Allow whole milk in school meals

For decades, the government steered millions away from whole milk. Was that wrong? The clear answer to the question posed by the Washington Post today is yes, it was wrong. In July I said that the government should change overly restrictive limits on fat content in school meals.

In a study I co-authored for the League of Women Voters of the Fairfax Area in May 2014, we quoted comments questioning recommendations against whole milk:

Comments: “Remarkably few randomized clinical trials have examined the effects of reduced-fat milk (0 percent to 2 percent fat content) compared with whole milk on weight gain or other health outcomes,” David S. Ludwig and Walter C. Willett write in JAMA Pediatrics. Their article questions the scientific rationale for promoting reduced-fat milk consumption at these levels in children and adults and reconsiders the role of cow’s milk in human nutrition. CBS news reports that another study in the Archives of Disease in Childhood “echoed the JAMA study and showed that children who drank lower-fat milk were more likely to be overweight later in life.”

The Post is unpersuasive in trying to dismiss critics of some school lunch regulations

I am disappointed by the cursory and biased editorial in the Washington Post that says, “Don’t let lobbyists decide what your children eat at school.”

Perhaps the editors are hoping that readers will recoil at the mention of the word “lobbyists.” If that isn’t enough to make the point, the editors ascribe all criticism of the new school meal regulations to the “School Lunch Industrial Complex.”

Perhaps the editors are too busy to notice the news printed in their own paper that would lead any reasonable person to be concerned about overly restrictive limits on sodium. I quoted the Post last April: Prevent drastic reductions in sodium in school meals.

An op-ed in the New York Times was the inspiration for another blog post in July: Government should change overly restrictive limits on fat content in school meals .

I’ll provide more information in the coming weeks.

Skipping breakfast may not be linked to greater weight gain

The science of skipping breakfast: How government nutritionists may have gotten it wrong. Peter Whoriskey reports that there are no randomized controlled trials of the hypothesis that skipping breakfast can cause greater weight gain, but the 2010 Dietary Guidelines committee did cite several observational studies:

“Modest evidence suggests that children who do not eat breakfast are at increased risk of overweight and obesity,” the advisory committee said. “The evidence is stronger for adolescents.” As for adults, the evidence was described as “inconsistent.”

“When in the coming months the government unveils the 2015 Dietary Guidelines, it is unclear the advice on breakfast and weight gain will be included,” Whoriskey says. “The 2015 advisory committee issued a report that steered clear of the subject of skipping breakfast and weight.”

Looking at one variable, such as weight, may not tell the whole story about the relative benefits of breakfast. This is particularly true when it comes to the benefits of breakfast for children. The school breakfast program can clearly be a benefit to the young customers.

Breakfast in the Classroom leads to increased acceptance of school breakfasts

Tufts Nutrition reports that a study of the Breakfast in Classroom program shows that it increased participation in the National School Breakfast Program. Stephanie Anzman-Frasca studied a large urban school district where about 58 percent of schools had newly implemented Breakfast in the Classroom programs. “The other schools in the district continued to offer breakfast before school in the cafeteria.”

The results suggest that serving breakfast in class did improve participation in the National School Breakfast Program, with about three quarters of students participating, versus 43 percent in the other schools. Schools that offered Breakfast in the Classroom also had slightly better attendance. But the students at those schools did not better on standardized math and reading test than their peers at the other schools.

Why did the author consider it necessary to study math and reading tests? Isn’t it enough to provide nutritious food and perhaps increase the happiness of the students? “The authors note that academic performance might be better assessed after the programs have been up and running for more than a few months.”

Why did the author even try to assess math and reading test results after only a few months? The obsession with testing is apparently leading to an epidemic of tunnel-vision in the researchers given access to schools.

This study was published in JAMA Pediatrics, January 2015. The journal also published an editorial entitled “Continued Promise of School Breakfast Programs for Improving Academic Outcomes: Breakfast is Still the Most Important Meal of the Day.”

My grandfather, Joel J. White, who was a Navy doctor, often said that breakfast was the most important meal of the day. Having been taught this from an early age, I am a bit skeptical of some recent news reports citing evidence that breakfast is not really the most important meal of the day.

Government should change overly restrictive limits on fat content in school meals

Why Is the Federal Government Afraid of Fat? This provocative question is posed in an excellent op-ed in the New York Times.

“Recent research has established the futility of focusing on low-fat-foods,” according to Dariush Mozaffarian and David S. Ludwig. “Confirming many other observations, large randomized trials in 2006 and 2013 showed that a low-fat diet had no significant benefits for heart disease, stroke, diabetes or cancer risks, while a high-fat, Mediterranean-style diet rich in nuts or extra-virgin olive oil—exceeding 40 percent of calories in total fat—significantly reduced cardiovascular disease, diabetes and long-term weight gain.”

