MAHA Could Do Something Truly Radical (& Good)
On revitalizing nutrition research funding & infrastructure
Do food dyes increase hyperactivity in kids? You’d think this very simple question (one that has come up often in the growing MAHA movement) would be readily answerable. Unfortunately, it’s not- and that’s largely because of the state of funding and the research infrastructure we have to do good nutrition research. MAHA and RFK Jr could change that, revolutionize our understanding of health, and produce solid research that can readily drive policy -if they’re serious.
Food dyes are a conceptually simple topic to address - but simple questions obscure the intrinsic complexity of how what we eat influences our health. Food dyes represent many chemical compounds (including both natural and synthetic versions), that we can eat at various doses, and in various forms (e.g. added to beverages; in solid foods, etc). There may be a knee-jerk “obviously they’re bad, get them out of food” response to ‘chemicals in our food’ - but this is a philosophy, not science, and is close to impossible to legislate around (and as we saw with Michelle Obama’s efforts to get sodium reduced in schools, debates about the science on a topic can seriously slow down policy for years). For all aspects of diet that we think care about, we need to be able to readily study how a range of relevant intakes and formulations influences meaningful indicators of our health. At present, this is virtually impossible for researchers to do in a rigorous and serious way.
Clinical trials - where we can randomize participants to different diets or nutrition-related interventions and assess health - are expensive. Very expensive. Imagine wanting to study the effect of food dyes - let’s say Red 40 and Yellow No5 - on hyperactivity in kids. There are a dozen ways you could run these studies - testing different doses, formulations (e.g. in beverages, solid foods), assessing effects in the general population as well as kids already diagnosed with hyperactivity, assessing objective measures of kids attention vs parental perception, vs teacher perception. All of these trials would need participants to be compensated for their time/effort and travel; graduate students, postdocs and staff need to be paid for their time, that includes management of the study, recruitment, assessment of outcomes, analysis of outcomes, writing up the research etc. The staff you’re paying here are not just anybody - you need folks trained in food safety to prepare your intervention, you need folks who are qualified to work with vulnerable populations (e.g. kids with ADHD), you need statisticians who can consult on the appropriate analysis. You also need infrastructure - you need a research grade kitchen to prepare your intervention made with the dyes; you need a clinical unit to gather information on the participants as well as assess their attention outcomes; you need secure survey and data storage platforms. The list goes on and on. For a series of well-powered, rigorously conducted studies that can tell us something meaningful and inform policy, you need funding. You may think this is overkill for food dyes - just get them out of food. That’s fine -but consider that all of this applies to the impact of foods on health. We need a robust research infrastructure and well-funded grants to do this kind of critical work. But these barely exists and, at present, the burden for investigators is extreme. MAHA could change that.
I trained doing my PhD in nutritional sciences and as a registered dietitian and have conducted/been involved in controlled human interventions at private universities (Cornell), the NIH, a USDA human nutrition center, and in the global health space (Tanzania). I’ve got a pretty decent resume and human nutrition research accolades — but I don’t really see a career in it. I’ve spoken with numerous faculty search committees at top universities who all want human nutrition researchers to come be a part of their faculty - but also know their institutions minimally support such research and the grant dollars to do this work have dried up (definitely a completely dry well if you’re trying to study something like food dyes). I’ve watched as legacy nutrition researchers have retired and their faculty lines have been filled by molecular biologists studying what happens metabolically at the level of the cell or in a mouse, not researchers feeding different diets and assessing health in humans. For the few human nutrition researchers that are left in the field doing controlled intervention trials, they’re either inside the NIH with really limited capacity and funding, one of a few investigators with limited funds at the USDA human nutrition centers or they’re at universities and left to rely on stringing together a mix of agricultural commodity board funds and what little the USDA puts out - NIH has all but abandoned funding this kind of work. It simply shouldn’t be this hard for researchers to get funding to do 1 study; as a society, we should be worried about our extremely low capacity to do the research related to questions about (food, additives, processing techniques etc etc) and health.
It hasn’t always been like this. I’ve also spent the last year and a half editing a graduate-level textbook in the field of nutrition and we continually cite data from before the 2000s for many, many topics, because that’s the last time we somewhat seriously supported nutrition research on a number of topics. That history is worth digging into to understand how we got to where we are and where MAHA could funnel its efforts.
