by Marion Nestle

Search results: dietary guidelines

Jul 16 2020

Dietary Guidelines Advisory Committee releases report

The report of the 2020 Dietary Guidelines Advisory Committee is now available in online preprint.

It sets a record at 835 pages.

Its conclusions are highly consistent with those of previous Dietary Guidelines.

It recommends eating more of these foods:

Common characteristics of dietary patterns associated with positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or nonfat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils.

It recommends eating less of these foods:

The Committee found that negative (detrimental) health outcomes were associated with dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains.

It retained the recommendation: Eat less red and processed meats

It retained the recommendation to eat less saturated fat (replace with polyunsaturated or monounsaturated)

Thus, the Committee recommends that dietary cholesterol and saturated fat intake be as low as possible within a healthy dietary pattern, and that saturated fat intake be limited to less than of 10 percent of total energy intake, as recommended by the 2015-2020 Dietary Guidelines for Americans. This recommendation applies to adults and children ages 2 years and older.

It tightened up restrictions on alcoholic beverages from 2 drinks a day for men to 1 drink:

The Committee concluded that no evidence exists to relax current Dietary Guidelines for Americans recommendations, and there is evidence to tighten them for men such that recommended limits for both men and women who drink would be 1 drink per day on days when alcohol is consumed.

It tightened up restrictions on added sugars, from 10% of calories to 6%:

After considering the scientific evidence for the potential health impacts of added sugars intake, along with findings from model-based estimations of energy available in the dietary pattern after meeting nutrient requirements, the Committee suggests that less than 6 percent of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10 percent energy from added sugars.

What’s missing?

  • Salt: The report says remarkably little about sodium beyond that it is overconsumed and people should “reduce sodium intake.”  It’s possible that I missed it, but I could not find suggestions for quantitative limits.
  • Ultraprocessed: The word does not appear in the report except in the references.  A large body of evidence supports an association of ultraprocessed foods to poor health.  If the committee considered this evidence, it did not spell it out explicitly.
  • Sustainability: This was off the table from the beginning but this committee recommends that it be considered next time in the context of a food systems approach to the Dietary Guidelines (p.771).

Comment

This is an impressive, solid, conservative review of the existing science highly consistent with previous Dietary Guidelines but with mostly stronger recommendations.

This committee was up against:

  • A tight time frame
  • A first-time mandate to review literature on infancy, pregnancy, and lactation in addition to that for adults
  • A first-time process in which the agencies set the research agenda, not the committee
  • The Coronavirus pandemic

At the outset, I was concerned that the committee members might be heavily biased in favor of food industry interests.  If they were, such biases do not show up in the final report.  I think this committee deserves much praise for producing a report of this quality under these circumstances.

Want to weigh in on it? 

The agencies are taking public comments until August 13.  On August 11, there will be an online public meeting for even more comments.

What’s next?

This report is advisory, only.  USDA and HHS must boil this down to the actual 2020 Dietary Guidelines.  Whereas the committee process was transparent, the boiling down process is highly secretive, or was in 2015.  It will be interesting to see what the agencies do, especially given the heavy lobbying by proponents of meat, saturated fat, and low-carbohydrate diets.

Jun 17 2020

The Dietary Guidelines Advisory Committee reports in today

The Dietary Guidelines Advisory Committee (DGAC) meets today to talk about its draft report.  Register for it here.  

The agenda is here.

Reporters tell me that the DGAC report will not be released at this meeting; it is not ready.

Here’s what today’s announcement says:

The Committee will finalize their advisory report based on Committee discussion at the meeting. They will then submit their final report to the Secretaries of USDA and HHS. USDA and HHS will post the final report online, send out a public notification, and open a new public comment period for the Departments to accept comments on the Committee’s report. This action is expected on or around July 15, 2020.

This meeting is being held despite calls for delay.  Politico’s Helena Bottemillier Evich describes these calls under “Influential groups press for delay of Dietary Guidelines” (behind a paywall at the moment).

The groups are turning up the pressure ahead of the committee’s final public meeting on Wednesday, where the panel will discuss its draft conclusion statements. The committee is then expected to release in mid-July a sweeping scientific report to advise the Agriculture Department and Department of Health and Human Services on what the 2020 iteration of the guidelines should say.

Some of the Dietary Guidelines’ staunchest allies and fiercest critics — including professional groups and low-carb advocates — are urging a delay. They note that last year’s government shutdown and the continuing pandemic have made it more difficult for the committee to complete the necessary work before advising the government on the 2020 guidelines, which will last five years.

Corporate Accountability notes the undue influence of industry on the guidelines.  One of its recent reports documents ties of DGAC members to ILSI, an industry front group.

