Search results: dietary guidelines

I can hardly believe it but we are going to have to endure another round of dietary guidelines, these for 2025-2030.

Why endure?

Because they have basically said the same things since 1980:

• Eat more fruits and vegetables
• Balance calories
• Don’t eat too much of foods high in saturated fat, salt, and sugar

As I am fond of quoting Michael Pollan: “Eat food.  Not too much.  Mostly plants.”

The wording changes from edition to edition.  The editions get longer and longer.  And the basic problems—nutrients as euphemisms for the foods that contain them, more and more obfuscation–stay the same.

But maybe not this time?

ODPHP, the Health and Human Service Office of Disease Prevention and Health Promotion (of which I am an alum) has just announced “Proposed Scientific Questions to Inform the Development of the Dietary Guidelines for Americans, 2025-2030: Available for Public Comment April 15 to May 16!”

The questions whose answers will form the research basic of the forthcoming guidelines are listed here.

Several break new or necessary ground:

• What is the relationship between consumption of dietary patterns with varying amounts of ultra-processed foods and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: This was one of my big criticisms of the 2020-2025 guidelines; the word “ultraprocessed” was never mentioned, yet I consider it the most important nutrition concept to come along in decades.  So this is a big step forward.
• What is the relationship between beverage consumption (beverage patterns, dairy milk and milk alternatives, 100% juice, low- or no-calorie sweetened beverages, sugar-sweetened beverages, coffee, tea, water) and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance? risk of type 2 diabetes?  Comment: it will be good to have this clarified.
• What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?  Comment: This is an old issue but one under attack as being irrelevant.  Let’s get it settled, if that is possible.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: With luck, this will resolve the diet wars over low-carb v. low-fat, etc.  My prediction: they all work for some people.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment:  Finally, an unambiguous demand for research on diet and obesity (as opposed to euphemisms).

What’s missing here?  I think they should have a question on meat, since evidence on risk/benefit is also controversail.  OK, saturated fat is a euphemism for meat, but let’s stop using euphemisms.

What’s being ducked, at least in the guidelines?

There are two topics not on the list of questions to be examined by the 2025 Dietary Guidelines Advisory Committee that will be addressed in separate processes.

• Alcoholic beverages remain a high priority topic, but because it requires significant, specific expertise and has unique considerations, it will be examined in a separate effort led by HHS Agencies that support work on this topic.
• Sustainability and the complex relationship between nutrition and climate change is an important, cross-cutting, and high priority topic that also requires specific expertise. HHS and USDA will address this topic separate from the Committee’s process to inform work across the Departments.

Want to weigh in on this (please do!):  here’s how (read and follow the directions carefully to have maximum impact)

As usual ConscienHealth has interesting things to say about all this.  I particularly enjoyed:

So it’s both unsurprising and unimpressive to hear that people with strong views about nutrition believe the process is rife with conflicts of interest. A group that is disenchanted with the last output from this process lays it out with a new paper in Public Health Nutrition. But Tamar Haspel made the same point much more efficiently in a recent tweet:

“I think they should just let me write the Dietary Guidelines and call it a day.”

This also reminds me about the need to select a scientific committee as free of conflicted interests as possible.  The last committee was rife with them.  HHS/USDA ought to be starting the committee selection process fairly soon.  Stay tuned.

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.

You might think of the Dietary Guidelines for Americans as federal nutrition advice about how to eat healthfully but to some food companies it’s a marketing opportunity.

FoodNavigator-USA.com writes that the new guidelines for children under age 2 are a “treasure map” for Gerber, a leading baby food manufacturer.

the guidelines underscore the need for products that help babies consume sufficient iron, vitamin D and other nutrients of concern, safely introduce potential allergens, cut back on added-sugar, and cultivate diverse palate preferences to ensure healthy dietary preferences and reduce the risk of picky eaters later.\nInnovative, iron-enriched products need to boost consumption.

How does this work?

One of the main messages in the Dietary Guidelines is to provide infants and young children with sufficient iron.

Gerber to the rescue!

All you have to do is “feed children two servings of infant cereal a day.”

I still vote for feeding kids real food….

The American Heart Association (AHA) has just issued its latest set of dietary guidelines aimed at preventing the leading cause of death in the United States: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Because AHA guidelines apply not only to coronary heart disease but also to all other chronic disease conditions—and sustainability issues—influenced by dietary practices, they deserve special attention.

Most of these repeat and reinforce the 2020-2025 Dietary Guidelines for Americans.

The two big differences in the recommendations:

• Clarifying protein recommendations: these include all sources but emphasize plant sources (#4)
• Including a new one: minimize ultra-processed foods (#6)

These recommendations are way ahead of the US Dietary Guidelines in recognizing how much ultra-processed foods contribute to poor health, and how important it is to minimize their intake.

Also unlike the US guidelines, these are unambiguous and easily summarized.

The statement is worth reading for its emphasis on two other points.

• This dietary pattern addresses problems caused by other chronic conditions and also has a low environmental impact.
• Following this dietary pattern requires much more than personal responsibility for food choices.  It requires societal changes as well.

