5

Selling Meat and Dairy Foods

MANY PEOPLE PREFER NOT TO EAT MEAT OR DAIRY FOODS FOR reasons of religion, ethics, animal welfare, environmental protection, personal preference—or, of course, health. Vegetarians tend to live healthier lives and display less obesity, heart disease, and type 2 diabetes than people who eat beef and other red meats (chiefly pork and lamb). Some of the evidence for such benefits comes from investigators committed to vegetarian or vegan lifestyles, and some of their research is published in journal supplements sponsored by Loma Linda University, a Seventh-Day Adventist institution in California. Because Adventists are vegetarians, some more strictly adherent than others, investigators can correlate variations in vegetarian practices with long-term health effects.¹

Researchers who believe in the benefits of vegetarian diets are subject to intellectual or ideological biases that can influence their research. Such biases are common to all scientists and are inherent in scientific hypotheses. Scientists are—or should be—trained to control for potential biases in study design and interpretation. In the case of vegetarian diets, the preponderance of evidence from all sources supports health benefits. Dietary guidelines promote plant-based diets. The flip side is that diets high in animal products must be less healthful. But which products and how much less? The answers are not simple; they depend on what else nonvegetarians eat, drink, and do. Some studies find that vegetarians live longer than nonvegetarians, but others do not.²

As I discussed in Food Politics, the meat and dairy industries are so powerful that US dietary guidelines cannot advise Americans to eat less of their products. The 2015 guidelines use euphemisms: “Choose lean meats,” or, for dairy, “choose fat-free or low-fat.” The meat advice is based on “strong” evidence that eating less beef, pork, and lamb, and especially processed meats like bacon and sausage, helps reduce the risk of heart disease and on “moderate” evidence for a reduced risk of obesity, type 2 diabetes, and certain cancers. I put the judgments in quotes because the evidence is mainly correlational; meat-eating is consistently associated with disease risk, but whether it causes disease or is just a marker for other causal factors has been difficult to demonstrate.

We evolved to eat meat, but today meat-eating tracks with other unhealthful dietary and lifestyle practices. Modern meat contains residues of antibiotics and hormones used to promote animal growth. It is processed with potentially carcinogenic nitrites and other chemicals. Its industrial production causes environmental damage. The “lean” recommendation suggests that fat, especially saturated fat, is a concern. The 2015 US guidelines recommend no more than twenty-six ounces of meat a week, or three to four ounces a day. Many proponents of vegetarian diets go further; they believe that meat—and, sometimes, dairy foods—are so bad for health, the environment, and the animals themselves that nobody should ever eat these foods.³ For the meat and dairy industries, paying for research to counter such views is an essential marketing strategy, one that the USDA aids and abets through its generic marketing, promotion, and research programs—the “checkoffs.”

Checkoff-Funded Research: Meat

The explicit purpose of checkoff programs is to increase demand for commodity agricultural products. Producers pay fees per weight of product; these fees go into a common fund distributed to national and state programs. The USDA oversees and administers the programs, sets guidelines, approves board members, and monitors advertising, budgets, and contracts—as well as the research. The checkoff boards reimburse the USDA for the expenses it incurs. In theory, the boards advertise, educate, and do research; they are not supposed to lobby. In practice, the lines sometimes blur.⁴

The meat checkoffs include the American Lamb Board, the Cattlemen’s Beef Board, and the National Pork Board. Early in 2018, the National Cattlemen’s Beef Association (NCBA), which has a contract with the Cattlemen’s Beef Board for research grants “to enhance the profit potential for beef/beef products,” requested preproposals for research to support “health outcomes associated with aspects of physical and mental strength and wellbeing.” The NCBA was particularly seeking research proposals to demonstrate that beef improves physical function, supports heart health, reduces inflammation, and preserves cognitive function in the elderly.⁵ Positioning meat as a health food seems like a new tactic. Historically, the meat industry’s main research concern has been to counter suggestions that beef, pork, lamb, and processed meats increase the risk of cancer or heart disease.

