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Henrik Ennart – Food Pharmacy

Henrik Ennart

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Have the Standard Nutritional Recommendations Played their Part?

With horror-filled delight, I noticed that the Swedish National Food Agency has started working on a new edition of the Nordic nutritional recommendations, usually abbreviated as NNR.

Delight? Well, there is undoubtedly an improvement potential, although NNR took a few steps forward in the last edition published in 2012, where it was gratifying to have a little more focus on the quality of the raw materials we eat, rather than on the individual items included.

Horror? Yes, these are the written in stone scripts that, for a decade, until the 2030’s, will be invoked as the highest scientific evidence and knocked on the head of all alleged renegades.

Since I myself have sometimes been one of those who have been knocked on, it feels important that this time the job is done well. But the Nordic nutrition recommendations unfortunately have a history that is tinted, seeing as that they operate in close cooperation between governmental authorities and the food industry.

Representatives of the industry usually claim emphatically that NNR 2012 is based on more than a hundred researchers’ work and is perhaps the most solid research review that is done in the field of nutrition. And while that may be true, it is a truth with modification. NNR is also largely a negotiating product where the end result has been throttled back and forth with various stakeholders. Over the years I have talked to researchers who have written sections that have been laid out for them on unclear grounds in that process.

When the work on the current Nordic nutrition recommendations started in 2008, I was at an information meeting at the National Food Agency in Uppsala. It was mentioned in passing that an EU project would form the basis for the work. There was simply no money in the Nordic office to finance a complete review of the research on diet and nutrition. The cooperation with the EU was to take place through an organization called Eurreca, we were told. Of course, I became curious and began to investigate the matter more closely.

It turned out that the European Commission has given 13.2 million Euro to Eurreca to do its review, a huge sum in this context. What was not mentioned at the meeting, and is not affected by NNR 2012, was that Eurreca was started on the initiative of the International Life Sciences Institute, abbreviated ILSI.

ILSI is a lobbying organization founded in 1978 by Coca-Cola, General Foods, Heinz, Kraft and Procter & Gamble, which initially had the task of defending the tobacco industry. Today, ILSI is backed by hundreds of the world’s largest food, chemical and pharmaceutical companies.

Researchers from around 15 universities, as well as private consultants, several of whom had previous ties to ILSI, were associated with Eurreca. The Swedish Food Agency and the French Public Health Institute were the only national authorities represented among the members of the steering group.

Coordinator of Eurreca was a former research manager at ILSI Europe and the information was handled by a public relations consultancy who hired ILSI Europe as a subcontractor for the operation of Eurreca’s website.

It is really no exaggeration to say that the work on the Nordic nutritional recommendations was already in the laps of the industry.

You should also know that ILSI is a controversial organization that, just a few years earlier, had opposed the recommendation to reduce consumption of sugar to less than 10 percent of caloric intake. They did not believe that there was evidence to prove those measures would counteract obesity, which would have been a threat of course to the soft drink industry.

In NNR 2012, there is certainly the recommendation to eat less than 10 percent sugar, but Sweden and the other Nordic countries did not comply with the World Health Organization’s (WHO’s) recommendation to a maximum of 5 percent, the level at which cavities increases significantly.

If new NNR is to be given credibility, it is important to clear out this type of bond and work with a great deal of openness.

Another of several challenges for the new Nordic Nutrition Recommendations is the very starting point: finding reference values ​​for large groups of consumers.

Another note worth point out is the ever increasing amounts of research that are revealing the vast differences that exist between different individuals, related at the very least to the fact that we carry radically different sets of gut bacteria.

What one can easily consume themselves may simply be inappropriate for another. One size no longer fits everyone, not even if it is called Mediterranean food which in almost all studies has a positive impact on most. Even there, in every study, there is a fairly large minority that for some reason the Mediterranean diet does not sit well with.

Add to that the fact that research is currently developing very quickly. When the experts made their literature search for the current recommendations in 2010, there was hardly any research on our gut flora, which today is the most expansive field globally in the biological sciences.

