Every five years since 1980, we get to go through the most enormous fuss about dietary guidelines that have not changed in any fundamental way since then.

Then and now, they say eat more vegetables, balance calories, and reduce intake of foods high in sugar, salt, and fat.

You don’t believe me?  Here is the much more straightforward 1980 version.

Reminder: The Dietary Guidelines Advisory Committee is just that: advisory.  The agencies will write the actual guidelines.  Until the guidelines actually appear, everything remains speculative.  They are due to appear by the end of 2025.  Between now and then, we have an election to deal with.  No matter who wins, political appointees in the two sponsoring departments will change and could greatly intervene.

I love the Dietary Guidelines.  They are endlessly entertaining examples of food politics in action.

The current Dietary Guidelines Advisory Committee has produced its draft recommendations.  These, as I discuss tomorrow, are mostly banal, much the same as all guidelines since 1980.

But this year there are two rather shocking exceptions, both having to do with what is not recommended.

Incredible non-recommendation #1.  Reduce the focus of the Dietary Guidelines on reduction of chronic disease risk.

What???  The entire purpose of the Dietary Guidelines is to reduce the risk of diet-related disease.  Chronic diseases—obesity, type-2 diabetes, heart disease, cancer, etc—are the leading causes of death and disability among U.S. adults.

Maybe this was a typo?  Surely this committee means to say “Recommend increasing the focus of the Dietary Guidelines on chronic disease risk reduction.

The current wording is a travesty.  I’m not the only one who thinks so.  See Jerry Mande’s Tweet (X).

Update: I gather the uproar over this did some good and the committee is changing the wording.

Incredible non-recommendation #2.  Say nothing about ultra-processed foods.

The committee made it clear that they were not going to say a word about ultra-processed foods.  At least not now.  Why not?

Scientific experts tasked with advising federal officials drafting the 2025-2030 Dietary Guidelines for Americans said the data were far too limited to draw conclusions…Ultra-processed foods don’t have a recognized definition or a robust body of scientific literature that has studied them, they said, so guidelines would be premature.

Another travesty.  An overwhelming body of observational research suggests harm from diets high in ultra-processed foods.  OK, these studies only demonstrate association, not causation.

But—not one, but two well-controlled clinical trials demonstrate that ultra-processed foods induce people to consume more calories than they would otherwise: 500 more in one trial and more than 800 in the second.  These are enormous differences.

Yes, it would be great to know why, exactly.  And yes, the definition of ultra-processed can be fuzzy with respect to a few—remarkably few—foods.

But what more do you need to know?  Isn’t this enough to tell people that if they want to keep caloric intake under control, a good way to do that would be to limit consumption of ultra-processed foods?

But this committee chose to ignore the controlled trials because they didn’t last long enough.

As I explain in that link, the committee’s hands are tied by having to make “science-based” recommendations.  But in nutrition, most of the science is observational, which is why those controlled trials, short in duration as they are, matter so much.

The committee needs to revisit this decision.  If the guidelines do not include a recommendation to limit intake of ultra-processed foods, they will be ignoring the science and will be behind the times.

Worse, the guidelines will not help Americans reduce their risks for chronic disease.

See: Stat News:  5 questions about the next U.S. dietary guidelines, and the ‘impossible restriction’ on them: Difficulty of nutrition research leaves problems like ultra-processed foods largely unaddressed. 

Tomorrow: the banality of the latest recommendations.

Thanks to Jim Krieger of Healthy Food America for this one.

Substituting Refined Sugars With Maple Syrup Decreases Key Cardiometabolic Risk Factors in Individuals With Mild Metabolic Alterations: A Randomized, Double-Blind, Controlled Crossover Trial. Arianne Morissette, Anne-Laure Agrinier, Théo Gignac, Lamia Ramadan, Khoudia Diop, Julie Marois, Thibault V Varin, Geneviève Pilon, Serge Simard, Éric Larose, Claudia Gagnon, Benoit J Arsenault, Jean-Pierre Després, Anne-Marie Carreau, Marie-Claude Vohl, André Marette.  The Journal of Nutrition, Volume 154, Issue 10, 2024, Pages 2963-2975.  https://doi.org/10.1016/j.tjnut.2024.08.014.

Methods: In a randomized, double-blind, controlled crossover trial with 42 overweight adults with mild cardiometabolic alterations, participants were instructed to substitute 5% of their total caloric intake from added sugars with either maple syrup or an artificially flavored sucrose syrup for 8 wk.

Results: Replacing refined sugars with maple syrup over 8 wk decreased the glucose area under the curve when compared with substituting refined sugars with sucrose syrup, as determined during the oral glucose tolerance test, leading to a significant difference between the intervention arms.

