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I have examined the testimonies on nutrition very carefully indeed. In my opinion, they contain a number of serious weaknesses with respect to the criticism of McDonald's products. These can be summarised as follows:
1. There is an underlying assumption that meals purchased in McDonald's make a major contribution to the diet of the customers. There is also an implication, from a nutritional perspective, that the McDonald's products are unique
2. There is a failure to appreciate the complexity of the relationships between diet and health. This means that there are tremendous difficulties for scientists, in their attempts to understand these relationships. Furthermore, there are even greater problems when it comes to translating the results of the scientific investigations into a form which can be used to formulate govern-ant policy and to make recommendations for the general public
3. There is a failure to recognise that nutrition is not the only factor which people take into account when deciding on their choice of food
4. Even within the nutrition field, there is undue emphasis on the role of the major components of the diet - fat, sugar and fibre - at the expense of the minor components
5. There appears to be an assumption that there should be absolute safety as far as food is concerned. No risk is acceptable, however small or unlikely
Now I will explain in greater detail my reasoning for these conclusions :
1. Contribution of food from McDonald's to the total diet of customers
I have prepared a series of weekly diets which consist of a meal in a McDonald's restaurant on the Saturday plus all other meals made of foods commonly consumed in the UK. From these (Tables 1 and 2) it can be shown that for adults the average contribution by a McDonald's meal to the weekly diet is 4.7% of calories, if they visit a restaurant once a week. For children, the contribution is slightly higher at 5.8%. This means that even for a heavy user of McDonald's restaurants, the contribution to the total diet is very small. The data show that it is quite possible to achieve the dietary recommendations for total fat, saturated fat and sugar even though an individual McDonald's meal does not conform to the guidelines. All the foods used are commonly available and include sausage, egg, chocolate biscuits, chill) con came, chicken, spaghetti, pork chop, roast potatoes, fish and chips. This information demonstrates that a normal healthy diet which conforms to the recommendations includes products which have a wide range of composition.
There is no dispute that many of the McDonald's products are relatively high in fat and in saturated fat. However, it must be recognised that the product range in McDonald's is very limited compared with the variety of foods currently available on the market. Most of McDonald's products contain meat and/or dairy products. If we restrict our consideration to the content of fat and saturated fat, it can be shown that there are certain food categories which are the main sources of fat in the average British diet. These are milk and milk products, meat and meat products, baked foods and confectionery, spreading fats and cooking oils. Table 3 gives the content of the fat, saturated fat, sugar, fibre and salt for a selection of McDonald's products. A comparison with a selection of other readily available foods containing meat, dairy and some processed foods, shows that the composition is really quite similar (Table 4). A diet consisting mainly of these products would obviously fall outside the dietary recommendations as the content of fat and sugar would be relatively high.
Therefore, if the targets are to be reached, it is essential to include products which are relatively low in fat and sugar. These are mainly foods based on the cereals, bread, rice, pasta, dairy products made with low fat milk, as well as fresh fruit and vegetables. Some examples are given in Table 5.
Incidentally, one of the points to emerge from this study is that it is perfectly feasible to construct a diet that meets the dietary recommendations for fat, saturated fat, sugar and fibre, but it is virtually impossible to reach the COMA recommendations for salt with commonly available processed foods. However, the COMA panel did not make strong recommendations to reduce the level of salt in the British diet.
2. The relationship between diet and health
As I explained in my earlier report, it is extremely difficult to elucidate the relationships between diet and health or illness. Obviously, if we are dealing with a dietary component which is acutely poisonous and affects all humans and all mammalian species, it is relatively easy to identify such a substance. However, with constituents of the diet such as saturated fat or sugar, it is extremely difficult to determine the relationships because
A. If there is an adverse effect, it is probably developed over a very long period
B. There is probably a threshold - in the sense that it is only when consumption reaches a certain level that adverse effects may occur
C. The effects may vary between individuals, because of genetics, between populations, between young and old, between men and women
D. The effects may be modified by the other constituents in the diet or by lifestyle, eg, how much exercise is taken
With this background, it is not surprising that there has been an enormous amount of research conducted in this field. Because of the inherent difficulties, it is necessary for a variety of approaches and disciplines to be used. This means that there is a plethora of data available, with information from thousands of investigations conducted all over the world. Some of the research may be disregarded because of poor methodology. There can be major inconsistencies between different research groups and between the different approaches being used. It is, therefore, quite unreasonable to extrapolate, for example, from an investigation done on a small number of middle-aged men to the entire population. The reality is that if governments and other organisations wish to make recommendations for the general public, then they have a responsibility to be very careful indeed. In particular, they have to be reasonably confident that there are likely to be benefits for the whole population and, more importantly, they should be virtually certain that there will be no danger to people who follow the advice.
