Food Bytes: May 6 - May 25

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Annual Reviews have just released a special issue on the Future of Food. Presents 20 articles on "Research & efforts to ensure a safe, nutritious, & affordable global food supply, while preserving biodiversity & minimizing environmental damage." Keen to read these by some stellar scientists!

Processed food is having its moment. New research shows that those who eat ultra-processed foods gain more weight than those who ate whole or minimally processed foods. Researchers at the National Institutes of Health, tested this using the randomized, controlled trial approach. Study participants on the ultra-processed diet ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. People on the unprocessed diet ended up losing about 2 pounds on average over a two-week period. Fantastic food writer Bee Wilson has a new book entitled: The Way We Eat Now: How the Food Revolution Has Transformed Our Lives, Our Bodies, and Our World. She writes about how these processed foods, ala junk food, has taken over traditional diets everywhere in the world, and is having impacts on health, at a very alarming pace.

Another study highlighted the impacts of poor diets on health. An estimated 80,110 new cancer cases among adults 20 and older in the United States in 2015 were attributable to eating a poor diet. Other research supports this claim. The study found that decreasing dietary fat and eating more fruits and vegetables may lower a woman’s risk of dying of breast cancer. They tracked 48,835 women ages 50 to 79 without breast cancer since the 1990s.

The way we eat is changing. There is a fantastic piece by the Guardian looking at how more and more people are eating alone, and it has quite dramatic changes on the way we eat, what we eat and why we eat. Netflix is involved in this equation…

Let’s discuss individual foods. Are you obsessed with vanilla? Check this out. Like citrus? You may be disappointed after reading this. With 70% of America consuming bananas, they can’t be that bad right? Think again. Do you dig on swine? This may scare you.

Some places, as we know still are food insecure in the world. The UN FAO reports 815 million people go to bed hungry. Venezuela, sadly is not immune, and is really in a free fall. NYT is reporting that “Butchers have stopped selling meat cuts in favor of offal, fat shavings and cow hooves, the only animal protein many of their customers can afford.” Terrible times for the country. Let’s hope things turn around soon.

On the polar opposite, but strangely, very much on the same side of the coin, it always thought that urbanization is driving the obesity pandemic. A very impactful Nature study has shown that 55% of the global rise in mean body mass index since the mid-1980s—and more than 80% in low- and middle-income regions—was due to increases in body mass index in rural areas. The team of scientists argue that: “There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.”

The difference between rural and urban mean body mass index in women. Figure A is 1985. Figure B is 2017.

Nature is on a role. They also just published a really important paper nothing related to food, but on HIV. The researchers used a high spatial resolution across the continent to look at HIV prevalence sub-nationally. They already published a similar study examining undernutrition. They show that the epidemic is very unevenly spread. Of the 25 million HIV-positive people in sub-Saharan Africa, one third live in very small, highly concentrated pockets. The remaining two-thirds are spread out more broadly. This work will help hone in on the hotspots and where attention should be drawn to continue progress on halting the spread of HIV.

As for furthering education and building capacity, the London School of Hygiene and Tropical Medicine is starting a new Center on Climate Change & Planetary Health and the University of Washington has a new degree program on Food Systems, Nutrition and Health. Google them if you are interested in these new academic programs!

The Sustainable Development Solutions Network is hosting a 3-day webinar on Nutrition-sensitive agriculture. Sign up! We have three stellar speakers who will be talking about:

  • Smallholder production and Dietary Diversity

  • Market Challenges and Solutions to Nutritious Food Access

  • Women’s Empowerment for Better Nutrition

And on a personal note, I was sad to hear about the passing of Kenyan writer Binyavanga Wainaina. He has some famous stories, including How to Write About Africa. But his most defining moment has been his coming out as a gay man, in a letter to his mum, raising awareness and rights of LGBTQIA throughout the continent.

