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

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Henrik Ennart

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Thank Goodness for Health Books

Thank goodness for health books! Not only are books just the best but they also fill an important function, providing a platform to highlight new exciting research. One of the latest examples is the book Brain Changer – The Good Mental Health Diet (available here), written by Australian researcher Felice Jacka. It is simply a must read for anyone who wants to keep up with the debate on food and mental health.

I interviewed Felice Jacka in mine and Niklas Ekstedts first Happy Food book. This was due to the fact that since 2015, healthcare providers in Australia and New Zealand focus on diet, exercise, smoking and sleep before even considering other therapies when dealing with a patient suffering from mental health issues such as depression.

Felice Jacka is one of the driving forces behind the change and an often interviewed authority on the matter. She has many important articles published in the largest magazines and journals on the subject. She is head of the Food & Mood Center at Deakin University in Geelong, Australia, the only one in the world that is completely focused on the link between food and mental health.

Nowadays she is also chairman of a global network for the rapidly emerging research area of ​​nutrition psychiatry, ISNPR. There, researchers meet from completely different angles, from those who study the intestinal flora to those who engage in traditional diet studies.
Perhaps it’s an Australian mentality that contributes to Felice Jacka’s unity of a strictly scientific and critical approach to evaluating results, with a desire to draw conclusions about what we need to do here and now based on the knowledge that actually exists. Faced with epidemics of obesity, diabetes and mental illness, it is no longer possible to close our eyes to how we are affected by fiberless junk food for both body and soul.

At a time when many science bloggers reject most of that which is lacking large and expensive randomized trial studies, Felice Jacka methodically weaves together ironklad knowledge that covers the issue from so many points that it becomes clear, in some cases 100% clear, that it is irresponsible to continuing sitting with your arms crossed.

Thought experiment: Would tax and warning texts on tobacco have been introduced today with the scientific evidence that existed in the 1970’s, without randomized control studies? Probably not. Still, it was obviously a very good decision.

There are, of course, many causes of mental illness, but after reading Brain Changer, it is difficult to wave off the importance of food and other factors such as exercise. If simple lifestyle changes can help at least some then there is no need to wait. The food that is recommended, i.e., Mediterranean diet, is what we all should already be eating anyways for other health reasons. The only known side effect is that we can live longer.

The book also contains details that can be controversial. For example, how mental health/illness is affected by the recent vegetarian/vegan wave? Felice Jacka herself has been a vegetarian since her childhood, but now, based on her own and others’ research, she thinks her teenage daughters should eat meat at least once a week. But, it should be from grass-fed animals with a lot of omega-3 fat. Rarely is anything only black or white.

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 our first book Happy Food in English here.).

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Henrik Ennart

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How is it That People Living in Cilento Can Live So Long?

The people who live in Cilento, a mountainous coastal area just south of the Salerno Bay in southern Italy, live to remarkable ages, but how is this possible? Not only do they live longer lives, they retain more of their cognitive abilities and suffer fewer heart diseases than the rest of us in their later days. This autumn, together with the super-pro health coach and yoga instructor Charlotte Fredriksson, I lead a trip with Go Active Travel to the small village of Acciaroli where more than one in ten inhabitants are over one hundred years old.

According to the Italian statistics agency, ISTAT, the latest calculations (for 2016) show that there are 183 hundred-year-olds living in the area, 143 women and 40 men. Average life-expectancy in Cilento is also off the charts, 92 years for women and 85 years for men. In the village of Acciaroli there were 81 centenarians within its population of 700. For comparison, take Sweden for example, where the average is about 20 centenarians per 100,000 inhabitants. For the skeptics, this phenomenon is not the result of all the young people moving away or because Acciaroli is some sort of hot spot for wealthy pensioners. Those who live there have lived most of their lives there as poor fishermen and had to pay with sweat for every lire(local currency) earned.

In recent years, scientists from all over the world have been drawn to Cilento and Acciaroli to try to understand the secret of healthy aging, which means the area is on its way to qualifying as a scientifically confirmed blue zone, alongside the Japanese island of Okinawa, the Nicoya Peninsula in Costa Rica, Ogliastra in eastern Sardinia and the Greek island of Ikaria. As in the other blue zones, there is hardly just one reason why so many people are over 100 years old. For a long life, a combination of healthy food, physical activity, stable social networks and a sense of meaning in life are all needed.

While all of this characterizes life in Acciaroli it is the food which stands out in their society. Cilento is an ancient cultural land that has long been identified as the cradle of the Mediterranean. You may have heard of the American biologist and nutritionist Ancel Keys. In recent years, he has often been criticized for his role in 1960’s of pointing out fat and cholesterol as the major health hazard while ignoring the risks of sugar. That analysis is largely wrong today, and has been abandoned, but this should not obscure Keys’ perhaps most important contribution, putting the traditional Mediterranean diet on the map.