The idea that red meat is linked to cancer risk emerged shortly after World War II when the physician Denis Burkitt (famous for describing the cancer now known as Burkitt’s lymphoma) observed that people consuming high-meat Western diets exhibited more cancers of the colon and rectum. Cigarette smoking and obesity are well-established risk factors for certain cancers; population studies suggest that meat is too. People who eat the most meat display about a 20 percent higher risk of colon and rectal cancers, but they also seem to be at higher risk for cancers of the esophagus, liver, lung, and pancreas.⁶

The reasons for these associations are not fully understood. Scientists suspect that certain components of meat naturally present or created during cooking or processing—salts, iron, nitrates, or nitrites—are potential carcinogens. On this basis, the World Health Organization (WHO) classifies red meat as “probably carcinogenic to humans” and processed meats as unambiguously “carcinogenic to humans.”⁷ These findings, says WHO, support public health recommendations to limit meat consumption.

You don’t like this conclusion? Start by casting doubt on the science. The NCBA says, “The available scientific evidence simply does not support a causal relationship between red or processed meat and any type of cancer.”⁸ As evidence, it cites studies funded through contracts with the Cattlemen’s Beef Board that not only find no association between red and processed meats and prostate cancer (which is not usually linked to meat) but also exonerate high-temperature cooking methods and several suspected carcinogens.⁹

Beyond checkoffs, the meat industry supports its own research. The North American Meat Institute funded a study concluding that children who eat processed lunch meats have healthier diets; they get more fruit, whole grains, protein foods, calcium, potassium, and vitamin C, but less sugar.¹⁰ An investigator who reports financial ties to several meat groups says, “Targeting certain foods and beverages, including chocolate milk, processed meats, added sugars,… as villains in the nutrition wars is not a science-based strategy and may need to be countered on the political front if appointed scientific review committees continue to take this approach.”¹¹ Science funded by the meat industry argues that meat is nutritious, necessary, and safe. Independently funded scientists advise eating less meat. Take your pick.

If anything, arguments about saturated fat as a risk factor for heart disease are even more contentious. Meat and dairy foods are the highest sources of saturated fatty acids (SFAs) in American diets. Milk fats—and therefore cheese—can be as high as 75 percent SFAs. The proportion in beef fat is about 40 percent, whereas the SFAs in avocados and olives are about 13 percent, less but still significant. Is the high proportion of SFAs from meat and dairy foods harmful? The meat and dairy industries fund studies to counter this idea; they typically find SFAs so benign that you would expect to be healthier if you ate more saturated fat. These industries want evidence that SFAs do not raise blood cholesterol levels or increase the risk of heart disease.

Studies funded by the meat industry yield predictable results. One concludes that eating more red meat than is recommended has no effect on blood cholesterol levels; its senior author discloses support from the beef and pork checkoff programs, among other food-industry groups. Another suggests that advice to reduce intake of SFAs may cause undesirable reductions in protein intake; it is published in a journal supplement sponsored by the beef checkoff, among others, and two of its six authors report receiving research or consulting funds from that program.¹² But the American Heart Association argues otherwise; its scientists observe substantial health benefits when SFAs are replaced by unsaturated fats.¹³

Researchers’ financial ties to meat or dairy groups complicate debates about the effects of SFAs. For decades, the preponderance of research has shown that SFAs raise blood cholesterol levels when substituted for unsaturated fatty acids. In 2015, Harvard investigators demonstrated this again. But the senior author of that study, Frank Hu, reports receiving funding from trade associations for avocados and walnuts, sources of “healthy” fats. He also was senior author on a previous article in the BMJ (formerly the British Medical Journal) stating that dietary advice should continue to focus on replacing total saturated fat with healthier energy sources.¹⁴ A letter to the BMJ complained that four of Hu’s coauthors worked for Unilever, a company that produces margarines low in SFAs, raising “an unacceptable risk of bias, with previous research demonstrating that industry funded studies produce more favourable results than independent research.”¹⁵

Point taken, although some industry-funded studies of SFAs do yield contrary results. The beef checkoff and the NCBA jointly funded a comparison of the effects of consuming low-carbohydrate, high-protein (beef) diets containing either 8 percent SFAs or 15 percent SFAs. After three weeks, the higher-SFA diet led to significantly increased levels of blood cholesterol and cardiovascular risk, consistent with research dating back to the 1950s.¹⁶

As I see these arguments, focusing on saturated fat rather than the foods and diets that contain it makes no sense. In chemical terms, fats (fatty acids, actually) are hydrocarbons distinguished by how much hydrogen is linked to their carbon atoms. If hydrogens are missing, the carbons link to each other with double bonds; their potential links to hydrogen are unfilled and, therefore, “unsaturated.” The fats in foods are always—no exceptions—mixtures of fatty acids that are saturated (fully hydrogenated), monounsaturated (one double bond), or polyunsaturated (more than one double bond). Only the proportions of the three types differ. All three have the same digestibility and number of calories.