"EAT"ing my banoffee pie

I had the pleasure of launching the EAT Lancet Commission report in beautiful Cork Ireland at the University of Cork College, hosted by Nick Chisholm at the Center for Global Development. It was a really great event attended by a diverse set of individuals including those from the livestock sector and dairy farmers, advocates, students, professors and researchers.

I presented the overall findings from the EAT Lancet Commission report but I also gave two additional perspectives. The first was my personal view on what I thought the EAT Lancet did not cover adequately or ignored, but should not have. The second was the Ireland perspective - what does the EAT Lancet mean for the future of Ireland’s food system? My slides are here.

On what I thought the EAT Lancet did not adequately do. It did not:

1. Address the confused space of sustainable diets and the epidemiology and science to support it. This was the most contentious aspect of the report and continues to be questioned. I don’t think the report cleared up the debate of what are considered sustainable diets and may have made things more contentious and perplexing.

Inequities in meat consumption

Inequities in meat consumption

2. Tackle the inequities in food systems. The report did not at all go into how people experience difficulties in accessing healthy foods and the inequities in which they bring. It is easy to say eat less meat, but it really depends on where you are in the world, who you are, how contexts and situations can be more or less vulnerable, and what you can afford and access.

3. Take on the entirety of food systems. The EAT Lancet Commission just covered food production and consumption — the head and the tail of the food system — but we know there is this whole middle piece that drives health, sustainable and economies: food supply chains, food environments and drivers of food system transition. The EAT fell short in covering the full scope of food systems but if we did, the report would be 500 pages, not the current 50, in which still, no one read…

4. Focus on who will feed us and their livelihoods. The report did not at all go into the impacts of this type of diet and earth system change on food producers and their livelihoods, ways of life, and traditions. Nor did it go into women producers, small and medium sized producers or rural development/impacts.

5. Examine the actors, especially, consumers and behavior change. The diet really looked at supply side changes and not much on how consumers can take on such a diet, how behavior change is needed and what nudges should be put into place.

6. Consider the local social determinants, and the trade-offs. The report was lofty, ambitious and global. But local nuance, decision making and context is needed, and the report just didn’t have the bandwidth to take on local to global perspectives.

On Ireland. It was fascinating to launch the report in Ireland for a few reasons. I took the train from Dublin to Cork and the landscape was riddled with black and white cows and green rolling hills. I knew the launch could be tough…Was I entering a snake pit?

Bountiful beef cows!

Bountiful beef cows!

First, the cattle and dairy industry is strong here. And for good reason. The agriculture sector contributes significantly to the GDP of the country. The Irish beef sector currently accounts for over 30% of the value of Irish agricultural output at producer prices. Number of cattle heads here. The beef output of Irish farming provides the key input to the Irish meat processing industry. In 2014 the Irish meat processing employed over 13,000 people. Irish agriculture is dominated by family-owned farms.  There are almost 140,000 farms, with an average land holding of 32.5 hectares.  Pasture-based farm enterprises dominate, and as a result, Irish output is dominated by dairy and livestock, especially beef.  Dairy and beef account for two-thirds of gross agricultural output and similar proportions of agri-food exports. Ireland is currently one of the world’s fastest-growing dairy producers and exporters.

Second, the impacts on climate change should not be taken lightly. They have seen a 25% and 9% increase in dairy and cattle head numbers. As a result, their agriculture sector contributes 33% of GHGe in Ireland. Methane is 64% of that. Nitrous oxide from N fertilizer application and excretion of manure is 31%. Energy contributes less - 20% and transport 19% of GHGe. GHGe have been increasing 3.5% every year since 2015 in Ireland. Ireland can play a lead role in fulfilling the “sustainable intensification” goal but so far, they are falling short on the climate agenda. Irish farmers are aware of the need to produce more from less and are addressing their carbon footprint. There is a lot more to do. A Teagasc blueprint on how to make Irish farming carbon neutral is a roadmap, but stakeholders have not signed up to the necessary timelines which will cause them to be fined 600 million for not adhering to the targets set out during the Paris COP agreement. 

