking these drugs, the weight tends to come right back, so you’d have to take them every day for the rest of your life. But people do stop taking them. Using pharmacy data from a million people, most Alli users stopped after the very first purchase and most Meridia users didn’t even make it three months. Taking weight-loss meds is so disagreeable that 98 percent of users stopped taking them within the first year. 

    Studies show that many doctors tend to overestimate the amount of weight that can be lost with these drugs or are simply clueless. One reason may be that some clinical practice guidelines go out of their way to advocate prescribing medications for obesity. Are they seriously recommending drugging a third of Americans—more than 100 million people? You may not be surprised to learn that the principal author of the guidelines has a “significant financial interest or leadership position” in six separate pharmaceutical companies that all (coincidently) work on obesity drugs. In contrast, independent expert panels, like the Canadian Task Force on Preventive Health Care, explicitly recommend against weight-loss drugs, given their poor track record of safety and efficacy. 

    In case you missed my related video, check out Are Weight Loss Pills Safe?.

    As with all lifestyle diseases, it’s better to treat the underlying cause, which, in the case of obesity, is a fattening diet. For an example of what’s possible with a healthy diet intervention, see Flashback Friday: The Weight Loss Program That Got Better with Time. 

    Check out the related videos below for more about weight loss. 

    Michael Greger M.D. FACLM

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  • Is It Safe to Take Weight-Loss Pills?  | NutritionFacts.org

    Is It Safe to Take Weight-Loss Pills?  | NutritionFacts.org

    Why don’t more people take the weight-loss medications currently on the market? 

    Despite the myriad menus of FDA-approved medications for weight loss, they’ve only been prescribed for about 1 in 50 patients with obesity. We tend to worship medical magic bullets in the United States, so what gives? As I discuss in my video Friday Favorites: Are Weight-Loss Supplements Safe and Effective?, one of the reasons anti-obesity drugs are so “highly stigmatized” is that, historically, they’ve been anything but magical and the bullets have been blanks—or worse. 

    To date, most weight-loss drugs that were initially approved as safe have since been pulled from the market for unforeseen side effects that turned them into a “threat to public health.” As you may remember from my video Brown Fat: Losing Weight Through Thermogenesis, it all started with DNP, a pesticide with a promise to safely melt away fat that melted away people’s eyesight instead. (That actually helped lead to the passage of the landmark Food, Drug, and Cosmetic Act in 1938.) Thanks to the internet, DNP has made a comeback with “predictably lethal results.” 

    Then came the amphetamines. Currently, more than half a million Americans may be addicted to amphetamines like crystal meth, but the “original amphetamine epidemic was generated by the pharmaceutical industry and medical profession.” By the 1960s, drug companies were churning out about 80,000 kilos of amphetamines a year, which is nearly enough for a weekly dose for every man, woman, and child in the United States. Billions of doses a year were prescribed for weight loss, and weight-loss clinics were raking in huge profits. A dispensing diet doctor could buy 100,000 amphetamine tablets for less than $100, then turn around and sell them to patients for $12,000.  

    At a 1970 Senate Hearing, Senator Thomas Dodd (father of “Dodd-Frank” Senator Chris Dodd) suggested that America’s speed freak problem “was no by means an ‘accidental development’: ‘Multihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have, pill by pill, led, coaxed and seduced post-World War II generations into the ‘freaked-out’ drug culture…’” I’ll leave drawing the Big Pharma parallels to the current opioid crisis as an exercise for the viewer.  

    Aminorex was a widely-prescribed appetite suppressant before it was pulled for causing lung damage. Eighteen million Americans were on fen-phen before it was pulled from the market for causing severe damage to heart valves. Meridia was pulled for heart attacks and strokes, Acomplia was pulled for psychiatric side effects, including suicide, and the list goes on, as you can see below and at 2:51 in my video. 

    The fen-phen debacle resulted in “some of the largest litigation pay-outs ever seen in the pharmaceutical industry, with individual amounts of up to US$200,000 and a total value of ~US$14 billion,” but that’s all baked into the formula. If you read the journal PharmacoEconomics (and who doesn’t!), you may be aware that a new weight-loss drug may injure and kill so many that “expected litigation cost” could exceed $80 million, but Big Pharma consultants estimate that if it’s successful, the drug could bring in more than $100 million, so do the math. 

    What does work for weight loss? I dive deep into that and more in How Not to Diet.  For more of my videos on weight loss, check out the related videos below. 

    Michael Greger M.D. FACLM

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