‘Deeply disturbing’: Nestle meal replacement shakes are endorsed as a diabetes treatment
The endorsement of a popular brand of meal replacement shakes by a peak health body has exposed ‘deeply disturbing’ links to a multi-national food company.
A diet of Nestle meal replacement shakes has been endorsed by Australia’s peak diabetes body as a key treatment to combat the disease following a study part-authored by a University of Sydney researcher who was previously a scientific adviser to the multinational food giant.
Nestle – which stands to make millions of dollars from the endorsement - donated its Optifast shakes for free to the study, which has been accused of risking a perception of a lack of independence.
One of the authors of the study associate professor Tania Markovic from the University of Sydney’s Charles Perkins Centre, disclosed an interest on the paper, published last month, as she had previously been on the advisory board for Nestle Health Sciences.
The guarantor for the study, Professor Emeritus Stephen Colagiuri, Professor of Metabolic Health and director of USyd’s Boden Institute, has been a promoter of low glycaemic-index diets for over a decade including co-authoring bestselling books and is a notable low-carb sceptic.
The University of Sydney was commissioned by Diabetes NSW & ACT to conduct the DiRECT-Aus study which set out to replicate a UK trial that established a structured weight management program delivered in primary care using meal replacement shakes could result in diabetes remission. The study found a very low-energy diet replacing food with Nestle Optifast shakes for 13 weeks resulted in remission of type 2 diabetes for one in two Australian adults in a primary care setting at 12 months. Food was reintroduced after 13 weeks and a maintenance program later established.
In endorsing the ultra low-calorie approach with shakes, Diabetes Australia said it was hoped the results would add to the growing body of evidence that type 2 diabetes can be put into remission.
“That is great news for people living with type 2 diabetes, those at risk and newly diagnosed. It may provide alternative treatment options for people living with type 2 diabetes as well as hope and motivation and a renewed sense of action after a diagnosis of type 2 diabetes,” Diabetes Australia said of the trial.
Doctors are now questioning what they allege is a lack of independence in research, policy and service delivery among peak bodies and leading endocrinologists pushing a “medicalised” model of diabetes management.
They’re questioning why Nestle’s Optifast Very Low Calorie Diet has been promoted as the key path to diabetes remission when low-carb approaches are just as effective and arguably more sustainable. Diabetes Australia also supports a low-carb approach but the Direct-Aus study is the nation’s first randomised control trial into diabetes remission.
“These approaches over-medicalise the issues that should be managed by proper public health policy.”
The results of the Direct-Aus study, published last month, found that 56 per cent of the 100 participants in the study were able to send their type 2 diabetes into remission by replacing all food with Nestle Optifast shakes for 13 weeks, followed by eight weeks of structured food reintroduction and over six months of supported weight maintenance.
If a person in the community was to follow the same diet, they would spend at least of $200 on Optifast shakes, which cost about $52.00 on special for a 10-pack at Chemist Warehouse.
Nestle Optifast products are endorsed by the GI Foundation, which lists pages of Optifast products on its website with what clearly appear to be advertorial endorsements.
“This easy to prepare shake is one of the satisfying products in the OPTIFAST® VLCD™ range,” the listing for the vanilla shake says. “It is part of a nutritionally complete Program, is high in protein, a source of fibre, and tastes delicious.”
The University of Sydney said Professor Colagiuri was not on the board of the GI Foundation at the time the research took place, as he is now, and “had no direct involvement with Nestle in any capacity”.
“Industry involvement has led to exciting developments across many fields of medical research and rigorous procedures are in place to govern engagement with industry,” a spokesperson for USyd said. “The conduct of the research and interpretation of the findings are strictly insulated from industry and as per standard practice.
“All relevant disclosures were declared when the paper was submitted for publication and researchers declared any potential conflicts of interest related to the conduct of this research as required by our Research Code of Conduct and the Australian Code for the Responsible Conduct of Research.
Critics nevertheless said they were disturbed by the partnership between diabetes researchers and an ultra-processed food company that causes the very sickness the study was trying to reverse. “Nestle is a company where over 60 per cent of its portfolio has been deemed to be unhealthy, in other words, the majority of their products actually impair metabolic function,” says Former Australian of the Year, ophthalmologist James Muecke. “Now they’re offering up a line of products to try and improve metabolic function. They want to capture both sides of the market. It’s deeply disturbing.”