The insanely delicious banoffee pie

The insanely delicious banoffee pie

Third, we know that the traditional Irish diet is not sustainable. Some of the top risk factors of death and disease in Ireland are related to diet. And have you ever had banoffee pie? Enough said.

While I was there, there were a lot of the questions about the “hangover” of the report. More of the questions asked by media were about the political backlash of the report findings, why WHO pulled their consensus of the report, and what it means for Ireland’s livestock industry. I found myself defending a report that while I feel fully responsible for what it says, I too find not helpful when we get into the nitty gritties, the realities and the nuance needed to make such transformational changes.

I have never been in something so high profile that I have had to defend but don’t have complete ownership over its content. I am glad to take the fall on things that I believe in or that I have been solely responsible for. But this is a different beast.

Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

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The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

  • Why do we still have hunger & undernutrition?

  • Why are we not seeing improvements? And in some cases reversals of progress?

  • How did we get to this place of paradox: hunger & obesity?

  • What can we do about it?

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I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

  • Limited resources and lack of access to healthy, affordable foods

  • Cycles of food deprivation and overeating

  • High levels of stress, anxiety and depression

  • Limited access to health care

  • Fewer opportunities for physical activity

  • Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

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  1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

  2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

  3. Consider the situation a “Syndemic” and take on triple duty actions.

  4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

  5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

  6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

  7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

  8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

  9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused

  10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Nutrition and Agriculture Research: Some Thoughts

I recently was asked to provide some commentary at the International Food Policy Research Institute (IFPRI) at the ARENA-II (Advancing Research on Nutrition and Agriculture) project policy seminar. I thought I would post my speaking notes on what I think is a really fascinating set of research findings stemming from the project. The seminar presented new research on food markets and nutrition including cross-country studies of the costs of nutritious foods and nutritious diets as a whole, and case studies of fish, dairy, and poultry products. The event can be watched here.

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ARENA is trying to understand markets in low-income contexts. Markets play a key role in delivering food and nutrition, even for poor and remote rural households. But nutrient-rich foods, especially animal-sourced foods, are very expensive in poor countries, suggesting that markets for perishable but nutritious foods are not functioning well. Both scientific research and real-world programs have largely focused on farm-level interventions to diversify household production and consumption, not recognizing the important role of market purchases.

The major findings coming out of ARENA:

1. Nutritious foods are typically very expensive sources of calories in low income countries, although there are exceptions.

2. Consumption patterns are strongly associated with prices - price variations explains a LOT of the gap between low and high consumers.

3. Indirect evidence that non-price factors (also implicit price factors) matter a lot: e.g. refrigeration and water quality.

4. No single solution for improving affordability or increasing consumption:

  • Eggs: domestic productivity is key, often improving feed sectors (maize, soybean, fishmeal).

  • Dairy: production in some countries, but trade in others. Markets work incredibly badly in rural areas.

  • Fish: cheap and nutritious but under-appreciated by consumers.

  • Domestic and international value chains very important, but also important to think about industrial policy: e.g. How do we create a viable modern dairy industry that delivers affordable safe milk to both rural and urban consumers?

My talking points:

Diets are significant risk factors of morbidity, disability and mortality

The Global Burden of Disease based out of the University of Washington in Seattle has recently assessed the burden of malnutrition in all its forms for the Syndemic commission report in the Lancet. Globally and in the lower income countries, malnutrition in all its forms (shown as the contributions of undernutrition, high. body-mass index, and dietary risks) contributes as much disease burden as high blood pressure, tobacco, high fasting blood glucose and water, sanitation and hygiene combined. For countries with a low Socio-demographic Index, undernutrition incurs a much higher burden both in absolute terms and relative to the other leading contributors. The recognition that undernutrition and obesity are both due to poor diet quality and a low variety of healthy foods is a more helpful perspective to resolve nutrition problems collectively.