Conclusions: Substituting refined sugars with maple syrup in individuals with mild metabolic alterations result in a significantly greater reduction of key cardiometabolic risk factors compared with substitution with sucrose syrup, in association with specific changes in gut microbiota.

Funding: This study was funded by the Producteurs et productrices acéricoles du Québec (PPAQ) and the Ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec (MAPAQ). The sponsors had no role in study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Marianna Chilton.  The Painful Truth about Hunger in America: Why We Must Unlearn Everything We Think We Know—and Start Again.  MIT Press, 2024. 366 pages.

MIT Press asked me to do a back-cover blurb for this book, which I was pleased to do.

Marianna Chilton’s uncompromising book cuts to the heart of what’s wrong with America’s “safety net” for poverty and hunger.  Her tough analysis derives from the lived experience of people dependent on this system despite its demonstrable inadequacies, inequities, and indignities.

This is one tough book to read, as Chilton warns us right from the start.  Accepting food and financial assistance is a deeply humiliating experience.  Worse, it is intended to be so, right from the start.

Chilton’s work is highly unusual.  She gains the trust of participants in this system by listening closely when they tell her what it is really like for them, and how they feel about it.

This system is so bad and self-sustaining that nothing short of  a complete overhaul can fix it.  We could, should, must do better.

She says:

Poverty costs the United States at least $1.03 trillion a year.  For every dollar spent on reducing childhood poverty, the country would save at least $7 in government spending to address the health and social problems that arise from poverty…To fix this, we need to spend more money to help people avoid poverty; we need to fix the tax code, wage structures, and many other policies that exclude and exploit people who are poor so the wealthy will stop profiting off them.

Chilton recommends the universals:

• Universal health care
• Universal Basic Income
• Universal school meals
• Universal child care

Anything short of that keeps the current system in place.

Late in September, the British government issued guidance about reducing intake of foods high in fat, salt, and sugar, collectively HFSS.

The guidance is based on  the provisions of the Food (Promotion and Placement) (England) Regulations of 2021.

The regulations provide for restrictions on the promotions and placement in retail stores and their online equivalents of certain foods and drinks that are high in fat, salt or sugar (HFSS) or ‘less healthy’.

The regulations have led to a flurry of product reformulations to get the fat, sugar, and salt below the cut point for the restrictions.

According to one report, “reformulation is rife in F&B but consumers aren’t sold yet: Brands are reformulating to improve nutritional value and reduce or remove ‘unhealthy’ ingredient levels. But this is not always a vote winner with customers. Why?… Read more”

In fact, just this week, food and beverage giant, PepsiCo, announced the reformulation of one of its flagship brands, Doritos. The US multinational said in the statement that, in addition to making its famous crisp ‘crunchier’, it was also cutting salt by 24% and fat by 15%, making it HFSS compliant…And while there are a variety of reasons for brands to reformulate their products, including the rising cost of commodities such as sugar, the primary reason is HFSS compliance.

If PepsiCo can do this in England, it surely can do this here.

Apparently, it takes government action to get companies to do these things…

I am late getting to this report but am finally ready to take it on.

This is the annual report from FAO, which always tries to put as positive a spin on its findings as it can.

The press release says:

Hunger numbers stubbornly high for three consecutive years as global crises deepen: UN report

1 in 11 people worldwide faced hunger in 2023, 1 in 5 in Africa

Rio de Janeiro – Around 733 million people faced hunger in 2023, equivalent to one in eleven people globally and one in five in Africa, according to the latest State of Food Security and Nutrition in the World (SOFI) report published today by five United Nations specialized agencies.

Each of these reports tries to do something different, and this one is about financing.  It talks about the cost of a health diet (CoHD).

The CoHD has risen worldwide since 2017 (the first year for which FAO disseminates estimates) and continued to rise in 2022, peaking at an average of 3.96 PPP dollars per person per day in 2022. This represents a surge in the global average CoHD, from a 6 percent increase between 2020 and 2021 to an 11 percent increase the following year…Despite the increase in the CoHD, the number of people in the world unable to afford a healthy diet fell for two consecutive years, from 2020 to 2022. Worldwide, an estimated 35.5 percent of people in the world (2.83 billion) were unable to afford a healthy diet in 2022, compared with 36.5 percent (2.88 billion) in 2021.

So the good news is that the percentage of people who can’t afford to eat healthfully dropped by 1%.

That’s still a third of people in the world.

Impossible.  Unacceptable.  And tragic and frustrating beyond belief.

Resources

• The FAO home page for these reports
• The 2024 report
• The press conference
• Press materials and video

I attended a meeting at Cornell last week at which FDA Commissioner Robert Califf answered questions from faculty and staff.

He started out by remarking on the poor health status of Americans, despite our spending twice as much on health as any other country.  He noted the disparities in health status, particularly singling out the declining health of rural Americans.

