An Englishman Stirred – the False Dichotomy of “Children’s” and “Adult’s” Cereals

I doubt I will be accused of being overly hasty in my campaign against the labelling of cereal products by supermarkets, but that does not mean that my quest has faltered, nor has my zeal lost its edge. I first blogged on this subject at the end of December, and that it has taken me 4 months to plot my second move is something I like to put down to an English predilection for a measured, well-considered response, respect for the other side to give them ample time to deliver their riposte – oh and being a full-time GP with a busy life might have something to do with it.

Nevertheless, I promised to report back the response of the giants in the supermarket world to my humble request to remove the label “Children’s” from its close attachment to certain types of sugary, chocolatey cereals. This on the seemingly reasonable grounds that separating cereals into those suitable for children, and those suitable for adults, is a false dichotomy that sends completely the wrong health message in these times of increasing obesity.

I sent letters to the local managers of both Tesco and Sainsbury’s and am disappointed to say that they scored 0-0 in their response – not a word or a peep or even an automated acknowledgement from either of them. Customer service is not what it used to be! The regional Customer Services offices at least wrote back, and I attach a scanned copy of their letters. Sainsbury’s were non-committal and advised me that they will be considering my comments at their next marketing team meeting – but they have not committed to responding again after this meeting and I am not holding my breath. Tesco gave a fuller report – full of PR babble that had little bearing to my concern. They commented on problems with space on the shelves and not wanting to take anything away from children, when all I am concerned about is the sign coming down from the ceiling. Maybe my letter was confusing and I need to restate my case – or perhaps they prefer not to understand and would rather waffle away my objection than seriously consider it.

Let me be clear. I have no problem with the fact that cereal companies manufacture sugar-coated products – some regulation here to try to keep them healthier is important, but freedom to buy unhealthy food if you so choose is necessary in a liberal democracy. I have no issue with supermarkets stocking them and giving them ample self space. Unlike cigarettes, I have no wish to see them in plain packaging or behind protective screens – they are not that bad for you after all. However, why, oh why, oh why do the supermarkets feel the need to separate them into “Adult” and “Children” categories? Granted, you won’t want to give hard-to-chew lumps to a 7 month old baby, and may prefer to avoid nuts altogether in the under 3’s, but with these minor exceptions there is no reason why an adult should not choose Frosties for breakfast, or a child prefer Shredded Wheat – or am I missing some vital nutritional understanding here?

So I shall write again, and enclose photographic evidence this time to make my point clearer. And my MP happens to be Anne Milton, Health Minister – I think a letter to her might not go amiss either. Once more into the breach…

Sainsbury’s Letter of Reply

Tesco’s Letter of Reply Page 1

Tesco’s Letter of Reply Page 2

Letter to Anne Milton MP

Letter to Tesco

Letter to Sainsbury’s

Warning: Written on a computer also used for completing homework, may contain traces of GCSE English

When the manufacturer of a packet of peanuts feels obliged to print the allergy information: Contains nuts we know we are living in a world that has lost touch with basic common sense. That another food producer considers that they are doing their customers a service with a label such as: Ingredients: No nuts; Factory: No nuts; Cannot guarantee nut free nearly completes the ridiculous confusion that is food labelling. I say nearly because the natural conclusion of such a defensive, litigation-fearing attitude to food labelling is to include such comments as: Workers’ canteen: No nuts; Workers’ packed lunch boxes: Cannot guarantee nut free; Company policy on workers’ lunch boxes: Should be nut free.

We can all laugh at this, but if you are at risk of anaphylactic shock from exposure to even a small quantity of peanut then you are unlikely to appreciate the joke. What are we to make of these labels? The British Medical Journal published a helpful analysis of the situation last year, which makes interesting, if sobering, reading. The link to the article is here, although you will need to be a subscriber in order to access it.

The first thing is to realise the important difference between the labelling requirements of raw ingredients and that of possible contaminants. Under EU law there is a legal requirement to list any of 14 ingredients that are commonly associated with allergy if they are one of the raw ingredients in the product. The full list of these allergens is as follows: Cereals containing gluten (wheat, rye, barley, oats, spelt and kamut), crustaceans, egg, fish, peanuts, milk, tree nuts (e.g. hazelnut, walnut etc), soy, sesame, celery, mustard, lupin (a type of bean rather than the garden flower – I had to look this up!), molluscs and sulphur dioxide or sulphites. On the other hand, allergy information about possible contaminants is entirely voluntary, with no clear guidelines for manufacturers.

Whether or not manufacturers place these advisory labels, and the wording that is used, appears to be alarmingly arbitrary. A 2010 European study published in the journal Food Additives Contaminants – a niche publication if ever there was one! – looked at the presence of peanuts and hazelnuts in cookies and chocolates that did not have either listed as an ingredient. Approximately 60% of the 500 or so products tested carried an advisory label about the possible presence of the nuts. For peanuts the presence of the label was associated with a 33% incidence of detectable quantities of peanut in the product – and for those with no label the figure was 25% – which makes using the label as your guide only marginally better than lucky dip. For Hazelnut the figures were slightly more favourable with the labelled products containing hazelnut in 60% of cases compared with 31% of unlabeled products, although this is hardly a ringing endorsement of our present system.

All of these figures seem very high, which may in part be because this study involved confectionary and biscuits, which are associated with a much higher incidence of cross contamination than other products. A further study in the Journal of Allergy and Clinical Immunology found peanut to be present in 8% of confectionary items labelled with an advisory warning, but in none of 64 non-confectionary products studied, despite the presence of a similar warning. Some caution is needed here, however, as this was a US based study and manufacturing conditions may be very different across the Atlantic.

Despite the problems with interpreting these labels we find it very difficult to ignore warning labels. For many of us it is akin to breaking the rules, or tempting fate. A survey of parents with children with nut allergies published in Paediatric Allergy and Immunology found that 80% of parents avoided products that stated May contain nuts, but only 50% avoided products with the label May contain traces of nuts. This is understandable, but worrying as there is no correlation between the wording on such labels and the chance of finding nuts in the product, or the quantity of nut that could be present.

The answer to sorting out this mess is not easy. If allergy advice labels became compulsory this could greatly restrict consumer choice for those who suffer from allergies – unnecessary advice labels could become even more commonplace as companies try to protect themselves. If the arbitrary placement of advice labels was outlawed you could even find companies adding a small quantity of an allergen to the ingredients so that they can legitimately declare it – the market share commanded by allergy sufferers is likely to be so small that they could easily take the hit, and at least they would know that they could not be sued. The amount of allergen that could cause problems is also very difficult to quantify. For most sufferers there needs to be a clearly detectable level of allergen exposure before they will suffer a reaction, but there will always be individuals who are so sensitive that even the smallest quantities will result in potentially life-threatening anaphylaxis.

Probably the best attempt to find a way forward is the incorporation of a standard risk assessment took called VITAL which has been used in Australia and New Zealand, and has some prospect of being incorporated across Europe in time. VITAL defines a threshold for allergens, with a ten-fold safety factor, and companies are advised to issue a label if their product is found to exceed this level. While this may not help the extreme anaphylaxis sufferer, it will at least give some clarity to the majority who are affected, and help for companies as well who are probably as anxious as consumers in this whole situation.

Ultimately this issue exposes yet again the difficulty in finding real facts and clear evidence when it comes to medicine – which is what motivates me to continue writing this blog. You might call it the pursuit of Truth, but as Oscar Wilde said: ‘The truth is rarely pure, and never simple.’

Dang! There’s that GCSE English – I knew it might contaminate this somehow!