Academic research, including nutrition research, in America is not that old. Much of the first half of the 20th century was spent discovering the essential components of food (macronutrients, vitamins, minerals) - because these requirements are not unique to humans and have big agricultural implications, a lot of this work was done in animal models. The first clinical research center came about in Boston in 1923 (Thorndike Memorial Laboratory at Boston Children’s Hospital) - and had an immediate impact on our understanding of human nutrition, making advancements in our understanding of the nutritional causes of common anemias, namely vitamin B12, folate and iron deficiencies. Kind of gross historical note: patients who presented with pernicious anemia, now known to be caused by the lack of a protein in the stomach required to absorb vitamin B12, were feed partially digested (by the investigator) and regurgitated meat which improved their anemia and led to the understanding that something was missing in the digestive process of patients with pernicious anemia. Fortunately, research ethics and food safety have much improved since.
As the NIH expanded after WWII, funding for the General Clinical Research Centers (GCRC) emerged in the 1960s. These centers were federally funded clinical research laboratories that provided infrastructure and staffing (research nurses, dietitians, statisticians, managers, recruiters, etc) that supported federally funded research grants (more or less for free) and industry grants (for a fee). To say these centers facilitated much of what we understand in modern human physiology, endocrinology and metabolism is not an overstatement at all - human biology is complex and these centers provided the ability to do intricate protocols that advanced many fields. For human nutrition, these centers are in large part why we have a ton of data on the effect of diet on cardiovascular disease risk factors, like blood cholesterol fractions and blood pressure. The clinical research centers were essential to doing feeding studies, providing for trained chefs who prepare meals precisely, with each ingredient weighed out; dietitians, who design menus that facilitate research investigators desires to understand how specific components of food might influence our health; and nurses and technical staff who helped draw blood and other samples and undertake a range of analyses that tell us about foods impact on health.
Changes to the oversight and funding of the GCRCs started to happen in 2006-2011 before they were totally defunded. The replacement for the GCRCs are the Clinical Translational Science Institutes (CTSIs) that lack the same funding and staffing model, and are more or less left to industry to upkeep (read: challenging for non-pharmaceutical intervention researchers to exist in). This had a huge impact on the field of human nutrition (also pretty much anyone doing non-pharmaceutical industry funded human physiology, endocrinology and metabolism). I came into academic human nutrition more or less in 2013. You know when you walk into a room and feel like something bad just happened? That’s sort of what it felt like entering the field - I tried to network with everybody in the field of controlled human nutrition intervention studies and see what was going on. I entered the field having inhaled the data from the previous decades and finding it all so interesting. Why did it seem like the research I read about wasn’t really actively happening anymore? Over the past decade, i’ve gotten to hear what now feels like lore about metabolic kitchens and research setups that used to exist but are either now entirely gone or minimally active. I’ve heard about good ol days when it was much easier to initiate controlled human nutrition intervention studies and have watched as now, investigators have to rely on agricultural commodity boards, and restrict their questions to those foods (eggs, beef, dairy, soy, walnuts, avocado etc - all the foods you see in the media where there’s new research) [note: i’m grateful for ag commodity boards and other industry $ in nutrition but this cannot be the main source to drive advancement in nutrition science and policy). These changes to clinical research funding have more less decimated many fields of research, not just human nutrition interventions. If you think ‘decimated’ is a strong word here, it is not hyperbole - there are 2 commentaries from top academics both describing ‘eulogies’ for the field of clinical research and metabolic clinical research. Having been in this field as an early career investigator post-GCRC defunding, I’d agree the field is at least on hospice. If nothing else, I hope MAHA leaders read and digest the 2 eulogy pieces and understand why a serious overhaul of our food system will have to be undertaken in the absence of really rigorous science because we simply don’t fund it.