More than 90 percent of all studies in the field have been published as of late. That speed will hardly slow down, and without continuous updating, publications like NNR, which is renewed at its height every eight years, risk being outdated and useless.

An ongoing update of appropriate doses of vitamins and minerals may be in order, as well as a call to action for eating more greens and avoiding processed junk foods with lots of sugar and refined fats. The question at hand here is if standard recommendations of this type really play any active part in nutrition for the mass general public?

Henrik Ennart, together with Niklas Ekstedt, is the author of the recently published book Happy Food 2.0 (currently only available in Swedish, however your can find their first book Happy Food in English here.). The views in the chronicle are the writer’s own.

Photo: Joanie Simon, Unsplash



Henrik Ennart

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Eat to Beat Disease?

I recently wrote a foreword for a book with the possibly controversial title Eat to Beat Disease.

In it, the author, William Li, takes the reader through the body’s five dominant systems for self-healing and explains which foods contain substances with the potential to slow down or stimulate processes. Essentially it is about regulating regeneration of blood vessels (interesting in regards to the development of cancer) but also the immune system, the protection of our DNA, the function of our stem cells and the role of the gut flora.

Here, for example, we learn what unites cherries, kale, squid ink, coffee, walnuts and dark chocolate. They all belong to the rather limited family of raw materials that promote our self-healing across all systems simultaneously. But we are also told that beer, in addition to well-known disadvantages, can bring something good for health as well.

The effect of bioactive substances found in food, or those which are formed in the body after having eaten, attracts great interest in the research world right now. The area has already got its own name: postbiotics. William Li’s book is not a complete manual but it provides an interesting insight into a young but rapidly growing field of research.

But for me, it is also somewhat thought provoking that an American researcher writes a book that in a Swedish debate, with a Swedish author, would most likely have been aggressively questioned. I believe this due to its discussions around subjects where there is relatively strong support in the research but where decisive, major studies remain to be completed. So let’s dive into this a little.

Who is William Li? Some may remember last year’s Nobel festivities where things got shaken up a bit when the guitarist in the rock group U2 – The Edge – broke the norms by wearing the hat that has become his signature. He was invited due to his support for Texas researcher Jim Allison, who in 2018 was rewarded for discovery of cancer immunotherapy. Few understood that the U2 guitarist participated as a representative of The Angiogenesis foundation where he is on the board.

The chairman of, and founder, of The Angiogenesis foundation is William Li. In that role, he can follow the development of the next generation of drugs, which is largely based on stimulating and utilizing the body’s own healing system.

William Li emphasizes that even today there are currently no treatment methods that make it possible for diet to be used in place of drugs in the case of an illness. But he also sees the dilemma in which many of the drugs being developed become enormously expensive and will never be accessible to all people.

At the same time, he notes, the drugs are based on substances found in common raw materials, easily accessible to most people. Already today it is possible to choose food that strengthens their own chances.

However, another emphasis of his is that no one should experiment on their own during medical treatment. Substances in food can both reduce and increase the effect of drugs, and there is a need for expert expertise from doctors and dieticians in each individual case.

What would likely go wrong in a Swedish debate of this book is that William Li, when writing his book, not only writes as a researcher. He also dares to take a step out of that role and make an analysis based on benefit vs. risk. Benefit and risk are like yin and yang, two sides of the same coin. Even though a valuation of the scientific evidence is crucial, it is still only one part of a whole where the other part is the risk: the risk of doing something though there is incomplete knowledge or the risk of not and leaving it be.

The scientifically reported benefits he sees in the food are strong enough for pharmaceutical companies to dare to invest large sums in trying to convert them into patented drugs. One could then presume that the benefits of eating food that is completely harmless and where there is only an upside, is probably also great enough for you and I to do so.

Henrik Ennart, together with Niklas Ekstedt, is the author of the recently published book Happy Food 2.0 (currently only available in Swedish, however your can find their first book Happy Food in English here.). The views in the chronicle are the writer’s own.



Henrik Ennart

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Grilling Season, AGE and Roasted Carrots

BBQ Season. Hmm. I find myself often pondering between good and healthy, rarely does it become as abundantly clear to me as when grilling season is upon us again.