In answer to questions from panel members and, later, from the audience, he said (my notes and paraphrase, unless in quotes):

• We have real health problems on the ground right now.
• The  big issue is chronic disease, on which we are “doing terribly.”
• We have to deal with the marketing of ultra-processed foods designed to make you hungry for more.
• On tradeoffs in trying to discourage ultra-processed foods: This isn’t like drugs with clear risk/benefit calculations.  Food research has big confidence intervals and less rigorous estimates. The FDA has lots of bosses.  The executive branch and Congress can overrule anything it does.
• One Health (the movement to treat human and animal health issues as parts of a whole) is essential to the future of humanity.
• Climate change has moved pathogens into areas where they didn’t used to be.
• Action on animal antibiotics stagnated as a result of the pandemic: “We are all sinners in this regard.”
• We need a global strategy; infectious diseases do not respect borders.
• ”There is a lot of rhetoric about food safety, but the systems do not come together as they should.
• There is too much financial influence on policy.  “Policy is everyone’s job.”
• A lot of people are making a lot of money on our food and health systems, but it’s not spent on the right things.
• On the Supreme Court’s overturn of Chevron: the FDA cannot extend its rulings beyond what Congress intended.  It will slow things down.
• “We should reserve most of our energy to do our jobs well.”
• Courage is important: we must have courage to do things differently.

Comment

I was impressed by his knowledge, thoughtfulness, and concern about public health issues, especially those around food, as well as his understanding of the current political barriers against using expertise and regulation to improve food systems and public health.

He used the occasion to encourage students to consider careers in the FDA and noted the remarkably low turnover of permanent staff.

Jerry Mande sent me a link to a report of remarks the Commisioner made in December: America has a life expectancy crisis. But it’s not a political priority (Washington Post), and also to Helena Bottemiller Evich’s report, FDA Commissioner says ultra-processed foods drive addictive behavior.

So the Commissioner is giving serious thought to these issues.  So are others: see Announcement below.

The big question: who at FDA will take the lead on all this?

The FDA has just undergone a major reorganization.

As of October 1, the Human Foods Program looks like this.

The big question: who will head the new Nutrition Center of Excellence?

My big hope: Califf will appoint someone to that position who shares his committment to reducing diet-associated chronic disease.  Fingers crossed.

Announcement

Senator Bernie Sanders (I-Vt.), announced that his Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing on the urgent need for the FDA to “adequately protect Americans – especially children – from unhealthy foods that are pushed on consumers by the food and beverage industry.”  Here is his invitation letter to Commissioner Califf and Deputy Commissioner Jim Jones, who heads the FDA’s Human Foods Program.

When: 10:00 a.m. ET, Thursday, December 5, 2024
Where: Room 562 Dirksen Senate Office Building. The hearing will also be livestreamed on the HELP Committee’s website and Sanders’ socials.

Potatoes, a source of rapidly absorbable starch, have such a bad reputation that some nutritionists advise against eating them.  I am not one of them.  I enjoy eating potatoes and think their blood sugar-raising effects depend on how they are prepared and how muh of them you eat.

The potato industry, alarmed about advice not to eat potatoes, funds research to prove they are healthy, or at least do no harm.  Hence:

Djousse L, Zhou X, Lim J, Kim E, Sesso HD, Lee IM, Buring JE, McClelland RL, Gaziano JM, Steffen LM, Manson JE. Potato Consumption and Risk of Type 2 Diabetes Mellitus: A Harmonized Analysis of 7 Prospective Cohorts. J Nutr. 2024 Oct;154(10):3079-3087. doi: 10.1016/j.tjnut.2024.07.020.

• Results: In the primary analysis, total potato intake was not associated with T2D risk:…In secondary analyses, consumption of combined baked, boiled, and mashed potatoes was not associated with T2D risk, whereas fried potato consumption was positively associated with T2D risk:.
• Conclusions: Although consumption of total potato is not associated with T2D risk, a modest elevated risk of T2D is observed with fried potato consumption.
• Conflict of interest: LD received investigator-initiated grant from the Alliance for Potato Research and Education (as principal investigator).
• Funding: This project was supported by a grant from the Alliance Potato Research and Education (principal investigator: LD).  A lengthy list of other funders, including NIH and Mars Edge, follows.

Comment: This potato industry-funded study did not find potatoes to be associated with type 2 diabetes, which must be a huge relief to this industry. But the study did find a weak association (barely statistically significant) beween fried potatoes and type 2 diabetes.  The Potato Alliance ought to be delighted with this result.   I’m guessing the result is real (it’s what I would have predicted), but I’d be happier with it if it had been conducted by investigators independent of industry funding.  As it is, it looks like the potato industry got what it paid for.