The press release summarizes the problems in society that make following healthy diets so difficult, if not impossible:

• Widespread dietary misinformation from the Internet;
• A lack of nutrition education in grade schools and medical schools;
• Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
• Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
• Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

As the statement concludes: “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”

Amen to that.

Comment: From my perspective, this statement thoroughly supersedes the 2020-2025 Dietary Guidelines for Americans, which—because they say nothing about ultra-processed foods , differential protein sources, sustainability, or doing anything to counter societal determinants of poor diets—were out of date the instant they appeared.

Some of the details of the AHA statement will be debated but its overall approach should not be.

The committee that put these guidelines together deserves much praise for basing its advice on today’s research and most pressing societal needs.

Additional AHA Resources:

• Spanish news release 
• Available multimedia is on right column of release link: https://newsroom.heart.org/news/new-look-at-nutrition-research-identifies-10-features-of-a-heart-healthy-eating-pattern?preview=288ef57763869cab946e725d341dbb63
• After Nov. 2, 2021, view the manuscript online.
• What kind of diet helps heart health?
• Eating walnuts daily lowered bad cholesterol and may reduce cardiovascular disease risk
• Eating more plant foods may lower heart disease risk in young adults, older women
• Sugar 101
• Follow AHA/ASA news on Twitter @HeartNews

I only have a few more comments about the Dietary Guidelines beyond what I posted last week.

One is my surprise that the USDA did not do a new food guide.  The existing one, after all, dates from the Obama administration.  It has not changed.

Here’s how it is explained in the new guidelines:

My translation: Eat more plant foods, eat less meat, avoid ultraprocessed foods (including sugary beverages).

This requires a translation because the guidelines say nothing about ultraprocessed junk foods, and they try hard to avoid singling out foods to avoid.

These guidelines are similar to those in 2015 and are, therefore, woefully out of date.

They do mention the pandemic, once:

The importance of following the Dietary Guidelines across all life stages has been brought into focus even more with the emergence of COVID-19, as people living with diet-related chronic conditions and diseases are at an increased risk of severe illness from the novel coronavirus (p. 4).

They do mention food insecurity several times, for example:

In 2019, 10.5 percent of households were food insecure at least some time during the year. Food insecurity occurs when access to nutritionally adequate and safe food is limited or uncertain. Food insecurity can be temporary or persist over time, preventing individuals and families from following a healthy dietary pattern that aligns with the Dietary Guidelines. The prevalence of food insecurity typically rises during times of economic downturn as households experience greater hardship. Government and nongovernment nutrition assistance programs help alleviate food insecurity and play an essential role by providing food, meals, and educational resources so that participants can make healthy food choices within their budget (p. 50).

And they do mention food assistance programs (on page 81), although they do not discuss how the USDA has been relentless in trying to cut those programs.

Nothing about food systems.  Nothing about the effects of food production and consumption on climate change and sustainablity.

Nothing about eating less meat other than implying that eating less processed meat might be a good idea.

One other point: the complexity is increasing.  Here is the history of the page numbers:

As I’m fond of saying, Michael Pollan can do all this in seven words: “Eat food.  Not too much.  Mostly plants.”

If we can’t do better than this 164 pages of obfuscation, isn’t it about time to stop requiring these things every five years?

Here’s what other people are saying about them

• New York Times report (I’m quoted)
• Wall Street Journal (quotes American Beverage and Beer Associations)
• New York Daily News (I’m quoted)
• CNN (I’m quoted)
• Bipartisan Policy Center [Dan Glickman (Dem) and Ann Veneman (Rep), former USDA secretaries]
• Physicians Committee for Responsible Medicine (accuses guidelines of racial bias)
• USA Today
• National Fisheries Institute 
• Produce for Better Health Foundation

So much for my plan to take the week off.

The new 2020-2025 Dietary Guidelines came out today.  See them at DietaryGuidelines.gov.  The new guidelines are much the same as the ones in 2015.

The big news: They paid no attention to the recommendations of the Dietary Guidelines Advisory Committee (I covered this in a previous post).

USDA and HHS overrode the scientific decisions of the DGAC.  So much for “science-based” dietary guidelines.

I would love to know what the members of the DGAC think of this.

More later.  These come from the USDA’s press release.

• Dietary Guidelines for Americans, 2020-2025 along with companion pieces:
• Executive Summary of the Dietary Guidelines for Americans, 2020-2025
• The Top 10 Things You Need to Know About the Dietary Guidelines
• Make Every Bite Count with the Dietary Guidelines video
• The Dietary Guidelines Consumer Brochure: Small Changes Matter. Start Simple with MyPlate Today
• Dietary Guidelines infographic series on topics like:
  • Making Every Bite Count with the Dietary Guidelines
  • The Dietary Guidelines Can Help You Eat Healthy to Be Healthy
  • Public Engagement Strengthens the Process
  • USDA-HHS Process to Develop the Dietary Guidelines
  • What’s the Difference between the Dietary Guidelines Advisory Committee Report & the Dietary Guidelines for Americans
• Video of the Dietary Guidelines for Americans, 2020-2025 virtual event
• Press release announcing the Dietary Guidelines for Americans, 2020-2025

And here’s the USDA’s explanation, such as it is, of why it overrode the decisions of the DGAC on sugar and alcohol

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.

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.

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.