They note that for the first time in 35 years the scientists on the 2015 Dietary Guidelines Advisory Committee have sent recommendations to the government without any upper limit on total fat. “In addition, reduced-fat foods were specifically not recommended for obesity prevention.”

The limit on total fat is an outdated concept, an obstacle to sensible change that promotes harmful low-fat foods, undermines efforts to limit refined grains and added sugars, and discourages the food industry from developing products higher in healthy fats. Fortunately, the people behind the Dietary Guidelines understand that. Will the government, policy makers and the food industry take notice this time?

“Astoundingly, the National School Lunch Program bans whole milk, but allows sugar-sweetened skim milk,” Mozaffarian and Ludwig complain.

Some of the so-called reforms in the school lunch and breakfast programs need to be reformed based on the most current science regarding nutrition and health.

North Carolina school nutrition chief cites problems with new federal rules

Today, during a hearing before the House Subcommittee on Early Childhood, Elementary, and Secondary Education, Dr. Lynn Harvey, the incoming Vice President of the School Nutrition Association (SNA), testified about the costs of complying with new regulations on school meals and snacks. As the Chief of School Nutrition Services for the North Carolina Department of Public Instruction, Harvey discussed how North Carolina schools have struggled with student acceptance of new menus and financial challenges under the new standards.

“Compliance has come at a significant cost for schools in North Carolina and, more important, for students,” she said. “Student participation in school meals has declined by 5% under the new rules.”

Harvey highlighted challenges with the new mandate that all grains offered with school meals must be whole grain-rich.  “For two years, local School Nutrition Directors have offered these items under ideal conditions and have encouraged students to try them. Yet, students continue to reject them because their taste, texture and appearance are quite different from that to which they are accustomed…Students’ dissatisfaction with whole grain-rich biscuits has led to a decline in breakfast participation in 60% of our school districts.”

Harvey also cited the higher cost of meeting the new rules’ mandates and a statewide loss of more than $20 million in a la carte revenue as a result of the Smart Snacks in School mandates. These factors have contributed to “significant financial challenges” in North Carolina’s school meal programs. “Over half of School Nutrition Programs in North Carolina are operating at a revenue loss. The average loss is nearly $2.5 million,” Harvey testified.  She called for increased funding and flexibility under the rules to address these losses.  Harvey submitted to the record similar stories highlighting challenges in school districts in each of the Subcommittee members’ home states:

I believe that the new regulations were rushed to implementation without taking into consideration the impact they would have on plate waste, food costs or customer acceptability. My grandkids go to one of the schools in my district and they used to LOVE eating lunch at school. NOW I get complaints from them every day! (Arizona)

As a dietitian, I do believe it is important for children to get the vitamins and minerals they need to support a healthy lifestyle, but when a lot of that ends up in the trash, it becomes a financial issue as well. There has to be a more cost effective way to get children the nutrition they need- but requiring them to take something that is going to go straight in the garbage is wasteful. (Florida)

I have been offering and encouraging students to choose more 100% whole grains, but there are certain items that just don’t go over well in a whole grain-rich variety. Our Thanksgiving lunch was embarrassing – the whole grain-rich corn bread dressing was sad, sad, sad. We need flexibility to allow exceptions for a few menu items. (Oklahoma)

Ever since the implementation of the new regulations, Bloomfield Hills School’s food service department has seen a decrease each year in the number of students buying lunches. In addition we have seen a decrease in our a la carte sales after the Smart Snacks rule went into effect. If we were allowed to have more flexibility with the regulations we could find the items our students want to eat.” (Michigan)

Children need salt for good health

The health benefits of salt also apply to children.  A recent Washington Post article  notes that it’s possible that sodium aids growth. “As scientists from New Jersey Medical School found out, if you put rats on low-salt diets, their bones and muscles fail to grow as fast as they normally would,” Martin Zaraska reports. “In one of his experiments, Leshem found that children in general reach for more salt than adults do–independent of calorie intake–which may be explained by the needs of their growing bodies.”

This is yet another reason why we should prevent drastic reductions in sodium in school meals.