It is now established practice for governments and other official bodies such as the World Health Organisation to set up groups of experts who will conduct a thorough evaluation of the available evidence and provide an important input for policy formulation. Here in Britain, the Committee on Medical Aspects of Food Policy (COMA) has that function and, over the years, has provided reports on a variety of topics. The most recent one of relevance to this case is the report entitled "Dietary Reference Values for Food Energy and Nutrients for the United Kingdom". This report is based on a painstaking examination of the available research and is generally regarded by nutritionists as a very significant step forward in working out the requirements for nutrients. There was an enormous amount of background work done on the preparation of the report. It is highly relevant that the recommendations (termed Dietary Reference Values - DRVs) in the diet for the major constituents, eg, fat, sugar, fibre, are very much in agreement with many other reports produced in many different countries.
These recommendations have been accepted by the UK Government and some of them are now used as a key component in formulated policy on nutrition and health.
It was concluded in the COMA report that
"The association between the CHD mortality is closest with saturated fatty acid (SFA) supplies, which has been demonstrated in both international and national studies"
Because of the role of SFA in the development of CHD, the panel recommended that the SFA content of the British diet should be reduced by 35%.
The links between fat and cancer were considered to be relatively weak and the COMA panel concluded that
"... there is currently insufficient evidence on which to base a recommendation for a decrease in fat intakes to prevent cancer, although an increase in consumption of any fatty acid should not be encouraged"
The position on sugar taken by COMA panel is as follows:
"The Panel agreed that non-milk extrinsic sugars intake should be limited because of their role in dental caries. However, the Panel recognised that the data in support of any specific quantified targets for non-milk extrinsic sugars intake were scanty. In order to provide guidance for uses as specified in paragraph 1.4, the Panel agreed that sufficient evidence existed to make proposals for DRVs. The Panel accepted that the dental effects of non-milk extrinsic sugars were most likely to be related to the frequency, and so in practice absolute mass, of sugars consumption rather than the overall dietary composition, but considered that the value of DRVs would be greater if expressed not only as mass, but also as their contribution to dietary energy. This also allows DRVs for starches plus intrinsic sugars to be calculated. The Panel therefore proposed that the population's average intake of non-milk extrinsic sugars should not exceed about 60 g/d or 10 per cent of total dietary energy"
The position on sodium is that "... restricted sodium intakes reduce blood pressure in individuals with established hyper-tension, they do not do so reliably in those with normal blood pressure ... "
The Panel accepted the possibility that public health benefits such as reduced cardiovascular disease mortality might arise from such a change, ie, a reduction in dietary sodium intake, but other interventions such as reduction of obesity, increased potassium, reduced energy intakes, altered quantity and quality of fat intake and reduced alcohol consumption may also have at least as great an import on such diseases. The Panel cautioned against any trend towards increased Na intakes. The Panel further agreed that current Na intakes were needlessly high, and decided to set DRVs on the basis of the balance of risks and benefits which might practically be expected to occur, given the prevailing socio-cultural environment"
McDonald's fully accepts the COMA report as the current authoritative document dealing with the relationship between diet and health in the UK. Furthermore, the company is on record that it supports 'The Health of the Nation' White Paper, the official government policy document, which was released in 1992. This contains several dietary targets, which are based on recommendations made by the COMA. The main ones are to reduce saturated fat in the British diet by 35% between 1990 and 2005, and to reduce total fat by 12% over the same period.
McDonald's has its own Healthy Eating Policy, which has been published (see attached booklet). In recent years the Company has made a number of changes in the composition of its regular products. These include
- replacement of the lard in buns with a lower amount of vegetable oil - thereby reducing the saturated fat content substantially
- introduction of dressings and sauces with a low oil (fat) content
- re-formulation of the processed cheese so that the total fat content is reduced
- low fat spread offered as an alternative to butter
- mineral water, fresh orange juice and diet coke introduced
- a sweetener is offered instead of sugar
- within the last few months, the frying oil for french fries and hash browns has been changed to vegetable oil. As a result, the saturated fat content of the products has been reduced significantly
This demonstrates very clearly that McDonald's in the UK takes nutrition very seriously, and has already made a constructive contribution towards improvements in the range and composition of products available. If the same approach was adopted by other major food companies, then there would certainly be very significant progress in achieving the targets set by the Government.