On balance, evidence supports the idea that substituting SFAs for unsaturated fats raises blood cholesterol levels and coronary risk. But once the studies start dealing with foods and diets, the results become far more complicated and difficult to interpret. That so much of this research is funded by industry only adds to the confusion, a problem especially acute when dealing with studies funded by dairy-industry groups.

Checkoff-Funded Research: Dairy

The dairy checkoffs are the National Dairy Promotion and Research Board and the Fluid Milk Processors Promotion Program. These programs generate about $200 million annually in fees and are best known for the milk-mustache “Got milk?” campaign.¹⁷ A similar dairy program in Canada funds research to promote “the efficiency and sustainability of Canadian dairy farms, grow markets, and supply high-quality, safe and nutritious dairy products to Canadians.”¹⁸

Michele Simon is currently the executive director of the Plant Based Food Association, a trade group for companies producing replacements for animal products. In 2014, she wrote Whitewashed, a report unsurprisingly critical of the USDA’s promotion of dairy products (Figure 5.1). Simon made three intriguing observations: nearly half the US milk supply goes for cheese and frozen desserts; chocolate-and strawberry-flavored milks (with sugar added) account for 70 percent of milk sales in schools; and more than 10 percent of all US sugar goes into the production of dairy products. Checkoff funds, she said, should not be used to promote “dairy junk foods” that conflict with dietary guidelines. Her report also called for better USDA oversight to make certain that checkoff funds were not used for lobbying.¹⁹

FIGURE 5.1. Michele Simon’s June 2014 report Whitewashed: How Industry and Government Promote Dairy Junk Foods argues that the government should stop helping the dairy industry sell junk foods through USDA-managed checkoff programs. Used with permission, courtesy of Michele Simon.

Whitewashed did not say much about the role of checkoff programs in dairy research, which is too bad, but it could have done so because the programs actively engage in research to demonstrate the health benefits of dairy foods. When I wrote What to Eat in 2006, it took me three chapters to explain the research arguments about issues related to dairy foods. From my reading of the research, I concluded that dairy foods are just like other foods. I still hold that opinion. If you do not like dairy foods, cannot tolerate their lactose, are allergic to their proteins, or do not want to eat them for any reason, you do not have to. Plenty of other foods provide the same nutrients. If you like dairy foods (as I do), that is fine too—but watch out for calories and added sugars.

That said, the most troubling problem with dairy research is that so much of it is funded by the dairy industry. I know of only one study that has looked at dairy-funding effects, in this case on studies of obesity. It found no relationship between funding and study outcome, but the authors said they had a hard time locating studies that were not sponsored by dairy trade groups.²⁰

I enjoy my conversations and debates with Greg Miller, the chief scientific officer of the National Dairy Council (NDC), who routinely sends me studies demonstrating the benefits of dairy products. The NDC is the marketing arm of the dairy checkoffs; it offers grants for research proposals to find health benefits for dairy foods.

The NDC says it funds research based on principles of scientific integrity, transparency, and public-private partnerships, as set forth by ILSI, the industry-funded entity mentioned often in this book. An NDC report lists hundreds of the studies it funds in three categories: nutrition, product development, and sustainability. In the nutrition category alone, I counted 119 studies completed or in progress from 2010 to 2016. Public health studies investigate the benefits of dairy products—particularly full-fat varieties—for cardiovascular, bone, metabolic, and childhood health. Studies aimed at consumer benefits examine how dairy foods improve muscle health, sports performance, digestive health, and cognition. The NDC also has other research priorities aimed at demonstrating the benefits of whey ingredients and milk fractions. It funds a few projects on sustainability—on methane emissions, for example.²¹

I knew that the dairy industry funded a great deal of nutrition research because one-third of the studies in my year-long collection were funded by dairy groups or conducted by investigators with ties to those groups. These studies typically concluded that dairy foods are beneficial or harmless, even when they suggest that “the possibility that milk intake is simply a marker of diets higher in nutritional quality cannot be ruled out.”²² “Harmless” allows a positive spin. A dairy-funded study with a neutral result elicited this press headline: dairy “does not increase heart attack or stroke risk.”²³ In general, dairy-funded studies routinely find that dairy foods protect against stroke and coronary heart disease, help manage type 2 diabetes, reduce metabolic abnormalities, improve intake of vitamins and minerals, reduce the risk of allergies in children, and restore fluid balance after exercise more effectively than electrolyte solutions.²⁴ A consortium of dairy trade associations from Canada, Australia, the Netherlands, and Denmark sponsored a study concluding that dairy fats have no effect on “a large array of cardiometabolic variables”²⁵ These are impressive accomplishments for just one food.