Dr Muecke questioned by the diet that was studied and funded was one using commercial shakes, rather than a low-carb approach that had proven more effective and more sustainable in the US in what was known as the Virta trial.
“Optifast also contains a significant metabolic disruptor in the form of canola oil.
“It also contains milk powder, lactose, which is made up of galactose and glucose, so it still breaks down to produce glucose. Someone who is glucose intolerant, such as someone with type 2 diabetes, should therefore avoid lactose-containing products.”
At the heart of the issue was that funding for research into obesity and diabetes has been routed in recent years. Government research funding for diabetes has slumped by 35 per cent in the last decade despite a 32 per cent increase in people living with diabetes, forcing researchers to rely on other funding sources.
Diabetes Australia is a charity and receives a very small fraction of its funding from pharmaceutical companies. But pharma logos are often prominent on major research reports, with companies such as Novo Nordisk frequently providing educational grants to subsidise key reports published by Diabetes Australia.
The consultancy PWC has been contracted to produce such reports. Diabetes Australia and its subsidiary organisations also hold contracts to provide services to diabetic patients via the $140 million-a-year National Diabetes Services Scheme. Patients registered with the scheme get access to subsidised devices including glucose monitors and insulin pumps which reap pharma and device companies big profits.
“Pharmaceutical companies have no influence over Diabetes Australia’s health advice, or advocacy for people living with diabetes,” a spokesperson for the charity said. “Last year, income from pharmaceutical companies was less than 1 per cent (0.6%) of our total income.
“We actively promote information to the community about the latest evidence
regarding dietary approaches to remission including low carb, keto and Very Low Energy Diet (VLED) approaches.”
Nestle defended its decision to donate the shakes to the Direct-Aus trial, saying very low calorie diets were an evidence-based intervention that were recommended in the Australian Obesity Management Algorithm. It said it had originally been approached by Diabetes NSW & ACT to provide Optifast products for the trial.
“Nestlé Health Science was not involved in the design or undertaking of the study and had no influence on the research findings.”
“Our teams work with researchers, healthcare professionals and patients to support scientific research and product development for clinical conditions to ultimately improve health through nutrition. When supporting research, Nestlé is committed to promoting academic freedom, ethics and integrity and we require Nestlé’s contribution to research to be disclosed.”
The former chair of the Australian National Preventative Health Taskforce, professor of public health Rob Moodie, agreed the decision of the Direct-Aus study’s leaders to accept donations from Nestle, and effectively endorse the use of Nestle Optifast shakes via the research, raised questions of independence.
“This is a standard practice of not only ultra-processed food companies, but of tobacco and alcohol companies, where they fund research that will always pretty much be favourable to their approaches and their products,” Professor Moodie said. “In donating the shakes, Nestle is influencing the study in a way, in a sense they’re giving the funding by virtue of giving the shakes, and then incorporating that into the way of thinking of what’s normal.
“Nestle is a fascinating company, it’s more than transnational, it’s actually supranational and
their systems are so effective because of their capacity to influence decision-making. Funding research is one of the many ways that they’ll do it.
“I think that Diabetes Australia should have a much greater interest in upstream prevention of this disease. And I hope that that’s the way they will go in the future, because it’s the way the only way that we’re going to be able to manage this epidemic on a population level.
“The overall thinking on prevention and remission has been way too slow. It’s been a bit like ‘well we’ll treat our way out of this’ rather than the notion that prevention is better cure.”
Diabetes Australia is a charity and receives a very small fraction of its funding from pharmaceutical companies. But pharma has a significant presence in policy formation via the charity, with companies such as Novo Nordisk frequently providing educational grants to subsidise key reports published by Diabetes Australia. The consultancy PWC has been contracted to produce such reports.
“Corporations fund research to control the narrative,” said public health researcher and Monash University lecturer Grant Ennis. “It’s well known that Nestlé and other corporations capture charitable organisations by donating to them and funding their research.
“Australians would never want to see a gun violence charity accepting vests from gun-makers and yet it’s perfectly fine that the makers of the foods giving us diabetes and lobbying to worsen our community nutrition, can donate to the charities purporting to alleviate ill health?”
