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Wednesday, April 8, 2015

What part of a complete breakfast?

In the latest educational music video for kids produced by my non-profit, my own 15-year-old son, our front man, essentially asks the question: if multicolored marshmallows in a cereal box are part of a complete breakfast, what part IS that?

By posing the question, I think he is also answering the one Kellogg's seems to be asking, namely: what happened to us? How did we lose control of the American breakfast?

That story is elaborated in a Bloomberg Business profile that chronicles the century-spanning rise, and recent fall, of Tony the Tiger, Toucan Sam, and the rest of the menagerie. I defer to the business experts on the sociocultural trends that figure in Kellogg's travails, such as working mothers, smaller families, and breakfasts preferentially eaten on the run.

From my perspective, at least some of the answers are just about as blatant as the psychedelic glow of those marshmallows in my son's lyric.

There has been a tremendous concentration of attention over recent years to the adverse health effects of miscellaneous food adulterations, from the general harms of added sugar, to the specific ills of high-fructose corn syrup; to the liabilities of refined grains; to the potential harms of food chemicals; to the insidious (and ill-defined) menace of genetic modification; to the willful sabotage of appetite control with hyper-processed concoctions. When dietary worry was all directed at excess fat intake, pseudo-fruit (Kellogg's makes Froot-Loops and Apple Jacks) and multicolored marshmallows (actually, General Mills makes Lucky Charms) were able to fly under the radar. A widening array of worries has cost them that cover.

There is also a movement under way to expunge the magical thinking attached to added nutrients. Historically, food companies have applied vitamins and minerals much like lipstick on a pig: whatever the general character of the product, it would introduce itself with bold assertions about fortification. The banner ad across the front of the package, like some honorific bandolier, never says: “my first ingredient is added sugar!” true though that may be. It is far more likely to say something about “essential nutrients!”

That, in fact, is the basis for the classic marketing line: “part of a complete breakfast!” The typical TV commercial for a kid's cereal features multicolored, madly frenetic antics, followed by the sonorous voice of an announcer, presumably allaying the concerns of mom or dad: “fortified with 11 essential vitamins and minerals, part of a complete breakfast.” The inevitable juxtaposition of the two assertions implies that the latter follows naturally from the former. In other words, our concoction deserves to be part of your family's “complete breakfast” because, after all, it is fortified with these very important nutrients.

But as I have been motivated to opine before, nutrient additions to a vat of gloop cannot exonerate the gloop. The new book, Vitamania, by Catherine Price, about which she and I recently corresponded, apparently develops the same theme.

So the public has learned that low-fat does not a wholesome food make; and that nutrient additions to junk produce, well, nutrient-fortified junk.

And that's where a whole lot of breakfast cereals fall. Kellogg's is by no means alone in those dietary badlands.

The result is that health-conscious eaters are likely rejecting cereals they formerly embraced, and they are quite right to do so. Eaters that aren't at all health conscious weren't eating cereal in the first place, they were having donuts, Danish, and muffins; or maybe sausage and egg sandwiches. Either way, they are probably uninterested in cereal.

Personally, I am an inveterate cereal eater, but have long favored the exceptionally wholesome offerings of especially virtuous companies. My standard choice most days is one of the whole grain offerings of Nature's Path, a cereal line noteworthy for purity, and simplicity, with minimal additions of sugar, salt, or anything else unwelcome, and maximal preservation of the native grain nutrients. My very favorite product of theirs, a cereal called Synergy, is no longer available in the U.S., because I was apparently the only one down here eating it! It is made from eight whole grains, with no added sugar and no added salt. I guess it was a bit like cardboard to the typical American palate, but my taste buds don't have that unfortunate condition, and I loved the stuff.

I have long been a fan of KIND for their simple and wholesome bars, and have embraced their cereal line for the same reasons. There are others, too, including Wholesome Goodness, a company I advise on nutrition; and some of Kashi's offerings (Kashi is owned by Kellogg); and so on. But most of the cereals that cater to the prevailing American palate have far too much added sugar and salt for my taste. Many popular (or formerly popular?) cereal brands have more added salt, relative to calories, than almost anything in the salty snack aisle (go ahead, check the nutrition facts panels). The only reason they don't taste overtly salty to most Americans is because (a) the salt is masked by even more copious additions of sugar; and (b) the typical American's taste buds are in a sugar- and salt-induced coma. Perhaps that's changing, to Kellogg's apparent dismay.

Of the dubious concoctions over which we poured our milk all these years, the cereals preferentially marketed to children are by far the worst. How we ever got the idea that “junk” could be food, I'll never know; but that we then got the idea that the junkiest of all foods could be “kid” food is utterly astounding. Food is the one and only construction material for the growing bodies of children we love. How does “junk” sound now? Apparently, less good. Perhaps health conscious parents are seeing past the bright glow of that lipstick at last.

To the extent that Kellogg's lost breakfast, and I'm not sure the final chapter has yet been written, it is because they were playing the wrong game for much of the past 5 decades or so. They, along with all of the others in this same space, were looking for best ways to put makeup on a pig, rather than looking for ways to make up the best, most nutritious formulations.

They lost the game because we finally caught on, and figured out what game they had been playing, and who was actually losing.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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