In this context, it is important to appreciate that it is only in recent years that the full significance of the research findings has been recognised in the UK. Publication of The White Paper in July 1992 was only eighteen months ago and, as yet, has had limited impact -on the food industry. McDonald's was actually making changes before the White Paper was released and is, clearly, one of the leaders in the field.
3. Factors affecting choice of food
The impression given by the critics is that nutrition is the only factor which should determine the choice of food. In reality, for most people, nutrition only plays a minor role. Factors such as family background, availability of food, price, and most important of all, taste. The vast majority of people expect their food to be enjoyable to eat. Consumers are free to choose for themselves the food they wish to eat. Governments, food companies or nutritionists cannot force people to eat food simply because it is considered to be nutritious. However, companies can assist by providing foods which meet the criteria for price, taste, etc, but are also "healthy". The success of this approach can be illustrated by considering what has happened with milk. The introduction of semi-skimmed milk, which has less than half the fat of whole milk, has been a huge success. Within less than 10 years, the proportion of the total liquid milk market, which is semi-skimmed, has grown from virtually zero to about 50%. Semi-skimmed milk is similar to whole milk in the way it is used, and tastes very much the same as whole milk. So the "health" aspect in the form of reduced fat is a bonus which requires little effort or inconvenience. By contrast, the demand for totally skimmed milk has remained static over the same period. Even though it is obviously "healthier" with almost no fat, the taste is rather water and, therefore, is not acceptable to most consumers.
The McDonald's strategy is to make a series of small changes to the product composition in order to move in the direction indicated by the dietary recommendations. These can involve considerable research and development and so the exercise does take time. Nevertheless, substantial progress has been made and will continue to be made in the future.
Meeting the requirements for the minerals and vitamins
Although much of the current public concern is on the fat, sugar and fibre, we must not lose sight of the fact that the minor nutrients, the vitamins and minerals, are also essential. Here again, the need for variety and balance is paramount because the main sources of each one can be different. For example, carrots and red peppers are good sources of carotene but poor sources of protein; oranges, blackcurrants and grapefruit are a good source of vitamin C but contain no vitamin D; herrings and mackerel are good sources of Vitamin D but there is virtually none in haddock or halibut.
Red meat is a good source of iron and several of the B vitamins. Iron is especially important for women because of the loss of blood (containing some iron) during menstruation. It has been shown that some young women who become vegetarian by removing meat from their diet completely can suffer from anaemia.
Similarly, milk and dairy products are important sources of calcium-in the diet. Young people who only have a small amount in their diet may be susceptible to osteoporosis later in life.
There is absolutely no doubt that the type of products which are supplied by McDonald's do play a critical part in the diet. Anyone who decides that they must not consume these types of products would need to be very well informed about nutrition principles to be sure that they were adequately nourished.
5. Absolute safety !
Absolute safety is simply not attainable. Some hazards are inevitable.
First, we simply do not know enough about the links between diet and disease to advise people what to eat in order to avoid all conceivable risks. Second, people would not necessarily be prepared to act on the advice (cf. smoking - it is now generally accepted that smoking can be hazardous, yet many people continue to smoke and are prepared to take their chances). Third, there has to be a trade-off between achieving safety and the costs involved. The more we attempt to reduce hazards, the greater will be the cost and the range of foods will be restricted very considerably.
In a FOOD SENSE FACT SHEET on "Intolerance to Foods, Food Ingredients and Food Additives" produced by MAFF, it is stated that
"To guarantee that no-one would ever experience problems would require elimination of a large proportion of food additives and foodstuffs. For these reasons, most regulatory authorities, including those in the UK and other EC countries, have opted not to ban additives that might cause intolerance reactions, thereby enabling individuals to avoid foods containing additives to which they might react".
McDonald's provides details of the nutrition composition and all the ingredients in publications, which are freely available in restaurants. The company has been doing this for several years and is a leader in the field.
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January 13, 1994
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Appeared in court
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exhibits: Expert witness report
transcripts of court appearances:
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