To be fair, dairy-funded studies occasionally show no benefit. The Danish Dairy Research Foundation helped support a study of more than ninety-seven thousand people to find out whether milk-drinking reduced risks for obesity and type 2 diabetes. It did not. Independently funded studies also sometimes show negative effects, such as an association of dairy food consumption with reproductive difficulties in otherwise healthy premenopausal women.²⁶

The dairy industry works especially hard to demonstrate the health benefits of specific products—cheese, for example. Cheese is high in SFAs, but not as high as butter; in comparison, cheese appears healthier. This may explain why a systematic review and meta-analysis of randomized controlled trials, written by authors with financial ties to dairy industry groups, concludes that eating hard cheese reduces blood cholesterol levels—as compared to eating butter.²⁷

Another dairy consortium funded a study with this conclusion: diets containing high-fat cheese are less risky than low-fat, high-carbohydrate diets.²⁸ Letters to the editor about this study complained that the experimental diets appeared to be designed to reach the desired conclusion. The high-SFA diets were unusually high in dietary fiber and enriched with polyunsaturated fats, both of which reduce blood cholesterol levels; the low-fat diet had been enriched with SFAs likely to raise cholesterol levels. The authors replied by defending their methods and insisting that “the sponsors had no influence on the execution of the study, analysis and interpretation of the data, or the final manuscript.”²⁹ Perhaps, but funding effects may occur unconsciously.

Yogurt companies in particular want us to believe that the living bacteria (“probiotics”) in yogurt confer special health benefits. This idea dates to the early twentieth century when the Russian scientist Élie Metchnikoff attributed the ostensibly long life of Bulgarians to their yogurt consumption. I say “ostensibly” because claims of their longevity—and yogurt-eating—did not hold up to scrutiny. Nevertheless, the idea stuck. Yogurt-funded studies show that yogurt is associated with another wide array of benefits: reduced risk of metabolic syndrome, type 2 diabetes, weight gain, and obesity; higher bone density in older adults; and better digestibility by people intolerant to the lactose sugar in milk.³⁰ “Associated with” indicates correlation, not causation. This matters because some yogurt-funded studies do not show benefits. The drug company Sanofi-Aventis, which makes and sells probiotics, helped fund a study asking whether habitual yogurt consumption made people feel better about their health. It did not.³¹

During the year I was collecting industry-funded research on my blog, I received an anonymous comment referring to a study of dairy foods and type 2 diabetes. The comment came from an employee of the California Dairy Research Foundation, the study’s sponsor. The unidentified writer said, “We take exception to the fact that you have judged our paper simply by its funding source rather than its content.… We used all of the highest quality of academic research available to draw these conclusions. This is the same process that a nonindustry academic would have gone through in order to produce this type of paper.” The writer must not have read the entire post, which ended with my statement that industry funding does not inevitably bias a study, although it does suggest that the research question and interpretation require more than the usual level of scrutiny.³²

As mentioned earlier, the scientific quality of industry-funded studies is not usually at issue. Most biases turn up in the research question (comparing cheese and butter) or in the interpretation (interpreting a neutral result as positive). But sometimes an industry-funded study is so egregiously self-serving that it gives all such studies a bad name. Try this: chocolate milk alleviates symptoms of concussions in high school football players. No, I am not making this up.

The University of Maryland’s Chocolate Milk Scandal

In December 2015, the University of Maryland issued a press release announcing that “Fifth Quarter Fresh, a new, high-protein chocolate milk, helped high school football players improve their cognitive and motor function over the course of a season, even after experiencing concussions.” The study had been conducted by Jae Kun Shim, a professor of kinesiology, who had followed 474 football players from several high schools in western Maryland throughout the fall 2014 season. The press release quoted professor Shim: “High school football players, regardless of concussions, who drank Fifth Quarter Fresh chocolate milk during the season, showed positive results overall… specifically in the areas of verbal and visual memory.”³³