Almost everything we eat contains some component that can be interpreted as dangerous, but in that exact same bite may also be things that are undoubtedly good for our health.

Even when I think that I manage to make a sensible decision for health purposes, that sand castle can quickly deteriorate when climate, environment, fair trade and animal welfare are also accounted for.

And to add to that stack, it would be nice if the food taste good too.

Barbecue season is officially here and along with it pops up the issue of: AGE. It is an abbreviation of advanced glycation end products. This topic has already been breached here on Food Pharmacy by Stig Bengmark , he has highlighted the dangers of AGE for quite some time and that’s good.

Simplified, it’s about amino acids (the building blocks of proteins) reacting when they come into contact with sugars. AGE is considered to be one of several factors behind the aging process and is considered to contribute to Alzheimer’s. The effect has been similar to when an old rubber band dries up and cracks, with the slight difference of that it is happening within your own tissue in the skin, blood vessels and heart valves.

High blood sugar is a risk factor, but you can also absorb AGE directly through food. The largest direct source of AGE via the diet is by far from consuming meat that is fried or roasted at high temperatures. Other sources are processed food and pasteurized products, including hard cheese made from pasteurized milk.

One way to circumvent this is of course to avoid the dominant sources, but AGE can be formed to some extent in quite a few foods when heated up. One tactic is then to only eat foods that have not been heated above 70-80 degrees, but I think this is a rather sad solution because many flavors and fragrances are released just by heating through the so-called Maillard reaction and also by the process of caramelization. Cooking and heating can also have other advantages such as increasing the uptake of some substances which, on the contrary, are protective.

For the risk averse, there may be a golden middle road. In 2009, a study showed that test persons who ate a low-AGE diet could lower their AGE values ​​by as much as 60 percent in four months. Because AGE is sometimes used as a measure of biological aging, they were, at least according to this single parameter, younger. How did their low-AGE diet look? In addition to eating a lot of vegetables with antioxidants, they prepared their meat by poaching, steaming or using it in stews. Since water never gets warmer than 100 degrees, no large amounts of AGE are formed.

AGE is also counteracted by vitamin E, which is found among other things in nuts and seeds. I myself draw two conclusions, but you’re welcome to oppose. The first is that, it is not just about removing the dangerous sources, but also about adding vegetables to the plate that at least partially neutralize the harmful effects.

The second is that I will once again be taking out the grill this year. No one can live a completely risk-free life. Some want to take their chances parachuting or climbing mountains. I myself choose to not to heavily weigh the dangers of occasionally roasting something like these:

Roasted carrot with arugula, goat cheese, pumpkin seeds and orange

2 bunches of carrots
3 tablespoons olive oil
6-8 thyme sprigs
3 tablespoons pumpkin seeds
1 orange
100 g of goat cheese (chevre)
1 handful arugula

Peel and split the carrots lengthwise. Heat the oven to 200°C/400°F. Put the carrots on a baking sheet with 1 tablespoon of olive oil, thyme twigs and a pinch of salt. Roast in the oven until the carrots begin to get some color, about 25 minutes.

Roast the pumpkin seeds in a dry frying pan on medium heat. Grate the peel of the orange and squeeze out the juice. Combine with olive oil and a pinch of salt to create a dressing. Garnish the carrots with goat cheese, orange dressing, arugula and roasted pumpkin seeds.

So simple, so appetizing and so good.

But aren’t there harmful substances formed when the carrot is heated to such high temperature? My Answer: Raw materials stuffed with antioxidants provide protection, but don’t let it burn. The best is just when it starts to take on some color.

Photo: David Loftus

Henrik Ennart, together with Niklas Ekstedt, is the author of the recently published book Happy Food 2.0 (currently only available in Swedish, however your can find their first book Happy Food in English here.).




Henrik Ennart

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The World’s Second Most Influential Foodie

Richard Horton, editor-in-chief of The Lancet magazine, stated this year that “A large part of the scientific literature, perhaps half, can quite simply be false.”

