Processed Food—An Experiment That Failed

Opinion Viewpoint buy previously unaffordable luxuries for her grandson including toi- letries, fresh produce, winter blankets, and a nightlight. Like Beatrice, single women making less than $10 000 yearly headed many of the families we served. The good news for these women and their children was 2-fold. First, these types of families are the EITC’s target population and, as such, received thousands of dollars in tax credit. Second, for those who filed in prior years, StreetCred saved them money previously lost to the for-profit tax- filing industry by providing free services in the comfort of a trusted setting: their pediatrician’s office. These women expressed both gratitude and practical impact as they reported their ability to not only more fully meet their children’s basic needs, but also take a first step toward financial stability by paying off loans, which are stories consistent with national data on the ways taxpayers use EITC monies. 7 Moreover, StreetCred empowered families with EITC edu- cation. Some clients expressed enthusiasm about working more hours in the coming year to qualify for a larger EITC on their next tax return. Other single mothers learned that they, not their ex- -earned-income-tax-credit. Published January 15, 2016. Accessed July 7, 2016. ARTICLE INFORMATION Published Online: January 17, 2017. doi:10.1001/jamapediatrics.2016.3868 Conflict of Interest Disclosures: None reported. Additional Contributions: We thank Barry Zuckerman, MD (Boston University School of Medicine); Paul Wise, MD, MPH (Stanford University); and James Perrin, MD (Harvard Medical School), for editing assistance and manuscript review. They did not receive compensation for their contributions. REFERENCES 1. Center on Budget and Policy Priorities. Policy basics: the earned income tax credit. http://www .cbpp.org/research/federal-tax/policy-basics-the VIEWPOINT Robert H. Lustig, MD, MSL Department of Pediatrics, University of California, San Francisco; and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Corresponding Author: Robert H. Lustig, MD, MSL, Division of Pediatric Endocrinology, University of California, San Francisco, 550 16th St, PO Box 0434, San Francisco, CA 94143 (rlustig@ucsf.edu). husbands, should claim the children as tax-return dependents be- cause they served as primary caretakers. StreetCred is another example of how the US health care sys- tem can be a gateway to the public benefits, community resources, and financial stability supporting low-income parents, like Bea- trice, in one of the most important jobs in the United States: raising healthy children. The trust and regular contact between families and their children’s medical professionals present a special opportunity to screen for and address the social determinants of health. Street- Cred aims to make accessing programs, such as the EITC, cheaper, faster, and easier to understand. The program’s short-term goals are 2-fold: (1) expand free tax-preparation services to other clinics and hospitals serving low-income families with children and (2) expand its services portfolio with additional asset-building tools so families might truly break the cycle of poverty. Innovative programs extend- ing beyond the traditional boundaries of pediatric health services remain an important approach to promoting the health and devel- opment of our patients growing up poor. 5. Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016; 137(4):e20160339. 2. Marr C, Huang C-C, Sherman A, Debot B. EITC and child tax credit promote work, reduce poverty, and support children’s development, research finds. Center on Budget and Policy Priorities website. http://www.cbpp.org/research/federal-tax /eitc-and-child-tax-credit-promote-work-reduce -poverty-and-support-childrens. Published October 1, 2015. Accessed July 7, 2016. 6. Holzer HJ, Shanzenbach DW, Duncan GJ, Ludwig J; National Poverty Center. National Poverty Center Working Paper Series, 07-04: The economic costs of poverty in the United States: subsequent effects of children growing up poor. http://www.npc.umich .edu/publications/u/working_paper07-04.pdf. Published January 2007. Accessed July 7, 2016. 3. US Internal Revenue Service. About EITC. http://www.eitc.irs.gov/EITC-Central/abouteitc. Accessed April 1, 2015. 7. Goodman-Bacon A, McGranahan L. How do EITC recipients spend their refunds? Econ Perspect. 4. Weinstein P, Patten B. The Price of Paying Taxes II: How Paid Tax Preparer Fees are Diminishing the Earned Income Tax Credit (EITC). Washington, DC: The Progressive Policy Institute; 2016. Processed Food—An Experiment That Failed Those of us who have participated in science know that 9 of every 10 experiments are failures. Now imagine that the last 50 years has been a grand clinical research experi- ment, with the American population as unwitting partici- pants,conductedby10principalinvestigators—Coca-Cola, Pepsico, Kraft, Unilever, General Mills, Nestle, Mars, Kellogg, Proctor & Gamble, and Johnson & Johnson. In 1965, these corporations posed the hypothesis that pro- cessed food is better than real food. To determine if the ex- perimentwasasuccessorafailure,wehavetoexaminethe outcomevariables.Inthiscase,thereare4:foodconsump- tion, health/disease, environment, and cash flow, divided into companies, consumers, and society. Processed food is defined by 7 food engineering crite- ria; it is mass produced, is consistent batch to batch, is con- sistentcountrytocountry,usesspecializedingredientsfrom specialized companies, consists of prefrozen macronutri- ents, stays emulsified, and has long shelf life or freezer life. 1 Furthermore, 11 nutritional properties distinguish pro- cessed food. 2 (1) Too little fiber. When fiber (soluble and insoluble) is consumed within food, it forms a gelatinous barrier along the intestinal wall. This delays the intestine’s ability to absorb nutrients, instead feeding the gut micro- biome. Attenuation of the glucose rise results in insulin re- duction. Attenuation of fructose absorption reduces liver fataccumulation.(2)and(3)Toofewω-3andtoomanyω-6 fatty acids. ω-3s are precursors to docahexaenoic and ei- cosapentanoicacids(anti-inflammatory).Conversely,ω-6s are precursors of arachidonic acid (proinflammatory). Our ratio of ω-6 to ω-3 fatty acids should be approximately 1:1. Currently, our ratio is about 25:1, favoring a proinflamma- tory state, which can drive oxidative stress and cell dam- age. (4) Too few micronutrients. Antioxidants, such as vi- tamins C and E, quench oxygen radicals in peroxisomes to preventcellulardamage,whileothers,suchascarotenoids and α-lipoic acid, prevent lipid peroxidation. (5) Too many JAMA Pediatrics March 2017 Volume 171, Number 3 (Reprinted) Copyright 2017 American Medical Association. All rights reserved. Downloaded From: http://jamanetwork.com/pdfaccess.ashx?url=/data/journals/peds/936064/ by a UCSF LIBRARY User on 04/05/2017 jamapediatrics.com