This was stunning news. Concussions are a deep concern in sports these days, increasingly recognized as causing not only short-term cognitive deficits but also permanent brain damage. Based on this evidence, pediatricians are now urging school boards to discontinue football programs.³⁴ The press release quoted Clayton Wilcox, superintendent of the local public schools: “There is nothing more important than protecting our student-athletes.… Now that we understand the findings of this study, we are determined to provide Fifth Quarter Fresh to all of our athletes.” Wilcox told a reporter from Stat News that he planned to buy $25,000 worth of the milk because “a lot of kids just don’t drink milk anymore,” and Fifth Quarter has “really stumbled across that secret sauce.”³⁵

The press release got plenty of press attention, although surely not what the university wanted. Health News Review (HNR), an outfit that evaluates press releases on their clarity and accuracy, ranked this one as “highly unsatisfactory.” Its evaluation began: “Got facts? They are almost absent from this boastful release touting vague neurological benefits of a specific chocolate milk.” HNR noted that the press release said nothing about the measures that improved, the level of improvement, the study itself, or the composition of the drink. Its conclusion: the press release “may further the health haloing of a beverage that drop per drop has more calories and nearly as much sugar as Coca-Cola.”³⁶

Indeed it does. Fifth Quarter Fresh contained only four ingredients: fat-free milk, sugar, cocoa powder, and vitamins. Its fourteen-ounce bottle provided forty-two grams of sugars—more than ten teaspoons—making this drink nothing more than heavily sweetened chocolate skim milk with a vitamin supplement. You could easily make this at home. But as late as 2017 the company’s website (no longer available) boasted that the drink contains milk from “super, natural” cows, is free of chemicals and preservatives, and “combines the best of protein drinks with an outstanding formula for rehydration, including unsurpassed levels of calcium plus Vitamins A and D” and twenty grams of protein.

An HNR reviewer asked the university to explain and reported, “What I heard astounded me. I couldn’t find any journal article because there wasn’t one.… There wasn’t even an unpublished report they could send me.”³⁷ The Baltimore press also was “shocked and confused by the University of Maryland’s decision to put out a press release about the study, which has not yet been peer-reviewed, published in a journal, or even written in full.”³⁸ The Baltimore Business Journal obtained a summary of the study and a PowerPoint presentation but could not release them publicly. New York Magazine provided a link to the PowerPoint presentation—the only source of information about what the study actually involved.³⁹

Reporters noted that the study seemed badly designed. It did not compare the effects of Fifth Quarter Fresh to other brands of chocolate milk or to any other sweetened drink; it relied on athletic departments rather than trained investigators to administer the test and provide the milk to players; and it was based on cognitive tests of questionable validity. Also, Shim had not required waivers from players or permission from parents for participation, and he did not disclose his funding source or financial ties.

In response to the press uproar, the university appointed a committee to investigate; its report appeared in March 2016.⁴⁰ The report dealt mostly with the failure of the university and Shim to observe established research protocols and ethics but also revealed some juicy details. The parent company of Fifth Quarter Fresh had provided support for salaries and research materials, and a Pennsylvania dairy group had contributed $200,000 to Shim. The committee was dismayed by the widespread ignorance of basic principles of research ethics it found among university personnel. Shim, for example, had not considered the funding to be a conflict of interest because the money went to his research, not to him personally.

The committee advised the university to make sure that future press releases disclosed funding sources and dealt only with work that had been published. The university, it said, should require all research faculty, staff, and graduate students to undergo mandatory, in-person training on the principles of conflicts of interest in research and the need for disclosure. It advised the university to return all research and gift funds received from the dairy groups and to remove all press releases related to this incident from its website. The university complied and returned nearly $230,000.⁴¹

Even so, Julia Belluz of Vox judged the university as “incredibly irresponsible” in “behaving like a marketing machine for a dairy company.”⁴² HNR criticized the committee for not dealing adequately with the university’s failure to be more transparent with the media. The AP’s Candice Choi dug deeper and obtained emails between Fifth Quarter and the investigator that explained their hurry to publish the press release. Fifth Quarter wanted the study results out in time to coincide with the opening of the film Concussion, an exposé of the National Football League’s decades of inaction in dealing with head trauma.⁴³ I can only imagine what this “study” could have done for sales of Fifth Quarter Fresh.

The moral: universities run grave reputational risks if they do not hold industry-sponsored research and research investigators to high standards of ethical conduct. Sometimes, as in this case, “it’s everything wrong with modern-day science-by-press-release in one anecdote.”⁴⁴ Universities earn respect when they hold everyone—students, professors, administrators, and even public relations staff—to high ethical standards.