The guidelines are subject to criticism from just about everyone (me too).  I’m interested to see what this committee does.  Stay tuned.

Mar 4 2020

Coca-Cola wants the 2020 dietary guidelines to say more about beverages

I am indebted to Margarita Raycheva, who writes for the highly informative newsletter, IEG Policy Agribusiness, for her recent article, which certainly got my attention: “Coca-Cola asks DGAC to develop detailed dietary recommendations for beverages” (this is probably behind a paywall).

Her article is about comments filed by Coca-Cola to the DGAC, the 2020 Dietary Guidelines Advisory Committee.  She did not provide a link to those comments, so I had to search for them.  This involved finding the DGAC comments page, searching for Coca-Cola, locating the company’s letter, and opening the pdf attachment.

The 12-page document reads like a highly sophisticated advertisement for Coca-Cola’s astounding number of beverage options, many of them low in sugar or sugar-free.

Over the last few years, Coca-Cola has been transforming to become a total beverage company that meets Americans’ fast-changing preferences across a wide array of beverage categories. We support the World Health Organization’s recommendation that people should limit added sugar to no more than 10% of their total daily calorie consumption1 and are rethinking existing recipes, package sizes and offerings to ensure we are helping consumers manage their daily intake of added sugar and other nutrients from our portfolio.  Today, we offer more than 800 drinks in the U.S. alone, ranging from soft drinks to juices, teas, coffee, dairy, sports drinks, water and more – more than 250 of which are low- or zero-sugar options. More than 40% of our sparkling beverage brands in the U.S. are now available in package sizes that are smaller than 8.5 ounces. We are increasing marketing support for low-sugar, no-sugar and unsweetened products…; we are introducing less sweet versions of classic soft drinks…; and we are accelerating our expansion into new beverage categories through the acquisition of brands….We are taking these actions because we recognize the critical role that we – and the entire industry – can play in advancing nutritional goals by using our scale for good.

Why do this?

• About 15% of energy comes from beverages
• Beverages, such as sweetened soft drinks, coffee and tea contribute more than 40% of daily added sugar intake
• Beverages, mainly milk and 100% juice, contribute over 40% of vitamin C and D intake and more than 20% intake of carbohydrates, calcium, potassium and magnesium
• Fruit intake (0.9 cup/day) is half of recommended levels (2 cups/day); 100% fruit juice contributes up to 24% of fruit intake in children, but decreases after adolescence
• Coffee and tea contribute up to 12% of potassium intake in adults
• Waters contribute up to 10% of calcium intake in adults

In other words, drink more (of our) beverages!

Coca-Cola’s proposals for how beverages can enhance diets:

  • Hydration
  • Nutrition and health
  • Enjoyment
  • Performance

What should the DGAC do?

By creating a framework that includes guidance for all types of beverages, the DGA can help drive Americans towards healthier versions of drinks they are typically consuming. Recommending limited
consumption or small shifts towards healthier beverages is more effective than simply discouraging the consumption of entire beverage categories.

The company’s proposals for how the DGAC can help it sell more beverages include sample statements like these examples [with my translations]:

  • Water should be the primary beverage choice [recommend our bottled water]
  • Milk plays an important role in development and health, and contributes essential nutrients to healthy eating patterns, including protein, calcium, vitamin D and potassium [recommend our milk drinks]
  • When fortified, plant-based beverages may provide nutrients and support consumer choice, but generally should not be considered a replacement for dairy [please don’t recommend almond, soy, or oat milks–we don’t make any of those drinks]
  • Juice contributes to the public’s consumption of essential nutrients, phytonutrient and fruit/vegetable intake [recommend our juice drinks]
  • Coffee and tea are sources of health-promoting phytonutrients and are associated with reduced risk of rtain non-communicable diseases (NCDs) [recommend them; we sell those too]
  • Replace sugar-sweetened beverages >40 kcal that do not contribute significantly to nutrition needs with these beverages to reduce calorie and sugar consumption [if you must recommend avoing sugary beverages, at least recommend replacement with everything else we sell]
  • Sports drinks can be beneficial for individuals who engage in prolonged vigorous physical activity, or those sweating for prolonged hours due to warm to hot temperatures [OK, they have sugar, but recommend them anyway]

I can’t wait to see what the DGAC does with this impressively written document.

Not that it matters, really.  Recall: The DGAC submits the research report, but the agencies—USDA takes the lead this time—write the actual guidelines.

Feb 26 2019

At last: the 2020 Dietary Guidelines Advisory Committee

Very late in the process, the USDA and HHS have finally announced the membership of the Dietary Guidelines Advisory Committee for 2020:

Today the Secretaries of USDA and HHS announced 20 nationally recognized experts who have been selected to serve on the 2020 Dietary Guidelines Advisory Committee.