Our knowledge of diets is still a black box

Understanding what people are eating is important to shape food system and nutrition policies, including dietary guidelines. However, determining what people are eating, remains somewhat of a black box. We don’t know key questions such as, what are people actually eating? Where do they get their food from and how much do they pay, or are willing to pay for food? What influences their dietary choices? Does health or even the environment factor into their decision making? Data on diets and their sourcing and costs are developing with better use of metrics and surveys that feed into larger databases. We are learning more and more with each passing year. We still have significant gaps in low-income settings on many of these questions.

Diets are inequitable

We are really living in a time of haves and have nots. Globally, there is a significant debate going on about the impacts of animal source foods (mainly large ruminants) on climate change, the environment and on human health. Clearly, this debate sits with high-income countries and those countries which produce and consume vast quantities of meat that do not align with the sustainable development goals. However, we know that the production and consumption practices of some, will impact the many living in low-income countries who do not have the resources to adapt and change rapidly and are limited in their options. The inequities are staggering - the rural, the poor, the geographically isolated struggle to get enough animal source foods that are important, particularly for young children who are growing and developing and need nutrient-rich foods high in iron, zinc, protein, D, B12 etc. The ARENA study advances are understanding of the challenges that rural populations face in getting access to these critical foods – eggs, dairy and fish, rich in important nutrients and other health promoting properties – through both informal and formal markets. While the evidence is growing on the impacts of on-farm production to dietary diversity of households, we know rural peoples, smallholder farming families and day labor workers are net buyers of food and they need market that work.

 My questions

I know the ARENA is meant to of course shed and shine a light but it is also meant to set out a research and policy agenda. Here are some of my questions that I was left wondering about for future research:

  • Infrastructure is so important. Not just roads but technology and innovation along supply chains. What would be the role of the private sector or PPPs to accelerate action and get over the barriers to access?

  • We cannot think about commodities as stand alone. They interact (the ARENA shows how important feed sectors (maize, soybean, fishmeal) are critical for the growth of animal source foods). How do we grapple this with land use changes?

  • The enabling environment is key. What should policies focus on? Subsidies? Trade?

  • Changing food environments or markets. How shall we measure changes and rapid shifts that we are seeing in many rural places, with the encroachment and influence of urban hubs? I would be keen to see how processed, packaged foods are changing the diets and market landscape in rural places.

  • Many consumers all over the world are driven by the same issues - price, convenience, taste. Other factors matter too like reliability and safety. How do we get consumers to care more about nutrition or is that completely unrealistic? What are the trade-offs?

  • Eggs: Can these rural areas shift from scavenging systems to intensive systems? How realistic is that? How much does that cost? Is there infrastructure and investment to do this? There is new evidence showing eggs increase cholesterol and heart disease risk - once again, eggs are deemed to not be god for us. Should we be worried about future burdens if we are promoting these foods to children to improve nutrition?

  • Dairy: Lactose intolerance. The expression of lactase which digests lactose from milk in humans is generally lost after weaning, but selected mutations influencing the promoter of the lactase gene have spread into the human populations. This is considered a classical example of gene-culture co-evolution, and several studies suggested that the lactase gene has been under strong directional evolutionary selective pressure in the past 5000 to 10,000 years. These data indicate that a combination of socio-economic, ethnic and evolutionary factors converged to shape the genetic structure of lactase persistence in East African populations. A Lancet systematic review study in 2017 showed that lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. 63% (54–72) in sub-Saharan Africa. Lactose malabsorption was also widespread in Africa. including northern Africa (53–84%) and sub-Saharan Africa (77–100%), with the exception of Niger (13%), Kenya (39%), Sudan (55%), and Tanzania (45%) - pastoralist populations. I am keen to learn more about this?

  • Fish: What would be the strategies to improve the status of fish among consumers as they get wealthier? What role does aquaculture play in these areas and ensuring feed is affordable and more sustainable? What about alternative feeds?

  • Are there gender links to any of these commodities as they become commercialized and how does that change household intake of these foods?

  • How do we ensure these rural places thrive? Someone needs to feed this growing urban population. Who will it be and how if rural places struggle to feed themselves?