A tragic example of a misguided zealotry to limit salt intake in a young patient lead to his death. Zaraska reports:

In 1940 the case of a little boy was described in the Journal of the American Medical Association. From the time he was a year old, the boy would go out of his way to eat massive amounts of salt. When he started speaking, one of his first words was “salt.” During a hospital stay (unrelated to his dietary habits), he was put on a low-sodium diet. To prevent him from sneaking around the hospital and stealing salt, he was strapped to his bed. He soon died. The reason? Due to severe and undiagnosed cortico-adrenal insufficiency, his kidneys were unable to retain sodium. Only eating huge amounts of salt had kept the boy alive.

Prevent drastic reductions in sodium in school meals

More scientists doubt salt is as bad for you as the government says.  This excellent Washington Post article explains the science (or lack of science) behind the government recommendations on salt. Left unmentioned is the lack of science regarding healthy salt levels for children. In the absence of such studies, it seems more important than ever to follow the recommendation of the School Nutrition Association (SNA) to hold off on further restrictions on salt in school lunches and breakfasts.

Here is the SNA 2015 position paper on sodium in the re-authorization of the Healthy, Hunger-Free kids Act.

Maintain the Target 1 sodium level reductions and suspend implementation of further targets.

Naturally occurring sodium present in milk, meats and other foods will force schools to take nutritious choices off the menu, and drive more students away from healthy school meals. Studies have shown school meals are more nutritious than packed lunches or lunches purchased from fast food restaurants. Despite these benefits, student lunch participation is down by 1.4 million per day since 2012, when the new standards took effect. Schools made significant sodium reductions to meet Target 1, effective July 2014. Before advancing to Target 2, the Institute of Medicine recommended assessing the impact of Target 1 “on student participation rates, food cost, safety and food service operations to determine a reasonable target for the next period…reducing the sodium content of school meals as specified and in a way that is well accepted by students will present major challenges and may not be possible.” (School Meals:  Building Blocks for Healthy Children)

The Government Accountability Office affirmed that the new standards influenced this decline in participation and warned that forthcoming limits on sodium would remain problematic with cost and product availability making sodium targets difficult for many schools to implement.

The health benefits to students choosing nutritious school lunches within Target 1 sodium limits is clear. Additional sodium reductions, at the risk of decreasing student participation, are not merited based on the inconclusive evidence on the benefits of sodium reduction for children.

National School Lunch Program

Sodium Reduction Targets

Grades Target 1
July 2014
Target 2
July 2017
Final Target
July 2022
K-5 ≤1,230 ≤935 ≤640
6-8 ≤1,360 ≤1,035 ≤710
9-12 ≤1,420 ≤1,080 ≤740


I support the School Nutrition Association proposals

The most recent New York Times article on school lunch controversies was written by Nicholas Confessore, a political correspondent. His article focuses on personalities and doesn’t address the substance of the advocacy of the School Nutrition Association (SNA) for changes in some of the new regulations.

He calls the members of SNA “lunch ladies,” a term he says that almost nobody in Washington uses in public and almost everyone uses in private.

The consistent use of this term throughout the article adds to a dismissive bias against critics of certain regulations. I think that Congress should change some school lunch requirements. Perhaps the Times should assign some of its science reporters to explain the scientific, rather than the political, controversies on subjects such as salt and fat.

It is misleading to imply that this is a contest between politicians and scientists. At one point in the article, Confessore describes the School Nutrition Association as “isolated.” He cites other organizations that opposed the one-year waiver of some of the school meal standards.

So, instead of trying to explain the rationale behind certain rules, such as the amount of sodium in school lunches and breakfasts, the Times instead subtly tries to persuade its readers to ignore the “isolated” lunch ladies. The article refers to the federal dietary guidelines for sodium, but does not note the new studies questioning these guidelines or the Times editorial noting these questions.

Is this an article about the latest fashions, or the latest in the science of nutrition?

I support the school lunch ladies.





More on salt and health

If you are looking for a good summary about the recent scientific studies on salt and health, the New York Times editorial board says, “There is considerable evidence that lowering sodium can reduce blood pressure, but there is scant evidence that reducing blood pressure from levels that are not clearly high will necessarily reduce the risk of heart attacks, strokes and death.”

Previous studies have found little evidence to support those low recommended sodium targets. Now a large study by researchers at McMaster University in Ontario, Canada, which tracked more than 100,000 people from 17 countries on five continents, has found that the safest levels of sodium consumption are between 3,000 and 6,000 milligrams. Consumption below that level (but higher than our current targets) showed increased risk of death and cardiovascular events. Roughly 10 percent of the patients followed in the study fell below 3,000 milligrams, a sizable number to put at risk. Other studies have found that very low levels of sodium can disrupt biochemical systems that are essential to human health or trigger hormones that raise cardiovascular risk

Clearly the U.S. Department of Agriculture should reconsider how far to reduce salt content in school meals.