When I discussed Horton’s astounding statement with representatives from SBU(The Swedish Agency for Health Technology Assessment), they agreed with his assessment. Often, methods are insufficient as a result of too limited selections, or that small effects are over exaggerated and that the researchers draw incorrect conclusions.

But, there are also a lot of partial studies and conflicts of interest where the authors may have various connections to the industry which can be open or hidden as well as conscious or unconscious.

Someone who has submerged themselves into this matter and is rather experienced, at now 83 years old, is food professor Marion Nestle at New York University whom I’ve had the pleasure of interviewing several times. Forbes magazine has ranked her as the world’s second most influential foodie, just behind by Michelle Obama. In recent years she has kept herself amused on her blog by picking apart studies that have been extensively cited in both established media and social media. Her findings, after a closer look, reveal the “studies” as nothing more than pure marketing for manufacturers.

When she, for a period of time, went through 168 industry-funded studies on diet and nutrition, it turned out that 156 of these produced a result that benefited the sponsor’s product. Even though she asked her followers for help, she only managed to find twelve studies where the result went against the study’s financiers.

It became the prelude to the book Unsavory truth – How Food Companies Skew the Science of What We Eat, which was released last fall. There, Marion Nestle shows how money goes directly from large food giants to researchers’ labs, which in turn delivers “scientific” results that can meet all the high standardized requirements except one, you guessed it, to be independent. Marketing and research merge into to one another.

One of several obvious problems with sponsored studies is the concern that unwanted results are never published and instead remain forever locked away in a chest somewhere. But more often than not, according to Marion Nestle, it is actually about more subtle influences such as, what is to be studied or not, by whom, how and not least, how the questions in the studies are formulated.

Are eggs good or bad to eat? Personally, I am not worried about eating an egg per day, none the less it is a fact that many of the studies which downplay the risks of eggs are sponsored by the egg industry. Same goes for health benefits pertaining to chocolate, avocados or nuts, or studies that want to restore confidence in potatoes, even a push to eat breakfast.

Research on wine’s excellence come from and benefits wine-producing countries and the benefits of soy are never described as well as by soy-sponsored university researchers in the US or Canadian agricultural districts. Around the Mediterranean, many results sing the song of olive oil, while a study of the life-giving forces of canola oil, or the lingonberry , is more likely to come from Sweden.

Full-scale market wars, which are reflected in the research, are underway in a variety of industries. Milk is challenged by soy and oat beverages. The manufacturers of sugar and sweeteners have long been pestering eachother with studies showing the excellent properties of their own product and the other’s harmful effects.

I myself like nuts and avocados. Of course, sponsorship does not mean that the results must be wrong, but that the credibility is reduced. It would simply be better if independent and impartial researchers looked at the matter. Perhaps there are many other commodities that are just as useful, but never explored. The consequence is that the focus is on a few selected superfoods when the biggest health benefit is actually eating variety.

Marion Nestle has been in the midst of the American diet debate for five decades, including as a member of committees that evaluate research and establish national guidelines.

Based on her own experience as a target for lobbying, and as a pioneer in independent research on food, she describes how the academic nutrition research emerged from the outset as the industry’s extended arm, where all the focus was on increasing and streamlining production. Not only researchers but entire departments at large universities were and still are sponsored by, or have side assignments for, the food industry. Marion Nestle sometimes lectures in the Pepsi auditorium at Cornell.

Yet she finds only eleven (11!) studies that attempted to clarify the consequences of industry-funded food research. Why do so few researchers want to investigate this? This can be compared to thousands of studies on the pharmaceutical industry’s sponsorship.

It strikes me that many science bloggers are willingly and methodically shredding studies done by independent researchers at universities funded by public funds, but rarely digging themselves into issues of power and impartiality. Ultimately, it may be about who formulates the framework and the rules of the game for research.

Of course, eating healthy is not particularly difficult, Marion Nestle points out. Eat your vegetables and fruits, don’t eat too much, and don’t eat a lot of junk food. Her best advice is to eat a large variety of unprocessed food and to be active.

And there you have it, a health book that simultaneously reviews researchers.

Henrik Ennart, together with Niklas Ekstedt, is the author of the recently published book Happy Food 2.0