Marion Nestle, PhD, a professor of nutrition and food studies at New York University, has a big problem with the food industry. And she doesn't think much of functional foods or dietary supplements, either. Nestle is the author of Food Politics: How the Food Industry Influences Nutrition and Health (University of California Press, 2002). Her premise is that industry's fundamental goal is to make money by influencing consumers to eat more, and this has greatly contributed to a growing obesity crisis in the Western world, with staggering implications to public health.
Nestle's book has been called a timely analysis of the origins of this epidemic and the many influences on the American diet. Her background has positioned her well for this analysis. She is a former staff member of the US Surgeon General's Office, she served on the dietary guidelines committees and the advisory committees to the US FDA and is a food consultant. While Nestle's viewpoint is certainly unpopular and even infuriating to many in the industry, there is no disputing the public health impact of the obesity crisis and the value of her insider perspective on ways in which industry influences Congress, federal agencies and public health policy.
Her keynote address at Nutracon 2003 represents a first step toward dialogue between industry and public policy-makers to find a new system in which products are developed based on sound health data rather than well-intentioned theories or raw profit motives.
Here she talks to New Hope Natural Media's Karen Raterman about her contentious views on health claims, DSHEA, functional foods and the role of the FDA.
FF&N: In reading the section in your book about dietary supplements, it is pretty safe to say that you don't think much of DSHEA. If this is not the right regulatory framework, then how do we develop one that balances the risks vs. benefits to make products widely available yet safe and efficacious?
MARION NESTLE: You're talking about products in diets that are very complex. I just think of them as products, not as medicines. I think you can eat a perfectly healthy diet with real food. Do I think that people ought to be putting wood pulp into margarine—No. Should people be putting vitamins into Sugar Frosted Flakes—No. Vegetable extract into gummy bears—No.
As for herbal remedies—as far as I can tell, the more rigorously they are studied, the less they show. That is one of the difficulties. Take the anecdotal stuff—do people feel better if they take herbs? Absolutely. Does the science show it? It depends on how well it is done, and the better it's done the less I think it shows—and that's a problem.
FF&N: As you say, we are talking about very complex botanicals. And perhaps trying to fit traditional medicines into a Western allopathic paradigm of the double-blind, placebo-controlled study is like trying to fit a square peg into a round hole. But if we are talking about herbs not as food, but as medicines, if it is not DSHEA, is there a standard that would be appropriate?
MN: I don't know. I go into health food stores and look at what's there, and I am pretty astounded at what people put in their bodies. But I guess I am in favour of honesty in labelling and appropriate health claims. If it were up to me I would not permit health claims in foods and probably not on supplements either. But Congress in its wisdom has decided otherwise. Obviously in the next two years, the administration won't be looking at DSHEA. I think the only thing that would make Congress take another look at DSHEA is a disaster. And I think there is a disaster waiting out there.
FF&N: But we certainly have seen our share of food recalls recently, so one could argue that the food safety standards are not all that rigorous. With drugs, the standards are much more rigorous but there are thousands of deaths every year from both food and drugs. So why is it that there is so much concern about dietary supplements?
MN: I suspect that if the death certificates were filled out correctly, food and drugs would be right up there on the top-ten list of causes of death. This is one of the arguments that is routinely used in defence of supplements. The problem is the claims that are made for them. If they are just available and people want to take them—fine. Sixty per cent of the adult population in the US takes supplements, and those who do feel that they help them. And you could argue that it doesn't matter if it is a placebo. If it helps people, it's a good thing. And if they don't substitute them for something that they really need. And most supplements manufacturers aren't putting poisons in them, so for the most part it is a system that works. I get concerned when inappropriate and misleading claims are made for them.
FF&N: You say that the FDA needs to be strong. But since the passage of DSHEA, how many years did it take for FDA to establish good manufacturing practices for dietary supplements. Aren't they interested in supplements?
MN: The FDA is just a totally crippled agency. Congress is furious with it and doesn't give it any money. It's partly a resource issue and partly a personnel issue. They don't have the resources or the political will—because it is an agency under siege all the time. They have an enormous and ridiculous mandate that no agency could be expected to fill. The gap between what they are supposed to do and what they have the resources to do is so enormous that it's laughable. It is tough to try to regulate and do things right when you're being taken to court and losing all the time. And the companies that are taking FDA to court are being encouraged to do so.
The fact that FDA is so weak is not good for industry. Certainly the FDA's role in adhering to science-based standards in the way they did, was totally inflammatory to the industry and its supporters. And there might have been more creative ways to deal with it, but they didn't do that, so they bear some responsibility as well. But then that result is not good for the American public in the long run.
FF&N: What are your thoughts on functional foods?
MN: I don't think they are necessary or desirable. Food is food, and we have plenty of food. It is perfectly possible to eat a great diet with food that already exists. I see them as a marketing tool developed specifically to market foods that will fit into health claims. I don't believe in health claims—if it were up to me we wouldn't have health claims on food. I take a very extreme position on this.
FF&N: What would be your ideal regulatory system for foods?
MN: Decent labelling that discloses what's in them and no health claims.
FF&N: What do you see as the problem with health claims?
MN: They are totally misleading. There is no way to have a health claim that isn't misleading because the claim suggests that if you eat this product, you're going to solve that disease problem. Wouldn't it be wonderful if it were true? But it can't possibly be true. Eating Cheerios isn't going to prevent a heart attack. Now I'm not picking on Cheerios—I like Cheerios—but it's not going to prevent heart attacks. Then there's the label that shows up on the Heinz ketchup brand with the illegal claim for lycopene and prostate and cervical cancer. You put ketchup on your potatoes and you're protected against cervical cancer—I don't think so.
FF&N: But there is some good science behind lycopene. Don't you think the ingredient itself may serve a purpose in preventing, say, prostate cancer?
MN: No, I think vegetables and vegetable-based diets do. If you take it disease by disease and component by component, plants have hundreds of components that may induce or prevent carcinogenesis, but these systems are really complex and I don't think you can single one out. But if you look at the enzyme systems that metabolise carcinogens, you have no way of knowing whether a single factor is going to stimulate something that is going to make something more or less toxic because the systems are so complicated. So is lycopene a good thing? Probably, but so what? So is soforophane, so are all these others. That doesn't mean that you take them one by one or look at them disease by disease.
It seems to me that the really profound concept about nutrition is that the same kind of diet is protective against many diseases and diets too high in calories derange metabolism in a way that leads to a whole variety of diseases. So there is a unifying way of looking at this that just doesn't work if you take it nutrient by nutrient or factor by factor.
Marion Nestle, PhD, is the keynote speaker at Nutracon 2003 on Thursday, March 6, at 8:30 am at the Anaheim Convention Center, Anaheim, California. More information: www.nutraconference.com