Ancel’s launchpad for the diet was Cilento in the 1950s after having been struck by the high proportion of centenarians. After retirement, he lived for 28 years in Pioppi, a neighboring town of Acciaroli and left just before his 100th birthday to move home to Minneapolis where he died a year later, just before his 101th birthday. Most certainly there are aspects of Ancel’s work that can be discussed however, Ancel Keys did in the end live a long life after eating a Mediterranean diet and growing his own vegetables in his garden.

In addition to the traditional ingredients of the Mediterranean diet such as vegetables, legumes, fruits, whole grains, seeds, fish, olive oil and some red wine, the herbs have attracted the most interest in Cilento. Just like on the Greek island of Ikaria, they grow wild in the mountains and an analysis has shown that people have traditionally picked upwards of 90 different sorts, of which at least 40 had medical effects and were used extensively in cooking. Rosemary has been particularly pointed out as it grows abundantly in the mountains around Acciaroli. In recent years, researchers have discovered that healthy 100-year-olds in Cilento are characterized by very good blood circulation. This is interesting because the body’s ability to balance the flow of the many miles of microscopic blood vessels that traverse us plays a central role in regulating blood pressure but also our ability to regulate body temperature, keep the skin elastic, heal wounds, counteract tumors and keep us free of toxins. Interesting findings now indicate that bioactive substances in rosemary and other herbs could be an important explanation that contribute to a good and balanced microcirculation. Look at that! A great reason to go to Acciaroli to learn more! Cilento is, by the way, a forgotten part of Italy by most but is located just a few notches south of the popular Amalfi Coast, only here you can find temple ruins.

The awe of history here is slightly stunning. It was here that the founder of Rome, Aeneas, is said to have made shore first in western Italy after the battle of Troy, and it is also said to be here along the coast that the sirens called on Odysseus with their songs. Whether it is the food, the herbs or the genes is yet to be completely determined, but one thing is for sure, there is certainly lust for life here. Researchers even report an unusually active sex life far up in the years among the old in Cilento.

Henrik Ennart together with Niklas Ekstedt is the author of the recently published book Happy Food 2.0. Currently only available in Swedish however you can get their first book Happy Food in english on amazon here.

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Henrik Ennart

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Cancer Treatment, Common Medications and the Food We Eat

What an exciting impact my recent article series (in a swedish paper) had! The series was about correlations between food and cancer and got thousands of shares not to mention that several of those I interviewed ended up in TV interviews in the following days!. Pretty cool!

It’s about time for some debate on this issue! After talking with doctors, nurses, researchers, patients and dieticians, there’s no doubt that everybody only means well.  What separates them, is their perspectives. Doctors focus often on the short term and on the patients who are the worst. For patients with severe weight loss or nausea and vomiting, it can be about life or death and the need to supply their bodies with enough nutrition. So if it only works with juice or ice cream and nothing else, then serve juice and ice cream for heaven’s sake!

But not all patients have such difficult symptoms, and for those who may have undergone a breast or prostate cancer surgery that very same ice cream and juice or cold ham sandwich could almost be considered offensive.

A research group at Sahlgrenska who has surveyed how Sweden’s cancer clinics work with this issue have concluded that “the advice to avoid fiber should no longer be given”. Partly because good food reduces the risk of a new cancer later in life, and partly because radiation therapy can quite often cause chronic intestinal problems which, according to a new study, appear to be reduced among those who early on ate most fiber.

It seems that the emergency diets for those with the worst symptoms in many places have become the standard diet offered to everyone. Not how it should be obviously and many in health care are working to push the recently updated recommendations from the World Cancer Research Fund, WCRF, who says that anyone who does not suffer from weight loss or eating problems should be advised to follow WCRF dietary advice, which are for example to eat fiber rich foods and avoid sugary drinks.

However, the links between food and health care has more dimensions than this. Some might have noted the report that was published last spring, which showed that common drugs affect our intestinal bacteria.

In work with my and Niklas Ekstedt’s new book Happy Food 2.0  I called Peer Bork, research director at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany. It was his team who did the study and went through 923 common drugs which were not antibiotics and discovered that 250 of them killed or affected in other ways the bacterial species that inhabit a healthy intestinal flora.

He thought the results were alarming.

– It is highly probable that the effect is actually much greater. We only measured the effect on 40 of the approximate one thousand bacteria most common in the intestine. The doses we gave correspond to those given on a regular basis, says Peer Bork.

This is the first time this question has been investigated. Until now, no one has the slightest idea that many of our most common drugs affect our intestinal bacteria. Peer Bork emphasizes that it is difficult to determine so far whether the effect in individual cases is good or bad. Occasionally, the effects on the intestinal bacteria may be a part of the positive effects of the drugs and sometimes something that causes side effects.

– This is the first time this is being investigated and I am convinced that it will be of great significance. In future, a doctor will need to consider how the drug affects the patient’s individual intestinal flora, “says Peer Bork.

Henrik Ennart together with Niklas Ekstedt is the author of the recently published book Happy Food 2.0. Currently only available in Swedish however you can get their first book Happy Food in english on amazon here.

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