The independent Advisory Committee will review the scientific evidence on topics from the Departments and provide a report to the Secretaries that, along with public and agency comments, will help inform USDA and HHS’s development of the 2020-2025 Dietary Guidelines for Americans.

I know several of the members.  I served with Barbara Schneeman on the 1995 DGAC, for example.

Some members have financial ties to food companies with deep interests in the what the guidelines say.  This is despite the agencies’ statements that

The vetting process also included a background check by the USDA Office of the Secretary to determine if any of the candidates have a financial, ethical, legal, and/or criminal conflict of interest that would prohibit them from serving on the Committee…Each Committee member submitted a financial disclosure report prior to appointment and will continue to do so annually thereafter. Each report was reviewed by USDA ethics officials for financial conflicts of interest and compliance with Federal ethics rules.

Politico’s Helena Bottemiller Evich asked groups to say who they nominated to the committee.  What she found is here, but behind a paywall.  I’ve added the information from these lists in red.  She is still trying to find out who nominated the others.

  • Jamy Ard, MD – Wake Forest University
  • Regan Bailey, PhD, MPH, RD – Purdue University, Department of Nutrition Science Academy of Nutrition and Dietetics
  • Lydia Bazzano, MD, PhD – Tulane University  Atkins Nutritional
  • Carol Boushey, PhD, MPH, RD – University of Hawaii  National Cattlemen’s Beef Association
  • Teresa Davis, PhD – Baylor College of Medicine
  • Kathryn Dewey, PhD – University of California, Davis
  • Sharon Donovan, PhD, RD – University of Illinois
  • Steven Heymsfield, MD – Louisiana State University American Beverage Association
  • Ronald Kleinman, MD – Harvard University
  • Heather Leidy, PhD – University of Texas National Cattlemen’s Beef Association
  • Richard Mattes, PhD, MPH, RD – Purdue University Academy of Nutrition and Dietetics
  • Elizabeth Mayer-Davis, PhD, RD – University of North Carolina
  • Timothy Naimi, MD – Boston University
  • Rachel Novotny, PhD, RDN, LD – University of Hawaii
  • Joan Sabaté, DrPH, MD – Loma Linda University
  • Barbara Schneeman, PhD – University of California, Davis  American Beverage Association
  • Linda Snetselaar, PhD, RD – University of Iowa Academy of Nutrition and Dietetics
  • Jamie Stang, PhD – University of Minnesota, School of Public Health, Division of Epidemiology & Community Health Academy of Nutrition and Dietetics
  • Elsie Taveras, MD, MPH – Massachusetts General Hospital, Harvard Medical School, and Harvard Chan School of Public Health
  • Linda Van Horn, PhD, RDN, LD – Northwestern University

As for transparency:

Helena Bottemiller Evich (@hbottemiller) tweeted at 11:36 AM on Fri, Feb 22, 2019:
Everyone says they want a “more transparent” Dietary Guidelines process, but the minute I ask for who X group nominated to be on DGAC food/ag/health groups are like https://t.co/6J8GJnGpD7
(https://twitter.com/hbottemiller/status/1099030227009835008?s=03)

Overall, this looks to me like any other DGAC except that there are twice as many members as in the past.

Their job is to review the research and write a report.  The agencies write the guidelines.

I will be following all this with great interest, as always.

 

Nov 8 2018

Progress, of sorts, on the 2020 Dietary Guidelines

Remember the Dietary Guidelines?  Those pesky things that have to be revised every five years by order of Congress?

This time, the USDA is firmly in charge of the joint process with HHS.

It says the updating process is well underway.

The call has gone out for nominations of advisory committee members.  This is now closed and USDA expects to appoint the committee within the next few months.

And now it has put the official charter for the process out for comment.

It also has issued a Q and A.

And provides a schedule for public engagement.

A few aspects of this especially interest me:

  • Nothing has been said about a new food guide (MyPlate is left over from the 2010 guidelines).
  • USDA’s close control.  It says this is mandated by Congress.
  • The level of scrutiny of the process will be exceptional, giving the fuss about the 2015 guidelines.
  • Expect the process to be highly politicized.

This committee will have its work cut out for it.  Much appreciation to the brave souls willing to take this on.

I can’t wait to see who they are.

Stay tuned.

Sep 10 2018

Call for nominations: 2020 Dietary Guidelines Advisory Committee (deadline Oct 6)

The USDA has issued a Call for Nominations for the 2020 Dietary Guidelines Advisory Committee

The independent advisory committee will review the scientific evidence to help inform the next edition of the Dietary Guidelines for Americans. The deadline to submit nominations for the Dietary Guidelines Advisory Committee is October 6, 2018, at 11:59 pm, Eastern Time.