It is tempting to glamorize the GCRCs but they were not perfect - you can find numerous reports from advisory councils and the Institute of Medicine about the need to improve leadership, coordinate clinical leadership better, cut costs/improve efficiency, etc. This network of inpatient and outpatient beds that allowed for understanding physiology and disease at a deep level should’ve been reformed to be better, not defunded. It is so sad to think about the advancement in methods/analysis we have now (everything from genome sequencing and metabolomics to new biomarkers of health and disease) that could be applied in the setting of controlled clinical research and how much more we’d know. A bit more scary is thinking about how we are coming up on a couple decades of highly trained folks who could do this research having retired and few new up and coming clinical investigators getting trained in these critical historical clinical research approaches. America is losing so much ground here compared to other countries that really investing in this type of research (I just got back from a conference seeing some of the awesome and innovative work being done in India where the government has pumped money into really solid nutrition research).
I don’t have all of the answers for MAHA/RFK Jr about what to do - but this history of the field is critical to understanding why advocates are left to push for the removal of food dyes based on tiny studies that report mixed results that don’t allow us to be confident in much. There is no shortage of theories about the impact of various foods, nutrients, ingredients and processing methods that influence our health pushed out onto the internet and having masses of people advocating for policy around - in the absence of rigorous data, individuals’ biases about their favorite theory will drive policy, not science. You might not think we should prioritize science in the case of synthetic food dye policy and that’s totally fine - but spend about 12 seconds on the wellness internet investigating any other topic in nutrition, and you’ll find vehement and loud activists fighting for change in the food system in totally opposing ways (think: vegan vs carnivore; removal of ultraprocessed foods vs advocating for highly processed plant-based alternatives and protein powders). Funding nutrition science could be a bipartisan win that define MAHA and RFK Jrs legacy and lead to continued impacts well beyond the next few years. MAHA as a political movement could easily be the driving force behind having top decision makers at the NIH and congressional levels get into a room that they (metaphorically) don’t leave until there’s a plan to revolutionize clinical nutrition research funding and fast track the generation of data needed to inform policy.
A few notes/disclaimers:
It’s not just me and a few clinical investigators in 2016 articles talking about this issue of a lack of funding and research infrastructure. In recent years, the NIH’s top intramural nutrition scientist, Kevin Hall, PhD, has been calling for the funding of large centers to be able to do controlled feeding studies, in large part to tease out whether and what aspects of ultraprocessed foods can cause harm.
mixed data on food dyes is just the tip of the iceberg. I think a lot of MAHA advocates (self termed MAHA Moms) be incredibly shocked how little data we have for understanding pregnancy/lactation/children’s nutrition - this is something my colleagues and I detailed a couple years back. There are countless topics too innumerable to list out in a single blog that lag far behind the evidence we need to inform policy.
There is a lot of uncertainty in nutrition science - even the ability to do controlled feeding trials readily won’t solve every issue that MAHA cares about. Beefing up and improving other lines of research, like nutritional epidemiology and toxicology, will also be critical.
There are 6 USDA Human Nutrition Centers. Last Trump term, the funding for these was threatened. In reality, they are some of the last places with the existing infrastructure to do really solid human nutrition work. Like the GCRCs, they could stand to restrategize and coordinate a bit better but in general, they need to be revitalized with funding for research, faculty positions, trainees, etc.
You might say, “hey, but I've heard up to 5% of the NIH budget is nutrition and obesity research - how is it underfunded?" . The history and account I've laid out in this post is still very accurate - the numbers you see for NIH funding are composite metrics - it includes all types of nutrition research from epidemiology to mouse models. I have never found a great number for just nutrition and food-based interventions but it is undoubtedly extremely tiny, especially relative to when GCRCs used to be funded.
Michelle Obama’s learned experience on sodium science should be sobering about the degree to which MAHA folks think their opponents (in politics & industry) won’t be able to stop their proposed policy changes. The mini recap is that M Obama wanted reduced sodium in school lunches; opponents challenged the science on it; it led to a long process to get sodium science reviewed and updated by the National Academies of Science, which ultimately found harm from sodium intakes in the ranges we consume them, and policy change was more readily facilitated. The delays in sodium policy occurred despite a relatively rigorous body of evidence for sodium, in part facilitated by clinical trials that have assessed its relationship to blood pressure. The science is nowhere near as robust for topics like food additives and until there is the capacity to do rigorous, policy-relevant science, MAHA efforts will be a huge uphill battle that will have to invoke the precautionary principle, not science.