Good luck with this. I don’t envy anyone serving on this committee.

The issues:

  • The late start. By law, the guidelines are supposed to be submitted in 2020. The committee will be under pressure to move quickly.
  • USDA’s dominance. The guidelines are supposed to be jointly produced by two agencies; the other is HHS. The absence of HHS from this announcement seems curious. USDA must be the lead this year and can be expected to allow politics to trump (pardon the expression) science.
  • Science politics. Questions—qualitative and quantitative—about fat v. carbohydrates are hotly debated and not easy to resolve.
  • Food industry influence. This is always a problem but this influence—on research and policy—is now under sharp scrutiny (my forthcoming book adds to the scrutiny, I hope).
  • Government interference. The committee writes an advisory report. Then USDA and HHS take over and do what they please with what the committee produces.  And we know, because USDA said so, that this administration intends to take a more active role in setting the agenda and in committee discussions.
  • Spotlight. Everything this committee does will be public and publicized on the front pages of newspapers and in social media.
  • Courage. It will take plenty.

Here’s what USDA says about factors to be considered in reviewing nominations:

  • Educational background – advanced degree in nutrition- or health-related field, including registered dietitians, nutrition scientists, physicians, and those with public health degrees
  • Professional experience – at least 10 years of experience as an academic, researcher, practitioner, or other health professional in a field related to one or more of the topics to be examined; consideration of leadership experience and participation on previous committees or panels
  • Demonstrated scientific expertise – expertise related to one or more of the topics to be examined by the committee as demonstrated by number and quality of peer-reviewed publications and presentations
  • Obligations under the Federal Advisory Committee Act – ensuring the Committee is balanced fairly in points of view and types of expertise
  • Requirements regarding a balanced membership – including, to the extent possible, individuals who are minorities, women, persons with disabilities, and representatives from different geographic areas and institutions

More information is available on DietaryGuidelines.gov:

Feb 27 2018

New process for Dietary Guidelines: open for comments

I was on a conference call yesterday with representatives from USDA and HHS announcing the new process for doing the 2020-2025 Dietary Guidelines for Americans.

The idea is to follow recommendations of the National Academy of Medicine to make the process more scientifically rigorous and transparent.

To that end, the agencies have posted the topics they want the Dietary Guidelines Advisory Committee (DGAC) to discuss and have opened these suggestions to immediate public comment.

Once the agencies decide on the topics, they will call for nominations for DGAC members.  They hope to do this by late spring or early summer 2018 so the guidelines can be released by the end of 2020.

If I understand this correctly, this means that the DGAC:

  • Will be appointed and meet sometime in the fall.
  • Will not decide on the scientific issues to review.
  • Will have maybe a year and a half to review the research on those questions, write its report, and submit the report to the agencies.

The agencies will then turn the research report into published guidelines.

This, of course, means that the scientific decisions are made by the agencies, not the DGAC.  A case of politics trumping science?

Reporters asked whether USDA thinks it’s really necessary to revise the guidelines (yes, because the Farm Bill said the guidelines should deal with life stages), whether the guidelines would focus on dietary patterns (yes), whether all this is because of the fuss over sustainability in the last set of guidelines (waffle), and whether there would be other changes in the process (they will tell us later).

The scientific questions posed on the website seem worth attention.  They are divided into life stages.

If you disagree, or can think of others, now is the time to weigh in.  You only have one months to do this.

 

Feb 7 2018

Food industry lobbyists running the dietary guidelines?

This tweet certainly got my attention:

It referred to Alex Kotch’s article in the International Business Times about how White House lawyer Donald McGahn has granted a waiver of conflict of interest rules to allow Kailee Tkacz, a former lobbyist for the Snack Food Association and, more recently, for the Corn Refiners Association, to advise the USDA about the forthcoming 2020 dietary guidelines.

Ms. Tkacz also was food policy director for the Corn Refiners Association, which represents producers of high fructose corn syrup (HFCS).

McGahn explained that this waiver would allow Ms. Tkacz “to advise the Secretary of Agriculture and other senior Department officials with respect to the Dietary Guidelines for Americans process.”

He says “it is in the public interest to grant this limited waiver because of Ms. Tkacz’s expertise in the process by which the Dietary Guidelines for Americans are issued every five years.”

The dietary guidelines historically have issued recommendations to consume less salt and sugar.  Snack foods are major sources of salt in U.S. diets.  Soft drinks sweetened with HFCS are major sources of sugars.

USDA is the lead agency for the 2020 guidelines.

Want to make some bets on what they will say about salt and sugar (a wild guess: the science isn’t firm enough to suggest eating less of either).